Issuance Date:    				July 17, 2009
RFA Clarification Questions Due: 		July 24, 2009
Closing Date and Time for 
Application Submission:      			August 24, 2009  10:00 AM  Local Time 

Subject:  	Request for Applications (RFA) Number: RFA-111-09-000001

RFA Title:	Small-Scale Infrastructure Program

Ladies and Gentlemen:
 
The United States Agency for International Development (USAID) is seeking applications for Assistance Agreements for funding to support a program entitled “Small-Scale Infrastructure Program.”  The authority for the RFA is found in the Foreign Assistance Act of 1961, as amended.  Please refer to the Program Description for a complete statement of goals and expected results.

While for-profit firms may participate, pursuant to 22 CFR 226.81, it is USAID policy not to award profit under assistance instruments such as cooperative agreements.  However, all reasonable, allocable, and allowable expenses, both direct and indirect, which are related to the grant program and are in accordance with applicable cost standards (22 CFR 226, OMB Circular A-122 for non-profit organization, OMB Circular A-21 for universities, and the Federal Acquisition Regulation (FAR) Part 31 for-profit organizations), may be paid under the LWA Cooperative Agreement.

Applicants under consideration for an award that have never received funding from USAID will be subject to a pre-award audit to determine fiscal responsibility, ensure adequacy of financial controls and establish an indirect cost rate.

Subject to the availability of funds, USAID intends to provide approximately $2,307,928.00 in total USAID funding to be allocated over the 2 year period.  USAID reserves the right to fund any or none of the applications submitted.

Awards will be made to the responsible applicants whose applications offer the greatest value to the U.S. Government.  Issuance of this RFA does not constitute an award commitment on the part of the Government, nor does it commit the Government to pay for costs incurred in the preparation and submission of an application.  

This RFA and any future amendments can be downloaded from http://www.grants.gov.  Select “Find Grant Opportunities,” then click on “Browse by Agency,” and select the “U.S. Agency for International Development” and search for the RFA.  In the event of an inconsistency between the documents comprising this RFA, it shall be resolved at the discretion of the Agreement Officer.  

Applicants should also note that the documents listed in this RFA under “Useful References” are intended only as sources for background information that may be helpful to applicants, but are not a part of this RFA.  All guidance included in this RFA takes precedence over any reference documents referred to in the RFA. Any clarification questions concerning this RFA should be submitted in writing to Armen Karapetyan, via email at akarapetyan@usaid.gov by the date listed above.  If there are problems in downloading the RFA from the Internet, please contact the Grants.gov help desk at 1.800.518.4726 or support@grants.gov for technical assistance.  

For the purposes of this RFA, the term "Grant" is synonymous with "Cooperative Agreement"; "Grantee" is synonymous with "Recipient"; and "Grant Officer" is synonymous with "Agreement Officer".

Applications must be submitted in electronic form in addition or instead of the hard copies to the attention of Armen Karapetyan, Acquisition Specialist, USAID/Armenia at: akarapetyan@usaid.gov. The receipt of Applications will be confirmed within two days.  If not, please contact Armen Karapetyan.  The total size of each e-mail attachment should not exceed 3 MBs. Every page of the proposal must be numbered. The application must have a table of contents. Large graphics files are discouraged.  Attached file format must be Microsoft Word, Excel or PDF.  Attached files should be printable on US letter size paper.  

Applicants must submit technical and cost portions of their applications in separate volumes.  Budgets to be submitted in unlocked Excel format with all formulas to demonstrate calculations.  Award will be made to that responsible applicant(s) whose application(s) offers the greatest value.

Applications must be received by the closing date and time indicated at the top of this cover letter.  Late applications will not be considered for award.  Applications must be directly responsive to the terms and conditions of this RFA. Telegraphic or fax applications (entire proposal) are not authorized for this RFA and will not be accepted. 

Issuance of this RFA does not constitute an award commitment on the part of the Government, nor does it commit the Government to pay for costs incurred in the preparation and submission of an application.  In addition, final award of any resultant grant cannot be made until funds have been fully appropriated, allocated, and committed through internal USAID procedures.  While it is anticipated that these procedures will be successfully completed, potential applicants are hereby notified of these requirements and conditions for award. Applications are submitted at the risk of the applicant; should circumstances prevent award of an agreement, all preparation and submission costs are at the applicant's expense.
 
The preferred method of distribution is via Grants.gov on the internet. This RFA and any future amendments can be downloaded from http://www.grants.gov.  If you have difficulty accessing the RFA, please contact Armen Karapetyan at akarapetyan@usaid.gov. It is the responsibility of the recipient of the application document to ensure that it has been received from Grants.gov in its entirety and USAID bears no responsibility for data errors resulting from transmission or conversion processes.

Sincerely,

John F. Lord
Agreement Officer

SECTION A

Funding Opportunity Description 

I.  Award Information 

USAID expects to award one Cooperative Agreement based on this RFA.  The anticipated total federal funding amount is $2,307,928.00.  The period of performance is two years with an anticipated start date of September 23, 2009.

The Government plans to award one Cooperative Agreement pursuant to this RFA to the responsible applicant whose application conforming to this RFA offers the best prospects for success and value. The Government may (a) reject any or all applications, (b) accept other than the lowest cost application, (c) accept more than one application, (d) accept alternate applications, and (e) waive informalities and minor irregularities in applications received.
 
The Government may make award on the basis of initial applications received, without discussions or negotiations.  Therefore, each initial application should contain the applicant's best terms from a cost and technical standpoint. The Government reserves the right (but is not under obligation to do so), however, to enter into discussions with one or more applicants in order to obtain clarifications, additional detail, or to suggest refinements in the program description, budget, or other aspects of an application.  
 
Neither financial data submitted with an application nor representations concerning facilities or financing, will form a part of the resulting agreement.
 
The Agreement Officer is the only individual who may legally commit the Government to the expenditure of public funds.  No costs chargeable to the proposed award may be incurred before receipt of either a fully executed cooperative agreement or a specific, written authorization from the Agreement Officer.

Neither financial data submitted with an application nor representations concerning facilities or financing, will form a part of the resulting agreement(s).
 
The Agreement Officer is the only individual who may legally commit the Government to the expenditure of public funds.  No costs chargeable to the proposed award may be incurred before receipt of either a fully executed cooperative agreement or a specific, written authorization from the Agreement Officer.

II.  Eligibility Information 

1. Eligible Applicants

USAID entertains applications from qualified U.S. and non-U.S. entities, such as private, non-profit organizations (or for-profit companies willing to forego profits), including private voluntary organizations, universities, research organizations, professional associations, and relevant special interest associations.
 
2. Cost Sharing or Matching

Cost Sharing is desirable but not required.  The minimum cost share amount is not specified for this RFA.

III.  Application and Submission Information 

1. Address to Request Application Package 

This application is found on the internet at www.grants.gov .  Potential applicants that cannot download application materials electronically may request paper copies of the RFA by contacting:

Armen Karapetyan
Acquisition Specialist
Acquisition and Assistance Office
USAID/Armenia
1-st American Avenue
Yerevan 0082 Armenia
Tel: 37410 494493
Email: akarapetyan@usaid.gov

2. Content and Form of Application Submission

Applications shall be submitted in two separate parts: (a) technical proposal or management plan, and (b) cost or business application.

TECHNICAL APPLICATION FORMAT
 
Technical applications should be specific, complete and presented concisely.  The applications should demonstrate the applicant's capabilities and expertise with respect to achieving the goals of this program.  Technical applications should take into account requirements of the program and evaluation criteria found in this RFA.

PREPARATION GUIDELINES
 
 All applications received by the deadline will be reviewed for responsiveness to the specifications outlined in these guidelines and the application format.  Section B addresses the technical evaluation procedures for the applications.  Applications which are submitted late or are incomplete run the risk of not being considered in the review process.  Late applications will not be considered for award unless the Agreement Officer determines it is in the Government's interest.
 
 Applications shall be submitted in two separate parts: (a) technical and (b) cost or business application. Electronic submission is required.  If an applicant chooses to submit a hard copy in addition to the electronic copy, technical portion of applications should be submitted in an original and 1 copy and cost portions of applications in an original and 1 copy.
 
 The application should be prepared according to the structural format set forth below.  Applications must be submitted no later than the date and time indicated on the cover page of this RFA.  Applications and modifications thereof shall be submitted in envelopes with the name and address of the applicant and RFA # (referenced above) inscribed thereon, to:

Armen Karapetyan
Acquisition Specialist
USAID/Armenia
1-st American Avenue 
Yerevan, 0082 Armenia

 Applicants should retain for their records one copy of the application and all enclosures which accompany their application.  To facilitate the competitive review of the applications, USAID will consider only applications conforming to the format prescribed below.

The Technical Application shall include:

a. Cover Page - A single page with the names of the organizations/institutions involved in the proposed application and the lead or primary Applicant clearly identified.  Any proposed sub grantees (hereafter referred to as the “subs”) should be listed separately; including a brief narrative describing the unique capacities/skills brought to the program by each sub.  In addition, the Cover Page should provide a contact person for the prime Applicant, including this individual’s name (both typed and his/her signature), title or position with the organization/institution, address telephone and fax numbers.  State whether the contact person is the person with authority to contract for the Applicant, and if not, that person should also be listed.  

b.  Executive Summary -  Not exceed two (2) pages.  This section should summarize the key elements of the Applicant’s strategy, approach, and implementation plan.  

c.  Program Description – (maximum 20 pages) includes a description of the types of activities that will be undertaken to achieve the proposed objectives, a general timeline, and how the proposed activities are expected to achieve the objectives outlined in the purpose section of this RFA. The narrative should be brief, concise and provide a clear description of what the Applicant proposes to do, where, why, when, how and by whom. The applications should take into account the technical evaluation criteria found in Section B. 

d.  Expected Impact - Applicants will be expected to establish a monitoring and evaluation plan. In four (4) pages or less the Applications should outline expected results and the mechanisms proposed to monitor and measure progress and achievements. 

e. Technical/Administrative Capabilities in Proposed Work Area - Not exceed three (3) pages. Describe your organization's technical and administrative experience and capabilities in conducting programs similar to the project being proposed. Describe any teaming arrangement, partnership, consortium or coalition arrangements between applicant and partner organizations.

f.	Past Performance (maximum 3 pages): Applicants are requested to list all contracts,
 grants, and cooperative agreements involving relevant (similar or related) programs conducted by the applicant (or consortium partners) over the past three years. Reference information shall include the location, current telephone numbers, points of contact, overall dollar value of the program, and award numbers if available. A brief description of work performed by the applicant is also required. Newer organizations, or Applicants with no related prior grant awards, remain eligible for consideration and are encouraged to apply.

g.	Program Management and Key Personnel (maximum 3 pages): In this section, the
 Applicant should briefly provide an overview of how the proposed program will be managed.  Applicants should identify the key personnel positions for this program.  Include position descriptions (including roles and responsibilities), relevant experience and academic and professional qualifications for all key personnel. Applicants should also include a two to three page curriculum vita as an appendix for each candidate.

The Applicant(s) in their application(s) must demonstrate how they will structure projects so as to maximize employment labor opportunities in all projects that they undertake. The Applicant(s) in their application(s) must describe their proposed approach in project selection. Ideally, applications would balance the need for quick start projects which may be pre-identified in the application, and a competitive process for other projects to: (i) identify benefiting villages and communities: (ii) identify potential impacts on the community and the value of infrastructure to be rehabilitated; (iii) explore all cost share possibilities for those communities (from community and/or other donors); (iv) identify potential employment from the project. 

Application package must contain at least several specific quick start employment generation projects for implementation in 2009 (first set of projects) which have the potential to have tangible impacts in terms of employment by the end of 2009. Simplified projects selection procedure could be used for this first set of projects. 

For selection of the second set of projects (for 2010 and 2011) USAID would recommend applicants to consider the following parameters in project selection: 

•	Projects result in the maximum number of short-term job employment possible.
•	Ensure that the most vulnerable, women, and the unemployed are used in the project to the maximum possible and practicable. 
•	Projects should be identified and prioritized jointly by the community and the local government;
•	Gain commitment from the community to ensure that maintenance is provided for the infrastructure produced under this program;
•	Projects should take place in a range of geographic locations; 
•	Cost sharing is desirable (from community and/or other donors). 

The Applicant(s) in their application package must pay particular attention to describing their experience with employment generation, small-scale infrastructure projects and similar activities, projects with rapid startup should be marked.  A list of all contracts, grants or cooperative agreements involving similar or related programs over the past three years have to be submitted.  Reference information shall include the location, current telephone numbers/e-mail address (if applicable), points of contact, award numbers if available, and a brief description of work performed.

The capabilities of the staff (COP, communication specialist, water supply & sanitation specialist, civil engineer, environmental specialist, construction supervision specialist) proposed for program must commensurate with the proposed activities and level of assigned responsibilities.

It is anticipated that some sub-grants/sub-awards/contracts to local organizations could be proposed.  If so, the Applicant(s) in their applications must provide an explanation of their proposed system for identifying and evaluating sub-grants/sub-awards/contracts recipients.

An Initial Environmental Examination (IEE) (IEE#DCN: 2009-ARM-008) has been prepared for Small-Scale Infrastructure Program funding this RFA. The IEE covers activities expected to be implemented under this CA(s). USAID has determined that a Negative Determination with conditions applies to one or more of the proposed activities. This indicates that if these activities are implemented subject to the specified conditions, they are expected to have no significant adverse effect on the environment. The Applicant(s) shall be responsible for implementing all IEE conditions pertaining to activities to be funded under this award(s).

Applications shall be written in English and typed on standard 8 1/2" x 11" or A4 paper single spaced, using Times New Roman font, regular, size 12, with each page numbered consecutively.  Items such as graphs, charts, cover pages, dividers, table of contents, and attachments (i.e. key personnel resumes, case studies, table summarizing qualifications of proposed personnel, past performance summary table and past performance report forms) will not be counted against the page limitation.

COST APPLICATION FORMAT

The Cost or Business Application shall be submitted separately from the technical application.  Certain documents are required to be submitted by an applicant in order for the Agreement Officer to make a determination of responsibility.  

The following sections describe the documentation that applicants for Assistance award must submit to USAID prior to award.   While there is no page limit for this portion, applicants are encouraged to be as concise as possible, but still provide the necessary detail to address the following:
 
A. Include a budget in Excel format with an accompanying budget narrative which provides in detail the total costs for implementation of the program your organization is proposing.  Detailed budget notes and supporting justification of all proposed budget line items should be included.  In addition, a summary of the budget must be submitted using Standard Form 424 and 424A.  Budgets must be in U.S. dollars.  Budgets to be submitted in unlocked Excel format with all formulas to demonstrate calculations.

The budget shall include:
 
1.	The breakdown of all costs associated with the program according to costs of, if applicable, headquarters, regional and/or country offices;

2.	The breakdown of all costs according to each partner organization or subcontractor/subgrantee involved in the program;

3.	The costs associated with external, expatriate technical assistance and those associated with local in-country technical assistance;

4.	The breakdown of the financial and in-kind contributions of all organizations involved in implementing this Cooperative Agreement;

5.	Potential contributions of non-USAID or private commercial donors to this Cooperative Agreement;

6.	A procurement plan for commodities.
 
B.  A copy of the latest Negotiated Indirect Cost Rate Agreement if your organization has such an agreement with the US Government;

C.  Applicants which do not currently have a Negotiated Indirect Cost Rate Agreement (NICRA) from their cognizant agency shall also submit the following information:
 
1.	Copies of the applicant's financial reports for the previous 3-year period, which have been audited by a certified public accountant or other auditor satisfactory to USAID;

2.	Projected budget, cash flow and organizational chart; and

3.	A copy of the organization's accounting manual.
 
D.  Applicants should submit additional evidence of responsibility they deem necessary for the Agreement Officer to make a determination of responsibility.  The information submitted should substantiate that the Applicant:
 
1.	Has adequate financial resources or the ability to obtain such resources as required during the performance of the award.

2.	Has the ability to comply with the award conditions, taking into account all existing and currently prospective commitments of the applicant, nongovernmental and governmental.

3.	Has a satisfactory record of performance.  Past relevant unsatisfactory performance is ordinarily sufficient to justify a finding of non-responsibility, unless there is clear evidence of subsequent satisfactory performance.

4.	Has a satisfactory record of integrity and business ethics; and

5.	Is otherwise qualified and eligible to receive a cooperative agreement under applicable laws and regulations (e.g., EEO).

E. Required certifications, assurances, and other statements.  These forms include:

-Assurance of Compliance with Laws and Regulations Governing – 
    Nondiscrimination in Federally Assisted Programs
-Certification Regarding Lobbying
-Prohibition on Assistance to Drug Traffickers for Covered Countries 
-Certification on Terrorist Financing 
-Certification of Recipient
-Key Individual and Participant Certifications Narcotics Offence and Drug Trafficking
- Survey On Ensuring Equal Opportunity For Applicants
-Applicant Information
-Procurement Information  

These forms are provided in Section D.

F.   Applicants that have never received a cooperative agreement, grant or contract from the U.S. Government are required to submit a copy of their accounting manual.  If a copy has already been submitted to the U.S. Government, the applicant should advise which Federal Office has a copy.

3. Submission Dates and Times 

Applications are due to USAID by August 24, 2009 10 AM Local Time.
(Applications which are submitted late or are incomplete run the risk of not being considered in the review process.  "Late applications will be considered for award if the Agreement Officer determines it is in the Government's interest.")

Hard copies of applications and modifications thereof (Technical portion of applications should be submitted in an original and 4 copies and cost portions of applications in an original and 1 copy) should be submitted in sealed envelopes or packages with the RFA number, the name and address of the applicant, and whether the contents contain technical and/or cost proposals noted on the outside of the envelopes/packages to:

Armen Karapetyan
Acquisition Specialist
USAID/Armenia
1-st American Avenue 
Yerevan, 0082 Armenia

4. Other Submission Requirements

A.  Unnecessarily Elaborate Applications – Unnecessarily elaborate brochures or other presentations beyond those sufficient to present a complete and effective application in response to this RFA are not desired and may be construed as an indication of the applicant's lack of cost consciousness.  Elaborate art work, expensive paper and bindings, and expensive visual and other presentation aids are neither necessary nor wanted.
 
B. Proprietary Information – Applicants which include data that they do not want disclosed to the public for any purpose or used by the U.S. Government except for evaluation purposes, should:
 
1.	Mark the title page with the following legend:
 
 "This application includes data that shall not be disclosed outside the U.S. Government and shall not be duplicated, used, or disclosed - in whole or in part - for any purpose other than to evaluate this application.  If, however, a cooperative agreement is awarded to this applicant as a result of - or in connection with - the submission of this data, the U.S. Government shall have the right to duplicate, use, or disclose the data to the extent provided in the resulting agreement.  This restriction does not limit the U.S. Government's right to use information contained in this data if it is obtained from another source without restriction. The data subject to this restriction are contained in pages ___; and”
 
       2.  Mark each sheet of data it wishes to restrict with the following legend:
 
 "Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this application."
 
C.  Explanation to Prospective Applicants – Any  prospective applicant desiring an explanation or interpretation of this RFA must request it in writing.  Questions should preferably be sent before the deadline July 24, 2009 10:00 AM Local Time to allow a reply to reach all prospective applicants before the submission of their applications.  Oral explanations or instructions given before award of a Cooperative Agreement will not be binding.  Any information given to a prospective applicant concerning this RFA will be furnished promptly to all other prospective applicants as an amendment of this RFA, if that information is necessary in submitting applications or if the lack of it would be prejudicial to any other prospective applicants.

D. Telegraphic or Faxed Applications – Telegraphic  or faxed applications will not be considered; however, applications may be modified by written or telegraphic notice, if that notice is received by the time specified for receipt of applications.

E. Language – All applications must be in English.

SECTION B.  

Application Review Information 

1. Criteria 

Applicants should note that these criteria (a) serve as the standard against which all applications will be evaluated, and (b) serve to identify the significant matters that should be addressed in all applications.

Applications will undergo preliminary review by USAID procurement and technical staffs for completeness and responsiveness.

Applications that are submitted late or incomplete run the risk of not being considered in the review process.

The Government will award cooperative agreement(s) to the applicant whose offer represents the best value to the Government on the basis of the following: A) Technical Merit; and B) Cost.

Numerical weighting indicates the relative order of importance of the technical criteria, to guide applicants in determining which areas require emphasis in the preparation of applications.  The applicant will be selected on the basis of its written proposal, its past experience working in this field and a demonstrated capacity to manage human and financial resources.

Proposals will be judged on the ability of the applicant to achieve the expected results in a reasonable time frame at a reasonable cost.  The application will be reviewed and rated on the following criteria, with a total possible score of 100 points.

                            Criteria					        Points 
______________________________________________________________________
A. 	Overall Ability to Achieve Results				100

40 points: Proposed Program Approach - well-conceived, technically sound and responsive approach presented in the implementation plan that provides convincing evidence of the applicant's understanding of the program of activities and results it proposes to accomplish and would like to support in terms of short-term employment opportunities to the vulnerable and improving public services in remote villages. The applicants have to demonstrate how they will identify unemployed and vulnerable. The application demonstrates a thorough knowledge of the issues and problems faced in addressing generation of short-term employment opportunities and immediate village/community level infrastructure needs of the vulnerable through service delivery in Armenia. In presenting their program approach, the applicants need to address their potential for better results in terms of rapid startup and creation of short-term employment opportunities through small-scale projects, and specifically take into account issues of gender, age and disability status.  Applicant’s proposals will be evaluated on the total number of days of short-term employment expected to be provided by the program, and that total number of days must be disaggregated by years for 2009, 2010 and 2011.

20 points: First set of feasible projects to be implemented in 2009 - Proposing quick start/immediate employment generation projects for implementation in 2009 with tangible impacts in terms of job creation by the end of 2009

15 points: Past Performance: The applicant must have a demonstrated successful track record in implementing and monitoring similar or related activities to those contained in the program description (i.e. implementation of small-scale infrastructure projects, and public works programs) in an overseas (non-U.S.) environment.  

15 points: Key personnel (COP, communication specialist, water supply & sanitation specialist, civil engineer, environmental specialist, construction supervision specialist).
   
10 points: Organizational Capacity: The applicant has a demonstrated organizational capacity to manage the proposed activities under the cooperative agreement, including transparent personnel, procurement and financial management systems.  

B.	Effectiveness and reasonableness of total estimated cost		
Demonstrated ability to minimize recurrent costs and maximize cost-effectiveness.  Maximizing the percentage of the costs allocated to program delivery as compared to administrative costs will also be a factor in evaluating applications.  The cost realism analysis is intended to meet the following three goals:
a)	verify the Applicant's understanding of the requirements and regulations;
b)	assess the degree to which the cost proposal reflects the approaches in the technical application; and;
assess the degree to which the cost included in the cost proposal accurately represents the work effort included in the technical application.

2. Review and Selection Process

All applications which meet the eligibility and program requirements, and conform to the application preparation and submission instructions, will be reviewed and scored by a panel of USAID reviewers strictly in accordance with the evaluation criteria set forth in this section.

The budget narrative of all applications under consideration for award will be reviewed for cost realism and reasonableness.  After initial review of applications, USAID may conduct written and/or oral discussions with those applicants whose applications remain under consideration for award.  The decision to conduct such discussions should not be considered a final decision about which organizations will receive an award, but rather would be part of the evaluation process.

3. AWARD CONSIDERATIONS

USAID/Armenia will evaluate applications and make an award based on that application which best would achieve the expected outcomes of the program and offers the greatest overall benefit in response to the requirement.

Although technical evaluation factors are significantly more important than cost, the closer the technical evaluations of the various applications are to one another, the more important cost considerations become. The Agreement Officer may determine that a highly ranked application based on the technical evaluation factors is unreasonable or unrealistic in terms of cost.  Award will be made to the applicant whose application offers the best value to the Government.  Best value is defined as the expected outcome that, in the Government’s estimation, provides the greatest overall benefit in response to the requirement and available funds. 

Award Administration Information

Reporting

The Recipient will comply with the financial reporting requirements in accordance with 22 CFR 226. In addition, the Recipient will submit to the USAID AOTR, a quarterly financial report that specifically includes line item budgets, expenditures and accruals, and a pipeline (balance remaining). A table with expenditures and accruals will be submitted to the AOTR no less than 15 days before the end of each (USAID) fiscal year quarter through the life of the project. The Recipient shall submit these forms in the following manner:
 
(1) The SF 272 and 272a (if necessary) must be submitted via electronic format to the U.S. Department of Health and Human Services (http://www.dpm.psc.gov).  A copy of this form shall also be submitted at the same time to the Agreement Officer and the Agreement Officer Technical Representative.
 
(2) The SF 269 or 269a (as appropriate) shall be submitted to the Agreement Officer Technical Representative with one copy to the Agreement Officer.
 
(3) In accordance with 22 CFR 226.70-72, the original and two copies of all final financial reports shall be submitted to M/FM, the Agreement Officer (if requested) and the AOTR.  The electronic version of the final SF 272 or 272a shall be submitted to HHS in accordance with paragraph (1) above.

1.	Quarterly Reports

The Recipient shall deliver semi-annual progress reports to USAID within 15 days from the end of each three month period.  These reports shall collectively discuss the work of the program, highlighting: (1) major activities planned and underway; (2) timeline of events; (3) significant results to date; (4) problems with implementation; (5) adjustments to the Implementation Plan.  

2.	End-of-Project Report

The Recipient shall submit a final report of the program within one month of the close of the project.  The final report shall include (but not be limited to): (1) executive summary; (2) brief description of the results of the program; (3) success stories; (4) problems and how they were overcome; (5) cost-effectiveness; (6) lessons learned; (7) recommendations for USAID’s future support in this area. 

5.  USAID Branding and Marking 

Branding and Marking Requirements for this Small-Scale Infrastructure Program will conform to ADS 320.3.3 (effective 01/08/2007 and revised 05/05/2009).

It is a federal statutory and regulatory requirement that all USAID programs, projects, activities, public communications, and commodities that USAID partially or fully funds under a USAID grant or cooperative agreement or other assistance award or subaward, must be marked appropriately overseas with the USAID Identity.  USAID will require the submission of a Branding Strategy and a Marking Plan by the apparent successful applicant under this RFA.  For more information, see:  http://www.usaid.gov/branding/assistance.html 

USAID/Armenia anticipates making available approximately $2,307,928.00 under this award.  USAID reserves the right to fund any or none of the applications submitted.  It is expected that funded projects will run for 2 years. 

SECTION C - PROGRAM DESCRIPTION

U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT/ARMENIA
SMALL- SCALE INFRASTRUCTURE PROGRAM

A. SUMMARY

This Small-Scale Infrastructure Program is a new activity to respond to the Global Economic Crisis (GEC) and to assist vulnerable communities and rural villages in Armenia by creating short-term employment through quick response job creation projects and by carrying out easily implementable small-scale infrastructure projects that will rehabilitate community prioritized infrastructure. The main purpose of this activity will be to provide short term employment in rural villages in Armenia to alleviate the Global Economic Crisis, and the implementer must therefore be prepared to rapidly begin implementation and immediately launch a portion of the projects shortly after award with a high potential to provide jobs to the unemployed in hard hit communities. Over the longer term, the project should contribute to both job creation and to leaving behind a legacy of improvement to the local communities which are assisted by the program. So, the program will consist of two sets of small-scale projects - the first set will be proposed with the implementer’s application package and will be initiated within the first months of the program. The second set of projects will be developed later on (probably within the first six month of the program) in accordance with the requirements and parameters listed below and this set will be implemented during 2010 and 2011. 

With approximately 30% of the population living at or under the poverty line (mainly in rural area), relatively high under and unemployment, and the declining quality of and access to public services, many Armenians have yet to feel the benefits of the transition to a market democracy. Actually, the situation is worsening because of Global Economic Crisis, reduced remittances, declined trade and 200,000 migrants expected back from Russia, which is increasing the number of unemployed people and creating additional social tension. 

For developing economies, access to reliable public services continues to be a key factor in determining the pace of the economic growth.  Furthermore, investments in community water and sewer facilities, school, health clinics and others rehabilitation/ renovation generate significant economic benefits beyond the obvious results – they support social stability and reduce poverty.  This program will support activities designed to create short-term employment and improve access to public services in remote villages and communities.  At least one-third of the program resources must be allocated for potable water and sanitation projects.

The proposed program will contribute to addressing the goals of the USG Country Assistance Strategy in Armenia for 2009-2013, under the Priority Goal 4 - Increase Armenia's economic growth, private sector competitiveness and economic sustainability (clean productive environment (4.8.2)) and Priority Goal 5 - Enhance Armenia's health and human, social and economic services,  (water supply and sanitation (3.1.8) and social assistance (3.3.3)).    

This program will contribute to the mitigation of adverse impact of GEC by a) providing short-term employment; and b) identifying and providing locally sustainable public services to the most vulnerable populations of Armenia. Through this RFA, USAID/Armenia seeks to support initiatives for improving access to public services and infrastructure implemented at the grass-roots level, as means for efficiency and effectiveness.  Due to the high degree of needs and the growing frustration with the government’s inability to provide required support, activities should be designed to provide immediate employment opportunities and services to the population.  

B. DETAILED PROGRAM DESCRIPTION 

The objective of this program is to rapidly provide temporary employment in rural villages, rehabilitate vital social and economic infrastructure in order to meet citizens’ needs, and improve public services delivery.  The program is designed to provide short-term employment opportunities as quickly as possible to people in the selected villages working on these selected small-scale infrastructure projects.  

The implementing partner(s) should seek to maximize the impact of the short-term and long-term jobs to be created. Short-term employment will be created during the small-scale infrastructure project works, and long-term employment will be generated for the operation and maintenance of the rehabilitated infrastructure. The requirement for long-term jobs will be incorporated in a Memorandum of Understanding (MOU) to be signed with communities prior to initiation of the projects.

The program should fund only small-scale projects which can be quickly implemented, and start up times must be minimized, at least for the initial set of projects. Applicants should therefore propose both a set of quick start employment generation projects which will generate immediate results and provide employment within the first four-six months of project start up, and a second set of projects following the quick start phase.  As such, community prioritized infrastructure projects which require more planning and design elements, would fall into the second phase (or set) of projects.

Appropriate representatives (active community members with the appropriate knowledge) should be involved in the oversight of project implementation and serve as liaisons between the community and implementing partner(s). Upon completion of the project they will be responsible for the maintenance of the renovated facility.  By utilizing a demand driven strategy, these projects will provide opportunities to selected communities to effectively manage and maintain local infrastructure, basic services, and natural resources resulting in increased capacity, ownership and responsibility toward their own development.

Quick response job creation small-scale infrastructure projects will include repairing/renovation of schools, health clinics, community centers, water supply systems and other community prioritized infrastructure projects. These projects will include rehabilitation/upgrade works limited to regular small-scale construction works like replacement/renovation of doors, windows and roofs; plastering and painting works; and renovation of sanitary facilities - bathrooms/toilets, tiles, installation of sinks and water closets. Water supply projects will mostly include provision/rehabilitation of water supply systems through replacement of the most critical and deteriorated sections of village/community level water supply infrastructure (trenches, pipes, fittings and connections, some of regulating chambers). It is USAID’s preference not to provide equipment or do capital intensive projects but rather to use project resources towards local labor costs.  

Based on USAID’s previous experience on similar activities, projects supported under this program are expected to focus on quick response job creation projects, the rehabilitation/renovation of health facilities, kindergartens, the upgrading of water networks for residential use and other infrastructure designed to support the provision of social services.  The small-scale projects are expected to be short-term in nature (5-6 months maximum), and would be meant to provide immediate, but interim, employment to those most in need (on average 3 months).

The implementing partner(s) will be responsible for:
•	ensuring that the project objective of maximum job creation is met; 
•	ensuring that sub-grantees or contractors hire the vulnerable or unemployed, and that appropriate beneficiaries are given these work opportunities;
•	identification of small-scale projects  in communities, in collaboration with selected communities and respective local and central governments;
•	final selection of small-scale projects in accordance with selection criteria approved by USAID;
•	provision of sub-grants or contracts, as necessary, for project implementation;
•	ensuring sound design of the selected projects; 
•	oversight of the small-scale projects to be funded through the program, including environmental compliance;
•	project management (managing labor etc.);
•	project monitoring and reporting.

Most importantly, the implementing partner must ensure that the program objective of job creation and temporary employment is maximized.  USAID is also seeking to ensure that there is quick implementation in the early months of an initial set of quick start employment generation projects.  While USAID is ultimately focused on job creation, the implementing partner should also seek to ensure that all projects result in meaningful impact to the beneficiary communities and are sustainable.

The structure of the small-scale projects should build on lessons learned in the World Bank’s Social Investment Fund (SIF) and World Food Programme’s (WFP) Food for Work program. USAID’s program intends to hire local unemployed and therefore, special consideration will be sought for the businesses to utilize this resource. Only labor-intensive small-scale projects will be selected for implementation in order to maximize the number of employment opportunities generated. Based on USAID’s experience with the highest priority community needs identified under previous programs, projects supported under this program are expected to focus on the upgrading of water networks, the rehabilitation or construction of health and educational facilities, and other infrastructure designed to support the provision of public services.  The projects are expected to be relatively short-term in nature, and would be meant to provide immediate, but interim, employment to those most in need. 
 
Based on the past experience USAID is assuming that each project, including labor and materials, would be in the range of $30,000 - $120,000, and that a total of 16-20 small-scale projects will be implemented each year. Projects with an estimated cost of over $120,000 will not be considered for implementation. USAID is assuming that in frame of the available budget, supported with possible cost-share, at least 23,000 days of labor will be created through implementation of specified number of small-scale projects. The total amount to be allocated for projects implementation should not be less that $1.7 million. USAID will hire an Architectural-Engineering Company to provide construction works quality control.

C. PROGRAM TIMETABLE

The award(s) made under this RFA will be for up to a 24-month period. The estimated time frame for program implementation is from approximately September 23, 2009 to September 22, 2011.

Project proposals should include an initial set of quick start projects which would be implemented during the first six months of the program.  A more detailed list of projects for the first year of the program should be proposed after employing a competitive approach for project selection.  This list should be developed within the first four months of the project.  Another competitive round of projects will be selected for implementation in the second year.  

D. LEVEL OF FUNDING

The estimated level of funding provided by USAID available for awards under this RFA is about $2.3 million over a two year period. USAID may choose to make multiple awards under this RFA.  The funding amount is the total amount estimated to be made available for any and all awards related to this program description.

Out of about $2.3 million available for this program not less than $1.7 million shall be allocated for small-scale projects, including not less than $650,000 for water supply and sanitation projects.

E. SUBSTANTIAL INVOLVEMENT

USAID/Armenia anticipates the following substantial involvement in the recipient’s activities: 

1.  Approval of the recipient's annual Implementation Plans:  On an annual basis, the recipient shall prepare and provide for USAID’s approval at an annual implementation plan.  The initial implementation plan for the first year of activities will be submitted as part of the applicant’s technical proposal. Project proposals should include an initial set of quick start projects which would be implemented during the first six months of the program.  

The applicant will be expected to provide a detailed plan for the implementation of small-scale infrastructure projects for USAID review and approval following cooperative agreement award.  This more detailed list of projects for the first year of the program should be proposed after employing a competitive approach for project selection (number of created short-term job employment have to be the first deciding factor).  This list should be developed within the first four months of the project.  Another competitive round of projects will be selected for implementation in the second year. Any changes in the initial workplan will require additional approval. 
               
  2.  Approval of specified key personnel: USAID will approve the key personnel as essential staff for the successful implementation of the award and any changes to key personnel.  

3.  Approval of the selection of small-scale projects: The recipient is expected to rehabilitate community/village level small-scale infrastructure.  USAID will be involved in all stages of selection of target communities and projects to ensure that program objectives are met (including adequate arrangements for provision of maximum short-term employment). The recipient has to obtain the AOTR’s approval for each identified and proposed small-scale project prior to the approval for the sub-award, transfer, or contracting out of any work under an award. Standards and specifications will be requested and approved by USAID for each small-scale infrastructure project.

4.  Approval of the recipient's monitoring and evaluation plans: USAID will review and approve the recipient’s monitoring and evaluation plan.  An adequate monitoring and evaluation plan is critical for the successful tracking of program progress and achievement of results.  This monitoring and evaluation plan should be clearly linked to the achievement of USAID’s intermediate results, and should track program impact on men and women and communities as a whole. All people-level data should be accumulated and disaggregated by gender. 

5.  Ongoing monitoring of program implementation: USAID will consistently and regularly monitor program performance to ensure compliance and complementarities of activities with other ongoing USAID-supported programs (including those in the areas of primary health and reproductive health, local government, other activities under the social transition program, and micro-enterprise).  USAID will monitor small-scale projects activities to ensure program objectives are being met. 

6.  Agency authority to immediately halt a construction activity: Works, materials and equipment used for all small-scale infrastructure projects must meet the requirements of the RA standards for construction, environment, health and safety. USAID specific requirements for environment, health and safety also have to be met. The AO may immediately halt a construction if identified specifications/standards are not met or if determined that conditions warrant immediate corrective action.

SECTION D

CERTIFICATIONS, ASSURANCES, AND OTHER STATEMENTS OF THE RECIPIENT (MAY 2006)
 
NOTE: When these Certifications, Assurances, and Other Statements of Recipient are used for cooperative agreements, the term "Grant" means "Cooperative Agreement". 

PART I - CERTIFICATIONS AND ASSURANCES
  
1. ASSURANCE OF COMPLIANCE WITH LAWS AND REGULATIONS GOVERNING NON-DISCRIMINATION IN FEDERALLY ASSISTED PROGRAMS

Note: This certification applies to Non-U.S. organizations if any part of the program will be undertaken in the United States.
  
     (a)   The recipient hereby assures that no person in the United States shall, on the bases set forth below, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under, any program or activity receiving financial assistance from USAID, and that with respect to the Cooperative Agreement for which application is being made, it will comply with the requirements of:
  
       (1)  Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352, 42 U.S.C. 2000-d), which prohibits discrimination on the basis of race, color or national origin, in programs and activities receiving Federal financial assistance;
  
       (2)  Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), which prohibits discrimination on the basis of handicap in programs and activities receiving Federal financial assistance;
  
       (3)  The Age Discrimination Act of 1975, as amended (Pub. L. 95-478), which prohibits discrimination based on age in the delivery of services and benefits supported with Federal funds;
  
       (4)  Title IX of the Education Amendments of 1972 (20 U.S.C. 1681, et seq.), which prohibits discrimination on the basis of sex in education programs and activities receiving Federal financial assistance (whether or not the programs or activities are offered or sponsored by an educational institution); and
  
       (5)  USAID regulations implementing the above nondiscrimination laws, set forth in Chapter II of Title 22 of the Code of Federal Regulations.
  
     (b)  If the recipient is an institution of higher education, the Assurances given herein extend to admission practices and to all other practices relating to the treatment of students or clients of the institution, or relating to the opportunity to participate in the provision of services or other benefits to such individuals, and shall be applicable to the entire institution unless the recipient establishes to the satisfaction of the USAID Administrator that the institution's practices in designated parts or programs of the institution will in no way affect its practices in the program of the institution for which financial assistance is sought, or the beneficiaries of, or participants in, such programs.
  
     (c)  This assurance is given in consideration of and for the purpose of obtaining any and all Federal grants, loans, contracts, property, discounts, or other Federal financial assistance extended after the date hereof to the recipient by the Agency, including installment payments after such date on account of applications for Federal financial assistance which was approved before such date.  The recipient recognizes and agrees that such Federal financial assistance will be extended in reliance on the representations and agreements made in this Assurance, and that the United States shall have the right to seek judicial enforcement of this Assurance.  This Assurance is binding on the recipient, its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this Assurance on behalf of the recipient.
    
2.  CERTIFICATION REGARDING LOBBYING
  
 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 Cooperative Agreement, 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 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 subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) 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, United States 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.

 Statement for Loan Guarantees and Loan Insurance
  
 The undersigned states, to the best of his or her knowledge and  belief, that:  If any 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 commitment providing for the United States to insure or guarantee a loan, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. Submission of this statement 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 statement shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

 3.  PROHIBITION ON ASSISTANCE TO DRUG TRAFFICKERS FOR COVERED COUNTRIES AND INDIVIDUALS (ADS 206)
  
 USAID reserves the right to terminate this Agreement, to demand a refund or take other appropriate measures if the Grantee is found to have been  convicted of a narcotics offense or to have been engaged in drug trafficking as defined in 22 CFR Part 140. The undersigned shall review USAID ADS 206 to determine if any certifications are required for Key Individuals or Covered Participants.
  
 If there are COVERED PARTICIPANTS: USAID reserves the right to terminate assistance to or take other appropriate measures with respect to, any participant approved by USAID who is found to have been convicted of a narcotics offense or to have been engaged in drug trafficking as  defined in 22 CFR Part 140.

4.  CERTIFICATION REGARDING TERRORIST FINANCING IMPLEMENTING EXECUTIVE ORDER 13224
  
By signing and submitting this application, the prospective recipient provides the certification set out below:

1. The Recipient, to the best of its current knowledge, did not provide, within the
previous ten years, and will take all reasonable steps to ensure that it does not and will not knowingly provide, material support or resources to any individual or entity that commits, attempts to commit, advocates, facilitates, or participates in terrorist acts, or has committed, attempted to commit, facilitated, or participated in terrorist acts, as that term is defined in paragraph 3.

2. The following steps may enable the Recipient to comply with its obligations under paragraph 1:

a. Before providing any material support or resources to an individual or entity, the Recipient will verify that the individual or entity does not (i) appear on the master list of Specially Designated Nationals and Blocked Persons, which list is maintained by the U.S. Treasury’s Office of Foreign Assets Control (OFAC) and is available online at OFAC’s website : http://www.treas.gov/offices/eotffc/ofac/sdn/t11sdn.pdf or (ii) is not included in any supplementary information concerning prohibited individuals or entities that may be provided by USAID to the Recipient.

b. Before providing any material support or resources to an individual or entity, the Recipient also will verify that the individual or entity has not been designated by the United Nations Security (UNSC) sanctions committee established under UNSC Resolution 1267 (1999) (the “1267 Committee”) [individuals and entities linked to the Taliban, Usama bin Laden, or the Al Qaida Organization]. To determine whether there has been a published designation of an individual or entity by the 1267 Committee, the Recipient should refer to the consolidated list available online at the Committee’s website: 

http://www.un.org/Docs/sc/committees/1267/1267ListEng.htm.

c. Before providing any material support or resources to an individual or entity, the Recipient will consider all information about that individual or entity of which it is aware and all public information that is reasonably available to it or of which it should be aware.

d. The Recipient also will implement reasonable monitoring and oversight procedures to safeguard against assistance being diverted to support terrorist activity.

3. For purposes of this Certification-

a. “Material support and resources” means currency or monetary instruments or
financial securities, financial services, lodging, training, expert advice or assistance, safehouses, false documentation or identification, communications equipment, facilities, weapons, lethal substances, explosives, personnel, transportation, and other physical assets, except medicine or religious materials.”

b. “Terrorist act” means-

(i)	an act prohibited pursuant to one of the 12 United Nations Conventions and Protocols related to terrorism (see UN terrorism conventions Internet site: http://untreaty.un.org/English/Terrorism.asp ) or

(ii) an act of premeditated, politically motivated violence perpetrated against noncombatant targets by subnational groups or clandestine agents; or

(iii) any other act intended to cause death or serious bodily injury to a civilian, or to any other person not taking an active part in hostilities in a situation of armed conflict, when the purpose of such act, by its nature or context, is to intimidate a population, or to compel a government or an international organization to do or to abstain from doing any act.

c. “Entity” means a partnership, association, corporation, or other organization, group or subgroup.

d. References in this Certification to the provision of material support and resources shall not be deemed to include the furnishing of USAID funds or USAID-financed commodities to the ultimate beneficiaries of USAID assistance, such as recipients of food, medical care, micro-enterprise loans, shelter, etc., unless the Recipient has reason to believe that one or more of these beneficiaries commits, attempts to commit, advocates, facilitates, or participates in terrorist acts, or has committed, attempted to commit, facilitated or participated in terrorist acts.

e. The Recipient’s obligations under paragraph 1 are not applicable to the
procurement of goods and/or services by the Recipient that are acquired in the ordinary course of business through contract or purchase, e.g., utilities, rents, office supplies, gasoline, etc., unless the Recipient has reason to believe that a vendor or supplier of such goods and services commits, attempts to commit, advocates, facilitates, or participates in terrorist acts, or has committed, attempted to commit, facilitated or participated in terrorist acts.

This Certification is an express term and condition of any agreement issued as a result of this application, and any violation of it shall be grounds for unilateral termination of the agreement by USAID prior to the end of its term.

5.  CERTIFICATION OF RECIPIENT
  
By signing below the recipient provides certifications and assurances for (1) the Assurance of Compliance with Laws and Regulations Governing Non-Discrimination in Federally Assisted Programs, (2) the Certification Regarding Lobbying, (3) the Prohibition on Assistance to Drug Traffickers for Covered Countries and Individuals (ADS 206) and (4) the Certification Regarding Terrorist Financing Implementing Executive Order 13224 above.

 RFA No. ________________________________
  
 Application No.      ______________________________
  
 Date of Application ______________________________
  
 Name of Recipient   _______________________________
  
 Typed Name and Title   __________________________________
 
 Signature              _____________________________________

 Date                   _______________

PART II – KEY INDIVIDUAL CERTIFICATION NARCOTICS OFFENSES AND DRUG TRAFFICKING
  
 I hereby certify that within the last ten years:
  
   1. I have not been convicted of a violation of, or a conspiracy to violate, any law or regulation of the United States or any other country concerning narcotic or psychotropic drugs or other controlled substances.
  
   2. I am not and have not been an illicit trafficker in any such drug or controlled substance.
  
   3. I am not and have not been a knowing assistor, abettor, conspirator, or colluder with others in the illicit trafficking in any such drug or substance.
  
 Signature: 		____________________________
  
 Date: 			____________________________
  
 Name: 		___________________________
  
 Title/Position: 	____________________________
  
 Organization:	 	____________________________

 Address: 		____________________________
  
          			____________________________
  
 Date of Birth: 	____________________________
  
 NOTICE:
  
   1. You are required to sign this Certification under the provisions of 22 CFR Part 140, Prohibition on Assistance to Drug Traffickers. These regulations were issued by the Department of State and require that certain key individuals of organizations must sign this Certification.
  
   2. If you make a false Certification you are subject to U.S. criminal prosecution under 18 U.S.C. 1001.
 
PART III - PARTICIPANT CERTIFICATION NARCOTICS OFFENSES AND DRUG TRAFFICKING

   1. I hereby certify that within the last ten years:
  
     a. I have not been convicted of a violation of, or a conspiracy to violate, any law or regulation of the United States or any other country concerning narcotic or psychotropic drugs or other controlled substances.
  
     b. I am not and have not been an illicit trafficker in any such drug or controlled substance.
  
     c. I am not or have not been a knowing assistor, abettor, conspirator, or colluder with others in the illicit trafficking in any such drug or substance.
  
   2. I understand that USAID may terminate my training if it is determined that I engaged in the above conduct during the last ten years or during my USAID training.
  
 Signature: 		___________________________________
  
 Name: 		___________________________________
  
 Date: 			___________________________________
  
 Address: 		___________________________________
  
			___________________________________
  
 Date of Birth: 	___________________________________
  
 NOTICE:
  
   1. You are required to sign this Certification under the provisions of 22 CFR Part 140, Prohibition on Assistance to Drug Traffickers. These regulations were issued by the Department of State and require that certain participants must sign this Certification.
  
   2. If you make a false Certification you are subject to U.S. criminal prosecution under 18 U.S.C. 1001.

PART IV - SURVEY ON ENSURING EQUAL OPPORTUNITY FOR APPLICANTS

Applicability:  All RFA’s must include the attached Survey on Ensuring Equal Opportunity for Applicants as an attachment to the RFA package. Applicants under unsolicited applications are also to be provided the survey. (While inclusion of the survey by Agreement Officers in RFA packages is required, the applicant’s completion of the survey is voluntary, and must not be a requirement of the RFA. The absence of a completed survey in an application may not be a basis upon which the application is determined incomplete or non-responsive. Applicants who volunteer to complete and submit the survey under a competitive or non-competitive action are instructed within the text of the survey to submit it as part of the application process.)

See Survey on Ensuring Equal Opportunity for Applicants at the below internet link:
http://www.ed.gov/fund/grant/apply/appforms/surveyeo.pdf

PART V - OTHER STATEMENTS OF RECIPIENT
  
	1.  AUTHORIZED INDIVIDUALS
  
 The recipient represents that the following persons are authorized to negotiate on its behalf with the Government and to bind the recipient in connection with this application or grant:
  
          Name               Title               Telephone No.      Facsimile No.
  
   ________________________________________________________________
  
   ________________________________________________________________
  
   ________________________________________________________________

	2.  TAXPAYER IDENTIFICATION NUMBER (TIN)
  
 If the recipient is a U.S. organization, or a foreign organization which has income effectively connected with the conduct of activities in the U.S. or has an office or a place of business or a fiscal paying agent in the U.S., please indicate the recipient's TIN:
  
 TIN: ________________________________

3.  DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER
  
     (a)  In the space provided at the end of this provision, the recipient should supply the Data Universal Numbering System (DUNS) number applicable to that name and address.  Recipients should take care to report the number that identifies the recipient's name and address exactly as stated in the proposal.
  
     (b)  The DUNS is a 9-digit number assigned by Dun and Bradstreet Information Services.  If the recipient does not have a DUNS number, the recipient should call Dun and Bradstreet directly at 1-800-333-0505. A DUNS number will be provided immediately by telephone at no charge to the recipient.  The recipient should be prepared to provide the following information:
  
       (1) Recipient's name.
       (2) Recipient's address.
       (3) Recipient's telephone number.
       (4) Line of business.
       (5) Chief executive officer/key manager.
       (6) Date the organization was started.
       (7) Number of people employed by the recipient.
       (8) Company affiliation.
  
     (c)  Recipients located outside the United States may obtain the location and phone number of the local Dun and Bradstreet Information Services office from the Internet Home Page at http://www.dbisna.com/dbis/customer/custlist.htm. If an offeror is unable to locate a local service center, it may send an e-mail to Dun and Bradstreet at globalinfo@dbisma.com.
  
 The  DUNS system is distinct from the Federal Taxpayer Identification Number (TIN) system.
  
 DUNS: ________________________________________

4.  LETTER OF CREDIT (LOC) NUMBER
  
 If the recipient has an existing Letter of Credit (LOC) with USAID, please indicate the LOC number:
  
 LOC:  _________________________________________

	5.  PROCUREMENT INFORMATION
  
     (a)  Applicability.  This applies to the procurement of goods and services planned by the recipient (i.e., contracts, purchase orders, etc.) from a supplier of goods or services for the direct use or benefit of the recipient in conducting the program supported by the grant, and not to assistance provided by the recipient (i.e., a subgrant or subagreement) to a subgrantee or subrecipient in support of the subgrantee's or subrecipient's program.  Provision by the recipient of the requested information does not, in and of itself, constitute USAID approval.
  
     (b)  Amount of Procurement.  Please indicate the total estimated dollar amount of goods and services which the recipient plans to purchase under the grant:
  
      $__________________________
  
     (c) Nonexpendable Property.  If the recipient plans to purchase nonexpendable equipment which would require the approval of the Agreement Officer, please indicate below (using a continuation page, as necessary) the types, quantities of each, and estimated unit costs. Nonexpendable equipment for which the Agreement Officer's approval to purchase is required is any article of nonexpendable tangible personal property charged directly to the grant, having a useful life of more than one year and an acquisition cost of $5,000 or more per unit.
 
 TYPE/DESCRIPTION
(Generic)                           ____________________________            

QUANTITY	                  _____________________________       

ESTIMATED 
UNIT COST                      _____________________________

     (d)  Source, Origin, and Componentry of Goods.  If the recipient plans to purchase any goods/commodities which are not of U.S. source and/or U.S. origin, and/or does not contain at least 50% componentry, which are not at least 50% U.S. source and origin, please indicate below (using a continuation page, as necessary) the types and quantities of each, estimated unit costs of each, and probable source and/or origin, to include the probable source and/or origin of the components if less than 50% U.S. components will be contained in the commodity.  "Source" means the country from which a commodity is shipped to the cooperating country or the cooperating country itself if the commodity is located therein at the time of purchase.  However, where a commodity is shipped from a free port or bonded warehouse in the form in which received therein, "source" means the country from which the commodity was shipped to the free port or bonded warehouse.  Any commodity whose source is a non-Free World country is ineligible for USAID financing.  The "origin" of a commodity is the country or area in which a commodity is mined, grown, or produced.  A commodity is produced when, through manufacturing, processing, or substantial and major assembling of components, a commercially recognized new commodity results, which is substantially different in basic characteristics or in purpose or utility from its components.  Merely packaging various items together for a particular procurement or relabeling items do not constitute production of a commodity.  Any commodity whose origin is a non-Free World country is ineligible for USAID financing.  "Components" are the goods, which go directly into the production of a produced commodity. Any component from a non-Free World country makes the commodity ineligible for USAID financing.

TYPE/DESCRIPTION 	
(Generic)                               ______________________________ 

QUANTITY 		           ______________________________ 

ESTIMATED 			 
UNIT COST                           ______________________________

GOODS
COMPONENTS                     ______________________________

PROBABLE 			
SOURCE 			______________________________ 

GOODS
COMPONENTS                     ______________________________

PROBABLE			 
ORIGIN 			______________________________ 

 
  
     (e)  Restricted Goods.  If the recipient plans to purchase any restricted goods, please indicate below (using a continuation page, as necessary) the types and quantities of each, estimated unit costs of each, intended use, and probable source and/or origin.  Restricted goods are Agricultural Commodities, Motor Vehicles, Pharmaceuticals, Pesticides, Rubber Compounding Chemicals and Plasticizers, Used Equipment, U.S. Government-Owned Excess Property, and Fertilizer.
  
TYPE/DESCRIPTION 	______________________________ 
(Generic)
QUANTITY 			______________________________ 

ESTIMATED 			 
UNIT COST			______________________________

PROBABLE 			
SOURCE			______________________________ 

PROBABLE 			 
ORIGIN		                        _____________________________ 	 

INTENDED 
USE                                             ________________________________  

     (f)  Supplier Nationality.  If the recipient plans to purchase any goods or services from suppliers of goods and services whose nationality is not in the U.S., please indicate below (using a continuation page, as necessary) the types and quantities of each good or service, estimated costs of each, probable nationality of each non-U.S. supplier of each good or service, and the rationale for purchasing from a non-U.S. supplier.  Any supplier whose nationality is a non-Free World country is ineligible for USAID financing.

TYPE/DESCRIPTION
(Generic) 		 	_____________________________ 

QUANTITY 			_____________________________ 

ESTIMATED
UNIT COST 			_____________________________ 

PROBABLE SUPPLIER 	
(Non-US Only)                        _____________________________

NATIONALITY 	           _____________________________ 

RATIONALE			
FOR NON-US 		_____________________________ 

  
     (g)  Proposed Disposition.  If the recipient plans to purchase any nonexpendable equipment with a unit acquisition cost of $5,000 or more, please indicate below (using a continuation page, as necessary) the proposed disposition of each such item.  Generally, the recipient may either retain the property for other uses and make compensation to USAID (computed by applying the percentage of federal participation in the cost of the original program to the current fair market value of the property), or sell the property and reimburse USAID an amount computed by applying to the sales proceeds the percentage of federal participation in the cost of the original program (except that the recipient may deduct from the federal share $500 or 10% of the proceeds, whichever is greater, for selling and handling expenses), or donate the property to a host country institution, or otherwise dispose of the property as instructed by USAID.
  
 TYPE/DESCRIPTION
(Generic)                            ___________________________

QUANTITY                      ___________________________   

ESTIMATED 
UNIT COST                     ____________________________ 

PROPOSED   
DISPOSITION                 ____________________________

	6.  PAST PERFORMANCE REFERENCES
  
 On a continuation page, please provide past performance information requested in the RFA.

	7.  TYPE OF ORGANIZATION
  
 The recipient, by checking the applicable box, represents that -
  
     (a)  If the recipient is a U.S. entity, it operates as [  ] a corporation incorporated under the laws of the State of, [ ] an individual, [  ] a partnership, [  ] a nongovernmental nonprofit organization, [  ] a state or loc al governmental organization, [  ] a private college or university, [  ] a public college or university, [  ] an international organization, or [  ] a joint venture; or
  
     (b)  If the recipient is a non-U.S. entity, it operates as [  ] a corporation organized under the laws of _____________________________ (country), [  ] an individual, [  ] a partnership, [  ] a nongovernmental nonprofit organization, [  ] a nongovernmental educational institution, [ ] a governmental organization, [ ] an international organization, or [ ] a joint venture.
  
	8.  ESTIMATED COSTS OF COMMUNICATIONS PRODUCTS
  
 The following are the estimate(s) of the cost of each separate communications product (i.e., any printed material [other than non- color photocopy material], photographic services, or video production services) which is anticipated under the grant.  Each estimate must include all the costs associated with preparation and execution of the product.  Use a continuation page as necessary. 

SECTION E – ANNEXES

1.    MANDATORY STANDARD PROVISIONS FOR U.S. NONGOVERNMENTAL
RECIPIENTS

Please refer to the following website to access the above mentioned Provisions:
http://www.usaid.gov/policy/ads/300/303maa.pdf

2.	STANDARD FORMS 424, 424A AND 424B, APPLICATION FOR FEDERAL ASSISTANCE, BUDGET INFORMATION-NON-CONSTRUCTION PROGRAMS AND ASSURANCES-NON-CONSTRUCTION PROGRAMS

The SF 424, SF 424A and SF 424B documents are not included but can be found at the
following website:

http://www.grants.gov

3.	MARKING UNDER ASSISTANCE-BRANDING STRATEGY – ASSISTANCE  (December 2005)

(a) Definitions

Branding Strategy means a strategy that is submitted at the specific request of a USAID
Agreement Officer by an Apparently Successful Applicant after evaluation of an application for USAID funding, describing how the program, project, or activity is named and positioned, and how it is promoted and communicated to beneficiaries and host country citizens. It identifies all donors and explains how they will be acknowledged.

Apparently Successful Applicant(s) means the applicant(s) for USAID funding recommended for an award after evaluation, but who has not yet been awarded a grant, cooperative agreement or other assistance award by the Agreement Officer.
The Agreement Officer will request that the Apparently Successful Applicants submit a
Branding Strategy and Marking Plan. Apparently Successful Applicant status confers no right and constitutes no USAID commitment to an award.

USAID Identity (Identity) means the official marking for the Agency, comprised of the USAID logo and new brandmark, which clearly communicates that our assistance is from the American people. The USAID Identity is available on the USAID website and is provided without royalty, license, or other fee to recipients of USAID-funded grants or cooperative agreements or other assistance awards or subawards.

(b) Submission. The Apparently Successful Applicant, upon request of the Agreement Officer, will submit and negotiate a Branding Strategy. The Branding Strategy will be included in and made a part of the resulting grant or cooperative agreement. The Branding Strategy will be negotiated within the time that the Agreement Officer specifies. Failure to submit and negotiate a Branding Strategy will make the applicant ineligible for award of a grant or cooperative agreement. The Apparently Successful Applicant must include all estimated costs associated with branding and marking USAID programs, such as plaques, stickers, banners, press events and materials, and the like.

(c) Submission Requirements
At a minimum, the Apparently Successful Applicant’s Branding Strategy will address the
following:

(1) Positioning
What is the intended name of this program, project, or activity?

Guidelines: USAID prefers to have the USAID Identity included as part of the program or project name, such as a "title sponsor," if possible and appropriate. It is acceptable to "co-brand" the title with USAID’s and the Apparently Successful Applicant’s identities. For example: "The USAID and [Apparently Successful Applicant] Health Center." 

If it would be inappropriate or is not possible to "brand" the project this way, such as when rehabilitating a structure that already exists or if there are multiple donors, please explain and indicate how you intend to showcase USAID's involvement in publicizing the program or project. For example:School #123, rehabilitated by USAID and [Apparently Successful Applicant]/ [other donors].
Note: the Agency prefers "made possible by (or with) the generous support of the American People" next to the USAID Identity in acknowledging our contribution, instead of the phrase "funded by." USAID prefers local language translations.

Will a program logo be developed and used consistently to identify this program? If yes, please attach a copy of the proposed program logo.

Note: USAID prefers to fund projects that do NOT have a separate logo or identity that
competes with the USAID Identity.

(2) Program Communications and Publicity

Who are the primary and secondary audiences for this project or program?

Guidelines: Please include direct beneficiaries and any special target segments or influencers. For Example: Primary audience: schoolgirls age 8-12, Secondary audience: teachers and parents–specifically mothers.

What communications or program materials will be used to explain or market the program to beneficiaries?

Guidelines: These include training materials, posters, pamphlets, Public Service
Announcements, billboards, websites, and so forth.

What is the main program message(s)?

Guidelines: For example: "Be tested for HIV-AIDS" or "Have your child inoculated. "Please indicate if you also plan to incorporate USAID’s primary message – this aid is "from the American people" – into the narrative of program materials. This is optional; however, marking with the USAID Identity is required.

Will the recipient announce and promote publicly this program or project to host country
citizens? If yes, what press and promotional activities are planned?

Guidelines: These may include media releases, press conferences, public events, and so forth. Note: incorporating the message, “USAID from the American People”, and the USAID Identity is required.

Please provide any additional ideas about how to increase awareness that the American people support this project or program.

Guidelines: One of our goals is to ensure that both beneficiaries and host-country citizens know that the aid the Agency is providing is "from the American people." Please provide any initial ideas on how to further this goal.

(3) Acknowledgements

Will there be any direct involvement from a host-country government ministry? If yes, please indicate which one or ones. Will the recipient acknowledge the ministry as an additional cosponsor?

Note: it is perfectly acceptable and often encouraged for USAID to "co-brand" programs with government ministries.

Please indicate if there are any other groups whose logo or identity the recipient will use on program materials and related communications.

Guidelines: Please indicate if they are also a donor or why they will be visibly acknowledged, and if they will receive the same prominence as USAID.

(d) Award Criteria. The Agreement Officer will review the Branding Strategy for adequacy, ensuring that it contains the required information on naming and positioning the USAID-funded program, project, or activity, and promoting and communicating it to cooperating country beneficiaries and citizens. The Agreement Officer also will evaluate this information to ensure that it is consistent with the stated objectives of the award; with the Apparently Successful Applicant’s cost data submissions; with the Apparently Successful Applicant’s project, activity, or program performance plan; and with the regulatory requirements set out in 22 CFR 226.91. The Agreement Officer may obtain advice and recommendations from technical experts while performing the evaluation.

4.	MARKING UNDER ASSISTANCE -MARKING PLAN – ASSISTANCE                (December 2005)

(a)Definitions

Marking Plan means a plan that the Apparently Successful Applicant submits at the specific request of a USAID Agreement Officer after evaluation of an application for USAID funding, detailing the public communications, commodities, and program materials and other items that will visibly bear the USAID Identity. Recipients may request approval of Presumptive Exceptions to marking requirements in the Marking Plan.

Apparently Successful Applicant(s) means the applicant(s) for USAID funding recommended for an award after evaluation, but who has not yet been awarded a grant, cooperative agreement or other assistance award by the Agreement Officer.
The Agreement Officer will request that Apparently Successful Applicants submit a Branding Strategy and Marking Plan. Apparently Successful Applicant status confers no right and constitutes no USAID commitment to an award, which the Agreement Officer must still obligate.

USAID Identity (Identity) means the official marking for the Agency, comprised of the
USAID logo and new brandmark, which clearly communicates that our assistance is from the American people. The USAID Identity is available on the USAID website and USAID provides it without royalty, license, or other fee to recipients of USAID funded grants, cooperative agreements, or other assistance awards or subawards.

A Presumptive Exception exempts the applicant from the general marking requirements for a particular USAID-funded public communication, commodity, program material or other deliverable, or a category of USAID-funded public communications, commodities, program materials or other deliverables that would otherwise be required to visibly bear the USAID Identity. The Presumptive Exceptions are:

Presumptive Exception (i). USAID marking requirements may not apply if they would
compromise the intrinsic independence or neutrality of a program or materials where
independence or neutrality is an inherent aspect of the program and materials, such as election monitoring or ballots, and voter information literature; political party support or public policy advocacy or reform; independent media, such as television and radio broadcasts, newspaper articles and editorials; and public service announcements or public opinion polls and surveys (22 C.F.R. 226.91(h)(1)).

Presumptive Exception (ii). USAID marking requirements may not apply if they would
diminish the credibility of audits, reports, analyses, studies, or policy recommendations whose data or findings must be seen as independent (22 C.F.R. 226.91(h)(2)).

Presumptive Exception (iii). USAID marking requirements may not apply if they would
undercut host-country government “ownership” of constitutions, laws, regulations, policies, studies, assessments, reports, publications, surveys or audits, public service announcements, or other communications better positioned as “by” or “from” a cooperating country ministry or government official (22 C.F.R. 226.91(h)(3)).

Presumptive Exception (iv). USAID marking requirements may not apply if they would impair the functionality of an item, such as sterilized equipment or spare parts (22 C.F.R.
226.91(h)(4)).

Presumptive Exception (v). USAID marking requirements may not apply if they would incur substantial costs or be impractical, such as items too small or otherwise unsuited for individual marking, such as food in bulk (22 C.F.R. 226.91(h)(5)).

Presumptive Exception (vi). USAID marking requirements may not apply if they would offend local cultural or social norms, or be considered inappropriate on such items as condoms, toilets, bed pans, or similar commodities (22 C.F.R. 226.91(h)(6)).

Presumptive Exception (vii). USAID marking requirements may not apply if they would
conflict with international law (22 C.F.R. 226.91(h)(7)).

(b) Submission. The Apparently Successful Applicant, upon the request of the Agreement Officer, will submit and negotiate a Marking Plan that addresses the details of the public communications, commodities, program materials that will visibly bear the USAID Identity. The marking plan will be customized for the particular program, project, or activity under the resultant grant or cooperative agreement. The plan will be included in and made a part of the resulting grant or cooperative agreement. USAID and the Apparently Successful Applicant will negotiate the Marking Plan within the time specified by the Agreement Officer. Failure to submit and negotiate a Marking Plan will make the applicant ineligible for award of a grant or cooperative agreement. The applicant must include an estimate of all costs associated with branding and marking USAID programs, such as plaques, labels, banners, press events, promotional materials, and so forth in the budget portion of its application. These costs are subject to revision and negotiation with the Agreement Officer upon submission of the Marking Plan and will be incorporated into the Total Estimated Amount of the grant, cooperative agreement or other assistance instrument.

(c) Submission Requirements. The Marking Plan will include the following:

(1) A description of the public communications, commodities, and program materials that the recipient will be produced as a part of the grant or cooperative agreement and which will visibly bear the USAID Identity. These include:

(i) program, project, or activity sites funded by USAID, including visible infrastructure projects or other programs, projects, or activities that are physical in nature;

(ii) technical assistance, studies, reports, papers, publications, audio-visual productions, public service announcements, Web sites/Internet activities and other promotional, informational, media, or communications products funded by USAID;

(iii) events financed by USAID, such as training courses, conferences, seminars, exhibitions, fairs, workshops, press conferences, and other public activities; and

(iv) all commodities financed by USAID, including commodities or equipment provided under humanitarian assistance or disaster relief programs, and all other equipment, supplies and other materials funded by USAID, and their export packaging.

(2) A table specifying:

(i) the program deliverables that the recipient will mark with the USAID Identity,

(ii) the type of marking and what materials the applicant will be used to mark the program deliverables with the USAID Identity, and

(iii) when in the performance period the applicant will mark the program deliverables, and where the applicant will place the marking.

(3) A table specifying:

(i) what program deliverables will not be marked with the USAID Identity, and

(ii) the rationale for not marking these program deliverables.

(d) Presumptive Exceptions.
(1) The Apparently Successful Applicant may request a Presumptive Exception as part of the overall Marking Plan submission. To request a Presumptive Exception, the Apparently Successful Applicant must identify which Presumptive Exception applies, and state why, in light of the Apparently Successful Applicant’s technical proposal and in the context of the program description or program statement in the USAID Request For Application or Annual Program Statement, marking requirements should not be required.

(2) Specific guidelines for addressing each Presumptive Exception are:

(i) For Presumptive Exception (i), identify the USAID Strategic Objective, Interim Result, or program goal furthered by an appearance of neutrality, or state why the program, project, activity, commodity, or communication is ‘intrinsically neutral.’ Identify, by category or deliverable item, examples of program materials funded under the award for which you are seeking exception 1.

(ii) For Presumptive Exception (ii), state what data, studies, or other deliverables will be produced under the USAID funded award, and explain why the data, studies, or deliverables must be seen as credible.
(iii) For Presumptive Exception (iii), identify the item or media product produced under the USAID funded award, and explain why each item or product, or category of item and product, is better positioned as an item or product produced by the cooperating country government.

(iv) For Presumptive Exception (iv), identify the item or commodity to be marked, or categories of items or commodities, and explain how marking would impair the item’s or commodity’s functionality.

(v) For Presumptive Exception (v), explain why marking would not be cost-beneficial or
practical. 

(vi) For Presumptive Exception (vi), identify the relevant cultural or social norm, and explain why marking would violate that norm or otherwise be inappropriate.

(vii) For Presumptive Exception (vii), identify the applicable international law violated by marking.

(3) The Agreement Officer will review the request for adequacy and reasonableness. In
consultation with the Cognizant Technical Officer and other agency personnel as necessary, the Agreement Officer will approve or disapprove the requested Presumptive Exception. Approved exceptions will be made part of the approved Marking Plan, and will apply for the term of the award, unless provided otherwise.

(e) Award Criteria: The Agreement Officer will review the Marking Plan for adequacy and reasonableness, ensuring that it contains sufficient detail and information concerning public communications, commodities, and program materials that will visibly bear the USAID Identity. The Agreement Officer will evaluate the plan to ensure that it is consistent with the stated objectives of the award; with the applicant’s cost data submissions; with the applicant’s actual project, activity, or program performance plan; and with the regulatory requirements of 22 C.F.R 226.91. The Agreement Officer will approve or disapprove any requested Presumptive Exceptions (see paragraph (d)) on the basis of adequacy and reasonableness. The Agreement Officer may obtain advice and recommendations from technical experts while performing the evaluation.

5.	MARKING UNDER USAID-FUNDED ASSISTANCE INSTRUMENTS
(December 2005)

(a) Definitions

Commodities mean any material, article, supply, goods or equipment, excluding recipient offices, vehicles, and non-deliverable items for recipient’s internal use, in administration of the USAID funded grant, cooperative agreement, or other agreement or subagreement.

Principal Officer means the most senior officer in a USAID Operating Unit in the field, e.g., USAID Mission Director or USAID Representative. For global programs managed from Washington but executed across many countries, such as disaster relief and assistance to internally displaced persons, humanitarian emergencies or immediate post conflict and political crisis response, the cognizant Principal Officer may be an Office Director, for example, the Directors of USAID/W/Office of Foreign Disaster Assistance and Office of Transition Initiatives. For non-presence countries, the cognizant Principal Officer is the Senior USAID officer in a regional USAID Operating Unit responsible for the non-presence country, or in the absence of such a responsible operating unit, the Principal U.S Diplomatic Officer in the nonpresence country exercising delegated authority from USAID.

Programs mean an organized set of activities and allocation of resources directed toward a common purpose, objective, or goal undertaken or proposed by an organization to carry out the responsibilities assigned to it.

Projects include all the marginal costs of inputs (including the proposed investment)
technically required to produce a discrete marketable output or a desired result (for example, services from a fully functional water/sewage treatment facility).

Public communications are documents and messages intended for distribution to audiences external to the recipient’s organization. They include, but are not limited to, correspondence, publications, studies, reports, audio visual productions, and other informational products; applications, forms, press and promotional materials used in connection with USAID funded programs, projects or activities, including signage and plaques; Web sites/Internet activities; and events such as training courses, conferences, seminars, press conferences and so forth.

Subrecipient means any person or government (including cooperating country government) department, agency, establishment, or for profit or nonprofit organization that receives a USAID subaward, as defined in 22 C.F.R. 226.2.

Technical Assistance means the provision of funds, goods, services, or other foreign
assistance, such as loan guarantees or food for work, to developing countries and other USAID recipients, and through such recipients to subrecipients, in direct support of a development objective – as opposed to the internal management of the foreign assistance program.

USAID Identity (Identity) means the official marking for the United States Agency for
International Development (USAID), comprised of the USAID logo or seal and new
brandmark, with the tagline that clearly communicates that our assistance is “from the
American people.” The USAID Identity is available on the USAID website at www.usaid.gov/branding and USAID provides it without royalty, license, or other fee to
recipients of USAID-funded grants, or cooperative agreements, or other assistance awards

(b) Marking of Program Deliverables

(1) All recipients must mark appropriately all overseas programs, projects, activities, public communications, and commodities partially or fully funded by a USAID grant or cooperative agreement or other assistance award or subaward with the USAID Identity, of a size and prominence equivalent to or greater than the recipient’s, other donor’s, or any other third party’s identity or logo.

(2) The Recipient will mark all program, project, or activity sites funded by USAID, including visible infrastructure projects (for example, roads, bridges, buildings) or other programs, projects, or activities that are physical in nature (for example, agriculture, forestry, water management) with the USAID Identity.
The Recipient should erect temporary signs or plaques early in the construction or
implementation phase. When construction or implementation is complete, the Recipient must install a permanent, durable sign, plaque or other marking.

(3) The Recipient will mark technical assistance, studies, reports, papers, publications, audiovisual productions, public service announcements, Web sites/Internet activities and other promotional, informational, media, or communications products funded by USAID with the USAID Identity.

(4) The Recipient will appropriately mark events financed by USAID, such as training courses, conferences, seminars, exhibitions, fairs, workshops, press conferences and other public activities, with the USAID Identity. Unless directly prohibited and as appropriate to the surroundings, recipients should display additional materials, such as signs and banners, with the USAID Identity. In circumstances in which the USAID Identity cannot be displayed visually, the recipient is encouraged otherwise to acknowledge USAID and the American people’s support.

(5) The Recipient will mark all commodities financed by USAID, including commodities or equipment provided under humanitarian assistance or disaster relief programs, and all other equipment, supplies, and other materials funded by USAID, and their export packaging with the USAID Identity.

(6) The Agreement Officer may require the USAID Identity to be larger and more prominent if it is the majority donor, or to require that a cooperating country government’s identity be larger and more prominent if circumstances warrant, and as appropriate depending on the audience, program goals, and materials produced.

(7) The Agreement Officer may require marking with the USAID Identity in the event that the recipient does not choose to mark with its own identity or logo.

(8) The Agreement Officer may require a pre-production review of USAID-funded public
communications and program materials for compliance with the approved Marking Plan.

(9) Subrecipients. To ensure that the marking requirements “flow down'' to subrecipients of subawards, recipients of USAID funded grants and cooperative agreements or other assistance awards will include the USAID-approved marking provision in any USAID funded subaward, as follows:

“As a condition of receipt of this subaward, marking with the USAID Identity of a size and prominence equivalent to or greater than the recipient’s, subrecipient’s, other donor’s or third party’s is required. In the event the recipient chooses not to require marking with its own identity or logo by the subrecipient, USAID may, at its discretion, require marking by the subrecipient with the USAID Identity.”

(10) Any ‘public communications’, as defined in 22 C.F.R. 226.2, funded by USAID, in which the content has not been approved by USAID, must contain the following disclaimer:

“This study/report/audio/visual/other information/media product (specify) is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of [insert recipient name] and do not necessarily reflect the views of USAID or the United States Government.”

(11) The recipient will provide the Cognizant Technical Officer (CTO) or other USAID
personnel designated in the grant or cooperative agreement with two copies of all program and communications materials produced under the award. In addition, the recipient will submit one electronic or one hard copy of all final documents to USAID’s Development Experience Clearinghouse.

(c) Implementation of marking requirements.

(1) When the grant or cooperative agreement contains an approved Marking Plan, the recipient will implement the requirements of this provision following the approved Marking Plan.

(2) When the grant or cooperative agreement does not contain an approved Marking Plan, the recipient will propose and submit a plan for implementing the requirements of this provision within [Agreement Officer fill-in] days after the effective date of this provision. The plan will include:

(i) A description of the program deliverables specified in paragraph (b) of this provision that the recipient will produce as a part of the grant or cooperative agreement and which will visibly bear the USAID Identity.

(ii) the type of marking and what materials the applicant uses to mark the program deliverables with the USAID Identity,

(iii) when in the performance period the applicant will mark the program deliverables, and where the applicant will place the marking,

(3) The recipient may request program deliverables not be marked with the USAID Identity by identifying the program deliverables and providing a rationale for not marking these program deliverables. Program deliverables may be exempted from USAID marking requirements when:

(i) USAID marking requirements would compromise the intrinsic independence or neutrality of a program or materials where independence or neutrality is an inherent aspect of the program and materials;

(ii) USAID marking requirements would diminish the credibility of audits, reports, analyses, studies, or policy recommendations whose data or findings must be seen as independent;

(iii) USAID marking requirements would undercut host-country government “ownership” of constitutions, laws, regulations, policies, studies, assessments, reports, publications, surveys or audits, public service announcements, or other communications better positioned as “by” or “from” a cooperating country ministry or government official;

(iv) USAID marking requirements would impair the functionality of an item;

(v) USAID marking requirements would incur substantial costs or be impractical;

(vi) USAID marking requirements would offend local cultural or social norms, or be considered inappropriate;

(vii) USAID marking requirements would conflict with international law.

(4) The proposed plan for implementing the requirements of this provision, including any
proposed exemptions, will be negotiated within the time specified by the Agreement Officer after receipt of the proposed plan. Failure to negotiate an approved plan with the time specified by the Agreement Officer may be considered as noncompliance with the requirements is provision.

(d) Waivers.

(1) The recipient may request a waiver of the Marking Plan or of the marking requirements of this provision, in whole or in part, for each program, project, activity, public communication or commodity, or, in exceptional circumstances, for a region or country, when USAID required marking would pose compelling political, safety, or security concerns, or when marking would have an adverse impact in the cooperating country. The recipient will submit the request through the Cognizant Technical Officer. The Principal Officer is responsible for approvals or disapprovals of waiver requests.

(2) The request will describe the compelling political, safety, security concerns, or adverse impact that require a waiver, detail the circumstances and rationale for the waiver, detail the specific requirements to be waived, the specific portion of the Marking Plan to be waived, or specific marking to be waived, and include a description of how program materials will be marked (if at all) if the USAID Identity is removed. The request should also provide a rationale for any use of recipient’s own identity/logo or that of a third party on materials that will be subject to the waiver.

(3) Approved waivers are not limited in duration but are subject to Principal Officer review at any time, due to changed circumstances.

(4) Approved waivers “flow down” to recipients of subawards unless specified otherwise. The waiver may also include the removal of USAID markings already affixed, if circumstances warrant.

(5) Determinations regarding waiver requests are subject to appeal to the Principal Officer’s cognizant Assistant Administrator. The recipient may appeal by submitting a written request to reconsider the Principal Officer’s waiver determination to the cognizant Assistant Administrator.

(e) Non-retroactivity. The requirements of this provision do apply to any materials, events, or commodities produced prior to January 2, 2006. The requirements of this provision do not apply to program, project, or activity sites funded by USAID, including visible infrastructure projects (for example, roads, bridges, buildings) or other programs, projects, or activities that are physical in nature (for example, agriculture, forestry, water management) where the construction and implementation of these are complete prior to January 2, 2006 and the period of the grant does not extend past January 2, 2006.

APPLICATION FOR

FEDERAL ASSISTANCE

2. DATE SUBMITTED

1. TYPE OF SUBMISSION:

3. DATE RECEIVED BY STATE

4. DATE RECEIVED BY FEDERAL AGENCY

Construction

Construction

Non-Construction

Non-Construction

5. APPLICANT INFORMATION

Address:

6. EMPLOYER IDENTIFICATION NUMBER

8. TYPE OF APPLICATION:

10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:

12. AREAS AFFECTED BY PROJECT

13. PROPOSED PROJECT

15. ESTIMATED FUNDING:

18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT. THE

DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE

ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.

Organizational Unit:

Name and telephone number of persons to be contacted on matters

involving this application (give area code)

7. TYPE OF APPLICANT:

9. NAME OF FEDERAL AGENCY:

11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:

14. CONGRESSIONAL DISTRICTS OF:

16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE

ORDER 12372 PROCESS?

17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?

Application

Legal Name:

Organizational DUNS:

Street:

City:

County:

State:

Country:

If revision, enter appropriate letter(s) in box(es)

(See back of form for description of letters.)

Other (specify)

TITLE (Name of Program):

Start Date:

a. Federal

b. Applicant

c. State

d. Local

e. Other

f. Program Income

g. TOTAL

a. Authorized Representative

Prefix

Last Name

b. Title

d. Signature of Authorized Representative

Previous Edition Usable

Authorized for Local Reproduction

Pre-application

Zip Code

(EIN):

(Cities, Counties, States, etc.):

Ending Date:

$

$

$

$

$

$

$

.00

.00

.00

.00

.00

.00

.00

First Name

Version 7/03

Applicant Identifier

State Application Identifier

Federal Identifier

Department:

Division:

Prefix:

Middle Name

Last Name

Suffix:

Email:

Phone Number (give area code)

Other (specify)

a. Applicant

a. Yes.

b. No.

First Name:

Fax Number (give area code)

(See back of form for Application Types)

b. Project

THIS PREAPPLICATION/APPLICATION WAS MADE

AVAILABLE TO THE STATE EXECUTIVE ORDER 12372

PROCESS FOR REVIEW ON

DATE:

PROGRAM IS NOT COVERED BY E.O. 12372

OR PROGRAM HAS NOT BEEN SELECTED BY STATE

FOR REVIEW

Yes If "Yes" attach an explanation.

No

Middle Name

Suffix

c.Telephone Number (give area code)

e.Date Signed

Standard Form 424 (Rev.9-2003)

Prescribed by OMB Circular A-102

  

INSTRUCTIONS FOR THE SF424

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET, SEND IT TO THE

ADDRESS PROVIDED BY THE SPONSORING AGENCY.

Public reporting burden for this collection of information is estimated to average 45 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 (0348-0043), Washington, DC 20503.

This is a standard form used by applicants as a required facesheet for preapplications and applications submitted for Federal

assistance.  It will be used by Federal agencies to obtain application certification that States which have established a review and comment

procedure in response to Executive Order 12372 and have selected the program to be included in their process, have been given an

opportunity to review the applicant's submission.

Item:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Entry:

Select Type of Submission.

Date application submitted to Federal agency (or State if applicable)

and applicant's control number (if applicable).

State use only (if applicable).

Enter Date Received by Federal Agency

Federal identifier number: If this application is a continuation or

revision to an existing award, enter the present Federal Identifier

number. If for a new project, leave blank.

Enter legal name of applicant, name of primary organizational unit

(including division, if applicable), which will undertake the

assistance activity, enter the organization's DUNS number

(received from Dun and Bradstreet), enter the complete address of

the applicant (including country), and name, telephone number, e-

mail and fax of the person to contact on matters related to this

application.

Enter Employer Identification Number (EIN) as assigned by the

Internal Revenue Service.

Select the appropriate letter in

the space provided.

A.     State

B.     County

C.     Municipal

D.     Township

E.     Interstate

F.     Intermunicipal

G.     Special District

H.     Independent School

         District

I.     State Controlled

        Institution of Higher

        Learning

J.     Private University

K.     Indian Tribe

L.     Individual

M.     Profit Organization

N.     Other (Specify)

O.     Net for Profit

         Organization

Select the type from the following list:

-   "New" means a new assistance award.

-   "Continuation" means an extension for an additional

      funding/budget period for a project with a projected completion

      date.

-   "Revision" means any change in the Federal Government's

      financial obligation or contingent liability from an existing

      obligation. If a revision enter the appropriate letter:

                   A. Increase Award          B. Decrease Award

                   C. Increase Duration       D. Decrease Duration

Name of Federal agency from which assistance is being requested

with this application.

Use the Catalog of Federal Domestic Assistance number and title of

the program under which assistance is requested.

Item:

11.

12.

13.

14.

15.

16.

17.

18.

Entry:

Enter a brief descriptive title of the project. If more than one

program is involved, you should append an explanation on a

separate sheet. If appropriate (e.g., construction or real

property projects), attach a map showing project location. For

preapplications, use a separate sheet to provide a summary

description of this project

List only the largest political entities affected (e.g., State,

counties, cities).

Enter the proposed start date and end date of the project.

List the applicant's Congressional District and any District(s)

affected by the program or project

Amount requested or to be contributed during the first

funding/budget period by each contributor. Value of in kind

contributions should be included on appropriate lines as

applicable. If the action will result in a dollar change to an

existing award, indicate only the amount of the change. For

decreases, enclose the amounts in parentheses. If both basic

and supplemental amounts are included, show breakdown on

an attached sheet. For multiple program funding, use totals

and show breakdown using same categories as item 15.

Applicants should contact the State Single Point of Contact

(SPOC) for Federal Executive Order 12372 to determine

whether the application is subject to the State

intergovernmental review process.

This question applies to the applicant organization, not the

person who signs as the authorized representative. Categories

of debt include delinquent audit disallowances, loans and

taxes.

To be signed by the authorized representative of the applicant

A copy of the governing body's authorization for you to sign

this application as official representative must be on file in the

applicant's office. (Certain Federal agencies may require that

this authorization be submitted as part of the application.)

SF-424 Back (Rev. 7-97) Back

  

BUDGET INFORMATION - Non-Construction Programs

Grant Program

Catalog of Federal

Estimated Unobligated Funds

New or Revised Budget

Function

Domestic Assist-

or Activity

ance Number

Federal

Non-Federal

Federal

Non-Federal

Total

(a)

(b)

(c)

(d)

(e)

(f)

(g)

1.

-

2.

-

3.

-

4.

-

5.  Totals

Grant Program Function or Activity

Total

6. Object Class Categories

(1)

(2)

(3)

(4)

(5)

a. Personnel

b. Fringe Benefits

c. Travel

d. Equipment

e. Supplies

f. Contractual

g. Construction

h. Other

i. Total Direct Charges (Sum of 6a-6h)

j. Indirect Charges

k. TOTALS (Sum of 6i and 6j)

7. Program Income

Previous Edition Usable

Authorized for Local Reproduction

Standard Form 424A (Rev. 4/92)

Prescribed by OMB Circular A-102

  

BUDGET INFORMATION - Non-Construction Programs (cont'd)

(a) Grant Program

(b) Applicant

(c) State

(d) Other Sources

(e) TOTALS

8.

9.

10.

11.

12. TOTAL (Sum of lines 8-11)

Total Amt 1st Year

1st Quarter

2nd Quarter

3rd Quarter

4th Quarter

13. Federal

14. Non-Federal

15. TOTAL (Sum of lines 13 and 14)

FUTURE FUNDING PERIODS (Years)

(a) Grant Program

(b) First

(c) Second

(d) Third

(e) Fourth

16.

17.

18.

19.

20. TOTAL (Sum of lines 16-19)

21. Direct Charges:

22. Indirect Charges:

23. Remarks:

Authorized for Local Reproduction

Standard Form 424A (Rev. 4/92)  Page 2

  

INSTRUCTION FOR THE SF424A

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT

AND BUDGET, SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.

Public reporting burden for this collection of information is estimated to average 180 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 (0348-0044), Washington, DC 20503.

General Instructions

in Column (5), Line 6k, should be the same as the total amount shown

in Section A, Column (g), Line 5.  For supplemental grants and changes

This form is designed so that application can be made for funds from

to grants, the total amount of the increase or decrease as shown in

one or more grant programs.  In preparing the budget, adhere to any

Column (1) - (4), Line 6k should be the same as the sum of the amounts

existing Federal grantor agency guidelines which prescribe how and

in Section A, Columns (e) and (f) on Line 5.

whether budgeted amounts should be separately shown for different

functions or activities within the program.  For some programs,

Line 7 - Enter the estimated amount of income, if any, expected to

grantor agencies may require a breakdown by function or activity.

be generated from this project.  Do not add or subtract this amount

Sections A, B, C, and D should include budget estimates for the whole

from the total project amount.  Show under the program narrative

project except when applying for assistance which requires Federal

statement the nature and source of income.  The estimated amount of

authorization in annual or other funding period increments.  In the

program income may be considered by the Federal grantor agency in

latter case, Sections A, B, C, and D should provide the budget for

determining the total amount of the grant.

the first budget period (usually a year) and Section E should present

the need for Federal assistance in the subsequent budget periods.

Section C. Non-Federal Resources

All applications should contain a breakdown by the object class

categories shown in Lines a - k of Section B.

Lines 8-11  Enter amounts of non-Federal resources that will be used

on the grant.  If in-kind contributions are included, provide a brief

Section A, Budget Summary Lines 1-4 Columns (a) and (b)

explanation on a separate sheet.

For applications pertaining to a single Federal grant program (Federal

Column (a) - Enter the program titles identical to Column (a),

activity breakdown, enter on Line 1 under Column (a) the catalog

Section A.  A breakdown by function or activity is not necessary

program title and the catalog number in Column (b).

Column (b) - Enter the amount of the State's cash and in-kind

For applications pertaining to a single program requiring budget

contribution if the applicant is not a State or State agency.

amounts by multiple functions or activities, enter the name of each

activity or function on each line in Column (a), and enter the catalog

Column (c) - Enter the amount of the State's cash and in-kind

number in Column (b).  For applications pertaining to multiple

contribution if the applicant is not a State or State agency.

programs where none of the programs require a breakdown by function

Applicants which are a State or State agencies should leave

or activity, enter the catalog program title on each line in Column

this column blank.

(a) and the respective catalog number on each line in Column (b).

Column (d) - Enter the amount of cash and in-kind contributions

For applications pertaining to multiple programs where one or more

to be made from all other sources

programs require a breakdown by function or activity, prepare a

separate sheet for each program requiring the breakdown.  Additional

Column (e) Enter total of columns (b), (c) and (d).

sheets should be used when one form does not provide adequate space

for all breakdown of data required.  However, when more than one sheet

Line 12 - Enter the total for each of Columns (b)-(e).  The amount in

is used, the first page should always provide the summary totals by

Column (c) should be equal to the amount on Line 5, Column (f),

programs.

Section A.

Lines 1-4 Columns (c) through (g)

Section D.  Forecasted Cash Needs

For new applications, leave Columns (c) and (d) blank.  For each line

Line 13 - Enter the amount of cash needed by quarter from the grantor

entry in Columns (a) and (b), enter in Columns (e), (f), and (g) the

agency during the first year.

appropriate amounts of funds needed to support the project for the

first funding period (usually a year).

Line 14 - Enter the amount of cash from all other sources needed by

quarter during the first year.

For continuing grant program applications, submit these forms before

the end of each funding period as required by the grantor agency.

Line 15 - Enter the totals of amounts on Lines 13 and 14.

Enter in Columns (c) and (d) the estimated amounts of funds which will

remain unobligated at the end of the grant funding period only if the

Section E.  Budget Estimates of Federal Funds Needed for Balance of

Federal grantor agency instructions provide for this.  Otherwise,

the Project.

leave these columns blank.  Enter in Columns (e) and (f) the amounts

of funds needed for the upcoming period.  The amount(s) in Column (g)

Lines 16-19 - Enter in Column (a) the same grant program titles shown

should be the sum of amounts in Columns (c) and (f).

in Column (a), Section A.  A breakdown by function or activity is not

necessary.  For new applications and continuation grant applications,

For supplemental grants and changes to existing grants, do not use

enter in the proper columns amounts of Federal funds which will be

Columns (c) and (d).  Enter in Column (e) the amount of the increase

needed to complete the program or project over the succeeding funding

or decrease of Federal funds and enter in Column (f) the amount of

periods (usually in years).  This section need not be completed for

the increase or decrease of non-Federal funds.  In Column (g) enter

revisions (amendments, changes, or supplements) to funds for the

the new total budgeted amount (Federal and non-Federal) which includes

current year of existing grants.

the total previous authorized budgeted amounts plus or minus, as

appropriate, the amounts shown in Columns (c) and (f).  The amount(s)

If more than four lines are needed to list the program titles, submit

in Column (g) should not equal the sum of amounts in Columns (c) and (f).

additional schedules as necessary

Line 5 - Show the totals for all columns used

Line 20 - Enter the total for each of the Columns (b)-(e).  When

schedules are prepared for this Section, annotate accordingly and

Section B Budget Categories

show the overall totals on this line.

In the column headings (1) through (4), enter the titles of the same

Section F.  Other Budget Information

programs, functions, and activities shown on Lines 1-4.  Column (a),

Section A.  When additional sheets are prepared for Section A, provide

Line 21 - Use this space to explain amounts for individual direct

similar column headings on each sheet.  For each program, function or

object-class cost categories that may appear to be out of the ordinary

activity, fill in the total requirements for funds (both Federal and

or to explain the details as required by the Federal grantor agency.

non-Federal) by object class categories.

Line 22 - Enter the type of indirect rate (provisional, predetermined,

Lines 6a - i  Show the totals of Lines 6a to 6h in each column.

final or fixed) that will be in effect during the funding period, the

estimated amount of the base to which the rate is applied, and the

Line 6j    Show the amount of indirect cost.

total indirect expense.

Line 6k - Enter the total of amounts on Lines 6i and 6j.  For all

Line 23 - Provide any other explanations or comments deemed necessary.

applications for new grants and continuation grants the total amount

Standard Form 424A (Rev. 4/92) Page 3

  

ASSURANCES - NON-CONSTRUCTION PROGRAMS

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT

AND BUDGET, SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.

Public reporting burden for this collection of information is estimated to average 15 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 redurcing this burden, to the Office of Management

and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503.

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 Federal assist-

and Alcoholism Prevention.  Treatment and Rehabili-

ance and the institutional, managerial and financial

tation Act of 1970 (P.L. 91-616), as amended, relating

capability (including funds sufficient to pay the non-

to nondiscrimination on the basis of alcohol abuse or

Federal share of project cost) to ensure proper

alcoholism; (g) ½½523 and 527 of the Public Health

planning, management and completion of the project

Service Act of 1912 (42 U.S.C. 290 dd-3 and 290 cc-3),

described in this application.

as amended, relating to confidentiality of alcohol

and drug abuse patient records; (h) Title VIII of the

2.  Will give the awarding agency, the Comptroller

Civil Rights Act of 1968 (42 U.S.C. ½3601 et seq.),

General of United States, and if appropriate, the

as amended, relating to nondiscrimination in the sale,

State, through any authorized representative, access

rental or financing of housing; (i) any other non-

to and the right to examine all records, books,

discrimination provisions in the specific statute(s)

papers, or documents related to the award; and will

under which application for Federal assistance is

establish a proper accounting system in accordance

being made; and (j) the requirements of any other

with generally accepted accounting standards or agency

nondiscrimination statute(s) which may apply to the

directives.

application.

3.  Will establish safeguards to prohibit employees

7.  Will comply, or has already complied, with the

from using their positions for a purpose that

requirements of Titles II and III of the Uniform

constitutes or presents the appearance of personal

Relocation Assistance and Real Property Acquisition

or organizational conflict of interest, or personal

Policies Act of 1970 (P.L. 91-646) which provide for

gain.

fair and equitable treatment of persons displaced or

whose property is acquired as a result of Federal

4.  Will initiate and complete the work within the

or federally assisted programs.  These requirements

applicable time frame after receipt of approval of

apply to all interests in real property acquired for

the awarding agency.

project purposes regardless of Federal participation

in purchases.

5.  Will comply with the Intergovernmental Personnel Act

of 1970 (42 U.S.C. ½4728-4763) relating to prescribed

8.  Will comply, as applicable, with provisions of the

standards for merit systems for programs funded under

Hatch Act (5 U.S.C. ½½1501-1508 and 7324-7328) which

one of the nineteen statutes or regulations specified

limit the political activities of employees whose

in Appendix A of OPM's Standards for a Merit System

principal employment activities are funded in whole

of Personnel Administration (5 C.F.R. 900, Subpart F).

or in part with Federal funds.

6.  Will comply with all Federal statutes relating to

9.  Will comply as applicable, with the provisions of the

nondiscrimination.  These include but are not limited

Davis-Bacon Act (40 U.S.C. ½½276a to 276z - 276a-7),

by (a) Title VI of the Civil Rights Act of 1964

the Copeland Act (40 U.S.C. ½½276c and 18 U.S.C. ½½874),

(P.L. 88-352) which prohibits discrimination on the

and the Contract Work Hours and Safety Standards Act

basis of race, color or national origin; (b) Title IX

(40 U.S.C. ½½327-333), regarding labor standards for

of the Education Amendments of 1972, as amended

federally assisted construction subagreements.

(20 U.S.C. ½1681-1683, and 1685-1686), which prohibits

discrimination on the basis of sex; (c) Section 504

10.  Will comply if applicable, with flood insurance

of the Rehabilitation Act of 1973, as amended (29 U.S

purchase requirements of Section 102(a) of the Flood

C. ½794), which prohibits discrimination on the basis

Disaster Protection Act of 1973 (P.L. 93-234) which

of handicaps; (d) the Age Discrimination Act of 1975,

requires recipients in a special flood hazard are to

as amended (42 U.S.C. ½6101-6107), which prohibits

participate in the program and to purchase flood

discrimination on the basis of age; (e) the Drug Abuse

insurance if the total cost of insurable construction

Office and Treatment Act of 1972 (P.L. 92-255), as

and acquisition is $10,000 or more.

amended, relating to nondiscrimination on the basis

of drug abuse; (f) the Comprehensive Alcohol Abuse

Standard Form 424B (Rev. 7/97)

Previous Edition Unusable

Prescribed by OMB Circular A-102

  

ASSURANCES - NON-CONSTRUCTION PROGRAMS (cont'd)

11.  Will comply with environmental standards which may

14.  Will comply with P.L. 93-348 regarding the protection

be prescribed pursuant to the following: (a) insti-

of human subjects involved in research, development,

tution of environmental quality control measures

and related activities supported by this award of

under the National Environmental Policy Act of

assistance.

1969 (P.L. 91-190) and Executive Order (E.O.) 11514;

(b) notification of violating facilities pursuant to

15.  Will comply with the Laboratory Animal Welfare Act

EO 11738; (c) protection of wetlands pursuant to EO

of 1966 (P.L. 89-544, as amended, 7 U.S.C. 2131 et

11990; (d) evaluation of flood hazards in floodplains

seq.) pertaining to the care, handling, and treat-

in accordance with EO 11988; (e) assurance of project

ment of warm blooded animals held for research,

consistency with the approved State management program

teaching, or other activities supported by this

developed under the Coastal Zone Management Act of

award of assistance.

1972 (16 U.S.C. ½½1451 et seq.); (f) conformity of

Federal actions to State (Clean Air) Implementation

16.  Will comply with the Lead-Based Paint Poisoning

Plans under Section 176(c) of the Clean Air Act of

Prevention Act (42 U.S.C. ½½4801 et seq.) which

1955, as amended (42 U.S.C. ½½7401 et seq.); (g)

prohibits the use of lead based paint in construc-

protection of underground sources of drinking water

tion or rehabilitation of residence structures.

under the Save Drinking Water Act of 1974, as amended,

(P.L. 93-523); and (h) protection of endangered species

17.  Will ensure to be performed the required financial

under the Endangered Species Act of 1973, as amended,

and compliance audits in accordance with the Single

(P.L. 93-205).

Audit Act of 1984 or OMB Circular No. A-133, Audits

of Institutions or Higher Learning and other Non-

12. Will comply with the Wild and Scenic Rivers Act

profit Institutions.

of 1968 (16 U.S.C. ½½1271 et seq.) related to

protecting components or potential components of

18.  Will comply with all applicable requirements of all

the national wild and scenic rivers system.

other Federal laws, executive orders, regulations

and policies governing this program.

13.  Will assist the awarding agency in assuring compli-

ance with Section 106 of the National Historic

Preservation Act of 1966, as amended (16 U.S.C. 470),

EO 11593 (identification and protection of historic

properties), and the Archacological and Historic

Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.).

SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL

TITLE

APPLICANT ORGANIZATION

DATE SUBMITTED

Standard Form 424B (Rev. 7/97) Back