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Historic Design Guide IA ContractCITY OF DUBUQUE, IOWA MEMORANDUM February 15, 2001 TO: FROM: SUBJECT: The Honorable Mayor and City Council Members Michael C. Van Milligen, City Manager State Contract - Design Review Guidelines Booklet Planning Services Manager Laura Carstens is recommending approval of a contract with the State Historical Society of Iowa for a $7,500 grant that the City of Dubuque has received to develop a design review guidelines booklet for historic districts. I concur with the recommendation and respectfully recommend Mayor and City Council approval. Michael C Van Mdhgen MCVM/jh Attachment cc: Barry Lindahl, Corporation Counsel Tim Moerman, Assistant City Manager Laura Cm'stens, Planning Services Manager CITY OF DUBUQUE, IOWA lqEt4ORANDUlq February lq, 2001 TO: FROM: SUBJECT: Michael C. Van Milligen, City Manager Laura Carstens, Planning Services Manager State Contract - Design Review Guidelines Booklet This memo transmits a contract with the State Historical Society of Iowa for a $7,500 grant that the City of Dubuque has received to develop a design review guidelines booklet for our historic districts. I recommend that the City Council authorize the Mayor to sign the contract on behalf of the City. LC/mkr Attachments Contract No. 01-00.020 STATE HISTORICAL SOCIETY OF IOWA GRANT-IN-AID AGREEMENT FOR: City of Dubuque Design Review Guidelines Booklet This agreement is made and entered into by and between City of Dubuque, hereinafter referred to as the RECIPIENT, aqd the STATE HISTORICAL SOCIETY OF IOWA, hereinafter referred to as the STATE; WITNESSETH THAT: WHEREAS, the STATE, is interested in broadening the role of local governments in historic preservation through the Certified Local Government program; and WHEREAS, the STATE, in accordance with the National Historic Preservation Amendments of 1980, is providing 10% of its annual federal Historic Preservation Fund appropriation to Certified Local Governments; and WHEREAS, the RECIPIENT has demonstrated its interest in histodc preservation by becoming a Certified Local Government, and desires to complete Design Review Guidelines Booklet; NOW THEREFORE, it is agreed by and between the parties hereto as follows: 1. That the RECIPIENT is qualified to complete the attached Scope of Work (Exhibit C); 2. That the RECIPIENT will be responsible for overseeing ail aspects of fiscal management; 3. That the RECIPIENT provide a permanent copy of financial records suitable for State and Federal audit as directed under the Single Audit Act of 1984, P.L 98-502, if required; That the STATE provide for only project costs eligible under provisions stipulated by the National Park Service, U.S. Department of the Interior for grants -in-aid. Project work which does not meet Secretary of Interior Standards will not be reimbursed for under this contract; 5. That the STATE monitor the project and provide input as called for in the attached Scope of Work (Exhibit C); 6. That the Recipient and the STATE mutually agree that if, during the duration of the contract, it is deemed necessary by either party to make alterations to or amendments to this Agreement, such changes shall be incorporated into this contract upon mutual agreement and shall be in effect as of the date of the amendment unless otherwise specified within the amendment; 7. That the STATE agrees to pay the project eligible costs under the terms of this Agreement; 8. That the RECIPIENT and the STATE mutually agree to abide by the general and specific conditions attached hereto as Exhibits A, B, C, and D; 9. That the RECIPIENT and the STATE mutually agree that all work performed under this contract will be completed by June 30, 2002: 10. That the RECIPIENT and the STATE mutually agree that the cost of this contract shall be. All eligible costs necessary to carry out the project shall be initially advanced by the RECIPIENT and then the STATE shall reimburse the RECIPIENT for $7,500.00, upon receipt of ali work products and as specified in the Scope of Work. The agreement will end on June 30, 2002. The final bill must be submitted with the final report by June 30, 2002. 11. Expenditures are to be according to the Budget, attached as Exhibit D. Adjustments between budget categories are permissible following written mutual consent between the RECIPIENT and the STATE; 12. The RECIPIENT will faithfully comply with all applicable Federal and State laws, regulations and guidelines, including the Secretary of the Interior's Standards and Guidelines for Archaeology and Historic Preservation as published in the Federal Register on September 29, 1983; 13. The RECIPIENT shall hold the STATE and federal government harmless from damages in any action arising from the performance of work described herein. 'IN WITNESS WHEREOF, the parties hereto have executed this contract on the day and year last specified below. RECIPIENT~.--~ <:~/.~ Terrancj~ Duggan,~ayo? ~'~ Date STATE Patricia Ohlerking, Deputy State Historic Preservation Officer Date 2 EXHIBIT A GENERAL CONDITIONS ARTICLE I - Amendment of Contract: The RECIPIENT or the STATE may, during the duration of the Contract, deem it necessary to make alterations to the provisions of this agreement. Any changes, which shall be mutually agreed upon by both parties, shall be incorporated into this Contract. The provisions of the amendment shall be in effect as of the date of the amendment unless otherwise specified within the amendment. A waiver of any conditions of this Contract must be in writing from a duly authorized official of the STATE. ARTICLE II - Patent and Copyright: a. No material or product in whole or in part under this Contract shall be Subject to patent or copyright by either part in the United States or in any other country. b. The U.S. Department of the Interior reserves a rayalty-free no-exclusive and irrevocable license to reproduce, publish, or otherwise use, and to authorize others to use, any materiels produced in whole or in part under this Contract for government purposes. Any publication by the RECIPIENT must bear in an appropriate place an acknowledgment of grant support under the National Historic Preservation Act of 1966, as amended, from the U.S. Department of the thtedor and the State Historical Society of Iowa. ARTICLE III * Accounts and Records: a. Accounts - the RECIPIENT shall maintain books, records, documents and other evidence pertaining to all costs and expenses incurred and revenues acquired under this Contract to the extent and in such detail as will properly reflect alt costs, direct and indirect, of labor, materials, supplies, services, and other costs and expenses of whatever nature, for which payment is claimed under this Contract. b. Audit and inspection - At all times during normal business hou. rs and as frequently as is deemed necessary, the RECIPIENT shall make available to the STATE all of its records, pertaining to all matters covered by this Contract and shall permit the STATE to audit, examine and make excerpts from such records and all other matters covered by this Contract. c. Retention of Financial Records - All records in the possession of the RECIPIENT pertaining to this Contract shall be retained by the RECIPIENT for a period of three (3) years beginning with the date upon which final payment under this Contract is issued. All records shall be retained beyond the three (3) year period if audit findings have not been resolved within that period. d. The STATE shall reimburse the RECIPIENT for actual, necessary and eligible costs incurred by the RECIPIENT in the conduct of this project. All claims shall include copies of time utilization sheets, records, documents and other evidence in support of all costs and expenses incurred for the performance of this Contract. ARTICLE IV - Termination of Contract a. Termination for Cause - The STATE or the RECIPIENT may terminate this Contract in whole or in part, at any time before the date of completion, whenever it is determined that the other party has failed to comply with the conditions of the Contract. The STATE or RECIPIENT shall promptly notify the ether party in writing of the determination and the reasons for the termination, together with the effective date. The RECIPIENT shall not incur new obligations for the terminated portion after the effective date, and shall cancel as many outstanding obligations as possible. The STATE shall allow full credit to the RECIPIENT for no-cancelable obligations up to the amount of $7,500.00, if said obligations are properly incurred by the RECIPIENT pdor to termination. The STATE shall terminate the contract if it determines that the RECIPIENT is not following cost eligibility as outlined in the Secretary of Interior Standards, 36 CFR; OMB Circuiar A-87; and OMB Circular A-102. b. Termination for Convenience - The STATE and the RECIPIENT may terminate this Contract in whole or in part, when both parties agree that the continuation of the project would not produce beneficial results commensurate with the '3 future expenditure of funds. The two par~ies shall agree upon the termination conditions, including the effect date and, in the case of partial termination, the portion to be terminated. The RECIPIENT shall not incur new obligations for the terminated portion after the effective date, and shall canca[ as many outstanding obligations as possible. The STATE shall allow full credit to the RECIPIENT for non-cancelable obligations up to the amount of award, if said obligations are properly incurred by the RECIPIENT prior to termination. c. Termination due to Non-Apprapdation - Notwithstanding any other provisions of this Contract, if funds anticipated for the continued fulfillment of the Contract are at any time not forthcoming or insufficient, either through the failure of the Federal Government or of the State of iowa to appropriate funds or discontinuance or material alteration of the program under which funds were provided, then the STATE shall have the right to terminate this Contract without penalty by giving not less than thirty (30) days wri~en notice documenting the lack of funding, discontinuance or program alteration. Unless otherwise agreed to by the parties, the Contract shall become null and void on the last day of the fiscal year for which appropriations were received, except that if an appropriation to cover the costs of this Contract becomes available within sixty (60) days subsequent to termination under this clause, the STATE agrees to re-enter a Contract with the terminated RECIPIENT under the same provisions, terms and conditions as the original award, in the event of termthation of this Contract due to non-appropriation, the exclusive, sole and complete remedy of the RECIPIENT shall be payment for service completed prior to termination. d. Right in Incomplete Products - In the event the Contract is terminated, all finished or unfinished portions of the work prepared by or for the RECIPIENT under this Contract shall, at the option of the STATE, become its property, and the RECIPIENT shall be entitled to receive just and equitable compensation for any satisfactory work completed on the project. ARTICLE V - Interest of Officials and Others: a. STATE - No officer, employee or advisor of the STATE including a member of the State Historical Society of Iowa Board of Trustees or the State Nominations Review Committee, shall participate in any decisions relating to this Contract which affect his personal interest or the interest of any corporation, partnership or association in which he is directly or indirectly interested er have any interest, direct or indirect, in this Contract or the proceeds thereof. A person has a conflict of interest with respect to a subgrant, contract subcontract, or any agreement supported with state or federal assistance if the person or any of the following has a financial interest in that application. 1. The person, the person's spouse, minor child, or partner, or; 2. Any organization in which the person is serving as an officer, director, trustee, partner or employee or; 3. Any person or organization with whom the person is negotiating or has any arrangements concerning prospective employment. Benefit or remuneration other than a fee in accordance with applicable statewide procedures includes, without exception, royalty, commission, contingent fee, professional services contract, brokerage fee, or other payment accruing to the person or any member of his immediate family. b. RECIPIENT - The RECIPIENT covenants that it presently has no interest and shafl not acquire any interest, direct or indirect, which would conflict in any manner or degree with the performance of services required to be ped=ormed under this Contract. ARTICLE VI - Assignment of Interest: Neither this Agreement or any interest therein, no claim thereunder, shall be assigned or transferred by the RECIPIENT to any other party or parties. 4 ARTICLE VII - Subcontract: None of the work or services required under this Agreement shall be subcontracted by the RECIPIENT without prior written approval to subcontract by the STATE. ARTICLE VIII - Procurement of Professional Services and Equipment: The RECIPIENT shall procure professional services by competitive negotiation, or small purchase procedures. This requires solicitations from at least three sources to permit reasonable competition consistent with the nature and requirements or the procurement. "Cost-plus-a-percentage-of-cost" contracting is strictly forbidden. Rather, cost reimbursement or fixed price contracting is required. Project principal investigators must meet the minimum professional standards as outlined in the Code of Federal Regulations, Volume 36 Part 61. The purchase of any equipment under this agreement over $300 may not occur without prior wdtten permission of the STATE. The STATE will not approve such purchases until the same are approved in writing by the National Park Service. EXHIBIT B SPECIAL CONDITIONS ARTICLE I - Identification of Parties: This Contract is entered into by and between the State Historical Society of Iowa, hereinafter called the STATE, and the, hereinafter called the RECIPIENT. ARTICLE II - Designation of Officials: a. STATE 4 The State Historic Preservation Officer is the State Official authorized to execute any changes in the terms, conditions, or amounts specified in this Contract. He/She may designate a member of his/her staff to negotiate, on behalf of the State, any changes to the Contract. b. RECIPIENT - City of Dubuque, is authorized to execute any changes in the terms, conditions, or amounts as specified in this contract. ARTICLE III -Additional Special Conditions: a. Audit Requirements - The RECIPIENT shall annually have performed, on a timely basis, independent financial and compliance audits of the historic preservation funds received from the STATE. All such audits shall be conducted in accordance with applicable auditing standards set forth in OMB Circular A-128, "Audits of State and Local Governments", pursuant to the Single Audit Act of 1984. Costs associated with such audits are the responsibility of the RECIPIENT. A copy of this audit must be submitted to the STATE. If the RECIPIENT is a non-profit organization, public college or university, audits shall be made in accordance with statutory requirements and the provision of Circular A-110 a copy of this audit must be submitted to the STATE. b. General Obligations - All work performed under this Contract shall be carded out in a lawful, proper and satisfactory manner in accordance with appropriate Federal, State and Local regulations, including OMB Circular A-102 and NPS 49; and any circular, policies, procedures and requirements as may from time to time be prescribed by the U.S. Department of Interior. 5 ARTICLE IV - Conditions of Payment: a. Maximum Payment - It is expressly understood and agreed to that the maximum amounts to be paid to the RECIPIENT by the STATE for any item of work or services shall be the amount specified herein. All payments for work and services under this Contract shall be on a cost incurred, non-profit basis. b. Requisition for Payment - All payments to the RECIPIENT shall be subject to the receipt by the STATE of a Request for Reimbursement. This request shall be made according to the format specified by the STATE with reimbursement to the RECIPIENT occurring at intervals no more than sixty (60) days after approval of request. ARTICLE V - REQUIRED ACKNOWLEDGMENTS: Publication, films, exhibits, etc. developed as a part of this Contract shall acknowledge Federal aid by including the following statement as part of the Title or Acknowledgment Section with each item produced. "This project has been funded with the assistance of a matching grant-in-aid from the State Historical Society of Iowa, Community Programs Bureau, through the Department of the Interior, National Park Service, under provisions of the National Historic Preservation Act of 1966; the opinions expressed herein are not necessarily those of the Department of the Interior." ARTICLE VI - Equal Opportunity Acknowledgment: Publications, films, exhibits, etc. developed as a part of the Contract shall acknowledge equal opportunity and nondiscrimination practices by including the following statement as part of the Title or Acknowledgment Section with each item produced. "This program received Federal funds from the National Park Service. Regulations of the U.S. Department of the Interior strictly prohibit unlawful discrimination in Federally Assisted Programs on the basis of race, color, national odgin, age or handicap. Any person who believes he or she has been discriminated against in any program, activity, or facility operated by a recipient of Federal assistance should write to: Director, Equal Opportunity Program, U.S. Department of the Interior, National Park Service, 1849 C Street, Washington, D.C. 20240." ARTICLE VII - Certification Regarding Lobbying: This certification is required by Section 1352, Title 31, U.S. Code. The sub-grantee certifies, to the best of his or her k,3owledge 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, any officer or emptoyee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) if any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan or cooperative agreement, the undersigned shall complete and submit Standard Form 1963 "Disclosure Form to Report Lobbying," in accordance with instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to civil penalty of not less than $10,000 and not more than $100,000 for each such failure. ARTICLE VIII - Equal Opportunity: Code of Fair Practices 1. The RECIPIENT will not discriminate against any employee or applicant for employment because of race, creed, color, religion, national origin, sex, age or physical or mental disability. The RECIPIENT will take affirmative action to insure that applicants are employed and that employees are treated during employment without regard to their' race, creed, color, religion, national odgin, sex, age or physical or mental disability except where it related to a bona fide occupational qualification. Such action shall include but be not limited to the following; employment, upgrading, demotion or transfer, recruitment or recruitment advertising; layoff or termination; rate of pay or other forms of compensation; and selection for training, including apprenticeship. The RECIPIENT agrees to post in conspicuous places, available to employees and applicants for employment, notices setting forth provisions of this nondiscrimination clause. 2. The RECIPIENT will, in all solicitations or advertisements for employees placed by or on behalf of the RECIPIENT, state that all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, national origin, sex, age or physical or mental disability except where it relates to a bona fide occupational qualification. 3. The RECIPIENT will send to each labor union or representative of workers with which he has a collective bargaining agreement or other contract or understanding, a notice advising the labor union or worker's representative of the RECIPIENT commitments under this nondiscrimination clause and shall post copies of the notice in a conspicuous place available to employees and applicants for employment. 4. The RECIPIENT will comply with all relevant provisions of the Iowa Civil Rights Act of 1965 as amended, Iowa Executive Order #15 of 1973, Federal Executive Order 11246 of 1965 as amended by Federal Executive Order 11275 of 1967, the Equal Employment Opportunity Act of 1972, and all provision relevant to fair employment of the rules and regulations of the STATE. The RECIPIENT will furnish all information and reports requested by the STATE or required by or pursuant to the rules and regulations thereof and will permit access to payroll and employment records by the STATE for purposes of investigation to ascertain compliance with such rules, regulations or requests, or with this nondiscrimination clause. 5. In the event of the RECIPIENTS noncompliance clauses of this contract or with any of the aforesaid rules, regulations or requests, this contract may be canceled, terminated, or suspended in whole or in part and the RECIPIENT may be declared ineligible for further contracts with the STATE. In addition, the STATE may take such further action, and such other sanctions may be imposed and remedies invoked, as provided by the Iowa Civil Rights Act of 1965 as amended, Chapter 601A, Code of Iowa 1973, as heretofore and hereinafter amended, or by the rules and regulations of the State or as otherwise provided by law. ASSURANCES - NON-CONSTRUCTiON PROGRAMS Public reporting burden for this collection of information is estimated to average 15 minutes per response, ncluding time for rev~ewmg instructions, searching existing data sources, gathering and mainta n ng the data needed, and completing and reviewing the collection of information. Send c:mments regarding the burden estimate or any other aspect of this collection of information including sugeestions for reducing this burden, to the Office of Management and Budget, ' - Paperwork Reduction Project (9348-0040), Washington, DC 20503~ PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOT~: 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 t~ certi~ to additional assurances. If such is the case, you w be notified. As the duly authorized representative of the applicant, I cer[ify that the applicant: Has the legal authority to apply for Federal assistance and the institutional, managerial and financial capapilib/ (including funds sufficient to pay the non-Federal share of project cost) to ensure proper planning, managemedt and completion of the project dascdbed in this application. Wile give the awarding agency, the Compu'oller General of the United States and, if appropriate, the State, through any authorized representative, access to and the dght to examine all records, books, papers, or documents related to the award; and will estapiish a proper accounting .system in accordance with generally accepted accounting standards or agency directives. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of pereonal or organizational conflict of interest, or personal gain. Will initiate and complete the work within the apolicabte time frame after receipt of approval of the awarding agency. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §§4728-4763) relating to preasnbed standards for merit systems for programs funded under one of the 19 statutes or regulations specifisd m Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpert F). Will comply with all Federal statutes relating to nondiscdminstion. These include but are not limited to: (a) Title VI of the Civil Rights Act of t964 (P.L 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) ]]tie IX of the Education Amendments of 1972, as amended (20 U.S.C. §§1681- 1683. and 1685-1686), which prohibits discrimination on the basis of sex; (c) Secfion 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prabibits discbmir~atian on the basis of handicaps; (d) the Age Diasdminatian Act of t975, as amended (42 U.S.C. §§810t-6107), which prohibits disedmination on the da.sis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L 92-255), as amended, relating to nondiscdmination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of !970 (P.L 9t-616), as amended, relating to nondiscdminafion on the basis of alcohol abuse or alcoholism; (g) §§523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; {h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as amended, relating to nondiscrimination in the sate, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statutefs) under which application for Federal assistance is being made; and, 0) the requirements of any other nondiscdmination statute(s) which may apply to the applicadon. Will comply, or has already complied, with the requirements of Titles Il and Itl of the Uniform Relocation Assistance and Real Propeny Acquisition Policies Act al 1970 (P.L 91-646) which provide for fair and equitable treatment of persons d~splaced or whose property is acquired es a result of Federal or federally-assisted programs. These requ~ramenta apply to ail interests in real property acquired for project purposes regardless of Federal particzpabon in purchases. Will comply, as applicable, with prowsions of the Hatch Act (5 U.S.C. §§150t-t508 and 7324-7328) which limit the potidcal activities of employees whose principal employment activities are funded in whole or in part with Federal funds. ~revious Edition Usable Authorized for Local Reproduction Standard Form 424a (Rev. 7-97) Prescribed by OMB CircuIar A-102 I0. 11. Will comply, as applicable, with the provisions of the Davis- Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act (40 U.S.C. §276c and 18 U.S.C. §874), and the Contract Work Hours and Safety Standards 'Act (40 U.S.C. §§327- 333), regarding labor standards for federally-essisted construction subagreements. Will comply, if applicable, with flood insurance purchase requiramenta of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L 93-234) which requires racJpiects in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10.000 or more. Will comply with environmental standards which may be prescribed pursuant to the foflowing: (a) institution of environmental quality control measures under the National Environmental Pciicy Act of 1969 (P.L 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. §§1451 et seq.); (f) c~nformfly of Federal actions to State (Clean Air) Implementation Plans under Section 176(c} of the Clean Air Act of 1955, as amended (42 U.S.C. §§7401 et seq.); (g) protection of underground sources of drinking water under the Safe Ddnking Water Act of 1974, as amended (P.L 93-523); and. (h) protection of endangered species under the Endangered Species Act of 1973, as amended (P.L. 93- 205). 12. 13. 14. 15. 16. 17. 18. Will COmply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. §§1271 et seq.) reiatad to protemJng components or potential components of the national wild and scenic dvera system. Will assist the awarding agency in assunng comDJfanc~ with Secdon 106 of the National Historic Praservst~oh Act of 1966. as amended (16 U,S.C. :~70), EO 11553 (identification and protection of histodc properties), and the Archaeological and Histodc Preservation Act of 1974 (16 U.S.C. §~469a-1 et seq.). Will comply with P.L 93-348 regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L 8.9-544., as amended, 7 U.S.C. §§2131 et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for rasearoh, teaching, or other activities supported by this award of assistance. Will comply with the Lead-Based Faint Poisoning Prevention Act (42 U.S.C. §§4801 et seq.) which prohibits the use of lead-based paint in construction or rehabilitation of residence structures. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A-133, 'Audits of States, Local Governments, and Non-Profit Qrganizatioes.' Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, and policies governing this program. SIGNATURE OF AUTHORIZED CERTI~-'f'ING OFFICIAL L CANT ORGANIZ-~.TION /~// TITLE fDATE SUBMITTED U.S. Department of the Interior Certifications Regarding Debarment. Suspension and Other Responsibility Matters, Drug-Free Workplace Requirements and Lobbying Persons signing this form should refer to the regulations referenced below for complete ins'~uctlons: Cert~cation Regarding Debarment. Susper~ionl and Other Reapoeaibitity Matters -PdmaW Covered Transactions - The prospective primary participant further agrees by submitting this proposal that it will include the clause titled. 'CertificatiOn Regarding Debarmenf~ Suspension, Ineligibitty and Voluntary E~clusion - Lower Tier Covered Transaction." provided by the department or agency entering into this covered ttansactlon, without modification, in all lower tier covered t~ansacfions and in ail solicitations for lower tier covered transactions. See below for language to be used or use this form for cad.cation and sign. (See Appendix A of SubparLD of 43 CFR Part 12.) Cert~cation Regarding Debarment, Suspension, Inetigibilit7 and Voluntary Exclusion - Lower Tier Covered Transa~ons (See Appendix B of Subpart D of 43 CFR Part 12.) Certification Regarding Drug-Free'Workplace Requirements Akemate L (Grantees Other Than Individuals) and Alternate II. (Grantees Who are Individuals) - (See Appendix C of Subpart D of 43 CFR Part 12) Signature on this form provides for compliance with ced~cetlon requirements under 43 CFR Parts 12 and 18. The certifications shall be heated as a matedal representation of tact upon which reliance wilt be placed when the Department of the letedor deter'mthes to award the covered trartsac~oR, grant, cooperative agreement or loan. PART A: Certification Regarding Debarment, Suspension, and Other ResponsibilitY Matters Pdmary Covered Transactions CHECK__IF THiS C-.ERTIFICA ~ON IS FOR A PRIMARY COVERED 7~4NSACTION AND IS APPLICABLE. (1) The prospective pdmary participant certes to the best of [ts knowledge and belief, that it and its prfacipals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or volontadly excluded by any Federal departrr~nt or agency; (b) Have not within a three?ear period preceding this proposal beee convicted of or had a civil judgment rendered against them for commission of freud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal. State er local) transac*Jon or contract under a public bansact~on; violation of Federal or State antib-ust statutes or commission of embe_~Jement, theft, forgery., bribery, falsification or destructon of records, making talse statements, or receiving stolen property; (c) Are_ not present~/, indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local} with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and (d) Have not within a three-year penod preceding this applicatiorJproposal had one or more public transactions (Federal, State or local) terminated for cause or default. (2) Where the prospective primary participant is unable to certif7 to any of the statements in this certification, such prospective participant snail attach an explanation to this propesat. PART B: Certification Regarding Debarment. Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions CHECK__IF THtS CERTIFiC_.A ~ON IS FOR A LOWER TIER COVERED TRANSACTION AND IS APPLICABLE. (1) The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspendedl 'proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency, (2) Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal, · ,~,~, ~.. ~er~rac~lon ~egar~ng Drug-Free Wor~(ptaca Requirements CHECK__IF THIS CER77FICATIDN IS FOR AN At=PUC. ANT WHO iS NO7' AN INDIVIDUAL Alternate L (Grantees Other Than Individuals} A. The grantee certh~es that it will or continue to provide a drug-fl'aa workplace by: (a) Publishing a statement notifying employees that the unlawful manufacture, dis~ibufion, dispensing, possession, or uae of a contruiied substance is prohibited Jn the grantee's workplace and specifying the actions that wtil be taken against employees for violation of such prohibition; (b) Establishthg an ongoing drug-free awareness program to inform employees about- (1) The dangers of drug abuse in the warkplsce; · (2) The grantee's policy of maintaining a drug-free wark'Place; (3) Any avallabie drug counseling, rehabilitation, and employee assistance Programs; and (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the warP-place; (c) Making it a requirement that each employee to be engaged in the performance of the grant be given a Copy of the statement required by paragraph (a); (d) Nofi~'ing the employee in the statement required by paragraph (a) that, as a Condition of employment under the grant, the employee '.viii - (1) Abide by the terms of the statement; end (2) Notify the employer in writing of his or her conviction for a viols*Jon of a cdmthat drug statute occurring in the workplace no later than five calendar days after such COnviction; (e) Notifying the agency in writing, within ten calendar days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction. Employers of Convicted employees must provide notice, including position tifie, to eve~ grant officer on whose grant activity the convicted employee was working, unless the Federal agency has designated a central point for the receipt of such notices. Notice shall inctude fl~e ident~catJon numbers(s) of each affected grant; (f) Taking one of the following actions, w~hin 30 calendar days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted - (1) Taking appropriate personnel action against such an employee, up to and including termination, Consistent with the requirements of the Rehabilitation Act of 1973, as amended; or (2) Requiring such employee to pantJcipete safisfactodly in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; (g) Making a good faith effor~ ~o continue to maintain a drug-free workplace through implementation of paragraphs (a) (b), (c), (d), (e) and (f). 9. The grantee may insert in the space provided below the site(s for the performance of work done in connection with the specific grant: Piac~ of Performance (Street address, city, county, state, zip code) Check__if there are workplaces on file that are not identified here. PART D: Certification Regarding Druo-Free Workplace Reauirements CHECK__IF THIS CERTIFICATION IS FOR AN APPLICANT WHO IS AN INDIVIDUAL. Alternate fi. (Grantees Who Are Individuals) (a) The grantee certifies that, as a condition of the grant, he or she will not engage in the unlawful manufacture, distribution, dispens rig, possession, or use of a controlled substance in conducting any activity with the grant; (b) If convicted of a criminal drug offense resulting from a violation occurring during the conduct of any grant activity, he or she will report the COnviction, n wfitthg, within 10 calendar days of the COnviction. to the grant officer or other designee, un ess the Federal agency designates a central point for the receipt of such notices. When notice is made to such a central point, it shall include the identification number(s) of each affected grant. PART E: Certification Regarding Lobbying Certificatign for Contracts, Grants, Loans, and Cooperative Agreements CHEC,~ IF CERTIFICATION IS ?OR THE AWARD Of= ANY Of= THE FOLLOWING AND THE AMO~J-NT E~CEEDS $100,000: A FEDERAL GRANT OR COOf=ERA TIVE AGREEMEN"~; SUBCON77~CT, OR SUBGRANT UNDER THE GRANT OR COOPERATiVE AGREEMENT. CHECK__IF CERTIFICATION IS FOR THE AWARD OF A f=EDERAL LOAN EXCEEDING THE AMOUNT OF $150,000, OR A SUBGRANT OR SUBCONTRACT EXCEEDINGS100,000, UNDER THE LOAN. The uedemigned certifies, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress. and officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entedng 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 fends 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 bndersigned shall complete and submit Standard ForrmLLL, "Dis. closure Form to Repor~ Lobbying," in accordance with its instructions. (3) The undersigned shall require that the language of this certffication be included in the award documents for all subewards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that ail subrecipients shall certif7 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 cer~cafion is a prereduisite for making or entedng into'this transaction imposed by Section 1352, ti'de 31. U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such fail ura. As the authorized certifying offidaL I hereby cerflfy that the above specified cer~cations are true. SIGNATURE OF AUTHORIZED CE?~FYING OFFICIAL ]~fPED NAME AND TITLE DATE ID. EXHIBIT C SCOPE OF WORK WORK ELEMENTS The City of Dubuque will develop, publish, and distribute design review guidelines that will aid in the preservation of the City's historic districts. Recent inappropriate alterations of historic homes in Dubuque have pointed to the critical need for Design Review Guidelines. A task force of local citizens and members of the Historic Preservation Commission have recommended the development of design review guidelines for the historic districts. Commissioners and staff discussed that design review guidelines could make the job of the Commissioners easier and more efficient. Planning Services staff beiieve that design review guidelines for each district would make the job of staff easier and more efficient. Design guidelines would provide opportunities for streamlined staff sign-offs on certain types of projects that meet established criteria. Staff and commission have discussed cases in which staff sign-off is appropriate. An example is the replacement of an aluminum porch with a wooden porch that matches a porch shown in an old photograph of the building and that is appropriate for the structure's period of significance. These guidelines would be formulated using the Secretary of Interior's Standards and Guidelines for Restoration and Rehabilitation as a baseline and adding informative illustrations and other aides to help property owners comprehend and follow the Design Review guidelines. The State will review and comment on draft and proposed final versions of the guidelines to insure compliance with Iowa CLG Program and Federal requirements. The most effective and useful design guidelines are those which were developed for a specific district or districts of like historic character, function, and contemporary pedods of significance. The City of Dubuque will select one or several such locally designated districts for which design guidelines will be developed. To accomplish these goals, the City of Dubuque wil! undertake the following: 1. Hire a historic preservation consultant with demonstrated experience in design guideline development who meets the Secretary of the Interior's Professional Qualification Standards for Architectural History or Preservation/Historic Architect. The consultant will work with the local Project Director, Historic Preservation Commission, other City Staff and the public on all phases of the project. · 2. Phase 1, Advance Preparation, will involve working with a consultant to prepare background information that will provide a basis for informed discussions. This phase will entail the consultant's review of existing regulations, historical research, and other materials in order to gain an understanding of the existing context. In addition, the City will form a volunteer Advisory Group to focus on guiding the project, to help recruit participants for the public workshop, and to ensure that critical, major interests of the community are represented. The Advisory Group will also serve as a data source and sounding board. The consultant and Advisory Group will select the historic district or districts for which the design guidelines will be developed. Finally, a refined schedule of meeting dates, deadlines for drafts and scheduled conference calls will be developed. 3. Phase 2, Define District Character and Goals, includes defining the existing character, identifying development trends that may influence its future, and establishing design goals for the areas. During this phase the following activities will occur. The consultant will conduct logistical meetings with city staff and the Advisory Group in order to identity goals, objectives and timetables for this phase. A key purpose is to gain an understanding of how staff and boards use the guidelines on a daily basis. Aisc, for the consultant to elicit input on the group's view of the district's character, development trends, and design goals. The consultant, city staff and the advisory group will tour the historic district(s) to identify design issues in the field. The tour will also include photo-documentation of design issues. The consultant will collect and copy historic photos and descriptions to use in this project and take supplementary photographs of existing conditions and issues in slide and print form, assemble various planning documents and acquire base maps. The final activity in Phase 2 is the public workshop for residents, property owners, professionals and interested citizens. It will be organized to provide an overview of the design guidelines process, define issues and explain the timetable of the project to the public. The meeting will introduce the concept of the design guidelines and present a range of design issues, problems and solutions in a slide show to establish a common base of understanding of the project. Basic goals and policies for guidelines will be developed that provide direction for the development of the guidelines that will follow in Phase 3. Participants will be asked to identify typical design problems that are encountered in the area. The consultant assisted by City staff will direct the workshop. 4. Phase 3, Develop Draft Guidelines, involves developing an initial draft of the design guidelines. The draft design guidelines for the historic district(s) will cover topics such as lot and sfreetscape features, mass and scale, building materials, architectural features (e.g. doors, roofs, windows), parking and secondary structures, building additions and relocations, and new, infiil developments. The Guidelines will contain an annotated outline of design review issues. The outline will cover the following topics, as they relate to the design review guidelines for the Historic District (s): historical character of the district (s), description of building types and styles; identifying the character defining features of the building types or styles that are encountered in the historic district (s); and goals for the design review and guideline process. The draft design guidelines will be sent to in advance to City Staff, Advisory Group, State Project Manager and State Preservation Architect for review and comment. Copies will be made available for public review and comment. 5~ Phase 4, Prepare final Design Guidelines. The consultant will schedule at least one conference call with the City Staff, Advisory Group, and State Project Manager and Preservation Architect to review the draft Design Guidelines. During the call, the consultant will review the draft Design Guidelines and answer questions. The purpose of the review conference calls will be to to clarify, strengthen, or weaken design guideline language. Based on the verbal review and wdtten comment provided by the State, Public and others, the Consultant will revise the draft. The revised draft will be submitted to the State for final review and approval pdor to printing the final edition of the Design Guidelines. The consultant will submit a final print ready copy of the Design Guidelines to the City Staff for duplication, distribution and use. 6. Phase 5, the CLG Project Manager and Historic Preservation Commission will hold a workshop for the public to explain how the Design Guidelines will be used and illustrate their application in the development of projects within the historic district (s). - All work on the project will conform to the "Secretary of the interior's Standards and Guidelines for Preservation Planning, Registration, and Treatments for Historic Preservation Projects", Federal Register of September 29, 1983; to the Fiscal Year 2000 Grants Manual For Certified Local Governments; and to the CLG's grant application submitted in August, 2000. The CLG financial officer is responsible for fiscal administration of the Grant. The CLG Project Director will be the Community Development Director who will work with the consultant in coordinating grant activities. Project Director responsibilities will include administration of the grant, scheduling of meetings, copying and distributing information from the consultant to the volunteers and others involved in the project. The project director will be responsible for developing and disseminating press releases about various grant activities. The project director will be the point of contact for all communications between the consultant, volunteers and the State Historical Society Project Manager. The CLG Project Director and consultant will oversee production of the products identified below. The CLG Historic Preservation Commission, elected officials, and the State will review and comment on the draft and final products. The Historic Preservation Commission will be responsible for furnishing the public with draft copies of products for review and comment. Changes directed by the State shall be made prior to submission of the final versions of the products. PI~ODUCTS 14 The State wilt furnish the followinc~: 1) One Historic-Architectural database (HADB) encoding form; 2) C°py(s) of the final National Register of Historic Places nomination(s) for the selected histodc district (s); The CLG will prepare the followino products: 1) Two copies of the draft Request for Proposals to be submitted to consultants; 2) Two copies of the draft subcontract agreement with the consultant; 3) Three copies of the fully executed subcontract agreement with the consultant; 4) A Phase 2 workshop involving the pubtic in the development of the design guidelines; 5) A minimum of twenty five copies of the draft design guidelines. 6) The following acknowledgements will appear on the title page of the draft and final versions of all publications produced under this grant: 7) "This Project has been funded with the assistance of a matching grant-in-aid fi.om the State Historical Society of Iowa, Community Programs Bureau, through the department of the Interior, National Park Service, under provisions of the National Histodc Preservation Act of 1966; the opinions expressed herein are not necessarily those of the Department of the lntador' "This program received Federal funds fi.om the National Park Service. Regulations of the U.S. Department of the Interior strlctiy prohibit unlawful discrimination in Federally Assisted Programs on the basis of race, color, national origin, age or handicap: Any person who believes he or she has been discriminated against in any program, activity, or facility operated by a recipient of Federal assistance should write to: Director, Equal Opportunity Program, U.S. Department of the Interior, National Park Service, P.O. box 37127, Washington, D.C. 20013-7127." Two Hundred and fifty copies of the final version of the draf~ Design Guidelines; which will include one print-ready master copy; 8) A Phase 5 workshop to train the public in the utilization and application of the design guidelines when developing restoration or rehabilitation projects in the histodc district (s); 9) Six copies of each mailing and any other promotional material,used to publize, promote, and invite the public to participate in the Phase 2 workshop, Phase 5 training workshop and to provide comment on the draft guidelines; 10) Two copies of a one-page report, summarizing the project results, as required for all grant-funded activities; and 11) One completed Historic-Architectural database (HADB) encoding form (provided by the State). The CLG will distribute the pr0dt, lcts ¢S follows: 1) One copy of the draft Request for Proposals will be submitted to the State for review and approval prior to send to consultants; 2) One copy of the draft consultant subcontract will be submitted to State's project manager for review and approval prior to execution with the consultant; 3) The State will receive one copy of the fully executed subcontract; the consultant and CLG will retain copies for their respective files; 4) C°pies of the first draft of the Design Guidelines will be submitted to the State (Project Manager), City Staff, CLG's Advisory Group, and the other interested publics, respectively, for review and comment; 5) Six copies of the final Design Guidelines will be submifted to the State; 6} Six copies of each mailing and any other promotional material, used to publicize, promote, and invite the public to provide comment on the draft guidelines and to participate in the Phase 2 and Phase 5 workshops shall be submitted to the State; 7) A minimum of five copies including one unbound, print-ready master copy of final draft Design Guidelines will be kept by the CLG; extra copies will be distributed to historic distdct property owners; 8) One copy of the one-page project report will be submitted to the State, the CLG will keep one copy; 9) One completed Historic-Architectural database (HADB) encoding form (provided by the State) will be submitted to the State. C. SCHEDULE Work under this contract will begin in the Spring of 2001, upon signing of the contract by the CITY OF DUBUQUE and the STATE. The CITY OF DUBUQUE is expected to begin work on the project within 20 days of receiving a copy of the fully executed contract, signed by the CITY OF DUBUQUE and the STATE. The contract will end on or before June 30, 2002. Early completion of contract activities and submission of contract products is encouraged. Deadlines for contract activities are as follows: The CLG will return ail three copies of the contract, bearing the chief elected-official's signature, to the State no later than February 15, 2001. State will return one fully executed copy to CLG no later than March 1, 2001 The recipient will submit the draft Request for Proposals and draft subcontract for consultant to the State for review and approval no later than April 15, 2001. State will provide comments and approval no later than May 15, 2001. The recipient will submit a copy of executed subcontract with consultant to the State no later than June 15, 2001. Contracted projects which do not have consultants under subcontract by June 15, 2001 will be canceled. The recipient will submit the dra¢t Design Guidelines and Annotated Outline of Design Review issues for the State's review and comment no later than March 1, 2002. State will provide written comment and approval of the draft report no later than April 1, 2002. The recipient will submit the revised draft Guidelines incorporating State and Public comment to the State for review and comment no later than May 1, 2002. The State will provide wdtten comment and approval of the revised draft Guidelines no later than June 1', 2002. The recipient will submit final versions of the grant products by June 30, 2002. Payments by the State shall be made upon receipt of billing invoices from the CLG that relate expenses being billed to budgeted expenses identified in Exhibit E. Each payment request will be audited 16 by the State to insure that sufficient progress has been made in support of the invoice. Timely submission of products is essential for reimbursement. Claims for reimbursement must be accompanied by a progress report. Claims and progress repods must be submitted to Lavon Grimes, Grants Programs Assistant, State Historical Society of Iowa, New Historical Building, 600 East Locust, Des Moines, Iowa 50319 ' 0290. The following payment schedule shall be used: Approval of draft report: up to 70% of grant Approval of all products: 100% of the grant E. COORD~IATION This agreement will be managed by the CITY OF DUBUQUE in cooperation with the STATE. The CITY OF DUBUQUE will be represented the Project Director: Laura Carstens, 50 West 13th Street, Dubuque, Iowa 52001, (319) 589-4210 (day), (319) 557-8855 (evening), and the STATE will be represented by Kerry McGrath, Project Manager, Community Programs Bureau, State Historical Society of Iowa, 600 East Locust Street, Des Moines, Iowa 50319-0290, 515/281-6826, Kerry. McGrath~dca.state.ia.us. and Cynthia Nieb, Grant Programs Manager. Routine information and technical guidance will be provided by Kerry McGrath, Project Manager. Lavon Gdmes, Grant Programs Assistant (515) 242-6194, shall handle all accountidg matters and payments. The CITY OF DUBUQUE's Project Director, Laura Carstens, will maintain continuous coordination with the STATE's Project Manager, Kerry McGrath, during the course of this contract. This will consist of a written monthly progress report due on the 5th of each month. These reports will keep the STATE abreast of contract progress and serve as a vehicle for assessing performance of the conbact. Progress reports shall be directed to Kerry McGrath. t7 EXHIBIT D BUDGET CLG FY 200'~ Application for Histodc Preservation Fund Grant-in Aid Page 8 This project was completed on-time and all reports were submitted in a timely fashion. This was accomplished, in part, by involving the Histodc Preservation Commission, the City Council, other City DepaJh~ents and Commissions and community citizens. The City is also beginning work on an Historical Resource Development Program (HRDP) Grant (Contract No. 00-007) for Phase !1 of the City of Dubuque Architectural/Historical Context Survey and Evaluation. This project has been contracted to James E. Jacobsen, History Pays!, and Molly Myers Naumann, with a completion date established as January 15, 2002. Section iV: Proposed Project Budget Expenditure A. * B. ** Applicant's Match Projec~on Federal* Applicant's C. Cash D. In-Kind Consultant (salary & $ 2,000.00 $5,000.00 $5,000.00 expenses) Design Guidelines Printing (draft copy) 250.00 Printing final copy 3,000.00 Guideline Distribution (postage) 750.00 Seminar 1,000.00 Cledcal/Miscella neous costs (Postage/phone) 500.00 I Project Oversight 500.00 $500;00 GRANT PROJECT Federal Total* Applicant Total $5,000.00 $500.00 TOTAL = $13,000.00 $7,500.00 ** $5,500.00 CERTIFICATION: I certify that the matching share proposed for this project does not include funding from other Federal sources, and that these funds are not being used as match ag..~.~P/s/t'"'ihY other Federal~gJ::.~nt ap.P.~pplication. AUTHORIZED SIGNATURE ° Column A- Grant, the total amount of Column A must note.xceed 60% of total project costs. "Column B - Match, this future must equal a minimum of 40% of total project costs. EXHIBIT D BUDGET This project was completed on-time and all reports were submitted in a timbly fashion. This was accomplished, in part, by involving the Historic Preservation Commission, the City Council, other City Departments and Commissions and community citizens. The City is also beginning work on an Historical Resource Development Program (HRDP) Grant (Contract No. 00-007) for Phase ][]i of the City of Dubuque Architectural/Historical Context Survey and Evaluation. This project has been contracted to .lames E. Jacobsen, History Pays!, and Molly Myers Naumann, with a completion date established as .lanuary 15, 2002. Section ~V: ProPosed Project Budget Expenditure A. * B. ** Applicant's Match Projection Federal* Applicant's C. Cash D. lin-Kind Consultant (salary & $ 2,000.00 $ 5,000.00 $5,000.00 expenses) Design Guidelines Printing (draft copy) 250.00 Pdnting final copy 3,000.00 Guideline Distribution (postage) 750.00 Seminar 1,000.00 Cledcal/Miscella neous costs (Postage/phone) 500.00 Project Oversight 500.00 $500.00 GRANT PRO]ECl' TOTAL Federal Total* Applicant Total $5,000.00 $500.00 = $13,000.00 $7,500.00 ** $5,500.00 CERTIFICATION: I cerl;jfy that the matching share proposed for this project does not include funding from other Federal sources, and that these funds are not being used as match against any other Federal grant application. ALFFHORIZED SIGNATURE Column A - Grant, the total amount of Column A must not exceed 60% of total project costs. Column B - Hatch, this future must equal a minimum of 40% of total project costs. 20