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WASHINGTON SERVICE CORPS
Individual Placement Program
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Program Year September 1, 2012—August 31, 2013
MEMORANDUM OF UNDERSTANDING
The purpose of this Memorandum of Understanding (MOU) is to establish the compliance
expectations of the Washington Service Corps (WSC) Individual Placement Program, These
expectations are designed to establish effective coordination between sponsoring organizations
and the WSC, to ensure that the objectives of the WSC, Washington State Commission for
National and Community Service, and the Corporation for National and Community Service are
met, and to ensure a positive service experience for the AmeriCorps member(s).
Mail completed original to Washington Service Corps
P.O. Box 9046, Olympia, WA 98507 JUL 1 q 20iZ
or hand deliver to Washington Service Corps
670 Woodland Square Loop SE,Lacey,WA 98503 WA Service core;
Sponsorin2 Organization Information
Organization (Legal Name): cityof Aubum
Organization Website URL. http:/tw,w.aubumwa.gov
Project Title: City of Auburn Disaster Educator
Duns#• 032942575
Name&Title of Legal Applicant: Peter o.Lewis/Mayor
Mailing Address: 25 W Main Street;Aubum,WA 98001
Telephone Number 253-931-3041 Fax Number 253-288-3132
Email Address: piewis@aubumwa.gov
Project Supervisor: saran K.Miner
Mailing Address: 25 W Main Street;Aubum,WA 98001
Telephone Number 253-876-1909 Fax Number 253-939-7769
Email Address: sianitler@auburnwa.gov
Site Supervisor: same
Mailing Address:
Telephone Number Fax Number
Email Address:
Number of AmeriCor s positions awarded: 2
Start date: 09/01/2012
Cash Match Total: $9000
The original signed Memorandum of Understanding will be frled at Employment Security Department,
Washington Service Corps.
We reconunend you keep a copy for your records, until a fully-executed copy is returned to you.
Funding Contingency
In the event funding for the Washington Service Corps is reduced or eliminated, or if federal
program requirements change, prior to or after the date of this Memorandum of Understanding,
the Washington Service Corps may terminate or modify this Memorandum of Understanding with
30 days written notification to the sponsoring agency
Responsibilities of the Sponsoring Organization
Section I—Financial Responsibility
1 Submit$4,500 cash match per member on or before October 31, 2012. Invoice with payment
instructions will be sent by Washington Service Corps to sponsoring organizations on or about
September 1, 2012. Refer to RFA Guidance Document for additional details pertaining to the
use of federal funds. For those returning organizations applying for two program-years, be
aware that the cash match may increase the second year Cash match will only be pro-rated for
any member who terminates prior to serving 15% of their term. Organizations will not receive
a pro-rated refund if members serve more than 15% of their term. Failure to pay the full cash
match requirement per member may result in removal of the member(s) from site, up to and
including termination of our contract.
2. Non-governmental organizations: Submit to Washington Service Corps proof of current
liability coverage or a rider, listing Washington Service Corps as the certificate holder,
indicating a minimum of$1,000,000 per incident, no later than July 31, 2012.
3 Provide transportation or mileage reimbursement to AmeriCorps member(s)to conduct service
away from their established service site during service hours.
4 Be responsible for providing transportation or mileage reimbursement according to State rates
to AmeriCorps member(s) as they attend the required SERVES Institute tentatively scheduled
for October 29-31 in Yakima. The Washington Service Corps covers the cost of provided
meals and lodging expenses for the members at this event.
5 Pay for any member costs around Washington state WATCH background checks. WSC will
provide a one-time fee per member for using required channeler(FieldPrint). Any
cancellations to the appointments less than 24 hours will require that the site reimburses WSC.
6. Member costs that are deemed disallowed through monitoring or audit review(s)will be the
responsibility of the site.
7 Sponsoring organizations are only permitted to subcontract member placement with
permission of Washington Service Corps.
Section II- Risk Management and Compliance
I Comply with the Assurances and Certifications(Attachment A) of the Washington Service
Corps Individual Placement Program, Grant Program Civil Rights and Non-Harassment Policy
(Attachment B), AmeriCorps Member Service Agreement and the RFA Expectations &
Agreements.
2. Comply with all Washington Service Corps Policies and Procedures, including the current
policies and procedures listed below, and other policies or procedures that may be developed
and implemented throughout the program year-
Policy No. 1 AmeriCorps State Member Leave
Policy No. 2 Service Gear and Appearance
Policy No. 3 SERVES Training Institute
Policy No. 4 Member Grievance Policy and Procedures
Policy No. 5 AmeriCorps State Member Conduct
2012-2013 WSC IP RFA Page 12
Policy No. 6 AmeriCorps State Member Transfer
Policy No. 7 AmeriCorps Member Deployment
Policy No. 8 Nondiscrimination on the Basis of Disability
Policy No. 9 Member Hours and Allowable Service Activities
Policy No. 10 Criminal History Background Check Requirements
Procedure No. PC Criminal History Background Check Requirements
3 Establish safety guidelines and rules that ensure the well-being of the AmeriCorps member(s)
and participants
4 Ensure your organization has current Drug-Free Work Place and Non-Discrimination Policies.
5. Ensure that AmeriCorps member(s) provides direct service in accordance with the position
description. Ensure any changes to duties are updated on the member Position Description
Form and immediately sent to WSC. In the event administrative duties are necessary to reach
the member's service goals, such duties will be allowed. However, administrative duties that
support general organizational goals are not allowed.
6. Ensure that service activities do not duplicate routine functions of or displace, paid
employees. Service activities must expand or enhance the organization's impact.
7 Ensure accuracy of member's service. Accurate records should include hours served as
service hours, training hours, and fundraising hours. No hours can be granted for service or
training out-of-state without prior Washington Service Corps approval.
8. Ensure that members do not participate in out-of-country trainings or other activities which are
not allowable under CNCS regulations.
9 Monitor and ensure AmeriCorps member(s) service hours to determine if the member is
serving an average of 40 hours a week for 10.5 months and is on track to complete the required
1700 service hours. Communicate to members that they must be available to serve the hours
needed by the project including weekend and evening service activities.
10. Mail original, signed member timesheets to Washington Service Corps within seven days
following the end of the month.
11 Ensure AmeriCorps member(s) wear AmeriCorps gear and/or identifiers while serving as
outlined in Washington Service Corps Policy 42 Service Gear and Appearance.
12. Require and retain member's proof of valid driver's license and current proof of vehicle
insurance, if the member is reimbursed for use of a personal vehicle in the performance of
their service duties.
13 Participate in the on-site monitoring/audit process by a Program Coordinator or an authorized
representative,a (lowing access to member or program files, documents and materials.
14 Host scheduled programmatic visits as requested by Washington Service Corps Program
Coordinator
15 Maintain the following documents separately and securely from the member personnel file:
• criminal history background check results
• medical information
• grievance documentation
16. Retain member personnel file, background check documentation, and other program-related
documentation for a period of seven years after the end of the program year The official end
of the program year is the 3151 of August. For returning sites, this required retention
adjustment of six years to seven years needs to apply to past program year documentation in
your archiving of records, so please adjust date as necessary to meet this requirement.
17 In the event of any change to the information regarding the Legal Applicant, notify the WSC
Program Coordinator within ten working days.
18. Ensure that member eligibility verification is met and all required WSC enrollment
documentation is provided.
2012-2013 WSC IP RFA Page 13
19 Ensure all required WSC enrollment documents are submitted on established dates.
.Section III- Prohibited AmeriCorps Member Activities
There are certain activities, including lobbying, political, religious or advocacy activities that
AmeriCorps members may not perform in the course of their duties while charging time to the
AmeriCorps program, or at the request of sponsoring organization staff. Furthermore, members
and staff may not engage in conduct in a manner that would associate the national service program
or the Corporation for National and Community Service (CNCS) with the prohibited activities.
Programs must become familiar with specific provisions described in the Corporation's formal
regulation (45 C.F.R. 2520.65) and the grant provisions. The list of prohibited activities includes:
CNCS Prohibited activities:
1 Attempting to influence legislation;
2. Organizing or engaging in protests, petitions, boycotts, or strikes;
3 Assisting, promoting, or deterring union organizing;
4. Impairing existing contracts for services or collective bargaining agreements;
5 Engaging in partisan political activities, or other activities designed to influence the
outcome of an election to any public office;
6. Participating in,or endorsing, events or activities that are likely to include advocacy for
or against political parties, political platforms, political candidates, proposed
legislation, or elected officials;
7 Engaging in religious instruction, conducting worship services, providing instruction as
part of a program that includes mandatory religious instruction or worship,
constructing or operating facilities devoted to religious instruction or worship,
maintaining facilities primarily or inherently devoted to religious instruction or
worship, or engaging in any form of religious proselytization;
8. Providing a direct benefit to-
(i) A business organized for profit;
(ii) A labor union;
(iii)A partisan political organization;
(iv) A nonprofit organization that fails to comply with the restrictions contained
in section 501(c)(3) of the Internal Revenue Code of 1986 except that
nothing in this section shall be construed to prevent participants from
engaging in advocacy activities undertaken at their own initiative; and
(v) An organization engaged in the religious activities described in paragraph
(7)of this section, unless Corporation assistance is not used to support those
religious activities;
9 Conducting a voter registration drive or using Corporation funds to conduct a voter
registration drive;
10 Providing abortion services or referrals for receipt of such services;
1 1 Such other activities as the Corporation may prohibit;
WSC prohibited activities:
1 Organizing a letter-writing campaign to Congress;
2. Participating in activities that pose a significant safety risk to participants;
3 Preparing any part of a grant proposal or performing other fundraising functions to help
the program achieve its match requirements, or to pay the program's general operating
expenses; and
2012-2013 WSC IP RFA Page 14
4 Fundraising, unless under the following circumstances: if it provides direct support to a
specific service activity, falls within the program's approved objectives, is not the
primary activity of the program, and does not exceed 10%of the total hours served for
any member
AmeriCorps members, like other private citizens, may participate in the above listed activities on
their own time, at their own expense, and on their own initiative. However, the AmeriCorps logo
must not be worn while doing so.
Federal funding for AmeriCorps members is approved with the understanding that member service
is directly supporting AmeriCorps objectives. Contrary circumstances could lead to removal of
AmeriCorps member(s) from the site.
Section IV- Recruitment and Enrollment of AmeriCorps Member(s)
1 Conduct AmeriCorps member(s) recruitment, interviews, and selection.
2. Comply with Washington Service Corps criminal history background check requirements as
identified, but not limited to, Policy#10 and Procedure#PC1 AmeriCorps members must
pass criminal history background checks prior to their start date and cannot be listed on the
National Sex Offender Registry Comply with other criminal background check requirements
that may be developed and required throughout the program year to maintain CNCS
compliance.
3 Submit completed AmeriCorps member enrollment packet,to include all completed items on
checklist, to Washington Service Corps at least one week prior to the member's start date.
Section V - Support and Supervision of AmeriCorps Member(s)
1 Identify a staff person from the organization to supervise the AmeriCorps member(s)on site.
Designate an alternate supervisor If the member serves off site, designate off-site supervisor
2. Supervisors identified as"covered positions"are required to complete the same criminal
history background checks as members and cannot be listed on the National Sex Offender
Registry
3 Comply with other criminal background check requirements that may be developed and
required throughout the program year and providing original documents to the WSC to
maintain.
4. Identify a staff person from the organization to be the project supervisor and key contact for
Washington Service Corps.
5 In the event of a change in supervisor level, notify WSC Program Coordinator within ten (10)
working days.
6. Orient AmeriCorps member(s) to AmeriCorps; your site; the community; and the service they
will provide.
7 Inform AmeriCorps member(s) about your organization's rules of conduct and appropriate
behavior, including procedures for communicating service hours and absences. Provide
member(s)with policy manuals and/or handbooks, and include your organizational chart.
8. Introduce AmeriCorps member(s)to other organization staff and include member(s) in
appropriate organization functions.
9 Provide appropriate tools and equipment for the AmeriCorps member(s)to perform service
and to communicate with Washington Service Corps. Tools and equipment may include, but
are not limited to work space, computer with internet and agency e-mail, phone and fax access.
10 Increase community awareness of the service the member(s) provides and prominently display
AmeriCorps logo at service site(s), as well as permit and encourage AmeriCorps member(s) to
2012-2013 WSC,IP RFA Page 15
wear gear provided by WSC at agency-related events or other activities to provide awareness
of AmeriCorps member
1 I Recognize and support distinct roles and responsibilities of the AmeriCorps member(s) as
outlined in the member's position description.
12. Provide oversight on the AmeriCorps member's progress and skill development, including
member's participation in required site and Washington Service Corps training.
13 Ensure member(s) participation in days of national service including, but not limited to, Martin
Luther King Jr Day of Service and AmeriCorps Week.
14 Communicate immediately with Washington Service Corps program coordinator regarding
AmeriCorps member(s) performance issues or other program concerns.
15 Document AmeriCorps member performance/personnel issues in writing, including actions
taken toward resolution.
16. Follow AmeriCorps member discipline procedures as outlined in the Member Service
Agreement.
17 Coordinate with Washington Service Corps program coordinator prior to removal or transfer
of AmeriCorps member
18. Use retention strategies to ensure member(s) successfully completes his/her full term of
service.
19 Provide transportation or mileage reimbursement to AmeriCorps members to conduct service
away from their established service site during service hours if that is expected by the site
during his/her term of service.
Section VI- Performance Objectives and Reporting
1 Collaborate with Washington Service Corps and the AmeriCorps member(s)to develop a well-
defined project that has clear goals and objectives in accordance with the AmeriCorps
member's position description and the Request for Application. Any adjustments or revisions
need prior approval of WSC Program Coordinator
2. Ensure performance objectives are quantifiable and demonstrate the impact of the AmeriCorps
member's service in one of the focus areas, as defined in application and negotiated in writing
with WSC. Example of quantifiable outcomes: 100 adults will receive financial literacy
training, 80%will complete the training, and of those that complete the training, 75%will
increase their knowledge of financial literacy
3 Implement data tracking systems to monitor progress on the performance objectives defined in
the Request for Application and the AmeriCorps member's position description.
4 Submit quarterly progress reports,or as requested by Washington Service Corps, on outcomes
for each performance objective defined in the Request for Application and the AmeriCorps
member's position description.
5 Support the AmeriCorps member(s) in reaching the performance goals for volunteer
recruitment and training.Track and report on goals for total number of unduplicated
community volunteers, hours to be served by volunteers, number of baby boomer volunteers,
number of veteran and military family volunteers, and effective volunteer management
strategies.
6. Retain data collection documentation such as attendance rosters, pre/post test results and other
reports related to performance for seven years after the end of the program year
7 Update member position descriptions as necessary and submit signed originals to the
Washington Service Corps. A change in supervisor, schedule, or duties requires an amended
position description sent in to WSC for approval.
2012-2013 WSC IP RPA Page 16
8. Submit original, signed performance evaluations of the AmeriCorps member twice during the
service term (January 31 and June 30) using forms provided by the Washington Service Corps
on its website.
9 Ensure that members submit at least one"Great Story" per quarter Report AmeriCorps-
sponsored activities and events in which stakeholders, legislators or other elected officials are
invited to be educated in the effectiveness of the AmeriCorps program.
10. Submit copies of written or electronic articles that highlight AmeriCorps member(s)and/or
AmeriCorps projects.
11 Provide, as requested by WSC, additional performance- and programmatic-related information
as may be needed throughout the program year
Section VII - Career Development/Training
I Ensure AmeriCorps member site supervisor or project supervisor attend one of the
Washington Service Corps orientations scheduled in July or August 2012.
2. Provide adequate training to AmeriCorps member(s) to ensure member(s) is prepared for the
roles and responsibilities of the project.
3 Provide AmeriCorps member(s)a minimum of two site-specific trainings related to the service
position. Not more than 20%of AmeriCorps members' total service hours may be spent in
training. Training received by AmeriCorps member(s) during orientation do not count toward
the site-specific training.
4 Submit all requests for out-of-state training for the member to the Washington Service Corps
program coordinator prior to the event.
5 Support AmeriCorps member(s) in attending Washington Service Corps training and career
development opportunities. Release AmeriCorps member(s) to attend mandatory training
events, service projects, and other Washington Service Corps events including Washington
Service Corps sponsored overnight SERVES Training Institute to be held October 29-31, 2012
in Yakima, Washington.
6. Ensure that the member(s) receives training related to the core training requirements during
their term of service. Many of these are offered at SERVES, however, they may not all be
available. Sites are responsible for ensuring members meet all core training requirements.
7 Support AmeriCorps member(s) in updating and submitting the Member Training Plan to
Washington Service Corps quarterly
8. Release AmeriCorps member(s) from regular service to respond to disasters in accordance
with WSC Policy#7 Member Deployment.
Section VIII -Sustainability
I The AmeriCorps project must support the long-term goals of the organization and the
organization must be committed to the project.
2. The project must be designed to yield results beyond the AmeriCorps member's term of
service.
3 The AmeriCorps member's position is to enhance or expand an organization's service, not to
maintain existing programs or replace staff.
Section IX—Use and Disclosure of Information
The sponsoring organization shall use any private and confidential information provided under
this Memorandum of Understanding (MOU) solely for the purpose for which the information was
disclosed.The sponsoring organization shall not misuse any private and confidential information
under this MOU. The sponsoring organization shall not disclose any private or confidential
information unless the disclosure is authorized by law The misuse or unauthorized release of
2012-2013 WSC JP RFA Page 17
private and confidential information shall subject sponsoring organization, its employees or agents
to a civil penalty of Five Thousand dollars ($5,000) and other applicable sanctions under state and
federal law
Section X—Responsibilities
Responsibilities of Washington Service Corps
1 Provide program orientation for all AmeriCorps members and supervisors.
2. Provide on-going technical support to AmeriCorps member and supervisors by telephone
and/or e-mail,and on-site visits as arranged.
3. Communicate expectations and procedures about AmeriCorps member service and
performance.
4 Conduct on-site monitoring reviews and issue reports that list findings, concerns and
observations. Provide technical assistance to the organization and AmeriCorps member(s) to
complete corrective action.
5 Process timesheets for each AmeriCorps member(s) and maintain the original member file.
6. Process AmeriCorps member stipend for payment on the 10`h and the 25th of each month.
7 Provide State Industrial Insurance coverage for the AmeriCorps Iember(s).
8. Provide Medical Insurance coverage for the AmeriCorps member(s).
9 Provide sponsoring organizations with AmeriCorps posters to post in a prominent location.
10. Provide AmeriCorps member(s)with AmeriCorps gear and lapel pin.
I 1 Provide AmeriCorps member(s)training and development opportunities at the SERVES
Training Institute. Cover the cost of meals and lodging expenses required for attendance at
SERVES.
Responsibilities of AmeriCorps Member
Comply with the AmeriCorps Member Service Agreement.
Special Conditions
1 Failure to comply with the Responsibilities of the Sponsoring Organization sections within this
MOU may result in termination of this Memorandum of Understanding and removal of the
AmeriCorps member(s) from the site.
2. The Washington Service Corps retains the authority to review and approve or disapprove all
subcontracts. For any proposed subcontractor the sponsoring organization shall:
a. Be responsible for subcontractor compliance with this Memorandum of Understanding and
attachments thereto.
b. Ensure that the subcontractor follows the Washington Service Corps' reporting formats and
procedures as specified by the Washington Service Corps.
2012-2013 WSC IP RFA Page 18
This Memorandum of Understanding clarifies the focus and intent of the joint working
relationship of mutual support, cooperation and coordination between the sponsoring
organization and the Washington Service Corps AmeriCorps program. By signing below
you agree to perform all actions and support all intentions of this Memorandum of
Understanding.
Legal Applicant: Peter B Lewis
ti n agettcy's Organizational Chart)
Signature: ✓ Date:07/16/2012
Legal Applicant signature
Project Supervisor. Sarah K. Miller
Signature: Date:07/16/2012
Pr 'ect Supervisor Ngnature
Site Supervisor•Same
Signature: Date:
Site Supervisor signature
Washington Service Corps:
Signature: Date:
Debbie Aoki,Director
or �Q / Q
Signature: G2 o ✓"�' Date: R' -7- 12
Erie kindvall,Director of Programs &Operations
The original signed Memorandum of Understanding will be filed at Employment Security Department.
We recommend you keep a copy for your records,until a fully-executed copy ds returned to you.
2012-2013 WSC IP RFA Page 19
ATTACHMENT A
Assurances and Certifications
ASSURANCES
As the duly authorized representative of the applicant, I certify,to the best of my knowledge and
belief, that the applicant:
• Has the legal authority to apply for federal assistance, and the institutional, managerial, and
financial capability(including funds sufficient to pay the non-federal share of project costs) to
ensure proper planning, management, and completion of the project described in this
application.
• Will give the awarding agency, the Comptroller General of the United States, and if
appropriate, the state, through any authorized representative, access to and the right to examine
all records, books, papers, or documents related to the award; and will establish a proper
accounting system in accordance with generally accepted accounting standards or agency
directives.
• Will establish safeguards to prohibit employees from using their position for a purpose that
constitutes or presents the appearance of personal or organizational conflict of interest, or
personal gain.
• Will initiate and complete the work within the applicable 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 prescribed standards for merit systems for programs funded under one of the
nineteen statutes or regulations specified in Appendix A of OPM's Standards for a Merit
System of Personnel Administration (5 CFR 900, Subpart F).
• Will comply with all federal statutes relating to nondiscrimination. These include but are not
limited to: Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits
discrimination on the basis of race, color, or national origin; (b) Title 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) Section 504 of the Rehabilitation Act of 1973, as
amended (29 U.S.C. 794), which prohibits discrimination on the basis of disability(d)The
Age Discrimination Act of 1975, as amended (42 U.S.C. 6101-6107), which prohibits
discrimination on the basis of age; (e)The Drug Abuse Office and Treatment Act of 1972
(P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f)The
Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act
of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse
or alcoholism, (g) sections 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C.
290dd-3 and 290ee-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 sale, rental or financing of housing; (i) any other
nondiscrimination provisions in the National and Community Service Act of 1990,as
amended; and Q) the requirements of any other nondiscrimination statute(s) which may apply
to the application.
• Will comply, or has already complied, with the requirements of Titles 11 and 111 of the Uniform
Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which
2012.2013 WSC iP RFA Page 110
provide for fair and equitable treatment of persons displaced or whose property is acquired as a
result of federal or federally assisted programs. These requirements apply to all interests in real
property acquired for project purposes regardless of federal participation in purchases.
• Will comply with the provisions of the Hatch Act (5 U.S.C. 1501-1508 and 7324-7328) which
limit the political activities of employees whose principal employment activities are funded in
whole or in part with Federal funds.
• Will comply, as applicable, with the provisions of the Davis-Bacon Act(40 U.S.0 276a and
276a-77), the Copeland Act (40 U.S.0 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 assisted
construction sub-agreements.
• Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of
the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires the recipients 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 following:
(a) institution of environmental quality control measures under the National Environmental
Policy 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.0 1451 et seq.); (f) conformity 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 Drinking 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).
• Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.0 1271 et seq.) related to
protecting components or potential components of the national wild and scenic rivers system.
• Will assist the awarding agency in assuring compliance 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 Archaeological and Historic Preservation Act of
1974 (16U.S.C. 469a-I 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. 89-544, as amended, 7
U.S.C. 2131 et seq.) pertaining to the care, handling, and treatment of warm blooded animals
held for research, teaching, or other activities supported by this award of assistance.
• Will comply with the Lead-Based Paint 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.
2012.2013 WSC IP RFA Page I I 1
• Will cause to be performed the required financial and compliance audits in accordance with
the Single Audit Act of 1984, as amended, and OMB Circular A-133, Audits of States, Local
Governments,and Non-Profit Organizations.
• Will comply with all applicable requirements of all other Federal laws, executive orders,
regulations, application guidelines, and policies governing this program.
CERTIFICATIONS
Certification—Debarment, Suspension, and Other Responsibility Matters
This certification is required by the government-wide regulations implementing Executive Order
12549, Debarment and Suspension, 2 CFR Part 180, Section 180.335, What information must I
provide before entering into a covered transaction with a Federal agency?
As the duly authorized representative of the applicant, I certify, to the best of my knowledge and
belief, that neither the applicant nor its principals:
• Is presently excluded or disqualified;
• Has been convicted within the preceding three years of any of the offenses listed in §
180.800(a) or had a civil judgment rendered against it for one of those offenses within
that time period;
• Is presently indicted for or otherwise criminally or civilly charged by a governmental
entity (Federal, State, or local)with commission or any of the offenses listed in §
180.800(a); or
• Has had one or more public transactions (Federal, State, or local) terminated within the
preceding three years for cause or default.
Certification —Drug Free Workplace
This certification is required by the Corporation's regulations implementing sections 5150-5160
of the Drug-Free Workplace Act of 1988 (P.L. 100-690), 45 CFR Part 2545,,Subpart B. The
regulations require certification by grantees, prior to award, that they will make a good faith
effort, on a continuing basis, to maintain a drug-free workplace. The certification set out below
is a material representation of fact upon which reliance will be placed when the agency
determines to award the grant. False certification or violation of the certification may be
grounds for suspension of payments, suspension or termination of grants, or government-wide
suspension or debarment(see 2 CFR Part 180, Subparts G and H).
As the duly authorized representative of the grantee, I certify, to the best of my knowledge and
belief, that the grantee will provide a drug-free workplace by-
A. Publishing a drug-free workplace statement that:
a. Notifies employees that the unlawful manufacture, distribution, dispensing,
possession, or use of a controlled substance is prohibited in the grantee's
workplace;
b. Specifies the actions that the grantee will take against employees for violating that
prohibition; and
2012-2013 WSC IP RFA Page 112
c. Informs employees that, as a condition of employment under any award, each
employee will abide by the terms of the statement and notify the grantee in writing
if the employee is convicted for a violation of a criminal drug statute occurring in
the workplace within five days of the conviction;
B. Requiring that a copy of the statement described in paragraph (A) be given to each employee
who will be engaged in the performance of any Federal award;
C. Establishing a drug-free awareness program to inform employees about:
a. The dangers of drug abuse in the workplace;
b. The grantee's policy of maintaining a drug-free workplace;
c. Any available drug counseling, rehabilitation, and employee assistance programs;
and
d. The penalties that the grantee may impose upon them for drug abuse violations
occurring in the workplace;
D Providing us, as well as any other Federal agency on whose award the convicted employee
was working, with written notification within 10 calendar days of learning that an employee
has been convicted of a drug violation in the workplace;
E. Taking one of the following actions within 30 calendar days of learning that an employee
has been convicted of a drug violation in the workplace:
a. Taking appropriate personnel action against the employee, up to and including
termination; or
b. Requiring that the employee participate satisfactorily in a drug abuse assistance or
rehabilitation program approved for these purposes by a Federal, State, or local
health, law enforcement, or other appropriate agency;
F Making a good faith effort to continue to maintain a drug-free workplace through
implementation of paragraphs (A)through (E).
Certification - Lobbying Activities
As required by Section 1352, Title 31 of the U.S. Code, as the duly authorized representative of
the applicant, I certify, to the best of my knowledge and belief, that:
• No federal appropriated funds have been paid or will be paid, by or on behalf of the
applicant, to any person for influencing or attempting to influence an officer or
employee of any agency, a member of Congress, an officer of Congress in connection
with the awarding of any federal contract, the making of any federal loan,the entering
into of any cooperative agreement, or modi fication of any federal contract, grant, loan,
or cooperative agreement;
2012.2013 WSC IP RFA Page 113
• 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 applicant will submit Standard Form-LLL, "Disclosure
Form to Report Lobbying," in accordance with its instructions;
• The applicant will require that the language of this certification be included in the
award documents for all subcontracts at all tiers (including subcontracts, subgrants, and
contracts under grants, loans and cooperative agreements) and that all subrecipients
will certify and disclose accordingly
Erroneous certification or assurance
The assurances and certifications are material representations of fact upon which we rely in
determining whether to enter into this transaction. If we later determine that you knowingly
submitted an erroneous certification or assurance, in addition to other remedies available to the
federal government, we may terminate this transaction for cause or default.
Notice of error in certification or assurance
You must provide immediate written notice to us if at any time you learn that a certification or
assurance was erroneous when submitted or has become erroneous because of changed
circumstances.
Definitions
The terms"debarment', "suspension', "excluded", "disqualified", "ineligible", "participant',
"person", "principal", "proposal', and "voluntarily excluded"as used in this document have the
meanings set out in 2 CFR Part 180, subpart I, "Definitions." A transaction shall be considered a
"covered transaction" if it meets the definition in 2 CFR part 180 subpart B, "Covered
Transactions."
Assurance requirement for subgrant agreements
You agree by submitting this proposal that if we approve your application you shall not knowingly
enter into any lower tier covered transaction with a person who is debarred, suspended, declared
ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized
by us.
Assurance inclusion in subgrant agreements
You agree by submitting this proposal that you will obtain an assurance from prospective
participants in all lower tier covered transactions and in all solicitations for lower tier covered
transactions that the participants are not debarred, suspended, ineligible, or voluntarily excluded
from the covered transaction.
Assurance of subgrant principals
You may rely upon an assurance of a prospective participant in a lower-tier covered transaction
that is not debarred, suspended, ineligible,or voluntarily excluded from the covered transaction,
unless you know that the assurance is erroneous. You may decide the method and frequency by
which you determine the eligibility of your principals. You may, but are not required to, check the
List of Parties Excluded from Federal Procurement and Nonprocurement Programs.
2012-2013 WSC IP RFA Page 114
Non-assurance in subgrant agreements
If you knowingly enter into a lower tier covered transaction with a person who is suspended,
debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to
other remedies available to the federal government, we may terminate this transaction for cause or
default.
Prudent person standard
Nothing contained in the aforementioned may be construed to require establishment of a system of
records in order to render in good faith the assurances and certifications required. Your
knowledge and information is not required to exceed that which is normally possessed by a
prudent person in the ordinary course of business dealings.
ASSURANCES AND CERTIFICATIONS
By signing below you certify
1 that you agree to perform all actions and support all intentions in the Assurances Section; and,
2. that you agree to perform all actions and support all intentions in the Certification Sections of
this application. The three Certifications include:
■ Certification: Debarment, Suspension and Other Responsibility Matters
• Certification: Drug-Free Workplace
■ Certification: Lobbying Activities
Organization Name: City of Auburn
Project Name: City of Auburn Disaster Educator
Sarah K. Miller Emergency Preparedness Manager
Name Title
07/16/2012
ignat re Date
2012-2013 W SC IP RFA Page 115
CwroratWn w IZOL Hav YtRk Avaua,hVf
NATIMAL& walb �mn ce2g525
COMMMUNITY zoz-cass000
SEROCEE� NaabnalselvlcaeoY
Grant Program Civil Rights and Non-Haragement Policy
The Corporation for National and Community 9srvico(CNCS)has zero tolaronce for the harassment
of any individual or group of Individuals for any reason. CNCS Is committed to troalbn&all poisons
with dignity and mspeck CNa prohibits all forms of discrimination based upon race,color,national
origin,gender, age, religion,sexual arientatiory disability,gender identity or expression,political
affiliation,marital or parental status,or military sorvlca All programs administered by,or receiving
Federal financial ossistancefrom CNC S,mwtbefrttfromaU loans o/harasmenl, Wholherin CNCS
offices or campuses,in other servke.mhtled settings such as training sessions or service sites,or at
service-related social events,such harassment is unacceptable. Any such harassment,if found,will
result In Immediate co;mcdva action, up to and Including removal or termination of any CNCS
employee or volunteer. Recipients of Federal financial assistance,be they Individuals,organizations,
programs and/or projects we aiso subject to this Taro tolerance policy. Where a violation is found,
and subject to regulatory procedures,appropriate corrective action will be taken,up to and Including
termination of Federal financial asilstallce from fiff Federal sources.
Slurs and other verbal or physical conduct relating to an individual's gender,race,ethnicity,religion,
sexual orientation.or any other basis constitute harassment when It has the purpose or effect of
interfering with service performance or creating an intimidating, hoatie,.or offensive service
environment. Harassment includes, but Is not nailed to:explicit or Implicit demands for sexual
favors;pressure for dates;deliberate touching,loaning over,or cornering;offensive toiing,jokes,
remarks,or questions;letters,phone calls,or distribution or display of offensive materials;offensive
lcoks or geslums;gender,racial,¢Nude,or religious baiting;physical assaults or other threatening
behavior,or demeaning,debasing or abusive comments or actions that intimidate.
CNCS does not relocate harassment by anyone including persons of the same or different races,sexes,
religions,or ethnic origin:,or.fmm a CNICS employee or supervisor,a project,or site employee or
supervisors,rwn-employee(e.g.,client);a co-worker orservice member.
I expect supervisors and managers of CNCS programs and projects,when made aware of alleged
harassment by employees,service participants,or other individuals,to immediately take swift and
appropriate action. CNCS will not tolerate retalinflon against a person who raises harassment
concerns In good faith. Any CNCS employee who violates this policy will be subject to discipline,up
to and Including terminalion,and any granlce that permits harassment in violation of this policy will
be subject to a finding of non<ormplianoe and administrative procedures that may result In
termination of Federal fmandal assistance from CNCS and all other Federal agencies.
Any perm who believes that he or she has been discriminated against In violation of civil rights laws,
regulations, or this policy, or In retaliation toy opposition to discrimination or participation In
discrimination complaint proceedings(mg.,as a complainant or wiuwss)in any CNCS program or
project may raise his or her concerns with our Office of Civil Rights and inclusiveness(OCRQ.
Discrimination claim:not brought to the attention of OCRI within 45 days of their occurrence may not
beacmpted in a fomal complaint of disaimime om No one mn be requirod to use a program,pm)ect
or sponsor dispute resolution procedure before contacting OCRI. If another procedure is used,Itdoes
not affect the 45.day time fimit OCRI may be reached at(202)606.2503(yoke),(202)6063472(1-M,
eo%cm.eov,or through w vw.nadonaservka.cov.
5/15/2012 0
Dale Weudybpen ' Iaf Execvtive Officer
WSASIERSOtvICES I ECOROVACOPPORTIUM I EDUCATION 1 EHVlRINMfN1ALSTEIYAROSNIP I REALTIIYMURES I VEFERARSAROHRITARY FAMRk3
ANERICORPS I SENIOR CORPS 1 SOCIAL.IHHOVATtOH FUND
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