HomeMy WebLinkAboutC2005-024 - 2/8/2005 - Approved~'BEYERAeEI
ENFORCING THE UNDERAGE DRINKING LAWS
GRANT APPLICATION COVERSHEET 2005
1 Legal name of organization applying: City of Corpus
~hri~ti
8 Trtle of Project: Eni'orcinq the Underage Ddnkinu Laws
2 Division or unit within the applicant organization to
administer the project: Police Department
9 Funding applied for~
Enfomlng ~he Underage Drlnldng Lav~ (84000 & 8~)
~A ~ f~727
3. Official applicant mailing address: (if a PO Box,
p~ese atso Jst ~ a~ernaOve phys/ca/address )
4. P.O. BOX 9010. 321 John Sartain
5. Corpus Christi. Texas 78469
10. Grant Period:
June '1, 200~ - May 31, 2006 (12
4 Person TABC should contac~ to answer specific
questions about the application:
Name: Pat P. Eldridqe
Title: Police Administration ManaQer
Address: P, O. Box 9016
Axidress: Corous Christi, Texas 78469
Telephone Numbe~ 361-88~-269~
Fax: 3~1-~86-2607
E-mail: [~at~cctexas.com
5. Total Fundim:j Requested;
TABC ReQuest + A~encv Match = To~ql Cost
$ 49,998 + $ 23.800 = $ 73,798
11. County wflere headquarters are based: Hu~
Population of the county where headquarters are based:
Nueces
CRies and counties m the ea~ces area of the prcYject and
the population of each: Comu~ Chdsti 275,000
12. Is this a continuation grerfO no
Ii: so, how many years has it been previously ~unded?
6. ,~ency's State Payee/Employer identification Numbe~
74-(IO00-574-1
7. Is the applicant delinquent on any state or federal debt?
Yes [] No []
13. If this is a local or regional project, list regional COG
submitted to: Coastal Bond Council of Governments
14. COG Applicant Id~n~t~ __
15. If the project is statew~de, on what date was the copy of
the application subm~ed for TRACS Review? 07,./15/05
TABC
........... -II information in this application is true and correct The application has bean duly
200~-024 the applicant and t~ appllcant agrees to comply with all TABC rules, including the
02/08/05/,~ /
Res026132 ///~,.__~ ~'..~/I 0 0 ~'
iota. ed ?' S~na~re of t?Fe Aathortzed
Date
S~gned
Official
DesiqnaUon of Grant Officials
Project Ti'de: Enforcing Underage Ddnking Laws
Legal name of Grantee: City of Corpus Chdsti
Prolect Director
[] Mr. [] Mrs.
P. Alvarez, Jr.
Project Director Name (Type or Pdnt)
P. O. Box 9016, Coq~s Christi, Texas 78469
Agency Mailing Address
palvarez~cctexas.com
E-Mail Address
361-886-2604
Telephone Number (Extension)
Chief of Police
Title
361-886-2607
Fax Number
FinancMI Officer
[] Mr. [] Mrs.
Cindy O'Bden
Financial Officer Name ('Type or Print)
P. O. Box 9277, Corpus ChdstJ, Texas 76469
Agency Mailing Address
cindyoi~cctexas.com
E-Mail Address
361-880-3804
Telephone Number (Extension)
Finance Director
Title
361-880-3601
Fax Number
Author/zeal Off/c/a/
[] Mr. [] Mrs.
George K. Noe
Authorized Official Name (Type or Pdnt)
P. O. Box 9277, Corpus Chdsti, Texas 78469
Agency Mailing Address
Georgen~cctexas.com
E-Mail Address
361-880-3208
Telephone Number (Extension)
City Manager
Title
361-8~0-3839
Fax Number
The position designated by the autho~zed official to request grant adj~,,,ents Is [he (select one):
[] Financial Officer [] Project Director
FEDERAL ASSURANCES
COMPREHEN~IVECER~RCA~ON
This cerlitlcation is a material representation of fact upon which reliance was placed with the agency determined
to award the grant. I[ it is later determined that the grantee knowingly rendered an erroneous certification, the
agency, in addition to any other remedies available to the federal government, may take available action.
If this application is for federal funds in excess of $100,000, I certi~' to the best of my knowledge and belief:
1. No federal appropriated funds have been paid or will be paid to any parson for influencing or attempting to
influence an officer or employee of any agency, a member o[ Congress, an officer or employee of Congress, or
an employee of a member of Congress in connection with the awarding of any federal contract, the making of
any I'nderal grant, the making of any federal loan, the entering into any cooperative agreement, and the
extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative
agreement;
2. If any non-federal funds have been paid or will be paid to any parson I~or 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 undemigned shall contact TABC or your local council of governments for tbe 'Disclosure Form to
Report Lobbying," and
3. The undemigned shall require thai the language of this certificatJon be included in the award documents for all
sub-awards at all tiers and that all sub-racipleots shall certify accordingly.
If this appilcation is for federal funds, I cerafy that to the best of my knowledge and belief:
1. The applicant certifies that it will provide a drug-frae wort(place by:
A. Publishing a statement notifying employees that the unlawful manu[acture, distribution, dispanslng,
possession, or use of a controlled substance is prohibited in the grantee's wodq~ace and specifying the
actions that will be taken against employees for violation of such prohibition.
B.Establishing a drug-free awareness program to inform employees about:
1. Ihe dangers of drug abuse In the workplaco;
2. the applicant's policy of mainl, alning a drug-frae workplace;
3. any available drug counsatlng, rahabilitaUon, and employee assistance programs; and
4. the penalties that may be imposed upon employees for drug abuse violations.
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. Notifying the employee In the statement r~luimd by paragraph that, as a condition of employmenl under
the grant, the employee will:
1. abide by the terms of the statement, and
2. notify Ihe employer of any criminal drug statute conviction for a violation occurring in the wonV, place
not later than five days after such conviction.
E. Notifying the agency within ten days after receiving notice under subparagraph (D)(2) Eom an employee
or
othenmse receiving actual notice of such conviction.
F. Taking one of the following actions wffh respect to any employee who is so convicted:
(P~3e 2 Feo~'al Assurances: Comprehensive Cer~c.a~n)
1. taking appropriate personnel action against such an employee, up to and including termination; or
2. requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation
program
approved i'or such purposes by a tederal, state, or local health, law enforcement, or other appropriate
agency.
Making a good faith effort to continue to maintain a drug-I=ree workplace through lhe implementation of
paragraphs (A), (B), (C), (D), (E), and (F)
Enforcing Underage Drinldng Laws
Project Title
City of Corpus Chdsti
Applicant Organization
George K. Noe, City Manager
Pdnted I~
Sigr~ur~
and Title of Authorized Official
, Authorized Official
Date
(Pag~ 3 Federal Assurances: Additional Certlflcatfons)
PART I-IV (ADDmONAL FEDERAL CERTIFICATIONS)
PART I: AUDIT CERTIFICATION -ANNUAL REPORTING REQUIREMENT
Audits of state and local units of government, institutions of higher education, and other non-profit institutions
must comply with the organizational audit requirements of OMB circular A-133, which states that recipients who
expend $500,000 or more of federal funds during their fiscal year are required to submit an organization-wide
financial and compilance audit report within 9 months after the close of each fiscal year during the term of the
award to the Federal Audit Clearinghouse.
I cerfffy one of the following (initial one only):
[] The applicant agency cun'ently expends federal I~undlng ot $500,000 or more and, therefore, Is required to
submit an annual single audit by an independent auditor made in accordance with Ihe Single Audit Act
Amendments of 1996 and OMB Cimular A-133.
[] The applicant agency currently expends combined federal funding of less than $500,000 and therefore is
exempt from the Single Audit Act and cannot charge audit costs to this grant. I undem-'tand, however, that TABC
may require a limited scope audit as defined in OMB Circular A-133.
PART I1: EQUAL EMPLOYMENT OPPORTUNITY PLAN
To IdenUfy your type of organlza~on, please Inlffal one of the fotlowfng:
Type I Entity
EducationaUmedical/non-pmfit institution/Native Amedcan Tdbe -certificalion required (initial below); EEOP
NOT redulmd.
[] I certify this organization is a Type I Entity. This e~tity will comply with the prohibitions against discrimination
in any program or activity (28 CFR § 42.203), is not required to maintain an Equal Employment Opportunity Plan
(EEOP), but will comply with equal employment opportunity program guidelines of the Department of Health and
Human Services (28 CFR 42.302).
[] I am unable to certify the above statement and have attached an explanation to this application.
OR
Type II Emlty
All other recipients receiving less than $25,000 -certification required (initial below); EEOP NOT required.
[] I certify this organization is a Type II Entity. This entity will comply with the prohibitions against discrimination
in any program or activity (28 CFR § 42.203), but Is not required to maintain an EEOP (28 CFR42.301 et seq.).
OR
(Page 4 Federal Assurances: Additional Certifications)
Type III Entity
All other recipients receiving more than $25,000, but not more than $500,000 -certification required (initial
below); organizations must maintain EEOP on tile for possible audit If the organization has more than 50
employees.
[] I certify this organization is a Type III Entity that employs less than 50 peoplel This entity will comply with the
prohibitions against discrimination in any program or activity (28 CFR § 42.203), but is not required to maintain
an EEOP (28 CFR 42.301 et seq.);
[] I caritfy this organization is a Typo III Entity that employs 50 or more poople. This entity will comply with the
prohibitions against discrimination in any program or activity (28 CFR § 42.203), and has formulated an equal
employment opportunify program (28 CFR 42.301 et seq.), that is on file in the office of
(insert organization name here).
OR
Type IV Entity
For-praffi entities and state and local governments receiving $500,000 or more -certification required (Initial
below); the organization must submit an EEOP to Office i~or Civil Rights (OCR) for approval.
[] I certify this organization is a Type IV Entity. This entity will comply with the prohibitions against
discrimination in any program or activity (28 CFR § 42.203), and has formulated an equal employment
opportunity program (28 CFR 42.301 et seq.), that will be submit'led to the Office for Civil Rights, Office of
Justice Programs, Department of Justice, for approval upon award of a grant.
PART Ill: DEBARMENT CERTIFICATION~ANNUAL REPORTING REQUIREMENT
If this appllcadon is for federal funds In exr,=cc of $15,000, I certify that (inWai one only):
[] By submission ol~ this proposal, that neither the applicant agency nor its principals are presently debarred,
suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this
transaction by any federal department or agency.
[] I am unable to certify the above statement and have attached an explanation to this application.
(Page 5 Federal Assurances: A~al Certil~-'a~fons)
PART IV: SIGNATURE
Applicants must complete this form and submit it to TABC before they will receive state and/or federal funds.
Recipients of federel ~unds must fully undem-'tend and comply with the requirements listed on this document.
Failure to compiy may result in the withholding of funds, termination of the award, or olher sanctions.
Enforcing Underage Drinldng Laws
Project Title
City of Corpus Chdsti
Applicant Organization
George K. Noe, City Manager
Pdnted Name and Title of Authorized Official
Date
STATE ASSURANCES
($~u Uniform Admin~D-~tlve Requlremen~ for Grants and Coope~,~Uve Agreement, Sul.)p~rt B, Pre-
Award Requirements, Sec. . f4. Januaw 200~1)
In addition to federal requirements, state law requires a number of assurances from applicants for federal pass-
through or other s-tare-appropriated funds. These assurances are as follows:
(1) A grantee must comply with Texas Government Code, Chapter 573, Vemon's 1994, by en~dng that no
officer, employee, or member of the applicant's geveming body or of the applicant's contractor shall vote or
confirm the employment of any person related within the second degree o1: affinity or the third degree
consanguinity to any member of the governing body or to any other officer or employee authorized to employ or
supervise such person. This prohibition shall not prohibit the employment of a person who shall have been
continuously employed for a period of two years, or such other period stipulated by local law, pflor to the
election or appointment ol~ the officer, employee, or governing body member related to such person in the
prohibited degree.
(2) A grantee mum insure that all iol'ormation collected, assembled or maintained by the applicant relative to a
project will be available to the public dudng normal business hours in compliance with Texas Government Cede,
Chapter 552, Vemon's 1994, unless otherwise expressly prohibited by law.
(3) A grantee must comply with Texas Government Cede, Chapter 551, Vemon's 1994, which requires all
regular, special or celled meeting of governmental bodies to be open to the public, excep~ as otherwise previded
by law or specifically permlUed In the Texas Constitution.
(4) A grantee must comply with Section 231.006, Texas Family Code, which prohibits payments to a person who
is in an-ears on child support payments.
(5) No health and human services agency or public safety or law enforcement agency may contract with or issue
a license, certificate or permit to the ovmer, operator or administrator of a facility if the license, permit or
certificate has been revoked by another I~alth add human services agency or public safety or law enforcement
agency.
(6) A grantee that is a law enforcement agency regulated by Texas Government Code, Chapter 415, must he in
compliance with all rules adopted by the Texas Commission on Law Enforcement Officer Standards and
Education pursuant Io Chapter 415, Texas Government Code or must provide the grantor agency with a
certil~cation from the Texas Commission on Law Enforcement Officer Staddards and Education that the agency
is in the p¢ocess of achieving compliance with such rules.
(7) When incorporated into a grant award or contract, standard assurances contained in the application package
become terms or conditions for receip¢ ot'granl funds. Administering state agencies and local sub recipients
shall maintain an approp~-iate contract administration system to insure that all terms, conditions, and
specifications are mat. (See Section .38 for additional guidance on contract provisions.)
(8) A grantee must comply with the Texas Family Code, Section 2~1.101 which requires reporting of ail
suspected cases of child abuse to local law enl~orcement authorities and to the Texas Department of Child
Protective and Regulatory Services. Grantees shall also ensure that all program personnel are propedy trained
and aware of this requirement.
(9) Grantc, c= will comply with all federal slatutes relating to nondiscrimination. These include but are not limited
to: (a) Title VI of the Civil Rights Act of 19~4 (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 1685-1888), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation
ACt o[ 1973, as amended (29 U.S.C. § 794), which prohibits discrimination on the pasts ot handicaps and the
Americans With Disabilities ACt of 1990; (cl) the Age Discrimination Act of 1974, as amended (42 U.S.C. §§
6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act o1'
1972 (P.L. 92-255), es amended, relatleg 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 the noddiscrimlnatlon on the basis of alcohol abuse or alcoholism; (g) §§ 523 and
(Page 2 State Assunmces)
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; th) '13tle 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; (]) any
other nondiscrimination provisions in the specific statute(s) under which application for federal assistance is
being made; and (j) the requirements of any other nondiscrimination statute(s) which may apply to the
application
(10) Grantees 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 [or federally assisted construction sub
agreements.
(11) Grantees will cemply with requirements of the pmvis~ons of the Uniform RelocaUon Assistance and Real
Property Acquisitions Act of 1970 (P. L. 91-846) which 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.
(12) Grantees will comply with the provisions of the Hatch Political Activity Act (5 U.S.C. § 7321-29) which limit
the political activity of employees whose principal employment activities are f~nded in whole or in part with
tederel funds.
(13) Grantees will comply with the minimum wage and maximum hours provisions of the Federal Fair Labor
Standards Act and the Intergovernmental Personnel Act of 1970, as applicable.
(14) Grantees will Insure that the facilities under its ownemhip, lease or supewision which shall be utilized in the
accomplishment of the project are not listed on the Environmental Protections Agency's (EPA) list of V~olating
Facilities and that if will notlty the federal grantor agency of the receipt of any communication from the Direotor
of the EPA Office of Federal Activities indicating that a facil~ to be used in the project is under consideration for
listing by the EPA (EO 11738).
(I 5) Grantees will comply with the flood Insarance purchase requirements of 102(a) of the Flood Disaster
Protection Act of 1973, Public Law 93-234. Section 102 (a) requires the purchase of flood insurance in
communities where such insurance is available as a condition for the receipt of any federal financial assistance
for construction or acquisition proposed for use In any area that has been identified by the Secretary of the
Department of Housing and Urban Development as an area having si3eclal flood hazards.
(16) Grantees will comply with envlronmemal standards which may be proscribed 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 ol' project consistency with the approved state management program developed under
the Coastal Zone Management ACt of 1972 (16 U.S.C. §§ 1451 et .seq.); (r) conformity of federal actions to State
(Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.$.C. §
7401 et seq.); (g) protect/on of underground sources of drinking water under the Safe Drinking Water ACt of
1974, as emended (P.L. 93-523); and th) proteotion of endangered species under the Endangered Species Act
of 1973, as amended, (P.L 93-205).
(17) Grantees will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. §§ 1271 et seq.) related to
protecting components er potential compunerds of the national wild and ,scenic dvers system.
(18) Grantees wltl assist the awarding agency in assudng compliance with Section 106 of the National Histodc
Preservation Act of 1966, as amended (16 U.S.C. 470), EO 11593 (identification and protection of histodc
properties), and Ihe Archaeological and Historic Preservation ACt of 1974 (16 U.S.C. 4698-1 et seq.).
(Page 3 State Assurances)
(19) Grantees 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 core, handling, and treatment of warm blooded animals held for research,
teaching, or other activities supported by this award of assistance.
(20) Grantees will comply with the Lead-Based Pain[ Poisoning Prevention Act (42 U.S.C. §§ 4801 et seq.)
which prohibits the use of lead-based paint in construction or rehabilitation of residential structures.
(21) Grantees will comply with Public Law 103-277, also known as the Pm-Children Act of 1994 (Act), which
prohibits smoking within any portion of any indoor facility used for [he provision of services for children as
deigned by the Act.
(22) Grantees will comply with all federal tax laws and are solely responsible for filing all required state and
federal tax forms.
(23) Grantees will comply with all applicoble requirements of all other federal and state laws, executive orders,
regulations and policies govemlng this program.
(24) The applicant must certify that they are not debarred or suspended or otherwise excJuded from or ineligible
for parlicipation in federal assistance programs.
(25) Grantees must adolX and implement applicable provisions of the model HIV/AIOS work place guidelines of
the Texas Department of Health as required by the Texas Health and Safety Cede, Ann., Sec. 85.001, et seq.
STATE S~NOLE POINTS OF CONTACT/LOCAL COUNCIL OF GOVERNMENTS
Executive On:let 12372 requires appliconts from state and loc, al units of government or other organizations
providing services within a state to submit a copy of the appllcotion package to the State Single Point of Contact
(SPOC). Locol units of govemment applying for a state grant should submit a copy of the appllcotion package
[o their local Council of Government (COG) for review.
SIGNATURE:
Appllconts must complete this form and submit it to TABC before they will m~,,eive federal funds.
Recipients of federal funds must fully understand and comply with the requirements listed on this document.
Failure to comply may result in the withholding of funds, termination of the award, or other sanctions.
Enforcing Underage Drinking Laws
Project Title
City of Corpus Chdstl
Applicont Organization
George K. Noe, City Manager
Pdnted Name and Ti'de of Authorized Official
Date
Non-Profit Information Form
Part h Initial Reporfinq Requirements
The following information regarding the non-profit corporatio.n is required from each non-profit
corporation applying for a TABC grant.
· Year in which the corporation was
founded:
· Date that the IRS letter granted 501 (c)(3) tax exemption
status:
· Employer Identification Number assigned by the
IRS:
· Charter number and the date assigned by the Texas Secretary of State:
Charter No: Date:
· Attach the IRS 501 (c)(3) letter
Part I1: Identifvirm Omanizational Information
In the space provided below, state the purpose of the organization as stated in the
Articles of Incorporation or the Bylaws:
If any member of the board is related to one another or an employee of the non-profit
corporation, so indicate explaining the relationship:
Part II1: Si.nature Paoe
All non-profit corporations applying for TABC grant funds that have not previously received a
TABC grant must submit a Non-Profit Information Form, Accounting System and Financial
Capability Questionnaire, and most recent financial statements (as requested in the
Accounting System and Financial Capability Questionnaire), with the application. Failure to
comply may result in denial of the grant award.
Project Title
Applicant Oq~anlzation
Pdnted Name and Title of Authorized Official
Signature of the Authorized Official Date
ACCOUNTING SYSTEM AND FINANCIAL CAPABILrFY QUESTIONNAIRE
SECTION A: PURPOSE
The financial responsibility of grantees must be such that the grantee can properly discharge
the public trust, which accompanies the authority to expend public funds. Adequate
accounting systems should meet the following criteria as outlined in the "Uniform Grant
Management Standards (UGMS), OMB "Common Rule" and OJP manual, "Financial and
Administrative Guide for Grants."
2,
Accounting records should provide information needed to adequately identify the
receipt of funds under each grant awarded and the expenditure of funds for each
grant. These records must contain information pertaining to grant or sub grant awards
and authorizations, obligations, unobligated balances, assets, liabilities, outlays or
expenditures, and income.
Entries in accounting records should refer to subsidiary records and/or documentation
which support the entry and which can be readily located.
The accounting system should provide accurate current financial reporting information.
The accounting system should be integrated with an adequate system of internal
controls to safeguard the funds and assets covered, check the accuracy and reliability
of accounting data, provide operational efficiency, and encourage adherence to
prescribed management policies.
copy; otherwise, complete the following items:
a. VVhen was the organization founded/incorporated?
b. Financial Officer and Title:
Section B: General
If your organization publishes a general information pamphlet setting forth the history,
purpose and organizational structure of your business, please provide this office with a
month day year
c. Employer Identification Number
d. Number of Employees: (Full time Part time )
2. Is the organization affiliated with any other organizations? [] YES [] NO (choose one) If
"yes", provide details:
Total Revenue in the most recent accounting period, (12 months) $
(Page 2 Accounting System ~ Financial Requirements)
SECTION C: ACCOUN'rlN~ SYSTEM
Choose the appropriate response: YES NO (or N/A If available)
Has any government agency rendered an official written opinion concerning the
adequacy of the accounting system for collection, identification, and allocation of costs
under federal contracts/grants? [] YES [] NO
a. If yes, provide name and address of agency providing review, and attach copy of the
official written opinion:
Nots: If the review occurred within the past three years, omit questions 2 - 9 of this
Section and Section D.
Choose the appropriate response:
2. Which of the following best describes your accounting system?
[] Manual [] Automated or [] Combination
Does your organization use a double-enb-y system in accounting for project funds?
[] YES [] NO or [] N/A
Does your accounting system identify the receipt and expenditures of project funds
separately for each contractJgrant?
[] YES [] NO or [] N/A
Does your accounting system provide for the recording of expenditures for each grant
contract by the component project and budget cost categories shown in the approved
budget?
[] YES [] NO or [] NIA
Are time distribution records maintained for an employee when his/her efforts can be
specifically identified to a particular cost objective?
[] YES [] NO or [] N/A
If your organization proposes an overhead rate, does the accounting system provide for
the segregation of direct and indirect costs?
[] YES [] NO or [] N/A
Does your accounting/financial system include budgetary controls to preclude incurring
obligations in excess of:
a. Total funds available for the grant?
[] YES [] NO or [] N/A
b. Total funds available for a budget cost category (e.g Salaries, Travel, etc.?)
[] YES [] NO or [] N/A
Is your organization generally familiar with existing regulations and guidelines containing
the cost principles end procedures for the determination and allowance of costs in
connection with awarded contracts/grants?
[] YES [] NO or [] N/A
(Page 3 Accounting System and Financial Requirements)
Section D: Fund Control
Choose the appropriate response: YES NO
1. Is a separate bank account maintained for grant/contract funds?
[] YES [] NO
If grant/contract funds are commingled with organization funds, can the grant funds and
related costs and expenditures be readily identified?
[] YES [] NO
3. Are the officials of this organization bonded? [] YES [] NO
Section E: Financial Statements
Choose the appropriate response: YES NO (or NIA if available)
Has an independent certified public accountant (CPA) examined your financial
statements?
[] YES [] NO
2. If an independent CPA review was performed, attach a copy of their latest report along
with any management letters issued and your responses.
If an independent CPA was engaged to perform a review and no report was issued,
please provide details and an explanation below:
If an independent CPA has never examined your financial statements, please develop
and provide this office with a copy of the following statements:
a. a detailed "Balance Sheet" for the most current and previous year;
b. a detailed "Income Statement" for the most current and previous year; and the
c. "Notes to the Financial Statements" for the most current and previous year.
Section F: Additional Information
USE THIS SPACE FOR ANY ADDITIONAL INFORMATION (Indicate Section and Item
numbers if a continuation or attach additional pages)
(Page 4 Accounting System and Financial RequYements)
SECTION (~: APPUCANT CERTIFICATION
I CERTIFY THAT THE ABOVE INFORMATION IS COMPLETE AND CORRECT TO THE
BEST OF MY KNOWLEDGE:
Typed Name:
Signature:
Organization Name:
Address:
Title:
Telephone Number:
CONFIDENTIAL FUNDS
Any applicant requesting purchase of evidence funds must read the conditions for
confidential funds as set forth in the effective edition of OJP's Financial Guide, These
conditions are available in the Appendix of this application kit or at the following website:
http:llwww.ojp.usdoj.(iovlFinGuidelpart3-ch8.htrnS~vrittenprocedures
Please complete and return the following certification once these conditions are read. Failure
to submit this certification by applicants requesting purchase of evidence funds may result in
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Date: -~'/ /
Project Director Signature: ~- ~.....-~.-.._~
Organization: City of Corpus Christi
Project Title: Enforcing Underage Drinking Laws