Backup Documents 12/13-14/2011 Item #16D 2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLI1I 6D 2
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper.Attach to original document.Original documents should be hand delivered to the Board Office.The completed routing slip and original
documentc are to he forwarded to the Roard Office only after the Rnard hac taken action on the item 1
ROUTING SLIP
Complete routing lines#1 through#4 as appropriate for additional signatures,dates,and/or information needed.If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#4,complete the checklist,and forward to Ian Mitchell(line#5).
Route to Addressee(s) Office Initials Date
(List in routing order)
1. Ian Mitchell BCC Office A�`- 1 Z(1 44
2.
6. Minutes and Records Clerk of Court's Office M 1,2 r lq(I i
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval.Normally the primary contact is the person who created/prepared the executive
summary.Primary contact information is needed in the event one of the addressees above,including Ian Mitchell,need to contact staff for additional or missing
information.MI original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the
item.)
Name of Primary Staff Wendy Klopf Phone Number 252-2901
Contact Operations Coordinator
Agenda Date Item was December 13,2011 Agenda Item Number 16D2
Approved by the BCC
Type of Document Certifications&Resolution DV\ Number of Original 6
Attached O���`` Documents Attached
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Original document has been signed/initialed for legal sufficiency.(All documents to be WK
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.This includes signature pages from ordinances,
resolutions,etc. signed by the County Attorney's Office and signature pages from
contracts,agreements,etc.that have been fully executed by all parties except the BCC
Chairman and Clerk to the Board and possibly State Officials.)
2. All handwritten strike-through and revisions have been initialed by the County Attorney's WK n/a
Office and all other parties except the BCC Chairman and the Clerk to the Board
3. The Chairman's signature line date has been entered as the date of BCC approval of the WK
document or the final negotiated contract date whichever is applicable.
4. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's WK
signature and initials are required.
5. In most cases(some contracts are an exception),the original document and this routing slip WK
should be provided to Ian Mitchell in the BCC office within 24 hours of BCC approval.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified.Be aware of your deadlines!
6. The document was approved by the BCC on 12/13/11 and all changes made during WK Isi/,4 is not
the meeting have been incorporated in the attached document.The County Attorney's ah option for
Office has reviewed the changes,if applicable.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05
160 2
MEMORANDUM
Date: December 20, 2011
To: Wendy Klopf, Operations Coordinator
Housing & Human Services
From: Martha Vergara, Deputy Clerk
Minutes & Records Department
Re: CPMP Non-State Grantee Certification (3)
& Resolution 2011-219 (2-Original, 1-Certified)
Attached are the three (3) original certifications, one (1) certified resolution & (2)
original resolutions referenced above, (Item #16D2) approved by Board of County
Commissioners on Tuesday, December 13, 2011.
Forward a fully executed original to the Minutes & Records Department, where it
will be kept as part of the Board's Official Records.
If you should have any questions, please contact me at 252-7240.
Thank you.
160 2
RESOLUTION NO. 2011 - 219
A RESOLUTION BY THE BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY, FLORIDA, APPROVING FISCAL YEAR 2010-2011
CONSOLIDATED ANNUAL PERFORMANCE AND APPRAISAL
REPORT (CAPER) FOR THE COMMUNITY DEVELOPMENT BLOCK
GRANT (CDBG), HOME INVESTMENT PARTNERSHIP (HOME) AND
EMERGENCY SHELTER GRANT (ESG) PROGRAMS AS REQUIRED
BY THE U.S. DEPARTMENT OF HOUSING AND URBAN
DEVELOPMENT (HUD), AND AUTHORIZING THE CHAIRMAN OF
THE BOARD OF COUNTY COMMISSIONERS TO CERTIFY THE
CAPER FOR SUBMISSION TO HUD.
WHEREAS, HUD requires all entitlement communities to prepare a Consolidated
Annual Performance and Evaluation Report (CAPER) annually to determine whether the
recipient of HUD funds is in compliance with federal statutes and has the capacity to implement
and administer these programs; and
WHEREAS, the CAPER provides a comprehensive review of the progress being made
toward meeting overall goals and objectives identified in the Five-Year Consolidated Plan and
One-Year Action Plan; and
WHEREAS, the purpose of the CAPER is to demonstrate how federal funds are being
expended within very low to moderate-income communities;
NOW, THEREFORE BE IT RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA, that based upon representations
from staff that the information contained in the CAPER is accurate and reflects the activities
actually accomplished during the reporting period, the Board of County Commissioners of Collier
County approves the Fiscal 2010-2011 Consolidated Annual Performance and Appraisal Report
(CAPER) for the Community Development Block Grant (CDBG), HOME Investment Partnership
(HOME) and Emergency Shelter Grant (ESG) programs.
BE IT FURTHER RESOLVED that the Chairman of the Board of County
Commissioners is authorized to certify the CAPER for submission to HUD on behalf of the
County.
1
16E1 2
THIS RESOLUTION ADOPTED after motion, second and majority vote on this the
13th day of December, 2011.
ATTEST: `, --- c.A„ BOARD OF COUNTY COMMISSIONERS
DWIGHT-E. BRQC ;Clerk COLLIER COUNTY, FLORIDA
By V :, .- r/ By: ' - W to-
Attest el to Chi ir ', °`-pu`, Clerk FRED W. COYLE, CHAI' 4i N
4 tQ%atur a on i..'
Approved as to form and
legal s fici;, c
1 a�
41 i
Jeffrey 'I atzkow
County Ott . I ey
2
1 6 a . 2
g r
llili\ CPM P N -
* on State Grantee
8�oEv�` `� Certifications
Many elements of this document may be completed
electronically, however a signature must be manually applied and the
document must be submitted in paper form to the Field Office.
0 This certification does not apply.
0 This certification is applicable.
NON-STATE GOVERNMENT CERTIFICATIONS
In accordance with the applicable statutes and the regulations governing the
consolidated plan regulations, the jurisdiction certifies that:
Affirmatively Further Fair Housing --The jurisdiction will affirmatively further fair housing, which
means it will conduct an analysis of impediments to fair housing choice within the jurisdiction, take
appropriate actions to overcome the effects of any impediments identified through that analysis, and
maintain records reflecting that analysis and actions in this regard.
Anti-displacement and Relocation Plan --It will comply with the acquisition and relocation
requirements of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, as
amended,and implementing regulations at 49 CFR 24; and it has in effect and is following a residential
antidisplacement and relocation assistance plan required under section 104(d)of the Housing and
Community Development Act of 1974, as amended, in connection with any activity assisted with funding
under the CDBG or HOME programs.
Drug Free Workplace--It will or will continue to provide a drug-free workplace by:
1. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing,
possession, or use of a controlled substance is prohibited in the grantee's workplace and specifying
the actions that will be taken against employees for violation of such prohibition;
2. Establishing an ongoing 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 may be imposed upon employees for drug abuse violations occurring in the
workplace;
3. 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 1;
4. Notifying the employee in the statement required by paragraph 1 that, as a condition of employment
under the grant, the employee will -
a. Abide by the terms of the statement; and
b. Notify the employer in writing of his or her conviction for a violation of a criminal drug statute
occurring in the workplace no later than five calendar days after such conviction;
5. Notifying the agency in writing, within ten calendar days after receiving notice under subparagraph
4(b) from an employee or otherwise receiving actual notice of such conviction. Employers of
convicted employees must provide notice, including position title, to every grant officer or other
designee 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 include the identification
number(s)of each affected grant;
6. Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph
4(b), with respect to any employee who is so convicted -
a. 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
b. Requiring such employee to participate satisfactorily 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;
7. Making a good faith effort to continue to maintain a drug-free workplace through implementation of
paragraphs 1, 2, 3, 4, 5 and 6.
CPMP Non-State Grantee Certifications 1 Version 1.3
Jurisdiction
Anti-Lobbying --To the best of the jurisdiction's knowledge and belief:
8. No Federal appropriated funds have been paid or will be paid, by or on behalf of it, to any
person for influencing or attempting to influence an officer or employee of any agency, a Member
of Congress, an officer or employee of Congress, or an employee of a Member of Congress
in connection with the awarding of any Federal contract, the making of any Federal 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;
9. 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, it will complete and submit
Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with
its instructions; and
10. It will require that the language of paragraph 1 and 2 of this anti-lobbying certification be
included in the award documents for all subawards at all tiers (including subcontracts, subgrants,
and contracts under grants, loans, and cooperative agreements) and that all
subrecipients shall certify and disclose accordingly.
Authority of Jurisdiction --The consolidated plan is authorized under State and local law (as applicable)
and the jurisdiction possesses the legal authority to carry out the programs for which it is seeking funding,
in accordance with applicable HUD regulations.
Consistency with plan --The housing activities to be undertaken with CDBG, HOME, ESG, and HOPWA
funds are consistent with the strategic plan.
Section 3 --It will comply with section 3 of the Housing and Urban Development Act of 1968, and
implementing regulations at 24 CFR Part 135.
W.
12/13/11
Signature/Authorized Official Date
Fred W. Coyle
Name
Chairman, Board of County Commissioners f
Title
3299 E Tamiami Trail Suite 303 1
Address
Naples FL 34112
City/State/Zip
t�V'
•
(239) 252-8097 ATTE • ;ott
Telephone Number
Tf
Appr form and legal sufficiency: Tyr, -QMla� �
Jeffre A latzkow
County Attorney
CPMP Non-State Grantee Certifications 2 Version 1.3
16112
Jurisdiction
❑ This certification does not apply.
2+ This certification Is applicable.
Specific CDBG Certifications
The Entitlement Community certifies that:
Citizen Participation--It is in full compliance and following a detailed citizen participation plan that
satisfies the requirements of 24 CFR 91.105.
Community Development Plan--Its consolidated housing and community development plan identifies
community development and housing needs and specifies both short-term and long-term community
development objectives that provide decent housing, expand economic opportunities primarily for persons
of low and moderate income. (See CFR 24 570.2 and CFR 24 part 570)
Following a Plan--It is following a current consolidated plan (or Comprehensive Housing Affordability
Strategy) that has been approved by HUD.
Use of Funds--It has complied with the following criteria:
11. Maximum Feasible Priority -With respect to activities expected to be assisted with CDBG funds, it
certifies that it has developed its Action Plan so as to give maximum feasible priority to activities
which benefit low and moderate income families or aid in the prevention or elimination of slums or
blight. The Action Plan may also include activities which the grantee certifies are designed to meet
other community development needs having a particular urgency because existing conditions pose a
serious and immediate threat to the health or welfare of the community, and other financial resources
are not available);
12. Overall Benefit-The aggregate use of CDBG funds including section 108 guaranteed loans during
program year(s) 2009, 2010, 2011, (a period specified by the grantee consisting of one, two, or three
specific consecutive program years), shall principally benefit persons of low and moderate income in a
manner that ensures that at least 70 percent of the amount is expended for activities that benefit
such persons during the designated period;
13. Special Assessments -It will not attempt to recover any capital costs of public improvements assisted
with CDBG funds including Section 108 loan guaranteed funds by assessing any amount against
properties owned and occupied by persons of low and moderate income, including any fee charged or
assessment made as a condition of obtaining access to such public improvements.
However, if CDBG funds are used to pay the proportion of a fee or assessment that relates to the
capital costs of public improvements (assisted in part with CDBG funds) financed from other revenue
sources, an assessment or charge may be made against the property with respect to the public
improvements financed by a source other than CDBG funds.
The jurisdiction will not attempt to recover any capital costs of public improvements assisted with
CDBG funds, including Section 108, unless CDBG funds are used to pay the proportion of fee or
assessment attributable to the capital costs of public improvements financed from other revenue
sources. In this case, an assessment or charge may be made against the property with respect to the
public improvements financed by a source other than CDBG funds. Also, in the case of properties
owned and occupied by moderate-income (not low-income)families, an assessment or charge may be
made against the property for public improvements financed by a source other than CDBG funds if the
jurisdiction certifies that it lacks CDBG funds to cover the assessment.
Excessive Force--It has adopted and is enforcing:
14. A policy prohibiting the use of excessive force by law enforcement agencies within its jurisdiction
against any individuals engaged in non-violent civil rights demonstrations; and
15. A policy of enforcing applicable State and local laws against physically barring entrance to or exit from
a facility or location which is the subject of such non-violent civil rights demonstrations within its
jurisdiction;
CPMP Non-State Grantee Certifications 3
Version 1.3
160 , 2
Jurisdiction
Compliance With Anti-discrimination laws--The grant will be conducted and administered in
conformity with title VI of the Civil Rights Act of 1964 (42 USC 2000d), the Fair Housing Act(42 USC
3601-3619), and implementing regulations.
Lead-Based Paint--Its activities concerning lead-based paint will comply with the requirements of
part 35, subparts A, B,3, K and R, of title 24;
Compliance with Laws--It will comply with applicable laws. 12/13/11
Signature/Authorized Official Date
Fred W. Coyle
Name
Chairman, Board of County Commissioners
Title
3299 E Tamiami Trail Suite 303
Address
Naples FL 34112
City/State/Zip
(239) 252-8097
Telephone Number
ATTE.S1''r •
9 L T . BROck CCERIC
Y .
Ape o e as I form and legal sufficiency: ,�- '�
Att{1it, t0.. }
Jeffr C �. •latzkow
Cou y ttorney ,+
CPMP Non-State Grantee Certifications 4 Version 1.3
160
Jurisdiction
( (This certification does not apply.
[U This certification is applicable.
OPTIONAL CERTIFICATION
CDBG
Submit the following certification only when one or more of the activities in the
action plan are designed to meet other community development needs having a
particular urgency as specified in 24 CFR 570.208(c):
The grantee hereby certifies that the Annual Plan includes one or more specifically identified
CDBG-assisted activities, which are designed to meet other community development needs
having a particular urgency because existing conditions pose a serious and immediate threat to
the health or welfare of the community and other financial resources are not available to meet
such needs.
nI (� 12/13/11
Signature/Authorized Official Date
Fred W. Coyle
Name
I Chairman, Board of County Commissioners
Title
3299 E Tamiami Trail Suite 303
Address
Naples, FL 34112
City/State/Zip
(239) 252-8097
Telephone Number
ATTEST:
Appr -• ._ to-dorm and legal sufficiency:
)WIGHT E. BROCK. CLERK
"
Jeffre • Klatzkow
Count A torney
CPMP Non-State Grantee Certifications 5 Version 1.3
160 2
Jurisdiction
❑ This certification does not apply.
® This certification is applicable.
Specific HOME Certifications
The HOME participating jurisdiction certifies that:
Tenant Based Rental Assistance--If the participating jurisdiction intends to provide tenant-based
rental assistance:
The use of HOME funds for tenant-based rental assistance is an essential element of the
participating jurisdiction's consolidated plan for expanding the supply, affordability, and
availability of decent, safe, sanitary, and affordable housing.
Eligible Activities and Costs-- it is using and will use HOME funds for eligible activities and costs, as
described in 24 CFR§ 92.205 through 92.209 and that it is not using and will not use HOME funds for
prohibited activities, as described in § 92.214.
Appropriate Financial Assistance-- before committing any funds to a project, it will evaluate the
project in accordance with the guidelines that it adopts for this purpose and will not invest any more
HOME funds in combination with other Federal assistance than is necessary to provide affordable housing;
LO' 12/13/11
1
Signature/Authorized Official Date
Fred W. Coyle
Name
Chairman, Board of County Commissioners
Title
3299 E Tamiami Trail Suite 303
Address
Naples, FL 34112
c.( t r
ATTE57r; r .
City/State/Zip T •f. B'+s .
(239) 252-8097 s Y i� r'
Telephone Number
91*MteCst
Appr d ,, to form and legal sufficiency:
Jeffrey • •tzkow
County At l+rney
CPMP Non-State Grantee Certifications 6 Version 1.3
160 2
Jurisdiction
►i1 This certification does not apply.
❑ This certification is applicable.
HOPWA Certifications
The HOPWA grantee certifies that:
Activities--Activities funded under the program will meet urgent needs that are not being met by
available public and private sources.
Building--Any building or structure assisted under that program shall be operated for the purpose
specified in the plan:
1. For at least 10 years in the case of assistance involving new construction, substantial rehabilitation, or
acquisition of a facility,
2. For at least 3 years in the case of assistance involving non-substantial rehabilitation or repair of a
building or structure.
Yl it t 12/13/11
Signature/Authorized Official Date
Fred W. Coyle
Name
Chairman, Board of County Commissioners I
Title
3299 E Tamiami Trail Suite 303
Address
Naples, FL 34112
City/State/Zip
(239) 252-8097 ATTEST
IGHT E. BROOK. CLERK
Telephone Number NIGHT
Api11 • as to form and legal sufficiency:
-.r r1■
Jeffr. . latzkow
Coun ttorney
CPMP Non-State Grantee Certifications 7 Version 1.3
16132
Jurisdiction
IThis� p does not ,
nds ce$ atlon.is appicabte
ESG Certifications
I, Fred W. Coyle , Chief Executive Officer of Jurisdiction, certify that the local
government will ensure the provision of the matching supplemental funds required by
the regulation at 24 CFR 576.51. I have attached to this certification a description of
the sources and amounts of such supplemental funds.
I further certify that the local government will comply with:
1. The requirements of 24 CFR 576.53 concerning the continued use of buildings for
which Emergency Shelter Grants are used for rehabilitation or conversion of
buildings for use as emergency shelters for the homeless; or when funds are used
solely for operating costs or essential services.
2. The building standards requirement of 24 CFR 576.55.
3. The requirements of 24 CFR 576.56, concerning assurances on services and other
assistance to the homeless.
4. The requirements of 24 CFR 576.57, other appropriate provisions of 24 CFR Part
576, and other applicable federal laws concerning nondiscrimination and equal
opportunity.
5. The requirements of 24 CFR 576.59(b) concerning the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970.
6. The requirement of 24 CFR 576.59 concerning minimizing the displacement of
persons as a result of a project assisted with these funds.
7. The requirements of 24 CFR Part 24 concerning the Drug Free Workplace Act of
1988.
8. The requirements of 24 CFR 576.56(a) and 576.65(b) that grantees develop and
implement procedures to ensure the confidentiality of records pertaining to any
individual provided family violence prevention or treatment services under any
project assisted with ESG funds and that the address or location of any family
violence shelter project will not be made public, except with written authorization
of the person or persons responsible for the operation of such shelter.
9. The requirement that recipients involve themselves, to the maximum extent
practicable and where appropriate, homeless individuals and families in
policymaking, renovating, maintaining, and operating facilities assisted under the
ESG program, and in providing services for occupants of these facilities as provided
by 24 CFR 76.56.
10.The requirements of 24 CFR 576.57(e) dealing with the provisions of, and
regulations and procedures applicable with respect to the environmental review
responsibilities under the National Environmental Policy Act of 1969 and related
CPMP Non-State Grantee Certifications 8
VerSlnn 1
16D 2
Jurisdiction
authorities as specified in 24 CFR Part 58.
11.The requirements of 24 CFR 576.21(a)(4) providing that the funding of homeless
prevention activities for families that have received eviction notices or notices of
termination of utility services will meet the requirements that: (A) the inability of
the family to make the required payments must be the result of a sudden
reduction in income; (B) the assistance must be necessary to avoid eviction of the
family or termination of the services to the family; (C) there must be a reasonable
prospect that the family will be able to resume payments within a reasonable
period of time; and (D) the assistance must not supplant funding for preexisting
homeless prevention activities from any other source.
12.The new requirement of the McKinney-Vento Act (42 USC 11362) to develop and
implement, to the maximum extent practicable and where appropriate, policies
and protocols for the discharge of persons from publicly funded institutions or
systems of care (such as health care facilities, foster care or other youth
facilities, or correction programs and institutions) in order to prevent such
discharge from immediately resulting in homelessness for such persons. I further
understand that state and local governments are primarily responsible for the
care of these individuals, and that ESG funds are not to be used to assist such
persons in place of state and local resources.
13. HUD's standards for participation in a local Homeless Management Information
System (HMIS) and the collection and reporting of client-level information.
I further certify that the submission of a completed and approved Consolidated Plan
with its certifications, which act as the application for an Emergency Shelter Grant, is
authorized under state and/or local law, and that the local government possesses legal
authority to carry out grant activities in accordance with the applicable laws and
regulations of the U. S. Department of Housing and Urban Development.
12/13/11
Signature/Authorized Official Date
Fred W. Coyle I
Name
Chairman, Board of County Commissioners I
Title
3299 E Tamiami Trail Suite 303 I L
Address anESfl , r'
GHtt :
16D 2
Jurisdiction
❑ This certification does not apply.
CI This certification is applicable.
APPENDIX TO CERTIFICATIONS
Instructions Concerning Lobbying and Drug-Free Workplace Requirements
Lobbying Certification
This certification is a material representation of fact upon which reliance was placed when this transaction
was made or entered into. Submission of this certification is a prerequisite for making or entering into
this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required
certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for
each such failure.
Drug-Free Workplace Certification
1. By signing and/or submitting this application or grant agreement, the grantee is providing the
certification.
2. The certification is a material representation of fact upon which reliance is placed when the agency
awards the grant. If it is later determined that the grantee knowingly rendered a false certification,
or otherwise violates the requirements of the Drug-Free Workplace Act, HUD, in addition to any other
remedies available to the Federal Government, may take action authorized under the Drug-Free
Workplace Act.
3. Workplaces under grants, for grantees other than individuals, need not be identified on the
certification. If known, they may be identified in the grant application. If the grantee does not identify
the workplaces at the time of application, or upon award, if there is no application, the grantee must
keep the identity of the workplace(s) on file in its office and make the information available for
Federal inspection. Failure to identify all known workplaces constitutes a violation of the grantee's
drug-free workplace requirements.
4. Workplace identifications must include the actual address of buildings (or parts of buildings) or other
sites where work under the grant takes place. Categorical descriptions may be used (e.g., all vehicles
of a mass transit authority or State highway department while in operation, State employees in each
local unemployment office, performers in concert halls or radio stations).
5. If the workplace identified to the agency changes during the performance of the grant, the grantee
shall inform the agency of the change(s), if it previously identified the workplaces in question (see
paragraph three).
6. The grantee may insert in the space provided below the site(s) for the performance of work done in
connection with the specific grant: Place of Performance (Street address, city, county, state, zip code)
Check if there are workplaces on file that are not identified here. The certification with regard to the
drug-free workplace is required by 24 CFR part 21.
Place Name Street City County State
Zip
7. Definitions of terms in the Nonprocurement Suspension and Debarment common rule and Drug-Free
Workplace common rule apply to this certification. Grantees'attention is called, in particular, to the
following definitions from these rules: "Controlled substance" means a controlled substance in
Schedules I through V of the Controlled
Substances Act(21 U.S.C. 812) and as further defined by regulation (21 CFR 1308.11 through
1308.15); "Conviction" means a finding of guilt(including a plea of nolo contendere) or imposition of
sentence, or both, by any judicial body charged with the responsibility to determine violations of the
Federal or State criminal drug statutes; "Criminal drug statute" means a Federal or non-Federal
criminal statute involving the manufacture, distribution, dispensing, use, or possession of any
CPMP Non-State Grantee Certifications 10 Version 1.3
16D 2
Jurisdiction
controlled substance; "Employee" means the employee of a grantee directly engaged in the
performance of work under a grant, including:
a. All "direct charge"employees;
b. all "indirect charge"employees unless their impact or involvement is insignificant to the
performance of the grant; and
c. temporary personnel and consultants who are directly engaged in the performance of work under
the grant and who are on the grantee's payroll. This definition does not include workers not on
the payroll of the grantee (e.g., volunteers, even if used to meet a matching requirement;
consultants or independent contractors not on the grantee's payroll; or employees of
subrecipients or subcontractors in covered workplaces).
Note that by signing these certifications, certain documents must completed, in use, and on file for
verification. These documents include:
1. Analysis of Impediments to Fair Housing
2. Citizen Participation Plan
3. Anti-displacement and Relocation Plan
• 12/13/11
Signature/Authorized Official Date
I Fred W. Coyle
Name
I Chairman, Board of County Commissioners I I
Title
3299 E Tamiami Trail Suite 303 I
Address
I Naples, FL 34112
City/State/Zip
(239) 252-8097 I
Telephone Number
ATTEST,:
; • `
� • « G
tIli
* i' t0 as ~
b •
App , • and legal sufficiency: >
1411 ►
Jeffre A . zkow
County A tomey
CPMP Non-State Grantee Certifications 11
Version 1.3