Agenda 06/23/2015 Item #16J26/23/2015 16.J.2.
EXECUTIVE SUMMARY
Recommendation that the Board of County Commissioners provide after the fact approval
for the Sheriffs Office FY 2016 COPS Anti -Gang Initiative (CAGI) Program grant.
OBJECTIVE: To request after the fact approval from the Board of County Commissioners to
accept the FY 2016 grant application under the COPS CAGI Program.
CONSIDERATION: The COPS CAGI provides federal funding to law enforcement agencies
with multijurisdictional partnership comprised of federal, state and local law enforcement
agencies to address gang activity. CCSO applied for over -time and equipment for the members
of the anti -gang unit.
FISCAL IMPACT: The COPS CAGI application requested the following funding:
Federal funding FY2016- FY2018: $275,000
No Match Required.
GROWTH MANAGEMENT: None
LEGAL CONSIDERATIONS: The Board will have the opportunity to accept or reject the funds
if the grant is approved. Accordingly, this Office has no issue with respect to the legality of this
request, which is appropriate for Board action and requires a majority vote for Board action. —
JAB
RECOMMENDATION: To request after the fact approval from the Board of County
Commissioners to accept the grant application under the COPS Anti -Gang Initiative Program
PREPARED BY: Andrea Marsh, Finance Director
APPROVED BY: Kevin Rambosk, Sheriff
DATE: June 10, 2015
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COLLIER COUNTY
Board of County Commissioners
Item Number: 16.16.1.16.1.2.
Item Summary: Recommendation that the Board of County Commissioners provide after
the fact approval for the Sheriff's Office FY 2016 COPS Anti -Gang Initiative (CAGI) Program
grant.
Meeting Date: 6/23/2015
Prepared By
Approved By
Name: KlatzkowJeff
Title: County Attorney,
Date: 6/16/2015 9:37:46 PM
Name: BelpedioJennifer
Title: Assistant County Attorney, CAO General Services
Date: 6/17/2015 10:29:40 AM
Name: StanleyTherese
Title: Manager - Grants Compliance, Grants Management Office
Date: 6/17/2015 11:10:44 AM
Name: OchsLeo
Title: County Manager, County Managers Office
Date: 6/17/2015 11:34:32 AM
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it
Collier County Sheriff's Department
COMMUNITY ORIENTED POLICING SERVICES
U.S. DEPARTMENT OF JUSTICE
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Federal assistance is being requested under the following COPS program:
Verify the COPS grant program for which you are requesting federal assistance. A separate application must be completed for each
COPS program for which you are applying. Please ensure that you read, understand, and agree to comply with the applicable grant
ns and conditions as outlined in the COPS Application Guide before finalizing your selection.
program you have selected is: COPS Anti -Gang Initiative
SECTION 2: AGENCY ELIGIBILITY INFORMATION
A. Type of Agency (select one)
Law Enforcement
Non -Law Enforcement
From the list below, please select the type of agency which best describes the applicant.
Law Enforcement Entities
Sheriff
2C. CAGI Eligibility Questions
1. Is your agency the lead agency for this multi - jurisdictional anti -gang task force?
Yes
2. Does your task force have all three components (state, local, and federal) represented on the task force?
Yes
SECTION 3: GENERAL AGENCY INFORMATION
A. Applicant ORI Number FLO1100
The ORI number is assigned by the FBI and is your agency's unique identifier. The COPS Office uses the first seven characters of
this number. The first two letters are your state abbreviation, the next three numbers are your county's code, and the next two
numbers identify your jurisdiction within your county. If you do not currently have an ORi number, the COPS Office will assign one
t- vour agency for the purpose of tracking your grant. ORI numbers assigned to agencies by the COPS Office may end in "ZZ. "
.pplicant Data Universal Numbering System (DUNS) Number:
A Data Universal Numbering System (DUNS) number is required prior to submitting this application. A DUNS number is a unique
nine or thirteen digit sequence recognized as the universal standard for identifying and keeping track of entities receiving federal
funds. For more information about how to obtain a DUNS number, please refer to the "How to Apply" section of the COPS
Application Guide.
C. System for Award Management (SAM)
The System for Award Management (SAM) replaces the Central Contractor Registration (CCR) database as the repository for
standard information about federal financial assistance applicants. recipients, and sub- recipients. DOJ requires that all applicants
(other than individuals) for federal financial assistance maintain current registrations in the SAM database. Please note that
applicants must update or renew their SAM registration at least once a year to maintain active status.
Applicants that were previously registered in the CCR database must, at a minimum:
Create a SAM account
Log into SAM and migrate permissions to the SAM account (all the entity registrations and records should already have been
migrated).
Applicants that were not previously registered in the CCR database must register in SAM prior to registering in Grants.gov.
Information about SAM Registration procedures can be accessed at http: / /Www.sam.gov.
For more information about how to register with SAM, please refer to the "How to Apply" section of the COPS Application Guide.
Your SAM Registration is set to expire on:
Please enter date in MM/DD/YYYY format.
Note: if your SAM registration is set to expire prior to September 30, 2015, please renew your SAM Registration prior to completing
application. Contact the SAM Service Desk at 866- 606 -8220 or view /update your registration information at http ://www.sam.gov
geographic Names Information System (GNIS) ID:
Please enter your Geographic Names information System (GNIS) identification Number. This is a unique ID assigned to all
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geographic entities by the U.S. Geological Survey. To look up your GNIS Feature ID, please go to the websitc.
http: / /geonames.usgs.gov /domestic /index.html. For more information about how to obtain a GNIS number, please refer to the "How
to Apply" section of the COPS Application Guide.
E. Cognizant Federal Agency: [.,era r, of ]nstice
Select the legal applicant's Cognizant Federal Agency. A Cognizant Federal Agency, generally, is the federal agency from which
your jurisdiction receives the most federal funding. Your Cognizant Federal Agency also may have been previously designated by
the Office of Management and Budget. Applicants that have never received federal funding should select the "Department of
Justice" as the Cognizant Federal Agency.
F. Fiscal Year: From to
Please enter date in MM/DD/YYYY format.
G. Law Enforcement Agency Sworn Force Information
1. Enter the Fiscal Year Budgeted Sworn Force Strength for the current fiscal year below. The budgeted number of sworn officer
positions is the number of sworn positions funded in your agency's budget, including funded but frozen positions, as well as state,
Bureau of Indian Affairs, and /or locally funded vacancies. Do not include unfunded vacancies or unpaid /reserve officers.
a. Number of officers funded in agency's current fiscal year budget:
Full -Time:
Part -Time:
H. Civilian Staffing
1. Enter the number of civilian positions funded in agency's current fiscal year budget:
a. Number of civilian positions funded in agency's current fiscal year budget:
Full -Time:
Part -Time:
I. U.S. Department of Justice and Other Federal Funding
Applicants are required to disclose whether they have pending applications for federally funded assistance or active federal grants
that support the same or similar activities or services for which grant funding is being requested under this application.
Be advised that as a general rule COPS grant funding may not be used for the same item or service funded through another funding
source. However, leveraging multiple funding sources in a complementary manner to implement comprehensive programs or
projects is encouraged and is not seen as inappropriate. To aid the COPS Office in the prevention of awarding potentially duplicative
funding, please indicate whether your agency has a pending application and /or an active grant with any other federal funding source
(e.g. direct federal funding or indirect federal funding through State sub - awarded federal funds) which supports the same or similar
activities or services as being proposed in this COPS application. (check all that apply):
Bureau of Justice Assistance (BJA)
Pending Application
Active Grant
Office of Justice Programs (OJP)
Pending Application
Active Grant
Office of Juvenile Justice and Delinquency Prevention (OJJDP)
Pending Application
Active Grant
Office on Violence Against Women (OVW)
Pending Application
Active Grant
National Institute of Justice (NIJ)
Pending Application
Active Grant
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Office for Victims of Crime (OVC)
Pending Application
Active Grant
�r Department of Justice Funding
Pending Application
Active Grant
Other Federal or State Sub - awarded Funding
Pending Application
Active Grant
Please specify the other Federal or State sub - awarded funding source(s)
No Federal or State Sub - awarded Funding
SECTION 4: EXECUTIVE INFORMATION
Note: Listing individuals without ultimate programmatic and financial authority for the grant could delay the review of your
application, or remove your application from consideration.
A. Law Enforcement Executive /Agency Executive Information:
For Law Enforcement Agencies: This is the highest ranking law enforcement official within your jurisdiction (e.g., Chief of Police,
Sheriff, or equivalent). The section below has been pre - populated from the information listed in your COPS Office Agency Portal
Account. if this information is no longer correct, please log in to your COPS Office Agency Portal account and make the necessary
,)ctions before proceeding with this application. For assistance, please call the COPS Office Response Center at 800- 421 -6770.
Non -Law Enforcement Agencies: This is the highest ranking individual in the applicant agency (e.g., CEO, President,
Chairperson, Director, etc.) who has the authority to apply for this grant on behalf of the applicant agency. If the grant is awarded,
this position would ultimately be responsible for the programmatic implementation of the award. The section below has been pre -
populated from the information listed in your COPS Office Agency Portal Account. If this information is no longer correct, please log
in to your COPS Office Agency Portal account and make the necessary corrections before proceeding with this application. For
assistance, please call the COPS Office Response Center at 800 - 421 -6770.
Title: Sheriff
First Name: Kevin MI: Last Name: Rambosk Suffix:
Agency Name: Collier County Sheriffs Department
Streetl: 3319 Tamiami Trail East
Street2:
City: Naples State: FL Zip / Postal Code: 34112
Telephone Number: 2392529203 Fax: 2397939333 Email: hq @colliersheriff.org
Edit Contact Information
B. Government Executive /Financial Official Information:
For Government Agencies: This is the highest ranking government official within your jurisdiction (e.g., Mayor, City Administrator, or
equivalent). The section below has been pre - populated from the information listed in your COPS Office Agency Portal Account. If
this information is no longer correct, please log in to your COPS Office Agency Portal account and make the necessary corrections
before proceeding with this application. For assistance, please call the COPS Office Response Center at 800 -421 -6770. For Non -
Government Agencies: This is the financial official who has the authority to apply for this grant on behalf of the applicant agency
(e.g., CFO, Treasurer, etc.). If the grant is awarded, this position would ultimately be responsible for the financial management of the
award. Please note that information for non - executive positions (e.g., clerks, trustees, etc.) is not acceptable. The section below has
been pre - populated from the information listed in your COPS Office Agency Portal Account. If this information is no longer correct,
r'-ase log in to your COPS Office Agency Portal account and make the necessary corrections before proceeding with this
cation. For assistance, please call the COPS Office Response Center at 800- 421 -6770.
1 me: Commissioner
First Name: Tim MI: Last Name: Nance Suffix:
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Agency Name: Collier County Sheriff's Department
Streetl: 3299 Tamiami Trial East
Street2:
City: Naples State: FL Zip / Postal Code: 34112
Telephone Number: 2392528604 Fax: Email: TimNance @colliergov.net
Edit Contact Information
C. Application Contact Information:
Application Contact: Enter the application contact's name and contact information.
Title:
First Name: MI: Last Name: Suffix:
Select One...
Agency Name:
Streetl :
Street2:
City: State: FL Zip / Postal Code:
Telephone Number: Fax: Email:
SECTION 6A: LAW ENFORCEMENT & COMMUNITY POLICING STRATEGY
Community Policing Definition Framework
The following is the COPS Office definition of community policing that emphasizes the primary components of community
partnerships, organizational transformation, and problem solving.
Community policing is a philosophy that promotes organizational strategies, which support the systematic use of partnerships and
problem solving techniques, to proactively address the immediate conditions that give rise to public safety issues, such as crime,
social disorder, and fear of crime.
The COPS Office has completed the development of a comprehensive community policing self- assessment tool for use by law
enforcement agencies. Based on this work, we have developed the following list of primary sub - elements of community policing.
Please refer to the COPS Office web site (http: / /www.cops.usdoj.gov) for further information regarding these sub - elements.
Community Partnerships:
Collaborative partnerships between the law enforcement agency and the individuals and organizations they serve to both develop
solutions to problems and increase trust in police.
Other Government Agencies
Community Members /Groups
Non - Profits /Service Providers
Private Businesses
Media
Organizational Transformation:
The alignment of organizational management, structure, personnel and information systems to support community partnerships and
proactive problem - solving efforts.
Agency Management
Climate and culture
Leadership
Labor relations
Decision - making
Strategic planning
Policies
Organizational evaluations
Transparency
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Organizational Structure
Geographic assignment of officers
Despecialization
Durces and finances
Personnel
Recruitment, hiring and selection
Personnel supervision /evaluations
Training
Information Systems (Technology)
Communication /access to data
Quality and accuracy of data
Problem Solving:
The process of engaging in the proactive and systematic examination of identified problems to develop effective responses that are
rigorously evaluated.
Scanning: Identifying and prioritizing problems
Analysis: Analyzing problems
Response: Responding to problems
Assessment: Assessing problem - solving initiatives
Using the Crime Triangle to focus on immediate conditions (Victim /Offender /Location)
CP1) To what extent is there community support in your jurisdiction for implementing the proposed grant activities?
a) High level of support
b) Moderate support
c) Minimal support
-) If awarded, to what extent will the grant activities impact the other components of the criminal justice system in your
jurisdiction?
a) Potentially decreased burden
b) No change in burden
c) Potentially increased burden
SECTION 7: NEED FOR FEDERAL ASSISTANCE
A. Explanation of Need for Federal Assistance
All applicants are required to explain their inability to address the need for this award without federal assistance. Please do so in the
space below. [Please limit your response to a maximum of 4,000 characters.]
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SECTION 8: CONTINUATION OF PROJECT AFTER FEDERAL FUNDING
ENDS
If you are applying for a COPS grant with a post -grant retention plan requirement, please complete A. If you are applying
for a COPS grant without a post -grant retention plan requirement, please complete B.
B. Continuation of Project after Federal Funding Ends (for other COPS grants with no retention plan requirement)
Please complete these questions to indicate any plans you may have to continue this program, project, or activity after the
conclusion of federal funding.
1. Does your agency plan to obtain necessary support and continue the program, project, or activity following the
conclusion of federal support?
Yes
No
2. Please identify the source(s) of funding that your agency plans to utilize to continue the program, project, or activity
following the conclusion of federal support: (check all that apply)
General funds
Raise bond /tax issue
Private sources /donations
Non - federal asset forfeiture funds (subject to approval from the state or local oversight agency)
State, local, or other non - federal grant funding
Fundraising efforts
Other
If other, please provide a brief description of the source(s) of funding not to exceed 500 characters.
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SECTION 10: EXECUTIVE SUMMARY
Please provide a brief summary of how your agency will use this federal funding. Refer to the COPS Program Specific Application
Guide for clarification on specific information to include in your summary, and be sure to provide a description of how you expect
this grant to impact public safety and/or crime prevention in your community. The Executive Summary may be used to keep
Congress or other executive branch agencies informed on law enforcement strategies to deter crime in your community.
[Responses are limited to a maximum of 4000 characters.]
f sJil a
P' -ase include in your application an in -depth narrative response detailing your proposed project. Please refer to the COPS program
ific Application Guide: "How to Apply" for information on what should be included in your response, as well as any additional
i, natting requirements and page length limitations. Note: Community Policing Development (CPD), COPS Anti - Methamphetamine
Program (CAMP), Anti- Heroin Task Force Program (AHTF) and COPS Anti -Gang Initiative (CAGI) grant applicants must submit
their entire project description as an attachment in Section 13 of this application.
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F. Project Description (Narrative) Attachment:
Your Project Narrative attachment must address each element on the following form
http: / /www. cops. usdoj. gov / pdf /2015AwardDocs/ cagi /CAGI_Project_Narrative. pdf. Your Budget Narrative attachment must address
each element on the following form http: / /www. cops.usdoj. gov /pdf /2015AwardDocs /cagi /CAGI_Budget_N arrative.pdf.
SECTION 12: OFFICIAL PARTNER(S) CONTACT INFORMATION
An official "partner" under the grant may be a governmental, private, school district, or other applicable entity that has established a
legal, contractual, or other agreement with the applicant for the purpose of supporting and working together for mutual benefits of
the grant. Please see the COPS Application Guide for more information on official partners that may be required.
��r4t N4 ?" �t �4r
Title:
First Name:
Suffix: S(,i- ctCme...
Middle Name:
Name of Partner Agency (e.g.,Smithville High School):
Type of Partner Agency (e.g., School District):
Street1:
Street2:
City:
Telephone Number:
State: seiec orr- .
Fax:
Last Name:
Zip/ Postal Code:
""Amu
Important! Please click "Add Partner' below to add a partner to the list.
Reminder! If you have modified (edit, update, or delete) the list of partners in any way, please click "Save" to store your
changes before moving to the next section.
This section should be used to attach any required or applicable attachments to your grant applications (e.g., Memorandum of
Understanding, etc.)
To complete the CAGI Project and Budget Narratives, applicants must follow each link to obtain the required forms. Your Project
Narrative attachment must address each element on the following form:
http: / /www. cops. usdoj. gov / pdf /2015AwardDocs/ cagi /CAGI_Project_Narrative. pdf. Your Budget Narrative attachment must address
each element on the following form: http: / /www. cops. usdoj. gov / pdf /2015AwardDocs/ cagi /CAGI_Budget_Narrative. pdf. Once
completed, all CAGI applicants must attach both the Project Narrative and Budget Narrative to Section 13 using the appropriate titles
in the drop down menu below. Additional information is also provided in the CAGI Application Guide.
If the program for which you are applying requires a Memorandum of Understanding (MOU), this document should define the roles
and responsibilities of the individuals and partner(s) involved in your proposed project. Please refer to the program - specific
Application Guide to determine if an MOU or other application attachments are required. The Guide will also specify if optional
attachments are permitted for submission. Please use appropriately descriptive file names (e.g., Program Narrative, Budget Detail
Worksheet and Budget Narrative, Timelines, Memoranda of Understanding, Resumes) for all attachments. Please do not submit
executable file types as application attachments. These disallowed file types include, but are not limited to, the following extensions:
.com, .bat, .exe, .vbs, .cfg, .dat, .db, .dbf, All, .ini, .log, .ora, .sys, and .zip. The system may reject applications with files that use
these extensions.
Current Attachments
Upload attachments using "Browse..." and "Upload... ". File names may only contain: a- z0- 9period(.), underscore(_), hyphen(-
)Characters other than these will be replaced by a hyphen(- ).After clicking the "Upload..." button, please wait for the page to refresh.
The uploaded file will automatically appear in the file list.
Form COPS_Sh ,,pplicationAtiachrrnent 2 2- V2.2.odf
SF -424
Delete
Form SF424 2_'- V2.1.pdf
SF -424
Delete
2016- CAGI - Budget- Narrative.doc
Budget Narrative
Delete
CAGI- 7Y16-Na,rative-_doc
Project Narrative
Delete
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no file selected
SECTION 14: BUDGET DETAIL WORKSHEETS
Instructions for Completing the Budget Detail Worksheets
following Budget Detail Worksheets are designed to allow all COPS grant and cooperative agreement applicants to use the
same budget forms to request funding. Allowable and unallowable costs vary widely and depend upon the type of COPS program.
The maximum federal funds that can be requested and the federal /local share breakdown requirements also vary.
Please refer to the program- specific Application Guide to determine the allowable /unallowable costs, the maximum amount of
federal funds that can be requested, and the federal /local share requirements for the COPS program for which your agency is
applying(See http: / /www. cops. usdoj.gov /Default.asp ?Item =46). To assist you, sample Budget Detail Worksheets are included in
each Application Guide
Please complete each section of the Budget Detail Worksheets applicable to the program for which you are applying (See
http: / /www. cops .usdoj.gov /Default.asp ?Item =46 for requirements). If you are not requesting anything under a particular budget
category, please check the appropriate box in that category indicating that no positions or items are requested.
Final calculations will be rounded to the nearest whole dollar. Once the budget for your proposal has been completed, a budget
summary page will reflect the total amounts requested in each category, the total project costs, and the total federal and local
shares.
If you need assistance in completing the Budget Detail Worksheets, please call the COPS Office Response Center at 800-
421 -6770.
1. How many new entry - level, full -time sworn officer positions, not currently funded in your agency(s) local budget, is your
agency requesting in this application? If your agency is not requesting funding for new entry- level, full -time sworn officer positions in
this application, please insert a zero in the response box. Please note you should not account for requests for officer overtime here.
SECTION 14A: BUDGET DETAIL WORKSHEETS
Instructions: This worksheet will assist your agency in reporting your agency's current entry-level salary and benefits and identifying
the total salary and benefits request per officer position for the length of the grant term. Please list the current entry-level base
salary and fringe benefits rounded to the nearest whole dollar for one full -time sworn officer position within your agency. Do not
de employee contributions. (Please refer to http: / /www. cops .usdoj.gov /DefauIt.asp ?Item =46 for information on the length of the
— it term for the program under which you are applying.)
Special note regarding sworn officer fringe benefits: For agencies that do not include fringe benefits as part of the base salary costs
and typically calculate these separately, the allowable expenditures may be included under Part 1, Section B. Any fringe benefits
that are already included as part of the agency's base salary (Part 1, Section A of the Sworn Officer Budget Worksheet) should not
also be included in the separate fringe listing (Part 1, Section B). Please refer to http: / /www. cops .usdoj.gov /Default.asp ?Item=46 for
information about allowable and unallowable fringe benefits for sworn officer positions requested under the program to which your
agency is applying.
A. SWORN OFFICER POSITIONS
Full -Time Entry-Level Sworn Officer Base Salary information
Part 1: Instructions: Please Complete the questions below based on your agency's entry -level salary and benefits package for one
locally- funded officer position. As applicable per the program - specific Application Guide, you may also be required to project Year 2
and Year 3 salaries.
Sworn Offirer Position
A. Base Salary Information
Year 1 Salary
Enter the First
year entry -level
base salary for
one sworn officer
position.
Please check this
box if base salary
includes vacation
costs.
Please check this
box if the base
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Year 2 Salary
Enter the second
year entry -level
base salary for
one sworn officer
position.
Please check this
box if base salary
includes vacation
costs.
Please check this
box if the base
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salary includes sick salary incl..
leave costs. leave costs.
B. Fringe Benefit costs should be calculated for each year of the grant term.
FRINGE BENEFITS: Year 1 Fringe Benefits Year 2 Fringe Benefits
COST % OF COST % OF
BASE SALARY BASE SALARY
Social security expenses Exempt 6.2% Fixed Rate
cannot exceed 6.2%
i Medicare expenses °
cannot exceed 1.45% Exempt 1.45 /o Fixed Rate
Health Insurance (Family Coverage)
Life Insurance
Vacation Number of Hours Annually:
Sick Leave Number of Hours Annually:
Retirement
Worker's Compensation
Exempt
Unemployment Insurance
Exempt
Other
Sebct One
Other
Sl,,� le, ct Dric
Other
Select one
Benefits Sub -Total Per Year (1 Position)
C. Total Salary + Benefits Per Year (1 Position)
D. Total Salary and Benefits for Years 1 and 2 (1 Position): X # of Positions
BASE SALARY AND FRINGE BENEFITS
.WERSONNEL
Instructions: Please complete the questions below for one non -sworn position salary and benefits package. As applicable per the
program- specific Application Guide, you may also be required to project Year 2 and Year 3 salaries. Please refer to
http: / /www. cops .usdoj.gov /DefauIt.asp ?Item =46 for information about allowable and unallowable fringe benefits for civilian /non-
sworn personnel requested under the program to which your agency is applying.
B. CIVILIAN POSITIONS
Remove Position
A. Base Salary Information
Position Title
Description
Year 1 Salary Year 2 Salary
Enter the first
year entry -level
base salary for
this civilian /non-
sworn position.
X % of time on project
Enter the second
year entry -level
base salary for
this civilian /non-
sworn position.
X o/ of time on project
Please check this Please check this
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box if base salary
includes vacation
costs.
Please check this
box if the base
salary includes sick
leave costs.
B. Fringe Benefit costs should be calculated for each year of the grant term.
FRINGE BENEFITS:
Social security expenses
cannot exceed 6.2%
Medicare expenses
cannot exceed 1.45%
Health insurance
Life Insurance
Vacation
Sick Leave
Exempt 6.2% Fixed Rate
Exempt 1.45% Fixed Rate
Number of Hours Annually:
Number of Hours Annually:
Retirement
l Worker's Compensation Exempt
employment Insurance Exempt
Other
Other
Other- .,,,;_,
Benefits Sub -Total Per Year (1 Position)
C. Total Salary + Benefits Per Year (1 Position)
D. Total Salary and Benefits for Years 1 and 2 (1 Position
Year 1 Fringe Benefits
COST % OF
BASE SALARY
>X
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box if base salary
includes vacation
costs.
Please check this
box if the base
salary includes sick
leave costs.
Year 2 Fringe Benefits
COST % OF
BASE SALARY
Of Positiors
Ir
No Equipment/Technology Requested
Instructions: List non - expendable items that are to be purchased. Provide a specific description for each item in the description
boxes below and explain how the item supports the project goals and objectives as outlined in your application. Non - expendable
equipment is tangible property (e.g., information technology systems) having a useful life of more than one year and an acquisition
cost of $5,000 or more per unit. Expendable items should be included either in the "SUPPLIES" or "OTHER" categories. Applicants
should analyze the cost benefits of purchasing versus leasing equipment, especially for high -price items and those subject to rapid
technical advances. Rented or leased equipment costs should be listed in the "CONTRACTS / CONSULTANTS" category.
Please be advised that, to the greatest extent practical, all equipment and products purchased with these funds must be American -
made.
agencies purchasing items related to enhanced communications systems, the COPS Office expects and encourages
t„dt, wherever feasible, such voice or data communications equipment should be incorporated into an intra- or
interjurisdictional strategy for communications interoperability among federal, state, and local law enforcement agencies.
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See http: / /www. cops .usdoj.gov /Default.asp ?Item =46 for a list of allowable /unallowable costs for this program. r Uoz��- 111111L yuu
descriptions to 1000 characters.
Item Name
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D. SUPPLIES
No Supplies Requested
Instructions: List items by type (office supplies; postage; 'training materials; copying paper; books; hand -held tape recorders;
computing devices costing less than $5,000; etc). Provide a specific description for each item in the description boxes below and
explain how it supports the project goals and objectives outlined in your application. Generally, supplies include any materials that
are expendable or consumed during the course of the project, costing less than $5,000.
See http: / /www. cops .usdoj.gov /DefauIt.asp ?Item =46 for a list of allowable /unallowable costs for this program. Please limit your
descriptions to 1000 characters.
TRAVEL /TRAINING
No Travel /Training Requested
Instructions: Travel costs are the expenses for transportation, lodging, subsistence, and related items incurred by employees who
are in travel status on official business of the non - Federal entity. Itemize grant - related travel expenses of grantee personnel
(excluding consultants, whose expenses are listed in Section F) by event (e.g., mandatory training, staff to training, field interviews,
advisory group meetings). Identify the location of travel whenever possible, and show the number of staff expected to attend each
event. Training fees, transportation, lodging and per diem rates for trainees should be listed as separate travel items. Grantee travel
costs specific to the grant project may be based on the grantee's written travel policy, assuming the costs are reasonable. Grantees
without a written travel policy must follow the established federal rates (found at http: / /www.gsa.gov) for lodging, meals, and per
diem. For all grantees (with or without a written travel policy), airfare travel costs must be one of the following: the lowest discount
commercal airfare, standard coach airfare, or the Federal Government contract airfare (if authorized and available).
See http: / /www. cops . usdoj.gov /Default.asp ?Item =46 for a list of allowable /unallowable costs for this program. Provide a specific
description in the description boxes below for each item and explain how the item supports the project goals and objectives as
outlined in your application. Please limit your descriptions to 1000 characters.
Event Title and Location
Registration:
Lodging:
Per Diem:
Transportation:
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Registration:
Lodging:
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Transportation:
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F. CONTRACTS /CONSULTANTS
No Contract Costs Requested
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Instructions: See http: / /www. cops .usdoj.gov /Default.asp ?Item =46 for a list of allowable /unallowable costs for the particular program
to which you are applying. Provide a specific description in the description boxes below for each item and explain how the item
supports project goals and objectives as outlined in your application. Please limit your descriptions to 1000 characters.
Contracts: Provide a cost estimate for the product or service to be procured by contract. Applicants are encouraged to promote free
and open competition in awarding contracts. If awarded, requests for sole source procurements of equipment, technology, or
services in excess of $150,000 must be submitted to the COPS Office for prior approval. (See
http: / /www. cops . usdoj.gov /Default.asp ?Item =46 for more information on the required submission.)
'o Consultant Fees Requested
—tructions: See http: / /www. cops . usdoj.gov /Default.asp ?Item =46 for a list of allowable /unallowable costs for the particular program
to which you are applying. Provide a specific description in the description boxes below for each item and explain how the item
supports the project goals and objectives as outlined in your application. Please limit your descriptions to 1000 characters.
Consultant Fees: For each consultant enter the name (if known), service to be provided, hourly or daily fee (based upon an 8 -hour
day), and estimated length of time on the project. Unless otherwise approved by the COPS Office, approved consultant rates will be
based on the salary a consultant receives from his or her primary employer. Consultant fees in excess of $550 per day require
additional written justification and must be pre- approved in writing by the COPS Office if the consultant is hired via a noncompetitive
bidding process.
No Consultant Travel Requested
Instructions: See http:/ iwww.cops.usdoj.ciov /Default.asp ?Item =46 for a list of allowable /unallowable costs for the particular program
to which you are applying. Provide a specific description in the description bores below for each item and explain how the item
supports the project goals and objectives as outlined in your application. Please limit your descriptions to 1000 characters.
Consultant Travel: List all travel - related expenses to be paid from the grant to the individual consultants (e.g., transportation, meals,
lodging) separate from their consultant fees.
No Consultant Expenses Requested
Instructions: See http: / /wvrA /. cops .usdoj.gov /Default.asp ?Item =46 for a list of allowabie /unallowable costs for the particular program
to which you are applying. Provide a specific description in the description boxes below for each item and explain how the item
supports the project goals and objectives as outlined in your application. Please limit your descriptions to 1000 characters.
Consultant Expenses: List all other expenses to be paid from the grant to the individual consultants separate from their consultant
fees and travel expenses (e.g., computer equipment and office supplies).
o Other Costs Requested
Instructions: List other requested items that will support the project goals and objectives as outlined in your application. Provide a
specific description for each item in the description boxes below and explain how the item supports the project goals and objectives
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as outlined in your application.
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Please be advised that, to the greatest extent practical, all equipment and products purchased with these funds must be American -
made.
See http: / /www. cops .usdoj.gov /Default.asp ?Item =46 for a list of allowable /unallowable costs for this program. Please limit your
descriptions to 1000 characters.
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S. BUDGET SUMMARY
Total :
Delete
Instructions: Please review the category totals and the total project costs below. If the category totals and project amounts shown
are correct, please continue with the submission of your application. Should you need to make revisions to a budget category,
please return to the Budget Detail Worksheet.
Section
Budget Category
Category Total
A. Sworn Officer Positions
$0.00
B. Non -Sworn Personnel
$0.00
C. Equipment & Technology
$29812.54
D. Supplies
$0.00
E. Travel & Training
$36635.00
F. Contracts & Consultants
$0.00
G. Other Costs
$208552.50
H. Indirect Costs
$0.00
Total Project Amount:
$275000.04
Total Federal Share Amount:
(Total Project Amount X Federal Share Percentage Allowable)
$275000.04
100.000000%
Total Local Share Amount(If applicable):
(Total Project Amount - Total Federal Share Amount)
$0.00
0.000000%
Contact Information for Budget Questions
Please provide contact information of the financial official that the COPS Office may contact with questions related to your budget
submission.
First Name:
Last Name:
Title:
Telephone Number:
Fax:
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Email Address:
SECTION 15A: ASSURANCES
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arai provisions of federal law and policy apply to all grant programs. The Office of Community Oriented Policing Services needs
to secure your assurance that the applicant will comply with these provisions. If you would like further information about any of
these assurances, please contact your state's COPS Grant Program Specialist at 800 - 421 -6770.
By signing this form, the applicant assures that it will comply with all legal and administrative requirements that govern the applicant
for acceptance and use of federal grant funds. In particular, the applicant assures us that:
1. It has been legally and officially authorized by the appropriate governing body (for example, mayor or city council) to apply for this
grant and that the persons signing the application and these assurances on its behalf are authorized to do so and to act on its behalf
with respect to any issues that may arise during processing of this application.
2. It will comply with the provisions of federal law, which limit certain political activities of grantee employees whose principal
employment is in connection with an activity financed in whole or in part with this grant. These restrictions are set forth in 5 U.S.C. §
1501, et seq.
3. It will comply with the minimum wage and maximum hours provisions of the Federal Fair Labor Standards Act, if applicable.
4. It will establish safeguards, if it has not done so already, to prohibit employees from using their positions for a purpose that is, or
gives the appearance of being, motivated by a desire for private gain for themselves or others, particularly those with whom they
have family, business or other ties.
5. It will give the Department of Justice or the Comptroller General access to and the right to examine records and documents
related to the grant.
6. It will comply with all requirements imposed by the Department of Justice as a condition or administrative requirement of the
grant, including but not limited to: the requirements of 2 C.F.R. Part 200 (Uniform Administrative Requirements, Cost Principles, and
Audit Requirements for Federal Awards) as adopted by the Department of Justice in 2 C.F.R. § 2800.101 ; 48 C.F.R. Part 31 (FAR
Part 31) (Contract Cost Principles and Procedures); the applicable provisions of the Omnibus Crime Control and Safe Streets Act of
1968, as amended; 28 C.F.R. § 38.1; the applicable COPS Application Guide; the applicable COPS Grant Owner's Manuals; and
with all other applicable program requirements, laws, orders, or regulations.
will, to the extent practicable and consistent with applicable law, seek, recruit and hire qualified members of racial and ethnic
_)rity groups and qualified women in order to further effective law enforcement by increasing their ranks within the sworn
positions in the agency.
8. It will not (and will require any subgrantees, contractors, successors, transferees, and assignees not to), on the grounds of race,
color, religion, national origin, sex, disability, or age, unlawfully exclude any person from participation in, deny the benefits of or
employment to any person, or subject any person to discrimination in connection with any programs or activities funded in whole or
in part with federal funds. These civil rights requirements are found in the non - discrimination provisions of Title VI of the Civil Rights
Act of 1964, as amended (42 U.S.C. § 2000d); the Omnibus Crime Control and Safe Streets Act of 1968, as amended (42 U.S.C. §
3789d); Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. § 794); the Age Discrimination Act of 1975 (42 U.S.C.
§ 6101, et seq.); Title IX of the Education Amendments of 1972, as amended (20 U.S.C. § 1681, et seq.); and the corresponding
DOJ regulations implementing those statutes at 28 C.F.R. Part 42 (subparts C, D, E, G, and 1). It will also comply with Executive
Order 13279 Equal Treatment for Faith -Based Organizations and its implementing regulations at 28 C.F.R. Part 38, which requires
equal treatment of religious organizations in the funding process and nondiscrimination of beneficiaries by Faith -Based
Organizations on the basis of belief or non- belief.
A. In the event that any court or administrative agency makes a finding of discrimination on grounds of race, color, religion, national
origin, gender, disability or age against the applicant after a due process hearing, it agrees to forward a copy of the finding to the
Office for Civil Riahts, Office of Justice Programs, 810 7th Street, NW, Washington, Q.C. 20531.
B. If your organization has received an award for $500,000 or more and has 50 or more employees, then it has to prepare an Equal
Employment Opportunity Plan (ESOP) and submit it to the Office for Civil Rights ( "OCR "), Office of Justice Programs, 810 7th
Street; N.W., Washington, DC 20531, for review within 60 days of the notification of the award. If your organization received an
award between $25,000 and $500,000 and has 50 or more employees, your organization still has to prepare an EEOP, but it does
not have to submit the EEOP to OCR for review. instead, your organization has to maintain the EEOP on file and make it available
for review on request. In addition, your organization has to complete Section B of the Certification Form and return it to OCR. If your
organization received an award for less than 525,000; or if your organization has less than 50 employees, regardless of the amount
of the award; or if your organization is a medical institution, educational institution, nonprofit organization or Indian tribe, then your
organization is exempt from the EEOP requirement. However, your organization must complete Section A of the Certification Form
return it to OCR.
ursuant to Department of Justice guidelines (June 18, 2002 Federal Register (Volume 67, Number 117, pages 41455 - 41472)),
under Title VI of the Civil Rights Act of 1964, it will ensure meaningful access to its programs and activities by persons with limited
English proficiency.
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10. It will ensure that any facilities under its ownership, lease or supervision which shall be utilized in the accomplishment of the
project are not listed on the Environmental Protection Agency' (EPA) list of Violating Facilities and that it will notify us if advised by
the EPA that a facility to be used in this grant is under consideration for such listing by the EPA..
11. If the applicant's state has established a review and comment procedure under Executive Order 12372 and has selected this
program for review, it has made this application available for review by the state Single Point of Contact.
12. It will submit all surveys, interview protocols, and other information collections to the COPS Office for submission to the Office of
Management and Budget for clearance under the Paperwork Reduction Act of 1995 if required.
13. It will comply with the Human Subjects Research Risk Protections requirements of 28 C.F.R. Part 46 if any part of the funded
project contains non - exempt research or statistical activities which involve human subjects and also with 28 C.F.R. Part 22,
requiring the safeguarding of individually identifiable information collected from research participants.
14. Pursuant to Executive Order 13043, it will enforce on -the -job seat belt policies and programs for employees when operating
agency- owned, rented or personally -owned vehicles.
15. It will not use COPS funds to supplant (replace) state, local, or Bureau of Indian Affairs funds that otherwise would be made
available for the purposes of this grant, as applicable.
16. If the awarded grant contains a retention requirement, it will retain the increased officer staffing level and /or the increased officer
redeployment level, as applicable, with state or local funds for a minimum of 12 months following expiration of the grant period.
17. It will not use any federal funding directly or indirectly to influence in any manner a Member of Congress, a jurisdiction, or an
official of any government, to favor, adopt, or oppose, by vote or otherwise, any legislation, law ratification, policy or appropriation
whether before or after the introduction of any bill, measure, or resolution proposing such legislation, law, ratification, policy or
appropriation as set forth in the Anti- Lobby Act, 18 U.S.C. § 1913.
18. In the event that a portion of grant reimbursements are seized to pay off delinquent federal debts through the Treasury Offset
Program or other debt collection process, it agrees to increase the non - federal share (or, if the awarded grant does not contain a
cost sharing requirement, contribute a non- federal share) equal to the amount seized in order to fully implement the grant project.
19. None of the funds made available under this award may be distributed to the Association of Community Organizations for
Reform Now (ACORN) or its subsidiaries.
False statements or claims made in connection with COPS grants (including cooperative agreements) may result in fines,
imprisonment, disbarment from participating in federal grants or contracts, and /or any other remedy available by law.
I certify that the assurances provided are true and accurate to the best of my knowledge.
Elections or other selections of new officials will not relieve the grantee entity of its obligations under this grant.
Signature of Law Enforcement Executive /Agency Executive (For your electronic signature, please type in your name) Kevin
Rambosk
Date:
Signature of Government Executive /Financial Official (For your electronic signature, please type in your name) Tim Nance
Date
Regarding Lobbying; Debarment, Suspension and Other Responsibility Matters; Federal Taxes and Assessments; Drug -
Free Workplace Requirements; and Coordination with Affected Agencies.
Although the Department of Justice has made every effort to simplify the application process, other provisions of federal law require
us to seek your agency's certification regarding certain matters. Applicants should read the regulations cited below and the
instructions for certification included in the regulations to understand the requirements and whether they apply to a particular
applicant. Signing this form complies with certification requirements under 28 C.F.R. Part 69, "New Restrictions on Lobbying," 2
C.F.R. Part 2867, "Nonprocurement Debarment and Suspension," the applicable appropriations Acts, 28 C.F.R. Part 83,
"Government -Wide Requirements for Drug -Free Workplace (Grants)," and the coordination requirements of the Public Safety
Partnership and Community Policing Act of 1994. The certifications shall be treated as a material representation of fact upon which
reliance will be placed when the Department of Justice determines to award the covered grant.
1. Lobbying
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As required by 31 U.S.C. § 1352, implemented at 28 C.F.R. Part 69, for persons entering into a grant or COOPM CILIVC ayrcc rrcrIL
over $100,000, and 2 C.F.R. § 200.450 as adopted by the Department of Justice in 2 C.F.R. § 2800.101, the applicant certifies that:
A. No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or
attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an
)loyee of a member of Congress in connection with the making of any federal grant; the entering into of any cooperative
cement; and the extension, continuation, renewal, amendment or modification of any federal grant or cooperative agreement;
B. 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 grant or cooperative agreement, the undersigned shall complete and submit
Standard Form - LLL, "Disclosure of Lobbying Activities," in accordance with its instructions; and
C. If applicant is a nonprofit organization or an institution of higher education, it will comply with the additional lobbying restrictions
set forth in 2 C.F.R. § 200.450(c) as adopted by the Department of Justice in 2 C.F.R. § 2800.101; and
D. The undersigned shall require that the language of this certification be included in the award documents for all subawards at all
tiers (including subgrants, contracts under grants and cooperative agreements, and subcontracts) and that all sub - recipients shall
certify and disclose accordingly.
2. Debarment, Suspension and Other Responsibility Matters (Direct Recipient)
Pursuant to Executive Order 12549, Debarment and Suspension, as implemented at 2 C.F.R. Part 2867, for prospective participants
in primary covered transactions, as defined at 2 C.F.R. § 2867.20(a), and other requirements, the applicant certifies that it and its
principals:
A. Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of federal benefits by
a state or federal court, or voluntarily excluded from covered transactions by any federal department or agency;
B. Have not within a three -year period preceding this application been convicted of a felony criminal violation under any Federal
law, or been convicted or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection
with obtaining, attempting to obtain, or performing a public (federal, state or local) or private agreement or transaction; violation of
federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records,
making false statements, tax evasion or receiving stolen property, making false claims, or obstruction of justice, or commission of
any offense indicating a lack of business integrity or business honesty that seriously and directly affects your present responsibility;
C. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state or local) with
mission of any of the offenses enumerated in paragraph (B) of this certification; and
L�. Have not within a three -year period preceding this application had one or more public transactions (federal, state or local)
terminated for cause or default.
3. Mandatory Disclosure
Pursuant to the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, 2 C.F.R. §
200.113 as adopted by the Department of Justice in 2 C.F.R. § 2800.101, the applicant certifies that it:
A. Has not violated any federal criminal law involving fraud, bribery, or gratuity that may potentially affect the federal grant or
cooperative agreement.
B. Shall timely disclose in writing to the federal awarding agency or pass- through entity, as applicable, any violation of federal
criminal law involving fraud, bribery, or gratuity that may potentially affect the federal grant or cooperative agreement.
C. Shall require that the language of this certification he included in the award documents for all subavv,2rds (inclitriing Cijbgrants and
cooperative agreements) and shall require all subrecipients certify and disclose accordingly.
4. Federal Taxes and Assessments
A. If applicable, an applicant who receives an award in excess of $5,000,000 certifies that, to the best of its knowledge and belief,
the applicant has filed all Federal tax returns required during the three years preceding the certification, has not been convicted of a
criminal offense under the Internal Revenue Code of 1986, and has not, more than 90 days prior to certification, been notified of
any unpaid Federal tax assessment for which the liability remains unsatisfied, unless the assessment is the subject of an installment
agreement or offer in compromise that has been approved by the Internal Revenue Service and is not in default, or the assessment
is the subject of a non - frivolous administrative or judicial proceeding.
B. The applicant certifies that it does not have any unpaid Federal tax liability that has been assessed, for which all judicial and
administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an
agreement with the authority responsible for collecting the tax liability.
5. Drug -Free Workplace (Grantees Other Than Individuals)
squired by the Drug -Free Workplace Act of 1988, and implemented at 28 C.F.R. Part 83, for grantees /recipients, as defined at
;-,o C.F.R. § 83.660 -
A. The applicant certifies that it will, or will continue to, provide a drug -free workplace by:
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(i) 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;
(ii) Establishing an on -going drug -free awareness program to inform employees about -
(a) Tile 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;
(iii) 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 (i);
(iv) Notifying the employee in the statement required by paragraph (i) 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;
(v) Notifying the agency, in writing, within 10 calendar days after receiving notice under subparagraph (iv)(b) from an employee or
otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title,
to: COPS Office, 145 N St, NE, Washington, D.C. 20530. Notice shall include the identification number(s) of each affected grant;
(vi) Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph (iv)(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;
(vii) Making a good faith effort to continue to maintain a drug -free workplace through implementation of paragraphs (i), (ii), (iii), (iv),
(v), and (vi).
B. The applicant further certifies that it will identify all known workplaces under each COPS Office award, keep the identification
documents on file, and make them available for inspection upon request by the Department of Justice officials or their designated
representatives.
6. Coordination
The Public Safety Partnership and Community Policing Act of 1994 requires applicants to certify that there has been appropriate
coordination with all agencies that may be affected by the applicant's grant proposal if approved. Affected agencies may include,
among others, the Office of the United States Attorney, state or local prosecutors, or correctional agencies. The applicant certifies
that there has been appropriate coordination with all affected agencies.
Where the applicant is unable to certify to any of the statements in this Certifications form, he or she shall attach an explanation
to this application regarding the particular statement that cannot be certified. Please check the box if an explanation is attached to
this application. Please note that the applicant is still required to sign the Certifications form to certify to all the other applicable
statements.
False statements or claims made in connection with COPS grants (including cooperative agreements) may result in fines,
imprisonment, disbarment from participating in federal grants or contracts, and /or any other remedy available by law.
I certify that the assurances provided are true and accurate to the best of my knowledge.
Elections or other selections of new officials will not relieve the grantee entity of its obligations under this grant.
Signature of Law Enforcement Executive /agency Executive (For your electronic signature, please type in your name) Kevin
Rambosk
Late:
Signature of Government Executive /Financial Official (For your electronic signature, please type in your name) Tim stance
Date
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SECTION 16: DISCLOSURE OF LOBBYING ACTIVITIES
`ructions for Completion of SF -LLL, Disclosure of Lobbying Activities
,_s disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or
receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a
form is required for each payment or agreement to make payment to any lobbying entity 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 a covered Federal action. Complete all items that apply for both the initial filing and material change
report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is and /or has been secured to influence the outcome of a
covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a follow -up report caused by a material change to the information
previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report
by this reporting entity for this covered Federal action.
4. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District number, if known.
Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient.
Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to
subcontracts, subgrants and contract awards under grants.
5. If the organization filing the report in item 4 checks "Subawardee," then enter the full name, address, city, state and zip code of
the prime Federal recipient. Include Congressional District, if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level below
agency name, if known. For example, Department of Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal
Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments.
8 Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for
�osal (RFP) number; Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number;
application /proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFPD E -90- 001."
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal
amount of the award /loan commitment for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting registrant identified in
item 4 to influence the covered Federal action.
(b) Enter the full name(s) of the individual(s) performing services, and include full address if different from 10 (a). Enter Last Name,
First Name, and Middle Initial (MI).
11. The certifying official shall sign and date the form, print his /her name, title and telephone number.
According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it
displays a valid OMB Control Number. The valid OMB control number for this information collection is OMB No. 0348 -0046. Public
reporting burden for this collection of information is estimated to average 10 minutes per response. including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information.
including suggestions for reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project (0348 - 0046).
Washington, DC 20503.
Disclosure of Lobbying Activities
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352.
Not Applicable
1. Type of Federal Action:
a. contract
b. grant
1. cooperative agreement
u. loan
e. loan guarantee
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f. loan insurance
2. Status of Federal Action:
a. bid /offer /application
b. initial award
c. post -award
3. Report Type:
a. initial filing
b. material change
For Material Change Only: If you select "b. material change" above, the following three fields are required.
4. Name and Address of Reporting Entity:
a. Prime
b. Subawardee
Subawardee Tier, if known
Congressional District (number), if known:
5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime:
Congressional District (number), if known:
6. Federal Department/Agency:
7. Federal Program Name /Description:
CFDA Number, if applicable:
8. Federal Action Number, if known:
9. Award Amount, if known:
10. a. Name and Address of Lobbying Registrant (if individual, last name, first name, Ml):
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10 b. Individuals Performing Services (including address if different from No.1 Oa) (last name, first name, MI)'.
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11. Information requested through this form is authorized by Title 31 U.S.C. Section 1352. This disclosure of lobbying
activities is a material representation of fact upon which reliance was placed by the tier above when this transaction was
made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the
Congress semi - annually and will be available for public inspection. Any person who fails to file the required disclosure
shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
Typed Name:
Title:
Telephone Number:
DATE:
Federal Use Only:
Authorized for Local Reproduction, Standard Form - LLL
SECTION 17: CERTIFICATION OF REVIEW AND REPRESENTATION OF
COMPLIANCE WITH REQUIREMENTS
1) Federal Civil Rights and Grant Reviews:
;se be advised that an application may not be funded and, if awarded, a hold may be placed on the award if it is deemed that the
applicant is not in compliance with federal civil rights laws, and /or is not cooperating with an ongoing federal civil rights investigation,
and /or is not cooperating with a Department of Justice grant review or audit.
2) Certification of Review of 28 C.F.R. Part 23 /Criminal Intelligence Systems:
Please review the COPS Application Guide: Legal Requirements Section for additional information.
Please check one of the following, as applicable to your agency's intended use of this grant:
No, my agency will not use these COPS grant funds (if awarded) to operate an interjurisdictional criminal intelligence system.
Yes, my agency will use these COPS grant funds (if awarded) to operate an interjurisdictional criminal intelligence system. By
signing below, we assure that our agency will comply with the requirements of 28 C.F.R. Part 23.
3) Certification of Review and Representation of Compliance with Requirements:
The signatures of the Law Enforcement Executive /Agency Executive, Government Executive /Financial Official, and the Person
Submitting this Application on the Reviews and Certifications represent to the COPS Office that:
a) the signatories have been legally and officially authorized by the appropriate governing body to submit this application and act on
behalf of the grant applicant entity;
b) the applicant will comply with all legal, administrative, and programmatic requirements that govern the applicant for acceptance
and use of federal funds as outlined in the applicable COPS Application Guide; the COPS Grant Owner's Manual, Assurances,
Certifications and all other applicable program regulations, laws, orders, and circulars;
c) the applicant understands that false statements or claims made in connection with COPS programs may result in fines,
imprisonment, debarment from participating in federal grants, cooperative agreements, or contracts, and /or any other remedy
available by law to the federal government;
d) the information provided in this application, including any amendments, shall be treated as material representations of fact upon
which reliance will be placed when the Department of Justice determines to award the covered grant;
e applicant understands that as a general rule COPS funding may not be used for the same item or service funded through
a pother funding source; and
f) the applicant and any required or identified official partner(s) listed in Section 12 are partners in this grant project and mutually
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agreed to this partnership prior to this grant application.
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The signatures of the Law Enforcement Executive /Agency Executive and the Government Executive /Financial Official on this
application must be the same as those identified in Section 4 of this application. Applications with missing, incomplete, or inaccurate
signatories or responses may not be considered for funding.
Signature of Law Enforcement Executive /Agency Executive (For your electronic signature, please type in your name) Kevin
Rambosk
Date
Signature of Government Executive /Financial Official (For your electronic signature, please type in your name) Tim Nance
Date:
Signature of Person Submitting This Application (For your electronic signature, please type in your name)
Date:
By clicking this box, the applicant understands that the use of typed names in this grant application and the required grant
forms, including the Assurances and Certifications, constitute electronic signatures and that the electronic signatures are the legal
equivalent of handwritten signatures.
APPLICATION REVIEW
No Audit .Errors available for this agency
Your application has been successfully recorded.
Submission Date: 2015 -06 -12 14:55:49
ORI: FL01100
Confirmation Number: 1002508_64459130
Program Type: COPS Anti -Gang Initiative
Thank you for submitting your agency's COPS Application. If you have any questions or concerns you may contact the COPS Office
Response Center at 800.421.6770. When contacting the COPS Office concerning the submission of this application, please reference your
agency's OPI number.
Click mere to return to the COPS Application home page.
Paperwork Reduction Act Notice
The public reporting burden for this collection of information is estimated to be up to 11.3 hours per response, depending upon the COPS
program being applied for, which includes time for reviewing instructions. Send comments regarding this burden estimate or any other
aspects of the collection of this information, including suggestions for reducing this burden, to the Office of Community Oriented Policing
Services, U.S. Department of Justice, 145 N Street NE, Washington, DC 20530; and to the Public Use Reports Project, Office of
Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
You are not required to respond to this collection of information unless it displays a valid OMB control number. The OMB control number
for this application is 1103 -0098 and the expiration date is 04/30/2017.
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