Solar Electric Light Fund

C
1 OF 2
Electrical Schematic
DC Overview
JEFF KORCAN
SabanaCrespo, Colombia
19FEB14
1612 K STREET NW, WASHINGTON, DC 20006 USA
A
Solar Electric Light Fund
B
2 OF 2
Electrical Schematic
AC Overview
JEFF KORCAN
SabanaCrespo, Colombia
19FEB14
1612 K STREET NW, WASHINGTON, DC 20006 USA
A
10'-8"
[3.25 m]
6
'
-
6
12
"
[
2
.
0
0

m
]
BATTERY
ROOM
INVERTER
ROOM
12'-8"
[3.86 m]
ROOFLINE
4'-1
1
2
"
[1.26 m]
6'-2
1
2
"
[1.89 m]
4"
[0.10 m]
TYPICAL WALL
1'-2
1
2
"
[0.37 m]
BOTH SIDES
2'-6"
[0.76 m]
TYPICAL DOOR
BOTH SIDES
2
'
-
1
0
12
"
[
0
.
8
7

m
]
B
O
T
H

S
I
D
E
S
1612 K STREET NW, WASHINGTON, DC 20006 USA
SabanaCrespo, Colombia
JEFF KORCAN
Battery and Control Rooms
Top View
Solar Electric Light Fund
21FEB14
A
1 OF 6
A
1612 K STREET NW, WASHINGTON, DC 20006 USA
SabanaCrespo, Colombia
JEFF KORCAN
Battery and Control Rooms
Front View
Solar Electric Light Fund
21FEB14
A
2 OF 6
A
1612 K STREET NW, WASHINGTON, DC 20006 USA
SabanaCrespo, Colombia
JEFF KORCAN
Battery and Control Rooms
Side View
Solar Electric Light Fund
21FEB14
A
3 OF 6
A
1612 K STREET NW, WASHINGTON, DC 20006 USA
SabanaCrespo, Colombia
JEFF KORCAN
Battery and Control Rooms
IsometricView
Solar Electric Light Fund
21FEB14
A
4 OF 6
A
1612 K STREET NW, WASHINGTON, DC 20006 USA
SabanaCrespo, Colombia
JEFF KORCAN
Battery and Control Rooms
IsometricView 2
Solar Electric Light Fund
21FEB14
A
6 OF 6
A
CATEGORY ITEM UNIT TOTAL QTY NOTES
PV MODULES - 235 WATT EOPLLY EP156 P60 235 W EACH 28
DONATED BY SELF, 24 FOR VILLAGE
POWER, 2 FOR CAFETERIA FRIDGE, 2
SPARES
PV MODULES - 285 WATT EOPLLY EP156 P72 285 W EACH 26
DONATED BY SELF, 24 FOR VILLAGE
POWER, 2 SPARES
PV WIRING MC4 10/1 15FT CABLE EACH 18
PV WIRING MC4 10/1 30FT CABLE EACH 10
PV WIRING LAY-IN LUG (10 per PACK) EACH 1
PV WIRING CABLE CLIP (100 per PACK) for item 2,3 EACH 1
PV WIRING
STRING COMBINER BOX, 4 CIRCUITS, FUSED, NEMA 3R, 600 VDC, 48
AMPS, INCLUDING MOUNTING BRACKET,SCREWS AND WASHERS EACH 2
PV WIRING FUSES, 600VDC 15A MIDGET TYPE FOR STRING COMBINER BOX EACH 20
PV WIRING LOCKNUT, 1/2" EACH 20
PV WIRING STRAIN RELIEF 1/2" 2-HOLE EACH 10
PV WIRING STRAIN RELIEF 1/2" 1-HOLE EACH 5
BATTERY 6 VOLT, 445 AH @ C/20, FLOODED LEAD ACID INDUSTRIAL BATTERY EACH 8
BATTERY BATTERY POSITIVE CABLE WITH LUGS - 4/0 8FT RED EACH 1
BATTERY BATTERY POSITIVE CABLE WITH LUGS - 4/0 2FT RED EACH 1
BATTERY BATTERY NEGATIVE CABLE WITH LUGS - 4/0 10FT BLK EACH 1
BATTERY BATTERY CABLE LUG COPPER 4/O EACH 30
BATTERY BATTERY INTERCONNECT CABLES WITH LUGS - 4/0 12IN. RED-BLK EACH 7
BATTERY BOLT, HEX BOLT, 5/16-1", STAINLESS STEEL EACH 50
BATTERY NUT, 5/16-18, STAINLESS STEEL EACH 50
BATTERY WASHER, 5/16 FLATWASHER 18-8 STAINLESS STEEL EACH 100
BATTERY WASHER, 5/16 SPLIT LOCKWASHER, STAINLESS STEEL EACH 50
BATTERY BATTERY FUSE BLOCK W/ 400A CLASS T EACH 1
BATTERY BATTERY REPLACEMENT FUSE - 400A CLASS T EACH 2
INVERTER
OUTBACK RADIAN INVERTER, 8000 WATT, 48 VDC WITH COMPLETE
PACKAGE INCLUDING ALARM LIGHTS PER SELF EACH 1
DONATED BY SELF, WITH SPARE
BOARDS
CHARGE CONTROL OUTBACK FM80 CHARGE CONTROLS EACH 4 DONATED BY SELF, WITH SPARE
STRUCTURE
GROUND MOUNT STRUCTURE FOR 24 SOLAR MODULES, 285 Watts
each EACH 1
STRUCTURE ROOF MOUNT STRUCTURE FOR 6 MODULES, 235 Watts each EACH 4
STRUCTURE SIDE OF POLE MOUNT FOR 1 EOPLLY 235 W PV MODULE, 235 Watts EACH 2
GENERAL ELEC/MECH WIREWAY, NEMA 1 W/ COVER, STEEL, 30 X 6 X 6 IN. EACH 1
GENERAL ELEC/MECH KNOCKOUT BUSHING, 1.00IN. EACH 2
GENERAL ELEC/MECH KNOCKOUT BUSHING, 2.00IN. EACH 1
GENERAL ELEC/MECH
STRUT, METAL FRAMING CHANNEL, B22 SINGLE, HDG, 1-5/8"X1-
5/8", 10-FT EACH
1
GENERAL ELEC/MECH STRUT NUT, 1/4-20 EACH 20
GENERAL ELEC/MECH MACHINE SCREW, 1/4-20 X 1", PAN HEAD EACH 20
GENERAL ELEC/MECH BOLT, WEDGE ANCHOR, 1/4 x 2", GALV STEEL EACH 100
GENERAL ELEC/MECH BOX , 4" OCTAGON, METALLIC W/ 1/2" + 3/4" KNOCKOUTS EACH 70
GENERAL ELEC/MECH BOX , 4" OCTAGON, METALLIC W/ 1/2" KNOCKOUTS EACH 40
GENERAL ELEC/MECH BOX COVER, 4" OCTAGON, METAL, BLANK EACH 40
GENERAL ELEC/MECH BOX COVER, METAL, 2 GANG, DUPLEX RECEPTACLE EACH 40
GENERAL ELEC/MECH BOX COVER, UTILITY BOX, METAL, 1G, TOGGLE SWITCH EACH 40
GENERAL ELEC/MECH BOX, UTILITY BOX, METAL, 1G, DEEP, W/ 1/2" & 3/4" KNOCKOUTS EACH 40
GENERAL ELEC/MECH CIRCUIT BREAKER, 1P 15A, 120V (GE THQL1115) EACH 30
GENERAL ELEC/MECH CIRCUIT BREAKER, 1P 30A, 120V (GE THQL1130) EACH 10
GENERAL ELEC/MECH CIRCUIT BREAKER, 2P 40A, 240V (GE THQL2140) EACH 6
GENERAL ELEC/MECH CIRCUIT BREALER, 1P 20A, 120V (GE THQL1120) EACH 15
GENERAL ELEC/MECH CONDUIT BODY COVER, 1.00 IN. EACH 5
GENERAL ELEC/MECH CONDUIT BODY COVER, 1.25 IN. EACH 1
GENERAL ELEC/MECH CONDUIT BODY COVER, SEALING GASKET, 1.00 IN. EACH 5
GENERAL ELEC/MECH CONDUIT BODY COVER, SEALING GASKET, 1.25 IN. EACH 1
GENERAL ELEC/MECH CONDUIT BODY, LB, RIGID, 0.75 IN. EACH 40
GENERAL ELEC/MECH CONDUIT BODY, LB, RIGID, 1.00 IN. EACH 5
GENERAL ELEC/MECH CONDUIT BODY, T, RIGID, 1.25 IN. EACH 1
GENERAL ELEC/MECH CONDUIT CONNECTOR, COMPRESSION, EMT, 0.75 IN. EACH 40
GENERAL ELEC/MECH CONDUIT CONNECTOR, COMPRESSION, EMT, 1.00 IN. EACH 14
GENERAL ELEC/MECH CONDUIT CONNECTOR, COMPRESSION, EMT, 1.25 IN. EACH 6
GENERAL ELEC/MECH CONDUIT CONNECTOR, SET SCREW, EMT, 0.50 IN. EACH 200
GENERAL ELEC/MECH CONDUIT CONNECTOR, SET SCREW, EMT, 0.75 IN. EACH 150
GENERAL ELEC/MECH CONDUIT COUPLING, EMT, COMPRESSION, 1.00 IN. EACH 24
GENERAL ELEC/MECH CONDUIT COUPLING, EMT, COMPRESSION, 1.25 IN. EACH 2
GENERAL ELEC/MECH CONDUIT COUPLING, EMT, SET SCREW, 0.50 IN. EACH 100
GENERAL ELEC/MECH CONDUIT COUPLING, EMT, SET SCREW, 0.75 IN. EACH 40
GENERAL ELEC/MECH CONDUIT COUPLING, PVC, 0.75 IN. EACH 120
GENERAL ELEC/MECH CONDUIT COUPLING, PVC, 1.25 IN. EACH 10
GENERAL ELEC/MECH CONDUIT COUPLING, RIGID, THREADED, 1.25 IN. EACH 2
GENERAL ELEC/MECH CONDUIT ELBOW, EMT, 90DEG, 0.50 IN. EACH 60
GENERAL ELEC/MECH CONDUIT ELBOW, EMT, 90DEG, 0.75 IN. EACH 20
GENERAL ELEC/MECH CONDUIT ELBOW, EMT, 90DEG, 1.00 IN. EACH 5
GENERAL ELEC/MECH CONDUIT ELBOW, EMT, 90DEG, 1.25 IN. EACH 1
GENERAL ELEC/MECH CONDUIT ELBOW, PVC, 0.75 IN. EACH 40
GENERAL ELEC/MECH CONDUIT ELBOW, PVC, 1.25 IN. EACH 2
GENERAL ELEC/MECH CONDUIT EMT, 10-FT, 0.50 IN. FEET 800
GENERAL ELEC/MECH CONDUIT EMT, 10-FT, 0.75 IN. FEET 700
GENERAL ELEC/MECH CONDUIT EMT, 10-FT, 1.00 IN. FEET 140
GENERAL ELEC/MECH CONDUIT EMT, 10-FT, 1.25 IN. FEET 20
GENERAL ELEC/MECH CONDUIT FEMALE ADAPTER, PVC, 0.75 IN. EACH 50
GENERAL ELEC/MECH CONDUIT NIPPLE, EMT, 3/4 IN. X 8 IN. EACH 40
GENERAL ELEC/MECH CONDUIT PVC, SCH40, 10-FT W/ BELL END, 1.25 IN. FEET 100
GENERAL ELEC/MECH CONDUIT PVC,SCH40, 10-FT W/ BELL END, 0.75 IN. FEET 800
GENERAL ELEC/MECH CONDUIT STRAP, EMT, 1-HOLE, 0.50 IN. EACH 250
GENERAL ELEC/MECH CONDUIT STRAP, EMT, 1-HOLE, 0.75 IN. EACH 100
GENERAL ELEC/MECH CONDUIT STRAP, EMT, 1-HOLE, 1.00 IN. EACH 70
GENERAL ELEC/MECH CONDUIT STRAP, EMT, 1-HOLE, 1.25 IN. EACH 10
GENERAL ELEC/MECH CONDUIT STRAP, EMT, 2-HOLE, 1.00 IN. EACH 100
GENERAL ELEC/MECH CONDUIT TERMINAL ADAPTER, PVC, 1.25 IN. EACH 2
GENERAL ELEC/MECH CONNECTOR, 2-SCREW CLAMP, 2.00 IN. EACH 1
GENERAL ELEC/MECH GROUDN ROD, COPPER PLATED STEEL, POINTED, 5/8IN. X 8FT EACH 3
GENERAL ELEC/MECH GROUND ROD CLAMP, BRONZE, 5/8IN. DIAMETER ROD EACH 3
GENERAL ELEC/MECH LAMP, BOMBILLO, LED,7W, 120 VAC MED BASE EACH 24
GENERAL ELEC/MECH LAMPHOLDER, KEYLESS, MED BASE ROSETTE POR #90 EACH 21
GENERAL ELEC/MECH
LAMP, TUBO, LED, 17 W, 120 VAC PLUS THE FISTURE TO MOUNT
THE TUBE EACH 22
GENERAL ELEC/MECH LOAD CENTER, NEMA 1, 70A 4CCT EACH 15
GENERAL ELEC/MECH LOAD CENTER, NEMA 1, 70A 8CCT EACH 2
GENERAL ELEC/MECH LOAD CENTER, NEMA1, 125A 12CCT (EX. GE TLM1212CCU) EACH 1
GENERAL ELEC/MECH LOCK NUT, 0.50 IN. EACH 20
GENERAL ELEC/MECH LOCK NUT, 0.75 IN. EACH 20
GENERAL ELEC/MECH LUG, COMPRESSION LUG/RING TERMINAL, #14, 1/4" STUD EACH 2
GENERAL ELEC/MECH LUG, COMPRESSION LUG/RING TERMINAL, #4, 1/4" STUD EACH 8
GENERAL ELEC/MECH LUG, COMPRESSION LUG/RING TERMINAL, #6, 1/4" STUD EACH 12
GENERAL ELEC/MECH NYLON BUSHING 1.00 IN. EACH 32
GENERAL ELEC/MECH NYLON BUSHING 1.25 IN. EACH 2
GENERAL ELEC/MECH PVC GLUE, PINT EACH 2
GENERAL ELEC/MECH RECEPTACLE, DUPLEX, 15A/120V, STANDARD GRADE EACH 80
GENERAL ELEC/MECH REDUCER BUSHING, 1.25IN. TO 1.00IN. EACH 1
GENERAL ELEC/MECH SCREW INSERT, MASONRY/CONCRETE, FOR 10-1 SCREW EACH 350
GENERAL ELEC/MECH SCREW, PAN HEAD, STAINLESS STEEL, PHILIPS, 10 - 1" (PK OF 100) EACH 1300
GENERAL ELEC/MECH SCREW, TAPCON HEX-HEAD, 1/4" x 1-1/4" (PK OF 100) EACH 1
GENERAL ELEC/MECH SPLIT BOLT, COPPER, BURNDY KS22-3 EACH 4
GENERAL ELEC/MECH STRAP, NONMETALLIC SHEATHED CABLE, PLASTIC (PK OF 500) EACH 1
GENERAL ELEC/MECH SWITCH, TOGGLE, 15A 120V, SINGLE-POLE, STANDARD GRADE EACH 40
GENERAL ELEC/MECH SWTICH, 3-POLE 2-THROW, 60A, GENERAL DUTY EACH 1
GENERAL ELEC/MECH VINYL ELECTRICAL TAPE, BLACK EACH 10
GENERAL ELEC/MECH VINYL ELECTRICAL TAPE, RED EACH 10
GENERAL ELEC/MECH VINYL ELECTRICAL TAPE, WHITE EACH 10
GENERAL ELEC/MECH WIRE CONNECTOR, IDEAL BLUE 30-340 (PK OF 100) EACH 2
GENERAL ELEC/MECH WIRE, NONMETALLIC SHEATHED CABLE, 14/2 EACH 2000
GENERAL ELEC/MECH WIRE, #12 AWG, STRANDED COPPER, THHN-2, BLK EACH 1000
GENERAL ELEC/MECH WIRE, #12 AWG, STRANDED COPPER, THHN-2, GRN EACH 1000
GENERAL ELEC/MECH WIRE, #12 AWG, STRANDED COPPER, THHN-2, WHT EACH 1000
GENERAL ELEC/MECH WIRE, #10 AWG, STRANDED COPPER, THHN-2, BLK EACH 100
GENERAL ELEC/MECH WIRE, #10 AWG, STRANDED COPPER, THHN-2, GRN EACH 100
GENERAL ELEC/MECH WIRE, #10 AWG, STRANDED COPPER, THHN-2, WHT EACH 100
GENERAL ELEC/MECH WIRE, #6 AWG, STRANDED COPPER, BARE EACH 315
GENERAL ELEC/MECH WIRE, #6 AWG, STRANDED COPPER, THHN-2, GRN EACH 300
GENERAL ELEC/MECH WIRE, #6 AWG, STRANDED COPPER, THHN-2, RED EACH 300
GENERAL ELEC/MECH WIRE, #6 AWG, STRANDED COPPER, THHN-2, WHT EACH 300
GENERAL ELEC/MECH WIRE, #4 AWG, STRANDED COPPER, THHN-2, GRN EACH 100
GENERAL ELEC/MECH WIRE, #4 AWG, STRANDED COPPER, THHN-2, RED EACH 200
GENERAL ELEC/MECH WIRE, #4 AWG, STRANDED COPPER, THHN-2, WHT EACH 200
MAINTENANCE HYDROMETER EACH 3
MAINTENANCE SAFETY GLASSES/GOGGLES EACH 3
MAINTENANCE DIGITAL VOLT METER EACH 2
MAINTENANCE CHEMICAL RESISTANT NITRILE GLOVES EACH 12
MAINTENANCE CHEMICAL RESISTANT RUBBER APRON EACH 3
MAINTENANCE WIRE BRUCH WITH STAINLESS STEEL BRISTLES EACH 2
MAINTENANCE CANVAS ZIPPER TOOL BAG 17" X 12" EACH 2
MAINTENANCE BASTER FOR ADDING BATTERY WATER EACH 3
MAINTENANCE ANTI-CORROSION BATTERY TERMINAL SPRAY EACH 3
SPECIAL EQUIPMENT REFRIGERATOR/FREEZER 14.5 CUBIC FOOT EACH 2
SPECIAL EQUIPMENT LAB REFRIGERATOR EACH 1
SPECIAL EQUIPMENT FREEZER COMPRESSOR TIMER EACH 3
SPECIAL EQUIPMENT REFRIGERATOR - SURECHILL BLF100DC EACH 1 DONATED BY SELF
CertificationsandAssurances

AsapotentialrecipientofaU.S.Governmentsubawardtheapplicantisrequiredtoprovidethe
followingcertificationsregardingtheuseofUSGovernmentfunds.

CertificationRegardingLobbying

Theundersignedcertifies,tothebestofhisorherknowledgeandbelief,that:
(1)NoFederalappropriatedfundshavebeenpaidorwillbepaid,byoronbehalfoftheundersigned,to
anypersonforinfluencingorattemptingtoinfluenceanofficeroremployeeofanyagency,aMember
ofCongress,anofficeroremployeeofCongress,oranemployeeofaMemberofCongressinconnection
withtheawardingofanyFederalcontract,themakingofanyFederalCooperativeAgreement,the
makingofanyFederalloan,theenteringintoofanycooperativeagreement,andtheextension,
continuation,renewal,amendmentormodificationofanyFederalcontract,grant,loan,orcooperative
agreement.
(2)IfanyfundsotherthanFederalappropriatedfundshavebeenpaidorwillbepaidtoanypersonfor
influencingorattemptingtoinfluenceanofficeroremployeeofanyagency,aMemberofCongress,an
officeroremployeeofCongress,oranemployeeofaMemberofCongressinconnectionwiththis
Federalcontract,grant,loan,orcooperativeagreement,theundersignedmustcompleteandsubmit
StandardFormLLL,DisclosureofLobbyingActivities,inaccordancewithitsinstructions.
(3)Theundersignedmustrequirethatthelanguageofthiscertificationbeincludedintheaward
documentsforallsubawardsatalltiers(includingsubcontracts,subgrants,andcontractsundergrants,
loans,andcooperativeagreements)andthatallsubrecipientsmustcertifyanddiscloseaccordingly.

Thiscertificationisamaterialrepresentationoffactuponwhichreliancewasplacedwhenthis
transactionwasmadeorenteredinto.Submissionofthiscertificationisaprerequisiteformakingor
enteringintothistransactionimposedbysection1352,title31,UnitedStatesCode.Anypersonwho
failstofiletherequiredcertificationwillbesubjecttoacivilpenaltyofnotlessthan$10,000andnot
morethan$100,000foreachsuchfailure.

ProhibitiononAssistancetoDrugTraffickersforCoveredCountriesandIndividuals(ADS206)

USAIDreservestherighttoterminatethisAgreement,todemandarefundortakeotherappropriate
measuresiftheGranteeisfoundtohavebeenconvictedofanarcoticsoffenseortohavebeenengaged
indrugtraffickingasdefinedin22CFRPart140.TheundersignedmustreviewUSAIDADS206to
determineifanycertificationsarerequiredforKeyIndividualsorCoveredParticipants.
IfthereareCOVEREDPARTICIPANTS:USAIDreservestherighttoterminateassistancetoortakeother
appropriatemeasureswithrespectto,anyparticipantapprovedbyUSAIDwhoisfoundtohavebeen
convictedofanarcoticsoffenseortohavebeenengagedindrugtraffickingasdefinedin22CFRPart
140.

CertificationRegardingTerroristFinancing,ImplementingExecutiveOrder13224
Bysigningandsubmittingthisapplication,theprospectiverecipientprovidesthecertificationsetout
below:

1.TheRecipient,tothebestofitscurrentknowledge,didnotprovide,withinthe
previoustenyears,andwilltakeallreasonablestepstoensurethatitdoesnotandwillnotknowingly
provide,materialsupportorresourcestoanyindividualorentitythatcommits,attemptstocommit,
advocates,facilitates,orparticipatesinterroristacts,orhascommitted,attemptedtocommit,
facilitated,orparticipatedinterroristacts,asthattermisdefinedinparagraph3.

2.ThefollowingstepsmayenabletheRecipienttocomplywithitsobligationsunderparagraph1:
a.Beforeprovidinganymaterialsupportorresourcestoanindividualorentity,theRecipientwillverify
thattheindividualorentitydoesnot(i)appearonthemasterlistofSpeciallyDesignatedNationalsand
BlockedPersons,whichismaintainedbytheU.S.TreasurysOfficeofForeignAssetsControl(OFAC),or
(ii)isnotincludedinanysupplementaryinformationconcerningprohibitedindividualsorentitiesthat
maybeprovidedbyUSAIDtotheRecipient.
b.Beforeprovidinganymaterialsupportorresourcestoanindividualorentity,theRecipientalsowill
verifythattheindividualorentityhasnotbeendesignatedbytheUnitedNationsSecurity(UNSC)
sanctionscommitteeestablishedunderUNSCResolution1267(1999)(the1267Committee)
[individualsandentitieslinkedtotheTaliban,UsamabinLaden,ortheAlQaidaOrganization].To
determinewhethertherehasbeenapublisheddesignationofanindividualorentitybythe1267
Committee,theRecipientshouldrefertotheconsolidatedlistavailableonlineattheCommitteesWeb
site:http://www.un.org/Docs/sc/committees/1267/1267ListEng.htm.
c.Beforeprovidinganymaterialsupportorresourcestoanindividualorentity,theRecipientwill
considerallinformationaboutthatindividualorentityofwhichitisawareandallpublicinformation
thatisreasonablyavailabletoitorofwhichitshouldbeaware.
d.TheRecipientalsowillimplementreasonablemonitoringandoversightprocedurestosafeguard
againstassistancebeingdivertedtosupportterroristactivity.

3.ForpurposesofthisCertification
a.Materialsupportandresourcesmeanscurrencyormonetaryinstrumentsorfinancialsecurities,
financialservices,lodging,training,expertadviceorassistance,safehouses,falsedocumentationor
identification,communicationsequipment,facilities,weapons,lethalsubstances,explosives,personnel,
transportation,andotherphysicalassets,exceptmedicineorreligiousmaterials.
b.Terroristactmeans
(i)anactprohibitedpursuanttooneofthe12UnitedNationsConventionsandProtocolsrelatedto
terrorism(seeUNterrorismconventionsInternetsite:http://untreaty.un.org/English/Terrorism.asp);
or
(ii)anactofpremeditated,politicallymotivatedviolenceperpetratedagainstnoncombatanttargetsby
subnationalgroupsorclandestineagents;or
(iii)anyotheractintendedtocausedeathorseriousbodilyinjurytoacivilian,ortoanyotherperson
nottakinganactivepartinhostilitiesinasituationofarmedconflict,whenthepurposeofsuchact,by
itsnatureorcontext,istointimidateapopulation,ortocompelagovernmentoraninternational
organizationtodoortoabstainfromdoinganyact.
c.Entitymeansapartnership,association,corporation,orotherorganization,grouporsubgroup.
d.ReferencesinthisCertificationtotheprovisionofmaterialsupportandresourcesmustnotbe
deemedtoincludethefurnishingofUSAIDfundsorUSAIDfinancedcommoditiestotheultimate
beneficiariesofUSAIDassistance,suchasrecipientsoffood,medicalcare,microenterpriseloans,
shelter,etc.,unlesstheRecipienthasreasontobelievethatoneormoreofthesebeneficiariescommits,
attemptstocommit,advocates,facilitates,orparticipatesinterroristacts,orhascommitted,attempted
tocommit,facilitatedorparticipatedinterroristacts.
e.TheRecipientsobligationsunderparagraph1arenotapplicabletothe
procurementofgoodsand/orservicesbytheRecipientthatareacquiredintheordinarycourseof
businessthroughcontractorpurchase,e.g.,utilities,rents,officesupplies,gasoline,etc.,unlessthe
Recipienthasreasontobelievethatavendororsupplierofsuchgoodsandservicescommits,attempts
tocommit,advocates,facilitates,orparticipatesinterroristacts,orhascommitted,attemptedto
commit,facilitatedorparticipatedinterroristacts.
ThisCertificationisanexpresstermandconditionofanyagreementissuedasaresultofthis
application,andanyviolationofitwillbegroundsforunilateralterminationoftheagreementbyUSAID
priortotheendofitsterm.

5.CertificationofRecipient
Bysigningbelowtherecipientprovidescertificationsandassurancesfor(1)theAssuranceof
CompliancewithLawsandRegulationsGoverningNonDiscriminationinFederallyAssistedPrograms,(2)
theCertificationRegardingLobbying,(3)theProhibitiononAssistancetoDrugTraffickersforCovered
CountriesandIndividuals(ADS206)and(4)theCertificationRegardingTerroristFinancingImplementing
ExecutiveOrder13224above.

Thesecertificationsandassurancesaregiveninconsiderationofandforthepurposeofobtainingany
andallFederalgrants,loans,contracts,property,discounts,orotherFederalfinancialassistance
extendedafterthedatehereoftotherecipientbytheAgency,includinginstallmentpaymentsafter
suchdateonaccountofapplicationsforFederalfinancialassistancewhichwasapprovedbeforesuch
date.TherecipientrecognizesandagreesthatsuchFederalfinancialassistancewillbeextendedin
relianceontherepresentationsandagreementsmadeintheseassurances,andthattheUnitedStates
willhavetherighttoseekjudicialenforcementoftheseassurances.Theseassurancesarebindingonthe
recipient,itssuccessors,transferees,andassignees,andthepersonorpersonswhosesignaturesappear
belowareauthorizedtosigntheseassurancesonbehalfoftherecipient.

RequestforApplicationNo.___________________________

ApplicationNo.________________________________

DateofApplication________________________________

NameofRecipient________________________________

TypedNameandTitle________________________________

Signature________________________________

Date________________________________

PartIIKeyIndividualCertificationNarcoticsOffensesandDrugTrafficking

Iherebycertifythatwithinthelasttenyears:

1. Ihavenotbeenconvictedofaviolationof,oraconspiracytoviolate,anylaworregulation
oftheUnitedStatesoranyothercountryconcerningnarcoticorpsychotropicdrugsorother
controlledsubstances.

2. Iamnotandhavenotbeenanillicittraffickerinanysuchdrugorcontrolledsubstance.

3. Iamnotandhavenotbeenaknowingassistor,abettor,conspirator,orcolluderwithothers
intheillicittraffickinginanysuchdrugorsubstance.

Signature:____________________________

Date:____________________________

Name:____________________________

Title/Position:____________________________

Organization:____________________________

Address:____________________________

____________________________

DateofBirth:____________________________

NOTICE:

1. YouarerequiredtosignthisCertificationundertheprovisionsof22CFRPart140,Prohibitionon
AssistancetoDrugTraffickers.TheseregulationswereissuedbytheDepartmentofStateand
requirethatcertainkeyindividualsoforganizationsmustsignthisCertification.

2. IfyoumakeafalseCertificationyouaresubjecttoU.S.criminalprosecutionunder18U.S.C.
1001.