United States Department of Agriculture Rural Development ‘Salt Lake Giy, Utah March 23, 2006 The City of Monticello PO Box 457 17 North 100 East Monticello, UT 84535, ATTN: GREG MARTIN SUBJECT: LETTER OF CONDITIONS $38,500 FY2006 BUSINESS ENTERPRISE GRANT (RBEG) PLUS $28,000 FY2005 RBEG FUNDING FOR A TOTAL OF $66,500 WIND RESOURCE ASSESSMENT FEASIBILITY STUDY ‘This letter establishes the conditions that must be understood and agreed to by the City of Monticello before further consideration can be given to funding a Rural Business Enterprise Grant (RBEG) in the amount not to exceed a total of $66,500 between FY2006 funding of $38,500 and FY2005 funding of $28,000. This letter of conditions does not constitute grant approval, nor does it ensure that funds are or will be available for the project. This letter of conditions addresses the total $66,500 RBEG request for the project. ‘The total amount of $66,500 needed to fund the project has been split between two funding cycles. $38,500 has been funded from the FY2006 & $28,000 total has been funded from the F¥Y2005 allocation. Neither the FY2005 $28,000 RBEG funds nor the FY 2006 $38,500 RBEG funds will be disbursed until all project funding is in place. Please complete and return the attached Form RD 1942-46 "Letter of Intent to Meet Conditions" if you desire that further consideration be given to your application. Please note that USDA-Rural Development reserves the right to discontinue processing x, this request, and withdraw your application if Form RD 1942-46 “Letter of Intent to Meet {? Conditions” is not executed by the City of Monticello within 1 week of the date of this oe letter of conditions. Please also complete and return the attached Form RD 1940-1 "Request for Obligation of Funds" if you desire that further consideration be given to this RBEG request. Please only remit to this office Form RD 1940-1, and keep the attached RD Instruction 1942-G, Attachment 1, Section B “General Requirements for Administration of Rural Business Enterprise and Television Demonstration Grants” for your reference. 4125 South Stato St, #4311, Salt Lake City, UT 84188, Phone (801) 524-4920, Fax (801) 524-4406 commited tthe ture ofa communtiee ‘Rural Development an Equal Opportunity Lender, Provider, and Employer. Complains of disceminaton should be sent 1 USDA, Director, Office of Civil Fights, Washington, D. C. 20250-9610This RBEG will be considered approved on the date a fully executed and signed copy of Form 1940-1, "Request for Obligation of Funds" is returned to you by this office. You may fax the signed Forms RD 1942-46 and 1940-1 to this office to expedite processing of this request. Our fax number is (801) 524-4406. ‘Throughout this letter or any form or document used in connection with the grant, whenever the words "Farmers Home Administration” (FmHA) or "Rural Economic and ‘Community Development" (RECD) may appear, the words "United States of America" or "USDA Rural Development" or “agency” may be substituted. Any changes in project cost, source of funds, scope of work or any other significant changes in the project or entity must be reported to and approved by USDA-Rural Development by written amendment to this letter. Failure to obtain prior approval of changes to the project cost, source of funds, scope of work or budget can result in suspension or termination of RBEG grant funds. This Grant request is subject to the following: PURPOSE CITY OF MONTICELLO must use RBEG proceeds to promote the economic development of multiple small and emerging rural businesses, except as noted below in accordance with section 6014 of the 2002 farmbill. Businesses assisted with this RBEG must be located in, and primarily serve a rural area. Rural areas for the RBEG program are defined as communities with a population of 50,000 or less, and not located adjacent to urban areas of more than 50,000 population. For the State of Utah, it is easier to list communities that are not eligible for the RBEG program. The following communities are considered urban (50,000 or more population as listed in the 2000 census) and are NOT. eligible areas for this program: Ogden, Layton, Salt Lake, Sandy, West Valley, West Jordan, Taylorsville, Orem, and Provo. Also, the following listed communities are adjacent to the above listed urban areas, and are also ineligible areas for this program: North Ogden, South Ogden, Harrisville, Washington Terrace, Riverdale, East Layton, Clearfield, Syracuse, Kaysville, Centerville, Woods Cross, Bountiful, North Salt Lake, South Salt Lake, Magna, Kearns, Taylorsville, Holladay, Sugar House, Murray, Midvale, Jordan, West Jordan, South Jordan, Draper, Pleasant Grove, Lindon, Lakeview, Ironton, and Springville. All other communities in Utah are eligible rural areas for this program. ‘Small and emerging businesses for the RBEG program are defined as having fewer than 50 new employees, and less than $1 million in gross revenues, EXCEPT that the small and emerging limitation will not apply to businesses with a principal office that is located on the land of an existing or former Native American Reservation and located in a city, town, or unincorporated area that has a population of not more than 5,000 inhabitants. The specific purpose of this RBEG is to assist CITY OF MONTICELLO fund a “Wind Resource Assessment” project that will provide accurate and reliable wind resource data, which hopefully lead to a wind power project. Project will be used to purchase and install four (4) towers with anemometers for a total project cost of $ 70,000. The City of Monticello is working with several land owners RBEG proceeds will be used to purchase and install equipment needed to install four towers with anemometers for wind resource assessment.(1) The funding is also contingent upon ‘The City of Monticello’ being verified as a VY duly organized and recognized public body, with the legal authority to operate, maintain, and manage the project funded in whole or in part with this grant. SOURCES AND USE OF FUNDS SOURCE OF FUNDS USDA-Rural Development (RBEG) FY 2005 State Office Funds —-—-----—- $28,000 USDA-Rural Development (RBEG) FY2006 State Office Funds -—-—------- 38,500 Total USDA RD funds ~ $66,500 CITY OF MONTICELLO (Matching Funds-Cash)- 3,500 Total $70,000 A. CITY OF MONTICELLO will maintain a separate ledger on the construction, contracts, equipment, labor, etc. funded with this RBEG. All matched funds for this project must deposited into this separate account at the same time the RBEG is closed. Matched funds will be expended before, or as equitably pro-rated with RBEG proceeds for like purposes. The City of Monticello will provide matching funds of $3,500 will be in the form of cash. The City of Monticello will have to provide appropriate permits, licenses, etc. necessary in order to purchase, build and operate the Wind Resource Assessment towers and show that is in compliance with zoning, local, state & other applicable laws, ordinances, etc. » v9 m No grants funds will be disbursed unless all of the funds necessary to fund the total project are available. USE OF FUNDS Construction & Installation of Equipment for 4 anemometer towers: 1. Four towers with anemometers @ $12,000 e: $ 48,000 2. Labor, installation of 4 towers @ $4,000 —- 16,000 3, Land contracts @ $500/yr/tower for 2 yrs 4,000 4. Consultation for placement of anemometers = 2,000 TOTAL PROJECT COST: $70,000 ORGANIZATION Eligible applicants for the RBEG program are limited to public bodies, private non-profit organizations, or Federally-recognized Indian Tribes. A. This letter of Conditions is issued on the basis that the City of Monticello is a duly organized and recognized public body, with the legal authority to operate, maintain, and manage the project funded in whole or in part with this grant 1. The City of Monticello must provide USDA-Rural Development with a legal opinion (multi-opinion letter) ensuring that the City of Monticello is a dulyorganized and recognized public body, and has the legal authority to operate, maintain, and manage the project funded with this request. Ti Cay Mtoe eet provide USDA Riel Detelopmen iO. a cums 1) Certificate of Good Standing (or equivalent Certificate of Existence) from the State of Utah, . OFFICE OF GENERAL COUNSEL REVIEW A. The Office of General Counsel (OGC) (legal counsel for USDA-Rural Development) is required to review the organizational documents and legal opinion (multi-opinion letter), for the City of Monticello, and render an opinion to this office that the City of ‘Monticello is a duly formed, organized and recognized and has the legal authority to operate, maintain, and manage the project funded with this request. B. OGC will also provide this office with grant closing instruction: C. OGC requires a minimum of 30 days to conduct this review and issue grant closing instructions GRANT DISBURSEMENT This letter of conditions addresses the total $66,500 RBEG request for the project. The total amount of $66,500 needed to fund the project has been split between two funding eycles. $38,500 has been funded from the FY2006 allocation & $28,000 has been funded from the FY 2005 allocation. Neither the FY2005 $28,000 RBEG funds nor the FY2006 $38,500 RBEG funds will be disbursed until all project funding is in place. Grant funds will be disbursed to CITY OF MONTICELLO by Electronic Funds Transfer (EET) through the Automatic Clearing House (ACH) network. a USDA-Rural Development will request funds disbursement through the EFT/ACH, system after acceptable review of Form SF-270 "Request for Advance or Reimbursement” from CITY OF MONTICELLO as discussed below. Except for grants “7° for revolving loan funds, grant funds will be disbursed by the USDA-Rural Development / on a reimbursement basis. All matching funds for this project will be expended before, or as equitably pro rated with RBEG proceeds for like purposes. J A. CITY OF MONTICELLO must provide USDA-Rural Development with a properly completed SF-3881 "Electronic Funds Transfer Payment Enrollment Form" necessary to establish a ACH electronic funds transfer system a minimum of three weeks before grants funds will be required: B. USDA-Rural Development will request funds disbursement through the EFT/ACH system afier acceptable review of Form SF-270 "Request for Advance or Reimbursement" from CITY OF MONTICELLO. 1. Form SF-270 "Request for Advance or Reimbursement" must be completed by CITY OF MONTICELLO and submitted to USDA-RURAL_ DEVELOPMENT to request RBEG funds. 2. USDA-Rural Development will request funds disbursement through the EFT/ACH system afier acceptable review of Form SF-270. Funds will be sent to CITY OF MONTICELLO via EFT within 30 days after receipt of a properly completed SF-270 form.3. Form SF-270 “Request for Advance or Reimbursement” must be supported with a invoice for services funded with this request in accordance with the ‘Use of RBEG Funds’ section of this letter of conditions. 4, Requests cannot exceed one advance every 30 days. C. CITY OF MONTICELLO shall provide effective control and accountability of all RBEG funds. CONTRACTS FOR PROFESSIONAL SERVICES ‘A. Any contracts or other forms of agreement between CITY OF MONTICELLO and other professional and technical representatives for this project are subject to Rural Development's concurrence. B. Fees for such services must be reasonable i.e., not in excess of those ordinarily charged by the profession for similar work when Rural Development financing is not involved. RECORDS AND REPORTS A. CITY OF MONTICELLO must ensure that this project is completed in accordance with the scope of work and this letter of conditions. B. CITY OF MONTICELLO will provide a financial management system which will: 1. Provide accurate, current, and complete disclosure of the financial result of the RBEG. 2. Include records, which adequately identify the source and application of funds for the RBEG supporting activities, together with documentation to support the records. Those records shall contain information pertaining to the RBEG award and authorizations, obligations, un-obligated balances, assets, liabilities, outlays, | | and income. 3. Provide effective control over and accountability for all funds. CITY OF MONTICELLO shall adequately safeguard all such assets and shall assure that RBEG proceeds are used solely for authorized purposes. C., CITY OF MONTICELLO shall constantly monitor performance to ensure that time schedules are being met, projected work by time periods is being accomplished, and other performance objectives are being achieved. D. CITY OF MONTICELLO must submit Form SF-269 ‘Financial Status Report! of. sje, ide ¢ this project on a quarteriy basis (ue 15 working days after the end of each quartet) es? until all project funds have been disbursed, and the project has been completed. 2 E, CITY OF MONTICELLO must submit a project performance activity report on this, project on a quarterly basis (due 15 working days after the end of each quarter) until all project funds have been disbursed, and the project has been completed. There is no standardized form for the project performance report. However, project performance reports shall include the following: 1. A comparison of actual accomplishments to the objectives established for that period. 2. Reasons why established objectives were not met. 3. Problems, delays, or adverse conditions, if any, which have affected or will affect attainment of overall project objectives, prevent meeting time schedules or objectives, or preclude the attainment of particular project work elements during, established time periods, This disclosure shall be accompanied by a statement of the action taken or planned to resolve the situation, 4, Objectives and timetable established for the next reporting period.F. A final project performance report will be required with the final SF-269 ‘Financial status report’ . G. The Agency will also require CITY OF MONTICELLO to prepare a report suitable for public distribution describing the accomplishments made through this RBEG. This report should include an assessment of actual or potential jobs created/saved, and businesses assisted through this RBEG. HL This request is subject to audit requirements of 7 CFR 5052--AUDITS OF STATES, LOCAL GOVERNMENTS, AND NON-PROFIT ORGANIZATIONS. 1. Audits completed in accordance with the Generally Accepted Government Auditing Standards (GAGAS) will be acceptable if CITY OF MONTICELLO expends less than $300,000 in Federal funds in any fiscal year. GAGAS standards are set forth in the "Government Auditing Standards, 1994 Revision” (commonly referred to as the ‘yellow book’). a. GAGAS audits must be submitted to this office within 150 days of the "as is" audit date. 2. Audits completed in accordance with OMB Circular A-133, AUDITS OF INSTITUTIONS OF HIGHER EDUCATION AND OTHER NONPROFIT INSTITUTIONS will be required if CITY OF MONTICELLO expends $300,000 or more in Federal funds in any fiscal year. a. OMB Circular A-133 audits must be submitted to this office within 9 months afier the end of the grantee's fiscal year. 3. Applicable audits are required in the fiscal year in which RBEG proceeds are received and years in which work is accomplished that will be paid for with RBEG proceeds. I CITY OF MONTICELLO will retain financial records, supporting documents, statistical records, and all other records pertinent to the grant for a period of at least 3 years after grant closing, or termination of the project, except that the records shall be retained beyond the 3 year period if audit findings have not been resolved or if directed by the United States. Microfilm copies may be substituted in lieu of original records. The Agency and the Comptroller General of the United States, or any of their duly authorized representative, shall have access to any books, documents, papers CITY OF MONTICELLO may have pertinent to the RBEG for the purpose of making audit, examination, excerpts, and transcripts. COMPLIANCE WITH SPECIAL LAWS AND REGULATIONS A. CITY OF MONTICELLO shall keep records and submit to the agency, upon request, timely, complete and accurate compliance reports as the agency may determine to be necessary to ascertain compliance with the Civil Rights laws and Equal Opportunity Jaws and program regulations. B. CITY OF MONTICELLO must keep and provide data on race, gender, and national origin and any such records, accounts, and other sources of information and facilities as may be pertinent for the agency to determine whether CITY OF MONTICELLO has complied or are complying with regulations. C. CITY OF MONTICELLO must comply with the following: 1, Title VI of the Civil Rights Act of 1964- a, Title VI states that no person shall, on the grounds of race, color, or national origin, be excluded from participation in, be denied the benefits of, or besubject to discrimination under any program or activity receiving Federal financial assistance. 2. Title IX of the Education Amendments of 1972- a. Title IX prohibits discrimination on the basis of sex in education programs and activities receiving Federal financial assistance. 3. Section 504 of The Rehabilitation Act of 1973 as amended (29 U.S.C. 794) and 7. CER Part 15b- a. No qualified individual with a disability and solely by reason of their disability may be excluded from using or participating in the benefits of any facility receiving Department of Agriculture (USDA) Rural Development assistance. 4. Age Discrimination Act of 1975- a. Prohibits discrimination based upon age. 5. Other Equal Opportunity and Nondiscrimination Requirements- a. Beneficiaries of Federal financial assistance must comply with all additional Federal Civil Rights laws and requirements as applicable to the entity, service, or program. COMPLIANCE REVIEW REQUIREMENTS 1, To ensure that these requirements are met, we are obligated to complete periodic Civil Rights Compliance reviews, and document these reviews on Form RD 400-8 “Compliance Review” on all RBEG financed projects. 2. Compliance reviews will be performed before the grant is closed, and at least every 3 years thereafter, as long as the RBEG financed project is used for the original or similar purpose for which assistance was intended a, Toassist us in this process, we request that you complete the enclosed “Civil Rights Compliance Review” check-sheet. Please complete and return this check-sheet to our office as soon as possible, so that we can complete the required compliance review prior to grant closing. 3. In order for the agency to properly complete civil rights compliance reviews, you must provide racial/ethnic and gender data for CITY OF MONTICELLO and borrowers/clients served by CITY OF MONTICELLO. a. Racial data shall be categorized by: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or other Pacific Islander, and White. b. Ethnicity data shall be categorized by Hispanic or Latino, Not Hispanic or Latino, 4, CITY OF MONTICELLO must set up an internal process to collect this required data from your clients to provide to the agency upon request. 5. The following will be reviewed for compliance: a, Various types of racial/ethic and gender data on applicants to CITY OF MONTICELLO and clients served from the RBEG request, and racial/ethic and gender data on employees of CITY OF MONTICELLO. 1. This can be accomplished by revising CITY OF MONTICELLO’s admissions application to include statistical data and a disclosure statement.cr a. The statistical data should include racial/ethnic and gender data. There should be a category for a statement such as, “I do not wish to furnish this information.” 'b. The disclosure statement should read, “The following information is requested by the Federal Government for certain types of Federal Assistance, in order to monitor compliance with equal credit opportunity laws. You ate not required to furnish this information, but are encouraged to do so. The law requires that CITY OF MONTICELLO may neither discriminate on the basis of this information nor on whether you choose to furnish it. However, if you choose not to furnish it, under Federal regulations, CITY OF MONTICELLO is required to note race/ethnicity on the basis of visual observation or surname. If you do not wish to furnish the above information, please check the box below.” 1. CITY OF MONTICELLO must review the above material to assure that the disclosures satisfy all requirements to which CITY OF MONTICELLO is subject under applicable State law for the particular type of program. 2. Each application will carry the equal opportunity logo, “This is an Equal Opportunity Program. Discrimination is prohibited by Federal Law. Complaints of discrimination may be filed with the USDA, Director, Office of Civil Rights, Washington, D.C. 20250”. A summary of actions for each application (rejected, withdrawn, ete.) 1, Records should be maintained on an annual basis. 4. User fees or charges for service- including reasons that certain individuals are charged different or higher rates than others. . Racial/ethnic and gender data of CITY OF MONTICELLO employees, board members. For example, what efforts have been made to attract minority and persons with disabilities to the board of directors or similar governing body. £. Methods used by CITY OF MONTICELLO to inform the community of the availability of services. All written materials, such as pamphlets, brochures, letterhead, handouts, newspaper articles and ads should have the non-discrimination statement printed on them, Example: “Equal Opportunity Lender/Agency ”. g. Methods whereby special accommodations are made by CITY OF MONTICELLO to persons with disabilities, for example, accessible by wheelchairs or access to TDD or relay service for persons with hearing impairment. Facility should have an accessible route through common use areas to meet the Americans with Disabilities Act/Accessibility Guidelines (ADA/AG) or Section 504 of the Rehabilitation Act of 1973. (Refer to the Uniform Federal ‘Accessibility Standard (UFAS) and ADA/AG, Section 4.3) 1. The ADA/AG handbook may be accessed through the internet at the following address: www.access-board, gov/ufas/ufas-html 2. Accessibility guidelines may be accessed through the internet at the following address:www.access-board.gov/adaag/htmV/adaag.htm . In accordance with 7 CFR Subtitle A, Section 15b.8, if your organization has not complied with accessibility standards, a self- evaluation has to be conducted with the assistance of person(s) knowledgeable of accessibility issues. a. The self-evaluation should address but not be limited to ramp and parking, entrance to an office, and restrooms). b. A Transition Plan should be developed outlining your plan of action by which all accessibility requirements will be met. If applicable, RBS will request a Self-Evaluation and Transition Plan. ©. Accessible parking spaces shall be designated as reserved for persons with disabilities by a sign showing the symbol of accessibility. A vehicle parked in the space shall not obscure such signs. d. CITY OF MONTICELLO should have a designated accessible restroom for persons with disabilities. The restroom must be accessible in accordance with the Uniform Federal Accessibility Standard (UFAS) and ADA/AG, Section 4.22. h. Bulletin board(s) displayed in a public area(s) with “And Justice for All” and an “Equal Employment Opportunity is the Law” posters. ‘You are reminded that you may be subject to additional civil rights Jaws and regulations. Although Rural Development does not enforce these laws, if, in the course of a compliance review, Rural Development detects a potential violation of these laws, Rural Development is obligated to refer the potential violation to the appropriate enforcement agency. 6. Since we are required by law to report non-compliance in these requirements, please ensure that you have a mechanism in place to capture this required data. 7. In addition, all RBEG’s used for construction projects are subject to the Americans with Disabilities Act, Title II of 1990. OTHER CONDITIONS Debarment certifications- A. CITY OF MONTICELLO is required to comply with Rural Development Instruction 1940-M with respect to debarment procedures. Forms AD-1047, "Certification Regarding Debarment, Suspension, and Other Responsibility Matters-Primary Covered Transactions" and Form AD-1048, "Certification Regarding Debarment, Suspension, Incligibility and Voluntary Exclusion-Lower Tier Covered Transactions" will be used for this purpose. 1 CITY OF MONTICELLO must obtain certifications on Form AD-1048 ‘Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered Transactions" from any person or entity you do business with as a result of this government assistance certifying that they are not debarred or suspended from government assistance.a. AD-1048 certifications will need to be executed by contractors for business development technical assistance, and all presenters utilized by CITY OF MONTICELLO for this project. B, Fidelity bond coverage will be required on all persons of CITY OF MONTICELLO authorized to receive and/or disburse Federal funds. Coverage may be provided either for all individuals or persons, or through a "blanket" coverage providing protection for all appropriate persons. C. CITY OF MONTICELLO further agrees to the terms and conditions of the enclosed RD Instruction 1942-G, Attachment 1, Section B. The following items attached for your reference and use: a, Form RD 1942-46, "Letter of Intent to Meet Conditions" b. Form RD 1940-1,."Request for Obligation of Funds" c. RD Instruction 1942-G, Attachment 1, Section B “General Requirements for Administration of Rural Business Enterprise and Television Demonstration Grants” I. Scope of Work Form SF-270 "Request for Advance or Reimbursement" Form $F 3881 “Electronic Funds Transfer Payment Enrollment Form” . Form SF-269 "Financial Status Report" Form RD 400-1 “Equal Opportunity Agreement” Form RD 400-4 “Assurance Agreement” Form RD 400-8 “Compliance Review” “Civil Rights Compliance Review” checksheet “And Justice For All” poster “Equal Employment Opportunity is the Law” poster n, Form AD-1048 "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered Transactions" Please contact Roger Koon, if you have any questions. Roger may be contacted by phone at 801.524.4301. Richard Carrig Rural Business and Cooperative Programs Director USDA Rural Development Ce: Roger Koon 10RD Instruction 1942-6 ‘ Attachment 1 Page 8 (Revision 2) M. Grant cancellation. Grants may be cancelled by the grant approval official by use of Form RD 1940-10, "Cancellation of U.S. Treasury Check and/or Obligation.* The State Director will notify the applicant by letter that the grant has been cancelled. A copy of the letter will be sent to the applicant's attorney and engineer and to the Regional Attorney, occ, if the Regional Attorney has been involved. N. Grant servicing. Grants will be serviced in accordance with Subpart 2 of Part 1951 of this chapter. ©. Subsequent grants. subsequent grants will be processed in accordance with the requirements set forth in this subpart. Section B TIT. Responsibilities of the Grantee ‘This section contains information regarding the responsibilities of the grantee for receipt of monies under the RBE/television demonstration grant program. This section shall become a permanent attachment to Form RD 19401 as outlined in Section A, paragraph IT. H. of this Attachment. These requirements do not supersede the requirenent for receipt of Federal funds as stated in Parts 3015, 3016, and 3019 of the Uniform Federal Assistance Regulations; however, specific areas related to the RBE/television demonstration grant program are cited below. (Revised 07-16-03, PN 361.) Grantee agrees to: A. Comply with property management standards established by 7 CPR Parts 3015, 3016, and 3019 for real and personal property. ‘Personal property" means property of any kind except real property. It may be tangible - having physical existence - or intangible - having no physical existenc such as patents, inventions, and copyrights. | *Nonexpendable personal property" means tangible personal property having a useful life of more than 1 year and an acquisition cost of $300 or more per unit. A grantee may use its own definition of nonexpendable personal property provided that such definition would at least include all tangible personal property as defined above. "Expendable personal property” refers to all tangible personal property other than nonexpendable property. when real property or nonexpendable property is acquired by a grantee with project funds, title shall not be taken by the Federal Government but shall be vested in the grantee subject to the following conditions: (Revised 07-16-03, PN 361.)(08-20-92) RD Instruction 1942-¢ ‘Attachment 1 Page 9 a. When title is transferred either to the Federal Government or to a third party and the grantee is instructed to ship the property elsewhere, the grantee shall be reimbursed by the benefiting Federal’ agency with an amount which is computed by applying the percentage of the grantee participation in the cost Of the original grant project or program to the current fair market value of the property, plus any reasonable shipping or interim storage costs incurred. 2. Use of other real or nonexpendable personal property for which the grantee has title. a. The grantee shall use the property in the project or program for which it was.acquired as long as needed, whether or not the project or program continues to be supported by Federal funds. When it is no longer needed for the original project or program, the, grantee shall use the property in connection with its other federally sponsored activities in the following order of priorit; 4. Activities sponsored by Ania. ii, Activities sponsored by other Federal agencies: b. Shared use. During the time that nonexpendable personal property is held for use on the project or program for which it was acquired, the grantee shall make it available for use on other projects or programs if such other use will not interfere with the work on the project or progran for which the property was originally acquired. First preference for such other use shall be given to projects or programs sponsored by FnHA; second preference shall be given to projects or programs sponsored by other Federal agencies. If the property is owned by the Federal Government, use for other activities not sponsored by the Federal Government shall be permissible if authorized by PmHA. User charges should be considered, if appropriate. 3. Disposition of real or nonexpendable personal property. when the grantee no longer needs the property as provided in Section B, paragraph III A 2 of this Attachment, the property may be used for other activities in accordance with the following standard: @. Personal property with a unit acquisition cost of less than $1,000, ‘The grantee may use the property for other activities without reimbursement to the Federal Government or sell the Property and retain the proceeds. SPECIAL PN(08-20-92) SPECIAL PN RD Instruction 1942-6 Attachment 1 Page 11 ii. Sources of the property including grant or ‘other a agreement number. iv. Whether title vests in the grantee or the Federal Government. W. Acquisition date (or date received, if the property was furnished by the Federal Government) and cost. Wis Percentage (at the end of the budget year) of Federal participation in the cost of the project or program for which the property was acquired. (Not applicable to property furnished by the Federal Government). xii. Location, use, and condition of the Property and the date the information was reported. viii. Unit acquisition cost. 4x. Ultimate disposition data, including date of disposal and sales price or the method used to determine current fair market value where a grantee compensates the Federal agency for its share. b. Property owned by the Federal Governnent must be marked to indicate Federal ownership. S.A physical inventory of property shall be taken and the results reconciled with the property records at least once every 2 years. Any differences between guantities determined by the physical inspection and those shown in the accounting records shall be investigated to determine the causes of the difference. The grantee shall, in connection with the inventory, verify the existence, current utilization, and continued need for’ the property.RD Instruction 1942-6 Attachment 1. Page 13 (Revision 1) B. Cause said program to be completed within the total sums available to it, including said grant, in accordance with the program plan and any necessary modifications thereof prepared by grantee and approved by grantor. C. Permit periodic inspection of the program operations by a representative of grantor. D. Make the program available to all persons in grantee's service area without regard to race, color, national origin, religion, sex, marital status, age, physical or mental handicap who have also received Pui related assistance from the grantee. E. Not use grant funds to replace any financial support previously provided or assured from any other source. The grantee agrees that the general level of expenditure by the grantee for the benefit of program area and/or program covered by this attachment shall be maintained and not reduced as a result of the Federal share of funds received under this grant. F, No nonexpendable personal property to be owned or used by the borrower or its affiliate(s) for use other than the grant purposes will be acquired wholly or in part with grant funds. G. Use of the property including land, land improvement, structures, and appurtenances thereto, for authorized purposes of the grant as long as needed. The grantee shall obtain approval of the grantor before using the real property for other purposes when the grantee determines that the property is no longer needed for the original grant purposes. H. Provide financial management systems which will include: 1, Accurate, current, and complete disclosure of the financial results of each grant. Financial reporting will be on an accrual basis. 2. Records which identify adequately the source and application of funds for grant-supporting activities. Those records shall contain information pertaining to grant awards and authorizations, obligations, unobligated balances, assets, liabilities, outlays, and income. 3. Bffective control over, and accountability for, all funds. Grantees shall adequately safeguard all such assets and shall ensure that they are used solely for authorized purposes. 4, Aecounting records supported by source documentation. (08-20-92) SPECIAL PNRD Instruction 1942-6 Attachment 1. Page 148 (Added 07-17-02, PN 348) 0. In contracts in excess of $2,000 and in other contracts in excess of $2,500 which involve the employment of mechanics or laborers, to include a provision for compliance with Sectidns 103 and 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C. 227-330) as supplemented by Department of Labor regulations (29 CFR, Part 5). Applies only where Davis Bacon requirements apply. P, Include in all contracts in excess of $100,000 a provision for compliance with all applicable standards, orders, or regulations issued pursuant to the Clear Air Act of 1970. Violations shall be reported to the grantor and the Regional Office of the Environmental Protection agency. (08-20-92) SPECIAL PNc2se0004 me REQUEST FOR ADVANCE eo Soo OR REIMBURSEMENT 1 CU ADVANCE = [[]_-REIMBURSE- oo or Cessn ims eRe (See nso on back) ae! | qa Daccrua {FEL SOOT ABT NO ORATOR EEGETTO |RSS oT Eparraraer reas Tenner ona commoner vena omnes? presow aor Camorneanrcton [reeanensscoonmaamn |B Pano COVERED BY THe REQUEST a Secon aT ora aT STREET RE TET se ne sant sr tease Sc on, se, oy, st ozP coe ez as: a ‘COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANGES REQUESTED PROGRAMSIFUNCTIONSIACTIVITIES Be ea o le Tora Ta faa cance s s ‘ s 0.00 Less: Cumulative progam income 0.00 Spun ap en 0.00 200 200 0.00 7 ES erat carom ET aRE pote 000 2. Total (Sum of ines ¢ & d) 9.00 0.00 9.00 9.00 {Non Far har of amarante 009 4. Fado tar ct antonio 0.00 1 ada pana ountd 0.00 Tics os ow ona _aninus tine h a o 0.00 0.00 0.00 0.00 7 Adee equ ton ven opecos |_ 1m 0.00 oy Patel pero agency for use In making ee Li) a ae = [ALTERNATE COMPUTATION FOR ABVANGES ONLY 8. Estimated Fedral cash outays that will ba made during period covered by the advance s Las Esta ben Fedora a fgg laden pres ¢Anareqmaed anna : 200 ‘AUTHORIZED FOR LOCAL REPRODUCTION (Corded on Rovers) ‘STANDARD FORMZTO (Rov. 7-97) Prosutbedby OM Coa A102 and A110= (CERTIFICATION GRC AER CENSOR. SRE REaREST | certty that 10 the best of my soured eonledgo abot he data on ‘oro are coectand all cute Mteremade in cordance with te, | ‘fant condone or thr agromant_ | NBCRPANTED WANE HOTTIE Soe Sra at payments do and has rat Screg Ben previa requested "Tis pace or agenay use em Pubic reporting burden for this collection of informatio is estimated to average 60 minutes per response, incuding time for reslowig isructons, searching exiting data sources, gathering end ‘maintaining the data nooded, and completing and rviowing the collection of information. Send ‘comments regarding the burden estimate or any other aspect of his collation a information, Including suggestions for reducing this burden, tote Offoe of Management and Budget, Paperwork, Roduction Project (0848-0004), Washington, DC 20603. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT ‘AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. INSTRUCTIONS Please type or pint legibly. Items 1, 3, 5, 9, 10, 11¢, 11f 11g, 111,12 and 19 are sell-explanatory, specific Instructions for other item are as follows: Enty 2. Indicate whether request is prepared on cash or accrued expenditure basis. All requests for advances shall be prepared on a cash basis. 4, Enter the Fodoral grant number, or other identifying number assigned by the Federal sponsoring agency. If the advance or reimbursement is for more than one grant ‘or other agreement, insert N/A; then, show the aggregate amounts. On a separate sheet, list each grant or agreement number and the Federal share of outlays made against the grant or agreement. 6. Enter the employer identification number assigned by the US. Internal Revenue Service, or the FICE (institution) code if requested by the Federal agency. 7. This space Is reserved for an account number or other ‘dentitying number that may be assigned by the recipient. 8 Enter the month, day, and year for the beginning and Not: 1 tending ofthe period covered in this request. If the request is for an advance or for both an advance and reimbursement, show the period that the advance will cover. If the request is for reimbursement , show the period for which the reimbursement is requested. ‘The Federal sponsoring agencies have the option of requiring recipients to complete items 11 oF 12, but not both. Item 12 should be used when only a minimum ‘amount of information is needed to make an advance and ‘outlay information contained in item 11 can be obtained in a timely manner from other reports 1. The purpose of the vetcal columns (a), (b) and () i to provide space for separate cost breakdowns when a project has been planned and budgeted by program, funeton, or tem ita. 1b. 14. 18, Enty activity. If additional columns are needed, use as many ‘additional forms as needed and indicate page number in space provided in upper right; however, the summary totals of all programs, functions, or activities should be shown in the "total" column on the first page. Enter in ‘as of dato," the month, day, and year of the tending of the accounting period to which this amount applies. Enter program outlays to date (net of refunds, rebates, and discounts), in the appropriate columns. For requests prepared on a cash basis, outlays are the sum of actual cash disbursements for goods and services, the amount of indirect expenses charged, the value of in- kind contributions applied, and the amount of cash advances and payments made to subcontractors and. subrecipients. For requests prepared on an accrued, expenditure basis, outlays are the sum of the actual cash disbursements, the amount of indirect expenses incurred, and the not increase (or decrease) in the ‘amounts owed by the recipient for goods and other property received and for services performed by ‘employees, contracts, subgrantees and other payees. Enter the cumulative cash income received to date, it requests are prepared on a cash basis. For requests prepared on an accrued expenditure basis, enter the ‘cumulative income earned to date. Under either basis, center only the amount applicable to program income that was required to be used for the project or program by the terms ofthe grant or other agreement. Only when making requests for advance payments, conter the total estimated amount of cash outlays that will bbe made during the period covered by the advance. ‘Complete the certification before submiting this request. ‘srA0170 FORUE7O (767 BaskFINANGIAL STATUS REPORT (Long Form) (Follow insiructions on the back) ‘ouch Repo Suites FF Aaa nd Oipneatond Barat FE Fa ra tha ei Naa FeSDRAZ Cua Ae Pas By Feces homey he. 0348-0039 Reset Ggaiaaten Naps ad carpe a ss ang EP a) [a pie Goan Nebr [= Retin Aasount mbar ota Je PraiRopot [7 Basa From: (oD, Yu) e Fanangct Paod (See rans) [Pes Goat te Rapa fe ono, Yex) | Fem: eon On, Yeu [Pe ono, Ye) Prom Ropees | __ ths Punt mute a Tanta Roti als 0 Wako i as em tes Bond) Rechlents share of et outay, consisting of: fe Titty ning) anton oer Fs avers adhd bs ona HUGH ew 1 Foga Razne maw arc wih nang col Ate eit ola neon cara TE 1 Tecpel sr fale Samat nara Lod) ereselshaectneonaje (nessa) Tar igs ato ake T Resin sat agus Siang sigs cee See oe eeetea tesa Tatas ahr fs] am) ferrets ond Fo aa PE Ubinas a Fase nas iw oma ro 2. Oataedrepam are sham on ter candor 92818 00! Dabs ropa recog he sn alate 5 Uhaabosed pagan hase Ta oa icone aid Sm tines Fane) 0.00] Je Tipe cas ae 97 apna bod Br Provaona 1 Predetermined Brit Dries Specs Ea Teak Foie Sa _goveming gilt. Raa: Rc sy xan Saad roa ot SGTO Taio iy Fada Rag eRe SONGS wi Ha GetcanTealy to te bat of my onic and bec ali ropo scared and compete ada al ouays an ngs obtatons afr he purposes st forth inte award docimants, [pete Pied ane ar Tite Feetone Gee coe, rambo tran) Sse ohatoraod Cong OE Ds Rapa Sais Froico Eon alo mater Sinsad Form Rec 7) Prertaty OMB Chevars102 an 10 20-408 0.139 Face)Peeps aren ors caacton tomatoe ara aerage 20 mind er eso rig ine reir auton, FINANCIAL STATUS REPORT hong Far) ‘arn ering cata srs, garg an marae dis ons, an arpa ove een tomato, Sr cent ‘epg be tren evr ey ent apo er cease ot aon cng eagonsoe tangs aes, whe Os game rt Bue Paper Reson Pj (340 O09), Vcnngtn De 2500 PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET, Pease type or print legibly. The folowing general instructions explain how to use the form isl, You may need actions Information to compete cetain tems correctly, of to decde whether a specie tom ie applcable to tie award. Usual, such informaton wi be found in the Federal agency's grant regulations of the terms and condtions ofthe award (e.g. how to calculate the Federl share, the permissible uses of program income, the value of inkind contrbutons, elt). You may also contact the Federal agency direct item 4 40. 1a nity 2and3, Settextanotoy, Ener the Employer ieriication Number (EN) _assgned by tho US. riral Revenue Serves, ‘Space reserved for an account bet oF oer ‘dong umber aslgned by he reapont Chock yes only Hts Is the last repeat forthe vid own nto 8. Seteptnatoy, Unless you have rected othr insrusions om ‘ne anardng agency, enter Be begining od fndng datea of the cent nng period tis 23 muyear progam, the Federal agency mght requre cumulative reporng trough consecutive fuing periods. that cas, tar the beating and ending dates of the grant prod, andin the rest of these hsivctons,subatte the fem “pant eto for "unas peed Settexplanatory ‘The purpose of eaunns, and Iti o how be ‘fect of bis reporing|periads transacions on ‘camulatie fenci efatue. The amounts entered falum I wil mal be Be same ae hase bh talus Hof the previous reper In to. same funding period. Wis the fst or only report of ‘he funding parc, lave cobs | ant bank. you need to adjust amounts entered on previous reports, fons the cole | eny on his report ‘id atach an explanation. Enter total grass progam oulays.incide ‘Sebursoments of cash roalzod as program inca If mat iome wil algo be shown on nee 10s oF 10g. Do ret ince program incame that will be shown en ines Yor r 105 For rpors prepared on a cash bass, outlays are the sum of actus cash abusementa for rect oes for goods and sere, the amount of nsrect ‘expense charged the value of nnd contbutons ‘poled, and the ameant of cash advances and Payments mae to. subrecipents For reports Prepared on an accrul basis, outays ar tho sam ‘factual cash csburaamens for diet charges fer {pode and eros, he iount of hect expense Incued, tha value of inknd contra apie, snd te nat nereate or decrease i the amounts ‘vod bythe reipiont or goods and ether propery ‘ceived, for senices performed by employees, corractrs, subgrarees and her payees, ard ‘other amounts becoming owed under programs for ‘whieh no cutent eeroes or performances. are Foguted, such as annus, insurance clans, an ‘er benefit payments tem 10. 102, Not: 10, 10% so tom. 109, tte ue. M18, a te Not: Ent. Enter ary roi related fo outays reported on the form tat ar bing weoed as a reducion ef expenditure ‘ater than income, and were el aca neti cut of the amount shown as oudaye on ne 103, Ent tho amount of program income that was used in ‘cordance withthe desuconateatve, Program noone used in accordance wih other ‘loratvs Is erred on Ines , fad &. Rehblnts feporing on cath basis shoud ener th amo of 20h inome reeeed on an acual bau, onto te Program income eared. Pregram income may of may hot have been nod in an appltionbusget enor {budget on te oward document facial come Ie fom a eilrent source oF le sriicanty diferent amount, ai an explanation or uso Go remarks secon, e.t.9.h end}. Set-explanatay Enter the tial amount of uniguated obigators, lecusng unguided ebtgatons to eubgrantees and contractors LUniquistesobtgstons ona cash bel are eilgstons Incurred, but not ya pa. On an accrual asi, they ae bigatensincured, but for which an ou has net yet been eooded ‘Do net neue ay amounts on Se TOK that have been Incided on nos 108 and 10, ‘onthe fina oper ie OK mat be 2 Set-explanatory (nthe roport ne 10m must tobe zero 0,P.9.t, and Seltersonstoy Satteelenaton, Ente the indirect cost rate in offect dsing the epetng atiod Enfer the amount ofthe base again! which the rate was eppiod. Ente the toll amu of inect costs charged ding the repo pelos Enter tha Federal share ofthe amountin 1 mor than on rate was infect dng the period shaun in le 8, each a schedule showing the bases ‘gaint which the aiferent rales were sppled, the Tespoctve rates, tha calendar periods thy were in sted, amwounis of indest expense charged to the Project_and the Feceral share of Indret expense ‘charged io the project date. ‘5.280 Bak Row. 757)ACH VENDORIMISCELLANEOUS PAYMENT OMB No, 1510-0055 ENROLLMENT FORM Expiration Date 01/31/2000 This form is used for Automated Clearing House (ACH) payments with an addendum record that contains payment- related information processed through the Vendor Express Program. Recipients of these payments should bring this information to the attention of their financial institution when presenting this form for completion. PRIVACY ACT STATEMENT The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). All infor- mation collected on this form is required under the provisions of 31 U.S:C. 3322 and 31 CFR 210. This information will be used by the Treasury Department to transmit payment data, by electronic means to vendors financial institution. Failure to provide the requested information may delay or prevent the receipt of payments through the Automated Clearing House Payment System. ‘AGENCY INFORMATION FEDERAL PROGRAM AGENCY AGENCY IDENTIFIER: IASENGY LOCATION CODE (ALG} KOR FORMAT: Cleon em ere [ADDRESS (CONTACT PERSON NAME: TELEPHONE NUMBER: "RODITIONAL FORWATION. PAYEE/COMPANY INFORMATION Tan SSHNO. OR TAXPAYER 1D NO. [ADDRESS [CONTACT PERSON NAME: FFELEPHONE NUMBER: FINANCIAL INSTITUTION INFORMATION TAME: ADDRESS: [AGH COORDINATOR NAME: [TELEPHONE NUMBER: INE-DIGIT ROUTING TRANSIT NUMBER: DEPOSTOR AGOUNT THES DEPOSTTOR ACCOUNT NONBER: TOCRBOK NOWBERE [TYRE OF ACCOUNT: Dictectane Csavives Ctocksox ‘SIGNATURE AND TITLE OF AUTHORIZED OFFICIAL: TELEPHONE NUMBER: {Cou be the same as ACH Coacinter) NSN TSO SS aT TET1 uspa. Position 5 ron arrnoven Form RD 40-8 On No. 05750018, (Rev. 8.00) DATE OF REVIEW COMPLIANCE REVIEW a [coUNTY rennin by Rc SOURCE OF FUND: Sf anil Asitace trong s U.S:beparnentaf Agile) ease NEE iret insured DATE LOAN OR GRANT CLOSED TYPE OF ASSISTANCE, CORRH and LH Organization Housing Preservation Grant] Water and Waste Disposal Loan or Grant Intermediary Relending Program Crees Cloraring Association DURurat Housing Site Loans roc DIE Cooperative cooperative Service CIBat Loans Cicommunity Facies Bother NAME OF BORROWER ORGANIZATION OR ASSOCIATION. ADDRESS OF BORROWER 1, STATISTICAL INFORMATION (For the purpose ofthis report, the erm "PARTICIPANTS" will be used to describe PURCHASER" OR Potential Users for pre-loan closing compliance reviews, as applicable. Aw. POPULATION {EMBERS,” OCCUPANTS," "SITE PARTICIPANTS LAST REVIEW ETHNICITY No | % | No % | vo % Hispanic or Latino [Not Hispanic or Latino TOTAL MALE FEMALE, ot morgaeran mea our auc asPOPULATION PARTICIPANTS AQ. THIS REVIEW _LAST REVIEW RACE no | % |xo | |x | American Indian/Alaskan ‘Native Asian Black oF African American Native Hewalian White TOTAL Mate Female AQ). EMPLOYEES: EMPLOYEES MALE FEMALE MALE FEMALE eranicrty | No. | % | No | % | No | % eranicrty | No. | % | No | % | No | ® Hispanic or Latino Hispanic or Latino Not Hispanic orBOARD OF A@).cont. EMPLOYEES DIRECTORS RACE wo | % [xo] % | no | « RACE No. | % | xo] % | no | x ‘American ‘American Indian/Alaskan IndisevAlaskan Native Native ‘Asian Asian Black or Black or ‘Aftican Afiean American American Native Native Hawaiian Hawaiian white white TOTAL TOTAL 11. APPLICATION INFORMATION (Project, Facility, Complex of Lendet) BO. Number of Applicaton Received Number of ‘This Review Last Review Applications Approved ETHNICITY No. % No. ® No. ® No, % Hispanic or Latino [Not Hispanic or Latino TOTAL Male ToraL | Female FamilyBa) Number of Applicaton Received Number of Number of This Review Last Review Appliestions Approved Applications Rejected RACE Ss % No. % No. * No. % American Indian/ Alaskan Native Asian Black or Aftican American [Native Hawaiian White TOTAL Mal ToraL | Female Family [A, Are racial and gender of the participants and the number of employees in proportion to the population percentages? - -Oves (No B, Number of participants as of lat review: Date of last review: . Are all interested individuals permitted to file an application (written or otherwise) for participation? .. If"NO" explain why not: ves Oo . Does or wil secipient of financial assistance maintain adequate records on the receipt and disposition of applications, including a list of applicants wishing to become participants? - Ces Ono ia 10" what action is being taken to establish adequate records: 1°YEs number of applicants wishing to become participants on list _ [Number on list from minority group E, Number of applications received from prospective participants since last review: Total If zero skip to HL From minority group applicants P, Number of applications which have been withdrawn or rejected since last review: From minority group applicantsG. Number of applications now pending on which no action has been taken: Total ‘group applicants... TH, LOCATION OF THE FACILITY ‘A. Does the location ofthe facility or complex have the effect of denying access to any person on the basis of race, color, national origin, age, sex, or disability? yes Ono B. Describe the racial makeup of the area surrounding the facility (f area is not the same as population). TV, USE OF SERVICES AND FACILITIES ‘A, Are ll participants required to pay the same fees, assessments, and charges per unit forthe use ofthe facilites? C] Yes INO If°NO, expla B. Explain how charges for services, ie., rent, connestion, end user fees are assessed, Is the use ofthe services or the facilities restricted in any manner because of race, color, or national origin? Dyes Ono] If"YES", explain: [Dus there evidence that individuals, in a protecied class, are provided different services , charged different or higher rate amounts than others? CO yesCNo If "YES", explain B ist the methods used by the recipient to inform the community ofthe availability of services or benefits of the facility (newspaper, radio, tv, ete). Do these methods reach the minority group population equally with the rest of the community’ _ Yes No G. Are appropriate Equal Opportunity posters conspicuously displayed? (And Justice For All and the Faic Housing poster) _O Yes ONO H. Do written materials, i.e. ads, pamphlets, brochures, handbooks and manuals, have a nondiserimination statement, Fair Housing, and/or accessibility logo or Equal Opportunity statement? Yes LINO 1. Deseribe the efforts of the recipient to attract minorities, females, and persons with disabilities to serve on the advisory board, board of directors or similar boards. I Indicate whether the facility is being properly maintained and whether services are provided on @ timely basis. Describe any resrictions that may exist on the use ofthe facility Le. no playgrounds Tor children: restrictions on use by ‘minorities, segregated or prohibited by age or disability of tenant or other participants.K. Describe any restrictions that may exist on the use of the facility, i.e. no playgrounds for children; restrictions on use by ‘minorities, segregated or prohibited by age or disability of tenant or other participants. LL. If participation is restricted by age of beneficiary, please indicate any Federal statute, or sate or local ordinance which may permit such restrictions, ‘Wi. How does tis facility compare-with other similar fallities in the area serving low income beneficlaries which are privately or federally financed by other agencies. ‘Answer N for RRH and LH onl [N. Does the organization's Operating Rules provide for standard reasons for eviction? _ If"YES,” specify: “Are these reasons stipulated in the Lease Agreements? ves no If not, how are they made known to participants? Y. ACCESSIBILITY REQUIREMENTS (DISABILITY) (For All Programs Funded By Rural Development) ‘A. Does the facility ot project have an accessible route through common use areas? — ~. OyesONo 'B, Has a self-evaluation for Section 504 of the Rehabilitation Act been conducted and a transition plan developed forall steuctural barriers? "____ DyesONo C. Does this facility or project have a Telecommunication Device for the Deaf (TDD) or participate in a relay service? - DYESONO If not is this part ofthe self-evaluation and transition plan? D. Describe reasonable accommodations made by the ecipient for making the program acces ‘VI. ACCESSIBILITY REQUIREMENTS FOR RURAL RENTAL HOUSING ‘A. Does the complex meet the 5% accessibility requirement of $04 ofthe Rehabilitation Act of 1973 for facilities built after June 1982? COyes No -- Ovestno B. Are the units occupied by persons with disabilities in need of the special design features? . I not, indicate what outreach has been conducted utilizing appropriste org eed of such units. ions and advertising to reach the individuals inVI. ACCESSIBILITY REQUIREMENTS FOR COMMUNITY FACILITIES. (Health Care Facilities) ‘A. List methods used by healthcare providers to communicate withthe hearing impaired in the emergency room. BB List methods used to communicate waivers and consent to Wealment requirements to persons with disabilities, including those with impaired sensory or speaking skills. C. Are there restrictions in delivery of serviees forthe treatment of alcohol, drug addiction or other related illnesses? (Aids, Hepatitis) Oves Oxo ‘VIII. COMPLEXES AND FACILITIES THAT PROVIDE HOUSING (Nursing Homes, Retirement Group, Raral Renal) ‘A. Does the facility have an approved A\fimative Fair Housing Marketing Plan? _ __Oves Ono B. Is there copy of the most recently approved plan being used and conspicuously posted? Oves Oxo . 1s management meeting the objectives ofthe plan? _ Ono 1 not, is there an updated plan in place? TX, PROGRAMS THAT CREATE EMPLOYMENT {ATs there evidence that individuals in a protected class are requited to meet diferent employment selection criteria than non- minorities? ves Ono B.Is there evidence that individuals of « protected elas are being terminated in a disproportionate rate than non-minority employees? - i: Dyes Ovo C. Do recipients that employ fiteen or more persons have a designated person to coordinate is efforts to comply with Section 504 of the Retabiltation Act of 19732 Oves Oxo 1D. Has the recipient provided reasonable accommodations to the known physical or mental impairment of employees with disabilities? Oves Ono ‘X. CONTACTS WITH INDIVIDUALS AFFILIATED WITH THE FACILITY OR COMPLEX A. List contacts made with a diverse selection of tenants, users, patients, employees, and others affiliated with the facility or complex. List by name, race, sex, and disability (if provided). 'B, Summarize comments made by the person(s) contacted.XI. COMMUNITY CONTACTS A. List contacts made with community leaders and organizations representing minorities, females, families with children, and individuals with disabilities. Include the date and the method of contact B. Summari comments made by person(s) contacted. XII, PAST ASSISTANCE FROM RD OR OTHER FEDERAL AGENCY A List past loans or other federal financial ass tance from other agencies. B, Does the recipient have a pending application with RD or another Federal agency’? ‘XII CIVIL RIGHTS COMPLIANCE HISTORY Provide a history ofthe followin A. Compliance Review. Has this recipient had a finding of non-compliance by RD or another federal agency? Oves Oxo BB. Discrimination Complaints. Has @ complaint of prohibited discrimination been fled against this recipient in the past three (3) years? Oves Dino . Law Suit, Has a law suit based on prohibited discrimination been filed against this recipient in the past three (3) years? If so, ° ° ° ‘White o ° ° o TOTAL ° ° ° ° ° ° o o Male ° ° ° 0 roraL | Female e 0 ° ° Family ° ° ° 0 A. Ae racial and gender ofthe participants and the number of employees in proportion tothe population percentages? yes ONO 1B. Number of participants as of last review: Date of lst review: . Are all interested individuals permitted to file an application (written or otherwise) for participation? TE"NO” explain why not YES ONO 1D. Does or will recipient of financial assistance maintain adequate records on the receipt and disposition of applications, including a list of applicants wishing to become participants? yes Tino {f"NO" what action is being taken to establish adequate records: If"YES" number of applicants wishing to become participants On Hist nna ‘Number on list from minority group E, Number of applications received from prospective participants since last review: Total. If zero skip to HL From minority group applicants. F, Number of applications which have been withdrawn or rejected since last review: Teal From minority group applicantsG. Number of applications now pending on which no action has been taken: Total ‘From minority group applicanls.. TI LOCATION OF THE FACILITY ‘A. Does the location of the facility or complex have the effect of denying access to any person on the basis of race, color, national origin, age, sex, or disability? aww IYES INO ‘B. Describe the racial makeup of the area surrounding the facility (iC area is not the same as population), Rural Community with S8t AI/AN, and 38% white representing 96% of the city's population. TV-USE OF SERVICES AND FACILITIES ‘A. Are all participants required to pay the same fees, assessments, and charges per unit forthe use of the facilities? .... Yes NO "NO", explain: BB. Explain how charges for services, i., rent, connection, and user fees are assessed, Fees for service, billed on a monthly basis, which is based on usage. C. Is the use ofthe services or the facilities restricted in any manner because of race, colo, or national origin? 1D Yes ENO IP"YES", explain: 1 Ts there evidence that individu ina protected lass are provided Gifferen services, changed differen or higher ats amoanls than others? 1D YESEINO IC*YES', explain E. List the methods used by the recipient to inform the community of the availablity of services or benefits ofthe Facility (newspaper, adio, , ee.). County public notices/advertisement, and word of mouth. F. Do these methods reach the minority group population equally with the rest ofthe community? ‘Yes ONO G. Are appropriate Equal Opportunity posters conspicuously displayed? (And Justice For All and the Fair Housing poster) : 1 Yes NO H. Do written materials, ic, ads, pamphlets, brochures, handbooks and manuals, have a nondiscrimination statement, Fair Housing, andlor accessibility logo or Equal Opportunity statement? 1 Yes {NO I. Describe the efforts ofthe recipient to attract minorities, females, and persons with disabilities to serve on the advisory board, board of directors, or similar boards. Encourage participation regarding appointments, and/or vacancies on Board J Indicate whether the facility is being properly maintained and whether services are provided on a timely basis. As a new borrower, it appears that the water system is properly designed and in good working order. It is anticipated that facility will be adequately maintained. K. Describe any restrictions that may exist on the use of the facility, ie., no playgrounds for children; restrictions on use by ‘minorities, segregated or prohibited by age or disability of tenant or other participants. None noted.K. Describe any restrictions that may exist on the use of the facility, i., no playgrounds for children; restrictions on use by ‘minorities, segregated or prohibited by age or disability of tenant or other participants. Again, None noted. L. If participation i restricted by age of beneficiary, please indicate any Federal statue, or state or local ordinance which may permit such restrictions None noted. M, How does this facility compare-with other similar facilities in the area serving low income beneficiaries which are privately or federally financed by other agencies. In-line with other similar systems. “Answer N for RRH and LH onl 'N. Does the organization's Operating Rules provide for standard reasons for eviction? OYEsoNO IE" YES" specify ‘Are these reasons stipulated in the Lease Agreements? 7 0 yestNo Tf'not, how are they made known to participants? V. ACCESSIBILITY REQUIREMENTS (DISABILITY) (For Alt Programs Funded By Rural Development) ‘A. Does the facility or project have an accessible route through common tse areas? = 2 YESONO 1. Has a self-evaluation for Setion 504 of the Rehabilitation Act been conducted anda transition plan developed forall structural aries? ___ ByESONO C. Does this facility or project have a Telecommunication Device for the Deaf (TDD) o participate ina relay service? ye for area residents. © NO G yYEszNo Frontier communications provides int not, is this pat ofthe self-evaluation and transition plan? D, Describe reasonable accommodations made by the recipient for making the program accessible to individuals with disabilities. Best Practices. Parking properly identified, and facility, including bathrooms and public meeting room is fully accessible. ‘VE ACCESSIBILITY REQUIREMENTS FOR RURAL RENTAL HOUSING ‘A. Does the complex meet the 5% accessibility requirement of 504 of the Rehabilitation Act of 1973 for fuclities built after June 19827 OYESONO OyYEsoNo B, Are the units oosupied by persons with disabilities in neo of the spesial design features? . If not, indicate what outreach has been conducted utilizing appropriate organizations and advertising to reach the individuals in need of such units,‘VIL ACCESSIBILITY REQUIREMENTS FOR COMMUNITY FACILITIES (Health Care Facilities) A. List methods used by health care providers to communicate with the hearing impaired in the emergency room. B. List methods used to communicate waivers and consent to treatment requirements to persons with disabilities, including those with impaired sensory or speaking skills. C. Are there restrictions in delivery of services forthe treatment of alcohol, drug addiction or other related illnesses? (Aids, Hepatitis) _Oves ONO ‘VEL COMPLEXES AND FACILITIES THAT PROVIDE HOUSING (@iursing Homes, Retirement Group, Rural Rental) A. Does the facility have an approved Affirmative Fair Housing Marketing Plan? Oyss No B. Is there a copy of the most reeently approved plan being used and conspicuously posted? Oyss No C. Is management meeting the objectives of the plan? Oyss ONO If not, is there an updated plan in place? TK PROGRAMS THAT CREATE EMPLOYMENT ‘A. Is there evidence that individuals ina protected class are required to meet different employment selection criteria than non ‘minorities? Oves No BB. Is there evidence that individuals of a protected class are being terminated in a disproportionate rate than non-minority employees? ves C. Do recipients that employ fifteen or more persons have a designated person to coordinate its efforts to comply with Section 504 of ‘th Rehabilitation Act of 19732 Contract relationship-Danny Fleming, Blanding, ur (YES INO 'D. Has the recipient provided reasonable accommodations to the known physical or mental impairment of employees with disabilities? yes ONO ‘X CONTACTS WITH INDIVIDUALS AFFILIATED WITH THE FACILITY OR COMPLEX ‘A List contacts made with diverse selection of tenants, user, patients, employees, and others afiliated withthe facility or complex List by namo, race, sex, and disblity (if provided). Robert Mueller, white, male, BA Bill Balaz, white, male, NA Danny Fleming, white, male, NA Richard Neff, white, ‘wale, NA ‘B. Summarize comments made by the person(s) contacted. Programs provides services to all comminity residents who have accessibility to water system connections. Program doesn't track Race, Ethnicity, or Gender of its customer base or applicants‘XL. COMMUNITY CONTACTS ‘A. List contacts made with community leaders and organizations representing minorities, females, families with children, and individuals with disabilities. Include the date and the method of contact, Clint Howell, Vice-Chairman, MHssp, 435.683.2263 Richard Neff, Secretary, MISSD, 435.683.2226 Marlene, Comunity Member & Business Owner, Mexican Hat, 435.683.2220 ‘B, Summarize comments made by person(s) contacted, ‘The above list of community leaders were identified during the compliance review, as resources, but were not contacted at this time. XIL PAST ASSISTANCE FROM RD OR OTHER FEDERAL AGENCY ‘A List past loans or other federal financial asistance from other agencies. NA B. Does the recipient have a pending application with RD or another Federal agency? cece ‘30D. CIVIL RIGHTS COMPLIANCE Provide a history of the following: ‘A. Compliance Review. Has this recipient hada finding of non-compliance by RD or another federal agency? CO ves NO BB. Discrimination Complaints. Has a complaint of prohibited discrimination been filed against this recipient inthe past three (3) years? OvEs 2 No (C. Law Suit. Has a law suit based on prohibited discrimination been filed agains this recipient in the past three (3) years? Ifo, describe and attach copies ofthe law suit YES NO D. Did the recipient take appropriate corrective or remedial action to achieve compliance with civil laws orto resolve any discrimination complaint cases or law suits? (yes C1 No EE, Identify the resources and or contacts used in verifying the recipient's past civil rights compliance history. Borrower file, and employee interview.‘XIV. CONCLUSIONS A. Did your review of the records maintained by the association or organization disclose any evidence of discrimination on the ‘grounds of race, color, national origin, sex, age, or disability inthe services or use ofthe facility? OYes If "YES," describe in detail such discrimination: B. Did your contacts with community leaders, including minority leaders, disclose any evidence of discrimination as to race, color, ‘ational origin, sex, age, or disability inthe services or use of the facility?” ~ Oves ‘©. Did your observation ofthis borrower's operations or proposed operations indicate any discrimination on the grounds of race, color, national origin, sex, age, or disability in the services or use ofthe facility? a Over ZNO IE"YES," describe in detail such discrimination: D. Comments for other observations or conclusions ‘Basod upon my observation ofthis borrower's operation or proposed operation and the attitude ofthe Governing Body and (Officials itis my opinion that the Recipient _¥_Is___Is Not complying with the requirements under Title VI of the Civil Rights Act of 1964, Seotion 504 of the Rehubilitaion Act of 1973, Age Discrimination Act of 1975, and Title DC of the Education Amendments Act of 1972. 12-22-2004 DATE ‘COMPLIANCE REVIEW OFFICER ‘XV. RECIPIENT IS IN NON-COMPLIANCE (Complete only if there isa finding of non-comy A. Sent recipient notice of non-compliance on this date ‘B. Date of compliance meeting, . Target date for recipient to voluntarily comply _D. Recipient has complied with al requirements and made all ‘necessary corrective action by this date , Deseribe all meetings with recipient to achieve compliance. F- Recipient has refused to voluntarily comply by this date . Comments:unos = TECUEST On ADVANGE __ sven | OR REIMBURSEMENT 1 [Clapvance ]-REIMBURSE- ee sr | oom a ene Siero [Goa Gea | ccna | nat a — . Leas: Cumulative program income 0.00 See = = = ~ *Silisuereneteie oe 000 eT oa oa a9 one {Non Foderal share of amount online 900 en 000 a oe fare a tanec 0.00 0.00 0.00, 9.00 ioxmasecel| aes ae agency for use in making ne oy Setceees eee o z ATERATE COREA FENCES HY ee ee i re =a ono sien Stas eter Fae eae Presb by OMB Credue AZ and A110(CERTIFICATION | certify that to the best of my krowrige ane boi he data on the revere are comet ar! tot loys ‘were made in accordance wth the ‘gant constone or ther agreement ‘hd that payments doe and as not been previously requastod ove suwoen, Thr pac oragenay ase Public reporting tarden fr this collection of Ifornaion s estimated fo average 60 minutes per responce nung ime fo reviowig inerucion, searching existing dat sous gathering and ‘maitsning the data needed, and completing and evieung the colocton of vormaton. Send ‘comments regarding the burden estimate or any other aspect ofthis calecion of formation, ‘feuding suggestions fr recucng ts buon, to the Often of Management and Budget, Paperwork Reduction Proje (0348-0008), Washington,DC 20508. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT [AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. INSTRUCTIONS Please ype or print legibly. tems 1,3, 6,9, 10, 110, 116 11g, 1 Instructions for other items are 2s (lows: tem Enty 2. Indicate whether request is propared on cash or accrued expenditure basis. All requests for advances shall be prepared on a cash bass 4, Enter the Federal grant number, or other identifying ‘number assigned by the Federal sponsoring agency. IF ‘he advance or reimbursement is for more than one grant ‘or other agreement, insert N/A; then, show the aggregate amounts. On a separate sheet, list each grant or ‘agreement number and the Federal share of outlays made agains! the grant or agreement. 6. Enter the employer identifcation number assigned by the U.S. Internal Revenue Service, or the FICE (institution) code if requested by the Federal agency. 7. This space is reserved for an account number or other ‘dentiying number that may be assigned by the recipient. 8, Enter the month, day, and year for the beginning and tending ofthe period covered in this request. IFthe request is for an advance or for both an advance and reimbursement, show the period that the advance will ‘cover. Ifthe request is for reimbursement , show the ‘period for which the reimbursement is requested. Note:The Federal sponsoring agencies have the option of requiring recipients to complete items 11 or 12, but not both. Item 12 should be used when only a minimum, ‘amount of information is needed to make an advance and ‘outay information contained in item 11 can be obtained in ‘a tmaly manner from other reports. 11. The purpose ofthe vertical columns (a), (b) and () is to provide space for separate cost breakdowns when a project has been planned and budgeted by program, function, or 12 and 13 are selF-explanatory, specific. om Enty ‘acy. additional columns are needed, use as many ‘addtional forms as needed and indicate page number in ‘space provided in upper right; however, the summary totals ofall programs, functions, or activites should be shown in the "ota" column on the fst page. ‘Ya. Enter in “as of date," the month, day, and year of the tending of the accounting period to which this amount applies. Enter program outlays to date (net of refunds, rebates, and discounts), in he appropriate columns. For requests prepared on a cash basis, oullays are the sum ‘of actual cash disbursements for goods and services, ‘he amount of indirect expenses charged, the value ofin- kind contributions applied, and the amount of cash ‘advances and payments made to subcontractors and subrecipients. For requests prepared on an accrued expenditure basis, outlays are the sum of the actual ‘cash disbursements, the amount of indirect expenses Incurred, and the net increase (or decrease) in the amounts owed by the recipient for goods and other property received and for services performed by ‘employees, contracts, subgrantees and other payees. ‘1b. Enter the cumulative cash income received to date, if requests are prepared on a cash basis. For requests prepared on an accrued expenditure basis, enter the ‘cumulative income eamed to date. Under either basis, ‘enter only the amount applicable to program income that was required to be used for the project or program by the terms ofthe grant or other agreement. 1144. Only when making requests for advance payments, enter the total estimated amount of cash outlays that will bbe made during the period covered by the advance. 18, Complete the certiication before submiting this request SANDRO FORA 270 Pe. 797 Bock