Form ED-900 Application for Investment Assistance

Application for Investment Assistance

Single_AP_12_21_07_bk4

Application for Investment Assistance

OMB: 0610-0094

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0610-0094 can be found here:

Document [pdf]

Download: pdf | pdf

Form ED-900 (Rev. 12/07)
OMB Control No. XXXX-XXX
Expires XX/XX/XXXX

Print Form

ECONOMIC DEVELOPMENT ADMINISTRATION

APPLICATION FOR
INVESTMENT ASSISTANCE
The Economic Development Administration (EDA) uses the Application for Investment Assistance
to evaluate applications under EDA's economic development assistance programs. EDA may ask
applicants to provide supplemental information as needed during the evaluation and selection process.
Please visit our Internet website at www.eda.gov for more information on EDA's programs,
selection and evaluation criteria, and application procedures, as set forth in applicable Federal
Funding Opportunity (FFO) announcements. These FFO announcements are also published
annually in the Federal Register.
PWEDA Section 201
(CFDA No. 11.300)
Public Works and Economic
Development Program

PWEDA Section 203
(CFDA No. 11.302)
Planning Program

PWEDA Section 207
(CFDA No. 11.303)
Local and National Technical
Assistance and University
Center Economic
Development Program

PWEDA Section 207
(CFDA No. 11.312)
Research and Evaluation
Program

PWEDA Section 209
(CFDA No. 11.307)
Economic Adjustment
Assistance Program

Page
Section A - To Be Completed by All Applicants
Section B - Regional Eligibility (Public Works and Economic
Adjustment Assistance)
Section C - Technical Assistance & Research/Evaluation
Assistance
Section D - To Be Completed by All Non-Governmental
Applicants (excluding Public Universities)
Section E - Budgeting and Staffing/Non-Construction
Assistance
Section F - Partnership Planning Assistance
Section G - Short-Term Planning Assistance
Section H - State Planning Assistance
Section I - Local or National Technical Assistance
Section J - University Center Program Assistance
Section K - Economic Adjustment Assistance
Section L - Revolving Loan Fund (RLF) Assistance
Section M - Construction Assistance
Section N - Design and Engineering Assistance

3
8
10
11
12
13
13
14
14
15
15
16
16
25

Page 1

Application for Investment Assistance (Form ED-XXX)
OMB Control No. XXX
Expires XXX
Notwithstanding any other provision of the law, no person is required to respond to, nor shall
any person be subject to a penalty for failure to comply with, a collection of information
subject to the requirements of the Paperwork Reduction Act, unless the collection of
information displays a currently valid OMB Control Number.
The information requested in this Application for Investment Assistance is required to obtain
or retain benefits from EDA pursuant to the Public Works and Economic Development Act of
1965 (PWEDA), as amended (42 U.S.C. 3121 et seq.). The reasons for collecting this
information are to enable applicants to submit applications for financial assistance and to
assist EDA in determining applicants' eligibility and compliance with legal and programmatic
requirements. The information submitted on this application and in accompanying
documents is subject to public disclosure under the Freedom of Information Act, as amended
(5 U.S.C. 552), unless exempt from disclosure as trade secrets or privileged or confidential
commercial or financial information under 5 U.S.C. 552(b)(4).
The public reporting burden for this collection of information is estimated to average XX
hours per response, including time for reviewing instructions, gathering data, and completing
the application. Comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing paperwork burden may be sent
to: Economic Development Administration, U.S. Department of Commerce, 1401
Constitution Avenue, N.W., Washington, D.C. 20230, and to the Office of Information and
Regulatory Affairs, Office of Management and Budget, Washington, D.C. 20503.

Page 2

INSTRUCTIONS FOR ELECTRONIC AND HARDCOPY FORMATS
Electronic Submissions: Please visit www.Grants.gov for detailed instructions on electronic
submissions. This form is designed to be completed in Adobe Acrobat Reader, versions 7.0 and
above. If using Adobe Acrobat Reader version 7.0 or above, all interactive features should work.
Responses may be composed in a separate word processing program and then copied and pasted into
the appropriate response field. NOTE: Applicants who would like to save a copy for their records must
save a copy to their local hard drive under a unique name. Additional documentation or information
applicants must provide may be submitted as electronic attachments through www.Grants.gov.
Hardcopy Submissions: EDA encourages applicants to submit applications in electronic format
via www.grants.gov. However, if the applicant is unable to complete this application using Adobe
Acrobat version 7.0 or above, the applicant may send in a hardcopy application. If submitting a
hardcopy application, the applicant should print this application, type or print the responses, and attach
all narratives as exhibits. Applicants must label each exhibit so that it corresponds to the section
letters and question numbers listed in this application (e.g., A.1. "Investment (Project) Region). As
appropriate, applicants should indicate which sub-question the narrative addresses (e.g., M.4.d).
Applicants should mail the completed application to the appropriate Regional Office. See EDA's
internet website (www.eda.gov) for a listing of Regional Offices.

NOTE ON EDA'S APPLICATION PROCESS
To limit the burden on the applicant, EDA only requests certain items of documentation if EDA
determines that the applicant's project merits further consideration. Applicants should note that the
following items will be subsequently requested if, and only if, EDA selects their project for further
consideration:
For all types of projects:
--A copy of the region's Comprehensive Economic Development Strategy (CEDS) or alternate EDAapproved planning document
--Letters of commitment to document non-EDA funding
For construction projects only:
--USGS map of project site
--Letters of commitment from private beneficiaries of the proposed project
--Comments from the metropolitan area review/clearinghouse agency
--A legal opinion and other documentation, as necessary, verifying the applicant's answer to
questions regarding project ownership, operation, maintenance, and management
--An engineering report
--An environmental narrative
--Documented approval from the State Historic Preservation Officer (SHPO)
For Revolving Loan Fund projects only:
--Revolving Loan Fund Plan
For non-profit applicants only:
--Certificate of good standing from the state
--A copy of the organization's Articles of Incorporation and By-Laws
--Resolution from a general purpose subdivision of government of a state acknowledging that the
organization is acting in cooperation with officials of that subdivision
--Comments from a general purpose government entity (construction projects only)

Page 3

SECTION A - TO BE COMPLETED BY ALL APPLICANTS
General Instructions
Please answer all questions completely and accurately and provide a concise narrative statement for
each question below. Most narratives need not exceed one paragraph. Any attachments to this
application may either be attached electronically through www.grants.gov or submitted in hardcopy to
the Regional Office (www.eda.gov/AboutEDA/Regions.xml) that processes applications for your state.
Applicants should consult EDA's program requirements and evaluation criteria set forth in
13 C.F.R. Chapter III (EDA's regulations), as supplemented by the applicable Federal Funding
Opportunity Announcement (FFO) on www.grants.gov, when completing this application. (EDA's
regulations begin on page 20 of the Federal Register notice posted at www.eda.gov/ImageCache/
EDAPublic/documents/pdfdocs2006/2006final_20rule_2epdf/v1/2006final_20rule.pdf.) Applicants
are encouraged to contact an EDA representative (see list of Regional Offices above) for assistance in
completing this application. Preparation of an application may involve coordination with other local,
state and federal agencies.
Public Works and Economic Adjustment Assistance projects must satisfy regional eligibility
requirements (see 13 C.F.R. ' 304.1). Legal citations referencing EDA's regulations are included for
the applicant's information; however, all of the information needed to complete this application is
contained within the form itself or within the web links included in this form. Legal assistance is not
generally required to complete this form, although applicants may need to consult with an attorney
concerning any legal issues implicated by the receipt of federal assistance.
Please indicate the type of EDA investment assistance for which you are applying:

Economic Adjustment

Complete Sections A, B, and M.
Complete Sections A, B, E, and K. Also Complete
Sections M and/or N if request has construction
and/or design/engineering components.

Partnership Planning

Complete Sections A, C, E, and F.

Short-term Planning

Complete Sections A, C, E, and G.

State Planning

Complete Sections A, C, E, G, and H.

University Center

Complete Sections A, C, E, and J.

Local Technical Assistance

Complete Sections A, C, E, and I.

National Technical Assistance

Complete Sections A, C, E, and I.

Revolving Loan Fund

Complete Sections A, B, E, K, and L.

Design and Engineering

Complete Sections A, B, and N.

Public Works

Please indicate which type of applicant you are:
Governmental (or quasi-governmental, to include District Organizations, universities, or public
institutions of higher learning)
Non-governmental (e.g. private or public non-profit organizations, for-profit organizations)
In addition to the sections specific to the program for which you are applying (see above), nongovernmental applicants also must complete Section D.

Page 4

A.1.

Investment (Project) Region

Identify and describe the region where the project will be located, identify and describe the region
that will benefit from the project (if different from or in addition to the region in which the project will
be located), and discuss the project's expected economic impact. For purposes of this application,
a region is defined as "an economic unit of human, natural, technological, capital or other
resources, defined geographically. Geographic areas comprising a region need not be continguous
or defined by political boundaries, but should constitute a cohesive area capable of undertaking
self-sustained economic development." (See 13 C.F.R. ' 300.3 for the definition of "Region.")

A.2.

Investment (Project) Description

Provide a detailed description of the complete scope of work for the proposed EDA investment. If
you are proposing a construction project, please include specific construction components. Also, for
National Technical Assistance, Training and Research and Evaluation Projects, provide a description
of the methodology to be used to complete the project.

Note: If EDA determines that your project merits further consideration, and if your project includes
construction, you will be required to provide a USGS map of the site.
A.3.
a.

Economic Development Needs
Does the region in which the project will be located have a Comprehensive Economic
Development Strategy (CEDS)? (See www.eda.gov/ImageCache/EDAPublic/documents/
pdfdocs2006/cedsflyer081706_2epdf/v1/cedsflyer081706.pdf.) (Note: Except for strategy
grants as described in 13 C.F.R. ' 303.7, the region in which Public Works or Economic
Adjustment projects will be located must have a CEDS with which the project is consistent.)
Yes

If Yes, what is the source? Note: If you are unsure if your region has a CEDS, please contact your
local District Organization.

If No, what alternate strategic planning document do you wish to govern this investment? Note:
You will be asked to provide a copy of this planning document if your project is selected for further
consideration.

b.
Briefly describe the economic development needs of the region and how the proposed
investment addresses the goals and objectives of the CEDS for the region or the alternate
strategic planning document as noted above. (See 13 C.F.R. part 303.)

Page 5

A.4.

Briefly describe the economic conditions of the region described in A.1, as well as the
economic adjustment problems or economic dislocations the region has experienced (or is
about to experience) and the regional impact of these conditions.

Investment (Project) Impact and Fit with EDA Funding Priorities

Discuss how the proposed investment satisfies EDA's Investment Policy Guidelines as set forth in
13 C.F.R. ' 301.8, as well as the EDA funding priorities set forth in the applicable Federal Funding
Opportunity (FFO) announcement on www.Grants.gov.

A.5.

Applicant's Capability

Briefly describe the applicant's capability to administer, implement, and attract private sector
investments to the project.

A.6.

Proposed Time Schedule for the Project

Provide a proposed time schedule for completion of the project, including when (month/year)
the project will begin and end. Explain any potential issues that could affect project implementation.

A.7.

Civil Rights

Does the applicant understand and agree to comply with all applicable civil rights
requirements (see 13 C.F.R. ' 302.20), including the requirement to provide signed
assurances of compliance?
Yes
No (explain below)

Do identified "Other Parties" as defined in 13 C.F.R. ' 302.20(b) understand and agree to
comply with all applicable civil rights requirements, including the requirement to provide
signed assurances of compliance?
Yes
No (explain below)
Not Applicable (No Other Parties Identified)

A.8.

Proposed Project Budget
For Construction investments, complete Form SF-424C.
For Non-Construction investments, complete Form SF-424A.

Page 6

Note: If you are applying in hardcopy,you may download these forms from www.Grants.gov/
techlib/SF424A-V1.0.pdf and www.Grants.gov/techlib/SF424C-V1.0.pdf

A.9.

Non-EDA Funding for the Project

Identify the source, nature and amount of all non-EDA funds, including in-kind contributions
(non-cash contributions of space, equipment, services, or assumptions of debt; see
definition of "In-Kind Contribution(s) in 13 C.F.R. ' 300.3). Explain the status of all funding
commitments, including the date the funds will be available from each source, and describe
any conditions or restrictions on the use of such funds. If in-kind contributions are included,
explain the basis on which they are valued.

Are all non-EDA funds committed to the project, available as needed, and not conditioned
or encumbered in any way that would preclude their use consistent with the purpose of the
project? (See 13 C.F.R. ' 301.5.)
Yes
No (explain below)

Note: If EDA determines that your project merits further consideration, you will be required to
provide letters of commitment from any proposed non-EDA funding sources.

Discuss the actions that need to be taken and the timing required to secure any non-EDA
funds.

Does the applicant plan to seek other federal financial assistance as part of or in connection
with this project? If so, please describe the source, amount, any terms and conditions
of the funding, and when the funding will be available for use by the applicant.
Yes

Is the requested EDA investment assistance available from any other federal economic
Yes (explain below)
No (explain below)
development program?

If Yes, identify the source and provide an explanation of why EDA investment assistance
is required.

Page 7

A.10. Lobbying Certifications
All applicants for federal financial assistance must certify that federal funds have not been used
and will not be used for lobbying in connection with this request for federal financial assistance
(Form CD-511). If non-federal funds have been or are planned to be used for lobbying in
connection with this request for federal financial assistance, Form SF-LLL also must be
completed. Please check all that apply:
Applicant's "Certifications Regarding Lobbying" (Form CD-511--see Exhibit E) is completed.
Applicant's "Disclosure of Lobbying Activities" (Form SF-LLL) is required and attached. (If
applicant is applying in hardcopy, access the form at www.whitehouse.gov/omb/grants/
sflllin.pdf.)
Note: Applicants must comply with 13 C.F.R. 302.10 regarding attorneys' and consultants' fees
and the employment of expediters. This regulation requires that applicants identify and disclose
the amount of fees paid to anyone engaged to assist the applicant in obtaining assistance under
the Public Works and Economic Development Act of 1965 (PWEDA), as amended.
A.11. Compliance with Executive Order 12372, State Single Point of Contact (SPOC)
a.

Does the state in which the project will be located have a project review process that requres
submission to a Single Point of Contact (SPOC)? (See 13 C.F.R. ' 302.9(b).) Note: If you
are unsure if your state has a Single Point of Contact, or do not know who this individual is,
please refer to OMB's SPOC list (www.whitehouse.gov/omb/grants/spoc.html).
Yes

No (go to A.12))

If Yes to A.11(a) above, does this request for EDA investment assistance meet the SPOC
process established by the state?
Yes
No (go to question A.11(d))

If Yes to A.11(b) above, were SPOC comments/clearance received?
Yes, and the comments/clearance are attached.
No, the review period has expired and no comments were received.

If No to question A.11(b) above, please explain any known reason for the lack of comments.

A.12. Justification for Sole Source Procurement
a.

Will you subcontract work to complete part or all of this project?
Yes

If Yes, will contracts be awarded by competitive bid?
Yes

If contracts will not be awarded by competitive bid, please provide a justification. A
cost analysis will be necessary when adequate price competition is lacking, and for sole
source procurements, including contract modifications or change orders.
(See 15 C.F.R. ' 14.40-14.48 or ' 24.36, as applicable.)

Page 8

SECTION B - REGIONAL ELIGIBILITY:
TO BE COMPLETED BY APPLICANTS FOR PUBLIC WORKS
OR ECONOMIC ADJUSTMENT ASSISTANCE ONLY
Public Works and Economic Adjustment Assistance projects must satisfy regional eligibility
requirements (see 13 C.F.R. part 301). This section will assist EDA in determining if the proposed
project satisfies these eligibility requirements. Please answer all questions completely and
accurately and attach explanations and supporting documentation where applicable.
1.

Identify the region upon which the applicant is basing the eligibility calculation.

If this region is different from the region described in Section A of this application,
please explain.

If this region is not defined by political boundaries (e.g., it is a neighborhood within a
large city rather than an autonomous town), provide a description of the project region
and documentation to show that: (i) the region is of sufficient size appropriate for the
proposed project, and (ii) the area used for regional eligiblity is the same as the area
that will benefit from the proposed project.

Source of data provided for regional eligibility determination: Check the source of data
used to determine regional eligibility, and attach an explanation and a copy of this data. The
explanation must: (i) identify the data used (e.g., American Community Survey (ACS)); (ii) if the
data used are other than the ACS, explain why ACS data were not used; and (iii) if the data
used are other than federal data, explain why federal data were not used and identify the
source of the non-federal data. ACS data (www.census.gov/acs) should be used whenever
possible, but if such data are not available, the order of data preference is as listed below.
a. The most recent ACS data published by the U.S. Census Bureau.

b. The most recent other federal data for the region in which the project is located (e.g., U.S.
Census Bureau or the Bureaus of Economic Analysis, Labor Statistics, Indian Affairs, etc.)
c. If no federal data are available, the most recent data available through the state
government for the region in which the project is located.
d. Other data to substantiate regional eligibility based on a "Special Need" as defined in
13 C.F.R. ' 300.3.

Page 9

Economic Distress: Check all that apply in establishing regional eligibility
(see 13 C.F.R. § 301.3 (a)(1)):
A.

Unemployment rate: The project is located in a region that has an unemployment rate
that is, for the most recent 24-month period for which data are available, at least one
percentage point above the national unemployment rate.

Per capita income: The project is located in a region that has a per capita income that
is, for the most recent period for which data are available, 80 percent or less of the
national average per capita income.

Special need: The project is located in a region that has experienced or is about to
experience a "Special Need" (as defined in 13 C.F.R. § 300.3) arising from actual or
threatened severe unemployment or economic adjustment problems resulting from
severe short-term or long-term changes in economic conditions, including:
Substantial out-migration or population loss;
Underemployment; that is, employment of workers at less than full-time or at less skilled
tasks than their training or abilities permit;
Military base closure or realignment, defense contractor reductions-in-force, or U.S.
Department of Energy defense-related funding reductions;
Natural or other major disasters or emergencies;
Extraordinary depletion of natural resources;
Closing or restructuring of an industrial firm or loss of other major employer;
Negative effects of changing trade patterns; or
Other circumstances set forth in the applicable FFO (please explain below).

Substantial Direct Benefit: A project located within an Economic Development District (EDD)
that is located in a region that does not meet the economic distress criteria set forth in section
B.3 above, is also eligible for EDA investment assistance if EDA determines that
the project will be of "substantial direct benefit" to a geographic area within the EDD that meets
the distress criteria set forth in question B.3 above by providing significant employment
opportunities for unemployed, underemployed, or low-income residents of the distressed
geographic area within the EDD. If applicable, identify the EDD in which the proposed project
will be located, as well as the geographic area within the EDD that meets the economic distress
criteria detailed in section B.3. above, and explain how the proposed project will provide a
substantial direct benefit to this geographic area within the EDD. (See 13 C.F.R. § 301.3 (a)(2).)
No, not applicable. The project is located in a region that meets the economic distress
criteria in section B.3.
Yes, this project will provide a "substantial direct benefit" to residents of an area meeting
the economic distress criteria. Please provide an explanation below.
If Yes,
explain:

Page 10

Project Beneficiaries: Identify private sector employers that will benefit from the project,
and attach letters of commitment electronically through www.grants.gov or in hardcopy, if
available. In the last column, select 'Committed' if the company has committed to being a
partner in the project or 'Interest Only' if it has merely expressed interest.
If none, check this box, do not complete this chart, and go to Section C.

Company

Products and
Services
Produced by
Company 5 digit
NAICS code

Number of
Company
Jobs Saved
by Project

Number of
Company
Jobs Created
by Project

Amount of
Company
Investment
($)

Company
Committed or
Only
Interested?

Note: If EDA determines that your project merits further consideration, you will be required to
provide letters of commitment from the project's beneficiaries, verifying the above information.

SECTION C - MAXIMUM ALLOWABLE EDA INVESTMENT
RATES: TO BE COMPLETED BY PLANNING, TECHNICAL
ASSISTANCE, UNIVERSITY CENTER PROGRAM,
AND RESEARCH/EVALUATION APPLICANTS ONLY
According to EDA's regulations, the maximum allowable EDA investment rate for Planning
Investments, Local and National Technical Assistance, the University Center Program, and
Research and Evaluation Investments shall be based on the relative needs of the Region that the
project will serve. However, a project of a national scope may be eligible for up to a 100 percent
investment rate if the project will be of no or only incidental benefit to the eligible recipient or if the
project merits, and is otherwise infeasible without further EDA assistance. Please answer the
following questions completely to determine eligibility for an EDA investment rate greater than 50
percent.
1.

Is the project national in scope?
Yes

No (go to Section D)

Please describe how the project is national in scope.

Page 11

Will the project be of no benefit or only incidental benefit to the applicant?
Yes (go to question C.4)

No (explain below)

Is the project not otherwise feasible without an EDA investment rate greater than 50
percent?
Yes (explain)
No

If Yes, explain why the project merits an EDA investment rate greater than 50 percent.

All applicants for EDA National Technical Assistance, Training, and Research and
Evaluation Assistance must complete the EDA National Technical Assistance, Training,
and Research and Evaluation Investments Additional Assurances form. See attached
Exhibit D on page 32 of this application.
Yes, the applicant's Additional Assurances form is completed.
Not applicable; the applicant is not applying for National Technical Assistance,
Training, or Research and Evaluation investment assistance.

SECTION D - TO BE COMPLETED BY ALL
NON-GOVERNMENTAL APPLICANTS (EXCLUDING
PUBLIC UNIVERSITIES AND DISTRICT ORGANIZATIONS)
1.

All non-governmental applicants for federal financial assistance must provide a
'Name Check' form (Form CD-346) completed by each officer, the executive director, and the
chief financial officer of the applicant organization, unless: (i) proposed award amounts are
$100,000 or less; or (ii) applicants have been recipients of DOC financial assistance for
three or more consecutive years without any adverse programmatic or audit findings.
Unless you meet one of the two exemption criteria listed above, please list the names of your
organization's Chief Financial Officer, Executive Director, and all other officers.

Yes, applicant's "Name Check" form(s) is/are attached. (Download form from
www.doc.gov/forms/direct.htm.)
No, applicant's "Name Check" form(s) is/are not attached. If No, explain below.

Page 12

Non-profit organization applicants must provide a current Certificate of Good Standing from
the State in which they are incorporated.
Can you provide a Certificate of Good Standing (or its legal equivalent) from the State in
which your organization is incorporated?
Yes
No (explain below )

Note: You will be asked to provide this at a later date if your project is selected for further
consideration.
3.

New non-profit organization applicants must provide their Articles of Incorporation and ByLaws. Current non-profit organization applicants also must provide their Articles of
Incorporation or By-Laws if either has been amended, or a statement certifying that there
has been no change in the organization's Articles of Incorporation or By-Laws.
Can you provide this?

Yes

No (explain below )

Note: You will be asked to provide this at a later date if your project is selected for further
consideration.
4.

Will you be able to provide a resolution passed by (or a letter signed by) an authorized
representative of a general purpose political subdivision of a State (e.g., local government
entity), acknowledging that the applicant is acting in cooperation with officials of the political
subdivision? EDA may waive this requirement for certain projects of significant regional or
national scope. (See 13 C.F.R. § 301.2(b).)
Yes

No (explain below)

Note: You will be asked to provide this at a later date if your project is selected for further
consideration.
5.

If you are applying for a construction or RLF investment, you must afford the appropriate
general purpose governmental authority a minimum of 15 days to review and comment on
the proposed project. (See 13 C.F.R. § 302.9(a).) Note: You will be asked to provide this
at a later date if your project is selected for further consideration.
Will you be able to provide these comments?
Yes
No, this is not applicable because I am not applying for a construction or RLF investment.
No, for another reason (explain).

Page 13

SECTION E - BUDGETING AND STAFFING SUPPLEMENT:
TO BE COMPLETED BY APPLICANTS
FOR NON-CONSTRUCTION ASSISTANCE ONLY
1.

Explain the proposed use of any amounts budgeted for "Equipment," "Contractual," or
"Other," if any, on Form SF-424A, 'Budget Information - Non-Construction Programs.'

Explain the types of indirect costs, if any, on Form SF-424A.

Note: A completed Indirect Cost Rate Agreement or other documentation applicable to an indirect
cost rate determination will be requested if EDA selects the project for further consideration.
3.

Identify key applicant staff who will undertake and complete project activities. Include a
description of the knowledge, organizational experience, and expertise of individual staff
members. In addition, explain how organizational resources will be used to complete
project activities. For National Technical Assistance, Training and Research and Evaluation
projects, specify which positions will be charged to the federal and non-federal portion of the
project budget.

SECTION F - TO BE COMPLETED BY APPLICANTS
FOR PARTNERSHIP PLANNING ASSISTANCE ONLY
1.

Explain how the proposed scope of work will develop, implement, revise, or replace a
Comprehensive Economic Development Strategy (CEDS) for the region and be part of a
continuous planning process. The CEDS must comply with EDA's requirements.
(See 13 C.F.R. § 303.7.)

2.
Provide a list of the applicant's Strategy Committee members. The Strategy Committee
must represent the main economic interests of the region and must include private sector
representatives as a majority. In addition, the Committee should include public officials,
community leaders, representatives of workforce development boards, institutions of higher
education, minority and labor groups, and private individuals. A State or Indian tribal planning
organization should contact the appropriate EDA Regional Office if it needs to vary the
composition of its Committee. (See 13 C.F.R. § § 303.2 and 303.6(a).)

Page 14

Provide a list of the applicant's governing board members. Board membership must comply
with EDA's regulations at 13 C.F.R. § 304.2(c)(2).

SECTION G - TO BE COMPLETED BY APPLICANTS
FOR SHORT-TERM PLANNING ASSISTANCE ONLY
1. Explain how the proposed scope of work will develop the economic development planning
capacity of the State, local government, university, or non-profit organization to assist in
institutional capacity building or to undertake innovative approaches to economic development in
economically distressed regions. If a CEDS exists for the region in which the project will be
located, explain how the proposed scope of work relates to the CEDS. (See 13 C.F.R. § 303.9.)

Explain how the proposed scope of work will function in conjunction with any other available
federal, State, or local planning assistance.

Explain what performance measures will be used to evaluate the success of the project.

SECTION H - TO BE COMPLETED BY APPLICANTS
FOR STATE PLANNING ASSISTANCE
1.

Does a State CEDS already exist that satisfies EDA CEDS requirements?
No
Yes
(See 13 C.F.R. § 303.7.)

If Yes, please attach a copy of the CEDS.
If No, is the proposed project for the development of a CEDS?
Yes

Page 15

If the proposed project is for the development of a CEDS, explain how the State CEDS will
incorporate existing local CEDS, as well as input from other State agencies, local
governments, and District Organizations.

SECTION I - TO BE COMPLETED BY APPLICANTS
FOR LOCAL OR NATIONAL TECHNICAL ASSISTANCE ONLY
1.

Describe how the proposed project will strengthen the capacity of local, State, or national
organizations and institutions to undertake and promote effective economic development
programs targeted to regions of economic distress.

Describe whether and how the proposed project will benefit distressed regions.

Describe any innovative approaches that will be used to stimulate economic development
in distressed regions.

If applicable, describe how the proposed project is consistent with an EDA-approved CEDS
for the region in which the project will be located. (See 13 C.F.R. § 306.2.)

SECTION J - TO BE COMPLETED BY APPLICANTS
FOR UNIVERSITY CENTER PROGRAM ASSISTANCE ONLY
1.

Explain how the proposed project will address the economic development needs, issues,
and opportunities of the region and benefit distressed areas of the region.

Describe how the proposed project will provide services that are unique and maximize
coordination with other organizations in the region.

Page 16

Discuss how the proposed project activities are consistent with the expertise, programs, and
other available resources of the sponsoring institution.

Describe the commitment and support (both financial and non-financial) for the proposed
project by the sponsoring institution's senior level management.

Describe the sponsoring institution's past experience in administering technical assistance
programs. (See 13 C.F.R. § 306.5.)

SECTION K - TO BE COMPLETED BY APPLICANTS
FOR ECONOMIC ADJUSTMENT ASSISTANCE ONLY
Note: You are not required to complete this section if you are applying for a "Strategy Grant"
under 13 C.F.R § 307.3.
1.

Explain how the proposed project will assist in overcoming major obstacles already identified
in a CEDS (or other strategic planning document), expand the capacity of public officials and
economic development organizations to work effectively with employers, enable the region
to plan and coordinate the use of available resources to support economic recovery and the
development of a regional economy, and/or develop innovative approaches to economic
revitalization in the region.

Explain how the proposed project will help the region meet a "Special Need".
(See 13 C.F.R. §§ 300.3 and 307.2(b).)

SECTION L - TO BE COMPLETED BY APPLICANTS
FOR REVOLVING LOAN FUND (RLF) ASSISTANCE ONLY
1.

Explain the need for a new or expanded public financing tool to enhance other business
assistance programs and services targeting economic sectors described in the CEDS (or
alternate EDA-approved plan or economic development strategy) for the region.

Page 17

Note: A strategy other than a CEDS must be approved by EDA.
2.

Explain the types of financing activities anticipated.

Describe the capacity of the RLF organization to manage lending activities, create networks
between the business community and other financial providers, and implement the CEDS
(or alternate EDA approved plan or strategy). (See 13 C.F.R. § 307.4.(c)(2)).

If EDA determines that your project merits further consideration, you will be asked to provide a
Revolving Loan Fund Plan. This Plan must comply with EDA's RLF Plan requirements set forth in
13 C.F.R. § 307.9. Also, please note that you will be asked to provide a copy of the CEDS or
alternate EDA-approved economic development plan or strategy for your region at a later date if
your project is selected by EDA for further consideration.

SECTION M - TO BE COMPLETED BY
CONSTRUCTION ASSISTANCE APPLICANTS ONLY
M.1. Metropolitan Area Review
a.

Projects involving the development of hospitals, airports, libraries, water supply and
distribution facilities, sewage and waste treatment works, highways, transportation facilities,
water development, or land conservation within a metropolitan statistical area (MSA),
require comments from the metropolitan area clearinghouse/agency. Does the proposed
project involve any of the above identified developments within an MSA?
Yes

If Yes, please indicate which of the following you will be able to provide:
Comments from the responsible metropolitan area clearinghouse/agency and a statement
that such comments have been considered; or
An explanation as to why comments are not available; or
A statement indicating the date the application was made available to the appropriate
metropolitan area clearinghouse/agency and units of general local government for review and
certifying that the application has been before the metropolitan area clearinghouse/agency for
a period of 60 days without comments or recommendations.

Page 18

M.2. District Organization Project Administration
Will the District Organization for the region in which the project will be located administer the project
Yes
No
for the applicant?
If Yes, you must certify to all of the following and indicate your certification by checking each box:
The administration of the project is beyond the capacity of the applicant's current staff and
would require hiring additional staff or contracting for such services;
No local organization/ business exists that could administer the project in a more efficient or
cost-effective manner than the District Organization; and
The District Organization will administer the project without subcontracting the work.
If the project will be adminstered by the District Organization and you did not certify to all of the
above, explain below.

M.3. Engineering Report
An engineering report must be submitted if EDA selects the project for further consideration and
must include (at a minimum) the following information:
1.

A statement of project components. Indicate if the proposed project involves the
construction of a new facility or facilities or the enlargement, expansion, renovation, or
replacement of an existing facility or facilities. Describe the existing facility and proposed
project components in terms of dimensions, capacities, quantities, etc.

Clear copies of sketches or schematics showing the general layout and location of the
project components.

A feasibility analysis. Include a review of existing conditions. Discuss any potential
problems that might delay construction and affect project components.

A proposed method of construction. Indicate whether the project will be constructed by
competitive bid, single contract, or multiple contracts. Indicate if any portion of the
construction work is proposed to be done by design/build, construction management at
risk, or by the applicant's own forces.

An estimate of useful life of the facility and an explanation of basis on which it is determined.

A current detailed construction cost estimate for each of project component, showing
quantities, unit prices, and total costs.

A list of all permits required for the proposed project and the status of each permit.

An estimate of the number of months for each of the following: (i) design period, (ii) solicitation
of bids and awarding of contracts, and (iii) construction period.

Will you be able to provide this information?

Yes

No (explain below)

Note: If this information is available at this time, you may submit it as an electronic attachment
through www.Grants .gov or in hardcopy.
Page 19

M.4. Title Requirements
a.

Does the applicant currently hold title to all project facilities, underlying land, necessary
easements, and rights-of-way required for the project?
Yes (go to question M.4(d))

No (explain below)

If No, does the applicant plan to obtain title?
Yes
How and when will the applicant obtain title? (After answering this, go to question M.4(d))

No
Please explain why not (and answer question M.4(c))

If you indicated that the applicant does not currently have title and does not intend to obtain
title, does the applicant hold a long-term lease or hold interest in project property for a period
not less than the estimated useful life of the project?

Yes
No
If No, Please explain below why EDA should not require the applicant to have title to or a longterm leasehold interest in the property.

Describe any required State permits, easements, rights-of-way or leases necessary to
construct, operate, and maintain the project.

Describe any liens, mortgages, other encumbrances, reservations, reversionary interests
or other restrictions on the applicant's interest in the property.

Is the project located on a military or Department of Energy installation that is closed or
scheduled for closure or realignment?
Yes
No

Does the project involve construction within a railroad's right-of-way or over a railroad
crossing?
Yes (explain below)
No

Page 20

Does the project include construction of a highway owned by a State or local government
(other than the applicant)?
Yes (explain below)

M.5. Sale or Lease
a.

Does the applicant intend to sell, lease, transfer, dedicate or otherwise convey any interest
in the project facilities, underlying land, or any land improved with EDA investment
assistance?
Yes (explain below)
No

Is the purpose of the project to construct facilities to serve industrial or commercial parks or
sites owned by the applicant for sale or lease to private parties?
Yes
No
If Yes, identify the owners of the acreage, provide an estimate of the number of acres benefiting
from the proposed investment and explain how EDA's requirements will continue to be met after
any sale or lease.

Note: If EDA determines the project merits further consideration, the applicant will be asked to
provide documentation that EDA's requirements will continue to be met after the sale or lease.
c.

Is the purpose of the project to construct facilities to serve privately-owned industrial or
commercial parks or sites for sale or lease?
Yes
No

If Yes, identify the owners of the acreage, provide an estimate of the number of acres benefiting
from the proposed investment, and explain below how EDA's requirements will continue to be met
after the sale or lease. Note that EDA may require evidence that the private party has title to the
park or site prior to such sale or lease and condition the award of investment assistance upon
assurances given by the private party that EDA determines are necessary to ensure consistency
with the project purpose(s). (See 13 C.F.R. § 314.7.)

For privately-owned land, is the private owner willing to enter into an agreement to limit the
sale price of the improved land to its fair market value before the improvements
for a reasonable period of time?
Yes (explain below)
No
Not applicable (no private owners)

Page 21

Is the purpose of the project to construct, renovate or purchase a building?
Yes (explain below)

Will the building be leased in whole or in part?
Yes (explain below)

M.6.
a.

Will there be limitations on the length of the lease term?
Yes (explain below)

Is the purpose of the building to provide incubator space to new companies?
Yes (explain below)

No (go to M.6)

Is the purpose of the project to provide building space to a single user or multiple users?
In either case, explain below the terms of the proposed lease.

Ownership, Operation, Maintenance and Management
Briefly describe plans for the ownership, operation, maintenance and management of all
project facilities, including any land, improved land, structures, appurtenances thereto, other
improvements, or personal property.

Note: You will be asked to provide a legal opinion verifying your answers to these questions if
EDA selects the project for further consideration.
b.

Will real property or project facilities to be acquired or improved with EDA investment
assistance be owned, operated, or maintained by an entity other than the applicant?
Yes (explain below)
No
(See 13 C.F.R. § 314.7.)

Page 22

Will real property or project facilities to be acquired or improved with EDA investment
assistance, including any industrial or commercial park acreage, be mortgaged or used to
collateralize any type of financing, including but not limited to bonds or tax credits, or is any
real property to be used for the project currently mortgaged or being used as collateral?
Yes (explain below)
No

Will the applicant provide EDA a security interest or other statement of EDA's interest in the
real property or in significant items of tangible personal property acquired or improved with
EDA investment assistance? (See 13 C.F.R. § § 314.8 and 314.9.)
Yes
No (explain below)

Is (or was) any real property to be acquired or improved with the proposed EDA investment
assistance subject to eminent domain proceedings or the threat of such proceedings?
Yes (explain below)

Does the project include the acquisition or improvement of significant items of tangible
personal property (i.e., items that are moveable and not permanently attached to the land,
such as business equipment, furniture or vehicles)?
Yes (explain below)
No

M.7. Calculation of Estimated Relocation and Land Acquisition Expenses
All applicants must complete the "Calculation of Estimated Relocation and Land Acquisition
Expenses" form, and enter the estimated total for "costs incidental to land acquisition" (line item 1)
on line item 3 ("relocation expenses and payments") of Form SF-424C, 'Budget Information Construction Programs.' This is separate from the estimated purchase price of the property.
a.

Are relocation expenses part of the proposed project's EDA budget?
Yes
No

Will the proposed project cause the displacement of individuals, families, businesses or
farms?
Yes

Page 23

If Yes, explain how relocation procedures will comply with the Uniform Relocation Assistance and
Real Property Acquisition Policies Act of 1990 (13 C.F.R. § 302.5 ; see Certification #11
on Form SF-424D, 'Assurances - Construction Programs, for an explanation of this requirement.)

M.8. Environmental Requirements
a.

Provide a brief physical description of the project site, noting topography, vegetation, bodies of
water, and location and condition of any man-made structures or buildings. If available,
provide a Geographic Information System (GIS) analysis of the sensitive environmental
areas, including contaminated sites, archeological sites, properties or sites listed on the
National Register of Historic Places, and wetlands that are within a two-mile radius of the
project site.

Will the project be located in or adjacent to a floodplain or wetland area?
Yes (explain)
No

Will the project be located in or adjacent to an area with known hazardous or toxic
contamination?
Yes (explain)
No

Will there be any toxic or hazardous waste or asbestos removal associated with the project?
Yes (explain)
No

Will the project impact any archeological sites, buildings or structures older than 50 years,
or any properties listed or eligible for listing on the National Register of Historic Places?
Yes (explain)
No

Page 24

Note: If EDA determines that the applicant's project merits further consideration, the applicant will be
required to submit materials to the appropriate State Historic Preservation Officer (SHPO).
Regardless of whether the applicant believes historic or archaeological artifacts are present, the
applicant will be required to provide the SHPO with: (i) a narrative description of the project's
elements and its location; (ii) a map of the area surrounding the project that identifies the project site,
adjacent streets, and other identifiable objects; (iii) line drawings or sketches of the project; and (iv)
photographs of the affected properties if building demolition or renovation is involved.
Please note that the clearance process can be lengthy. When submitting this material to the
SHPO, the applicant must request that the SHPO submit comments on the proposed project to the
EDA Regional Office processing the application. If the applicant has already received comments
from the SHPO, please provide as an electronic attachment through www.Grants.gov or in hardcopy.
f.

Will this project result in any other adverse environmental impacts that could affect
endangered or threatened species, scenic rivers, or other sensitive ecological habitats?
Yes (explain)
No

Has an environmental impact statement or other similar analysis been completed for this
proposed project or for other activities in the region?
Yes (explain)
No

Federal agencies are required by law to assess the expected environmental impacts associated
with proposed federal actions.
IF EDA SELECTS THE PROJECT FOR FURTHER CONSIDERATION, EDA may request
additional information to obtain an understanding of the current environmental conditions and the
project elements that will affect the environment.
It is important to understand the comprehensive nature of the information required to complete an
environmental review in accordance with the National Environmental Policy Act (NEPA).
Information must be provided for the: (i) site(s) where the proposed project facilities will be
constructed and the surrounding areas affected by its operation; and (ii) areas to be affected by
any primary beneficiaries of the project. The information submitted must be sufficient to evaluate
all reasonable alternatives to the proposed project and the direct and indirect environmental
impacts of the project, as well as the cumulative impacts on the environment as defined in the
regulations for implementing the procedural provisions of NEPA (see 40 C.F.R. parts 1500-1508).
The level of detail should be commensurate with the complexity and size of the project and the
magnitude of the expected impact. Previously completed environmental impact documentation
(assessments, impact statements, etc.) for activities in the region in which the proposed project will
be located may be used as documentation.
h.

Will you be able to provide the above information?

Yes

No (explain below)

Note: If EDA selects the project for further consideration, the template for the environmental
narrative that the applicant will be required to submit is available at [link]. If you currently have this
information, you may submit it as an electronic attachment through www.Grants.gov or in hardcopy.

Page 25

SECTION N - TO BE COMPLETED BY APPLICANTS
FOR DESIGN AND ENGINEERING
ASSISTANCE ONLY
When the primary purpose of the EDA investment is to accomplish only the design and
engineering work required for the construction of a complex or environmentally sensitive public
works or development facility project, the following information must be provided. Note: EDA will
award grants for design and engineering work only when there is a reasonable expectation
that construction of the project can and will begin soon after the completion of design and
engineering. EDA's funding of the project for design and engineering work does not in any
way obligate EDA to fund construction of the project. (See 13 C.F.R. § 305.4.)

Provide a description of the components of the project for which the design and engineering
work will be accomplished.

Explain the reasons why such work needs to be accomplished separately from the project's
construction phase. For example, describe the highly specialized features or complex or
environmentally-sensitive nature of the project such that design and engineering work must
be completed to determine the project's feasibility or to ensure that all required permits and
approvals by State or federal regulatory authorities (e.g., the Environmental Protection
Agency) can be obtained in the most effective and efficient manner possible.

Provide a statement regarding the proposed method of financing and funding sources that
will be used to finance the construction of the project upon completion of the design and
engineering work, including commitments made, if any, for the project's permanent financing and
the likelihood that EDA or another federal assistance agency will be requested to provide funds
for the construction of the project. Note: EDA cannot make a commitment against a future fiscal
year's appropriation.

Provide an estimate of how many months will be required after the design and engineering
work is completed for the project's construction phase to begin. Note: Even if the
proposed project can be constructed in phases, the design and engineering work must be
completed before construction can begin.

Page 26

Exhibit A.
ASSURANCES OF COMPLIANCE
With Civil Rights and Other Legal Requirements
(To Be Executed by "Other Parties")
"Other Party" is herein defined as an entity that creates and/or saves (or intends to create/and or save)
15 or more permanent jobs as a result of the Economic Development Assistance (EDA ) investment
assistance, provided that such entity is also either specifically named in the application as benefiting
from the project or is or will be located in a building, port, facility, or industrial, commercial, or business
park constructed or improved in whole or in part with EDA investment assistance prior to EDA's final
disbursement of funds. See 13 C.F.R. § 302.20.
Applicant's Name:

"Other Party" Name:

Address:

Phone Number:

The obligations incurred under this form apply only to the building, port, facility, or industrial, commercial
or business park constructed or improved in whole or in part with investment assistance from the EDA.
This form must be executed by an "Other Party" who satisfies the following conditions:
The "Other Party" will (or intends to) create and/or save fifteen (15) or more permanent jobs
(estimated number of jobs
) as a result of the EDA investment assistance; and (check
applicable section below)
(a) is specifically named in the application for EDA investment assistance as benefiting from the
project; or
(b) is or will be located in a building, port, facility, or industrial, commercial or business park
constructed or improved in whole or in part with EDA investment assistance before EDA has made
its final disbursement of EDA funds.
ASSURANCES OF COMPLIANCE WITH THE U.S. DEPARTMENT OF COMMERCE AND EDA
REGULATIONS (13 C.F.R. § 302.20) UNDER SECTION 601 OF TITLE VI OF THE CIVIL RIGHTS
ACT OF 1964, SECTION 112 OF PUBLIC LAW 92-65, TITLE IX OF THE EDUCATION
AMENDMENTS OF 1972, SECTION 504 OF THE REHABILITATION ACT OF 1973, AND THE AGE
DISCRIMINATION ACT OF 1975, ALL AS AMENDED.
The "Other Party" assures that it will comply with Section 601 of Title VI of the Civil Rights Act of 1964,
as amended (42 U.S.C. 2000d et seq.), and the U.S. Department of Commerce's implementing
regulations found at 15 C.F.R. part 8, and any amendments thereto.
The "Other Party" agrees to comply with the provisions of Section 112 of Public Law 92-65
(42 U.S.C. 3123) and 42 U.S.C. 6709, and the U.S. Department of Commerce's implementing
regulations found at 15 C.F.R. §§ 8.7-8.15, and any amendments thereto.
The "Other Party" agrees to comply with Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794)
and the U.S. Department of Commerce's implementing regulations found at 15 C.F.R. part 8b; Title IX
of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.); the Age Discrimination Act of 1975

Page 27

(42 U.S.C. 6101 et seq.) and the U.S. Department of Commerce's implementing regulations found at
15 C.F.R. part 20, and the non-discrimination on the basis of age regulations found at 45 C.F.R. part 90.
Such requirements hold that no person in the United States shall on the ground of race, color, national
origin, sex, handicap, or age be excluded from participation in, denied the benefits of, or
otherwise subjected to discrimination under any program or activity for which federal financial
assistance has been extended.
In accordance with these assurances and without limiting the above, the "Other Party" agrees that
these assurances shall be binding upon it and any grantees, assignees, transferees, lessees, and
successors in interest. These assurances shall also be binding through any modification or
amendment to the financial assistance award or to the project.
The "Other Party" acknowledges that it is aware that if there appears to be a failure or threatened failure
to comply with these assurances and the noncompliance or threatened noncompliance cannot be
corrected by informal means, compliance may be effected by the suspension or termination of, or
refusal to grant or to continue, federal financial assistance or by any other means authorized by law.
NOTICE
This form must be executed by an official authorized to make the aforementioned assurances, with full authority to
bind the "Other Party" identified herein. If the "Other Party" is a corporation, this form must be executed by a
corporate officer or person so authorized to make such assurances, and the title block must clearly indicate such
authority. Assurance forms executed by employees other than corporate officers will not be accepted unless they are
accompanied by a separate certification signed by a corporate officer or corporate counsel stating that the assuror
has full authority to legally bind the "Other Party" identified below. In the case of an individual executing this
assurance form as a sole owner, the sole owner's title must be indicated. For circumstances other than those
discussed herein, contact the EDA Regional Office for instructions.

ACCEPTANCE OF ASSURANCES OF COMPLIANCE
These assurances are made binding for:

Name of "Other Party":

Address:

Telephone Number:

By:

*(Title of Corporate Officer)

(Signature of Official)

(Date)

* If the person signing this form is not a corporate officer, the company's corporate officer or corporate
counsel must certify in writing that the signatory is authorized to legally bind the company. Such written
certification should be included as an electronic through www.Grants.gov or in hardcopy.
--WARNING-False statements or representations made in connection with the "ASSURANCES OF COMPLIANCE"
are a violation of federal law punishable by a fine of not more than $10,000 or by imprisonment for not
more than five years, or both (see 42 U.S.C. 3220; 18 U.S.C. 1001).

Page 28

Exhibit B.

OMB Approval No. 0348-0042

ASSURANCES - CONSTRUCTION PROGRAMS

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0042), Washington, DC 20503.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
Awarding Agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional
assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant:
1.

Has the legal authority to apply for Federal assistance,
and the institutional, managerial and financial capability
(including funds sufficient to pay the non-Federal share
of project costs) to ensure proper planning, management
and completion of the project described in this
application.

Will comply with the Intergovernmental Personnel Act
of 1970 (42 U.S.C. §§4728-4763) relating to prescribed
standards for merit systems for programs funded under
one of the 19 statutes or regulations specified in
Appendix A of OPM's Standards for a Merit System of
Personnel Administration (5 C.F.R. 900, Subpart F).

Will give the awarding agency, the Comptroller General
of the United States and, if appropriate, the State,
through any authorized representative, access to and
the right to examine all records, books, papers, or
documents related to the assistance; and will establish
a proper accounting system in accordance with generally
accepted
accounting
standards
or
agency
directives.

Will comply with the Lead-Based Paint Poisoning
Prevention Act (42 U.S.C. §§4801 et seq.) which
prohibits the use of lead-based paint in construction or
rehabilitation of residence structures.

10.

Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a)
Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race,
color or national origin; (b) Title IX of the Education
Amendments of 1972, as amended (20 U.S.C. §§16811683, and 1685-1686), which prohibits discrimination
on the basis of sex; (c) Section 504 of the Rehabilitation
Act
of
1973,
as
amended
(29
U.S.C.
§794), which prohibits discrimination on the basis of
handicaps; (d) the Age Discrimination Act of 1975, as
amended (42 U.S.C. §§6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse
Office and Treatment Act of 1972 (P.L. 92-255), as
amended, relating to nondiscrimination on the basis of
drug abuse; (f) the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) §§523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the
Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
amended, relating to nondiscrimination in the sale,
rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statute(s)
under which application for Federal assistance is being
made; and, (j) the requirements of any other
nondiscrimination statute(s) which may apply to the
application.

Will not dispose of, modify the use of, or change the
terms of the real property title, or other interest in the
site and facilities without permission and instructions
from the awarding agency. Will record the Federal
interest in the title of real property in accordance with
awarding agency directives and will include a covenant
in the title of real property aquired in whole or in part
with Federal assistance funds to assure nondiscrimination during the useful life of the project.

Will comply with the requirements of the assistance
awarding agency with regard to the drafting, review and
approval of construction plans and specifications.

Will provide and maintain competent and adequate
engineering supervision at the construction site to ensure
that the complete work conforms with the approved plans
and specifications and will furnish progress reports and
such other information as may be required by the
assistance awarding agency or State.

Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding
agency.

Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal or organizational
conflict of interest, or personal gain.

Authorized for Local Reproduction
Previous Edition Usable

Standard Form 424D (Rev. 7-97)
Prescribed by OMB Circular A-102

Page 29

11.

Will comply, or has already complied, with the requirements
of Titles II and III of the Uniform Relocation Assistance and
Real Property Acquisition Policies Act of 1970 (P.L. 91-646)
which provide for fair and equitable treatment of persons
displaced or whose property is acquired as a result of
Federal
and
federally-assisted
programs.
These
requirements apply to all interests in real property acquired
for project purposes regardless of Federal participation in
purchases.

12.

Will comply with the provisions of the Hatch Act (5 U.S.C.
§§1501-1508 and 7324-7328) which limit the political
activities of employees whose principal employment
activities are funded in whole or in part with Federal funds.

13.

National Environmental Policy Act of 1969 (P.L. 91190) and Executive Order (EO) 11514; (b) notification
of violating facilities pursuant to EO 11738; (c) protection
of wetlands pursuant to EO 11990; (d) evaluation of flood
hazards in floodplains in accordance with EO 11988; (e)
assurance of project consistency with the approved
State management program developed under the
Coastal Zone Management Act of 1972 (16 U.S.C.
§§1451 et seq.); (f) conformity of Federal actions to
State (Clean Air) Implementation Plans under Section
176(c) of the Clean Air Act of 1955, as amended (42 U.S.
C. §§7401 et seq.); (g) protection of underground
sources of drinking water under the Safe Drinking Water
Act of 1974, as amended (P.L. 93-523); and, (h)
protection of endangered species under the Endangered
Species Act of 1973, as amended (P.L. 93-205).
16.

Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. §§1271 et seq.) related to protecting
components or potential components of the national
wild and scenic rivers system.

14.

Will comply with flood insurance purchase requirements of
Section 102(a) of the Flood Disaster Protection Act of 1973
(P.L. 93-234) which requires recipients in a special flood
hazard area to participate in the program and to purchase
flood insurance if the total cost of insurable construction
and acquisition is $10,000 or more.

17.

Will assist the awarding agency in assuring compliance
with Section 106 of the National Historic Preservation
Act of 1966, as amended (16 U.S.C. §470), EO 11593
(identification and protection of historic properties), and
the Archaeological and Historic Preservation Act of
1974 (16 U.S.C. §§469a-1 et seq.).

15.

Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the

18.

Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit
Act Amendments of 1996 and OMB Circular No. A-133,
"Audits of States, Local Governments, and Non-Profit
Organizations."

19.

Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations, and policies
governing this program.

SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL

APPLICANT ORGANIZATION

TITLE

DATE SUBMITTED

May 21, 2006
SF-424D (Rev. 7-97) Back

Page 30

Exhibit C.
OMB Approval No. 0348-0040

ASSURANCES - NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such
is the case, you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant:
1.

Has the legal authority to apply for Federal assistance
and the institutional, managerial and financial capability
(including funds sufficient to pay the non-Federal share
of project cost) to ensure proper planning, management
and completion of the project described in this
application.

Will give the awarding agency, the Comptroller General
of the United States and, if appropriate, the State,
through any authorized representative, access to and
the right to examine all records, books, papers, or
documents related to the award; and will establish a
proper accounting system in accordance with generally
accepted accounting standards or agency directives.

Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding
agency.

Will comply with the Intergovernmental Personnel Act of
1970 (42 U.S.C. §§4728-4763) relating to prescribed
standards for merit systems for programs funded under
one of the 19 statutes or regulations specified in
Appendix A of OPM's Standards for a Merit System of
Personnel Administration (5 C.F.R. 900, Subpart F).

of handicaps; (d) the Age Discrimination Act of 1975, as
amended (42 U.S.C. §§6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse
Office and Treatment Act of 1972 (P.L. 92-255), as
amended, relating to nondiscrimination on the basis of
drug abuse; (f) the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) §§523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the
Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
amended, relating to nondiscrimination in the sale,
rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statute(s)
under which application for Federal assistance is being
made; and, (j) the requirements of any other
nondiscrimination statute(s) which may apply to the
application.
7.

Will comply, or has already complied, with the
requirements of Titles II and III of the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of
1970 (P.L. 91-646) which provide for fair and equitable
treatment of persons displaced or whose property is
acquired as a result of Federal or federally-assisted
programs. These requirements apply to all interests in real
property acquired for project purposes regardless of
Federal participation in purchases.

Will comply, as applicable, with provisions of the
Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328)
which limit the political activities of employees whose
principal employment activities are funded in whole or
in part with Federal funds.

Previous Edition Usable

Standard Form 424B (Rev. 7-97)

Authorized for Local Reproduction

Prescribed by OMB Circular A-102

Page 31

10.

11.

Will comply, as applicable, with the provisions of the DavisBacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act
(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract
Work Hours and Safety Standards Act (40 U.S.C. §§327333), regarding labor standards for federally-assisted
construction subagreements.
Will comply, if applicable, with flood insurance purchase
requirements of Section 102(a) of the Flood Disaster
Protection Act of 1973 (P.L. 93-234) which requires recipients in a
special flood hazard area to participate in the program and to
purchase flood insurance if the total cost of insurable
construction and acquisition is $10,000 or more.
Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National
Environmental Policy Act of 1969 (P.L. 91-190) and Executive
Order (EO) 11514; (b) notification of violating facilities pursuant
to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d)
evaluation of flood hazards in floodplains in accordance with EO
11988; (e) assurance of project consistency with the approved
State management program developed under the Coastal Zone
Management Act of 1972 (16 U.S.C. §§1451 et seq.); (f)
conformity of Federal actions to State (Clean Air) Implementation
Plans under Section 176(c) of the Clean Air Act of 1955, as
amended (42 U.S.C. §§7401 et seq.); (g) protection of
underground sources of drinking water under the Safe
Drinking Water Act of 1974, as amended (P.L. 93-523);
and, (h) protection of endangered species under the Endangered
Species Act of 1973, as amended (P.L. 93-205).

SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL

APPLICANT ORGANIZATION

12.

Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. §§1271 et seq.) related to protecting
components or potential components of the national
wild and scenic rivers system.

13.

14.

Will comply with P.L. 93-348 regarding the protection of
human subjects involved in research, development, and
related activities supported by this award of assistance.

15.

Will comply with the Laboratory Animal Welfare Act of
1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et
seq.) pertaining to the care, handling, and treatment of
warm blooded animals held for research, teaching, or
other activities supported by this award of assistance.

16.

Will comply with the Lead-Based Paint Poisoning Prevention
Act (42 U.S.C. §§4801 et seq.) which prohibits the use of
lead-based paint in construction or rehabilitation of
residence structures.

17.

18.

Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations, and policies
governing this program.

TITLE

DATE SUBMITTED

May 19, 2006
Standard Form 424B (Rev. 7-97) Back

Page 32

Exhibit D.

EDA NATIONAL TECHNICAL ASSISTANCE, TRAINING, AND
RESEARCH AND EVALUATION INVESTMENTS
ADDITIONAL ASSURANCES
As a duly authorized representative of the applicant, I further certify that the applicant:
1. Will comply with applicable regulations regarding indirect cost rates, if indirect costs are included in
the application.
2. Will comply with the requirement that this investment assistance will not provide a proprietary benefit
to a private individual, for-profit corporation, or other commercial entity.
3. Understands that attorneys' or consultants' fees, whether direct or indirect, expended for securing or
obtaining EDA investment assistance are not eligible costs. See 13 C.F.R. § 302.10(a).
4. Understands that conflicts of interest or appearances of conflicts of interest are prohibited and may
jeopardize this application or result in the forfeiture of investment funds. A conflict of interest occurs,
for example, where a representative, official, employee, architect, attorney, engineer, or inspector of the
applicant, or a representative or official of the federal, State or local government, has a direct or indirect
financial interest in the acquisition or furnishing of any materials, equipment, or services to or in
connection with the project. See 13 C.F.R. § 302.17.
5. Will comply with the reporting requirements under the Government Performance and Results Act
(GPRA) of 1993 for measuring and reporting project performance.

Signature of Authorized Certifying Official

Title

Applicant Organization

Date

Page 33

Exhibit E.
FORM CD-511
(REV 1-05)

U.S. DEPARTMENT OF COMMERCE

CERTIFICATION REGARDING LOBBYING

Applicants should also review the instructions for certification included in the regulations before completing this form. Signature on
this form provides for compliance with certification requirements under 15 CFR Part 28, "New Restrictions on Lobbying." The
certifications shall be treated as a material representation of fact upon which reliance will be placed when the Department of
Commerce determines to award the covered transaction, grant, or cooperative agreement.
LOBBYING
As required by Section 1352, Title 31 of the U.S. Code, and
implemented at 15 CFR Part 28, for persons entering into a grant,
cooperative agreement or contract over $100,000 or a loan or
loan guarantee over $150,000 as defined at 15 CFR Part 28,
Sections 28.105 and 28.110, the applicant certifies that to the
best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid,
by or on behalf of the undersigned, to any person for influencing
or attempting to influence an officer or employee of any agency,
a Member of Congress in conncection with the awarding of any
Federal contract, the making of any Federal grant, the making of
any Federal loan, the entering into of any cooperative agreement,
and the extension, continuation, renewal, amendment, or
modification of any Federal contract, grant, loan, or cooperative
agreement.
(2) If any funds other than Federal appropriated funds have been
paid or will be paid to any person for influencing or attempting to
influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of
a member of Congress in connection with this Federal contract,
grant, loan, or cooperative agreement, the undersigned shall
complete and submit Standard Form-LLL, ''Disclosure Form to
Report Lobbying.'' in accordance with its instructions.

Statement

for

Loan

Guarantees

and

Loan

Insurance

The undersigned states, to the best of his or her knowledge
and belief, that:
In any funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee
of any agency, a Member of Congress, an officer or
employee of Congress, or an employee of a Member of
Congress in connection with this commitment providing for
the United States to insure or guarantee a loan, the
undersigned shall complete and submit Standard Form-LLL,
''Disclosure Form to Report Lobbying,'' in accordance with its
instructions.
Submission of this statement is a prerequisite for making or
entering into this transaction imposed by section 1352, title
31, U.S. Code. Any person who fails to file the required
statement shall be subject to a civil penalty of not less than
$10,000 and not more than $100,000 for each such failure
occurring on or before October 23, 1996, and of not less than
$11,000 and not more than $110,000 for each such failure
occurring after October 23, 1996.

(3) The undersigned shall require that the language of this
certification be included in the award documents for all
subawards at all tiers (including subcontracts, subgrants, and
contracts
under
grants, loans, and cooperative agreements) and that all
subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which
reliance was placed when this transaction was made or entered
into. Submission of this certification is a prerequisite for making
or
entering into this transaction imposed by section 1352, title 31, U.
S. Code. Any person who fails to file the required certification
shall be subject to a civil penalty of not less than $10,000 and
not more than $100,000 for each such failure occurring on or
before October 23, 1996, and of not less than $11,000 and not
more than $110,000 for each such failure occurring after
October 23, 1996.

As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the
above applicable certification.
NAME OF APPLICANT

AWARD NUMBER AND/OR PROJECT NAME

PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE
SIGNATURE

DATE

Page 34

EDA CAPACITY BUILDING INVESTMENTS
ADDITIONAL ASSURANCES
As a duly authorized representative of the applicant, I further certify that the applicant:
1. Will comply with applicable regulations regarding indirect cost rates, if indirect costs are included in
the application.
2. Will comply with the requirement that this investment assistance will not provide a proprietary benefit
to a private individual, a for-profit corporation or other commercial entity.
3. Understands that attorneys' or consultants' fees, whether direct or indirect, expended for securing or
obtaining EDA investment assistance are not eligible costs. See 13 C.F.R. § 302.10(a).
4. Understands that conflicts of interest or appearances of conflicts of interest are prohibited and may
jeopardize this application, or result in the forfeiture of investment funds. A conflict of interest occurs,
for example, where a representative, official, employee, architect, attorney, engineer or inspector of the
applicant, or a representative or official of the federal, State or local government, has a direct or indirect
financial interest in the acquisition or furnishing of any materials, equipment or services to or in
connection with the project. See 13 C.F.R. § 302.17.
5. Will comply with the reporting requirements under the Government Performance and Results Act
(GPRA) of 1993 for measuring and reporting project performance.

Signature of Authorized Certifying Official

Title

Applicant Organization

Date Submitted

Page 35

EDA CONSTRUCTION INVESTMENTS
ADDITIONAL ASSURANCES
As a duly authorized representative of the applicant, I further certify that the applicant:
1.

Will operate and maintain the facility in accordance with at least the minimum standards as may be
required or prescribed by applicable federal, State and local agencies for the maintenance and
operation of such facilities.
Will require the facility to be designed to comply with the Americans with Disabilities Act of 1990
(ADA) (42 U.S.C. 12101 et seq.), the Architectural Barriers Act of 1968 (42 U.S.C. 4151 et seq.)
and the Accessibility Guidelines for Buildings and Facilities regulations, as amended (36 CFR part
1191), and will be responsible for conducting inspections to insure compliance with these
requirements.

For the two-year period beginning on the date EDA investment assistance is awarded, will refrain from
employing, offering any office or employment to, or retaining for professional services any person who,
on the date on which the investment assistance is awarded or within the one-year (1) period ending on
that date, served as an officer, attorney, agent or employee of the Department of Commerce and
occupied a position or engaged in activities that EDA determines involved discretion with respect to the
award of investment assistance under PWEDA. See section 606 of PWEDA and 13 C.F.R. §302.10(b).

Will have no facilities under ownership, lease or supervision to be utilized in this project that are
listed or under consideration for listing on EPA's List of Violating Facilities.

Will comply with Executive Order 12699, "Seismic Safety of Federal and Federally Assisted or
Regulated New Building Construction," which imposes requirements that federally-assisted
facilities be designed and constructed in accordance with the most current local building codes
determined by the awarding agency or by the Interagency Committee for Seismic Safety in
Construction (ICSSC) and the most recent edition of the American National Standards Institute
Standards A58, Minimum Design Loads for Buildings and Other Structures.

Will observe and comply with federal procurement rules, as set forth in 15 CFR parts 14 or 24, as
applicable, for award of any contracts for architectural engineering, grant administration services,
or construction financed with EDA investment assistance.

Understands that attorneys' or consultants' fees, whether direct or indirect, expended for securing
or obtaining EDA investment assistance are not eligible costs. See 13 C.F.R. § 302.10(a).

Understands that conflicts of interest or appearances of conflicts of interest are prohibited and may
jeopardize this application, or result in the forfeiture of investment funds. A conflict of interest occurs, for
example, where a representative, official, employee, architect, attorney, engineer or inspector of the
applicant, or a representative or official of the Federal, State or local government, has a direct or
indirect financial interest in the acquisition or furnishing of any materials, equipment or services to or in
connection with the project. See 13 C.F.R. § 302.17.

Will comply with the reporting requirements under the Government Performance and Results Act
of 1993 (GPRA) for measuring and reporting project performance.

Signature of Authorized Certifying Official

Title

Applicant Organization

Date

Page 36

File Type	application/pdf
File Modified	2007-12-21
File Created	2007-12-21