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OMB Control No 0610-0094,
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止1
EcoNOMIC DEVELOPMENT ADMiNISTRATION
APPL:CAT:ON FOR
INVESTMENT ASS:STANCE
The Economic Development Administralon(EDA)uses the Applica‖ on forlnvestment Assistance
to evaluate applications under EDA:s econorn:c development assistance programs. EDA may ask
applicants to provide supplementalinformation as needed during the evaluation and select:on process
Please visit ourinternet website at― .eda.gov for more infoH‖ ation on EDA's programs,
se:ection and evaluation criteria,and app:icatiOn procedures,as set forth in appllcable Federal
Funding Opportunity(FFO)annOuncements. These FFO announcements are also published
annually in the Federa′ Register
PWEDA Section 201
Section A
1‐
(CFDA No.11300)
Public Mlorks and Economic
‐Devё lopment PrOgram ■
PWEDA Section‐ 203
(CFDA No l1 302)
- To Be Completed
Section B― RegiOnal Eligibility(PubliC VVOrks and Economic
Adiustment Assistance)
Section C - Technical Assistance & ResearchiEvaluation
Section D -
Planning Program
by AllApplicants
Assistance
To Be Completed by All Non-Governmental
Applicants (excluding Public Universities)
Section E - Budgeting and Staffing/Non-Construction
PWEDA Section 207
(CFDA No.11303)
Assistance
I Localland Nち tional ttechnital
Assistance and University
Section F - Partnership Planning Assistance
l Center EconOmic‐
Devё lopment Program
Section G - Short-Term Planning Assistance
Section H - State Planning Assistance
PWEDA Section1207
Section
l‐
(CFDA No l1 312)
Research and Evaluation
‐ProOあ m
l
■
￨
‐PWEDA Se‐ Ction‐
‐
209
‐
(CFDA No l1 307)
EconOmicハ dluStment
‐Assiltance Program
- Local or National TechnicalAssistance
Section J - University Center Program Assistance
I
Section K - Economic Adjustment Assistance
Section L - Revolving Loan Fund (RLF) Assistance
Section M - Construction Assistance
l
Section N - Design and Engineering Assistance
￨‐
￨
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‐
長寵
lNSTRUC丁 :ONS FOR ELECttRONIC AND HARDCOPY FORMAttS
Submissions: Please visit http;l/www.grants.gov/assetslFindAp-plyUsercuide.p_df for
instructions on electronic submissions. This form is designed to be completed in Adobe
robat Reader, versions 8.1.1 and above. lf using Adobe Acrobat Reader version 8.1.1 or above,
features willwork. Responses may be composed in a separate word processing program
then copied and pasted into the appropriate response field. NOTE: Applicants who would like to
a copy for their records must save a copy to their local hard drive under a unique name.
mentation or information applicants must provide may be submitted as electronic attachments
the 'Attachments' form that is part of the application package downloaded from www.Grants,gov
Submissions: EDA encourages applicants to submit applications in electronic format via
.Grants.gov. However, if the applicant is unable to complete this application using the latest
Adobe Reader version, the applicant may send in a hardcopy application. lf submitting a
application, the applicant should print this applicati on (ED-900), the SF-424, and either the
F424A (Non-construction lnvestments) or the SF-424C (Construction lnvestments), and either the
4B (Non-Construction lnvestments) or the SF424D (Construction lnvestments), and the CD-511,
type or print the responses. Applicants should mail the completed application to the appropriate
Offlce. See EDA's internet website (uaa ry-eda.gav) 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 approvalfrom the State Historic Preservation Offlcer (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 lncorporation 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)
一 一
０ ●
丁 ・
SECT10N A
BE COMPLEttED BY ALL APPLiCANTS
Ceneralinstructions
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.qda,gov/AboutEDAlRegions.xmt) that processes applications for your state.
Applicants should consult EDA's program requirements and evaluation criteria set forth in 13 C.F.R.
Chapter lll (EDA's regulations), as supplemented by the applicable Federal Funding Opportunity
Announcement (FFO) on wwurGrants.gov, when completing this application. (EDA's regulations begin
on page 20 of the Federal Register notice posted at uaryw.edagayllnagelachelEDAluh,[s/
.) Applicants are
documenls/pdldoc-s200-6-l2000tinaf-20ruls-2epdflv1/20!6final-Z0r-ule.pdl
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. S 304.1). Legalcitations 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. lf you change the
type of EDA lnvestment Asistance for which you are applying, make sure you save the application under
a different file name.
rsス ,D and Eリ
ere secriO月 sス ,3,and M and Ex力 わ′
rcomρ ′
f
Economic Adjustment
!
f
Partnership Planning
(Complete Secflons A, B, and K and Exhibit C. Also
Complete Secfions M and Exhibits A, D, and E if request
construction components, and Section N if request has o
design/engineering requirements. Complete Section E if
request has no construction components.)
(Complete Secfions A, C, E, and F and Exhibit C.)
Short{erm Planning
(Complete Sectrbns A, C, E, and G and Exhibit C.)
□ State Planning
!
University Center
!
[]
I
!
I
Local Technical Assistance
National Technical Assistance
難 ０
PuЫ たWOrks
rcomρ rele secriOnsス ,c,こ G,and tt and Exわ わ〃C.リ
(Complete Secfions A, C, E, and J and Exhibit C.)
ere secriOnsハ ,Q tt ar7d′ and Exわ わ″C.リ
rcomρ ′
(Complete Secflons A, C, E, and I and Exhibit B.)
Research and Evaluation Assistance (Complete Secfions A, C, E and Exhibit B.)
Revolving Loan Fund
(Complete Secfions A, B, E, K, and L and Exhibit C.)
Design and Engineering
rcomρ rere
secI′ ο
nsハ ′
3,and
Ⅳ and
D(わ
め″C.,
Please indicate which type of appllcant you are:
E
I
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)
to the program for which you are applying (see above), nonln addition to the secflons
governmental applicanfs a/so must complete Section D.
加”
□
A.1.
lnvestment (Project) Region
ldentify 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. S 300.3 for the definition of "Region.")
Provide a detailed description of the complete scope of work for the proposed EDA investment. lf you
are proposing a construction project, please include specific construction components. Also, for
NationalTechnicalAssistance, Training and Research and Evaluation Projects, provide a description
of the methodology to be used to complete the project.
Note: lf 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. You may provide this now using
the 'Attachments'form that is paft of the application package downloaded from ww.Gtants.gtpy or in
hard copy.
Does the region in which the project will be located have a Comprehensive Economic
Development Strategy (CEDS)? (See wunu.eda,govl|magreQa_c_helE!_APublis/dqe uments,
(Nofe: Except for strategy
/pdfdoe-s-200^61c-eds-flyer081L06-2epdf/v11cedsflyer08l706.pd[)
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 projectis consistenf.)
Yes
ENo
lf Yes, what is the source? Note: lf you are unsure if your region has a CEDS, please contact your
rOca′ Dた ょ
″cr
lf 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 se/ecfed for further
consideration. You may provide this now using the 'Aftachments' form that is pafi of the application
package downloaded from :gww,Araats.go-lr- or in hard copy.
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.)
c.
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.
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A.4.
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:nvestFnent(PrOieCt):rnpact and Fitlwith EDA Funding PriOrities
Discuss how the proposed investment satisfies EDA's lnvestment Policy Guidelines as set forth in 13
C.F.R. S 301.8, as well as the EDA funding priorities set forth in the applicable Federal Funding
Opportu n ity (F FO) an nou ncement on unaauGrads,gav.
A.5.
Applicant'sCapability
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.
a.
Givil Rights
Does the applicant understand and agree to comply with all applicable civil rights
requirements (see 13 C.F.R. S 302.20), including the requirement to
assurances of compliance?
Do identified "Other Parties" as defined in 13 C.F.R. S 302.20(b) understand and agree to
comply with all applicable civil rights requirements, including the requirement to provide
signed assurances of compliance?
f Yes
E
No (explain
below) f
Not Applicable (No Other Parties ldentified)
f
tr
For Construction investments, complete Form SF424C.
For Non-Construction investments, complete Form SF-424A.
Note: lf you are applying in hardcopy,you may download these forms from
w$nry,-8r"ao-ts-g-eyJleehljllSF-424Ajl1,Opdf and unary-G-rants.gov/tec-hlih1-SF-4?Lc-:y1-.0.pdl-, or go
to EDA's
we b site at unuu.t:_da.gov-.
Non-EDA Funding for the Project
a.
ldentify 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 "ln-Kind Contribution(s)" in 13 C.F.R. S 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. lf in-kind contributions are included,
explain the basis on which they are valued.
b.
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. S 301 .5.)
Note: lf EDA determines that your project meits further consideration, and if your project includes
construction, you will be required to provide letters of commitment. You may provide these now
using the 'Aftachments'form that is paft of the application package downloaded from
wwwOranTs,gPY or in hard coPY.
c.
Discuss the actions that need to be taken and the timing required to secure the non-EDA
funds.
Does the applicant plan to seek other federal financial assistance as part of or in connection
with this project? lf so, please describe the source, amount and any terms and conditions
ofthe
, and when the funding will be available for use by the applicant.
Yes (explain below)
ls the requested EDA investment assistance available from any other federal economic
development program?
Yes (explain below)
No (
f
lf Yes, identify the source and provide an explanation of why EDA investment assistance
lf No, explain your efforts to identify and obtain funding from other sources.
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-s11). lf non-federalfunds 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 certify to the
following:
Applicantis:iCertincatiOns Regarding Lobbying"(Forrn CE)-511)is COmpleted.(lf appliCant is
or at EDA's website at
in hardcopv, access the form at
Applicant's "Disclosure of Lobbying Activities" (Form SF-LLL) is attached, if required. (lf not
required by law, also check the box. lf applicant is applying in hardcopy, access the form at
u^lr'tlthltellause.gav1,omb&lrantsls-f
lllin+d-f
.)
Note: Applicanfs must comply with 13 C.F.R. 302.10 regarding aftorneys' and consultanfs'fees
and the employment of expediters. Ihrs regulation requires that applicants identify and disclose
the amount of fees paid to anyone engaged fo 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)
Does the state in which the project will be located have a project review process that requires
submission to a Single Point of Contact (SPOC)? (See 13 C.F.R. S 302.9(b).) Note: lf you
are unsure if your sfate has a Single Point of Contact, or do not know who this individual is,
please refer to OMB's SPOC /isf (www.whitehouse.gov/omb/grants/spu>,c.html).
Yes
b
tr
No (go to A.12)
lf Yes to A.1 1(a) above, does this request for EDA investment assistance meet the SPOC
process established by the state?
No (go to question A.11.d)
f Yes
I
lf Yes to A.1 1(b) above, were SPOC comments/clearance received?
I
I
Yes, and the comments/clearance are attached.
No, the review period has expired and no comments were received.
lf No to question A.11(b) above, please explain any known reason for the lack of comments.
Wll you subcontract work to complete part or all of this project?
Yes
b
lf Yes, will contracts be awarded by competitive bid?
[Yes
C.
E No
ENo
lf 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. S 14.40-14.48 or $ 24.36, as applicable.)
For Construction investments, complete Form SF-424D.
For Non-Construction investments, complete Form SF-4248.
Note: lf you are applying in hardcopy, you may access these forms as paft of the application
package downloaded from wwu.Gealsgey from wytw-.-Grants,geylleehliblSL424B-V1.1.pit
and wvvdranls,goyltecblib/S-F-424D-V1,1qdf, or go to EDA's website at www.eda,gou.
.
SECTION B. REGIONAL ELIGIBILITY:
TO BE COMPLETED BY APPLICANTS FOR PUBLIC WORKS
OR ECONOMIC ADJUSTMENT ASSISTANCE ONLY
Public Works and Economic Adjustment Assistance projects (including Revolving Loan Fund
Assistance and Design and Engineering Assistance) must satisfy regionaleligibility 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
documentation where
1.
ldentiff the region upon which the applicant is basing the eligibility calculation.
lf this region is different from the region described in Section A of this application,
please explain.
lf this region is not defined by political boundaries (e.9., 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 atlach an explanation and a copy of this data
(additionaldocumentation or information applicants must provide may be submitted as
electronic attachments using the 'Attachments' form that is part of the application package
downloaded from uns-ry.-G_rants.gp-y). The explanation must: (i) identify the data used (e.9.,
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 identifo the source of the non-federal data. ACS data
(www.census.govlacs) should be used whenever possible, but if such data are not available,
2
the order of data preference is as listed below.
tr
a. The most recent ACS
tr
b. The most recent other federal data for the region
t]
c.
lf no federal data are available, the most recent data available through the state
govemment for the region in which the project is located.
tr
d.
Other data to substantiate regionaleligibili$ based on a "Special Need" as defined in
13 C.F.R. S 300.3.
3
data published by the U.S. Census Bureau.
in which the project is located (e.9., U.S.
Census Bureau or the Bureaus of Economic Analysis, Labor Statistics, lndian Affairs, etc.)
Economic Distress: Check allthat apply in establishing regional eligibility
(see 13 C.F.R. S 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.
□
B.
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.
□
C.
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. S 300.3) arising from actualor
threatened severe unemployment or economic adjustment problems resulting from
severe short-term or long-term changes in economic conditions, including:
tr Substantial out-migration orpopulation loss;
Underemployment; that is, employment of workers at less than fulltime or at less skilled
I I tasks
than their training or abilities permit;
or U.S.
Tt
t-J Military base closure or realignment, defense contractor reductions-in-force,
Department of Energy defense-related funding reductions;
I
tr
tr
tr
tr
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).
4.
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
8.3 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 8.3 above by providing significant employment
opportunities for unemployed, underemployed, or low-income residents of the distressed
geographic area within the EDD. lf applicable, identifo 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. S 301 .3 (aX2).)
No, not applicable. The project is located in a region that meets the economic distress
criteria in section 8.3.
Yes, this project will provide a "substantial direct benefit" to residents of an area meeting
the economic distress criteria. Please provide an explanation below.
lf Yes,
explain:
Project Beneficiaries: ldentify private sector employers that will benefit from the project, and
attach letters of commitment electronically (using the 'Attachments' form that is part of the
application package downloaded from uaul.Grants.glov) or in hardcopy, if available. ln the last
column, select'Committed'if the company has committed to being a partner in the project or
'lnterest Only' if it has merely expressed interest. PLEASE NOTE: Exhibit A must be completed
for EACH beneficiary listed in the chart below. The applicant must send an electronic or hard
copy of Exhibit A to each beneficiary. Each beneficiary should then complete Exhibit A and
return to the applicant. Once received, the applicant can attach Exhibit A (all copies)
electronically using the 'Attachments' form that is part of the application package downloaded
from www,Grantsgov or the applicant can submit Exhibit A (all copies) as part of a hard copy
application.
I
lf none, check this box, do not complete this chart, and go to Section C.
Products and
Services- Number of
Produced by Company
Company (5
Jobs
digit NAICS
code)
Saved
by Project
Number of
Company
Jobs
Created
Company
Amount of Company
lnvestment
Committed or
OnlY
lnterested?,,i,
Note: lf EDA determines that your project merits fufther consideration, you will be required to
provide lefters of commitment from the project's beneficiaries, veifying the above information.
SECTION C . MAXIMUM ALLOWABLE EDA TNVESTMENT
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
lnvestments, Localand NationalTechnicalAssistance, the University Center Program, and
Research and Evaluation lnvestments 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.
!
E
Yes
No (go to Section D)
2.
Please describe how the project is national in scope.
3.
\Mll the project be of no benefit or only incidental benefit to the applicant?
E
Yes (go to question
C.4)
f]
No (explain below)
ls the project not otherwise feasible without an EDA investment rate greater than 50 percent?
!
Yes (explain)
ENo
lf Yes, explain why the project merits an EDA investment rate greater than 50 percent.
5.
Allapplicants for EDA NationalTechnicalAssistance, Training, and Research and
Evaluation Assistance must complete the EDA National TechnicalAssistance, Training,
and Research and Evaluation lnvestments AdditionalAssurances form. See attached
Exhibit B of this application.
E
I
Yes, the applicant's AdditionalAssurances form is completed.
Not applicable; the applicant is not applying for NationalTechnicalAssistance,
Training, or Research and Evaluation investment assistance.
SEC丁 10N D‐ TO BE COMPLEttED BY ALL
NON-GOVERN MENTAL APPLTCANTS (EXCLUDt NG
PUBLIC UNTVERSTTTES AND DTSTRTCT ORGANTZATTONS)
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 financialassistance 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
t4n ,y.do_q,qqvfg!'n0sldirelt,htm.) Additionaldocumentation or information applicants
must provide may be submitted as electronic attachments using the 'Attachments'form
that is part of the application package downloaded from uryury--Grants-,go-y.
□
No, applicant's "Name Check" form(s) isiare not attached. If No, explain below.
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
E
No (explain below
)
Note: You will be asked to provide this at a later date if your projectis se/ecfed for furiher
consideration. You may provide this now using the 'Aftachments'form that is paft of the
application package downloaded from www._Granls,gov or in hard copy.
3.
New non-profit organization applicants must provide their Articles of lncorporation and By-
Laws. Non-profits with an active EDA grant must either provide a) a revised copy of their
Articles of lncorporation of By-Laws if these have been amended or b) a statement certifying
that there has been no change in the organization's Articles of lncorporation or By-Laws.
Can you provide this?
Yes
E
No (explain below )
Note:.You will be asked to provide this at a later date if your project rs se/ecfed for fufther
consideration. You may provide this now using the 'Aftachments'form that is part of the
application package downloaded from www.Grants.gov or in hard copy.
4
Willyou 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.9., 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
nationalscope. (See 13 C.F.R. $ 301.2(b).)
Yes
E
No (explain below)
Note: You will be asked to provide these comments at a later date if your project is selected for
further consideration. You may provide this now using the 'Attachments'form that is pafi of the
application package downloaded from wtyy&rantlgou or in hard copy.
5.
lf 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. S 302.9(a).) Note: You will be asked to provide this
at a later date if your projecf is se/ecfed for further consideration.
Willyou be able to provide these comments?
I
f]
Yes
Not applicable, because I am not applying for a construction or RLF grant.
No, for another reason (explain)
１．
Explain the proposed use of any amounts budgeted for "Equipment," "Contractual," or
"Other," if any, on Form SF-4244,'Budget lnformation - Non-Construction Programs.'
Explain the types of indirect costs, if any, on Form SF-424A.
Note: A completed lndirect Cosf Rafe Agreement or other documentation applicable to an indirect
cost rate determination will be requested if EDA se/ects the project for further consideration.
ldentify key applicant staff who will undertake and complete project activities. lnclude a
description of the knowledge, organizational experience, and expertise of individual staff
members. ln addition, explain how organizational resources will be used to complete project
activities. For National TechnicalAssistance, Training and Research and Evaluation projects,
specify which positions will be charged to the federal and non-federal portion of the project
budget. lf project is construction ONLY, enter "Not Applicable."
SEC丁 10N F=丁 O BE COMPLETED BY APPLiCANTS
FoR PARTNERsHIP PLANNING ASSiSTANCE ONLY
1.
Explain how the proposed scope of work w‖ l develop,irnplement,revise,or replace a
Comprehensive Economic Development Strategy(CEDS)forthe region and be part of a
continuous planning process.丁 he CEDS mustcomply with EDA's requirements.
(See 13 C.F.R.§ 303.7.)
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. ln 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 lndian 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. S S 303.2 and 303.6(a).)
3.
Provide a list of the applicant's governing board members. Board membership must comply
with EDA's regulations at 13 C.F.R. S 304.2(c)(2).
SHORTttTЁ RM OR STATЁ
pLA‐
NNlNG ASSiSTANCE
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. lf 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. S 303.9.)
Explain how the proposed scope of work will function in conjunction with any other available
federal, State, or local planning assistance.
3.
Explain what performance measures will be used to evaluate the success of the project.
SEC丁 :ONIH■ TO BE COMPLETED BY‐ APPLiCANTS
I ■ IFOR STAttE PLA‐ NNING ASSiSTANCE ●.■ ‐
Does a State CEDS already exist that satisfies EDA CEDS requirements?
(See 13 C.FR§ 303.7.)
Yes
□ No
lf Yes, please attach a copy of the CEDS. You may provide this using the 'Attachments' form
that is part of the application package downloaded from www.Grants,gov or in hard copy.
lf No, is the proposed project for the development of a CEDS?
!
3.
Yes
□
No
lf 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.
■ ￨■ SEC丁 10‐ N:ITO BE COMPLETED BY
FOR‐ LOCAL OR NA丁 10NAL ttECHNICAL
APPLiCANTS■
￨
ASSiSTANCE ONLY
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.
2.
Describe whether and how the proposed project will benefit distressed regions.
3.
Describe any innovative approaches that will be used to stimulate economic development
in distressed regions.
lf 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. S 306.2.)
ISEC丁 10N J“
TO BE COMPLETED BY APPLiCANTS
IFOR 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.
2.
Describe how the proposed project will provide services that are unique and maximize
coordination with other organizations in the region.
3.
Discuss how the proposed project activities are consistent with the expertise, programs, and
other available resources of the sponsoring institution.
4.
Describe the commitment and support (both financial and non-financial) for the proposed
project by the sponsoring institution's senior level management.
5.
Describe the sponsoring institution's past experience in administering technical assistance
programs. (See 13 C.F.R. S 306.5.)
SECT10NIK・ =TO・ BE
COMPLETEDIBY APPLiCANTS
FOR ECONOMiC ADJUSTMENtt ASSISttANCE ONLY
Are you applying for a "Strategy Grant" under 13 C.F.R S 307.3. ?
Yes
No
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.
2. Expla:n how the proposed proieCt Will help the region meet a"Special Need"
(See 13 C.FR §§300.3 and 307.2(b).)
SEC丁 10N L‐ 丁O BE COMPLETED BY APPLiCANTS
FOR REVOLVING LoAN Fり ND(RLF)ASSISTANCE10NLY
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.
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. S 307.4.(cX2)).
Ｆトトト
lf EDA determines that your project merits fufther 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. S 307.9. Also, please note that you will be asked to provide a copy of the CEDS or
altemate EDA-approved economic development plan or strategy for your region at a later date if
your projecf is se/ecfed by EDA for fufther consideration.
■ ■SECIT:ON
M‐ 丁O BEICOMPLETED‐ BY
CONSTRUC丁 10N ASS:STANCE APPLiCANTS ONLY
Are you applying for Construction Assistance?
No
Yes
M。 1:
a.
Metrop61itan Area Review
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 atea clearinghouse/agency. Does the proposed project
involve any of the above identified developments within an MSA?
Yes
b.
I
tr
tr
INo
lf 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.
\Mll the District Organization for the region in which the
for the applicant?
Yes
ENo
lf Yes, you must
will be located administer the
your
checking each box:
tr
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;
tr
No local organization/ business exists that could administer the project in a more efficient or
cost-effective manner than the District Organization; and
I
The District Organization will administer the project without subcontracting the work.
lf the project will be adminstered by the District Organization and you did not certify to all of the
An engineering report must be submitted if EDA selects the project for further consideration and
must include (at a minimum) the following information:
A statement of project components. lndicate 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.
3.
A feasibility analysis. Include a review of existing conditions. Discuss any potential
problems that might delay construction and affect project components.
4.
A proposed method of construction. lndicate whether the project will be co nstructed by
competitive bid, single contract, or multiple contracts. lndicate 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.
5.
An estimate of useful life of the facility and an explanation of basis on which it is determined.
6.
A current detailed construction cost estimate for each of project component, showing
quantities, unit prices, and totalcosts.
7.
A list of all permits required for the proposed project and the status of each permit.
B.
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.
Willyou be able to provide this information?
f Yes
E
No (explain below)
Note: lf this information is available at this time, you may submit it as an electronic aftachment
through wttw$rants.-gloy or in hardcopy.
Does the applicant currently hold title to all project facilities, underlying land, necessary
easements, and
Yes (go to question M.4.d)
b.
E
No (explain below)
lf No, does the applicant plan to obtain title?
f
Yes
How and when willthe applicant obtain title? (After answering this, go to question M.4(d))
INo
Please explain why not (and answer question M.4(c))
c.
lf 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 propefi for a period
not less than the estimated useful life of the project?
fYes
INo
lf No, Please explain below why EDA should not require the applicant to have title to or a long-term
leasehold interest in the property.
d.
Describe any required State permits, easements, rights-of-way or leases necessary to
construct, operate, and maintain the project.
e.
Describe any liens, mortgages, other encumbrances, reservations, reversionary interests
or other restrictions on the applicant's interest in the property.
ls the project located on a military or Department of Energy installation that is closed or
scheduled for closure or
Yes
!
?
ENo
Does the project involve construction within a railroad's right-of-way or over a railroad crossing?
g.
!
h.
ENo
Does the project include construction of a highway owned by a State or local government
(other than the applicant)?
f
M.5.
a.
Yes (explain below)
Yes (explain below)
ENo
Sale or Lease
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?
f,
Yes (explain below)
ENo
b.
ls 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?
INo
Yes
lf 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: lf EDA determines the project merits fufther consideration, the applicant will be asked to
provide documentation that EDA's requirements will continue to be met after the sale or lease.
c.
ls the purpose of the project to construct facilities to serve privately-owned industrial or
commercial parks or sites for sale or lease?
[Yes
[No
lf 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. S 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) E No
I
Not applicable (no private owners)
ls the purpose of the project to construct, renovate or purchase a building?
!
1/Vi‖
!
Yes (explain below)
I
No (go to M.6)
the building be leased in whole orin part?
Yes (explain below)
ENo
ls the purpose of the building to provide incubator space to new companies?
Yes (explain below)
ENo
h.
1/Vi‖
there be lirnitations on the
INo
Yes (explain below)
i.
ls the purpose of the project to provide building space to a single user or multiple users?
ln either case, explain below the terms of the proposed lease.
Ownership, Operation, Maintenance and Management
a.
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 legalopinion veifying your answers fo fhese questions if
EDA selects the project for further consideration.
b.
Will real property or project facilities to be acquired or improved with EDA investment
other than the
assistance be owned, operated, or maintained by an
(See 13 C.F.R. S 314.7.)
Yes (explain below)
ENo
!
c.
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)
d.
ENo
\Mllthe 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. S S 314.8 and 314.9.)
E
Yes
No (explain below)
ls (or was) any real propefi 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)
nNo
f.
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)?
f
Yes (explain below)
□
No
All applicants must complete the "Calculation of Estimated Relocation and Land Acquisition
Expenses" form (see Exhibit E), and enter the estimated total for "costs incidental to land
acquisition" (line item 1) on line item 3 ("relocation expenses and payments") of Form SF424C,
'Budget lnformation - Construction Programs.' This is separate from the estimated purchase price
of the property.
Are relocation expenses part of the proposed project's EDA budget?
a.
Yes
□
No
\Mll the proposed project cause the displacement of individuals, families, businesses or farms?
f
Yes
□
No
lf Yes, explain how relocation procedures will comply with the Uniform Relocation Assistance and
Real Property Acquisition Policies Act of 1990 (13 C.F.R. S 302.5 ; see Certification #1 1 on Form
SF-424D, 'Assurances - Construction Programs, for an explanation of this requirement.)
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. lf available,
provide a Geographic lnformation System (GlS) 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.
b.
Will the project be located in or adjacent to a floodplain or wetland area?
!
Yes (explain)
ENo
c.
Will the project be located in or adjacent to an area with known hazardous or toxic
contamination?
Yes(explain)
No
d.
Willthere be any toxic or hazardous waste or asbestos removal associated with the project?
Yes(explain)
No
e.
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
Note: lf EDA determines that the applicant's project meits fufther 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 nanative description of the project's
elements and its location; (ii) a map of the area surrounding the project that identifies the project site,
adjacent sfreefs, and other identifiable objects; (iii) line drawings or skefches of the project; and (iv)
photographs of the affected propefties if building demolition or renovation is involved.
Please note that the clearance process can be lengthy. lMren submitting this mateialto the
SHPO, the applicant must request that the SHPO submit comments on the proposed project to the
EDA Regional Office processing the application. lf the applicant has already received comments from
the SHPO, p/ease provide as an electronic attachment (using the 'Attachments' form fhat is part of the
application package downloaded from www.Grants.gov) or in hardcopy.
Willthis project result in any other adverse environmental impacts that could affect
or threatened species, scenic rivers, or other sensitive ecological habitats?
Yes (explain)
f.
I
g.
ENo
Has an environmental impact statement or other similar analysis been completed for this
rject or for other activities in the region?
I
No (explain)
Federal agencies are required by law to assess the expected environmental impacts associated with
proposed federal actions.
lF 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). lnformation
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 wellas 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.
\Mll you be able to provide the above information?
Yes
E
No (explain)
Note: lf EDA se/ecfs the project for further consideration, the template for the environmental
narrative that the applicant will be required to submit is available at the 'Funding Oppoftunities'
poftion of www-ela,gou. lf you currently have this information, you may submit it as an electronic
attachment (using the 'Attachments' form that is part of the application package downloaded from
wwy.Cranls.geg or in hardcopy.
,‐
F9■ 9N N“ 丁01甲 E‐ 99‐ 甲
￨ I
I‐
::り
FOR DESiGN AN [矯[[RE首 ￡
‐
■ ■
■ ■ ASSiSTANCE.ONLY・
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9今‐
■ ■・ ￨
ls the primary purpose of the EDA investment to accomplish only the design and engineering work
required?
Yes
□ No
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■3 CIF.R.
Provide a description of the components of the project for which the design and engineering
work will be accomplished. Also, please describe any known environmental issues related to
the site and/or project, including floodplains, wetlands, contamination, asbestos, endangered
species, and/or archeological/historic sites.
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.9., the Environmental Protection
Agency) can be obtained in the most effective and efflcient 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
4.
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.
Exhibit A.
ASSURANCES OF COMPLIANCE
With Civ‖ Rights and Other Lega:Requirements
(丁 o
Be Executed by"C)ther Parties")
Party" is herein defined as an entity that creates and/or saves (or intends to create/and or save) 'l 5 or more
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
EDA ihvesthent assistance p百 orto EDA:s ina:disbursement of funds.See 13 C.F.R§ 302.201
"Other Party" Name:
Applicant's Name:
Address:
Street
1:
Street 2:
County:
City:
State:
Province:
Country:
A: UNITED STATES
ZiplPostal
Phone
Number:
Code:
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:
E
The "Other Party_fUll!_{St_Elelds to) create and/or save fifteen (15) or more permanent jobs (estimated
number of
) as a result of the EDA investment assistance; and
(check applicable section below)
E
(a)
jobs
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
L-J improved in whole or in part with EDA investment assistance before EDA has made
_
its final disbursement of EDA funds.
ASSURANCES OF COMPL:ANCE VViTH THE U.S,DEPARTMENT OF COMMERCE AND EDA
(13C.F:R.§ 302.20)UNDER SECT10N 601 0F TITLE VI.OF THE CiV:LIRIGHTS
‐
ACT OF 1964,SECT10N l12 0F PUBLiC LAW 92‐ 65,T:TLE iX OF ttHE EDUCAT10N
IAMENDMENTS OF 1972,SECT:ON 504 0F THE REHAB:LITAT10N ACT OF 1973,'AND THE.AGE
DISCRIMINAT:ON ACT OF 1975,ALL AS AMENDED.
丁he‖ Other Party"assures that k will comply with Section 601 of Tlle Vl ofthe C市
il Rights Act of 1 964,as
amended(42 U S C 2000d etseq),and the U S Department of Commerce:s implemenlng regulalons found at
15 C F R part8,and any amendments thereto.
The"C)ther Pany''agrees to comply with the provisions of Seclon l12 of Public Law 92-65(42 U S C 3123)and
42 U S C 6709,andthe U S.Department of Commerce's implemenung regulalons found at15 C F R§ §
87‐ 815,and any amendments thereto
The"Other Party‖ agrees to comply with Section 504 ofthe Rehabiltalon Act of 1 973(29 U S C 794)andthe u s
Department of Conlmercets imp!ementing regulations found at 15 C F R part 8b;丁 itle lX ofthe Education
Amendments of1972(20 U S C 1681 etseq)ithe Age Disc‖ mlnalon Act of1975(42 U S C 6101 etseq)and
the U S Department of Commercelsimplementing regulatiOns found at15 C F R part 20,and the non―
discrinlination on the basis of age regulatlons 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.
ln 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.
NOT:CE
This form must be executed by an official authorized to make the aforementioned assurances, with full authority to
bind the "Other Party" identified herein. lf 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. ln 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 Reqional Office for instructions.
ACCEPttANCE OF ASSURANCES OF COMPLIANCE
These assurances are made binding for:
Name of "Other Party":
Address:
Street
1:
Street 2:
City:
State:
Province:
Country:
ZiplPostal
Telephone
Number:
Code:
By:
Middle Name
First Name:
Last Name:
Suffix:
*(Title of Corporate Officer)
(Signature of Official)
(Date)
*
lf 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 signature through ltnryw"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).
Exhibit B.
EDA‐ NA丁 10NAL ttECHNICAL ASSiSttANc‐ E,TRハ lNl‐ NG:‐ AND
RESEARCH AND EVALUATION INVESTMENTS
■
・ ADDi丁 10NAL ASSURANCES
I
As a dulv authё rized representative ofthe aDOliCant.:further certifv that the aDOliCanti
1. Wll 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. S 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. S 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.
eted by Grants.gov upon submission
SiG‐
NATURE OF AUTHORIZED‐ CER丁IFY:NG OFFIC:AL
TITLE
eted by Grants.gov upon submission
APPLiCANT ORCANIZAT10N
DAttE
Exhibit C.
￨
I
‐
■
■
￨
■
￨ ￨‐ ‐
■ ・
EDA CAPACITY BUILDING INVESttMENTS
‐
‐
ll
￨‐
￨I A‐ DIT19NAI.AS,IUR^NCEsl
P‐
As a dulv authorized representative ofthe app‖ cant,l further certifν
1. Will comply with applicable
■
‐
■
that the applicant:
regulations regarding indirect cost rates, if indirect costs are included in
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. S 302.17.
5. Will comply with the reporting
requirements under the Government Performance and Results Act
GPRA)of1993 for measu百 ng and
ompleted by crants.gov upon submission
SIGNAttURE OF AUTHORIZED CERTIFYING10FFiC!AL
TITLE
ompl-eted
APPLICANT ORGANIZAT10N
DATE
by Grants.gov upon submission
Exhibit D.
￨￨￨￨￨￨￨￨￨￨￨￨￨
■
￨￨￨‐
￨
‐
￨￨￨‐
‐￨
■
‐
￨￨￨￨￨￨
‐
￨￨￨￨
EDA CONSttRUCT10N INVESttMENTS
■ A‐ DDIT:ONAL
ASSURANCES
‐
As a dulv authOrized representative ofthё applicant`:further certifV that thё
‐ ‐
applicant:
\r'/ill 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
2.
3.
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 ef seg.), the Architectural Barriers Act of 1968 (42 U.S.C. 4151 et seg.)
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. 5302.10(b).
4
5
6
\Mll 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.
Wll 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 lnteragency Committee for Seismic Safety in
Construction (ICSSC) and the most recent edition of the American National Standards lnstitute
Standards A58, Minimum Design Loads for Buildings and Other Structures.
\Mll observe and complywith federal procurement rules, as setforth in 15 CFR parts 14 or24,as
applicable, for award of any contracts for architectural engineering, grant administration services,
or construction financed with EDA investment assistance.
7.
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).
8.
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, offlcial, 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. S 302.17.
9_
V/ill comply with the reporting requirements under the Government Performance and Results Act
of 1993 (GPRA) for measuring and reporting project performance.
Ieted by Grants.gov upon submission
SIGNAttURE OF AUTHORIZED CERTIFYING OFFIC:AL
丁ITL巨
ompleted by Grants.gov upon submission
APPLICANtt ORGANIZAT!ON
DATE
Exhibit E.
Are you applying
CALCULAT10N OF ESTIMATED RELOCAT:ON
AND LAND ACQUiSIT10N EXPENSES
for Construction Assistance?
E]Yes
□ No
lTEM l.COSTS INCIDENTAL TO LAND ACQUISIT10N‐ ESTIMATES
Number ofland transactions involved(including options,easements and rights― o「 way):
Recording fees,transfer taxes,suⅣ eys,appraisa:s,tit!e
search and similar expenses-Section 303(1)
Penalty costs-Section 303(2)
Real Property taxes-Section 303(3)
Litigation expenses-Section 304(a)
Total - Estimated costs incidental to transfer of title
ITEM 2. RELOCATION. ESTIMATES
a. TENANTS - Estimates: Number of GIaims
(1)Moving Expenses:
Actual Expenses-Section 202(a)(1
)
ln lieu payments-Section 202(b)
Total- Moving Expenses
(2) Replacement housing payments:
Rental payments-Section 204(1 )
Down payment-Section 204(2)
Total - Replacement housing payments
Total - Estimated Tenants
b. OWNER-OCCUPANTS - Estimates: Number of CIaims
(1) Moving expenses:
Actual Expenses-Section 202(a)(1
)
ln lieu payments-Section 202(b)
Total- Moving Expenses
(2) Replacement housing payments:
Purchase payments-Section 203(a)(1
)
Reasonable replacement costs-Section 203(aX1 XA)
lncreased interest costs-Section 203(a)(1 )(B)
Closing costs-Section 203(aX1 XC)
Rental payments-Section 204(1 )
Down payment-Section 204(2)
Total - Replacement housing payments
Total - Estimated Owner-Occupants
c. BUSINESS - Estimates: Number of Claims
Moving Expenses:
Actual Expenses-Section 202(a)(1
)
Actual loss of tangible personal property-Section 202(a)(2)
Actual searching expenses-Section 202(a)(3)
ln lieu payments-Section 202(c)
Total - Estimated Business
d. NONPROFIT ORGANIZATIONS - Estimates: Number of Claims
Moving Expenses:
Actual Expenses-Section 202(a)(1 )
Actual loss of tan
g
i
ble
pe
rsonal property-Section 202(a) (2)
Actual searching expenses-Section 202(a)(3)
ln lieu payments-Section 202(c)
Total - Estimated Nonprofit Organizations
e. FARM OPERATIONS - Estimates: Number of Claims
Moving Expenses:
Actual Expenses-Section 202(a)(1
)
Actual loss of tangible personal property-Section 202(a)(2)
Actual searching expenses-Section 202(a)(3)
ln lieu payments-Section 202(c)
Total - Estimated Farm Operations
f. ADVISORY SERVICES - Estimates: Number of Claims
Total - Expenses of grantee/borrower-Section 205
g. ADMINISTRATION - Estimates: Number of Claims
Contracting with individual, firm, association, or corporationSection 212
Agreement w/ Federal or State government agency or
instrumentality- Section 21 2
Total - Estimated Administration
ITEM 3. GRAND TOTAL
Enter the sum of ltems 1 and 2 (parts (a) through (g)) in this ltem
GRAND TOTAL RELOCATION EXPENSES
| File Type | application/pdf |
| File Modified | 0000-00-00 |
| File Created | 2013-04-08 |