Form 10-912 Rehabilitation and Innovation Grant Agreement

OMB Control Number 1024-0048
Expiration Date: XX/XX/2016

UNITED STATES DEPARTMENT OF THE INTERIOR
NATIONAL PARK SERVICE
URBAN PARK AND RECREATION RECOVERY PROGRAM GRANT
REHABILITATION AND INNOVATION AGREEMENT
______________________________________________________________________________
Applicant Name:
Grant Number:
______________________________________________________________________________
Administering Agency:
______________________________________________________________________________
Grant Title:
______________________________________________________________________________
[ ] Rehabilitation
[ ] Innovation
[ ] Eligible
[ ] Discretionary
Grant Expiration Date:
______________________________________________________________________________
Proposal Scope (description of proposal on individual site or project basis, with identification of
each site)

______________________________________________________________________________
Grant Cost:
Total Cost

$__________

UPARR request %__

$__________

State Match

%__

$__________

Local Match

%__

$__________

Other

%__

$__________

Appropriation: FY__

$__________

FY__

$__________

The following are hereby incorporated
into this agreement:
1. General Provisions
2. UPARR Grants Manual (NPS-37)
3. Project Application and Attachments
4. OMB Circular A-102
5. 43 CFR Part 12
6. 36 CFR Chapter I, Part 72
7. _________________________________

NPS Form 10-912 (August 2013)

OMB Control Number 1024-0048
Expiration Date: XX/XX/2016

Grant Agreement No: ____________________
The United States of America, represented by the Director, National Park Service, United States Department of the
Interior, and the Grant Recipient above (hereinafter referred to as the Grantee), mutually agree to perform this
agreement in accordance with Title X, Urban Park and Recreation Recovery Program, 16 USC 2501, 92 Stat. 3538
(1978), and with the terms, promises, conditions, plans, specifications, estimates, procedures, project proposals,
maps, and assurances attached hereto and hereby made a part hereof.
The United States hereby promises, in consideration of the promises made by the Grantee herein, to obligate to the
Grantee the amount of money referred to above, and to tender to the Grantee that portion of the obligation that is
required to pay the United States’ share of the costs of the above Grant based upon the above percentage of
assistance. The Grantee hereby promises, in consideration of the promises made by the United States herein, to
execute the Grant described above in accordance with the terms of this agreement.
The following special grant terms and conditions were added to this agreement before it was signed by the parties
hereto:

In witness whereof, the parties hereto have executed this agreement as of the date entered below.
UNITED STATES OF AMERICA

GRANTEE

BY_________________________________
(Signature)

____________________________________
(Government Name)

____________________________________
(Name)
____________________________________
(Title)
National Park Service
____________________________________
(Date)

BY ________________________________
(Signature)
____________________________________
(Name)
____________________________________
(Title)

______________________________________________________________________________________
Paperwork Reduction Act Statement: We collect this information under the authority of the Urban Park and Recreation
Recovery Act of 1978 (16 USC 2501 et seq.). We use this information to document the proposal scope and grant costs as well as
the legal obligations of each party. Your response is required to obtain or retain a benefit. We estimate that it will take you 1
hour to complete this form. The estimate includes time for reviewing the instructions, gathering and maintaining data, and
reviewing and completing the form.
You may send comments on the burden estimate or any aspect of this form to the Information Collection Clearance Officer,
National Park Service, 1849 C Street NW (2601), Washington, DC 20240. We may not collect or sponsor and you are not
required to respond to a collection of information unless it displays a currently valid OMB control number.

NPS Form 10-912 (August 2013)