99-319 9
Resolution No . 99-319
RESOLUTION
AUTHORIZING EXECUTION OF A GRANT AWARD DOCUMENT FROM THE
BUREAU OF ALCOHOL, TOBACCO AND FIREARMS
FOR GANG RESISTANCE EDUCATION AND TRAINING
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF ELGIN,
ILLINOIS, that Joyce A. Parker, City Manager, be and is hereby
authorized and directed to execute a Grant Award Document from
the Department of the Treasury, Bureau of Alcohol , Tobacco and
Firearms for a $3 , 500 grant for Gang Resistance Education and
Training, a copy of which is attached hereto and made a part
hereof by reference .
Ed Schock, Mayor
Presented: December 15, 1999
Adopted:
Vote : Yeas Nays
Recorded:
Attest :
Dolonna Mecum, City Clerk
?to, u ,Acz ;)'-7
t‘C-1. 7U
ti v� . --<-C t l f�, C
6
GRANT AWARD DOCUMENT
Bureau of Alcohol,Tobacco and Firearms
Gang Resistance Education and Training Program
•
Applicant Organization's Name: Elgin Police Department
Grant: 050100000188
Law Enforcement Executive Name: Chief William D. Miller
Address: 151 Douglas Avenue
City, State, Zip Code: Elgin, Illinois 60120-5555
Telephone: (847) 289-2760
Fax: (847) 289-2642
Government Executive Name: Ms. Joyce Parker, City Manager
Address: 150 Dexter Ct.
City, State, Zip Code: Elgin Il. , 60120-5555
Telephone: (847) 931-5590
Fax: (847) 931-5610
Award Start Date: January 16, 2000
Award End Date: January 15, 2001
Total Award Amount: $3,500.00
John Krieger Date
Grants Officer
By signing this award, the signatory officials are agreeing to abide by the Conditions
of Grant Award found on the attached page of this document.
Signature of Law Enforcement Official with Date
Authority to accept this grant award
William Miller, Chief of Pn1icc
Printed Name and Title of Law Enforcement Official
:4e/4 . / ,;Z/,249'
Sign. ure If Government Executive with the Date
Authority to accept this grant
Joyce Parker, City Manager
Printed Name and Title of Government Executive
``
CONDITIONS OF GRANT AWARD
1. The funding under this program is for the purchase of classroom materials and
incentives. Funds may also be used to provide transportation and per diem for sworn
law enforcement officers attending G.R.E.A.T. training.
2. All G.R.E.A.T. materials and incentives shall be purchased from any of the three
authorized G.R.E.A.T. merchandise manufacturers listed below.
Best Expression Creative Impression Treadway Graphics
21602 N. 3rd Ave. 5305 E. 18th St. 1401 Cannon Circle
Phoenix, AZ 85027 Suite F Suite 2
800-931-8931 Vancouver, WA 98661 Fairbault, MN 55021
800-654-0724 800-658-7063
3. Travel costs for transportation and per diem will be considered reasonable and
allowable only if such costs do not exceed the charges normally allowed by your
jurisdiction. If your jurisdiction does not have a written policy with regard to travel
costs, the rates and amounts established under the Federal Travel Regulation shall be
used for travel.
4. Grantee agrees to comply with OMB Circulars A-87, Cost Principles for State, Local
and Indian Tribal Governments, A-102, Uniform Administrative Requirements for
Grants and Cooperative Agreements to State and Local Governments, and A-133-
Audits of State and Local Governments, as they relate to this grant.
5. Prior to the reimbursement of any expenses, the grantee will provide whatever
payment information is necessary to transfer funds (electronic payment information,
bank account numbers, etc.) in accordance with Title 31 of the Code of Federal
Regulations, Part 208, effective July 01, 1997.
6. The Bureau of Alcohol, Tobacco and Firearms (ATF), or any other authorized
Federal Agency may evaluate the G.R.E.A.T. Program. The grantee agrees to
cooperate with the evaluators to the extent practicable.
7. In order to assist the ATF in the monitoring of the award, your agency will be
responsible for submitting an annual financial status report and an annual progress •
report. The annual financial report shall include: How funds were expended,receipts
for items purchased or travel. The annual progress report shall include: The number
of officers trained, the number of students who participated in the program, and the
number of students who graduated from the program.
APPLICATION FOR OMB Approval No.0348-00
. FEDERAL ASSISTANCE 2.DATE SUBMITTED / Applicant Identifier
11/30/99 IL0450600
1.TYPE OF SUBMISSION: 3.DATE RECEIVED BY STATE State Application Identifier
A plication Preapplication
[�Construction ❑Construction 4.DATE RECEIVED BY FEDERAL AGENCY Federal Identifier
El Non-Construction _❑Non-Construction
5.APPLICANT INFORMATION •
Legal Name: Organizational Unit:
City Of Elgin, Illinois Police Department Police Depart•f.ent
Address(give city,county, State,and zip code): Name and telephone number of person to be contacted on matters involvi
this application(give area code)
151 Douglas Avenue, Elgin, Il. 60120 Deputy Chief James Burns e47-289-2762
6.EMPLOYER IDENTIFICATION NUMBER(E/N): 7.TYPE OF APPLICANT:(enterappropriate letter in box)
3 6
--6-10 101 518I 6 A.State H. Independent School Dist.
8.TYPE OF APPLICATION: B.County I.State Controlled Institution of Higher Learning
New ❑Continuation El Revision C.Municipal J.Private University
D.Township K. Indian Tribe
If Revision,enter appropriate letter(s)in box(es) E. Interstate L. Individual
F. Intermunicipal M.Profit Organization
A. Increase Award B. Decrease Award C. Increase Duration . G:Special District N.Other.(Specify) •
D.Decrease Duration Othe(specify). •. .• •
•
9.NAME OF FEDERAL AGENCY:
Dept. of Treasury, Bureau of Alcohol
Tobacco and Firearms
10.CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 11.DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
I - II
TITLE: N/A
12.AREAS AFFECTED BY PROJECT(Cities, Counties,States,etc.): G.R.E.A.T.Program
City Officer Training and Classroom Supplies
13.PROPOSED PROJECT 14.CONGRESSIONAL DISTRICTS OF:
GREAT Program 14th District
Start Date Ending Date a.Applicant b.Project
1994 continuing
15.ESTIMATED FUNDING: . 16.IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE
ORDER 12372 PROCESS? unknown
a.Federal $ co
3,500%. a.YES. THIS PREAPPLICATION/APPLICATION WAS MADE
b.Applicant $ 00 — AVAILABLE TO THE STATE EXECUTIVE ORDER 12372
PROCESS FOR REVIEW ON:
c.State $
DATE
d.Local $ • 03 .
b. No. ❑ PROGRAM IS NOT COVERED BY E.O. 12372
e.Other $ 00 ❑ OR PROGRAM HAS NOT BEEN SELECTED BY STATE
FOR REVIEW
f.Program Income $ 03
17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
g.TOTAL $
3,500 ❑Yes If"Yes," attach an explanation. Ei No
18.TO THE BEST OF MY KNOWLEDGE AND BELIEF,ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT,THE
DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE
ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.
a.Type Name of Authorized Representative b.Title c.Telephone Number
William Miller __ Chief of Police (847) 289-2760
d.Signature of Authorized Representative e. Date Signed
Previous Edition Usable Standard Form 424(Rev.7-97)
Authorized for Local Reproduction Prescribed by OMB Circular A-102
INSTRUCTIONS FOR THE SF-424
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection o
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions fo
reducing this burden,to the Office of Management and Budget,Paperwork Reduction Project(0348-0043),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.
This is a standard form used by applicants as a required facesheet for preapplications and applications submitted for Federal assistance. I
will be used by Federal agencies to obtain applicant certification that States which have established a review and comment procedure it
response to Executive Order 12372 and have selected the program to be included in their process, have been given an opportunity to reviev
the applicant's submission.
Item: Entry: Item: Entry:
1. Self-explanatory. 12. List only the largest political entities affected (e.g.,State,
counties, cities).
•
2. Date application submitted to Federal agency(or State if
applicable)and applicant's control number(if applicable). 13. Self-explanatory.
3. State use only(if applicable). 14. List the applicant's Congressional District and any
District(s) affected by the program or project.
4. If this application is to continue or revise an existing award,
enter present Federal identifier number. If for a new project, 15. Amount requested or to.be contributed during the first
leave blank. - funding/budget period by each contributor.Value of in-
kind contributions should be included on appropriate
5. Legal name of applicant, name of primary organizational unit lines as applicable. If the action will result in a dollar
which will undertake the assistance activity,complete address of change to an existing award, indicate on/v the amount
the applicant, and name and telephone number of the person to of the change. For decreases,enclose the amounts in
contact on matters related to this application. parentheses. If both basic and supplemental amounts
are included, show breakdown on an attached sheet.
6. Enter Employer Identification Number(EIN)as assigned by the For multiple program funding, use totals and show
Internal Revenue Service. breakdown using same categories as item 15.
7. Enter the appropriate letter in the space provided. 16. Applicants should contact the State Single Point of
Contact(SPOC)for Federal Executive Order 12372 to
8. Check appropriate box and enter appropriate letter(s) in the determine whether the application is subject to the
space(s) provided: State intergovernmental review process.
--"New" means a new assistance award. 17. This question applies to the applicant organization, not
the person who signs as the authorized representative.
--"Continuation"means an extension for an additional Categories of debt include delinquent audit
funding/budget period for a project with a projected disallowances, loans and taxes.
completion date.
18. To be signed by the authorized representative of the
--"Revision" means any change in the Federal applicant.A copy of the governing body's
Government's financial obligation or contingent authorization for you to sign this application as official
liability from an existing obligation. representative must be on file in the applicant's office.
(Certain Federal agencies may require that this
9. Name of.Federal agency from which assistance is being authorization be submitted as part of the application.)
requested with this application.
10. Use the Catalog of Federal Domestic Assistance number and
title of the program under which assistance is requested.
11. Enter a brief descriptive title of the project. If more than one
program is involved,you should append an explanation on a
separate sheet. If appropriate(e.g.,construction or real
• property projects), attach a map showing project location. For
preapplications, use a separate sheet to provide a summary SF-424(Rev.7-97)Back
description of this project.
ACH VENDOR/MISCELLANEOUS PAYMENT OMB No.1510-0056
- ENROLLMENT FORM Expiration Date 01i31i2000
This form is used for Automated Clearing House (ACH) payments with an addendum record that contains
payment-related information processed through the Vendor Express Program. Recipients of these
payments should bring this information to the attention of their financial institution when presenting this
form for completion.
PRIVACY ACT STATEMENT
The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). All
information collected on this form is required under the provisions of 31 U.S.C. 3322 and 31 CFR
210. This information will be used by the Treasury Department to transmit payment data, by
electronic means to vendor's financial institution. Failure to provide the requested information may
delay or prevent the receipt of payments through the Automated Clearing House Payment System.
AGENCY INFORMATION
FEDERAL PROGRAM AGENCY BUREAU OF ALCOHOL,TOBACCO AND FIREARMS
AGENCY IDENTIFIER: 303 AGENCY LOCATION CODE(ALCI: 20-10-0001 ACH FORMAT:
CCD+ D CTX D CTP
ADDRESS: PO BOX 51071,WASHINGTON,DC 20091-1071
•
•
CONTACT PERSON NAME: WILLIAM T.WRIGHT T.
(202)927-7725
ADDITIONAL INFORMATION:
PAYEE/COMPANY INFORMATION
NAME SSN NO.OR TAXPAYER ID NO.
City of Elgin , 36-6005862
ADDRESS
150 Dexter Ct.
Elgin Il. , 60120
CONTACT PERSON NAME: TELEPHONE NUMBER:
Deputy ChiefJames Burns (847 1 289-2761
FINANCIAL INSTITUTION INFORMATION
NAME:
Amcore Bank
ADDRESS:
1950 Big Timber Rd.
Elgin Illinois 60123-1136
ACH COORDINATOR NAME: TELEPHONE NUMBER:
Lisa Stout 1 847 1622-4231
NINE-DIGIT ROUTING TRANSIT NUMBER:
0 7 1 9 0 0 4 5 6
DEPOSITOR ACCOUNT TITLE:
City of Elgin General Account
DEPOSITOR ACCOUNT NUMBER: LOCKBOX NUMBER:
0154565
TYPE OF ACCOUNT:
ElCHECKING El SAVINGS El LOCKBOX
SIGNATURE AND TITLE OF AUTHORIZED OFFICIAL: TELEPHONE NUMBER:
(Could be the same as ACH Coordinator)
• • s ( 84.7 81 ev1) 771— 628 -
NSN 7540-01-274-9925 38
AGENCY COPY Prescribed by Department of Treasury
31 U S C 3322;31 CFR 210
Instructions for Completing SF 3881 Form
1. Agency Information Section - Federal agency prints or types the name and address of
the Federal program agency originating the vendor/miscellaneous payment, agency
identifier, agency location code, contact person name and telephone number of the
agency. Also, the appropriate box for ACH format is checked.
2. Payee/Company Information Section - Payee prints or types the name of the
payee/company and address that will receive ACH vendor/miscellaneous payments,
social security or taxpayer ID number, and contact person name and telephone number
of the payee/company. Payee also verifies depositor account number, account title,
and type of account entered by your financial institution in the Financial Institution
Information Section.
3. Financial Institution Information Section - Financial institution prints or types the name
and address of the payee/company's financial institution who will receive the ACH
payment, ACH coordinator name and telephone number, nine-digit routing transit
number, depositor (payee/company) account title and account number. Also, the box
for type of account is checked, and the signature, title, and telephone number of the
appropriate financial institution official are included.
Burden Estimate Statement
The estimated average burden associated with this collection of information is 15 minutes
per respondent or recordkeeper, depending on individual circumstances. Comments
concerning the accuracy of this burden estimate and suggestions for reducing this burden
should be directed to the Financial Management Service, Facilities Management Division,
Property and Supply Branch, Room B-101, 3700 East West Highway, Hyattsville, MD
20782 and the Office of Management and Budget, Paperwork Reduction Project
(1510-0056), Washington, DC 20503.
OMB APPROVAL NO. ` PAGE OF
0348-0004 ( PAGES
REQUEST FOR ADVANCE a. oneo both bares 2.BASIS OF REQUEST
OR REIMBURSEMENT 1. ❑ADVANCE ❑ REIMBURSE-
TYPE OF MENT ❑CASH
PAYMENT b. X the applicable box
(See instructions on back) REQUESTED ❑FINAL ❑PARTIAL ❑ACCRUAL
3.FEDERAL SPONSORING AGENCY AND ORGANIZATIONAL ELEMENT TO 4.FEDERAL GRANT OR OTHER 5.PARTIAL PAYMENT REQUEST
WHICH THIS REPORT IS SUBMITTED IDENTIFYING NUMBER ASSIGNED NUMBER FOR THIS REQUEST
BY FEDERAL AGENCY
6.EMPLOYER IDENTIFICATION 7.RECIPIENTS ACCOUNT NUMBER 8. PERIOD COVERED BY THIS REQUEST
NUMBER OR IDENTIFYING NUMBER FROM(month,day,year) TO(month,day,year)
9.RECIPIENT ORGANIZATION 10.PAYEE(Where check is to be sent if different than item 9)
Name: Name:
Number Number
and Street: and Street:
•
City,State City,State
and ZIP Code: and ZIP Code:
•
11. COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED
(a) (b) (c)
PROGRAMS/FUNCTIONS/ACTIVITIES
TOTAL
a.Total program (As of dale) $ $
outlays to date
b.Less: Cumulative program income
c.Net program outlays(Line a minus
line b)
d.Estimated net cash outlays for advance
period
e.Total(Sum of lines c 8 d)
f.Non-Federal share of amount on line e
g.Federal share of amount on line e
h.Federal payments previously requested
i.Federal share now requested(Line g
minus line h)
j. Advances required by
month, when requested 1st month
by Federal grantor
agency for use in making 2nd month
prescheduled advances
3rd month _
12. ALTERNATE COMPUTATION FOR ADVANCES ONLY
a.Estimated Federal cash outlays that will be made during period covered by the advance $
b.Less: Estimated balance of Federal cash on hand as of beginning of advance period
c.Amount requestediL ine a minus line b) $
AUTHORIZED FOR LOCAL REPRODUCTION (Continued on Reverse) STANDARD FORM 270(Rev.7-97)
Prescribed by OMB Circulars A-102 and A-110
13. CERTIFICATION
SIGNATURE OR AUTHORIZED CERTIFYING OFFICIAL DATE REQUEST
I certify that to the best of my SUBMITTED
knowledge and belief the data on the /
reverse are correct and that all outlays
were made in accordance with the TYPED OR PRINTED NAME AND TITLE TELEPHONE(AREA
grant conditions or other agreement CODE,NUMBER,
and that payment is due and has not EXTENSION)
been previously requested.
This space for agency use
Public reporting burden for this collection of information is estimated to average 60 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(0348-0004),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.
INSTRUCTIONS
Please type or print legibly. Items 1, 3, 5, 9, 10, 11e, 11f, 11g, 11i, 12 and 13 are self-explanatory; specific
instructions for other items are as follows:
Item Entry Item Entry ••
2 Indicate whether request is prepared on cash or accrued activity. If additional columns are needed, use as many
expenditure basis. All requests for advances shall be additional forms as needed and indicate page number in
prepared on a cash basis. space provided in upper right; however, the summary
totals of all programs, functions, or activities should be
4 Enter the Federal grant number, or other identifying shown in the"total"column on the first page.
number assigned by the Federal sponsoring agency. If
the advance or reimbursement is for more than one grant 11a Enter in "as of date," the month, day, and year of the
or other agreement, insert N/A; then, show the aggregate ending of the accounting period to which this amount
amounts. On a separate sheet, list each grant or applies. Enter program outlays to date (net of refunds,
agreement number and the Federal' share of outlays rebates, and discounts), in the appropriate columns. For
made against the grant or agreement. requests prepared on a cash basis, outlays are the sum
of actual cash disbursements for goods and services,
6 Enter the employer identification number assigned by the the amount of indirect expenses charged,the value of in-
U.S. Internal Revenue Service, or the FICE (institution) kind contributions applied, and the amount of cash
code if requested by the Federal agency. advances and payments made to subcontractors and
subrecipients. For requests prepared on an accrued
7 This space is reserved for an account number or other expenditure basis, outlays are the sum of the actual
identifying number that may be assigned by the recipient. • cash disbursements, the amount of indirect expenses
incurred, and the net increase (or decrease) in the
8 Enter the month, day, and year for the beginning and amounts owed by the recipient for goods and other
ending of the period covered in this request. If the request property received and for services performed by
is for an advance or for both an advance and employees, contracts, subgrantees and other payees.
reimbursement, show the period that the advance will
cover. If the request is for reimbursement, show the 11b Enter the cumulative cash income received to date, if
period for which the reimbursement is requested. requests are prepared on a cash basis. For requests
prepared on an accrued expenditure basis, enter the
Note: The Federal sponsoring agencies have the option of cumulative income earned to date. Under either basis,
requiring recipients to complete items 11 or 12, but not enter only the amount applicable to program income that
both. Item 12 should be used when only a minimum was required to be used for the project or program by
amount of information is needed to make an advance and the terms of the grant or other agreement.
outlay information contained in item 11 can be obtained in
a timely manner from other reports. 11d Only when making requests for advance payments,
enter the total estimated amount of cash outlays that will
11 The purpose of the vertical columns (a), (b), and (c) is to be made during the period covered by the advance.
provide space for separate cost breakdowns when a
project has been planned and budgeted by program, 13 Complete the certification before submitting this request.
function, or
STANDARD FORM 270(Rev.7-97)Back
BUDGET INFORMATION - Non-Construction Programs OMB Approval No.0348-0044
SECTION A- BUDGET SUMMARY
Grant Program Catalog of Federal Estimated Unobligated Funds New or Revised Budget
Function Domestic Assistance
or Activity Number Federal Non-Federal Federal Non-Federal Total
(a) (b) (c) (d) (e) (f) (g)
1. $ $ $ $ $
2.
3.
4.
5. N Totals $ $ $ $ $
SECTION B-BUDGET CATEGORIES
6. Object Class Categories GRANT PROGRAM,FUNCTION OR ACTIVITY Total
(1) (2) (3) (4) (5)
a. Personnel $ $ $ $ $
2,000.00
b. Fringe Benefits
c. Travel 1,000.00
d. Equipment
e. Supplies 500.00
f. Contractual
g. Construction
-
h. Other
i. Total Direct Charges (sum of 6a-6h)
j. Indirect Charges
•
k. TOTALS (sum of 6i and 6j) $ $ $ $ $
3,500.00
7. Program Income $ $ $ $ $
Authorized for Local Reproduction Standard Form 424A(Rev.7-97)
Previous Edition Usable Prescribed by OMB Circular A-102
SECTION C- NON-FEDERAL RESOURCES
(a) Grant Program (b) Applicant (c) State (d) Other Sources (e) TOTALS .
8. $ $ $ $
9' N/A
10.
11. -
12. TOTAL (sum of lines 8-11) $ $ $ $
SECTION D-FORECASTED CASH NEEDS
Total for 1st Year 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter
13. Federal
$ 3,500.00 $2,000.00 $ $ 1,500.00 $ _
14. Non-Federal
15. TOTAL (sum of lines 13 and 14) $ 3,500.00 $ $ $ $
.
',4-, SECTION E-BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT
(a) Grant Program FUTURE FUNDING PERIODS (Years)
(b) First (c) Second (d) Third (e) Fourth
16. $ $ $ $
17.
18.
19.
20. TOTAL (sum of lines 16-19) $ $ $ $
SECTION F-OTHER BUDGET INFORMATION
r�+F;
21. Direct Charges: 22. Indirect Charges:
23. Remarks:
Authorized for Local Reproduction Standard Form 424A(Rev.7-97)Page
9. Will comply, as applicable,with the provisions of the Davis- 12. Will comfy with the Wild and Scenic Rivers Act of
Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act 1968 (16 U.S.C. §§1271 et seq.) related to protecting
(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract components or potential components of the national
Work Hours and Safety Standards Act (40 U.S.C. §§327- wild and scenic rivers system.
333), regarding labor standards for federally-assisted
construction subagreements. 13. Will assist the awarding agency in assuring compliance
with Section 106 of the National Historic Preservation
10. Will comply, if applicable, with flood insurance purchase Act of 1966, as amended (16 U.S.C. §470), E0 11593
requirements of Section 102(a) of the Flood Disaster (identification and protection of historic properties), anc
Protection Act of 1973 (P.L. 93-234) which requires the Archaeological and Historic Preservation Act of
recipients in a special flood hazard area to participate in the 1974 (16 U.S.C. §§469a-1 et seq.).
program and to purchase flood insurance if the total cost of
insurable construction and acquisition is$10,000 or more. 14. Will comply with P.L. 93-348 regarding the protection of
human subjects involved in research,development,and
11. Will comply with environmental standards which may be related activities supported by this award of assistance.
prescribed pursuant to the following: (a) institution of _
environmental quality control measures under the National 15. Will comply with the Laboratory Animal Welfare Act of
Environmental Policy Act of 1969 (P.L. 91-190) and 1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et
Executive Order (EO) 11514; (b) notification of violating seq.) pertaining to the care, handling, and treatment of
facilities pursuant to EO 11738; (c) protection of wetlands warm blooded animals held for research, teaching, or
pursuant to EO 11990; (d) evaluation of flood hazards in other activities supported by this award of assistance.
•
floodplains in accordance with EO 11988; (e) assurance of
project consistency with the approved State management 16. Will comply..with the Lead-Based Paint Poisoning
program developed under the Coastal Zone Management Prevention Act (42 U.S.C. §§4801 et seq,) which
Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of prohibits the use of lead-based paint in construction or
Federal actions to State (Clean Air) Implementation Plans rehabilitation of residence structures.
under Section 176(c) of the Clean Air Act of 1955, as
amended (42 U.S.C. §§7401 et seq.); (g) protection of 17. Will cause to be performed the required financial and
underground sources of drinking water under the Safe compliance audits in accordance with the Single Audit
Drinking Water Act of 1974, as amended (P.L. 93-523); Act Amendments of 1996 and OMB Circular No. A-133,
and, (h) protection of endangered species under the "Audits of States, Local Governments, and Non-Profit
Endangered Species Act of 1973, as amended (P.L. 93- Organizations."
205).
18. Will comply with all applicable requirements of all other
Federal laws,executive orders, regulations,and policies
governing this program.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE
Chief of Police, City of Elgin I1.
APPLICANT ORGANIZATION [DATE SUBMITTED
Elgin Police Department 11/30/99
Standard Form 424B(Rev.7-97)Bac
OMB Approval No.0348-004C
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 Act of 1973, as amended (29 U.S.C. §794), which
and the institutional, managerial and financial capability prohibits discrimination on the basis of handicaps; (d)
(including funds sufficient to pay the non-Federal share the Age Discrimination Act of 1975, as amended (42
of project cost) to ensure proper planning, management U.S.C. §§6101-6107), which prohibits discrimination
and completion of the project described in this on the basis of age; (e) the Drug Abuse Office and
application: •• • Treatment Act of 1972 (P.L. 92-255), as amended,
relating to nondiscrimination on the basis of drug
2. Will give the awarding agency, the Comptroller General abuse; (f) the Comprehensive Alcohol Abuse and
of the United States and, if appropriate, the State, Alcoholism Prevention, Treatment and Rehabilitation
through any authorized representative, access to and Act of 1970 (P.L. 91-616), as amended, relating to
the right to examine all records, books, papers, or nondiscrimination on the basis of alcohol abuse or
documents related to the award; and will establish a alcoholism; (g) §§523 and 527 of the Public Health
proper accounting system in accordance with generally Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee
accepted accounting standards or agency directives. 3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the
3. Will establish safeguards to prohibit employees from Civil Rights Act of 1968(42 U.S.C. §§3601 et seq.), as
using their positions for a purpose that constitutes or amended, relating to nondiscrimination in the sale,
presents the appearance of personal or organizational rental or financing of housing; (i) any other
conflict of interest, or personal gain. nondiscrimination provisions in the specific statute(s)
under which application for Federal assistance is being
4. Will initiate and complete the work within the applicable made; and, (j) the requirements of any other
time frame after receipt of approval of the awarding nondiscrimination statute(s) which may apply to the
agency. application.
5. Will comply with the Intergovernmental Personnel Act of 7. Will comply, or has already complied, with the
1970 (42 U.S.C. §§4728-4763) relating to prescribed requirements of Titles II and Ill of the Uniform
standards for merit systems for programs funded under Relocation Assistance and Real Property Acquisition
one of the 19 statutes or regulations specified in Policies Act of 1970 (P.L. 91-646) which provide for
Appendix A of OPM's Standards for a Merit System of fair and equitable treatment of persons displaced or
Personnel Administration (5 C.F.R.900, Subpart F). whose property is acquired as a result of Federal or
federally-assisted programs. These requirements apply
6. Will comply with all Federal statutes relating to to all interests in real property acquired for project
nondiscrimination. These include but are not limited to: purposes regardless of Federal participation in
(a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) purchases.
which prohibits discrimination on the basis of race,color
or national origin; (b) Title IX of the Education 8. Will comply, as applicable, with provisions of the
Amendments of 1972, as amended (20 U.S.C. §§1681- Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328)
1683, and 1685-1686),which prohibits discrimination on which limit the political activities of employees whose
the basis of sex; (c) Section 504 of the Rehabilitation principal employment activities are funded in whole or
in part with Federal funds.
Previous Edition Usable Standard Form 4248(Rev.7-97)
Authorized for Local Reproduction Prescribed by OMB Circular A-102
DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB
Complete this form to disclose lobbying activities pursuant to 31 UA.C. 1352 0348-0046
(See reverse for public burden disclosure.)
1.Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
a. contract L I la. bid/offer/application a. initial filing
b. grant b. initial award b.material change
c. cooperative agreement c. post-award For Material Change Only:
d. loan year quarter
e. loan guarantee date of last report
f. loan insurance
4. Name and Address of Reporting Entity: 5. If Reporting Entity in No.4 is a Subawardee, Enter Name
0 Prime ❑Subawardee and Address of Prime:
Tier , if known:
Congressional District, if known: Congressional District, if known:
6. Federal Department/Agency: 7. Federal Program Name/Description:
•
CFDA Number, if applicable: • • •
8. Federal Action Number, if known: 9.Award Amount, if known:
10.a. Name and Address of Lobbying Entity b. Individuals Performing Services (including address if
(if individual, last name, first name, Ml): different from No. 10a)
(last name, first name, MI):
•
(attach Continuation Sheet(s)SF-LLLA,if necessary)
11. Amount of Payment (check all that apply): 13.Type of Payment (check all that apply):
❑actual ❑planned ❑a.retainer
0 b.one-time fee
12. Form of Payment (check all that apply): ❑c.commission
❑a.cash 0 d.contingent fee
0 b.in-kind;specify: nature 0 e.deferred
value 0 f.other;specify:
14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s),
employee(s), or Member(s) contacted,for Payment Indicated in Item 11:
(attach Continuation Sheet(s)SF-LLLA,if necessary)
15. Continuation Sheet(s) SF-LLLA attached: ❑Yes ] No
16.Information requested through this form is authorized by tide 31 U.S.C. section Signature:
1352. This disclosure of lobbying activities is a material representation of fact
upon which reliance was placed by the tier above when this transaction was made print Name: Will lam_Miller
or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This
information will be reported to the Congress semi-annually and will be available for Chief of Police, City of Elgin
public Inspection. My person who fails to file the required disclosure shall be Title:
subject to a civil penalty of not less that$10,000 and not more than$100,000 for
each such failure. Telephone No.: (847) 289-2760 Date:
•,d Date: 11/..0/9
9
Authorized for Local Reproduction
UCtion
Federal Use Onl y` ur s f i � �},� -+>T V4 s , Yr -s
' M:.4:4}-
Standard Form LLL(Rev.7-97)
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OOLOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity,whether subawardee or prime Federal recipient,at the initiation or receipt of a covered Federa
action,or a material change to a previous filing,pursuant to title 31 U.S.C.section 1352.The filing of a form is required for each payment or agreement to make
payment to any lobbying entity 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 employeeof a Member of Congress in connection with a covered Federal action.Use the SF-LLLA Continuation Sheet for additional information if
the space on the form is inadequate.Complete all items that apply for both the Initial filing and material change report. Refer to the implementing guidance
published by the Office of Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal actic
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a followup report caused by a material change to the information previously reported,enter
the year and quarter in which the change occurred.Enter the date of the last previously submitted report by this reporting entity for this covered Fede•.
action.
4. Enter the full name,address,city,State and zip code of the reporting entity.Include Congressional District,if known.Check the appropriate classification
of the reporting entity that designates if it is,or expects to be,a prime or subaward recipient.Identify the tier of the subawardee,e.g.,the first subawardee
of the prime is the 1st tier.Subawards include but are not limited to subcontracts,subgrants and contract awards under grants.
5. If the organization filing the report in item 4 checks 'Subawardee,'then enter the full name, address, city, State and zip code of the prime Federal
recipient.Include Congressional District,if known.
6. Enter the name of the Federal agency making the.award or loan commitment.Include at least one organizationallevel below agency name,if known.For
example,Department of Transportation,United States Coast Guard. •
7. Enter the Federal program name or description for the covered Federal action(item 1). If known,enter the full Catalog of Federal Domestic Assistance
(CFDA)number for grants,cooperative agreements,loans,and loan commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal(RFP) number;
Ir..`tation for Bid (IFB) number; grant announcement number, the contract, grant, or loan award number; the application/proposal control number
-:`yned by the Federal agency). Include prefixes,e.g.,'RFP-DE-90-001.'
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency,enter the Federal amount of the award/loan
commitment for the prime entity identified in item 4 or 5.
10. (a)Enter the full name,address,city,State and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influence the covere
Federal action.
(b)Enter the full names of the individual(s)performing services,and include full address if different from 10(a).Enter Last Name,First Name,and
Middle Initial(MI).
11. Enter the amount of compensation paid or reasonabiyexpectedto be paid by the reporting entity(item 4)to the lobbying entity(item 10).Indicate whether
the payment has been made(actual)or will be made(planned).Check all boxes that apply. If this is a material change report,enter the cumulative
amount of payment made or planned to be made.
12. Check the appropriatebox(es).Check all boxes that apply.If payment is made through an in-kind contribution,specify the nature and value of the in-kind
payment.
13. Check the appropriate box(es).Check all boxes that apply. If other,specify nature.
14. Proiidea specific and detaileddescription of the services that the lobbyist has performed,or will be expected to perform,and the date(s)of any services
rendered. Include all preparatory and related activity, not just time spent in actual contact with Federal officials. Identify the Federal official(s) or
employee(s)contacted or the officer(s),employee(s),or Member(s)of Congress that were contacted.
15. Check whether or not a SF-LLLA Continuation Sheet(s)is attached.
16. The certifying official shall sign and date the form,print his/her name,title,and telephone number.
According to the Paperwork Reduction Act,as amended,no persons are required to respond to a collection of information unless it displays a valid OMB Control
Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information is
estimated to average 30 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 cf
information,including suggestions for reducing this burden,to the Office of Management and Budget,Paperwork Reduction Project(0348-0046),Washingtor,
DC 20503.