HomeMy WebLinkAboutCALIFORNIA STATE LIBRARY (8)-2017City of Santa An -
Clerk of the Cou r
AGREEMENT TERMINATION FORM
Please complete this form in its entirety when the attached agreemeCC,,��t, nd all
amendments (if any) are no longer in effect. � T22 pFEI- d I'M 3: 39
Note: If your agreement is grant related, please ensure that all grant retention requirement, [�
have been satisfied prior to signing the termination form.T Y OF SA N TA A NA
Is the agreement(s) a permanent record? Yes _ No CLE"A U� COUNCIL
Return form to the Clerk of the Council Office (M-30).
Call 647-1520 if you have any questions.
The agreement with
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Revise; 10-I8-16
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Department:
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Signature: SA-J(2-kA�
Date: � ��
A-2017-232
California State Library LSTA GA PAGE 1
Fiscal Office LSTA GRANT AWARD # 40-8787
P.O.942837
Sacramento, CA 94237-0001
Project Title: Youth Know: Community Social Innovation Project
System/Agency: Santa Ana Public Library
INSURANCE NOT RFO UIRFO
W0'iK MAY PROCEFg CONSOLIDATED APPLICATION
CLERK Or COUNCIL. NOTIFICATION OF GRANT AWARD
11TF, AUG 2 4 2017
I. The subrecipient designated above hereby certifies to the California State Library, for a grant of
funds in the amount $65,800 . This block grant will provide library services as set forth in the LSTA
Service Project Application as approved and/or as amended by the California State Librarian.
The subrecipient agency and its named or designated fiscal agent hereby assures the California
State Library that:
1. It is mutually understood between the parties that this grant award may have been written
before ascertaining the availability of congressional appropriation of funds, for the mutual benefit of
both parties in order to avoid program and fiscal delays which would occur if the grant award were
executed after that determination was made.
2. This grant award is valid and enforceable only if sufficient funds are made available to
the State by the United States government for the Fiscal Year 2017/18 for the purposes of this
program. In addition, this grant award is subject to any additional restrictions, limitations, or
conditions enacted by the Congress or any statute enacted by the Congress which may affect
the provisions, terms or funding of this grant award in any manner.
3. It is mutually agreed that if the Congress does not appropriate sufficient funds for the
program, this grant award shall be amended to reflect any reduction in funds.
4. The California State Library has the option to amend the grant award to reflect any
reduction of funds.
5. Upon the grant award approval by the State Librarian, one (1) completed set of this
CONSOLIDATED APPLICATION NOTIFICATION OF GRANT AWARD will be sent to the
subgrantee. Such copy shall be the officially approved agreement for the conduct of the approved
project.
6. "Subrecipient" means the government or other legal entity to which a subaward is awarded
and which is accountable to the grantee for the use of the funds provided.
7. The subrecipient will make reports to the State Librarian in such form and containing such
information as may be required to enable the California State Library to perform its duties. The
subrecipient will keep such records and afford such access as the California State Librarian,
California State Library may find necessary to assure the correctness and verification of such
reports.
California State Library
Fiscal Office
P.O. 942837
Sacramento, CA 94237-0001
LSTA GA PAGE 2
LSTA GRANT AWARD # 40-8787
Project Title: Youth Know: Community Social Innovation Project
System/Agency: Santa Ana Public Library
CONSOLIDATED APPLICATION
NOTIFICATION OF GRANT AWARD, LSTA (continued)
8. The control of funds and title to property derived there from shall be in a subrecipient
agency for the uses and purposes provided; a subrecipient agency will administer such property
and funds and shall apply funds only for the purposes for which they were granted.
9. The expenditure under this program will not be used to supplant subrecipient effort.
10. This agreement is entered into under provisions of the Library Services and Technology
Act, Public Law 104-208 on September 30, 1996; and Congressional Record — House, H11644 -
H11728 on September 28, 1996, H12266 -H12267 on October 3, 1996; and 2 CFR 200, Uniform
Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards,
December 26, 2013. Congress enacted the Museum and Library Services Act of 2010 (Pub. L.
111-340, codified at 20 U.S.C. § 9101 et seq.), which also incorporates Library Services and
Technology Act (LSTA).
11. Performance of the provisions of this agreement is subject to the conditions and availability
of funds as awarded by the State Librarian under said Act.
12. The terms of this agreement shall be from upon execution until the end of the grant period,
but shall be subject to termination by either party by giving written notice to the other party at least
thirty (30) days prior to the effective date of termination.
In the event this agreement is so terminated, the subrecipient shall deliver to the State Librarian
copies of all reports and/or materials prepared up to the date of termination, and the State Librarian
shall determine, and pay the subrecipient for the necessary and appropriate expenditures and
obligations to the date of termination which have not been covered by prior installments heretofore
paid to the subrecipient. If funding has been advanced to the subrecipient, any unobligated
balances, as determined by the State Librarian, shall be returned to the State Library within 60
days of the notice of termination.
13. The State Librarian is empowered to review, audit, and inspect the project for compliance
with this agreement.
LIMITATION OF EXPENDITURE
Expenditure for all projects must conform to the approved budget, as amended, and with
applicable Federal and State laws and regulations.
California State Library
Fiscal Office
P.O. 942837
Sacramento, CA 94237-0001
Project Title: Youth Know: Community Social Innovation Project
System/Agency: Santa Ana Public Library
LSTA GA PAGE 3
LSTA GRANT AWARD # 40-8787
CONSOLIDATED APPLICATION
NOTIFICATION OF GRANT AWARD, LSTA (continued)
During the grant period, the subrecipient may find that the awarded budget may need to be modified. Budget
changes, requests for additional funds, or requests for reductions in the grant funding award must be discussed
with the assigned State Library Grant Monitor and a Grant Award Modification (LSTA Form 4) may be required
to be submitted according to the instructions. Approval is by the State Librarian. Adjustments should be
reported on the next financial report. Any adjustments in approved budgets must be documented and
documentation retained in project accounts. The total amount paid by the California State Library to the
subrecipient under this agreement shall not exceed $65,800 and shall be expended/encumbered in the
designated grant period.
REPORTS AND CLAIMS
It is the responsibility of the recipient of these instructions to see that the proper individual to supply the required
reports and claims receives the instructions and makes the required reports and claims to the California State
Library.
The subrecipient shall be responsible for the submission of two Narrative Reports, unless otherwise
noted in the Grant Guide for the project located on the CSL's website, on the progress and activities
of the project to the State Library within 30 days following the end of the designated quarter.
The subrecipient shall submit quarterly Financial Reports to the State Library, unless otherwise
noted in the Grant Guide for the project located on the CSL's website. These reports are to reflect
the expenditures made by the subrecipient under the agreement. The financial reports are to be
submitted within 30 days following the end of the designated quarter.
111. To obtain payment hereunder the subrecipient shall submit authorized claims provided by the State
Library for that purpose, on each of the following mentioned dates for payment, and the California
State Library agrees to reimburse the Library as soon thereafter as State fiscal procedures will
permit.
IV. The final 10% of the grant award (if applicable) is payable only if the subrecipient fulfills all project
reporting requirements and returns all unspent funds by the time specified in the Grant Guide.
Failure to provide timely reports is a serious breach of a grant recipient's administrative duty under
the award, which may result in federal audit exceptions against the State and the loss of LSTA funds.
The State Librarian may extend the final deadline for good cause. Request for extension beyond the
final deadline of the grant period must be received at least 30 days prior to that deadline.
Payment will be provided to cover the expenditures incurred by the subrecipient for the project in the following
manner:
$29,610 upon execution of the agreement and submission of claim by fiscal agent
$29,610 on or about October 30, 2017
$6,580 on the submission of all reporting and return of funds
If the amount of payment made by the California State Library shall exceed the actual expenses during the
term of this agreement, as reflected in the financial reports to be filed by the subrecipient, the subrecipient
shall refund to the California State Library the amount of such excess payment.
LSTA PAGE 4
LSTA GRANT AWARD # 40-8787
Project Title: Youth Know: Community Social Innovation Project
System/Agency: Santa Ana Public Library
CERTIFICATIONS REGARDING: NONDISCRIMINATION; DEBARMENT AND
SUSPENSION; AND OTHER ASSURANCES
The authorized representative certifies that the Subrecipient or its Fiscal Agent will comply
with the following:
Nondiscrimination
(a) Title VI of the Civil Rights Act of 1964, as amended (42 U.S.C. § 2000 et seq.), which
prohibits discrimination on the basis of race, color, or national origin;
(b) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. § 701 et seq.), which
prohibits discrimination on the basis of disability (note: IMLS applies the regulations in 45 C.F.R
part
1170 in determining compliance with § 504 as it applies to recipients of Federal assistance);
(c) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. § 1681-83, 1685-86),
which prohibits discrimination on the basis of sex in education programs; and
(d) The Age Discrimination in Employment Act of 1975, as amended (42 U.S.C. § 6101 et seq.),
which prohibits discrimination on the basis of age.
The authorized representative certifies to the best of his or her knowledge and belief that
neither the Subrecipient nor its Fiscal Agent:
Debarment and Suspension
(a) Are presently excluded or disqualified;
(b) Have been convicted within the preceding three years of any of the offenses listed in 2 C.F.R. part
180.800(a) or had a civil judgment rendered against it or them for one of those offenses within
that time period; fraud, antitrust, embezzlement, forgery, bribery, tax evasion, making false
statements, receiving stolen property, or similar offenses so serious as to affect the integrity of
the subrecipient or its fiscal agent.
(c) Are presently indicted for or otherwise criminally or civilly charged by a governmental entity
(Federal, State, or local) with commission of any of the offenses listed in 2 C.F.R. part
180.800(a) and enumerated above.
(d) Have had one or more public transactions (Federal, State, or local) terminated within the
preceding three years for cause or default.
Trafficking in Persons
• engages in trafficking in persons, procures a commercial sex act, or uses forced labor
• procures a commercial sex act during the period of time that the award is in effect
• uses forced labor in the performance of the grant
Federal Debt Status
Representative certifies to the best of his or her knowledge and belief that the Subrecipient is not
delinquent in the repayment of any Federal debt.
LSTA PAGE 5
LSTA GRANT AWARD # 40-8787
Project Title: Youth Know: Community Social Innovation Project
System/Agency: Santa Ana Public Library
CERTIFICATIONS REGARDING: NONDISCRIMINATION; DEBARMENT AND
SUSPENSION; AND OTHER ASSURANCES (continued)
Certification Regarding Lobbying Activities (Applies to Applicants Requesting Funds in
Excess of $100,000) (31 U.S.C. § 1352)
(a) No Library Services and Technology Act funds have been paid or will be paid, by or on behalf of
the undersigned, to any person for influencing or attempting to influence an officer or employee
of any Federal agency, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with the awarding of a Federal contract, the
making of a Federal grant, the making of a Federal loan, the entering into of a cooperative
agreement, or the extension, continuation, renewal, amendment, or modification of a Federal
contract, grant, loan, or cooperative agreement.
(b) No Library Services and Technology Act funds have been paid or will be paid, by or on behalf of
the undersigned, to any person for influencing or attempting to influence an officer or employee
of any State agency, Member of the Legislature, an officer or employee of the Legislature, or an
employee of a Member of the Legislature in connection with legislative action through oral or
written communication with State legislative officials, or solicitation of others to influence or
attempt to influence legislative action.
(c) No Library Services and Technology Act or other federal funds have been paid or will be paid, by
or on behalf of the undersigned, to any person for influencing or attempting to influence
any officer or employee of any county, district, or city agency, in connection with legislative
action through oral or written communication with officials, or solicitation of others to influence or
attempt to influence legislative action. LSTA funds will not be used for costs to:
• draft legislation or resolutions
• travel to meetings of governmental bodies urge passage of legislation or resolutions
• survey voters regarding passage and drafting of legislation or resolutions
• pay governmental fees (use fees, ballot filing fees, permits, etc.)
Drug -Free Workplace
(a) Continue to provide a drug-free workplace by complying with the requirements in 2 C.F.R. part
3186 (Requirements for Drug -Free Workplace (Financial Assistance)). In particular, the recipient
must comply with drug- free workplace requirements in subpart B of 2 C.F.R. part 3186, which
adopts the Government -wide implementation (2 C.F.R. part 182) of sections 5152-5158 of the
Drug -Free Workplace Act of 1988 (P. L. 100-690, Title V, Subtitle D; 41 U.S.C. §§ 701-707).
(b) This includes, but is not limited to: making a good faith effort, on a continuing basis, to maintain a
drug-free workplace; publishing a drug-free workplace statement; establishing a drug-free
awareness program for the employees; taking actions concerning employees who are convicted
of violating drug statutes in the workplace.
LSTA PAGE 6
LSTA GRANT AWARD # 40-8787
Project Title: Youth Know: Community Social Innovation Project
System/Agency: Santa Ana Public Library
The authorized representative also certifies that the Subreciplent or its Fiscal Agent will
comply with the following:
• will comply with all requirements by the Federal -sponsoring agency concerning special
requirements of law, program requirements, and other administrative requirements.
• will insure that the facilities under its ownership, lease or supervision which shall be
utilized in the accomplishment of the project are not listed on the Environmental Protection
Agency's (EPA) list of violating facilities and that it will notify the Federal grantor agency of
the receipt of any communication from the Director of the EPA Office of Federal Activities
indicating that a facility to be used in the project is under consideration for listing by the
EPA.
• will comply with the flood insurance purchase requirements of Section 102(a) requires, on
or after March 2, 1975, the purchase of flood insurance in communities where such
insurance is available as a condition for the receipt of any Federal financial assistance for
construction or acquisition purposes for use in any area that has been identified by the
Secretary of the Department of Housing and Urban Development as an area having
special flood hazards. The phrase "Federal financial assistance" includes any form of
loan, grant, guaranty, insurance payment, rebate, subsidy, disaster assistance loan or
grant, or any other form of direct or indirect Federal assistance.
will assist the Federal grantor agency in its compliance with Section 106 of the National
Historic Preservation Act of 1966 as amended (16 U.S.C. 470), Executive Order 11593,
and the Archeological and Historic Preservation Act of 1966 (16 U.S.C. 469a-1 et seq.) by
(a) consulting with the State Historic Preservation Officer on the conduct of investigations,
as necessary to identify properties listed in or eligible for inclusion in the National Register
of Historic Places that. are subject to adverse effects (see 36 CFR Part 800.8) by the
activity, and notifying the Federal grantor agency of the existence of any such properties,
and by (b) complying with all requirements established by the Federal grantor agency to
avoid or mitigate adverse effects upon such properties.
LSTA GRANT AWARD DOCUMENTATION
Budget Citation Chapter 14, Item 6120-211-0890
LSTA Award #: 40-8787
Project Title: Youth Know: Community Social Innovation Project
Subgrantee: Santa Ana Public Library
Approval Date: 7/1/2017
Funding Start Date: **upon execution** Term: upon execution — end of grant period
Approved Funds: $65,800
Payments: $29,610 upon execution of agreement Schedule No.
$29,610 on or about October 30, 2017 Schedule No.
$6,580 on completion and return of abatements Schedule No.
Appropriation Encumbered (designate where applicable) For: FY 17/18
Augmentation Encumbered For: FY 17/18
Reporting Structure: 61202000 COA: 5432000
Program #: 5312 DUNS #: 083153247
The LSTA program is a federal grant from the Institute of Museum and Library Services (IMLS)
Catalog Number From Catalog of Federal Domestic Assistance (CFDA) #: 45.310
IMLS FAIN: LS -00-17-0005-17 IMLS Federal Award Date: 01/18/17 (partial award)
06/13/17 (remaining award)
IMLS Total Amount of the Federal Award and Obligated by this action: $15,178,758
APPROVED
BUDGET CATEGORY BUDGET
SALARIES
$55,000
CONSULTANT FEES
TRAVEL
$400
SUPPLIES/MATERIALS
$6,000
EQUIPMENT
SERVICES
INDIRECT COSTS
$4,400
TOTAL $65,800
ATTENTION
ATTACHED IS THE CLAIM FOR PAYMENT AND THE LSTA CERTIFICATION. THESE
TWO FORMS MUST BE COMPLETED, SIGNED (WITH ORIGINAL SIGNATURES),
AND RETURNED TO:
CALIFORNIA STATE LIBRARY
FISCAL OFFICE - LSTA
P.O. BOX 942837
SACRAMENTO, CA 94237-0001
THESE FORMS MUST BE SUBMITTED AS SOON AS POSSIBLE TO AVOID DELAY IN
RECEIVING FUNDS. YOU SHOULD RETAIN COPIES OF THE CLAIM AND THE
CERTIFICATION FOR YOUR FILES. THESE ARE THE ONLY DOCUMENTS THAT
NEED TO BE RETURNED AT THIS TIME.
THANK YOU.
Attachments
CALIFORNIA STATE LIBRARY40-8787-0
Libraryi Technology
FINANCIAL CLAIM
IST i -T x1,9
FY: 17/18
FAIN: LS -00-17-0005-17
ITEM NO: 6120-211-0890, Chapter 14, Statutes of 2017
PURCHASING AUTHORITY NUMBER: CSL -6120
REPORTING STRUCTURE: 61202000
COA: 5432000
PROGRAM #: 5312
SCHEDULE NO:
SCHEDULE DATE:
Claim of: Santa Ana Public Library
Address: 20 flvIG C„ }e,- l'l z—.
For: Santa Ana Public Library
(Name of System or Agency)
DATE: (! — iv,/- % 7
FX 23 , C.✓1 k. fine,/ 1.A {)74';/
Project Title: Youth Know: Community Social Innovation Project
' • -• $29,610 Grant Award •- 40-8 787
For Period From: upon execution to end of grant period
Type of Payment PROGRESS FINAL IN FULL
Payable Upon Execution of Agreement 7/1/2017
CERTIFICATION
I hereby certify under penalty of perjury: that I am the duly authorized
representative of the claimant herein; that this claim is in all respects true,
correct and in accordance with law and the terms of the agreement; and that
payment has not previously been received for the amount claimed herein.
pyTyw +pw /} /�'J f/ 7o-
------�uthorized
by�
.Cynthia z it (Signature of the representative)
Interim City Manager MARIA L7.HUIZAR
CLERK OF THE COUNCIL
--{T Cj Z1L'rl� l`f -zi---------------
State of California, State Library Fiscal Officen�Nrrs�<tj
by date
(State Library representative)
MAIL ONE ORIGINAL SIGNATURE TO:
P.O.California State Lib ry
Fiscal Office — LSTA
Box 942837
Sacramento, CA 94237-001
LSTA GRANT AWARD # 40-8787
Project Title: Youth Know: Community Social Innovation Project
System/Agency: Santa Ana Public Library
PLEASE COMPLETE AND RETURN THIS PAGE
CERTIFICATION
I certify that I am the legally designated representative for this award and am authorized to
receive and expend funds for the conduct of this program.
I certify that all information provided to the California State Library for review in association
with this award is and will be correct and complete to the best of my knowledge; that as
the authorized representative of the grant award, I have the legal authority to commit my
organization to the conditions of this award.
III. 1 certify that any or all other subrecipients participating in the program have agreed to the
terms of the application/grant award, and have entered into an agreement{s} concerning
the final disposition of equipment, facilities, and materials purchased for this program from
the funds awarded for the activities and services described in the attached, as approved
and/or as amended in the applicats1,
SIGNED ` `,e c S' DATE
Authorized re resentative
aY6 Za �� / M44eT- te't�rsu� -,1 1404), -OW
Type or print name and Otte of authorized representative
E-mail address of authorized representative
This form, with signature, must be
returned to:
California State Library
Fiscal Office — LSTA
P.O. Office 942837
Sacramento, CA 94237-0001
CALIFORNIA STATE LIBRARY
Library Services and Technology Act
FINANCIAL CLAIM
IST PAYMENT
FY: 17/18
FAIN: LS -00-17-0005-17
ITEM NO: 6120-211-0890, Chapter 14, Statutes of 2017
PURCHASING AUTHORITY NUMBER: CSL -6120
REPORTING STRUCTURE: 61202000
COA: 5432000
PROGRAM #: 5312
SCHEDULE NO:
SCHEDULE DATE:
Claim of: Santa Ana Public Library
Address: 2C C, •� C �ntr,- t'l<
For: Santa Ana Public Library
(Name of System or Agency)
INVOICE #: 40.8787-001
T, 0 6 -)
DATE: r
1/-1 7
C +fi yHc,ll ��m ,y
Project Title: Youth Know: Community Social Innovation Project
Amount Claimed: $29,610 Grant Award Number
For Period From: upon execution to end of grant period
Type of Payment PROGRESS FINAL IN FULL
Payable Upon Execution of Agreement 7/1/2017
CERTIFICATION
F� 76/) /
I hereby certify under penalty of perjury: that I am the duly authorized
representative of the claimant herein; that this claim is in all respects true,
correct and in accordance with law and the terms of the agreement; and that
payment has not previously been received for the amount claimed herein.
(Signature of the4authorized representative)
-----------------------------------------------------
----------------------------------- - --- --- ----- ----------------
State of California, State Library Fiscal Officenr?�rea<I�/
bydate
(Stat Li racy re rese e)
MAIL ONE ORIGINAL SIGNATURE TO:
California State Library
Fiscal Office — LSTA
P.O. Box 942837
Sacramento, CA 94237-0001