HomeMy WebLinkAbout(0013) Fully Executed_TIM ILA_Fort Worth_TRN6662 (3).pdfDocuSign Envelope ID: 08E541A8-7B86-4091-900B-888511EED21C
NORTH CENTRAL TEXAS COUNCIL OF GOVERNMENTS
TRAFFIC INCIDENT MANAGEMENT PROGRAM
Program Implementation
AGREEMENT COVER SHEET
TYPE OF AGREEMENT: Subrecipient agreement for reimbursable activities to City of Fort Worth
(DUNS #782003727)
FEDERAL AWARD IDENTIFICATION NUMBER (FAIN): 693JJ2193000OZ400TX2020420
FEDERAL AWARD PERFORMANCE PERIOD: September 24, 2019 through August 31, 2022
FUNDING SOURCE: FHWA Congestion Mitigation and Air Quality (CMAQ) Improvement Program
Funds
ASSISTANCE LISTING NAME & NUMBER: Highway Planning & Construction 20.205
AWARD AMOUNT: $152,479 ($107,500 TO THE CITY + $44,979 TO THE POLICE DEPARTMENT)
AGREEMENT PERIOD: Date of final execution through June 30, 2022
North Central Texas Council of Governments
616 Six Flags Drive
Centerpoint II
Arlington, Texas 76011
City of Fort Worth
200 Texas Street
Fort Worth, Texas
Texas Department of Transportation
4777 East Highway 80
Mesquite, Texas 75150-6643
Project Manager:
Camille Fountain
Transportation Planner 111
cfountain(a)_nctcog. orq
817-704-2521
Project Manager:
Keith Morris
Grants Manager
Keith. morris(a)fortworthtexas. gov
817-392-4243
Project Manager:
Christopher Blain
Transportation Systems Management and
Operations
Christopher. blain(a)_ txdot. go v
DocuSign Envelope ID: 08E541A8-7B86-4091-900B-888511EED21C
INTERLOCAL COOPERATION AGREEMENT
Between
THE NORTH CENTRAL TEXAS COUNCIL OF GOVERNMENTS
and
CITY OF FORT WORTH
for
IMPLEMENTATION OF TRAFFIC INCIDENT MANAGEMENT PROGRAM
WHEREAS, the North Central Texas Council of Governments (NCTCOG) has been designated as the
Metropolitan Planning Organization for the Dallas -Fort Worth Metropolitan Area by the Governor of Texas
in accordance with federal law; and,
WHEREAS, the Regional Transportation Council (RTC), comprised primarily of local elected officials, is
the regional transportation policy body associated with NCTCOG and has been and continues to be a
forum for cooperative decisions on transportation; and,
WHEREAS, the RTC is committed to the development and implementation of policies, projects, and
programs to improve air quality and reduce emissions; and,
WHEREAS, on May 10, 2018, the RTC approved funding for implementation of the Traffic Incident
Management Program; and,
WHEREAS, on November 14, 2019, the RTC approved the criteria for the competitive selection of
participants in the Incident Management Equipment Purchase Call for Projects; and,
WHEREAS, on July 9, 2020, the RTC approved the funding awards in the Traffic Incident Management
Program; and,
WHEREAS, on July 23, 2020, the Executive Board in its capacity as the RTC's fiduciary agent, authorized
NCTCOG to enter into agreements with the City of Fort Worth as part of the Traffic Incident Management
Program; and,
WHEREAS, the North Central Texas Council of Governments selected the City of Fort Worth as part of
the Traffic Incident Management Program; and,
WHEREAS, the Interlocal Cooperation Act, Chapter 791 of the Texas Government Code, provides
authority for the North Central Texas Council of Governments and LOCAL GOVERNMENTs to enter into
this agreement for the provision of governmental functions and services of mutual interest.
NOW, THEREFORE, for and in consideration of the mutual covenants and conditions contained herein,
the parties agree as follows:
ARTICLE 1. PARTIES
1.1 Parties. This Agreement, hereinafter referred to as the "Agreement", is made and entered
into by and between the North Central Texas Council of Governments, hereinafter referred
to as "NCTCOG", and the City of Fort Worth, hereinafter referred to as "LOCAL
GOVERNMENT". NCTCOG and LOCAL GOVERNMENT may each be referred to as a
"Party" and may be collectively referred to as "Parties" to this Agreement.
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Traffic Incident Management Program
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ARTICLE 2. FUNDING
2.1. Award Amount. NCTCOG will reimburse LOCAL GOVERNMENT'S eligible costs as
outlined in the Scope of Work (SCOPE) under the conditions in this Agreement not to
exceed the Maximum Award Amount of one hundred fifty two thousand four hundred
seventy nine dollars ($152,479). The actual amount of reimbursement may be less than
the Maximum Award Amount and will be determined under the conditions of this Agreement.
LOCAL GOVERNMENT shall be responsible for any costs in excess of the Maximum Award
Amount.
2.2. Source of Funds. The source of funds for this Agreement is United States Department of
Transportation Congestion Mitigation and Air Quality Improvement (CMAQ) Program funds,
hereinafter referred to as "Funding Program". LOCAL GOVERNMENT agrees to comply
with any and all requirements associated with the Funding Program. NCTCOG and the
Texas Department of Transportation (TxDOT) executed an Agreement on August 29, 2019,
for two million, seven hundred thirty-seven thousand, nine hundred ninety-nine dollars
($2,737,999) to support Traffic Incident Management activities.
2.3. Indirect Costs. Indirect costs are ineligible under this Agreement.
2.4. Compliance. All activities funded, operated, and maintained under this Agreement must
be in compliance with the Uniform Administrative Requirements, Cost Principles and Audit
Requirements for Federal Awards, 2 Code of Federal Regulations (CFR) 200 and other
federal, State, and local law. Additionally, the LOCAL GOVERNMENT shall ensure
compliance with funding agency requirements set forth in Appendix F.
ARTICLE 3. SCOPE OF WORK
3.1 Scope of Work. NCTCOG will provide reimbursement to LOCAL GOVERNMENT for
LOCAL GOVERNMENT'S Improvements under this Agreement, implemented through the
Project, as more fully set out in the application submitted by the Local Government. The
Local Government's application is attached as Appendix A (the Project) and is incorporated
herein. If there is a conflict between this Agreement and the application, this Agreement
prevails.
3.2 Scope of Work Changes. Changes to the SCOPE must be agreed to by both Parties in
writing. LOCAL GOVERNMENT may move funds within Equipment/Technology Types
without need of NCTCOG approval so long as the Maximum Award Amount is not
exceeded, and all Equipment/Technology Type commitments are met as reflected in the
SCOPE. LOCAL GOVERNMENT shall provide written notice to NCTCOG's Project
Manager of any such adjustments as part of the reimbursement request.
3.3 LOCAL GOVERNMENT shall complete the SCOPE by June 30, 2022.
ARTICLE 4. TERM
4.1 Term. This Agreement shall take effect on the date executed by the Parties and shall
remain in effect until it is terminated. This Agreement shall automatically terminate upon
completion of the Project.
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4.2 Termination. Either Party reserves the right to terminate this Agreement in whole or in
part. Notice of termination must be provided in writing, shall set forth the reasons for
termination, and shall provide for a minimum of ten (10) days to cure the defect. Termination
is effective only in the event the Party fails to cure the defect within the period stated in the
termination notice including any written extensions. If the Agreement is terminated,
NCTCOG shall only be liable for eligible expenses incurred before the effective date of
termination. The Parties may terminate this Agreement at any time by mutual written
concurrence.
ARTICLE 5. REIMBURSEMENT AND REPORTING REQUIREMENTS
5.1 Payment. LOCAL GOVERNMENT will submit a single Request for Reimbursement upon
completion of all SCOPE items. Any reimbursement under this Agreement shall be payable
only after eligible costs are approved by NCTCOG. NCTCOG will approve payments as
soon as practicable, but not later than forty-five (45) days after a complete Request for
Reimbursement has been received, provided that complete and accurate supporting
documentation has been submitted to NCTCOG. Costs incurred prior to execution of this
Agreement are not be eligible for reimbursement. There shall be no obligation whatsoever
to pay for performance of this Agreement from the monies of NCTCOG, other than grant
funds received by NCTCOG from NCTCOG's funding agency for the purposes of
reimbursement under this Agreement. NCTCOG shall provide LOCAL GOVERNMENT
with written notice within five (5) business days after becoming aware that grant funds
received by NCTCOG from NCTCOG's funding agency for the purposes of reimbursement
under this agreement are no longer available for reimbursement to LOCAL GOVERNMENT.
5.2 Reimbursement. LOCAL GOVERNMENT shall submit its Reimbursement Request to
NCTCOG at TRGrants@nctcog.org. Requests for Reimbursement shall be submitted
utilizing the template provided in Appendix I. Reimbursement Request shall be printed on
letterhead and include proof of payment, applicable receipts, a signature by a certifying
official as detailed in Article 5.3, and other supporting documentation. NCTCOG may deem
a Request for Reimbursement incomplete if the data and/or documentation are incomplete
or improper, or if the LOCAL GOVERNMENT fails to submit necessary reports or provide
other information requested by NCTCOG under the terms of this Agreement. NCTCOG
may reject requests for reimbursements which fail to demonstrate that costs are eligible for
reimbursement and/or which fail to conform to the requirements of this Agreement.
5.3 Certifying Official. As detailed in Article 5.2, the LOCAL GOVERNMENT is required to
provide signed invoices. The individual noted below has the authority, on behalf of the
LOCAL GOVERNMENT, to certify and serve as the signatory on invoices related to this
project. By signing the invoice, Certifying Officials are acknowledging review of invoices to
ensure expenses included in the invoice are consistent with the agreement, all services and
costs are documented on the invoices are accurate and eligible, and all subrecipients and
contractors have been fully paid. Any invoices received by NCTCOG without the signature
of the individual noted below may result in the invoice being returned unpaid.
Certifying Official:
Name: Edwin Kraus
Title: Chief of Police
5.4 Eligible Expenses. Costs incurred by the LOCAL GOVERNMENT prior to final execution
of this Agreement are not eligible for reimbursement. NCTCOG may reject requests for
reimbursement which fail to demonstrate that costs are eligible for reimbursement and/or
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which fail to conform to the requirements of this Agreement. Eligible and allowable
expenses are limited to costs determined by NCTCOG in its sole discretion as eligible costs
necessary to complete the Project and consistent with cost principles established in 2 CFR
200, Subpart E.
5.5 Availability of Funds. Any reimbursement under this Agreement shall be payable only
after eligible costs are approved by NCTCOG. This Agreement and all claims, suits, or
obligations arising under or related to this Agreement are subject to and limited to the receipt
and availability of funds which are received from the funding agency by NCTCOG dedicated
for the purpose of this Agreement.
5.6 Return of Funds. The LOCAL GOVERNMENT agrees to return funds received from
NCTCOG for reimbursement under this Agreement where the LOCAL GOVERNMENT has
failed to comply with the requirements set forth in this Agreement.
5.7 Annual Usage Reporting. The LOCAL GOVERNMENT agrees to submit Annual Usage
Reports to NCTCOG utilizing the form provided in Appendix B. Annual Usage Reports
should be provided to NCTCOG no later than January 31 of each year.
ARTICLE 6. PROCUREMENT AND PROPERTY MANAGEMENT
6.1 Procurement Standards. LOCAL GOVERNMENT agrees that its purchase of
equipment/technology under this Agreement will comply with the procurement standards
and requirements 2 CFR Part 200.316-.327 and any state law requirements applicable to
the LOCAL GOVERNMENT. LOCAL GOVERNMENT shall ensure that contract clauses in
Article 11 of this Agreement shall be included in all solicitations and resulting contracts for
the purchase of equipment/technology under this Agreement. LOCAL GOVERNMENT
shall use the following procurement methods for the purchase of items under this
Agreement in the following order of preference:
a. The use of purchase cooperative contract that meets the requirements of 2 CFR
200.316-.327. LOCAL GOVERNMENT may use a federally compliant purchase
cooperative contract identified by NCTCOG or a purchase cooperative contract
the LOCAL GOVERNMENT has determined meets the requirements of 2 CFR
200.316-327. NCTCOG preapproval is not required; or
b. Only if no federally compliant purchase cooperative contract is available, LOCAL
GOVERNMENT may conduct its own federally compliant procurement which
must meet the specific requirements set forth in 2 CFR 200.316-.327; NCTCOG
preapproval is not required.
c. LOCAL GOVERNMENT must obtain NCTCOG prior written approval for any
sole source and/or non-competitive purchase.
If LOCAL GOVERNMENT fails to meet the requirements as described above, NCTCOG
may deny reimbursement requests. If such failure is determined after reimbursement has
been made, LOCAL GOVERNMENT agrees to return reimbursed funds that were not in
compliance with these requirements, whether determined by NCTCOG, the State, or the
United States Department of Transportation or its agents. The LOCAL GOVERNMENT'S
Purchasing Manager or other equivalent position and/or personnel with oversight of the
LOCAL GOVERNMENT'S purchasing functions shall acknowledge the requirements of this
Article 6.1 by execution of Appendix H attached hereto.
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6.2 Equipment Use, Management, and Disposition. LOCAL GOVERNMENT agrees that its
purchase of equipment/technology under this Agreement will comply with the property
management standards and requirements outlined by the United States Department of
Transportation in 2 CFR 200.312. The LOCAL GOVERNMENT agrees to provide NCTCOG
reasonable information concerning the use and condition of the equipment upon request.
ARTICLE 7. MODIFICATION, WAIVER, AND SEVERABILITY
7.1 Whole Agreement. This Agreement embodies all of the agreements of the parties relating
to its subject matter and supersedes all prior understandings and agreements regarding
such subject matter.
7.2 Severability. In the event any one or more of the provisions contained in this Agreement
shall be for any reason held to be invalid, illegal, or unenforceable in any respect, such
invalidity, illegality, or unenforceability shall not affect any other provision(s) hereof, and this
Agreement shall be revised so as to cure such invalid, illegal, or unenforceable provision(s)
to carry out as near as possible the original intent of the Parties.
7.3 Changed Circumstances. If future federal, State, or local statute, ordinance, regulation,
rule, or action render this Agreement, in whole or in part, illegal, invalid, unenforceable, or
impractical, the parties agree to delete and/or to modify such portions of the Agreement as
are necessary to render it valid, enforceable, and/or practical. Each section, paragraph, or
provision of this Agreement shall be considered severable, and if, for any reason, any
section, paragraph, or provision herein is determined to be invalid under current or future
law, regulation, or rule, such invalidity shall not impair the operation of or otherwise affect
the valid portions of this instrument.
7.4 Assignment. Without the prior written consent of NCTCOG, the LOCAL GOVERNMENT
may not transfer or assign any rights or duties under or any interest in this Agreement.
7.5 Amendments. Amendments to this Agreement must be agreed to in writing signed by each
Party.
ARTICLE 8. MISCELLANEOUS PROVISIONS
8.1 Liability. The Parties agree that neither party is an agent, servant, employee of the other
party and each party agrees it is responsible for its individual acts and deeds, as well as the
acts and deeds of its contractors, employees, representatives, and agents.
8.2 Force Majeure. It is expressly understood and agreed by the parties to this Agreement
that, if the performance of any provision of this Agreement is delayed by force majeure,
defined as reason of war, civil commotion, act of God, governmental restriction, regulation
or interference, fire, explosion, hurricane, flood, failure of transportation, court injunction, or
any circumstances which are reasonably beyond the control of the party obligated or
permitted under the terms of this Agreement to do or perform the same, regardless of
whether any such circumstance is similar to any of those enumerated herein, the party so
obligated or permitted shall be excused from doing or performing the same during such
period of delay, so that the period of time applicable to such requirement shall be extended
for a period of time equal to the period of time such party was delayed. Each party must
inform the other in writing within reasonable time of the existence of such force majeure.
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8.3 Property Insurance. The LOCAL GOVERNMENT must maintain sufficient property
insurance or self-insurance for the repair or replacement of any equipment/technology
funded under this Agreement, unless otherwise expressly agreed upon in writing by
NCTCOG.
8.4 Captions. The captions, headings, and arrangements used in this Agreement are for
convenience only and shall not in any way affect, limit, amplify, or modify its terms and
provisions.
8.5 Disputes and Remedies. The LOCAL GOVERNMENT and NCTCOG shall negotiate in
good faith toward resolving any disputes that arise under this Agreement. This agreement
does not limit any remedy or right under law available to a Party to enforce the terms herein.
8.6 Notice. All notices regarding this Agreement shall be in writing and shall be delivered to
the persons identified below:
NCTCOG
Mailing Address:
Michael Morris, P.E.,
Transportation Director
North Central Texas Council of Governments
616 Six Flags Dr, CenterPoint II
Arlington, Texas 76011
NCTCOG Project Manager
Camille Fountain
Transportation Planner III
North Central Texas Council of Governments
616 Six Flags Dr, CenterPoint II
Arlington, Texas 76011
LOCAL GOVERNMENT
Project Manager:
Keith Morris
Grants Manager
200 Texas Street
Fort Worth, Texas 76102
8.7 Governing Law and Venue. This Agreement shall be governed by and construed in
accordance with the laws of the State of Texas. The mandatory and exclusive venue for
the adjudication or resolution of any dispute arising out of this Agreement shall be in
Tarrant County, Texas.
8.8 Regional ITS Memorandum of Understanding. LOCAL GOVERNMENT agrees to
exercise reasonable, good faith efforts to review, comment on and finalize with NCTCOG
a Memorandum of Understanding Between Dallas -Fort Worth Regional Intelligent
Transportation System Partners Concerning Guiding Principles for Multi -Agency
Communication, Data and Video Sharing.
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NCTCOG and City of Fort Worth — TRN6662
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ARTICLE 9. ACCESSIBILITY AND MAINTENANCE OF RECORDS
9.1 Maintenance. The LOCAL GOVERNMENT shall maintain a record keeping system for all
of its activities, including program records and financial management records, which support
and document all expenditures of funds made under this Agreement, in accordance with
federal regulations, state rules, and the Agreement. This section shall not be interpreted to
require maintenance of multiple exact duplicate copies of any record or document.
9.2 Retention. All records must be maintained for a minimum of four (4) years following final
reimbursement. In the event that any litigation or claim is still pending, these records shall
be retained until resolution of the litigation or claim. NCTCOG, NCTCOG's funding agency,
or their designees shall have access to all records that are directly applicable to this
Agreement for the purpose of making audit examinations.
ARTICLE 10. AUDITS
10.1 Audits. LOCAL GOVERNMENT agrees that NCTCOG, the State of Texas, and/or the
Federal Government may conduct an audit, or investigation, and/or site visits related to
funds received under this Agreement.
10.2 Single Audit Act. As applicable, the PERFORMING PARTY shall comply with the
requirements of the audit provisions of 2 CFR Part 200, Subpart F, which requires that a
non -Federal entity that expends $750,000 or more during the non-federal entity's fiscal year
in federal awards must have a single or program -specific audit conducted for that year.
ARTICLE 11. REQUIRED CLAUSES AND ASSURANCES
11.1 Equal Employment Opportunity. LOCAL GOVERNMENT shall not discriminate against
any employee or applicant for employment because of race, religion, color, sex, sexual
orientation, gender identity, or national origin. LOCAL GOVERNMENT shall take affirmative
actions to ensure that applicants are employed, and that employees are treated, during their
employment, without regard to their race, religion, color, sex, sexual orientation, gender
identity or national origin. Such actions shall include, but not be limited to, the following:
employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff
or termination; rates of pay or other forms of compensation; and selection for training,
including apprenticeship.
11.2 Davis -Bacon Act. LOCAL GOVERNMENT agrees to comply with all applicable provisions
of 40 USC §3141 — 3148.
11.3 Contract Work Hours and Selection Standards. LOCAL GOVERNMENT agrees to
comply with all applicable provisions of 40 USC §3701 — 3708 to the extent this agreement
indicates any employment of mechanics or laborers.
11.4 Rights to Invention Made Under Contract or Agreement. LOCAL GOVERNMENT
agrees to comply with all applicable provisions of 37 CFR Part 401.
11.5 Clean Air Act, Federal Water Pollution Control Act, and Energy Policy Conservation
Act. LOCAL GOVERNMENT agrees to comply with all applicable provisions of the Clean
Air Act under 42 USC §7401 — 7671, the Energy Federal Water Pollution Control Act 33
USC §1251 — 1387, and the Energy Policy Conservation Act under 42 USC §6201.
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11.6 Debarment/Suspension. LOCAL GOVERNMENT is prohibited from making any award or
permitting any award at any tier to any party which is debarred or suspended or otherwise
excluded from or ineligible for participation in federal assistance programs under Executive
Order 12549, Debarment and Suspension. LOCAL GOVERNMENT and its subcontractors
shall comply with the special provision "Certification Requirements for Recipients of Grants
and Cooperative Agreements Regarding Debarments and Suspensions" which is included
as Appendix C of this agreement.
11.7 Restrictions on Lobbying. LOCAL GOVERNMENT is prohibited from using monies for
lobbying purposes; LOCAL GOVERNMENT shall comply with the special provision
"Restrictions on Lobbying," which is included as Appendix D of this Agreement. LOCAL
GOVERNMENT shall include a statement of compliance with the Lobbying Certification and
Disclosure of Lobbying Activities in applicable procurement solicitations. Lobbying
Certification and Disclosure of Lobbying Activities shall be completed by subcontractors and
included in subcontractor contracts, as applicable.
11.8 Procurement of Recovered Materials. LOCAL GOVERNMENT agrees to comply with all
applicable provisions of 2 CFR §200.322.
11.9 Prohibition on Certain Telecommunications and Video Surveillance Services or
Equipment. Pursuant to Public Law 115-232, Section 889, and 2 CFR Part 200, including
§200.216 and §200.471, NCTCOG is prohibited from using federal funds to procure,
contract with entities who use, or extend contracts with entities who use certain
telecommunications and video surveillance equipment or services provided by certain
Chinese controlled entities. The Subrecipient agrees that it is not providing NCTCOG with
or using telecommunications or video surveillance equipment and services as prohibited by
2 CFR §200.216 and §200.471. Subrecipient shall certify its compliance through execution
of the "Prohibited Telecommunications and Video Surveillance Services or Equipment
Certification" which is included as Appendix G of this Agreement. The Subrecipient shall
pass these requirements down to any of its contractors funded under this Agreement. The
Subrecipient shall notify NCTCOG if the Subrecipient cannot comply with the prohibition
during the performance of this Agreement.
11.10 Buy America. The LOCAL GOVERNMENT agrees to comply with all Buy America
requirements under 23 USC 313 and 23 CFR 635.410, which require a domestic
manufacturing process for any steel or iron products. The LOCAL GOVERNMENT must
provide a Buy America Certification, example Certification document attached as
Appendix E, completed by the equipment manufacturer or demonstrate that the Federal
Highway Administration has granted a waiver of the Buy America requirements.
11.11 Disadvantaged Business Enterprises (DBE). The LOCAL GOVERNMENT shall not
discriminate on the basis of race, color, national origin, or sex in the performance of this
contract. The contractor shall carry out applicable requirements of 49 CFR Part 26 and
2 CFR 200.320 in the award and administration of United States Department of
Transportation -assisted contracts. Failure by the contractor to carry out these requirements
is a material breach of this agreement, which may result in the termination of this agreement
or such other remedy as the recipient deems appropriate.
11.12 Internal Compliance Program. NCTCOG has adopted an Internal Compliance Program
to prevent waste, fraud, or abuse. Contractors, agents, and volunteers can report suspected
waste, fraud, or abuse at: https://www.nctcog.org/agency-administration/compliance-portal.
Additional information regarding the Internal Compliance Program is available at the
previous web address.
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11.13 Domestic Preference. As appropriate and to the extent consistent with law, the LOCAL
GOVERNMENT should, to the greatest extent practicable, provide a preference for the
purchase, acquisition, or use of goods, products, or materials produced in the United States
(including but not limited to iron, aluminum, steel, cement, and other manufactured
products). Consistent with §200.322, the following items shall be defined as: "Produced in
the United States" means, for iron and steel products, that all manufacturing processes,
from the initial melting stage through the application of coatings, occurred in the United
States. "Manufactured products" means items and construction materials composed in
whole or in part of non-ferrous metals such as aluminum; plastics and polymer -based
products such as polyvinyl chloride pipe; aggregates such as concrete; glass, including
optical fiber; and lumber.
APPENDICES
The following appendices are attached and made part of this Agreement.
Appendix A: Call for Projects Application & Scope of Work
Appendix B: Annual Performance Usage Survey
Appendix C: Lower Tier Participant Debarment Certification
Appendix D: Lobbying Certification and Disclosure of Lobbying Activities
Appendix E: Buy America Certification
Appendix F: TxDOT Flow Down Provisions
Appendix G: Prohibited Telecommunications and Video Surveillance Services or Equipment
Certification
Appendix H: Federal Procurement Requirements Acknowledgement
Appendix I: Reimbursement Request Form
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IN WITNESS HEREOF, the parties have executed this Agreement. This Agreement is effective on the
day the last Party signs.
NORTH CENTRAL TEXAS COUNCIL OF GOVERNMENTS
rDocuSigned by:
l i(,�,at,�, fu S�{ alp
aa€
Mike Eastland
Executive Director
CITY OF FORT WORTH
r�,
ocuSigned by:
YA M h, , b�SbVG
€&D4G ...
William M. Johnson
TPW Director
Interlocal Cooperation Agreement
NCTCOG and City of Fort Worth — TRN6662
Traffic Incident Management Program
7/6/2021
Date
7/6/2021
Date
Page 11
DocuSign Envelope ID: 08E541A8-7B86-4091-900B-888511EED21C
APPENDIX A
CALL FOR PROJECTS APPLICATION & SCOPE OF WORK
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INCIDENT MANAGEMENT EQUIPMENT PURCHASE 2020 CALL FOR PROJECTS
0 North Central Texas Council of Governments
Incident Management Equipment Purchase CFP ILA SCOPE OF WORK TEMPLATE
1. AGENCY NAME City of Fork Worth
2. PROJECT NAME: purchase Equipments for Incident Management Throughout the City
3. TOTAL PROJECT AMOUNT AWARDED: 1$107,500
4. SCOPE ITEMS
LOCAL GOVERNMENT has been awarded funds to purchase the following incident
management equipmenUtechnologies in the Quantities and Amounts shown below. LOCAL
GOVERNMENT shall acquire and utilize the fallowing equipment+technologies consistent with
the terms of the agreement.
EquipmentlTechnology Type
(e.g., traffic control equipment, responder
safety gear. dynamic message board, etc.)
Estirinated
quantity
(Included in
Application)
Award
Amount
Product
Service Life
(Specific to
Each Product)
Pan -Till -Zoom -Cameras
4
$107, 00
6-10 years
2
3
4
5
G
7
s
9
10
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DocuSign Envelope ID: 08E541A8-7B86-4091-900B-888511EED21C
INCIDENT MANAGEMENT ECUIPMENT PURCHASE 2D2D CALL FOR PROJECTS
izNorth Central Texas (=:ouncil of Governments
Incident Management Equipment Purchase CFP ILA SCOPE OF WORK TEMPLATE
1. AGENCY NAME F0I1 �Mprth Police Department
2. PROJECT NAME: FF PV TrLiffic Incident P.'lonogement
3. TOTAL PROJECT AMOUNT AWARDED: I 4a97
4. SCOPE ITEMS
LOCAL GOVERNMENT has been awarded funds to purchase the following incident
management equipmenUtechnologies in the Quantities and Amounts shown below. LOCAL
GOVERNMENT shall acquire and utilize the following equipment+technologies consistent with
the terms of the agreement.
EquipmentlTechnology Type
(e.g,, traffic control equipment, responder
safety gear, dynamic message board, etc.)
Estimated
Quantity
(Incl4lded in
Application)
Award
Amount
Product
Service Life
(Specific to
Each Productl
1
4)1x20' Recovery Strap
1
1 .70
5 gears
2
Bumper Hitch for 2017 F150
5
$1..422.95
10 gears
3
Multi —Ball Mount Wfhook and „ shank
1
927. 0
10 years
4
Portable Compressor
10
$1,59.90
3 gears
-Ton Troller Jack lit
8
$519.92
5 years
6
.-Ton Floor Jack
2
S499.98
5 gears
7
Lug Wrench
10
S249.90
10 years
8
Battery Booster Cable
10
S849.90
5 gears
Traffic Coney
1 500
$6,150
7 years
10
High Visibility Jacket for Motor Unit
33
1 1,352
years
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Traffic Incident Management Program
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E q u i pm enlUTech n o log y Type
(e.g.. traffic control equipment, responder
safety gear. dynamic message board, etc.)
Estimated
Quantity
(Included in
Application)
Award
Amount
Product
Service Life
[Specific to
Each Product
11
Water Shed Storm Force Bravo Pants
33
$87349
5 years
12
Tactical Flashlight
22
$2..331.78
3 years
13
Rain Pants for ,abandoned Vehicle
1
949.90
{area r
14
Rain Pants for Traffic Enforcement
1
99
5 years
15
Rain Boots
27112
4 years
16
Storm Traffic Gloves for Abandoned Vehicle
22
$725.78
3 yea r
17
1 mpact Recsistarrt Gloves for Traffic Enforcement
22
$769.78
yea r
18
High Visibility Jacket for Traffic Enforcement
2
5..0
5 years
19
20
21
22
23
24
25
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APPENDIX B
ANNUAL PERFORMANCE USAGE SURVEY
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INCIDENT MANAGEMENT EQUIPMENT PURCHASE 2020 CALL FOR PROJECTS
North Central Texas Council of Governments
Annual Performance and Usage Survey
As a selected recipient through the NCTCOG Incident Management Equipment Purchase 2020 Call for Projects, your
agency received funding to be used for the purchase of equipment and technology that aid in quick incident clearance and
crash mitigation in the North Central Texas (NCT) Nanattainment Area. Included as a stipulation to receive the funds,
recipient agencies are reauired to complete an annual performance and usage survey reaardina the use of the
equipment. Recipient agencies agree to utilize the eguipmentitechnology purchased or it must be returned to
NCTCOG. Please submit your completed survey (via Microsoft Forms link sent to your email address), and
requested performance measures to Camille Fountain at cfountainli_nctcoq.org by January 31 annually,
AGENCY NAME
PROJECT NAME
PRODUCT SERVICE LIFE
EXPECTANCY
IS YOUR AGENCY STILL
UTILIZING THE EQUIPMENT?
Specify Items Purchased as part of the CFP
(if multiple items purchased, include one
roject perfine item)
Specify the product service
rife at initial purchase and
Erne remaonong.
(Y!N)
1
Yes ❑ No ❑ If No, explain below
2
Yes ❑ No ❑ If No, explain belov.
3
Yes ❑ No ❑ If No, explain belov.
T
Yes ❑ No ❑ If No, explain below
5
Yes ❑ No ❑ If No, explain below
G
Yes ❑ No ❑ If No, explain below
7
Yes ❑ No ❑ If No, explain below
8
Yes ❑ No ❑ If No, explain below
{1
Yes ❑ No ❑ If No, explain below
1
Yes ❑ No ❑ If No, explain below
Supplemental Information:
1 _ Has the equipmenthechnology purchased meet your agency's expectations needs? Yes ❑ No ❑ If No, please explain
(onclude project name and provide detaitsjl
2_ If your agency is NOT util¢ing the equipmentftechnology purchased through the NCTCOG Incident Management Call
for Projects, please explain why_ Include project name and provide details for each product not in use_
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APPENDIX C
LOWER TIER PARTICIPANT DEBARMENT CERTIFICATION
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APPENDIX C
CERTIFICATION REQUIREMENTS FOR RECIPIENTS OF GRANTS
AND COOPERATIVE AGREEMENTS REGARDING
DEBARMENT AND SUSPENSIONS
Department of Transportation (DOT) Circular 2015.1 excludes entities and individuals that the federal
government has either debarred or suspended from obtaining federal assistance funds through grants,
cooperative agreements, or third -party contracts. NCTCOG has elected to include the requirements of the
DOT Circular 2015.1 in all third -party contracts for federal funds. A certification process has been
established by 49 CFR Part 29 as a means to ensure that debarred, suspended, or voluntarily excluded
persons do not participate in a federally assisted project. The inability of a person to provide the required
certification will not necessarily result in a denial of participation in a covered transaction. A person that is
unable to provide a positive certification as set forth in the Circular may submit a complete explanation
attached to the certification. DOT will consider the certification and any accompanying explanation in
determining whether or not to provide assistance for the project. Failure to furnish a certification or any
explanation may disqualify that person from participating in the project.
Each potential third -party contractor, subcontractor under a third -party contract, subgrantee, or
subrecipient must provide to the grantee or recipient of a cooperative agreement, as appropriate, a
certification for a lower -tier participant. In general, lower -level employees or procurements of less than
$25,000 will not be covered by the certification process procedures, except in the case of procurements
with individuals that would have a critical influence on or substantive control over the project; nevertheless,
a participant is not authorized to involve a lower -level employee or enter into a contract of less than $25,000
with a person actually known by the participant to be debarred, suspended or voluntarily excluded.
NCTCOG requires each potential contractor subgrantee, or subrecipient for a third -party contract
to complete the certification in Appendix C.2 for itself and its principals.
If an applicant for a grant or cooperative agreement or a potential contractor for a third -party contract
knowingly enters into a lower -tier covered transaction such as a third -party contract or subcontract under
a major third -party contract or subgrant with a person that is suspended, debarred, ineligible, or voluntarily
excluded from participation in the project, in addition to other remedies available to the federal government,
DOT may terminate the grant or subcontract, the underlying grant or cooperative agreement for cause or
default.
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APPENDIX C.1
CERTIFICATION INFORMATION
This certification is to be used by contractors pursuant to 49 CFR 29 when any of the following occur:
any transaction between the contractor and a person (other than a procurement
contract for goods and services), regardless of type, under a primary covered
transaction.
• any procurement contract for goods or services when the estimated cost is $25,000
or more.
• any procurement contract for goods or services between the contractor and a person,
regardless of the amount, under which the person will have a critical influence on or
substantive control over that covered transaction. Such persons include principal
investigators and providers of federally required audit services.
A procurement transaction is the process of acquiring goods and services.
A nonprocurement transaction is the granting of financial assistance to entities to assist the grantor in
meeting objectives that are mutually beneficial to the grantee and grantor.
A COPY OF THIS CERTIFICATION IS TO BE FURNISHED TO AUTHORIZED REPRESENTATIVES OF
THE STATE OR THE UNITED STATES DEPARTMENT OF TRANSPORTATION UPON REQUEST.
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APPENDIX C.2
LOWER TIER PARTICIPANT DEBARMENT CERTIFICATION
William M. Johnson
being duly
(Name of certifying official)
sworn or under penalty of perjury under the laws of the United States, certifies that neither
City of Fort Worth
nor its principals
(Name of lower tier participant)
are presently:
• debarred, suspended, proposed for debarment,
• declared ineligible,
• or voluntarily excluded from participation in this transaction by any federal department or
agency.
Where the above identified lower -tier participant is unable to certify to any of the above statements
in this certification, such prospective participant shall indicate below to whom the exception applies,
the initiating agency, and dates of action.
Exceptions will not necessarily result in denial of award but will be considered in determining
contractor responsibility. Providing false information may result in criminal prosecution or
administrative sanctions.
EXCEPTIONS:
DoSigned by:
, Enncgup
b�Sbt&
aFasaFFnam
Signature of Certifying Official
TPW Director
Title
7/6/2021
Date of Certification
Form 1734
Rev.10-91
TPFS
Interlocal Cooperation Agreement
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APPENDIX D
LOBBYING CERTIFICATION
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APPENDIX D
LOBBYING CERTIFICATION
RESTRICTIONS ON LOBBYING
Section 319 of Public Law 101-121 prohibits recipients of federal contracts, grants, and loans exceeding
$100,000 at any tier under a federal contract from using appropriated funds for lobbying the Executive
or Legislative Branches of the federal government in connection with a specific contract, grant, or loan.
Section 319 also requires each person who requests or receives a federal contract or grant in excess
of $100,000 to disclose lobbying.
No appropriated funds may be expended by the recipient of a federal contract, loan, or cooperative
agreement to pay any person for influencing or attempting to influence an officer or employee of any
federal executive department or agency as well as any independent regulatory commission or
government corporation, a Member of Congress, an officer or employee of Congress, or an employee
of a Member of Congress in connection with any of the following covered federal actions: the awarding
of any federal contract, the making of any federal grant, the making of any federal loan the entering into
of any cooperative agreement and the extension, continuation, renewal, amendment, or modification of
any federal contract, grant, loan, or cooperative agreement.
As a recipient of a federal grant exceeding $100,000, NCTCOG requires its subcontractors of that grant
to file a certification, set for in Appendix D.1, that neither the agency nor its employees have made, or
will make, any payment prohibited by the preceding paragraph.
Subcontractors are also required to file with NCTCOG a disclosure form, set forth in Appendix C.1, if
the subcontractor or its employees have made or have agreed to make any payment using
nonappropriated funds (to include profits from any federal action), which would be prohibited if paid for
with appropriated funds.
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APPENDIX DA
LOBBYING CERTIFICATION
FOR CONTRACTS, GRANTS, LOANS, AND COOPERATIVE AGREEMENTS
The undersigned certifies to the best of his or her knowledge and belief, that:
(1) No federal appropriated funds have been paid or will be paid by or on behalf of the undersigned, to
any person for influencing or attempting to influence an officer or employee of any 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 any federal contract, the making of any federal grant, the making of
any federal loan, the entering into of any cooperative agreement, and the extension continuation,
renewal amendment, or modification of any federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress in connection with this
federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit
Standard Form - LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award
documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants,
loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making or
entering into this transaction imposed by Section 1352, Title 31, US Code. Any person who fails to file
the required certification shall be subject to a civil penalty of not less than $10,000 and not more than
$100,000 for each such failure.
DocuSigned by:
Signature
TPW Director
Title
City of Fort Worth
Agency
7/6/2021
Date
TxDOT
1-91
TPFS
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APPENDIX D.2
DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
(See instructions for public burden disclosure)
1. Type of Federal Action:
2. Status of Federal Action:
3. Report Type:
❑ a. contract
❑ a. bid/offer/application
❑ a. initial filing
b. grant
b. initial award
b. material charge
c. cooperative agreement
c. post -award
d. loan
For Material Change Only:
e. loan guarantee
year quarter
f. loan insurance
date of last report
4. Name and Address of Reporting Entity:
5. If Reporting Entity in No. 4 is Subawardee, Enter Name
[I Prime ❑ Tier if known
and Address of Prime:
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, MI):
different from No. 10a)
(last name, first name, MI):
(attach Continuation Sheet(s) SF-LLL-A, if necessary
11. Amount of Payment (check all that apply):
13. Type of Payment (check all that apply):
❑ a. retainer
$ ❑ actual ❑ planned
❑ b. one-time fee
❑ c. commission
❑ d. contingent fee
12. Form of payment (check all that apply):
❑ a. cash
❑ e. deferred
❑ b. in -kind specify: nature
❑ f. other; specify:
value
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 Sheets SF-LLL-A, if necessary)
15. Continuation sheet(s) SF-LLL-A attached: ❑
Yes ❑ No
16. Information requested through this form is authorized by title
31 U.S.C. section 1352. This disclosure of lobbying activities is
a material representation of fact upon which reliance was
Signature:
placed by the tier above when this transaction was made or
entered into. This disclosure is required pursuant to 31 U.S.C.
Print Name:
1352. This information will be reported to the Congress semi-
annually and will be available for public inspection. Any
Title:
person who fails to file the required disclosure shall be subject
to a civil penalty of not less than $10,000 and not more than
Telephone: Date:
$100,000 for each such failure.
Federal Use Only:
Authorized for Local Reproduction Standard Form - LLL
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INSTRUCTIONS FOR COMPLETION OF SF-LLL DISCLOSURE OF LOBBYING 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 Federal action, or a material change to a previous filing
pursuant to title 31 USC 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 employee of a Member of
Congress in connection with a covered Federal action. Use the SF-LLL-A 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 action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a follow-up 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 Federal 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
organizational level 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 Federal action identified in item
1 (e.g., Request for Proposal (RFP) number; invitation for Bid (B) number, grant announcement
number; the contract grant, or loan award number; the application/proposal control number assigned
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 40 to influence the covered Federal action.
(b) Enter the full names of the individuals(s) performing services and include full address if different
from 10(a). Enter Last Name, First Name and Middle Initial (MI).
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11. Enter the amount of compensation paid or reasonably expected to 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 appropriate box(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 boxes(s). Check all boxes that apply. If other, specify nature.
14. Provide a specific and detailed description 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 contract with Federal officials. Identify the Federal official(s) or
employee(s) contracted or the officer(s), employees, or Member(s) of Congress that were contacted.
15. Check whether or not a SF-LLL-A Continuation Sheet(s) is attached.
16. The certifying official shall sign and date the form, print his/her name, title, and the telephone
number.
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 of information, including suggestions for reducing this
burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington,
D.C. 20503.
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DISCLOSURE OF LOBBYING ACTIVITIES
CONTINUATION SHEET
Reporting Entity: Page of
Authorized for Local Reproduction
Standard Form - LLL-A
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APPENDIX E
BUY AMERICA CERTIFICATION
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BUY AMERICA CERTIFICATION
The undersigned certifies that the following equipment complies with the Federal Highway
Administration Buy America requirements under 23 CFR 635.410 requiring a domestic manufacturing
process for any steel or iron products (including protective coatings).
1.
2.
3.
4.
5.
To be considered domestic, all steel and iron used, and all products manufactured from steel and
iron must be produced in the United States and all manufacturing processes, including application of a
coating, for these materials must occur in the United States. Coating includes all processes which
protect or enhance the value of the material to which the coating is applied. This requirement does not
preclude minimal use of foreign steel, and iron materials that does not exceed one -tenth of one percent
of the total contract cost or $2,500, whichever is greater.
Name, Title
Date
Company
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BUY AMERICA CERTIFICATION
The undersigned cannot certify that the following equipment complies with the Federal Highway
Administration Buy America requirements under 23 CFR 635.410 requiring a domestic manufacturing
process for any steel or iron products (including protective coatings).
2.
3.
4.
5.
The Buy America certification cannot be made for the following reasons:
Name, Title
Date
Interlocal Cooperation Agreement
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Company
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APPENDIX F
TXDOT FLOW DOWN PROVISIONS
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FLOW DOWN PROVISIONS FROM
TEXAS DEPARTMENT OF TRANSPORTATION
FUNDING AGREEMENT
1. Civil Rights Compliance
a. Compliance with Regulations: LOCAL GOVERNMENT will comply with the Acts and the
Regulations relative to Nondiscrimination in federally assisted programs of the United
States Department of Transportation (USDOT), the Federal Highway Administration
(FHWA), as they may be amended from time to time, which are herein incorporated by
reference and made part of this agreement.
b. Nondiscrimination: LOCAL GOVERNMENT, with regard to the work performed by it
during the contract, will not discriminate on the grounds of race, color, or national origin in
the selection and retention of subcontractors, including procurement of materials and
leases of equipment. LOCAL GOVERNMENT will not participate directly or indirectly in
the discrimination prohibited by the Acts and the Regulations, including employment
practices when the contract covers any activity, project, or program set forth in Appendix
B of 45 CFR Part 21.
c. Solicitations for Subcontracts, Including Procurement of Materials and Equipment: In all
solicitations either by competitive bidding or negotiation made by LOCAL GOVERNMENT
for work to be performed under a subcontract, including procurement of materials or
leases of equipment, each potential subcontractor or supplier will be notified by LOCAL
GOVERNMENT of obligations under this contract and the Acts and Regulations relative to
Nondiscrimination on the grounds of race, color, or national origin.
d. Information and Reports: LOCAL GOVERNMENT will provide all information and reports
required by the Acts, the Regulations, and directives issued pursuant thereto, and will
permit access to its books, records, accounts, other sources of information, and facilities
as may be determined by the State or the FHWA to be pertinent to ascertain compliance
with such Acts, Regulations or directives. Where any information required of LOCAL
GOVERNMENT is in the exclusive possession of another who fails or refuses to furnish
this information, LOCAL GOVERNMENT will so certify to NCTCOG, the Texas
Department of Transportation ("the State") or the Federal Highway Administration, as
appropriate, and will set forth what efforts it has made to obtain the information.
e. Sanctions for Noncompliance: In the event of LOCAL GOVERNMENT'S noncompliance
with the Nondiscrimination provisions of this contract, NCTCOG will impose such contract
sanctions as it the State or the FHWA may determine to be appropriate, including, but not
limited to:
i. withholding of payments to LOCAL GOVERNMENT under the contract until the
LOCAL GOVERNMENT complies and/or
ii. cancelling, terminating, or suspending of the contract, in whole or in part.
f. Incorporation of Provisions: LOCAL GOVERNMENT will include the provisions of
paragraphs (a) through (f) in every subcontract, including procurement of materials and
leases of equipment, unless exempt by the Acts, the Regulations and directives issued
pursuant thereto. LOCAL GOVERNMENT will take such action with respect to any
subcontract or procurement as NCTCOG, the State, or the FHWA may direct as a means
of enforcing such provisions including sanctions for noncompliance. Provided, that if
LOCAL GOVERNMENT becomes involved in, or is threatened with, litigation with a
subcontractor or supplier because of such direction, LOCAL GOVERNMENT may request
the State to enter into such litigation to protect the interests of the State. In addition,
LOCAL GOVERNMENT may request the United States to enter into such litigation to
protect the interests of the United States.
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2. Disadvantaged Business Enterprise Program Requirements
a. LOCAL GOVERNMENT shall not discriminate on the basis of race, color, national origin,
or sex in the award and performance of any USDOT-assisted contract or in the
administration of its Disadvantaged Business Enterprise (DBE) program or the
requirements of 49 CFR Part 26. LOCAL GOVERNMENT shall take all necessary and
reasonable steps under 49 CFR Part 26 to ensure non-discrimination in award and
administration of DOT -assisted contracts.
b. Each sub -award or sub -contract must include the following assurance: The contractor,
sub -recipient, or sub -contractor shall not discriminate on the basis of race, color, national
origin, or sex in the performance of this contract. The contractor shall carry out applicable
requirements of 49 CFR Part 26 in the award and administration of DOT -assisted
contracts. Failure by the contractor to carry out these requirements is a material breach of
this agreement, which may result in the termination of this agreement or such other
remedy as the recipient deems appropriate.
3. Federal Funding Accountability and Transparency Act Requirements
a. Asa recipient of funds under this agreement LOCAL GOVERNMENT agrees to comply
with the Federal Funding Accountability and Transparency Act (FFATA) and implementing
regulations at 2 CFR Part 170, including Appendix A. This agreement is subject to the
following award terms:
http://www.gpo.qov/fdsys/pkq/FR-2010-09-14/pdf/2010-22705.pdf and
http://www.qpo.gov/fdsVs/pkq/FR-2010-09-14/pdf/2010-22706.pd .
b. LOCAL GOVERNMENT agrees that it shall:
i. Obtain and provide to NCTCOG a System for Award Management (SAM) number
(Federal Acquisition Regulation, Part 4, Sub -part 4.11) if this award provides more
than $25,000 in Federal funding. The SAM number may be obtained by visiting
the SAM website whose address is: https://www.sam.gov/portal/public/SAM/
ii. Obtain and provide to NCTCOG a Data Universal Numbering System (DUNS)
number, a unique nine -character number that allows the federal government to
track the distribution of federal money. The DUNS number may be requested free
of charge for all businesses and entities required to do so by visiting the Dun &
Bradstreet on-line registration website http://fedgov.dnb.com/webform; and
c. Report total compensation and names of its top five (5) executives to the State if:
i. More than 80% of annual gross revenues are from the federal government, and
those revenues are greater than $25,000,000; and
ii. The compensation information is not already available through reporting to the
United States Securities and Exchange Commission.
4. Single Audit Report
a. LOCAL GOVERNMENT shall comply with the requirements of the Single Audit Act of
1984, P.L. 98-502, ensuring that the single audit report includes the coverage stipulated in
2 CFR 200.
b. If threshold expenditures of $750,000 or more are met during the fiscal year, LOCAL
GOVERNMENT must submit a Single Audit Report and Management Letter (if applicable)
to NCTCOG.
c. If expenditures of less than the threshold during LOCAL GOVERNMENT'S fiscal year,
LOCAL GOVERNMENT must submit a statement to NCTCOG as follows: "We did not
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meet the $ expenditure threshold and therefore, are not required to have a single
audit performed for FY "
d. For each year the project remains open for federal funding expenditures, LOCAL
GOVERNMENT will be responsible for filing a report or statement as described above.
The required annual filing shall extend throughout the life of the agreement, unless
otherwise amended or the project has been formally closed out and no charges have
been incurred within the current fiscal year.
5. Pertinent Non -Discrimination Authorities
During the performance of this contract LOCAL GOVERNMENT, for itself, its assignees, and
successors in interest agree to comply with the following nondiscrimination statutes and
authorities; including but not limited to:
a. Title VI of the Civil Rights Act of 1964 (42 USC §2000d et seq., 78 stat. 252), (prohibits
discrimination on the basis of race, color, national origin); and 49 CFR Part 21.
b. The Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970,
(42 USC §4601), (prohibits unfair treatment of persons displaced or whose property has
been acquired because of federal or federal -aid programs and projects).
c. Federal -Aid Highway Act of 1973, (23 USC §324 et seq.), as amended, (prohibits
discrimination on the basis of sex).
d. Section 504 of the Rehabilitation Act of 1973, (29 USC §794 et seq.) as amended,
(prohibits discrimination on the basis of disability); and 49 CFR Part 27.
e. The Age Discrimination Act of 1975, as amended, (49 USC §6101 et seq.), (prohibits
discrimination on the basis of age).
f. Airport and Airway Improvement Act of 1982, (49 USC Chapter 471, Section 47123), as
amended, (prohibits discrimination based on race, creed, color, national origin, or sex).
g. The Civil Rights Restoration Act of 1987, (PL 100-209), (Broadened the scope, coverage
and applicability of Title VI of the Civil Rights Act of 1964, The Age Discrimination Act of
1975 and Section 504 of the Rehabilitation Act of 1973, by expanding the definition of the
terms "programs or activities" to include all of the programs or activities of the Federal -aid
recipients, subrecipients and contractors, whether such programs or activities are
Federally funded or not).
h. Titles II and III of the Americans with Disabilities Act, which prohibits discrimination on the
basis of disability in the operation of public entities, public and private transportation
systems, places of public accommodation, and certain testing entities (42 USC §§12131-
12189) as implemented by Department of Transportation regulations at 49 CFR parts 37
and 38.
i. The Federal Aviation Administration's Nondiscrimination statute (49 USC §47123)
(prohibits discrimination on the basis of race, color, national origin, and sex).
j. Executive Order 12898, Federal Actions to Address Environmental Justice in Minority
Populations and Low -Income Populations, which ensures nondiscrimination against
minority populations by discouraging programs, policies, and activities with
disproportionately high and adverse human health or environmental effects on minority
and low-income populations.
k. Executive Order 13166, Improving Access to Services for Persons with Limited English
Proficiency, and resulting agency guidance, national origin discrimination includes
discrimination because of limited English proficiency (LEP). To ensure compliance with
Title VI, the parties must take reasonable steps to ensure that LEP persons have
meaningful access to the programs (70 Fed. Reg. at 74087 to 74100).
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Title IX of the Education Amendments of 1972, as amended, which prohibits the parties
from discriminating because of sex in education programs or activities (20 USC 1681 et
seq.).
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APPENDIX G
PROHIBITED TELECOMMUNICATIONS AND VIDEO SURVEILLANCE SERVICES OR
EQUIPMENT CERTIFICATION
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APPENDIX G
PROHIBITED TELECOMMUNICATIONS AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT
CERTIFICATION
This Agreement is subject to the Public Law 115-232, Section 889, and 2 Code of Federal Regulations
(CFR) Part 200, including §200.216 and §200.471, for prohibition on certain telecommunications and video
surveillance or equipment.
Public Law 115-232, Section 889, identifies that restricted telecommunications and video surveillance
equipment or services (e.g., phones, internet, video surveillance, cloud servers) include the following:
A) Telecommunications equipment that is produced by Huawei Technologies Company or ZTE
Corporation (or any subsidiary or affiliates of such entities).
B) Video surveillance and telecommunications equipment produced by Hytera Communications
Corporations, Hangzhou Hikvision Digital Technology Company, or Dahua Technology Company
(or any subsidiary or affiliates of such entities).
C) Telecommunications or video surveillance services used by such entities or using such equipment.
D) Telecommunications or video surveillance equipment or services produced or provided by an entity
that the Secretary of Defense, Director of the National Intelligence, or the Director of the Federal
Bureau of Investigation reasonably believes to be an entity owned or controlled by the government
of a covered foreign country.
The entity identified below, through its authorized representative, hereby certifies that no funds under this
Contract will be obligated or expended to procure or obtain telecommunication or video surveillance
services or equipment or systems that use covered telecommunications equipment or services as a
substantial or essential component of any system, or as a critical technology as part of any system
prohibited by 2 CFR §200.216 and §200.471, or applicable provisions in Public Law 115-232 Section 889.
IN The Subrecipient hereby certifies that it does comply with the requirements of 2 CFR §200.216 and
§200.471, or applicable regulations in Public Law 115-232 Section 889.
SIGNATURE OF AUTHORIZED PERSON
NAME OF AUTHORIZED PERSON:
NAME OF COMPANY:
DATE:
DocuSigned by: , II
bU In,SbW
William M. 7ohnson
City of Fort Worth
7/6/2021
-OR-
El The Subrecipient hereby certifies that it cannot comply with the requirements of 2 CFR §200.216 and
§200.471, or applicable regulations in Public Law 115-232 Section 889.
SIGNATURE OF AUTHORIZED PERSON:
NAME OF AUTHORIZED PERSON:
NAME OF COMPANY:
DATE:
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APPENDIX H
FEDERAL PROCUREMENT REQUIREMENTS ACKNOWLEDGEMENT
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APPENDIX H
FEDERAL PROCUREMENT REQUIREMENTS ACKNOWLEDGEMENT
By signing below, the Purchasing Manager or equivalent position or personnel responsible for oversight of
procurement activities within the LOCAL GOVERNMENT acknowledges the following:
1. 1 have read Article 6.1 of the attached Agreement and understand that purchases under this
Agreement must comply with 2 CFR 200.316-.327 in addition to any applicable state law
requirements.
2. 1 will ensure that contract clauses in Article 11 of this Agreement shall be included in all solicitations
and resulting contracts for the purchase of equipment/technology under this Agreement.
3. The preferred method for the purchase of items under this Agreement is the use of a procurement
cooperative contracts that comply with requirements 2 CFR 200.316-.327 and applicable state law
requirements.
4. Only if no federally compliant purchase cooperative contract is available, LOCAL GOVERNMENT
may conduct its own federally compliant procurement, which must meet the specific requirements
set forth in 2 CFR 200.316-.327.
5. LOCAL GOVERNMENT must obtain NCTCOG prior written approval for any sole source and/or
non-competitive purchase.
6. If LOCAL GOVERNMENT fails to meet the requirements as described above NCTCOG may deny
reimbursement requests.
W'44=
Signature of Purchasing Manager/Equivalent Position
Cynthia Garcia
Name, Title
Date
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APPENDIX I
REIMBURSEMENT REQUEST FORM
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INCIDENT MANAGEMENT EQUIPMENT PURCHASE 2020 CALL FOR PROJECTS
North (-:entail Texas Council of Governments
Reimbursement Request Form
1. Agency Name:
2, Project Name:
3, NCTCOG Agreement Number (e.g., TRNxxxx)
4. Approved Award Amount:
5, Total Expenses Incurred: USS
6, Total Reiml)ursernent Amount Rerluested: USS
7, As outlined in Article 3 of the Interlocal Cooperative Agreement executed with NCTCOG, were
any adjustments made to the scope of work?
❑ No
❑ Yes (Selecting yes confirms that approval for scope changes was previously received, in writing, from the
NCTCOG Project Manager, prior to LOCAL GOVERNMENT requesting reimbursement.)
8, Itemized Purchases
As mentioned in Article 5.2 ofthe agreement, all Requests for Reimbursements) shall includethe LOCAL
GOVERNMENT s invoice on agency's letterhead with signature by Certifying [official identified in Article 5.3 of
the agreement, proof of payment, applicable receipts, and other supporting docurnentation_ NCTCOG may deem
a Requestfor Reimbursement incomplete if the data andior documentation are incomplete or improper, or if the
LOCAL GOVERNMENT fails to submit necessary reports or provide other information requested by NCTCOG
under the terms of this Agreement_ NCTCOG may reject requests for reimbursements which fail to demonstrate
that costs are eligible for reimbursement andfor which fail to conform to the requirements of this Agreement_
E ui pmeniffechnolo Purchased
Quantity
Unit Price
Total Amount
1
2
3
4
5
6
7
8
,x
10
SIGNATURE (Certifying Official}:
All reimbursement requests shall be submitted within 30 days of purchase, to NCTCOG at the email
address below:
Email: TRcirantsepnctcomorg
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