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State Energy Conservation Office
CITY ECRETAjY 39 ILa
COMPTROLLER OF PUBLIC ACCOUNTS GRANT AGREEMENT IARRAI
FOR
TRAFFIC SIGNAL SYNCHRONIZATION OR REPLACEMENT
FORTWORTH
t
IAL RECORDSECRETARY
ORTH, TX
CITY OF FORT WORTH
FORTWORTH
INTEROFFICE MEMO
TO: Mark Mathis, Transportation and Public Works Department
FROM: Allison Tidwell, City Secretary's Office
DATE: February 17, 2010
SUBJECT: ARRA GRANT CONTRACT FOR TRAFFIC SIGNAL SYNCHRONIZATION
OR REPLACEMENT
These documents are being forwarded to you for original signatures from State Comptroller. All
signed copies of the contract must be returned with original signatures for final processing.
Failure to return the documents will delay the final processing of the contract. Once we have
received all of the documents, we will assign a contract number. Thank you in advance for your
cooperation.
If you have any questions, please call me at 817-392-6090.
Attached: 5 sets
1,1 SECO
State Energy Conservation Office
COMPTROLLER OF PUBLIC ACCOUNTS GRANT AGREEMENT FARRAj
FOR
TRAFFIC SIGNAL SYNCHRONIZATION OR REPLACEMENT
CITY OF FORT WORTH
OFFICIAL RECORD
CI71' SECRETARY
FT: WORTH, TX
COMPTROLLER OF PUBLIC ACCOUNTS GRANT AGREEMENT IARRAI
FOR
TRAFFIC SIGNAL SYNCHRONIZATION OR REPLACEMENT
CITY OF FORT WORTH
STATE OF TEXAS
COUNTY OF TRAVIS
Recitals
Whereas, the United States Congress enacted and the President signed the American Recovery and Reinvestment Act of
2009, Public Law 111-5 (2009) (ARRA) to promote economic recovery, investment and creation of new jobs and
opportunities for all Americans including Texans in the form of stimulus grant funds for projects that meet the
requirements of both ARRA and Comptroller's SECO programs, funded through the United States Department of Energy
v (DOE); and
Whereas, the Comptroller of Public Accounts (Comptroller) Stimulus Program (the "Program") has applied for and the
Comptroller has been awarded ARRA funds to support the Comptroller's State Energy Program for energy efficiency,
renewable energy, energy assurances and other initiatives, which are managed by the State Energy Conservation Office
(SECO); and
Whereas, Chapters 403, 447, and 2305, Texas Government Code; 42 U.S.C. §§ 6321, et seq, and the Act, P.L. 111-5,
(2009), authorize the Comptroller and SECO to consider applications for and award ARRA stimulus funds to local
governments, municipalities, and other governmental organizations to fund approved grant -funded projects and activities;
and
Whereas, the Comptroller published a Notice of Availability and Request for Applications (RFA) for ARRA grant
funding in order to make competitive awards of grants; and
Whereas, City of Fort Worth is eligible to receive an award of ARRA grant funding as a result of the RFA process to be
utilized for purposes authorized by ARRA; and
Whereas, the Comptroller wishes to award ARRA grant funding to City of Fort Worth (Grantee) and the Comptroller and
Grantee wish to enter into this Grant Agreement (the "Agreement"); and
Whereas, on November 3, 2009, the governing board or city council of Grantee, City of Fort Worth adopted a resolution
authorizing execution of this Agreement; and
Whereas, under this Agreement, Grantee shall fully comply with all terms, conditions, requirements, and other
requirements of the Program and this Grant Agreement, including those set forth in the Attachments attached to and
incorporated in this Agreement; and
Whereas, in consideration of Grantee's compliance with all eligibility and other requirements of the Program and this
Agreement, Comptroller agrees to award ARRA funds to Grantee on a cost reimbursement basis in an amount not to
exceed $750,000.00; and
Whereas, the foregoing grant amount shall be utilized by Grantee solely for the purposes of the Program and
Comptroller's requirements regarding same, in addition to requirements as may be provided by Comptroller throughout
the term of this Agreement.
Now, Therefore, in consideration of all of the foregoing, the parties hereby agree as follows:
I. Parties
This Agreement is made and entered into by the following parties:
Comptroller: Comptroller of Public Accounts,
LBJ State Office Building
111 E. 17`h Street
Austin, Texas 78774
City of Fort Worth Page 1 of 52
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Grantee: City of Fort Worth
1000 Throckmorton Street
Fort Worth, Texas 76102-0000
II. Authority
This Grant Agreement (Agreement) is entered into pursuant to Chapters 403, 447, and 2305, Texas Government Code; 42
U.S.C. §§6321, et seq, and the American Recovery and Reinvestment Act of 2009, P-L. 111-5 (2009) (ARRA). Funding
of this grant is provided by the Comptroller of Public Accounts via the United States Department of Energy (DOE).
III. Services
Grantee shall utilize the grant funds solely for the purposes authorized by the Comptroller and the Program and shall
maintain full compliance with all terms and conditions described in the Grant Application and all Attachments to this
Agreement, which are attached here and incorporated here for all purposes. In addition, Grantee shall fully comply with
all special provisions of this Agreement and reporting requirements and with Comptroller directives, throughout the term
of this Agreement.
Grantee shall retain full control over the personnel, equipment, supplies, and other items Grantee selects as necessary to
comply with the terms of this Grant and as described in Attachment A. This Agreement does not involve proprietary
rights or intellectual property issues.
Grantee shall submit such records, information, and reports in such form and at such times as may be required by
Comptroller; these reports shall include, but are not limited to, the reports specified in Attachment B.
IV. Payments
Total payments to Grantee under this Agreement shall not exceed SEVEN HUNDRED FIFTY THOUSAND AND
NO/100 DOLLARS ($750,000.00). Grantee's payments under this Agreement are limited to reimbursements of actual
authorized costs incurred pursuant to the budget provided in Attachment B, attached to and incorporated in this
Agreement. No other amounts shall be paid. Each month, Grantee shall submit each request for payment by submitting a
detailed invoice, listing expenses by budget categories to the Comptroller. Grantee shall submit invoices that are fully
supported by receipts and such other documentation. Comptroller reserves the right, in its sole discretion, to withhold
s payment of invoices for which Grantee does not submit documentation acceptable to Comptroller. Grantee shall submit
monthly invoices for services performed and costs incurred in the prior month.
Title to and control over equipment or license of any software so purchased for Grantee's performance under this
Agreement shall remain with Grantee so long as it is being used for the purpose for which it was intended under the terms
= of this Agreement.
Comptroller reserves the right, in its sole discretion, to authorize revisions to budgeted amounts to provide for flexibility
within budget categories. Comptroller must give prior approval of all such revisions through its execution of a written
amendment to this Agreement.
V. Inspection, Monitoring and Records
Grantee shall permit Comptroller to inspect and shall make available to Comptroller for inspection any and all pertinent
records, files, information and other written material pertaining to the operation of programs and expenditure of funds
under this Agreement. This information includes, but is not limited to, all information maintained by Grantee or any of its
agents, employees or other parties. Grantee shall maintain, keep and preserve at its principal office all such records for a
period of four (4) years and make the same available to Comptroller, other state or federal agencies for auditing or other
purposes authorized by applicable federal or state law or guidelines. Comptroller may also carry out monitoring and
evaluation activities to ensure Grantee's compliance with the Program that is the subject of this Agreement and to make
available copies of all financial audits and related management letters of Grantee, if any, as required under any applicable
federal or state law or guidelines. Grantee shall also comply with the inspection, monitoring and records requirements
described in Attachment B.
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
City of Fort Worth Page 2 of 52
VI. Termination
Comptroller reserves the right, in its sole discretion, to terminate this Agreement at any time, with or without cause, upon
thirty (30) days' written notice to Grantee.
Upon receipt of notice of termination from Comptroller, Grantee shall immediately cease to submit monthly statements or
requests for reimbursement and shall cancel, withdraw or otherwise terminate any outstanding orders or commitments
under this Agreement as of the effective date of such termination and shall otherwise cease to incur any costs; Comptroller
shall have no liability whatsoever for any costs incurred after such termination date.
VII. Indemnification
TO THE EXTENT PERMITTED UNDER THE CONSTITUTION AND LAWS OF THE STATE OF TEXAS,
GRANTEE SHALL DEFEND, INDEMNIFY AND HOLD HARMLESS THE COMPTROLLER, ITS OFFICERS,
AND EMPLOYEES AND GRANTEES, AND THE STATE OF TEXAS, ITS OFFICERS, AND EMPLOYEES
AND GRANTEES, FROM AND AGAINST ALL CLAIMS, ACTIONS, SUITS, DEMANDS, PROCEEDINGS,
COSTS, DAMAGES, AND LIABILITIES, INCLUDING WITHOUT LIMITATION ATTORNEYS' FEES AND
COURT COSTS, ARISING OUT OF, CONNECTED WITH, OR RESULTING FROM ANY ACTS OR
OMISSIONS OF GRANTEE, GRANTEE OR ANY AGENT, EMPLOYEE, SUBGRANTEE, OR SUPPLIER OF
GRANTEE OR GRANTEE IN THE EXECUTION OR PERFORMANCE OF ANY CONTRACT WITH
COMPTROLLER OR THE STATE RESULTING FROM THIS AGREEMENT. GRANTEE SHALL
COORDINATE ITS DEFENSE WITH THE TEXAS ATTORNEY GENERAL AS REQUESTED BY
COMPTROLLER.
THIS SECTION IS NOT INTENDED TO AND SHALL NOT BE CONSTRUED TO REQUIRE GRANTEE TO
INDEMNIFY OR HOLD HARMLESS THE COMPTROLLER OR THE STATE FROM ANY CLAIMS OR
LIABILITIES RESULTING FROM THE NEGLIGENT ACTS OR OMISSIONS OF COMPTROLLER OF ITS
EMPLOYEES.
VIII. Subcontracting
Grantee may subcontract or sub -grant for the purposes of this Agreement as specifically authorized by Comptroller
pursuant to the terms and subject to compliance with the flow down provisions of Attachment I of this Agreement.
IX. Amendments
This Agreement may only be amended upon the written agreement of the parties by executing an amendment to this
Agreement; however, Comptroller may unilaterally amend this Agreement as provided in Paragraph XVIII.
X. Incorporation of Attachments; Incorporation by Reference
This Agreement consists of
all of the following documents which are attached to and incorporated in this Agreement for
all purposes:
This Grant Agreement;
The Comptroller's
RFA; Official Questions & Answers
Attachment A:
Deliverables Statement
Attachment A-1:
Application
Attachment B:
Project Budget
Attachment C:
DOE Required Special Terms & Conditions;
Attachment C-1:
Assurance of Compliance with Nondiscrimination Laws -Grantee;
Attachment C-2:
Assurance of Compliance with Nondiscrimination Laws -Subcontractor
Attachment D:
Certification Regarding Debarment, Suspension, Eligibility;
Attachment E:
Certification Regarding Lobbying, Suspension;
Attachment F:
Lobbying Activities;
Attachment G:
National Environmental Policy Act Assurances as Award Terms;
Attachment H:
Intellectual Property Provisions;
Attachment I:
Subcontractor or Sub -grantees; Flow down Provisions; and
Attachment J:
Affidavit of Compliance
Attachment K: Execution of Apphcation
Attachment L: Reporting Requirements
City of Fort Worth Page 3 of 52
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX I
In the event of a conflict, the documents shall control in the following order of precedence:
1. Grant Agreement and its Attachments
2. Comptroller's RFA and Question and Answer document
3. Agreed Project Work Plan; and
4. The Application
All applicable rules, regulations and all other requirements imposed by law, including, but not limited to, those pertinent
rules and regulations of Comptroller and the State of Texas, are incorporated into this Agreement by reference as if
specifically written herein.
XI. Funding
Comptroller's performance of its obligations under this Agreement is contingent upon and subject to availability of and
actual receipt by Comptroller of sufficient and adequate funds from the sources contemplated by this Agreement. This
Agreement is subject to immediate cancellation or termination, without penalty to Comptroller, subject to the availability
and receipt of these funds. In addition, Comptroller's authority and appropriations are subject to the actions of the Texas
Legislature. If Comptroller becomes subject to a legislative change, revocation of statutory authority or lack of funds that
would render the services to be provided under this Agreement impossible or unnecessary, Comptroller may terminate this
Agreement without penalty to Comptroller or the State of Texas. In the event of a termination or cancellation under this
Paragraph, Comptroller shall not be required to give notice and shall not be liable for damages or losses caused or
associated with such termination or cancellation.
XII. Term of Agreement
The term of this Agreement shall begin on the date executed by all parties and be effective until December 31, 2011,
unless terminated earlier in accordance with other provisions of this Agreement. The Comptroller shall have the right, in
its sole judgment and discretion, to renew this Agreement for one (1) additional one-year term. The provisions of the
following shall survive the termination or expiration of this Agreement: Paragraphs V, VII, XV, XVI, XVII; Sections
20.2, 20.3, 20.6; and Attachment C.
XIII. Force Majeure
Except as otherwise provided, neither Grantee nor Comptroller shall be liable to the other for any delay in, or failure of
performance of any requirement contained in this Agreement caused by force majeure. The existence of such causes of
delay or failure shall extend the period of performance until after the causes of delay or failure have been removed provide
the non -performing party exercises all reasonable due diligence to perform. Force majeure is defined as acts of God, war,
terrorist attacks, fires, explosions, earthquakes, hurricanes, floods, failure of transportation, or other causes that are
beyond the reasonable control of either party and that by exercise of due foresight such party could not reasonably have
been expected to avoid, and which, by the exercise of all reasonable due diligence, such party is unable to overcome. Each
party must inform the other in writing with proof of receipt within three (3) business days of the existence of such force
majeure or otherwise waive this right as a defense.
XIV. Assignment
Grantee shall not transfer or assign any rights or duties under or any interest in this Agreement. Grantee shall not delegate
its responsibilities or duties under the terms of this Agreement.
XV. Property Rights
For purposes of this Agreement, the term "Work" is defined as all reports, work papers, work products, materials,
approaches, designs, specification, systems, documentation, methodologies, concepts, intellectual property or other
property developed, produced or generated in connection with the Grantee's Project(s) under this Agreement. Grantee
acknowledges and agrees that the Work (and all rights therein) belongs to and shall be the sole and exclusive property of
Comptroller.
Grantee does hereby assign, and transfer to Comptroller, its successors and assigns, the entire right, title and interest in
and to the copyright in the Work and any registrations and copyright applications relating thereto and any renewals and
extensions thereof, and in and to all works based upon, derived from, and incorporating the Work, and in and to all
income, royalties, damages, claims, and payments now or hereafter due or payable with respect thereto, and in and to all
City of Fort Worth Page 4 of 52
causes of action, either in law or in equity for past, present, or future infringement based on the copyrights, and in and to
all rights corresponding to the foregoing. Grantee agrees to execute all papers and to perform such other property rights
transfers, as Comptroller may deem necessary to secure for Comptroller or its designee the rights herein assigned.
Grantee and Grantee's employees shall have no rights in or ownership of the Work and any and all documentation or
other products and results of Grantee's Project(s) or any other property of Comptroller.
No later than the first calendar day after the termination or expiration of this Agreement or at Comptroller's request,
Grantee shall deliver to Comptroller all completed, or partially completed Work and any and all documentation or other
products and results of the Grantees Project(s). Failure to timely deliver such Work and any and all documentation or
other products and results of results of the Grantee's Project(s) shall be considered a material breach of this Agreement.
Grantee shall not make or retain any copies of the Work or any and all documentation or other products and results of the
Grantee's Project(s) without the prior written consent of Comptroller, except to the extent necessary in the ordinary course
of business.
In the event of any conflicting provisions between this Paragraph and Attachment H, Attachment H shall control.
XVI. Severability Clause
In the event that any provision of this Agreement is later determined to be invalid, void, or unenforceable, then the
remaining provisions of this Agreement shall remain in full force and effect, and shall in no way be affected, impaired, or
invalidated.
XVII. Dispute Resolution Process
Chapter 2260 of the Texas Government Code ("Chapter 2260") prescribes dispute resolution processes for certain breach
of contract claims applicable to certain contracts for goods and services. As required by Chapter 2260, Comptroller has
adopted rules under Chapter 2260, codified at 34 Texas Administrative Code §§ 1.360 — 1.387, and may adopt revisions to
these rules throughout the term of this Agreement, including any extensions. Grantee shall comply with such rules.
The dispute resolution process provided for in Chapter 2260 of the Government Code shall be used, as further described
herein, by Comptroller and Grantee to attempt to resolve any claim for breach of contract made by Grantee under this
Agreement:
(A) Grantee's claim for breach of this Agreement that the parties cannot resolve in the ordinary course of
business shall be submitted to the negotiation process provided in Chapter 2260. To initiate the process,
Grantee shall submit written notice, as required by Chapter 2260, to the Deputy Comptroller or his or her
designee. Said notice shall also be given to all other representatives of Comptroller and Grantee
otherwise entitled to notice under this Agreement. Compliance by Grantee with Chapter 2260 is a
condition precedent to the filing of a contested case proceeding under Chapter 2260.
(B) The contested case process provided in Chapter 2260 is Grantee's sole and exclusive process for seeking
a remedy for an alleged breach of contract by Comptroller if the parties are unable to resolve their
disputes under subparagraph (A) of this Section.
(C) Compliance with the contested case process provided in Chapter 2260 is a condition precedent to seeking
consent to sue from the Legislature under Chapter 107, Civ. Prac. and Rem. Code. Neither the execution
of this Agreement by Comptroller nor any other conduct of any representative of Comptroller relating to
this Agreement shall be considered a waiver of sovereign immunity to suit.
For all other specific breach of contract claims or disputes under this Agreement, the following shall apply:
Should a dispute arise out of this Agreement, Comptroller and Grantee shall first attempt to resolve it through
direct discussions in a spirit of mutual cooperation. If the parties' attempts to resolve their disagreements through
negotiations fail, the dispute will be mediated by a mutually acceptable third party to be chosen by Comptroller
and Grantee within fifteen (15) days after written notice by one of them demanding mediation under this Section.
Grantee and Comptroller shall pay all costs of the mediation equally. By mutual agreement, Comptroller and
Grantee may use a non -binding form of dispute resolution other than mediation. The purpose of this Section is to
reasonably ensure that Comptroller and Grantee shall in good faith utilize mediation or another non -binding
dispute resolution process before pursuing litigation. Comptroller's participation in or the results of any
mediation or another non -binding dispute resolution process under this Section or the provisions of this Section
shall not be construed as a waiver by Comptroller of (1) any rights, privileges, defenses_ remedies or immunities
available to Comptroller as an Comptroller of the State of Texas or otherwise available to Comptroller; (2)
Comptroller's termination rights; or (3) other termination provisions or expiration dates of this Agreemenl,
City of Fort Worth Page 5 of 52 CITY SECF; _ AY
FT. WORTH, TX
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XVIII. Applicable Law and Conforming Amendments
Grantee shall comply with all state and federal laws, regulations, requirements and guidelines applicable to a Grantee
providing services to the State of Texas, as these laws, regulations, requirements and guidelines currently exist and as they
are amended throughout the term of this Agreement. Comptroller reserves the right, in its sole discretion, to unilaterally
amend this Agreement prior to award and throughout the term of this Agreement to incorporate any modifications
necessary for Comptroller's or Grantee's compliance with all applicable state and federal laws, regulations, requirements
and guidelines. Other than this provision, this Agreement may only be amended by the written agreement of the parties.
XIX. ARRA Reporting Requirements
Sub -recipient Reporting. The Grantee/Prime Recipient shall require that the sub -recipient with whom it sub -contracts or
sub -grants, submit monthly Use of Funds Reports to the Grantee/Prime Recipient containing the data elements described
in Section 1512(c) of the Act. In compliance with this requirement, the Grantee/Prime Recipient and its sub -grantees and
sub -contractors shall provide the reports as set forth in Attachment G attached hereto and incorporated herein These
reports shall be due on or before the 25th day of each month, with the first report due to the Grantee/Prime Recipient on or
before the 25th day of each month of this Agreement. Failure to submit a Monthly Progress Report may be grounds for
termination of the Agreement. Grantee shall submit performance reports as required by Attachment L, attached to and
incorporated in this Agreement.
Sub -recipient Assurance. Sub -recipients and Sub -Grantees shall require any individual, organization, or other entity
with whom it subcontracts, sub -grants, or enters into any other contractual relationship involving the transfer or payment
of recovery funds originally received from the Grantee/Prime Recipient to submit monthly Use of Funds Reports
described in Section 1512(c) of the Act to the Sub -recipient containing the data elements described above. To this end, the
Sub -recipient shall be required to sign a written assurance form. This condition shall be met monthly on or before the 25th
- day or each month. Compliance with this condition is defined as the submission of an accurate and completed report to the
Sub -recipient.
Data Collection and Access to Records. Sub -recipient and Sub -Grantee agrees to compile and maintain information
pertaining to programs or activities developed as a result of the Sub -recipient's award of Federal recovery funds under the
American Recovery and Reinvestment Act of 2009. Such compilations shall include a quarterly Use of Funds Report, to
be submitted to the entity which awarded the funds that are the subject of this document or Agreement.
XX. Additional Provisions
20.1 Time Limits
Time is of the essence in the performance of this Agreement and accordingly all time limits shall be strictly construed and
rigidly enforced.
20.2 No Waiver
This Agreement shall not constitute or be construed as a waiver of any of the privileges, rights, defenses, remedies, or
immunities available to Comptroller as an Comptroller of the State of Texas or otherwise available to Comptroller. The
failure to enforce or any delay in the enforcement of any privileges, rights, defenses, remedies, or immunities available to
Comptroller under this Agreement or under applicable law shall not constitute a waiver of such privileges, rights,
defenses, remedies, or immunities or be considered as a basis for estoppel. Comptroller does not waive any privileges,
rights, defenses, or immunities available to Comptroller as an Comptroller of the State of Texas, or otherwise available to
Comptroller, by entering into this Agreement or by its conduct prior to or subsequent to entering into this Agreement.
The modification of any privileges, rights, defenses, remedies, or immunities available to Comptroller must be in
writing, must reference this section, and must be signed by Comptroller to be effective, and such modification of
any privileges, rights, defenses, remedies, or immunities available to Comptroller shall not constitute waiver of any
subsequent privileges, rights, defenses, remedies, or immunities under this Agreement or under applicable law.
F-
OFFICIAL RECORD
CITY SECRETARY
FT. WOI �'li, TX
City of Fort Worth Page 6 of 52
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20.3 No Liability upon Termination
If this Agreement is terminated for any reason, Comptroller, the Board, the Comptroller, and the State of Texas shall not
be liable for any damages, claims, losses, expenses, costs or any other amounts of any kind whatsoever arising from or
related to any such termination.
20.4 Limitation on Authority; No Other Obligations
Grantee shall have no authority to act for or on behalf of Comptroller or the State of Texas except as expressly provided
for in this Agreement; no other authority, power, use, or joint enterprise is granted or implied. Grantee may not incur any
debts, obligations, expenses or liabilities of any kind on behalf of Comptroller.
20.5 No Other Benefits
Grantee shall have no exclusive rights or benefits other than those set forth herein.
20.6 Supporting Documents; Right to Audit; Independent Audits
Grantee shall maintain and retain supporting fiscal documents adequate to ensure that claims for contract funds are in
accordance with applicable Comptroller and State of Texas requirements. Grantee shall maintain all such documents and
other records relating to this Agreement and the State's property for a period of four (4) years after the date of submission
of the final invoices or until a resolution of all billing questions, whichever is later. Grantee shall make available at
reasonable times and upon reasonable notice, and for reasonable periods, all information related to the State's property,
such as work papers, reports, books, data, files, software, records, and other supporting documents pertaining to this
Agreement, for purposes of inspecting, monitoring, auditing, or evaluating by Comptroller, the State of Texas or their
authorized representatives. Grantee shall cooperate with auditors and other authorized Comptroller and State of Texas
representatives and shall provide them with prompt access to all of such State's property as requested by Comptroller or
the State of Texas. By example and not as exclusion to other breaches or failures, Grantee's failure to comply with this
Section shall constitute a material breach of this Agreement and shall authorize Comptroller to immediately assess the
liquidated damages for such failure. Comptroller may require, at Grantee's sole cost and expense, independent audits by a
qualified certified public accounting firm of Grantee's books and records or the State's property. The independent auditor
shall provide Comptroller with a copy of such audit at the same time it is provided to Grantee. Comptroller retains the
right to issue a request for applications for the services of an independent certified public accounting firm under this
Agreement. In addition to and without limitation on the other audit provisions of this Agreement, pursuant to Section
2262.003, Tex. Gov't Code, the state auditor may conduct an audit or investigation of the Grantee or any other entity or
person receiving funds from the state directly under this Agreement or indirectly through a subcontract under this
Agreement. The acceptance of funds by the Grantee or any other entity or person directly under this Agreement or
indirectly through a subcontract under this Agreement acts as acceptance of the authority of the state auditor, under the
direction of the legislative audit committee, to conduct an audit or investigation in connection with those funds. Under the
direction of the legislative audit committee, the Grantee or other entity that is the subject of an audit or investigation by
the state auditor must provide the state auditor with access to any information the state auditor considers relevant to the
investigation or audit. This Agreement may be amended unilaterally by the Comptroller to comply with any rules and
procedures of the state auditor in the implementation and enforcement of Section 2262.003. Under procedures provided
by the state auditor on September 5, 2003, in addition to the above, (1) the Grantee understands that the acceptance of
funds under this Agreement acts as acceptance of the authority of the state auditor to conduct an audit or investigation in
connection with those funds; (2) the Grantee further agrees to cooperate fully with the state auditor in the conduct of the
audit or investigation, including providing all records requested; (3) the Grantee shall ensure that this paragraph
concerning the authority to audit funds received indirectly by subgrantees through the Grantee and the requirement to
cooperate is included in any subcontract it awards; and (4) the state auditor shall at any time have access to and the right
to examine, audit, excerpt, and transcribe any pertinent books, documents, working papers, and records of the Grantee
relating to this Agreement.
20.7 Davis Bacon Act
Grantee shall comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C. §§ 276a to 276a-7), the
Copeland Act (40 U.S.C. § 276c and 18 U.S.C. §§ 874), and the Contract Work Hours and Safety Standards Act (40
U.S.C. §§ 327-333), regarding labor standards for federally assisted construction sub -agreements as implemented through
29 CFR 5.5(a)." httt)://www.dol.2ov/esa/whe/contracts/dbra.htm.
RECORD
CITY SE-C eTARY
_ FT: TX
City of Fort Worth Page 7 of 52
20.8 ARRA 1512 Reporting Requirements
The Comptroller's office is requiring all agencies that have received a Notification of Award (NOA) for ARRA funds and
have a federal program subject to 1512 Recipient Reporting to perform a pilot project of reporting information pursuant to
Section 1512 of the Recovery Act.
20.9 Buy American Act — ARRA 1606
In certain government procurements, the requirement purchase may be waived if the domestic product is more expensive
than an identical foreign -sourced product by a certain percentage, if the product is not available domestically in sufficient
quantity or quality, or if doing so is in the public interest. Grantee shall comply with this provision as applicable.
http://www.acquisition. gov/FAR/current/html/subpart%2025_6.htm1
20.10 Federal Funding Accountability and Transparency Act (P.L. 109-282).
P.L. 109-282 requires a reduction in "wasteful and unnecessary spending" by the federal government, including spending
on funds earmarked for special projects. The legislation requires the Office of Management and Budget (OMB) to
establish a publicly available, online database containing information about entities that are awarded federal grants, loans,
and contracts. Grantee shall comply with this provision as applicable.
20.11 Data Management
In compliance with OMB Circular A-123, it is essential for Grantees to apply appropriate internal controls to effectively
manage the accuracy, integrity, timeliness, and appropriate privacy of all data submitted to httn://www.USAst)endin2.lzov.
20.12 National Environmental Policy Act
Grantee shall comply with the National Environmental Policy Act, 42 U.S.C. §§4321 et. seq. "NEPA" and shall not take
any action that will have an adverse environmental impact (e.g., physical disturbance of a site such as breaking of ground)
or limit the choice of reasonable alternatives until either a NEPA clearance or final NEPA decision is provided by the
National Energy Technology Laboratory (NETL) NEPA compliance Officer. If the ARRA are used for the purchase of
equipment for new alternative fuel(s) refueling stations and/or purchase of equipment for retrofits of existing refueling
stations, Grantee shall provide additional project information and, if requested, shall prepare or provide any assistance
necessary to assist DOE in the preparation of any required Environmental Impact Statements or other environmental
documentation.
20.13 National Historic Preservation Act of 1966
Grantee shall comply with the National Historic Preservation Act of 1966 (§§16 U.S.C. 470 et seq) and shall not take any
action that will affect any district, site, building, structure, or object that is included in the National Register without prior
notification to and concurrence of the DOE and the State Historic Preservation Office (SHPO) which in Texas is the
Texas Historical Commission. Grantee shall identify any property listed or eligible for listing on the National Register of
Historic Places that will be affected by this award, and comply with or assist with the compliance of §16 U.S.C. 470f and
the Archaeological and Historic Preservation Act of 1974 (16 U.S.C.469a-1, et seq.). Compliance with Section 106 of the
NHPA occurs only after Grantee has submitted adequate background documentation to the SHPO for its review, and the
SHPO has provided written concurrence to the Grantee that it does not object to its Section 106 finding or determination.
Grantee shall provide a copy of this concurrence to the Contracting Officer.
20.14 Solid Waste Disposal Act
Prior to the expenditure of Federal funds to store, process, or dispose of hazardous materials Grantee shall comply with
the Solid Waste Disposal Act, Texas Health & Safety Code, Chapter 361, and Title 30, Texas Administrative Code,
Chapter 335 "Industrial Solid Waste and Municipal Hazardous Waste" administered by the Texas Commission on
Environmental Quality. Sanitary or hazardous waste is defined in 40 CFR Part 260 and 30 TAC Chapter 335 to include,
but not be limited to, old light bulbs, lead ballasts, piping, roofing material, discarded equipment, debris, asbestos, etc.
Grantee shall obtain any required permit and retain all compliance documentation related to the project.
20.15 Report of Fraud, Waste and Abuse: Texas Government Code, Section 321.022
If the administrative head of a department or entity that is subject to audit by the (texas State Auditor has reasonable cause
to believe that money received from the State by the Grantee or by a client or bntractor of the Grantee may have been
City of Fort Worth Page 8 of 52 CITY SECRETARY
FT. WORTH, TX
lost, misappropriated, or misused, or that other fraudulent or unlawful conduct has occurred in relation to the operation of
the Grantee, the administrative head shall report the reason and basis for the belief to the Texas State Auditor. The Texas
State Auditor may investigate the report or may monitor any investigation conducted by the Grantee. See
http://sao.fraud.state.tx.us/.
XXI. Signatories
The undersigned signatories represent and warrant that they have full authority to enter into this Agreement on behalf of
the respective parties.
XXH. Merger
This Agreement contains the entire agreement between the parties relating to the rights granted and the obligations
assumed in it. Any oral representations or modifications concerning this Agreement shall be of no force or effect unless
contained in a subsequent writing, signed by both parties.
wo
,r
COMPTROLLER OF PUBLIC ACCOUNTS
Comptroller
1 2/Date: ho
AW
'R City of Fort Worth
M0
CITY OF FORT WORTH
By`�,�.
Fernando Costa
Assistant City Manager
Date:
Page 9 of 52
Recommended for Signature:
William A. Vefkesi—,P.E.�d�blicDirector, Transportation Works Depart.
APPROVED AS TO LEGAL FORM:
Assistant City Attorney
by:
r � ,
lenkCity Secretary !
EiC L RECORD
Y SECRET'S,Ry
. WO TH
ATTACHMENT A
DELIVERABLES STATEMENT
Deliverable Requirements for Traffic Signal Synchronization or Replacement:
• Grantee shall conduct an audit in accordance with the Institute of Transportation Engineers "report card" to
determine needs prior to submitting Application. The "report card" self assessment is a subjective and
qualitative tool designed to assist traffic professionals in assessing their organization's performance in
creating and maintaining effective traffic signal operation. See: httn://www.ite.org/reuortcard/ for Traffic
Signal Audit Guide.
• Grantee shall perform an inventory of existing signal equipment (controller equipment, signal heads,
- detectors, pedestrian signals and pushbuttons) and identify existing equipment and signal related signing,
pavement markings, street lighting for compliance with current standards.
0 Grantee shall collect relevant field data for analysis purposes including, but not limited to, intersection data
(number of lanes and lane use, pedestrian signalization/crosswalks, available storage lengths and shoulder
widths), existing signal parameters (timing, cycle length, phasing, and time -or -day schedules, pre-emption
equipment) and posted speed limits (including school speed zones).
• Grantee shall identify, develop and oversee replacement of outdated and/or malfunctioning equipment and/or
installation of equipment necessary for the implementation of signal systems. Typically, this equipment will
include controllers, cabinets, loop detectors, and interconnect cable and microcomputer equipment for
intersection monitoring.
• Grantee shall develop a maintenance plan to include monitoring of new signal timings for accuracy.
• Grantee shall certify that no major changes will be made to the proposed project area during the term of the
- Grant Agreement that would change the physical layout of the street or disrupt the data collection effort or
significantly alter traffic patterns and volumes.
• Grantee shall purchase signal light components, materials, and services in accordance with all federal, state,
and local laws concerning purchase of goods and services.
• Grantee shall prepare and submit a Monthly Progress Report via internet on or by the 25th day of each month.
• Grantee shall prepare and submit the Final Project Report no later than 30 days following the end of the
Agreement.
Reporting Requirements
o ARRA Section 1512, DOE, OMB, and state issued rules and regulations impose an array of reporting
requirement on the Comptroller who must, in turn, rely on its Grantees in order to meet these
reporting obligations. The Grant Agreement, and in particular Attachment L to the Grant Agreement,
specifically identifies the initial and monthly reporting requirements that the Grantee shall provide.
Due to the importance of the reporting requirements, a Grantee's failure to meet its reporting
obligations under the Grant Agreement may result in termination of the grant award and the Grantee
being ineligible for future grants.
o An initial information report shall be submitted that provides key grantee and project information that
will likely remain constant through the term of grant including the congressional representatives for
" Grantee's primary location and primary project locations and key personnel. Additionally, when the
Grantee, sub -grantee, or subcontractor has received 80% of its gross revenue or more than $25
million from federal awards in the last year and the grant award or sub -award is over $25,000, then
such entity must also provide the names and compensation of the five most highly compensated
individuals of the Grantee, sub -grantee, or subcontractor, as applicable.
o The required information that must be provided in the Monthly Report is set forth in full in
City of Fort Worth Page 10 of 52
Attachment L to the Sample Grant Agreement which is Appendix A to the RFA. It is summarized as
follows:
I. Grantee Identification. Must include the Grantee name, the contact information for the individual
filing the report, grant award number, and grant award date and performance period.
H. Grant Award/Budget Information. This portion must include the grant award amount, the
cumulative total amount of funds received at the time of the report, the cumulative total amount of
funds disbursed by the Grantee at the time of the report, and show funds budgeted and funds
disbursed for each budget item.
III. Project Information. This information must include the Project name, performance location,
Project objective and status, a progress evaluation comparing the objectives to the status, and
description of Project efforts that may adversely affect obtaining the objectives. Also, a brief
description of any products produced or technology transfer activities accomplished that reflect
accomplishments of the Project.
IV. Job Created/Retained. Grantees must provide a tally of the jobs created or retained as a result of
the grant funding and a brief description of the types of jobs and anticipated or likely duration.
V. Technical Measures. Reports must include, for the Transportation Efficiency program, the
technical measures which are the number of energy -efficient traffic signals installed; and the number
of street lane -miles for which synchronized traffic signals were installed.
o Grantee shall require that any of its sub -grantees or subcontractors shall provide monthly reports that
provide the information necessary for the Grantee to fulfill its reporting obligations.
Comptroller reserves the authority to change these requirements as the federal eovernment more fully
identiries the information that it will require of the Comptroller.
City of Fort Worth Page 11 of 52
ATTACHMENT A-1
APPLICATION
The application of City of Fort Worth is incorporated by reference into this Attachment A-1 of this Agreement
for all purposes
City of Fort Worth
Page 12 of 52
ATTACHMENT B
BUDGET
Budget:
Equipment
Subcontract
Total Amount
Match:
City of Fort Worth Page 13 of 52
$750,000.00
$[TBD]
$[TBD]
$750,000.00
$187,500.00
ATTACHMENT C
DOE SPECIAL TERMS AND CONDITIONS REQUIRED
IN GRANT TO THE COMPTROLLER OF PUBLIC ACCOUNTS
AND FLOW DOWN TO ARRA GRANTS AND COOPERATIVE AGREEMENTS
RESOLUTION OF CONFLICTING CONDITIONS
Any apparent inconsistency between Federal statutes and regulations and the terms and conditions contained in this award
must be referred to the DOE Award Administrator for guidance.
AWARD AGREEMENT TERMS AND CONDITIONS
This award/agreement consists of the Grant and Cooperative Agreement cover page, plus the following:
a. Special terms and conditions.
b. Attachments:
Attachment No. Title
1 Intellectual Property Provisions
2 Federal Assistance Reporting Checklist
3 Budget Page(s)
4 SEP Narrative Information Worksheets
c. Applicable program regulations (specify) (Date)
d. DOE Assistance Regulations, 10 CFR Part 600at httD://ecfr.gvoaccess.aov
e. Application/proposal as approved by DOE.
f. National Policy Assurances to Be Incorporated as Award Terms in effect on date of award at
httD:Hmanasement.eneriay.gov/business doe/1374.htm.
ADVANCED UNDERSTANDING CONCERNING PUBLICLY FINANCED ENERGY IMPROVEMENT
PROGRAMS
The parties recognize that the Recipient may use funds under this award for Property -Assessed Clean Energy (PACE)
loans, Sustainable Energy Municipal Financing, Clean Energy Assessment Districts, Energy Loan Tax Assessment
Programs (ELTAPS), or any other form or derivation of Special Taxing District whereby taxing entities collect payments
through increased tax assessments for energy efficiency and renewable energy building improvements made by their
constituents. The Department of Energy intends to publish "Best Practices" or other guidelines pertaining to the use of
funds made available to the recipient under this award pertaining to the programs identified herein. By accepting this
award, the recipient agrees to incorporate, to the maximum extent practicable, those Best Practices and other guidelines
into any such program(s) within a reasonable time after notification by DOE that the Best Practices or guidelines have
been made available. The recipient also agrees, by its acceptance of this award, to require its sub -recipients to incorporate
to the maximum extent practicable the best practices and other guideline into any such program used by the sub -
recipient."
PAYMENT PROCEDURES - ADVANCES THROUGH_ THE AUTOMATED STANDARD APPLICATION FOR
PAYMENTS(ASAP)SYSTEM
a. Method of Payment. Payment will be made by advances through the Department of Treasury's ASAP system.
b. Requesting Advances. Requests for advances must be made through the ASAP system. You may submit requests
as frequently as required to meet your needs to disburse funds for the Federal share of project costs. If feasible, you
should time each request so that you receive payment on the same day that you disburse funds for direct project costs and
the proportionate share of any allowable indirect costs. If same -day transfers are not feasible, advance payments must be
as close as is administratively feasible to actual disbursements.
City of Fort Worth Page 14 of 52
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WV C. Adjusting payment requests for available cash. You must disburse any funds that are available from repayments
to and interest earned on a revolving fund, program income, rebates, refunds, contract settlements, audit recoveries,
ow credits, discounts, and interest earned on any of those funds before requesting additional cash payments from DOE.
d. Payments. All payments are made by electronic funds transfer to the bank account identified on the ASAP Bank
Information Form that you filed with the U.S. Department of Treasury.
REBUDGETING AND RECOVERY OF INDIRECT COSTS - REIMBURSABLE INDIRECT COSTS AND
FRINGE BENEFITS
Vol
a. If actual allowable indirect costs are less than those budgeted and funded under the award, you may use the
difference to pay additional allowable direct costs during the project period. If at the completion of the award the
Government's share of total allowable costs (i.e., direct and indirect), is less than the total costs reimbursed, you must
refund the difference.
b. Recipients are expected to manage their indirect costs. DOE will not amend an award solely to provide additional
funds for changes in indirect cost rates. DOE recognizes that the inability to obtain full reimbursement for indirect costs
means the recipient must absorb the underrecovery. Such underrecovery may be allocated as part of the organization's
required cost sharing.
USE OF PROGRAM INCOME - ADDITION
If you earn program income during the project period as a result of this award, you may add the program income to the
funds committed to the award and use it to further eligible project objectives.
STATEMENT OF FEDERAL STEWARDSHIP
DOE will exercise normal Federal stewardship in overseeing the project activities performed under this award.
Stewardship activities include, but are not limited to, conducting site visits; reviewing performance and financial reports;
providing technical assistance and/or temporary intervention in unusual circumstances to correct deficiencies which
develop during the project; assuring compliance with terms and conditions; and reviewing technical performance after
project completion to ensure that the award objectives have been accomplished.
HISTORIC PRESERVATION
1W Prior to the expenditure of Federal funds to alter any structure or site, the Recipient is required to comply with the
%r requirements of Section 106 of the National Historic Preservation Act (NHPA), consistent with DOE's 2009 letter of
delegation of authority regarding the NHPA. Section 106 applies to historic properties that are listed in or eligible for
listing in the National Register of Historic Places. In order to fulfill the requirements of Section 106, the recipient must
contact the State Historic Preservation Officer (SHPO), and, if applicable, the Tribal Historic Preservation Officer
(THPO), to coordinate the Section 106 review outlined in 36 CFR Part 800. SHPO contact information is available at the
following link: http://www.ncshpo.org/find/index.htm. THPO contact information is available at the following link:
httt)://www.nathDo.orp-/man.htmi.
Section 110(k) of the NHPA applies to DOE funded activities. Recipients shall avoid taking any action that results in an
adverse effect to historic properties pending compliance with Section 106.
Recipients should be aware that the DOE Contracting Officer will consider the recipient in compliance with Section 106
of the NHPA only after the Recipient has submitted adequate background documentation to the SHPO/THPO for its
review, and the SHPO/THPO has provided written concurrence to the Recipient that it does not object to its Section 106
finding or determination. Recipient shall provide a copy of this concurrence to the Contracting Officer.
w
-MV City of Fort Worth Page 15 of 52
SITE VISITS
DOE authorized representatives have the right to make site visits at reasonable times to review project accomplishments
and management control systems and to provide technical assistance, if required. You must provide, and must require
your sub-awardees to provide, reasonable access to facilities, office space, resources, and assistance for the safety and
convenience of the government representatives in the performance of their duties. All site visits and evaluations must be
performed in a manner that does not unduly interfere with or delay the work.
REPORTING REQUIREMENTS
a. Requirements. The reporting requirements for this award are identified on the Federal Assistance Reporting
Checklist, DOE F 4600.2, attached to this award. Failure to comply with these reporting requirements is considered a
material noncompliance with the terms of the award. Noncompliance may result in withholding of future payments,
suspension, or termination of the current award, and withholding of future awards. A willful failure to perform, a history
of failure to perform, or unsatisfactory performance of this and/or other financial assistance awards, may also result in a
debarment action to preclude future awards by Federal agencies.
b. Dissemination of scientific/technical reports. Scientific/technical reports submitted under this award will be
disseminated on the Internet via the DOE Information Bridge (www.osti.gov/bridge), unless the report contains patentable
material, protected data, or SBIR/STTR data. Citations for journal articles produced under the award will appear on the
DOE Energy Citations Database (www.osti.Lyov/eneruvcitations).
C. Restrictions. Reports submitted to the DOE Information Bridge must not contain any Protected Personal
Identifiable Information (PII), limited rights data (proprietary data), classified information, information subject to export
control classification, or other information not subject to release.
PUBLICATIONS
a. You are encouraged to publish or otherwise make publicly available the results of the work conducted under the
award.
b. An acknowledgment of Federal support and a disclaimer must appear in the publication of any material, whether
copyrighted or not, based on or developed under this project, as follows:
Acknowledgment: "This material is based upon work supported by the Department of Energy under Award Number(s)
DE-EE0000116."
Disclaimer: "This report was prepared as an account of work sponsored by an agency of the United States Government.
Neither the United States Government nor any agency thereof, nor any of their employees, makes any warranty, express
or implied, or assumes any legal liability or responsibility for the accuracy, completeness, or usefulness of any
information, apparatus, product, or process disclosed, or represents that its use would not infringe privately owned rights.
Reference herein to any specific commercial product, process, or service by trade name, trademark, manufacturer, or
otherwise does not necessarily constitute or imply its endorsement, recommendation, or favoring by the United States
Government or any agency thereof. The views and opinions of authors expressed herein do not necessarily state or reflect
those of the United States Government or any agency thereof."
FEDERAL. STATE. AND MUNICIPAL REQUIREMENTS
You must obtain any required permits and comply with applicable federal, state, and municipal laws, codes, and
regulations for work performed under this award.
City of Fort Worth Page 16 of 52
INTELLECTUAL PROPERTY PROVISIONS AND CONTACT INFORMATION
a. The intellectual property provisions applicable to this award are provided as an attachment to this award. A list of
all intellectual property provisions may be found at httD://www.Lc.doe.2ov/fmancial assistance awards.htm.
b. Questions regarding intellectual property matters should be referred to the DOE Award Administrator and the
Patent Counsel designated as the service provider for the DOE office that issued the award. The IP Service Providers List
is found at httD://www.¢c.doe.sov/documents/Intellectual Property (IP) Service Providers for Acauisition.vdf.
LOBBYING RESTRICTIONS
By accepting funds under this award, you agree that none of the funds obligated on the award shall be expended, directly
or indirectly, to influence congressional action on any legislation or appropriation matters pending before Congress, other
than to communicate to Members of Congress as described in 18 U.S.C. 1913. This restriction is in addition to those
prescribed elsewhere in statute and regulation.
NOTICE REGARDING THE PURCHASE OF AMERICAN-MADE EQUIPMENT AND PRODUCTS -- SENSE
OF CONGRESS
It is the sense of the Congress that, to the greatest extent practicable, all equipment and products purchased with funds
made available under this award should be American -made.
PRESERVATION OF OPEN COMPETITION AND GOVERNMENT NEUTRALITY TOWARDS
CONTRACTORS' LABOR RELATIONS ON FEDERALLY FUNDED CONSTRUCTION PROJECTS
a. Unless in conflict with State or local laws, you must ensure that bid specifications, project agreement, or other
controlling documents in construction contracts awarded pursuant to this agreement, or pursuant to a sub -award to this
agreement, do not:
1. Require or prohibit bidders, offer -ors, contractors, or subcontractors to enter into or adhere to agreements with
one or more labor organizations, on the same or other related construction project(s); or
2. Otherwise discriminate against bidders, offer -ors, contractors, or subcontractors for becoming or refusing to
become or remain signatories or otherwise to adhere to agreements with one or more labor organizations, on the same or
other related construction prof ect(s).
b. The term "construction contract" as used in this provision means any contract for the construction, rehabilitation,
alteration, conversion, extension, or repair of buildings, highways, or other improvements to real property.
c. Nothing in this provision prohibits bidders, offer -ors, contractors, or subcontractors from voluntarily entering into
agreements with labor organizations.
NATIONAL ENVIRONMENTAL POLICY ACT (NEPA)
You are restricted from taking any action using Federal funds for projects under this award that would have an adverse
effect on the environment or limit the choice of reasonable alternatives prior to DOE providing a final NEPA
determination regarding these projects.
Prohibited project activities include:
Distributed Renewable Energy Technology Program
Building Efficiency/Retrofit Program — Loans for Renewable energy -related projects
City of Fort Worth Page 17 of 52
Transportation Efficiency Program — Alternative Fuels activities including the purchase of equipment for new alternative
fuel(s) refueling stations and/or the purchase of equipment for retrofits of existing refueling stations.
The project activities listed above will require an individual NEPA review and determination. You must submit an
environmental questionnaire to the DOE Project Officer for each project activity identified above to allow DOE to
conduct an individual NEPA review and determination.
If you move forward with activities that are not authorized for federal funding by the DOE Contracting Officer in advance
of the final NEPA determination, you are doing so at risk of not receiving federal funding and such costs may not be
recognized as allowable cost share.
If DOE determines that NEPA requires the preparation of an environmental assessment (EA) or environmental
impact statement (EIS) for a project you propose, you will be responsible for paying the cost of preparing an EA or
EIS. Preparation of these types of NEPA documents can require 6-24 months. Accordingly you should carefully
consider whether such projects are consistent with the objectives of the ARRA and will allow the expenditure of
funds within the time periods allowed for by that statute.
This restriction does not preclude you from: performing information gathering, analysis, documentation, dissemination
and training and providing technical advice and planning assistance for the activities listed above.
Nor does this restriction preclude you from conducting the following project activities:
Energy Education Outreach Program
Administration
Energy Sector Training Centers
Transportation Efficiency Program — Traffic Signal activities and Alternative Fuels activities including the incremental
cost of plug-in hybrid vehicles, alternative fuel vehicles (CNG, LNG,LPG, Electric) and the incremental costs of
retrofitting diesel vehicles to alternative fuel vehicles.
Building Efficiency/Retrofit Program - Loans for commissioning, controls, JIVAC, lighting, building shell, and water
efficiency project activities
DECONTAMINATION AND/OR DECOMMISSIONING (D &D) COSTS
Notwithstanding any other provisions of this Agreement, the Government shall not be responsible for or have any
obligation to the recipient for (i) Decontamination and/or Decommissioning (D&D) of any of the recipient's facilities, or
(ii) any costs which may be incurred by the recipient in connection with the D&D of any of its facilities due to the
performance of the work under this Agreement, whether said work was performed prior to or subsequent to the effective
date of this Agreement.
SPECIAL PROVISIONS RELATING TO WORK FUNDED UNDER _AMERICAN RECOVERY AND
REINVESTMENT ACT OF 2009
Preamble
The American Recovery and Reinvestment Act of 2009, Pub. L. 111-5, (Recovery Act) was enacted to preserve and
create jobs and promote economic recovery, assist those most impacted by the recession, provide investments needed to
increase economic efficiency by spurring technological advances in science and health, invest in transportation,
environmental protection, and other infrastructure that will provide long-term economic benefits, stabilize State and local
government budgets, in order to minimize and avoid reductions in essential services and counterproductive State and local
tax increases. Recipients shall use grant funds in a manner that maximizes job creation and economic benefit.
The Recipient shall comply with all terms and conditions in the Recovery Act relating generally to governance,
accountability, transparency, data collection and resources as specified in Act itself and as discussed below.
City of Fort Worth Page 18 of 52
Recipients should begin planning activities for their first tier sub -recipients, including obtaining a DUNS number (or
updating the existing DUNS record), and registering with the Central Contractor Registration (CCR).
Be advised that Recovery Act funds can be used in conjunction with other funding as necessary to complete projects, but
tracking and reporting must be separate to meet the reporting requirements of the Recovery Act and related guidance. For
projects funded by sources other than the Recovery Act, Contractors must keep separate records for Recovery Act funds
and to ensure those records comply with the requirements of the Act.
The Government has not fully developed the implementing instructions of the Recovery Act, particularly concerning
specific procedural requirements for the new reporting requirements. The Recipient will be provided these details as they
become available. The Recipient must comply with all requirements of the Act. If the recipient believes there is any
inconsistency between ARRA requirements and current award terms and conditions, the issues will be referred to the
Contracting Officer for reconciliation.
Definitions
For purposes of this clause, Covered Funds means funds expended or obligated from appropriations under the American
Recovery and Reinvestment Act of 2009, Pub. L. 111-5. Covered Funds will have special accounting codes and will be
identified as Recovery Act funds in the grant, cooperative agreement or TIA and/or modification using Recovery Act
funds. Covered Funds must be reimbursed by September 30, 2015.
Non -Federal employer means any employer with respect to covered funds — the contractor, subcontractor, grantee, or
recipient, as the case may be, if the contractor, subcontractor, grantee, or recipient is an employer; and any professional
membership organization, certification of other professional body, any agent or licensee of the Federal government, or any
person acting directly or indirectly in the interest of an employer receiving covered funds; or with respect to covered funds
received by a State or local government, the State or local government receiving the funds and any contractor or
subcontractor receiving the funds and any contractor or subcontractor of the State or local government; and does not mean
any department, agency, or other entity of the federal government.
Recipient means any entity that receives Recovery Act funds directly from the Federal government (including Recovery
Act funds received through grant, loan, or contract) other than an individual and includes a State that receives Recovery
Act Funds.
Special Provisions
A. Flow Down Requirement
Recipients must include these special terms and conditions in any sub -award.
B. Segregation of Costs
Recipients must segregate the obligations and expenditures related to funding under the Recovery Act. Financial and
accounting systems should be revised as necessary to segregate, track and maintain these funds apart and separate from
other revenue streams. No part of the funds from the Recovery Act shall be commingled with any other funds or used for
a purpose other than that of making payments for costs allowable for Recovery Act projects.
C. Prohibition on Use of Funds
None of the funds provided under this agreement derived from the American Recovery and Reinvestment Act of 2009,
Pub. L. 111-5, may be used by any State or local government, or any private entity, for any casino or other gambling
establishment, aquarium, zoo, golf course, or swimming pool.
D. Access to Records
City of Fort Worth Page 19 of 52
With respect to each financial assistance agreement awarded utilizing at least some of the funds appropriated or otherwise
made available by the American Recovery and Reinvestment Act of 2009, Pub. L. 111-5, any representative of an
appropriate inspector general appointed under section 3 or 8G of the Inspector General Act of 1988 (5 U.S.C. App.) or of
the Comptroller General is authorized —
(1) to examine any records of the contractor or grantee, any of its subcontractors or sub -grantees, or any State or
local agency administering such contract that pertain to, and involve transactions relation to, the subcontract,
subcontract, grant, or sub -grant; and
(2) to interview any officer or employee of the contractor, grantee, sub -grantee, or agency regarding such
transactions.
E. Publication
An application may contain technical data and other data, including trade secrets and/or privileged or confidential
information, which the applicant does not want disclosed to the public or used by the Government for any purpose other
than the application. To protect such data, the applicant should specifically identify each page including each line or
paragraph thereof containing the data to be protected and mark the cover sheet of the application with the following
Notice as well as referring to the Notice on each page to which the Notice applies:
Notice of Restriction on Disclosure and Use of Data
The data contained in pages ---- of this application have been submitted in confidence and contain trade secrets or
proprietary information, and such data shall be used or disclosed only for evaluation purposes, provided that if this
applicant receives an award as a result of or in connection with the submission of this application, DOE shall have the
right to use or disclose the data here to the extent provided in the award. This restriction does not limit the Government's
right to use or disclose data obtained without restriction from any source, including the applicant.
Information about this agreement will be published on the Internet and linked to the website www.recoverv.eov.
maintained by the Accountability and Transparency Board. The Board may exclude posting contractual or other
information on the website on a case -by -case basis when necessary to protect national security or to protect information
that is not subject to disclosure under sections 552 and 552a of title 5, United States Code.
F. Protecting State and Local Government and Contractor Whistleblowers.
The requirements of Section 1553 of the Act are summarized below. They include, but are not limited to:
Prohibition on Reprisals: An employee of any non -Federal employer receiving covered funds under the American
Recovery and Reinvestment Act of 2009, Pub. L. 111-5, may not be discharged, demoted, or otherwise discriminated
against as a reprisal for disclosing, including a disclosure made in the ordinary course of an employee's duties, to the
Accountability and Transparency Board, an inspector general, the Comptroller General, a member of Congress, a State or
Federal regulatory or law enforcement agency, a person with supervisory authority over the employee (or other person
working for the employer who has the authority to investigate, discover or terminate misconduct, a court or grant jury, the
head of a Federal agency, or their representatives information that the employee believes is evidence of-
- gross management of an agency contract or grant relating to covered funds;
• a gross waste of covered funds
• a substantial and specific danger to public health or safety related to the implementation or use of covered funds;
• an abuse of authority related to the implementation or use of covered funds; or
• as violation of law, rule, or regulation related to an agency contract (including the competition for or negotiation
of a contract) or grant, awarded or issued relating to covered funds.
Agency Action: Not later than 30 days after receiving an inspector general report of an alleged reprisal, the head of the
agency shall determine whether there is sufficient basis to conclude that the non -Federal employer has subjected the
employee to a prohibited reprisal. The agency shall either issue an order denying relief in whole or in part or shall take
one or more of the following actions:
• Order the employer to take affirmative action to abate the reprisal.
• Order the employer to reinstate the person to the position that the person held before the reprisal, together with
compensation including back pay, compensatory damages, employment benefits, and other terms and conditions
City of Fort Worth Page 20 of 52
of employment that would apply to the person in that position if the reprisal had not been taken.
• Order the employer to pay the employee an amount equal to the aggregate amount of all costs and expenses
(including attorneys' fees and expert witnesses' fees) that were reasonably incurred by the employee for or in
connection with, bringing the complaint regarding the reprisal, as determined by the head of a court of competent
jurisdiction.
Non -enforceability of Certain Provisions Waiving Rights and remedies or Requiring Arbitration: Except as provided in a
collective bargaining agreement, the rights and remedies provided to aggrieved employees by this section may not be
` waived by any agreement, policy, form, or condition of employment, including any pre -dispute arbitration agreement. No
-_ pre -dispute arbitration agreement shall be valid or enforceable if it requires arbitration of a dispute arising out of this
section.
Requirement to Post Notice of Rights and Remedies: Any employer receiving covered funds under the American
,er Recovery and Reinvestment Act of 2009, Pub. L. 111-5, shall post notice of the rights and remedies as required therein.
(Refer to section 1553 of the American Recovery and Reinvestment Act of 2009, Pub. L. 111-5, www.Recovery.gov, for
specific requirements of this section and prescribed language for the notices.).
G. Reauest for Reimbursement
RESERVED
H. False Claims Act
Recipient and sub -recipients shall promptly refer to the DOE or other appropriate Inspector General any credible evidence
that a principal, employee, agent, contractor, sub -grantee, subcontractor or other person has submitted a false claim under
the False Claims Act or has committed a criminal or civil violation of laws pertaining to fraud, conflict or interest, bribery,
gratuity or similar misconduct involving those funds.
I. Information in su000rtine of Recovery Act Revortins
Recipient may be required to submit backup documentation for expenditures of funds under the Recovery Act including
such items as timecards and invoices. Recipient shall provide copies of backup documentation at the request of the
°W Contracting Officer or designee.
J. Availability of Funds
Funds appropriated under the Recovery Act and obligated to this award are available for reimbursement of costs until
September 30, 2015.
'qp K. Additional Fundine Distribution and Assurance of Aoorooriate Use of Funds
Certification by Governor -- Not later than April 3, 2009, for funds provided to any State or agency thereof by the
American Reinvestment and Recovery Act of 2009, Pub. L. 111-5, the Governor of the State shall certify that: 1) the state
will request and use funds provided by the Act; and 2) the funds will be used to create jobs and promote economic growth.
Acceptance by State Legislature -- If funds provided to any State in any division of the Act are not accepted for use by the
Governor, then acceptance by the State legislature, by means of the adoption of a concurrent resolution, shall be sufficient
to provide funding to such State.
Distribution — After adoption of a State legislature's concurrent resolution, funding to the State will be for distribution to
local governments, councils of government, public entities, and public -private entities within the State either by formula
or at the State's discretion.
L. Certifications
-W, City of Fort Worth Page 21 of 52
With respect to funds made available to State or local governments for infrastructure investments under the American
Recovery and Reinvestment Act of 2009, Pub. L. 111-5, the Governor, mayor, or other chief executive, as appropriate,
certified by acceptance of this award that the infrastructure investment has received the full review and vetting required by
law and that the chief executive accepts responsibility that the infrastructure investment is an appropriate use of taxpayer
dollars. Recipient shall provide an additional certification that includes a description of the investment, the estimated total
cost, and the amount of covered funds to be used for posting on the Internet. A State or local agency may not receive
infrastructure investment funding from funds made available by the Act unless this certification is made and posted.
REPORTING AND REGISTRATION REQUIREMENTS UNDER SECTION 1512 OF THE RECOVERY ACT
(a) This award requires the recipient to complete projects or activities which are funded under the American Recovery
and Reinvestment Act of 2009 (Recovery Act) and to report on use of Recovery Act funds provided through this award.
Information from these reports will be made available to the public.
(b) The reports are due no later than ten calendar days after each calendar quarter in which the recipient receives the
assistance award funded in whole or in part by the Recovery Act.
(c) Recipients and their first -tier recipients must maintain current registrations in the Central Contractor Registration
(http://Www.ccr.gov) at all times during which they have active federal awards funded with Recovery Act funds. A Dun
and Bradstreet Data Universal Numbering System (DUNS) Number (http://www.dnb.com) is one of the requirements for
registration in the Central Contractor Registration.
(d) The recipient shall report the information described in section 1512(c) of the Recovery Act using the reporting
instructions and data elements that will be provided online at http://Www.FederaiReporting.gov and ensure that any
information that is pre -filled is corrected or updated as needed.
REQUIRED USE OF AMERICAN IRON, STEEL. AND MANUFACTURED GOODS (COVERED UNDER
INTERNATIONAL AGREEMENTS) —SECTION 1605 OF THE AMERICAN RECOVERY AND
REINVESTMENT ACT OF 2009
(a) Definitions. As used in this award term and condition —
Designated country —(1) A World Trade Organization Government Procurement Agreement country (Aruba, Austria,
Belgium, Bulgaria, Canada, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hong Kong,
Hungary, Iceland, Ireland, Israel, Italy, Japan, Korea (Republic of), Latvia, Liechtenstein, Lithuania, Luxembourg, Malta,
Netherlands, Norway, Poland, Portugal, Romania, Singapore, Slovak Republic, Slovenia, Spain, Sweden, Switzerland,
and United Kingdom;
(2) A Free Trade Agreement (FTA) country (Australia, Bahrain, Canada, Chile, Costa Rica, Dominican Republic, El
Salvador, Guatemala, Honduras, Israel, Mexico, Morocco, Nicaragua, Oman, Peru, or Singapore); or
(3) A United States -European Communities Exchange of Letters (May 15, 1995) country: Austria, Belgium, Bulgaria,
Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia,
Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovak Republic, Slovenia, Spain, Sweden, and
United Kingdom.
Designated country iron, steel, and/or manufactured goods —(1) Is wholly the growth, product, or manufacture of a
designated country; or
(2) In the case of a manufactured good that consist in whole or in part of materials from another country, has been
substantially transformed in a designated country into a new and different manufactured good distinct from the materials
from which it was transformed.
Domestic iron, steel, and/or manufactured good —(1) Is wholly the growth, product, or manufacture of the United States;
City of Fort Worth Page 22 of 52
or
(2) In the case of a manufactured good that consists in whole or in part of materials from another country, has been
substantially transformed in the United States into a new and different manufactured good distinct from the materials from
which it was transformed. There is no requirement with regard to the origin of components or subcomponents in
manufactured goods or products, as long as the manufacture of the goods occurs in the United States.
Foreign iron, steel, andlor manufactured good means iron, steel and/or manufactured good that is not domestic or
designated country iron, steel, and/or manufactured good.
Manufactured good means a good brought to the construction site for incorporation into the building or work that has
been—
(1) Processed into a specific form and shape; or
(2) Combined with other raw material to create a material that has different properties than the properties of the individual
raw materials.
Public building and public work means a public building of, and a public work of, a governmental entity (the United
States; the District of Columbia; commonwealths, territories, and minor outlying islands of the United States; State and
local governments; and multi -State, regional, or interstate entities which have governmental functions). These buildings
and works may include, without limitation, bridges, dams, plants, highways, parkways, streets, subways, tunnels, sewers,
mains, power lines, pumping stations, heavy generators, railways, airports, terminals, docks, piers, wharves, ways,
lighthouses, buoys, jetties, breakwaters, levees, and canals, and the construction, alteration, maintenance, or repair of such
buildings and works.
Steel means an alloy that includes at least 50 percent iron, between .02 and 2 percent carbon, and may include other
elements.
(b) Iron, steel, and manufactured goods. (1) The award term and condition described in this section implements—
(i) Section 1605(a) of the American Recovery and Reinvestment Act of 2009 (Pub. L. 111-5) (Recovery Act), by
requiring that all iron, steel, and manufactured goods used in the project are produced in the United States; and
(ii) Section 1605(d), which requires application of the Buy American requirement in a manner consistent with U.S.
obligations under international agreements. The restrictions of section 1605 of the Recovery Act do not apply to
designated country iron, steel, and/or manufactured goods. The Buy American requirement in section 1605 shall not be
applied where the iron, steel or manufactured goods used in the project are from a Party to an international agreement that
obligates the recipient to treat the goods and services of that Party the same as domestic goods and services. This
obligation shall only apply to projects with an estimated value of $7,443,000 or more.
(2) The recipient shall use only domestic or designated country iron, steel, and manufactured goods in performing the
work funded in whole or part with this award, except as provided in paragraphs (b)(3) and (b)(4) of this section.
(3) The requirement in paragraph (b)(2) of this section does not apply to the iron, steel, and manufactured goods listed by
the Federal Government as follows:
[ Award official to list applicable excepted materials or indicate "none " ]
(4) The award official may add other iron, steel, and manufactured goods to the list in paragraph (b)(3) of this section if
the Federal Government determines that —
City of Fort Worth Page 23 of 52
(i) The cost of domestic iron, steel, and/or manufactured goods would be unreasonable. The cost of domestic iron, steel,
and/or manufactured goods used in the project is unreasonable when the cumulative cost of such material will increase the
overall cost of the project by more than 25 percent;
(ii) The iron, steel, and/or manufactured good is not produced, or manufactured in the United States in sufficient and
reasonably available commercial quantities of a satisfactory quality; or
(iii) The application of the restriction of section 1605 of the Recovery Act would be inconsistent with the public interest.
(c) Request for determination of inapplicability of section 1605 of the Recovery Act or the Buy American Act. (1)(i) Any
recipient request to use foreign iron, steel, and/or manufactured goods in accordance with paragraph (b)(4) of this section
shall include adequate information for Federal Government evaluation of the request, including —
(A) A description of the foreign and domestic iron, steel, and/or manufactured goods;
(B) Unit of measure;
(C) Quantity;
(D) Cost;
(E) Time of delivery or availability;
(F) Location of the project;
(G) Name and address of the proposed supplier; and
(H) A detailed justification of the reason for use of foreign iron, steel, and/or manufactured goods cited in accordance with
paragraph (b)(4) of this section.
(ii) A request based on unreasonable cost shall include a reasonable survey of the market and a completed cost
comparison table in the format in paragraph (d) of this section.
(iii) The cost of iron, steel, or manufactured goods shall include all delivery costs to the construction site and any
applicable duty.
(iv) Any recipient request for a determination submitted after Recovery Act funds have been obligated for a project for
construction, alteration, maintenance, or repair shall explain why the recipient could not reasonably foresee the need for
such determination and could not have requested the determination before the funds were obligated. If the recipient does
not submit a satisfactory explanation, the award official need not make a determination.
(2) If the Federal Government determines after funds have been obligated for a project for construction, alteration,
maintenance, or repair that an exception to section 1605 of the Recovery Act applies, the award official will amend the
award to allow use of the foreign iron, steel, and/or relevant manufactured goods. When the basis for the exception is non -
availability or public interest, the amended award shall reflect adjustment of the award amount, redistribution of budgeted
funds, and/or other appropriate actions taken to cover costs associated with acquiring or using the foreign iron, steel,
and/or relevant manufactured goods.. When the basis for the exception is the unreasonable cost of the domestic iron, steel,
or manufactured goods, the award official shall adjust the award amount or redistribute budgeted funds, as appropriate, by
at least the differential established in 2 CFR 176.110(a).
(3) Unless the Federal Government determines that an exception to section 1605 of the Recovery Act applies, use of
foreign iron, steel, and/or manufactured goods other than designated country iron, steel, and/or manufactured goods is
noncompliant with the applicable Act.
City of Fort Worth Page 24 of 52
(d) Data. To permit evaluation of requests under paragraph (b) of this section based on unreasonable cost, the applicant
shall include the following information and any applicable supporting data based on the survey of suppliers:
Foreign and Domestic Items Cost Comparison
Cost
Description Unit of measure Quantity (dollars)*
Item 1:
Foreign steel, iron, or manufactured good
Domestic steel, iron, or manufactured good
Item 2:
Foreign steel, iron, or manufactured good
Domestic steel, iron, or manufactured good
[List name, address, telephone number, email address, and contact for suppliers surveyed. Attach copy of response; if
oral, attach summary.]
[Include other applicable supporting information.]
[*Include all delivery costs to the construction site.]
WAGE RATE REQUIREMENTS UNDER SECTION 1606 OF THE RECOVERY ACT
(a) Section 1606 of the Recovery Act requires that all laborers and mechanics employed by contractors and
subcontractors on projects funded directly by or assisted in whole or in part by and through the Federal Government
pursuant to the Recovery Act shall be paid wages at rates not less than those prevailing on projects of a character similar
in the locality as determined by the Secretary of Labor in accordance with subchapter IV of chapter 31 of title 40, United
4 States Code.
Pursuant to Reorganization Plan No. 14 and the Copeland Act, 40 U.S.C. 3145, the Department of Labor has issued
regulations at 29 CFR parts 1, 3, and 5 to implement the Davis -Bacon and related Acts. Regulations in 29 CFR 5.5
instruct agencies concerning application of the standard Davis -Bacon contract clauses set forth in that section. Federal
agencies providing grants, cooperative agreements, and loans under the Recovery Act shall ensure that the standard
Davis -Bacon contract clauses found in 29 CFR 5.5(a) are incorporated in any resultant covered contracts that are in excess
of $2,000 for construction, alteration or repair (including painting and decorating).
(b) For additional guidance on the wage rate requirements of section 1606, contact your awarding agency. Recipients of
grants, cooperative agreements and loans should direct their initial inquiries concerning the application of Davis -Bacon
requirements to a particular federally assisted project to the Federal agency funding the project. The Secretary of Labor
retains final coverage authority under Reorganization Plan Number 14.
RECOVERY ACT TRANSACTIONS LISTED IN SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS
AND RECIPIENT RESPONSIBILITIES FOR INFORMAING SUBRECIPIENTS
(a) To maximize the transparency and accountability of funds authorized under the American Recovery and Reinvestment
Act of 2009 (Pub. L. 111-5) (Recovery Act) as required by Congress and in accordance with 2 CFR 215.21 "Uniform
Administrative Requirements for Grants and Agreements" and OMB Circular A-102 Common Rules provisions,
recipients agree to maintain records that identify adequately the source and application of Recovery Act funds. OMB
Circular A-102 is available at http://www.whitehouse.govlomb/circularsla102la102.html.
City of Fort Worth Page 25 of 52
(b) For recipients covered by the Single Audit Act Amendments of 1996 and OMB Circular A-133, "Audits of States,
Local Governments, and Non -Profit Organizations," recipients agree to separately identify the expenditures for Federal
awards under the Recovery Act on the Schedule of Expenditures of Federal Awards (SEFA) and the Data Collection Form
(SF —SAC) required by OMB Circular A-133. OMB Circular A-133 is available at
http://Www.whitehouse.govlomb/circulars/a1331a]33.html. This shall be accomplished by identifying expenditures for
Federal awards made under the Recovery Act separately on the SEFA, and as separate rows under Item 9 of Part III on the
SF —SAC by CFDA number, and inclusion of the prefix "ARRA-" in identifying the name of the Federal program on the
SEFA and as the first characters in Item 9d of Part III on the SF —SAC.
(c) Recipients agree to separately identify to each sub -recipient, and document at the time of sub -award and at the time of
disbursement of funds, the Federal award number, CFDA number, and amount of Recovery Act funds. When a recipient
awards Recovery Act funds for an existing program, the information furnished to sub -recipients shall distinguish the sub -
awards of incremental Recovery Act funds from regular sub -awards under the existing program.
(d) Recipients agree to require their sub -recipients to include on their SEFA information to specifically identify Recovery
Act funding similar to the requirements for the recipient SEFA described above. This information is needed to allow the
recipient to properly monitor sub -recipient expenditure of ARRA funds as well as oversight by the Federal awarding
agencies, Offices of Inspector General and the Government Accountability Office.
v City of Fort Worth Page 26 of 52
+.r
DOE F 1600.5
(06-94)
* All Other Editions Are Obsolete
ATTACHMENT C-1 Contract No.
U.S. DEPARTMENT OF ENERGY
Assurance of Compliance
Nondiscrimination in State Assisted Programs
OMB Burden Disclosure Statement
OMB Control No.
1910-0400
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions,
` searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments
F regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of
Information Resources Management Policy, Plans, and Oversight, Records Management Division, HR-422-GTN, Paperwork Reduction Project (1910-
0400), U.S. Department of Energy, 1000 Independence Avenue, S.W., Washington, DC 20585; and to the Office of Management and Budget (OMB),
Paperwork Reduction Project (1910-0400), Washington, DC 20503.
City of Fort Worth (Hereinafter called the "Applicant") HEREBY AGREES to comply with Title VI of the Civil Rights Act of 1964
(Pub. L. 88-352), Section 16 of the Federal Energy Administration Act of 1974 (Pub. L. 93-275), Section 401 of the Energy
Reorganization Act of 1974 (Pub. L. 93438), Title IX of the Education Amendments of 1972, as amended (Pub. L. 92-318, Pub. L.
93-568, and Pub. L. 94482), Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112), the Age Discrimination Act of 1977
(Pub. L. 94-135), Title VIII of the Civil Rights Act of 1968 (Pub. L. 90-284), the Department of Energy Organization Act of 1977
(Pub. L. 95-91), the Energy Conservation and Production Act of 1976, as amended, (Pub. L. 94-385) and Title 10 Code of Federal
Regulations, Part 1040. In accordance with the above laws and regulations issued pursuant thereto, the Applicant agrees to assure
r that no person in the United States shall, on the ground of race, color, national origin, sex, age, or disability, be excluded from
participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity in which the
Applicant receives Federal assistance from the Department of Energy.
Applicability and Period of Obligation
.. In the case of any service, financial aid, covered employment, equipment, property, or structure provided, leased, or improved with
Federal assistance funding extended to the Applicant by the Department of Energy, this assurance obligates the Applicant for the
V period during which the Federal assistance is extended. In the case of any transfer of such service, financial aid, equipment, property,
or structure, this assurance obligates the transferee for the period during which Federal assistance is extended. If any personal
property is so provided, this assurance obligates the Applicant for the period during which it retains ownership or possession of the
property. In all other cases, this assurance obligates the Applicant for the period during which the Federal assistance is extended to
the Applicant by the Department of Energy.
Employment Practices
Where a primary objective of the Federal assistance is to provide employment or where the Applicant's employment practices affect
the delivery of services in programs or activities resulting from Federal assistance extended by the Department of Energy, the
Applicant agrees not to discriminate on the ground of race, color, national origin, sex, and disability, in its employment practices.
Such employment practices may include, but are not limited to, recruitment, advertising, hiring, layoff or termination, promotion,
demotion, transfer, rates of pay, training and participation in upward mobility programs, or other forms of compensation and use of
facilities.
Sub -recipient Assurance
The Applicant shall require any individual, organization, or other entity with whom it subcontracts, sub -grants, or subleases for the
purpose of providing any service, financial aid, equipment, property, or structure to comply with laws cited above. To this end, the
sub -recipient shall be required to sign a written assurance form; however, the obligation of both recipient and sub -recipient to ensure
compliance is not relieved by the collection or submission of written assurance forms.
Data Collection and Access to Records
The Applicant agrees to compile and maintain information pertaining to programs or activities developed as a result of the Applicant's
receipt of Federal assistance from the Department of Energy. Such information shall include, but is not limited to the following: (1)
the manner in which services are or will be provided and related data necessary for determining whether any persons are or will be
denied such services on the basis of prohibited discrimination; (2) the population eligible to be serviced by race, color, national
W origin, sex, and disability; (3) data regarding covered employment, including use or planned use of bilingual public contact
employees serving beneficiaries of the program where necessary to permit effective participation by beneficiaries unable to speak or
understand English; (4) the location of existing or proposed facilities connected with the program and related information adequate
for determining whether the location has or will have the effect of unnecessarily denying access to any person on the basis of
prohibited discrimination; (5) the present or proposed membership by race, color, national origin, sex, and disability, in any planning
or advisory body which is an integral part of the program; and (6) any additional written data determined by the Department of
Energy to be relevant to the obligation to assure compliance by recipients with laws cited in the first paragraph of this assurance.
City of Fort Worth Page 27 of 52
The Applicant agrees to submit requested data to the Department of Energy regarding programs and activities developed by the
Applicant from the use of Federal funds extended by the Department of Energy. Facilities of the Applicant (including the physical
plants, buildings, or other structures) and all records, books, accounts, and other sources of information pertinent to the Applicant's
compliance with the civil rights laws shall be made available for inspection during normal business hours of request of an officer or
_ employee of the Department of Energy specifically authorized to make such inspections. Instructions in this regard will be provided
by the Director, Office of Civil Rights, U. S. Department of Energy.
This assurance is given in consideration of and for the purpose of obtaining any and all Federal grants, loans, contracts (excluding
procurement contracts), property, discounts or other Federal assistance extended after the date hereto, to the Applicants by the
Department of Energy, including installment payments on account after such date of application for Federal assistance which are
approved before such date. The Applicant recognizes and agrees that such Federal assistance will be extended in reliance upon the
representations and agreements made in this assurance and that the United State shall have the right to seek judicial enforcement of
this assurance. This assurance is binding on the Applicant, its successors, transferees, and assignees, as well as the person(s) whose
signature appears below and who is authorized to sign this assurance on behalf of the Applicant.
Applicant Certification
The Applicant certifies that it has complied, or that, within 90 days of the date of the grant, it will comply with all applicable
requirements of 10 C.F.R. § 1040.5 (a copy will be furnished to the Applicant upon written request to DOE.)
City of Fort Worth
Designated Responsible Employee
Fernando Costa, Assistant City Manager
Signature:
Telephone Number: (817) 392-6122
Date:
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City of Fort Worth Page 28 of 52
ATTACHMENT C-2 Contract No.
DOE F 1600.5
(06-94)
All Other Editions Are Obsolete
U.S. DEPARTMENT OF ENERGY
Assurance of Compliance
Nondiscrimination in State Assisted Programs
OMB Burden Disclosure Statement
OMB Control No.
1910-0400
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the 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 this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of
Information Resources Management Policy, Plans, and Oversight, Records Management Division, HR-422-GTN, Paperwork Reduction Project (1910-
0400), U.S. Department of Energy, 1000 Independence Avenue, S.W., Washington, DC 20585; and to the Office of Management and Budget (OMB),
Paperwork Reduction Project (1910-0400), Washington, DC 20503.
City of Fort Worth (Hereinafter called the "Applicant") HEREBY AGREES to comply with Title VI of
the Civil Rights Act of 1964 (Pub. L. 88-352), Section 16 of the Federal Energy Administration Act of 1974 (Pub. L. 93-275), Section
` 401 of the Energy Reorganization Act of 1974 (Pub. L. 93438), Title IX of the Education Amendments of 1972, as amended (Pub. L.
92-318, Pub. L. 93-568, and Pub. L. 94482), Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112), the Age Discrimination
Act of 1977 (Pub. L. 94-135), Title VIII of the Civil Rights Act of 1968 (Pub. L. 90-284), the Department of Energy Organization
Act of 1977 (Pub. L. 95-91), the Energy Conservation and Production Act of 1976, as amended, (Pub. L. 94-385) and Title 10 Code
s of Federal Regulations, Part 1040. In accordance with the above laws and regulations issued pursuant thereto, the Applicant agrees to
assure that no person in the United States shall, on the ground of race, color, national origin, sex, age, or disability, be excluded from
participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity in which the
Applicant receives Federal assistance from the Department of Energy.
Applicability and Period of Obligation
In the case of any service, financial aid, covered employment, equipment, property, or structure provided, leased, or improved with
Federal assistance funding extended to the Applicant by the Department of Energy, this assurance obligates the Applicant for the
period during which the Federal assistance is extended. In the case of any transfer of such service, financial aid, equipment, property,
or structure, this assurance obligates the transferee for the period during which Federal assistance is extended. If any personal
property is so provided, this assurance obligates the Applicant for the period during which it retains ownership or possession of the
property. In all other cases, this assurance obligates the Applicant for the period during which the Federal assistance is extended to
the Applicant by the Department of Energy.
Employment Practices
Where a primary objective of the Federal assistance is to provide employment or where the Applicant's employment practices affect
the delivery of services in programs or activities resulting from Federal assistance extended by the Department of Energy, the
Applicant agrees not to discriminate on the ground of race, color, national origin, sex, and disability, in its employment practices.
Such employment practices may include, but are not limited to, recruitment, advertising, hiring, layoff or termination, promotion,
demotion, transfer, rates of pay, training and participation in upward mobility programs, or other forms of compensation and use of
facilities.
Sub -recipient Assurance
The Applicant shall require any individual, organization, or other entity with whom it subcontracts, sub -grants, or subleases for the
purpose of providing any service, financial aid, equipment, property, or structure to comply with laws cited above. To this end, the
sub -recipient shall be required to sign a written assurance form; however, the obligation of both recipient and sub -recipient to ensure
compliance is not relieved by the collection or submission of written assurance forms.
Data Collection and Access to Records
The Applicant agrees to compile and maintain information pertaining to programs or activities developed as a result of the Applicant's
receipt of Federal assistance from the Department of Energy. Such information shall include, but is not limited to the following: (1)
the manner in which services are or will be provided and related data necessary for determining whether any persons are or will be
denied such services on the basis of prohibited discrimination; (2) the population eligible to be serviced by race, color, national
origin, sex, and disability; (3) data regarding covered employment, including use or planned use of bilingual public contact
employees serving beneficiaries of the program where necessary to permit effective participation by beneficiaries unable to speak or
understand English; (4) the location of existing or proposed facilities connected with the program and related information adequate
for determining whether the location has or will have the effect of unnecessarily denying access to any person on the basis of
City of Fort Worth Page 29 of 52
prohibited discrimination; (5) the present or proposed membership by race, color, national origin, sex, and disability, in any planning
or advisory body which is an integral part of the program; and (6) any additional written data determined by the Department of
Energy to be relevant to the obligation to assure compliance by recipients with laws cited in the first paragraph of this assurance.
The Applicant agrees to submit requested data to the Department of Energy regarding programs and activities developed by the
Applicant from the use of Federal funds extended by the Department of Energy. Facilities of the Applicant (including the physical
plants, buildings, or other structures) and all records, books, accounts, and other sources of information pertinent to the Applicant's
compliance with the civil rights laws shall be made available for inspection during normal business hours of request of an officer or
employee of the Department of Energy specifically authorized to make such inspections. Instructions in this regard will be provided
by the Director, Office of Civil Rights, U. S. Department of Energy.
This assurance is given in consideration of and for the purpose of obtaining any and all Federal grants, loans, contracts (excluding
procurement contracts), property, discounts or other Federal assistance extended after the date hereto, to the Applicants by the
Department of Energy, including installment payments on account after such date of application for Federal assistance which are
approved before such date. The Applicant recognizes and agrees that such Federal assistance will be extended in reliance upon the
representations and agreements made in this assurance and that the United State shall have the right to seek judicial enforcement of
this assurance. This assurance is binding on the Applicant, its successors, transferees, and assignees, as well as the person(s) whose
signature appears below and who is authorized to sign this assurance on behalf of the Applicant.
Applicant Certification
The Applicant certifies that it has complied, or that, within 90 days of the date of the grant, it will comply with all applicable
requirements of 10 C.F.R. § 1040.5 (a copy will be furnished to the Applicant upon written request to DOE.)
Contractor:
Name of Organization: Citv of Fort Worth
Address: 1000 Throckmorton St.
Fort Worth, Texas 76102
Authorized Official:
Name and Title: Fernando Costa, Assistant City Manager
Signature: `/
eew�M4
City of Fort Worth Page 30 of 52
Telephone Number: 817-392-6122
Telephone Number: 817-392-6122
Date: ,Z//O //O
ATTACHMENT D Contract No.
Certification Regarding Debarment, Suspension Ineligibility,
and Voluntary Exclusion -Lower Tier Covered Transactions
` Instructions for Certification
1. The prospective lower tier participant is required to sign the attached certification.
2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was
entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in
addition to other remedies available to the Federal Government, the department or agency with which this transaction originated
may pursue available remedies, including suspension and/or debarment.
3. The prospective lower tier participant shall provide immediate written notice to the person to which this application is submitted
- if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has become
erroneous by reason of changed circumstances.
4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant," "person,"
"primary covered transaction," "principle," "application," and "voluntarily excluded," as used in this clause, have the meanings set
out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the person to
which this application is submitted for assistance in obtaining a copy of those regulations.
5. The prospective lower tier participant agrees by submitting this application that, should the proposed covered transaction be
entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended,
declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or
agency with which this transaction originated.
6. The prospective lower tier participant further agrees by submitting this application that it will include the clause titled
"Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transaction,"
without modification, in all solicitations for lower tier covered transactions.
7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction
that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the
certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its
principals. Each participant may, but is not required to, check the Non -procurement List.
8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good
faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which
is normally possessed by a prudent person in the ordinary course of business dealings.
9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction knowingly
enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from
participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency with
which this transaction originated may pursue available remedies, including suspension and/or debarment.
(1) The prospective lower tier participant certifies, by submission of this application, that neither it nor its principals is
presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in
this transaction by any Federal department or agency.
(2) Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such
prospective participant shall attach an explanation to this application.
rt
Citv of Fort Worth
Organization Name
Fernando Costa. Assistant Citv Manaeer
Name and Title of Authorized Representative
Signature Date
City of Fort Worth Page 31 of 52
ATTACHMENT E Contract No.
CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHER
- RESPONSIBILITY MATTERS; AND DRUG -FREE WORKPLACE REQUIREMENTS
r Applicants should refer to the regulations cited below to determine the certification to which
they are required to attest. Applicants should also review the instructions
for certification included in the regulations before completing this form. Signature of this
form provides for compliance with certification requirements under 34 CFR
Part 82, "New Restrictions on Lobbying," and 34 CFR Part 85, "Government -wide Debarment and Suspension (Non -procurement) and Government -wide Requirements
- for Drug -Free Workplace (Grants)." The certifications shall be treated as a material representation of fact upon which reliance will be placed when the Department of
Energy determines to award the covered transaction, grant, or cooperative agreement.
certification shall be subject to a civil penalty of
w� LOBBYING
not less than $10,000 and not more than
$100,000 for
The undersigned certifies, to the best of his or
her knowledge and belief, that:
each such failure.
(1) No Federal appropriated funds have been
2. DEBARMENT, SUSPENSION, AND
paid or will be paid, by or on behalf of the
OTHER RESPONSIBILITY MATTERS
undersigned, to any person for influencing
or attempting to influence an officer or
1 The prospective rim
() p p primary participant certifies
_ employee of any agency, a Member of
to the best of its knowledge and belief, that
Congress, an officer or employee of
it and its principals:
Congress, or an employee of a Member of
Congress in connection with the awarding of
`
(a) Are not presently debarred, suspended,
any Federal contract, the making of any
proposed for debarment, declared
Federal grant, the making of any Federal
ineligible, or voluntarily excluded from
loan, the entering into of any cooperative
covered transactions by any Federal
agreement, and the extension, continuation,
department or agency;
renewal, amendment, or modification of any
(b) Have not within a three-year period
Federal contract, grant, loan, or cooperative
receding this proposal been convicted of
agreement.
or had a civil judgment rendered against
them for commission of fraud or a
(2) If any funds other than Federal appropriated
criminal offense in connection with
funds have been paid or will be paid to any
obtaining, attempting to obtain, or
person for influencing or attempting to
performing a public (Federal, State or
influence an officer or employee of any
local) transaction or contract under a
agency, a Member of Congress, an officer or
public transaction; violation of Federal
employee of Congress, or an employee of a
or State antitrust statutes or commission
Member of Congress in connection with this
of embezzlement, theft, forgery,
Federal contract, grant, loan, or cooperative
bribery, falsification or destruction of
agreement, the undersigned shall complete
records, making false statements, or
and submit Standard Form-LLL, "Disclosure
receiving stolen property;
Form to Report Lobbying," in accordance
(c) Are not presently indicted for or
with its instructions.
otherwise criminally or civilly charged
by a government entity (Federal, State
(3) The undersigned shall require that the
or local) with commission of any of the
language of this certification be included in
offenses enumerated in paragraph (1)(b)
the award documents for all sub -awards at
of this certification; and
all tiers (including subcontracts, sub -grants,
(d) Have not within a three-year period
and contracts under grants, loans, and
preceding this application/proposal had
cooperative agreements) and that all sub-
one or more public transactions
recipients shall certify and disclose
(Federal, State or local) terminated for
accordingly.
cause or default.
(2) Where the prospective primary participant is
This certification is a material representation of
unable to certify to any of the statements in
` fact upon which reliance was placed when this
this certification, such prospective
t
participant shall attach an explanation to this
transaction was made or entered into.
proposal.
Submission of this certification is a prerequisite
for making or entering into this transaction
imposed by section 1352, title 31, U.S. Code.
Any person who fails to file the required
3. DRUG -FREE WORKPLACE
City of Fort Worth Page 32 of 52
%W This certification is required by the Drug -Free
Workplace Act of 1988 (Pub. L. 100-690, Title
V, Subtitle D) and is implemented through
additions to the Debarment and Suspension
regulations, published in the Federal Register on
January 31, 1989, and May 25, 1990.
ALTERNATE I
(GRANTEES OTHER THAN INDIVIDUALS)
(1) The grantee certifies that it will or will
continue to provide a drug -free workplace
by:
(a)
Publishing a statement notifying
employees that the unlawful
manufacture, distribution, dispensing,
possession, or use of a controlled
substance is prohibited in the grantee's
workplace and specifying the actions
*�
that will be taken against employees for
violation of such prohibition;
(b)
Establishing an ongoing drug -free
awareness program to inform
employees about:
(1) The dangers of drug abuse in the
_
workplace;
(2) The grantee's policy of maintaining
a drug -free workplace;
(3) Any available drug counseling,
rehabilitation, and employee
assistance programs; and
(4) The penalties that may be imposed
upon employees for drug abuse
violations occurring in the
workplace;
_
(c)
Making it a requirement that each
employee to be engaged in the
performance of the grant be given a
copy of the statement required by
paragraph (a);
(d)
Notifying the employee in the statement
required by paragraph (a) that, as a
condition of employment under the
grant, the employee will:
(1) Abide by the terms of the
statement; and
(2) Notify the employer in writing, of
r
his or her conviction for a violation
of criminal drug statute occurring
in the work -place not later than five
calendar days after such conviction;
(e)
Notifying the agency, in writing, within
ten calendar days after receiving notice
under subparagraph (d)(2) from an
City of Fort Worth
employee or otherwise receiving actual
notice of such conviction. Employers of
convicted employees must provide
notice, including position title, to
energy grant officer or other designee
on whose grant activity the convicted
employee was working, unless the
Federal agency has designated a central
point for the receipt of such notices.
Notice shall include the identification
number(s) of each affected grant;
(f) Taking one of the following actions,
within 30 calendar days of receiving
notice under subparagraph (d)(2), with
respect to any employee who is so
convicted:
(1) Taking appropriate actions against
such an employee, up to and
including termination, consistent
with the requirements of the
Rehabilitation Act 9f 1973, as
amended; or
(2) Requiring such employee to
participate satisfactorily in a drug
abuse assistance or rehabilitation
program approved for such
purposes by a Federal, State or
local health, law enforcement, or
other appropriate agency;
(g) Making a good faith effort to continue
to maintain a drug -free workplace
through implementation of paragraphs
(a), (b), (c), (d), (e), and (f).
(2) The grantee may insert in the space provided
below the site(s) for the performance of
work done in connection with the specific
grant:
Place of Performance:
(Street address, city, county, state, zip code)
Check if there are workplaces on file that are
not identified here.
ALTERNATE H (GRANTEES WHO ARE
INDIVIDUALS)
(1) The grantee certifies that, as a condition of
the grant, he or she will not engage in the
Page 33 of 52
s
e
unlawful manufacture, distribution,
dispensing, possession, or use of a
controlled substances in conducting any
activity with the grant.
(2) If convicted of a criminal drug offense
resulting from a violation occurring
during the conduct of any grant activity,
he or she will report the conviction, in
4. LOBBYING DISCLOSURE ACT OF 1995,
SIMPSON-CRAIG AMENDMENT
Applicant organization which are described in
section 501 (c)(4) of the Internal Revenue Code
of 1986 and engage in lobbying activities after
December 31, 1995, shall not be eligible for the
receipt of Federal funds constituting an award,
— grant, or loan. Section 501(c)(4) of the Internal
Revenue Code of 1986 covers:
Civic leagues or organizations not
organized for profit but operated
' exclusively for the promotion of social
.. welfare, or local associations of
employees, the membership of which is
limited to the employees of a
designated persons or person in a
particular municipality, and the net
earning of which are devoted
Y exclusively to charitable, educational,
or recreational purposes.
As set forth in the Lobbying Disclosure Act of
1995 (Public Law 104-65, December 19, 1995),
as amended ["Simpson -Craig Amendment," see
Section 129 of The Balanced Budget Down -
payment Act, I (Public Law 104-99, January 26,
1996)], lobbying activities is defined broadly.
(See section 3 of the Act.)
The undersigned certifies, to the best of his or
her knowledge and belief, that: it IS NOT an
organization described in section 501 (c)(4) of
the Internal Revenue Code of 1986: OR that it
- IS an organization described in section 501
(c)(4) of the Internal Revenue Code of 1986,
which, after December 31, 1995, HAS NOT
engaged in any lobbying activities as defined in
the Lobbying Disclosure Act of 1995, as
amended.
City of Fort Worth Page 34 of 52
writing, within 10 calendar days of the
conviction, to every grant officer or
other designee, unless the Federal
agency designates a central point for the
receipt of such notices. When notice is
made to such a central point, it shall
include the identification number(s) of
each affected grant.
4 J
RW
.4w
Aw
qW
4W
+r
r
r
As the duly authorized representative of the Applicant, I hereby certify that the Applicant will comply with the above
certifications.
Citv of Fort Worth TR-AG2 -2 010
Name of Applicant Pre/Award Number and/or Project Name
Name, Title
Fernando Costa. Assistant Citv Manaeer Date:
City of Fort Worth Page 35 of 52
4W
Wr
vp
WP
R
ATTACHMENT F Contract No.
DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
1. Type of Federal Action: B 2. Status of Federal Action: A
a. contract a. bid/offer/application
b. grant b. initial award
c. cooperative agreement c. post award
d. loan
e. loan guarantee
f. loan insurance
Name and Address of Reporting Entity:
Name: City of Fort Worth
Address 1000 Throckmorton Street, Fort Worth,
TX 76102-6312
X Prime Sub-awardee
Tier, if known:
6. Federal Department/Agency:
Department of Energy
8. Federal Action Number, If known:
10.a. Name and Address of Lobbying Entity:
(if individual, last name, first name, Ml):
(attach Continuation Sheet(s) SF-LLL-A, if
necessary) NONE
11. Amount of Payment (check all that apply):
$_0.00 _ actual
planned
3. Report Type: A
a. initial filing
b. material change
For Material Change Only:
year quarter
date of last report
5. If Reporting Entity in No. 4 is Sub-awardee, Enter
Name and Address of Prime:
7. Federal Program Name/Description
CFDA Number, if applicable: ARRA
9. Award Amount, if known:
10.b. Individual Performing Services (including address
if different from No. l0A) (last name, first name,
Ml):
NONE
12. Form of Payment (check all that apply):
a. cash
b. in -kind; specify: nature
value
13. Type of Payment (check all that apply):
_ a. retainer _ c. commission _ e. deferred
b.one-time fee _ d.contingent fee _ f. other; specify
14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s),
employee(s), or Member(s) contacted, for Payment indicated in Item 11: NONE
15. Continuation Sheet(s) SF-LLL-A attached:
City of Fort Worth
Page 36 of 52
Yes X No
ATTACHMENT G
National Environmental Policv Act Assurances as Award Terms
(Version August 2008)
• To the extent that a term does not apply to a particular type of activity or award, it is self -deleting.
• The term "You" refers to Grantees and subcontractors of Grantees.
• The term "We" or "Us" refers to the Department of Energy and the Comptroller of Public Accounts.
To the extent that a term does not apply to a particular type of activity or award, it is self -deleting.
I. Nondiscrimination Policies
You must comply with applicable provisions of the following national policies prohibiting discrimination:
1 On the basis of race, color, or national origin, in Title VI of the Civil Rights Act of
1964 (42 U.S.C. 2000d et seq.), as implemented by DOE regulations at 10 CFR part 1040;
2 On the basis of sex or blindness, in Title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.), as implemented by
DOE regulations at 10 CFR parts 1041 and 1042;
3 On the basis of age, in the Age Discrimination Act of 1975 (42 U.S.C.6101 et seq.), as implemented by Department of Health and
Human Services regulations at 45 CFR part 90 and DOE regulations at 10 CFR part 1040;
4 On the basis of disability, in Section 504 of the Rehabilitation Act of 1973 (29 U.S.C.794), as implemented by Department of
Justice regulations at 28 CFR part 41 and DOE regulations at 10 CFR part 1041;
5 On the basis of race, color, national origin, religion, disability, familial status, and sex under Title VIII of the Civil Rights Act (42
U.S.C. 3601 et seq.) as implemented by the Department of Housing and Urban Development at 24 CFR part 100; and
6 On the basis of disability in the Architectural Barriers Act of 1968(42 U.S.C. 4151 et seq.) for the design, construction, and
alteration of buildings and facilities financed with Federal funds.
II. Environmental Policies
You must:
1 Comply with applicable provisions of the Clean Air Act (42 U.S.C.740 I, et. seq.) and Clean Water Act (33 U.S.C. 1251, et. seq.),
as implemented by Executive Order 11738 [3 CFR,1971-1975 Comp., p. 799] and Environmental Protection Agency rules at 40 CFR
part 32,
Subpart J.
2 Immediately identify to us, as the awarding agency, any potential impact that you find this award may have on:
a. The quality of the human environment, including wetlands, and provide any help we may need to comply with the National
Environmental Policy Act (NEPA, at 42 U.S.C. 4321 et. seq.) and assist us to prepare Environmental Impact Statements or other
environmental documentation. In such cases, you may take no action that will have an adverse environmental impact (e.g., physical
disturbance of a site such as breaking of ground) or limit the choice of reasonable alternatives until we provide written notification of
Federal compliance with NIEPA, as implemented by DOE at 10 CFR part 1021.
b. Flood -prone areas, and provide any help we may need to comply with the National Flood Insurance Act of 1968 and Flood Disaster
Protection Act of 1973 (42 U.S.C. 4001 et. seq.), which require flood insurance, when available, for Federally assisted construction or
acquisition in flood -prone areas, as implemented by DOE at 10 CFR part 1022.
c. Use of land and water resources of coastal zones, and provide any help we may need to comply with the Coastal Zone Management
Act of 1972(16 U.S.C. 1451, et. seq.).
d. Coastal barriers along the Atlantic and Gulf coasts and Great Lakes' shores, and provide help we may need to comply with the
Coastal Bathers Resource Act (16 U.S.C. 3501 et. seq.), concerning preservation of barrier resources.
e. Any existing or proposed component of the National Wild and Scenic Rivers system, and provide any help we may need to comply
City of Fort Worth Page 37 of 52
with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. 1271 et seq.).
f. Underground sources of drinking water in areas that have an aquifer that is the sole or principal drinking water source, and provide
any help we may need to comply with the Safe Drinking Water Act(42 U.S.C. 300h-3).
3 Comply with applicable provisions of the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. 48214846), as implemented by
the Department of Housing and Urban Development at 24 CFR part 35. The requirements concern lead -based paint in housing owned
by the Federal Government or receiving Federal assistance.
4 Comply with section 6002 of the Resource Conservation and Recovery Act of 1976, as amended (42 U.S.C. 6962), and
implementing regulations of the Environmental Protection Agency, 40 CFR Part 247, which require the purchase of recycled products
by States or political subdivision of States.
III. Live Organisms
1 Human research subjects. You must protect the rights and welfare of individuals that participate as human subjects in research
under this award in accordance with the Common Federal Policy for the Protection of Human Subjects (45 CFR part 46), as
implemented by DOE at 10 CFR part 745.
2 Animals and plants.
a. You must comply with applicable provisions of Department of Agriculture rules at 9 CFR parts 14 that implement the Laboratory
Animal Welfare Act of 1966(7 U.S.C. 2131-2156) and provide for humane transportation, handling, care, and treatment of animals
used in research, experimentation, or testing under this award.
b. You must follow the guidelines in the National Academy of Sciences(NAS) Publication "Guide for the Care and Use of Laboratory
Animals"(1996, which may be found currently at http://www.nap.edu/readingroomlbooks/labrats/) and comply with the Public Health
Service Policy and Government principles Regarding the Care and use of animals (included as Appendix D to the NAS Guide).
c. You must immediately identify to us, as the awarding agency, any potential impact that you find this award may have on
endangered species, as defined by the Endangered Species Act of 1973, as amended ("the Act," 16 U.S.C. 1531-1543), and
implementing regulations of the Departments of the Interior (50 CFR parts 10-24) and Commerce (50 CFR parts 217-227). You also
must provide any help we may need to comply with 16 U.S.C. 1536(a)(2). This is not in lieu of responsibilities you have to comply
with provisions of the Act that apply directly to you as a U.S. entity, independent of receiving this award.
IV. Other National Policies
1. Debarment and suspension. You must comply with requirements regarding debarment and suspension in Subpart C of 2 CFR
parts 180 and 901.
2. Drug -free workplace. You must comply with drug -free workplace requirements in Subpart B of 10 CFR part 607, which
implements sec. 5151-5160 of the Drug -Free Workplace Act of 1988 (Pub. L. 100-690, Title V, Subtitle D; 41 U.S.C. 701, et seq.).
3. Lobbying.
a. You must comply with the restrictions on lobbying in 31 U.S.C. 1352, as implemented by DOE at 10 CFR part 601, and submit all
disclosures required by that statute and regulation.
b. If you are a nonprofit organization described in section 501(c)(4)of title 26, United States Code (the Internal Revenue Code of
1968),you may not engage in lobbying activities as defined in the Lobbying Disclosure Act of 1995 (2 U.S.C., Chapter 26). If we
determine that you have engaged in lobbying activities, we will cease all payments to you under this and other awards and terminate
the awards unilaterally for material failure to comply with the award terms and conditions. By submitting an application and accepting
fluids under this agreement, you assure that you are not an organization described in section 501(c)(4) that has engaged in any
lobbying activities described in the Lobbying Disclosure Act of 1995 (2 U.S.C. 1611).
c. You must comply with the prohibition in 18 U.S.C. 1913 on the use of Federal funds, absent express Congressional authorization,
to pay directly or indirectly for any service, advertisement or other written matter, telephone communication, or other device intended
to influence at any time a Member of Congress or official of any government concerning any legislation, law, policy, appropriation, or
ratification.
4. Officials not to benefit. You must comply with the requirement that no member of Congress shall be admitted to any share or part
City of Fort Worth Page 38 of 52
of this agreement, or to any benefit arising from it, in accordance with 41U.S.C. 22.
5. Hatch Act. If applicable, you must comply with the provisions of the Hatch Act (5U.S.C. 1501-1508 and 7324-7326), as
implemented by the Office of Personnel Management at 5 CFR part 151, which limits political activity of employees or officers of
State or local governments whose employment is connected to an activity financed in whole or part with Federal funds.
6. Native American graves protection and repatriation. If you control or possess Native American remains and associated funerary
objects, you must comply with the requirements of 43 CFR part 10, the Department of the Interior implementation of the Native
American Graves Protection and Repatriation Act of 1990 (25 U.S.C., chapter 32).
7. Fly America Act. You must comply with the International Air Transportation Fair Competitive Practices Act of 1974 (49 U.S.C.
40118), commonly referred to as the "Fly America Act," and implementing regulations at 41 CFR 301-10.131 through 301-10.143.
r The law and regulations require air transport of people or property to, from, between or within a country other than the United States,
the cost of which is supported under this award, to be performed by or under a cost -sharing arrangement with a U.S. flag carrier, if
service is available.
8. Use of United States -flag vessels.
a. Pursuant to Pub. L. 664 (43 U.S.C. 1241(b)), at least 50 percent of any equipment, materials or commodities procured, contracted
for or otherwise obtained with funds under this award, and which may be transported by ocean vessel, must be transported on
privately owned United States -flag commercial vessels, if available.
b. Within 20 days following the date of loading for shipments originating within the United States or within 30 working days
following the date of loading for shipments originating outside the United States, a legible copy of a rated, "on -board" commercial
ocean bill -of -lading in English for each shipment of cargo described in paragraph 9.a of this section shall be furnished to both our
award administrator (through you in the case of your contractor's bill -of -lading) and to the Division of National Cargo, Office of
Market Development, Maritime Administration, Washington, DC 20590.
9. Research misconduct. You must comply with the government -wide policy on research misconduct issued by the Office of Science
y and Technology Policy (available in the Federal Register at 65 FR 76260, December 6,2000, or on the Internet at www.ostp.gov), as
implemented by DOE at 10 CFR part 733 and 10 CFR 600.31.
10. Requirements for an Institution of Higher Education Concerning Military recruiters and Reserve Officers Training Corps
(ROTC).
a. As a condition for receiving funds under an award by the National Nuclear Security Administration of the Department of Energy,
you agree that you are not an institution of higher education that has a policy or practice placing any of the restrictions specified in 10
U.S.C. 983. as implemented by 32 CFR part 216, on:
i. Maintenance, establishment, or operation of Senior ROTC units, or student participation in those units; or
ii.Military recruiters' access to campuses, students on campuses, or information about students.
b. If you are determined, using the procedures in 32 CFR part 216, to be such an institution of higher education during the period of
performance of this award, we:
i. Will cease all payments to you of funds under this award and all other awards subject to the requirements in 32 CFR part
F 216; and
ii. May suspend or terminate those awards unilaterally for material failure to comply with the award terms and conditions.
11. Historic preservation. You must identify to us any:
a. Any property listed or eligible for listing on the National Register of Historic Places that will be affected by this award, and provide
any help we may need, with respect to this award, to comply with Section 106 of the National Historic Preservation Act of 1966 (16
U.S.C. 470, as implemented by the Advisory Council on Historic Preservation regulations at 36 CFR part 800 and Executive Order
11593, "Identification and Protection of Historic Properties," [3 CFR, 1971-1975 Comp., p. 559].
b. Potential under this award for irreparable loss or destruction of significant scientific, prehistorical, historical, or archeological data,
and provide any help we may need, with respect to this award, to comply with the Archaeological and Historic Preservation Act of
1974 (16 U.S.C.469a-1, et seq.).
City of Fort Worth Page 39 of 52
r
12. Relocation and real property acquisition. You must comply with applicable provisions of 49 CFR part 24, which implements
the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970(42 U.S.C. 4601, et seq.) and provides for fair
and equitable treatment of persons displaced by federally assisted programs or persons whose property is acquired as a result of such
programs.
13. Confidentiality of patient records. You must keep confidential any records that you maintain of the identity, diagnosis,
prognosis, or treatment of any patient in connection with any program or activity relating to substance abuse education, prevention,
training, treatment, or rehabilitation that is assisted directly or indirectly under this award, in accordance with 42 U.S.C. 290dd-2.
14. Constitution Day. You must comply with Public Law 108-447, Div. J, Title I, Sec. 111(36 U.S.C. 106 note), which requires each
educational institution receiving Federal funds in a Federal fiscal year to hold an educational program on the United States
Constitution on September 17`h during that year for the students served by the educational institution.
15. Trafficking in Persons
a. Provisions applicable to a recipient that is a private entity.
1. You as the recipient, your employees, sub -recipients under this award, and sub -recipients'
employees may not—
i. Engage in severe forms of trafficking in persons during the period of time that the award is in effect;
ii. Procure a commercial sex act during the period of time that the award is in effect;
or
iii. Use forced labor in the performance of the award or sub -awards under the award.
2. We as the Federal awarding agency may unilaterally terminate this award, without penalty, if you or a sub -recipient that is
a private entity —
i. Is determined to have violated a prohibition in paragraph a. 1 of this award term;
or
ii. Has an employee who is determined by the agency official authorized to terminate the award to have violated a
prohibition in paragraph a.l of this award term through conduct that is either —
A. Associated with performance under this award; or
B. Imputed to you or the sub -recipient using the standards and due process for imputing the conduct of an individual to
an organization that are provided in 2 CFR part 180, "OMB Guidelines to Agencies on Government wide Debarment
and Suspension (Nonprocurement)," as implemented by our agency at 2 CFR part 901.
b. Provision applicable to a recipient other than a private entity. We as the Federal awarding agency may unilaterally terminate this
award, without penalty, if a sub -recipient that is a private entity-
1. Is determined to have violated an applicable prohibition in paragraph a. 1 of this award term; or
2. Has an employee who is determined by the agency official authorized to terminate the award to have violated an applicable
prohibition in paragraph a. 1 of this award term through conduct that is either—
i. Associated with performance under this award; or
ii. Imputed to the sub -recipient using the standards and due process for imputing the
conduct of an individual to an organization that are provided in 2 CFR part 180,
"OMB Guidelines to Agencies on Government wide Debarment and Suspension
(Nonprocurement)," as implemented by our agency at 2 CFR part 901.
c. Provisions applicable to any recipient.
1.You must inform us immediately of any information you receive from any source alleging a violation of a prohibition in
paragraph a.l of this award term.
2.Our right to terminate unilaterally that is described in paragraph a.2 orb. of this section:
i. Implements section 106(g) of the Trafficking Victims Protection Act of 2000 (TWA), as amended (22 U.S.C. 7104(g)),
and
City of Fort Worth Page 40 of 52
ii. Is in addition to all other remedies for noncompliance that are available to us under this award.
3.You must include the requirements of paragraph a. I of this award term in any sub -award you make to a private entity.
d. Definitions. For purposes of this award term:
1. "Employee" means either:
i. An individual employed by you or a sub -recipient who is engaged in the performance of the project or program under
this award; or
ii. Another person engaged in the performance of the project or program under this award and not compensated by you
including, but not limited to, a volunteer or individual whose services are contributed by a third party as an in -kind
contribution toward cost sharing or matching requirements.
2. "Forced labor" means labor obtained by any of the following methods: the recruitment, harboring, transportation,
provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of
subjection to involuntary servitude, peonage, debt bondage, or slavery.
F 3. "Private entity":
i. Means any entity other than a State, local government, Indian tribe, or foreign public entity, as those terms are defined
in 2 CFR 175.25.
ii. Includes:
A. A nonprofit organization, including any nonprofit institution of higher education, hospital, or tribal
organization other than one included in the definition of Indian tribe at 2 CFR 175.25(b).
B. A for -profit organization.
4. "`Severe forms of trafficking in persons," "commercial sex act," and "coercion" have the meanings given at section 103
of the TWA, as amended (22 U.S.C. 7102).
V. National Policy Requirements for Sub -awards.
Recipient responsibility. You must include in any sub -award you make under this award the requirements of the national policy
requirements in Sections I through IV of this document that apply, based on the type of sub-awardee organization and situation.
As the duly authorized representative of the Sub -recipient, I hereby certify that Sub -recipient will comply with the above
requirements. ' ���/j•
��b+elee.�.�oL�►^'
SUBRECIPIENT: City of Fort Worth
By: Fernando Costa Date:D�D
[Printed Name and Title]
As the duly authorized representative of the Subcontractor, I hereby certify that Subcontractor will comply with the above
requirements.
SUBCONTRACTOR
By.
City of Fort Worth
Page 41 of 52
Date:
9W
`r [Printed Name and Title]
MW
'W ATTACHMENT H Contract No.
wo Intellectual Property Provisions
AUTHORIZATION AND CONSENT (41 CFR 9-9.102-1)
The Government hereby gives its authorization and consent (without prejudice to any rights of indemnification) for all use and
manufacture, in the performance of this grant or any part hereof or any amendment hereto or any subcontract hereunder (including all
lower -tier subcontracts hereunder), of any invention described in and covered by a patent of the United States.
(a) embodied in the structure or composition of any article, the delivery of which is accepted by the Government under this
grant, or
(b) utilized in the machinery, tools, or methods, the use of which necessarily results from compliance by the Grantee or the
using subcontractor with
(i) specifications or written provisions now or hereafter forming a part of this grant, or
(ii) specific written instructions given by the Contracting Officer directing the manner of performance.
The entire liability to the Government for infringement of a patent of the United States shall be determined solely by the provisions of
the indemnity clauses, if any, included in this grant or any subcontract hereunder (including all lower -tier subcontracts hereunder), and
the Government assumes liability for all other infringement to the extent of the authorization and consent herein above granted.
PATENT INDEMNITY (41 CFR 9-9.103-1)
If the amount of this contract is in excess of $10,000 the contractor shall indemnify the Government and its officers, agents, and
employees against liability, including costs, for infringement of any United States letters patent (except U.S. letters patent issued upon
an application which is now or may hereafter be kept secret or otherwise withheld from issue by order of the Government) arising out
of the manufacture or delivery of supplies or out of construction, alteration, modification, or repair of real property (hereinafter
referred to as "construction work") under this contract, or out of the use or disposal by or for the account of the Government of such
supplies or construction work. The foregoing indemnity shall not apply unless the contractor shall have been informed as soon as
practicable by the Government of the suit or action alleging such infringement, and shall have been given such opportunity as is
afforded by applicable laws, rules, or regulations to participate in the defense thereof, and further, such indemnity shall not apply to:
(a) an infringement resulting from compliance with specific written instructions of the Contracting Officer directing a change in the
supplies to be delivered or in the materials or equipment to be used, or directing a manner of performance of the contract not normally
used by the contractor; (b) an infringement resulting from addition to or change in, such supplies or components furnished or
construction work performed which addition or change was made subsequent to delivery or performance by the contractor; or (c) a
claimed infringement which is settled without the consent of the contractor, unless required by final decree of a court of competent
jurisdiction.
NOTICE AND ASSISTANCE REGARDING PATENT AND COPYRIGHT INFRINGEMENT (41 CFR 9-9.104(b))
The provisions of this clause shall be applicable only if the amount of this grant exceeds $10,000.
(a) The Grantee shall report to the Contracting Officer, promptly and in reasonable written detail, each notice of claim of
patent or copyright infringement based on the performance of this grant of which the Grantee has knowledge.
(b) In the event of any claim or suit against the Government on account of any alleged patent or copyright infringement arising
out of the performance of this grant or out of the use of any supplies furnished or work or services performed hereunder,
the Grantee shall furnish to the Government, when requested by the Contracting Officer, all evidence and information in
possession of the Grantee pertaining to such suit or claim. Such evidence and information shall be furnished at the expense
of the Government except where the Grantee has agreed to indemnify the Government.
(c) This clause shall be included in all contracts and subgrants under this grant.
REPORTING OF ROYALTIES (41 CFR 9-9.110)
City of Fort Worth Page 42 of 52
If this grant is in an amount which exceeds $10,000 and if any royalty payments are directly involved in the grant or are reflected in
-- the grant price to the Government, the Grantee agrees to report in writing to the Patent Counsel (with notification by Patent Counsel to
the Contracting Officer) during the performance of this grant and prior to its completion of final settlement the amount of any royalties
or other payments paid or to be paid by it directly to others in connection with the performance of this grant together with the names
and addresses of licensers to whom such payments are made and either the patent numbers involved or such other information as will
permit the identification of the patents or other basis on which the royalties are to be paid. The approval of DOE of any individual
payments or royalties shall not stop the Government at any time from contesting the enforceability, validity or scope of, or title to, any
patent under which a royalty or payments are made.
RIGHTS IN TECHNICAL DATA (SHORT FORM)
(a) Definitions. The definitions of terms set forth in DEAR 927.401 apply to the extent these terms are used herein.
(b) Allocation of Rights.
(1) The Government shall have:
(i) Unlimited rights in technical data first produced or specifically used in the performance of this grant;
(ii) The right of the Contracting Officer or his representatives to inspect, at all reasonable times up to three years after
final payment under this grant, all technical data first produced or specifically used in the grant (for which inspection
the Grantee or its contractor or sub -grantee shall afford proper facilities to DOE); and
(iii) The right to have any technical data first produced or specifically used in the performance of this grant delivered to
the Government as the Contracting Officer may from time -to -time direct during the progress of the work, or in any
event as the Contracting Officer shall direct upon completion or termination of this grant.
(2) The Grantee shall have:
The right to use for its private purposes, subject to patent, security or other provisions of this grant, technical data it first
produces in the performance of this grant provided the date requirements of this grant have been met as of the date of the
private use of such data. The Grantee agrees that to the extent it receives or is given access to proprietary data or other
technical, business or financial data in the form of recorded information from DOE or a DOE contractor or
subcontractor, the Grantee shall treat such data in accordance with any restrictive legend contained thereon, unless use is
specially authorized by prior written approval of the Contracting Officer.
(c) Convrighted Material.
(1) The Grantee agrees to, and does hereby grant to the Government, and to others acting on its behalf:
v (i) A royalty -free, nonexclusive, irrevocable, worldwide license for Governmental purposes to reproduce, distribute,
display, and perform all copyrighted material first produced or composed in the performance of this grant by the
Grantee, its employees or any individual or concern specifically employed or assigned to originate and prepare such
material and to prepare derivative works based thereon; and
(ii) A license as aforesaid under any and all copyrighted or copyrighted work not first produced or composed by the
r Grantee in the performance of this grant but which is incorporated in the material fiunished under the grant,
provided that such license shall be only to the extent the Grantee now has, or prior to completion or close-out of the
Y grant, may acquire the right to grant such license without becoming liable to pay compensation to others solely
because of such grant.
(2) The Grantee agrees that it will not knowingly include any material copyrighted by others in any written or copyrighted
material famished or delivered under this grant without a license as provided for in subparagraph (c) (1) (ii) of this
section, or without the consent of the copyright owner, unless it obtains specific written approval of the Contracting
Officer for the inclusion of such copyrighted material.
RIGHTS TO PROPOSAL DATA (TECHNICAL) (48 CFR 52.227-23)
It is agreed that as a condition of award of this grant or modification and notwithstanding the conditions of any notice appearing on the
proposal(s), the Government shall have the right to use, duplicate, and disclose and have others to do so for any purpose whatsoever,
City of Fort Worth Page 43 of 52
the technical data contained in the proposal(s) upon which the grant or modification is based.
Citv of Fort Worth
Organization Name
Fernando Costa, Assistant City Manager
Name and Title of Authorized Representative
4.,L--4
Signature
Date
City of Fort Worth Page 44 of 52
ATTACHMENTI
Contract No.
SUBCONTRACTING PROVISIONS. MANDATORY FLOWDOWN PROVISION
F Grantee, if subcontracting any of its performance hereunder, shall legally bind sub -grantees to perform and make such
sub -grantees subject to all the duties, requirements, and obligations of Grantee under this Agreement. Grantee shall be
jointly and severally liable for all performances under this Agreement, including, but not limited to, the performance of its
sub -grantees to the extent permitted under the Constitution and laws of the State of Texas, as well as full compliance with
all reporting requirements set forth in Section XIX of the Agreement.
Grantee represents and warrants that it has obtained all necessary permits, licenses, easements, waivers and permissions of
whatsoever kind required for its performance and the performance of its sub -grantees under this Agreement. In no event
shall any provision of this Paragraph, including, but not limited to, the requirement that Grantee obtain the prior approval
of Agency on Grantee's proposed subcontracts, be construed as relieving Grantee of the responsibility for ensuring that all
services rendered under any subcontracts comply with all the terms and provisions of this Agreement as if they were
rendered by Grantee. Grantee shall, upon request, furnish Agency with copies of all proposed subcontracts and all
proposed amendments, assignments, cancellations or terminations of said subcontracts no later than thirty (30) days prior
to the proposed effective date of such contracts, amendments, assignments, cancellations or terminations; provided,
however, that this thirty (30) day period may be shortened by written agreement of the parties. Upon request from the
Comptroller, Grantee shall provide any and all documentation deemed necessary by the Comptroller to evidence
Subcontractors compliance with all terms, conditions and performance pertaining to the Agreement and all applicable law.
As the duly authorized representative of the Grantee and the Sub -grantee / Sub -recipient, I hereby certify that Grantee and
w Sub -grantee / Sub -recipient will comply with the above requirements.
GRANTEE: City of Fort Worth,
Fernando Costa,
Assistant City Manager
SUBGRANTEE/SUBRECIPIENT:
By:
[Printed Name]
[Title]
Date: ZlO/O
City of Fort Worth Page 45 of 52
ATTACHMENT J
AMERICAN RECOVERY & REINVESTMENT ACT --RECIPIENT AFFIDAVIT
This Affidavit must be sinned and sworn (notarized) and returned with all Anotications for this RFA
I, Fernando Costa, Assistant Citv Manager , an authorized representative of, City of Fort Worth, a [person, sole
proprietorship, partnership, corporation, limited liability company, nonprofit organization, governmental entity, political subdivision,
or other entity] (circle one) that is receiving American Recovery and Reinvestment Act of 2009 (ARRA or the Act) funding, hereby
swear and affirm that, to the best of my knowledge, internal controls, processes and procedures have been designed and implemented
to help ensure that the recipient and its use of these funds complies with the following: applicable state law; federal law, including
federal reporting requirements under Section 1512 of the Act, if applicable; rules; regulations; and other relevant guidance. I further
swear and affirm that all of the statements made and information provided herein, including statements made and information
provided in any attachments are true, complete, and correct, to the best of my knowledge.
I understand that I am receiving ARRA funding from State Comptroller's Office, a [state agency, institution of higher education,
governmental entity, political subdivision, or other entity] (circle one).
I understand that non-compliance with reporting requirements could be treated as a violation of the award agreement resulting in the
withholding of funds, debarment, or award termination or suspension, as appropriate.
I understand that it is a federal crime under 18 U.S.C. Section 1001 to, in any matter within the jurisdiction of the executive branch of
the U.S. Government, knowingly and willfully make any materially false, fictitious, or fraudulent statement or representation, or to
make or use any false writing or document knowing that it contains the same.
I understand that presenting a false or fraudulent claim, in whole or in part, or causing same, may subject me to civil penalties as
provided for in 31 U.S.C. Section 3729.
I understand that it is a felony offense under Section 37.10, Texas Penal Code, to knowingly make a false entry in, or false alteration
of, a governmental record, or to make, present, or use a governmental record with knowledge of its falsity, when the actor has the
intent to harm or defraud another.
I understand that the offense of perjury, under Section 37.02, Texas Penal Code, is committed when a person, with intent to deceive
and with knowledge of the statement's meaning, makes a false statement under oath or swears to the truth of a false statement
previously made and the statement is required or authorized by law to be made under oath.
I understand my obligation to track all ARRA funds and that ARRA funds cannot be comingled with Non-ARRA funds. I also
understand my obligation to immediately report any known or suspected waste, fraud, and abuse of funds received under the Act to
the United States Government Accountability Office at (800) 424-5454 and the Texas State Auditor's Office at (800) 892-8348. I
further understand that I will require all sub -recipients with whom I contract using funds made available under the Act to sign a
similar affidavit swearing to all of the above. I hereby swear and affirm that I have read the entire affidavit, and I understand its
contents.
Citv of Fort Worth
Recipient Name
Affrant Signature
Fernando Costa
Full Name
Assistant Citv Manager
Title
ilzol/D
Date
Sworn and subscribed before me by the said
Fe,rn&n d6 1_4651- .
(Printed Name of Recipient's Authorized Representative)
this � day ofre-(,R ilAeO 20 Iv .
Notary Public, State of Texas
EVONIA DANIELS
*= MY COMMISSION EXPIRES -
July 10, 2013
Notary's printed name: Z_✓ONiR ,b f},tI/E4s My commission expires: J tJ Iq >o, 2 b (Seal)
City of Fort Worth Page 46 of 52
ATTACHMENT K
Contract No.
Execution of Application
1. By signature hereon, Applicant represents and warrants that the provisions in this Execution of Application apply to Applicant
and all of Applicant's principals, officers, directors, shareholders, partners, owners, agents, employees, subcontractors,
independent contractors, and any other representatives who may provide services under, who have a financial interest in, or
otherwise are interested in this RFA or any contract resulting from it.
2. By signature hereon, Applicant represents and warrants its intent to furnish the requested items at the prices quoted in its
Proposal.
3. By signature hereon, Applicant represents and warrants that it has read and understood and shall comply with Comptroller's Anti -
Fraud Policy, located on Comptroller's website at httr)://www.window.state.tx.us/ssv/ethics.htrnl. as such Policy currently reads
and as it is amended throughout the term of any resulting contract.
4. By signature hereon, Applicant represents and warrants that its prices include all costs of Applicant in providing the requested
items that meet all specifications of this RFA, and that its prices will remain firm for acceptance for a minimum of ninety (90)
days from deadline for submission of Proposal.
5. By signature hereon, Applicant represents and warrants that each employee, including `replacement employees', will possess the
qualifications, education, training, experience and certifications necessary to perform the services in the manner required by this
RFA.
6. By signature hereon, Applicant represents and warrants that it has no actual or potential conflicts of interest in providing the
F requested items to Comptroller under the RFA and any resulting contract, if any, and that Applicant's provision of the requested
f items under the RFA and any resulting contract, if any, would not reasonably create an appearance of impropriety.
7. By signature hereon, pursuant to Section 2155.004(a), Texas Government Code, Applicant represents and warrants that it has not
given, nor intends to give at any time hereafter, any economic opportunity, future employment, gift, loan, gratuity, special
discount, trip, favor or service to a public servant in connection with the submitted Proposal.
8. By signature hereon, Applicant represents and warrants that it is not currently delinquent in the payment of any franchise taxes
owed the State of Texas under Chapter 171, Texas Tax Code. In addition, if Applicant is an individual not residing in Texas or a
business entity not incorporated in or whose principal domicile is not in Texas, the following certification applies. Applicant
represents and warrants that it holds a permit issued by Comptroller to collect or remit all state and local sales and use taxes that
become due and owing as a result of the individual's or entity's business in Texas or represents and warrants that it does not sell
tangible personal property or services that are subject to the state and local sales and use tax. Under Section 2155.004(a), Texas
Government Code, a state agency may not accept a bid or award a contract that includes proposed financial participation by a
person who received compensation from the agency to participate in preparing the specifications or request for proposals on
which the bid or contract is based. Further, Applicant certifies that the individual or business entity named in this Proposal or any
contract resulting from this RFA is not ineligible to receive the specified contract and acknowledges that the contract may be
terminated and payment withheld if this certification is inaccurate. See Texas Government Code Section 2155.004(b).
9. By signature hereon, Applicant hereby represents and warrants that, pursuant to 15 U.S.C. Sec. 1, et seq. and Tex. Bus. & Comm.
Code Sec. 15.01, et seq., neither Applicant nor the firm, corporation, partnership, or institution represented by Applicant, or
anyone acting for such a firm, corporation or institution has violated the antitrust laws of this state, federal antitrust laws, nor
communicated directly or indirectly the Proposal made to any competitor or any other person engaged in such line of business.
10. By signature hereon, Applicant represents and warrants that all statements and information prepared and submitted in response to
this RFA are current, complete and accurate.
11. By signature hereon, Applicant represents and warrants that the individual signing this document and the documents made part of
this RFA and Proposal is authorized to sign such documents on behalf of the company and to bind the company under any
contract which may result from the submission of this Proposal.
12. By signature hereon, Applicant represents and warrants that if a Texas address is shown as the address of the Applicant, Applicant
qualifies as a Texas Bidder as defined by 34 Texas Administrative Code §20.32(68).
13. Check below if preference claimed under 34 Texas Administrative Code §20.38:
• Goods produced or offered by a Texas bidder that is owned by a Texas resident service -disabled veteran
• Goods produced in Texas or offered by a Texas bidder that is not owned by a Texas resident service -disabled veteran
• Agricultural products grown in Texas
• Agricultural products offered by a Texas bidder
• Services offered by a Texas bidder that is owned by a Texas resident service -disabled veteran
• Services offered by a Texas bidder that is not owned by a Texas resident service disabled veteran
City of Fort Worth Page 47 of 52
• Texas Vegetation Native to the Region
• USA produced supplies, materials or equipment
• Products of persons with mental or physical disabilities
• Products made of recycled, remanufactured, or environmentally sensitive materials including recycled steel
• Energy Efficient Products
• Rubberized asphalt paving material
• Recycled motor oil and lubricants
• Products produced at facilities located on formerly contaminated property
• Products and services from economically depressed or blighted areas
• Vendors that meet or exceed air quality standards
• Recycled or Reused Computer Equipment of Other Manufacturers
• Foods of Higher Nutritional Value
14. By signature hereon, under Section 231.006, Texas Family Code, regarding child support, Applicant certifies that the individual
or business named in the Proposal is not ineligible to receive the specified payment and acknowledges that the contract may be
terminated and payment may be withheld if this certification is inaccurate. Furthermore, any Applicant subject to Section
231.006, Texas Family Code, must include names and Social Security numbers of each person with at least 25% ownership of the
business entity submitting the Proposal. This information must be provided prior to award. Enter the Name and Social Security
Number for each person below:
Name: SSN:
Name: SSN:
Name: SSN:
' FEDERAL PRIVACY ACT NOTICE: This notice is given pursuant to the Federal Privacy Act. Disclosure of your Social
Security Number (SSN) is required under Section 231.006(c) and Section 231.302(c)(2), Texas Family Code. The SSN will be
used to identify persons that may owe child support. The SSN will be kept confidential to the fullest extent allowed under Section
231.302(e), Texas Family Code.
15. By signature hereon, Applicant represents and warrants that no relationship, whether by relative, business associate, capital
funding contract or by any other such kinship exist between Applicant and an employee of any Comptroller component, and
Applicant has not been an employee of any Comptroller component within the immediate twelve (12) months prior to Applicant's
Proposal. By signature hereon, Applicant certifies that it is in compliance with Section 669.003, Texas Government Code,
relating to contracting with executive head of a state agency. All such disclosures will be subject to administrative review and
approval prior to Comptroller entering into any contract with Applicant. Applicant acknowledges that any contract resulting from
this RFA may be terminated at any time, and payments withheld, if this information is false.
16. By signature hereon, pursuant to Section 2155.004, Texas Government Code Applicant represents and warrants that neither it nor
any person or entity which will participate financially in any contract resulting from this RFA has received compensation for
participation in the preparation of specifications for this RFA.
17. By signature hereon, Applicant represents and warrants that all articles and services quoted in response to this RFA meet or
exceed the safety standards established and promulgated under the Federal Occupational Safety and Health Law and its
regulations in effect or proposed as of the date of this solicitation.
18. By signature hereon, Applicant represents and warrants its compliance with all federal laws and regulations pertaining to Equal
Employment Opportunities and Affirmative Action.
19. By signature hereon, Applicant represents and warrants its compliance with the requirements of the Americans With Disabilities
Act (ADA). Applicant further represents and warrants that it will comply with all applicable Texas Accessibility requirements.
20. By signature hereon, in accordance with Section 2155.4441, Texas Government Code, Applicant agrees that during the
performance of a contract for services it shall purchase products and materials produced in Texas when they are available at a
price and time comparable to products and materials produced outside this state.
21. By signature hereon, Applicant represents and warrants that Comptroller's payments to Applicant and Applicant's receipt of
appropriated or other funds under any contract resulting from this RFA are not prohibited by Section 556.005 or Section 556.008,
City of Fort Worth Page 48 of 52
Texas Government Code.
22. By signature hereon, Applicant represents and warrants that the offering entity and its principals are eligible to participate in this
transaction and have not been subjected to suspension, debarment, or similar ineligibility determined by any federal, state, or local
governmental entity and that Applicant is in compliance with the State of Texas statutes and rules relating to procurement and that
Applicant is not listed on the federal government's terrorism watch list as described in Executive Order 13224. Entities ineligible
for federal procurement are listed at http://www.et)ls.eov.
23. Under Section 2155.006(b), Texas Government Code, a state agency may not accept a bid or award a contract, including a
contract for which purchasing authority is delegated to a state agency, that includes proposed financial participation by a person
who, during the five-year period preceding the date of the bid or award, has been: (1) convicted of violating a federal law in
F connection with a contract awarded by the federal government for relief, recovery, or reconstruction efforts as a result of
Hurricane Rita, as defined by Section 39.459, Utilities Code, Hurricane Katrina, or any other disaster occurring after September
- 24, 2005; or (2) assessed a penalty in a federal civil or administrative enforcement action in connection with a contract awarded
by the federal government for relief, recovery, or reconstruction efforts as a result of Hurricane Rita, as defined by Section
39.459, Utilities Code, Hurricane Katrina, or any other disaster occurring after September 24, 2005. Under Section 2155.006,
Texas Government Code, Applicant certifies that the individual or business entity named in the Proposal is not ineligible to
receive the specified contract and acknowledges that any contract resulting from this RFA may be terminated and payment
withheld if this certification is inaccurate.
24. By signature hereon and by checking or initialing either Subsection (a) or Subsection (b), as applicable, Applicant represents and
warrants the following:
(a) _Applicant represents and warrants that it is not aware of and has received no notice of any court or governmental agency
actions, proceedings or investigations, etc., pending or threatened against Applicant or any of the individuals or entities
included in Section 1 of this document that would or could impair Applicant's performance under any contract resulting from
this RFA, relate to the solicited or similar goods or services, or otherwise be relevant to the agency's consideration of
Applicant's Proposal. Applicant represents and warrants that it is not aware of any such court or governmental agency actions,
proceedings or investigations, etc. against Applicant or any of these individuals or entities within the five (5) calendar years
immediately preceding the submission of Applicant's Proposal in response to this RFA. In addition, Applicant represents and
warrants that it shall notify Comptroller in writing within five (5) business days of any changes to the representations or
warranties in this Subsection (a) and understands that failure to so timely update Comptroller shall constitute breach of contract
and may result in immediate termination of the contract.
t (b) Applicant is unable to make the representation and warranty in Subsection (a) above and instead represents and warrants
that it has included as a detailed attachment in its Proposal, which expressly references this Subsection (b), a complete
disclosure of any such court or governmental agency actions, proceedings or investigations, etc., and specifically addresses
whether any of such past, pending or threatened actions, proceedings or investigations, etc., would or could (1) impair
Applicant's performance under any contract resulting from this RFA; (2) relate to the solicited or similar goods or services; or
(3) be otherwise relevant to the agency's consideration of Applicant's Proposal. In addition, Applicant represents and warrants
_ that it shall notify Comptroller in writing within five (5) business days of any changes to the representations or warranties in
this Subsection (b) or attachments in response to Subsection (b) and understands that failure to so timely update Comptroller
shall constitute breach of contract and may result in immediate termination of the contract.
Applicant understands that a Proposal returned without the appropriate checked or initialed representation and
warranty and the detailed attachment required in Subsection (b), when applicable, may be automatically disqualified.
25. By signature hereon, Applicant represents and warrants that it has read and agrees to all terms and conditions of this RFA, unless
Applicant specifically takes an exception and offers an alternative provision in Applicant's Proposal as provided in Exhibit C,
Section 2 of this RFA.
City of Fort Worth Page 49 of 52
Authorized signatory on behalf of Applicant must complete and sign the following:
Authorized Signature
Date Signed
Fernando Costa,
817-392-6122
Assistant City Manager
Phone Number
City of Fort Worth
817-392-6134
Applicant Name
Fax Number
75-6000528
Federal Employer Identification Number
1000 Throckmorton St.
Physical Street Address
Mailing Address, if different
frnando.costana,fortworthgov.org
E-Mail Address
Fort Worth, Texas 76102
City, State, Zip Code
City, State, Zip Code
City of Fort Worth
Page 50 of 52
ATTACHMENT L
4 ARRA REPORTING REOUIREMENTS
1. Subrecipient shall submit to the Comptroller the following reports:
A. INITIAL INFORMATION REPORT. The Subrecipient shall submit the following information upon the execution of the Grant
Agreement and return this report when the executed Grant Agreement is submitted to the Agency:
I. Subrecipient Identification:
a. Subrecipient name: Provide the following information for the Subrecipient;
(i) the official name of the Subrecipient as it appears on the Grant Agreement and DUNS #;
-- (ii) the street address, city, and county of the official place of business;
(iii) City, County, and U.S. Postal Zip Code + four digits;
(iv) the url designation or address of any official web site for the Subrecipient;
(v) U.S. Congressional District;
(vi) the state senatorial district;
(vii) the state house district;
(viii) a copy of the minutes or resolution by which the Subrecipient approved the Grant agreement and designated an
authorized representative for the Subrecipient;
' (ix) the grant/award number assigned to the Subrecipient by the Agency;
r (x) the date the Grant Agreement was signed (mm/dd/yyyy); and
(xi) the performance period established in the Grant Agreement during which sponsorship begins and ends.
b. Authorized Representative: Provide the following information for the person designated by the Subrecipient to represent the
Subrecipient in the performance of the Grant Agreement:
(i) the name of the authorized representative and official title, if any;
-r (ii) the street address, city, and county of the primary business location;
(iii) City, County, and U.S. Postal Zip Code + four digits;
(iv) area code and telephone number; and
(v) email address.
c. Key Personnel: Provide the following information for each employee or agent designated by the Subrecipient or the Authorized
Representative that may assist or serve as a representative for the Subrecipient in the performance of the Grant Agreement:
(i) the name of the key personnel and official title, if any;
(ii) primary role served for the Subrecipient with respect to the Grant;
(iii) the street address, city, and county of the primary business location;
(iv) City, County, and U.S. Postal Zip Code + four digits;
(v) area code and telephone number; and
(vi) email address.
d. Five most highly compensated individuals: The information required in this subsection is ONLY required when the reporting
entity (A) received 80 percent or more of its annual gross revenues in Federal awards the recipient in its preceding fiscal year, and
(B) received $ 25,000,000 or more in annual gross revenues from Federal awards; and (C) the public does not have access to
information about the compensation of the senior executives of the entity through periodic reports filed under section 13(a) or
15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986
[26 USC §61041. If this subsection is applicable, the report shall include:
(i) the names and total compensation for the five most highly compensated officers of the entity;
(ii) "Total compensation" means the cash and noncash dollar value earned by the executive during the subrecipient's past
fiscal year of the following: Salary and bonus; Awards of stock, stock options, and stock appreciation rights. Use the dollar
amount recognized for financial statement reporting purposes with respect to the fiscal year in accordance with FAS 123R;
Earnings for services under non -equity incentive plans. Does not include group life, health, hospitalization or medical
reimbursement plans that do not discriminate in favor of executives, and are available generally to all salaried employees;
Change in pension value. This is the change in present value of defined benefit and actuarial pension plans; Above -market
earnings on deferred compensation which are not tax -qualified. Other compensation, for example, severance, termination
payments, value of life insurance paid on behalf of the employee, perquisites or property if the value for the executive
exceeds $10,000.
II. Project Identification:
a. Proiect Name: Provide the brief descriptive title of the project or activity as identified in the Grant Agreement.
t b. Primary Performance Location: Provide physical location of primary place of performance by:
(i) street address,
(ii) City, County, and U.S. Postal Zip Code + four digits
(iii) U.S. Congressional District;
(iv) the state senatorial district; and
City of Fort Worth Page 51 of 52
m (v) the statehouse district;
c. Proiect Obiective: A description of the overall purpose and expected outputs and outcomes or results of the Grant Agreement,
including significant deliverables and, if appropriate, units of measure.
B. MONTHLY REPORT. On the last day of each calendar month, the Subrecipient shall submit an electronic performance report
found at httvs:Hfinx.ciDa.state.tx.us/finx/index.vht). (click on SECO Stimulus Reporting Tool).
In order to access the reporting tool the Subrecipient must first receive a User ID from the SECO Stimulus Grant Manager.
The web reporting tool will capture project status and Department of Energy and ARRA performance metrics, including jobs created
and jobs retained.
All reporting must be completed through the web reporting system. In rare situations that the web reporting tool is not available or the
subrecipient is unable to access the system, a faxed, scanned or emailed report will be acceptable upon notification and approval.
C. FINAL REPORT.
1. No later than 30 days following the grant ending date, the Subrecipient shall submit an electronic Final Report via the web
reporting tool at httvs://finx.ct)a.state.tx.us/finx/index.t)hv (click on SECO Stimulus Reporting Tool) through the last day of the grant
performance period. All reporting must be completed through the web reporting system. In rare situations that the web reporting tool
is not available or the subrecipient is unable to access the system, a faxed, scanned or emailed report will be acceptable upon
notification and approval.
2. Subrecipient is required to collect and report required project information from any of its vendors or subcontractors that are
remitted any funds provided under this agreement.
3. Failure to comply with the requirements of this attachment may result in termination of the grant award and the Subrecipient being
ineligible for future grants.
4. The form and substance of these reporting requirements may be amended by the Comptroller at any time.
As the duly authorized representative of the Subrecipient, I hereby certify that Subrecipient will comply with the above requirements.
SUBRECIPIENT: City of Fort Worth
By:
Fernando Costa, Assistant City Manager
Federal Employer Identification Number: 75-6000528
DUNS Number: 0731704580000
Texas Identification Number: 756000528
Date: 44�1
City of Fort Worth Page 52 of 52
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ATTACHMENT A-1
TR-AG2-2010
Traffic Signal Synchronization or
Replacement
GRANTEE:
City of Fort Worth
FORTWORTH
October 29, 2009
Mr. William Clay Harris
Assistant General Counsel, Contracts
Comptroller of Public Accounts
Issuing Office
111 E. 17`h Street, Room 201
Austin, TX 78774
RE: Request for Applications
RFA No. TR-AG2-2010
Transportation Energy Efficiency Traffic Signal Synchronization or Replacement
Stimulus Grant Program of the Texas Comptroller of Public Accounts
Dear Mr. Harris:
The City of Fort Worth, Texas is pleased to submit the attached application for the
Transportation Energy Efficiency Traffic Signal Synchronization or Replacement Stimulus Grant
Program of the Texas Comptroller of Public Accounts.
If awarded the Grant, the City is committed to using the funds as described in the application, to
make minor modifications and equipment upgrades at 14 traffic signals and to reconstruct two
traffic signals.
Sincerely,
Fernando Costa
Assistant City Manager
CITY MANAGER'S OFFICE
THE Crry of Foxr Womm * 1000 THRoacmorrrow STRErr * Fozr Worms, Texas 76102
817-10W A VfZf Ax 817-392-6134
C Printed on recycled paper
1
Executive Summary I
Applicant Name: City of Fort Worth
Project Director: Mark Mathis, P. E., Traffic Services Manager
Project Title: Riverside Signal Reconstruction & Modification Project
]
Project Objectives: The proposed project seeks to lower fossil fuel consumption and carbon
_]
emissions through the reduction in vehicle delay and stops within. the
Riverside Community of the City of Fort Worth
Project Description:
i
`
The scope of the project consists of documenting the existing traffic delay conditions of four
arterial roadways: East Belknap Street, Sylvania Avenue, Riverside Drive and North Beach
Street. The goal is to make traffic signal improvements and implement synchronized traffic
signal timing plans, including documentation of the resulting reduction in traffic delay
conditions.
Actual field data collection, such as average daily traffic volumes, turning movement counts, and
'F
floating car delay studies along each of the four arterials will be used to build and calibrate
i
computer models of the traffic conditions. From these arterial and intersection models, both
synchronized traffic signal timing plans and engineering recommendations to improve the
existing traffic signal hardware and intersection control will be developed.
Two signalized intersections, Sylvania Avenue/Race Street and Sylvania Avenue/Yucca Street,
will be completely reconstructed. Minor traffic signal hardware improvements will be made at
the intersections listed below, including, but not limited to, replacing controller equipment and
cabinets, replacing traffic signal heads to improve lane control, installing communication
hardware, and replacing existing vehicle detection systems with video camera vehicle detection
systems.
Beach Street & SH-121 Frontage Roads
—�
Beach Street & West Beach Street
.r
Beach Street & Belknap Street & Yucca Street
Beach Street & Chesser -Boyer
" -
Beach Street & Springdale Drive
J
Beach Street & Long Avenue
Beach Street & Stanley -Keller Road
_
Beach Street & Meacham Boulevard
Riverside Drive & Yucca Street
Riverside Drive & Sylvania Avenue
Sylvania Avenue & 4" Street
Sylvania & SH-121 Frontage Roads
In 2005, the North Central Council of Governments implemented a region wide effort to reduce
`1
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vehicle travel time by retaining a team of consulting engineers to develop and implement
�J
synchronized traffic signal timing plans on numerous arterial roadways in almost every city in
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Page 2 of 75
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the Dallas -Fort Worth metro area. East Belknap Street was part of Corridor 605. This project
to do as recommended in the Final Technical Memorandum prepared b Kimle -Hom
proposes PreP Y Y
and Associates which states the following in Section 7.0, Conclusion and Recommendations:
"The timing for Belknap corridor should be integrated into a larger control group.
Specifically, north -south progression on Beach, Riverside and Sylvania should be
J
integrated with the east -west progression of both N.E. 28 h and Belknap."
In. 2007, the City of Fort Worth participated in the National Traffic Signal Report Card
conducted by the National Transportation Operation Coalition. Although the City improved its
report grade from the 2005 Report Card, it still received a D-. Two areas where the City scored
low marks were "Signal Operation in Coordinated Systems" and "Specialized Timing Practices."
This project seeks to address these two report card areas within the Riverside Community.
Consultant services will be retained to develop plans, specifications and bid proposals; conduct
'!
before studies; conduct computer modeling; develop operational improvement recommendations;
implement controller timing programs; and perform after studies and documentation of benefits
including calculating the reduction of fuel consumption and carbon emissions.
140
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Page 3 of 75
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TABLE OF CONTENTS
Pate No.
Transmittal Letter
1
Executive Summary
2-3
Table of Contents
3-4
Applicant Identifying Information
6-15
Identifying Information and Statements Required for all Subcontracts
16
Project Work Plan
17-23
Budget
24-26
Conflict of Interest Statement
27-28
DOE Required Special Terms & Conditions — ARRA Stimulus Funds
30-46
DOE Assurance of Compliance, as completed by Applicant
47-48
DOE Assurance of Compliance, as completed by each proposed subcontractor
of Applicant
49-50
Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary
Exclusion -Lower Tier Covered Transactions, as completed by Applicant
51
Certifications Regarding Lobbying; Debarment, Suspension and Other Responsibility
Matters; and Drug -Free Workplace Requirements, as completed by Applicant
52-55
Disclosure of Lobbying Activities, as completed by Applicant
56
ARRA Assurances
57-62
Intellectual Property Provisions, as Completed by Applicant
63-65
Subcontracting Provisions — Flowdown Provision
66
Executed Comptroller of Public Accounts Affidavit
67-68
Execution of Application, as Completed by Applicant
69-72
Page 4 of 75
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No
Reporting Requirements
Appendix A — National Traffic Signal Report Card Submittal
Appendix B — Project Schedule
Page 5 of 75
73-75
"0
Applicant Identifying Information
Applicant Information
City of Fort Worth
Department of Transportation and Public Works
Traffic Services Division
1000 Throckmorton
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Fort Worth, TX 76102-6312
Federal Employer Identification Number: 75-6000528
DUNS Number: 0731704580000
..
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Texas Identification Number: 756000528
tPrincipal
Contact
_A
Mark Mathis, P.E.
�
Traffic Services Manager
5001 James Avenue
Fort Worth, TX 76115
Phone: 817-392-7861
Email: Mark.Mathisna.fortwortheov.ora
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Fax: 817-392-2533
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Page 6 of 75
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ORCA - C(M Information
page 1 of 2
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"Create ORCA record".
Sy btrbmiiltfng the raps and cerL-, in ORCA, you are attesting to the accuracy of the lnformaMon and may tie
subject to perialtios for mi5mremmtatlon.
Business Alaittc
t� CITY OF - -
Physical Addre
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ORT WORTH
State:
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Postal Cade:
610Z6312 M-
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MAICA Cddag_
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4211900ther General GovemmQnt support
IPSC Codes: `
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U.S. Government Entity
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'Service -disabled veteran -owned business concern:
No
tJi;imber oEm—p—plc �es��oncern:.=�4
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Average Annual Gross Revenues: _
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Minority -owned Ethnicity:
Historically black college or university:—
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ORGANIZATION CHART
Elected City Council Members I
-- —i .. —.
6. f, , City Attorney. City Manager, ( Crty Secsefary l
Dale A Fisseler, P.E. I ti
B
r Fernando Costa
I{ Assistant City
Manager
William A. Verkest, P.E.
Director,
Tranrtation & Public Works
George Behmanesh, P.E.
Assistant Director
Mark Mathis, P.E. 1
Project Director J
Marisa Conlin, P.E.
Project Manager
r Engmeenng .. l Construction f Ken Brock Homero Beltran ( Frank Brock I
Consultant (T. 11 I f Contractor (TBD)' I Construction Inspector Plan Review Task Leader I Traffic System Supv.
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Page 8 of 75
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L Mark MaMk4 P.E, MSCE
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Project Dbector
T
My of Fat Via 0
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Department of Transportation & Public Works
Traffic Services Division
-
5001 James Avenue
Fort Worth, TX 76115
- J
Education and Trainin_q
1997. Masters of Science in Civil Engineering
University of Texas at Arlington, College of Engineering, Arlington, Texas:
Transportation Engineeri
ng studies.
1981: Bachelor of Arts
University of North Texas, Department of English, Denton, Texas.
Research and Professional Experience
Traffic Services Manager, Citv of Fort Worth, Texas, June, 2002 - present
-
Division Manager of 94 staff associates, $8.9 million annual operating budget,
a rolling fleet of 56 pieces of equipment, over $15 million in planned
transportation capital projects and over $4 million in various transportation
grant projects;
• Oversee the professional disciplines of 2 senior P.E.'s, 1 P.E. and 2 graduate
�(
engineers;
• Engineering projects include ITS, railroad crossing safety, traffic signals and
roadway lighting;
• Division mission includes the design, construction, operation and
maintenance of 123,000 traffic signs, 740 lane miles of pavement marking,
63,000 street lights and 700 traffic signals and surface maintenance of
railroad grade crossings for a City with an estimated population of 642,000;
"
Division mission also includes managing and operating Departmental parts
and materials warehouse and Department call center.
-1'
Traffic Signal Operations Manager, Citv of Fort Worth. Texas, Jan. 2000 — June,
2002
• Team leader of 6 associates;
Traffic signal construction contract administrator;
µ
• Supervisor of Traffic Management Center;
Traffic signal design engineer, including preparation of specifications and
J
estimate of probable cost;
• Traffic signal timing plan development;
• Traffic signal consultant contract administration and project oversight.
Traffic Engineering Manager, Citv of Grand Prairie. Texas, Oct, 1994 — Jan, 2000
-
Page 9 of 75
• Division Manager of signal, signs and markings maintenance programs: (17
associates in Division; four directly under my supervision);
•
State and Federal Grant application preparation, contract administrator and
project leader;
•
Annual General & Capital Project Fund budget preparation and
... - ;
administration;
•
Traffic signal engineer and construction contract administrator,
•
Department consultant contract manager,
•
Street intersection capacity analysis and schematic design;
J
•
Coordinate traffic operations issues with new development;
•
Assist in preparation of annual Department Capital Improvements budget;
'
•
Alternate City representative to the Regional Surface Transportation
Technical Committee with NCTCOG.
'"� •-,
Transportation Planner, City of Grand Prairie. Texas, 1991 —1987
r ;
•
Roadway network modeling and future needs analysis;
•
Development review and site planning;
-�
•
Traffic field data collection supervisor,
fto
•
Transit Program Manager,
400
•
Federal Transit Administrator Grant Manager.
LICENSE:
Professional Engineer, State of Texas, Serial Number 86006
�+ PROFESSIONAL ORGANIZATIONS:
• Member of Institute of Transportation Engineers (ITE), including state and
local section memberships;
0 Contributing member of ITE Traffic Engineering Technical Committee project
#TENC-105-02: "Real -World Experience with New Technology;"
• City Representative the Regional Surface Transportation Technical Advisory
(STI-C) committee through NCTCOG (2004-07);
• Member of American Public Works Association.
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Page 10 of 75
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Marisa Con&4 P.E.
iy-� Safety CaphW Projects Marv*W
Ckyof Fait Math
Department of Transportation & Public Works
-.
Traffic Services Division
5001 James Avenue
Fort Worth, TX 76115
Education and Traiain_q
University of Oklahoma, Norman, OK May 2000
�1
Bachelor of Science in Civil Engineering, GPA 3.2/4.0
Chi Epsilon Honor Society
�?
Research and Professional Experience
`-'
Traffic Safety Capital Projects Manager, March 2008 — Present
• Supervise the Traffic Safety Staff, which includes 2 Graduate Engineer, 3 Sr.
Construction Inspectors, 2 Engineering Technicians, and 1 Sr. Administrative Assistant;
• Manage the Street Light & Traffic Signal Program, including project funds of $ 16.3
million;
• Select signal operations, signal capital, and street light capital projects by managing
system analyses, which include equipment assessment, warrant, volume, speed, delay,
—'
and collision studies;
• Review and authorize timing, phasing, and operations changes for existing and
.r
reconstructed signals;
• Review and approve street light and signal capital design plans;
:00
• Perform project management and administration for professional service agreements and
wo
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construction contracts;
Manage the Camp Bowie LAQ Signal Reconstruction Project to rebuild 11 signals,
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modify 12 signals, and retime 23 signals;
w
• Manage the Thoroughfare Assessment Program, Phase 3.2 by reviewing, installing, and
fine-tuning new signal timing plans and signal modifications for 88 signalized
J
intersections.
_
Signal Operations Supervisor/Traffic Signal Project Manager, January 2004 — February
2008
a Supervise the Signal Operations Staff, which includes 2 Graduate Engineers, 1
Construction Inspector, and 3 Engineering Technicians;
• Manage the Traffic Signal Program, including project funds of $8.8 million;
Select new and reconstructed signal projects by completing system analyses, which
include equipment assessment, warrant, volume, speed, delay, and collision studies;
00
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Page 11 of 75
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• Perform project management and administration for agreements and construction
contracts;
• Manage the Central Business District (CBD) Signal Retiming Project by reviewing,
installing, and fine-tuning five new signal plans at 122 signals; prepare reports and
�r
present findings;
_
"''
• Manage the Thoroughfare Assessment Program Phases 2.0 & 3.1 by reviewing,
`1
'
installing, and fine-tuning new signal timing plans and signal modifications for 58
JJ
signalized intersections.
_
• Coordinate Holiday and Special Event Timing by developing, reviewing, and installing
�
synchronized timing for Hulen Mall, Ridgmar Mall, TCU football games, and other
areas.
Signal Timing Graduate Engineer, June 2000 — December 2003
• Design and install synchronized arterial timing, including system analyses, signal
'
warrants, signal plan review, data collection, laboratory testing, signal activation, and
fine-tuning;
• Investigate citizen requests for traffic signal timing; including field observations,
operation modifications, delay studies, protected left turn studies, collision studies, work
order submissions, and citizen notification;
-�
• Design new traffic signals, prepare technical reports, and review signal layouts.
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Page 12 of 75
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Fr=k Brock, Traffic Systems Supervisor
CWof FortVftd�
Department of Transportation & Public Works
_
Traffic Services Division
5001 James Avenue
Fort Worth, TX 76115
Education and Trainin_q
Abilene Hiah School. 1975
ICC Texas State Exam, Licensed Master Electrician
Fort Worth Exam, Licensed Journeyman Electrician
Grav Bov Publishing Proprietary School, Basic Electrical Codes Certification
International Brotherhood of Electrical Workers, Journeyman Lineman
International Municipal Signal Association, Certified Work Zone Safety Specialist
Research and Professional Experience
_
Supervisor. Citv of Fort Worth — Supervise, plan, assign, prioritize, review, train,
participate and coordinate signal crews in the construction and maintenance of traffic
signals and street lighting; 1994-present
Master Electrician. Citv of Fort Worth — set up electrical meter accounts, pull electrical
permits, coordinate with TXU, Oncor, City of Fort Worth Fire, Development, Signal
Operations, and Finance Departments; 1989-1994
Inspector. Citv of Fort Worth — Inspect contractor's progress and quality of work while
the process of building Traffic Signal Intersections; 1987-1989
Electrical &Electronic Field; 34 yrs
�
Joumevman Lineman; 36 yrs
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Page 13 of 75
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Holrnem Been - Plan Review Task Leader
CKYOf FortVfte
Department of Transportation & Public Works
Traffic Services Division
5001 James Avenue
Fort Worth, TX 76115
Education and Tra/ainq
Universitv of Texas in Arlinaton. Civil Engineering, Currently Pursuing a Bachelors'
Degree
Tarrant County Colleae. A.A.A. Degree, 2003
Tarrant Countv College. Computer Aided Drafting/Design, A.A.S. Degree,. 1999
Research and Professional Experience
Senior Enaineerina Technician. Citv of Fort Worth - Review signal plans, meet with
engineering consultants and contractors to discuss signal design, coordinate &
schedule signal construction meetings with contractors, advertise, bidding process,
manage Traffic Signal Contracts, review construction invoicing, manager and maintain
traffic signal files and reports, manager traffic signal material inventory; 2006 - present
Enaineerina Technician II. Citv of Fort Worth — Design/review traffic signal construction
plans, analyzed accident reports
Enaineerina Technician 1. City of Fort Worth — Primary functions involved designing
construction plans for new/rehab water and sewer projects
Enaineerina Technician Ill. Texas Department of Transportation — Review and design
traffic signal construction plans, construction estimation, prepare PS&E for letting
projects. Conducted engineering & traffic investigations as basis for establishing
regulatory speed zones, signinglpavement marking placement, and traffic control
warrants; 2002-2006
Page 14 of 75
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tel eth Brock - Project ConsbLlclioll Ir1otiowd 1'
My of Fat Vft Id1
Department of Transportation & Public Works
Traffic Services Division
5001 James Avenue
Fort Worth, TX 76115
Education and Tia/nin_q
Licensed Journeyman Electrician (May 3, 2004)
International Brotherhood of Electrical Workers, Journeyman Lineman
International Municipal Sional Association, Traffic Signal Certification Program
International Municipal Sional Association. Certified Work Zone Safety Specialist
Steven Decatur High School (1977)
Research and Professional Experience
Senior Sional Inspector. City of Fort Worth - review signal plans, meet with engineering
consultants and contractors to discuss signal design, coordinate signal construction with
utility Co., supervise and inspect all aspects of signal and streetlight, construction work
performed by contractors, manage Loop Maintenance and Resurface Contract, prepare
traffic signal construction reports manage and maintain traffic signal files and reports,
manage traffic signal material inventory; 2001- present
Joumevman Electrician. Citv of Fort Worth - coordinate with the Fire Dept. and Oncor to
obtain traffic signal service addresses and service meters for new traffic signals; 1996-
2001
Crew Leader. Citv of Fort Worth - lead crew members in the repair and construction
installation of existing and new traffic signals and streetlight; 1986-1996.
Electrical & Electronic Field; 20yrs.
Journeyman Lineman; 30yrs.
Page 15 of 75
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6
Identifying Information and Statements Required for All Subcontracts
Applications must identify plans for subcontracting and outline the relationships
envisioned.
W i After awarding contracts to subcontractors as a result of legally mandated solicitation
j processes, Applicants must provide statements from each of its awarded subcontractors,
signed by an individual authorized to legally obligate each subcontractor, attesting to the
fact that it will provide the services for Applicant as represented in the Applicant's
application.
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Riverside Signal System Work Plan
s
A. Project Summary
The proposed project seeks to lower fossil fuel consumption and carbon emissions through the
reduction in vehicle delay and stops within the Riverside Community of the city of Fort Worth.
The scope of the project consists of documenting the existing traffic delay conditions of four
f arterial roadways, E. Belknap St., Sylvania Av., Riverside Dr. and N. Beach St., through the
Riverside Community, making traffic signal improvements along the four arterials and
implementing synchronized traffic signal timing plans, followed by documenting the resulting
�
reduction in traffic y
ffic delay conditions. 1
'
�1
PART I: Consultant Services
Task 1: Traffic Signal Timing
~
Consultant services will be retained to develop a profile of the existing traffic conditions along
the four main arterial roadways of E. Belknap St., N. Beach St., Sylvania St. and Riverside Dr.
This work will include field data collection of average daily traffic counts, turning movement
counts at each intersection for up to four peak traffic periods, floating car travel runs to measure
current average intersection delay and stops, and a report including "before" conditions, minor
signal modification recommendations, and layouts showing the signal modifications.
^
This data, along with geometric intersection distances and current intersection lane control, will
be used to develop a computer simulation model of the existing travel conditions along the four
arterials. From this model, a "before" base condition will be developed.
The model will then be used as a tool to develop synchronized traffic signal controller timing
plans as well as recommend operational and capacity improvements at each signalized
intersection within the project limits. Any minor recommended improvements such as signal
head, sign, or marking changes will be designed and installed prior to the signal ,fine-tuning.
+
Any major reconstruction recommendations will be in Task 2.
Up to four new traffic signal timing plans will be field installed and fine tuned under this task.
Then an after study will be conducted using the floating car method to record average vehicle
stops and delays. The field data will be used to calibrate the "after" computer simulation model.
The model results will then be used as a go/no-go decision point. The project will only proceed
to the next task based on improved metrics of reduced fuel consumption and vehicle emissions.
" Task deliverables will include, but not be limited to, engineering reports of findings and benefits
of proposed traffic signal operation changes and timing synchronization.
Part II: Contractual Construction Services
Task 2: Traffic Signal Designs
rl Page 17 of 75
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This task will involve the preparation of complete signal reconstruction plans for two
intersections previously identified by staff as warranting replacement, namely Sylvania Av. &
Yucca St. and Race St. & Sylvania Av.
Task deliverables will include, but not be limited to, engineering reports of recommended
construction changes, plans, estimates of probable costs and construction bid proposal. �J
Task 3: Bidding
Staff will advertise the construction bid proposal, conduct a pre -bid meeting with all interested
bidders, receive, tabulate and evaluate bids and make a recommendation to City Council to
accept the best bid.
Task deliverables will include, but not be limited to, tabulation of bids received and
communication to Council recommending bid award.
Task 4: Construction Phase Services
Staff will hold a pre -construction meeting with the engineering consultant. Staff will inspect all
field construction work and prepare field mark-ups of any field changes to the engineering plans.
The consultant will use the field mark-ups to prepare `as -built' record drawings. Staff will
review and approve all construction invoices for quality assurance of field installed materials.
Task deliverables will include, but not be limited to, "as built" record drawings.
f
PART III: In-house Signal Modifications
Task 1: Staff will purchase new traffic signal controller equipment, vehicle detection system
equipment and fabricate traffic signs as recommended by the engineering report in Task 1. In-
house crews will prepare and install the traffic signal controller equipment and install new
*- -�
vehicle detection systems and signal modifications as shown on the engineering drawings.
-� B. Risk Management
A J
Process Definition:
The Project Team recognizes that all contain risk. Similar projects' historical experience,
business experience and experienced personnel allow Project Team to forecast and limit most
j project risk. Project risk is often caused by inexperience, lack of communication, unreliable
J contractors and lack of project control.
�J
The Project Team will mange project risk using the following systems and methodologies:
Page 18 of 75 J
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o Thorough and continuous planning
o Contractual document review and legal review of term and conditions
o Adherence to safety programs
o Application of claims avoidance programs
o Competitive bidding and supplier evaluation
o Employee training
�1
o Implementation of a quality control and assurance program
o Implementation of Project Control processes for scheduling, cost control, earned value,
documentation and reporting systems
o Insurance requirements
o Contractor bonding
_
o Product warranties
Risk Assessment.-
The project Team risk management process evaluates these risks to determine the probability of
_
occurrence and the impact of the occurrence on the project. The components of the assessment
are defined below:
Probability of Occurrence:
�?
o Very unlikely to occur
_
o Unlikely to occur
o May occur about half of the time
o Likely to occur
o Very likely to occur
Impact:
o Low risk exposure has little or not potential of increase in cost, disruption of schedule, or
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degradation of performance and quality of work. Actions within the scope of the planned
project and normal management attention should result in controlling acceptable risk.
o Moderate risk exposure may cause some increase in cost, disruption of schedule, or
degradation of performance and quality of work. Special action and management
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attention may be required to control acceptable risk.
o High risk exposure may cause significant increase in cost, disruption of schedule, or
degradation of performance and quality of work. Significant additional action and
management attention will be required to control acceptable risk.
The Project Teams has identified the following risks as having a potential influence on the
project objectives. The impacts and probabilities are included in the table below:
Risks Probability of Impact
Occurrence
Selection of consultant team that lacks Unlikely High
a strong transportation engineering
experience performs poorly and requires numerous rework
or recollection of field data
Poor construction work requires numerous delays to make Unlikely Moderate
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corrections
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Field conditions do not match engineering plans require Moderate Moderate
redesign or relocation of underground utilities or
acquisition of right-of-way easements causing unnecessary
delays
Loss of key staff Unlikely Moderate
Unexpected and unusual weather delays Moderate Moderate
Risk Mitigation Strategies
The Project Team proposes the following course of action to manage the risks identified above:
Risks
Selection of consultant team that lacks
a strong transportation engineering
experience performs poorly and requires
numerous rework or recollection of field
data
Poor construction work requires numerous
delays to make corrections
Field conditions do not match engineering
plans require redesign or relocation of
underground utilities or acquisition of
right-of-way easements causing
unnecessary delays
Loss of key staff
Unexpected and unusual weather delays
Mitigation Strategy
Consultant will only be selected for firms
with a proven work record of meeting
staffs expectation in previous projects.
Will require references from previous
clients on bidding contractors work have
not worked on previous traffic signal
construction projects. Experience staff
inspector will work closely with the
construction contractor to stay on top of
poor workmanship and have it corrected
immediately.
Field visited will be made with the Project
Team and consultant team together to
ensure a thorough site assessment is
completed before any design work
commences. Experience staff inspector will
work closely with the construction
contractor to stay on top of issues and flag
them to the project manager through
weekly meetings.
If a current project team member is no
longer available, staff will be pulled in
from other areas of the Division to come
those duties, or additional consultant
services will retained to keep the project on
track.
Project construction work will be let well
ahead of the grant time limit to allow
unforeseen weather conditions that may
cause work to be stopped for a long time
period. Cit field crews will be asked to
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assist if the delays appear to impact
completing the project in time.
C. Milestone Log
The following represents the monthly milestone log that will be submitted during the duration of
the project.
Reporting Period:
Date Submitted:
Total Project Estimated Percent Complete:
PART 1: Consultant and Contractual Services
Milestone 1: Before travel time studies, traffic counts, capacity analyses, recommendation
report for each corridor
Implementation: 2/1A0 Completion: 3/8/10
Status: Est. Percent Complete
Project Activities This Reporting Period:
On track: Yes / No (If no, provide planned actions to get task on track.)
Milestone 2: Development of individual timing plans for each intersection, installation of
timing plans in field controllers, fine-tuning, after travel time runs, after conditions report
submitted.
Implementation: 3/22/10 Completion: 5/3/10
Status: Est. Percent Complete
Project Activities This Reporting Period:
On track: Yes / No (If no, provide planned actions to get task on track.)
Milestone 3: Prepare engineering plans, specifications, and estimates
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Implementation: 5/17/10 Completion: 9/13/10
Status: Est. Percent Complete
Project Activities This Reporting Period:
On track: Yes / No (If no, provide planned actions to get task on track.)
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Milestone 4: Prepare contract documents, advertisement, bidding
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Implementation: 9/13/10 Completion: 10/11/10
Status: Est. Percent Complete
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Project Activities This Reporting Period:
On track: Yes / No (If no, provide planned actions to get task on track.)
Milestone 5: Reconstruct signals including the installation of cabinets, communication
equipment, and vehicle detection systems.
y
Implementation: 9/20/10 Completion: 11/22/10
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Status: Est. Percent Complete
Project Activities This Reporting Period:
On track: Yes / No (If no, provide planned actions to get task on track.)
Milestone 6: Prepare "as built" record drawings and final grant reports.
Implementation: 2/21/11 Completion: 05/02/11
Status: Est. Percent Complete
Project Activities This Reporting Period:
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On track: Yes / No (If no, provide planned actions to get task on track.)
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PART II: In-house Signal Modifications
Milestone 1: Install new cabinet -controller assemblies and new vehicle detection systems at
the intersections to be modified.
Implementation: 11/16/09 Completion: 3/29/10
Status: Est. Percent Complete
Project Activities This Reporting Period:
On track: Yes / No (If no, provide planned actions to get task on track.)
D. Project Timeline:
See Attached Appendix B
E. Success Criteria at Decision Points:
The critical decision point in the project will come at the conclusion of Task 1 as part of the
consultant services contract. The consultant will provide a final report that will compare the
computer modeling of before or existing travel conditions to the after or improved travel
conditions once the traffic signal timings have been optimized. The decision to proceed will be
based on the desired outcome showing a reduction in vehicle delays and stops, and a
corresponding reduction in fossil fuel consumption and likewise a reduction in vehicle
emissions.
Assuming a reduction in fossil fuel consumption and in vehicle emissions is shown, the project
will proceed to plan preparation and construction letting. If no benefit is documented, the grant
will be finalized and final reports submitted concluding the project
Page 23 of 75
BUDGET
City of Fort worth
Riverside Signal Reconstruction & Modification Project
20% Grant Match: $187,500
80% Grant Request: $750,000
Total Project Cost: $937,500
Work Phase
Task
Total Cost
Design
Project Management
$3,500
Staff Time for Plan Review
$6,500
Professional Services:
Assessment, Data Collection,
Signal Warranting, Timing
Development, & Timing
Installation, PS&E
$165,000
Design Subtotal:
$175,000
Pre -
Construction
Project Management
$500
Professional Services: Bidding
$6,000
Pre -Construction Subtotal:
$6,500
Construction
Project Management
$12,000
Inspection
$16,000
Staff Time for Cabinet -Controller
Assembly, Signal Head,
Detection System Installations
$126,000
Signal Equipment: Controller -
Cabinet Assemblies, Detection
Systems; Poles; Mast Arms
$260,000
Construction Contract
$315,000
Annual Agreement Services for
Markings
$10,000
Construction Subtotal:
$739,000
Close -Out
Project Management
$500
Professional Services: Record
Drawings
$16,500
Close -Out Subtotal:
$17,000
TOTAL:
$937,500
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EQUIPMENT LIST
Riverside Signal Reconstruction & Modification Project
20% Grant Match: $187,500
80% Grant Request: $750,000
Total Project Cost: $937,500
No.
J Description Of Equipment
Unit
Material Price
1
16' Monolever Traffic Signal Arm
EA
$561.20
2
20' Monolever Traffic Signal Arm
EA
$726.11
3
2^' Monolever Traffic Signal Arm
EA
$913.33
4
28' Monolever Traffic Signal Arm
EA
$966.46
5
32' Monolever Traffic Signal Arm
EA
$951.05
6
36' Monolever Traffic Signal Arm
EA
$1,265.00
Standard # 41 27.5' with Street Light
7
Assembly
EA
$3,343.84
8
Standard # 42 21 'Assembly
EA
$2,975.28
9
40' Monolever Traffic Signal Arm
EA
$1,588.84
10
44' Monolever Traffic Signal Arm
EA
$1,485.80
11
48' Monolever Traffic Signal Arm
EA
$1,964.55 kl
12
Standard # 43 27.5' Street Light Assembly
EA
$3,827.07
13
Standard # 44 21' Assembly
EA
$3,419.30 1
14
52' Monolever Traffic Signal Arm
EA
$3,796.27 1
15
56' Monolever Traffic Signal Arm
EA
$3,581.10
16
60' Monolever Traffic Signal Arm
EA
$3,860.55
17
Standard # 45 27.5' Street Light
EA
$5,901.67
18
Standard # 46 21'
EA
$5,371.19
Type 332-A Aux.Controller-Cabinet
19
Assembly
EA
$9,378.25
20
GPS Clock
EA
$562.35
21
Opticom Emergency Pre-emption Assembly
LS
$3,169.40
22
VIVDS Package
LS
$11,895.60
23
Radar Setback Detection System
LS
$13,334.25
24
Radar Presence Detection System
LS
$22,130.60
SUBCONTRACTOR OPPORTUNITY
Riverside Signal Reconstruction & Modification Project
20% Grant Match: $187,500
80% Grant Request: $750,000
Page 25 of 75
Total Project Cost:
Professional Services
Breakdown
Professional Services:
Assessment, Data
Collection, Signal
Warranting, Timing
Development, & Timing
Installation, PS&E
Professional Services:
Bidding
Professional Services:
Record Drawings
Total:
Construction Contract
Breakdown
Construction Contract
Total:
Page 26 of 75
$937,500
Total Cost
$165,000
$6,000
$16,500
$187,500
Total Cost
$315,000
$315,000
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2.9 Conflict of Interest Statement Required
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In submitting an application in response to this RFA, an Applicant represents and
warrants to the Comptroller that it and each of its subcontractors that it awards
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subcontracts to perform services pertaining to the Project, have the requisite resources,
�!
qualifications and independence to complete the project free from outside direction,
control, or influence, and are subject only to the requirements of this RFA. Applicants
�►
that cannot make this representation and warranty should not respond to this RFA.
_
In its application, each Applicant must disclose any existing or potential conflicts of
interest or possible issues that might create appearances of impropriety relative to
Applicant's and its future subcontractors' submission of a application, possible selection
.�
as Grantee or its performance toward completion of the Project.
As part of this disclosure requirement, each Applicant must include in its application all
_
past and present contractual, business, financial or personal relationships between
Applicant and the Comptroller. After awarding contracts to subcontractors as a result of
legally mandated solicitation processes, Applicants must provide to the Comptroller
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documentation regarding subcontractor(s), past and present contractual, business,
financial or personal relationships between subcontractor(s) and the Comptroller. For
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purposes of this disclosure requirement, "past" is defined as within the two (2) calendar
years prior to the deadline for submission of applications in response to this RFA. For
purposes of this disclosure requirement, "the Comptroller" is defined as the statewide
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elected official who heads the state agency, Texas Comptroller of Public Accounts, as
well as the Comptroller's employees or recent former employees. For purposes of this
disclosure requirement, "recent former employees" are defined as those Comptroller
employees who have terminated agency employment within the two (2) calendar years
prior to the deadline for submission of applications in response to this RFA. For each
item, Applicant must provide a detailed explanation of why Applicant does or does not
believe such item poses a conflict of interest, potential conflict of interest, or appearance
t
of impropriety issue relative to Applicant's submission of an application, possible
selection as the Grantee or its performance toward completion of the Project.
For purposes of this RFA, "personal relationship" is defined as a current or past
connection other than a clearly contractual, business, financial or similar relationship and
includes family relationships or other connections outside simply providing a response to
this RFA. For this purpose, "family relationship" means a relationship within the third
degree of consanguinity or second degree of affinity; see Chapter 573, Tex Gov't Code,
which defines these degrees of consanguinity and affinity. Connections other than such
_} family relationships fall within this definition and must be disclosed if a reasonable
J person could expect the connection to diminish the Applicant's independence of
judgment or effectiveness in the performance toward completion of the Project
Applicant's responsibilities to the Comptroller or the state toward completion of the
Project. Connections also fall within this definition if a reasonable person could expect
the connection, within the overall content of the Applicant's submission of an
Page 27 of 75
application, possible selection as the Grantee or its performance toward completion of
the Project, to create an issue for the Comptroller's consideration relative to a potential
j appearance of impropriety or conflict of interest. Connections also fall within this
definition if the relationship is with a Comptroller or other State of Texas employee with
authority to make decisions or recommendations on state contracting or procurement or
this RFA. For purposes of this provision, those persons with authority to make decisions
or recommendations are those persons who fall within the definition of "purchasing
personnel" in Section 2262.004(a)(2), Tex Gov't Code.
F In submitting an, application in response to this RFA, an Applicant affirms that it has not
given, nor intends to give, at any time hereafter, any economic opportunity, future
employment, gift, loan, gratuity, special discount, trip, favor, or service to a public
servant or any employee or representative of same, in connection with this RFA.
IApplicants must disclose any proposed personnel in its application who are current or
recent former employees of the Comptroller or the State of Texas. Recent former
employees are defined above.
Disclosures under these provisions are information that will be evaluated by the
Comptroller, however, all information provided will not necessarily lead to a restriction
or disqualification. Issues will be considered on a case by case basis in the best interests
of the State of Texas.
If an Applicant is in doubt about whether information should be disclosed, Applicant
may submit a question during the official period for submission of questions. Failure to
disclose any required information under these provisions may be cause for application
disqualification or Grant Agreement resulting from this RFA. The Comptroller reserves
the right, in its sole discretion, to determine if an issue should result in application
disqualification or termination of the Grant Agreement resulting from this RFA.
If circumstances change or additional information is obtained subsequent to submission
of applications, the Applicant's duty to disclose under these provisions continues under
! the term of the Grant Agreement and does not end with submission of an application or
receipt of grant award.
IPage 28 of 75
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2.10 Confidential Information; Nondisclosure; Open Records
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Following the award of a grant under this RFA, responses to this RFA are subject to
release as public information unless the application nor specific parts of the response can
be shown to be exempt from the Texas Public Information Act. All Applicants are
advised to consult with their legal counsel regarding disclosure issues and take the
appropriate precautions to safeguard trade secrets or any other proprietary information
The Comptroller assumes no obligation or responsibility relating to the disclosure or
nondisclosure of information submitted by Applicants.
if Applicant believes that any portion of an application is confidential, then Applicant
must so specify. The Applicant must stamp in bold red letters the term
+r "CONFIDENTIAL" on that specific part or page of the application which Applicant
believes to be confidential. The Applicant must submit in writing specific detailed
reasons, including any relevant legal authority, stating why Applicant believes the material
' to be confidential. Vague and general claims as to confidentiality will not be accepted.
The Comptroller will be the sole judge as to whether a claim is general and/or vague in
+.� nature. All applications and parts of applications which are not marked as confidential
will be automatically considered public information after the award of a grant. An
application resulting in an award may be considered public information even though parts
are marked confidential.
"
In the event Comptroller receives a request for portions of an application marked as
"confidential" as specified above, Comptroller shall forward such request to the Office of
the Attorney General for an opinion on whether such information may be withheld from
disclosure under the Texas Public Information Act. Comptroller will notify the Applicant
subject to the request when the information is forwarded to the Office of the Attorney
General. Applicants are advised that Comptroller is obligated to comply with the Attorney
General's decision, including any such decision calling for the release of information
marked "confidential" by an Applicant.
Coovriphted applications are unacceptable and are subject to disqualification as non-
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,. ATTACHMENT C
DOE SPECIAL TERMS AND CONDITIONS REQUIRED
-' IN GRANT TO THE COMPTROLLER OF PUBLIC ACCOUNTS
AND FLOW DOWN TO ARRA GRANTS AND COOPERATIVE AGREEMENTS
aw
RESOLUTION OF CONFLICTING CONDITIONS
Any apparent inconsistency between Federal statutes and regulations and the terms and conditions
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contained in this award must be referred to the DOE Award Administrator for guidance.
AWARD AGREEMENT TERMS AND CONDITIONS
t This awardlagreement consists of the Grant and Cooperative Agreement cover page, plus the following:
a. Special terms and conditions.
b. Attachments:
Attachment No. Title
1 Intellectual Property Provisions
2 Federal Assistance Reporting Checklist
- 3 Budget Page(s)
4 SEP Narrative Information Worksheets
c. Applicable program regulations (spec) (Dale)
d. DOE Assistance Regulations, 10 CFR Part 600at htta://ecfr.aDoaccess.aov
e. Application/proposal as approved by DOE.
f. National Policy Assurances to Be Incorporated as Award Terms in effect on date of award at
httD://manaaement.eneray.aov/business doe/1374.htm.
ADVANCED UNDERSTANDING CONCERNING PUBLICLY FINANCED ENERGY
IMPROVEMENT PROGRAMS
The parties recognize that the Recipient may use funds under this award for Property -Assessed Clean
Energy (PACE) loans, Sustainable Energy Municipal Financing, Clean Energy Assessment Districts,
_ Energy Loan Tax Assessment Programs (ELTAPS), or any other form or derivation of Special Taxing
District whereby taxing entities collect payments through increased tax assessments for energy efficiency
*� A and renewable energy building improvements made by their constituents. The Department of Energy
intends to publish 'Best Practices" or other guidelines pertaining to the use of funds made available to the
recipient under this award pertaining to the programs identified herein. By accepting this award, the
recipient agrees to incorporate, to the maximum extent practicable, those Best Practices and other
guidelines into any such program(s) within a reasonable time after notification by DOE that the Best
Practices or guidelines have been made available. The recipient also agrees, by its acceptance of this
award, to require its sub -recipients to incorporate to the maximum prae-cable the best practices
and other guideline into any such program used by the sub -recipient."
PAYMENT PROCEDURES - ADVANCES THROUGH THE AUTOMATED STANDARD
APPLICATION FOR PAYMENTS (ASAP) SYSTEM
a. Method of Payment. Payment will be made by advances through the Department of Treasury's
ASAP system.
Page 30 of 75
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j b. Requesting Advances. Requests for advances must be made through the ASAP system. You
may submit requests as frequently as required to meet your needs to disburse funds for the Federal share
of project costs. If feasible, you should time each request so that you receive payment on the same day
that you disburse funds for direct project costs and the proportionate share of any allowable indirect costs.
If same -day transfers are not feasible, advance payments must be as close as is administratively feasible
to actual disbursements.
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C. Adjusting payment requests for available cash. You must disburse any funds that are available
` from repayments to and interest earned on a revolving fund, program income, rebates, refunds, contract
settlements, audit recoveries, credits, discounts, and interest earned on any of those funds before
requesting additional cash payments from DOE.
d. Payments. All payments are made by electronic funds transfer to the bank account identified on
the ASAP Bank Information Form that you filed with the U.S. Department of Treasury.
REBUDGETING AND RECOVERY OF INDIRECT COSTS - REIMBURSABLE INDIRECT
COSTS AND FRINGE BENEFITS
a. If actual allowable indirect costs are less than those budgeted and funded under the award, you
may use the difference to pay additional allowable direct costs during the project period. If at the
completion of the award the Government's share of total allowable costs (i.e., direct and indirect), is less
than the total costs reimbursed, you must refund the difference.
b. Recipients are expected to manage their indirect costs. DOE will not amend an award solely to
provide additional funds for changes in indirect cost rates. DOE recognizes that the inability to obtain full
,r reimbursement for indirect costs means the recipient must absorb the underrecovery. Such underrecovery
may be allocated as part of the organization's required cost sharing.
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.W J USE OF PROGRAM INCOME - ADDITION
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J If you earn program income during the project period as a result of this award, you may add the program
income to the funds committed to the award and use it to further eligible project objectives.
v STATEMENT OF FEDERAL STEWARDSHIP
DOE will exercise normal Federal stewardship in overseeing the project activities performed under this
award. Stewardship activities include, but are not limited to, conducting site visits; reviewing
performance and financial reports; providing technical assistance and/or tQUAI. 04y intervention in
unusual circumstances to correct deficiencies which develop during the project; assuring compliance with
terms and conditions; and reviewing technical performance after project completion to ensure that the
award objectives have been accomplished.
HISTORIC PRESERVATION
Prior to the expenditure of Federal funds to alter any structure or site, the Recipient is required to comply
�- with the requirements of Section 106 of the National Historic Preservation Act (NHPA), consistent with
J DOE's 2009 letter of delegation of authority regarding the NHPA. Section 106 applies to historic
properties that are Iisted in or eligible for listing in the National Register of Historic Places. In order to
fulfill the requirements of Section 106, the recipient must contact the State Historic Preservation Officer
Page 31 of 75
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(SHPO), and, if applicable, the Tribal Historic Preservation Officer (THP% to coordinate the Section
106 review outlined in 36 CFR Part 800. SHPO contact information is available at the following link-
http://www.ncshpo.orgtfmd/index.htm. THPO contact information is available at the following link:
http://www.nathpo.org/map.html .
Section I I0(k) of the NHPA applies to DOE funded activities. Recipients shall avoid taking any action
that results in an adverse effect to historic properties pending compliance with Section 106.
,.i Recipients should be aware that the DOE Contracting Officer will consider the recipient in compliance
with Section 106 of the NHPA only after the Recipient has submitted adequate background
-- documentation to the SHPOPTHPO for its review, and the SHPO/THPO has provided written concurrence
to the Recipient that it does not object to its Section 106 finding or determination. Recipient shall provide
a copy of this concurrence to the Contracting Officer.
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SITE VISITS
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-1 DOE authorized representatives have the right to make site visits at reasonable times to review project
accomplishments and management control systems and to provide technical assistance, if required. You
must provide, and must require your subawardees to provide, reasonable access to facilities, office space,
resources, and assistance for the safety and convenience of the government representatives in the
' performance of their duties. All site visits and evaluations must be performed in a manner that does not
Now unduly interfere with or delay the work -
law "" r REPORTING REQUIREMENTS
J a. Requirements. The reporting requirements for this award are identified on the Federal Assistance
Reporting Checklist, DOE F 4600.2, attached to this award. Failure to comply with these reporting
7 requirements is considered a material noncompliance with the terms of the award. Noncompliance may
A result in withholding of future payments, suspension, or termination of the current award, and
withholding of future awards. A willful failure to perform, a history of failure to perform, or
unsatisfactory performance of this and/or other financial assistance awards, may also result in a
t debarment action to preclude future awards by Federal agencies.
b. Dissemination of scientific/technical reports. Scientific/technical reports submitted under this
i award will be disseminated on the Internet via the DOE Information Bridge (www.osti.gov/bridge),
,. unless the report contains patentable material, protected data, or SBIR/STTR data. Citations for journal
articles produced under the award will appear on the DOE Energy Citations Database
�.. (www.osti.gov/energycitations).
_ C. Restrictions. Reports submitted to the DOE Information Bridge must not contain any Protected
Personal Identifiable Information (PH), limited rights data (proprietary data), classified information,
_1 information subject to export control classification, or other information not subject to release.
PUBLICATIONS
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a. You are encouraged to publish or otherwise make publicly available the results of the work
..j conducted under the award.
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b. An acknowledgment of Federal support and a disclaimer must appear in the publication of any
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material, whether copyrighted or not, based on or developed under this project, as follows:
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"This
Acknowledgment: material is based upon work supported by the Department of Energy under
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Award Number(s) DE-EE00001 16."
"This
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Disclaimer: report was prepared as an account of work sponsored by an agency of the United
States Government Neither the United States Government nor any agency thereof, nor any of their
employees, makes any warranty, express or implied, or assumes any legal liability or responsibility for the
accuracy, completeness, or usefulness of any information, apparatus, product, or process disclosed, or
represents that its use would not infringe privately owned rights. Reference herein to any specific
commercial product, process, or service by trade name, trademark, manufacturer, or otherwise does not
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necessarily constitute or imply its endorsement, recommendation, or favoring by the United States
Government or any agency thereof. The views and opinions of authors expressed herein do not
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necessarily state or reflect those of the United States Goverment or any agency thereof."
FEDERAL, STATE, AND MUNICIPAL REQUIREMENTS
You must obtain lany required permits and comply with applicable federal, state, and municipal laws,
codes, and regulations for work performed under this award.
INTELLECTUAL PROPERTY PROVISIONS AND CONTACT INFORMATION
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a. The intellectual property provisions applicable to this award are provided as an attachment to this
award. A list of all intellectual property provisions may be found at
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httD://www.ec•doe-aov/financial assistance awards.htm.
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b. Questions regarding intellectual property matters should be referred to the DOE Award
Administrator and the Patent Counsel designated as the service provider for the DOE office that issued
the award. The 1P Service Providers List is found at
http:/lwww.gc.doe.gov/documents/lntellectual Property_(IP) Service_Providers for Acquisition.pdf.
LOBBYING RESTRICTIONS
By accepting funds under this award, you agree that none of the funds obligated on the award shall be
' expended, or indirectly, to influence congressional action on any legislation or appropriation
matters pending before Congress, other than to communicate to Members of Congress as described in 18
U.S.C. 1913. This restriction is in addition to those prescribed elsewhere in statute and regulation.
NOTICE REGARDING THE PURCHASE OF AMERICAN-MADE EQUIPMENT AND
PRODUCTS -- SENSE OF CONGRESS
It is the sense of the Congress that, to the greatest extent practicable, all equipment and products
purchased with funds made available under this award should be American -made.
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PRESERVATION OF OPEN COMPETITION AND GOVERNMENT NEUTRALITY TOWARDS
CONTRACTORS' LABOR RELATIONS ON FEDERALLY FUNDED CONSTRUCTION
PROJECTS
a. Unless in conflict with State or local laws, you must ensure that bid specifications, project agreement,
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or other controlling documents in construction contracts awarded pursuant to this agreement, or pursuant
to a subaward to this agreement, do not:
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1. Require or prohibit bidders, offerors, contractors, or subcontractors to enter into or adhere to
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agreements with one or more labor organizations, on the same or other related construction project(s); or
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2. Otherwise discriminate against bidders, offerors, contractors, or subcontractors for becoming
or refusing to become or remain signatories or otherwise to adhere to agreements with one or more labor
organizations, on the same or other related construction project(s).
b. The term "construction contract" as used in this provision means any contract for the construction,
rehabilitation, alteration, conversion, extension, or repair of buildings, highways, or other improvements
to real property.
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c. Nothing in this provision prohibits bidders, offerors, contractors, or subcontractors from voluntarily
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entering into agreements with labor organizations.
NATIONAL ENVIRONMENTAL POLICY ACT (NEPA)
You are restricted from taking any action using Federal funds for projects under this award that would
have an adverse effect on the environment or limit the choice of reasonable alternatives prior to DOE
providing a final NEPA determination regarding these projects.
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Prohibited project activities include:
—,
Distributed Renewable Energy Technology Program
Building Efficiency/Retrofit Program — Loans for Renewable energy -related projects
Transportation Efficiency Program — Alternative Fuels activities including the purchase of equipment for
new alternative fuel(s) refueling stations and/or the purchase of equipment for retrofits of existing
refueling stations.
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The project activities listed above will require an individual NEPA review and determination. You must
submit an environmental questionnaire to the DOE Project Officer for each project activity identified
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above to allow DOE to conduct an individual NEPA review and determination.
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If you move forward with activities that are not authorized for federal finding by the DOE Contracting
Officer in advance of the final NEPA determination, you are doing so at risk of not receiving federal
funding and such costs may not be recognized as allowable cost share.
If DOE determines that NEPA requires the preparation of an environmental assessment (EA) or
environmental impact statement (EIS) for a project you propose, you will be responsible for paying
the cost of preparing an EA or EIS. Preparation of these types of NEPA documents can require 6-
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24 months. Accordingly you should carefully consider whether such projects are consistent with
the objectives of the ARRA and will allow the expenditure of funds within the time periods allowed
for by that statute.
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This restriction does not preclude you from: performing information gathering analysis, documentation,
dissemination and training andproviding technical advice andplanning assistance for the activities listed
above.
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Nor does this restriction preclude you from conducting the following project activities:
Energy Education Outreach Program
Administration
Energy Sector Training Centers
Transportation Efficiency Program — Traffic Signal activities and Alternative Fuels activities including
the incremental cost of plug-in hybrid vehicles, alternative fuel vehicles (CNG, LNG,LPG, Electric) and
the incremental costs of retrofitting diesel vehicles to alternative fuel vehicles.
Building Efficiency/Retrofit Program - Loans for commissioning, controls, HVAC, lighting, building
shell, and water efficiency project activities
DECONTAMINATION AND/OR DECOMMISSIONING (D &D) COSTS
Notwithstanding any other provisions of this Agreement, the Government shall not be responsible for or
have any obligation to the recipient for (i) Decontamination and/or Decommissioning (D&D) of any of
the recipient's facilities, or (ii) any costs which may be incurred by the recipient in connection with the
{ D&D of any of its facilities due to the performance of the work under this Agreement, whether said work
was performed prior to or subsequent to the effective date of this Agreement.
SPECIAL PROVISIONS RELATING TO WORK FUNDED UNDER AMERICAN RECOVERY
AND REINVESTMENT ACT OF 2009
Preamble
The American Recovery and Reinvestment Act of 2009, Pub. L. 111-5, (Recovery Act) was enacted to
preserve and create jobs and promote economic recovery, assist those most impacted by the recession,
provide investments needed to increase economic efficiency by spurring technological advances in
i science and health, invest in transportation, environmental protection, and other infrastructure that will
provide long-term economic benefits, stabilize State and local government budgets, in order to minimize
`1 and avoid reductions in essential services and counterproductive State and local tax increases. Recipients
shall use grant funds in a manner that maximizes job creation and economic benefit.
�j The Recipient shall comply with all terms and conditions in the Recovery Act relating generally to
J governance, accountability, transparency, data collection and resources as specified in Act itself and as
discussed below,
Recipients should begin planning activities for their first tier subrecipients, including obtaining a DUNS
number (or updating the existing DUNS record), and registering with the Central Contractor Registration
(CCR).
ur
Be advised that Recovery Act funds can be used in conjunction with other funding as necessary to
r complete projects, but tracking and reporting must be separate to meet the reporting requirements of the
Recovery Act and related guidance. For projects funded by sources other than the Recovery Act,
„f Contractors must keep separate records for Recovery Act funds and to ensure those records comply with
the requirements of the Act.
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The Government has not fully developed the implementing instructions of the Recovery Act, particularly
concerning specific procedural requirements forthe new reporting requirements. The Recipient will be
provided these details as they become available. The Recipient must comply with all requirements of the
Act. If the recipient believes there is any inconsistency between ARRA requirements and current award
terms and conditions, the issues will be referred to the Contracting Officer for reconciliation.
Definitions
For purposes of this clause, Covered Funds means funds expended or obligated from appropriations under
the American Recovery and Reinvestment Act of 2009, Pub. L. 111-5. Covered Funds will have special
accounting codes and will be identified as Recovery Act funds in the grant, cooperative agreement or TIA
and/or modification using Recovery Act funds. Covered Funds must be reimbursed by September 30,
2015.
-i Non -Federal employer means any employer with respect to covered funds — the contractor, subcontractor,
grantee, or recipient, as the case may be, if the contractor, subcontractor, grantee, or recipient is an
employer; and any professional membership organization, certification of other professional body, any
agent or licensee of the Federal government, or any person acting directly or indirectly in the interest of
an employer receiving covered funds; or with respect to covered funds received by a State or local
government, the State or local government receiving the funds and any contractor or subcontractor
receiving the funds and any contractor or subcontractor of the State or local government; and does not
j mean any department, agency, or other entity of the federal government.
Recipient means any entity that receives Recovery Act funds directly from the Federal government
(including Recovery Act funds received through grant, loan, or contract) other than an individual and
-} includes a State that receives Recovery Act Funds.
Special Provisions
A. Flow Down Reuuirement
IRecipients must include these special terms and conditions in any subaward.
MW B. Segregation of Costs
Recipients must segregate the obligations and expenditures related to funding under the Recovery Act.
Financial and accounting systems should be revised as necessary to segregate, track and maintain these
funds apart and separate from other revenue streams. No part of the funds from the Recovery Act shall be
commingled with any other funds or used for a purpose other than that of making payments for costs
allowable for Recovery Act projects.
C. Prohibition on Use of Funds
None of the funds provided under this agreement derived from the American Recovery and Reinvestment
Act of 2009, Pub. L. 111-5, may be used by any State or local government, or any private entity, for any
410 casino or other gambling establishment, aquarium, zoo, golf course, or swimming pool.
D. Access to Records
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With respect to each financial assistance agreement awarded utilizing at least some of the funds
appropriated or otherwise made available by the American Recovery and Reinvestment Act of 2009, Pub.
r L. 111-5, any representative of an appropriate inspector general appointed under section 3 or 8G of the
Inspector General Act of 1988 (5 U.S.C. App.) or of the Comptroller General is authorized --
(1) to examine any records of the contractor or grantee, any of its subcontractors or subgrantees,
or any State or local agency administering such contract that pertain to, and involve transactions
relation to, the subcontract, subcontract, grant, or subgrant; and
(2) to interview any officer or employee of the contractor, grantee, subgrantee, or agency
regarding such transactions.
E. Publication
An application may contain technical data and other data, including trade secrets and/or privileged or
J confidential information, which the applicant does not want disclosed to the public or used by the
Government for any purpose other than the application. To protect such data, the applicant should
specifically identify each page including each line or paragraph thereof containing the data to be protected
and mark the cover sheet of the application with the following Notice as well as referring to the Notice on
each page to which the Notice applies:
Notice of Restriction on Disclosure and Use of Data
The data contained in pages ---- of this application have been submitted in confidence and contain trade
secrets or proprietary information, and such data shall be used or disclosed only for evaluation purposes,
provided that if this applicant receives an award as a result of or in connection with the submission of this
application, DOE shall have the right to use or disclose the data here to the extent provided in the award.
This restriction does not limit the Government's right to use or disclose data obtained without restriction
from any source, including the applicant.
Information about this agreement will be published on the Internet and linked to the website
www.recoverv.gov, maintained by the Accountability and Transparency Board. The Board may exclude
posting contractual or other information on the website on a case -by -case basis when necessary to protect
national security or to protect information that is not subject to disclosure under sections 552 and 552a of
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title 5, United States Code.
F. Protectine State and Local Government and Contractor Whistleblowers.
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The requirements of Section 1553 of the Act are summarized below. They include, but are not limited to:
*
Prohibition on Reprisals: An employee of any non -Federal employer receiving covered funds under the
American Recovery and Reinvestment Act of 2009, Pub. L. I I 1-5, may not be discharged, demoted, or
otherwise discriminated against as a reprisal for disclosing, including a disclosure made in the ordinary
course of an employee's duties, to the Accountability and Transparency Board, an inspector general, the
Comptroller General, a member of Congress, a State or Federal regulatory or law enforcement agency, a
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person with supervisory authority over the employee (or other person working for the employer who has
the authority to investigate, discover or terminate misconduct, a court or grant jury, the head of a Federal
agency, or their representatives information that the employee believes is evidence of:
• gross management of an agency contract or grant relating to covered funds;
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• a gross waste of covered funds
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• a substantial and specific danger to public health or safety related to the implementation or use
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of covered funds;
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• an abuse of authority related to the implementation or use of covered funds; or
• as violation of law, rule, or regulation related to an agency contract (including the competition
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~ ( for or negotiation of a contract) or grant, awarded or issued relating to covered funds.
Agency Action: Not later than 30 days after receiving an inspector general report of an alleged reprisal,
the head of the agency shall determine whether there is sufficient basis to conclude that the non -Federal
employer has subjected the employee to a prohibited reprisal. The agency shall either issue an order
denying relief in whole or in part or shall take one or more of the following actions:
• Order the employer to take affirmative action to abate the reprisal.
• Order the employer to reinstate the person to the position that the person held before the
reprisal, together with compensation including back pay, compensatory damages, employment
benefits, and other terms and conditions of employment that would apply to the person in that
-
position if the reprisal had not been taken.
• Order the employer to pay the employee an amount equal to the aggregate amount of all costs
and expenses (including attorneys' fees and expert witnesses' fees) that were reasonably incurred
by the employee for or in connection with, bringing the complaint regarding the reprisal, as
determined by the head of a court of competent jurisdiction.
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Nonenforceablity of Certain Provisions Waiving Rights and remedies or Requiring Arbitration: Except as
provided in a collective bargaining agreement, the rights and remedies provided to aggrieved employees
by this section may not be waived by any agreement, policy, form, or condition of employment, including
any predispute arbitration agreement. No predispute arbitration agreement shall be valid or enforceable if
it requires arbitration of a dispute arising out of this section.
Requirement to Post Notice of Rights and Remedies: Any employer receiving covered funds under the
American Recovery and Reinvestment Act of 2009, Pub. L. 111-5, shall post notice of the rights and
remedies as required therein. (Refer to section 1553 of the American Recovery and Reinvestment Act of
2009, Pub. L. 111-5, www.Recovery.gov, for specific requirements of this section and prescribed
—1
language for the notices.).
G. Reauest for Reimbursement
RESERVED
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H. False Claims Act
Recipient and sub -recipients shall promptly refer to the DOE or other appropriate Inspector General any
` ! credible evidence that a principal, employee, agent, contractor, sub -grantee, subcontractor or other person
has submitted a false claim under the False Claims Act or has committed a criminal or civil violation of
laws pertaining to fraud, conflict or interest, bribery, gratuity or similar misconduct involving those funds.
I. Information in suntiortine of Recovery Act Reporting
jRecipient may be required to submit backup documentation for expenditures of funds under the Recovery
~J Act including such items as timecards and invoices. Recipient shall provide copies of backup
documentation at the request of the Contracting Officer or designee.
J. Availability of Funds
Funds appropriated under the Recovery Act and obligated to this award are available for reimbursement
of costs until September 30, 2015.
., K Additional Fundina Distribution and Assurance of ADDIODriate Use of Funds
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Certification by Governor -- Not later than April 3, 2009, for funds provided to any State or agency
— thereof by the American Reinvestment and Recovery Act of 2009, Pub. L. 111-5, the Governor of the
State shall certify that: 1) the state will request and use funds provided by the Act; and 2) the funds will
be used to create jobs and promote economic growth.
* Acceptance by State Legislature — If funds provided to any State in any division of the Act are not
accepted for use by the Governor, then acceptance by the State legislature, by means of the adoption of a
concurrent resolution, shall be sufficient to provide funding to such State.
Distribution — After adoption of a State legislature's concurrent resolution, funding to the State will be for
distribution to local governments, councils of government, public entities, and public -private entities
within the State either by formula or at the State's discretion.
L. Certifications
With respect to funds made available to State or local governments for infrastructure investments under
the American Recovery and Reinvestment Act of 2009, Pub. L. 111-5, the Governor, mayor, or other
chief executive, as appropriate, certified by acceptance of this award that the infrastructure investment has
received the full review and vetting required by law and that the chief executive accepts responsibility
that the infrastructure investment is an appropriate use of taxpayer dollars. Recipient shall provide an
�J additional certification that includes a description of the investment, the estimated total cost, and the
amount of covered funds to be used for posting on the Internet. A State or local agency may not receive
infrastructure investment funding from funds made available by the Act unless this certification is made
and posted.
REPORTING AND REGISTRATION REQUIREMENTS UNDER SECTION 1512 OF THE
RECOVERY ACT
(a) This award requires the recipient to complete projects or activities which are funded under the
American Recovery and Reinvestment Act of 2009 (Recovery Act) and to report on use of Recovery Act
funds provided through this award. Information from these reports will be made available to the public.
(b) The reports are due no later than ten calendar days after each calendar quarter in which the recipient
receives the assistance award funded in whole or in part by the Recovery Act.
J(c) Recipients and their first -tier recipients must maintain current registrations in the Central Contractor
Registration (http://www.ecr.gov) at all times during which they have active federal awards funded with
Recovery Act funds. A Dun and Bradstreet Data Universal Numbering System (DUNS) Number
(http://www.dnb.com) is one of the requirements for registration in the Central Contractor Registration.
(d) The recipient shall report the information described in section 1512(c) of the Recovery Act using the
reporting instructions and data elements that will be provided online at http://www.FederalReporting.gov
and ensure that any information that is pre -filled is corrected or updated as needed.
:` Page 39 of 75
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A
jREQUIRED
USE OF AMERICAN IRON, STEEL, AND MANUFACTURED GOODS
(COVERED UNDER INTERNATIONAL AGREEMENTS -SECTION 1605 OF THE
-;
AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009
VO
(a) Definitions. As used in this award term and condition —
Designated country --(1) A World Trade Organization Government Procurement Agreement country
(Aruba, Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark Estonia, Finland,
w.
France, Germany, Greece, Hong Kong, Hungary, Iceland, Ireland, Israel, Italy, Japan, Korea (Republic
+.�
of), Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal,
Romania, Singapore, Slovak Republic, Slovenia, Spain, Sweden, Switzerland, and United Kingdom;
(2) A Free Trade Agreement (FTA) country (Australia, Bahrain, Canada, Chile, Costa Rica, Dominican
Republic, El Salvador, Guatemala, Honduras, Israel, Mexico, Morocco, Nicaragua, Oman, Peru, or
Singapore); or
(3) A United States -European Communities Exchange of Letters (May 15, 1995) country: Austria,
-
Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France Germany, Greece,
Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania,
-1
Slovak Republic, Slovenia, Spain, Sweden, and United Kingdom.
Designated country iron, steel, and/or manufactured goods —(1) Is wholly the growth, product, or
_
y.
manufacture of a designated country; or
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(2) In the case of a manufactured good that consist in whole or in part of materials from another country,
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has been substantially transformed in a designated country into a new and different manufactured good
J
distinct from the materials from which it was transformed.
Domestic iron, steel, and/or manufactured good —(1) Is wholly the growth, product, or manufacture of
the United States; or
s (2) In the case of a manufactured good that consists in whole or in part of materials from another country,
j has been substantially transformed in the United States into a new and different manufactured good
distinct from the materials from which it was transformed. There is no requirement with regard to the
- origin of components or subcomponents in manufactured goods or products, as long as the manufacture of
the goods occurs in the United States.
qW Foreign iron, steel, and/or manufactured good means iron, steel and/or manufactured good that is not
,.r J domestic or designated country iron, steel, and/or manufactured good.
1 Manufactured good means a good brought to the construction site for incorporation into the building or
y work that has been—
(1) Processed into a specific form and shape; or
(2) Combined with other raw material to create a material that has different properties than the properties
of the individual raw materials.
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Public building and public work means a public building of, and a public work of, a governmental entity
(the United States; the District of Columbia; commonwealths, territories, and minor outlying islands of
the United States; State and local governments; and multi -State, regional, or interstate entities which have
governmental functions). These buildings and works may include, without limitation, bridges, dams,
plants, highways, parkways, streets, subways, tunnels, sewers, mains, power lines, pumping stations,
-;
heavy generators, railways, airports, terminals, docks, piers, wharves, ways, lighthouses, buoys, jetties,
breakwaters, levees, and canals, and the construction, alteration, maintenance, or repair of such buildings
and works.
Steel means an alloy that includes at least 50 percent iron, between .02 and 2 percent carbon, and may
include other elements.
(b) Iron, steel, and manufactured goods. (1) The award term and condition described in this section
implements—
(i) Section 1605(a) of the American Recovery and Reinvestment Act of 2009 (Pub. L_ 111-5) (Recovery
�N
Act), by requiring that all -iron, steel, and manufactured goods used in the project are produced in the
�.►
United States; and
i
(ii) Section 1605(d), which requires application of the Buy American requirement in a manner consistent
with U.S. obligations under international agreements. The restrictions of section 1605 of the Recovery
'
Act do not apply to designated country iron, steel, and/or manufactured goods. The Buy American
requirement in section 1605 shall not be applied where the iron, steel or manufactured goods used in the
project are from a Party to an international agreement that obligates the recipient to treat the goods and
1.
services of that Party the same as domestic goods and services. This obligation shall only apply to
projects with an estimated value of $7,443,000 or more.
J�
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(2) The recipient shall use only domestic or designated country iron, steel, and manufactured goods in
performing the work funded in whole or part with this award, except as provided in paragraphs (b)(3) and
(b)(4) of this section.
(3) The requirement in paragraph (b)(2) of this section does not apply to the iron, steel, and manufactured
goods listed by the Federal Government as follows:
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[Award official to list applicable excepted materials or indicate "none " ]
.r
(4) The award official may add other iron, steel, and manufactured goods to the list in paragraph (b)(3) of
*+R
this section if the Federal Government determines that—
(i) The cost of domestic iron, steel, and/or manufactured goods would be unreasonable. The cost of
'
domestic iron, steel, and/or manufactured goods used in the project is unreasonable when the cumulative
cost of such material will increase the overall cost of the project by more than 25 percent;
(ii) The iron, steel, and/or manufactured good is not produced, or manufactured in the United States in
j
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sufficient and reasonably available commercial quantities of a satisfactory quality; or
(iii) The application of the restriction of section 1605 of the Recovery Act would be inconsistent with the
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public interest.
(c) Request for determination of inapplicability of section 1605 of the Recovery Act or the Buy American
Act. (1)(i) Any recipient request to use foreign iron, steel, and/or manufactured goods in accordance with
` paragraph (b)(4) of this section shall include adequate information for Federal Government evaluation of
the request, including—
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(A) A description of the foreign and domestic iron, steel, and/or manufactured goods;
(B) Unit of measure;
(C) Quantity;
(D) Cost;
(E) Time of delivery or availability;
-� (F) Location of the project;
(G) Name and address of the proposed supplier, and
(11) A detailed justification of the reason for use of foreign iron, steel, and/or manufactured goods cited in
accordance with paragraph (b)(4) of this section.
(ii) A request based on unreasonable cost shall include a reasonable survey of the market and a completed
cost comparison table in the format in paragraph (d) of this section.
i (iii) The cost of iron, steel, or manufactured goods shall include all delivery costs to the construction site
-- and any applicable duty.
j (iv) Any recipient request for a determination submitted after Recovery Act funds have been obligated for
a project for construction, alteration, maintenance, or repair shall explain why the recipient could not
reasonably foresee the need for such determination and could not have requested the determination before
l the funds were obligated. If the recipient does not submit a satisfactory explanation, the award official
need not make a determination.
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(2) If the Federal Government determines after funds have been obligated for a project for construction,
alteration, maintenance, or repair that an exception to section 1605 of the Recovery Act applies, the award
official will amend the award to allow use of the foreign iron, steel, and/or relevant manufactured goods.
400 When the basis for the exception is nonavailability or public interest, the amended award shall reflect
adjustment of the award amount, redistribution of budgeted funds, and/or other appropriate actions taken
J to cover costs associated with acquiring or using the foreign iron, steel, and/or relevant manufactured
goods.. When the basis for the exception is the unreasonable cost of the domestic iron, steel, or
F manufactured goods, the award official shall adjust the award amount or redistribute budgeted funds, as
appropriate, by at least the differential established in 2 CFR 176.110(a).
l (3) Unless the Federal Government determines that an exception to section 1605 of the Recovery Act
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applies, use of foreign iron, steel, and/or manufactured goods other than designated country iron, steel,
and/or manufactured goods is noncompliant with the applicable Act.
(d) Data. To permit evaluation of requests under paragraph (b) of this section based on unreasonable cost,
the applicant shall include the following information and any applicable supporting data based on the
survey of suppliers:
Foreign and Domestic Items Cost Comparison
Description
Item 1:
Foreign steel, iron, or manufactured good
Domestic steel, iron, or manufactured good
Item 2:
Foreign steel, iron, or manufactured
Qod
Domestic steel, iron, or manufactured good
*NOTE; See Letter on Page 44
Page 43 of 75
Cost
Unit of measure Quantity (dollars)*
JCTURAL AND S'EEL
PRODUCTS, INC.
00wher 24, 2069
J_ Mark MathLs. P.E.
Traffic Servicesb&nagu
Transporation and PuNio Works Despt_
aly of Fori w odh
50DI hnaesAve
Fart Wurlh. Texas 76115
Re: USA Swcme:nt
OM3FIpl,
All rnatetlal used in fbrimtioA of the traffic signal poles for the Clay of Fort lkorth wlli bt: from
T)wnesdeMilis Josmu:.din dse United Stal*5 aFA mertca:lbis woald include his oat ilmilea to all
COD stock MoL n.-hur bolls, flanga plate material and miscatlineonA material iu rsgaTd& W
Eataicstion of Lae traffic signal nrsgr arm assembly, Cudguotioms for this makainl notiryt its
origin may Be requesod. by the city of Fort Worth berc+re releasing paymon t fnr nowd mawrial.
Sincewly,
Mchael bwker
Vice Presldcnt Tabular Group
St =wml aAd Sred Products inn.
1&'05IINIVEMrVDR. ■ al"E701 ■ Fr.WGMH.TX7M07 ■ PHWE817332-7417 ■ FNSati�1�-03SadB1T39?R992
Page 44 of 75
- WAGE RATE REQUIREMENTS UNDER SECTION 1606 OF THE RECOVERY ACT
(a) Section 1606 of the Recovery Act requires that all laborers and mechanics employed by contractors
and subcontractors on projects funded directly by or assisted in whole or in part by and through the
Federal Government pursuant to the Recovery Act shall be paid wages at rates not less than those
prevailing on projects of a character similar in the locality as determined by the Secretary of Labor in
accordance with subchapter 1V of chapter 31 of title 40, United States Code.
Pursuant to Reorganization Plan No. 14 and the Copeland Act, 40 U.S.C. 3145, the Department of Labor
has issued regulations at 29 CFR parts 1, 3, and 5 to implement the Davis -Bacon and related Acts.
Regulations in 29 CFR 5.5 instruct agencies concerning application of the standard Davis -Bacon contract
clauses set forth in that section. Federal agencies providing grants, cooperative agreements, and loans
under the Recovery Act shall ensure that the standard Davis -Bacon contract clauses found in 29 CFR
5.5(a) are incorporated in any resultant covered contracts that are in excess of $2,000 for construction,
alteration or repair (including painting and decorating).
(b) For additional guidance on the wage rate requirements of section 1606, contact your awarding agency.
Recipients of grants, cooperative agreements and loans should direct their initial inquiries concerning the
application of Davis -Bacon requirements to a particular federally assisted project to the Federal agency
funding the project. The Secretary of Labor retains final coverage authority under Reorganization Plan
Number 14.
RECOVERY ACT TRANSACTIONS LISTED IN SCHEDULE OF EXPENDITURES OF
FEDERAL AWARDS AND RECIPIENT RESPONSIBILITIES FOR INFORMAING
SUBRECIPIENTS
(a) To maximize the transparency and accountability of funds authorized under the American Recovery
and Reinvestment Act of 2009 (Pub. L. 111-5) (Recovery Act) as required by Congress and in
accordance with 2 CFR 215.21 "Uniform Administrative Requirements for Grants and Agreements" and
OMB Circular A-102 Common Rules provisions, recipients agree to maintain records that identify
U
adequately the source and application of Recovery Act funds. OMB Circular A-102 is available at
http.lAvww.whilehouse.gov/omb/circulars/a10214102,him1.
(b) For recipients covered by the Single Audit Act Amendments of 1996 and OMB Circular A-133,
"Audits of States, Local Governments, and Non -Profit Organizations," recipients agree to separately
identify the expenditures for Federal awards under the Recovery Act on the Schedule of Expenditures of
Federal Awards (SEFA) and the Data Collection Form (SF —SAC) required by OMB Circular A-133.
*,
OMB Circular A-133 is available at http://www.whilehouse.gov/omh/circulcns/a133la133.html. This
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shall be accomplished by identifying expenditures for Federal awards made under the Recovery Act
separately on the SEFA, and as separate rows under Item 9 of Part III on the SF —SAC by CFDA number,
and inclusion of the prefix "ARRA-" in identifying the name of the Federal program on the SEFA and as
Jthe
first characters in Item 9d of Part III on the SF —SAC.
(c) Recipients agree to separately identify to each subrecipient, and document at the time of subaward and
j
at the time of disbursement of funds, the Federal award number, CFDA number, and amount of Recovery
`-
Act funds. When a recipient awards Recovery Act funds for an existing program, the information
furnished to subrecipients shall distinguish the subawards of incremental Recovery Act funds from
regular subawards under the existing program.
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(d) Recipients agree to require their subrecipients to include on their SEFA information to specifically
identify Recovery Act finding similar to the requirements for the recipient SEFA described above. This
information is needed to allow the recipient to properly monitor subrecipient expenditure of ARRA funds
as well as oversight by the Federal awarding agencies, Offices of Inspector General and the Government
Accountability Office.
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ATTACHMEENT C-1 Contract No.
DOE F 1600.5 OMB Control No.
(06-94) 1910-0400
All Other Editions Are Obsolete
'rt U.S. DEPARTMENT OF ENERGY
.. -' Assurance of Compliance
7; Nondiscrimination in State Assisted Programs
OMB Burden Disclosure Statement
(
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for
1
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information,
--t
including suggestions for reducing this burden, to Office of Information Resources Management Policy, Plans, and Oversight,
Records Management Division, HR422-GTN, Paperwork Reduction Project (1910-0400), U.S. Department of Energy, 1000
i
Independence Avenue, S.W., Washington, DC 20585; and to the Office of Management and Budget (0)AB), Paperwork Reduction
�.
Project (1910-0400), Washington, DC 20503.
i
The Citv of Fort Worth (Hereinafter called the "Applicant") HEREBY AGREES to comply with Title VI of the
Civil Rights Act of 1964 (Pub. L. 88-352), Section 16 of the Federal Energy Administration Act of 1974 (Pub. L.
i
93-275), Section 401 of the Energy Reorganization Act of 1974 (Pub. L. 93-438), Title IX of the Education
�s
Amendments of 1972, as amended (Pub. L. 92-318, Pub. L. 93-568, and Pub. L. 94-482), Section 504 of the
Rehabilitation Act of 1973 (Pub. L. 93-112), the Age Discrimination Act of 1977 (Pub. L. 94-135), Title VIII of the
Civil Rights Act of 1968 (Pub. L. 90-284), the Department of Energy Organization Act of 1977 (Pub. L. 95-91), the
Energy Conservation and Production Act of 1976, as amended, (Pub. L. 94-385) and Title 10 Code of Federal
Regulations, Part 1040. In accordance with the above laws and regulations issued pursuant thereto, the Applicant
R
agrees to assure that no person in the United States shall, on the ground of race, color, national origin, sex, age, or
disability, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination
under any program or activity in which the Applicant receives Federal assistance from the Department of Energy.
Applicability and Period of Obligation
lIn
the case of any service, financial aid, covered employment, equipment, property, or structure provided, leased, or
improved with Federal assistance funding extended to the Applicant by the Department of Energy, this assurance
obligates the Applicant for the period during which the Federal assistance is extended. In the case of any transfer of
i
such service, financial aid, equipment, property, or structure, this assurance obligates the transferee for the period
�i
during which Federal assistance is extended. If any personal property is so provided, this assurance obligates the
Applicant for the period during which it retains ownership or possession of the property. In all other cases, this
assurance obligates the Applicant for the period during which the Federal assistance is extended to the Applicant by
�
LJ�
the Department of Energy.
Employment Practices
Where a primary objective of the Federal assistance is to provide employment or where the Applicant`s employment
practices affect the delivery of services in programs or activities resulting from Federal assistance extended by the
Department of Energy, the Applicant agrees not to discriminate on the ground of race, color, national origin, sex,
and disability, in. its employment practices. Such employment practices may include, but are not limited to,
recruitment, advertising, hiring, layoff or termination, promotion, demotion, transfer, rates of pay, training and
�.
participation in upward mobility programs, or other forms of compensation and use of facilities.
Subrecipient Assurance
The Applicant shall require any individual, organization, or other entity with whom it subcontracts, subgrants, or
subleases for the purpose of providing any service, financial aid, equipment, property, or structure to comply with
J
laws cited above. To this end, the subrecipient shall be required to sign a written assurance form; however, the
obligation of both recipient and subrecipient to ensure compliance is not relieved by the collection or submission of
I
written assurance forms.
Data Collection and Access to Records
The Applicant agrees to compile and maintain information pertaining to programs or activities developed as a result
of the Applicant's receipt of Federal assistance from the Department of Energy. Such information shall include, but
IPage 47 of 75
is not limited to the following: (1) the manner in which services are or will be provided and related data necessary
for determining whether any persons are or will be denied such services on the basis of prohibited discrimination;
(2) the population eligible to be serviced by race, color, national origin, sex, and disability; (3) data regarding
covered employment, including use or planned use of bilingual public contact employees serving beneficiaries of
the program where necessary to permit effective participation by beneficiaries unable to speak or understand
English; (4) the location of existing or proposed facilities connected with the program and related information
adequate for determining whether the location has or will have the effect of unnecessarily denying access to any
low person on the basis of prohibited discrimination; (5) the present or proposed membership by race, color, national
origin, sex, and disability, in any planning or advisory body which is an integral part of the program; and (6) any
AMP additional written data determined by the Department of Energy to be relevant to the obligation to assure
j compliance by recipients with laws cited in the first paragraph of this assurance.
The Applicant agrees to submit requested data to the Department of Energy regarding programs and activities
developed by the Applicant from the use of Federal funds extended by the Department of Energy. Facilities of the
Applicant (including the physical plants, buildings, or other structures) and all records, books, accounts, and other
sources of information pertinent to the Applicant's compliance with the civil rights laws shall be made available for
.- t inspection during normal business hours of request of an officer or employee of the Department of Energy
specifically authorized to make such inspections. Instructions in this regard will be provided by the Director, Office
�. of Civil Rights, U.- S. Department of Energy.
This assurance is given in consideration of and for the purpose of obtaining any and all Federal grants, loans,
contracts (excluding procurement contracts), property, discounts or other Federal assistance extended after the date
hereto, to the Applicants by the Department of Energy, including installment payments on account after such date
of application for Federal assistance which are approved before such date. The Applicant recognizes and agrees
that such Federal assistance will be extended in reliance upon the representations and agreements made in this
assurance and that the United State shall have the right to seek judicial enforcement of this assurance. This
assurance is binding on the Applicant, its successors, transferees, and assignees, as well as the person(s) whose
signature appears below and who is authorized to sign this assurance on behalf of the Applicant.
Applicant Certification
The Applicant certifies that it has complied, or that, within 90 days of the date of the grant, it will comply with all
applicable requirements of 10 CYR § 1040.5 (a copy will be furnished to the Applicant upon written request to
DOE.)
Designated Responsible Employee
Fernando Costa- Assistant Citv Manaaer
Name and ' Jed or T ed)
Signaturen.,�.w•
mil - -kr—
Page 48 of 75
(817392-6122
Telephone Number
Date Oct. 29, 2009
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ATTACHMENT C-2 Contract No.
DOE F 1600.5 OMB Control No.
- (06-94) 1910-0400
-� All Other Editions Are Obsolete
U.S. DEPARTMENT OF ENERGY
Assurance of Compliance
Nondiscrimination in State Assisted Programs
'1
.. OMB Burden Disclosure Statement
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions,
I
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information Send comments
�1 regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of
Information Resources Management Policy, Plans, and Oversight, Records Management Division, liR-422-GTN, Paperwork Reduction Project (1910-
0400). U.S. Department of Energy, I000 independence Avenue, S.W., Washington, DC 20585; and to the Office of Management and Budget (OMB),
Paperwork Reduction Project (1910.0400), Washington, DC 20503.
- City of Fort Worth (Hereinafter called the "Applicant") HEREBY AGREES to comply with Title VI of the Civil Rights Act of 1964
(Pub. L. 88-352), Section 16 of the Federal Energy Administration Act of 1974 (Pub. L. 93-275), Section 401 of the Energy
Reorganization Act of 1974 (Pub. L. 93438), Title IX of the Education Amendments of 1972, as amended (Pub. L. 92-318, Pub. L.
93-568, and Pub. L. 94482), Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112), the Age Discrimination Act of 1977
(Pub. L. 94-135), Title VHI of the Civil Rights Act of 1968 (Pub. L. 90-284), the Department of Energy Organization Act of 1977
(Pub. L. 95-91), the Energy Conservation and Production Act of 1976, as amended, (Pub. L. 94-385) and Title 10 Code of Federal
Regulations, Part 1040. In accordance with the above laws and regulations issued pursuant thereto, the Applicant agrees to assure
that no person in the United States shall, on the ground of race, color, national origin, sex, age, or disability, be excluded from
w participation in, be denied the benefits oty or be otherwise subjected to discrimination under any program or activity in which the
Applicant receives Federal assistance from the Department of Energy.
Applicability and Period of Obligation
In the case of any service, financial aid, covered employment, equipment, property, or structure provided, leased, or improved with
%0 Federal assistance funding extended to the Applicant by the Department of Energy, this assurance obligates the Applicant for the
period during which the Federal assistance is extended. In the case of any transfer of such service, financial aid, equipment, property,
or structure, this assurance obligates the transferee for the period during which Federal assistance is extended. If any personal
' property is so provided, this assurance obligates the Applicant for the period during which it retains ownership or possession of the
property. In all other cases, this assurance obligates the Applicant for the period during which the Federal assistance is extended to
the Applicant by the Department of Energy.
" Employment Practices
-� Where a primary objective of the Federal assistance is to provide employment or where the Applicant's employment practices affect
the delivery of services in programs or activities resulting from Federal assistance extended by the Department of Energy, the
Applicant agrees not to discriminate on the ground of race, color, national origin, sex, and disability, in its employm
ent practices.
Such employment practices may include, but are not limited to, recruitment, advertising, hiring, layoff or termination, promotion,
+r Jr- demotion, transfer, rates of pay, training and participation in upward mobility programs, or other forms of compensation and use of
facilities.
' Subrecipient Assurance
The Applicant shall require any individual, organization, or other entity with whom it subcontracts, subgrants, or subleases for the
' purpose of providing any service, financial aid, equipment, property, or structure to comply with laws cited above. To this end, the
subrecipient shall be required to sign a written assurance form; however, the obligation of both recipient and subrecipient to ensure
compliance is not relieved by the collection or submission of written assurance forms.
Data Collection and Access to Records
The Applicant agrees to compile and maintain information pertaining to programs or activities developed as a result of the Applicant's
receipt of Federal assistance from the Department of Energy. Such information shall include, but is not limited to the following: (1)
Ll� the manner in which services are or will be provided and related data necessary for determining whether any persons are or will be
denied such services on the basis of prohibited discrimination; (2) the population eligible to be serviced by race, color, national
origin, sex, and disability; (3) data regarding covered employment, including use or planned use of bilingual public contact
�j employees serving beneficiaries of the program where necessary to permit effective participation by beneficiaries unable to speak or
understand English; (4) the location of existing or proposed facilities connected with the program and related information adequate
Page 49 of 75
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for determining whether the location has or will have the effect of unnecessarily denying access to any person on the basis of
prohibited discrimination; (5) the present or proposed membership by race, color, national origin, sex, and disability, in any planning
or advisory body which is an integral part of the program; and (6) any additional written data determined by the Department of
Energy to be relevant to the obligation to assure compliance by recipients with laws cited in the first paragraph of this assurance.
The Applicant agrees to submit requested data to the Department of Energy regarding programs and activities developed by the
Applicant from the use of Federal fiords extended by the Department of Energy. Facilities of the Applicant (including the physical
plants, buildings, or other structures) and all records, books, accounts, and other sources of information pertinent to the Applicant's
compliance with the civil rights laws shall be made available for inspection during normal business hours of request of an officer or
employee of the Department of Energy specifically authorized to make such inspections. Inshuctions in this regard will be provided
by the Director, Office of Civil Rights, U. S. Department of Energy.
This assurance is given in consideration of and for the purpose of obtaining any and all Federal grants, loans, contracts (excluding
procurement contracts), property, discounts or other Federal assistance extended after the date hereto, to the Applicants by the
Department of Energy, including installment payments on account after such date of application for Federal assistance which are
approved before such date. The Applicant recognizes and agrees that such Federal assistance will be extended in reliance upon the
representations and agreements made in this assurance and that the United State shall have the right to seek judicial enforcement of
this assurance. This assurance is binding on the Applicant, its successors, transferees, and assignees, as well as the person(s) whose
signature appears below and who is authorized to sign this assurance on behalf of the Applicant.
Applicant Certification
The Applicant certifies that it has complied, or that, within 90 days of the date of the grant, it will comply with all applicable
requirements of 10 C.F.R § 1040.5 (a copy will be furnished to the Applicant upon written request to DOE.)
Contractor
Name of Organization
City of Fort worth
Address 1000 Throckmorton, Fort Worth, TX 76102-6312
Authorized Official:
Name and Title (Printed or Typed) Fernando Costa, Assistant City Manager
Signature
K
Telephone Number 817-392-2255
Telephone Number 817,392-6122
Date October 29, 2009
Page 50 of 75
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ATTACHMENT D Contract No.
Certification Re ardin Debarment, Suspension Ineligibility,
i and Volantaryacluston-Lower Tier Covered '�'ransactions
Instructions for Certification
l . The prospective lower tier participant is required to sign the attached certification.
2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was
entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in
addition to other remedies available to the Federal Government, the department or agency with which this transaction originated
may pursue available remedies, including suspension and/or debarment.
3. The prospective lower tier participant shall provide immediate written notice to the person to which this application is submitted
if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has become
erroneous by reason of changed circumstances.
4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant," "person,"
"primary covered transaction," "principle," "application," and "voluntarily excluded," as used in this clause, have the meanings set
- out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the person to
which this application is submitted for assistance in obtaining a copy of those regulations.
5. The prospective lower tier participant agrees by submitting this application that, should the proposed covered transaction be
entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended,
declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or
agency with which this transaction originated.
6. The prospective lower tier participant further agrees by submitting this application that it will include the clause titled
"Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transaction,"
without modification, in all solicitations for lower tier covered transactions.
7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction
that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the
certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its
_ principals. Each participant may, but is not required to, check the Non -procurement List.
8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good
faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which
is normally possessed by a prudent person in the ordinary course of business dealings.
9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction knowingly
enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from
participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency with
_
which this transaction originated may pursue available remedies, including suspension and/or debarment.
(1) The prospective lower tier participant certifies, by submission of this application, that neither it nor its principals is
_
presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in
this transaction by any Federal department or agency.
(2) Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such
prospective participant shall attach an explanation to this application.
Companv Nape Citv of FortWorth
!�
Organization Name
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Name. Title Ferr�apdo Cgsta. Assistant Cip Manaeer
Name and Title of Authorized Representative
low
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October 29. 2009
Signature Date
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51 of 75
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ATTACHMENT E
Contract No.
CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHER
-'
RESPONSIBILITY MATTERS; AND DRUG -FREE WORKPLACE REQUIREMENTS
Applicants should refer to the regulations cited below to determine the certification to which they are required to attest Applicants should also review the instructions
for certification included in the regulations before completing this form. Signature of this form provides for compliance with certification requirements under 34 CFR
Part 82, "New Restrictions on Lobbying," and 34 CFR Part 95, T . i ,.ride Debarment and Suspension (Nonprocurement) and Government -wide Requirements
—� for Drug -Free Workplace (Grants)." The certifications shall be treated as a material representation of fact upon which reliance will be placed when the Department of
Energy determines to award the covered transaction, grant, or cooperative agreement
. -
not less than $10,000 and not more than
LOBBYING
$100,000 for
The undersigned certifies, to the best of his or
each such failure.
her knowledge and beliefs that:
2. DEBARMENT, SUSPENSION, AND
(1) No Federal appropriated funds have been
OTHER RESPONSIBILITY MATTERS
paid or will be paid, by or on behalf of the
undersigned, to any person for influencing
(1) The prospective primary participant certifies
or attempting to influence an officer or
to the best of its knowledge and belies; that
employee of any agency, a Member of
it and its principals:
Congress, an officer or employee of
_1 Congress, or an employee of a Member of
(a) Are not presently debarred, suspended,
Congress in connection with the awarding of
proposed for debarment, declared
—, any Federal contract, the making of any
ineligible, or voluntarily excluded from
*� ! Federal grant, the making of any Federal
covered transactions by any Federal
.. —' loan, the entering into of any cooperative
department or agency;
agreement, and the extension, continuation,
(b) Have not within a three-year period
renewal, amendment, or modification of any
receding this proposal been convicted of
Federal contract, grant, loan, or cooperative
or had a civil judgment rendered against
agreement.
them for commission of fraud or a
-?
criminal offense in connection with
(2) If any funds other than Federal appropriated
obtaining, attempting to obtain, or
funds have been paid or will be paid to any
performing a public (Federal, State or
person for influencing or attempting to
local) transaction or contract under a
i influence an officer or employee of any
Member Congress,
public transaction; violation of Federal
agency, a of an officer or
or State antitrust statutes or commission
employee of Congress, or an employee of a
of embezzlement, theft, forgery,
.. - Member of Congress in connection with this
bribery, falsification or destruction of
Federal contract, grant, loan, or cooperative
( 1�
records, making false statements, or
� agreement, the undersigned shall complete
receiving stolen property;
and submit Standard Form-LLL, "Disclosure
(c) Are not presently indicted for or
+ Form to Report Lobbying," in accordance
otherwise criminally or civilly charged
_ with its instructions.
by a government entity (Federal, State
or local) with commission of any of the
— (3) The undersigned shall require that the
offenses enumerated in paragraph (1)(b)
language of this certification be included in
-W ; t
of this certification; and
the award documents for all subawards at all
(d) Have not within a three-year period
tiers (including subcontracts, subgrants, and
preceding this application/proposal had
contracts under grants, loans, and
one or more public transactions
_ cooperative agreements) and that all
(Federal, State or local) terminated for
subrecipients shall certify and disclose
cause or default.
`` accordingly.
(2) Where the prospective primary participant is
i
unable to certify to any of the statements in
This certification is a material representation of
this certification, such prospective
fact upon which reliance was placed when this
participant shall attach an explanation to this
m 1
proposal.
j transaction was made or entered into.
q' Submission of this certification is a prerequisite
- for making or entering into this transaction
l
imposed by section 1352, title 31, U.S. Code.
3. DRUG -FREE WORKPLACE
. —• Any person who fails to file the required
certification shall be subject to a civil penalty of
T certification is required by the Drug -Free
Page 52 of 75
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Workplace Act of 1988 (Pub. L. 100-690, Title
V, Subtitle D) and is implemented through
additions to the Debarment and Suspension
regulations, published in the Federal Register on
y
1
January 31, 1989, and May 25, 1990.
ALTERNATEI
(GRANTEES OTHER THANINDIVIDUALS)
(1) The grantee certifies that it will or will
continue to provide a drug -free workplace
by:
(a) Publishing a statement notifying
�J
employees that the unlawful
�1
manufacture, distribution, dispensing,
possession, or use of a controlled
substance is prohibited in the grantee's
workplace and specifying the actions
that will be taken against employees for
violation of such prohibition;
p
(b) Establishing an ongoing drug -free
awareness program to inform
employees about:
(1) The dangers of drug abuse in the
workplace;
+'
(2) The grantee's policy of maintaining
�_..�
a drug -free workplace;
j
(3) Any available drug counseling,
J'
rehabilitation, and employee
assistance programs; and
(4) The penalties that may be imposed
�r
!
upon employees for drug abuse
violations occurring in the
workplace;
(c) Making it a requirement that each
employee to be engaged in the
performance of the grant be given a
copy of the statement required by
patraP,mph (a);
(d) Notifying the employee in the statement
required by paragraph (a) that, as a
condition of employment under the
grant, the employee will:
(1) Abide by the terms of the
statement; and
(2) Notify the employer in writing, of
his or her conviction for a violation
of criminal drug statute occurring
in the work -place not later than five
calendar days after such conviction;
(e) Notifying the agency, in writing, within
�j
ten calendar days after receiving notice
under subparagraph (d)(2) from an
employee or otherwise receiving actual
notice of such conviction. Employers of
at i 'I Page 53 of 75
noli
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convicted employees must provide
notice, including position title, to
energy grant officer or other designee
on whose grant activity the convicted
employee was working, unless the
Federal agency has designated a central
point for the receipt of such notices.
Notice shall include the identification
number(s) of each affected grant;
(f) Taking one of the following actions,
within 30 calendar days of receiving
notice under subparagraph (d)(2), with
respect to any employee who is so
convicted:
(1) Taking appropriate actions against
such an employee, up to and
including termination, consistent
with the requirements of the
Rehabilitation Act 9f 1973, as
amended; or
(2) Requiring such employee to
participate satisfactorily in a drug
abuse assistance or rehabilitation
program approved for such
purposes by a Federal, State or
local health, law enforcement, or
other appropriate agency;
(g) Making a good faith effort to continue
to maintain a drug -free workplace
through implementation of paragraphs
(a), (b), (c), (d), (e), and (f).
(2) The grantee may insert in the space provided
below the site(s) for the performance of
work done in connection with the specific
grant:
Place of Performance:
(Street address, city, county, state, zip code)
❑ Check if there are workplaces on file that are
not identified here.
ALTERNATE H (GRANTEES WHO ARE
INDIVID UALS)
(1) The grantee certifies that, as a condition of
the grant, he or she will not engage in the
unlawful manufacture, distribution,
dispensing, possession, or use of a
j controlled substances in conducting any conviction, to every grant officer or
activity with the grant other designee, unless the Federal
agency designates a central point for the
(2) If convicted of a criminal drug offense receipt of such notices. When notice is
t resulting from a violation occurring made to such a central point, it shall J
during the conduct of any grant activity, include the identification number(s) of
he or she will report the conviction, in each affected grant
writing, within 10 calendar days of the
4. LOBBYING DISCLOSURE ACT OF 1995,
SL%IPSON-CRAIG AMENDMENT
Applicant organization which are described in
section 501 (c)(4) of the Internal Revenue Code
of 1986 and engage in lobbying activities after
December 31, 1995, shall not be eligible for the
receipt of Federal fiords constituting an award,
grant, or loan. Section 501(c)(4) of the Internal
1 Revenue Code of 1986 covers:
-�
Civic leagues or organizations not
`
organized for profit but operated
exclusively for the promotion of social
welfare or local associations of
employees, the membership of which is
limited to the employees of a
J
designated persons or person in a
particular municipality, and the net
earning of which are devoted
i
exclusively to charitable, educational,
or recreational purposes.
r
`•
As set forth in the Lobbying Disclosure Act of
1995 (Public Law 104-65, December 19, 1995),
..
as amended ["Simpson -Craig Amendment," see
1
Section 129 of The Balanced Budget
*�
Downpayment Act, I (Public Law 104-99,
January 26, 1996)], lobbying activities is
defined broadly. (See section 3 of the Act.)
r,
The undersigned certifies, to the best of his or
her knowledge and belies; that: it IS NOT an
organization described in section 501 (c)(4) of
1
the Internal Revenue Code of 1986: OR that it
IS an organization described in section 501
j
(cx4) of the Internal Revenue Code of 1986,
_
which, after December 31, 1995, HAS NOT
engaged in any lobbying activities as defined in
J
the Lobbying Disclosure Act of 1995, as
1
amended.
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Page 54 of 75
M.
As the duly authorized representative of the Applicant, I hereby certify that the Applicant will comply with
the above certifications.
Citv of Fort Worth
Name of Applicant
Name, Title
Printed Name and Title of Authorized Representative
Fernando Costa
,r Page 55 of 75
Riverside Sienal Svstem Proiect
Pre/Award Number and/or Project Name
Assistant Citv Manager
ATTACHMENT F Contract No.
DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
1. Type of Federal Action: B 2. Status of Federal Action: A 3. Report Type: A
a. contract a. bid/offer/application a. initial filing
b. grant b. initial award b. material change
c. cooperative agreement c. post award For Material Change Only:
d. loan year quarter
e. loan guarantee date of last report
f. loan insurance
Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter
Name and Address of Prime:
Name. City of Fort Worth
Address 1000 Throckmorton Street, Fort Worth,
TX 76102-6312 r
X Prime _ Subawardee J
Tier, if known:
6. Federal Department/Agency: 7. Federal Program Name/Description
Department of Energy CFDA Number, if applicable: ARRA
8. Federal Action Number, If known: 9. Award Amount, if known:
10.a. Name and Address of Lobbying Entity: 10.b. Individual Performing Services (including address
(if individual, last name, first name, Ml): if different from No. 10A) (last name, first name,
(attach Continuation Sheet(s) SF-LLL-A, if Mf):
necessary) NONE NONE
11. Amount of Payment (check all that apply): 12. Form of Payment (check all that apply):
a. cash
$_0.00 actual b. in -kind; specify: nature
planned value
13. Type of Payment (check all that apply):
a. retainer _ c. commission e. deferred
b.one-time fee _ d.contingent fee — f. other; specify
14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s),
employee(s), or Member(s) contacted, for Payment indicated in Item 11: NONE
15. Continuation Sheet(s) SF-LLL-A attached: _ Yes X No
Page 56 of 75
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ATTACHMENT G
National Environmental Policv Act Assurances as Award Terms
(Version August 2008)
• To the extent that a term does not apply to a particular type of activity or award, it is self -deleting.
• The term "You" refers to Grantees and subcontractors of Grantees.
• The term "We" or "Us" refers to the Department of Energy and the Comptroller of Public Accounts.
To the extent that a term does not apply to a particular type of activity or award, it is self -deleting.
L Nondiscrimination Policies
You must comply with applicable provisions of the following national policies prohibiting discrimination:
1 On the basis of race, color, or national origin, in Title VI of the Civil Rights Act of
1964 (42 U.S.C. 2000d et seq.), as implemented by DOE regulations at 10 CFR part 1040;
2 On the basis of sex or blindness, in Title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.), as
implemented by DOE regulations at 10 CFR parts 1041 and 1042;
3 On the basis of age, in the Age Discrimination Act of 1975 (42 U.S.C.6101 et seq.), as implemented by
Department of Health and Human Services regulations at 45 CFR part 90 and DOE regulations at 10 CFR part 1040;
4 On the basis of disability, in Section 504 of the Rehabilitation Act of 1973 (29 U.S.C.794), as implemented by
Department of Justice regulations at 28 CFR part 41 and DOE regulations at 10 CFR part 1041;
5 On the basis of race, color, national origin, religion, disability, familial status, and sex under Title VIII of the
Civil Rights Act (42 U.S.C. 3601 et seq.) as implemented by the Department of Housing and Urban Development at
24 CFR part 100; and
6 On the basis of disability in the Architectural Barriers Act of 1968(42 U.S.C. 4151 et seq.) for the design,
construction, and alteration of buildings and facilities financed with Federal funds.
H. Environmental Policies
You must:
1 Comply with applicable provisions of the Clean Air Act (42 U.S.C.740 I, et. seq.) and Clean Water Act (33
U.S.C. 1251, et. seq.), as implemented by Executive Order 11738 [3 C7R,1971-1975 Comp., p. 799] and
Environmental Protection Agency rules at 40 CFR part 32,
Subpart J.
2 Immediately identify to us, as the awarding agency, any potential impact that you find this award may have on:
a. The quality of the human environment, including wetlands, and provide any help we may need to comply with the
National Environmental Policy Act (NEPA, at 42 U.S.C. 4321 et. seq.) and assist us to prepare Environmental
Impact Statements or other environmental documentation. In such cases, you may take no action that will have an
adverse environmental impact (e.g., physical disturbance of a site such as breaking of ground) or limit the choice of
reasonable alternatives until we provide written notification of Federal compliance with N1EPA, as implemented by
DOE at 10 CFR part 1021.
y b. Flood -prone areas, and provide any help we may need to comply with the National Flood Insurance Act of 1968
J and Flood Disaster Protection Act of 1973 (42 U.S.C. 4001 et. seq.), which require flood insurance, when available,
for Federally assisted construction or acquisition in flood -prone areas, as implemented by DOE at 10 CFR part 1022.
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c. Use of land and water resources of coastal zones, and provide any help we may need to comply with the Coastal
Zone Management Act of 1972(16 U.S.C. 1451, et seq.).
d. Coastal barriers along the Atlantic and Gulf coasts and Great Lakes' shores, and provide help we may need to
comply with the Coastal Bathers Resource Act (16 U.S.C. 3501 et. seq.), concerning preservation of barrier
resources.
e. Any existing or proposed component of the National Wild and Scenic Rivers system, and provide any help we
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may need to comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. 1271 et seq.).
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f. Underground sources of drinking water in areas that have an aquifer that is the sole or principal drinking water
source, and provide any help we may need to comply with the Safe Drinking Water Act(42 U.S.C. 300h-3).
'?
3 Comply with applicable provisions of the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. 4821-4846), as
implemented by the Department of Housing and Urban Development at 24 CFR part 35. The requirements concern
lead -based paint in housing ownedby the Federal Government or receiving Federal assistance.
4 Comply with section 6002 of the Resource Conservation and Recovery Act of 1976, as amended (42 U.S.C.
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6962), and implementing regulations of the Environmental Protection Agency, 40 CFR Part 247, which require the
purchase of recycled products by States or political subdivision of States.
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III. Live Organisms
1 Human research subjects. You must protect the rights and welfare of individuals that participate as human
subjects in research under this award in accordance with the Common Federal Policy for the Protection of Human
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Subjects (45 CFR part 46), as implemented by DOE at 10 CFR part 745.
2 Animals and plants.
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a. You must comply with applicable provisions of Department of Agriculture rules at 9 CFR parts 1-4 that
implement the Laboratory Animal Welfare Act of 1966(7 U.S.C. 2131-2I56) and provide for humane transportation,
handling, care, and treatment of animals used in research, experimentation, or testing under this award.
b. You must follow the guidelines in the National Academy of Sciences(NAS) Publication "Guide for the Care and
Use of Laboratory Animals"(1996, which may be found currently at
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http://www.nap.edu/readingroomlbooksAabmtsl) and comply with the Public Health Service Policy and Government
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principles Regarding the Care and use of animals (included as Appendix D to the NAS Guide).
c. You must immediately identify to us, as the awarding agency, any potential impact that you find this award may
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have on endangered species, as defined by the Endangered Species Act of 1973, as amended ("the Act," 16 U.S.C.
1531-1543), and implementing regulations of the Departments of the Interior (50 CFR parts 10-24) and Commerce
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(50 CFR parts 217-227). You also must provide any help we may need to comply with 16 U.S.C. 1536(ax2). This is
not in lieu of responsibilities you have to comply with provisions of the Act that apply directly to you as a U.S.
entity, independent of receiving this award.
IV. Other National Policies
1. Debarment and suspension. You must comply with requirements regarding debarment and suspension in
Subpart C of 2 CFR parts 180 and 901.
2. Drug -free workplace. You must comply with drug -free workplace requirements in Subpart B of 10 CFR part
607, which implements sec. 5151-5160 of the Drug -Free Workplace Act of 1988 (Pub. L. 100-690, Title V, Subtitle
D; 41 U.S.C. 701, et seq.).
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3. Lobbying.
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' a. You must comply with the restrictions on lobbying in 31 U.S.C. 1352, as implemented by DOE at 10 CFR part
601, and submit all disclosures required by that statute and regulation.
rt b. If you are a nonprofit organization described in section 501(c)(4)of title 26, United States Code (the Internal
Revenue Code of 1968),you may not engage in lobbying activities as defined in the Lobbying Disclosure Act of
1995 (2 U.S.C., Chapter 26). If we determine that you have engaged in lobbying activities, we will cease all
`? payments to you under this and other awards and terminate the awards unilaterally for material failure to comply
with the award terms and conditions. By submitting an application and accepting fluids under this agreement, you
assure that you are not an organization described in section 501(c)(4) that has engaged in any lobbying activities
described in the Lobbying Disclosure Act of 1995 (2 U.S.C. 1611).
�i c. You must comply with the prohibition in 18 U.S.C. 1913 on the use of Federal funds, absent express
Congressional authorization, to pay directly or indirectly for any service, advertisement or other written matter,
,l telephone communication, or other device intended to influence at any time a Member of Congress or official of any
government concerning any legislation, law, policy, appropriation, or ratification.
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4.Officials not to benefit. You must comply with the requirement that no member of Congress shall be admitted to
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any share or part of this agreement, or to any benefit arising from it, in accordance with 41U.S.C. 22.
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5. Hatch Act. if applicable, you must comply with the provisions of the Hatch Act (5U.S.C. 1501-1508 and 7324-
��
7326), as implemented by the Office of Personnel Management at 5 CFR part 151, which limits political activity of
employees or officers of State or local governments whose employment is connected to an activity financed in
whole or part with Federal funds.
6. Native American graves protection and repatriation. If you control or possess Native American remains and
associated funerary objects, you must comply with the requirements of 43 CFR part 10, the Department of the
Interior implementation of the Native
American Graves Protection and Repatriation Act of 1990 (25 U.S.C., chapter 32).
7. Fly America Act. You must comply with the International Air Transportation Fair Competitive Practices Act of
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1974 (49 U.S.C. 40118), commonly referred to as the "Fly America Act," and implementing regulations at 41 CFR
301-10.131 through 301-10.143. The law and regulations require air transport of people or property to, from,
between or within a country other than the United States, the cost of which is supported under this award, to be
�.
performed by or under a cost -sharing arrangement with a U.S. flag carrier, if service is available.
8. Use of United States -flag vessels.
a. Pursuant to Pub. L. 664 (43 U.S.C. 1241(b)), at least 50 percent of any equipment, materials or commodities
�..
procured, contracted for or otherwise obtained with funds under this award, and which may be transported by ocean
vessel, must be transported on privately owned United States -flag commercial vessels, if available.
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b. Within 20 days following the date of loading for shipments originating within the United States or within 30
working days following the date of loading for shipments originating outside the United States, a legible copy of a
rated, "on -board" commercial ocean bill -of -lading in English for each shipment of cargo described in paragraph 9.a
of this section shall be furnished to both our award administrator (through you in the case of your contractor's bill -
of -lading) and to the Division of National Cargo, Office of Market Development, Maritime Administration,
Washington, DC 20590.
9. Research misconduct. You must comply with the government -wide policy on research misconduct issued by the
Office of Science and Technology Policy (available in the Federal Register at 65 FR 76260, December 6,2000, or on
the Internet at www.ostp.gov), as implemented by DOE at 10 CFR part 733 and 10 CFR 600.31.
10. Requirements for an Institution of Higher Education Concerning Military recruiters and Reserve Officers
Training Corps (ROTC).
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i a. As a condition for receiving funds under an award by the National Nuclear Security Administration of the
Department of Energy, you agree that you are not an institution of higher education that has a policy or practice
placing any of the restrictions specified in 10 U.S.C. 983. as implemented by 32 CFR part 216, on:
i. Maintenance, establishment, or operation of Senior ROTC units, or student participation in those units; or
j ii.Military recruiters' access to campuses, students on campuses, or information about students.
b. If you are determined, using the procedures in 32 CFR part 216, to be such an institution of higher education
�j during the period of performance of this award, we:
! i. Will cease all payments to you of funds under this award and all other awards subject to the requirements
in 32 CFR part 216; and
ii.May suspend or terminate those awards unilaterally for material failure to comply with the award terms
and conditions.
11. Historic preservation. You must identify to us any:
a. Any property listed or eligible for listing on the National Register of Historic Places that will be affected by this
award, and provide any help we may need, with respect to this award, to comply with Section 106 of the National
- Historic Preservation Act of 1966 (16 U.S.C. 470, as implemented by the Advisory Council on Historic Preservation
�. regulations at 36 CFR part 300 and Executive Order 11593, "Identification and Protection of Historic Properties," [3
CFR, 1971-1975 Comp., p. 5591.
b. Potential under this award for irreparable loss or destruction of significant scientific, prehistorical, historical, or
= i archeological data, and provide any help we may need, with respect to this award, to comply with the
Archaeological and Historic Preservation Act of 1974 (16 U.S.CA69a-1, et seq.).
12. Relocation and real property acquisition. You must comply with applicable provisions of 49 CFR part 24,
�. which implements the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970(42 U.S.C.
4601, et seq.) and provides for fair and equitable treatment of persons displaced by federally assisted programs or
i persons whose property is acquired as a result of such programs.
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13. Confidentiality of patient records. You must keep confidential any records that you maintain of the identity,
--� diagnosis, prognosis, or treatment of any patient in connection with any program or activity relating to substance
abuse education, prevention, training, treatment, or rehabilitation that is assisted directly or indirectly under this
award, in accordance with 42 U.S.C. 290dd-2.
14. Constitution Day. You must comply with Public Law 1MAW, Div. J, Title I, Sec. 111(36 U.S.C. 106 note),
�► •- i which requires each educational institution receiving Federal funds in aFederal fiscal year to hold an educational
program on the United States Constitution on September 17`s during that year for the students served by the
i educational institution.
15. Trafficking in Persons
a. Provisions applicable to a recipient that is a private entity.
1. You as the recipient, your employees, subrecipients under this award, and subrecipients'
employees may not
i. Engage in severe forms of trafficking in persons during the period of time that the award is in
effect;
J ii. Procure a commercial sex act during the period of time that the award is in effect;
;. or.
iii. Use forced labor in the performance of the award or subawards under the award.
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2. We as the Federal awarding agency may unilaterally terminate this award„ without penalty, if you or a
subrecipient that is a private entity —
i. Is determined to have violated a prohibition in paragraph a. 1 of this award term;
or
ii. Has an employee who is determined by the agency official authorized to terminate the award to have
violated a prohibition in paragraph a.l of this award term through conduct that is either —
A. Associated with performance under this award; or
B. Imputed to you or the subrecipient using the standards and due process for imputing the conduct of
an individual to an organization that are provided in 2 CFR part 180, "OMB Guidelines to Agencies
on Governmentwide Debarment and Suspension (Nonprocurement)," as implemented by our agency
at 2 CFR part 901.
b. Provision applicable to a recipient other than a private entity. We as the Federal awarding agency may unilaterally
terminate this award, without penalty, if a subrecipient that is a private entity—
1. Is determined to have violated an applicable prohibition in paragraph a. 1 of this award term; or
2. Has an employee who is detennined by the agency official authorized to terminate the award to have violated
an applicable prohibition in paragraph a. 1 of this award term through conduct that is either—
i. Associated with performance under this award; or
ii. Imputed to the subrecipient using the standards and due process for imputing the
conduct of an individual to an organization that are provided in 2 CFR part 180,
"OMB Guidelines to Agencies on Governmentwide Debarment and Suspension
(Nonprocurement)," as implemented by our agency at 2 CFR part 901.
c. Provisions applicable to any recipient.
1.You must inform us immediately of any information you receive from any source alleging a violation of a
prohibition in paragraph a.l of this award term.
2.Our right to terminate unilaterally that is described in paragraph a.2 orb. of this section:
i. Implements section 106(g) of the Trafficking Victims Protection Act of 2000 (TWA), as amended (22
U.S.C. 7104(g)), and
ii. Is in addition to all other remedies for noncompliance that are available to us under this award.
3.You must include the requirements of paragraph a. 1 of this award term in any subaward you make to a
private entity.
d. Definitions. For purposes of this award term:
1. "Employee" means either.
i. An individual employed by you or a subrecipient who is engaged in the performance of the project
or program under this award; or
ii. Another person engaged in the performance of the project or program under this award and not
compensated by you including, but not limited to, a volunteer or individual whose services are
contributed by a third party as an in-ldnd contribution toward cost sharing or matching
requirements.
2. "Forced labor" means labor obtained by any of the following methods: the recruitment, harboring,
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transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud,
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or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.
3. "Private entity":
i. Means any entity other than a State, local government, Indian tribe, or foreign public entity, as those
terms are defined in 2 CFR 175.25.
ii. Includes:
A. A nonprofit organization, including any nonprofit institution of higher education, hospital, or
tribal organization other than one included in the definition of Indian tribe at 2 CFR
175.25(b).
B. A for -profit organization.
4. "'Severe forms of trafficking in persons," "commercial sex act," and "coercion" have the meanings
given at section 103 of the TWA, as amended (22 U.S.C. 7102).
V. National Policy Requirements for Subawards.
Recipient responsibility. You must include in any subaward you make under this award the requirements of the
national policy requirements in Sections I through IV of this document that apply, based on the type of subawardee
organization and situation.
As the duly authorized representative of the Subrecipient, I hereby certify that Subrecipient will comply with the
above requirements.
SUBRECIPIENT:
By: Date:
[Printed Name and Title]
As the duly authorized representative of the Subcontractor, I hereby certify that Subcontractor will comply with the
above requirements.
SUBCONTRACTOR
By:
[Printed Name and Title]
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Date:
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ATTACIEWENT H Contract No.
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Intellectual Property Provisions
AUTHORIZATION AND CONSENT (41 CFR 9-9.102-1)
The Government hereby gives its authorization and consent (without prejudice to any rights of indemnification) for
all use and manufacture, in the performance of this grant or any part hereof or any amendment hereto or any
subcontract hereunder (including all lower -tier subcontracts hereunder), of any invention described in and covered
by a patent of the United States.
(a) embodied in the structure or composition of any article, the delivery of which is accepted by the
Government under this grant, or
(b) utilized in the machinery, tools, or methods, the use of which necessarily results from compliance by the
Grantee or the using subcontractor with
(i) specifications or written provisions now or hereafter forming a part of this grant, or
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(h) specific written instructions given by the Contracting Officer directing the manner of performance.
The entire liability to the Government for infringement of a patent of the United States shall be determined solely by
the provisions of the indemnity clauses, if any, included in this grant or any subcontract hereunder (including all
lower -tier subcontracts hereunder), and the Government assumes liability for all other infringement to the extent of
the authorization and consent herein above granted.
PATENT INDEMNITY (41 CFR 9-9.103-1)
If the amount of this contract is in excess of $10,000 the contractor shall indemnify the Government and its officers,
agents, and employees against liability, including costs, for infringement of any United States letters patent (except
U.S. letters patent issued upon an application which is now or may hereafter be kept secret or otherwise withheld
from issue by order of the Government) arising out of the manufacture or delivery of supplies or out of construction,
alteration, modification, or repair of real property (hereinafter referred to as "construction work") under this contract,
or out of the use or disposal by or for the account of the Government of such supplies or construction work. The
foregoing indemnity shall not apply unless the contractor shall have been informed as soon as practicable by the
Government of the suit or action alleging such infringement, and shall have been given such opportunity as is
afforded by applicable laws, rules, or regulations to participate in the defense thereof, and further, such indemnity
shall not apply to: (a) an infringement resulting from compliance with specific written instructions of the
j Contracting Officer directing a change in the supplies to be delivered or in the materials or equipment to be used, or
directing a manner of performance of the contract not normally used by the contractor; (b) an infringement resulting
from addition to or change in, such supplies or components furnished or construction work performed which
addition or change was made subsequent to delivery or performance by the contractor; or (c) a claimed infringement
J which is settled without the consent of the contractor, unless required by final decree of a court of competent
jurisdiction.
NOTICE AND ASSISTANCE REGARDING PATENT AND COPYRIGHT INFRINGEMENT (41 CFR 9-
+.M 9.104(b))
-j The provisions of this clause shall be applicable only if the amount of this grant exceeds $10,000.
(a) The Grantee shall report to the Contracting Officer, promptly and in reasonable written detail, each
notice of claim of patent or copyright infringement based on the performance of this grant of which the
j Grantee has knowledge.
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(b) In the event of any claim or suit against the Government on account of any alleged patent or copyright
r� infringement arising out of the performance of this grant or out of the use of any supplies famished or
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work or services performed hereunder, the Grantee shall furnish to the Government, when requested by
the Contracting Officer, all evidence and information in possession of the Grantee pertaining to such suit
or claim. Such evidence and information shall be furnished at the expense of the Government except
where the Grantee has agreed to indemnify the Government.
(c) This clause shall be included in all contracts and subgrants under this grant.
REPORTING OF ROYALTIES (41 CFR 9-9.110)
If this grant is in an amount which exceeds $10,000 and if any royalty payments are directly involved in the grant or
are reflected in the grant price to the Government, the Grantee agrees to report in writing to the Patent Counsel (with
notification by Patent Counsel to the Contracting Officer) during the performance of this grant and prior to its
completion of final settlement the amount of any royalties or other payments paid or to be paid by it directly to
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others in connection with the performance of this grant together with the names and addresses of licensers to whom
such payments are made and either the patent numbers involved or such other information as will permit the
identification of the patents or other basis on which the royalties are to be paicIL The approval of DOE of any
individual payments or royalties shall not stop the Government at any time from contesting the enforceability,
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validity or scope o& or title to, any patent under which a royalty or payments are made.
RIGHTS IN TECHNICAL DATA (SHORT FORM)
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(a) Definitions. The definitions of terms set forth in DEAR 927.401 apply to the extent these terms are used
herein.
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(b) Allocation ofRiehts.
. _;
(1) The Government shall have:
(i) Unlimited rights in technical data first produced or specifically used in the performance of this
grant;
R (ii) The right of the Contracting Officer or his representatives to inspect, at all reasonable times up to
l three years after final payment under this grant, all technical data first produced or specifically
used in the grant (for which inspection the Grantee or its contractor or subgrantee shall afford
—� proper facilities to DOE); and
(iii) The right to have any technical data first produced or specifically used in the performance of this
grant delivered to the Government as the Contracting Officer may from time -to -time direct during
the progress of the work, or in any event as the Contracting Officer shall direct upon completion or
_ termination of this grant.
(2) The Grantee shall have:
The right to use for its private purposes, subject to patent, security or other provisions of this grant,
,— technical data it first produces in the performance of this grant provided the date requirements of this
I grant have been met as of the date of the private use of such data The Grantee agrees that to the extent
J it receives or is given access to proprietary data or other technical, business or financial data in the
form of recorded information from DOE or a DOE contractor or subcontractor, the Grantee shall treat
-� such data in accordance with any restrictive legend contained thereon, unless use is specially
1 authorized by prior written approval of the Contracting Officer.
1 (c) CqMriehted Material.
_i (1) The Grantee agrees to, and does hereby grant to the Government, and to others acting on its behalf -
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(i) A royalty -flee, nonexclusive, irrevocable, worldwide license for Governmental purposes to
reproduce, distribute, display, and perform all copyrighted material first produced or composed in
the performance of this grant by the Grantee, its employees or any individual or concern
specifically employed or assigned to originate and prepare such material and to prepare derivative
works based thereon; and
(h) A license as aforesaid under any and all copyrighted or copyrighted work not first produced or
composed by the Grantee in the performance of this grant but which is incorporated in the material
furnished under the grant, provided that such license shall be only to the extent the Grantee now
has, or prior to completion or close-out of the grant, may acquire the right to grant such license
without becoming liable to pay compensation to others solely because of such gent
(2) The Grantee agrees that it will not knowingly include any material copyrighted by others in any written
or copyrighted material furnished or delivered under this grant without a license as provided for in
subparagraph (c) (1) (ii) of this section, or without the consent of the copyright owner, unless it obtains
specific written approval of the Contracting Officer for the inclusion of such copyrighted material.
RIGHTS TO PROPOSAL DATA (TECHNICAL) (48 CM 52.227-23)
it is agreed that as a condition of award of this grant or modification and notwithstanding the conditions of any
notice appearing on the proposal(s), the Government shall have the right to use, duplicate, and disclose and have
others to do so for any purpose whatsoever, the technical data contained in the proposal(s) upon which the grant or
modification is based.
City of Fort worth
Organization Name
Assistant Citv Manaver
Name and Title of Authorized Representative
Signature
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Date
ATTACB:MENT I
Contract No.
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SUBCONTRACTING PROVISIONS: MANDATORY FLOWDOWN PROVISION
Grantee, if subcontracting any of its performance hereunder, shall Iegally bind subgrantees to perform and
make such subgrantees subject to all the duties, requirements, and obligations of Grantee under this
Agreement. Grantee shall be jointly and severally liable for all performances under this Agreement,
including, but not limited to, the performance of its subgrantees to the extent permitted under the
Constitution and laws of the State of Texas, as well as full compliance with all reporting requirements set
forth in Section XIX of the Agreement.
Grantee represents and warrants that it has obtained all necessary permits, licenses, easements, waivers
!
and permissions of whatsoever kind required for its performance and the performance of its subgrantees
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under this Agreement. In no event shall any provision of this Paragraph, including, but not limited to, the
requirement that Grantee obtain the prior approval of Agency on Grantee's proposed subcontracts, be
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construed as relieving Grantee of the responsibility for ensuring that all services rendered under any
subcontracts comply with all the terms and provisions of this Agreement as if they were rendered by
Grantee. Grantee shall, upon request, furnish Agency with copies of all proposed subcontracts and all
s.
proposed amendments, assignments, cancellations or terminations of said subcontracts no later than thirty
(30) days prior to the proposed effective date of such contracts, amendments, assignments, cancellations
or terminations; provided, however, that this thirty (30) day period may be shortened by written
agreement of the parties. Upon request from the Comptroller, Grantee shall provide any and all
documentation deemed necessary by the Comptroller to evidence Subcontractors compliance with all
terms, conditions and performance pertaining to the Agreement and all applicable Iaw.
As the duly authorized representative of the Grantee and the Subgrantee/Subrecipient, I hereby certify
"
that Grantee and Subgrantee/Subrecipient will comply with the above requirements.
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GRANTEE
E SUBGRANTEE/SUBRECIPIENT:
[Printed Name]
.3
[Title]
-J Date:
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ATTACHMENT J
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AMERICAN RECOVERY & REINVESTMENT ACT —RECIPIENT AFFIDAVIT
This Affidavit must be slened and sworn (notarized) and returned with all ADDUcations for this RFA
I, Fermando Costa, an authorized representative of City of Fort Worth, a [person, sole proprietorship, partnership,
corporation, limited liability company, nonprofit organization, governmental entity, political subdivision, or other
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entity] (circle one) that is receiving American Recovery and Reinvestment Act of 2009 (ARRA or the Act) funding,
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hereby swear and affirm that, to the best of my knowledge, internal controls, processes and procedures have been
designed and implemented to help ensure that the recipient and its use of these funds complies with the following:
applicable state law; federal law, including federal reporting requirements under Section 1512 of the Act, if
applicable; rules; regulations; and other relevant guidance. I further swear and affirm that all of the statements made
and information provided herein, including statements made and information provided in any attachments are true,
complete, and correct, to the best of my knowledge.
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I understand that I am receiving ARRA funding from The Texas Controller of Public Accounts. State Enerev
Conservation Office. a [state agency, institution of higher education, governmental entity, political subdivision, or
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other entity] (circle one).
I understand that non-compliance with reporting requirements could be treated as a violation of the award agreement
resulting in the withholding of funds, debarment, or award termination or suspension, as appropriate.
I understand that it is a federal crime under 18 U.S.C. Section 1001 to, in any matter within the jurisdiction of the
executive branch of the U.S. Government, knowingly and willfully make any materially false, fictitious, or
fraudulent statement or representation, or to make or use any false writing or document knowing that it contains the
same.
I understand that presenting a false or fraudulent claim, in whole or in part, or causing same, may subject me to civil
penalties as provided for in 31 U.S.C. Section 3729.
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I understand that it is a felony offense under Section 37.10, Texas Penal Code, to knowingly make a false entry in,
or false alteration ot; a governmental record, or to make, present, or use a governmental record with knowledge of
its falsity, when the actor has the intent to harm or defraud another.
+..
I understand that the offense of perjury, under Section 37.02, Texas Penal Code, is committed when a person, with
intent to deceive and with knowledge of the statement's meaning, makes a false statement under oath or swears to
the truth of a false statement previously made and the statement is required or authorized by law to be made under
oath.
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I understand my obligation to track all ARRA funds and that ARRA funds cannot be comingled with Non-ARRA
funds. I also understand my obligation to immediately report any known or suspected waste, fraud, and abuse of
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funds received under the Act to the United States Government Accountability Office at (800) 424-5454 and the
Texas State Auditor's Office at (800) 992-8348. I futher understand that I will require all sub -recipients with whom
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I contract using funds made available under the Act to sign a similar affidavit swearing to all of the above. I hereby
swear and affirm that I have read the entire affidavit, and I understand its contents.
City of Fort Worth /I
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Affiant Signature
Jennando Costa
Full Name
Assistant City Manager
Title
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October 29, 1009
Date
Sworn and subscribed before me by the said
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Page 67 of 75
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—J
CAROL ANN PHILLIPS
Notary Public, State of Texas
My Commission Expires
9W August 20, 2013
(Printed Name of Recipient's Authorized Representative) -FT
this.11 day of &4ker 2067.
Notary Public, State of TCXw
Notary's printed name: L*DfAWWAM. My commission expires: 26 (Seal)
Page 69 of 75
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ATTACHMENT K
Contract No.
Execution of Application
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1. By signature hereon, Applicant represents and warrants that the provisions in this Execution of Application
apply to Applicant and all of Applicant's principals, officers, directors, shareholders, partners, owners, agents,
employees, subcontractors, independent contractors, and any other representatives who may provide services
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under, who have a financial interest in, or otherwise are interested in this RFA or any contract resulting from it.
2. By signature hereon, Applicant represents and warrants its intent to Runish the requested items at the prices
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quoted in its Proposal.
3. By signature hereon, Applicant represents and warrants that it has read and understood and shall comply with
Comptrollers Anti -Fraud Policy, located on Comptroller's website at
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htto://www.window.state.tx.us/ssv/ethics.html, as such Policy currently reads and as it is amended throughout
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the term of any resulting contract.
4. By signature hereon, Applicant represents and warrants that its prices include all costs of Applicant in providing
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the requested items that meet all specifications of this RFA, and that its prices will remain firm for acceptance
for a minimum of ninety (90) days from deadline for submission of Proposal.
5. By signature hereon, Applicant represents and warrants that each employee, including `replacement
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employees', will possess the qualifications, education, training, experience and certifications necessary to
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perform the services in the manner required by this RFA.
6. By signature hereon, Applicant represents and warrants that it has no actual or potential conflicts of interest in
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providing the requested items to Comptroller under the RFA and any resulting contract, if any, and that
Applicant's provision of the requested items under the RFA and any resulting contract, if any, would not
reasonably create an appearance of impropriety.
7. By signature hereon, pursuant to Section 2155.004(a), Texas Government Code, Applicant represents and
warrants that it has not given, nor intends to give at any time hereafter, any economic opportunity, future
employment, gift, loan, gratuity, special discount, hip, favor or service to a public servant in connection with
the submitted Proposal.
8. By signature hereon, Applicant represents and warrants that it is not currently delinquent in the payment of any
franchise taxes owed the State of Texas under Chapter 171, Texas Tax Code. In addition, if Applicant is an
individual not residing in Texas or a business entity not incorporated in or whose principal domicile is not in
Texas, the following certification applies. Applicant represents and warrants that it holds a permit issued by
Comptroller to collect or remit all state and local sales and use taxes that become due and owing as a result of
the individual's or entity's business in Texas or represents and warrants that it does not sell tangible personal
property or services that are subject to the state and local sales and use tax. Under Section 2155.004(a), Texas
Government Code, a state agency may not accept a bid or award a contract that includes proposed financial
participation by a person who received compensation from the agency to participate in preparing the
specifications or request for proposals on which the bid or contract is based. Further, Applicant certifies that the
individual or business entity named in this Proposal or any contract resulting from this RFA is not ineligible to
receive the specified contract and acknowledges that the contract may be terminated and payment withheld if
this certification is inaccurate. See Texas Government Code Section 2155.004(b).
9. By signature hereon, Applicant hereby represents and warrants that, pursuant to 15 U.S.C. Sec. 1, et seq. and
Tex. Bus. & Comm. Code Sec. 15.01, et seq., neither Applicant nor the firm, corporation, partnership, or
institution represented by Applicant, or anyone acting for such a firm, corporation or institution has violated the
antitrust laws of this state, federal antitrust laws, nor communicated directly or indirectly the Proposal made to
any competitor or any other person engaged in such line of business.
10. By signature hereon, Applicant represents and warrants that all statements and information prepared and
submitted in response to this RFA are current, complete and accurate.
Page 69 of 75
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11. By signature hereon, Applicant represents and warrants that the individual signing this document and the
documents made part of this RFA and Proposal is authorized to sign such documents on behalf of the company
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and to bind the company under any contract which may result from the submission of this Proposal.
12. By signature hereon, Applicant represents and warrants that if a Texas address is shown as the address of the
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Applicant, Applicant qualifies as a Texas Bidder as defined by 34 Texas Administrative Code §20.32(68).
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13. Check below if preference claimed under 34 Texas Administrative Code §20.38:
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• Goods produced or offered by a Texas bidder that is owned by a Texas resident service -disabled
veteran
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• Goods produced in Texas or offered by a Texas bidder that is not owned by a Texas resident service -
disabled veteran
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Agricultural products grown in Texas
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• Agricultural products offered by a Texas bidder
• Services offered by a Texas bidder that is owned by a Texas resident service -disabled veteran
a Services offered by a Texas bidder that is not owned by a Texas resident service disabled veteran
• Texas Vegetation Native to the Region
USA produced supplies, materials or equipment
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Products of persons with mental or physical disabilities
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• Products made of recycled, remanufactured, or environmentally sensitive materials including
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recycled steel
• Energy Efficient Products
• Rubberized asphalt paving material
• Recycled motor oil and lubricants
• Products produced at facilities located on formerly contaminated property
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• Products and services from economically depressed or blighted areas
• Vendors that meet or exceed air quality standards
• Recycled or Reused Computer Equipment of Other Manufacturers
Foods of Higher Nutritional Value
14. By signature hereon, under Section 231.006, Texas Family Code, regarding child support, Applicant certifies
that the individual or business named in the Proposal is not ineligible to receive the specified payment and
acknowledges that the contract may be terminated and payment may be withheld if this certification is
inaccurate. Furthermore, any Applicant subject to Section 231.006, Texas Family Code, must include names
and Social Security numbers of each person with at least 25% ownership of the business entity submitting the
Proposal. This information must be provided prior to award. Enter the Name and Social Security Number for
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each person below:
Name: SSN:
Name: SSN:
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Name: SSN:
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FEDERAL PRIVACY ACT NOTICE: This notice is given pursuant to the Federal Privacy Act Disclosure
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of your Social Security Number (SSN) is required under Section 231.006(c) and Section 231.302(c)(2), Texas
Family Code. The SSN will be used to identify persons that may owe child support. The SSN will be kept
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confidential to the fullest extent allowed under Section 231.302(e), Texas Family Code.
By signature hereon, Applicant represents and warrants that no relationship, whether by relative, business
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associate, capital funding contract or by any other such kinship exist between Applicant and an employee of any
Comptroller component, and Applicant has not been an employee of any Comptroller component within the
immediate twelve (12) months prior to Applicant's Proposal. By signature hereon, Applicant certifies that it is
in compliance with Section 669.003, Texas Government Code, relating to contracting with executive head of a
state agency. All such disclosures will be subject to administrative review and approval prior to Comptroller
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entering into any contract with Applicant. Applicant acknowledges that any contract resulting from this RFA
may be terminated at any time, and payments withheld, if this information is false.
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16. By signature hereon, pursuant to Section 2155.004, Texas Government Code Applicant represents and wan -ants
that neither it nor any person or entity which will participate financially in any contract resulting from this RFA
has received compensation for participation in the preparation of specifications for this RFA.
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17. By signature hereon, Applicant represents and warrants that all articles and services quoted in response to this
RFA meet or exceed the safety standards established and promulgated under the Federal Occupational Safety
and Health Law and its regulations in effect or proposed as of the date of this solicitation.
18. By signature hereon, Applicant represents and warrants its compliance with all federal laws and regulations
pertaining to Equal Employment Opportunities and Affirmative Action.
19. By signature hereon, Applicant represents and warrants its compliance with the requirements of the Americans
With Disabilities Act (ADA). Applicant further represents and warrants that it will comply with all applicable
Texas Accessibility requirements.
20. By signature hereon, in accordance with Section 2155.4441, Texas Government Code, Applicant agrees that
,.
during the performance of a contract for services it shall purchase products and materials produced in Texas
when they are available at a price and time comparable to products and materials produced
outside this state.
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21. By signature hereon, Applicant represents and warrants. that Comptrollets payments to Applicant and
Applicant's receipt of appropriated or other funds under any contract resulting from this RFA are not prohibited
by Section 556.005 or Section 556.008, Texas Government Code.
22. By signature hereon, Applicant represents and warrants that the offering entity and its principals are eligible to
_
participate in this transaction and have not been subjected to suspension, debarment, or similar ineligibility
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determined by any federal, state, or local governmental entity and that Applicant is in compliance with the State
EE
of Texas statutes and rules relating to procurement and that Applicant is not listed on the federal governments
terrorism watch list as described in Executive Order 13224. Entities ineligible for federal procurement are
listed at htto://www.enis.eov.
23. Under Section 2155.006(b), Texas Government Code, a state agency may not accept a bid or award a contract,
including a contract for which purchasing authority is delegated to a state agency, that includes proposed
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financial participation by a person who, during the five-year period preceding the date of the bid or award, has
,. �.J•
been: (1) convicted of violating a federal law in connection with a contract awarded by the federal government
for relies; recovery, or reconstruction efforts as a result of Hurricane Rita, as defined by Section 39.459,
Utilities Code, Hurricane Katrina, or any other disaster occurring after September 24, 2005; or (2) assessed a
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penalty in a federal civil or administrative enforcement action in connection with a contract awarded by the
federal government for relief, recovery, or reconstruction efforts as a result of Hurricane Rita, as defined by
_
Section 39.459, Utilities Code, Hurricane Katrina, or any other disaster occurring after September 24, 2005.
Under Section 2155.006, Texas Government Code, Applicant certifies that the individual or business entity
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named in the Proposal is not ineligible to receive the specified contract and acknowledges that any contract
resulting from this RFA may be terminated and payment withheld if this certification is inaccurate.
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24. By signature hereon and by checking or initialing either Subsection (a) or Subsection (b), as applicable,
Applicant represents and warrants the following:
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(a) pplicant represents and warrants that it is not aware of and has received no notice of any court or
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governmental agency actions, proceedings or investigations, etc., pending or threatened against Applicant or
any of the individuals or entities included in Section 1 of this document that would or could impair
Applicant's performance under any contract resulting from this RFA, relate to the solicited or similar goods
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Page 71 of 75
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or services, or otherwise be relevant to the agency's consideration of Applicant's Proposal. Applicant
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represents and warrants that it is not aware of any such court or governmental agency actions, proceedings or
investigations, etc. against Applicant or any of these individuals or entities within the five (5) calendar years
}
immediately preceding the submission of Applicant's Proposal in response to this RFA. in addition,
Applicant represents and warrants that it shall notify Comptroller in writing within five (5) business days of
any changes to the representations or warranties in this Subsection (a) and understands that failure to so
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timely update Comptroller shall constitute breach of contract and may result in immediate termination of the
contract.
(b) Applicant is unable to make the representation and warranty in Subsection (a) above and instead
represents and warrants that it has included as a detailed attachment in its Proposal, which expressly
references this Subsection (b), a complete disclosure of any such court or governmental agency actions,
proceedings or investigations, etc., and specifically addresses whether any of such past, pending or threatened
actions, proceedings or investigations, etc., would or could (1) impair Applicant's performance under any
contract resulting from this RFA; (2) relate to the solicited or similar goods or services; or (3) be otherwise
relevant to the agency's consideration of Applicant's Proposal. In addition, Applicant represents and
warrants that it shall notify Comptroller in writing within five (5) business days of any changes to the
representations or warranties in this Subsection (b) or attachments in response to Subsection (b) and
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understands that failure to so timely update Comptroller shall constitute breach of contract and may result in
immediate termination of the contract.
Applicant understands that a Proposal returned without the appropriate checked or initialed
representation and warranty and the detailed attachment required in Subsection (b), when applicable,
may be automatically disqualified.
25. By signature hereon, Applicant represents and warrants that it has read and agrees to all terms and conditions of
this RFA, unless Applicant specifically takes an exception and offers an alternative provision in Applicant's
Proposal as provided in Exhibit C, Section 2 of this RFA.
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Authorized signatory on behalf of Applicant must complete and sign
the following:
Gs�sew.rC l..evL --.
October 29, 2009
Authorized Signature
Date Signed
Fermando Costa, Assistant City Manager
917-392-6122
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Printed Name and Title of
Phone Number
Authorized Signature
City of Fort Worth
817-392-2533
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Company Name
Fax Number
75-6000528
Fernando.Costa(a)fortworthgov.org
Federal Employer Identification Number
E-Mail Address
1000 Throckmorton Street
Fort Worth, TX 76102-6312
Physical Street Address
City, State, Zip Code
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Mailing Address, if different
City, State, Zip Code
Page 72 of 75
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ATTACIBffNT L
ARRA REPORTING REOUIREMENTS
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1. Grantee shall submit to the Comptroller the following reports:
A. INITIAL INFORMATION REPORT. The Grantee shall submit the following information upon the execution
!
of the Grant Agreement and return this report when the executed Grant Agreement is submitted to the Agency:
L Grantee Identification:
a. Grantee name: Provide the following information for the Grantee;
(i) the official name of the Grantee as it appears on the Grant Agreement;
(ii) the street address, city, and county of the official place of business;
(iii) City, County, and U.S. Postal Zip Code + four digits;
(iv) the url designation or address of any official web site for the Grantee;
(v) U.S. Congressional District;
(vi) the state senatorial district;
(vin) the state house district;
(viii) a copy of the minutes or resolution by which the Grantee approved the Grant agreement and
designated an authorized representative for the Grantee;
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(ix) the grant/award number assigned to the Grantee by the Agency;
(x) the date the Grant Agreement was signed (mm/dd/yyyy)• and
(xi) the performance period established in the Grant Agreement during which sponsorship begins and ends.
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b. Authorized Representative: Provide the following information for the person designated by the Grantee to
represent the Grantee in the performance of the Grant Agreement:
(i) the name of the authorized representative and official title, if any;
(ii) the street address, city, and county of the primary business location;
(iii) City, County, and U.S. Postal Zip Code + four digits;
(iv) area code and telephone number; and
—'
(v) email address.
c. Kev Personnel: Provide the following information for each employee or agent designated by the Grantee or
the Authorized Representative that may assist or serve as representative for the Grantee in the performance of
-,
the Grant Agreement:
(i) the name of the key personnel and official title, if any;
(ii) primary role served for the Grantee with respect to the Grant;
(iii) the street address, city, and county of the primary business location;
(iv) City, County, and U.S. Postal Zip Code + four digits;
(v) area code and telephone number; and
(vi) email address.
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d. Five most hieWv compensated individuals: The information required in this subsection is ONLY required
when the reporting entity (A) received 80 percent or more of its annual gross revenues in Federal awards the
recipient in its preceding fiscal year, or (B) received $ 25,000,000 or more in annual gross revenues from
Federal awards; and (C) the public does not have access to information about the compensation of the senior
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executives of the entity through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange
J
Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986 [26 USC §6104].
If this subsection is applicable, the report shall include:
(i) the names and total compensation for the five most highly compensated officers of the entity;
"Total
(ii) compensation" means the cash and noncash dollar value earned by the executive during the
subrecipient's past fiscal year of the following: Salary and bonus; Awards of stock, stock options, and stock
appreciation rights. Use the dollar amount recognized for financial statement reporting purposes with
respect to the fiscal year in accordance with FAS 123R; Earnings for services under non -equity incentive
plans. Does not include group life, health, hospitalization or medical reimbursement plans that do not
discriminate in favor of executives, and are available generally to all salaried employees; Change in
pension value. This is the change in present value of defined benefit and actuarial pension plans; Above -
market earnings on deferred compensation which are not tax -qualified;. Other compensation, for example,
severance, termination payments, value of life insurance paid on behalf of the employee, perquisites or
property if the value for the executive exceeds $10,000.
Page 73 of 75
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Project Identification:
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a. Proiect Namel Provide the brief descriptive title of the project or activity as identified in the Grant
Agreement.
b. Primary Performance Location: Provide physical location of primary place of performance by:
(i) street address,
(ii) City, County, and U.S. Postal Zip Code + four digits
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(iii) U.S. Congressional District;
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(iv) the state senatorial district; and
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(v) the state house district;
c. Proiect Obiective: A description of the overall purpose and expected outputs and outcomes or results of the
Grant Agreement, including significant deliverables and, if appropriate, units of measure.
B. MONTHLY REPORT. On 25`s day of each calendar month, the Grantee shall submit a report in the format
�"" ;
required by the Comptroller containing the following information:
L Grantee Identification:
a. Grantee name: Provide the name of the Grantee as it appears on the Grant Agreement.
b. Report Contact: Provide the name of person preparing and submitting the report and contact information
including telephone number and email address.
c. Award Number- Provide the grantlaward number (if any) assigned to the Grantee by the Agency.
d. Grant Dates: Provide the date the Grant Agreement was signed (mm/dd/yyyy) and the performance period
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established in the Grant Agreement during which sponsorship begins and ends.
eL Changes to the Initial Information Report: Provide any amendments or changes to the information provided
in the Initial Information Report.
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H. Grant Award/Budget Information:
a. Total Amount of Grant: Provide the anticipated total amount of cash to be disbursed to Grantee by the
expiration date of the Grant Agreement, respectively.
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b. Amount of Grant Funds Received: Provide the cumulative amount of cash received by the Grantee as of the
reporting period end date.
c. Amount of Grant funds Disbursed: Provide the cumulative amount of cash disbursed by the Grantee as of the
reporting period end date.
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d. Cost Status: Show funds budgeted and funds disbursed for each budget item. If cost sharing is required
break out by Comptroller share, Grantee share, and total costs.
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M. Project Information:
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a. Proiect Name: Provide the brief descriptive title of the project or activity as identified in the Grant
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Agreement.
b. Proiect Obiective: A description of the overall purpose and expected outputs and outcomes or results of the
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Grant Agreement, including significant deliverables and, if appropriate, units of measure.
c. Schedule Status: List milestones, anticipated completion dates and actual completion dates. If you submitted
a project management plan with your application, you must use this plan to report schedule and budget
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variance.
d. Proeress Evaluation Provide a brief description of overall progress on each project objective (such as: Not
started; Less than 50% completed; Completed 50% or more; Fully Completed) and a comparison of the actual
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accomplishments with the goals and objectives established for the period and reasons why the established goals
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were not met.
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e. Proiect Efforts; Provide a brief narrative of any changes in approach or aims and reasons for change
(remember significant changes to the objectives and scope require prior approval by the contracting officer),
actual or anticipated problems or delays and actions taken or planned to resolve them; and any absence of key
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personnel or changes in consortium/teaming arrangement.
z. Product or technology transfer activities: A description of any product produced or technology transfer
activities accomplished during this reporting period, such as:
(i) Publications (list journal name, volume, issue); conference papers; or other public releases of
results;
(ii) Web site or other Internet sites that reflect the results of this project;
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Page 74 of 75
(iii) Networks or collaborations fostered;
(iv) Technologies/Techniques;
(v) Inventions/Patent Applications
(vi) Other products, such as data or databases, physical collections, audio or video, software or
netware, models, educational aid or curricula, instruments or equipment.
IV. Job Created/Retained:
a. Definitions: In providing information for Jobs Created/Retained, please use the following definitions:
"Jobs created" means those new positions created and filled, or previously existing unfilled positions that
are filled, as a result of funding provided pursuant to this Grant Agreement_ A job reported as a job created
cannot be also reported as a job retained.
"Jobs retained" means those previously existing filled positions that are retained as a result of funding
provided pursuant to this Grant Agreement. This description may rely on job titles, broader labor categories, or
the contractor's existing practice for describing jobs as long as the terms used are widely understood and
describe the general nature of the work A job reported as a job retained cannot be also reported as a job created.
"The United States and outlying areas" means the 50 States, the District of Columbia, the
Commonwealths of Puerto Rico, and the Northern Mariana Islands, the Territories of American Samoa, Guam,
and the U.S. Virgin Islands; and the Minor outlying islands of Baker, Howland, Jarvis, Midway, and Navassa
Islands; Johnston, Palmyra, and Wake Atolls, and Kingman Reef.
b. Jobs Created:
(i) The number of jobs created in the United States and outlying areas;
(ii) a brief description of the types of jobs created; and
(iii) the anticipated or likely duration of the jobs created.
c. Jobs Retained;
(i) The number of jobs retained in the United States and outlying areas;
(ii) a brief description of the types of jobs retained; and
(iii) the anticipated or likely duration of the jobs retained.
V. Technical Measures:
a.. Number of energy -efficient traffic signals installed; and
b. Number of street lane -miles for which synchronized traffic signals were installed.
C. FINAL REPORT. No later than 30 days following the grant ending date, the Grantee shall submit a Final
Report in the format required by the Comptroller containing all the information required for the Monthly Report
cumulative through the last day of the grant performance period.
2. Grantee shall require any of its Sub -Grantees or subcontractors that are remitted any fiords provided under this
agreement to submit the reports identified in this attachment substituting the word "Grantee" and replacing it with
Sub -grantee or subcontractor, as appropriate.
3. Failure to comply with the requirements of this attachment may result in termination of the grant award and the
Grantee being ineligible for future grants.
4. The form and substance of these reporting requirements may be amended by the Comptroller at any time.
As the duly authorized representative of the Grantee, I hereby certify that Grantee will comply with the above
GRANTEE:
By: Fernando Costa Assistant City Manager
[Printed Name and Title]
GNP IqW
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Page 75 of 75
Date: October 29.2009
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APPENDICES
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2007 Traffic Signal Operation Self Assessment
Results Sheet
Scoring for the 2007 Traffic Signal Operation Self Assessment
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Developed by
Nedwd Mwwr u� Opaudom Co•6tion
N700C
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Scoring for the 2007 Traffix Signal Operation Se fAssessment
The 2007 Traffic Signal Operation Self Assessment consists of six sections. Each section contains a
number of questions concerning traffic signal operation policies and practices. Respondents are asked to
rate the extent to which a particular policy or practice has been adopted and implemented by your agency.
Score each question from 1 to 6, based on your program's progress in each area as detailed below. It may
prove useful to briefly document the reasons for each question's scoring,
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The self assessment is designed to describe the benchmark for traffic signal operation best practices. Each
question is followed by a short description that illustrates outstanding practice (a 5 score) or provides
guidance on how to score within a range (1 to 6). This provides your agency with a target for improving
your own traffic signal operation. It is not anticipated that any agency will have a perfect score.
Some questions apply only to agencies that have specialized equipment or applications. In those
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instances, "not applicable" (N/A) is provided as a scoring option. Questions scored as "not applicable"
will not contribute to the overall score and should not be included on your results sheet.
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Below is general guidance for scoring from 1 to 6:
1. Not being done
currently
• May have been discussed informally but no action has been taken
2. Very little being done
1
Minimal activity
Issue has been acknowledged and is being investigated
7 3. Efforts are moderate. Some good processes exist but they may not be well executed —results are
mixed.
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• Has been put into practice on a limited or experimental basis
i • Processes are not consistently applied
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4. Efforts are strong and results are promising; however, there is room for improvement
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• Has become a generally accepted practice but refinements or changes are being discussed or
pursued
• Is done in practice but is not yet integrated as "standard procedure"
5. Efforts are outstanding with good to excellent results.
• Has become accepted practice and is consistently implemented
• Policies and procedures are documented and well integrated as "standard procedure"
6. Not applicable: The questign does not apply to your agency.
In assigning a rating to an item, first decide which level of effort best fits the overall item response.
Overall "best fit" does not require total agreement with each of the questions or the description for that
scoring range. Assigning the actual score within the range requires evaluating the level of effort that has
been applied within a particular area. If only a minimal effort has been applied, a 2 or 3 should be
assigned. If no effort has been applied, a 1 should be assigned. If a comprehensive effort has been applied,
the highest rating for a range should be assigned. If the question does not apply to your agency, a 6 should
be assigned.
There are six sections in this self assessment:
• Section 1: Management
• Section 2: Signal operation at individual intersections
• Section 3: Signal operation in coordinated systems
• Section 4: Signal timing practices
• Section 5: Traffic monitoring and data collection
• Section 6: Maintenance
All questions have equal weight. To calculate your score for each section, simply average your result for
all questions in that section, excluding any questions scored as not applicable. To calculate your overall
score, average your results for all questions, excluding any questions scored as not applicable. The
following results sheet is provided for your convenience.
Average = Score (100-point scale) _
scores for all s Average (100)
Section questions = raw
score "s" Number questions 5
answered
1. Management
2. Signal operation at Q
individual intersections 7 3. 9 7v
3. Signal operation in
coordinated s.Tstems 7i G 3. 3 G
4. Specialized timing Practices e
5. Traffic monitoring and • Z lr 7
data collection
6. Maintenance
Total /o S >�►. 3 f 3 G G
Al Craa) . 3G G= G / fV-1
11
11
11
3
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For the national report card results, individual scores will be converted to a 100-point scale and
assigned a letter grade. The conversion is:
A = 90-100 or 4.5-5
B = 80-89 or 4-4.4
70-79 or 3.5-3.9
D — 9 or 3-3.4
= less than 60 or less than 3
We ask that your results be provided for inclusion in the National Traffic Signal Report Card.
Individual results and participating agencies are anonymous. Please return your results as
follows:
We strongly urge you to return results electronically by logging into
www.ite.ore/selfassessment. Complete the results sheet on the Web site and click "submit."
For paper copies, mail the completed results sheet to:
Institute of Transportation Engineers
Attention: Tatyana Jenkins
1099 14th Street, NW, Suite 300 West
Washington, DC 20005-3438
Registered participants who return their results by December 29, 2006 will receive the following:
• Certificate of completion
• Final report on the National Report Card
• Press kit for conducting a local press event (including background information and graphics
designed for the press, summary of national results, fill -in -the -blank templates for your
agency's results and suggestions on conducting your local press event)
• Traffic signal audit guide
Please return your results by December 29, 2006.
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General Information
ALL INFORMATION AND RESPONSES TO THIS SELF ASSESSMENT WILL REMAIN
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CONFIDENTIAL.
The information below is requested so that we may contact you with questions regarding the
information you have submitted It will also be used as a mailing address for the material we will send
you in response to your completion of the survey and will enable us to correlate survey responses
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with demographics (organization type, etc.).
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Name: J. ek 11-67-AMS
Title: ��QAFF/G �ER!/ZGES,Q
Employer.
Address: fD/d dyo►s�Or�Dvi Public information contact person
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(optional):
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Name: 41'rZ mr `,( ,I
State: z/yd.S
Phone: XZ7, 30L. 7.*d
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(Check one)
1. City/municipality
2. County
3. State/province
4.Other, Please specify
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How many traffic signals does your jurisdiction operate and maintain?
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❑ Less than 50
❑ 50-150 signals
-
❑ 150-450 signals
Y 45(W ,000 signals
❑ More than 1,000 signals
What is your jurisdiction's population?
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❑ Less than 50,000
❑ 50,000-250,000
❑ 250,00-500,000
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�( 500,000-1,000,000
❑ Greater than 1 million
If yourjurisdiction is part of a larger metropolitan area, what is the population of the metropolitan
area?
❑ Less than 50,000
❑ 50,000-250,000
❑ 250,00-500,000
u 500,000-1,000,000
KGreater than I million
Are you willing to have your response shared with the FHWA Division Office arterial management
staff person in your state? The information is for internal use at the Division Office only and the
details of your response will not be shared with anyone else. The intent is to allow the Division Office
staff to understand needs and offer to provide appropriate technical assistance and resources.
X Yes
O No
Thank you for completing this self assessment. We hope it has helped your agency evaluate the
operation of its traffic signal system operations. We encourage you to use the results of this self
assessment to plan, budget and implement enhancements to your traffic signal system.
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AND HAS PARTICIPATED IN THE NATIONAL TRAFFIC SIGNAL. REPORT GARD
October 2007
PRESENTED BY THE INSTITUTE OF TRANSPORTAATION ENGINEERS OIL BEHALF OF THE
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_ City of Fort Worth, Texas
Mayor and Council Communication
COUNCIL ACTION: Approved on 1113/2009 - Ord. No. 18890-11-2009
DATE: Tuesday, November 03, 2009 REFERENCE NO.: "C-23884
LOG NAME: 20RECOVERY ACT SECO TRAFFIC SIGNAL GRANT
SUBJECT:
Ratify the Application for and, if Awarded, Acceptance of a $750,000.00 Transportation Energy Efficiency
Traffic Signal Synchronization or Replacement Stimulus Grant through the Texas State Energy
Conservation Office and Adopt Appropriation Ordinance
RECOMMENDATION:
It is recommended that the City Council:
1. Ratify the Transportation and Public Works Department's Application for a $750,000.00 Transportation
Energy Efficiency Traffic Signal Synchronization or Replacement Stimulus cost sharing matching grant
administered through the Texas State Energy Conservation Office;
2, If awarded the grant:
a. Authorize the City Manager to accept the $750,000.00 cost sharing matching grant from the Texas
State Energy Conservation Office;
b. Authorize the transfer of $187,500.00 from the 2007 Critical Capital Projects Fund to the Grant
Capital Projects Fund; and
c. Adopt the attached appropriation ordinance increasing estimated receipts and appropriations in the
Grant Capital Projects Fund in the amount of $937,500.00, subject to receipt of the grant.
DISCUSSION:
The American Recovery and Reinvestment Act of 2009, (ARRA) made available federal stimulus funds for
qualified and accepted projects. Under this Act, the United States Department of Energy (DOE) is
responsible for distribution and management of ARRA funds to states through State Energy Programs.
Texas Comptroller of Public Accounts' State Energy Conservation Office (SECO) is offering competitive
opportunities for cost reimbursement awards to eligible governmental entities to assist them in their
initiatives to synchronize traffic signals or replace signal lights to achieve energy efficiencies.
The Transportation and Public Works Department (TPW) proposes to use these grant funds for minor
modifications and equipment upgrades at 14 traffic signals and to reconstruct two traffic signals in the
Riverside community area as shown on the attached map.
TPW plans to retain consultant services to prepare plans, specifications and contract proposals, develop
synchronization timing plans, prepare before and after studies and handle grant reporting requirements.
This project involves improvements to City transportation facilities located in COUNCIL DISTRICTS 2, 4
and 8.
Logname: 20RECOVERY ACT SECO TRAFFIC SIGNAL GRANT Page 1 of 2
FISCAL INFORMATION / CERTIFICATION:
The Financial Management Services Director certifies that upon approval of the above recommendations
and adoption of the attached appropriation ordinance, funds will be available in the current capital budget,
as appropriated, of the Grant Capital Projects Fund.
FUND CENTERS:
TO Fund/Account/Centers
2a) GR74 451988 020437425000
26 GR74 5XXXXX 020437425010
2b)GR74 472295 020437425000
CERTIFICATIONS:
Submitted for Cltv Manaaees Office by
Oriainatinq Deoartment Head:
Additional Information Contact:
FROM Fund/Account/Centers
$750.000.00 2b) C295 538070 204720143180
$937.500.00
$187.500.00
Fernando Costa (6122)
William A. Verkest (7801)
Mark Mathis (7861)
Logname: 20RECOVERY ACT SEGO TRAFFIC SIGNAL GRANT
$187.5 00.00
Page 2 of 2
Ordinance No, 18890-11-2009
AN ORDINANCE INCREASING THE ESTIMATED RECEIPTS AND APPROPRIATIONS
IN THE GRANT CAPITAL PROJECTS FUND IN THE AMOUNT OF $937,500.00,
SUBJECT TO RECEIPT OF A MATCHING GRANT FROM THE TEXAS STATE ENERGY
CONSERVATION OFFICE FOR THE PURPOSE OF MINOR MODIFICATIONS AND
EQUIPMENT UPGRADES AT 14 TRAFFIC SIGNALS AND RECONSTRUCTION OF
TWO TRAFFIC SIGNALS; PROVIDING FOR A SEVERABILITY CLAUSE; MAKING THIS
ORDINANCE CUMULATIVE OF PRIOR ORDINANCES AND REPEALING ALL PRIOR
ORDINANCES IN CONFLICT HEREWITH; AND PROVIDING AN EFFECTIVE DATE.
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF FORT WORTH, TEXAS:
SECTION 1.
That in addition to those amounts allocated to the various City departments for Fiscal Year 2009-2010 and
in the Budget of the City Manager, there shall also be increased estimated receipts and appropriations in
the Grant Capital Projects fund in the amount of $937,500.00, subject to receipt of a matching grant from
the Texas State Energy Conservation Office for the purpose of minor modifications and equipment
upgrades at 14 traffic signals and reconstruction of two traffic signals.
SECTION 2.
That should any portion, section or part of a section of this ordinance be declared invalid, inoperative or void
for any reason by a court of competent jurisdiction, such decision, opinion or judgment shall in no way
impair the remaining portions, sections, or parts of sections of this ordinance, which said remaining
provisions shall be and remain in full force and effect.
SECTION 3.
That this ordinance shall be cumulative of Ordinance No. 18809 and all other ordinances and appropriations
amending the same except in those instances where the provisions of this ordinance are in direct conflict
with such other ordinances and appropriations, in which instance said conflicting provisions of said prior
ordinances and appropriations are hereby expressly repealed.
SECTION 4.
This ordinance shall take effect upon adoption.
APPROVEDWAttorn
/ND GALITY:
Assistant Cit
ADOPTED AND EFFECTIVE: November , 2009