App Submitted 6.30.25.pdf

City of Buckeye — Regular Council Meeting (2025-09-16)

Extracted text (via ocr_local) 39552 characters

Standard Applicant Information

Project Information

Project Title

Buckeye hiring of new career law enforcement
Officers dedicated to creating a human
trafficking, domestic violence, and sexual
assault team to increase common sense
community policing capacity.

Federal Estimated Funding (Federal
Share)

500000.0

Total Estimated Funding
930068.0

Proposed Project Start Date
10/1/25

Applicant Estimated Funding (Non-
Federal Share)

430068.0

Areas Affected by Project (Cities, Counties, States, etc.)

City of Buckeye

Type Of Applicant

Type of Applicant 1: Select Applicant Type:

C: City or Township Government

Type of Applicant 2: Select Applicant Type:

Type of Applicant 3: Select Applicant Type:

Other (specify):

Application Submitter Contact Information

Application POC Prefix Name

Application POC First Name
Rob

Application POC Suffix Name

Organizational Affiliation

City af Ruckeve

Application POC Middle Name

Title

Grant Pranram Mananer

Proposed Project End Date

9/30/28

Program Income Estimated Funding
0.0

Application POC Last Name
Roach

Email ID

rraach@bhuickavea7 anv

wry ee ene eee egrets sees beeen eeeige
Phone Number Fax Number

623-349-6165 —

ORINumber

Executive Order and Delinquent Debt Information

Is Application Subject to Review by State Under Executive Order 12372? *

b. Program is subject to E.O. 12372 but has not been selected by the State for review

Is the Applicant Delinquent on Federal Debt?
No

SF424 Attachments (2)

Name Date Added
-» Form SF424_4 0-V4.0.pdf 6/13/25

Name Date Added
ha | GrantApplication.xml 6/13/25

Authorized Representative

Law Enforcement Executive Information Government Executive Information
Title Title

Grant Program Manager Grant Program Manager

Prefix Name Prefix Name

Mr. Mr.

First Name Middle Name Last Name First Name Middle Name Last Name
Rob — Roach Rob — Roach
Suffix Name Suffix Name

Verify Legal Name, Doing Business As, and Legal Address

Legal Name Doing Business As
CITY OF BUCKEYE

UEI
WYJHKKNHLA38

Legal Address

Street 1

530 E MONROE AVE

Street 2

City State Zip/Postal Code
BUCKEYE AZ 85326
CongressionalDistrict Country

09 USA

Certification
The legal name + Doing Business As (DBA) and legal address define a unique entity in the system as represented in its entity profile. The profile legal

name and address is applicable to ALL applications and awards associated to this fiscal agent.

1. If this information is correct confirm/acknowledge to continue with completion of this application.

I confirm this is the correct entity.

Signer Name
Rob Roach

Certification Date / Time
06/30/2025 03:46 PM

2. If the information displayed does not accurately represent the legal entity applying for federal assistance:
a. Contact your Entity Administrator.
b. Contact the System for Award Management (SAM.gov) to update the entity legal name/address.

3. If the above information is not the entity for which this application is being submitted, Withdraw/Delete this application. Please initiate a new
application in Grants.gov with using the correct UEI/SAM profile.

Proposal Abstract

Data Requested with Application

> CHP NOFO FY2025

Proposal Narrative

Budget and Associated Documentation

Budget Summary
Budget Category Total Cost
Sworn Officer Positions: $930,068.00
Civilian or Non-Sworn Personnel: $0.00
Travel: $0.00
Equipment: $0.00
Supplies: $0.00
SubAwards: $0.00
Procurement Contracts: $0.00
Other Costs: $0.00
Total Direct Costs: $930,068.00
Indirect Costs: $0.00
Total Project Costs: $930,068.00
Federal Funds: $500,000.00
Match Amount: $430,068.00
Program Income: $0.00

Local Match Details

Local Match Progression Table

As part of the local match requirement for the COPS Hiring Program, grantees must assume a progressively larger share of the cost of the grant with
local funds over the three-year grant period. This means that your local match must increase each year, while the federal share must decrease.

Please project in the chart below how your agency plans to assume a progressively larger share of the grant cost during each year of the program. The
chart is only a projection of your plans. While your agency may deviate from these specific projects during the grant period, it must still ensure that the
federal share decreases and the local share increases.

Year 1 Year 2 Year 3 Total Total from Budget
Local Match $136,421 $143,242 $150,404 $430,068 $430,068
Federal Share $158,604 $166,534 $174,861 $500,000 $500,000
Total $295,025.79 $309,776.87 $325,265.34 $930,068 $930,068

Waiver of Local Match

The COPS Office may waive some or all of a grantee's local match requirement based on severe fiscal distress. During the application review process,
your agency's waiver request will be evaluated based on the availability of funding, a demonstration of sever fiscal distress as reflected through the fiscal
health data provided in the application, and a comparison of your fiscal health data with that of the overall applicant pool.

Budget / Financial Attachments
Additional Attachments

Name Category Created by Date Added
COPS Buckeye wage excel Budget Other Rob Roach 6/30/2025 12:52 PM
submission.xlsx

Budget and Associated Documentation
DOES THIS BUDGET CONTAIN CONFERENCE COSTS WHICH IS DEFINED BROADLY TO INCLUDE MEETINGS, RETREATS, SEMINARS, SYMPOSIA,

AND TRAINING ACTIVITIES?

Base Salary and Fringe Benefits for Sworn Officer

Sworn Officer

Position
Position Title Position Description
Sworn Officer Human Trafficking, domestic violence, and digital forensic investigation

Number of Positions

4
\ Salary per Officer
Salary Year 1 Year 2 Year 3
$68,515.00 $71,940.75 $75,538.16
~\ Fringe Benefits per Officer
Year 1 Year 2 Year 3
Social Security
6.2% 6.20% $4,247.93 $4,460.33 $4,683.37
Medicare
1.45% 1.45% $993.47 $1,043.14 $1,095.30
Health Insurance
Exempt $0.00 $0.00 $0.00

Life Insurance
Exempt $0.00 $0.00 $0.00

Vacation
Included in Salary? Hours
No —

Sick Leave

Included in Salary? Hours
No —

Retirement
Exempt

Workers Compensation
Exempt

Unemployment Insurance

Exempt

Other Benefit

None

Other Benefit

None

Other Benefit

None

$0.00

Summary Totals

Benefits per Officer
Salary per Officer
Total per Officer

Total per Officer All Years
$232,517
Total Salary and Benefits
$930,068

Personnel

Instructions

List each position by title and name of employee, if available. Show the annual salary rate and the percentage of time to be devoted to the project.

Year 1

$5,241.40

$68,515.0
0

$73,756.40

Year 2

$5,503.47

$71,940.7
5

$77,444.22

Year 3

$5,778.67

$75,538.1
6

$81,316.83

Compensation paid for employees engaged in grant activities must be consistent with that paid for similar work within the applicant organization. In the
narrative section, please provide a specific description of the responsibilities and duties for each position, and explain how the responsibilities and duties
support the project goals and objectives outlined in your application.

Year 1

Year 1
Personnel Detail

Name Position Salary Rate Time
Worked

No items

Personnel Total Cost
$0
Additional Narrative

Percentage Total
of Time (%) Cost

Fringe Benefits

Instructions

Fringe benefits should be based on the actual known costs or an approved negotiated rate by a Federal Agency. If not based on an approved negotiated rate,
list the composition of the fringe benefit package. Fringe benefits are for the personnel listed in Personnel budget category listed and only for the percentage

of time devoted to the project. In the narrative section, please provide a specific description for each item

Year 1

Fringe Benefit Detail

Name Base Rate (%) Total Cost

No items

Fringe Benefits Total Cost

$0
Additional Narrative

Travel

Instructions

Itemize travel expenses of staff personnel (e.g. staff to training, field interviews, advisory group meeting, etc.). Describe the purpose of each travel
expenditure in reference to the project objectives. Show the basis of computation (e.g., six people to 3-day training at $X airfare, $X lodging, $X
subsistence). In training projects, travel and meals for trainees should be listed separately. Show the number of trainees and the unit costs involved.
Identify the location of travel, if known; or if unknown, indicate "location to be determined." Indicate whether applicant's formal written travel policy or the
Federal Travel Regulations are followed. Note: Travel expenses for consultants should be included in the “Consultant Travel” data fields under the
“Subawards (Subgrants)/Procurement Contracts” category. For each Purpose Area applied for, the budget should include the estimated cost for travel
and accommodations for two staff to attend two three-day long meetings, with one in Washington D.C. and one in their region, with the exception of
Purpose Area 1, which should budget for one meeting in Washington D.C, and Purpose Areas 6 and 7, which should budget for 3 meetings within a 3
year period, with 2 in Washington D.C, and 1 within their region. All requested information must be included in the budget detail worksheet and budget

narrative.

Year 1

Travel Detail

Pu FPOSe | ocation Type of Basis
Travel Expense
No items

Travel Total Cost
$0

Quantity yop #of TotalCost = Non-Federal Federal
Staff Trips Contribution Request

Equipment

Instructions

List non-expendable items that are to be purchased (Note: Organization’s own capitalization policy for classification of equipment should be used).
Expendable items should be included in the “Supplies” category Applications should analyze the cost benefits of purchasing versus leasing equipment,
especially high cost items and those subject to rapid technological advances. Rented or leased equipment costs should be listed in the “Contracts” data fields
under the “Sub awards” (Sub grants)/Procurement Contracts” category. In the budget narrative, explain how the equipment is necessary for the success In
the budget narrative, explain how the equipment is necessary for the success of the project, and describe the procurement method to be used. All requested
information must be included in the budget detail worksheet and budget narrative.

Year 1
Equipment Detail

Equipment # of Cost ‘Total Non-Federal
Item Items Cost Contribution

Federal
Request

No items

Equipment Total Cost
$0

Supply Items
Instructions

List items by type (office supplies, postage, training materials, copy paper, and expendable equipment items costing less than $10,000, such as books,
hand held tape recorders) and show the basis for computation. Generally, supplies include any materials that are expendable or consumed during the
course of the project. All requested information must be included in the budget detail worksheet and budget narrative.

Year 1

Supply Item Detail

Purpose of # of Non-Federal Federal
Supply Items Items Unit Cost Total Cost Contribution Request

No items.

Supplies Total Cost
$0

Construction

Instructions

As arule, construction costs are not allowable. In some cases, minor repairs or renovations may be allowable. Consult with the DOJ grant-making
component before budgeting funds in this category. In the narrative section, please provide a specific description for each item, and explain how the item
supports the project goals and objectives outlined in your application.

Year 1

Construction Detail

Purpose of Description #of Cost Total Non-Federal Federal
Construction of Work Items Cost Contribution Request
No items

Construction Total Cost
$0

Subawards

Instructions

Subawards (see "Subaward" definition at 2 CFR 200.92) : Provide a description of the Federal Award activities proposed to be carried out by any
subrecipient and an estimate of the cost (include the cost per subrecipient, to the extent known prior to the application submission). For each
subrecipient, enter the subrecipient entity name, if known. Please indicate any subaward information included under budget category Subawards
(Subgrants) Contracts by including the label "(subaward)" with each subaward category.

Year 1

Subaward (Subgrant) Detail

Description Purpose Consultant Country State/U.S. City Total Non-Federal Federal
Territory Cost Contribution Request

No items.

Subawards Total Cost
$0
Add Consultant Travel

Procurement contracts (see “Contract” definition at 2 CFR 200.22): Provide a description of the product or service to be
procured by contract and an estimate of the cost. Indicate whether the applicant’s formal, written Procurement Policy or the
Federal Acquisition Regulation is followed. Applicants are encouraged to promote free and open competition in awarding
procurement contracts. A separate justification must be provided for sole source procurements in excess of the Simplified
Acquisition Threshold set in accordance with 41 U.S.C. 1908 (currently set at $250,000) for prior approval. Please provide a
specific description for each item, and explain how the item supports the project goals and objectives outlined in your
application. Consultant Fees: For each consultant enter the name, if known, service to be provided, hourly or daily fee (8-
hour day), and estimated time on the project. Unless otherwise approved by the COPS Office, approved consultant rates will
be based on the salary a consultant receives from his or her primary employer. Consultant fees in excess of $650 per day
require additional written justification, and must be pre-approved in writing by the COPS Office if the consultant is hired via
a noncompetitive bidding process. Please provide a specific description for each item, and explain how the item supports
the project goals and objectives outlined in your application. Please visit https://cops.usdoj.gov/grants for a list of allowable
and unallowable costs for this program.

Instructions

Procurement contracts (see “Contract” definition at 2 CFR 200.1): Provide a description of the product or service to be procured by contract and an
estimate of the cost. Indicate whether the applicant's formal, written Procurement Policy or the Federal Acquisition Regulation is followed. Applicants are
encouraged to promote free and open competition in awarding procurement contracts. A separate justification must be provided for noncompetitive
procurements in excess of the Simplified Acquisition Threshold set in accordance with 41 U.S.C. 1908 (currently set at $250,000).

Consultant Fees: For each consultant enter the name, if known, service to be provided, hourly or daily fee (8-hour day), and estimated time on the
project. Written prior approval and additional justification is required for consultant fees in excess of the DOJ grant-making component's threshold for an

8-hour day.

In the narrative section, please provide a specific description for each item, and explain how the item supports the project goals and objectives outlined
in your application.

Year 1

~\ Procurement Contract Detail

Description Purpose Consultant Country State/U.S. City Total Non-Federal Federal
Territory Cost Contribution Request

No items.

Do you need Consultant Travel?
No
Procurement Cost

Other Direct Costs
Instructions

List items (e.g., rent, reproduction, telephone, janitorial or security services, and investigative or confidential funds) by type and the basis of the
computation. For example, provide the square footage and the cost per square foot for rent, or provide a monthly rental cost and how many months to
rent. All requested information must be included in the budget detail worksheet and budget narrative.

Year 1
Other Cost Detail
Length
Description Quantity Basis Costs of Total Costs Non-Federal _ Federal
Time Contribution Request
No items

Other Costs Total Cost
$0

Additional Narrative

The Buckeye Police Department is not requesting funds for "Other".

Indirect Costs
Instructions

Indirect costs are allowed only if: a) the applicant has a current, federally approved indirect cost rate; or b) the applicant is eligible to use and elects to
use the “de minimis” indirect cost rate described in 2 C.F.R. 200.414(f). (See paragraph D.1.b. in Appendix VII to Part 200—States and Local
Government and Indian Tribe Indirect Cost Proposals for a description of entities that may not elect to use the “de minimis” rate.) An applicant with a
current, federally approved indirect cost rate must attach a copy of the rate approval, (a fully-executed, negotiated agreement). If the applicant does not
have an approved rate, one can be requested by contacting the applicant's cognizant Federal agency, which will review all documentation and approve a
rate for the applicant organization, or if the applicant's accounting system permits, costs may be allocated in the direct costs categories. (Applicant Indian
tribal governments, in particular, should review Appendix VII to Part 200—States and Local Government and Indian Tribe Indirect Cost Proposals
regarding submission and documentation of indirect cost proposals.) All requested information must be included in the budget detail worksheet and
budget narrative. In order to use the “de minimis” indirect rate an applicant would need to attach written documentation to the application that advises
DOJ of both the applicant's eligibility (to use the “de minimis” rate) and its election. If the applicant elects the de minimis method, costs must be
consistently charged as either indirect or direct costs, but may not be double charged or inconsistently charged as both. In addition, if this method is
chosen then it must be used consistently for all federal awards until such time as the applicant entity chooses to negotiate a federally approved indirect
cost rate.

Year 1

Indirect Cost Detail

Description Base

No items.

Indirect Costs Total Cost
$0
Additional Narrative

Indirect
Cost Non-Federal
Rate Total Cost Contribution

Federal
Request

Memoranda of Understanding (MOUs) and Other Supportive Documents

The recommended files to upload are PDF, Microsoft Word and Excel.

No documents have been uploaded for Memoranda of Understanding (MOUs) and Other Supportive Documents

Additional Application Components

Letters of Support

No documents have been uploaded for Letters of Support

Additional Attachments

Name
COPS Hiring Program

abstract narrative.docx

Name
Authorized

Representatives.docx

Category

Additional Application
Components Other

Created by
Rob Roach

Date Added
6/30/2025 3:35 PM

Date Added
6/30/2025 12:52 PM

Disclosures and Assurances

No Lobbying Activities

The applicant is not required to submit a lobbying disclosure under 31 U.S.C. 1352 for this application.

No documents have been uploaded for Disclosure of Lobbying Activities

DOJ Certified Standard Assurances

U.S. DEPARTMENT OF JUSTICE

CERTIFIED STANDARD ASSURANCES

On behalf of the Applicant, and in support of this application for a grant or cooperative agreement, | certify under penalty of perjury to the U.S. Department
of Justice ("Department"), that all of the following are true and correct:

(1) | have the authority to make the following representations on behalf of myself and the Applicant. | understand that these representations
will be relied upon as material in any Department decision to make an award to the Applicant based on its application.

(2) | certify that the Applicant has the legal authority to apply for the federal assistance sought by the application, and that it has the
institutional, managerial, and financial capability (including funds sufficient to pay any required non-federal share of project costs) to plan,
manage, and complete the project described in the application properly.

(3) | assure that, throughout the period of performance for the award (if any) made by the Department based on the application—-

a. the Applicant will comply with all award requirements and all federal statutes and regulations applicable to the award;

b. the Applicant will require all subrecipients to comply with all applicable award requirements and all applicable federal statutes and
regulations; and

c. the Applicant will maintain safeguards to address and prevent any organizational conflict of interest, and also to prohibit employees
from using their positions in any manner that poses, or appears to pose, a personal or financial conflict of interest.

(4) The Applicant understands that the federal statutes and regulations applicable to the award (if any) made by the Department based on
the application specifically include statutes and regulations pertaining to civil rights and nondiscrimination, and, in addition--

a. the Applicant understands that the applicable statutes pertaining to civil rights will include section 601 of the Civil Rights Act of 1964
(42 U.S.C. § 2000d); section 504 of the Rehabilitation Act of 1973 (29 U.S.C. § 794); section 901 of the Education Amendments of
1972 (20 U.S.C. § 1681); and section 303 of the Age Discrimination Act of 1975 (42 U.S.C. § 6102);

b. the Applicant understands that the applicable statutes pertaining to nondiscrimination may include section 809(c) of Title | of the
Omnibus Crime Control and Safe Streets Act of 1968 (34 U.S.C. § 10228(c)); section 1407(e) of the Victims of Crime Act of 1984 (34
U.S.C. § 20110(e)); section 299A(b) of the Juvenile Justice and Delinquency Prevention Act of 2002 (34 U.S.C. § 11182(b)); and that
the grant condition set out at section 40002(b)(13) of the Violence Against Women Act (34 U.S.C. § 12291(b)(13)), which will apply to
all awards made by the Office on Violence Against Women, also may apply to an award made otherwise;

c. the Applicant understands that it must require any subrecipient to comply with all such applicable statutes (and associated
regulations); and

d. on behalf of the Applicant, | make the specific assurances set out in 28 C.F.R. §§ 42.105 and 42.204.

(5) The Applicant also understands that (in addition to any applicable program-specific regulations and to applicable federal regulations that
pertain to civil rights and nondiscrimination) the federal regulations applicable to the award (if any) made by the Department based on the
application may include, but are not limited to, 2 C.F.R. Part 2800 (the DOJ "Part 200 Uniform Requirements") and 28 C.F.R. Parts 22
(confidentiality - research and statistical information), 23 (criminal intelligence systems), 38 (regarding faith-based or religious organizations
participating in federal financial assistance programs), and 46 (human subjects protection).

(6) | assure that the Applicant will assist the Department as necessary (and will require subrecipients and contractors to assist as necessary)
with the Department's compliance with section 106 of the National Historic Preservation Act of 1966 (54 U.S.C. § 306108), the Archeological
and Historical Preservation Act of 1974 (54 U.S.C. §§ 312501-312508), and the National Environmental Policy Act of 1969 (42 U.S.C.

§§ 4321-4335), and 28 C.F.R. Parts 61 (NEPA) and 63 (floodplains and wetlands).

(7) | assure that the Applicant will give the Department and the Government Accountability Office, through any authorized representative,
access to, and opportunity to examine, all paper or electronic records related to the award (if any) made by the Department based on the
application.

(8) If this application is for an award from the National Institute of Justice or the Bureau of Justice Statistics pursuant to which award funds

may be made available (whether by the award directly or by any subaward at any tier) to an institution of higher education (as defined at 34

U.S.C. § 10251(a)(17)), | assure that, if any award funds actually are made available to such an institution, the Applicant will require that,
throughout the period of performance--

a. each such institution comply with any requirements that are imposed on it by the First Amendment to the Constitution of the United
States; and

b. subject to par. a, each such institution comply with its own representations, if any, concerning academic freedom, freedom of inquiry
and debate, research independence, and research integrity, at the institution, that are included in promotional materials, in official
statements, in formal policies, in applications for grants (including this award application), for accreditation, or for licensing, or in
submissions relating to such grants, accreditation, or licensing, or that otherwise are made or disseminated to students, to faculty, or
to the general public.

(9) | assure that, if the Applicant is a governmental entity, with respect to the award (if any) made by the Department based on the
application--

a. it will comply with the requirements of the Uniform Relocation Assistance and Real Property Acquisitions Act of 1970 (42 U.S.C.
§§ 4601-4655), which govern the treatment of persons displaced as a result of federal and federally-assisted programs; and

b. it will comply with requirements of 5 U.S.C. §§ 1501-1508 and 7324-7328, which limit certain political activities of State or local
government employees whose principal employment is in connection with an activity financed in whole or in part by federal
assistance.

(10) If the Applicant applies for and receives an award from the Office of Community Oriented Policing Services (COPS Office), | assure that
as required by 34 U.S.C. § 10382(c)(11), it will, to the extent practicable and consistent with applicable law--including, but not limited to, the
Indian Self- Determination and Education Assistance Act--seek, recruit, and hire qualified members of racial and ethnic minority groups and
qualified women in order to further effective law enforcement by increasing their ranks within the sworn positions, as provided under 34
U.S.C. § 10382(c)(11).

(11) If the Applicant applies for and receives a DOJ award under the STOP School Violence Act program, | assure as required by 34 U.S.C.
§ 10552(a)(3), that it will maintain and report such data, records, and information (programmatic and financial) as DOJ may reasonably
require.

| acknowledge that a materially false, fictitious, or fraudulent statement (or concealment or omission of a material fact) in this certification, or
in the application that it supports, may be the subject of criminal prosecution (including under 18 U.S.C. §§ 1001 and/or 1621, and/or 34
U.S.C. §§ 10271-10273), and also may subject me and the Applicant to civil penalties and administrative remedies for false claims or
otherwise (including under 31 U.S.C. §§ 3729-3730 and 3801-3812). | also acknowledge that the Department's awards, including
certifications provided in connection with such awards, are subject to review by the Department, including by its Office of the Inspector
General.

Please Acknowledge

Signed

SignerlD

troach@buckeyeaz.gov

Signing Date / Time
6/17/25 12:29 PM

DOJ Certifications Regarding Lobbying; Debarment, Suspension and Other Responsibility Matters; and Drug-Free
Workplace Requirements; Law Enforcement and Community Policing

U.S. DEFARTMENT UF JUSTLUE

CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS; DRUG-FREE
WORKPLACE REQUIREMENTS; COORDINATION WITH AFFECTED AGENCIES

Applicants should refer to the regulations and other requirements 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 or other cited requirements before completing this form. The certifications
shall be treated as a material representation of fact upon which reliance will be placed when the U.S.
Department of Justice (“Department”) determines to award the covered transaction, grant, or cooperative

agreement.

1. LOBBYING

As required by 31 U.S.C. § 1352, as implemented by 28 C.F.R. Part 69, the Applicant certifies and assures (to
the extent applicable) the following:

(a)No Federal appropriated funds have been paid or will be paid, by or on behalf of the Applicant, to any
person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress,
an officer or employee of Congress, or an employee of a Member of Congress in connection with the making
of any Federal grant, the entering into of any cooperative agreement, or the extension, continuation,

renewal, amendment, or modification of any Federal grant or cooperative agreement;

(b)I£ the Applicant’s request for Federal funds is in excess of $100,000, and any funds other than
Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to
influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress,
or an employee of a member of Congress in connection with this Federal grant or cooperative agreement, the
Applicant shall complete and submit Standard Form - LLL, “Disclosure of Lobbying Activities” in

accordance with its (and any DOJ awarding agency’s) instructions; and

(c) The Applicant shall require that the language of this certification be included in the award
documents for all subgrants and procurement contracts (and their subcontracts) funded with Federal award
funds and shall ensure that any certifications or lobbying disclosures required of recipients of such
subgrants and procurement contracts (or their subcontractors) are made and filed in accordance with 31 U.S.C.
§ 1352.

2. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS

A, Pursuant to Department regulations on nonprocurement debarment and suspension implemented at 2 C.F.R. Part
2867, and to other related requirements, the Applicant certifies, with respect to prospective participants in
a primary tier “covered transaction,” as defined at 2 C.F.R. § 2867.20(a), that neither it nor any of its

principals--

(a) is presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial
of Federal benefits by a State or Federal court, or voluntarily excluded from covered transactions by any

Federal department or agency;

(b) has within a three-year period preceding this application been convicted of a felony criminal
violation under any Federal law, or been convicted or had a civil judgment rendered against it for
commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or
performing a public (Federal, State, tribal, or local) transaction or private agreement or transaction;
violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery,
falsification or destruction of records, making false statements, tax evasion or receiving stolen property,
making false claims, or obstruction of justice, or commission of any offense indicating a lack of business
integrity or business honesty that seriously and directly affects its (or its principals’) present

responsibility;

(c) is presently indicted for or otherwise criminally or civilly charged by a governmental entity
(Federal, State, tribal, or local) with commission of any of the offenses enumerated in paragraph (b) of

this certification; and/or

(d) has within a three-year period preceding this application had one or more public transactions

(Federal, State, tribal, or local) terminated for cause or default.

B. Where the Applicant is unable to certify to any of the statements in this certification, it shall

attach an explanation to this application. Where the Applicant or any of its principals was convicted,

within a three-year period preceding this application, of a felony criminal violation under any Federal
law, the Applicant also must disclose such felony criminal conviction in writing to the Department (for
OJP Applicants, to OJP at Qjpcompliancereporting@usdoj.gov; for OVW Applicants, to OVW at
OVW.GFMD@usdoj.gov; or for COPS Applicants, to COPS at AskCOPSRC@usdoj.gov), unless such disclosure has
already been made.

3. FEDERAL TAXES

A, If the Applicant is a corporation, it certifies either that (1) the corporation has no unpaid Federal tax
liability that has been assessed, for which all judicial and administrative remedies have been exhausted or
have lapsed, that is not being paid in a timely manner pursuant to an agreement with the authority
responsible for collecting the tax liability, or (2) the corporation has provided written notice of such an
unpaid tax liability (or liabilities) to the Department (for OJP Applicants, to OJP at
Qjpcompliancereporting@usdoj.gov; for OVW Applicants, to OVW at OVW.GFMD@usdoj.gov; or for COPS Applicants,
to COPS at AskCOPSRC@usdoj.gov).

B.Where the Applicant is unable to certify to any of the statements in this certification, it shall attach an
explanation to this application.

4, DRUG-FREE WORKPLACE (GRANTEES OTHER THAN INDIVIDUALS)

As required by the Drug-Free Workplace Act of 1988, as implemented at 28 C.F.R. Part 83, Subpart F, for
grantees, as defined at 28 C.F.R. §§ 83.620 and 83.650:

A.The Applicant certifies and assures 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 its workplace and specifying the actions that

will be taken against employees for violation of such prohibition;

(b) Establishing an on-going drug-free awareness program to inform employees about--

(1) The dangers of drug abuse in the workplace;

(2) The Applicant’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;

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 award, the employee will--

1) Abide by the terms of the statement; and
Y
(2)Notify the employer in writing of the employee’s conviction for a violation of a criminal drug

statute occurring in the workplace no later than five calendar days after such conviction;

(e) Notifying the Department, in writing, within 10 calendar days after receiving notice under
subparagraph (da) (2) from an employee or otherwise receiving actual notice of such conviction. Employers of
convicted employees must provide notice, including position title of any such convicted employee to the

Department, as follows:
For COPS award recipients - COPS Office, 145 N Street, NE, Washington, DC, 20530;

For OJP and OVW award recipients - U.S. Department of Justice, Office of Justice Programs, ATTN:
Control Desk, 999 North Capitol Street, NE Washington, DC 20531.

Notice shall include the identification number(s) of each affected award;

(£) Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph

(a) (2), with respect to any employee who is so convicted:

(iy tekiny appiopirace persounes abeion ayaiuse suc au Cupsoyee, up LO anu iuciuuiny CeLminacton,

consistent with the requirements of the Rehabilitation Act of 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; and

(g) Making a good faith effort to continue to maintain a drug-free workplace through implementation of
paragraphs (a), (b), (c), (a), (e), and (£).

5. COORDINATION REQUIRED UNDER PUBLIC SAFETY AND COMMUNITY POLICING PROGRAMS

As required by the Public Safety Partnership and Community Policing Act of 1994, at 34 U.S.C. § 10382(c)
(5), if this application is for a COPS award, the Applicant certifies that there has been appropriate
coordination with all agencies that may be affected by its award. Affected agencies may include, among
others, Offices of the United States Attorneys; State, local, or tribal prosecutors; or correctional

agencies.

I acknowledge that a materially false, fictitious, or fraudulent statement (or concealment or omission of a
material fact) in this certification, or in the application that it supports, may be the subject of criminal
prosecution (including under 18 U.S.C. §§ 1001 and/or 1621, and/or 34 U.S.C. $§ 10271-10273), and also may
subject me and the Applicant to civil penalties and administrative remedies for false claims or otherwise
(including under 31 U.S.C. S$ 3729-3730 and 3801-3812). I also acknowledge that the Department’s awards,
including certifications provided in connection with such awards, are subject to review by the Department,

including by its Office of the Inspector General.

Please Acknowledge *
Certified

SignerID
troach@buckeyeaz.gov

Signing Date / Time
6/17/25 12:29 PM

Other Disclosures and Assurances

No documents have been uploaded for Other Disclosures and Assurances

Other

Declaration and Certification to the U.S. Department of Justice as to this Application Submission
By [taking this action], | --

1. Declare the following to the U.S. Department of Justice (DOJ), under penalty of perjury: (1) | have authority to make this declaration and
certification on behalf of the applicant; (2) | have conducted or there was conducted (including by the applicant's legal counsel as
appropriate, and made available to me) a diligent review of all requirements pertinent to and all matters encompassed by this declaration
and certification.

2. Certify to DOJ, under penalty of perjury, on behalf of myself and the applicant, to the best of my knowledge and belief, that the following
are true as of the date of this application submission: (1) | have reviewed this application and all supporting materials submitted in
connection therewith (including anything submitted in support of this application by any person on behalf of the applicant before or at the
time of the application submission and any materials that accompany this declaration and certification); (2) The information in this
application and in all supporting materials is accurate, true, and complete information as of the date of this request; and (3) | have the
authority to submit this application on behalf of the applicant.

3. Declare the following to DOJ, under penalty of perjury, on behalf of myself and the applicant: (1) | understand that, in taking (or not
taking) any action pursuant to this declaration and certification, DOJ will rely upon this declaration and certification as a material
representation; and (2) | understand that any materially false, fictitious, or fraudulent information or statement in this declaration and
certification (or concealment or omission of a material fact as to either) may be the subject of criminal prosecution (including under 18
U.S.C. §§ 1001 and/or 1621, and/or 34 U.S.C. §§ 10271-10273), and also may subject me and the applicant to civil penalties and
administrative remedies under the federal False Claims Act (including under 31 U.S.C. §§ 3729-3730 and/or §§ 3801-3812) or otherwise.

Please Acknowledge #*

Signed

SignerlD

troach@buckeyeaz.gov
Signing Date / Time

6/17/25 12:29 PM

No documents have been uploaded for Other

Certified