LSTA 2025 General Assurances and Certifications.pdf

City of Buckeye — Special (2025-08-26)

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Assurances and Certifications for  
2025 Arizona LSTA Subgrant Award 
 
A. Nondiscrimination  
 
The applicant shall comply with the following nondiscrimination statutes and their implementing 
regulations:  
 
• 
Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C. § 2000a et seq., which 
prohibits discrimination on the basis of race, color, or national origin (note: as clarified by 
Executive Order Number 13166, the applicant must take reasonable steps to ensure that 
persons with limited English proficiency (LEP) have meaningful access to the applicant's 
programs, see Institute of Museum and Library Servs.; Guidance to Federal Financial 
Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination 
Affecting Limited English Proficient Persons, 68 Fed. Reg. 47099 (Aug. 7, 2003)); 
• 
Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. § 701 et seq., 
including § 794, which prohibits discrimination on the basis of disability (note: IMLS applies 
the regulations in 45 C.F.R. Part 1181in determining compliance with Section 504 as it 
applies to recipients of Federal assistance); 
• 
Title IX of the Education Amendments of 1972, as amended, (20 U.S.C. § 1681 et seq.), 
which prohibits discrimination on the basis of sex in education programs; 
• 
The Age Discrimination in Employment Act of 1975, as amended, 42 U.S.C. § 6101et seq.), 
which prohibits discrimination on the basis of age; and 
• 
The requirements of any other nondiscrimination statute(s) which may apply to the 
application. 
 
B. Debarment and Suspension  
 
The applicant will comply with 2 C.F.R. Part 3185 and 2 C.F.R. Part 180, as applicable. The 
authorized representative, on behalf of the applicant, certifies to the best of his or her knowledge 
and belief that neither the applicant nor any of its principals: 
 
1. are presently excluded or disqualified;  
2. have been convicted of, or have a civil judgement rendered against you for, any of the 
offenses listed in 2 C.F.R. § 180.800(a) within preceding three years;  
3. are presently indicted for or otherwise criminally or civilly charged by a governmental entity 
(Federal, state, or local) with commission of any of the offenses listed in 2 C.F.R. § 
180.800(a); or  
4. have had one or more public transactions (Federal, state, or local) terminated within the 
preceding three years for cause or default.

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Where the applicant is unable to certify to any of these statements, the authorized representative, 
on behalf of the applicant, shall attach an explanation to this form. 
 
The applicant is required to comply with 2 C.F.R. Part 180, subpart C (Responsibilities of 
Participants Regarding Transactions Doing Business with Other Persons) as a condition of 
participation in the award. The applicant is also required to communicate the requirement to 
comply with 2 C.F.R. Part 180 (Subpart C) (Responsibilities of Participants Regarding Transactions 
Doing Business with Other Persons) to persons at the next lower tier with whom the applicant 
enters into covered transactions. 
 
As noted in the preceding paragraph, applicants who plan to use IMLS awards to fund contracts 
should be aware that they must comply with the communication and verification requirements set 
forth in the above Debarment and Suspension provisions. 
 
C. Federal Debt Status 
 
The authorized representative, on behalf of the applicant, certifies to the best of his or her 
knowledge and belief that the applicant is not delinquent in the repayment of any Federal debt, 
including but not limited to unpaid Federal tax liability. 
 
D. Drug-Free Workplace  
 
The authorized representative, on behalf of the applicant, certifies, as a condition of the award, 
that the applicant will or will continue to provide a drug-free workplace by complying with the 
requirements in 2 C.F.R. Part 3186 (Requirements for Drug-Free Workplace (Financial Assistance)). 
In particular, the applicant must comply with drug-free workplace requirements in Subpart B of 2 
C.F.R. Part 3186, which adopts the Governmentwide implementation (2 C.F.R. Part 182) of 
Sections 5152-5158 of the Drug-Free Workplace Act of 1988, 41 U.S.C. §§ 8101-8106. This 
includes, but is not limited to: making a good faith effort, on a continuing basis, to maintain a drug-
free workplace; publishing a drug-free workplace statement; establishing a drug-free awareness 
program for employees; taking actions concerning employees who are convicted of violating drug 
statutes in the workplace; and identifying (either at the time of application or upon award, or in 
documents kept on file in the recipient’s offices) all known workplaces under Federal awards.  
 
E. Trafficking in Persons  
The authorized representative, on behalf of the applicant, certifies, as a condition of the award, 
that the applicant will comply with the trafficking in persons requirements that are set out in 
Appendix A. 
 
F. Prohibitions Against Lobbying, Publicity, and Propaganda 
 
In accordance with Federal appropriations law, no IMLS funds may be used for publicity or 
propaganda purposes for the preparation, distribution, or use of any kit, pamphlet, booklet, 
publication, electronic communication, radio, television, or video presentation designed to 
support or defeat the enactment of legislation before the Congress or any state or local legislature 
or legislative body, or designed to support or defeat any proposed or pending regulation, 
administrative action, or order issued by the executive branch of any state or local government. No 
IMLS funds may be used to pay the salary or expenses of any grant or contract recipient, or agent 
acting for such recipient, related to any activity designed to influence the enactment of legislation,

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appropriations, regulation, administrative action, or Executive Order proposed or pending before 
the Congress or any State government, State legislature, or local legislature or legislative body. 
 
G. Certification Regarding Lobbying Activities 
 
(Applies to applicants requesting funds in excess of $100,000, see 31 U.S.C. § 1352.) 
 
The authorized representative certifies, to the best of his or her knowledge and belief, that: 
 
1. no Federally appropriated funds have been paid or will be paid, by or on behalf of the 
authorized representative, to any person for influencing or attempting to influence an 
officer or employee of an agency; a member of Congress, an officer or employee of 
Congress, or an employee of a member of Congress in connection with the awarding of any 
Federal contract, the making of any Federal grant, the making of any Federal loan, the 
entering into of any cooperative agreement, and the extension, continuation, renewal, 
amendment, or modification of any Federal contract, grant, loan, or cooperative 
agreement; 
2. if any funds other than Federal appropriated funds have been paid or will be paid to any 
person (other than a regularly employed officer or employee of the applicant, as provided in 
31 U.S.C. § 1352) for influencing or attempting to influence an officer or employee of any 
agency, a member of Congress, an officer or employee of Congress, or an employee of a 
member of Congress in connection with this Federal contract, grant, loan, or cooperative 
agreement, the authorized representative shall complete and submit Standard Form LLL, 
“Disclosure of Lobbying Activities,” in accordance with its instructions; and 
3. the authorized representative shall require that the language of this certification be 
included in the award documents for all subawards at all tiers (including subcontracts and 
contracts under grants, loans, and cooperative agreements) and that all subrecipients shall 
certify and disclose accordingly.  
 
This certification is a material representation of fact upon which reliance is placed when the 
transaction is made or entered into. Submission of this certification is a prerequisite for making or 
entering into the transaction imposed by 31 U.S.C. § 1352. Any person who fails to file the required 
certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 
for each such failure.  
 
H. Criminal Disclosures and Reporting of Matters Related to Recipient Integrity and 
Performance 
 
An applicant for, recipient, or subrecipient of a Federal award must promptly disclose whenever, in 
connection with the Federal award (including any activities or subawards thereunder), it has 
credible evidence of the commission of a violation of Federal criminal law involving fraud, conflict 
of interest, bribery, or gratuity violations found in Title 18 of the United States Code or a violation of 
the civil False Claims Act (31 U.S.C. 3729-3733). The disclosure must be made in writing to the 
Federal agency, IMLS’s Office of the General Counsel, and pass-through entity (if applicable) (2 
C.F.R. § 200.113 and 2 C.F.R. Part 3185.) 
 
I. Acknowledgement of IMLS Support 
 
All materials publicizing or resulting from grant activities must contain an acknowledgement of 
IMLS support, unless IMLS advises otherwise. This includes invitations, brochures, and signage;

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audio/video programming for radio, television, or web broadcast; and websites, social media, 
PowerPoint presentations, and e-mail announcements. (See Grantee Communications Kit, 
available at www.imls.gov, for specific guidance). 
 
The type of recognition varies according to the type of activity. Please use the following guidelines 
for acknowledgement: 
 
• 
Written materials must include a credit line indicating IMLS as a source of support. 
• 
Graphic items such as posters or brochures should include the IMLS logo (see Grantee 
Communications Kit, available at www.imls.gov) displayed in accordance with the Logo 
Standards Guide. 
• 
Online products, digital publications, and websites should include links to the IMLS 
website, www.imls.gov. 
• 
Audio/video broadcasts must include a tagline indicating IMLS as a source of support. 
Video broadcasts should display the IMLS logo. 
 
In materials that contain or present substantive project content, such as an exhibition, article, 
catalogue, or other publication, video documentary, or online exhibition or website, the 
acknowledgement must also include the following statement: 
 
"The views, findings, conclusions or recommendations expressed in this 
[publication/program/exhibition/website/article] do not necessarily represent those of the 
Institute of Museum and Library Services or the U.S. Government." 
 
If you have any question about whether your product requires this statement, contact the IMLS 
Office of Communications and Public Liaison. 
 
J. Acknowledgement of Federal Support 
 
When issuing statements, press releases, requests for proposals, bid solicitations and other 
documents describing projects or programs funded in whole or in part with Federal money, all 
awardees receiving IMLS-appropriated funding, including but not limited to State and local 
governments and recipients of Federal research grants, shall clearly state: 
 
1. the percentage of the total costs of the program or project which will be financed with 
Federal money; 
2. the dollar amount of Federal funds for the project or program; and 
3. the percentage and dollar amount of the total costs of the project or program that will 
be financed by non-governmental sources. 
 
K. General Certification 
 
The authorized representative, on behalf of the applicant, certifies that the applicant will comply 
with all applicable requirements of all other Federal laws, executive orders, regulations, and 
policies governing this program. 
 
L. Certifications Required for Certain Projects 
 
The following certifications are required if applicable to the project for which an application 
is being submitted. Applicants should be aware that additional Federal certifications, not

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listed below, might apply to a particular project. 
 
1. Native American Human Remains and Associated Funerary Objects 
 
The authorized representative, on behalf of the applicant, certifies that the applicant 
will comply with the provisions of the Native American Graves Protection and 
Repatriation Act of 1990 (25 U.S.C. § 3001 et seq.), which applies to any organization 
that controls or possesses Native American human remains, associated funerary 
objects and/or cultural items and which receives Federal funding, even for a purpose 
unrelated to the Act. 
 
2. Historic Properties 
 
The authorized representative, on behalf of the applicant, certifies that the applicant 
will assist the awarding agency in ensuring compliance with section 106 of the National 
Historic Preservation Act of 1966, as amended, 54 U.S.C. § 306101, Executive Order 
Number 11593, and any related applicable preservation laws. 
 
3. Environmental Protections 
 
The authorized representative, on behalf of the applicant, certifies that the applicant 
will comply with environmental standards, including the following: 
 
a. Institution of environmental quality control measures under the National 
Environmental Policy Act of 1969, as amended, 42 U.S.C. § 4321 et seq.) and 
Executive Order Number 11514; 
 
b. Notification of violating facilities pursuant to Executive Order Number 11738; 
 
c. Protection of wetlands pursuant to Executive Order Number 11990, as 
amended by Executive Order Number 12608; 
 
d. Evaluation of flood hazards in floodplains in accordance with Executive Order 
Number 11988, as amended (see Executive Order No. 12148); 
 
e. Assurance of project consistency with the approved state management 
program developed under the Coastal Zone Management Act of 1972, as 
amended, 16 U.S.C. § 1451 et seq.); 
 
f. Conformity of Federal actions to State (Clean Air) Implementation Plans under 
section 176(c) of the Clean Air Act of 1990, as amended, 42 U.S.C. § 7 401 et 
seq.); 
 
g. Protection of underground sources of drinking water under the Safe Drinking 
Water Act of 197 4, as amended, 42 U.S.C. § 300f et seq.); and 
 
h. Protection of endangered species under the Endangered Species Act of 1973, 
as amended, 16 U.S.C. § 1531 et seq.).

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The authorized representative, on behalf of the applicant, certifies that the project 
will comply with the Wild and Scenic Rivers Act of 1968, as amended, 16 U.S.C. § 
1271 et seq.), related to protecting components or potential components of the 
national wild and scenic rivers system. 
 
The authorized representative, on behalf of the applicant, certifies that the 
applicant will comply with the flood insurance purchase requirements of the 
National Flood Insurance Act of 1968, 9s amended, and the Flood Disaster 
Protection Act of 1973, as amended, 42 U.S.C. § 4001 et seq., which requires 
recipients in a special flood hazard area to participate in the program and to 
purchase flood insurance if the total cost of insurable construction and acquisition 
is $10,000 or more, or as otherwise designated. 
 
4. Research on Human Subjects 
 
The authorized representative, on behalf of the applicant, certifies that the applicant 
will comply with 45 C.F.R. Part 46 regarding the protection of human subjects involved 
in research, development, and related activities supported by this award of assistance. 
 
5. Research on Animal Subjects 
 
The authorized representative, on behalf of the applicant, certifies that the applicant 
will comply with the Animal Welfare Act of 1966, as amended, 7 U.S.C. § 2131 et seq.), 
pertaining to the care, handling, and treatment of warm-blooded animals held for 
research, teaching, or other activities supported by this award of assistance. 
 
M. Whistleblower Protections 
 
In accordance with 2 CFR 200.217 Whistleblower protections, an employee of a recipient must not 
be discharged, demoted, or otherwise discriminated against as a reprisal for disclosing to a person 
or body described in paragraph (a)(2) of 41 U.S.C. 4712 information that the employee reasonably 
believes is evidence of gross mismanagement of a Federal contract or grant, a gross waste of 
Federal funds, an abuse of authority relating to a Federal contract or grant, a substantial and 
specific danger to public health or safety, or a violation of law, rule, or regulation related to a 
Federal contract (including the competition for or negotiation of a contract) or grant. The recipient 
must inform their employees in writing of employee whistleblower rights and protections under 41 
U.S.C. 4712. See statutory requirements for whistleblower protections at 10 U.S.C. 4701, 41 U.S.C. 
4712, 41 U.S.C. 4304, and 10 U.S.C. 4310. 
 
N. Internal Controls 
 
In accordance with 2 CFR 200.303 Internal controls, the recipient must: 
 
1. Establish, document, and maintain effective internal control over the Federal award that 
provides reasonable assurance that the recipient is managing the Federal award in 
compliance with Federal statutes, regulations, and the terms and conditions of the Federal 
award. These internal controls should align with the guidance in “Standards for Internal 
Control in the Federal Government” issued by the Comptroller General of the United States 
or the “Internal Control-Integrated Framework” issued by the Committee of Sponsoring

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Organizations of the Treadway Commission (COSO). 
 
2. Comply with the U.S. Constitution, Federal statutes, regulations, and the terms and 
conditions of the Federal award. 
 
3. Evaluate and monitor the recipient's or subrecipient’s compliance with statutes, 
regulations, and the terms and conditions of Federal awards. 
 
4. Take prompt action when instances of noncompliance are identified. 
 
5. Take reasonable cybersecurity and other measures to safeguard information including 
protected personally identifiable information (PII) and other types of information. This also 
includes information the Federal agency or pass-through entity designates as sensitive or 
other information the recipient or subrecipient considers sensitive and is consistent with 
applicable Federal, State, local, and tribal laws regarding privacy and responsibility over 
confidentiality. 
 
O. Procurement of Recovered Materials 
 
1. A recipient or subrecipient that is a State agency or agency of a political subdivision of a 
State and its contractors must comply with section 6002 of the Solid Waste Disposal Act, 
as amended by the Resource Conservation and Recovery Act of 1976 as amended, 42 
U.S.C. 6962. The requirements of Section 6002 include procuring only items designated in 
the guidelines of the Environmental Protection Agency (EPA) at 40 CFR part 247 that contain 
the highest percentage of recovered materials practicable, consistent with maintaining a 
satisfactory level of competition, where the purchase price of the item exceeds $10,000 or 
the value of the quantity acquired during the preceding fiscal year exceeded $10,000; 
procuring solid waste management services in a manner that maximizes energy and 
resource recovery; and establishing an affirmative procurement program for procurement 
of recovered materials identified in the EPA guidelines. 
 
2. The recipient or subrecipient should, to the greatest extent practicable and consistent with 
law, purchase, acquire, or use products and services that can be reused, refurbished, or 
recycled; contain recycled content, are biobased, or are energy and water efficient; and are 
sustainable. This may include purchasing compostable items and other products and 
services that reduce the use of single-use plastic products. See Executive Order 14057, 
section 101, Policy. 
 
ACKNOWLEDGEMENT AND SIGNATURE 
 
These assurances and certifications are provided in connection with any and all financial 
assistance from IMLS after the date this form is signed. This includes payments after such date for 
financial assistance approved before such date. The applicant recognizes and agrees that any such 
assistance will be extended in reliance on the representations and agreements made in this 
assurance, and that the United States shall have the right to seek judicial enforcement of this 
Statement of Assurances and Certifications. These assurances and certifications are binding on 
the applicant, its successors, transferees, and assignees, and on the Authorized Certifying Official 
whose signature appears below.

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The undersigned further provides assurances that it will include, as applicable, the language of the 
assurances and certifications in all subawards and that all subrecipients shall certify and disclose 
accordingly.  
 
As the duly authorized representative of the applicant, I hereby certify that the applicant will 
comply with the above assurances and certifications.  
 
 
 __________________________________________ 
 __________________________________________ 
Signature of Authorized Certifying Official  
 
Library Name 
 
 ____________________________________________________________________________________________ 
 
Print Name and Title of Authorized Certifying Official 
 
 __________________________________________ 
Date

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Appendix A 
Trafficking in Persons 
 
The applicant must comply with Federal law pertaining to trafficking in persons. Under 22 U.S.C. § 
7104(g), any grant, contract, or cooperative agreement entered into by a federal agency under 
which funds are to be provided to a private entity shall include a condition that authorizes the 
Federal agency (IMLS) to terminate the grant, contract, or cooperative agreement, or take other 
authorized actions, if the grantee or any subgrantee, or the contractor or any subcontractor, 
engages in, or uses labor recruiters, brokers, or other agents who engage in trafficking in persons, 
the procurement of a commercial sex act, the use of forced labor, or acts that directly support or 
advance trafficking in persons. 2 C.F.R. Part 175 requires IMLS to include the following award term, 
which is made a part of this Statement of Assurances and Certifications: 
 
(a) Provisions applicable to a recipient that is a private entity. 
 
1) Under this award, the recipient, its employees, subrecipients under this award, and 
subrecipients' employees may not engage in: 
 
i. Severe forms of trafficking in persons; 
 
ii. The procurement of a commercial sex act during the period of time that this 
award or any subaward is in effect; 
 
iii. The use of forced labor in the performance of this award or any subaward; or 
 
iv. Acts that directly support or advance trafficking in persons, including the 
following acts: 
 
A. Destroying, concealing, removing, confiscating, or otherwise 
denying an employee access to that employee's identity or 
immigration documents; 
 
B. Failing to provide return transportation or pay for return 
transportation costs to an employee from a country outside the 
United States to the country from which the employee was recruited 
upon the end of employment if requested by the employee, unless: 
 
1) Exempted from the requirement to provide or pay for such 
return transportation by the Federal department or agency 
providing or entering into the grant or cooperative 
agreement; or 
 
2) The employee is a victim of human trafficking seeking victim 
services or legal redress in the country of employment or a 
witness in a human trafficking enforcement action; 
 
C. Soliciting a person for the purpose of employment, or offering 
employment, by means of materially false or fraudulent pretenses, 
representations, or promises regarding that employment;

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D. Charging recruited employees a placement or recruitment fee; or 
 
E. Providing or arranging housing that fails to meet the host country's 
housing and safety standards. 
 
2) The Federal agency may unilaterally terminate this award or take any remedial 
actions authorized by 22 U.S.C. 7104b(c), without penalty, if any private entity under 
this award: 
 
i. Is determined to have violated a prohibition in paragraph (a)(1) of this 
appendix; or 
 
ii. Has an employee that is determined to have violated a prohibition in 
paragraph (a)(1) of this appendix through conduct that is either: 
 
A. Associated with the performance under this award; or 
 
B. Imputed to the recipient or the subrecipient using the standards and 
due process for imputing the conduct of an individual to an 
organization that are provided in 2 C.F.R. Part 180 “OMB Guidelines 
to Agencies on Government-wide Debarment and Suspension 
(Nonprocurement),” as implemented by IMLS at 2 C.F.R. Part 3185. 
 
(b) Provision applicable to a recipient other than a private entity. 
 
1) The Federal agency may unilaterally terminate this award or take any remedial 
actions authorized by 22 U.S.C. 7104b(c), without penalty, if a subrecipient that is a 
private entity under this award: 
 
i. Is determined to have violated a prohibition in paragraph (a)(1) of this 
appendix; or 
 
ii. Has an employee that is determined to have violated a prohibition in 
paragraph (a)(1) of this appendix through conduct that is either: 
 
A. Associated with the performance under this award; or 
 
B. 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 C.F.R. Part 180 “OMB Guidelines to Agencies on 
Government-wide Debarment and Suspension (Nonprocurement),” 
as implemented by IMLS at 2 C.F.R. Part 3185. 
 
(c) Provisions applicable to any recipient. 
 
1) The recipient must inform the Federal agency and the Inspector General of the 
Federal agency immediately of any information you receive from any source alleging 
a violation of a prohibition in paragraph (a)(1) of this appendix.

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2) The Federal agency’s right to unilaterally terminate this award as described in 
paragraph (a)(2) or (b)(1) of this appendix: 
 
i. Implements the requirements of 22 U.S.C. 78, and 
 
ii. Is in addition to all other remedies for noncompliance that are available to 
the Federal agency under this award. 
 
3) The recipient must include the requirements of paragraph (a)(1) of this award term 
in any subaward it makes to a private entity. 
 
4) If applicable, the recipient must also comply with the compliance plan and 
certification requirements in 2 CFR 175.105(b). 
 
(d) Definitions. For purposes of this award term: 
 
Employee means either: 
 
1) An individual employed by the recipient or a subrecipient who is engaged in the 
performance of the project or program under this award; or 
 
2) Another person engaged in the performance of the project or program under this 
award and not compensated by the recipient 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 requirements. 
 
Private Entity means any entity, including for-profit organizations, nonprofit 
organizations, institutions of higher education, and hospitals. The term does not 
include foreign public entities, Indian Tribes, local governments, or states as defined by 
2 CFR 200.1. 
 
The terms “severe forms of trafficking in persons,” “commercial sex act,” “sex 
trafficking,” “Abuse or threatened abuse of law or legal process,” “coercion,” “debt 
bondage,” and “involuntary servitude” have the meanings given at section 103 of the 
TVPA, as amended (22 U.S.C. 7102).