UNSIGNED GRANT AGREEMENT 011916.PDF

DPS Grant Agreement No. 2015-250
ARIZONA DEPARTMENT OF PUBLIC SAFETY
VICTIMS OF CRIME ACT (VOCA)
VICTIM ASSISTANCE GRANT PROGRAM
FEDERAL GRANT #2015-VA-GX-0032
CFDA #16-575
SUB GRANT AWARD AGREEMENT
SUBRECIPIENT
AGENCY: Maricopa County Attorney's Office
ADDRESS: 301 W. Jefferson, Suite 800
CITY: Phoenix STATE: AZ ZIP: 85003-2163
2015/2016 AWARD AMOUNT: $148,705
2015/2016 REQUIRED MATCH (NON-FEDERAL SOURCE): $37,176
PROJECT PERIOD: 10/01/2015 to 09/30/2016
PROJECT PURPOSE: To provide assistance to victims of crime.
42 This USC agreement 10601, et is seq made as under the authority of the Victims of Crime Act of 1984, Public Law 98-473, Title II, Chapter XIV,
amended.
provide The purpose services of this agreement shall be to award Victims of Crime Act (VOCA) Assistance funds to the subrecipient to
federal, state, local, to and victims private of crime as authorized by the Victims of Crime Act. Awards may be supplemented by other
this Subgrant Award Agreement. funds. Subrecipient's agreement or amended agreement(s) is incorporated by reference into
This award is subject to agreement by the subrecipient, including any DPS VOCA funded positions and their immediate
program supervisors, guidelines; to conform to the provisions of the Victims of Crime Act of 1984; the UPS VOCA victim assistance grant
most recent version of the the subrecipient's Office of Justice application; Programs the attached general conditions and applicable special conditions; the
A-133; Executive Order 12372; and 28 CFR pts. 66 and Financial 70, all Guide; of which OMB are circulars incorporated A-21, A-87, A-102, A-110, A-122,
herein. by reference as if fully stated
specifically Subrecipients, and all their contractors, will comply with all lawful requirements imposed by the awarding agency,
term in 2 CFR including § 175.15 any (b); applicable section 106 regulations, of the such as 28 CFR pts. 18, 22, 23, 30, 35, 38, 42, 61, and 63, and the award
11593; the Archaeological and Historical Preservation National Act Historic of 1974 Preservation (16 USC § Act 469 of 1966 (16 USC § 470); Executive Order
Policy Act of 1969 (42 USC § 4321); and any applicable statutorily-imposed a-1 et seq.); the National Environmental
include Title VI of the Civil Rights Act of 1964 (42 USC § 2000d and 28 nondiscrimination CFR § 42.101 et seq); requirements, Section 504 which of may the
6102 Rehabilitation and 28 CFR Act § of 42.700 1973 et (29 USC § 794 and 28 CFR § 42.501 et seq); the Age Discrimination Act of 1975 (42 USC §
Omnibus Crime Control and Safe seq); Streets Title IX Act of of the Education Amendments of 1972 (20 USC § 1681 and 28 CFR pt 54); the
and Delinquency Prevention Act of 2002(42 USC 1968 § 5672(b)); (42 USC § 3789d and 28 CFR § 42.201 et seq); the Juvenile Justice
10604(e)); Title II of the Americans with Disabilities Act of Section 1990 (42 1407 USC of the Victims of Crime Act of 1984 (42 USC §
Treatment for Faith-Based Organizations (28 CFR pt 38 and Executive Order §12131-34 13279); and and 28 CFR pt. 35); and Equal
2009-09. The above referenced federal and state laws prohibit discrimination on the basis of State race, Executive color, religion, Order No.
and disability, prohibit and national origin (including limited English proficiency) in the delivery of services and employment practices, sex,
discrimination on the basis of age in the delivery of services.
Act Governmental of 1970 (42 entities USC § will 4601 comply et seq.), with and the 5 USC requirements of Uniform Relocation Assistance and Real Property Acquisitions
and local government employees whose principal §§ 1501-08 and §§ 7324-28 which limit certain political activities of State
by federal assistance. employment is in connection with an activity financed in whole or in part
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DP S Grant Agreement No. 2015-250
The Arizona Department of Public Safety agrees to pay subrecipient the above shown AWARD AMOUNT subject to the
conditions provided herein:
General Conditions
1.0 Definition of Terms. As used in this subgrant award agreement, the terms listed below are defined as
follows:
1.1 "Agreement" means a written online Request for Grant Application (RFGA) approved by the Arizona
Department of Public Safety.
1.2 "Agreement Amendment" means a written online document approved by the Arizona Department of Public
Safety that is requested by the subrecipient agency for the purpose of making changes in the agreement.
1.3 "Application" means a written online Request for Grant Application (RFGA).
1.4 "Days" means calendar days unless otherwise specified.
1.5 "Direct Service" means supportive services provided through direct contact with a victim in-person, by
phone or hotline, or by email.
1.6 "Director" means the head of the Arizona Department of Public Safety, or his/her designee, who is duly
authorized by the State to enter into grant agreements and make written determinations with respect to those
agreements.
1.7 "DPS" means the Arizona Department of Public Safety.
1.8 "Grant" means the furnishing of financial or other assistance, including state or federal grant funds, by the
Department of Public Safety to any person for the purpose of supporting or stimulating educational, cultural,
social or economic quality of life.
1.9 "Gratuity" means a payment, loan, subscription, advance, deposit of money, services, or anything of more
than nominal value, present or promised, unless consideration of substantially equal or greater value is
received.
1.10 "Match" means additional resources (cash or in-kind) provided by the subrecipient to support the DPS
VOCA funded project. Cash match shall be from a non-Federal source.
"Project" means activities and services supported by Victims of Crime Act (VOCA) funds plus required
match, relating to this subgrant award agreement only.
1.12 "Services" means the furnishing of labor, time or effort by a subrecipient which does not involve the delivery
of a specific end product other than required reports and performance. Allowable services include those
efforts that (1) respond to the emotional and physical needs [healing] of crime victims; (2) assist primary and
secondary victims of crime to stabilize [restitution/economic restabilization] their lives after a victimization;
(3) assist victims to understand and participate in the criminal [justice] system; and (4) provide victims of
crime with a measure of [safety] and security.
1.13 "State" means the State of Arizona and Department or Agency of the State that executes the subgrant award
agreement.
1.14 "Subgyant award agreement" means a written signed agreement between the Arizona Department of Public
Safety and the grant recipient for the award of DPS VOCA funds.
1.15 "Subrecipient" means the legal entity to which a subaward is made and which is accountable to DPS for the
use of the funds provided.
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1.16 "VOCA" means Victims of Crime Act of 1984, as amended, 42 USC 10601, et seq.
2.0 Subgrant award agreement interpretation.
2.1 Arizona Law. The Arizona law applies to this grant award agreement, including the Solicitation and Award
of Grants, Arizona Revised Statutes (A.R.S.) Title 41, Chapter 24, and its implementing rules.
2.2 Subgrant Award Agreement Order of Precedence. In the event of a conflict in the provisions of the subgrant
award agreement, as accepted by the State and as they may be amended, the following shall prevail in the
order set forth below:
2.2.1 Special Conditions;
2.2.2 General Conditions;
2.2.3 DPS / VOCA Guidelines;
2.2.4 Federal VOCA Guidelines; OJP Financial Guide; applicable OMB circulars; and Uniform Administrative
Requirements, Cost Principles, and Audit Requirements in 2 C.F.R. Part 200.
2.3 Relationship of parties. The subrecipient under this subgrant award agreement is an independent
subrecipient. Neither party to this subgrant award agreement shall be deemed to be the employee or agent of
the other party to the subgrant award agreement.
2.4 Severability. The provisions of this subgrant award agreement are severable. Any condition deemed illegal
or invalid shall not affect any other condition of the subgrant award agreement.
2.5 No parol evidence. This subgrant award agreement is intended by the parties as a final and complete
expression of their agreement. No prior dealings between the parties shall supplement or explain any terms
used in this document and no other understanding either oral or in writing shall be binding.
2.6 No waiver. Either party's failure to insist on strict performance of any condition of the subgrant award
agreement shall not be deemed a waiver of that condition even if the party accepting or acquiescing in the
nonconforming performance knows of the nature of the performance and fails to object to it.
3.0 Subgrant award agreement administration and operation.
3.1 Non-Discrimination. The subrecipient shall comply with State Executive Order No. 2009-09 and all other
applicable Federal and State laws, rules and regulations related to the prohibition against discrimination,
including Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Age
Discrimination Streets Act of 1968, Act of the 1975, Juvenile Title IX of the Education Amendments of 1972, the Omnibus Crime Control and Safe
1984, the Americans with Disabilities Justice Act and of Delinquency 1990, Department Prevention of Act of 2002, the Victims of Crime Act of
Treatment for Faith-Based Organizations. Justice implementing regulations and Equal
In the event a federal or state court or administrative agency makes a finding of discrimination after a due
process hearing against the subrecipient agency on the grounds of race, color, national origin, religion, sex,
or disability, the subrecipient shall forward a copy of the finding to the Department of Justice, Office of
Justice Programs, Office for Civil Rights and DPS.
3.1.1 Providing Services to Limited English Proficiency (LEP) Individuals. In accordance with Department of
Justice guidance, recipients (and subrecipients) of Federal financial assistance shall take reasonable steps to
provide meaningful access to their programs and activities for persons with limited English proficiency
(LEP).
3.1.2 Faith-Based Organi7ations. Department of Justice regulations prohibit faith-based organizations from using
financial assistance from the Department of Justice to fund inherently religious activities. While faith-based
organizations can engage in non-funded inherently religious activities, they shall be held separately from the
Department of Justice funded program, and customers or beneficiaries cannot be compelled to participate in
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DPS Grant Agreement No. 2015-250
them. Regulation also makes clear that organizations participating in programs funded by the Department of
Justice are not permitted to discriminate in the provision of services on the basis of a beneficiary's religion.
3.1.3 Equal Employment Opportunity Plan. The subrecipient acknowledges that failure to submit an acceptable
Equal Employment Opportunity Plan (if required to submit one pursuant to 28 CFR Section 42.302) that is
approved by the Office for Civil Rights is a violation of its Standard Assurances and may result in
suspension or termination of funding, until such time as the subrecipient is in compliance.
3.1.4 Civil Rights Compliance Review. The subrecipient shall provide relevant information regarding civil rights
policies and procedures during the DPS-VOCA Civil Rights Compliance Review process.
3.2 Certification Regarding Lobbying. Subrecipient agencies entering into a VOCA grant or cooperative
the agreement subrecipient, over $100,000 shall certify that no Federal funds have been paid or will be paid, by or on behalf of
agency, a Member to any of persons for influencing or attempting to influence an officer or employee of any
Congress in connection Congress, with the making an officer of any or Federal employee of Congress, or an employee of a Member of
and the extension, continuation, renewal, amendment, grant, or modification the entering into of any cooperative agreement,
agreement. Federal funds include but are not limited to such grants as of Victims any Federal of Crime grant Act or cooperative (VOCA),
Violence Against Women Act (VAWA), Family Violence Prevention and Services Act (Rural Safe Home
Network governmental Program), and the Children's Justice Act, which may be administered through a State or other local
have been paid agency. or will be Additionally, paid with any subrecipient funds other agencies than Federal shall funds. disclose to DPS any lobbying activities that
3.2.1 Lobbying Activities. The subrecipient understands and agrees that it cannot use any federal funds, either
directly or indirectly, in support of the enactment, repeal, modification or adoption of any law, regulation or
policy, at any level of government.
3.3 required Required by reports. DPS, to The subrecipient will submit reports on such data in such form and at such times as
include:
3.3.1 Monthly financial report due the 15'h of each month;
3.3.3 3.3.2 Quarterly statistical and programmatic report due 30 days following the close of each quarter;
Annual narrative report due 30 days following the close of the grant period;
3.3.4 DPS victim assistance survey due annually upon request; and
3.3.5 Year-end Amendment Agreement, if applicable, due 30 days following the close of the grant period.
three Failure to submit complete, accurate and timely reports may result in a reduction of the current award. Any
combined combined occurrences of monthly or quarterly reports submitted over 15 days late and/or three
may result occurrences in up to a 10% relating award to reduction the submission as of incomplete or inaccurate monthly or quarterly reports
determined by DPS.
3.3.6 If DPS determines that the subrecipient has failed to meet the acceptable standard for maintaining financial
and/or programmatic documentation or is identified as a high risk subrecipient, additional fmancial or
programmatic documentation may be required.
3.4 Records. The subrecipient shall retain all financial records, supporting documentation, statistical records and
all other records pertinent to this award until March 31 of the seventh year following the year indicated in the
Federal Grant Number of this Subgrant Award Agreement. (Federal Grant #2015-VA-GX-0032 plus seven
years — keep through March 31 of that seventh year). In addition, with a 24-hour notice, the subrecipient will
allow DPS and the Department of Justice's Office for Victims of Crime and/or the Office of the Chief
Financial Officer (or their representatives) to review all of the subrecipient's records concerning this grant
project.
3.5 Capital equipment. Any purchase of capital equipment shall be approved by DPS prior to purchase to
include submission of the subrecipient's procurement or purchasing policies and procedures and related
quote(s) for item purchase. The subrecipient shall maintain all capital equipment and furniture (costs in
excess of $5,000 per unit) purchased through this subgrant award agreement in accordance with the OW
Financial All capital Guide. The subrecipient shall submit documentation relevant to the purchase as required by DPS.
equipment and furniture shall be used for victim services as identified in the subrecipient's
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writing application by DPS. and this subgrant award agreement. Any deviation from this provision shall be approved in
3.6 Authorization of use. DPS reserves a royalty-free, non-exclusive, and irrevocable license to reproduce,
publish or otherwise use, and authorize others to use for government purposes, the copyright of any work
developed under this award and any rights of copyright to which a subrecipient purchases ownership with
support through this subgrant award agreement.
3.7 Research or statistical information. The subrecipient shall not use or reveal any research or statistical
information under this project that is identifiable to any specific person except for the purpose for which the
information was obtained, in accordance with VOCA.
3.8 Site inspections. The continuance of the subrecipient's subgrant award agreement is contingent upon
successful completion of random or for-cause inspections. Failure to satisfactorily comply with Required
Action items identified during the site inspection can result in termination of the subgrant award agreement.
3.9 200.500 Audit requirements. et seq.) of the The subrecipient shall comply with the audit requirements of Title 2 F.F.R. Subpart F (§
Federal Awards and the Uniform DPS VOCA Administrative guidelines. Requirements, If an audit is Cost required, Principles, a copy and of the Audit audit Requirements for
sent to DPS. report shall be
3.10 Financial statement availability. The nonprofit subrecipient shall make its financial statements available
online (either on the subrecipient's or another publicly available website). Subrecipient organizations that
have Federal 501(c)(3) tax status are considered in compliance with this requirement to the extent that such
organizations file IRS Form 990 or similar tax documents (e.g., 990-EZ), as several sources already provide
searchable online databases of such financial statements.
3.11 Certification of nonprofit status. The nonprofit subrecipient shall certify its nonprofit status by submitting a
statement to DPS affirmatively asserting that the subrecipient is a nonprofit organization, and by providing
either - 1) a copy of its 501(c)(3) designation letter; 2) a letter from the Arizona Department of Revenue or
Arizona Attorney General's Office stating that the subrecipient is a nonprofit organization operating within
Arizona; or 3) a copy of the agency's Arizona certificate of incorporation that substantiates its nonprofit
status. Subrecipients that are local nonprofit affiliates of Arizona or national nonprofits should have
available proof of (1), (2) or (3), and a statement by the Arizona or national parent organization that the
subrecipient is a local nonprofit affiliate.
3.12 Potential credible fraud, waste, abuse or misconduct. The subrecipient shall promptly notify DPS in writing of any
submitted evidence a false that claim a principal, for grant employee, funds agent, contractor, subcontractor, or other person has either 1)
violation of laws pertaining to fraud, conflict under of the interest, False Claims Act; or 2) committed a criminal or civil
award funds. bribery, gratuity, or similar misconduct involving
No subrecipient under this award may require any employee or contractor to sign an internal confidentiality
agreement (in or statement that prohibits or otherwise restricts, or purports to prohibit or restrict, the reporting
accordance with law) of waste, fraud, or abuse to an investigative or law enforcement representative of a
federal department or agency authorized to receive such information. The foregoing is not intended to
contravene requirements applicable to Standard Form 312 (which relates to classified information), Form
4414 (which relates to sensitive compartmented information), or any other form issued by a federal
department or agency governing the nondisclosure of classified information.
3.13 Prohibited activities. The following activities are prohibited under this subgrant award agreement:
I. New construction. 2. Any renovation or remodeling of a property either (a) listed on or eligible for listing
on the National Register of Historical Places or (b) located within a 100-year floodplain. 3. A renovation
which will change the basic prior use of a facility or significantly change its size. 4. Research and
technology 5. Implementation whose anticipated and future application could be expected to have an effect on the environment.
of a program involving the use of chemicals.
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3.14 Subgrant award agreement renewal. DPS has the option to renew this project for a specified additional time
period. The renewal of this project is contingent upon satisfactory performance, availability of funds, and
demonstrated need.
3.15 System for Award Management. The subrecipient agrees to comply with applicable requirements regarding
registration with the System for Award Management (SAM). After the initial registration, subrecipients are
required to review and update the information at least annually and more frequently if required by changes in
the subrecipient's information or another award item. Additional information about registration procedures
may be found at the SAM website (www.sam.gov ).
4.0 Cost and Payments.
4.1 Available funds. Any award is dependent upon receipt of the VOCA Assistance funds from the U.S.
Department of Justice, and there is no obligation on the part of DPS to award funds other than the federal
VOCA.
4.2 Match waiver. Any award made with a match waiver pending approval from the U.S. Department of Justice
is subject to reduction if the match waiver is not approved.
4.3 Compliance. Failure of the subrecipient to utilize DPS VOCA funds for direct services to crime victims or
for training purposes as stated in the approved budget may be subject to immediate cancellation. The
subrecipient shall not utilize VOCA funds for projects which serve perpetrators of crime or crime prevention,
and/or for any other non-allowable cost or activity in accordance with DPS / VOCA guidelines. The
subrecipient agrees to reimburse DPS for any VOCA funds the subrecipient expends that are not in full
compliance with this subgrant award agreement.
4.4 No charge to victims. Subrecipients shall provide services to crime victims, at no charge, through the
VOCA-funded project. The purpose of the VOCA victim assistance grant program is to provide services to
all crime victims regardless of their ability to pay for services rendered or availability of insurance or other
third-party payment resources.
4.5 On-call time. The subrecipient shall not utilize VOCA funds to support on-call time for staff. DPS may
approve the use of on-call time as program match.
4.6 Non-supplantation. VOCA crime victim assistance funds will be used to enhance or expand services and
shall not be used to supplant state and local funds that would otherwise be available for crime victim
services. See Section 1404(a)(2)(c), codified at 42 USC 10603(a)(2)(C). This supplantation clause applies to
state and local public agencies only.
4.7 Mandated services. The subrecipient shall not utilize VOCA funds to support legally mandated services.
4.8 Funds management. The subrecipient shall provide appropriate accounting and monitoring procedures to
ensure fiscal control and efficient management of funds, in accordance with the U.S. Department of Justice,
Office of Justice Programs, Financial Guide, effective edition.
4.9 Unexpended funds. The subrecipient shall immediately contact DPS to make arrangements to amend its
budget to expend remaining funds or to reduce the contracted amount when it becomes apparent that not all
VOCA grant funds will be expended by the end of the grant period. Any VOCA funds not expended or
encumbered prior to the end of the award period shall be reverted to DPS within 30 days of the close of the
grant period. Any funds not matched as required shall be reverted to DPS within 30 days of receipt of
written notification from DPS.
4.10 Matching funds. The subrecipient shall commit, track and report matching funds at approximately the same
percentage rate as expenditures. The subrecipient may commit, track and report match funds at a higher
percentage rate each month, not to exceed the total required match amount. The subgrant award agreement is
subject to cancellation if the required match funding committed, tracked, and reported each month is more
than 10% less than the rate of expenditures.
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4.11 Training and conference expense. The subrecipient agrees to comply with all applicable laws, regulations,
policies, and guidance (including specific cost limits, prior approval and reporting requirements, where
applicable) governing the use of federal funds for expenses related to conferences, meetings, training, and
other events, including the provision of food and/or beverage and costs of attendance at such events.
4.12 Prohibited any expense. The subrecipient shall not utilize VOCA funds, either directly or indirectly, in support of
subsidiaries. contract with the Association of Community Organizations for Reform Now (ACORN) or its
4.13 Training or training materials. The subrecipient understands and agrees that any training or training
Guiding materials developed or delivered with funding provided under this award shall adhere to the OW Training
Principles for Grantees and Subgrantees, available at
http://www.oip.usdoj.gov/funding/ojptrainingguidingprinciples.htm.
4.14 Duplicate funding. The subrecipient agrees that if it currently has an open award of federal or state
funds or if it receives an award of federal or state funds other than this award, and those award funds have
been, are being, or are to be used, in whole or in part, for one or more of the identical cost items for which
funds are being provided under this award, the subrecipient shall promptly notify DPS and, if so requested by
DPS, seek an agreement amendment request to eliminate any duplication of funding.
5.0 Subgrant Award Agreement Changes.
5.1 Agreement Arizona Amendment. This subgrant award agreement is issued under the authority of the Director of the
DPS and may be modified only through an Agreement Amendment, approved by DPS.
5.2 Assignment of duties. The subrecipient shall not assign or transfer any of its duties under this agreement
without express written permission of DPS.
5.3 Scope of work. Awards are based on information presented in the subrecipient's on-line application. Any
deviation from the scope of the project as stated in the Narrative and Budget sections of the subrecipient's
application shall be approved in writing by DPS prior to the use of such funds.
5.4 Subcontracts. The subrecipient shall not enter into any subcontract under this subgrant award agreement
without the advance written approval of DPS. The subrecipient shall clearly list any proposed subcontractors
and the subcontractor's proposed responsibilities in the application for funding or agreement amendment.
The subcontract shall incorporate by reference the terms and conditions of this subgrant award agreement.
6.0 Indemnification.
its Subrecipient departments, Indemnification. The parties to this subgrant award agreement agree that the State of Arizona,
subrecipient for vicarious agencies, boards and commissions shall be indemnified and held harmless by the
parties further agree that the liability State of of the State as a result of entering into this agreement. However, the
responsible for its own negligence. Each Arizona, party to its this departments, contract is responsible agencies, boards for its and own commissions shall be
negligence.
7.0 Grant Remedies.
7.1 Right to Assurance. If DPS in good faith has reason to believe that the subrecipient does not intend to, or is
unable to perform or continue performing under this subgrant award agreement, DPS may demand in writing
that the subrecipient give a written assurance of intent to perform. Failure by the subrecipient to provide
written assurance within the number of days specified in the demand may, at DPS's option, be the basis for
terminating available the subgrant award agreement under the General Conditions or other rights and remedies
by law or provided by the subgrant award agreement.
7.2 Project implementation. If a project is not operational within 60 days of the original start date of the project
period, the subrecipient shall submit written documentation to DPS explaining steps taken to initiate the
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DP S Grant Agreement No. 2015-250
the project, original the reasons for the delay, and the expected start date. If a project is not operational within 90 days of
start date of the project period, the subrecipient shall submit a second written statement
is explaining not operational the implementation within 90 days delay. of the DPS reserves the right to cancel the agreement if the proposed project
original start date.
8.0 Grant Termination.
8.1 Cancellation for conflict of interest. Pursuant to A.R.S. § 38-511, the State may cancel this agreement
without penalty or further obligation if any person significantly involved in initiating, negotiating, securing,
extension drafting or of creating the the agreement on behalf of the State is or becomes at any time while the agreement or an
with respect to the agreement subject is in effect an employee of or a consultant to any other party to this agreement
receives written notice of matter the cancellation of the agreement. The cancellation shall be effective when the subrecipient
political subdivision of the State, it may also unless cancel the this notice agreement specifies a later time. If the subrecipient is a
event of cancellation under this paragraph, any unexpended funds as received provided by in the A.R.S. § 38-511. In the
reverted within 30 days of the cancellation notification. subrecipient shall be
8.2 determines Gratuities. DPS may, by written notice, terminate this subgrant award agreement, in whole or in part, if DPS
subrecipient that to any employment or a gratuity was offered or made by the subrecipient or a representative of the
award or in securing officer the subgrant or employee of the state for the purpose of influencing the outcome of the grant
favorable treatment concerning the subgrant award agreement, award an amendment to the subgrant award agreement, or
decision about subgrant award agreement performance. agreement, DPS, including in addition the to making any other of any determination or
shall be entitled to recover exemplary damages in the amount of three times the value of rights the gratuity or remedies, offered
by the subrecipient.
8.3 Suspension or Debarment. DPS may, by written notice to the subrecipient, immediately terminate this
lawfully subgrant award agreement if DPS determines that the subrecipient has been debarred, suspended or otherwise
but not limited prohibited to, from being or ineligible for participation in federal assistance programs or activities, including
governmental body. Submittal disapproved of an application as a subcontractor of any public procurement unit or other
shall attest that the subrecipient is not currently for suspended funding or or execution debarred. of a subgrant award agreement
suspended or debarred, the subrecipient shall immediately notify DPS. If the subrecipient becomes
8.4 in Termination part any time, for convenience. when in the DPS reserves the right to terminate the subgrant award agreement, in whole or
notice, the subrecipient shall stop best all interest work as of directed DPS without in the penalty or recourse. Upon receipt of the written
the event of termination under this paragraph, any unexpended notice funds and received minimize all further costs to DPS. In
reverted within 30 days of the termination notification. by the subrecipient shall be
8.5 Termination for default. In addition to the rights reserved in the contract, DPS may terminate the subgrant
condition award agreement of the in whole or in part due to the failure of the subrecipient to comply with any term or
agreement. An subgrant award is award subject agreement to or to make satisfactory progress in performing the subgrant award
encumbered within 4 months of the cancellation contact start date, if less 40% than within 20% of the awarded funds are expended or
DPS shall provide a 30-day written notice of termination and the reasons 7 months, for termination and 70% to within the 10 months.
In the event of termination under this paragraph, any unexpended funds received by the subrecipient subrecipient. shall be
reverted calendar within days of 30 the days date of of the the termination notification. The subrecipient has the option to appeal within 20
the DPS Director or his designee. written notice of termination. The fmal decision will be at the discretion of
8.6 with Continuation the of performance through termination. The subrecipient shall continue to perform, in accordance
termination requirements notice. of the subgrant award agreement, up to the date of termination, as directed in the
8.7 agreement. Termination by subrecipient. Upon written notice to DPS, the subrecipient may cancel this subgrant award
Any unexpended funds shall immediately be reverted to DPS.
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9.0 Arbitration.
The parties to this subgrant award agreement agree to resolve all disputes arising out of or relating to this
subgrant award agreement through arbitration, after exhausting applicable administrative review, to the
extent required by A.R.S. § 12-1518 except as may be required by other applicable statutes (Title 41).
10.0 Other Service Requirements.
10.1 Collaboration. The subrecipient agrees to continually and proactively participate in developing partner
relationships among other service providers in the effort to aid crime victims within the community served.
10.2 Demographics. The subrecipient agrees to maintain information on victim services provided through this
project by race, national origin, sex, age and disability.
10.3 Key staff changes. The subrecipient agrees to promptly notify DPS of changes in key staff members
identified in the grant application, to include Project Contact, Civil Rights Contact, Crime Victim
Compensation Coordinator, Project Director, Financial Contact, Authorizing Official, and VOCA funded
staff and/or staff used as match.
10.4 Vacancies. The subrecipient agrees to promptly notify DPS in writing when any VOCA funded employee
position is vacated, and when any VOCA funded employee position is filled.
10.5 Surveys. The subrecipient agrees to utilize customer feedback surveys to assist the agency with contracted
project outcome and quality measures. Feedback and satisfaction surveys will utilize the Liken Scale of
Measurement (Strongly Agree, Agree, Neither Agree or Disagree, Disagree, Strongly Disagree).
10.6 Victim Compensation. The subrecipient agrees to assist eligible victims in seeking available crime victim
compensation benefits provided by the state victim compensation program. The subrecipient shall designate
a Victim Compensation Coordinator within its agency. The Victim Compensation Coordinator shall receive
victim compensation training from his/her county attorney's office or complete the Arizona Criminal Justice
Commission (ACJC) on-line Introduction to Crime Victim Compensation training module
subrecipient (http://www.azejc.gov/ACJC.Web/victirrilcbttraining.aspx) shall arrange for and attend training . If training has not been received, the
agreement or 90 days after reassignment of new staff within in this 90 role. days from the first day of this subgrant award
10.7 Victims' Rights. The subrecipient agrees to notify victims of Victims' Rights (A.R.S. Title 13, Chapter 40
Crime Victims' Rights; and A.R.S. Title 8, Chapter 3, Article 7 Victims' Rights for Juvenile Offenses) and to
offer to connect the victim with a representative from the prosecutor's or county attorney's office if the
victim so chooses. Subrecipients shall ensure that all DPS-VOCA funded and match staff and their first line
supervisor have received victims' rights training from a the Arizona Attorney General's Office.
10.8 Civil Rights. The subrecipient shall designate a Civil Rights Contact Person within its agency. This person
shall complete the on-line civil rights training program offered by the Office for Civil Rights (OCR), Office
of Justice Programs (0JP), Department of Justice (DOJ) via the Arizona Criminal Justice Commission
(ACJC) website. The subrecipient shall ensure the Civil Rights Contact Person completes the training within
90 days from the first day of this subgrant award agreement or 90 days after reassignment of new staff in this
role.
10.9 Volunteers. The subrecipient agrees to incorporate the use of volunteers to assist in carrying out the agency's
mission. The use of volunteers is a current and ongoing requirement for all projects.
10.10 Text messaging policy. Pursuant to Executive Order 13513, "Federal Leadership on Reducing Text
Messaging While Driving," 74 Fed. Reg. 51225 (October 1, 2009), the Department of Justice (D0J)
encourages subrecipients to adopt and enforce policies banning employees from text messaging while driving
any vehicle during the course of performing work funded by this grant, and to establish workplace safety
policies and conduct education, awareness, and other outreach to decrease crashes caused by distracted
drivers.
9

DPS Grant Agreement No. 2015-250
2015 - 2016
APPROVED BUDGET
Budget line items: Federal Match Total
Salaries and Wages $92,720 $37,176 $129,896
Fringe Benefits $38,990 $ 0 $38,990
Travel $ 0 $ 0 $ 0
Professional/Outside Services $ 0 $ 0 $ 0
Equipment $ 0 $ 0 $ 0
Other Operating $16,995 $ 0 $16,995
Total $148,705 $37,176 $185,881
1 0

DPS Grant Agreement No. 2015-250
For the Arizona Department of Public Safety:
Frank L. Milstead, Colonel Date
Director
Arizona Department of Public Safety
This Subgrant Award Agreement has been approved as to form by the Arizona Department of
Public Safety Legal Section as of December 16, 2015
For the Sub-recipient:
Project Director:
Signature:
Shawn Cox, Victim Services Division Chief Clint L. Hickman
Chairman, Maricopa County
Board of Supervisors
Date: Date:
Authorizing Official: ATTEST:
Signature:
William G. Montgomery Clerk of the Board
County Attorney
Date: Date:
Approved as to form:
Attorney for Subrecipient (optional)
11

CERTIFICATION FORM
Compliance with the Equal Employment Opportunity Plan (EEOP) Requirements
Please completes read Section carefully A or the C Instructions (see below) and then complete Section A or Section B or Section C, not all three. If recipient
and sub-grants a single award over $500,000, in addition, please complete Section D.
Recipient's Name:
Address:
Is agency a; o Direct or o Sub recipient of OJP, OVW or COPS funding? Law Enforcement Agency? o Yes o No
DUNS Number: Vendor Number (only if direct recipient)
Name and Title of Contact Person:
Telephone Number: E-Mail Address:
Section A—Declaration Claiming Complete Exemption from the EEOP Requirement
Please check all the following boxes that apply.
o Less than fifty employees. o Indian Tribe o Medical Institution.
o Nonprofit Organization o Educational Institution o Receiving a single award(s) less than $25,000.
I,
certify that [responsible official],
is not required to prepare an EEOP for the reason(s) checked above, pursuant to 28 C.F.R § 42.302. [recipient]
I further certify that
with applicable federal civil rights laws that prohibit discrimination in employment and in the delivery [recipient] of services. will comply
If recipient sub-grants a single award over $500,000, in addition, please complete Section D
Print or Type Name and Title Signature
Date
Section B—Declaration Claiming Exemption from the EEOP Submission Requirement and Certifying
That an EEOP Is on File for Review
If the a recipient recipient agency agency does has fifty not or more employees and is receiving a single award or, subawarcZ of $25,000 or more, but less than $500,000, then
have to submit an EEOP to the OCR for review as long as it certifies the following (42 C.F.R j" 42.305):
I,
official], certify that [responsible
than [recipient], $500,000, which has has fifty or more employees and is receiving a single award or subaward for $25,000 or more, but less
twenty-four months, formulated the proper an EEOP in accordance with 28 CFR pt. 42, subpt. E. I further certify that within the last
federal law, it is available for review authority by the has public, formulated and signed into effect the EEOP and, as required by applicable
Civil Rights, Office of Justice Programs, U.S. Department employees, of the appropriate state planning agency, and the Office for
Justice. The EEOP is on file at the following office:
[organization],
[address].
1 Print or Type Name and Title Signature
Date
Section C—Declaration Stating that an EEOP Short Form Has Been Submitted to the Office for Civil
Rights for Review
If must a recipient send an agency EEOP Short has fifty Form or to more the employees OCR for review. and is receiving a single award, or subaward, of $500,000 or more, then the recipient agency
I,
official], certify that [responsible
EEOP [recipient], in accordance which has with fifty or more employees and is receiving a single award of $500,000 or more, has formulated an
28 CFR pt. 42, subpt. E, and sent it for review on
[date] to the Office for Civil Rights, Office of Justice Programs, U.S. Department of Justice.
If recipient sub-grants a single award over $500,000, in addition, please complete Section D
Print or Type Name and Title Signature
Date

Section D—Declaration Stating that Recipient Subawards a Single Award Over $500,000
If a recipient agency, subcrwards a single award of $500,000 or more then the granting agency should provide a list; including, name, address and
DUNS # of each such sub-recipient.
Sub-Recipient Agency Name/Address Sub-Recipient DUNS Number
If additional space in necessary, please duplicate this page.
OMB Control No. 1121-0340 Expiration Date: 12131/2015

INSTRUCTIONS Completing the Certification Form Compliance with the Equal Employment
Opportunity Plan (EEOP) Requirements
The federal regulations implementing the Omnibus Crime Control and Safe Streets Act (Safe Streets Act) of 1968, as
amended, require some recipients of financial assistance from the U.S. Department of Justice subject to the statute's
administrative provisions to create, keep on file, submit to the Office for Civil Rights (OCR) at the Office of Justice
Programs (02) for review, and implement an Equal Employment Opportunity Plan (EEOP). See 28 C.F.R. pt. 42, subpt.
E. All awards from the Office of Community Oriented Policing Services (COPS) are subject to the EEOP requirements;
many awards from OW, including awards from the Bureau of Justice Assistance (BJA), the Office of Juvenile Justice and
Delinquency Prevention (OHDP), and the Office for Victims of Crime (OVC) are subject to the EEOP requirements; and
many awards from the Office on Violence Against Women (OVW) are also subject to the EEOP requirements. If you
have any questions as to whether your award from the U.S. Department of Justice is subject to the Safe Streets Act's
EEOP requirements, please consult your grant award document, your program manager, or the OCR
Recipients should complete either Section A or Section B or Section C, not all three. If recipient completes Section
A or C and sub-grants a single award over $500,000, in addition, please complete Section D.
Section A
The regulations exempt some recipients from all of the EEOP requirements. Your organization may claim an exemption
from all of the EEOP requirements if it meets any of the following criteria: it is a nonprofit organization, an educational
institution, a medical institution, or an Indian tribe; or it received an award under $25,000; or it has less than fifty
employees. To claim the complete exemption from the EEOP requirements, complete Section A.
Section B
Although the regulations require some recipients to create, maintain on file, and implement an EEOP, the regulations
allow some recipients to forego submitting the EEOP to the OCR for review. Recipients that (1) are a unit of state or local
government, an agency of state or local government, or a private business; and (2) have fifty or more employees; and (3)
have received a single grant award of $25,000 or more, but less than $500,000, may claim the limited exemption from the
submission requirement by completing Section B. In completing Section B, the recipient should note that the EEOP on
file has been prepared within twenty-four months of the date of the most recent grant award.
SMion
Recipients that (1) are a unit of state or local government, an agency of state or local government, or a private business,
and (2) have fifty or more employees, and (3) have received a single grant award of $500,000 or more, must prepare,
maintain on file, submit to the OCR for review, and implement an EEOP. Recipients that have submitted an EEOP
Utilization Report (or in the process of submitting one) to the OCR, should complete Section C.
Section D
Recipients that (1) receive a single award over $500,000; and (2) subaward a single award of $500,000 or more must
provide a list; including, name, address and DUNS # of each such sub-recipient by completing Section D.
Submission Process
Recipients should download the online Certification Form, complete required sections, have the appropriate official sign
it, electronically scan the signed document, and then send the signed document to the following e-mail address:
EEOPForms@usdoj.gov . The document must have the following title: EEOP Certification. If you have questions about
completing or submitting the Certification Form, please contact the Office for Civil Rights, Office of Justice Programs,
810 7th Street, NW, Washington, DC 20531 (Telephone: (202) 307-0690 and TTY: (202) 307-2027).
OMB Approval No. 1121-0340 Expiration Date: 12/31115

Public Reporting Burden Statement
Paperwork of Reduction Act Notice. Under the Paperwork Reduction Act, a person is not required to respond to a collection
information unless it displays a current valid OMB control number. We try to create forms and instructions that are
accurate, can be easily understood, and which impose the least possible burden on you to provide us with information.
The estimated minimum average time to complete and file this application is 20 minutes per form. If you have any
comments regarding the accuracy of this estimate, or suggestions for making this form simpler, you can write to the
Office of Justice Programs, 810 7th Street, N.W., Washington, D.C. 20531.

Arizona Department of Public Safety
Victims of Crime Act (VOCA) Administration
Certification Regarding Lobbying
Applicants should review the instructions for certification included in the regulations before
completing this form. Signature of this form provides for compliance with certification requirements
under 28 CFR Part 69 "New Restrictions on Lobbying". The certification shall be treated as a material
representation of fact upon which reliance will be placed when the Department of Justice determines to
award the covered transactions, grant, or cooperative agreement.
As required by Section 1352, Title 31 of the U.S. Code, and implemented at 28 CFR Part 69, for
persons entering into a grant or cooperative agreement over $100,000, as defined at 28 CFR Part 69,
the applicant certifies that:
a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or employee of
any 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, and the extension, continuation, renewal, amendment, or
modification of any Federal grant or cooperative agreement;
b) If any funds other than Federal appropriated funds have been paid or will be paid to any person
for influencing or attempting to influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with this Federal grant or cooperative agreement, the undersigned shall complete and
submit Standard Form — LLL, "Disclosure of Lobbying Activities," in accordance with its
_instructions;
El Not Applicable (Check box if subrecipient's VOCA award is less than $100,000. Whether
certification is applicable or not, complete the information below.)
As the duly authorized representative of the applicant, I hereby certify that the applicant will comply
with the above certification.
Subrecipient (organization) name:
Address:
DPS Contract #: Federal Employer Identification #:
Printed Name & Title of Authorizing Official:
Signature: Date:
Source: U.S. Dept. of Justice, Office of Justice Programs, Form 4061/6 (3-91)

DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046
(See reverse for public burden disclosure.)
1. Type Of Federal Action: 2. Status of Federal Action: 3. Report Type:
a. contract a. bid/offer/application a. initial filing
b. grant b. initial award b. material 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
4. Name and Address of Reporting Entity: 5. if Reporting Entity in No. 4 is a Subawardee, Enter Name
, Prime D Subawardee and Address of Prime: -
Tier , if known:
Congressional District, if known: 4c Congressional District, if known:
6. Federal Department/Agency: 7. Federal Program Name/Description:
CFDA Number, if applicable:
8. Federal Action Number, if known: 9. Award Amount, if known:
$
10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address if
(if individual, last name, first name, MI): different from No. 10a)
(last name, first name, MI):
11. 1352. Information This disclosure requested of through lobbying this activities form is authorized is a material by representation title 31 U.S.C. section of fact Si I nature: [1 Not Applicable
upon which reliance was placed by the tier above when this transaction was made
or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This Print Name:
information will be available for public inspection. Any person who fats to file the
required disclosure shall be subject to a civil penalty of not less than 510,000 and Title:
not more than $100,000 for each such failure.
Telephone No.: Date:
Federal Use Only: Authorized for Local Reproduction
Standard Form LLL (Rev. 7-97)

INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient,
action, or a material change to a previous filing, pursuant to title 31 U.S.C. section at the initiation or receipt of a covered Federal
paymentto any lobbying entity for influencing or 1352. The filing of a form is required for each payment or agreementto make
Congress, or an employeeof a Member of Congress attempting to influence an officer or empioyeeof any agency, a Member of Congress, an officer or employee of
change report Refer to the implementing in connection with a covered Federal action. Complete all items that apply for both the initial filing and material
guidance published by the Office of Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence
the outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report If this is a followup moon - caused by a material change to the information
the year and quarter in which the change occurred. Enter the date of the last previously submitted previously reported, enter
action. report by this reporting entity for this covered Federal
IP. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional
of the reporting entity that designates if it is, or expects to be, a prime or subaward District if known. Check the appropriate classification
of the prime is the 1st tier. Subawards include but are not limited recipient. Identify the tier of the subawardee, e.g., the first subawardee
to subcontracts, subgrants and contract awards under grants.
5. If the organization fiting the report in item 4 checks "Subawardee," then enter the full name, address,
recipient Include Congressional District, if known. city. State and zip code of the prime Federal
6. Enter The name of the Federal agency making the award or loan commitment. include at least one
example, Department of Transportation, United organizationallevel below agency name, if known. For
States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enterthe full
(CFDA) number for grants, cooperative agreements, Catalog of Federal Domestic Assistance
loans, and loan commitments.
8- Enter the most appropriate Federal identifying number availablefor the Federal action identified in item 1 (e.g.,
Invitation for Bid (IFS) number; grant announcement number; the contract, grant, or loan Request for Proposal (RFP) number;
assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001." award number, the apptication/proposal control number
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency,
commitment for the prime entity identified in item 4 or 5. enter the Federal amount of the award/loan
10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying
entity identified in item 4 to influence the covered Federal action. Disclosure Act of 1995 engaged by the reporting
(b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a).
Middle Initial (Mt). Enter Last Name, First Name, and
11. The certifying official shall sign and date the form, print his/her name, title, and telephone number.
According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information
Number. The valid OMB control number for this information collection is OMB No. unless it displays a valid OMB Contrail
estimated to average 10 minutes per response, including time for reviewing 0348-0046. Public reporting burden for this collection of information is.
needed, and completing and reviewing the collection of information. instructions, searching existing data sources, gathering and maintaining the data
information, including suggestions for reducing this burden, Send comments regarding the burden estimate or any other aspect of this collection oil
DC 20503. to the Office of Managementand Budget, Paperwork Reduction Project (0348-0046), Washington,,

U.S. DEPARTMENT OF JUSTICE
OFFICE OF JUSTICE PROGRAMS
OFFICE OF THE COMPTROLLER
Certification Regarding
Debarment, Suspension, Ineligibility and Voluntary Exclusion
Lower Tier Covered Transactions (Sub-Recipient)
This certification is required by the regulations implementing Executive Order 12549, Debarment and
Suspension, 28 CFR Part 67, Section 67.510, Participants' responsibilities. The regulations were published
as Part VII of the May 26, 1988 Federal Register (pages 19160-19211).
(BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON REVERSE)
(1) The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its
principals are presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from participation in this transaction by any Federal department of 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 proposal.
Name and Title of Authorized Representative
Signature Date
Name of Organization
Address of Organization
OJP FORM 4061/1 (REV. 2/89) Previous editions are obsolete

Instructions for Certification
1. By signing and submitting this proposal, the prospective lower tier participant is providing the
certification set out below.
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 proposal 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," "principal," "proposes," and "voluntarily
excluded," as used in this clause, have the meanings set out in the Definitions and Coverage sections of
rules implementing Executive Order 12549.
5. The prospective lower tier participant agrees by submitting this proposal 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 proposal that it will include the
clause titled, "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion — Lower
Tier Covered Transaction," without modification in all lower tier covered transactions and 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 check the
Nonprocurement List_
8. Nothing contained in the foregoing shall be construed to require establishment of a system of reports
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 voluntary 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.

Arizona Department of Public Safety
Victims of Crime Act (VOCA) Administration
Complying with Federal Civil Rights Program Requirements
Ensuring Access to Federally Assisted Programs
Federal laws prohibit recipients (and subrecipients) of federal financial assistance from discrimination on the basis of race,
color, national origin, religion, sex, or disability in funded program or activities, not only in respect to employment
practices but also in the delivery of services or benefits. Federal law also prohibits funded programs or activities from
discriminating on the basis of age in the delivery of services or benefits.
Providing Services to Limited English Proficiency (LEP) Individuals
In accordance with Department of Justice Guidance pertaining to Title VI of the Civil Rights Act of 1964, 42 U.S.C. §
2000d, recipients (and subrecipients) of federal financial assistance must take reasonable steps to provide meaningful
access to their programs and activities for persons with limited English proficiency (LEP). For more information on the
civil rights responsibilities that recipients have in providing language services to LEP individuals, please refer to
http://www.lep.gov .
Ensuring Equal Treatment for Faith-Based Organizations
The Department of Justice has published a regulation specifically pertaining to the funding of faith-based organizations. In
general, the regulation, Participation in Justice Department Programs by Religious Organizations; Providing for Equal
Treatment of all Justice Department Program Participants, and known as the Equal Treatment Regulation 28 C.F.R. part 38,
prohibits faith-based organizations from using financial assistance from the Department of Justice to fund inherently
religious activities. While faith-based organizations can engage in non-funded inherently religious activities, they must be
held separately from the Department of Justice funded program, and customers or beneficiaries cannot be compelled to
participate in them. The Equal Treatment Regulation also makes clear that organizations participating in programs funded
by the Department of Justice are not permitted to discriminate in the provision of services on the basis of a beneficiary's
religion. For more information on the regulation, please go to the Office for Civil Rights website at
http://oip.gov/about/ocr/equal fbo.htm.
Nondiscrimination Notification
DPS-VOCA subrecipient agencies must have a method of notifying employees, clients, customers, or program participants
that the subrecipient agency does not discriminate in employment practices or delivery of services, and must have a written
polioy-that-incIudes -the procedures for-filing-a complaint, and-the names and-contact information-for-the agencies that
receive complaints.
Discrimination Complaints
Employees, clients, customers, or program participants of a DPS-VOCA subrecipient who wish to file a complaint of
discrimination, may file a complaint directly with the subrecipient; or with the Arizona Department of Public Safety VOCA
Administration Unit (http://wvvw.azdps.gov/Services/Crime Victims/); the Arizona Office of the Attorney General, Office
for Civil Rights (http://vvww.azag.gov/civil rights/); or the Office for Civil Rights (OCR), Office of Justice Programs,
Department of Justice (http://www.justice.gov/crtf).
Submitting Findings of Discrimination
In the event a Federal or State court or Federal or State administrative agency makes an adverse finding of discrimination
against your organization after a due process hearing, on the grounds of race, color, national origin, religion, or sex, your
organization must submit a copy of the finding to OCR for review, with a copy to DPS-VOCA.
(printed name of responsible official), certify that the
(name of subrecipient organization) will comply with the Federal Civil
Rights Program requirements as outlined above.
Responsible Official's Title: DPS Contract Number:
Signature: Date:
6/12/2014

Arizona Department of Public Safety
Victims of Crime Act (VOCA) Administration
Proof of Nonprofit Status
Non-profit subgrantees shall demonstrate nonprofit status by any of the following means:
(I) Provide proof that the Internal Revenue Service recognizes the organization as being tax
exempt under 501(c)(3) of the Internal Revenue Code;
(2) A statement from a state taxing body or state secretary of state certifying that the organization
is a nonprofit organization and that no part of the organization's net earnings may benefit any
private shareholder or individual;
(3) A certified copy of a certificate of incorporation or similar document establishing nonprofit
status; or
(4) Any of the above, if it applies to a state or national parent organization, with a statement by the
state or national parent organization that the applicant is a local nonprofit affiliate.
This documentation shall be returned to DPS with the signed Award Agreement.
-I - certify (name of_subrecipient_
organization) is a nonprofit agency and attached is documentation demonstrating proof of nonprofit
status according to the requirements outlined in item number listed above.
Signature of Authorizing Official
Printed Name and Title of Authorizing Official
Date
12/22/2015

Arizona Department of Public Safety
Victims of Crime Act (VOCA) Administration
Certification regarding eligibility for
de minimis rate of 10% of Modified Total Direct Costs (MTDC)
Pursuant to § 200.414 Indirect (F&A) Costs of the Uniform Administrative Requirements, Cost
Principles, and Audit Requirements for Federal Awards, any non-Federal entity that has never received
a negotiated indirect cost rate, except for those non-Federal entities described in Appendix VII to Part
200 — States and Local Government and Indian Tribe Indirect Cost Proposals, paragraph (d)(1)(B),
may elect to charge a de minimis rate of 10% of modified total direct costs (MTDC) which may be
used indefinitely. As described in § 200.403 Factors affecting allowability of costs, costs must be
consistently charged as either indirect or direct costs, but may not be double charged or inconsistently
charged as both. If chosen, this methodology once elected must be used consistently for all Federal
awards until such time as a non-Federal entity chooses to negotiate for a rate, which the non-Federal
entity may apply to do at any time.
Additionally, pursuant to § 200.414(g), any non-Federal entity that has a federally negotiated indirect
cost rate may apply for a one-time extension of a current negotiated indirect cost rate for a period of up
to four years. This extension will be subject to the review and approval of the cognizant agency for
indirect costs. If an extension is granted the non-Federal entity may not request a rate review until the
extension period ends. At the end of the 4-year extension, the non-Federal entity must re-apply to
negotiate a rate.
I certify to the best of my knowledge (name of subrecipient
organization) has never received a federally negotiated rate and will conform to the requirements listed
above when utilizing the de minimis rate of 10% of modified total direct costs (MTDC).
Signature of Authorizing Official
Printed Name and Title of Authorizing Official
Date
12/22/2015

Approved: OMB No. 1121-0021
. ,
- .,.
... U.S. DEPARTMENT OF JUSTICE
„ . OFFICE OF JUSTICE PROGRAMS
",, '‘' • ACCOUNTING SYSTEM AND FINANCIAL CAPABILITY QUESTIONNAIRE
SECTION A: PURPOSE
The financial responsibility of grantees must be such that the grantee can properly discharge the public trust which accompanies the authority to expend
public funds. Adequate accounting systems should meet the following criteria as outlined in the OJP Financial Guide.
(1) Accounting records should provide information needed to adequately identify the receipt of funds under each grant awarded and the expenditure
of funds for each grant.
(2) Entries in accounting records should refer to subsidiary records and/or documentation which support the entry and which can be readily located.
(3) The accounting system should provide accurate and current financial reporting information.
(4) The accounting system should be integrated with an adequate system of internal controls to safeguard the funds and assets covered, check the
accuracy and reliability of accounting data, promote operational efficiency, and encourage adherence to prescribed management policies.
SECTION B: GENERAL
1. If your firm publishes a general information pamphlet setting forth the history, purpose and organizational structure of your business,
please provide this office with a copy; otherwise, complete the following items:
a. When was the organization b. Principle officers Titles
founded/incorporated - (month, day, year)
c. Employer Identification Number:
d. Number of Employees
Full Time: Part Time:
2. Is the firm affiliated with any other firm: EIYes ENO 3. Total Sales/Revenues in most recent
If yes, provide details: this is the first line accounting period. (12 months)
this is the second line $
SECTION C: ACCOUNTING SYSTEM
1_ Has ai- iy Government Agency rendered an offffialritten opinion concerning the adequacy ofthe accounting system -fo-r -thienon,
identification and allocation of costs under Federal contracts/grants? • Yes II. No
a. If yes, .provide name, and address of Agency performing review: b. Attach a copy of the latest review and any subsequent
correspondence, clearance documents, etc.
Note: If review occurred within the past three years, omit questions
2-8 of this Section and Section D.
2. Which of the following best describes the accounting system: LI Manual Automated El Combination
3. Does the accounting system identify the receipt and expenditure of program funds separately for each • Yes No Not Sure
contract/grant?
4. Does the accounting system provide for the recording of expenditures for each grant/contract by Yes No 0 Not Sure
the component project and budget cost categories shown in the approved budget?
5. Are time distribution records maintained for an employee when his/her effort can be EiYes No Not Sure
specifically identified to a particular cost objective?
6. If the organization proposes an overhead rate, does the accounting system provide for the E Yes EiNo El Not Sure
segregation of direct and indirect expenses?
7. Does the accounting/financial system include budgetary controls to preclude incurring
obligations in excess of:
a. Total funds available for a grant? Yes 11N0 Not Sure
b. Total funds available for a budget cost category (e.g. Personnel, Travel, etc)? Yes No • Not Sure
8. Is the firm generally familiar with the existing regulation and guidelines containing the cost II Yes IIINo Not Sure
principles and procedures for the determination and allowance of costs in connection with
Federal contracts/grants?
OJP FORM 7120/1 12/02)
(continued on reverse)

I SECTION D: FUNDS CONTROL j
1. If Federal grant/contract funds are commingled with organization funds, can the Federal Yes Ill
grant funds and related costs and expenses be readily identified? Not Sure
SECTION E: FINANCIAL STATEMENTS
. ..--.
1. Did an independent certified public accountant (CPA) ever examine the ri
financial statements? Yes No
2. If an independent CPA review was performed please provide this office with
a copy of their latest report and any management letters issued. Enclosed N lA
3. if an independent CPA was engaged to perform a review and no report was issued, please provide details and an explanation below:
SECTION F: ADDITIONAL INFORMATION
1. Use this space for any additional information (indicate section and item numbers if a continuation)
_
SECTION G: APPUCANT CERTIFICATION
I certify that the above information is complete and correct to the bestof my knowledge.
1. Signature b. Firm Name, Address, and Telephone Number
a. Title
SECTION H: CPA CERTIFICATION
The purpose of the CPA certification is to assure the Federal agency that the recipient can establish fiscal controls and accounting procedures which
assure that Federal and State/local funds available for the conduct of the grant programs and projects are disbursed and accounted for properly. If the
audit report requested in Section E 2 above is not enclosed, then completion of this Section is required.
1. Signature b. Firm Name, Address, and Telephone Number
a. Title
,
PUBLIC REPORTING BURDEN FOR THIS COLLECTION OF INFORMATION IS ESTIMATED TO AVERAGE 4 HOURS (OR
MINUTES) PER RESPONSE, INCLUDING THE TIME FOR REVIEVVING INSTRUCTIONS, SEARCHING EXISTING DATA
SOURCES, GATHERINGAND MAINTAINING THE DATA NEEDED, AND COMPLETING AND REVIEWING THE COLLECTION
OF INFORMATION. SEND COMMENTS REGARDING THIS BURDEN ESTIMATE OR ANY OTHER ASPECTS OF THIS
COLLECTION OF INFORMATION, INCLUDING SUGGESTIONS FOR REDUCING THIS BURDEN, TO OFFICE OF JUSTICE
PROGRAMS, OFFICE OF THE COMPTROLLER, 810-7h" STREET, NW, WASHINGTON, DC 20531; AND TO THE PUBUC USE
REPORTS PROJECT, 1121-7120, OFFICE OF INFORMATION AND REGULATORYAFFA1RS, OFFICE OF MANAGEMENT AND
BUDGET, WASHINGTON, DC 20503.
OJP FORM 7120/1(2512)

Arizona Department of Public Safety
Victims of Crime Act (VOCA) Administration
Certification regarding Non-Supplanting
As outlined in the U.S. Department of Justice, Office of Justice Programs, Federal Financial Guide,
Federal funds must be used to supplement existing State and local funds for program activities and
must not supplant those funds that have been appropriated for the same purpose. Furthermore,
supplanting is defined as "to deliberately reduce State or local funds because of the existence of
Federal funds. For example, when State funds are appropriated for a stated purpose and Federal funds
are awarded for that same purpose, the State replaces its State funds with Federal funds, thereby
reducing the total amount available for the stated purpose."
The following example is provided in the Federal Financial Guide to help clarify the difference
between supplementing and supplanting:
State funds are appropriated to hire 50 new police officers, and Federal funds are
awarded for hiring 60 new police officers. At the end of the year, the State has hired 60
new police officers, and the Federal funds have been exhausted. The State has not used
its funds towards hiring new officers, but instead reduced its appropriation for that
purpose and assigned or appropriated the funds to another purpose. In this case, the
State has supplanted its appropriation with the Federal funds. If supplanting had not
occurred, 110 new officers would have been hired using Federal funds for 60 officers
and State funds for 50 officers.
As a subrecipient of Victims of Crime Act (VOCA) Assistance funds, each agency shall certify
its understanding of and adherence to the prohibition against supplanting of State or local funds
with Federal funds.
I certify that the (name of subrecipient organization)
will comply with the prohibition against supplanting as outlined above.
Signature of Authorizing Official
Printed Name and Title of Authorizing Official
Date
12/22/2015

Sul:want Award Report (SAR)
Subrecipient Organization Name:
DPS-VOCA Contract #
Subrecipient Organization Type
INSTRUCTIONS: Check The appropriate box that best reflects your agency type.
A. Government Agencies Only: Which designation best describes this government agency (select one
response)?
01 Courts
Juvenile justice
Li Law enforcement
io Prosecutor
o Other government agency
B. Nonprofit Organization Only: Which designation best describes this nonprofit organization (select one
response)?
Li Child abuse service organization (e.g., child advocacy center)
o Coalition (e.g., state domestic violence or sexual assault coalition)
to Domestic and family violence organization
o Faith-based organization
o Organization provides domestic and family violence and sexual assault services
o Organization by and/or for underserved victims of crime (e.g., drunk driving, homicide, elder abuse)
o Sexual assaTAServices organizatiOrge.g., raprisis ceAter)
o Multi-service agency
o Other type of organization serving victims of crime
C. Federally Recognized Tribal Governments, Agencies, and Organizations Only: Which designation
best describes this tribal agency or organization (select one response)?
o Child abuse service organization (e.g., child advocacy center)
Li Court
o Domestic and family violence organization
o Faith-based organization
• Juvenile justice
o Law enforcement
o Organization provides domestic and family violence and sexual assault services
o Prosecutor
o Sexual assault services organization (e.g., rape crisis center)
o Other justice-based agency
o Other agency that is NOT justice-based (e.g., human services, health, education)
o Organization by and/or for a specific traditionally underserved community
o Organization by and/or for underserved victims of crime (e.g., drunk driving, homicide, elder abuse)
D. Campus Organizations Only: Which designation best describes this campus organization (select one
response)?
o Campus-based victims services
Li Law enforcement
10 Physical or mental health service program
Li Other:

Use of VOCA and Match Funds:
INSTRUCTIONS: For this suba ward, check the category of service and subcategory that best identifies the types
of services or activities that will be provided by this VOCA-funded project, as described below.
Note: Report only those program activities that will be implemented with this VOCA award. Do not report services
offered by another VOCA award received by your agency or any another agency.
• A. INFORMATION & REFERRAL
O Information about the criminal justice process
O Information about victim rights, how to obtain notifications, etc.
O Referral to other victim service programs "
O Referral to other services, supports, and resources (includes legal, medical, faith-based organizations,
address confidentiality programs, etc.)
O B. PERSONAL ADVOCACY/ACCOMPANIMENT
U Victim advocacy/accompaniment to emergency medical care
O Victim advocacy/accompaniment to medical forensic exam
• LI Law enforcement interview advocacy/accompaniment
U Individual advocacy (assistance in applying for public benefits, return of personal property or effects)
O Performance of medical forensic exam or interview, or medical evidence collection
CI Immigration assistance (e.g., special visas, continued presence application, other immigration relief)
O Intervention with employer, creditor, landlord, or academic institution
• Child and/or dependent care assistance (provided by agency)
Q Transportation assistance (provided by agency)
D. AnterpreteLservices
O Assistance with victim compensation application
O C. EMOTIONAL SUPPORT OR SAFETY SERVICES
• Crisis intervention (in-person, includes safety planning, etc.)
O Hotline/crisis line counseling
0 Individual counseling
O On-scene crisis response (e.g., community crisis response)
CI Therapy (traditional, cultural, or alternative healing; art, writing, or play therapy; etc.)
O Support groups (facilitated or peer)
O Emergency financial assistance (includes emergency loans, taxis, prophylactic and nonprophylactic
meds, durable/medical equipment, etc.)
O D. SHELTER/HOUSING SERVICES
• Emergency shelter or safe house
O Transitional housing
CI Relocation assistance
O E. CRIMINAUCIVIL JUSTICE SYSTEM ASSISTANCE
O Notification of criminal justice events (e.g., case status, arrest, court proceedings, case disposition,
release, etc.)
LI Victim impact statement assistance
• Assistance with restitution (includes assistance in requesting and when collection efforts are not
successful)
O Civil legal attorney assistance in obtaining protection or restraining order
O Civil legal attorney assistance with family law issues (e.g., custody, visitation, or support)
O Other emergency justice-related assistance
Cl Immigration attorney assistance (e.g., special visas, continued presence application, and other
immigration relief)
I0 Prosecution interview advocacy/accompaniment (includes accompaniment with prosecuting attorney
and with victim/witness)
O Law enforcement interview advocacy/accompaniment
O Criminal advocacy/accompaniment
• Other legal advice and/or counsel

Staffing
INSTRUCTIONS: Indicate your agency's total number of paid full-time equivalent staff for all
victimization programs and/or services for the current fiscal year. This FTE count should include the
VOCA funded staff as well as the agency's entire direct service staff.
Number of Full Time Equivalent (FTE) Staff: