G15SA0005A SF 424 APPLICATION FORMS.PDF

HIDTA
2015
SF-424 Application
SWB - Arizona HIDTA
G15SA0005A
Maricopa County Sheriff's Office
$619,848.00
Generated On: January 2, 2015

OFFICE OF NATIONAL DRUG CONTROL POLICY
FY 2015 HIDTA STATE AND LOCAL INITIATIVES
INSTRUCTIONS FOR APPLICANTS
Attached are the following documents for your FY 15 funding application:
• Approved FY 15 Budget to the Maricopa County Sheriff's Office for the Multiple Initiative(s).
• Application for Federal Assistance, SF-424.
• Budget Information Non-Construction Programs, SF-424A, Page 2. (Page 1 will not be utilized.)
• Assurances Non-Construction Programs, SF-424B.
• Budget Information Construction Programs, SF-424C.
Certification regarding Lobbying; Debarment, Suspension and other Responsibility Matters; Drug-Free
• Workplace Requirements; Federal Debt Status, and Non-Discrimination Statutes and Implementing Regulations.
• Disclosure of Lobbying Activities.
To submit a grant application for FY 15 HIDTA State and Local Initiative Funding, the following forms must be
signed and returned:
• Application for Federal Assistance, SF-424.
• Budget Information Non-Construction Programs, SF-424A, Page 2. (Page 1 will not be utilized.)
• Assurances Non-Construction Programs, SF-424B.
• Budget Information Construction Programs, SF-424C.
Certification regarding Lobbying; Debarment, Suspension and other Responsibility Matters; Drug-Free
• Workplace Requirements; Federal Debt Status, and Non-Discrimination Statutes and Implementing Regulations.
• Disclosure of Lobbying Activities.
Each of these documents have been completed based upon information submitted for the FY 15 initiatives. If this
information is incorrect, contact the National HIDTA Assistance Center for new forms.
These documents must be completed and signed in their entirely and returned with original signatures affixed
before the award letter can be initiated.
After completion, the forms should be sent to:
National HIDTA Assistance Center
11200 NW 20th ST, STE 100
Miami, FL 33172
(305) 715-7600

APPLICATION FOR
FEDERAL ASSISTANCE 2. DATE SUBMITTED 01/02/2015 Applicant Identifier:
1. TYPE OF SUBMISSION 3. DATE RECEIVED BY STATE State Application Identifier
Application Pre-application 4. DATE RECEIVED BY FED AGENCY Federal Identifier G15SA0005A
_ Construction _ Construction
X Non-Construction _ Non-Construction
5. APPLICANT INFORMATION
LEGAL NAME: Maricopa County ORGANIZATIONAL UNIT:
Organizational DUNS: 137783556 Maricopa County Sheriff's Office
ADDRESS (Give city, county, State and Zip Code) Name and telephone number of person to be contacted on
matters involving this application (give area code)
Maricopa County Sheriff's Office
550 W. Jackson Street Director Elizabeth Kempshall
Phoenix, AZ 85003
6. EMPLOYER IDENTIFICATION NUMBER (EIN) 7. TYPE OF APPLICANT: (Enter appropriate letters in box)
1866000472B6 A. State H. Independent School District
B. County I. State Controlled Institution of Higher
8. TYPE OF APPLICATION Learning
S New _ Continuation _ Revision C. Municipal J. Private University
If revision, enter appropriate letter(s) in box(es) D. Township K. Indian Tribe
(Specify) ___________________________ E. Interstate L. Individual
F. Inter-municipal M. Profit Organization
A. Increase Award B. Decrease Award
C. Increase Duration D. Decrease Duration G. Special District N. Other
Other (specify)________________________________ 9. NAME OF FEDERAL AGENCY ONDCP
10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE 11. DESCRIPTIVE TITLE OF APPLICANT’S PROJECT
NUMBER (CFDA):
Multiple
95.001
12. AREAS AFFECTED BY PROJECT
(Cities, Counties, States, etc.):
13. PROPOSED PROJECT 14. CONGRESSIONAL DISTRICTS OF
Start Date Ending Date a. Applicant b. Project
1/1/2015 12/31/2016
15. ESTIMATED FUNDING: 16. IS APPLICATION SUBJECT TO REVIEW BY STATE
EXECUTIVE ORDER 12372 PROCESS?
a. Federal $619,848.00
a. YES. This preapplication/application was made
b. Applicant available to the State Executive order 12372
process for b. Applicant review on:
c. State
d. Local Date: ______________________
e. Other b. No. Program is not covered by E.O. 12372
f. Program Income or program has not been selected by state for
review
g. Total $619,848.00 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
Yes If “Yes”, attach an explanation X No
TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT. THE
DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY
WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.
a. Type Name of Authorized Representative b. Title c. Telephone
Steve Chucri Chairman
d . Signature of Authorized Representative e. Date Signed

Instructions for the sf424
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project (0348-0043), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET; SEND IT
TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
This is a standard form used by applicants as a required face sheet for pre applications and application submitted for Federal assistance. It
will be used by Federal agencies to obtain applicant certification that States which have established a review and comment procedure in
response to Executive Order 12372 and have selected the program to be included in their process, have been given an opportunity to
review the applicant’s submission.
Item: Entry: Item: Entry:
1. Self -Explanatory. a separate sheet. If appropriate (e.g., construction or real
property projects), attach a map showing project location.
2. Data application submitted to Federal Agency (or State if For pre application, use a separate sheet to provide a
applicable) & applicant’s control number (if applicable). summary description of this project.
3. State use only (if applicable). 12. List only the largest political entities affected (e.g., State,
counties, cities).
4. Enter Date Received by Federal Agency, Federal
identification number: if this application is to continue or 13. Self- Explanatory.
revise an existing award, enter present Federal identifier
number. If for a new project, leave blank. 14. List the applicant’s Congressional-District and any
District(s) affected by the program or project.
5. Enter a legal name of applicant, name of primary
organizational unit (including division is applicable), which 15. Amount requested or to be contributed during the first
will undertake the assistance activity, enter the funding/budget period by each contributor. Value of in kind
organization’s DUNS number (received from Dun and contributions should be included on appropriate lines as
Bradstreet), enter the complete address of the applicant applicable. If the action will result in a dollar change to an
(including country), and name, telephone number, email existing award, indicate only the amount of the change. For
and fax of the person to contact on matters related to this decrease, enclose the amounts in parentheses. If both basic
application. and supplemental amounts are included, show breakdown
on an attached sheet. For multiple program funding, use
6. Enter employer Identification Number (EIN) as assigned by totals and show breakdown using same categories as item
the Internal Revenue Service. 15.
7. Enter the appropriate letter in the space provided. 16. Applicants should contact the State Single Point of Contact
(SPOC) for Federal Executive Order 12372 to determine
8. Check appropriate box and enter appropriate letter(s) in the whether the application is subject to the State
space(s) provided; intergovernmental review process.
• “New “ means a new assistance award
• “Continuation” means any change in the Federal 17. This question applies to the applicant organization, not the
Government’s financial obligation or contingent person who signs as the authorized representative.
liability from an existing obligations Categories of debt include delinquent audit disallowances,
• “Revision” means any change in the Federal loans and taxes.
Government’s financial obligation or contingent
liability from an existing obligation. 18. To be signed by the authorized representative of the
applicant. A copy of the governing body’s authorization for
9. Name of Federal agency from which assistance is being you to sign this application as official representative must
requested with this application. be on file in the applicant’s office. (Certain Federal
agencies may require that this authorization be submitted as
10. Use the Catalog of Federal Domestic Assistance number part of the application.
and title of the program under which assistance is
requested.
11. Enter a brief descriptive title of project. If more than one
program is involved, you should append an explanation on

Section C - Non-federal Resources
(a) Grant Program (b) Applicant (c) State (d) Other Resources (e) TOTALS
8. $ $ $ $
9.
10.
11.
12. Total (sum line 8 - 11) $ $ $ $
SECTION D – FORCASTED CASH NEEDS
Total for 1st Year 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter
13. Federal $619,848.00 $154,962.00 $154,962.00 $154,962.00 $154,962.00
14. Non-Federal
15. TOTAL (sum of 13 and 14) $ $ $ $ $
SECTION E – BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT
(b) First (c) Second (d) Third (e) Fourth
16.
17.
18.
19.
20.
SECTION F – OTHER BUDGET INFORMATION
21. Direct Charges 22. Indirect Charges
23. Remarks

INSTRUCTIONS FOR THE SF-424A
Public reporting burden for this collection of information is estimated to average 180 minutes per response, including time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden to the Office of Management and Budget, Paperwork Reduction
Project (0348-0044), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET,
SEND IT OT THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
General Instruction one sheet is used, the first page should provide the
summary totals by programs.
This form is designed so that application can be made for
funds from one or more grant programs. In preparing the Lines 1-4, column (c) through (g)
budget, adhere to any existing Federal grantor agency
guidelines, which prescribe how and whether budgeted For new application, leave columns (c) and (d) blank. For
amounts should be separately shown for different functions each line entry in Column (a) and (b), enter in Column (e),
or activities within the program. For some programs, (f), and (g) the appropriate amounts of funds needed to
grantor agencies may require budgets to be separately support the project for the first funding period (usually a
shown by function or activity. For other programs, grantor year).
agencies may require a breakdown by function or activity.
Section A,B,C, and D should include budget estimates for For continuing grant program applications, submit these
the whole project except when applying for assistance forms before the end of each funding period as required by
which requires Federal authorization in annual or other the grantor agency. Enter in column (c) and (d) the
funding period increments. In the latter case, Sections A, estimated amounts of funds which will remain not
B,C, and D should provide the budget for the first budget obligated at the end of the grant funding period only if the
period (usually a year) and Section E should present the Federal grantor agency instructions provide for this.
need for Federal assistance in the subsequent budget Otherwise, leave these columns blank. Enter in column (e)
periods. All applications should contain a breakdown by and (f) the amounts of funds needed for the upcoming
the object class categories shown in Lines a-k of Section period. The amount(s) in column (g) should be the sum of
B. amounts in Column (e) and (f).
Section A. Budget Summary Lines 1-4 column (a) and For supplemental grants and changes to existing grants,
(b) do not use column (c) and (d). Enter in Column (e) the
amount of the increase or decrease of Federal funds and
For applications pertaining to a single Federal grant enter in column (f) the amount of the increase of decrease
program (Federal Domestic Assistance Catalog number) of non-federal funds. In Column (g) enter the new total
and not requiring a functional or activity breakdown, enter budgeted amount (Federal and non-federal which includes
on Line 1 under Column (a) the catalog program title and the total previous authorized budgeted amounts plus or
the catalog number in Column (b). minus, as appropriate, the amounts shown in column (e)
and (f). The amount(s) in column (g) should not equal the
For application pertaining to a single program requiring sum of amounts in column (e) and (f).
budget amounts by multiple functions or activities, enter
the name of each activity or function on each line in Line 5- Show the totals for all columns used.
Column (a), and enter the catalog number in column (b).
For application pertaining to multiple programs where Section B Budget Categories
none of the programs require a breakdown by function or
activity, enter the catalog program title on each line in In the column headings (1) through (4), enter the titles of
column (a) and the respective catalog number on each line the same programs, functions, and activities shown on line
in column (b). 1-4, column (a), Section A. When additional sheets are
prepared for Section A, provide similar column headings
For application pertaining to multiple programs where one on each sheet. For each program, function or activity, fill
or more programs require a breakdown by function or in the total requirements for funds (both Federal and non-
activity, prepare a separate sheet for each program Federal) by object class categories.
requiring the breakdown. Additional sheets should be used
when one form does not provide adequate space for all Lines 6a-I- Show the totals of Lines 6a to 6h in each
breakdown of data required. However, when more than column.

Line 6j- Show the amount of indirect cost. Lines 16-19- Enter in Column (a) the same grant program
titles shown in Column (a), Section A. A breakdown by
Line 6K- Enter the total of amounts on Lines 6i and 6j. function or activity is not necessary. For new applications
For all applications for new grants and continuation grants and continuation grant applications, enter in the proper
the total amount in column (5), Line 6k, should be the columns amounts of Federal funds which will be needed to
same as the total amount shown in Section A, column (g), complete the program or project over the succeeding
Line 5. For supplemental grants and changes to grants, the funding period (usually in years). This section need not be
total amount of the increase or decrease as shown in completed for revisions (amendments, changes, or
column (1)-(4), Line 6k should be the same as the sum of supplements) to funds for the current year of existing
the amounts in Section A, column (e) and (f) on Line 5. grants.
Line 7- Enter the estimated amount of income, if any If more than four lines are needed to list the program titles,
expected to be generated from this project. Do not add or submit additional schedules as necessary.
subtract this amount. Show under the program narrative
statement the nature and source of income. The estimated Line 20- Enter the total for each of the Column (b)-(e).
amount of program income may be considered by the When additional schedules are prepared for this section,
federal grantor agency in determining the total amount of annotate accordingly and show the overall totals on this
the grant. line.
Section C. Non-Federal Resources Section F. Other Budget Information
Lines 8-11 Enter amounts of non-federal resources that Line 21 – Use this space to explain amounts for individual
will be used on the grant. If in-kind contributions are direct object class cost categories that may appear to be out
included, provide a brief explanation on a separate sheet. of the ordinary or to explain the details as required by the
Column (a) Enter the program titles identical to Federal grantor agency.
column (a), Section A. A breakdown by function
or activity is not necessary. Line 22- Enter the types of indirect rate (provisional,
predetermined, final or fixed) that will be in effect during
Column (b) Enter the contribution to be made by the funding period, the estimated amount of the base to
the applicant. which the rate is applied, and the total indirect expense.
Column (c) Enter the amount of the State’s cash Line 23- Provide any other explanations or comments
and in-kind contribution if the applicant is not a deemed necessary.
State or State agency. Applicants which are a
State or State agencies should leave this column
blank.
Column (d) Enter the amount of cash and in-kind
contribution to be made from all other sources.
Column (e) Enter total of column (b),(c), and (d).
Line 12- Enter the total for each of column (b)-(e). The
amount in column (e) should be equal to the amount on
Line 5, column (f) section A.
Section D. Forecasted Cash Needs
Line 13 Enter the amount of cash needed by quarter from
the grantor agency during the first year.
Line 14 –Enter the amount of cash from all other sources
needed by quarter during the first year.
Line 15 – Enter the totals of amounts on Lines 13 and 14.
Section E. Budget Estimates of Federal Funds Needed
for Balance of the Project

ASSURANCES – NON-CONTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the Office of Management and budget, Paperwork Reduction
Project (0348-0040), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET,
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE: Certain of these assurances may not be applicable to your project or program, if you have questions, please contact the
awarding agency. Further, certain Federal-awarding agencies may require applicants to certify to additional assurances. If such
is the case, you will be notified.
As the duly authorized representative of the applicant I certify that the applicant:
1. Has the legal authority to apply for Federal assistance Office and Treatment Act of 1972 (P. L. 92-255), as
and the institutional, managerial and financial amended, relating to nondiscrimination on the basis of
capability (including funds sufficient to pay the non- drug abuse; (f) the Comprehensive Alcohol Abuse and
federal share of project cost) to ensure proper Alcoholism Prevention, Treatment and Rehabilitation
planning, management and completion of the project Act of 1970 (P. L. 91-616), as amended, relating to
describe in this application. nondiscrimination on the basis of alcohol abuse or
2. Will give the awarding agency, the Comptroller alcoholism; (g) 523 and 527 of the Public Health
General of United States, and if appropriate, the State, Service Act of 1912 (42 U. S. C. 290 dd-3 and 290 ee-
through any authorized representative, access to and 3), as amended, relating to confidentiality of alcohol
the right to examine all record, books, paper, or and drug abuse patient records; (h) Title VIII of the
documents related to the award; and will establish a Civil Rights Act of 1968 (42 U S C. 3601 et seq), as
proper accounting system in accordance with amended, relating to nondiscrimination in the sale,
generally accepted accounting standards or agency rental or financing of housing; (I) any other
directives. nondiscrimination provisions in the specific statute(s)
3. Will establish safeguards to prohibit employees from under which application for Federal assistance is
using their positions for a purpose that constitutes or being made; and (j) the requirements of any other
presents the appearance of personal or organizational nondiscrimination statute(s) which may apply to the
conflict of interest, or personal gain. application.
4. Will initiate and complete the work within the 7. Will comply, or has already complied, with the
applicable time frame after receipt of approval of the requirements of Titles II and III of the Uniform
awarding agency. Relocations Assistance and Real Property Acquisition
5. Will comply with the Intergovernmental Personnel Policies Act of 1970 (P. L. 91-646) which provide for
Act of 1970 (42 U. U. C. 4728-4763) relating to fair and equitable treatment of persons displaced or
prescribed standards for merit systems for programs whose property is acquired as a result of Federal or
funded under one of the nineteen statutes or federally assistance programs. These requirements
regulations specified in Appendix A of OPM’s apply to all interest in real property acquired for
Standards for a Merit System of Personnel project purposes regardless of Federal participation in
Administration (5 C. F. R. 900, Subpart F). purchases.
6. Will comply with all Federal statutes relating to 8. Will comply, as applicable, with provisions of the
nondiscrimination. These include but are not limited Hatch Act (5 U. S.C. 1501-1508 and 7324-7328)
to: (a) Title VI of the Civil Rights Act of 1964 (P.L. which limit the political activities are funded in whole
88-352) which prohibits discrimination on the basis of or in part with Federal Funds.
race, color or national origin; (b) Title IX of the
Education Amendments of 1972, as amended (20 U.
S. C. 1681- 1683, and 1685-1686), which prohibits
discrimination on the basis of sex; (c) Section 504 of
the Rehabilitation Act of 1973, as amended (29 U. S.
C. 794), which prohibits discrimination on the basis of
handicaps; (d) the Age Discrimination Act of 1975, as
amended (42 U. S. C. 6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse

9. Will comply, as applicable, with the provisions of 12. Will comply with the Wild and Scenic: Rivers Act
the Davis-Bacon Act (40 U. S. C. 276a to 276a – of 1968 (16 U.S.C. 1271 et seq.) related to
7), the Copeland Act (40 U. S. C. 276c and 18 U. S. protecting components or potential components of
C. 874), and the Contract Work Hours and Safety the national wild and scenic rivers system.
Standards Act (40 U. S. C. 327-333), regarding
labor standards for federally assisted construction 13. Will assist the awarding agency in assuring
sub agreements. compliance with section 106 of the National
10. Will comply, if applicable, with flood insurance Historic Preservation Act of 1966, as amended (16
purchase requirements of Section 102(a) of the U.S.C. 470), EO 11593 (identification and
Flood Disaster Protection Act of 1973 (P.L. 93- protection of historic properties) and the
234) which requires recipients in a special flood Archaeological and Historic Preservation Act of
hazard area to participate in the program and to 1974 (16 U.S.C. 469a-1 et seq.).
purchase flood insurance if the total cost of 14. Will comply with P.L. 93-348 regarding the
insurable construction and acquisition is $10,000 or protection of human subjects involved in research,
more. development, and related activities supported by
11. Will comply with environmental standards which this award of assistance.
may be prescribed pursuant to the following: (a) 15.
institution of environmental quality control Will comply with the Laboratory Animal Welfare
measures under the National Environmental Policy Act of 1966 (P.L. 89-544, as amended, 7 U.S.C.
Act of 1969 (P.L. 91- 190) and Executive Order 2131 et seq.) pertaining to the care, handling, and
(EO) 11514; (b) notification of violating facilities treatment of warm blooded animals held for
pursuant to EO 11738; (c) protection of wetlands research, teaching, or other activities supported by
pursuant to EO 11990; (d) evaluation of flood this award of assistance.
hazards in floodplains in accordance with EO 16. Will comply with the Lead-Based Paint Poisoning
11988; (e) assurance of project consistency with Prevention Act (42 U.S.C. 4801 et seq.) which
the approved State management program developed prohibits the use of lead based paint in construction
under the Coastal Zone Management Act of 1972 or rehabilitation of residence structures.
(16 U.S.C. 1451 et esq.); (f) conformity of Federal
actions to State (Clear Air) Implementation Plans 17. Will cause to be performed the required financial
under Section 176 (c) if the Clear Air Act of 1955, and compliance audits in accordance with the
as amended (42 U.S.C. 7401 et esq.); (g) protection Single Audit Act of 1984 or OMB Circular No. A-
of underground sources of drinking water under the 133, Audits of Institutions of Higher Learning and
Safe Drinking Water Act of 1974, as amended, other Non-profit Institutions.
(P.L. 93-523); and (h) protection of endangered 18. Will comply with all applicable requirements of all
species under the Endangered Species Act of 1973, other Federal laws, executive orders, regulations
as amended, (P.L..93-205). and policies governing this program.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL Title
Steve Chucri Chairman
APPLICANT ORGANIZATION Date Submitted
Maricopa County on behalf of the Macricopa County
Sheriff's Office

BUDGET INFORMATION – CONTRUCTION PROGRAMS
NOTE: Certain Federal assistance programs require additional computations to arrive at the Federal share of project costs eligible for participation. If such is the case
your will be notified
COST CLASSIFICATION a. Total Cost b. Costs Not Allowable for c. Total Allowable Costs (Column
Participation a-b)
1. Administrative and legal expenses
2. Land, structures, rights of way, appraisals, etc.
3. Relocation expenses and payments
4. Architectural and engineering fees
5. Other architectural and engineering fees
6. Project inspection fees
7. Site work
8. Demolition and removal
9. Construction
10. Equipment
11. Miscellaneous
12. SUBTOTAL ( sum of lines 1 – 11)
13. Contingencies
14. SUBTOTAL
15. Project (program) income
16. TOTAL PROJECT COSTS (subtract # 15 from # 14)
FEDERAL FUNDING
17. Federal assistance requested, calculate as follows Enter eligible costs from line 16c Multiply X ______%
(Consult Federal agency for Federal percentage share).
Enter resulting Federal share.

INSTRUCTION FOR THE SF 424-C
Public reporting burden for this collection of information is estimated to average 180 minutes per response, including time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction
Project (0348-0041), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET,
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
This sheet is to be used for the following types of applications: (1) “New” (means a new [previous Un-funded] assistance
award); (2) “Continuation” (means funding in a succeeding budget which stemmed from a prior agreement to fund); and (3)
“Revised” (means any changes in the Federal government’s financial obligation or contingent liability from an existing
obligation). If there is no change in the award amount there is no need to complete this form. Certain Federal agencies may
require only an explanatory letter to the effect minor (no cost) changes. If you have questions please contact the Federal
agency.
Column a.- If this is an application for a “New” project, Line 4 – Enter estimate basic engineering fees related to
enter the total estimated cost of each of the items listed on construction (this includes start-up services and
lines 1 through 16 (as applicable) under “COST preparation of project performance work plan).
CLASSIFICATIONS.”
Line 5 – Enter estimated engineering costs, such as
If this application entails a change to an existing award, surveys, tests, soil borings, etc.
enter the eligible amounts approved under the previous
award for the items under “ COST CLASSIFICATION’ Line 6 – Enter estimated engineering inspection costs.
Column b. If this is an application for a “New” project, Line 7 – Enter estimated costs of site preparation and
enter that portion of the cost of each item in Column a. restoration which are not included in the basic construction
which is not allowable for Federal Assistance. Contact the contract.
Federal agency for assistance in determining the
allowability of specific costs. Line 9 – Enter estimated cost of the construction contract.
If this application entails a change to an existing award, Line 10 – Enter estimated cost of office, shop, laboratory,
enter the adjustment [ + or (-)] to the previously approved safety equipment, etc. to be used at the facility, if such
costs (from column a.) reflected in this application. costs are not included in the construction contract.
Column c. This is the net of line 1 through 16 in columns Line 11 – Enter estimated miscellaneous costs.
“a” and “b”.
Line 12 - Total of items 1 through 11.
Line 1- Enter estimated amounts needed to cover
administrative expenses. Do not include costs which are Line 13 – Enter estimated contingency costs. (Consult the
related to the normal functions of government. Allowable Federal agency for the percentage of the estimated
legal costs are generally only those associated with the construction cost to use.)
purchase of land which is allowable for Federal
participation and certain services in support of construction Line 14 – Enter the total of lines 12 and 13.
of the project.
Line 15 - Enter estimated program income to be earned
Line 2 – Enter estimated site and right(s) of way during the grant period, e.g. salvaged materials, etc.
acquisition costs (this includes purchase, lease, and/or
easements). Line 16 – Subtract line 15 from line 14.
Line 3 – Enter estimated cost related to relocation advisory Line 17 – This block if for the computation of the Federal
assistance, replacement housing, and relocation payments share. Multiply the total allowable project costs from line
to displaced persons and businesses, etc. 16, column “c” by the Federal percentage share (this may
be up to 100 percent; consult Federal agency for Federal
percentage share) and enter the product on line 17.

ASSURANCES – CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding the burden estate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the office of Management and Budget, Paperwork Reduction
Project (0348-0042), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET,
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE: Certain of theses assurances may not be applicable to your project or program. If you have questions, please contact
the Awarding Agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional
assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant I certify that the applicant:
1. Has the legal authority to apply for Federal assistance, prescribed standards for merit system for programs
and the institutional, managerial and financial funded under one of the nineteen statutes or
capability (including funds sufficient to pay the non- regulations specified in appendix A of OPM’s
Federal share of project costs) to ensure proper Standards for a Merit System of Personnel
planning, management and completion of the project Administration (5 C.F.R. 900 Subpart F).
described in this application. 9. Will comply with the Lead-Based Paint Poisoning
2. Will give the awarding agency, the Comptroller Prevention Act (42 U.S.C. 4801 et seq.) which
General of the United States, and if appropriate, the prohibits the use of lead based paint in construction or
State through any authorized representative, access to rehabilitation of residence structures.
and the right to examine all records, books, papers, or 10. Will comply with all Federal statues relating to non-
documents related to the assistance; and will establish discrimination. These include but are not limited to:
a proper accounting system in accordance with (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-
generally accepted accounting standards or agency 352) which prohibits discrimination on the basis of
directives. race, color or national origin; (b) Title IX of the
3. Will not dispose of , modify the use of, or change the Education Amendments of 1972, as amended (20
terms of the real property title, or other interest in the U.S.C. 1681-1683, and 1685-1686) which prohibits
site and facilities without permission and instructions discrimination on the basis of sex; (c) Section 504 of
from the awarding agency. Will record the Federal the Rehabilitation Act of 1973, as amended (29 U.S.C.
interest in the title of real property in accordance with 794) which prohibits discrimination of the basis of
awarding agency directives and will include a handicaps; (d) the Age Discrimination Act of 1975, as
covenant in the title of real property acquired in whole amended (42 U.S.C. 6101-6107) which prohibits
or in part with Federal assistance funds to assure non- discrimination on the basis of age; (e) the Drug Abuse
discrimination during the useful life of the project. Office and Treatment act of 1972 (P.L. 93-255), as
4. Will comply with the requirements of the assistance amended, relating to non-discrimination on the basis
awarding agency with regards to the drafting, review of drug abuse; (f) the comprehensive alcohol Abuse
and approval of construction plans and specifications. and alcoholism Prevention, Treatment and
5. Will provide and maintain competent and adequate Rehabilitation Act of 1970 (P.L. 91-616), as amended,
engineering supervision at the construction site to relating to nondiscrimination on the basis of alcohol
ensure that the complete work conforms with the abuse or alcoholism; (g) 523 and 527 of the Public
approved plans and specifications and will furnish Health Service Act of 1912 (42 U.S.C. 290 dd-3
progress reports and such other information as may e and290 ee-3), as amended, relating to confidentiality
required by the assistance awarding agency or State. of alcohol and drug abuse patient record; (h) Title VIII
6. Will initiate and complete the work within the of the Civil Rights Act of 1968 (42 U.S.C. 3601 et
applicable time frame after receipt of approval of the seq. ), as amended, relating to non-discrimination in
awarding agency. the sale, rental or financing of housing; (I) any other
7. Will establish safeguards to prohibit employees from non-discrimination provisions I the specific statute(s)
using their positions for a purpose that constitutes or under which application for Federal assistance is
present the appearance of personal or organizational being made and (j) the requirements on any other non-
conflict of interest, or personal gain. discrimination Statute(s) which may apply to the
8. Will comply with the Intergovernmental Personnel application.
Act of 1970 (42 U.S.C. 4728-4763) relating to

11. Will comply, or has already complied, with the protection of wetlands pursuant to EO 11990; (d)
requirements of Titles II and III of the Uniform evaluation of flood hazard in floodplains in
Relocation Assistance and real Property Acquisition accordance with EO 11988; (e) assurance of project
Policies Act of 1970 (P.L. 91-646) which provides for consistency with the approved State management
fair and equitable treatment of persons displaced or program developed under the Coastal Zone
whose property is acquired as a result of Federal and Management Act of 1972 (16 U.S.C. 1451 et seq.); (f)
federally assisted programs. These requirements apply conformity of Federal actions to State (Clean Air)
to all interest in real property acquired for project implementation Plans under Section 176(c) of the
purpose regardless of Federal participation in Clean Air Act of 1955, as amended (42 U.S.C. 7401 et
purchases seq.); (g) protection of underground sources of
12. Will comply with the provisions of the Hatch Act (5 drinking water under the Safe Drinking Water Act of
U.S.C. 1501-1508 and 7324-7328) which limit the 1974, as amended, (P.L. 93-523); and (h) protection of
political activities of employees whose principal endangered species under the Endangered species Act
employment activities are funded in whole or in part of 1973, as amended, (P.L. 93-205).
with Federal funds. 16. Will comply with the wild and scenic rivers act of
13. Will comply, as applicable, with the provisions of the 1968 (16 U.S.C. 1271 et seq.) related to protecting
Davis-Bacon Act (40 U.S.C. 276a to 276a-7), the components or potential components of the national
Copeland Act (40 U.S.C. 276c and 18 U.S.C. 874), wild and scenic rivers system.
The contract Work hours and safety Standards Act (40 17. Will assist the awarding agency in assuring
U. S. C. 327-333) regarding labor standards for compliance with section 106 of the National Historic
federally assisted construction sub-agreements. Preservation Act of 1966, as amended (16 U.S.C.
470), EO 11593 (identification and preservation of
14. Will comply with the flood insurance purchase historic properties), and the Archaeological and
requirements of Section 102(a) of the Flood Disaster Historic Preservation Act of 1974 (16 U.S.C. 469a-1
Protection Act of 1973 (P.L. 93-234) which requires et seq.).
recipients in a special flood hazard area to participate
in the program and to purchase flood insurance if the 18. Will cause to be performed the required financial and
total cost of insurable construction and acquisition is compliance audits in accordance with the single Audit
$10,000 or more Act of 1984.
19. Will comply with all applicable requirements of all
15. Will comply with environmental standards which may other Federal laws, Executive Orders, regulations and
be prescribe pursuant to the following: (a) institution policies governing this program.
of environmental quality control measures under the
National environmental policy Act of 1969 (P.L. 91-
190) and Executive Order (EO) 11514; (b) notification
of violating facilities pursuant to EO 11738; (c)
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL Title
Steve Chucri Chairman
APPLICANT ORGANIZATION Date Submitted
Maricopa County on behalf of the Maricopa County
Sheriff's Office

OFFICE OF NATIONAL DRUG CONTROL POLICY
CERTIFICATIONS REGARDING LOBBYING, DEBARMENT, SUSPENSION AND OTHER
RESPONSIBILITY MATTERS; DRUG-FREE WORKPLACE REQUIREMENTS; FEDERAL
DEBT STATUS, AND NONDISCRIMINATION STATUS AND IMPLEMENTING REGULATIONS
Instructions for the certifications (c) The undersigned shall require that the language of this
certification be included in the award document for all
General Requirements sub-awards at all tiers (including sub-grants, contracts
The Office of National Drug Control Policy (ONDCP) is under grants and cooperative agreements, and
required to obtain from all applicants’ certifications subcontracts) and that all sub-recipients shall certify and
regarding federal debt status, debarment and suspension, and disclose accordingly.
a drug free workplace. Applicants requesting monies greater
than $100,000 in grants funds must also certify regarding 2. DEBARMENT, SUSPENSION, AND OTHER
lobbing activities and may be required to submit a RESPONSIBILITY MATTER (DIRECT RECIPIENT)
Disclosure of Lobbying Activities” (Standard Form LLL). As required by Executive Order 12549, Debarment and
Institutional applicants are required to certify that they will Suspension and implemented at 21 CFR Part 1404, for
comply with the nondiscrimination statues and prospective participants in primary covered transactions
implementing regulations.
A. The applicant certifies that it and its principals:
Applicants should refer to the regulations cited below to
determine the certifications to which they are required to (a) Are not presently debarred, suspended, proposed for
attest. Applicants should also review the instructions for debarment, declared ineligible, sentenced to a denial of
certification included in the regulations before completing Federal benefits by a State or Federal court, or
this form. Signature of the form provides for compliance voluntarily excluded from covered transactions by any
with certification requirements under 21 CFR part 1405, Federal department or agency:
“New Restrictions on Lobbying” and 21 CFR part 1414, (b) Have not within a three-year period preceding this
Government wide Debarment and Suspension. application been convicted of or and a civil judgment
(Non procurement), Certification Regarding Federal debt rendered against them for commission of fraud or a
Status (OMB Circular A-129), and Certification Regarding criminal offense in connection with obtaining,
the Nondiscrimination Statutes and Implementing attempting to obtain or performing a public (Federal,
Regulations. The certifications shall be treated as a material State, or local ) transaction or contract under a public
representation of fact upon which reliance will be placed transaction’ violation of Federal or State antitrust
when the Office of National Drug Control Policy determines statures or commission of embezzlement, theft, forgery,
to award the covered cooperative agreement bribery, falsification or destruction of records, making
false statements, or receiving stolen property;
1. LOBBYING (c) Are not presently indicted for o otherwise criminally or
As required by Section 1352, Title 31 of the U.S. Code, and civilly charged by a governmental entity (Federal, State,
implemented in 21 CFR part 1405, for persons entering into or local) terminated for cause or default;and
a cooperative agreement over $100,000, as defined at 21
CFR Part 1405, the applicant certifies that: B. Where the applicant is unable to certify to any of the
statements in this certification. He or she shall attach an
(a) No federal appropriated funds have been paid or will be explanation to the application.
paid, by or on behalf of the undersigned, to any person
for influencing or attempting to influence an officer or 2. DRUG-FREE WORKPLACE (GRANTEES
employee of any agency, a member of Congress, and OTHER THAN INDIVIDUALS)
officer or employee of Congress, or an employee of a As required by the Drug Free Workplace Act of
Member of Congress in connection with the making of 1988, and implemented at 21 CFR Part 1404
any Federal grant, the entering into continuation, Subpart F.
renewal, amendment, or modification of any Federal A. The applicant certifies that it will or will continue
grant or cooperative agreement. to provide a drug free workplace by:
(b) If any funds other than Federal appropriated funds have
been paid or will being paid to any person for (a). Publishing a statement notifying employees that the
influencing or attempting to influence an officer or unlawful manufacture, distribution, dispensing, possession,
employee of Congress, or an employee of a Member of or use of a controlled substance is prohibited in the
Congress in connection with this Federal Grant or applicant’s workplace and specifying the actions that will be
cooperative agreement, the undersigned shall complete taken against employees for violations of such prohibition;
and submit Standard Form –LLL, “Disclosure of
Lobbying Activities,” in accordance with its (b) Establishing an on-going drug free awareness program to
instructions; inform employees about

(1) The dangers of drug abuse in the workplace; The regulations provide that a recipient that is a State may
(2) The applicant’s policy of maintaining a drug free elect of make one certification in each Federal fiscal year.
workplace; A copy of which should be included with each application
(3) Any available drug counseling, rehabilitation, and for ONDCP Funding.
employee assistance programs; and
(4) The penalties that may be imposed upon employees for DRUG FREE WORKPLACE (RECIPIENTS WHO
drug abuse violation occurring in the workplace; ARE INDIVIDUALS)
(d) Making it a requirement that each employee to be As required by the Drug Free Workplace Act of 1988, and
engaged in the performance of the grant be given a copy implemented at 21 CFR Part 1404 Subpart F.
of the statement required by paragraph (a); A. as a condition of the cooperative agreement, I certify
(e) Notifying the employee in the statement required by that I will not engage in the unlawful manufacture,
paragraph (a) that, as a condition of employment under distribution, dispensing, possession, or use of a
the grant, the employee will controlled substance in conduction any activity with the
grant; and
(1) Abide by the terms of the statement; and B. If convicted of a criminal drug offense resulting form a
(2) Notify the employer in writing of his or her conviction violation occurring during the conduct of any grant
for a violation of a criminal drug statute occurring in the activity, I will report the conviction in writing, within
workplace no later than five calendar days after such 10 calendar days of the conviction, to: The Assistance
conviction: Center, 8401 Northwest 53rd Terrace, Suite 208, Miami,
(f) Notifying the agency, in writing, within 10 calendar Florida 33166.
days after receiving notice under subparagraph (d)(2) 4. CERTIFICATION REGARDING FEDERAL
form an employee or otherwise receiving actual notice DEBT STATUS (OMB Circular A-129)
of such convictions. Employers of convicted employees The Applicant certifies to the best of its knowledge and
must provide notice including position title, to: The belief, that it is not delinquent in the repayment of any
Assistance Center, 8401 Northwest 53rd Terrace, suite federal debt.
200, Miami, Florida 33166. Notice shall include the
identification number of each affected grant; 5. CERTIFICATION REGARDING THE
NONDISCRIMINATIN STATUTES AND
(g) Taking one of the following actions within 30 calendar IMPLEMENTING REGULATIONS
days of receiving notice under subparagraph (d)(2), with
respect to any employee who is so convicted- The applicant certifies that it will comply with the following
nondiscrimination statues and their implementing
(1) Taking appropriate personnel action against such an regulations: (a) title VI of the Civil right Act of 1964 (42
employee, up to and including termination, consistent U.S.C. 2000D et seq.) which provides that no person in the
with the requirements of the Rehabilitation Act of 1973, United States shall, on the ground of race, color, or national
as amended; or origin, be excluded from participation in, be denied the
(2) Requiring such employee to participate satisfactorily in benefits of or be otherwise subjected to discrimination under
a drug abuse assistance or rehabilitation program any program or activity for which the applicant received
approved for such purposes by a Federal State, or local federal financial assistance; (b) Section 504 if the
health, law enforcement, or other appropriate agency; rehabilitation Act of 1973, as amended (29 U.S.C. 794),
which prohibits discrimination on the basis of handicap in
(h) Making a good faith effort to continue to maintain a programs and activities receiving federal financial
drug free workplace through implementation of assistance; (c) title IX of the Education Amendments of
paragraphs (a), (b), (c), (d), (e), and (f). 1972m as amended (20 U.S.C. 1981 et seq.) which prohibits
discrimination on the basis of sex in education programs and
B. The applicant may insert in the space provided activities receiving federal financial assistance; and (d) the
below the site(s) for the performance of work done Age Discrimination Act of 1975, and amended (42 U.S.C.
in connection with the specific cooperative 6101 et seq.) which prohibits discrimination on the basis of
agreement: age in programs and activities receiving federal financial
Place of Performance (street address, city, country, state, assistance, except that actions which reasonably take age
into account as a factor necessary for the normal operation
zip code) or achievement of any statutory objective of the project or
Maricopa County Sheriff's Office activity shall not violate this statute
Check if there are workplaces on file that are not
identified here.

As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above certifications.
Grantee Name and Address: Maricopa County Sheriff's Office
550 W. Jackson Street
Phoenix, AZ 85003
Application Number and/or Project Name: G15SA0005A
Multiple
Grantee IRS/Vendor Number: 1866000472B6
Type Name and Title of Authorized Steve Chucri
Representative:
Chairman
5. Signature: 6. Date:

DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose activities pursuant to 31 U.S.C. 1352
(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. b. grant b. b. Initial award a. b. material change
c. cooperative agreement c. post-award For Material Change only
d. loan
e. loan guarantee Year:____ Quarter:_____
f. loan insurance Date of last report:
4. Name and Address of reporting Entity 5. If reporting entity in No. 4 is Subawardee, Enter name
and address of Prime:
X Prime Subawardee
Tier ___ ,if uknown:
Maricopa County Sheriff's Office
550 W. Jackson Street
Phoenix, AZ 85003
Congressional District, if known Congressional District, if known
6. Federal Department/Agency: 7. Federal Program Name/Description:
ONDCP HIDTA
8. Federal Action Number, if known 9. Award Amount, if known
G15SA0005A $619,848.00
10. a. Name and Address of Lobbying Entity b. Individuals Performing Services (including address if
(if individual, last name, first name, MI) (if individual, last name, first name, MI) different from No. 10a)
last name, first name, MI)
None None
(attach Continuation Sheet (s) SF-LLL-A, if necessary)
11. Amount of Payment (check all that apply): 13. Type of Payment (check all that apply):
$ N/A ___actual ___planned ____ a. retainer
____ b. one-time fee
12. Form of Payment (check all that apply): ____ c. commission
____ d. contingent fee
___ a. cash ____ e. deferred
___ b. in-kind; specify: nature_____________ ____ f. other; specify:
value _____________
14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), employee(s), or Member(s) contacted, for
Payment indicated in Item 11:
HIDTA Related Initiatives
(attach Continuation Sheet (s) SF-LLL-A, if necessary)
15. Continuation Sheet(s) SF-LLL-A atached: ____ Yes X No
16. Information requested through this form is authorized by title 31 U.S.C. Signature: _________________________________
section 1352. This disclosure of lobbying activities is a material
representation of fact upon which reliance was placed by the tier above
when this transaction was made o entered into. This disclosure is requested Print Name: Steve Chucri
pursuant to 31 U.S.C. 1352. This information will be reported to the
Congress semi-annually and will be available for public inspection. Any Title: Chairman
person who fails to file the required disclosure shall be subject to a civil
penalty of not less than $10,000 and not more than $100,000 for each such Telephone No.:
failure.
Date:______________
Federal Use Only: Authorized for local reproduction
Standard Form – LLL