Assurances and Certifications

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By
ENSTEFUTE of CRO rD ER AOAAG  %
MuseumancLibrary : i ae:
SERVICES KATIE HOBBS > o
SECRETARY OF STATE Arizona State Library, ?

Archives and Public Records

Assurances and Certifications for
2021 Arizona LSTA Subgrant Award

1. Nondiscrimination

The applicant shall comply with the following nondiscrimination statutes and their
implementing regulations:

a) Title VI of the Civil Rights Act of 1964, as amended (42 U.S.C, § 2000 et seq),
which prohibits discrimination on the basis of race, color, or national origin
(note: as clarified by Executive Order 13166, reasonable steps must be taken to
ensure that limited English proficient (LEP) persons have meaningful access to
the programs (see IMLS guidance at 68 Federal Register 17679, April 10, 2003};

b) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. § 701 et
seq.), which prohibits discrimination on the basis of disability (note: IMLS
applies the regulations in 45 C.F.R part 1170 in determining compliance with §
504 as it applies to recipients of Federal assistance);

c) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§ 1681-
83, 1685-86), which prohibits discrimination on the basis of sex in education
programs;

d) the Age Discrimination in Employment Act of 1975, as amended (42 U.S.C. §
6101 et seq.), which prohibits discrimination on the basis of age;

e) the requirements of any other nondiscrimination statute(s) which may apply.

2. Debarment and Suspension

The applicant shall comply with 2 C.F.R. part 3185 and 2 C.F.R. part 180, as
applicable. The authorized representative, on behalf of the applicant, certifies to the
best of his or her knowledge and belief that neither the applicant nor any of its
principals:

a) Are presently excluded or disqualified;

b) Have been convicted within the preceding three years of any of the offenses
listed in 2 C.F.R. §180.800{a) or had a civil judgment rendered against it or
them for one of those offenses within that time period;

c) Are presently indicted for or otherwise criminally or civilly charged by a
governmental entity (Federal, State, or local) with commission of any of the
offenses listed in 2 C.F.R. §180.800(a); or

d) Have had one or more public transactions (Federal, State, or local) terminated
within the preceding three years for cause or default.

Where the applicant is unable to certify to any of the statements in this certification,
the authorized representative shall attach an explanation to this form.

The applicant is required to comply with 2 C.F.R. part 180 subpart C (Responsibilities
of Participants Regarding Transactions Doing Business with Other Persons) as a
condition of participation in the award. The applicant is also required to communicate
the requirement to comply with 2 C.F.R. part 180 subpart C (Responsibilities of

Participants Regarding Transactions Doing Business with Other Persons) to persons at
the next lower tier with whom the applicant enters into covered transactions,

3. Drug-Free Workplace

The authorized representative, on behalf of the applicant, certifies, as a condition of
the award, that the applicant will or will continue to provide a drug-free workplace by
complying with the requirements in 2 C.F.R. part 3186 (Requirements for Drug-Free
Workplace (Financial Assistance)}. In particular, the applicant as the recipient must
comply with drug-free workplace requirements in subpart B of 2 C.F.R. part 3186,
which adopts the Government-wide implementation (2 C.F.R. part 182) of the Drug-
Free Workplace Act of 1988 (41 U.S.C. §§ 701-707, as amended).

This includes, but is not limited to: making a good faith effort, on a continuing basis,
to maintain a drug-free workplace; publishing a drug-free workplace statement;
establishing a drug-free awareness program for the applicant’s employees; taking
actions concerning employees who are convicted of violating drug statutes in the
workplace; and identifying (either at the time of application or upon award, or in
documents that the applicant keeps on file in its offices) all known workplaces under
its Federal awards.

4, Federal Debt Status_The authorized representative, on behalf of the applicant,
certifies to the best of his or her knowledge and belief that the applicant is not
delinquent in the repayment of any Federal debt.

5. Certification Regarding Lobbying Activities (Applies to Applicants Requesting
Funds in Excess of $100,000)(31 U.S.C. §1352}

The authorized representative certifies, to the best of his or her knowledge and belief,
that:

a) No Federal appropriated funds have been paid or will be paid, by or on behalf of
the authorized representative, to any person for influencing or attempting to
influence an officer or employee of an agency, a Member of Congress, an officer
or employee of Congress, or an employee of a Member of Congress in connection
with the awarding of any Federal contract, the making of any Federal grant, the
making of any Federal loan, the entering into of any cooperative agreement, and
the extension, continuation, renewal, amendment, or modification of any
Federal contract, grant, loan, or cooperative agreement.

b) If any funds other than Federal appropriated funds have been paid or will be
paid to any person (other than a regularly employed officer or employee of the
applicant, as provided in 31 U.S.C. § 1352) for influencing or attempting to
influence an officer or employee of any agency, a Member of Congress, an officer
or employee of Congress, or an employee of a Member of Congress in connection
with this Federal contract, grant, loan, or cooperative agreement, the authorized
representative shall complete and submit Standard Form LLL, “Disclosure of
Lobbying Activities,” in accordance with its instructions.

c) The authorized representative shall require that the language of this
certification be included in the award documents for all subawards at all tiers
(including subcontracts, subgrants, and contracts under grants, loans, and
cooperative agreements) and that all subrecipients shall certify and disclose
accordingly.

This certification is a material representation of fact upon which reliance is placed
when the transaction is made or entered into. Submission of this certification is a
prerequisite for making or entering into the transaction imposed by 31 U.S.C. § 1352.

Any person who fails to file the required certification shall be subject to a civil penalty
of not less than $10,000 and not more than $100,000 for each such failure.

In addition, in accordance with Federal appropriations law, no IMLS funds may be
used for publicity or propaganda purposes for the preparation, distribution, or use of
any kit, pamphlet, booklet, publication, electronic communication, radio, television, or
video presentation designed to support or defeat the enactment of legislation before
the Congress or any State or local legislature or legislative body or designed to support
or defeat any proposed or pending regulation, administrative action, or order issued by
the executive branch of any State or local government, No IMLS funds may be used to
pay the salary or expenses of any grant or contract recipient, or agent acting for such
recipient, related to any activity designed to influence the enactment of legislation,
appropriations, regulation, administrative action or Executive order proposed or
pending before the Congress or any State government, State legislature or local
legislature or legislative body.

6. Trafficking in Persons

The applicant must comply with Federal law pertaining to trafficking in persons. nder
22 U.S.C. §7104(g), any grant, contract, or cooperative agreement entered into by a
Federal agency under which funds are to be provided to a private entity shall include a
condition that authorizes the Federal agency (IMLS) to terminate the grant, contract,
or cooperative agreement, or take other authorized actions, if the grantee or any
subgrantee, or the contractor or any subcontractor, engages in, or uses labor
recruiters, brokers, or other agents who engage in trafficking in persons, the
procurement of a commercial sex act, the use of forced labor, or acts that directly
support or advance trafficking in persons.

7. Updates and Addendums

Additional requirements may occur, effective immediately, based on guidance the
State Library receives from the Institute of Museum and Library Services. We
anticipate that additional guidance and requirements around 2 C.F.R. part 200 will be
forthcoming on the topics of procurement and audit requirements. The State Library
will communicate this information as it is received, and the applicant will be expected
to comply from the date of communication forward.

8. General Certification

The authorized representative, on behalf of the applicant, certifies that the applicant
will comply with all applicable requirements of all other Federal laws, executive orders,
regulations, and policies governing the program.

These assurances and certifications are provided in connection with any and all
financial assistance from the Institute of Museum and Library Services after the date
this form is signed. These assurances and certifications are binding on the applicant,
its successors, transferees, and assignees, and on the Authorized Certifying Official
whose signature appears below.

The undersigned further provides assurances that it will include, as applicable, the
language of the assurances and certifications in all subawards and that all
subrecipients shall certify and disclose accordingly.

As the duly authorized representative of the applicant, I hereby certify that the
applicant will comply with the above assurances and certifications.

WMNhal L fed. Gtondals Publis | aan

Signature of Authorized Certifying Official Library Name

Wichael L. Bede chte® Ubanan

Print Name and Title of Authorized Certifying Official

S\4| 224

Date

OMB Approval No. 0348-0040

ASSURANCES ~« NON-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 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

As the duly authorized representative of the applicant, | certify that the applicant:

1.

is the case, you will be notified.

Has the iegal authority to apply for Federal assistance
and the institutional, managerial and financial capability
(including funds sufficient to pay the non-Federal share
of project cost) to ensure proper planning, management
and completion of the project described in this
application.

Will give the awarding agency, the Comptroller General
of the United States and, if appropriate, the State,
through any authorized representative, access to and
the right to examine all records, books, papers, or
documents related to the award; and will establish a
proper accounting system in accordance with generally
accepted accounting standards or agency directives.

Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal or organizational
conflict of interest, or personal gain.

Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding
agency.

Will comply with the intergovernmental Personnel Act of
1970 (42 U.S.C. §§4728-4763) relating to prescribed
standards for merit systems for programs funded under
one of the 19 statutes or regulations specified in
Appendix A of OPM's Standards for a Merit System of
Personnel Administration (5 C.F.R. 900, Subpart F).

Will comply with all Federal statutes relating to
nondiscrimination. These include but are not limited to:
{a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of 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

Previous Edition Usable

Authorized for Local Reproduction

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 Office and
Treatment Act of 1972 (P.L. 92-255), as amended,
relating to nondiscrimination on the basis of drug
abuse; (f} the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; {g) §§523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee
3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIll of the
Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.}, as
amended, relating to nondiscrimination in the sale,
rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statute(s)
under which application for Federal assistance is being
made; and, (j) the requirements of any other
nondiscrimination statute(s) which may apply to the
application.

Will comply, or has already complied, with the
requirements of Titles Il and Ill of the Uniform
Relocation Assistance and Real Property Acquisition
Policies Act of 1970 (P.L. 91-646) which provide for
fair and equitable treatment of persons displaced or
whose property is acquired as a result of Federal or
federally-assisted programs. These requirements apply
to all interests in real property acquired for project
purposes regardless of Federal participation in
purchases.

Will comply, as applicable, with provisions of the
Hatch Act (6 U.S.C. §§1501-1508 and 7324-7328)
which limit the political activities of employees whose
principal empioyment activities are funded in whole or
in part with Federal funds.

Standard Form 424B (Rev. 7-97}
Prescribed by OMB Circular A-102

Mikal, ar

Michael L. Beck/Chief Librarian

g. Will comply, as applicable, with the provisions of the Davis- 12. Will comply with the Wild and Scenic Rivers Act of
Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act 1968 (16 U.S.C, §§1271 et seq.) related to protecting
(40 U.S.C. §276c and 18 U.S.C. §874}, and the Contract components or potential components of the national
Work Hours and Safety Siandards Act (40 U.S.C. §§327- wild and scenic rivers system.

333), regarding labor standards for federally-assisted

construction subagreements. 13. Will assist the awarding agency in assuring compliance

with Section 106 of the National Historic Preservation

10. Will comply, if applicable, with flood insurance purchase Act of 1966, as amended (16 U.S.C. §470), EO 11593

requirements of Section 102(a) of the Flood Disaster {identification and protection of historic properties), and

Protection Act of 1973 (P.L. 93-234) which requires the Archaeological and Historic Preservation Act of

recipients in a special flood hazard area to participate in the 1974 (16 U.S.C. §§469a-1 et seq.).

program and to purchase flood insurance if the total cost of

insurable construction and acquisition is $10,000 or more. 14. Will comply with P-L. 93-348 regarding the protection of

human subjects involved in research, development, and

11. Will comply with environmental standards which may be related activities supported by this award of assistance.

prescribed pursuant to the following: (a) institution of

environmental quality control measures under the National 15. Will comply with the Laboratory Anima! Welfare Act of

Environmental Policy Act of 1969 (P.L. 91-190) and 1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et

Executive Order (EO) 11514; (b) notification of violating seq.) pertaining to the care, handling, and treatment of

facilities pursuant to EO 11738; (c) protection of wetlands warm blooded animals held for research, teaching, or

pursuant to EO 11990; (d) evaluation of flood hazards in other activities supported by this award of assistance.

floodplains in accordance with EO 11988; (e) assurance of

project consistency with the approved State management 16. Will comply with the Lead-Based Paint Poisoning

program developed under the Coastal Zone Management Prevention Act (42 U.S.C. §§4801 et seq.) which

Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of prohibits the use of lead-based paint in construction or

Federal actions to State (Clean Air) Implementation Plans rehabilitation of residence structures.

under Section 176(c} of the Clean Air Act of 1955, as

amended (42 U.S.C. §§7401 et seq.); (g) protection of 17. Will cause to be performed the required financial and

underground sources of drinking water under the Safe compliance audits in accordance with the Single Audit

Drinking Water Act of 1974, as amended (P.L. 93-523); Act Amendments of 1996 and OMB Circular No. A-133,

and, (h) protection of endangered species under the “Audits of States, Local Governments, and Non-Profit

Endangered Species Act of 1973, as amended (P.L. 93- Organizations.”

205).

) 18. Will comply with all applicable requirements of all other
Federal! laws, executive orders, regulations, and policies
governing this program.

SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE

APPLICANT ORGANIZATION

Glendale Public Library

DATE SUBMITTED

May 4, 2021

Standard Form 424B (Rev. 7-97) Back

LSTA Request for Payment Form

Library Name: C end ale a Llc Qo brary

State Project Number: wy) OL -DOlLOo7 Che — 05

projectName:__ Mental Well being and Tou

Amount Requested: t t, 0 0) O

Payable To: Cita of Glendale

The undersigned acknowledges receipt of and agreement with the terms of the LSTA award documents,
and hereby requests funds to execute the project named above.

WVdhael L. pe.

Signature

Wichayl L Beale S|4|7»21

Printed Name & Date

Refer to award notification for CFDA and other grant information. Email completed form to Stacy
Nykorchuk at libgrants@azlibrary.gov.

INSTITUTE of

Museum:.n.Library
SERVICES

INTERNET SAFETY CERTIFICATION FOR APPLICANT PUBLIC LIBRARIES,
PUBLIC ELEMENTARY AND SECONDARY SCHOOL LIBRARIES, and
CONSORTIA WITH PUBLIC AND/OR PUBLIC SCHOOL LIBRARIES

As the duly authorized representative of the applicant library, | hereby certify that the library
is (check only one of the following boxes)

A. CIPA Compliant (The applicant library has complied with the requirements of
20 US.C. § 9134(f et seq.)
OR

B. | The CIPA requirements do not apply because no funds made available
under the LSTA program are being used to purchase computers to access

the Internet, or to pay for direct costs associated with accessing the
Internet.

Mahl 1. bec:

Signature of Authorized Representative

Michael L Beck

Printed Name of Authorized Representative

Chief Librarian

Title of Authorized Representative

5/4/2021

Date

Glendale Public Library/Mental Well Being & You

Name of Applicant Library/Program

OMB No. 3137-0071; Expiration Date: 6/30/2021