HomeMy WebLinkAboutFlorida Department of Law Enforcement - Subgrant Award Certificate form 2017 03 08 partial CERTIFICATION FORM
Compliance with the Equal Employment Opportunity Plan (EEOP)Requirements
Please read carefully the Instructions(see below)and then complete Section A or Section B or Section C,not all three.If recipient
com Metes Section A or C and sub- rants a sin,.ale award over$500,000, in addition, lease com_Mete Section D.
G
Recipient's Name City of Winter Springs
Address: 112-E SR 434 Winter Springs,FL 32708
Is a�enr a, ❑ Direct or® Sub rectient of OJP,OVW or COPSIT fundin ? Law Enforcement A�enc ?�cYes❑No
DUNS Number: 137047887 Vendor Number(only if direct recipient)
Name and Title of Contact Person: Lieutenant Nicholas Romano .._ ....... _ .._
Tele hone Number: 407-327-7998 E-Mail Address: nromano@winterspringsfl.org
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 ❑Medical Institution.
❑Nonprofit Organization o Educational Institution im Receiving a single award(s)less than$25,000.
I, Charles Lacey [responsible
official] certify that
the City of Winter Springs
[recipient] is not required to prepare an EEOP for the reason(s)checked above,pursuant to 28 C.F.R.§42.302.
I further certify that the City of Winter Springs _ _ p r _ v [recipient]
will comply with applicable federal civil rights laws that prohibit discrimination►in employment and in the delivery of
services.
If recipient sub-grants a single award over$500,000, in addition,plepse complete Section D
Charles Laced Na or,Rfthe City W�n�ter_ _t 3�_/2017
Print or T e Name and Title t ,ztature Date
Section B—Declaration Claiming Exemption from the EEOP Sub ssiun Requirement and Certifying
That an EEOP Is on File for Review
If a recipient agency has fifty or more employees and is receiving a single award or,subaward,of$25,000 or more,but less than$500,000,then
the recipient agency does not have to submit an EEOP to the OCR for review as long as it certifies the following(42 C.F.R.§42.305):
11 —_ _ ........ .. . [responsible
official], certify that __ _
which has fifty or more employees and is receiving a single
[recipient], yg g ward or subaward for$25,000 or more,but less
than$500,000,has formulated an EEOP in accordance with 28 CFR pt.42,subpt.E. I further certify that within the last
twenty-four months,the proper authority has formulated and signed into effect the EEOP and,as required by applicable
federal law,it is available for review by the public,employees,the appropriate state planning agency,and the Office for
Civil Rights,Office of Justice Programs,U.S. Department of Justice. The EEOP is on file at the following office:
[organization],
. ...........� __ .. ..... _. ......._ ..... ....... .._.
[address].
- __ ......-. ........................_._ -----------_....... -----
Print or T e Name and Title Sii �ature Date
Section C—Declaration Stating that an EEOP Short Form Has Been Submitted to the Office for Civil
Rights for Review
If a recipient agency has fifty or more employees and is receiving a single award,or subaward,of$500,000 or more,then the recipient agency
must send an EEOP Short Form to the OCR for review.
I, [responsible
official], certify that
which has fifty or more employees and is receiving a single award of$500,000 or more,has formulated an
[recipient], ftYg g
EEOP in accordance with 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 oe Name and Title Sz 1nature Date
AppE ition for Funding Assist" ce
Florida Department of Law Enforcement
Justice Assistance Grant - County-wide
--------......
In witness whereof, the parties affirm they each have read and agree to the conditions set
forth in this agreement, have read and understand the agreement in its entirety and have
executed this agreement by their duty authorized officers on the date, month and year set
out below.
Corrections on this page, including Strikeovers,
whiteout, etc. are not acceptable.
State of Florida
Department of Law Enforcement
Office of Criminal Justice Grants
Signature:
Typed Name and Title:
Date:
Subgrant Recipient
Authorizing Official of Governmental Unit
(Commission Chairman, Mayor, or Designated Representative)
Typed Name of Subgrart Recipient: City of Winters rings
Signature:
qm�v
Typed Name and `I tI ��
Mayor Charles A. Lacey ......_
Date: March 8,, 2017
Implementing Agency
Official,Administrator or Designated Representative
p.� �e��� d $m r
Typed Name of Im Imentin�g genC : oSignature:
Typed Name and Title: "
Date: A7