description: tags: application2005-2

8/14/2019 description: tags: application2005-2

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Filing Deadline: 8/5/2005 U.S. Department o f EducationImpact Aid Program

Washington, D.C. 20202-6244

APPLICATION FOR DISCRETIONARY CONSTRUCTION PROGRAMSECTION 8007(b)Catalog of Federal Domestic Assistance #84-041C

Send 1 copy to the State Educational Agency (SEA).

Form Approved: OMB number 1810-0657 Expiration date: 3/31/2007

Select One

Emergency Grant Modernization Grant

Is the Applicant Delinquenton Any Federal Debt?

Yes No

ApplicantsDUNS Number

Applicants TaxpayerIdentification Number

ApplicantsImpact Aid Number

Applicant Name :Street/P.O. Box :

City :County :

State & Zip :

Contact Person Name :Title :

Phone :Fax :

E-Mail :

Name of the School Facility for Which Funding Is Requested: Amount Requested:

Section 8003 Applicants

Enrollment in this School Facility on theSurvey Date Reported on Your LocalEducational Agencys (LEAs) Fiscal Year(FY) 2005 Section 8003 App lication

Section 8002 Applicants

Enrollment in this School Facility on theState Count Date in the Fall of School Year2003-2004

Enrollment in Your LEA on the State CountDate in the Fall of School Year 2003-2004

If Applicable, Date Application Was Submitted to State Agency for Execut ive Order 12372 Review:

I certify that I have read the statements contained in this application and that these statements and all of the data included in this application are, to the best of myknowledge and belief, true, complete and correct. I certify that I am authorized to make the representations and commitments in this appli cation, for and on behalf of theapplicant, and otherwise to act as the applicants authorized representative in submitting this application for funding under section 8007(b) of the Impact Aid Program (TitleVIII of the Elementary and Secondary Education Ac t). I declare that the applicant wi ll mail a complete copy o f this appl ication to t he SEA at the same time that it mails thisapplication to the U.S. Department of Education.

Name and Title of Authorized Representative (Please type or print.) Signature Date

Fiscal Year

2005

June 2005


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Page: 1

APPLICATION FOR DISCRETIONARY CONSTRUCTION PROGRAM SECTION 8007(b) ADDITIONAL INFORMATION

APPLICANTS INTEREST IN THE SCHOOL FACILITY Own Lease ________________________ Other(Expiration date)

If Other, Specify ______________________________________________________________________________________________________________________

AGE OF THE SCHOOL FACILITY Year of Orig inal Construct ion ________________

Year(s) and Descripti on(s) of Major Renovation(s) ________________ _______________________________________________________________________

________________ _______________________________________________________________________

________________ _______________________________________________________________________

Square Footage of Existing School Facility ________________

ACREAGE IN LOCAL EDUCATIONAL AGENCY (LEA)

Total Acres Within Boundaries of LEA __________________ Total Acres of Nontaxable Federal Property Within Boundaries of LEA __________________

BONDED INDEBTEDNESS AS OF THE END OF THE AGENCYS FISCAL YEAR 2003-2004

Maximum Bonding Capacity $______________________________________ Amount of Bonded Debt $__________________________________________

ASSESSED VALUE OF TAXABLE PROPERTY IN LEA

Name of Taxing Juri sdic tion (e.g., School Distri ct Name, Townsh ip Total Assessed Value of Real Property (Land and Improvements ) ThatName, City Name, County Name, etc.) May Be Taxed for School Purposes for School Year 2003-2004 on Behalf

of the LEA ________________________________________________________________ $_______________________________________________________________

________________________________________________________________ $_______________________________________________________________

________________________________________________________________ $_______________________________________________________________

STATE AVERAGE ASSESSED VALUE PER PUPILState Average Assessed Value Per Pupil of Real Property (Land and Improvements) That Was Taxed

for School Purposes for School Year 2003-2004 $____________________________________

June 2005 Form Approved: OMB number 1810-0657, Expiration date: 3/31/2007 Page 2


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APPLICATION FOR DISCRETIONARY CONSTRUCTION PROGRAM SECTION 8007(b) TAX RATE INFORMATION

Instructions: Enter the local real property tax levy, in mills or dollars and cents, that was used to raise funds forcapital expenditures for the local educational agency(LEA) for fiscal year 2003-2004. If the LEA does not have a separate tax rate for capital expenditures, enter the total tax rate for school purposes that was used forfiscal year 2003-2004. Most local taxing jurisdictions use a single tax rate for school operations expenditures for all types of real property under their authority. LEAs

with such a single tax rate will only need to use one line of this table. LEAs with multiple tax rates should use a separate line to report each type of property andcorresponding tax rate. When funds for capital expenditures for the LEA are raised by more than one taxing jurisdiction, use separate lines to report propertytypes and tax rates for each jurisdiction.

(Col. 1)Name of Taxing Jurisdiction

(e.g., school district name, township name,city name, county name, etc.)

Use a separate line for each di fferent

taxing jurisdicti on in the LEA.

(Col. 2)Type of Taxable Property

(e.g., residential, commercial,agricultural, etc.)

(Col. 3)Tax Rate for This Type ofProperty for Fiscal Year

2003-2004

(Col. 4)Specify whether the tax rate

reported in Col. 3 is for capitalexpenditures or total

expenditures for

school purposes.

Example:Jones County

Example:Agricultural

Examples:2.5 mills per $1 or$2.50 per $1,000

Example:Capital

per $

per $

per $

per $

per $

per $

per $



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APPLICATION FOR DISCRETIONARY CONSTRUCTION PROGRAM SECTION 8007(b) PROJECT NARRATIVE FOR EMERGENCY GRANT APPLICATION

Proposed Project Start Date Proposed Project Completion Date

Describe: (1) the emergency condi tion; (2) how the emergency condi tion adversely affects the health, safety and well-being of occupants of the schoolfacility; (3) the amount of square footage to be added to the school facility, if any; (4) the age of the facility systems associated with this project (e.g.,roofing, plumbing, HVAC, windows, electrical, etc.); (5) actions the applicant has taken to respond to the emergency condition and why the applicant hasbeen unable to resolve the condition; (6) how the proposed project will address the emergency condit ion; and (7) the proposed project and budget.



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APPLICATION FOR DISCRETIONARY CONSTRUCTION PROGRAM SECTION 8007(b) PROJECT NARRATIVE FOR MODERNIZATION GRANT APPLICATION

PROPOSED PROJECT START DATE PROPOSED PROJECT COMPLETION DATE

Describe: (1) the need for modernization of t he school facility; (2) the amount of square footage to be added to the schoo l facility, if any; (3) actions theapplicant has taken to respond to the cond ition requiring modernization and why the applicant has been unable to resolve the condition ; (4) how theproposed proj ect will address the condi tion requiring modernization; and (5) the proposed project and budget.



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APPLICATION FOR DISCRETIONARY CONSTRUCTION PROGRAM SECTION 8007(b) JUSTIFICATION FOR REBUILDING

If proposing new constructi on, provide justification for rebuilding instead of repairing or renovating the existing school facility. Specify the total squarefootage of the proposed new facility.



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APPLICATION FOR DISCRETIONARY CONSTRUCTION PROGRAM SECTION 8007(b) CHILDREN WHO ATTENDED THIS SCHOOL FACILITY AND WHOWERE INCLUDED ON TABLE 1 OF THE APPLICANTS SECTION 8003 APPLICATION

Report children included on Table 1 of section 8003 FY 2005 (school year 2003-2004) application who attended school facility for which funding is requested .

FEDERAL PROPERTY ON WHICH CHILDREN WITH DISABILITIES RESIDE CHILDREN WITH DISABILITIES

PROPERTYCODE

NUMBER(1)

OFFICIAL NAME,ADDRESS, CITY, STATE

(2)

NUMBER OFCHILDREN

ON SURVEYDATE

(3)

CATEGORY

(5)

NUMBER OFCHILDREN

ON SURVEYDATE

(6)

WITH A PARENT ON ACTIVE DUTY IN THEUNIFORMED SERVICES OF THE UNITED

STATESWITH A PARENT WHO IS BOTH AN

ACCREDITED FOREIGN GOVERNMENTOFFICIAL AND A FOREIGN MILITARY OFFICER

RESIDING ON ELIGIBLE INDIAN LANDS

TABLE 1-2 TOTAL

TABLE 1-1 TOTALJune 2005 Form Approved: OMB number 1810-0657, Expiration date: 3/31/2007 Page 8


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Report children included on Table 2 of section 8003 FY 2005 (school year 2003-2004) application who attended school facility for which funding is requested.

CHILDREN WITH DISABILITIES(2)

NUMBER OF CHILDREN ON SURVEY DATE(3)

WITH A PARENT ON ACTIVE DUTY IN THE UNIFORMED SERVICESOF THE UNITED STATES

WITH A PARENT WHO IS BOTH AN ACCREDITED FOREIGN GOVERNMENTOFFICIAL AND A FOREIGN MILITARY OFFICER



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Report children included on Table 3 of section 8003 FY 2005 (school year 2003-2004) application who attended school facility for which funding is requested .

FEDERAL PROPERTY ON WHICH CHILDREN RESIDE FEDERAL PROPERTY ON WHICH PARENTS ARE EMPLOYED

PROPERTY CODENUMBER

(1)

OFFICIAL NAME, ADDRESS, CITY, STATE

(2)

PROPERTY CODENUMBER

(3)

OFFICIAL NAME, ADDRESS, CITY, STATE

(4)

NUMBER OFCHILDREN

ON SURVEYDATE

(5)

TOTALJune 2005 Form Approved: OMB number 1810-0657, Expiration date: 3/31/2007 Page 10


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APPLICATION FOR DISCRETIONARY CONSTRUCTION PROGRAM SECTION 8007(b) CHILDREN WHO ATTENDED THIS SCHOOL FACILITY AND WHOWERE INCLUDED ON TABLES 4 AND 5 OF THE APPLICANTS SECTION 8003 APPLICATION

Report chi ldren included on Table 4 of section 8003 FY 2005 (school year2003-2004) application who attended school facility for wh ich funding is

requested.

Report chi ldren included on Table 5 of section 8003 FY 2005 (school year2003-2004) application who attended schoo l facility for which funding is

requested.

FEDERAL PROPERTY ON WHICH CHILDREN RESIDE FEDERAL PROPERTY ON WHICH PARENTS ARE EMPLOYED

PROPERTY CODENUMBER

(1)


(2)

NUMBER OFCHILDREN

ON SURVEYDATE

(3)

PROPERTY CODENUMBER

(4)


(5)

NUMBER OFCHILDREN

ON SURVEYDATE

(6)

TABLE 4 TOTAL TABLE 5 TOTALJune 2005 Form Approved: OMB number 1810-0657, Expiration date: 3/31/2007 Page 11


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APPLICATION FOR DISCRETIONARY CONSTRUCTION PROGRAM SECTION 8007(b) PROGRAM ASSURANCES AND CERTIFICATIONS

The applicant local educational agency (LEA) declares that it has filed the certifications regarding lobbying in ED Form 80-0013 with the U.S.

Department of Education (Department) as part of its section 8003 or section 8002 Impact Aid application. As of the date of the signature

below, the LEA reaffirms and incorporates by reference those assurances and certifications with respect to this grant award. The LEA

certifies that no circumstances affecting the validity of these assurances have changed since their previous filing.

With respect to the Certification Regarding Lobbying, the LEA recertifies that no 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 the making or renewal of Federal grants under this program; that the

LEA shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," when required (34 C.F.R. Part 82, Appendix B);

and that the LEA shall require the full certification, as set forth in 34 C.F.R. Part 82, Appendix A, in the award documents for all subawards at

all tiers.

The LEA further agrees to comply with the following Education Department General Administrative Regulations (EDGAR):

34 CFR Part 75 -- Direct Grant Programs, except 75.600 through 75.617

34 CFR Part 77 -- Definitions that Apply to Department Regulations

34 CFR Part 80 -- Uniform Administrative Requirements for Grants and Cooperative Agreements to State and Local Governments, including

the procurement provisions

34 CFR Part 81 -- General Education Provisions Act--Enforcement

34 CFR Part 82 -- New Restrictions on Lobbying

34 CFR Part 84 Governmentwide Requirements for Drug-free Workplace (Financial Assistance)34 CFR Part 85 -- Governmentwide Debarment and Suspension (Nonprocurement)

Signature Of Authorized Representative Date



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OMB Approval No. 0348-0042

ASSURANCES - CONSTRUCTION PROGRAMS

NOTE:

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

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 (0348-0042), 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.

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 assistance awarding agencies may require applicants to certify to additional

assurances. If such is the case, you will be notified.

Has the legal authority to apply for Federal assistance,

and the institutional, managerial and financial capability

(including funds sufficient to pay the non-Federal share

of project costs) 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, ordocuments related to the assistance; and will establish

a proper accounting system in accordance with

generally accepted accounting standards or agency

directives.

Will not dispose of, modify the use of, or change the

terms of the real property title, or other interest in the

site and facilities without permission and instructions

from the awarding agency. Will record the Federalinterest in the title of real property in accordance with

awarding agency directives and will include a covenant

in the title of real property aquired in whole or in part

with Federal assistance funds to assure non-

discrimination during the useful life of the project.

Will comply with the requirements of the assistance

awarding agency with regard to the drafting, review and

approval of construction plans and specifications.

Will provide and maintain competent and adequate

engineering supervision at the construction site to

ensure that the complete work conforms with the

approved plans and specifications and will furnish

progress reports and such other information as may be

required by the assistance awarding agency or State

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 OPMs Standards for a Merit System of

Personnel Administration (5 C.F.R. 900, Subpart F).

Will comply with the Lead-Based Paint Poisoning

Prevention Act (42 U.S.C. 4801 et seq.) which

prohibits the use of lead-based paint in construction or

rehabilitation of residence structures.

Will comply with all Federal statutes relating to non-

discrimination. 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 theRehabilitation 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 VIII of the

Ci il Ri ht A t f 1968 (42 U S C 3601 t )

8.

9.

10.

1.

2.

3.

4.

5.


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Will comply, or has already complied, with the

requirements of Titles II and III 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 and federally-assisted

programs. These requirements apply to all interests in real

property acquired for project purposes regardless of

Federal participation in purchases.

Will comply with the provisions of the Hatch Act (5 U.S.C.

1501-1508 and 7324-7328) which limit the political

activities of employees whose principal employment

activities are funded in whole or in part with Federal funds.

Will comply, as applicable, with the provisions of the Davis-

Bacon Act (40 U.S.C. 276a to 276a-7), the Copeland Act

(40 U.S.C. 276c and 18 U.S.C. 874), and the Contract

Work Hours and Safety Standards Act (40 U.S.C. 327-

333) regarding labor standards for federally-assisted

construction subagreements.

Will comply with flood insurance purchase requirements of

Section 102(a) of the Flood Disaster Protection Act of 1973(P.L. 93-234) which requires recipients in a special flood

hazard area to participate in the program and to purchase

flood insurance if the total cost of insurable construction

and acquisition is $10,000 or more.

Will comply with environmental standards which may be

prescribed pursuant to the following: (a) institution 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)

protection of wetlands pursuant to EO 11990; (d)

evaluation of flood hazards in floodplains in accordance

with EO 11988; (e) assurance of project consistencywith the approved State management program

developed under the Coastal Zone Management Act of

1972 (16 U.S.C. 1451 et seq.); (f) conformity of

Federal actions to State (Clean Air) Implementation

Plans under Section 176(c) of the Clean Air Act of

1955, as amended (42 U.S.C. 7401 et seq.); (g)

protection of underground sources of drinking water

under the Safe Drinking Water Act of 1974, as

amended (P.L. 93-523); and, (h) protection ofendangered species under the Endangered Species Act

of 1973, as amended (P.L. 93-205).

Will comply with the Wild and Scenic Rivers Act of

1968 (16 U.S.C. 1271 et seq.) related to protecting

components or potential components of the national

wild and scenic rivers system.

Will assist the awarding agency in assuring compliancewith Section 106 of the National Historic Preservation

Act of 1966, as amended (16 U.S.C. 470), EO 11593

(identification and protection of historic properties), and

the Archaeological and Historic Preservation Act of

1974 (16 U.S.C. 469a-1 et seq.).

Will cause to be performed the required financial and

compliance audits in accordance with the Single Audit

Act Amendments of 1996 and OMB Circular No. A-133,

"Audits of States, Local Governments, and Non-ProfitOrganizations."

Will comply with all applicable requirements of all other

Federal laws, executive orders, regulations, and policies

governing this program.

11.

12.

13.

14.

15.

16.

17.

18.

19.


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description: tags: application2005-2

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