HomeMy WebLinkAboutRESOLUTIONS-2013-014-R-13•
2/25/2013
14-R-13
A RESOLUTION
Authorizing the City Manager to Sign
a Notification and Conditions of Grant Award
to Fund the Long -Term Care Ombudsman Program
WHEREAS, the City of Evanston has made it a priority to focus on
providing for a comfortable and high stand of living for seniors; and
WHEREAS, pursuant to the Older Americans Act of 1965 (P.L. 109-365)
and the Illinois Act on Aging (20 ILCS 105/1 et seq.), the Parks, Recreation and
Community Services Department (the "Department") operates a Long -Term Care
Ombudsman Program; and
WHEREAS, the Ombudsman protects and promotes the rights and quality
• of life for residents of long-term care facilities by maintaining a working relationship with
the residents and staff of such facilities within the City; and
WHEREAS, the Department applied to the Illinois Department on Aging
for funding for its Ombudsman program; and
WHEREAS, the Department received a grant award in the amount of
twenty-seven thousand, nine hundred sixty dollars ($27,960.00); and
WHEREAS, the Department intends to use the grant award for personnel,
travel and training costs, supplies, and equipment for the Ombudsman program,
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF
THE CITY OF EVANSTON, COOK COUNTY, ILLINOIS:
40
14-R-13
SECTION 1: That the foregoing recitals are hereby found as fact and •
incorporated herein by reference.
SECTION 2: That the City Manager is hereby authorized to sign, and the
City Clerk herby authorized to attest, on behalf of the City of Evanston, the Notification
of Grant Award and Conditions of Award attached hereto as Exhibits A and B,
incorporated herein by reference.
SECTION 3: That the City Manager is hereby authorized and directed to
negotiate any additional conditions of the Grant Award as he may determine to be in the
best interests of the City.
SECTION 4: That this Resolution 14-R-13 shall be in full force and effect
from and after its passage and approval in the manner provided by law.
Ro ney Greene ity Clerk
Adopted: f' , 2013
EI' eth B. Tisdahl, Mayor
-2-
•
•
•
EXHIBIT A
Illinois Department on Aging
Notification of Grant Award
-3-
14-R-13
r
NOTIFICATION OF GRANT AWARD
AgeOptions - (Illinois Department on Aging - PSA 13)
Under Title III-B, Title-tll-C, Title III-D, Title III-E, & Title VII of the Older Americans
Act and under the State of Illinois General Revenue Funds
GRANTEE NAME, ADDRESS
Evanston, City of
Project ID: 13119
300 Dodge Avenue
Date: 9/26/2012
Evanston, IL 60202
Type of Grant: Ombu Ombudsman
Approved Costs for Project Period
Project Period:
a. Personnel/Fringe
$101,235
From: 10/1/2012
b. Food
0
To: 9/30/2013
c. Travel of Persons
4,300
d. Equipment & Supplies
2,500
Sub Areas: 021 Evanston
e. Delivery
0
f. Other
6,424
g. Total
$114,459
Computation of Grant Award
1. Total Cost
$114,459
8. Original Obligation:
$27,960
2. Less Anticipated
Revision 1:
$0
Project Income
0
Revision 2:
$0
3. Net Cost (estimated)
114,459
4. Nonfederal Share
86,499
9. Share of Net Cost
a. Local Cash
76,419
a. NonFederal Share
75.57%
b. Local Inkind
10,080
b. Local Cash Share
66.77%
5. Area Agency Share
27,960
c. Federal/State Share
24.43%
6. State Share
0
10. Application for Funds
7. New Obligation Awarded
$27,960
Date:
8/3/2012
The awarded obligation (8) includes the maximum Federal Share and State funds obligated to the
grantee provided all conditions are met.
Grantee - I have read all the conditions of this award, and agree to fully comply with all such condtions.
Name and Title
Signature
Subscribed and sworn to before me this
Date
day of 20
Notary Public Signature
AgeOptions (also referred to as Area Agency on Aging)
Signature:
Jonathan Lavin, Chief Executive Officer Date
NOTE: The attached Conditions of Award comply with Federal and State regulations and are an
integral component of this Notification of Grant Award.
•
•
•
is
•
•
EXHIBIT B
Illinois Department on Aging
Conditions of Award
Mc
14-R-13
0
Notification of Grant Award Cover Page
•
is
The area Agency on Aging of Suburban Cook County; since 1974 •
1048 _aike Street; Suite 30J . phone i800")699-90A3 '`dx . (,08)5/ -0870 vnv ;.ageo;fio�'s:or
Oak Park. ilinois bD3�l-i1��2 (7103)383-0258 TTY- (708)52; 10{3
AgeOptions Conditions of Award
Page 2 of 12
•
•
n addition to the conditions stated in this FY 2013 Conditions of Award document, the Grantee acknowledges,
where applicable, receipt of the following documents from AgeOptions and agrees to abide by the
requirements and policies set forth:
! . AgeOptions Service Definitions and Standards
o FY 2010 RFP Service Definitions and Standards (for Title III-B and Title III-E)
o FY 2012 -2014 Definitions and Standards (for Title III-C)
o FY 2009 Definitions and Standards (for Title III-D)
• AgeOptions Request for Proposals
o FY 2010 Request for Proposal (for Title III-B and Title III-E)
o FY 2012-14 Nutrition Request for Proposal (for Title III-C)
o FY 2009 Health Promotion/Disease Prevention Request for Proposal (for Title III-D)
• Requirements for Recipients of Title III Older Americans Act Funds (All Title III)
• FY 2012 Conditions of Award (All Title III)
Grantee's work plan as submitted to AgeOptions in the form of the Grantee's application for funding (AII
Title I I I
• Assurances
o FY 2010 AgeOptions Grant/Contract Assurances (for Title III-B)
o FY 2012 AgeOptions Grant/Contract Assurances (for Title III-C)
o FY 2009 AgeOotions Grant/Contract Assurances (for Title III-D)
Typed or Printed Name of Organization
Signature of Organization's Authorized Representative
Conditions of Award follow on Page 3
AgeOptions IN Lake Street, Suite 300 phone (800)699-9043 fax_ (708,524-0870
,.,,,.:n,•:.ageoptions.org. Oak ^ai-1c,lilinois 60301-1102 (;08)383-0258 7 (708)521--1653
AgeOptions Conditions of Award
Page 3 of 12
FY 2013 CONDITIONS OF AWARD •
From Page One of this Notification -of Grant Award (NGA):
a. The date indicated on Line 10 is the official work program for this grant.
b. The project period ends September 30. 2013, unless otherwise noted on Page 1. All costs
related to this grant must be obligated prior to September 30. 2013, and disbursed prior to
November 30, 2013.
c. The amount listed on Line 5 under Computation of Grant Award will constitute the ceiling for the
Title III federal participation in the approved cost. The Area Agency Share funds may be any
combination of Federal, State (General Revenue Funds) and/or, where appropriate, NSIP
(Nutrition Services Incentive Program). The amount listed on Line 6 under Computation of Grant
Award will constitute a ceiling for the state fund participation. In -kind and project income may
not replace the obligation for local cash, although local cash may replace in -kind. Final
AgeOptions participation will be based on the close-out report.
d. The Area Agency share of the approved net cost (Number 7 under Computation of Grant
Award) is earned ONLY when the approved cost is accrued and the NON-FEDERAL (Number
4) share of the cost has been contributed. Receipt of AgeOptions Funds (either through
advance or reimbursement) does not constitute earning of these funds. Failure to generate
agreed matching funds will require reimbursement to AgeOptions of unmatched AgeOptions
funds received.
e. If the actual net cost is less than the amount on Number 3, the non-federal share will be at the
percent indicated on Line 9a. In -kind may be up to the amount identified in this award. The
cash match must be at the percent identified on Line 9b (Local Cash Share) and the
federal/state share will be at the percent identified on Line 9c (Federal/State Share) of the net
cost for the project period of this grant.
Receipt of funds (Federal, including NSIP Commodity resources, or State ) is contingent upon the
following:
a. Appropriation: Obligations of AgeOptions will cease immediately without penalty of further
payment being required if in any fiscal year the Illinois General Assembly or Federal funding
source fails to appropriate or otherwise make available sufficient funds for this Agreement.
b. Compliance with AgeOptions requirements, terms, conditions, and the Notification of Grant
Award are being met.
i. Compliance with all of AgeOptions policies and requirements (including any updates)
contained in:
1. AgeOptions Service Definitions and Standards
a. FY 2010 RFP Service Definitions and Standards (for Title III-B and Title
III-E)
b. FY 2012 -2014 Definitions and Standards (for Title III-C)
c. FY 2009 Definitions and Standards (for Title III-D)
2. AgeOptions Request for Proposals
a. FY 2010 Request for Proposal (for Title III-B and Title III-E)
b. FY 2012-14 Nutrition Request for Proposal (for Title III-C)
c. FY 2009 Health Promotion/Disease Prevention Request for Proposal (for
Title III-D)
3. Requirements for Recipients of Title III Older Americans Act Funds (All Title III-B.
C, D and E)
4.. FY 2013 Conditions of Award (All Title III-B, C, D and E) •
AgeOptions 1048 Lake Street, Suite 300 p-ione. (800)699-9093 fax . (708;524-0870
,vyv,vv.ageoptio°Zs.c)rg Oak Pali k, Illinois 50301- 1102 (708)383-0258 TTY (708)524-1653
AgeOptions Conditions of Award
Page 4 of 12
• 5. Grantee's work plan as submitted to AgeOptions in the form of the Grantee's
application for funding and approved updated budget (All Title I II-B, C, D and E)
6. Assurances
a. FY 2010 AgeOptions Grant/Contract Assurances (for Title III-B)
b. FY 2012 AgeOptions Grant/Contract Assurances (for Title III-C)
c. FY 2009 AgeOptions Grant/Contract Assurances (for Title III-D)
c. Compliance with applicable state and federal laws, rules, and regulations
d. All funds must be obligated by the end of the approved budget period and must be used as
specified in the approved in the Request for Proposal application (if applicable); Letter of Intent
(if applicable) and/or budget.
e. All terms and conditions of the Notice of Grant Award are met.
f. Compliance with applicable state and federal laws and regulations.
g. Any State grant funds not expended or legally obligated by the end of the grant agreement, or
during the time limitation to grant fund expenditures set forth in this section, must be return to
AgeOptions within 45 days, f the funds are not already on deposit with the grantor agency or the
State Treasurer.
• h. Grantee shall maintain, for a minimum of 3 years after the completion of the grant, adequate
books, records, and supporting documents to verify the amounts, recipients, and uses of all
disbursements of funds passing in conjunction with the grant; the grant and all books, records
and supporting documents related to the grant shall be available for review and audit by
AgeOptions, the Illinois Department on Aging, Executive Inspector General, the Auditor
General, and the Attorney General; and the Grantee agrees to cooperate fully with any audit
conducted by AgeOptions, the Illinois Department on Aging, Executive Inspector General, the
Auditor General, and the Attorney General; and to provide full access to all relevant materials.
Failure to maintain the books, records, and supporting documents required by this Section shall
establish a presumption in favor of the State for the recovery of any funds paid by the State
under the Grant for which adequate books, records, and supporting documentation are not
available to support their purported disbursement.
For not -for -profit organizations who are grantees, until such time as the Federal Government
makes effective any other superseding rules, regulations, circulars, or other official issuances
governing the administration of sub grants to not -for -profit grantees under grants to State
Governments, not -for -profit grantees will continue to be covered by 45 CFR 74 and OMB
circulars A-110 (Uniform Administrative Requirements), A-122 (Cost Principles), and A-133
(Audit Requirements).
III. General and Administrative Requirements
a. Policies and procedures for administration of Title III Projects must include adherence to all
• requirements of federal government, state government and AgeOptions.
AgeOptions I N 8 Lake. Street, Suite 300 phone (800)099-9043 fax (708)24-08%0
%70}3835IFTY 708524-1053,- Y.aseoptiorns_org Ok Park, Illinois 60301-1102 )
AgeOptions Conditions of Award
Page 5 of 12
b. The Grantee must maintain sufficient and appropriate insurance and bond coverage for all Older
Americans Act funded services, and provide proof of coverage to AgeOptions prior to the project
period.
IV. Fiscal Reauirements
a. The Grantee must permit AgeOptions, authorized State of Illinois and authorized Federal
personnel access to financial program and service records for purposes of Title III audit,
monitoring, and evaluation.
b. Grantee must meet AgeOptions requirements for Title III fiscal records. The Grantee, in
determining the costs of work performed under this grant, agrees to comply with the standards
set forth in the applicable Office of Management Budget (OMB) Circular (A-122 [Cost Principles
for Nonprofit Organizations]; A-87 [Cost Principles for Governmental Agencies]; or A-21 [Cost
Principles for Educational Institutions]. The Grantee agrees to comply with audit requirements
imposed by federal and state authorities governing this grant including auditing standards
prescribed by the American Institute of Certified Public Accountants and Government Auditing
Standards issued by the Comptroller General of the United States.
c. Audits for agencies expending over $500,000 in federal funds, from all sources, shall be
conducted in accordance with OMB Circular A-133 (Single Audits of States, Local
Governments, and Non -Profit Organizations). Grantees in this category must submit copies of
the annual audit report, management letter of representations, management letter (if any) and
reconciliations to closeout reports within six (6) months after the end of their fiscal year.
d. The CFDA (C
ode of Federal Domestic Assistance) numbers for AgeOptions funding are:
Title CFDA
Title I I I B 93.044
Title 11113-0mbudsman 93.044 I
Title IIIC
93.045
NSI P
93.053
Title III-D
93.043
Title III-E
93.052
Title VI I Elder Abuse
93.041
Title VII Ombudsman
93.042
e. Fiscal reporting requirements, reconciliation and reports from agency auditors for agencies that
expend less than $500,000 in Federal funds, from all sources, during a year will be more limited
in scope than the requirements outlined in OMB Circular A-133. Specific components to be
included in these year-end reports and reconciliations will be prescribed by AgeOptions.
V. ReportinQ Reauirements
a. All grantees must submit a "reconciliation report" which balances their audited figures to the
AgeOptions "Close-out report". All funds received from AgeOptions must be segregated from
other sources of funding and clearly labeled. This "reconciliation report" must be sent to
AgeOptions within 30 days of the close of the grantee's audit.
•
•
b. The Grantee's accounting system must have supporting documentation for all expenses of the •
project, which include (but not limited to): canceled checks for all project costs; receipts; payroll
sheets for all personnel providing Older Americans Act funded services and/or services
AgeOptions I0J$_ Lake. Street, Suite 300 phone (800)u99-9043 fax (708)�24-0870
'TY (708jS24-1653 ;�,v4w..ageoptions.org Oak Park, Illinois 60301-1.102 (708)383-0248
AgeOptions Conditions of Award
Page 6 of 12
• provided with state funds granted by AgeOptions based on actual time spent in each service,
allocated and reported on the monthly financial reports; and bank statements and ledgers that
adequately represent the financial status of the Older Americans Act funded project and/or
project provided with state funds granted by AgeOptions. All in -kind and matching funds must
be documented in the same manner as Title III funds. Project Income must be expended based
upon the application, with any changes of expenditures to be approved by AgeOptions. All
Project Income must be reported to AgeOptions. All such records must be available for
inspection by AgeOptions, the Illinois Department on Aging, and/or federal representative(s).
c. All time sheets kept by staff and/or volunteers providing Older Americans Act funded services,
and/or services provided with state funds granted by AgeOptions, must detail the actual amount
of time spent per funded service per payroll period.
d. The Grantee must provide AgeOptions on or before December 10, 2012, an inventory sheet of
all Title III Older Americans Act funded equipment over $500.
e. All service outputs, budget, and narrative statements are to be adhered to by the Grantee.
Revisions of all parts of the work program may be requested through Auqust 30, 2013, but
cannot be implemented into the grant work plan without the written approval of AgeOptions.
f. Units of service must be provided in each quarter of the year or as agreed upon in the grant
application. New clients should be provided service and reported on in each quarter of the year,
or as agreed upon in the grant application.
g. The Grantee must maintain service records for all AgeOptions funded services. Records shall
• clearly support and substantiate all units, clients and other information reported to AgeOptions.
h. The Grantee must provide to AgeOptions in a manner prescribed and determined by
AgeOptions, service and client information. Such information shall be used in part to meet the
Illinois Department on Aging reporting requirements including those under the National Aging
Program Information System (NAPIS).
i. The Grantee/Contractor must submit all financial and program reports on forms provided by
AgeOptions or specifically approved in writing by AgeOptions. Reimbursement will depend on
the timely submittal of reports at times specified by AgeOptions. If reports are not submitted on
time, AgeOptions may hold reimbursements until the Grantee provides all reports and meets
deadlines.
•
j. Quarterly Service Cost Reports are due fifteen days following the end of the quarter for the first
three quarters. Fourth quarter reports are due ten days following the end of the quarter. If
necessary, final (revised) reports are due November 10th.
k. All forms or methods upon which program reports, reimbursement requests, and/or other
documentation is submitted to AgeOptions automatically assumes the following:
i. The Grantee/Contractor certifies that all information is correct at the time of submission,
regardless of submission method, and
ii. The individual preparing and/or submitting the form is authorized to submit and/or
prepare the form.
AgeOptions 1048 Lire Street, Suite 300 phone (800)699-9093 fax (708)524=0570
� .•..ageoptions.arg. Gak ark, IIlin�is 6'301-I102 .. (708)3133 0258 -TY (708)S2�-1o53
AgeOptions Conditions of Award
Page 7 of 12
I. Any unearned cash as determined in the closeout calculation for the grant year must be Is
returned to AgeOptions no later than 45 days following the receipt of the closeout report, unless
notified otherwise by AgeOptions.
m. The Grantee must request from AgeOptions approval of any cost change over ten percent
(10%) in either:
i. The budget categories of Personnel, Travel, Equipment/Supplies, Food, Delivery, Other
or
ii. The service categories.
iii. The Grantee should submit a Revision Request and letter requesting the changes and
rationale for the request by Auaust 30. 2013. If approved, AgeOptions will generate a
revised Notification of Grant Award (NGA).
n. For Title III-C Nutrition Grants — Grantees may not transfer funds from the Food and/or Delivery
budget categories into any other budget category (i.e. Personnel, Travel, Equipment/Supplies,
Other). If AgeOptions chooses to increase or decrease unit levels, AgeOptions will
increase/decrease allocations based on the AgeOptions per unit share of the food and delivery
cost as originally budgeted.
o. AgeOptions will only reimburse costs that it has legal authority to do under a current Illinois
Department on Aging Notification of Grant Award. The awarding of funds by AgeOptions to a
local project is contingent upon the issuance by the Illinois Department on Aging of a signed
Notification of Grant Award, which authorizes AgeOptions to distribute funds. The failure, at any
time, of the Illinois Department on Aging to issue AgeOptions a Notification of Grant Award will
result in this grant award becoming null and void. This grant award becomes null and void if an
existing Notification of Grant Award to AgeOptions is canceled; and/or federal and state funds •
awarded to AgeOptions throughout the grant year are not sufficient to maintain fiscal year
commitments.
p. AgeOptions has sole responsibility for allocating available resources under its approved
Notification of Grant Award. In the event that resources are not sufficient to meet obligations
under this grant, AgeOptions will issue a grant revision establishing new funding levels for the
grant period. Action to reduce grant levels will be in proportion to the level of funds determined
available for the program by AgeOptions. Instances when such action will occur include, but are
not limited to, reduction of funds from the federal or state government, insufficient carryover
from the previous year to cover obligations, and/or changes in funding, rules/standards or
directives required by the state or federal government.
q. The Grantee agrees to comply with all requirements of the Older Americans Act of 1965 as
amended, and regulations and program instructions from federal and state authorities under
which this grant is given, including all provider service regulations and requirements detailed in
Volume 53 No. 169 Federal Register, 33758 - 33759, August 31, 1988 and Titles 41 and 45 of
the Code of Federal Regulations.
The grant application (as identified in Condition (1)) includes a budget for delivery of services
and a list of the services to be provided by units and clients to be served. AgeOptions awards
funds to the Grantee with the expectation that the grant application goals for expenditures,
service units, and clients will be met during and throughout the Fiscal Year. If AgeOptions
determines that expenditures, service units, or client projections will not be met, AgeOptions
may take action as outlined in the Request for Proposal (RFP) or in AgeOptians Policy on is
AgeOptions 1048 Lake Street, Sue 300 phone (000?)699-9043 fax (708)J24-0870
702453eoptr:, Illinois 50301 1102 708)383-Oi58 'T� ;vga
AgeOptions Conditions of Award
Page 8 of 12
• Performance Deficiencies of Grantees. AgeOptions may initiate a revised grant award to reflect
the level of funds needed to reach reduced unit and client projections.
VI. ACCEPTANCE OF GRANT
a. I, the undersigned, under oath, certify that I have read and understand the terms of the
Notification of Grant Award and that this Agency will abide by them. I further certify that I am
authorized to sign for this Agency and that I have not been convicted of bribery or attempting to
bribe an officer or employee of the State of Illinois, nor have I made an admission of guilt of
such conduct which is a matter of record (30 ILCS 500/50-5). The Grantee certifies that he is
not in default on an educational local as provided in Public Act 85-827. The Grantee certifies
that is has not been barred from contracting with a unit of state or local government as a result
of a violation of Section 33E-3 or 33E-4 of the Criminal Code of 1961.
b. This certifies acceptance of the terms of this Grant under Title III of the Older Americans Act
of 1965, as amended; and in terms and conditions enumerated in the narrative and exhibits of
the approved Grant applicant. This further certifies that the accepting agency understands that
it must administer the Grant in compliance with all rules and regulations of the U.S. Department
of Health and Human Services, as well as those of the Illinois Department on Aging and
AgeOptions.
c. This further certifies that the Grantee understands that no alterations of the terms specified in
this grant, as approved, may be made without written authorization of AgeOptions.
d. Grantee certifies to the following in fulfilling the requirements of the Drug Free Workplace Act
(Check only one):
• That I am doing business as an individual and I certify that I will not engage in the
unlawful manufacture, distribution, dispensation, possession, or use of a controlled
substance in the performance of this contract.
The Drug Free Workplace Act does not apply (either the contract is less than
$5,000, or the contractor or grantee is a corporation, partnership, or other entity that
has less than 25 employees).
The Drug Free Workplace Act does apply and I have completed and attached the
required certification form. (The Drug Free Workplace Act applies to contracts or
grants of $5,000 or more with corporations, partnerships, or other entities with 25 or
more employees at the time the contract or grant is awarded.)
e. The Grantee certifies that it has not been barred from contracting with a unit of State or local
government as a result of a violation of Section 33E-3 or 33E-4 of the Criminal Code of 1961.
f. The Grantee certifies that neither it nor any substantially -owned affiliated company is
participating or shall participate in an international boycott in violation of the provision of the U.S.
Export Administration Act of 1979 or the regulations of the U.S. Department of Commerce
promulgated under that Act.
g. The Grantee certifies it and its employees will comply with applicable provisions of the U.S. Civil
Rights Act, Section 504 of the Federal Rehabilitation Act, the Americans with Disabilities Act (42
U.S.C. 1201 et.seq.) and applicable rules in performance under this grant.
• h. The Grantee certifies that it is not in default on an educational loan (5 ILCS 385/3). This applies
to individuals, sole proprietorships, partnerships and individuals as members of LLCs.
AgeOptions 1048lakl. St r et, St- to 300 p' one (800)699-9013 fox (; 08) 21-0�7U
Y,f, ,.;.ageoptio�sbrg Oak;111inois60301-1102 - (f )383-0258 TY (70B;521-105?
AgeOptions Conditions of Award
Page 9 of 12
I. The Grantee certifies it is a properly formed and existing legal entity (30 ILCS 500/1.15.80, 20- •
43); and as applicable has obtained an assumed name certificate from the appropriate authority,
or has registered to conduct business in Illinois and is in good standing with the Illinois
Secretary of State.
j. If the Grantee has been convicted of a felony, the Area Agency certifies at least five years have
passed after the date of completion of the sentence for such felony, unless no person held
responsible by a prosecutor's office for the facts upon which the conviction was based continues
to have any involvement with the business (301LCS 500/50-10).
k. The Grantee certifies that it and its affiliates are not delinquent in the payment of any debt to the
State (or if delinquent has entered into a deferred payment plan to pay the debt), and the
Grantee and its affiliates acknowledge the State may declare the grant void if this certification is
false (30 ILCS 500/50-11) or if the Grantee or an affiliate later become delinquent and has not
entered into a deferred payment plan to pay off the debt (30 ILCS 500/50-60).
I. The Grantee certifies it has not paid any money or valuable thing to 'induce any person to refrain
from bidding on a State contract, nor has the Grantee accepted any money or other valuable
thing, or acted upon the promise of same for not bidding on a State Contract (30 ILCS 500/50-
25).
m. The Grantee certifies it has not been convicted of the offense of bid rigging or bid rotating or any
similar offense of any state or of the United States (720 ILCS 5/33 E-3, E-4).
n. The Grantee certifies it complies with the Illinois Department of Human Rights Act and rules
applicable to public contracts, including equal employment opportunity, refraining from unlawful •
discrimination and having written sexual harassment policies (775 ILCS 5/2-105).
o. The Grantee certifies it does not pay dues to or reimburse or subsidize payments by its
employees or any dues or fees to any "discriminatory club" (775 LCS 25/2).
p. If Grantee, or any officer, director, partner, or other managerial agent of Grantee has been
convicted of a felony under the Sarbanes-Oxley Act of 2002, or a Class 3 or Class 2 felony
under the Illinois Securities Law of 1953, Grantee certifies at least five years have passed since
the date of the conviction. Grantee further certifies that it is not barred from being awarded a
grant and acknowledges that the State shall declare the grant void if this certification is false (30
ICLS 500/50-10.5)
q. Grantee certifies it is not in violation of the "Revolving Door' section of the Illinois Procurement
Code (30 ILCS 500/50-30).
r. Grantee certifies it is not retained a person or entity to attempt to influence the outcome of a
procurement decision for compensation continent in whole or in part upon the decision of
procurement (30 ILCS 500/50-38)
s. Grantee certifies it will report to the Illinois Attorney General and the Chief Procurement Officer
any suspected collusion or other anti -competitive practice among any bidders, offerors,
contractors, proposers or employees of the State (30 ILCS 500/50-40, 50-45, 50-50)
t. Grantee warrants and certifies that it and, to the best of its knowledge, its subcontractors have •
and will comply with Executive Order No. 1 (2007). The Order generally prohibits Grantees and
AgeOptions 1048 Lake, 5treet,Suite 300 phone (800)699-9043. f<,x (708)524-0870
ig Oak Par4;,111innis 60301-1102. (708)383-0258 TfY (708)524-1653
AgeOptions Conditions of Award
Page 10 of 12
• subcontractors from hiring the then serving Govemor's family members to lobby procurement
activities of the State, or any other unit of government in Illinois including local governments if
that procurement may result in a contract valued at over $25,000. This prohibition also applies
to hiring for that same purpose and former State employee who had procurement authority at
any time during the one-year preceding the procurement lobbying activity.
u. Grantee certifies that information technology, including electronic information, software, systems
and equipment, developed or provided under this grant will comply with the applicable
requirements of the Illinois Technology Accessibility Act Standards as published at
www.dhs.state.il.us/itaa (301LCS 587).
v. Grantee certifies that it has read, understands, and is in compliance with the registration
requirements of the Elections Code (10 ILCS 5/9-35) and the restrictions on making political
contributions and related requirements of the Illinois Procurement Code (30 ILCS 500/20-160
and 50-37). Grantee will not make a political contribution that will violate these requirements.
These requirements are effective for the duration of the term of office of the incumbent
Governor or for a period of two years after the end for the grant tern, whichever is longer.
VII. Under penalties of perjury, I certify that
a. The number shown on this form its my correct taxpayer identification number (or I am waiting for
a number to be issued to me), and
b. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or
(b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup
withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified
me that I am no longer subject to backup withholding, and
• c. I am a U.S. person (including a U.S. resident alien), and
d. All information in this grant agreement is true and correct to the best of my knowledge,
information and belief; the funds shall be used only for the purposes described in the grant
agreement; and the award of funds is conditioned upon such certification, and
e. I, the undersigned, under oath, certify that I have read and understand the terms of the Request
for Proposal and this Agency will abide by them at all times during the period set forth in the
Grant Award. I further certify that I am authorized to sign for this Agency and that I have read
the attached documents and hereby abide to follow the requirements and policies set forth
therein.
Typed or Printed Name of Organization
Signature of Organization's Authorized Representative
Organization's Federal Taxpayer Identification Number
Typed or printed Name and Title of Organization's
Authorized Representative
Date of Signature
STATEMENT OF NON-DISCRIMINATION
•AgeOptions does not discriminate in admission to programs or treatment of employment in programs or
activities in compliance with the Illinois Human Rights Act, the U.S. Civil Rights Act,- Section 504 of the
AgeOptions 1048 L aee Street, Suite 300. phone :(800)699-904 3 faxi708)524-0870
v,r.:nvageoptions.org Oak Park, Illinois 6030i-1102 (708)383-0258 TTY (70�)524-1653
/-%!I ions Conditions of Award
Page 11 of 12
Rehabilitation Act, The Age Discrimination Act; the Age Discrimination in Employment Act, and the U.S. and •
Illinois Constitution. If you feel you have been discriminated against, you have the right to file a complaint with
the Illinois Department on Aging. For information, call 1-800-252-8966 (Voice and TDD) or contact the
AgeOptions Civil Rights Coordinator at (708) 383-0258.
•
•
AgeOptions 1043 Lake Strt—et. Rke 300 phone (800)699-9043 Fax (081,524-0870
Vtr. i^.N.lgeoptiansorg Oak.p�ark, Illinois 5030.1-1102 -- f?OR) 333"0,58 mil' (7C jJ%�{-IoS,? ..
AgeOptions Conditions of Award
Page 12 of 12
• STATE OF ILLINOIS
ILLINOIS DEPARTMENT ON AING
DRUG FREE WORKPLACE CERTIFICATION
This certification is required by the Drug Free Workplace Act (30 ILCS 580/1 et seq.) The Drug Free Workplace Act, effective January
1, 1992, requires that no grantee or contractor shall receive a grant or be considered for the purposes of awarded a contract for the
procurement of any property or services from the State unless that grantee or contractor has certified to the State that the grantee or
contractor will provide a drug free workplace. False certification or violation of the certification may result in sanctions including, but not
limited to, suspension of contract or grant payments, termination of the contract of grant and debarment of contracting or grant
opportunities within the State for at least one (1) year but not more than five (5) years.
For the purpose of this certification, "grantee" or "contractor" means a corporation, partnership, or other entity with twenty five (25) or
more employees at the time of issuing the grant, or a department, division, or other unit thereof, directly responsible for the specific
performance under a contract or grant of $5,000 or more from the State.
The contractor/grantee certifies and agrees that it will provide a drug free workplace by:
Publishing a statement
(1) Notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance,
including cannabis, is prohibited in the grantee's or contractor's workplace.
(2) Specifying the actions that will be taken against employees for violations of such prohibition,
(3) Notifying the employee that, as a condition of employment on such contract or grant, the employee will:
(A) Abide by the terms of the statement;, and
(13) Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than
five (5) days after such conviction.
Establishing a drug free awareness program to inform employees about:
i. The dangers of drug abuse in the workplace;
ii. The grantee's or contractor's policy of maintaining a drug free workplace;
iii. Any available drug counseling, rehabilitation, and employee assistance programs; and
iv. The penalties that may be imposed upon an employee for drug violations.
• v. Providing a copy of the statement required by subparagraph
1. To each employee engaged in the performance of the contract or grant and to post the statement in
a prominent place in the workplace.
2. Notifying the contracting or granting agency within ten (10) days after receiving notice under part
(b) of paragraph (3) of subsection (a) above from an employee or otherwise receiving actual notice
of such conviction.
3. Imposing a sanction on, or requiring the satisfactory participation in a drug abuse assistance or
rehabilitation program by, any employee who is so convicted, as required by section5 of the Drug
Free Workplace Act.
4. Assisting employees in selecting a course of action in the event drug counseling, treatment, and
rehabilitation is required and indicating that a trained referral team is in place.
5. Making a good faith effort to continue to maintain a drug free workplace through implementation of
the Drug Free Workplace Act.
THE UNDERSIGNED AFFIRMS, UNDER PENALTIES OF PERJURY, THAT HE OR SHE IS AUTHORIZED TO EXECUTE THIS
CERITIFICATION ON BEHALF OTHE LEGAL ENTITY DESIGNATED BELOW.
Typed or Printed Name of Organization Signature of Organization's Authorized Representative
Organization's Federal Taxpayer Identification Number Typed or Printed Name and Title of Organizations Authorized
Representative
Date of Signature
•
AgeOptions 1048 La' 5 reet, Suite 300 p ione (800)699-9043 fax (708}524-0670
y� ::vv.ageoptio: s.org Oak Park, Illinois 60,301- 1102 f708}383-0i53 Tf" . (708}524-1653
•
•
C7