Certified Local Government Grants Manual for Heritage Preservation Commissions – Fiscal Year
Certified Local Government Grants Manual for Heritage Preservation Commissions – Fiscal Year 2014 Issued December 2013 Historic Preservation Department 345 Kellogg Blvd. W., St. Paul, MN 55102-1906 651-259-3452 www.mnhs.org MINNESOTA HISTORICAL SOCIETY MINNESOTA HISTORICAL SOCIETY Certified Local Government Grants Manual for Fiscal Year 2014 TABLE OF CONTENTS Part I Introduction Page 1 Part II General Grant Conditions A. Project Schedule (page 2) B. Project Budget (page 2) C. Additional Considerations (page 2) Page 2 Part III Eligible Program Activities and Priority for Projects A. Comprehensive Planning (page 3) B. Pre-Development (page 3) 1. Historic Structure Reports (page 3) 2. Reuse Studies (page 4) C. Survey (page 4) D. Evaluation (page 5) E. Local Designation (pages 5-6) F. National Register (page 6) G. Public Education (pages 6-7) Page 2 Part IV Application Process Page 8 Part V Instructions for Completing the On-Line Application Page 9 Part VI Project Administration and Reporting Page 12 Appendices: Appendix I – Historic Structure Report Format Appendix II - Sample CLG Grant Agreement Attachment A - Sample Project Description Attachment B - CLG Request for Reimbursement Form Attachment C - Supplemental Information on Allowable Costs Attachment D - Value of In-Kind and/or Donated Services Time Sheet Attachment E - Value of Donated Supplies and Material Form Attachment F - Monthly Progress Report Form FY 2014 Certified Local Government Manual This program receives federal funds from the National Park Service. Under Title VI of the Civil Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973, the U.S. Department of the Interior prohibits discrimination on the basis of race, color, national origin, or handicap in its federally assisted programs. If you believe that you have been discriminated against in any program, activity, or facility operated by a recipient of federal assistance, or if you desire further information, please write to: Office of Equal Opportunity, U.S. Department of the Interior, National Park Service, 1849 C Street, N.W., Washington, D.C. 20240. FY 2014 Certified Local Government Manual F. Y. 2014 Certified Local Governments Grants Manual PART I - INTRODUCTION The Minnesota Historical Society (MHS), through its Historic Preservation Department, administers the U. S. Department of the Interior's Historic Preservation Fund (HPF) Program in cooperation with the National Park Service (NPS). Under this program the Department of the Interior specifies that at least ten (10) percent of Minnesota's annual HPF Program award be designated as pass-through funding to Certified Local Governments (CLGs) each year. Subject to the final allocation of funding from the NPS, approximately $95,000 will be available for CLG grant awards for Fiscal Year 2014. To become a CLG, a local government must have enacted a preservation ordinance establishing a Heritage Preservation Commission program for local designation of historic properties and review of proposed changes to those properties. The requirements for certification are outlined in the document "Procedures for Applying for and Maintaining Certified Local Government Status," available from the MHS State Historic Preservation Office (SHPO). Applications for certification are accepted on a continuous basis; only those governments which have achieved certified status are eligible to apply for funding under this program. Representatives of CLGs interested in applying for a federal grant will find the procedures explained on the following pages. Included is information on General Grant Conditions, Eligible Program Activities and Priorities for Projects, the Application Process, Instructions for Completing the on-line Application, and Project Administration and Reporting. A sample CLG Grant Agreement and sample Project Description (Attachment A), a CLG Request for Reimbursement Form, Supplemental Information on Allowable Costs, and forms for fiscal documentation are also included. Because federal funds are used for CLG grants, numerous federal regulations apply. This manual describes the minimum requirements as specified by the NPS. Federal regulations will be enforced, and failure on the part of a CLG to meet them will result in the cancellation of a grant project. You should read this manual with care and use it when you prepare an application and when you administer a grant-funded project. MHS encourages representatives of CLGs to discuss project ideas with SHPO staff prior to submitting an application. For further information contact the State Historic Preservation Office at the Minnesota Historical Society, 345 Kellogg Boulevard W., St. Paul, MN 55102-1906; telephone 651-259-3452. FY 2013 Grant Deadlines: Pre-application deadline: Final application deadline: Grants Review Committee meeting: January 24, 2014 March 7, 2014 April 17, 2014 1 FY 2014 Certified Local Government Manual PART II - GENERAL GRANT CONDITIONS A. PROJECT SCHEDULE All work on projects funded in this grant cycle must be completed between June 1, 2014 and July 31, 2015. Project periods of appropriate length are permissible as long as the beginning and ending dates fall within this period. Most projects will begin on either June 1 or October 1 depending on the nature of the work. Work done before or after specific grant project beginning and ending dates will not be considered a part of the project or as a reimbursable budget expenditure. Federal regulations require interim financial closeout reports at the end of the federal fiscal year, September 30. This requirement will apply to all projects beginning prior to September 30 and ending after October 1. All federal dollars are disbursed on a reimbursable basis after appropriate fiscal documentation has been submitted to, and approved by, MHS. All applicants are encouraged to contact the MHS Grants Office to discuss the scheduling needs of their projects during the pre-application period. B. PROJECT BUDGET All project budgets must reflect an applicant match. Grant requests will require a minimum of a 40:60, local match: federal grant. A $10,000 project, for example, would require a local match of $4,000 to leverage a $6,000 CLG grant. Applicants are encouraged to provide a match that exceeds the minimum requirement. Matching funds may be cash, in-kind and/or donated services or materials contributed to the project (see Attachment C of the CLG Grant Agreement), or a combination of the three. Cash match is strongly encouraged. Typically Federal funds may not be used to match a CLG grant. However, funding through the Community Development Block Grant program is allowed as match. See the Detailed Project Budget section in Part V – Instructions for Completing the Application on page 9 for additional information. C. ADDITIONAL CONDITIONS The sample CLG Grant Agreement (see Appendix II) contains information on other grant conditions. In general, these conditions include requirements that: (1) projects adhere to federal standards to ensure fair competition for contracts; (2) proper accounting and management practices are followed; (3) expenses are auditable; (4) project deadlines are met; and (5) the CLG be able to prove it complies with certain federal regulations. PART III - ELIGIBLE PROGRAM ACTIVITIES AND PRIORITIES FOR PROJECTS Seven areas of eligible program activity are outlined in this section: (A) Comprehensive Planning; (B) PreDevelopment; (C) Survey; (D) Evaluation; (E) Local Designation Forms; (F) National Register Nomination Forms; and (G) Public Education. Projects that will receive special priority are those that: reflect the goals and strategies in the statewide preservation plan; promote sound preservation planning through historic context development and the completion of historic and archaeological surveys; result in local designations; and involve properties associated with the history of heretofore under-documented groups or communities (ethnic or racial minorities, for example, but also other groups defining themselves as communities). Applications will be evaluated on the basis of the above consideration and the criteria discussed under Part IV of this grants manual. 2 FY 2014 Certified Local Government Manual A. COMPREHENSIVE PLANNING Planning activities might include analyzing the community's history and developing historic contexts as a planning framework, preparing archaeological literature reviews, developing architectural guidelines for a designated area, or improving a local preservation ordinance. Guidance for planning work is found in the Secretary of the Interior's Standards for Planning (pages 44716 to 44720) in the Federal Register of 9-29-83, in SHPO Manual for Archaeological Projects in Minnesota of July 2005, and in MN SHPO's Guidelines for Architecture/History Projects of October 2010. The Manual and Guidelines can be found online: http://www.mnhs.org/shpo/survey/archsurvey.pdf and http://www.mnhs.org/shpo/survey/docs_pdfs/HistoryArchitectureSurveyManualOctober2010.pdf and the Standards: http://www.nps.gov/history/local-law/arch_stnds_0.htm The following information should be included in the application narratives: 1. Description of the product and its contents. 2. Discussion of who will use the product. 3. Discussion of the CLG's overall historic preservation planning process including previous planning activities and planning activities anticipated in the future. 4. Discussion of how this project fits into the CLG’s current planning activities. 5. Discussion of how the project relates to the state's comprehensive planning process and the statewide preservation plan released in the winter of 2011. The plan is available at http://www.mnhs.org/shpo/planning/docs_pdfs/preservationplan_2012-2017.pdf Simply citing the part of the plan to which the project relates is not sufficient. B. PRE-DEVELOPMENT PROJECTS Pre-development is the historical, architectural, and/or archaeological research necessary to properly document the historical significance and existing physical condition of a historic structure or site performed prior to the commencement of development. The report that is produced is a planning document for the preservation of an individual property. Pre-development activities include the preparation of a historic structure report or re-use study for a vacant, threatened, and/or under-used historic property. The property for which funds are being requested must be listed on or have been officially determined eligible for the National Register of Historic Places by SHPO. Properties that have not been evaluated are not eligible for funding. 1. HISTORIC STRUCTURE REPORTS A Historic Structure Report (HSR) can be a valuable tool that can save time and money and minimize mistakes in preservation projects. HSRs are used to analyze a historic or archeological property, to establish preservation objectives for the property, and to schedule their accomplishment. The recommended format for a HSR can be found in Appendix II. The following information should be included in the application narratives: 1. Physical description of the property including construction date, type of structure, original and present function, and type of construction. 2. Discussion of current ownership and the source of financial resources for the property’s use and continued preservation. 3. Discussion of the current and likely long-range use of the structure. 4. References to the Secretary of the Interior's Standards for the Treatment of Historic Properties sufficient to demonstrate that the project will conform to these standards. 5. Discussion of how the report will be used and how the recommendations will be implemented. 6. Discussion of how the project relates to the state's comprehensive planning process and the statewide preservation plan released in the winter of 2011. The plan is available at: http://www.mnhs.org/shpo/planning/docs_pdfs/preservationplan_2012-2017.pdf. Simply citing the part of the plan to which the project relates is not sufficient. 3 FY 2014 Certified Local Government Manual 2. REUSE STUDIES Historic properties that are vacant over an extended period of time are especially vulnerable to demolition or serious deterioration. The MN SHPO has developed a process called the Minnesota Historic Properties Reuse Team (HPRT) through which it works with communities and local citizens to conduct studies of vacant, threatened, and under-used historic properties in order to identify a range of potential new uses. The HPRT process is outlined in the publication, A Primer for Historic Properties Reuse Teams in Minnesota which can be found online: http://www.mnhs.org/shpo/planning/primer.pdf The following information should be included in the application narratives: 1. Physical description of the property including construction date, type of structure, original and present function, and type of construction. 2. Discussion of current ownership. 3. Discussion of how the building is threatened. 4. Discussion of the city’s and/or HPC’s role in the reuse study. 5. Discussion of how the city will follow the established HPRT process. 6. Anticipated reuse study schedule. 7. References to the Secretary of the Interior's Standards for the Treatment of Historic Properties sufficient to demonstrate that the project will conform to these standards. 8. Description of the how the report will be promoted, distributed, or made available to the public. 9. Discussion of how the report will be used and how the recommendations will be implemented. 10. Discussion of how the project relates to the state's comprehensive planning process and the statewide preservation plan released in the winter of 2011. The plan is available at: http://www.mnhs.org/shpo/planning/docs_pdfs/preservationplan_2012-2017.pdf. Simply citing the part of the plan to which the project relates is not sufficient. C. SURVEY Most Minnesota cities were included in the SHPO reconnaissance level county-by-county survey conducted between 1977 and 1988. Many, however, merit more intensive survey to compile comprehensive information for use in local planning and for identifying and evaluating additional properties for registration. Before beginning a long-range survey program, it is recommended that cities establish a series of historic contexts (see A above) as a framework for planning survey activities. Guidance for survey is found in the Secretary of the Interior's Standards for Identification (pages 44720 to 44723) in the Federal Register of 9-29-83, in SHPO Manual for Archaeological Projects in Minnesota of July 2005, and in MN SHPO's Guidelines for Architecture/History Projects of October 2010. The Manual and Guidelines can be found online: http://www.mnhs.org/shpo/survey/archsurvey.pdf and http://www.mnhs.org/shpo/survey/docs_pdfs/HistoryArchitectureSurveyManualOctober2010.pdf, and the Standards at: http://www.nps.gov/history/local-law/arch_stnds_0.htm The following information should be included in the application narratives: 1. Type of survey (architecture/history, archaeology, or both). 2. Level of documentation (intensive or reconnaissance). 3. Number of acres in survey area (include a map). 4. Statement explaining how the survey relates to previous and future survey work in the city. 5. Statement explaining how the survey relates to the statewide historic contexts developed by the SHPO, and local contexts, if applicable. 6. Anticipated survey work schedule. 7. References to the Secretary of the Interior's Standards for Identification sufficient to demonstrate that the project will conform to these standards. 4 FY 2014 Certified Local Government Manual 8. Discussion of how the project relates to the state's comprehensive planning process and the statewide preservation plan released in the winter of 2011. The plan is available at: http://www.mnhs.org/shpo/planning/docs_pdfs/preservationplan_2012-2017.pdf. Simply citing the part of the plan to which the project relates is not sufficient. Note: SHPO no longer provides black and white 35mm film, archival processing, or proof sheets for survey projects. If you choose to use black and white photography, these costs should be built into your project budget. Digital photography is an acceptable substitute for black and white photography. Specifications for digital photography are outlined in the MN SHPO’s Guidelines for Architecture/History Projects publication. D. EVALUATION Many cities have inventoried a substantial number of properties but have not systematically evaluated those properties for their eligibility for the National Register or local designation. Evaluation activities might take the form of applying established historic contexts (see A above) and specific evaluation criteria to the inventoried properties in order to determine and rank their significance. Guidance for evaluation work is found in the Secretary of the Interior's Standards for Evaluation (pages 44723 to 44726) in the Federal Register of 9-29-83, in SHPO Manual for Archaeological Projects in Minnesota of July 2005, and in MN SHPO's Guidelines for Architecture/History Projects of October 2010. The Manual and Guidelines can be found online: http://www.mnhs.org/shpo/survey/archsurvey.pdf and http://www.mnhs.org/shpo/survey/docs_pdfs/HistoryArchitectureSurveyManualOctober2010.pdf , and the Standards at: http://www.nps.gov/history/local-law/arch_stnds_0.htm The following information should be included in the application narratives: 1. Description of the activities which have resulted in the identification of the properties to be evaluated. 2. Description of the properties/area to be evaluated. 3. Description of the evaluation process. 4. References to the Secretary of the Interior's Standards for Evaluation sufficient to demonstrate that the project will conform to these standards. 5. Discussion of how the project relates to the state's comprehensive planning process and the statewide preservation plan released in the winter of 2011. The plan is available at: http://www.mnhs.org/shpo/planning/docs_pdfs/preservationplan_2012-2017.pdf. Simply citing the part of the plan to which the project relates is not sufficient. E. LOCAL DESIGNATION FORMS Heritage preservation commissions generally use locally developed designation forms to designate properties at the local level. Guidance for designation work is found in the Secretary of the Interior's Standards for Registration (pages 44726 to 44728) in the Federal Register of 9-29-83, in SHPO Manual for Archaeological Projects in Minnesota of July 2005, and in MN SHPO's Guidelines for Architecture/History Projects of October 2010. The Manual and Guidelines can be found on-line: http://www.mnhs.org/shpo/survey/archsurvey.pdf and http://www.mnhs.org/shpo/survey/docs_pdfs/HistoryArchitectureSurveyManualOctober2010.pdf, and the Standards at: http://www.nps.gov/history/local-law/arch_stnds_0.htm The following information should be included in the application: 1. The number of designation forms to be completed. 2. The type of designation forms (individual, district, thematic). 3. The number of contributing properties included in the designation forms. (See National Register Bulletin No. 14.) 4. The names of the properties to be documented including general statements about their significance. 5. Reference to the Secretary of the Interior's Standards for Registration sufficient to demonstrate that the project will conform to these standards. 6. The expected schedule for designation. 5 FY 2014 Certified Local Government Manual 7. Discussion of how the project relates to the state's comprehensive planning process and the statewide preservation plan released in the winter of 2011. The plan is available at: http://www.mnhs.org/shpo/planning/docs_pdfs/preservationplan_2012-2017.pdf. Simply citing the part of the plan to which the project relates is not sufficient. F. NATIONAL REGISTER NOMINATION FORMS In cities where a SHPO survey or a local survey has identified and evaluated certain properties that appear to meet the criteria of the National Register, cities may choose to apply for funds to complete the registration forms for nominations to the National Register. Please note, however, that nomination documents must meet federal standards and go through a careful and rigorous review before listing in the National Register of Historic Places, the nation's official list of significant properties. For some properties, establishing significance may require considerable research and explanation. In such cases, a CLG would be well advised to rely upon the experience and training of a preservation professional. Guidance for National Register projects is found in the Secretary of the Interior's Standards for Registration (pages 44726 to 44728) in the Federal Register of 9-2983, in SHPO Manual for Archaeological Projects in Minnesota of July 2005, and in MN SHPO's Guidelines for Architecture/History Projects of October 2010. The Manual and Guidelines can be found online: http://www.mnhs.org/shpo/survey/archsurvey.pdf and http://www.mnhs.org/shpo/survey/docs_pdfs/HistoryArchitectureSurveyManualOctober2010.pdf and the Standards at: http://www.nps.gov/history/local-law/arch_stnds_0.htm The following information should be included in the application narratives: 1. The number of registration forms to be completed. 2. The type of registration forms (individual, district, thematic). 3. The number of contributing properties included in the registration forms. (See National Register Bulletin No. 14. Copies of National Register Bulletins can be downloaded from: http://www.nps.gov/nr/publications/ 4. The names of the properties including general statements about their significance. 5. References to the Secretary of the Interior's Standards for Registration sufficient to demonstrate that the project will conform to these standards. 6. The expected schedule for registration. 7. Discussion of how the project relates to the state's comprehensive planning process and the statewide preservation plan released in the winter of 2011. The plan is available at: http://www.mnhs.org/shpo/planning/docs_pdfs/preservationplan_2012-2017.pdf. Simply citing the part of the plan to which the project relates is not sufficient. G. PUBLIC EDUCATION Public Education activities may include publications, educational curriculums, interpretive signage, or other programs dealing with various aspects of the local, state, and/or federal preservation program(s). Examples might include a guide to locally designated properties (planned only after a properly conducted local survey is substantially completed), a workshop on the application of design guidelines in a historic district, or interpretive materials about significant archaeological resources. Public education activities should be based on work that meets the Secretary of the Interior's Standards and Guidelines, where applicable. The Standards can be found online: http://www.nps.gov/history/local-law/arch_stnds_0.htm The following information should be included in the application narratives: 1. Description of the work on which the activity is based and an explanation of how that work meets applicable Secretary of the Interior's Standards and Guidelines. 2. Description of all the products the project will produce. 3. Discussion of how the project will be evaluated. 4. A detailed plan showing how each step in the project will be conducted, who will be responsible for each step (project director, HPC members, consultant, etc.), and the dates by which each will be completed. 6 FY 2014 Certified Local Government Manual 5. Description of the how the project will be publicized, distributed, or otherwise made available to the public. 6. For workshops, conferences, and publications, indicate if there is to be a charge and, if so, what the estimated income will be and how that income will be used. 7. Discussion of how the project relates to the state's comprehensive planning process and the statewide preservation plan released in the winter of 2011. The plan is available at: http://www.mnhs.org/shpo/planning/docs_pdfs/preservationplan_2012-2017.pdf. Simply citing the part of the plan to which the project relates is not sufficient. 7 FY 2014 Certified Local Government Manual PART IV - APPLICATION PROCESS INSTRUCTIONS FOR PRE-APPLICATION AND FINAL APPLICATION The Society’s Grants Office is now using an entirely on-line grants system. Applicants access the system through a grants portal (https://mnhs.fluxx.io/). The portal provides access to everything you’ll need in administering a grant from the Minnesota Historical Society, from the pre-application stage through reporting on the completion of a project. Here you will be able to track where an application is in the review process as well as have access to information about previous grants you have received. The portal allows you to save your work on an application and come back to finish it later. A. PRE-APPLICATIONS While not required, the Grants Office strongly recommends that an applicant submit a pre-application by the Friday, January 24, 2014 deadline. A pre-application is a draft of the application that staff will review in advance of the final application deadline. If you are submitting a draft for staff review, make sure the box “Please Consider for Pre-Application Review” is checked in the on-line application. It is located after the brief project summary. Staff will provide suggestions and comments in sufficient time to incorporate revisions into the final application. B. FINAL APPLICATIONS Final applications must be submitted through the Grants Portal by midnight on Friday, March 7, 2014. Incomplete applications received by the Grants Office near the application deadline may be disqualified. Instructions for completing the application should be followed carefully. C. REVIEW CRITERIA AND RATING SYSTEM Grant applications are reviewed and scored by SHPO staff reviewers. Projects will be evaluated on the following criteria (total points available 100): 1. How well the applicant addresses the questions outlined on pages 3-6 of the Grants Manual (0-25 points). 2. How well the annual priorities and criteria outlined on page 2 of the Grants Manual are addressed; and how well the project is related to the state preservation plan issued in the winter of 2011 (0-15 points). 3. Clearly stated measurable goals that can be realistically attained within the funding period; (0 to 15 points). 4. Demonstrated community support and leveraged funds (0 to 15 points). 5. Products and past performance of on previously administered CLG grants (0 to 15 points). 6. Quality and practicality of the budget (0 to 15 points). Once the applications have been reviewed and scored by staff, all eligible applications with staff recommendations are forwarded to the MHS Grants Review Committee members to be considered at their meeting on April 17, 2014. D. GRANTS REVIEW COMMITTEE MEETING Applications are reviewed by the MHS Grants Review Committee at a public meeting at the Minnesota Historical Society. The meeting is scheduled tentatively for April 17, 2014. Applicants are invited to make a three (3) minute presentation. The committee will review applications with respect to the factors outlined (see item C above), will make a reasonable effort to distribute funds among the maximum number of eligible local jurisdictions consistent with CFR 61.6 (f)(1) with a reasonable distribution between urban and rural preservation areas, and will make a reasonable effort consistent with CFR 8 FY 2014 Certified Local Government Manual 61.6.7(f)(2) that no CLG receives a disproportionate share of the CLG pass-through funds. (Previous awards may also enter into consideration.) The committee may recommend that: 1. A proposed project be funded as submitted; or, 2. A proposed project be funded with changes to the scope and/or budget; or, 3. A proposed project not be funded. E. FUNDING APPROVAL AND PROJECT TIMELINE The Grants Review Committee's recommendations for funding are forwarded to the State Historic Preservation Officer at the Minnesota Historical Society for final acceptance. After final approval is obtained, generally in May, notification of the grant award is made to the City and the Grants Office prepares and distributes the CLG Grant Agreements (see Appendix I). Shortly thereafter, the CLG Grant Agreement is executed by all parties. All project work for this grants cycle must take place between June 1, 2014 and July 31, 2015. Dates for consultations and progress reports, other deadlines, and information on Requests for Reimbursement will be specifically outlined by the Grants Office in the Project Description (Attachment A) of each CLG Grant Agreement. PART V - INSTRUCTIONS FOR COMPLETING THE ON-LINE APPLICATION The application process is handled entirely on-line through the grants portal. Before you start to complete the application, familiarize yourself with the information contained in Part III, Eligible Program Activities on pages 26 and the following instructions. Consultation with the Grants Office is strongly encouraged before submitting an application. Grants Portal: https://mnhs.fluxx.io/ USING THE GRANTEE PORTAL FOR THE FIRST TIME: In order to submit a grant application you must provide basic information about the city you represent when you request an account. If your city already has an account, disregard this step in the process. To request an account, click on “Create an account now” in the grants portal (https://mnhs.fluxx.io). Previous grantees will already be in the system but will need to log-on to register in order to access it for the first time. If you are creating an account for the first time, you will fill out your request and the Grants Office will follow up with an email providing you with a username (your email) and a randomly created password to access the grants portal. When you log in you will be greeted with the grants portal dashboard where you will be able to create and track your grant proposal as well file your financial and final report if your project is funded. You can create a new grant request by clicking on the "CREATE REQUEST" button. You will be presented with a choice of different grants programs offered. Scroll down to the Certified Local Government program and click on "CREATE NEW REQUEST" to go to the grant application. Please fill in the information requested using the following guidelines. After you have finished completing the form, please recheck to make sure that all application items are complete. Do not upload additional materials to your application unless they relate directly to the project. Please remember all final applications must be submitted through the MHS Grants Portal by midnight on the application deadline, Friday, March 7, 2014. 9 FY 2014 Certified Local Government Manual A. ON-LINE APPLICATION - APPLICANT INFORMATION APPLICANT INFORMATION B. C. Applicant: The city’s name that you entered in your original grant portal account request will be entered into the applicant field. Mailing Address: If the city has multiple locations you can select the location from the drop down menu, otherwise the mailing address will be the one you entered when you created your original portal account. Project Director: Select the name of the person who has the primary responsibility for the project and who will work with the Grants office through the project’s duration. If the project director is not in the list, contact the grants office. Authorized Official: Select the name of the individual authorized to conduct the applicant’s business. If the authorized officer is not in the list, contact the grants office. County: Enter the county in which the applicant is located. PROJECT INFORMATION Project Title: Provide a succinct title for the project in the space provided. Project Summary: Give a brief summary statement of the project. Category: From the dropdown menu, select the appropriate category for your project. The eligible categories are described in detail on pages 3-7. Please Consider for Pre-Application Review: Check or un-check the box, depending on whether this is a draft or final application. BUDGET INFORMATION Budget: This is a line-item budget. Line items are individual expense items designated for a specific purchase or service. Here you will list the totals for proposed funding including federal grant monies requested and amount of applicant match. Grants must be matched 40:60, local match: federal grant. Match may include cash, in-kind services, and/or other donated services, supplies, or materials. Minnesota Historical and Cultural (Legacy) grants may be used to match a CLG grant. Applicants are encouraged to use Legacy grants as match; note, however, that those grants are highly competitive and have different deadlines than CLG grants. As noted in the II. General Grant Conditions, B. Project Budget section on page two, cash match is strongly encouraged. Eligible budget costs can include: consultants fees (no hourly rates can exceed $89.41/hour including fringe benefits); travel expenses (no mileage rate can exceed $.56 per mile); office and general supplies; film and processing; duplication and distribution costs; administrative costs such as clerical, accounting, 10 FY 2014 Certified Local Government Manual communication, and legal; data processing; reference books; and conference costs. Ineligible costs include: bad debts; contingencies; contributions and donations of grant funds; entertainment; fines and penalties; interest and other financial costs; legislative or lobbying costs; museum curation costs; and fundraising expenses. For personnel items, please include rates and estimated hours to be charged or contributed to the project. Each applicant match item should be identified as cash, in-kind services, or other match by placing the dollar amount in the appropriate column. D. Entering your Budget Line Items: Click on the green plus button to begin entering line items. For each entry, complete the screen that identifies how much of the line item is requested from grant funds and/or whether it is matching funds. As you enter budget line items, the totals will calculate for you. If you need to delete or change an item you’ve already entered, click on the red delete button or the pencil to edit. How were the above figures determined? Describe briefly how your budget was determined. Amount Requested: Enter the total from the budget column titled ‘Grant Amt Requested” in the line item budget above. Match Amount Requested: Enter the total from the budget column titled “Total Match” in the line item budget above. APPLICATION NARRATIVES - PROJECT DESCRIPTION, PRODUCTS, COMMUNITY SUPPORT, PROJECT IMPACT AND PROJECT PERSONNEL Detailed Project Description: Before completing a detailed description of the project, please refer to Part III (pages 2-7) of this grants manual to assure that all necessary information is included. Please be as specific as possible; references to appropriate Secretary of the Interior's Standards and Guidelines, Federal Register, Vol. 48, No. 190 dated 9-29-83, must be included. Your description must fit in the space provided. Project Products: Provide a concise description of the products that will result from this project. Community Support: Provide a statement summarizing demonstrated community support for this project. Simply stating there is community support is not a demonstration of support. Project Impact: Provide a concise statement describing the expected effect of this project on the community's awareness and understanding of local government in addressing local preservation issues. Project Personnel: List principal project personnel and their qualifications. Personnel who meet the Secretary of the Interior's Professional Qualifications Standards (see page 44738) in the Federal Register of 9-29-83 should be so indicated and supporting information included. Projects must be under the direction of professionally qualified personnel. Include resumes of principal project personnel. Professional qualifications of project personnel will be reviewed by SHPO staff. 11 FY 2014 Certified Local Government Manual E. REQUIRED DOCUMENTS TO BE UPLOADED WITH COMPLETED CLG GRANT REQUEST Any required documents should now be uploaded through the "Request Documents" box. Check the project guidelines to determine what documents are required. For example, projects in the survey category require that a map be included. PART VI - PROJECT ADMINISTRATION AND REPORTING All aspects of the project must conform to OMB Circulars A-87and A-102 (revised). It is especially important that the City adhere to the procurement requirements outlined in OMB Circular A-102 (revised). Copies of the OMB circulars can be found online: http://www.whitehouse.gov/omb/circulars/. Acceptable documentation of the procurement process may include, (1) copies of newspaper advertisements or announcements; (2) the request for proposal (or any other information circulated by the City); (3) a resume for the consultant and/or any other key professionals involved in the project; (4) a copy of an executed contract with the consultant; and (5) a narrative description of the written criteria and process (e.g., HPC minutes) used to select the consultant. The City is also required to show justification for lack of competition when competitive bids or offers were not obtained. The procurement record should be clearly described to demonstrate that the City meets the federal procurement requirements. (See Item II, Assurances, of the CLG Grant Agreement.) The terms of the Grant Agreement require the City to agree to several provisions regarding the administration of the project. (See Item II, Assurances, of the CLG Grant Agreement.) During the administration of the project, it is imperative that adequate and thorough records be kept of all budget items, both in the federally funded portion and in the applicant portion. Attachment C of the CLG Grant Agreement outlines the types of fiscal documentation required. Attachments D and E can be used to itemize the fiscal documentation. The Project Description section (Attachment A) of the CLG Grant Agreement outlines the schedule for consultations as well as progress reports and the final products. It is important that reports and products be submitted on time. The timeliness of work on a project is one of the criteria that will be used in evaluating a CLG's subsequent grant applications. The Project Description also outlines the procedures for submitting a Request for Reimbursement Form. In general, the Final Request for Reimbursement and all accompanying documentation is due within two weeks of the project's ending date. Note regarding on-line reporting: Many of the documents you’ll need to provide throughout the life of your grant and in closing it out can be submitted through the grants portal. For projects starting prior to October 1, an interim financial close-out report, including a Request for Reimbursement Form for expenses and match incurred through September 30, will be due at the end of the federal fiscal year. (Also see Reimbursement Schedule of Attachment A of the Grant Agreement. 12 Appendices I. Historic Structure Report Format II. Sample CLG Grant Agreement Attachment A - Sample Project Description Attachment B - CLG Request for Reimbursement Form Attachment C - Supplemental Information on Allowable Costs Attachment D - Value of In-Kind and/or Donated Services Time Sheet Attachment E - Value of Donated Supplies and Material Form Attachment F - Monthly Progress Report Form Appendix II HISTORIC STRUCTURES AND HISTORIC LANDSCAPE REPORT FORMAT The Historic Structure Report or Historic Landscape Report format is required when a grant-assisted rehabilitation, restoration, or reconstruction project involves fabricating significant missing architectural or landscape features, recapturing the appearance of a property at one particular period of its history, or removing later additions. The following is the recommended format for a Historic Structures Report or Historic Landscape Report: Table of Contents. Foreword or Introduction. Purpose of the Report Preservation Objectives (proposed preservation treatment) History of the Property. Significance of the property’s structure or landscape and setting (historic events, persons associated, ownership history, etc.) The appearance, occupation, and use of the property and its setting from original construction to the present time (including a chronology) Historical documentation letters, builder records, photographs, etc.) Architectural Description and Assessment. A description and record of the existing condition (narrative and illustrations) Identification of the important structural or landscape features and distinctive qualities of the property An evaluation of the impact of the proposed use of the property Identification and analysis of the significant factors affecting the preservation of the property Recommended steps for preservation treatment, the basis for such recommendations, and, where applicable, preliminary design drawings Steps to minimize the potential impact of the proposed work on the property’s historic character Supplemental Material (when appropriate). Estimates of the cost to carry out the recommendations Recommendations for further study Materials analysis (e.g., paint) Bibliography Appendix II-Sample Agreement MINNESOTA HISTORICAL SOCIETY CERTIFIED LOCAL GOVERNMENT GRANT AGREEMENT ACCOUNT NUMBER 311.0284.332.01 FISCAL YEAR 2014 OBJECT CODE 5260 FEDERAL PROJECT NUMBER 27-14-21829./// DOLLAR AMOUNT $/,/// HPF grant funds $/,/// applicant match This Agreement is made by and between the Minnesota Historical Society hereinafter called the Society), and the City of ////////////// (hereinafter called the City), pursuant to authority granted by the National Historic Preservation Act of 1966, as amended. WHEREAS, pursuant to the Act, the Society has been allocated funds by the United States Department of the Interior for use by Certified Local Governments for qualifying historic preservation activities; and WHEREAS, the City has applied for and been granted Certified Local Government Status and has made application for Certified Local Government funds to be utilized in carrying out the project described in Attachment A of this Agreement, NOW, THEREFORE, in consideration of and in reliance upon the mutual covenants and agreements contained herein, the parties hereto do covenant and agree, each for themselves and their respective successors and assigns, to carry out the project under the following provisions. I. PROJECT DESCRIPTION A. The Project Time Period, Work Summary, Photograph Guidelines (where applicable), Consultations and Progress Reports, Final Products, Project Director's Report, Project Budget, and Reimbursement Schedule are described in the Project Description, Attachment A, which is attached hereto and made a part hereof. B. The City agrees the project will be carried out as described in the Project Description, unless modified pursuant to the provisions of Section V of this contract. C. The Society will reimburse the City for the budget costs identified as Historic Preservation Fund (HPF) federal dollars in the Project Description, following submittal of materials as described in Section III of this Agreement. Final products which do not conform to the terms and conditions of this Agreement or which do not meet the applicable Secretary of the Interior's Standards will not be reimbursed. Appendix II II. ASSURANCES A. The City assures that all work carried out on this project will conform to the Secretary of the Interior's Standards for Archaeology and Historic Preservation (as published in the Federal Register of September 29, 1983) and that the project personnel meet the Secretary of the Interior's Professional Qualifications Standards (as published in the Federal Register of September 29, 1983) as stipulated in the Project Description. B. The City assures that this project will be administered and conducted in accordance with the following: 1. OMB Circular A-87 "Cost Principles Applicable to Grants and Contracts with State and Local Government" and OMB Circular A-102 (revised) "Uniform Requirements for Assistance to State and Local Governments." 2. Department of the Interior regulations 43 CFR Part 12, Subpart C "Uniform Administrative Requirements for Grants and Cooperative Agreements to State and Local Governments." a. In addition to the requirements of these regulations the City will allow a minimum of two weeks between the date bid solicitations are published and the date bidders must respond; and allow eighteen calendar days between the date invitations are mailed to potential bidders and the date bidders must respond. C. 3. Public Law 101-517, Title V, Section 511, states: When issuing statements, press releases, requests for proposals, bid solicitations and other documents describing projects or programs funded in whole or in part with Federal money, all grantees receiving Federal funds, including but not limited to State and local governments, shall clearly state (1) the percentage of the total costs of the program or project which will be financed with Federal money, (2) the dollar amount of Federal funds for the project or program, and (3) percentage and dollar amount of the total costs of the project or program that will be furnished by nongovernmental sources. 4. The "Single Audit Act of 1984." 5. Historic Preservation Fund (HPF) Grants Manual (previously known as National Register Programs Guideline NPS-49). The City acknowledges that this project is being supported, in part, with funds from the United States Department of the Interior. As a condition of receiving such funds, the City assures compliance with Title VI of the Civil Rights Act Appendix II of 1964, Section 504 of the Rehabilitation Act of 1973, and the Age Discrimination Act of 1975. The City also agrees as follows: In the hiring of common or skilled labor for the performance of any work hereunder, no contractor, material supplier or vendor shall, by reason of race, creed or color, discriminate against any person or persons who are citizens of the United States, or resident aliens, who are qualified and available to perform the work to which the employment relates. No contractor, material supplier or vendor shall, in any manner, discriminate against, or intimidate, or prevent the employment of any person or persons identified in the preceding paragraph, or on being hired, prevent, or conspire to prevent, the person or persons from the performance of work under any contract on account of race, creed or color. The violation of this section is a misdemeanor pursuant to Minnesota Statutes. This Agreement may be canceled or terminated by the Society, and all money due, or to become due hereunder may be forfeited for a second or any subsequent violation of the terms of this section. D. The City will indemnify and save and hold the Society and the Department of the Interior harmless from any and all claims or causes of action arising from the performance of this project by the City. E. The City agrees to make repayment of grant funds to the Society if terms and conditions of this Agreement are not followed or costs claimed are subsequently disallowed. F. The City, in accordance with provisions of 18 USC 1913 regarding lobbying, assures that no part of grant budget will be used directly or indirectly or to pay for any personal service, advertisement, telegram, telephone, letter, printed or written matter, or other device intended or designed to influence in any manner a member of Congress, to favor or oppose, by vote or otherwise, any legislation or appropriation by Congress, whether before or after the introduction of any bill or resolution proposing such legislation or appropriation. This shall not prevent communicating to members of Congress on the request of any member or to Congress, through the proper official channels, requests for legislation or appropriations which they deem necessary for the efficient conduct of the public business. G. The City agrees any publications, studies, reports, presentations, films, audio visual materials, exhibits, or other material prepared with grant assistance will contain an acknowledgment of HPF grant funds and nondiscrimination policy as follows: Appendix II "The activity that is the subject of this (type of publication) has been financed (in part/entirely) with Federal funds from the National Park Service, U. S. Department of the Interior. However, the contents and opinions do not necessarily reflect the views or policies of the Department of the Interior, nor does the mention of trade names or commercial products constitute endorsement or recommendation by the Department of the Interior. "This program receives Federal financial assistance for identification and protection of historic properties. Under Title VI of the Civil Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973, the U. S. Department of the Interior prohibits discrimination on the basis of race, color, national origin, or disability in its federally assisted programs. If you believe you have been discriminated against in any program, activity, or facility as described above, or if you desire further information, please write to: Office for Equal Opportunity, U. S. Department of the Interior, National Park Service, P.O. 37127, Washington, D.C. 20013-7127." III. H. The City assures that transferred federal monies will not be applied as part of the matching (applicant) share, and that monies used as match on other federal grants will not be used as matching (applicant) share on this project. I. The City agrees not to contract with any party which is debarred or suspended or is otherwise excluded from or ineligible for participation in Federal assistance programs under Executive Order 12549, Debarment and Suspension. Current lists of such parties are on file in the Society's Grants Office and are available for review by the City. As a condition of this Agreement, the City shall complete and execute the attached Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion for Lower Tier Covered Transactions (see page 7-9). REIMBURSEMENT PROCEDURES A. Payments under this Agreement will be made on a reimbursable basis according to the schedule included in the Project Description (see Attachment A). All supporting fiscal documentation must be submitted prior to reimbursement. B. A Request for Reimbursement must include the following: 1. Request for Reimbursement Form (see Attachment B). 2. Supporting fiscal documentation for all project costs during the period covered by the request, including both federally funded items and applicant match items. (See Attachment C for Information on Allowable Costs.) Appendix II 3. If project work begins prior to September 30, and the City wishes to claim these costs, a Request for Reimbursement must be submitted at the end of the federal fiscal year. Applicant match must be equal to, or may exceed, the federal funds requested as of September 30 (also see Reimbursement Schedule of Attachment A). 4. Final Product(s) and the Project Director's Report are to be submitted with the Final Request for Reimbursement Form (see Attachment A). IV. C. The Request for Reimbursement Forms should be submitted to Mandy Skypala, Minnesota Historical Society, Grants Office, 345 Kellogg Boulevard West, Saint Paul, Minnesota 55102-1906. D. When both the financial documentation and the product documentation has been found to be acceptable by the Society, funds will be requested from the Department of the Interior and will be forwarded to the City when the funds have been received by the Society. AUDIT The City must submit a copy of all audited financial statements completed pursuant to OMB Circular A-128 for all fiscal years which include the project period. These must be submitted to Monica Zarembski, Minnesota Historical Society, Finance Office, 345 Kellogg Boulevard West, Saint Paul, Minnesota 55102-1906, within 120 days of their completion. V. AMENDMENTS AND CANCELLATION A. Amendments 1. Any significant variations from the approved work summary, products, budget, and performance/reporting milestones described in Attachment A which are experienced or anticipated during the course of the project and any significant problems, delays, or adverse conditions which materially affect planned performance should be submitted in writing to Mandy Skypala, Minnesota Historical Society, Grants Office, 345 Kellogg Boulevard West, Saint Paul, Minnesota, 55102-1906. The Society will respond in writing, either approving or not approving the changes, and may amend the contract if deemed necessary. The City is aware that some changes may require approval by the National Park Service and agrees to submit any necessary changes as early as possible during the project period. Variations which are not known until the conclusion of the project may be submitted with the final Request for Reimbursement; however, the City understands that costs may be disallowed if changes are not approved. 2. If any part of the budgeted federal grant funds will not be used, the City must notify the Society at least sixty (60) days before the project's ending Appendix II date. Failure of the City to notify the Society may result in the loss of federal funds to the state, and may have an adverse effect on future applications for CLG funds by the City. B. Cancellation. The Society reserves the right of termination for cause on a thirty (30) day notice should it be determined that the City has failed to materially comply with the terms and conditions of this Agreement. This Agreement may also be terminated when both parties agree that the project will not produce beneficial results commensurate with further expenditure of funds or because of circumstances beyond the control of the Society and/or the City. In the event of termination, the City may be reimbursed for eligible expenses incurred prior to termination or by a negotiated settlement. Once this Agreement is signed, it controls all activities during the project time period. IN WITNESS WHEREOF, the parties have caused this Agreement to be duly executed on the date(s) indicated below intending to be bound thereby. Minnesota Historical Society 345 Kellogg Boulevard West Saint Paul, Minnesota 55102 City of ////////// /////////////////// //////////, Minnesota ///// _________________________________________ _________________________________________ Stephen Elliott, Director (date) signature (authorized official) (date) Minnesota Historical Society and State Historic Preservation Officer _________________________________________ (print name) _________________________________________ _________________________________________ Barbara Mitchell Howard (date) (signature-City Clerk or City Manager) (date) Deputy State Historic Preservation Officer _________________________________________ (print name) _________________________________________ _________________________________________ (date) (signature- HPC Chairperson) (date) MHS Contract Officer _________________________________________ (print name) Appendix II – Sample Agreement City of ////////////// CLG Agreement U.S. Department of the Interior Certifications Regarding Debarment, Suspension, and Other Responsibility Matters, Drug-Free Workplace Requirements and Lobbying Persons signing this form should refer to the regulations referenced below for complete instructions: Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions - [The prospective primary participant further agrees by submitting this proposal that it will include the clause titled, "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transaction," provided by the department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. See below for language to be used; use this form for certification and sign; or use Department of the Interior Form 1954 (DI1954). See Appendix A of Subpart D of 43 CFR 12. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions - (See Appendix B of Subpart D of 43 CFR Part 12) Certification Regarding Drug-Free Workplace Requirements - Alternate I. (Grantees Other Than Individuals) and Alternate II. (Grantees Who are Individuals) - (See Appendix C of Subpart D of 43 CFR Part 12) Signature on this form provides for compliance with certification requirements under 43 CFR Parts 12 and 18. The certifications shall be treated as a material representation of fact upon which reliance will be placed when the Department of the Interior determines to award the covered transaction, grant, cooperative agreement or loan. PART A: Certification Regarding Debarment, Suspension, and Other Responsibility Matters - Primary Covered Transactions CHECK (1) (2) IF THIS CERTIFICATION IS FOR A PRIMARY COVERED TRANSACTION AND IS APPLICABLE. The prospective primary recipient certifies to the best of its knowledge and belief, that it and its principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and (d) Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default. Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. PART B: Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Transactions CHECK X IF THIS CERTIFICATION IS FOR A LOWER TIER COVERED TRANSACTION AND IS APPLICABLE. (1) The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. (2) Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Appendix II – Sample Agreement City of ////////////// CLG Agreement PART C: Certification Regarding Drug-Free Workplace Requirements CHECK X IF THIS CERTIFICATION IS FOR AN APPLICANT WHO IS NOT AN INDIVIDUAL Alternate I. (Grantees Other Than Individuals) A. The grantee certifies that it will provide or continue to provide a drug-free workplace by: (a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the grantee's workplace and specifying the actions that will be taken against employees for violation of such prohibition; (b) Establishing an ongoing drug-free awareness program to inform employees about-(1) The dangers of drug abuse in the workplace; (2) The grantee's policy of maintaining a drug-free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance programs; and (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; (c) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph (a): (d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will-(1) Abide by the terms of the statement; and (2) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five calendar days after such conviction; (e) Notifying the agency in writing, within ten calendar days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to every grant officer on whose grant activity the convicted employee was working, unless the Federal agency has designated a central point for the receipt of such notices. Notice shall include the identification number(s) of each affected grant; (f) Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted-(1) Taking appropriate personnel action against such employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; (g) Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a), (b), (c), (d), (e), and (f). B. The grantee may insert in the space provided below the site(s) for the performance of work done in connection with the specific grant: Place of Performance (Street address, city, county, state, zip code) Check if there are workplaces on file that are not identified here. PART D: Certification Regarding Drug-Free Workplace Requirements CHECK IF THIS CERTIFICATION IS FOR AN APPLICANT WHO IS AN INDIVIDUAL Alternate II. (Grantees Who Are Individuals) (a) The grantee certifies that, as a condition of the grant, he or she will not engage in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance in conducting any activity with the grant; (b) If convicted of a criminal drug offense resulting from a violation occurring during the conduct of any grant activity, he or she will report the conviction, in writing, within 10 calendar days of the conviction, to the grant officer or other designee, unless the Federal agency designates a central point for the receipt of such notices. When notice is made to such a central point, it shall include the identification number(s) of each affected grant. Page 8 Appendix II – Sample Agreement City of ////////////// CLG Agreement Part E: Certification Regarding Lobbying Certification for Contracts, Grants, Loans, and Cooperative Agreements CHECK IF CERTIFICATION IS FOR THE AWARD OF ANY OF THE FOLLOWING AND THE AMOUNT EXCEEDS $100,000: A FEDERAL GRANT OR COOPERATIVE AGREEMENT; SUBCONTRACT, OR SUBGRANT UNDER THE GRANT OR COOPERATIVE AGREEMENT. CHECK IF CERTIFICATION IS FOR THE AWARD OF A FEDERAL LOAN EXCEEDING THE AMOUNT OF $150,000, OR A SUBGRANT OR SUBCONTRACT EXCEEDING $100,000 UNDER THE LOAN. The undersigned certifies, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, 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. (2) If any funds other than 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 this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3) The undersigned 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 accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, title 31, U.S. Code. 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. As the authorized certifying official, I hereby certify that the above-specified certifications are true. SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TYPED NAME AND TITLE DATE SIGNED (This consolidated form may be used in place of the DI-1953, DI-1954, DI-1955, DI-1956, and DI-1963 forms.) Page 9 Appendix II – Sample Agreement Attachment A PROJECT DESCRIPTION City (CLG): City of ////////// Federal Grant No: 27-1116423./// Grant Time Period: Time periods will vary. Projects will generally begin on July 1, 2014 or October 1, 2014. Work must be completed no later than July 31, 2015. Work Summary: The purpose of this project is to . . . Project documentation will conform to the Secretary of the Interior’s Standards and Guidelines for Archaeology and Historic Preservation as published in the Federal Register of September 29, 1983 and the Minnesota State Historic Preservation Office’s Guidelines for Architecture/History and Archaeology Projects. The project will be accomplished under the supervision of personnel meeting the Secretary of the Interior's Professional Qualifications Standards. Consultations and Progress Reports: l. The CITY will inform the SOCIETY'S Grants Office of the name and qualifications of the historian, architectural historian, or historical architect with whom it has contracted within fifteen (15) days of the contract's execution. The CITY will, at the same time, provide a copy of the contract and a complete report on the procurement process demonstrating compliance with Federal competitive procurement requirements. (See II. ASSURANCES, item B, CLG Agreement, and Part VI of 2013 CLG Grants Manual.) 2. The CITY will submit a brief Monthly Progress Report (See 2013 CLG Grants Manual Attachment F) to the SOCIETY’S Grants Office by the 15th of each month for the duration of the project period. Product submittals will accompany the monthly reports as specified below. 3. By /////////, 2014, the CITY will submit a detailed schedule for completion of . . . 4. By /////////, 2014, the CITY will submit a draft of . . . to the SOCIETY'S Grants Office for SHPO staff review. 5. The SOCIETY may request other written progress reports and on-site reviews of project progress, as necessary. Appendix II – Sample Agreement Final Products: The Final Products to be submitted with the Request for Reimbursement (see Part III. of the CLG Agreement) and the Project Director’s Report will be three hard copies and one computer disk copy of the . . . Project Director’s Report: The report will include a brief description of the administration of the project. Two copies of this report will be submitted to the SOCIETY’S Grants Office with the Final Products and the Request for Reimbursement Form (see Part III. of the Grant Agreement). Project Budget: GRANT BUDGET ITEMS Consultant (xx hours @ $xx per hour) $x,xxx RECIPIENT MATCH Cash In-Kind Other $x,xxx TOTAL $x,xxx City - Project Director (xx hours @ $xx per hour) $x,xxx $x,xxx City . . . (xx hours @ $xx per hour) $x,xxx $x,xxx Misc. - advertising expenses, copying, etc. TOTALS $x,xxx $x,xxx $x,xxx $xx $xx $xx $xx,xxx Reimbursement Schedule: The CITY will be reimbursed, in total amount not to exceed $x,xxx, for the actual amounts expended under the federal (HPF) portion of the budget. The CITY must submit a Request for Reimbursement Form along with appropriate fiscal documentation, Final Products, and Project Director's Report to the SOCIETY'S Grants Office no later than August 15, 2015. All project work must be completed no later than July 31, 2015. Page 2 Appendix II – Sample Agreement Attachment B Minnesota Historical Society Grants Office Request for Reimbursement for Federal HPF Grants Project:______________________________ Federal Grant Number: _______________________ City: ________________________________ MHS Contract Number: ______________________ Address:________________________________ ________________________________ ________________________________ Federal Grant Amount: _______________________ Project Expenditure Classification: (use budget items from Attachment A of the Grant Agreement) Total Expenditures Federal ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ TOTAL __________ __________ Applicant Match Supporting documentation for all costs claimed in this request must be attached. Each supporting document should be labeled with the appropriate Project Expenditure Classification. I certify that this request for Reimbursement represents actual project expenditures carried out within the period of the project. Date:______________ Signature:____________________________________ Print name and title: ____________________________________ ____________________________________ Telephone: ___________________________________ Appendix II – Sample Agreement Attachment C SUPPLEMENTAL INFORMATION ON ALLOWABLE COSTS All costs for this project must be in conformance with OMB Circular A-87 and A-102 (revised) and the National Register Programs Guidelines NPS-49. The following points provide supplementary guidance and emphasis for areas where questions or problems may arise. 1. The project budget is divided into those costs to be reimbursed by Historic Preservation Funds (HPF federal dollars) and those costs which are covered by the City (applicant match). All costs--both HPF federal dollars and the applicant match--must be adequately documented on a Request for Reimbursement Form. The applicant match portion must total, at a minimum, an amount equal to the federal portion. 2. All costs must be in payment of an obligation incurred during the grant time period. 3. All costs must represent expenditures which are necessary for the accomplishment of approved grant objectives. 4. Transferred federal monies cannot be applied as matching applicant share; monies used as match on other federal grants may not be used as matching share on this project. 5. Specific cost categories: A. Personnel (1) Project Specific Personnel are hired as regular employees specifically for the grant project. Eligible costs may include salary expenses as well as other project related expenses incurred for the benefit of the project specific personnel. These costs may be charged to the federal portion and/or to the applicant portion of the project budget. Costs included on a Request for Reimbursement Form must be supported with copies of time sheets showing the employee's name, dates and hours worked, dollar amount, description of work performed, employee's signature, and the signature of the employee's supervisor. Either the City's time sheets with the above information or MHS time sheets (see Attachment D) are acceptable. (2) In-Kind Services (force account personnel) are regular employees of the City who spend all or part of their time on the grant project. Eligible costs include the actual salary of the employee including fringe benefits. (The employee must be working in the same skill for which he/she is normally paid, otherwise, only minimum wage can be used.) These costs may be charged to the federal portion and/or to the applicant portion of the project budget. Costs included on a Request for Reimbursement Form must be supported with copies of time sheets containing information described Appendix II – Sample Agreement under 5.A.(1) above as well as documentation supporting the claimed wage rate(s). (3) Donated Services (volunteer personnel) contribute time to the grant project. If a volunteer is performing tasks within his/her normal trade or profession, the value of the contribution is based on the volunteer's normal rate of pay or the rates listed below. (The Society will furnish rates for other areas upon request.) Benefits are not eligible. If the volunteer is performing tasks outside of his/her profession, only minimum wage rate can be used. These contributions may be utilized only for the applicant portion of the budget. Costs included on a Request for Reimbursement Form must be supported by time sheets with information described under 5.A.(1) above. Rates for Volunteer Personnel Non-specialized HPC member rate $ 21.91 per hour B. Contractual Services are services necessary for the completion of the project which are contracted by the City. The City must follow the requirements of OMB Circular A-102 (revised) regarding procurement standards in arranging for such services. Eligible costs may include the rates actually paid to the contractor. These costs may be charged to the state portion and/or to the applicant portion of the project budget. Costs included on a Request for Reimbursement Form must be supported by copies of invoices and copies of canceled checks. C. Supplies and Materials (1) Donated supplies and materials are those taken out of City stock or donated by third parties. The cost of these supplies and/or materials may be charged only to the applicant portion of the budget. Costs included on a Request for Reimbursement Form must be supported by a Value of Donated Supplies and Materials Form (see Attachment E) which must include a description of the materials and/or supplies, date of donation, fair market value, basis for the valuation (i.e., invoice price, price in retail outlet, etc.), and signature of verifying official. (2) Purchased supplies and materials are those items bought specifically for the project. The City must follow the requirements of OMB Circular A102 revised) in the purchase of supplies and materials. The cost of these supplies and/or materials may be charged to the federal portion and/or to the applicant portion of the budget. Costs included on a Request for Reimbursement Form must be supported by copies of invoices and copies of cancelled checks. Appendix II – Sample Agreement D. Indirect Costs may be charged to the project only if the City has a current rate that has been approved by the City’s cognizant federal agency and is currently in effect. These costs may be charged only to the applicant portion of the budget. Those costs must be included on page four of the City’s CLG grant application. E. Mileage Costs may be charged to the project for necessary costs incurred excluding costs of mileage from place of residence of project personnel to the project site. Mileage paid for by the City may be charged to the federal portion and/or to the applicant portion of the budget; donated mileage may be charged only to the applicant portion. Costs included on a Request for Reimbursement Form must be supported with the following information: project personnel name, date of travel, purpose of travel, beginning and ending mileage, and rate claimed. Maximum rate allowable is $.56 per mile. Appendix II – Sample Agreement Attachment D Minnesota Historical Society Value of In-Kind and/or Donated Services Time Sheets City and Project Name Federal Grant Number Name of Person Contributing Services Type of Worked Performed (research, planning, secretarial, etc.) Hourly Rate – Based on: ______________________________________________________________ Volunteer personnel donating his/her time to a project may be credited with an agreed rate (See Attachment C of Grant Agreement) unless he/she is professionally skilled in the work he/she is performing on the project. When this is the case, the wage rate the individual is normally paid for performing his/her service may be credited to the project. If a higher rate than the published volunteer rate is used, additional documentation and verification is required. Please consult with the Grants Office before claiming the higher rate. Date Start Time of Work End Start End Total Hours Hourly Rate Total Value of Donation Signature of Person Donating Time Date Supervisor Verifying Accuracy Date Value Hours x Rate Appendix II – Sample Agreement Attachment E Minnesota Historical Society Value of Donated Supplies and Materials City and Project Name Federal Grant Number Name and Address of Donor Description of Supplies and Material Donated Donation Date Fair Value Basis of Value Total Value of Donation Supervisor Verifying Accuracy Date Appendix II – Sample Agreement Attachment F MINNESOTA HISTORICAL SOCIETY STATE HISTORIC PRESERVATION OFFICE Monthly Progress Report Form -- CLG Grants Grantee: ___________________________ Federal Project No. ________________________ Report for the Month of: ______________________________ Contact: _________________________ Daytime Telephone: _________________________ 1. Describe month's progress toward accomplishing the goals of the project. Refer to "consultations" and "final products" listed in Attachment A. 2. Is the project currently on schedule? If not, please explain why. 3. Describe any significant problems encountered this month which may impede the successful completion of the project. 4. Is the project on budget? Approximate costs incurred since the previous progress report (estimate only, including both federal and matching share). Prepared by: _________________________ Signature: _____________________________ Date:_________________________________
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