CM-2026-184 - 7/10/2026 TEXAS '
HISTORICAL CLG TRAVEL GRANT CONTRACT
COMMISSIONAP (Federal GY2024)
REAL PLACES TELLING REAL STORIES
TEXAS HISTORICAL COMMISSION
THC Contract No. 808-26-262116
FEDERAL GRANT YEAR 2024 CERTIFIED LOCAL GOVERNMENT (CLG) GRANT
CFDA: 15.904
FEDERAL AGENCY: NATIONAL PARK SERVICE (NPS)
FEDERAL AWARD IDENTIFICATION NO. (FAIN): P24AF01736
GRANT Contract No. CLG-TX-24-027
1. PARTIES
The parties of this contract (Contract) are the Texas Historical Commission (THC),an agency of the State of
Texas;and the City of Round Rock(Grantee).
2. PURPOSE
This Contract is entered into pursuant to a grant made to THC for federal fiscal year 2024 (October 1,2023—
September 30,2024) by the U.S. Department of the Interior,National Park Service,under the provisions of the
National Historic Preservation Act of 1966,and as amended P.L. 89-665 (16 U.S.C. Sec. 470 et seq;54 US Code
Chapters 3021-3039).This grant is made for the purpose of funding a travel stipend to be utilized by Grantee as a
participant in the Certified Local Government (CLG) program.
3. SERVICES TO BE PROVIDED
The following services are to be provided within the Contract period on a schedule to be agreed upon by the parties
to this Contract.However,the services designated with specific deadlines must comply with those deadlines.
Grantee will send two (2) representative(s) (Attendee(s)] named in List of Grantee's FORUM 2026 Attendees
(Attachment A) to the National Alliance of Preservation Commission's FORUM 2026 in Minneapolis,Minnesota,
during July 22-26,2026.Pursuant to the terms of this Contract,THC will provide a travel stipend (the Grant) that
may fund lodging at the conference,roundtrip airfare costs to the conference,and ground transportation to/from
the airport. Local rental car costs,meals, and conference registration are not eligible for reimbursement under this
travel stipend. Eligible and ineligible expenses are detailed in Reimbursement Request Procedures and
Required Records (Attachment C). The Grantee may substitute another attendee not named in Attachment A
only with the written approval of THC.
Regulations of the U.S. Department of the Interior strictly prohibit unlawful discrimination in federally assisted
programs on the basis of race,color,and/or national origin.Therefore,the Grantee must sign DI Form 1350 U.S.
Department of the Interior Civil Rights Assurance (Attachment D) and return the signed form to THC with
this Contract.
4. AMOUNT OF THE CONTRACT
The total amount of this Contract shall not exceed$2,185.00 (two thousand one hundred eighty-five&No/100
Dollars).THC shall reimburse the Grantee for the eligible expenses hereunder,exclusively from U.S.Department
of the Interior grant-in-aid funds for historic preservation (CLG),and this Contract is subject to the availability of
those funds.
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5. PERIOD
This Contract shall commence on the date it is executed by both parties and shall terminate on December 31,
2026. It is further agreed that all travel,lodging,and any other eligible expenses as indicated in Attachment C
associated with this project shall be completed by August 2,2026, and all reimbursement requests shall be
submitted to THC by September 30,2026.
Any expenses incurred by the Attendee after August 2,2026, shall be considered ineligible for reimbursement
under this grant Contract.
Contract amendments may be requested in writing using the Contract Amendment Form (Attachment B) at any
time between execution of the contract and October 31,2026. Such requests may be approved at the sole option of
THC.
6. INDEPENDENT CONTRACTOR STATUS;INDEMNITY& HOLD HARMLESS AGREEMENT
Grantee is a Texas Municipal Corporation. Grantee is not an agency of the State of Texas. It is expressly
understood and agreed that the Grantee and Grantee's subcontractors,if any,are independent contractors and not
employees of THC. Grantee or any subcontractor shall not be considered the agent,the servant, or the employee
of THC for any purpose whatsoever.
7. INDEMNIFICATION
To the extent allowed by law, Grantee is responsible for any and all claims whatsoever due to actions or
performance under this grant, including,but not limited to,the use of automobiles or other transportation
taken by its owners,incorporators, officers, directors, employees,volunteers or any third parties. TO
THE EXTENT ALLOWED BY STATE LAW AND THE TEXAS CONSTITUTION, GRANTEE
AGREES TO DEFEND, INDEMNIFY AND HOLD HARMLESS THE STATE OF TEXAS AND
THC,AND/OR THC's OFFICERS,AGENTS, EMPLOYEES, REPRESENTATIVES,
CONTRACTORS,ASSIGNEES,AND/OR DESIGNEES FROM ANY AND ALL LIABILITY,
ACTIONS, CLAIMS,DEMANDS, OR SUITS,AND ALL RELATED COSTS,ATTORNEY FEES,
AND EXPENSES,ARISING OUT OF, OR RESULTING FROM ANY ACTS, PERFORMANCE, OR
OMISSIONS OF GRANTEE OR ITS AGENTS, EMPLOYEES, SUBCONTRACTORS, ORDER
FULFILLERS, OR SUPPLIERS OF SUBCONTRACTORS IN THE EXECUTION OR
PERFORMANCE OF THE CONTRACT AND ANY PURCHASE ORDERS ISSUED. UNDER THIS
CONTRACT, INCLUDING,BUT NOT LIMITED TO,NEGLIGENT ACT OR OMISSION,
INTENTIONAL TORT, INTELLECTUAL PROPERTY INFRINGEMENT, OR THE FAILURE TO
PAY A SUBCONTRACTOR.THE DEFENSE SHALL BE COORDINATED BY GRANTEE WITH
THE OFFICE OF THE TEXAS ATTORNEY GENERAL WHEN TEXAS STATE AGENCIES ARE
NAMED DEFENDANTS IN ANY LAWSUIT AND GRANTEE MAY NOT AGREE TO ANY
SETTLEMENT WITHOUT FIRST OBTAINING THE CONCURRENCE FROM THE OFFICE OF
THE TEXAS ATTORNEY GENERAL. GRANTEE AND THC AGREE TO FURNISH TIMELY
WRITTEN NOTICE TO EACH OTHER OF ANY SUCH CLAIM.
REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK.
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8. DOCUMENTATION AND PAYMENT
Grantee may submit to THC, for its approval,a properly completed invoice for eligible travel expenses rendered in
compliance with all requirements of the Contract as specified in the Reimbursement Request Procedures and
Required Records (Attachment C).
It is further agreed that the Grantee will update THC in writing on any changes or issues that may arise in advance
of the FORUM 2026 Conference. Failure to notify THC about changes before the start of the FORUM 2026
Conference on July 22,2026,as required may constitute breach of this grant Contract and result in forfeiture of the
Grant.
Reimbursement to the Grantee shall be subject to receipt of funds from the National Park Service and full
attendance of the FORUM 2026 conference as stipulated in the Reimbursement Request Procedures and
Required Records (Attachment C).
The payment shall be made as requested for eligible expenditures in one lump sum upon completion and approval
of all the requirements set forth in this Contract. It is further agreed that the total Grant award will be retained by
THC until the receipt of properly documented reimbursement materials.
Subject to the limitations of the Contract,THC's payments will be made in accordance with the Texas Prompt
Payment Act.
9. TERMINATION
Either party to this Contract may terminate by giving seven (7) days written notice to the other party. If the
Contract is terminated,any expenses incurred and/or relating to attendance of the FORUM 2026 will not be
reimbursed.
10. APPLICABLE LAWS
This Contract shall be governed by and construed in accordance with the laws of the State of Texas and the rules
and policies of THC.The venue of any suit arising under this Contract is fixed in any court of competent
jurisdiction of Travis County,Texas.
11. CONTRACT NOT ENTITLEMENT OR RIGHT
Reimbursement with Contract funds is not an entitlement or right. Reimbursement depends,among other things,
upon strict compliance with all terms,conditions,and provisions of this Contract and the HPF Grants Manual.
Parties agree that any act,action, or representation by either party,their agents,or employees that purports to
increase the amount of the Contract is void,unless a written amendment is first executed. Grantee agrees that
nothing in this Contract will be interpreted to create an obligation or liability of THC in excess of the funds
delineated in this Contract.
12. FUNDING LIMITATION
Grantee agrees that nothing in this grant will be interpreted to create an obligation or liability of THC in excess of
the funds delineated in this Contract. Grantee agrees that funding for this Contract is subject to the actual receipt by
THC of grant funds (state and/or federal) appropriated to THC. Grantee agrees that the grant funds,if any,
received from THC are limited by the term of each state biennium and by specific appropriation authority to and
the spending authority of THC for the purpose of this Contract. Grantee agrees that notwithstanding any
other provision of this Contract,if THC is not appropriated the funds or if THC does not receive the
appropriated funds for the purpose of this grant program, or if the funds appropriated to THC for this
grant program are required by the state or federal government to be reallocated,THC is not liable to pay
the Grantee any remaining balance on this Contract.
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13. AUDIT AND RECORDS RETENTION
Grantee represents and warrants its compliance with the records retention requirements of 2 CFR§ 200.333. In
addition to the terms detailed in this Contract,all federal requirements governing grants (Office of Management and
Budget Circulars A-87 or A-122,A-102 or A-110,A-133,and A-128) are applicable.
Grantee must maintain and retain all records relating to the performance of the grant including,but not limited to,
administrative, financial,procurement,reporting,and any other grant-related records and supporting fiscal
documents adequate to ensure that claims for grant funds are in accordance with applicable State of Texas
requirements.These records will be maintained and retained by Grantee for a period of seven (7)years following
the grant expiration date or until all audit,claim,and litigation matters are resolved,whichever is later. This period
begins on the date of receipt of the final reimbursement by the Grantee,or if applicable,after any issues have been
resolved that may have arisen from any litigation,claim,negotiation,audit,open records request,or any other action
involving these records.
THC reserves the right to direct Grantee to retain documents for a longer period of time or transfer certain records
to THC custody when it is determined the records possess longer term retention value. Grantee must include the
substance of this clause in all subawards and subcontracts. Grantee will provide full access to these records to THC
as well as any authorized federal,state,or independent auditors,to examine their contents and procedures to verify
compliance with federal and state regulations.
14. STATE AUDITOR
In addition to and without limitation on the other audit provisions of this Contract,pursuant to Texas Government
Code§ 2262.154,the State Auditor's Office may conduct an audit or investigation of Grantee or any other entity or
person receiving funds from the State directly under this Contract or indirectly through a subcontract under this
Contract.The acceptance of funds by Grantee or any other entity or person directly under this Contract or
indirectly through a subcontract under this Contract acts as acceptance of the authority of the State Auditor's
Office,under the direction of the Legislative Audit Committee,to conduct an audit or investigation in connection
with those funds. Under the direction of the Legislative Audit Committee,Grantee or any other entity that is the
subject of an audit or investigation by the State Auditor's Office must provide the State Auditor's Office with access
to any information the State Auditor's Office considers relevant to the investigation or audit. Grantee further agrees
to cooperate fully with the State Auditor's Office in the conduct of the audit or investigation,including providing all
records requested.The State Auditor's Office shall at any time have access to and the right to examine,audit,
excerpt,and transcribe any pertinent books,documents,working papers,and records of Grantee related to this
Contract.
15. STANDARD FEDERAL AND STATE GRANT CERTIFICATIONS
15.1. Child Support Obligation Affirmation.To the extent applicable,under Family Code§ 231.006,Grantee
certifies that the individual or business entity named in this Contract is not ineligible to receive the specified
grant and acknowledges that this Contract may be terminated and payment may be withheld if this
certification is inaccurate in addition to other remedies set out in Family Code § 231.006(f).
15.2. Compliance With Law, Rules, and Requirements. Grantee represents and warrants that it will comply,
and assure the compliance of all its employees and subrecipients,with all applicable federal and state laws,
rules,regulations,and policies in effect or hereafter established,including but not limited to the Uniform
Grant Management Act of 1981 (UGMA),Chapter 783,Texas Government Code,as amended. Grantee also
agrees to comply with the HPF Grants Manual (2007) and as updated,the Texas Grant Management
Standards (TxGMS),as promulgated by the Texas Comptroller's Office.
In addition,Grantee represents and warrants that it will comply with all requirements imposed by THC
concerning special requirements of law,program requirements,and other administrative requirements. In
instances where multiple requirements apply to the Grantee, the more restrictive requirement applies.
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15.3. Cybersecurity Training Programs. Grantee represents and warrants its compliance with Texas
Government Code § 2054.591 relating to the cybersecurity training program for local government employees
who have access to a local government computer system or database. If Grantee has access to any state
computer system or database,Grantee shall complete cybersecurity training and verify completion of the
training program to THC pursuant to and in accordance with Texas Government Code § 2054.5192.
15.4. Debarment and Suspension. Grantee certifies that it and its principals are not suspended or debarred from
doing business with the state or federal government as listed on the State of Texas Debarred Vendor List
maintained by the Texas Comptroller of Public Accounts (CPA) and the System for Award Management
(SAM) maintained by the General Services Administration.
15.5. Debts and Delinquencies. Grantee agrees that any payments due under this Contract shall be applied
towards any debt or delinquency that is owed to the State of Texas.
15.6. Disclosure of Violations of Federal Criminal Law. Grantee represents and warrants its compliance with 2
CFR§ 200.113 which requires the disclosure in writing of violations of federal criminal law involving fraud,
bribery,and gratuity and the reporting of certain civil,criminal,or administrative proceedings to SAM.
15.7. Disclosure Protections for Certain Charitable Organizations, Charitable Trusts, and Private
Foundations. Grantee represents and warrants that it will comply with Texas Government Code§ 2252.906,
relating to disclosure protections for certain charitable organizations,charitable trusts,and private
foundations.
15.8. Excluded Parties. Grantee certifies that it is not listed in the prohibited vendors list authorized by Executive
Order No. 13224,`Blocking Property and Prohibiting Transactions with Persons Who Commit,Threaten to
Commit,or Support Terrorism",published by the United States Department of the Treasury,Office of
Foreign Assets Control.
15.9. Executive Head of a State Agency Affirmation. Under Texas Government Code § 669.003,relating to
contracting with an executive head of a state agency,Grantee represents that no person who served as an
executive of THC,in the past four(4) years,was involved with or has any interest in the contract or grant. If
Grantee employs or has used the services of a former executive of THC,then Grantee shall provide the
following information to THC: name of the former executive,the name of the state agency,the date of
separation from the state agency,the position held with THC,and the date of employment with THC.
15.10.Law Enforcement Agency Grant Restriction. If Grantee is a law enforcement agency regulated by Chapter
1701,Texas Occupations Code,Grantee represents and warrants that it will not use appropriated money
unless the law enforcement agency is in compliance with all rules adopted by the Texas Commission on Law
Enforcement (TCOLE), or TCOLE certifies that it is in the process of achieving compliance with such rules.
15.11.Legal Authority. Grantee represents that it possesses legal authority to apply for the grant.A resolution,
motion or similar action has been duly adopted or passed as an official act of the Grantee's governing body,
authorizing the application for this grant,including all understandings and assurances contained therein,and
directing and authorizing the person identified as the official representative,or the designee of Grantee to act
in connection with the Contract and to provide such additional information as may be required.
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15.12.Limitations on Grants to Units of Local Government. Grantee acknowledges and agrees that
appropriated funds may not be expended in the form of a grant to,or contract with,a unit of local
government unless the terms of the grant or contract require that the funds received under the grant or
contract will be expended subject to the limitations and reporting requirements similar to those provided by
the following:
• Parts 2 and 3 of the Texas General Appropriations Act,Art. IX,except there is no requirement for
increased salaries for local government employees;
• Texas Government Code §§ 556.004—.006;and
• Texas Government Code§§ 2113.012 and 2113.101.
15.13.Lobbying Expenditure Restriction. Grantee represents and warrants that THC's payments to Grantee and
Grantee's receipt of appropriated or other funds under this Contract are not prohibited by Texas
Government Code§§ 403.1067 or 556.0055,which restrict lobbying expenditures.
15.14.Open Meetings. If the Grantee is a governmental entity,Grantee represents and warrants its compliance
with Chapter 551,Texas Government Code,which requires all regular,special or called meetings of a
governmental body to be open to the public,except as otherwise provided by law.
15.15.Political Polling Prohibition. Grantee represents and warrants that it does not perform political polling and
acknowledges that appropriated funds may not be granted to,or expended by,any entity that performs
political polling.
15.16.Public Camping Ban. Grantee certifies that it has not received a final judicial determination finding it
intentionally adopted or enforced a policy that prohibited or discouraged the enforcement of a public
camping ban in an action brought by the Attorney General under Local Government Code § 364.003. If
Grantee is currently being sued under the provisions of Local Government Code § 364.003 or is sued under
this section at any point during the duration of this grant,Grantee must immediately disclose the lawsuit and
its current posture to THC.
15.17.Reporting Suspected Fraud and Unlawful Conduct. Grantee represents and warrants that it will comply
with Texas Government Code § 321.022,which requires that suspected fraud and unlawful conduct be
reported to the State Auditor's Office.
16. CONFLICTS OF INTEREST;DISCLOSURE OF CONFLICTS
Grantee has not given or offered to give,nor does Grantee intend to give at any time hereafter,any economic
opportunity, future employment,gift,loan,gratuity,special discount, trip, favor,or service to a public servant or
employee of THC,at any time during the negotiation of this Contract or in connection with this Contract,except
as allowed under relevant state or federal law. Grantee represents and warrants its compliance with the federal
awarding agency's conflict of interest policies in accordance with 2 CFR§ 200.112. Grantee represents and warrants
that performance under the contract or grant will not constitute an actual or potential conflict of interest or
reasonably create an appearance of impropriety. Further,Grantee represents and warrants that in the administration
of the grant,it will comply with all conflict of interest prohibitions and disclosure requirements required by
applicable law,rules,and policies,including Chapter 176,Texas Local Government Code. Grantee will establish
safeguards to prohibit its employees from using their positions for a purpose that constitutes or presents the
appearance of personal or organizational conflict of interest or personal gain. Grantee will operate with complete
independence and objectivity without actual,potential,or apparent conflict of interest with respect to its
performance under this Contract. If circumstances change during the course of the Contract,including discovery
of any existing or potential conflicts of interest relative to Grantee's performance under this Contract,Grantee
must disclose and shall promptly notify THC,in writing,within fifteen (15) calendar days of discovery of the
change or conflict.
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17. NON-ASSIGNABILITY
Grantee shall not assign this Contract or assign,transfer, or delegate,in whole or in part,any of its interest in,or
rights,duties,or obligations under,this Contract without the prior written consent of THC,and any attempted or
purported assignment,transfer or delegation thereof without such consent will be null and void.
18. NO WAIVER OF SOVEREIGN IMMUNITY •
The parties expressly agree that no provision of this Contract is in any way intended to constitute a waiver by THC
or the State of Texas of any immunities from suit or from liability that THC or the State of Texas may have by
operation of law.
19. DISPUTE RESOLUTION
The dispute resolution processes provided for in Chapters 2009 and 2260,Texas Government Code,shall be used by the
parties to resolve any dispute arising under this Contract.
20. CONFIDENTIALITY AND PUBLIC INFORMATION ACT
Notwithstanding any provisions of this Contract to the contrary,Grantee understands that THC will comply with
the Texas Public Information Act(PIA),as codified in Chapter 552,Texas Government Code,and as interpreted by
judicial opinions of the Texas courts and opinions of the Attorney General of the State of Texas. Information,
documentation,and other material in connection with this Contract may be subject to public disclosure pursuant to
the Texas PIA. In accordance with Texas Government Code§ 2252.907, Grantee is required to make any
information created or exchanged with the State pursuant to the Contract,and not otherwise excepted from
disclosure under the Texas PIA,available in a format that is accessible the public at no additional charge to the
State.THC agrees to notify Grantee in writing within a reasonable time from receipt of a request for information
related to the Grantee's work under this grant. Grantee will cooperate with THC in the production of documents
responsive to the request.
21. NOTICES
Any notices and/or documents required hereunder shall be deemed to have been duly provided if in writing and
delivered personally or by pre-paid guaranteed overnight delivery service,or sent postage prepaid by United States
certified mail,return receipt requested.Any such notice shall be effective on the date of delivery if delivered
personally,on the next business day following delivery to the guaranteed overnight delivery service if the notice was
so delivered and the charges were prepaid,or on the date the recipient signed for the notice if sent by certified mail.
Notices shall be addressed as follows, or at such other address as any party hereto shall notify the other of in
writing:
If to THC:
Texas Historical Commission
P.O. Box 12276
Austin,TX 78711
If to Grantee:
City of Round Rock
301 W. Bagdad Ave., #210
Round Rock,TX 78664
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HISTORICAL ATTACHMENT A
CO M M I SS I O N 4 List of Grantee's FORUM 2026 Attendees
REAL PLACES TELLING REAL STORIES
City of Round Rock
1. Shagufta Ellam
2. Kerstin Harding
THC Contract No.808-26-262116/Grant Contract No.CLG-TX-24-027 Attachment A Page 1 of 1
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HISTORICAL ATTACHMENT B
CO M M I SS I O N 4 Certified Local Government (CLG) Travel Grant Contract Amendment Form
REAL PLACES TELLING REAL STORIES
• Amendment to CLG Grant Contract Number:
• Project Title:
• Grantee:
• Contact:
• Address:
• Phone:
• Amendment Type (please select one below:)
❑ Change in Attachment A—List of Attendees for Travel Grant Contract—Federal GY2024
❑ Change in Contract Amount
Note: Contract Amendment will not be effective until approved in writing by the Texas Historical Commission.
TEXAS HISTORICAL COMMISSION: GRANTEE:
Signature Signature
Typed Name&Title Typed Name&Title
Date Date
THIRD PARTY DESIGNEE: (IF APPLICABLE)
Signature
Typed Name&Title of Delegated Third Party
Date
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HISTORICAL ATTACHMENT C
COMMI SS I O N 4 Reimbursement Requests Procedures and Required Records
REAL PLACES TELLING REAL STORIES
The required travel stipend reimbursement request procedures and template are found in this attachment. Requests
must be received by the Texas Historical Commission (THC) no later than September 30, 2026,and must be
submitted electronically as a PDF file. Certified Local Governments (CLGs) awarded multiple stipends must submit
one reimbursement request;however,the CLG must be clear the costs were incurred by which individual(see
attached template).
Requests for payment shall be accompanied by complete documentation,including receipts for all eligible expenses.
Only eligible expenses will be reimbursed.Travel stipends will only be paid to the CLG.The CLG must
reimburse the individual for eligible expenses before requesting reimbursement from THC. Individuals
must attend the full FORUM 2026 conference to qualify for reimbursement.
Use this checklist of required documentation when preparing a reimbursement request:
(a.) ❑ Signed Billing Statement from the CLG to THC with federal tax identification number. (See attached
template)
(b.) El Copies of individual's or CLG's receipts (purchase of roundtrip airfare,hotel accommodations,ground
transportation)
(c.) ❑ Copies of receipts or properly endorsed cancelled (deposited) checks (front and back) as evidence that
the CLG reimbursed the individual, or credit card statements or properly endorsed cancelled (deposited)
checks (front and back) if the CLG paid for the airfare or hotel accommodations.
Eligible Expenses
Individuals must check in at the conference to qualify for reimbursement. Receipts for all expenses must
accompany requests for reimbursement.
Travel stipends can be used to cover the following costs:
• Airfare to and from Minneapolis,Minnesota
• Hotel lodging,including hotel taxes
• Rental car to and from Minneapolis,Minnesota (local rental car costs during the conference are not eligible
for reimbursement)
• Ground transportation to/from the airport
Travel stipends may not be used to cover the following costs:
• Conference registration
• Car rental for local (Minneapolis,Minnesota) transportation
• Food
• Beverages
• Other incidentals
Lodging
To comply with state and federal regulations, the THC may only reimburse for lodging up to the maximum
allowable federal reimbursement rate for Minneapolis,Minnesota, for Fiscal Year 2026:
The maximum amount that can be reimbursed for lodging is $148 per night,not including taxes. Taxes may be
reimbursed above this rate.Any room charges incurred above this rate per night will not be reimbursed. Hotel
parking will not be reimbursed,nor will incidentals or other charges to the room.
These rates are set by the U.S. General Services Administration,and can be found on the GSA website at
https://gsa.gov/travel.
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BILLING STATEMENT TEMPLATE
Date
TO: Texas Historical Commission
Attn: CLG Grants
P.O.Box 12276
Austin,TX 78711-2276
clga,thc.texas.gov
FROM: [Name&Address of Certified Local Government]
TAX IDENTIFICATION NUMBER:
RE: CLG Billing
Enclosed is documentation to support a billing for$[amount] to cover travel expenses associated with attending
FORUM 2026 in Minneapolis,Minnesota,during July 22-26,2026.The contract number is TX-26-[XXX] dated
[date of contract]. I certify no other federal funds were used for expenditures incurred during the execution of this
project.
Please send the above amount to:
[Name&Address of CLG and/or department to receive funds]
Name of Attendee PROPOSED ACTUAL
[Activity] $amount
[Activity] $amount
[Activity] $amount
Name of Attendee PROPOSED ACTUAL
[Activity] $amount
[Activity] $amount
[Activity] $amount
Sincerely,
Name
Title
Enclosures:
[receipts]
[cancelled checks or copies of bank statements]
THC Contract No.808-26-262116/Grant Contract No.CLG-TX-24-027 Attachment C Page 2 of 2
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HISTORICAL ATTACHMENT D
CO M M I SS I O N'4 U.S. Department of the Interior Civil Rights Assurance
REAL PLACES TELLING REAL STORIES
As the authorized representative of the applicant,I certify that the applicant agrees that,as a condition to receiving
any Federal financial assistance from the Department of the Interior,it will comply with all Federal laws relating to
nondiscrimination.These laws include but are not limited to: (a) Title VI of Civil Rights Act of 1964 (42 U.S.C.
2000d-1),which prohibits discrimination on the basis of race,color, or national origin; (b) Section 504 of the
Rehabilitation Act of 1973,as amended (29 U.S.C. 794),which prohibits discrimination on the basis of handicap; (c)
the Age Discrimination Act of 1975,as amended (42 U.S.C. 6101 et. seq.),which prohibits discrimination on the
basis of age;and applicable regulatory requirements to the end that no person in the United States shall,on the
grounds of race,color,national origin,handicap or age,be excluded from participation in,be denied the benefits of,
or be otherwise subjected to discrimination under any program or activity conducted by the applicant.THE
APPLICANT HEREBY GIVES ASSURANCE THAT it will immediately take any measures necessary to
effectuate this agreement.
THIS ASSURANCE shall apply to all aspects of the applicant's operations including those parts that have not
received or benefited from Federal financial assistance.
If any real property or structure thereon is provided or improved with the aid of Federal financial assistance
extended to the Applicant by the Department,this assurance shall obligate the Applicant,or in the case of any
transfer of such property,any transferee, for the period during which the real property or structure is used for a
purpose for which the Federal financial assistance is extended or for another purpose involving the provision of
similar services or benefits. If any personal property is so provided, this assurance shall obligate the Applicant for
the period during which it retains ownership or possession of the property. In all other cases,this assurance shall
obligate the Applicant for the period during which the Federal financial assistance is extended by the Department.
THIS ASSURANCE is given in consideration of and for the purpose of obtaining any and all Federal grants,loans,
contracts,property,discounts,or other Federal financial assistance extended after the date hereof to the Applicant
by the Department,including installment payments after such date on account of applicants for Federal financial
assistance which were approved before such date.
The Applicant recognizes and agrees that such Federal financial assistance will be extended in reliance on the
representations and agreements made in this assurance,and that the United States shall have the right to seek
judicial enforcement of this assurance. This assurance is binding on the Applicant,its successors,transferees,
assignees,and sub-recipients and the person whose signature appears below who is authorized to sign this assurance
on behalf of the Applicant.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE
Ciry
APPLICA /ORGANIZATION DATE SUBMITTED
C� " or ROUND DOCK, Ts( fuLy /0,2626.
APPLICANT/ORGANIZATION MAILING ADDRESS BUREAU OF OFFICE EXTENDING ASSISTANCE
2Z ) �� MA-iN srrza-r
/ZOUND 2crx, ry 7k6964
THC Contract No.808-26-262116/Grant Contract No.CLG-TX-24-027 Attachment D Page 1 of 1