R-02-01-10-12B1 - 1/10/2002::DDMA \WORLDOX \O: \WDOX \RRSOLUTI \R10110B1.WPD /sc
RESOLUTION NO. R- 02- 01- 10 -12B1
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF ROUND
ROCK AUTHORIZING THE MAYOR TO EXECUTE AGREEMENTS
ASSOCIATED WITH THE "URBAN FORESTRY PARTNERSHIP
GRANT PROGRAM" GRANT REQUEST AND COMMITTING SHARED
COST OF THE PROJECT AS DESCRIBED IN THE GRANT
APPLICATION.
WHEREAS, the 101st Congress of the United States, in
developing the Forestry Title of the 1990 Farm Bill, found that the
health of forests in urban areas and communities is on the decline;
and that these forests, trees, and open spaces improve the quality
of life for residents, enhance economic value of property, and are
effective at reducing the buildup of carbon dioxide, and
WHEREAS, Congress defined the purposes of this program to
include improving the understanding of the benefits of preserving
existing tree cover; encourage property owners to maintain trees
and expand forest cover; provide educational and technical
assistance to local organizations in maintaining and expanding
forest cover; provide competitive matching grants to local units of
government and other approved organizations for urban forestry
projects; implement a tree planting program; promote the
establishment of demonstration projects to illustrate the benefits
of forest cover; and enhance technical skills of individuals
involved in establishing or maintaining urban forest, and
WHEREAS, the City of Round Rock is eligible to participate
in this program and has successfully submitted a grant application
in the amount of $10,000.00, Now Therefore
BE IT RESOLVED BY THE COUNCIL OF THE CITY OF ROUND ROCK,
TEXAS, THAT:
Section 1: The City Council hereby authorizes the Mayor to
execute all agreements associated with the "Urban Forestry
Partnership Grant Program" Grant with the Texas Forest Service.
Section 2: The City Council commits to providing its share of
the project costs through "in- kind" services as described in the
grant application.
Section 3: The City Council endorses and permits the planting
of trees on public property under their jurisdiction in the City of
Round Rock.
The City Council hereby finds and declares that written notice
of the date, hour, place and subject of the meeting at which this
Resolution was adopted was posted and that such meeting was open to
the public as required by law at all times during which this
Resolution and the subject matter hereof were discussed, considered
and formally acted upon, all as required by the Open Meetings Act,
Chapter 551, Texas Government Code, as amended.
ATTEST:
RESOLVED this 10th day of Jan._ry, 2.02 AI
o .
ff .10 �L ,.
RO:'�A. TLUKA, JR., r
E . �a/u.vil
CHRISTINE R. MARTINEZ, City Secre
2
City of Round Rock, Texas
TEXAS
s FOREST ! SERVICE
�
i=ce
The Texas A &M University System
Urban Forestry Partnership Grant Program
2001 Grant Application Form
Part I: Applicant Information
Project Title: Tree Nursery
For Official Use Only
Grant No.
Organization: City Of Round Rock —PARD
Mailing Address: 605 Palm Valley Blvd.
Statewide: ❑ Local: ❑
City: Round Rock State. TX ZIP: 78664
Sharon Prete — Director I (51�) 218_5540
Contact Person: Emsud Horoznvic.TTrhan Forrecrelr Daytime Telephone: CSSI )) 336611 33335500
E -mail Address: ehor -rock. [x. us
Is your organization tax exempt? Yes Federal Employer ID Number: 74- 6017485
Part II: Executive Summary
A narrative of no more than three (3) typed pages must accompany each grant application form. The first part of
this narrative should be in the form of a one - paragraph Executive Summary that briefly describes the project.
Part III: Organizational Goals
The second part of the narrative should clearly state how the project fits within the mission and goals of the
organization by answering most or all of the following questions:
What is the overall mission of your organization? Who are your members or constituents? What is the role
of the organization in promoting urban forestry in the community? How does the project help your group
achieve its mission? What problem will it help solve? What will the long -term benefits to your organization
and the community be? How will these be measured?
Part IV: Section A -- F'roject Work Plan
The third part of the narrative should address the following areas:
1. Project Execution: describe all planned activities for the project, the timetable for its completion, and
the end result or product. A task/timeline chart may be included to summarize the activities.
2. Participants: name all the groups that will be involved and what their roles will be.
3. Use of Federal Funds: state how grant funds will be spent, along with any local cash contribution.
4. In -Kind Contributions: provide the sources and values for all in -kind contributions listed in the
project budget.
5. Project Communication: describe any publicity for the project or how the results or product will be
distributed in the community.
Expense Category
Part IV: Section B -
(1)
Grant Funds ($)
Project Budget
(
Local Cash ($)
(3)
Local In-Kind ($)
Personnel:
$8,500.00
Office Expenses:
$500.00
Travel:
Supplies and Materials:
$8,000.00
Equipment:
$3,000.00
Professional Services:
Contractual:
$2.000.00 insiiliaiion
Other( water ):
$11,000.00
*Column Totals:
(a) $10,000.00
(b)
(c) $12,000.00
"(a)= Grant Request,
I hereby certify that
requirements, and
the Urban Forestry
•
and Local Match Total (d (b)+(c) *Local Match Total:
Part V: Forester Certification (worth 10 pts.)
I have met with the applicant to review this proposal and the
have recommended any changes that would help the project achieve
Partnership Grant Program.
, i� �, ,
(d) $12,000.00
program
the goals of
As a duly authorized
all the information
certify that I understand
,Sbe ro
Signature of TFS Forester Date
Part VI: Grant Application Authorization
representative of the organization making this application, I hereby certify that
provided herein is true and represents the desires of this organization. I further
the purpose and rules of the program, as set out in the Application Guide.
> P dp. �t r s F In recrbk [U 12c r.
li
Name and Title of Authorized Representative D(y
Signature o
Date
SMRepres
ASSURANCES - NON-CONSTRUCTION PROGRAMS
OMB Approval No. 0348 -0040
Iblic reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348- 0040), Washington, DC 20503.
PLEASE DO NOT, RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such
is the case, you will be notified.
As the duly authorized representative of the applicant, 1 certify that the applicant:
Has the legal authority to apply for Federal assistance
and the institutional, managerial and financial capability
(including funds sufficient to pay the non - Federal share
of project cost) to ensure proper planning, management
and completion of the project described in this
application.
2. Will give the awarding agency, the Comptroller General
of the United States and, if appropriate, the State,
through any authorized representative, access to and
the right to examine all records, books, papers, or
documents related to the award; and will establish a
proper accounting system in accordance with generally
accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal or organizational
conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding
agency.
5. Will comply with the Intergovernmental Personnel Act of
1970 (42 U.S.C. § §4728 -4763) relating to prescribed
standards for merit systems for programs funded under
one of the 19 statutes or regulations specified in
Appendix A of OPM's Standards for a Merit System of
Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statutes relating to
nondiscrimination. These include but are not limited to:
(a) Title VI of the Civil Rights Act of 1964 (P.L. 88 -352)
which prohibits discrimination on the basis of race, color
or national origin; (b) Title IX of the Education
Amendments of 1972, as amended (20 U.S.C. § §1681-
1683, and 1685 - 1686), which prohibits discrimination on
the basis of sex; (c) Section 504 of the Rehabilitation
Act of 1973, as amended (29 U.S.C. §794), which
prohibits discrimination on the basis of handicaps; (d)
the Age Discrimination Act of 1975, as amended (42
U.S.C. § §6101- 6107). which prohibits discrimination
on the basis of age; (e) the Drug Abuse Office and
Treatment Act of 1972 (P.L. 92 -255), as amended,
relating to nondiscrimination on the basis of drug
abuse; (f) the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91 -616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) § §523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. § §290 dd -3 and 290 ee
3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the
Civil Rights Act of 1968 (42 U.S.C. § §3601 et seq.), as
amended, relating to nondiscrimination in the sale,
rental or financing of housing; (1) any other
nondiscrimination provisions in the specific statute(s)
under which application for Federal assistance is being
made; and, (j) the requirements of any other
nondiscrimination statute(s) which may apply to the
application.
7. Will comply, or has already complied, with the
requirements of Titles II and III of the Uniform
Relocation Assistance and Real Property Acquisition
Policies Act of 1970 (P.L. 91 -646) which provide for
fair and equitable treatment of persons displaced or
whose property is acquired as a result of Federal or
federally - assisted programs. These requirements apply
to all interests in real property acquired for project
purposes regardless of Federal participation in
purchases.
8. Will comply, as applicable, with provisions of the
Hatch Act (5 U.S.C. § §1501 -1508 and 7324 -7328)
which limit the political activities of employees whose
principal employment activities are funded in whole or
in part with Federal funds.
Previous Edition Usable Standard Form 4248 (Rev. 7.97)
Authorized for Local Reproduction Prescribed by OMB Circular A.102
S
9. Will comply, as applicable, with the provisions of the Davis -
Bacon Act (40 U.S.C. § §276a to 276a -7), the Copeland Act
(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract
Work Hours and Safety Standards Act (40 U.S.C. § §327-
333), regarding labor standards for federally- assisted
construction subagreements.
10. Will comply, if ,applicable, with flood insurance purchase
requirements of Section 102(a) of the Flood Disaster
Protection Act of 1973 (P.L. 93 -234) which requires
recipients in a special flood hazard area to participate in the
program and to purchase flood insurance if the total cost of
insurable construction and acquisition is $10,000 or more
11. Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National
Environmental Policy Act of 1969 (P.L. 91 -190) and
Executive Order (EO) 11514; (b) notification of violating
facilities pursuant to 60 11738; (c) protection of wetlands
pursuant to E0 11990; (d) evaluation of flood hazards in
floodplains in accordance with E0 11988; (e) assurance of
project consistency with the approved State management
program developed under the Coastal Zone Management
Act of 1972 (16 U.S.C. § §1451 et seq.); (f) conformity of
Federal actions to State (Clean Air) Implementation Plans
under Section 176(c) of the Clean Air Act of 1955, as
amended (42 U.S.C. § §7401 et seq.); (g) protection of
underground sources of drinking water under the Safe
Drinking Water Act of 1974, as amended (P.L. 93 -523);
and, (h) protection of endangered species under the
Endangered Species Act of 1973, as amended (P.L. 93-
205).
APPLICA
ATURE O �THORI D CE °TIFYING OFFICIAL "1,' /
r AL _ALL
GANIZATION
C 1 i y or /2ouiw Roc,
12. Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. § §1271 et seq.) related to protectin
components or potential components of the nation(
wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance
with Section 106 of the National Historic Preservation
Act of 1966, as amended (16 U.S.C. §470), E0 11593
(identification and protection of historic properties). and
the Archaeological and Historic Preservation Act of
1974 (16 U.S.C. § §469a -1 el seq.).
14. Will comply with P.L. 93 -348 regarding the protection of
human subjects involved in research, development, and
related activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of
1966 (P.L. 89 -544, as amended, 7 U.S.C. § §2131 et
seq.) pertaining to the care, handling, and treatment of
warm blooded animals held for research, teaching, or
other activities supported by this award of assistance.
16. Will comply with the Lead -Based Paint Poisoning
Prevention Act (42 U.S.C. § §4801 et seq.) which
prohibits the use of lead -based paint in construction or
rehabilitation of residence structures.
17. Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit
Act Amendments of 1996 and OMB Circular No. A -133 - 1
"Audits of States, Local Governments, and Non -Prof t
Organizations."
18. Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations, and policies
governing this program.
TITLE
mAyo2
DATE SUBMITTED
Standard Form 424B (Rev. 7.97) Bapk
Certifications Regarding Lobbying; Debarment, Suspension and Other
Responsibility Matters; and Drug -Free Workplace Requirements
Applicants should refer to the regulations cited below to determine the certification to which they are required to attest.
Applicants should also review the instructions for certification included in the regulations before completing this form. Signature
of this form provides for compliance with the certification requirements under 7 CFR 3018, "New Restrictions on Lobbying,'
and 7 CFR 3017, "Govemmentwide Debarment and Suspension (Nonprocurement) and Governmentwide Requirements for
Drug -Free Workplace (Grants)." The certifications shall be treated as a material representation of fact upon which reliance will
be placed when the USDA Forest Service determines to award the covered transaction, grant, or cooperative agreement.
1. Lobbying
As required by Section 1352, Title 31, of the U.S. Code, and implemented at 7 CFR 3018, for persons entering into a grant or
cooperative agreement over $100,000 as defined at 7 CFR 3018.105 and 3018.110, the applicant certifies that:
(I) 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 any agency, a Member of Congress, an officer or employee of
Congress, or an employee of a Member of Congress in connection with the making of any Federal grant, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal grant 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 grant 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 subgrants, contracts under grants and cooperative agreements, and subcontracts) and that all subrecipients
shall certify and disclose accordingly.
2. Debarment, Suspension, and Other Responsibility Matters
As required by Executive Order 12549, Debarment and Suspension, and implemented at 7 CFR 3017, for prospective
participants in primary covered transactions, as defined at 7 CFR 3017, Sections 3017.105 and 3017.110 --
1. The applicant certifies 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 application 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 Government entity (Federal, State, or local) with
commission of any offenses enumerated in paragraph (1)(b) of this certification; and
2. Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach an explanation to
this application.
3. Drug Free Workplace (Grantees Other Than Individuals)
As required by the Drug -Free Workplace Act of 1988, and implemented at 7 CFR 3017, Subpart F, Section 3017.600 Purpose
for grantees, as defined at 7 CFR 3017, Section 3017.605 and 3017.610 -
A. The applicant certifies that it will or will 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 that five calendar days after such conviction;
(e) Notifying the agency, in writing, within 10 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 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;
(1) 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 an 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, stale, zip code)
Check ❑ if there are workplaces on file that are not identified here.
.4s the duly authorized representative o the applicant, 1 hereby certify that the applicant will comply with the above
certifications.
Name of Applicant
e/Tv OF IeOthUO aG
Orea za hon Name
.€T /-7 677-11,6 � (71e. � /ro y02
i'inted Na and Tifr of • ; ed ' - .re5entative
O /-
PR/Award Number and/or Project Name
Form W-9
(Rev. December 2000)
a rnemal Revenue Service t a the er
`o
c
m
Part I
Name (See Specific nsuuctions on page 2.)
Business name, if different from above. (See Specific Instructions on page 2.)
Check appropriate box: Individual/Sole proprietor
Address (number, street. and apt. or suite no)
Enter your TIN in the appropriate box. For
individuals, this is your social security number
(SSN). However, for a resident alien, sole
proprietor, or disregarded entity, see the Part I
instructions on page 2. For other entities, it is your
employer identification number (EIN). If you do not
have a number, see How to get a TIN on page 2.
Note; if the account is in more than one name, see
the chart on page 2 for guidelines on whose number
to enter.
Part III
Sign
Here
City, stale, and ZIP code
Taxpayer Identification Number (TIN)
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number or I am waiting for a number to be issued to me). and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal
Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has
notified me that I am no longer subject to backup withholding, and
3. I am a U.S. person (including a U.S. resident alien).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply.
For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement
arrangement (IRA), and gene. - • -y - is other than interest and dividends- you are not required to sign the Certification. but you must
provide your correct TIN. ee the instru r ions on page 2.) , r
Signature
U.S. person
Purpose of Form
A person who is required to file an information
return with the IRS must get your correct
taxpayer identification number (TIN) to report. for
example. income paid to you, real estate
transactions. mortgage interest you paid
acquisition or abandonment of secured property,
cancellation of debt. or contributions you made
to an IRA.
Use Form W - 9 only If you are a U.S. person
(including a resident alien), to give your correct
TIN to the person requesting it (the requester)
and, when applicable, to:
1. Certify the TIN you are giving is correct for
you are waiting for a number to be issued).
2. Certify you are not subject to backup
withholding, or
3. Claim exemption from backup withholding if
you are a U.S. exempt payee.
If you are a foreign person, use the
appropriate Form W -8. See Pub. 515,
Withholding of Tax on Nonresident Aliens and
Foreign Corporations.
Note: if a requester gives you a form other than
Form W.9 to request your TIN, you must use the
requester's form if it is substantially similar to this
Form W -9.
Request for Taxpayer
Identification Number and Certification
Social security number
1 11-14111
or
Employer identification number
4111111
Corporation ❑ Partnership Other ►
What is backup withhold' d ? Persons making
certain payments to you must withhold and pay
to the IRS 31% of such payments under certain
conditions. This is called "backup withholding."
Payments that may be subject to backup
withholding include interest, dividends. broker
and barter exchange transactions, rents,
royalties. nonemployee pay. and certain
payments from fishing boat operators. Real
estate transactions are not subject to backup
withholding.
If you give the requester your correct TIN,
make the proper certifications. and report all
your taxable interest and dividends on your tax
return. payments you receive will not be subject
to backup withholding. Payments you receive
will be subject to backup withholding if:
1. You do not furnish your TIN to the
requester, or
2. You do not certify your TIN when required
(see the Part III instructions On page 2 for
details), or
3. The IRS tells the requester that you
fumished an incorrect TIN. or
4. The IRS tells you that you are subject to
backup withholding because you did not report
all your interest and dividends on your tax return
(for reportable interest and dividends only), or
Cat. No. 10231X
Requester's name and address (optional)
List account number(s) here (optional)
Part II
Date ► DI - /O -Dad •
Give form to the
requester. Do not
send to the IRS.
For U.S. Payees Exempt From
Backup Withholding (See the
instructions on page 2.)
5. You do not certify to the requester that you
are not subject to backup withholding under 4
above (For reportable interest and dividend
accounts opened after 1983 only).
Certain payees and payments are exempt
from backup withholding. See the Part II
instructions and the separate Instructions for
the Requester of Form W -
Penalties
Failure to furnish TIN. If you fail to furnish your
correct TIN to a requester, you are subject to a
penalty of 1150 for each such failure unless your
failure is due to reasonable cause and not to
willful neglect.
Civil penalty for false information with respect
to withholding. If you make a False statement
with no reasonable basis that results in no
backup withholding, you are subject to a $500
penalty.
Criminal penalty for falsifying Information.
Willfully falsifying certifications or affirmations
may subject you to criminal penalties including
fines and/or imprisonment
Misuse of TINS. If the requester discloses or
uses TINS in violation of Federal law, the
requester may be subject to civil and cdminal
penalties.
Form W -9 (Rev. 12 -2000)
Form W.9 (Rev. 12 -2000)
Specific Instructions
Name. If you are an individual, you must
generally enter the name shown on your social
security card. However, if you have changed
your last name. for instance, due to marriage
without informing the Social Security
Administration of the name change, enter your
first name, the last name shown on your social
security card, and your new last name.
If the account is in joint names, list first and
then circle the name of the person or entity
whose number you enter in Part I of the form.
Sole proprietor. Enter your individual name
as shown on your social security card on the
"Name" line. You may enter your business,
bade, or "doing business as (DBA)" name on the
"Business name" line.
Limited liability t parry (LLC). If you are a
single- member LLC (including a foreign LLC with
a domestic owner) that is disregarded as an
entity separate from its owner under Treasury
regulations section 301.7701 -3, enter the
owner's name on the "Name" line. Enter the
LLC's name on the "Business name" line.
Caution: A disregarded domestic entity that has
a foreign owner must use the appropriate
Form W -8.
Other entities. Enter your business name as
shown on required Federal tax documents on
the "Name" line. This name should match the
name shown on the charter or other legal
document creating the entity- You may enter any
business, bade, or DBA name on the "Business
name" line.
Part I— Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box.
If you are a resident alien and you do not
have and are not eligible to get an SSN, your
TIN is your IRS individual taxpayer identification
number (ITIN). Enter it in the social security
number box. If you do not have an !TIN, see
How to get a TIN below.
If you are a sole proprietor and you have an
EIN, you may enter either your SSN or EIN.
However. the IRS prefers that you use your SSN.
If you are an LLC that is disregarded as an
entity separate from its owner (see Limited
liability company (LLC) above), and are owned
by an individual, enter your 55N (or "pre -LLC"
EIN, if desired). If the owner of a disregarded
LLC is a corporation. partnership, etc., enter the
owner's EIN.
Note: See the chart on this page for further
clarification of name and TIN combinations.
How to get a TIN. If you do not have a TIN,
apply for one immediately. To apply for an SSN.
get Form SS -5, Application for a Social Security
Card, from your local Social Security
Administration office. Gel Form W -7, Application
for IRS Individual Taxpayer Identification
Number, to apply for an ITIN or Form SS -4,
Application for Employer Identification Number,
to apply for an EIN. You can get Forms W -7 and
S5 -4 from the IRS by calling 1- 800 - TAX -FORM
(1- 800 -829 -3676) or from the IRS's Internet Web
Site at www.irs.gov.
If you do not have a TIN, write "Applied For"
in the space for the TIN, sign and date the form,
and give it to the requester. For interest and
dividend payments, and certain payments made
with respect to readily tradable instruments,
generally you will have 60 days to gel a TIN and
give it to the requester before you are subject to
backup withholding on payments. The GO-day
rule does not apply to other types of payments.
You will be subject to backup withholding on all
such payments until you provide your TIN to the
requester.
Note: Writing 'Applied For" means that you have
already applied for a TIN or that you intend to
apply for one soon.
Pan II—For U.S. Payees Exempt From Backup
Withholding
Individuals ( ncludirg sole proprietors) are not
exempt from backup withholding. Corporations
are exempt from backup withholding for certain •
payments. such as interest and dividends. For
more information on exempt payees. see the
separate Instructions for the Requester of
Form W -9.
If you are exempt from backup withholding,
you should still complete this form to avoid
possible erroneous backup withholding. Enter
your correct TIN in Part I. write "Exempt" in
Part II, and sign and date the roan.
If you are a nonresident alien or a foreign
entity not subject to backup withholding, give
the requester the appropriate completed Form
W -8.
Part III— Certification
To establish to the withholding agent that you
are a U.S. person. or resident alien, sign Form
W -9. You may be requested to sign by the
withholding agent even if items 1, 3, and 5
below indicate otherwise.
For a joint account, only the person whose
TIN is shown in Pan 1 should sign (when
required).
1. Interest, dividend, and barter exchange
accounts opened before 1984 and broker
accounts considered active during 1983. You
must give your correct TIN, but you do not have
to sign the certification.
2. Interest, dividend, broker, and barter
exchange accounts opened after 1983 and
broker accounts considered inactive during
1983. You must sign the certification or backup
withholding will apply. If you are subject to
backup withholding and you are merely providing
your correct TIN to the requester, you must
cross out item 2 in the certification before
signing the form.
3. Real estate transactions. You must sign
the cent cation. You may cross out item 2 of the
certification,
4. Other payments. You must give your
correct TIN, but you do not have to sign the
certification unless you have been notified that
you have previously given an incorrect TIN.
"Other payments" include payments made in the
course of the requester's bade or business for
rents, royalties, goods (other than bills for
merchandise), medical and health care services
(including payments to corporations), payments
to a nonemployee for services, payments to
certain fishing boat crew members and
fishermen, and gross proceeds paid to attorneys
(including payments to corporations).
5. Mortgage interest paid by you,
acquisition or abandonment of secured
property, cancellation of debt qualified state
tuition program payments, IRA or MSA
contributions or distributions, and pension
distributions. You must give your correct TIN,
but you do not have to sign the certification.
Privacy Act Notice
Section 6109 of the Internal Revenue Code
requires you to give your correct TIN to persons
who must file information returns with the IRS to
report interest, dividends. and certain other
income paid to you, mortgage interest you paid,
the acquisition or abandonment Of secured
property, cancellation of debt, or contributions
you made to an IRA or MSA. The IRS uses the
numbers for identification purposes and to help
verify the accuracy of your tax return. The IRS
may also provide this information to the
Department of Justice for civil and criminal
litigation. and to cities, states. and the District of
Columbia to carry out their tax laws.
You must provide your TIN whether or not you
are required to file a tax return. Payers must
generally withhold 31% of taxable interest,
dividend, and certain other payments to a payee
who does not give a TIN to a payer. Certain
penalties may also apply.
What Name and Number To
Give the Requester
For this type of account:
1. Individual
2. Two or more
individuals 90)nt
account)
3. Custodian account or
minor (Uniform GM
to Minors Act)
4. a. The usual
revocable savings
trust (grantor is
also trustee)
b So -caned trust
account that is not
a legal or valid trust
under state law
5. sole proprietorship
For this type of account
6. Sole proprietorship
7. A valid trust, estate, or
pension trust
8. Corporate
0. Association, club.
religious. charitable.
educational, or otter
lax - exempt
organization
10. Partnership
11. A broker or registered
nominee
12. Account with the
Department of
Ag' ulture in the name
of a pudic entity )such
as a state or local
gov nment. school
district. or prison) that
receives agricultural
program payments
Give name and SSN of:
The individual
The actual owner of the
f tint or, if combined
unds. the first individual
on the account
The minor
The grantor oustee
The actual owner'
The owner'
Give name and EIN o1:
The owner'
Legal entity'
The corporation
The organization
The partnership
The broker or nominee
The public entity
Page 2
LIst first and circle the name of the person whose
number you furnish, If only one person on ajoint
account has an SSN, that person's number must be
furnished.
' Circle The minor's name and furnish the minor's SSN.
' You must show your individual name. but you may also
enter your business or 'DOA" name. You may use either
your 550 or EIN or you have one).
'List first and circle the name of the legal trust. estate.
or pension trust. too not furnish The TIN of the personal
representative or trustee unless the legal entity itself is
not designated in the account title.)
Note: If no name is circled when more than one
name is Listed, the number will be considered to
be that of the first name listed.
Federal Program
CFDA Number: 10.664
Period: 10 -01 -01 to 9 -30 -02
Urban Forestry Partnership Grant Program
A Cooperative Program Between the Texas Forest Service
And the USDA Forest Service
GRANT AGREEMENT
Grant Number: 01 -08 -08
Grant Amount: $10,000
Local Match: $10,000
This Grant Agreement is hereby entered into by and between the
Texas Forest Service (TFS), a Member of The Texas A &M University System,
and the City of Round Rock, Texas, hereafter referred to as 'Grantee.'
Article 1. All funds must be used for the purposes stated below. Any
modification of purpose, final product, grant award, or matching
contribution must be requested in writing and approved by the TFS. Grantee
must raise the entire balance of funds necessary to complete the budget as
proposed, from non - federal sources.
Purpose: To create a one -acre containerized tree nursery to supply
future plant material for public property. Grant funds will be used to
contract the installation of water and electric service to the site and
purchase of supplies and materials for potting the seedlings. Match
will consist of personnel and equipment time by city staff to develop
the site and donated volunteer time to pot the new trees.
Article 2. The $10,000 grant will be paid on a reimbursement basis upon
submission of approved cost records AND a project final report. Interim
reports detailing partial project accomplishments and costs will be
accepted for partial payment. The amount paid will equal 50% of the
approved project costs, not to exceed either the grant amount or the out -
of- pocket expenses. The Grantee shall be responsible for a minimum match
of $10,000, in eligible cash purchases or in -kind contributions.
Article 3. The Grantee shall be responsible for providing proof -of-
payment records for all purchases and in -kind contributions. These include
source documentation such as invoices, cancelled checks, paid receipts,
payroll or time and attendance records, contract documents, and valuation
letters for third -party in -kind contributions. Cost records must be
retained for three years following conclusion of the project.
Article 4. The Grantee must provide the TFS with an official resolution
passed by its governing body that authorizes its representative to execute
any agreements associated with this grant and commits the organization to
the matching contribution as proposed in the grant application and listed
above.
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Article 5. Applicable federal cost principles (attached OMB A -87 for
local governments, OMB A -21 for higher education institutions, or OMB A-
122 for nonprofit groups), administrative requirements (attached 7 CFR
Part 3016 or 7 CFR Parts 3015/3019), and the Grantee's application will be
followed in determining reasonableness, allowability, and allocation of
costs. Grantee's procurement procedures must conform to standards defined
in these documents and Grantees receiving $300,000 or more in federal
funds must comply with federal Single Audit Act requirements, as detailed
in circular OMB A -133.
Article 6. The Grantee agrees to comply with all applicable federal laws,
as specified in the attached Assurances for Non - Construction Programs.
Grantee must certify that they have not been debarred from this or any
other federal program, must comply with federal drug -free workplace
requirements, and must comply with restrictions on lobbying Congress.
Article 7. The Grantee shall submit a final project performance report, a
financial summary with supporting documentation, and a copy of any product
developed through the grant within 60 days of project completion, or by
November 30, 2002, at the latest. (If required, a copy of the Single Audit
report covering the grant period must also be submitted.)
Article 8. The State Forester and the Comptroller General of the United
States, or any of their authorized representatives, shall have the right
of access to any pertinent books, documents, papers, or other records of
the Grantee which are pertinent to the grant in order to make audits,
examinations, excerpts, and transcripts.
Article 9. (For tree planting projects only.) The Grantee must provide
the TFS with a resolution or letter from the governing body of the entity
that owns the property where the trees are to be planted. This document
must grant permission to the Grantee to install this planting and commit
to providing reasonable protection for the trees.
Article 10. (For tree planting projects only.) Exhibit A (Tree Planting
Maintenance Specifications), attached hereto and incorporated for all
purposes, must be followed and will be used by the TFS to measure
performance by the Grantee. Trees must be maintained for three full years
following planting. The Grantee must replace any dead trees within the
period of this Agreement if the number of live trees falls below 90% of
the original number planted and included in project cost reports.
Article 11. If a Grantee materially fails to comply with any term of this
award, as stated above, the TFS may temporarily withhold cash payments
pending correction of the deficiency by Grantee, disallow all or part of
the cost of the activity or action not in compliance, wholly or partly
suspend or terminate the current award for the Grantee, withhold further
awards for the program, demand repayment of the grant, or take other
legally available remedies.
Article 12. The Grantee may terminate this entire Agreement, without
cause, prior to the expiration of the grant period, upon thirty (30) days
written notice. Upon cancellation of this Agreement and release or return
of the unexpended grant funds, the Grantee is fully released of all
obligations under this Agreement.
Article 13. The Grantee agrees to hold the Texas Forest Service (TFS)
harmless from any injury to person or property occurring in connection
with project operations by Grantee, its agents, or employees, to the
extent allowed by law.
Article 14. If any part of this Agreement shall be deemed to be or shall,
in fact, be invalid, inoperative, or unenforceable as applied, such
circumstance shall not have the effect of rendering any other provision of
this Agreement invalid, inoperative, or unenforceable to any extent
whatever.
Acceptance: We accept this grant subject to the terms and provisions
stated above.
Grantee:
Grantor:
-3-
I r )4y r JR Title
aI OF o kou/Jc leOCK.
JPNU1Ry D JO ) 9COJ
James B. Hull
State Forester
Texas Forest Service
Date
DATE: January 10, 2002
SUBJECT: City Council Meeting — January 4, 2002
ITEM: 12.B.1. Consider a resolution authorizing the Mayor to execute agreements
associated with the Urban Forestry Partnership Grant Program to
establish a tree farm. The grant is in the amount of $10,000.00.
Resource: Sharon Prete, Parks and Recreation Director
Emsud Horozovic
History: PARD has applied for and received Grants over the passed four years. Previous
grant applications were to help fund the Urban Forester positions. This grant is
for the establishment of a tree farm.
Funding:
Cost: $22,000.00
Source of funds: $10,000.00 Texas Forest Service
$12,000.00 General Fund
Outside Resources: Texas Forest Service
ImpactBenefit: The Tree Farm will serve as a resource both to educate the public and to
develop a reforestation program.
Public Comment: N/A
Sponsor: PARD