R-03-01-09-9A1 - 1/9/2003CERTIFICATION REGARDING LOBBYING
for
CONTRACTS, GRANTS, LOANS, AND COOPERATIVE AGREEMENTS
(Required for grants exceeding $100,000)
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 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.
This certification is a material representation of fact upon which reliance was placed by the Texas
State Library 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.
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34 CFR 82 110 TSL 9304
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Instructions for Certification
I. By signing and submitting this proposal, the prospective lower tier participant is providing the certification set out
below.
•
2. The certification in this clause is a material representation of fact upon which reliance was placed when this
transaction was entered into. If it is later determined that the prospective lower tier participant knowingly
rendered an erroneous certification, in addition to other remedies available to the Federal Government, the
department or agency with which this transaction originated may pursue available remedies, including suspension
and/or debarment.
3. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal
is submitted, if at any time, the prospective lower tier participant leams that its certification was en when
submitted or has become erroneous by reason of changed circumstances.
4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction,"
"participant" "person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as used
in this clause, have the meanings set out in the Definitions and coverage sections ofrules implementing Executive
Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy
of those regulations.
5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered
transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who
is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction,
unless authorized by the department or agency with which this transaction originated.
6. The prospective lower tier participant further agrees by submitting this proposal that it will include the clause title
"Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion - -Lower Tier Covered
Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier
covered transactions.
7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier
covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered
transaction, unless it knows that the certification is erroneous. A participant may decide the method and
frequency by which It determines the eligibility of its principals. Each participant may, but is not required to,
check the Nonprocurement List.
8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to
render m good faith the certification required by this clause. The knowledge and Information of a participant is
not required to exceed that which is normally possessed by a prudent person in the ordinary course of busincss
dealings.
9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction
knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or
voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal
Government, the department or agency with which this transaction originated may pursue available remedies,
including suspension and/or debarment.
CERTIFICATION REGARDING
DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY
EXCLUSION
LOWER TIER COVERED TRANSACTIONS
This certification is required by the regulations implementing Executive Order 12549, Debarment and
Suspension, 34 CFR Part 85, Section 85.510, Participant's responsibilities. The regulations were published as
Part VII of the May 26, 1988 Federal Register (pages 19160- 12911). Copies of the regulations may be obtained
by contacting the person to which this proposal is submitted.
(BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON REVERSE)
(1) The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its
principals are 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.
C r op ou,vP PdC _ - RouND &cC— %suc . - ' Sys r
Applicant
W ILL1AIM UvHI
Name and Title ofAuthorized Certifying Official
Signature
Lie re- L OF % /,q-A/c
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Date
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Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348- 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, I certify that the applicant:
1. 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 lo:
(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
Previous Edition Usable
ASSURANCES - NON CONSTRUCTION PROGRAMS
OMB Approval No. 0348 - 0040
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; (i) 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.
Standard Form 424B (Rev. 7.97)
Authorized for Local Reproduction Prescribed by OMB Circular A - 102
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 EO 11738; (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards in
floodplains in accordance with EO 11988; (e) assurance of
project 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
Endange_ red Species Act of 1973, as amended (P.L. 93-
205).
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
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12. Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. § §1271 et seq.) related to protecting
components or potential components of the national
wild and scenic rivers system.
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), EO 11593
(identification and protection of historic properties), and
the Archaeological and Historic Preservation Act of
1974 (16 U.S.C. §§469a -1 et seq.).
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,
"Audits of States, Local Govemments, and Non - Profit
Organizations."
18. Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations, and policies
goveming this program.
TITLE
i eC1 -6,2 or F(nli1NCE
DATE SUBMITTED
01 - Zq
Standard Form 4248 (Rev. 7-97) Back
RESOLUTION NO. R- 03- 01- 09 -9A1
WHEREAS, the Texas State Library & Archives Commission has grant
funds available through the Loan Star Libraries Grant, and
WHEREAS, the City Council wishes to make application for the
available grant funds for improvements to the library system, Now
Therefore
BE IT RESOLVED BY THE COUNCIL OF THE CITY OF ROUND ROCK, TEXAS,
That the Mayor is hereby authorized and directed to make the
necessary application for the above - described grant.
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.
RESOLVED this 9th day of January, 2003.
77Ltuy,u,n)i
CHRISTINE R. MARTINEZ, City Secret
ii ODMA\ RORLDOX\ O . \NDO % \RESOLUTI \R30109A1.WPD /cc
y
WELL, Mayor
of Round Rock, Texas
TEXAS STATE LIBRARY & ARCHIVES COMMISSION
I. CONTRACTING PARTIES
LOAN STAR LIBRARIES GRANT
Grant Type C - Under $20,000
Grant # 442 -03409
Grantor: Texas State Library and Archives Commission (TSLAC)
Grantee: City of Round Rock, Round Rock Public Library System
216E Main Ave
Round Rock, Texas 78664
II. TERM OF GRANT
September 1, 2002 to August 31, 2003
III. GRANTOR CERTIFICATION
The Grantor certifies that (1) the services specified below are necessary and essential for activities
that are properly within the statutory functions and programs of the affected organizations; (2) the
services, supplies or materials contracted for are not required by Section 21 of Article 16 of the
Constitution of Texas to be supplied under contract given to the lowest bidder; and (3) the grant is
in compliance with Texas Government Code § 441.0091 et. seq., the Library System Act; Texas
Government Code § 441.006, General Powers and Duties; and, the Uniform Grant Management
Standards (UGMS).
IV. GRANT AMOUNTS
A. The total amount of the grant shall not exceed: $9,924
B. Source of funds: General Revenue
State Fiscal Year 2003
TSLAC's accounting codes: Index Code 34421
Object Code 7611
Fiscal Year 2003 Page 1 of 8
City of Round Rock Loan Star Libraries Grant
C. Payment for this grant award will be funded in full upon delivery of a legally executed contract to
Grantor. Grantee should receive payment within 10 days after TSLAC receives the contract.
D. Budget:
Supplies $9,924
Total Direct Costs $9,924
Indirect Costs
Total $9,924
V. WRITTEN PRIOR APPROVALS FOR FISCAL AND PROGRAMMATIC CHANGES
A. The Grantor must give written prior approval for any of the following fiscal changes:
1. Making cumulative transfers among budget cost categories or projects which are expected
to exceed ten (10) percent of the total grant.
2. Transferring any funds into a budget cost category that equals zero ($0).
Written prior approval is to be requested on the Loan Star Libraries Grant Program Revision
Form and shall be requested when nearing the 10% limit or the end of the grant term. This
provision does not allow the grant to be exceeded. All prior approvals must be requested by
August 1, 2003. Approvals received after this date will be considered on a case -by -case
basis.
B. The Grantor must give written prior approval for any of the following programmatic changes to
the application (Loan Star Libraries Grants for State Fiscal Year 2003).
1. Changing key persons specified in the grant; however, none of the personnel are considered
key personnel for the purpose of this section.
2. Obtaining the services of a third party to perform activities that are central to the purposes
of the grant.
3. Changing the scope or objectives (regardless of whether there is an associated budget
revision). A change in scope is a substantive difference in the approach or method used to
reach program objectives.
Written prior approval is to be requested on the Loan Star Libraries Grant Program Revision
Form. All prior approvals must be received by August 1, 2003.
Fiscal Year 2003 Page 2 of 8
City of Round Rock Loan Star Libraries Grant
C. The Grantor hereby gives prior approval for the items specified under the cost categories outlined
,below. Before the Grantee obligates or expends grant funds for additional items in the following
cost categories, the Grantor must give written prior approval. Written prior approval is to be
requested on the Program Revision form. Written prior approval is also required if an item's cost
or features are substantially different from what the grant specifies, or from a previous Program
Revision. All Program Revision forms must be received by Grantor on or before August 1, 2003.
COST CATEGORIES
1. Preaward Costs
None
2. Insurance (if not required by the grant)
None
3. Rearrangements and Alterations of Facilities
None
4. Equipment/property
None
Subject to the obligations and conditions set forth in Uniform Grant Management Standards
(UGMS) Section III, Subpart C.32 (a), title to equipment acquired under a grant will vest upon
acquisition in the Grantee.
Each piece of equipment/property is an article of nonexpendable, tangible personal property
having a useful life of more than one year and an acquisition cost that exceeds the capitalization
amount established by Grantee's governing entity. Equipment/property includes furniture, library
materials, etc., purchased wholly or in part with grant funds. The prior approval amount is the
capital expenditure, which means the cost of the equipment/property including the cost to put it in
place. Capital expenditure for equipment/property means the net invoice price of the
equipment/property, including the cost of any modifications, attachments, accessories, or auxiliary
apparatus necessary to make it usable for the purpose for which it is acquired. Ancillary charges,
such as taxes, duty, protective in transit insurance, freight, and installation may be included in, or
excluded from, capital expenditure cost in accordance with the Grantee's regular accounting
practices.
VI. STATEMENT OF SERVICES TO BE PERFORMED
The Grantee will comply during the period of this contract and provide services outlined within the
grant application (Loan Star Libraries Grants Plan of Action for SFY 2003) as approved by the
Grantor.
Fiscal Year 2003 Page 3 of 8
City of Round Rock Loan Star Libraries Grant
VII. TERMS AND CONDITIONS
A. The Grantee will comply with the Loan Star Libraries Administrative Rules for SFY 2003. Note
that per 2.1.65(c) of the Rules, assurances relating to non - resident fees or TexShare Library Card
Program are in effect for entire term of grant contract.
B. The Grantee acknowledges that the intent of the grant is to provide funds to maintain, improve,
and enhance local library services, and to provide Texans who are not residents of a particular
local community access to and services from the many participating public libraries.
C. The Grantee will comply with the Rules for Administering the Library Systems Act. Note that
Grantee must continue to meet system membership requirements to be eligible for future grants,
per Texas Government Code 441.138(c).
D. The Grantee will comply with the following three parts of the Governor's Office of Budget and
Planning Uniform Grant Management Standards (UGMS), revised January 2001, located at
http://www.governor.state.tx.usistategrants/UGMS012001.doc.
1. Cost Principles for state and Local Governments and Other Affected Entities
(adapted from OMB Circular A -87)
2. State Uniform Administrative Requirement for Grants and Cooperative Agreements
(adapted from OMB Circular A -102)
3. State of Texas Single Audit Circular
E. The Grantee will send the Grantor a copy of any management letters issued by the auditor with
the reporting package (or written notification, as applicable). The audit's Schedule of
Expenditures of Federal and State Awards will list the amount of awards expended for each
award year separately.
F. The Grantee may not obligate grant funds after August 31, 2003. By October 31, 2003, all
obligations must be liquidated. Any interest accrued above $100 must be retumed to Grantor,
per requirements in UGMS. All unexpended funds must be returned to the Grantor.
G. The Grantee will add any program income to the funds committed to the grant, using such
program income for the purposes and under the conditions of the grant. The source and amount
of the program income must be explained in box 12 of the Financial Status Report.
H . All publicity relating to the grant award must include acknowledgement of the Texas State
Library and Archives Commission whenever possible and practical. Publicity includes but is not
limited to press releases, media events, public events, displays in the library, announcements on
the library's website, and materials distributed through the grant project.
Fiscal Year 2003 Page 4 of 8
City of Round Rock Loan Star Libraries Grant
The Grantee certifies by this contract that it will comply with the Assurances — Non -
Construction Programs (OMB Standard Form 124B), the Certification Regarding Debarment,
Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions, and the
Certification Regarding Lobbying as submitted to the Grantor. Additional assurances are listed
in UGMS, Subpart B.14.
J. The Grantee affirms that it has not given, offered to give, nor intends to give at any time
hereafter, any economic opportunity, future employment, gift, loan, gratuity, special discount,
trip, favor or service to a public servant in connection with this contract. The Grantee further
affirms that its employees or agents shall neither solicit nor accept gratuities, favors or anything
of monetary value from contractors, potential contractors or parties to subagreements.
K. The Grantee agrees to provide the Grantor with one (1) set of any public relations materials
produced under this grant.
L. The Grantee agrees to maintain records on all equipment/property with an acquisition cost that
exceed goveming entity's capitalization level. The Grantee will reconcile the
equipment/property records with a physical inventory of the equipment/property every two years.
The UGMS Subpart C, Sec. 32, (d) (3) requires certain items of equipment (stereo systems, still
and video cameras, facsimile machines, VCRs and VCR/TV combinations, and cellular and
portable telephones) to be maintained on inventory if their cost is above $500, or if they could be
easily lost or stolen.
Subject to the obligations and conditions set forth in the UGMS Section III, Subpart C, Sec. 32
(a), title to equipment acquired under a grant will vest upon acquisition in the Grantee.
When property is vested in the Grantee, the Grantee will dispose of equipment/property in
accordance with the UGMS Subpart C, Sec. 32, (e).
M. The Grantee agrees to submit the Equipment/Property Acquired form by October 31, 2003 for all
equipment/property purchased during that grant year.
N. The State Legislature has charged the Grantor with submitting performance measurement
reports that specify the level of services provided by its programs and services. The Grantee
agrees to submit reports that are timely, accurate, auditable, and consistent with definitions.
The Grantee agrees to submit the Loan Star Libraries Performance Report for Loan Star
Libraries Grants according to the following schedule:
Reporting Period
September 1, 2002 — February 28, 2003
March 1, 2003 - August 31, 2003
Due Date
March 5, 2003
September 5, 2003
If library materials ordered with grant funds are received after the end of the grant year, a final
Loan Star Libraries Report may also be required covering receipt of those materials. This final
Report will be due on or before November 15, 2003.
Fiscal Year 2003 Page 5 of 8
City of Round Rock Loan Star Libraries Grant
Note: Per Rule 2.165 (e), future funds will not be awarded to a library until all requirements
for all preceding contracts have been fulfilled.
O. The Grantee agrees to submit the Financial Status Report for this contract according to the
following schedule:
Reporting Period
September 1, 2002 — February 28, 2003
March 1, 2003 - August 31, 2003
If necessary, a final Financial Status Report is due on or before November 15, 2003.
P. The Grantee agrees to maintain all financial and programmatic records, supporting documents,
statistical records, and other grantee records according to Section II, Subpart C.42, of UGMS. In
general, Grantees must maintain records for a minimum of three years from the date the Grantee
submits to Grantor the last single audit or audit report for the grant period.
VIII. ENFORCEMENT
Due Date
March 28, 2003
September 26, 2003
A. Remedies for noncompliance. If a grantee or subgrantee materially fails to comply with any term of
an award, whether stated in a federal or state statute or regulation, an assurance, in a state plan or
application, a notice of award, or elsewhere, the awarding agency may take one or more of the
following actions, or impose other sanctions, as appropriate in the circumstances:
(1) Temporarily withhold cash payments pending correction of the deficiency by the grantee or
subgrantee or more severe enforcement action by the awarding agency,
(2) Disallow (that is, deny both use of funds and matching credit for) all or part of the cost of the
activity or action not in compliance,
(3) Wholly or partly suspend or terminate the current award for the grantee's or subgrantee's program,
(4) Withhold further awards for the program, or
(5) Take other remedies that may be legally available.
B. Hearings, appeals. In taking an enforcement action, the awarding agency will provide the grantee or
subgrantee an opportunity for such hearing, appeal, or other administrative proceeding to which the
grantee or subgrantee is entitled under any statute or regulation applicable to the action involved.
Fiscal Year 2003 Page 6 of 8
City of Round Rock Loan Star Libraries Grant
C. Effects of suspension and termination. Costs of grantee or subgrantee resulting from obligations
incurred by the grantee or subgrantee during a suspension or after termination of an award are not
allowable unless the awarding agency expressly authorizes them in the notice of suspension or
termination or subsequently. Other grantee or subgrantee costs during suspension or after termination
which are necessary and not reasonably avoidable are allowable if:
(1) The costs result from obligations which were properly incurred by the grantee or subgrantee
before the effective date of suspension or termination, are not in anticipation of it, and, in the case
of a termination, are noncancelable, and,
(2) The costs would be allowable if the award were not suspended or expired normally at the end of
the funding period in which the termination takes effect.
D. Relationship to Debarment and Suspension. The enforcement remedies identified in this section,
including suspension and termination, do not preclude grantee or subgrantee from being subject to
"Debarment and Suspension" under E.O. 12549 (see Section .35) and state law.
IX. CONTACTS AT TSLAC
Questions or concerns about programmatic issues and Program Revision Requests should be
directed to this grant's Project Manager:
Margaret Whitehead Phone: 512- 463 -5475 Fax: 512- 463 -8800
Manager, Loan Star Libraries Program E -mail: margaret.whitehead@tsl.state.tx.us
Questions or concerns about regulatory or financial issues should be directed to:
Fax reports to:
Manager of Accounting and Grants Department
Phone: 512- 463 -6626
Grants Accountant
Phone: 512- 463 -5472
Fax: 512- 475 -0185
E -mail: akral(aitsl.state.tx.us
Payments to the Grantor, such as those for interest earned each quarter on advanced funds, should be
mailed with an explanation of the purpose of the payment and the grant number to:
Accounting and Grants Department
Texas State Library and Archives Commission
PO Box 12516
Austin, TX 78711-2516
Fiscal Year 2003 Page 7 of 8
City of Round Rock Loan Star Libraries Grant
X. APPLICABLE AND GOVERNING LAW
A. This grant shall be govemed by the laws of the State of Texas. All duties of either party shall be
legally performable in Texas. The applicable law for any legal disputes arising out of this
contract shall be the law of (and all actions hereunder shall be brought in) the State of Texas, and
the forum and venue for such disputes shall be Travis County, District Court.
B. This grant is subject to availability of funds.
XI. SIGNATURES
GRANTOR GRANTEE
Texas State Library and Archives Commission City of Round Rock, Round Rock Public Library System
Edward Seidenberg, Assistant State Librarian Signature (Must be an official empowered
to enter into contracts)
Date Typewritten or Printed Name
Donna Osbome, Chief Fiscal Officer Title
Date Date
Fiscal Year 2003 Page 8 of 8
City of Round Rock Loan Star Libraries Grant
DATE: January 2, 2003
SUBJECT: City Council Meeting — January 9, 2003
ITEM:
Outside Resources: N/A
Public Comment: N/A
Sponsor: N/A
9.A.1. Consider a resolution authorizing the Mayor to make the necessary
grant application to the Texas State Library & Archives Commission
for a Lone Star Libraries Grant.
Resource: Dale Ricklefs, Library
History: Second year grant funded by the State Legislature in 2001.
Funding:
Cost: $9,924
Source of funds: State grant
Impact: The library will use the funds to continue its pilot collections to attract hard to reach
youth and the Hispanic population. The library will be also be adding additional funds
for adding "classical" fiction to the collection, software upgrades to the existing
public catalog, and subscription to Chapter a Day. There will be continuing costs
(about $2000.00 in FY 2003 -4) if we continue with the software upgrade maintenance
and the Chapter a Day service.
Benefit: The funds will continue to introduce the library to a population that does not use us as
heavily and will also provide additional services to the users of the catalog. We have
already seen in growth in the graphic novel collection, and that audience, the past four
months.
ORIGINAL
II. TERM OF GRANT
TEXAS STATE LIBRARY & ARCHIVES COMMISSION
I. CONTRACTING PARTIES
September 1, 2002 to August 31, 2003
III. GRANTOR CERTIFICATION
LOAN STAR LIBRARIES GRANT
Grant Type C - Under $20,000
Grant # 442 -03409
Grantor: Texas State Library and Archives Commission (TSLAC)
Grantee: City of Round Rock, Round Rock Public Library System
216E Main Ave
Round Rock, Texas 78664
The Grantor certifies that (1) the services specified below are necessary and essential for activities
that are properly within the statutory functions and programs of the affected organizations; (2) the
services, supplies or materials contracted for are not required by Section 21 of Article 16 of the
Constitution of Texas to be supplied under contract given to the lowest bidder; and (3) the grant is
in compliance with Texas Government Code § 441.0091 et. seq., the Library System Act; Texas
Government Code § 441.006, General Powers and Duties; and, the Uniform Grant Management
Standards (UGMS).
IV. GRANT AMOUNTS
A. The total amount of the grant shall not exceed: $9,924
B. Source of funds: General Revenue
State Fiscal Year 2003
TSLAC's accounting codes: Index Code 34421
Object Code 7611
Fiscal Year 2003 Page 1 of 8
City of Round Rock Loan Star Libraries Grant
R- D3 -0I- oq -q#1
C. Payment for this grant award will be funded in full upon delivery of a legally executed contract to
Grantor. Grantee should receive payment within 10 days after TSLAC receives the contract.
D. Budget:
Supplies
Total Direct Costs
Indirect Costs
Total
$9,924
$9,924
$9,924
V. WRITTEN PRIOR APPROVALS FOR FISCAL AND PROGRAMMATIC CHANGES
A. The Grantor must give written prior approval for any of the following fiscal changes:
1. Making cumulative transfers among budget cost categories or projects which are expected
to exceed ten (10) percent of the total grant.
2. Transferring any funds into a budget cost category that equals zero ($0).
Written prior approval is to be requested on the Loan Star Libraries Grant Program Revision
Form and shall be requested when nearing the 10% limit or the end of the grant term. This
provision does not allow the grant to be exceeded. All prior approvals must be requested by
August 1, 2003. Approvals received after this date will be considered on a case - - case
basis.
B. The Grantor must give written prior approval for any of the following programmatic changes to
the application (Loan Star Libraries Grants for State Fiscal Year 2003).
1. Changing key persons specified in the grant; however, none of the personnel are considered
key personnel for the purpose of this section.
2. Obtaining the services of a third party to perform activities that are central to the purposes
of the grant.
3. Changing the scope or objectives (regardless of whether there is an associated budget
revision). A change in scope is a substantive difference in the approach or method used to
reach program objectives.
Written prior approval is to be requested on the Loan Star Libraries Grant Program Revision
Form. All prior approvals must be received by August 1, 2003.
Fiscal Year 2003 Page 2 of 8
City of Round Rock Loan Star Libraries Grant
C. The Grantor hereby gives prior approval for the items specified under the cost categories outlined
below. Before the Grantee obligates or expends grant funds for additional items in the following
cost categories, the Grantor must give written prior approval. Written prior approval is to be
requested on the Program Revision form. Written prior approval is also required if an item's cost
or features are substantially different from what the grant specifies, or from a previous Program
Revision. All Program Revision forms must be received by Grantor on or before August 1, 2003.
COST CATEGORIES
1. Preaward Costs
None
2. Insurance (if not required by the grant)
None
3. Rearrangements and Alterations of Facilities
None
4. Equipment/Property
None
Subject to the obligations and conditions set forth in Uniform Grant Management Standards
(UGMS) Section III, Subpart C.32 (a), title to equipment acquired under a grant will vest upon
acquisition in the Grantee.
Each piece of equipment/property is an article of nonexpendable, tangible personal property
having a useful life of more than one year and an acquisition cost that exceeds the capitalization
amount established by Grantee's governing entity. Equipment/property includes furniture, library
materials, etc., purchased wholly or in part with grant funds. The prior approval amount is the
capital expenditure, which means the cost of the equipment/property including the cost to put it in
place. Capital expenditure for equipment/property means the net invoice price of the
equipment/property, including the cost of any modifications, attachments, accessories, or auxiliary
apparatus necessary to make it usable for the purpose for which it is acquired. Ancillary charges,
such as taxes, duty, protective in transit insurance, freight, and installation may be included in, or
excluded from, capital expenditure cost in accordance with the Grantee's regular accounting
practices.
VI. STATEMENT OF SERVICES TO BE PERFORMED
The Grantee will comply during the period of this contract and provide services outlined within the
grant application (Loan Star Libraries Grants Plan of Action for SFY 2003) as approved by the
Grantor.
Fiscal Year 2003 Page 3 of 8
City of Round Rock Loan Star Libraries Grant
VII. TERMS AND CONDITIONS
A. The Grantee will comply with the Loan Star Libraries Administrative Rules for SFY 2003. Note
that per 2.165(c) of the Rules, assurances relating to non - resident fees or TexShare Library Card
Program are in effect for entire term of grant contract.
B. The Grantee acknowledges that the intent of the grant is to provide funds to maintain, improve,
and enhance local library services, and to provide Texans who are not residents of a particular
local community access to and services from the many participating public libraries.
C. The Grantee will comply with the Rules for Administering the Library Systems Act. Note that
Grantee must continue to meet system membership requirements to be eligible for future grants,
per Texas Government Code 441.138(c).
D. The Grantee will comply with the following three parts of the Govemor's Office of Budget and
Planning Uniform Grant Management Standards (UGMS), revised January 2001, located at
http://www.governor.state.tx.usistategrants/UGMS012001.doc.
1. Cost Principles for state and Local Governments and Other Affected Entities
(adapted from OMB Circular A -87)
2. State Uniform Administrative Requirement for Grants and Cooperative Agreements
(adapted from OMB Circular A -102)
3. State of Texas Single Audit Circular
E. The Grantee will send the Grantor a copy of any management letters issued by the auditor with
the reporting package (or written notification, as applicable). The audit's Schedule of
Expenditures of Federal and State Awards will list the amount of awards expended for each
award year separately.
F. The Grantee may not obligate grant funds after August 31, 2003. By October 31, 2003, all
obligations must be liquidated. Any interest accrued above $100 must be retumed to Grantor,
per requirements in UGMS. All unexpended funds must be returned to the Grantor.
G. The Grantee will add any program income to the funds committed to the grant, using such
program income for the purposes and under the conditions of the grant. The source and amount
of the program income must be explained in box 12 of the Financial Status Report.
H. All publicity relating to the grant award must include acknowledgement of the Texas State
Library and Archives Commission whenever possible and practical. Publicity includes but is not
limited to press releases, media events, public events, displays in the library, announcements on
the library's website, and materials distributed through the grant project.
Fiscal Year 2003 Page 4 of 8
City of Round Rock Loan Star Libraries Grant
The Grantee certifies by this contract that it will comply with the Assurances — Non -
Construction Programs (OMB Standard Form 124B), the Certification Regarding Debarment,
Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions, and the
Certification Regarding Lobbying as submitted to the Grantor. Additional assurances are listed
in UGMS, Subpart B.14.
J. The Grantee affirms that it has not given, offered to give, nor intends to give at any time
hereafter, any economic opportunity, future employment, gift, loan, gratuity, special discount,
trip, favor or service to a public servant in connection with this contract. The Grantee further
affirms that its employees or agents shall neither solicit nor accept gratuities, favors or anything
of monetary value from contractors, potential contractors or parties to subagreements.
K. The Grantee agrees to provide the Grantor with one (1) set of any public relations materials
produced under this grant.
L. The Grantee agrees to maintain records on all equipment/property with an acquisition cost that
exceed governing entity's capitalization level. The Grantee will reconcile the
equipment/property records with a physical inventory of the equipment/property every two years.
The UGMS Subpart C, Sec. 32, (d) (3) requires certain items of equipment (stereo systems, still
and video cameras, facsimile machines, VCRs and VCR/TV combinations, and cellular and
portable telephones) to be maintained on inventory if their cost is above $500, or if they could be
easily lost or stolen.
Subject to the obligations and conditions set forth in the UGMS Section III, Subpart C, Sec. 32
(a), title to equipment acquired under a grant will vest upon acquisition in the Grantee.
When property is vested in the Grantee, the Grantee will dispose of equipment/property in
accordance with the UGMS Subpart C, Sec. 32, (e).
M. The Grantee agrees to submit the Equipment/Property Acquired form by October 31, 2003 for all
equipment/property purchased during that grant year.
N. The State Legislature has charged the Grantor with submitting performance measurement
reports that specify the level of services provided by its programs and services. The Grantee
agrees to submit reports that are timely, accurate, auditable, and consistent with definitions.
The Grantee agrees to submit the Loan Star Libraries Performance Report for Loan Star
Libraries Grants according to the following schedule:
Reporting Period
September 1, 2002 — February 28, 2003
March 1, 2003 - August 31, 2003
Due Date
March 5, 2003
September 5, 2003
If library materials ordered with grant funds are received after the end of the grant year, a final
Loan Star Libraries Report may also be required covering receipt of those materials. This final
Report will be due on or before November 15, 2003.
Fiscal Year 2003 Page 5 of 8
City of Round Rock Loan Star Libraries Grant
Note: Per Rule 2.165 (e), future funds will not be awarded to a library until all requirements
for all preceding contracts have been fulfilled.
0. The Grantee agrees to submit the Financial Status Report for this contract according to the _
following schedule:
Reporting Period
September 1, 2002 — February 28, 2003
March 1, 2003 - August 31, 2003
If necessary, a final Financial Status Report is due on or before November 15, 2003.
P. The Grantee agrees to maintain all financial and programmatic records, supporting documents,
statistical records, and other grantee records according to Section 11, Subpart C.42, of UGMS. In
general, Grantees must maintain records for a minimum of three years from the date the Grantee
submits to Grantor the last single audit or audit report for the grant period.
VIII. ENFORCEMENT
Due Date
March 28, 2003
September 26, 2003
A. Remedies for noncompliance. If a grantee or subgrantee materially fails to comply with any term of
an award, whether stated in a federal or state statute or regulation, an assurance, in a state plan or
application, a notice of award, or elsewhere, the awarding agency may take one or more of the
following actions, or impose other sanctions, as appropriate in the circumstances:
(1) Temporarily withhold cash payments pending correction of the deficiency by the grantee or
subgrantee or more severe enforcement action by the awarding agency,
(2) Disallow (that is, deny both use of funds and matching credit for) all or part of the cost of the
activity or action not in compliance,
(3) Wholly or partly suspend or terminate the current award for the grantee's or subgrantee's program,
(4) Withhold further awards for the program, or
(5) Take other remedies that may be legally available.
B. Hearings, appeals. In taking an enforcement action, the awarding agency will provide the grantee or
subgrantee an opportunity for such hearing, appeal, or other administrative proceeding to which the
grantee or subgrantee is entitled under any statute or regulation applicable to the action involved.
Fiscal Year 2003 Page 6 of 8
City of Round Rock Loan Star Libraries Grant
C. Effects of suspension and termination. Costs of grantee or subgrantee resulting from obligations
incurred by the grantee or subgrantee during a suspension or after termination of an award are not
allowable unless the awarding agency expressly authorizes them in the notice of suspension or
termination or subsequently. Other grantee or subgrantee costs during suspension or after termination
which are necessary and not reasonably avoidable are allowable if:
(1) The costs result from obligations which were properly incurred by the grantee or subgrantee
before the effective date of suspension or termination, are not in anticipation of it, and, in the case
of a termination, are noncancelable, and,
(2) The costs would be allowable if the award were not suspended or expired normally at the end of
the funding period in which the termination takes effect.
D. Relationship to Debarment and Suspension. The enforcement remedies identified in this section,
including suspension and termination, do not preclude grantee or subgrantee from being subject to
"Debarment and Suspension" under E.O. 12549 (see Section .35) and state law.
IX. CONTACTS AT TSLAC
Questions or concerns about programmatic issues and Program Revision Requests should be
directed to this grant's Project Manager:
Margaret Whitehead . Phone: 512- 463 -5475 Fax: 512 -463 -8800
Manager, Loan Star Libraries Program E -mail: margaret.whitehead@tsl.state.tx.us
Questions or concems about regulatory or financial issues should be directed to:
Manager of Accounting and Grants Department
Phone: 512- 463 -6626
Fax reports to:
Grants Accountant
Phone: 512 -463 -5472
Fax: 512- 475 -0185
E -mail: akral tsl.state.tx.us
Payments to the Grantor, such as those for interest earned each quarter on advanced funds, should be
mailed with an explanation of the purpose of the payment and the grant number to:
Accounting and Grants Department
Texas State Library and Archives Commission
PO Box 12516
Austin, TX 78711 -2516
Fiscal Year 2003 Page 7 of 8
City of Round Rock Loan Star Libraries Grant
X. APPLICABLE AND GOVERNING LAW
Date
Date
A. This grant shall be governed by the laws of the State of Texas. All duties of either party shall be
legally performable in Texas. The applicable law for any legal disputes arising out of this _
contract shall be the law of (and all actions hereunder shall be brought in) the State of Texas, and
the forum and venue for such disputes shall be Travis County, District Court.
B. This grant is subject to availability of funds.
XI. SIGNATURES
GRANTOR
Texas State Library and Archives Commission City of ' . nd ' ck, r� • ' ock Public ibrary System
Donna Osbome, Chief Fiscal Officer
GRANTEE
Edward Seidenberg, Assistant State Librarian Si _,'a d7' Must be an official empowered
to enter into contracts)
'N\JIe, Ma -xwell
Typewritten or Printed Name
Maakinr
Title
1 -21— 03
Date
Fiscal Year 2003 Page 8 of 8
City of Round Rock Loan Star Libraries Grant
Fiscal Year
FY: 02 -3
FY:
FY:
FY:
FY:
TOTAL
Grant
Funding
$9,924
None
Required
City Match
None
TOTAL
$9,924
GRANT APPLICATION /PROPOSAL REVIEW (GAPR)
This form must be completed and presented to Department Leadership for review prior to:
a) the submission of a grant application;
b) the acceptance of a grant;
c) the renewal of a grant; or,
d) a change in the budgeted amount of the grant
Following review by Departmental Leadership, this form should be submitted to the City Budget
Supervisor (499 - 2869) for Budget Office Approval.
The GAPR form is due to the Budget Office for approval at least three (3) working days prior to
the grant application due date or any City Council- related deadline.
If a grant application requires prior City Council approval to submit, this form should be completed
by the department and submitted with the Council Action requesting approval to apply and the
"Request for Finance Approval" form. If a grant is awarded, a copy of this GAPR should be
submitted with the Council Action requesting authorization to accept the grant and the "Request
for Finance Approval" form.
NOTE: NO GRANT APPLICATION, RENEWAL, OR INCREASE IN GRANT FUNDING WILL
BE CONSIDERED WITHOUT THE SUBMISSION AND APPROVAL OF THIS FORM.
Grantor
Texas State Library and Archives Commission
Grant
Title:
Loan Star Grants
Please complete the sentences listed below by filling out the boxes:
This is the (list year):
2"" year
of a (list year)
Possibly indefinite I Grant.
Page 13
Grant Amount:
Grant
FTEs:
Grant Match:
$9,924
None
None
GRANT APPLICATION /PROPOSAL REVIEW (GAPR)
This form must be completed and presented to Department Leadership for review prior to:
a) the submission of a grant application;
b) the acceptance of a grant;
c) the renewal of a grant; or,
d) a change in the budgeted amount of the grant
Following review by Departmental Leadership, this form should be submitted to the City Budget
Supervisor (499 - 2869) for Budget Office Approval.
The GAPR form is due to the Budget Office for approval at least three (3) working days prior to
the grant application due date or any City Council- related deadline.
If a grant application requires prior City Council approval to submit, this form should be completed
by the department and submitted with the Council Action requesting approval to apply and the
"Request for Finance Approval" form. If a grant is awarded, a copy of this GAPR should be
submitted with the Council Action requesting authorization to accept the grant and the "Request
for Finance Approval" form.
NOTE: NO GRANT APPLICATION, RENEWAL, OR INCREASE IN GRANT FUNDING WILL
BE CONSIDERED WITHOUT THE SUBMISSION AND APPROVAL OF THIS FORM.
Grantor
Texas State Library and Archives Commission
Grant
Title:
Loan Star Grants
Please complete the sentences listed below by filling out the boxes:
This is the (list year):
2"" year
of a (list year)
Possibly indefinite I Grant.
Page 13
TERM YEAR
MONTH /DAY/YEAR
THROUGH
MONTH /DAY/YEAR
Year One:
9/1/02
Through
8/30/03
Year Two:
Through
Year Three:
Through
Year Four:
Through
Year Five:
Through
This Grant will be appropriated in FY:
12002 -2003
Other In -Kind Match Provided: $None
Total Program Budget: $9,924
Proposed Positions (FTE's) to be Funded:
[Indicate Title(s) and Status (regular /temporary). Please add rows if number is
insufficient. ]
Should we subcontract? If so, why?
This grant proposal /application is a: New Grant X Renewal Grant Revision
Type of Funds: _Federal _ Federal Pass- Through X State _ Private /Other
Funding Source: Texas State Library and Archives Commission
GRANT TERM DATES
This is an annual grant, given out as the State has funds.
Collaborations with other Agencies /Departments:
List the Departmental Goal or Strategy that will be supported by this grant (as included in the
Approved Budget Document): These funds are given to us with no strings attached. As we
really don't know the amount of funds available, and the state has encouraged us to try
something we normally don't do or to test a product, that is how were using it. Specifically, as
indicated in the blue sheet, the funds are to provide 2 year funding of the graphic novel and
fotonovella collection; 1 year funding of greatly improving the more "classic" literature in the
fiction area; enhance the access to the online Chapter a Day service; and improve public service
through the library public access terminals at home and on site by providing more content related
to the titles we hold.
Page 14
TITLE
STATUS (Reg./Temp.)
Estimated Cost
1.
None
2.
3.
TOTAL:
This Grant will be appropriated in FY:
12002 -2003
Other In -Kind Match Provided: $None
Total Program Budget: $9,924
Proposed Positions (FTE's) to be Funded:
[Indicate Title(s) and Status (regular /temporary). Please add rows if number is
insufficient. ]
Should we subcontract? If so, why?
This grant proposal /application is a: New Grant X Renewal Grant Revision
Type of Funds: _Federal _ Federal Pass- Through X State _ Private /Other
Funding Source: Texas State Library and Archives Commission
GRANT TERM DATES
This is an annual grant, given out as the State has funds.
Collaborations with other Agencies /Departments:
List the Departmental Goal or Strategy that will be supported by this grant (as included in the
Approved Budget Document): These funds are given to us with no strings attached. As we
really don't know the amount of funds available, and the state has encouraged us to try
something we normally don't do or to test a product, that is how were using it. Specifically, as
indicated in the blue sheet, the funds are to provide 2 year funding of the graphic novel and
fotonovella collection; 1 year funding of greatly improving the more "classic" literature in the
fiction area; enhance the access to the online Chapter a Day service; and improve public service
through the library public access terminals at home and on site by providing more content related
to the titles we hold.
Page 14
A
If this grant project's goals and objectives are reached, the Department will request
funding from the General Fund to continue the program if grant funding ends.
B
This grant- funded project is considered a baseline program that must be continued
with or without grant funding.
C.
X
This grant- funded project is not considered a baseline program that must be
continued with or without grant funding.
D.
This one -time grant- funded project intended to cease at the grant -term end. No
other funding will be requested from alternative grant sources or General Fund
dollars
E
If this grant- funded project's performance (for in the example of a pilot or
demonstration grant) indicates the need for the Department to apply for follow -up
funding, the project may require supplemental funding from the General
grant
Fund to cover the cost of the follow -up project.
F.
X
If this grant project's goals and objectives are reached, the Department ma
request funding from the General Fund to continue the program if grant funding
ends.
Associated Program /Program Objective:
PLANNED PERFORMANCE MEASURES (List MaiorThreet): None are required for the grant.
However, we are measuring:
1. Increased use of the special Graphic Novel and Fotonovella collections
2. We will develop a means to find out the effectiveness of the Chapter a Day program and the improvements to
the public access offerings.
3. Purely output —the number of fiction titles added for collection improvement
Brief description of proposed grant program:
As indicated earlier, this grant is a virtually free gift from the state. We may use the funds as we
wish. To restate, as indicated in the blue sheet, the funds are to provide 2 ntl year funding of the
graphic novel and fotonovella collection; 1 year funding of greatly improving the more "classic"
literature in the fiction area; enhance the access to the online Chapter a Day service; and improve
public service through the library public access terminals at home and on site by providing more
content related to the titles we hold.
Contingency Plan if Grant Funding Discontinued (Check Appropriate Box, or Detail in
"Other. "):
DEPARTMENTAL REVIEW /APPROVAL
(To be completed by the submitting Department)
Dept. Director Review /Approval: ,t J is . � �i+' � Date:
11 q103.
Date Application Due (if Applicable): C tf. 2t-&G/ Date Forwarded:
/v1i*
CITY BUDGET OFFICE REVIEW APPROVAL
(To be completed by the City Budget Office)
Page 15
IA,117)U2-
Date Received: / 2' 17 Date Approved /Disapproved: I z 1
Budget/Accounting Supervisor Review /Approv Date:
Finance Director Review /Approval: '> Date:
Page 16