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CM-10-07-140OMB Number: 4040-0004 Expiration Date: 01/31/2009 Application for Federal Assistance SF -424 Version 02 *1. Type of Submission: *2. Type of Application * If Revision, select appropriate letter(s) *Other (Specify) • Preapplication ►Zl New ® Application ❑ Changed/Corrected Application EDContinuation ■ Revision 3. Date Received: 4. Applicant Identifier: 5a. Federal Entity Identifier: *5b. Federal Award Identifier: State Use Only: 6. Date Received by State: 7. State Application Identifier: 8. APPLICANT INFORMATION: *a. Legal Name: City of Round Rock, Texas *b. Employer/Taxpayer Identification Number (EINITIN): 74-6017485 *c. Organizational DUNS: 102740792 d. Address: *Street 1: 221 E. Main St. Street 2: *City: Round Rock County: Williamson *State: Texas Province: *Country: U.S. *Zip / Postal Code 78664-5242 e. Organizational Unit: Department Name: Utility Administration Division Name: f. Name and contact information of person to be contacted on matters involving this application: Prefix: Mr. *First Name: Don Middle Name: *Last Name: Rundell Suffix: P.E. Title: Chief Utility Engineer Organizational Affiliation: *Telephone Number: 512-218-5554 Fax Number: 512-218-3242 *Email: drundell@round-rock.tx.us OIMO-W-P-10 OMB Number: 4040-0004 Expiration Date: 01/31/2009 Application for Federal Assistance SF -424 Version 02 *9. Type of Applicant 1: Select Applicant Type: C. City or Township Government Type of Applicant 2: Select Applicant Type: Type of Applicant 3: Select Applicant Type: *Other (Specify) *10 Name of Federal Agency: Department of Interior/Bureau of Reclamation 11. Catalog of Federal Domestic Assistance Number: 15.504 CFDA Title: ARRA/Challenge Grant *12 Funding Opportunity Number: *Title: Title XVI: Water Reclamation and Reuse Program 13. Competition Identification Number: Title: 14. Areas Affected by Project (Cities, Counties, States, etc.): City of Round Rock, Williamson County, Texas *15. Descriptive Title of Applicant's Project: City of Round Rock Reuse Water System OMB Number: 4040-0004 Expiration Date: 01/31/2009 Application for Federal Assistance SF -424 Version 02 Program/Project: 16. Congressional Districts Of: *a. Applicant: TX -031 *b. 17. Proposed Project: *a. Start Date: 08/01/2010 *b. End Date: 05/01/2011 18. Estimated Funding ($): *a. Federal $1,000,000.00 *b. Applicant $5,978,913.02 *c. State *d. Local *e. Other *f. Program Income *g. TOTAL $6,978,913.02 12372 Process? Order 12372 Process for review. for review on *19. Is Application Subject to Review By State Under Executive Order the Executive • a. This application was made available to the State under ►Z� b. Program is subject to E.O. 12372 but has not been selected by the State ■ c. Program is not covered by E. O. 12372 *20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes", provide explanation.) ■ Yes No 21. *By signing this application, I certify (1) to the statements contained in the herein are true, complete and accurate to the best of my knowledge. I also with any resulting terms if I accept an award. I am aware that any false, fictitious, me to criminal, civil, or administrative penalties. (U. S. Code, Title 218, Section list of certifications** and (2) that the statements provide the required assurances** and agree to comply or fraudulent statements or claims may subject 1001) obtain this list, is contained in the announcement or kvA ** I AGREE ** The list of certifications and assurances, or an Internet site where you may agency specific instructions Authorized Representative: Prefix: Mr. *First Name: James Middle Name: R. *Last Name: Nuse Suffix: P.E. *Title: City Manager *Telephone Number: 512-218-5402 Fax Number: 512-218-7097 * Email: jnuse@round-rock.tx.us *Signature of Authorized Representative: / *Date Signed: 7/ 770 Authorized for Local Reproduction Standard Form 424 (Revised 10/2005) Prescribed by OMB Circular A-102 OMB Number: 4040-0004 Expiration Date: 01/31/2009 Application for Federal Assistance SF -424 Version 02 *Applicant Federal Debt Delinquency Explanation The following should contain an explanation if the Applicant organization is delinquent of any Federal Debt. DISCLOSURE OF LOBBYING ACTIVITIES >lete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 reverse forpublic burden disclosure.) Approved by OMB 0348-0046 (See 1. Type of Federal Action: c.1 a. contract -- 1 b. grant c. cooperative agreement d. loan e. loan guarantee f. loan insurance 2. Status of Federal Action: award' 3. Report Type: a. initial filing b. material change For Material Change Only: year quarter I a. la. bid/offer/application }b. initial c. post -award date of last report 4. Name and Address of Reporting Entity: , if known: Rock, TX 78664 TX -031 5. If Reporting Entity in No. 4 is a Subawardee, Enter Name and Address of Prime: Congressional District, if known: © Prime ■ Subawardee Tier City of Round Rock - 221 Main St., Round Congressional District, if known: 6. Federal Department/Agency: Bureau of Reclamation (Dept. of Interior) 7. Federal Program ARRA Title XVI CFDA Number, Name/Description: if applicable: 15.504 8. Federal Action Number, if known: 9. Award Amount, if known: $ 1,000,000.00 10. a. Name and Address of Lobbying Registrant (if individual, last name, first name, MI): Capitol Partners - Holshouser, Carl 1107 17th Street NW Suite 202 Washington, DC 20036 b. Individuals Performing Services (including address if different from No. 10a) (last name, first name, MI): Information requested through this form is authorized by title 31 U.S.C. section 11.1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This disdosure is required pursuant to 31 U.S.C. 1352. This information will be available for public inspection. Any person who fails to file the required disclosure shalt be subject to a civil penalty of not less than $10,000 and not more than 5100,000 for each such failure. Signature: print Name: -s R. Nuse, P.E. Title: City M.• • - :--r Telephone No.: Date: p 512-218-5401 dQ/ j} Federal Use Only; Authorized for Local Reproduction Standard Form LLL (Rev. 7-97) BUDGET INFORMATION - Construction Programs NOTE: Certain Federal assistance programs require additional computations to arrive at the Federal share of projectcosts eligible for participation. If such is the case, you will be notified. c. Total Allowable Costs (Columns a -b) 0 C. VD OD o ... ,r, fa 0 CD 0 *,) 0 0 0 013 0 0 0 0 0 r- (0) 0 000000 0 V, CD 0 VI 0 0 0 0 w CO 0 69 0 0 VI 0 0 411 rs.1 0 •rr 0 1:4 0 0 14 0 000 .,... 4l.4 0., ' ,-. 10 0 C.1 v., 4N ... al co 0 ,f) Eft 0 0 ,,, 0 Crx 0 0 ,...1 EA 0 0 rn .-a Ch . r- a‘ ..0 10 0 0 0 69 0 0 , ) , 4 al N cr, 0 14 FEDERAL FUNDING C'J CO , a 0 . , as 10 b. Costs Not Allowable for Participation 69 VI VI - te VI I *A V/ - EA 69 VI VI 0 0 0 V/ VI 0 0 0 VI ---- VI 0 0 0 VI 17. Federal assistance requested, calculate as follows: (Consult Federal agency for Federal percentage share.) Enter eligible costs from line 16c Multiply X 14 % Enter the resulting Federal share. a. Total Cost 51,086.00 0.00 0 o 0 VI o o 0 0 0 . XI , in VI 0 0 o 64 VI cp 0 0 0 0 . OD 0 .--4 VI 0 0 0 V*69 5,340,250.00 0.00 14,927.00 5,889,263.00 1,089,650.00 6,978,913.00 o 0 0 VI o 0 rn a, . on V* COST CLASSIFICATION 1. Administrative and legal expenses 2. Land, structures, rights-of-way, appraisals, etc. 3. Relocation expenses and payments 4. Architectual and engineering fees 5. Other architectural and engineering fees 6. Project inspection fees 7. Site work 8. Demolition and removal 9. Construction 10. Equipment 11. Miscellaneous 12. SUBTOTAL (sum of lines 1-11) 13. Contingencies 14. SUBTOTAL 15. Project (program) income 16. TOTAL PROJECT COSTS (subtract #15 from #14) Authorized for Local Reporoduction Previous Edition Usable OMB Approval No. 0348-0042 ASSURANCES - CONSTRUCTION PROGRAMS 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 reganling the burden estimate or any other aspect of this mon of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0042), 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. Furth, certain Federal assistance awarding agencies may mire 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 8. Will corn* with the lntergovemmen ers of 1970 (42 U.S.C. W728-4763) rebating 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). 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 costs) 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 ss to and the right to examine all records, books, papers, or documents related to the assistance; and will establish a proper accounting system in accordance with generally accepted accounting standards cx agency directives. 3. Will not dispose of, modify the use of, or change the terms of the rear property title, or other interest in the site and facilities without permission and instructions from the awarding agency. WA record the Federal interest in the title of real property in accordance with awarding agency directives and will indude a covenant in the title of real property agaured in whole or in part with Federal assistance funds to assure non- discrimination during the useful fife of the project. 4. Will comply with the requirements of the assistance awarding agency with regard to the drarng, review and approval of construction plans and specifications. 5. Will provide and maintain competent and adequate engineering supervision at the construction site to ensure that the complete work conforms with the approved plans and specifications and wilt furnish progress reports and such other information as may be required by the assistance awarding agency or State. 6. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 7. 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. 9. 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. 10. Will comply with all Federal statutes relating to non- ctisc rimination. 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 handios; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §6101-6107), which prohibits cl`rscrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination n 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 proves in the specific statute(s) under which motion for Federal assistance is being made; and, (j) the requirements of any other nondiscrimination statute(s) which may apply to the application. Previous Edition Usable Authorized for Local Reproduction Standard Form 424D (Rev. 7-97) Prescribed by OMB Circular A-102 11. Will comply, or has already complied, with the requirements of Titles Il and ill 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 and fly -assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases. 12. Will comply with the provisions of the Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328) which limit the political activities of employees whose principal, moment activities are funded in whole or in part with Federal funds. 13. 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 subagreernerrts. 14. Will comply 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 katal cost of insurable construction and acquisition is $10,000 or more. 15. Will comply with environmental standards which may be prescribed pursuant to the Bowing: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91- 190) and Exectdive Order (EO) 11514; (b) notification of violating facilities pursuant. to EO 11738; (c) protection of wends 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 Endangered Species Act of 1973, as amended (P.L. 93-205). 16. Wilt 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. 17. Wdl assist the awarding agency in assuring compliance with Section 106 01 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.). 18_ WE cause to be performed the required financial and Wince 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." 19. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, and policies governing this program. SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE City Manager APPLICAN�`f d2GANIZATtON City of Re n1d Rock DATE SUBMI r i ED July 7, 2010 SF -4240 (Rev. 7-97) Back