ODOT - Traffic Safety Project Grant No. M1HVE-14-46-03 F
9
regon
Q' N Department of Transportation
N ' :2
Transportation Safety Division,MS 3
John A.Kitzhaber,MD,Governor 4040 Fairview Industrial Drive SE
Salem,OR 97302-1142
(503)986-4190
Fax:(503)986-3143
November 12, 2013
Attention: Lt. David Frisendahl, Project Director
Tigard Police Department
13125 SW Hall Blvd
Tigard, OR 97223
RE: Tigard PD Safety Belt Overtime Enforcement
Project Number: M1 HVE-14-46-03 JJJ
Congratulations! Your FY 2014 Traffic Safety Project is approved.
Enclosed is the executed project agreement, authorizing you to proceed as of November 12, 2013.
Your Agency Claim for Reimbursement and Project Evaluation Report forms have been
customized. Electronic files for these and other grant forms will be emailed to you.
If you have questions regarding the forms, please contact Kelly Mason, Grants Assistant at (503)
986-4202. Your project number and name should be referenced in all correspondence to us
regarding this project. Your CFDA number for this grant is 20.616.
Thank you for responding to our grant program and for all the effort required to make this project a
reality and a success. Efforts like this will make our highways and byways safer for all
Oregonians!
Sincerely,
Troy E. Costales, Administrator
Transportation Safety Division
cc: Grant File
TSD Project Manager
OREGON DEPARTMENT OF TRANSPORTATION
Transportation Safety Division
,i
,.... GRANT PROJECT APPL.CQTIE�
NOV 0 4 2013
Project No: M1HVE-14-46-03JJJ
Project Name: Tigard PD Safety Belt Overtime Enforcement
Answer each question in the boxes provided. Answer each question completely and according to the
instructions in Italics. All fields are required.
I. Project Description
The Tigard Police Department will conduct overtime traffic
enforcement during the blitz periods established by ODOT
Transportation Safety Division, and as funds allow, at other times
when additional traffic enforcement coverage is deemed appropriate
by the Police Department. Overtime traffic enforcement under this
grant will focus primarily on maintaining and increasing public
compliance with Oregon motor vehicle safety restraint laws and
secondarily on other local traffic safety priority issues. The
Department will notify their community of their planned participation in
the blitz periods and their results (news media, social media, agency
web a e or other.
II. Problem Statement
A. Describe the problem(s) this project will try to impact:
(Describe the problem(s) you intend to impact with this grant.)
The primary purpose of this project is to maintain or increase local
compliance with motor vehicle safety restraint laws. The most recent
100-car survey done in our community revealed a local belt use rate of
97%.
B. Provide summary data about the problem(s):
(Give summary data regarding the problem as it exists in your jurisdiction.)
Non-Use of Restraints: According to the 2013 Oregon observed use
survey, two percent of passenger car drivers, six percent of pickup
truck drivers and thirteen percent of sports car drivers do not use
restraints. During 2011, Oregon crash reports (FARS) indicate twenty-
eight percent of motor vehicle occupant fatalities were unrestrained
737-1001 — 10/03 Pg. 1
and thirteen percent were of unknown restraint use status.
Improper Use of Safety Belts: Oregon law requires "proper" use of
safety belt and child restraint systems. Some adult occupants
inadvertently compromise the effectiveness of their belt systems and
put themselves or other occupants at severe risk of unnecessary injury
by using safety belts improperly. This is most often accomplished by
placing the shoulder belt under the arm or behind the back, securing
more than one passenger in a single belt system, or using only the
automatic shoulder portion of a two-part belt system (where the lap
belt portion is manual).
Improper Use of Child Restraints: According to the 2013 Oregon
observed use survey, ninety-seven percent of children aged twelve
and under are riding in some type of restraint. However, data
collected through child seat fitting stations indicate the majority of child
restraints are used incorrectly- up to 73% according to Safe Kids
Worldwide. Drivers are confused by frequently changing Oregon
laws, national "best practice" recommendations, and constantly
evolving child seat technology.
In addition, calendar year 2011 Oregon crash reports indicated that
restraint use in crashes was only 38% among injured 4 - 7 year olds
and only 33% among fatally injured 4- 7 year olds.
Accordingly, overtime enforcement efforts will be directed to focus
especially on proper restraint usage for child passengers in the 4-7
year old age group.
C. List current activities and associated agencies already involved in solving the
problem(s):
(Include all related activities and agencies involved. If you have a current project,
list the objectives of that project and progress in achieving them.)
During 2013, fifty-six local police departments, thirty-one Sheriffs
Offices and the Oregon State Police participated in ODOT
Transportation Safety Division's safety belt overtime enforcement
program. Most of these agencies enforce restraint laws as a matter of
routine when working traffic. However, smaller departments often do
not have sufficient resources to adequately address traffic safety
concerns so rely heavily on ODOT's federal overtime funding support.
III. Objectives
(Describe quantifiable products or outcomes that address those problems identified in
Section 11 that should result from the proposed activities. Normally at least three very
specific objectives should be given and each should include beginning and ending date.
737-1001 - 10/03 Pg 2
The following are examples:
"To increase safety belt usage in (funded jurisdiction) from 85% to 90% by
September 30, 2004, with the use rate determined by conducting observed use
surveys."
"To reduce nighttime fatal and injury crashes occurring in (funded jurisdiction) by
20% from 60, the average for the 1998-2001 period, to 48 during the 12-month
period starting October 1, 2003, and ending September 30, 2004."
"To provide intensive probation supervision to a minimum of 30 additional persons
convicted of DUI/in (funded jurisdiction) by making at least three face-to-face
contacts with each person weekly from October 1, 2003, through September 30,
2004."
"To complete an evaluation by July 1, 2004, to determine if using photo radar will
lead to a significant reduction in fatal and injury traffic crashes in that location.)
Start Date End Date Objective
1. 10/01/2013 9/30/2014 Maintain or increase local compliance with
Oregon safety restraint laws.
2. 2/01/2014 9/07/2014 Conduct overtime enforcement during blitz
periods established by ODOT
Transportation Safety Division to
complement national Click It or Ticket and
National Child Passenger Safety Week
campaigns and at other times deemed
appropriate b the Police Department.
3. 10/01/2013 9/30/2014 Conduct other overtime activities described
in the Police Department's pre-application,
attached as Exhibit A.
4. 9/08/2014 9/30/2014 Conduct end- of-year 100 - car survey of
driver safety belt usage for comparison to
beginning of year rate on application.)
IV. Proposed Activities
A. Major Activities
(List major activities to be carried out to achieve objectives stated in Section 111
above. List the start and end date for each activity, and include in your description
what will be done, who will do it, and who will be affected.
Start Date End Date Activity
1. 2/19/2014 2/23/2014 Conduct overtime enforcement during
February 10-23 blitz with focus on
Belts/Child Restraints, Texting & Speed.
2. 5/19/2014 6/01/2014 Conduct overtime enforcement during May
19 - June 1 blitz and emphasize
Nighttime/daytime Belt Use, Prohibition of
Minors in Pickup Trucks -to complement
nationwide "Click It or Ticket" mobilization.
737-1001 —10/03 Pg. 3
3. 8/25/2014 9/06/2014 Conduct overtime enforcement during
August 25 - September 7 blitz and
emphasize Child Seats/Fitting Station
Referrals, Texting & Speed, to complement
National Child Passenger Safety Week.
4. 2/12/2014 9/13/2014 Notify community of planned participation
in blitz periods and results (news media,
social media, agency web a e or other.
5. 10/01/2013 9/30/2014 Conduct overtime safety belt and child
safety seat enforcement at other times
when additional traffic enforcement
coverage is deemed appropriate by the
Police Department.
6. 10/01/2013 9/30/2014 Record and summarize officer overtime
enforcement activity including hours
worked, number&type of enforcement
contacts made on overtime and match,
and education/media activity on forms
provided by ODOT Transportation Safety
Division.
7. 11/05/2014 11/05/2014 Prepare and submit claims for
reimbursement of overtime on a monthly or
quarterly basis with copies of completed
officer overtime activity reports and
Department overtime summary reports for
the period of requested overtime
reimbursement.
Plans for sharing the project activities with others:
Officer and Department enforcement activity will be summarized and
submitted to ODOT Transportation Safety Division along with Claims
for Reimbursement on a monthly or quarterly basis.
B. Coordination
(List the groups and agencies with which you will be cooperating to complete the
activities of the project. Explain how you will be working together. In those projects
not requiring the involvement of other agencies, a statement justifying the ability of
the applicant to carry out the project independently should be included.)
Is coordination with outside agencies or groups required? If yes, check here:
1) if you checked the box above, please fill in the following. Otherwise skip
to item 2) below.
Name/role of groups and agencies involved:
Department will coordinate blitz enforcement and media activities, as
practical, with area OSP, Sheriffs Offices, and other police
departments.
737-1001 - 10/03 Pg.4
2) Fill this if you did not check the box above:
Ability to complete the project independently:
C. Continuation
Plans to continue the project activities after funding ceases:
N/A
V. Evaluation Plan
A. Evaluation Questions
(You will be reporting on your objectives in your Project Evaluation. At a minimum
each objective should be rephrased as an evaluation question. For example, what
percentage of the public in (funded jurisdiction) wears a safety belt? What
percentage increase is this? Add questions that demonstrate expected or
potential impact of the project on the state or jurisdiction's traffic safety
environment. Avoid yes/no evaluation questions.)
Evaluation Question
1. Was your Department able to participate in all three blitzes?
Describe how your Department used overtime for traffic
enforcement conducted outside of established blitz periods, if any.
2. Briefly summarize how your Department used overtime, if any, for
educational activities.
3. How did your Department notify the community of participation in
the blitz periods?
4. How many contacts did your Department make during the year
specifically for suspected safety belt or child restraint violations?
5. Did your local safety belt use rate increase during the year, as
evidenced by your 100-car survey at beginning and end of year?
B. Data Requirements
1. Data to be collected: The Data Table presented as Exhibit A will be submitted
with required quarterly reports.
2. Data System
Describe how the data will be collected, stored, and tabulated:
TSD will provide required 100-car survey and standard activity
reporting forms on the Occupant Protection webpage. Agencies will
summarize and submit enforcement data with their monthly claims;
TSD will input to an internal, statewide database.
737-1001 -10/03 Pg. 5
C. Evaluation Design
Describe how the data will be analyzed:
100-car survey results will be compared from start of grant year (time
of application)to end of grant year(following last of three blitzes).
D. Project Evaluation Preparation
A Project Evaluation Report will be submitted to TSD following the requirements
given in the Agreements and Assurances.
VI. Grant Project Budget Summary
A. List of major budget items:
Staff(overtime).
B. Budget Allotment
The agency named in this document hereby applies for$7,000.00 in
Transportation Safety funds to be matched with $1,750.00 in funds from source
Straight-time Enforcement to carry out a traffic safety project described in this
document.
VII. Budget and Cost Sharing
(Complete Form 737-1003 Budget and Cost Sharing. You may attach one
page to explain specific requests. If you are applying for a multiple-year grant, you
must include a separate budget for each year for which you are requesting
funding.)
VIII. Exhibits
A. Exhibit A: 2014 Pre-application for Safety Belt Overtime Grant
B. Exhibit B: Job Descriptions
(Provide copy of job descriptions of all positions assigned to the project 500 hours
or more paid with grant funds.)
C. Exhibit C: Contracts or Service Agreements
(Provide signed copies of any contracts or other service agreements that are
entered into by the grantee as part of this project. These shall be reviewed by TSD
to determine whether the work to be accomplished is consistent with the objectives
of the project. All contracts awarded by the grantee shall include the provision that
any subcontracts include all provisions stated in the Agreements and Assurances.)
IX. Agreements and Assurances
(READ, sign and attach to the grant project application.)
737-1001 - 10/03 Pg. 6
X. Approval Signatures
I have read and understand the Agreements and Assurances stipulating the conditions
under which the funds for which are being applied will be available and can be utilized.
The agency named in this document is prepared to become a recipient of the funds
should the grant funds be awarded.
A. Agency Information
Agency Name*: Tigard Police Department
Street Address: 13125 SW Hall Blvd
City: Tigard
State: OR
Zip: 97223
B. Project Director
First Name: Last Name:
Title: u ��ys� � Email: a : rrrtsen��hl8s ttywe7-
Phone: cam, - 115s-ZsL Fax:
Street Address: i�vt�5 5i , �t ei vo
City:
State: ryr ion
Zip: y 5
Signature: Date: J()13" /;X
C. Authorizing Official of Agency Completing Application
First Name: �s r, Last Name:
Title: {0 cc, �f Email: r� 6c �f�a�eQ ch—•y &a
Phone: 3 7/d° 2J`�� Fax: c36�SrJ J y
Street Address: 3/Lf S'c�14l/✓I/
City: %T o✓o"
State:
Zip: 9/ZZ3
Signature: �� Date:
*Non-profit agencies must submit proof of exempt status under Code Sec.501(c)(3)
Mail signed copies to: Oregon Dept.of Transportation
Transportation Safety Division, MS 3
4040 Fairview Industrial Drive SE
Salem,OR 97302-1142
Email completed electronic copy to your TSD Program Manager.
737-1001 — 10/03 Pg. 7
ODOT GRANT BUDGET AND COST SHARING
Project No.: MIHVE-14-46-03 JJJ Project Period: 10/01/13 09/30/14
Project Name: Tigard PD Safety Belt Overtime Enforcement (From) (To)
Agency: Tigard Police Department (Office Use only)
Grant Adjustment#: 0
Grant Adjust.Effective Date:
This form should include all budget information. If additional information is required for clarity,please include on a separate page Project Yr.(1-23,Ongoing):
referencing appropriate budget item.
TSD FUNDS MATCH TOTAL
1. Personnel Costs-
A. Staff assigned and estimated hours: Hours Rate Total Cost
Straight Time Enforcement 50.00 @ $ 35.00 /hr= $ 1,750.00
0.00 @ $ /hr= $
0.00 @ $ /hr= $
0.00 @ $ /hr= $
0.00 @ $ /hr= $
0.00 @ $ - /hr= $
Staff Subtotal $ 1,750.00 $0.00 $1,750.00 $1,750.00
B. Overtime Hours Rate Total Cost
Overtime Enforcement 104.36 @ $ 67.07 /hr= $ 6,999.43
Calc.Adjustment 1.00 @ $ 0.57 /hr= $ 0.57
Overtime Subtotal $ 7,000.00 $7,000.00 $0.00 $7,000.00
C. Volunteer Time Hours Rate Total Cost
0.00 @ $ /hr= $
0.00 @ $ /hr= $
Volunteer Subtotal $ $0.00 $0.00 $0.00
2. Personnel Benefits Unit Cost #of Units Total Cost
A. $ @ 0 = $
B. $ @ 0 = $
Benefits Subtotal $ $0.00 $0.00 $0.00
3. Equipment Unit Cost #of Units Total Cost
A. $ @ 0 = $
B. $ @ 0 $
C. $ @ 0 = $
D. $ @ 0 = $
Equipment Subtotal $ $0.00 $0.00 $0.00
4. Materials/Printing Unit Cost #of Units Total Cost
a $ @ 0 = $
B. $ @0 = $
C. $ @ 0 $
Materials Subtotal $ $0.00 $0.00 $0.00
S. Overhead/Indirect Costs Unit Cost #of Units Total Cost
A. $ @ 0 $
B. $ @ 0 = $
Overhead Subtotal $ $0.00 $0.00
737-1003(Rev.10/03) Page 1
v
ODOT GRANT BUDGET AND COST SHARING
Project Number: Tigard PD Safety Belt Overtim
TSD FUNDS MATCH TOTAL
6. Other Project Costs
A. Travel In-State Unit Cost #of Units Total Cost
$ @ 0 = $ - $0.00 $0.00 $0.00
B. Travel Out-of-State(specify)"`:
$ - @ 0 = $ $0.00 $0.00 $0.00
C. Office Expenses(supplies,photocopy,telephone,postage)
$ - @ 0 = $ $0.00 $0.00 $0.00
D. Other Costs(specify):
1.) $ @ 0 = $
2.) $ @ 0 = $
3.) $ @ 0 = $
4.) $ @ 0 = $
5.) $ @ 0 = $
Other Project Costs Subtotal $ $0.00 $0.00 $0.00
7. Consultation/Contractual Services" Unit Cost #of Units Total Cost
A. $ @ 0 = $
B. $ @ 0 = $
Consultation/Contractual Services Total $ $0.00 $0.00 $0.00
B. Mini-Grants"' TSD Match
A. $ $
B. $ $
C. $ $
D. $ $
E. $ $
F. $ $
G. $ $
H. $ $
Mini-Grants Subtotals $ $ $0.00 $0.00 $0.00
FI-OT-A-L-1 $7,000.00 $1,750.00 $8,750.00
COST SHARING BREAKDOWN Budget Comments:
1. TSD Funds $ 7,000.00 80%-
2. Match:State
3. Match:Local $ 1,750.00 20%
4. Match:Other(specify)
a.)
b.)
C.)
5. TOTAL COSTS $ 8,750.00 100%
Job descriptions for all positions assigned to grant for 500 hours or more must be included in Exhibit B.
TSD approval required prior to expenditures.
737-1003(Rev.10/03) Page 2
PRE-APPLICATION FOR SAFETY BELT OVERTIME GRANT
F
rfaanFederal FY2014 Funding(CFDA 20.600)Administered by Oregon Department of
portaGon
Transportation—Transportation Safety Division
APPLICANT INFORMATION CV 9,D001 $ 5 , — 00
AGENCY NAME FEDERAL ID NUMBER
Tigard Police Department 93-0503940
ADDRESS CONTACT PERSON NAME PHONE
13125 SW Hall Blvd Sgt. David Frisendahl 503.718.2567
CITY,STATE,ZIP CONTACT PERSON E-MAIL ADDRESS
Tigard, Oregon 97223 david.frisendahl@tigard-or.gov
JURISDICTION INFORMATION
Number of officers available to work grant: 45
Size of jurisdiction (current population): 50,000
Local safety belt use rate(from most recent 100-car survey): 97%
GRANT INFORMATION
Overtime rate:$ 67.07
Amount requested for FY2014(10/1/2013-9/30/2014):$ 10,000
Amount of carryover from FY2013 (if any):+$ 0
TOTAL FUNDS REQUESTED:$ 10,000
SUBMISSION INFORMATION
NAME AND TITLE OF PERSON SUBMITTING THIS APPLICATION SIGNATURE' DATE
Sgt. David Frisendahl 24266 8/6/13
'Manual signature required.
Submit completed, signed application by,to:ODOT Transportation Safety Division MS3
Attn: Carla Levir i4040 Fairview Industrial Drive SE
Salem, OR 97302
DESCRIPTION OF GRANT USE
Provide a brief description of how your agency intends to use overtime funding to promote restraint use and address
priority traffic safety issues within your community. What benefit(s) or positive outcome(s)do you hope to achieve?
If you are filling this form electronically,the field below will expand as you type.If you are filling this form manually,use the reverse if more room is required
The Tigard Police Department is proactive in traffic enforcement and education. Currently the Tigard Police Department
has forty five officers who actively enforce traffic laws.Additionally,the department has three officers and a sergeant who
are assigned specifically to traffic enforcement and education. From July 1st 2012 to July 1st 2013, our agency has
issued approximately eight seven hundred citations for traffic violations and traffic crimes. Of the eighty seven hundred
citations we issued three hundred of the citations issued were for safety belt violations.
We are requesting ten thousand dollars for the 2013-2014 grant years. The amount requested was determined by
analyzing previous year's efforts, expenditures on our past grant and our current staffing schedule.As a result it became
obvious that more time if available could be used during the"blitz campaigns" mentioned below. Based on our
manpower allocations the ten thousand dollars would result in one hundred and fifity hours of devoted time to Three
Flags traffic enforcement campaign.
Our plan to administer the grant is as follows; traffic team members will work an estimated eight hours per month on grant
time totaling ninety six hours for the year. The additional fifty four hours would be used during the three blitz campaigns
and would be divided up evenly for each campaign. This would dedicate approximately eighteen hours for each two week
period of the campaign to directed patrol focusing on seatbelt usage, distracted driving and speed. We would add the
dedicated monthly hours(eight)during the three campaign times bringing the total hours for each campaign to twenty six
hours. Monthly grant hours would also be devoted to the safety of children. Members of the traffic team are certified child
safety seat installers; team members would assist with fitting station events throughout Washington County. The Tigard
Police Department is devoted to the Blitz campaigns and distributes a media release about the campaigns to the
737-3518(7/13) Page of The Way To Go.
FFY Agreements and Assurances
Failure to comply with applicable Federal statutes, replaced on or after July 1, 1976,at all pedestrian crosswalks
regulations and directives may subject State officials to (23 USC 402(b)(1)(D));
civil or criminal penalties and/or place the State in a high
risk grantee status in accordance with 49 CFR §18.12. The State will implement activities in support of national
highway safety goals to reduce motor vehicle related fatalities
Each fiscal year the State will sign these Certifications that also reflect the primary data-related crash factors within
and Assurances that the State complies with all the State as identified by the State highway safety planning
applicable Federal statutes, regulations,and directives in process, including:
effect with respect to the periods for which it receives
grant funding. Applicable provisions include, but not o National law enforcement mobilizations and high-
limited to,the following: visibility law enforcement mobilizations,
0 23 U.S.C. Chapter 4-Highway Safety Act of o Sustained enforcement of statutes addressing
1966,as amended; impaired driving,occupant protection, and driving in
excess of posted speed limits,
0 49 CFR Part 18-Uniform Administrative
Requirements for Grants and Cooperative o An annual statewide safety belt use survey in
Agreements to State and Local Governments accordance with criteria established by the Secretary
for the measurement of State safety belt use rates to
0 23 CFR Chapter II-(§§1200, 1205, 1206, 1250, ensure that the measurements are accurate and
1251,&1252) Regulations governing highway representative,
safety programs
o Development of statewide data systems to provide
o NHTSA Order 462-6C-Matching Rates for State timely and effective data analysis to support allocation
and Community Highway Safety Programs of highway safety resources.
o Highway Safety Grant Funding Policy for Field- o Coordination of its highway safety plan,data
Administered Grants collection,and information systems with the State
strategic highway safety plan (as defined in section
Certifications and Assurances 148)(a)).
Section 402 Requirements fas amended by Pub.L 112- (23 USC 402(b)(1)(F));
11111)
The Governor is responsible for the administration of the The State shall actively encourage all relevant law enforcement
agencies in the State to follow the guidelines established for
State highway safety program through a State highway vehicular pursuits issued by the International Association of
safety agency which has adequate powers and is suitably Chiefs of Police that are currently in effect. (23 USC 402(j)).
equipped and organized (as evidenced by appropriate
oversight procedures governing such areas as Cash drawdowns will be initiated only when actually needed for
procurement,financial administration,and the use, disbursement.49 CFR 18.20
management,and disposition of equipment)to carry out
the program (23 USC 402(b) (1)(A)); Cash disbursements and balances will be reported in a timely
manner as required by NHTSA.49 CFR 18.21.
The political subdivisions of this State are authorized,as
part of the State highway safety program,to carry out The same standards of timing and amount, including the
within their jurisdictions local highway safety programs reporting of cash disbursement and balances,will be imposed
which have been approved by the Governor and are in upon any secondary recipient organizations.49 CFR 18.41.
accordance with the uniform guidelines promulgated by
the Secretary of Transportation(23 USC 402(b)(1)(B)); Failure to adhere to these provisions may result in the
termination of drawdown privileges.
At least 40 per cent of all Federal funds apportioned to
this State under 23 USC 402 for this fiscal year will be The State has submitted appropriate documentation for review
expended by or for the benefit of the political subdivision to the single point of contact designated by the Governor to
of the State in carrying out local highway safety programs review Federal programs,as required by Executive Order
(23 USC 402(b)(1)(C)), unless this requirement is waived 12372(Intergovernmental Review of Federal Programs);
in writing; Equipment acquired under this agreement for use in highway
This State's highway safety program provides adequate safety program areas shall be used and kept in operation for
and reasonable access for the safe and convenient highway safety purposes by the State;or the State, by formal
movement of physically handicapped persons, including agreement with appropriate officials of a political subdivision
those in wheelchairs,across curbs constructed or or State agency,shall cause such equipment to be used and
(Revised 08/2/2012) Page 1
kept in operation for highway safety purposes(23 CFR §§ 1681-1683,and 1685-1686),which prohibits
1200.21); discrimination on the basis of sex;(c)Section 504 of the
Rehabilitation Act of 1973,as amended (29 U.S.C. §794) and
The State will comply with all applicable State the Americans with Disabilities Act of 1990(42 USC§ 12101,
procurement procedures and will maintain a financial et seq.;PL 101-336),which prohibits discrimination on the
management system that complies with the minimum basis of disabilities(and 49 CFR Part 27);(d)the Age
requirements of 49 CFR 18.20; Discrimination Act of 1975,as amended (42U.S.C.§§ 6101-
6107),which prohibits discrimination on the basis of age;(e)
Federal Funding Accountability and Transparency Act the Drug Abuse Office and Treatment Act of 1972 (P.L.92-
(FFATA) 255),as amended, relating to nondiscrimination on the basis
of drug abuse;(f)the comprehensive Alcohol Abuse and
The State will comply with FFATA guidance,OMB Alcoholism Prevention,Treatment and Rehabilitation Act of
Guidance on FFATA Subward and Executive 1970(P.L.91-616),as amended, relatingto nondiscrimination
Compensation Reporting August 27,2010, on the basis of alcohol abuse of alcoholism;(g) §§523 and
(htti)s7//www.fsrs.gQvZdocuinents/OMB Guidance on FF 527 of the Public Health Service Act of 1912 (42 U.S.C. §§
ATA Subaward and Executive Compensation Reporting 290 dd-3 and 290 ee-3),as amended, relating to
08272010.pdf) by reporting to FSRS.gov for each sub- confidentiality of alcohol and drug abuse patient records;(h)
grant awarded: Title VIII of the Civil Rights Act of 1968(42 U.S.C. §§3601 et
seq.),as amended, relating to nondiscrimination in the sale,
• Name of the entity receiving the award; rental or financing of housing;(i)any other nondiscrimination
• Amount of the award; provisions in the specific statute(s)under which application for
• Information on the award including transaction Federal assistance is being made;The Civil Rights Restoration
type,funding agency,the North American Act of 1987,which provides that any portion of a state or local
Industry Classification System code or Catalog of entity receiving federal funds will obligate all programs or
Federal Domestic Assistance number(where activities of that entity to comply with these civil rights laws;
applicable),program source; and, (k)the requirements of any other nondiscrimination
• Location of the entity receiving the award and the statute(s)which may apply to the application.
primary location of performance under the
award, including the city,State,congressional The Drug-free Workplace Act of 1988(41 U.S.C.702:):
district,and country; and an award title
descriptive of the purpose of each funding action; The State will provide a drug-free workplace by:
• A unique identifier(DUNS);
The names and total compensation of the five a. Publishing a statement notifying employees that the
• most highly compensated officers of the entity if- unlawful manufacture,distribution,dispensing,possession
of the entity receiving the award and of the or use of a controlled substance is prohibited in the
grantee's workplace and specifying the actions that will be
parent entity of the recipient,should the entity be taken against employees for violation of such prohibition;
owned by another entity;
(i)the entity in the preceding fiscal year b. Establishing a drug-free awareness program to inform
employees about:
received
(I)80 percent or more of its annual gross 1. The dangers of drug abuse in the workplace.
revenues in Federal awards;and(II)
$25,000,000 or more in annual gross 2, The grantee's policy of maintaining a drug-free
revenues from Federal awards;and(ii)the workplace.
public does not have access to information
about the compensation of the senior 3. Any available drug counseling, rehabilitation,and
executives of the entity through periodic employee assistance programs.
reports filed under section 13(a)or 15(d)of
the Securities Exchange Act of 1934(15 U.S.C. 4. The penalties that may be imposed upon employees
78m(a),78o(d))or section 6104 of the Internal for drug violations occurring in the workplace.
Revenue Code of 1986;
c. Making it a requirement that each employee engaged in
• Other relevant information specified by OMB the performance of the grant be given a copy of the
guidance. statement required by paragraph(a).
The State highway safety agency will comply with all d. Notifying the employee in the statement required by
Federal statutes and implementing regulations relating to paragraph(a)that,as a condition of employment under
nondiscrimination.These include but are not limited to: the grant,the employee will -
(a)Title VI of the Civil Rights Act of 1964(P.L.88-352)
which prohibits discrimination on the basis of race,color 1. Abide by the terms of the statement.
or national origin (and 49 CFR Part 21); (b)Title IX of the
Education Amendments of 1972,as amended (20 U.S.C.
(Revised 08/2/2012) Page 2
2. Notify the employer of any criminal drug statute 1. No Federal appropriated funds have been paid or will be
conviction for a violation occurring in the paid, by or on behalf of the undersigned,to any person for
workplace no later than five days after such influencing or attempting to influence an officer or
conviction. employee of any agency,a Member of Congress,an officer
or employee of Congress,or an employee of a Member of
e. Notifying the agency within ten days after receiving Congress in connection with the awarding of any Federal
notice under subparagraph(d)(2)from an employee contract,the making of any Federal grant,the making of
or otherwise receiving actual notice of such any Federal loan,the entering into of any cooperative
conviction. agreement,and the extension,continuation,renewal,
amendment,or modification of any Federal contract,
f. Taking one of the following actions,within 30 days of grant, loan,or cooperative agreement.
receiving notice under subparagraph (d)(2),with
respect to any employee who is so convicted - 2. If any funds other than Federal appropriated funds have
been paid or will be paid to any person for influencing or
1. Taking appropriate personnel action against such attempting to influence an officer or employee of any
an employee, up to and including termination. agency,a Member of Congress,an officer or employee of
Congress,or an employee of a Member of Congress in
2. Requiring such employee to participate connection with this Federal contract,grant, loan,or
satisfactorily in a drug abuse assistance or cooperative agreement,the undersigned shall complete
rehabilitation program approved for such and submit Standard Form-LLL,"Disclosure Form to Report
purposes by a Federal,State,or local health, law Lobbying,"in accordance with its instructions.
enforcement,or other appropriate agency.
3. The undersigned shall require that the language of this
g. Making a good faith effort to continue to maintain a certification be included in the award documents for all
drug-free workplace through implementation of sub-award at all tiers(including subcontracts,subgrants,
paragraphs(a),(b), (c), (d),(e),and (f)above. and contracts under grant, loans, and cooperative
agreements)and that all subrecipients shall certify and
Buy America Act disclose accordingly.
The State will comply with the provisions of the Buy This certification is a material representation of fact upon
America Act(49 U.S.C. 53230))which contains the which reliance was placed when this transaction was made or
following requirements: entered into. Submission of this certification is a prerequisite
for making or entering into this transaction imposed by section
Only steel,iron and manufactured products produced in 1352,title 31, U.S.Code.Any person who fails to file the
the United States may be purchased with Federal funds required certification shall be subject to a civil penalty of not
unless the Secretary of Transportation determines that less than$10,000 and not more than $100,000 for each such
such domestic purchases would be inconsistent with the failure.
public interest;that such materials are not reasonably
available and of a satisfactory quality;or that inclusion of Restriction on State LobbvinE
domestic materials will increase the cost of the overall
project contract by more than 25 percent.Clear None of the funds under this program will be used for any
justification for the purchase of non-domestic items must activity specifically designed to urge or influence a State or
be in the form of a waiver request submitted to and local Iegislatorto favor or oppose the adoption of any specific
approved by the Secretary of Transportation. legislative proposal pending before any State or local
legislative body.Such activities include both direct and indirect
Political Activity(Hatch Act) (e.g.,"grassroots") lobbying activities,with one exception.This
does not preclude a State official whose salary is supported
The State will comply, as applicable,with provisions of the with NHTSA funds from engaging in direct communications
Hatch Act(5 U.S.C. §§1501-1508 and 7324-7328)which with State or local legislative officials, in accordance with
limit the political activities of employees whose principal customary State practice, even if such communications urge
employment activities are funded in whole or in part with legislative officials to favor or oppose the adoption of a specific
Federal funds. pending legislative proposal.
Certification Regarding Federal LobbyinE Certification Regarding Debarment and Suspension
Certification for Contracts,Grants, Loans,and Instructions for Primary Certification
Cooperative Agreements
1. By signing and submitting this proposal,the prospective
The undersigned certifies,to the best of his or her primary participant is providingthe certification set out
knowledge and belief,that: below.
(Revised 08/2/2012) Page 3
2. The inability of a person to provide the certification 8. A participant in a covered transaction may rely upon a
required below will not necessarily result in denial of certification of a prospective participant in a lower tier
participation in this covered transaction.The covered transaction that it is not proposed for debarment
prospective participant shall submit an explanation of under 48 CFR Part 9,subpart 9.4,debarred,suspended,
why it cannot provide the certification set out below. ineligible, or voluntarily excluded from the covered
The certification or explanation will be considered in transaction, unless it knows that the certification is
connection with the department or agency's erroneous.A participant may decide the method and
determination whether to enter into this transaction. frequency by which it determines the eligibility of its
However,failure of the prospective primary principals. Each participant may, but is not required to,
participant to furnish a certification or an explanation check the list of Parties Excluded from Federal
shall disqualify such person from participation in this Procurement and Non-procurement Programs.
transaction.
9. Nothing contained in the foregoing shall be construed to
3. The certification in this clause is a material require establishment of a system of records in order to
representation of fact upon which reliance was render in good faith the certification required by this
placed when the department or agency determined to clause.The knowledge and information of a participant is
enter into this transaction.If it is later determined not required to exceed that which is normally possessed
that the prospective primary participant knowingly by a prudent person in the ordinary course of business
rendered an erroneous certification, in addition to dealings.
other remedies available to the Federal Government,
the department or agency may terminate this 10. Except for transactions authorized under paragraph 6 of
transaction for cause or default. these instructions, if a participant in a covered transaction
knowingly enters into a lower tier covered transaction with
4. The prospective primary participant shall provide a person who is proposed for debarment under 48 CFR
immediate written notice to the department or Part 9,subpart 9.4,suspended,debarred,ineligible,or
agency to which this proposal is submitted if at any voluntarily excluded from participation in this transaction,
time the prospective primary participant learns its in addition to other remedies available to the Federal
certification was erroneous when submitted or has Government,the department or agency may terminate this
become erroneous by reason of changed transaction for cause or default.
circumstances.
Certification Regarding Debarment Suspension and Other
5. The terms covered transaction, debarred,suspended, Responsibility Matters-Primary Covered Transactions
ineligible,lower tier covered transaction,participant,
person,primary covered transaction,principal, 1. The prospective primary participant certifies to the best of
proposal,and voluntarily excluded,as used in this its knowledge and belief,that its principals:
clause, have the meaning set out in the Definitions
and coverage sections of 49 CFR Part 29.You may a. Are not presently debarred,suspended, proposed for
contact the department or agency to which this debarment, declared ineligible,or voluntarily excluded
proposal is being submitted for assistance in by any Federal department or agency;
obtaining a copy of those regulations. b. Have not within a three-year period preceding this
proposal been convicted of or had a civil judgment
6. The prospective primary participant agrees by rendered against them for commission of fraud or a
submitting this proposal that,should the proposed criminal offense in connection with obtaining,
covered transaction be entered into, it shall not attempting to obtain,or performing a public(Federal,
knowingly enter into any lower tier covered State or local)transaction or contract under a public
transaction with a person who is proposed for transaction;violation of Federal or State antitrust
debarment under 48 CFR Part 9,subpart 9.4, statutes or commission of embezzlement,theft,
debarred,suspended,declared ineligible,or forgery, bribery,falsification or destruction of record,
voluntarily excluded from participation in this covered making false statements,or receiving stolen property;
transaction, unless authorized by the department or c. Are not presently indicted for or otherwise criminally or
agency entering into this transaction. civilly charged by a governmental entity(Federal,State
or Local)with commission of any of the offenses
7. The prospective primary participant further agrees by enumerated in paragraph (1)(b)of this certification;
submittingthis proposal that it will include the clause and
titled "Certification Regarding Debarment, d. Have not within a three-year period preceding this
Suspension, Ineligibility and Voluntary Exclusion- application/proposal had one or more public
Lower Tier Covered Transaction,"provided by the transactions(Federal,State,or local)terminated for
department or agency entering into this covered cause or default.
transaction,without modification, in all lower tier
covered transactions and in all solicitations for lower 2. Where the prospective primary participant is unable to
tier covered transactions. certify to any of the Statements in this certification,such
(Revised 08/2/2012) Page 4
prospective participant shall attach an explanation to excluded from the covered transaction, unless it knows
this proposal. that the certification is erroneous.A participant may
decide the method and frequency by which it determines
Instructions for Lower Tier Certification the eligibility of its principals. Each participant may, but is
not required to,check the List of Parties Excluded from
1. By signing and submitting this proposal,the Federal Procurement and Non-procurement Programs.
prospective lower tier participant is providing the
certification set out below. 8. Nothing contained in the foregoing shall be construed to
require establishment of a system of records in order to
2. The certification in this clause is a material render in good faith the certification required by this
representation of fact upon which reliance was clause.The knowledge and information of a participant is
placed when this transaction was entered into. If it is not required to exceed that which is normally possessed
later determined that the prospective lower tier by a prudent person in the ordinary course of business
participant knowingly rendered an erroneous dealings.
certification, in addition to other remedies available
to the Federal government,the department or agency 9. Except for transactions authorized under paragraph 5 of
with which this transaction originated may pursue these instructions,if a participant in a covered transaction
available remedies, including suspension and/or knowingly enters into a lower tier covered transaction with
debarment. a person who is proposed for debarment under 48 CFR
Part 9,subpart 9.4,suspended,debarred,ineligible,or
3. The prospective lower tier participant shall provide voluntarily excluded from participation in this transaction,
immediate written notice to the person to which this in addition to other remedies available to the Federal
proposal is submitted if at any time the prospective government,the department or agency with which this
lower tier participant learns that its certification was transaction originated may pursue available remedies,
erroneous when submitted or has become erroneous including suspension and/or debarment.
by reason of changed circumstances.
Certification Regarding Debarment Suspension,Ineligibility
4. The terms covered transaction, debarred,suspended, and Voluntary Exclusion-Lower Tier Covered Transactions:
ineligible, lower tier covered transaction,participant,
person,primary covered transaction,principal, 1. The prospective lower tier participant certifies,by
proposal, and voluntarily excluded,as used in this submission of this proposal,that neither it nor its
clause, have the meanings set out in the Definition principals is presently debarred,suspended, proposed for
and Coverage sections of 49 CFR Part 29.You may debarment,declared ineligible,or voluntarily excluded
contact the person to whom this proposal is from participation in this transaction by any Federal
submitted for assistance in obtaining a copy of those department or agency.
regulations.
2. Where the prospective lower tier participant is unable to
5. The prospective lower tier participant agrees by certify to any of the statements in this certification,such
submitting this proposal that,should the proposed prospective participant shall attach an explanation to this
covered transaction be entered into, it shall not proposal.
knowingly enter into any lower tier covered
transaction with a person who is proposed for Policy to Ban Text Messaging While Driving
debarment under 48 CFR Part 9,subpart 9.4,
debarred,suspended, declared ineligible,or In accordance with Executive Order 13513, Federal Leadership
voluntarily excluded from participation in this covered On Reducing Text Messaging While Driving, and DOT Order
transaction, unless authorized by the department or 3902.10,Text Messaging While Driving,States are encouraged
agency with which this transaction originated. to:
6. The prospective lower tier participant further agrees 1. Adopt and enforce workplace safety policies to decrease
by submittingthis proposal that is it will include the crashed caused by distracted driving including policies to
clause titled "Certification Regarding Debarment, ban text messaging while driving—
Suspension, Ineligibility and Voluntary Exclusion- a. Company-owned or-rented vehicles,or Government-
Lower Tier Covered Transaction,"without owned, leased or rented vehicles;or
modification, in all lower tier covered transactions b. Privately-owned when on official Government business
and in all solicitations for lower tier covered or when performing any work on or behalf of the
transactions.(See below) Government.
7. A participant in a covered transaction may rely upon a 2. Conduct workplace safety initiatives in a manner
certification of a prospective participant in a lower commensurate with the size of the business,such as -
tier covered transaction that it is not proposed for a. Establishment of new rules and programs or re-
debarment under 48 CFR Part 9,subpart 9.4, evaluation of existing programs to prohibit text
debarred,suspended,ineligible,or voluntarily messaging while driving; and
(Revised 08/2/2012) Page 5
b. Education,awareness,and other outreach to copy of all Single Audit Reports covering the time period of the
employees about the safety risks associated with grant award as soon as they become available. Federal funds
texting while driving. received have the following Catalog of Federal Domestic
Assistance(CFDA)numbers: 20.205, Highway Planning and
Environmental Impact Construction,20.600,State and Community Highway Safety;
20.601,Alcohol Impaired Driving Countermeasures Incentive
The Governor's Representative for Highway Safety has Grants;20.602,Occupant Protection Incentive Grants;
reviewed the State's Fiscal Year highway safety planning 20.608,Minimum Penalties for Repeat Offenders for Driving
document and hereby declares that no significant While Intoxicated;20.609,Safety Belt Performance Grants;
environmental impact will result from implementing this 20.610,State Traffic Safety Information System Improvement
Highway Safety Plan. If, under a future revision,this Plan Grants;20.611, Incentive Grant Program to Prohibit Racial
will be modified in such a manner that a project would be Profiling; 20.612, Incentive Grant Program to Increase
instituted that could affect environmental quality to the Motorcyclist Safety;and 20.613, Child Safety and Child
extent that a review and statement would be necessary, Booster Seats Incentive Grants.
this office is prepared to take the action necessary to
comply with the National Environmental Policy Act of The grantee shall reimburse TSD within 30 days for any
1969(42 USC 4321 et seq.)and the implementing ineligible or unauthorized expenditures as determined by a
regulations of the Council on Environmental Quality(40 state or federal review for which grant funds have been
CFR Parts 1500-1517). claimed and payment received.
The grantee,its subcontractors, if any,and all employers
Oregon General Grant Regulations working under this agreement are subject employers under the
Oregon Workers'Compensation Law and shall comply with ORS
Any federal funds committed shall be subject to the 656.017,which requires them to provide workers'
continuation of funds made available to TSD by the compensation coverage for all their subject workers.
National Highway Traffic Safety Administration (NHTSA)
and the Federal Highway Administration (FHWA)by The grantee shall make purchases of any equipment,
statute or administrative action. Projects are funded for materials,or services pursuant to this Agreement under
the federal fiscal year,which is October 1 through procedures consistent with those outlined in ORS Chapter
September 30 or the state fiscal year,which is July 1 279A,2798 and 279C;the Attorney General Model
through June 30. Typical grants are for one year but may Procurement Rules,OAR Chapter 137, Divisions 46,47,48
be continued for up to two additional years. Public and 49,as may have been modified by a contracting agency
information and education projects are continued pursuant to ORS 279A.065. [The Oregon Department of
indefinitely. Administrative Services Administrative Rules(Oregon
Administrative Rules,Chapter 125:and Oregon State Law,ORS
The grantee shall ensure compliance with 49 CFR Part Chapter 279)].
18.42 which addresses retention and access re-
quirements for grant-related records. The State,the The grantee shall defend,save and hold harmless the State of
federal grantor agency and the Comptroller General of the Oregon, including the Oregon Transportation Commission,the
United States,or any of their authorized representatives, Oregon Transportation Safety Committee,the Department of
shall have the right of access to any books,documents, Transportation,the Transportation Safety Division,and their
papers or other records of the grantee which are pertinent members, officers,agents,and employees from all claims,
to the grant. These records must be retained for a period suits,or actions of whatever nature arising out of the
of six years starting on the date the grantee submits its performance of this Agreement,except for claims arising out of
final request for reimbursement for this grant. the negligent acts or omissions of the State of Oregon,its
employees,or representatives. This provision is subject to the
Any obligation of grant funds extends only to those costs limitations, if applicable,set forth in Article XI,Section 10 of
incurred by the grantee after"Authorization to Proceed" the Oregon Constitution and in the Oregon Tort Claims Act,ORS
for the particular part of the program involving costs. 30.260 to 30.300.
Grant funds shall not be used for activities previously Prolect Director's Responsibilities
carried out with the grantee's own resources
(supplanting). The Project Director is responsible for fulfilling this Agreement
and establishing and maintaining procedures that will ensure
Income earned through services conducted through the the effective administration of the project objectives. The
project should be used to offset the cost of the project Project Director shall:
and be included in the Budget and Cost Summary.
1. Establish or use an accounting system that conforms to
The grantee shall ensure that all grant-related ex- generally accepted accounting principles,and ensure that
penditures are included as a part of entity-wide audits source documents are developed which will reliably
conducted in accordance with the Single Audit Act of account for the funds expended.
1984(31 USC 7561-7). The grantee shall provide TSD a
(Revised 08/2/2012) Page 6
2. Maintain copies of job descriptions and resumes of Project Revision
persons hired for all project-related positions which
are funded at 0.25 FTE or more. 1. Any proposed changes in the project objectives,key
project personnel,time period,budget,or mailing address
3. Maintain records showing actual hours utilized in must be requested in writing,and receive approval by TSD.
project-related activity by all grant-funded personnel A Grant Adjustment Form will be signed by both TSD and
and by all other staff personnel or volunteers whose the grantee.
time is used as in-kind match.
2. Anytime extension in the project period must be
4. Complete a Quarterly Highway Safety Project Report. requested at least six weeks prior to the end of the project
Each report must be signed by the Project Director or period and approved by the federal grantor agency if the
the Designated Alternate,and submitted to TSD by end of federal fiscal year is involved.
the tenth of the month following the close of each
calendar quarter for the duration of the grant period. Contracts and Other Service Agreements
The Designated Alternate is an individual who is given
the authority to sign Quarterly Highway Safety Project 1. Any contracts or other service agreements that are
Reports for the Project Director, in the event he/she entered into by the grantee as part of this project shall be
is unable to sign due to circumstances beyond reviewed and approved by TSD to determine whether the
his/her control. work to be accomplished is consistent with the objectives
of the project,and whether the provisions of paragraphs 2
5. Submit a Claim for Reimbursement within 35 days of through 4 of this section are considered.
the end of the calendar quarter in which expenses
were incurred,using the form provided by TSD as 2. All contracts awarded by the grantee shall include the
follows: provision that any subcontracts include all provisions
a. Copies of invoices and/or receipts for all stated in this section or the provision that no subcontracts
specified items must be submitted to TSD upon shall be awarded.
request with the Claim for Reimbursement;
b. claims may be submitted monthly,and must be 3. The grantee shall ensure that each contractor adhere to
submitted at least quarterly;and, applicable requirements established for the grant and that
c. claims must be signed by the Project Director or each contract include provisions for the following:
the Designated Alternate(duplicated signatures a. Administrative,contractual, or legal remedies in
will not be accepted). instances where contractors violate or breach contract
terms,and provide for such sanctions and penalties
6. Prepare a Project Directors Final Evaluation Report in as may be appropriate;
accordance with the Evaluation Plan described in the b. mandatory standards and policies relating to energy
grant document. The report will be no more than ten efficiency which are contained in the state energy
pages and will include the following elements: conservation plan issued in compliance with the
a. A summary of the project including problems ad- Energy Policy and Conservation Act (PL 94-163);
dressed, objectives, major activities, and accom- c. access by the grantee,the state,the federal grantor
plishments as they relate to the objectives; agency,the Comptroller General of the United States,
b. a summary of the costs of the project including or any of their duly authorized representatives,to any
amount paid by TSD,funded agency, other books,documents, papers, and records of the
agencies,and private sources. The amount of contractor which are directly pertinent to that specific
volunteer time should be identified; contract,for the purpose of making audit,
c. discussion of implementation process so that examination,excerpts, and transcriptions. Grantees
other agencies implementing similar projects can shall require contractors to maintain all required
learn from your experiences; What went as records for three years after grantees make final
planned? What didn't work as expected? What payments and all other pending matters are closed;
important elements made the project successful d. notice of grantor agency requirements and regulations
or not as successful as expected? pertaining to reporting, requirements and regulations
d. responses to Evaluation Questions. List each pertaining to patent rights with respect to any
question and answer(refer to Data Table);and, discovery or invention which arises or is developed in
e. completed Data Table. the course of or under such contract,and
requirements and regulations pertaining to copyrights
The Project Director's Final Evaluation Report must be and rights in data.
submitted within 35 days following the last day of the
grant period. 4. Where applicable, contracts shall include the
following provisions:
a. Termination for cause and for convenience by the
grantee including the manner by which it will be
effected and the basis for the settlement
(Contracts in excess of$10,000);
(Revised 08/2/2012) Page 7
b. Compliance with Executive Order 11246 of description, manufacturer's identification number and cost
September 24, 1965 entitled"Equal Employment of each item will be attached to the signed agreement. All
Opportunity,"as amended by Executive Order equipment should be identified with a property
11.375 of October 13, 1967 and supplemented identification number.
in Dept. of Labor regulations(41 CFR Part 60)
(Contracts in excess of$10,000); 2. All material and equipment purchased shall be produced
c. Compliance with sections 103 and 107 of the in the United States in accordance with Section 165 of the
Contract Work Hours and Safety Standards Act Surface Transportation Assistance Act of 1982(Pub.L.97-
(40 USC 327-330)as supplemented by Dept.of 424;96 Stat.2097) unless the Secretary of
Labor regulations(29 CFR Part 5) (Contracts in Transportation has determined under Section 165 that it
excess of$2,500); is appropriate to waive this agreement.
d. Bidders, proposers, and applicants must certify
that neitherthey nor their principals is presently 3. Material and equipment shall be used in the program or
debarred,suspended,proposed for debarment, activity for which it was acquired as long as needed,
declared ineligible,or voluntarily excluded from whether or not the project continues to be supported by
participating in this transaction by any federal grant funds. Ownership of equipment acquired with grant
agency or department (Contracts in excess of funds shall be vested with the grantee. Costs incurred for
$25,000). maintenance, repairs, updating,or support of such
equipment shall be borne by the grantee.
Travel
4. If any material or equipment ceases to be used in project
1. The grantee shall keep a record of all significant activities,the grantee agrees to promptly notify TSD. In
travel. In-state trips outside the grantee's jurisdiction such event,TSD may direct the grantee to transfer, return,
should be summarized on Quarterly Highway Safety keep,or otherwise dispose of the equipment.
Project Reports.
Termination
2. All out-of-state travel must be pre-approved by TSD.
To receive authorization,the trip must be detailed on 1. TSD may terminate this Agreement for convenience in
the project budget or requested in a grant whole or in part whenever:
adjustment. Reports on out-of-state trips shall be a. The requisite state and/or federal funding becomes
summarized on Quarterly Highway Safety Program unavailable through failure of appropriation or
Report. otherwise;or,
b. The requisite local funding to continue this project
3. Reimbursement will only be authorized for travel of becomes unavailable to grantee;or,
persons employed by the grantee in project-related c. Both parties agree that continuation of the project
activities unless prior written approval is granted by would not produce results commensurate with the
TSD. further expenditure of funds.
Development of Printed or Production Materials 2. TSD may, by written notice to grantee,terminate this
Agreement for any of the following reasons:
1. The grantee shall provide TSD with draft copies of all a. The grantee takes any action pertaining to this
materials developed using grant funds. TSD may Agreement without the approval of TSD and which
suggest revisions and must approve production. under the provisions of this agreement would have
required the approval of TSD;or,
2. All brochures;course,workshop and conference an- b. The commencement, prosecution,or timely
nouncements;and other materials that are completion of the project by grantee is,for any reason,
developed and/or printed using grant funds shall rendered improbable, impossible,or illegal;or,
include a statement crediting TSD and federal c. The grantee is in default under any provision of this
participation. Agreement.
3. Materials produced through this project shall be Conditions of Project Approval
provided to TSD for its use and distribution and may
not be sold for profit by either the grantee or any Actions taken by the Oregon Transportation Safety Committee,
other party. if any, regarding conditions under which this project is
approved are given in the Conditions of Approval. The grantee
Equipment Purchased with Grant Funds agrees to follow these conditions in implementing the project.
1. A Residual Value Agreement shall be completed and
submitted to TSD if grant funds are used in whole or
in part to acquire any single item equipment costing
$5,000 or more or at TSD discretion. A copy of the
original vendor's invoice indicating quantity,
(Revised 08/2/2012) Page 8
Contract Provisions and Signatures This Agreement shall be executed by those officials authorized
to execute this Agreement on the grantee's behalf. In the
It is understood and agreed that the grantee shall comply event grantee's governing body delegates signature of the
with all federal,state,and local laws, regulations,or Agreement,grantee shall attach to this Agreement a copy of
ordinances applicable to this agreement and that this the motion or resolution which authorizes said officials to
Agreement is contingent upon grantee complying with execute this Agreement, and shall also certify its authenticity.
such requirements.
(Revised 08/2/2012) Page 9
Agreements and Assurances
Project Director: TO BE COMPLETED BY TSD
David Frisendahl
Project No.: M 1 HVE-1 4-46-03 JJJ
Z'fzco- �
ignature Title: Tigard PD Safety Belt Overtime Enforcement
Date
Designated Alternate: OTC approval date: June 19, 2013
Total project cost: $8,750
TSD grant funds: $7,000
Signature
All matching funds: $1,750
Date Matching source(s): Local
Authorizing Government Official:
Erick Boothby, Lt.
Authority to approve modifications to this
Si nat agreement.is delegated to the Transportation
9 Safety Division gr manager.
&A
Date
Man ation Safety Division Oregon
ment f a sportation
IL?
Date
OREGON DEPARTMENT OF TRANSPORTATION
Transportation Safety Division
r
' Reports And Claims Due Dates
p Transporlbfibn Saibfy
C` OrePen DPParlmeni al Tron4Parenlien
Project No.: M 1 HVE-14-46-03 JJJ
Project Title: Tigard PD Safety Belt Overtime Enforcement
Calendar: FEDERAL FISCAL YEAR 2014 Grant Year: 2014
Reports/Claims Due Dates
First Quarter( October 01 - December 31 )
Claims for Reimbursement Wednesday, February 5, 2014
Second Quarter( January 01 - March 31 )
Claims for Reimbursement Monday, May 5, 2014
Third Quarter( April 01 -June 30 )
Claims for Reimbursement Tuesday, August 5, 2014
Fourth Quarter(July 01 -September 30 )
Claims for Reimbursement Wednesday, November 5, 2014
Project Evaluation Report ( October 01 -September 30 )
Evaluation Report Due Wednesday, November 5, 2014
laims for Reimbursement( October 01 -September 30 )
Final Claims Wednesday, November 5, 2014
The undersigned agree that the information included above has been reviewed and the required due dates and final
deadlines are understood.
Project Director's Name: Lt. David isend I
Project Director's Signature: ate:
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