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Application Uploads/Authorized Applicant Letter Template-palm desert.pdf Authorized Applicant Letter Template
This is an optional template that Energy Efficiency and Conservation Block Grant Program applicants can use to complete the Authorized Applicant Assurance Letter. Use of this template
is not required, and applicants may choose to submit this letter in other formats. DATE Authorized Applicant Assurance Letter Department of Energy Reference: Energy Efficiency
and Conservation Block Grant - DE- FOA-0002882 CDFA Number 81.128 To Whom It May Concern: Please consider this letter as my certification that [NAME and TITLE]
has been appointed to represent [GOVERNMENT ENTITY] and is the contact for [GOVERNMENT ENTITY, RECEIVING AGENCY], which is authorized to receive funds, and implement the Energy Efficiency
and Conservation Block Grant Program for the above referenced grant. The contact information is below: NAME: EMAIL: PHONE: Sincerely, [AUTHORIZED APPLICANT]
Application Uploads/Davis-Bacon Assurance Letter Template-palm desert.pdf Davis-Bacon Assurance Letter Template
This is an optional template that Energy Efficiency and Conservation Block Grant Program applicants can use to complete the Davis-Bacon Act Assurance Letter. Use of this template is
not required, and applicants may choose to submit this letter in other formats. DATE Davis-Bacon Assurance Letter U.S. Department of Energy Reference: Energy Efficiency
and Conservation Block Grant – DE- FOA-0002882 – CFDA No. 81.128 To Whom It May Concern, Please consider this letter written assurance that all laborers and
mechanics on projects funded directly by or assisted in whole or in part by and through funding appropriated by the Infrastructure, Investment, and Jobs Act will be paid wages at rates
not less than those prevailing on projects of a character similar in the locality as determined by Subchapter IV of Chapter 31 of Title 40, United States Code (Davis-Bacon Act). Sincerely,
[AUTHORIZED APPLICANT]
Application Uploads/EECS Template- palm desert.pdf Energy Efficiency and Conservation Strategy Template for Local Governments
1 EECBG Program: Energy Efficiency and Conservation Strategy Template for Local Governments Local governments must submit a proposed Energy Efficiency and Conservation Strategy (EECS)
to the Department of Energy (DOE) to meet the statutory requirements for the Energy Efficiency and Conservation Block Grant (EECBG) Program. The proposed EECS must include the information
contained in Part A of this template. Local governments may use this streamlined EECS Template to meet the requirement, but the template is not required. If a local government chooses
to submit an EECS using an alternative format, the information outlined in Part A must be included in the submission. Local governments have the option of submitting their EECS at
the time of application or no later than 1 year after the effective date of the award. If the latter option is chosen, the EECS should be a comprehensive strategy that covers, at a
minimum, all items detailed in this template. DOE will provide informational resources and technical assistance to support the development of comprehensive strategies. Local governments
that do not submit an EECS with their application must submit an EECBG Program Activity File with their application and select Activity 1 (Energy Efficiency and Conservation Strategy).
NOTE: All text fields are limited to 2000 characters. Part A: Grantee: Date: (mm/dd/yyyy) UEI Number Program Contact Email: 1) Local governments must include within their proposed
strategy a description of their goals for increased energy efficiency and conservation in the jurisdiction. Does your local government have existing energy efficiency and conservation
or related goals? a. Yes i. What goals do you have? (check all that apply) 1. GHG reduction goal a. Specific goal (e.g., 80% GHG reduced from 1990 levels) b. By what year? (e.g., 2050)
2. Energy use reduction goal a. Specific goal b. By what year? 3. Clean energy use goal a. Specific goal b. By what year? 4. EV adoption goal a. Specific goal b. By what year? 5. Job
creation goal a. Specific goal 2 b. By what year? 6. Job quality goal a. Specify goal b. By what year? 7. Other a. Specific goal b. By what year? b. No, our local government does not
have an existing goal, but we are selecting the following goal as part of our strategy. If you select option 5, you must also select from options 1-4 or option 6 (may select more than
one option). i. Carbon neutrality by 2050 or sooner ii. Reduce energy use by 50% by 2050 or sooner iii. 100% carbon-free energy use by 2050 or sooner iv. 80% EV adoption by 2050 or
sooner v. Pay prevailing wages for all construction and maintenance projects by 2025 vi. Other 2) Does your local government have an existing plan or strategy document (e.g., climate
action plan, energy conservation plan, comprehensive energy plan, etc.) to reduce energy use, increase energy efficiency, reduce emissions, or train workers for high-quality energy
efficiency jobs? a. Yes i. Please attach/submit/link your plan ii. Do you intend to update your plan in the next two years? 1. Yes a. Are you planning to use any of your EECBG Program
funds to update your plan? i. Yes ii. No b. What updates do you intend to make to your plan? b. No i. Please briefly describe your strategy to achieve your goals listed in Question
1 3) Are you planning to use a blueprint (see Section 4.5 of the EECBG Program Formula Grant Application Instructions document for more details)? a. Yes i. Which one(s)? 1. Energy
Planning 2. Energy Efficiency a. Energy Efficiency: Building Audits and Retrofits, including grid interactivity and electrification b. Energy Savings Performance Contracts for Efficiency
& Electrification in Municipal Buildings c. Building Efficiency & Electrification Campaign 3 d. Building Performance Standards for Existing Buildings and Stretch Codes for New Construction
3. Renewables a. Solar (and battery storage) Power Purchase Agreement (PPA) b. Community Solar c. Solarize Campaign d. Renewable Resource Planning for Communities 4. Transportation
a. Electric Vehicles for Municipal Fleets b. EV Charging Infrastructure for the Community 5. Unlocking Sustainable Financing Solutions for Energy Projects and Programs 6. Workforce
Development ii. How does this blueprint help you meet your strategy/goals? b. No i. What category of work do you plan to apply your EECBG Program funds to? (check all that apply) 1.
Strategy development a. Developing goals b. Developing measures to track progress c. Providing annual reporting on goals 2. Technical consultant services to assist in strategy development
3. Building energy audits a. Residential b. Commercial c. Industrial d. Municipal 4. Financial programs a. Loan programs b. Performance contracting programs c. Rebates/grants d. Incentives
e. Other 5. Energy efficiency retrofits a. Residential b. Commercial c. Industrial d. Municipal 6. Energy efficiency and conservation programs for buildings and facilities a. Residential
b. Commercial c. Industrial 4 d. Municipal 7. Transportation Programs a. Electric vehicle planning i. Municipal ii. Communitywide b. Purchasing of electric vehicles c. Installation
of electric vehicle chargers i. Municipal ii. Communitywide d. Use of flex time by employers e. Satellite work centers f. Zoning guidelines or requirements that promote energy efficient
development g. Infrastructure, such as bike lanes and pathways and pedestrian walkways h. Synchronization of traffic signals i. Public transit system improvement investments j. Other
8. Building codes and inspections a. Updating building codes b. Improving enforcement/compliance with building codes c. Building performance standards d. Other 9. Energy distribution
technologies for energy efficiency a. Distributed resources b. District heating and cooling systems c. Other 10. Material conservation programs a. Source reduction b. Recycling c.
Composting d. Sustainable procurement e. Other 11. Reduction and capture of methane and other greenhouse gases generated a. Landfills b. Wastewater treatment facilities c. Other 12.
Traffic signals and street lighting upgrades 13. Renewable energy on government buildings a. Solar b. Wind c. Fuel cells d. Biomass 5 14. Programs for financing, purchasing, and installing
energy efficiency, renewable energy, and zero-emission transportation (and associated infrastructure) 15. Other (requires approval of Secretary) ii. How will your use of funds help
your unit of government meet its strategy/goals? iii. Provide a brief description of your project(s)? 4) Local governments must coordinate and share information with the State in which
the eligible local government is located regarding activities carried out using the grant to maximize the energy efficiency and conservation benefits under the EECBG Program. Have you
coordinated and shared your planned activities with your State? a. Yes i. Please describe how you plan to coordinate with your State 5) Local governments must take into account any
plans for the use of funds by adjacent eligible local governments that receive grants under the EECBG Program. Have you taken into account how adjacent eligible units of local governments
plan to use their funds? a. Yes Part B. 1. Do you plan to collaborate with other eligible units of government? a. Yes, we are going to form a team and apply through a joint application
i. List the names of the units of government 1. Which unit of government is serving as the lead applicant? ii. Please describe what your team plans to work on together b. Yes, we are
going to informally collaborate i. List the names of the units of government ii. Please describe your planned collaboration c. We are not yet sure if we are going to collaborate with
others d. No 2. Are you planning to partner with other organizations including utilities, energy industry and financial companies, community-based organizations, labor unions, and other
non-profit organizations for your project? a. Yes i. Please list your partners b. No 3. Have you engaged local stakeholders (such as utilities, energy industry and financial companies,
community-based organizations, labor unions, and other non-profit organizations) in the development of your plan and/or how you intend to use your EECBG Program allocation? a. Yes b.
No 4. Will this EECBG Program funding help you to access additional sources of funding? a. Yes i. What kind? (Check all that apply) 1. Local government 6 2. State government 3. Federal
government 4. Philanthropic 5. Private sector 6. Other b. No i. Would you like assistance in identifying other sources of funding? 1. Yes 2. No 5. Do you anticipate needing support
for your project development/implementation? a. Yes i. What kind? (check all that apply) 1. Policy, planning and program design 2. Retrofits 3. Engineering and modeling 4. Stakeholder
engagement 5. Program administration and implementation support 6. Outreach, education and advertising 7. Other b. No 6. Do you anticipate the project(s) you use this funding for will
continue after the EECBG Program funding period? a. Yes i. Describe how the project(s) have been designed to ensure that it sustains benefits beyond the EECBG Program funding period
b. No i. What would help you to continue? (check all that apply) 1. Local sustainable financing 2. Public and local political support 3. Staff capacity 4. Other 7. How do you intend
for your project(s) to benefit disadvantaged communities? 1 (check all that apply) a. Benefits include (but are not limited to) measurable direct or indirect investments or positive
project outcomes that achieve or contribute to the following in disadvantaged communities: i. A decrease in energy burden2 ii. A decrease in environmental exposure and burdens iii.
An increase in access to low-cost capital iv. An increase in job quality (including paying prevailing wages for construction and maintenance projects by 2025) 1 Justice40 Initiative
| Department of Energy 2 The Initiative for Energy Justice https://iejusa.org/glossary-and-appendix/#glossary_of_terms 7 v. An increase in clean energy enterprise creation and contracting
(e.g., minorityowned or disadvantaged business enterprises) vi. An increase in clean energy jobs, job pipeline, and job training for individuals from disadvantaged communities vii.
An increase in parity in clean energy technology access and adoption viii. An increase in energy democracy ix. Other 1. Please explain 8. How will your strategy support the goal that
40% of the overall benefits of certain federal investments flow to disadvantaged communities, in line with the Justice40 initiative?
Application Uploads/Lobbying Cert- palm desert.pdf Certifications and Assurances for Use with SF-424
August 2005 U.S. DEPARTMENT OF ENERGY FINANCIAL ASSISTANCE CERTIFICATIONS AND ASSURANCES FOR USE WITH SF 424 Applicant: Solicitation No.: DE- The following certifications
and assurances must be completed and submitted with each application for financial assistance. The name of the person responsible for making the certifications and assurances must
be typed in the signature block on the forms. Certifications Regarding Lobbying; Debarment, Suspension and Other Responsibility Matters; and Drug Free Workplace Requirements
DOE F 1600.5, Assurance of Compliance Nondiscrimination in Federally Assisted Programs CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS;
AND DRUG FREE WORKPLACE REQUIREMENTS Applicants should refer to the regulations cited below to determine the certification to which they are required to attest. Applicants should
also review the instructions for certification included in the regulations before completing this form. Signature of this form provides for compliance with certification requirements
under 10 CFR Part 601 "New Restrictions on Lobbying," 10 CFR Part 606 "Governmentwide Debarment and Suspension (Nonprocurement) and 10 CFR Part 607 “Governmentwide Requirements for
Drug-Free Workplace (Grants)." The certifications shall be treated as a material representation of fact upon which reliance will be placed when the Department of Energy determines to
award the covered transaction, grant, or cooperative agreement. 1. LOBBYING 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 awarding of any Federal contract, the making of any Federal grant, the making
of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, 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 contract, grant, loan, 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 subcontracts, subgrants, and contracts under grants, loans, and cooperative
agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed 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. 2. ADDITIONAL LOBBYING REPRESENTATION
Applicant organizations which are described in section 501(c)(4) of the Internal Revenue Code of 1986 and engage in lobbying activities after December 31, 1995, are not eligible
for the receipt of Federal funds constituting an award, grant, or loan. As set forth in section 3 of the Lobbying Disclosure Act of 1995 as amended, (2 U.S.C. 1602), lobbying activities
are defined broadly to include, among other thins, contacts on behalf of an organization with specified employees of the Executive Branch and Congress with regard to Federal legislative,
regulatory, and program administrative matters. Check the appropriate block: The applicant is an organization described in section 501(c)(4) of the Internal Revenue Code of 1986?
Yes No If you checked “Yes” above, check the appropriate block: The applicant represents that after December 31, 1995 it has has not engaged in any lobbying activities
as defined in the Lobbying Disclosure Act of 1995, as amended. 3. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS (1) The prospective primary participant certifies to the
best of its knowledge and belief, that it and its principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
covered transactions by any Federal department or agency; (b) Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against
them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under
a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery; falsification or destruction of records, making
false statements, or receiving stolen property; (c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with
commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and (d) Have not within a three-year period preceding this application/proposal had one or
more public transactions (Federal, State or local) terminated for cause or default. (2) Where the prospective primary participant is unable to certify to any of the statements in
this certification, such prospective participant shall attach an explanation to this proposal. 4. DRUG-FREE WORKPLACE This certification is required by the Drug-Free Workplace Act
of 1988 (Pub.L. 100-690, Title V, Subtitle D) and is implemented through additions to the Debarment and Suspension regulations, published in the Federal Register on January 31, 1989,
and May 25, 1990. ALTERNATE I (GRANTEES OTHER THAN INDIVIDUALS) (1) The grantee certifies that it will or will continue to provide a drug-free workplace by: (a) Publishing a
statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the grantee's workplace and specifying
the actions that will be taken against employees for violation of such prohibition; (b) Establishing an ongoing drug-free awareness program to inform employees about: (1) The
dangers of drug abuse in the workplace; (2) The grantee's policy of maintaining a drug-free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance programs;
and (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; (c) Making it a requirement that each employee to be engaged in the
performance of the grant be given a copy of the statement required by paragraph (a); (d) Notifying the employee in the statement required by paragraph (a) that, as a condition of
employment under the grant, the employee will: (1) Abide by the terms of the statement; and (2) Notify the employer in writing of his or her conviction for a violation of a criminal
drug statute occurring in the workplace not later than five calendar days after such conviction; (e) Notifying the agency, in writing, within ten calendar days after receiving notice
under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to
every grant officer or other designee on whose grant activity the convicted employee was working, unless the Federal agency has designated a central point for the receipt of such notices.
Notice shall include the identification number(s) of each affected grant; (f) Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph
(d)(2), with respect to any employee who is so convicted: (1) Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements
of the Rehabilitation Act of 1973, as amended; or (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such
purposes by a Federal, State or local health, law enforcement, or other appropriate agency; (g) Making a good faith effort to continue to maintain a drug- free workplace through
implementation of paragraphs (a),(b),(c),(d),(e), and (f). (2) The grantee may insert in the space provided below the site(s) for the performance of work done in connection
with the specific grant: Place of Performance: (Street address, city, county, state, zip code) Check if there are workplaces on file that are not identified
here. ALTERNATE II (GRANTEES WHO ARE INDIVIDUALS) (1) The grantee certifies that, as a condition of the grant, he or she will not engage in the unlawful manufacture, distribution,
dispensing, possession, or use of a controlled substance in conducting any activity with the grant. (2) If convicted of a criminal drug offense resulting from a violation occurring
during the conduct of any grant activity, he or she will report the conviction, in writing, within 10 calendar days of the conviction, to every grant officer or other designee, unless
the Federal agency designates a central point for the receipt of such notices. When notice is made to such a central point, it shall include the identification number(s) of each affected
grant. 5. SIGNATURE As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above certifications. Name of Applicant:
Printed Name and Title of Authorized Representative: SIGNATURE DATE DOE F 1600.5 U.S. Department of Energy OMB
Control No. (06-94) All Other Editions are Obsolete Assurance of Compliance 1910-0400 Nondiscrimination in Federally Assisted Programs OMB Burden Disclosure Statement Public reporting
burden for this collection of information is estimated to average 15 minutes per response, including the 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 this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to Office of Information Resources Management Policy, Plans, and Oversight, Records Management Division, HR422 - GTN, Paperwork
Reduction Project (1900-0400), U.S. Department of Energy, 1000 Independence Avenue, S.W., Washington, DC 20585; and to the Office of Management and Budget (OMB), Paperwork Reduction
Project (1900-0400), Washington, DC 20503. (Hereinafter called the “Applicant”) HEREBY AGREES to comply with Title VI of the Civil Rights Act of 1964 (Pub. L.88-352), Section
16 of the Federal Energy Administration Act of 1974 (Pub.L.93-275), Section 401 of the Energy Reorganization Act of 1974 (Pub.L.93-438), Title IX of the Education Amendments of 1972,
as amended (Pub.L.92-318, Pub.L.93-568, and Pub.L.94-482), Section 504 of the Rehabilitation Act of 1973 (Pub.L.93-112), the Age Discrimination Act of 1975 (Pub.L.94-135), Title VIII
of the Civil Rights Act of 1968 (Pub.L.90-284), the Department of Energy Organization Act of 1977 (Pub.L.95-91), and the Energy Conservation and Production Act of 1976, as amended (Pub.L.94-385)
and Title 10, Code of Federal Regulations, Part 1040. In accordance with the above laws and regulations issued pursuant thereto, the Applicant agrees to assure that no person in the
United States shall, on the ground of race, color, national origin, sex, age, or disability, be excluded from participation in, be denied the benefits of, or be otherwise subjected
to discrimination under any program or activity in which the Applicant receives Federal assistance from the Department of Energy. Applicability and Period of Obligation In the case
of any service, financial aid, covered employment, equipment, property, or structure provided, leased, or improved with Federal assistance extended to the Applicant by the Department
of Energy, this assurance obligates the Applicant for the period during which Federal assistance is extended. In the case of any transfer of such service, financial aid, equipment,
property, or structure, this assurance obligates the transferee for the period during which Federal assistance is extended. If any personal property is so provided, this assurance
obligates the Applicant for the period during which it retains ownership or possession of the property. In all other cases, this assurance obligates the Applicant for the period during
which the Federal assistance is extended to the Applicant by the Department of Energy. Employment Practices Where a primary objective of the Federal assistance is to provide employment
or where the Applicant's employment practices affect the delivery of services in programs or activities resulting from Federal assistance extended by the Department, the Applicant agrees
not to discriminate on the ground of race, color, national origin, sex, age, or disability, in its employment practices. Such employment practices may include, but are not limited
to, recruitment advertising, hiring, layoff or termination, promotion, demotion, transfer, rates of pay, training and participation in upward mobility programs; or other forms of compensation
and use of facilities. Subrecipient Assurance The Applicant shall require any individual, organization, or other entity with whom it subcontracts, subgrants, or subleases for the
purpose of providing any service, financial aid, equipment, property, or structure to comply with laws cited above. To this end, the subrecipient shall be required to sign a written
assurance form, however, the obligation or both recipient and subrecipient to ensure compliance is not relieved by the collection or submission of written assurance forms. Data Collection
and Access to Records The Applicant agrees to compile and maintain information pertaining to programs or activities developed as a result of the Applicant's receipt of Federal assistance
from the Department of Energy. Such information shall include, but is not limited to, the following: (1) the manner in which services are or will be provided and related data necessary
for determining whether any persons are or will be denied such services on the basis of prohibited discrimination; (2) the population eligible to be served by race, color, national
origin, sex, age, and disability; (3) data regarding covered employment including use or planned use of bilingual public contact employees serving beneficiaries of the program where
necessary to permit effective participation by beneficiaries unable to speak or understand English; (4) the location of existing or proposed facilities connected with the program and
related information adequate for determining whether the location has or will have the effect of unnecessarily denying access to any person on the basis of prohibited discrimination;
(5) the present or proposed membership by race, color, national origin, sex, age, and disability, in any planning or advisory body which is an integral part of the program; and (6)
any additional written data determined by the Department of Energy to be relevant to its obligation to assure compliance by recipients with laws cited in the first paragraph of this
assurance. DOE F 1600.5 OMB Control No. (06-94) All Other Editions are Obsolete 1910-0400 The Applicant agrees to submit requested data to the Department of Energy regarding
programs and activities developed by the Applicant from the use of Federal assistance funds extended by the Department of Energy, Facilities of the Applicant (including the physical
plants, building, or other structures) and all records, books, accounts, and other sources of information pertinent to the Applicant's compliance with the civil rights laws shall be
made available for inspection during normal business hours on request of an officer or employee of the Department of Energy specifically authorized to make such inspections. Instructions
in this regard will be provided by the Director, Office of Civil Rights, U.S. Department of Energy. This assurance is given in consideration of and for the purpose of obtaining any
and all Federal grants, loans, contracts (excluding procurement contracts), property, discounts or other Federal assistance extended after the date hereto, to the Applicants by the
Department of Energy, including installment payments on account after such data of application for Federal assistance which are approved before such date. The Applicant recognizes
and agrees that such Federal assistance will be extended in reliance upon the representation and agreements made in this assurance and that the United States shall have the right to
seek judicial enforcement of this assurance. This assurance is binding on the Applicant, the successors, transferees, and assignees, as well as the person(s) whose signature appears
below and who are authorized to sign this assurance on behalf of the Applicant. Applicant Certification The Applicant certifies that it has complied, or that, within 90 days of the
date of the grant, it will comply with all applicable requirements of 10 C.F.R. § 1040.5 (a copy will be furnished to the Applicant upon written request to DOE). Designated Responsible
Employee ( ) - Name and Title (Printed to Typed) Telephone Number Signature Date ( ) - Applicant’s Name Telephone Number
Address: Date Authorized Official: President, Chief Executive Officer or Authorized Designee , ( ) - Name and Title (Printed
to Typed) Telephone Number Signature Date
Application Uploads/SF-LLL Form- palm desert.pdf Form
DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046 (See reverse for public burden disclosure.)
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract a. bid/offer/application a. initial filing b. grant b. initial award b. material change c. cooperative
agreement c. post-award For Material Change Only: d. loan year _________ quarter _________ e. loan guarantee date of last report ______________ f. loan insurance 4. Name and Address
of Reporting Entity: 5. If Reporting Entity in No. 4 is a Subawardee, Enter Name and Address of Prime: Tier ______, if known : Congressional District, if known : Congressional District,
if known : 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number, if applicable : _____________ 8. Federal Action Number, if known : 9. Award Amount, if known
: $ 10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services ( including address if ( if individual, last name, first name, MI ): different from No. 10a ) (
last name, first name, MI ): 11. Signature: Print Name: Title: Telephone No.: _______________________ Authorized for Local Reproduction Standard Form LLL (Rev. 7-97) Information requested
through this form is authorized by title 31 U.S.C. section 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 disclosure is required pursuant to 31 U.S.C. 1352. This information will be available for public inspection. required disclosure
shall be subject to a not more than $100,000 for each such failure. Prime Subawardee Federal Use Only: Date: who fails to file the Any person $10,000 and than civil penalty of not less
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material
change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreementto make paymentto any lobbyingentity for influencing
or attemptingto influence an officer or employeeof any agency, a Member of Congress, an officer or employeeof Congress, or an employeeof a Memberof Congress in connectionwith a coveredFederalaction.
Completeall items that applyfor both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional
information. 1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. 2. Identify
the status of the covered Federal action. 3. Identify the appropriateclassification of this report. If this is a followup report caused by a material change to the information previously
reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action. 4.
Enter the full name,address, city, Stateand zip code of the reportingentity.Include CongressionalDistrict, if known. Check the appropriateclassification of the reportingentitythat designatesif
it is, or expectsto be, a prime or subawardrecipient.Identifythe tier of the subawardee,e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited
to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report in item 4 checks "Subawardee," then enter the full name, address, city, State and
zip code of the prime Federal recipient. Include Congressional District, if known. 6. Enter the name of the Federal agency making the award or loan commitment. Include at least one
organizationallevel below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the Federal program name or description for the covered
Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments. 8. Enter the
most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitation for Bid (IFB) number; grant announcement
number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001." 9. For a covered
Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item
4 or 5. 10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified
in item 4 to influence the covered Federal action. (b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a). Enter Last Name,
First Name, and Middle Initial (MI). 11. The certifying official shall sign and date the form, print his/her name, title, and telephone number. According to the Paperwork Reduction
Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB Control Number. The valid OMB control number for this information collection
is OMB No. 0348-0046. Public reporting burden for this collection of information is estimated to average 10 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 (0348-0046), Washington,
DC 20503.
Application Uploads/Standard Form 424A- palm desert.pdf Budget Information for Non-Construction Programs (SF-424A)
SECTION A - BUDGET SUMMARY $ BUDGET INFORMATION - Non-Construction Programs OMB Number: 4040-0006 Expiration Date: 02/28/2025 Grant Program Function or Activity (a) Catalog of Federal
Domestic Assistance Number (b) Estimated Unobligated Funds New or Revised Budget Federal (c) Non-Federal (d) Federal (e) Non-Federal (f) Total (g) 5. Totals 4. 3. 2. 1. $$$$
$$$$$ Standard Form 424A (Rev. 7- 97) Prescribed by OMB (Circular A -102) Page 1 SECTION B - BUDGET CATEGORIES 7. Program Income d. Equipment e. Supplies f. Contractual g. Construction
h. Other j. Indirect Charges k. TOTALS (sum of 6i and 6j) i. Total Direct Charges (sum of 6a-6h) (1) Authorized for Local Reproduction Prescribed by OMB (Circular A -102) Page 1A Standard
Form 424A (Rev. 7- 97) GRANT PROGRAM, FUNCTION OR ACTIVITY (2) (3) (4) (5) Total6. Object Class Categories a. Personnel b. Fringe Benefits c. Travel $$$$$ $$$$$ $$$$$ $ $ SECTION D
- FORECASTED CASH NEEDS 14. Non-Federal SECTION C - NON-FEDERAL RESOURCES (a) Grant Program (b) Applicant (d) Other Sources (c) State (e)TOTALS $ $ $ $ $ $ $ $ $ $8. 9. 10. 11. 12.
TOTAL (sum of lines 8-11) 15. TOTAL (sum of lines 13 and 14) 13. Federal Total for 1st Year 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter $$ $ $ $ $ $ $ $ FUTURE FUNDING PERIODS
(YEARS) SECTION F - OTHER BUDGET INFORMATION SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT Authorized for Local Reproduction $ $ $$ $ $16. 17. 18.
19. 20. TOTAL (sum of lines 16 - 19) 21. Direct Charges: 22. Indirect Charges: 23. Remarks: (a) Grant Program (b)First (c) Second (d) Third (e) Fourth $$ Standard Form 424A (Rev. 7-
97) Prescribed by OMB (Circular A -102) Page 2
Application Uploads/Standard Form 424-palm desert.pdf SF424 Mandatory Form
APPLICATION FOR FEDERAL ASSISTANCE SF-424 - MANDATORY OMB Number: 4040-0020 Expiration Date: 02/28/2026 1.a. Type of Submission: Other (specify): 1.b. Frequency: Other (specify): 1.d.
Version: 2. Date Received: 3. Applicant Identifier: 4a. Federal Entity Identifier: 4b. Federal Award Identifier: 5. Date Received by State: 6. State Application Identifier: c. UEI:
Department Name: Division Name: Street1: Street2: City: County / Parish: State: Province: Zip / Postal Code:Country: b. Employer/Taxpayer Identification Number (EIN/TIN): Prefix: First
Name: Middle Name: Last Name: Suffix: Title: Organizational Affiliation: Telephone Number: Fax Number: Email: STATE USE ONLY: 7. APPLICANT INFORMATION: d. Address: a. Legal Name: e.
Organizational Unit: f. Name and contact information of person to be contacted on matters involving this submission: Application Plan Funding Request Other Annual Quarterly Other 1.c.
Consolidated Application/Plan/Funding Request? Yes No Initial Resubmission Revision Update Explanation USA: UNITED STATES 8a. TYPE OF APPLICANT: Other (specify): b. Additional Description:
9. Name of Federal Agency: 10. Catalog of Federal Domestic Assistance Number: CFDA Title: a. Applicant: b. Program/Project: a. Start Date: b. End Date: a. Federal ($): b. Match ($):
16. IS SUBMISSION SUBJECT TO REVIEW BY STATE UNDER EXECUTIVE ORDER 12372 PROCESS? 13. CONGRESSIONAL DISTRICTS OF: 14. FUNDING PERIOD: 15. ESTIMATED FUNDING: APPLICATION FOR FEDERAL
ASSISTANCE SF-424 - MANDATORY Attach an additional list of Program/Project Congressional Districts if needed. 11. Descriptive Title of Applicant's Project: 12. Areas Affected by Funding:
a. This submission was made available to the State under the Executive Order 12372 Process for review on: b. Program is subject to E.O. 12372 but has not been selected by State for
review. c. Program is not covered by E.O. 12372. View AttachmentDelete AttachmentAdd Attachment 17. Is The Applicant Delinquent On Any Federal Debt? Prefix: First Name: Middle Name:
Last Name: Suffix: Title: Organizational Affiliation: Telephone Number: Email: Fax Number: Signature of Authorized Representative: Date Signed: 18. By signing this application, I certify
(1) to the statements contained in the list of certifications** and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required
assurances** and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal,
civil, or administrative penalties. (U.S. Code, Title 18, Section 1001) Authorized Representative: Attach supporting documents as specified in agency instructions. APPLICATION FOR FEDERAL
ASSISTANCE SF-424 - MANDATORY ** This list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific
instructions. Yes No Explanation ** I Agree View AttachmentsDelete AttachmentsAdd Attachments APPLICATION FOR FEDERAL ASSISTANCE SF-424 - MANDATORY Consolidated Application/Plan/Funding
Request Explanation: APPLICATION FOR FEDERAL ASSISTANCE SF-424 - MANDATORY Applicant Federal Debt Delinquency Explanation: APPLICATION FOR FEDERAL ASSISTANCE SF-424 - MANDATORY