APPLICATION FOR FEDERAL ASSISTANCE SF-424 (3)OMB Number: 4040-0004
Expiration Date: 11/30/2025
Application for Federal Assistance SF -424
* 1. Type of Submission:
Preapplication
Application
* 2. Type
of Application: * If Revision, select appropriate letter(s):
New
Continuation
Revision
* Other (Specify):
►� Application
Changed/Corrected
* 3. Date Received: 4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier:
120492
State Use Only:
6. Date Received by State:
7. State Application Identifier:
8. APPLICANT INFORMATION:
*a. Legal Name:
City of Clearwater, Florida
* b. Employer/Taxpayer Identification Number (EIN/TIN):
* c. UEI:
59-6000289
SG2DQRMWJYL6
d. Address:
* Streetl:
Street2:
* City:
County/Parish:
* State:
Province:
* Country:
* Zip / Postal Code:
600 Cleveland Street
Suite 600
Clearwater
FL: Florida
USA: UNITED STATES
33755-4151
e. Organizational Unit:
Department Name:
Division Name:
Economic Development/Housing
Housing
f. Name and contact information of person to be contacted on matters involving this application:
Prefix:
Middle Name:
* Last Name:
Suffix:
ms. * First Name:
Ir in
Gomez
Title: HUD Programs Administrator
Organizational Affiliation:
* Telephone Number:
727-562-4032 Fax Number: 727-562-4037
*Email: irin.gomez@myclearwater.com
Application for Federal Assistance SF -424
* 9. Type of Applicant 1: Select Applicant Type:
C: City or Township Government
Type of Applicant 2: Select Applicant Type:
Type of Applicant 3: Select Applicant Type:
* Other (specify):
* 10. Name of Federal Agency:
U.S. Department of Housing and Urban Development
11. Catalog of Federal Domestic Assistance Number:
14.218
CFDA Title:
Community Development Block Grants/Entitlement Grants
* 12. Funding Opportunity Number:
* Title:
13. Competition Identification Number:
Title:
14. Areas Affected by Project (Cities, Counties, States, etc.):
F
* 15. Descriptive Title of Applicant's Project:
Community Development Block Grant Program (Federal FY 2023 Annual Action Plan)
Attach supporting documents as specified in agency instructions.
�W Add Attachments
t . _ nts
View t
1
Application for Federal Assistance SF -424
16. Congressional
* a. Applicant
Districts Of:
FL -013
* b. Program/Project FL -013
Attach an additional list of Program/Project Congressional Districts if needed.
Add Attachment i iet `Attar meat View l trach nt.
17. Proposed Project:
* a. Start Date:
10/01/2023
* b. End Date: 09/30/2024
18. Estimated Funding ($):
*a. Federal
* b. Applicant
* c. State
* d. Local
* e. Other
*f. Program Income
*g. TOTAL
913,337.00
1, 138, 092.00
1,274,537.00
3,325,966.00
* 19. Is Application
a. This application
Subject to Review By State Under Executive Order 12372 Process?
was made available to the State under the Executive Order 12372 Process for review on
is subject to E.O. 12372 but has not been selected by the State for review.
is not covered by E.O. 12372.
•
►I b. Program
c. Program
* 20. Is the Applicant
Yes
If "Yes", provide
Delinquent On Any
Federal Debt? (If "Yes," provide explanation in attachment)
No
explanation and attach
21. *By signing
herein are true,
comply with any
subject me to
this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements
complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to
resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may
criminal, civil, or administrative penalties. (U.S. Code, Title 18, Section 1001)
and assurances, or an intemet site where you may obtain this list, is contained in the announcement or agency
4 ** I AGREE
** The list of certifications
specific instructions.
Authorized Representative:
Prefix:
Middle Name:
* Last Name:
Suffix:
Ms .
* First Name: Jennifer
Poirrier
* Title: City Manager
*TelephoneNumber:
(727) 562-4040 FaxNumber: (727) 562-4052
*Email: jennifer.poirrier@myclearwater.com
* Signature of Authorized Representative:
*Date Signed: 07/20/2023
OMB Number: 4040-0004
Expiration Date: 11/30/2025
Application for Federal Assistance SF -424
* 1. Type of Submission:
Preapplication
Application
* 2. Type
of Application: * If Revision, select appropriate letter(s):
New
Continuation
Revision
* Other (Specify):
►� Application
Changed/Corrected
* 3. Date Received: 4. Applicant Identifier:
5a. Federal Entity Identifier:
5b. Federal Award Identifier:
120492
State Use Only:
6. Date Received by State:
7. State Application Identifier:
8. APPLICANT INFORMATION:
*a. Legal Name:
City of Clearwater, Florida
* b. Employer/Taxpayer Identification Number (EIN/TIN):
* c. UEI:
59-6000289
SG2DQRMWJYL6
d. Address:
* Streetl:
Street2:
* City:
County/Parish:
*State:
Province:
*Country:
*Zip / Postal Code:
600 Cleveland Street
Suite 600
Clearwater
FL: Florida
USA: UNITED STATES
33755-4151
e. Organizational Unit:
Department Name:
Division Name:
Economic Development/Housing
Housing
f. Name and contact information of person to be contacted on matters involving this application:
Prefix:
Middle Name:
* Last Name:
Suffix:
Ms . * First Name: Irin
Gomez
Title: HUD Programs Administrator
Organizational Affiliation:
* Telephone Number:
727-562-4032 Fax Number: 727-562-4037
*Email: irin.gomez@myclearwater.com
Application for Federal Assistance SF -424
* 9. Type of Applicant 1: Select Applicant Type:
C: City or Township Government
Type of Applicant 2: Select Applicant Type:
Type of Applicant 3: Select Applicant Type:
* Other (specify):
* 10. Name of Federal Agency:
U.S. Department of Housing and Urban Development
11. Catalog of Federal Domestic Assistance Number:
14.239
CFDA Title:
HOME Investment Partnerships Program
* 12. Funding Opportunity Number:
* Title:
13. Competition Identification Number:
Title:
14. Areas Affected by Project (Cities, Counties, States, etc.):
* 15. Descriptive Title of Applicant's Project:
HOME Investment Partnerships Program (Federal FY 2023 Annual Action Plan)
Attach supporting documents as specified in agency instructions.
1
Application for Federal Assistance SF -424
16. Congressional Districts Of:
* a. Applicant FL -013
* b. Program/Project FL -013
Attach an additional list of Program/Project Congressional Districts if needed.
Add Attar fa ent " . C Iete Attar ttrze ni Atta h nt
17. Proposed Project
* a. Start Date: 10/01/2023
* b. End Date: 09/30/2024
18. Estimated Funding
($):
* a. Federal
* b. Applicant
*c. State
* d. Local
* e. Other
*f. Program Income
*g. TOTAL
532,649.00
1,840,854.00
2, 477, 254.00
2, 869, 596.00
7,720,353.00
* 19. Is Application
a. This application
Subject to Review By State Under Executive Order 12372 Process?
was made available to the State under the Executive Order 12372 Process for review on
to E.O. 12372 but has not been selected by the State for review.
covered by E.O. 12372.
•
1 b. Program is subject
c. Program is not
* 20. Is the Applicant Delinquent On Any
Federal Debt? (If "Yes," provide explanation in attachment.)
Yes 1/ No
If "Yes", provide explanation and attach
�, I « ai.eet �a 7tir
21. *By signing this
herein are true, complete
comply with any resulting
subject me to criminal,
application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements
and accurate to the best of my knowledge. I also provide the required assurances** and agree to
terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may
civil, or administrative penalties. (U.S. Code, Title 18, Section 1001)
and assurances, or an Internet site where you may obtain this list, is contained in the announcement or agency
►� ** I AGREE
** The list of certifications
specific instructions.
Authorized Representative:
Prefix: Ms .
* First Name: Jennifer
Middle Name:
" Last Name: Poirrier
Suffix:
* Title: City Manager
*Telephone Number:
727-562-4040 Fax Number: 727-562-4052
* Email: Jennifer.poirrier@myclearwater.com
* Signature of Authorized Representative:
* Date Signed: 07/20/2023
OMB Number: 4040-0007
Expiration Date: 02/28/2025
ASSURANCES - NON -CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND
IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE:
Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances.
If such is the case, you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant:
1. Has the legal authority to apply for Federal assistance
and the institutional, managerial and financial capability
(including funds sufficient to pay the non -Federal share
of project cost) to ensure proper planning, management
and completion of the project described in this
application.
2. Will give the awarding agency, the Comptroller General
of the United States and, if appropriate, the State,
through any authorized representative, access to and
the right to examine all records, books, papers, or
documents related to the award; and will establish a
proper accounting system in accordance with generally
accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal or organizational
conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding
agency.
5. Will comply with the Intergovernmental Personnel Act of
1970 (42 U.S.C. §§4728-4763) relating to prescribed
standards for merit systems for programs funded under
one of the 19 statutes or regulations specified in
Appendix A of OPM's Standards for a Merit System of
Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statutes relating to
nondiscrimination. These include but are not limited to:
(a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race, color
or national origin; (b) Title IX of the Education
Amendments of 1972, as amended (20 U.S.C.§§1681-
1683, and 1685-1686), which prohibits discrimination on
the basis of sex; (c) Section 504 of the Rehabilitation
Act of 1973, as amended (29 U.S.C. §794), which
prohibits discrimination on the basis of handicaps; (d)
the Age Discrimination Act of 1975, as amended (42 U.
S.C. §§6101-6107), which prohibits discrimination on
the basis of age; (e) the Drug Abuse Office and
Treatment Act of 1972 (P.L. 92-255), as amended,
relating to nondiscrimination on the basis of drug
abuse; (0 the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) §§523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290
ee- 3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the Civil
Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
amended, relating to nondiscrimination in the sale,
rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statute(s)
under which application for Federal assistance is being
made; and, (j) the requirements of any other
nondiscrimination statute(s) which may apply to the
application.
7. Will comply, or has already complied, with the
requirements of Titles II and III of the Uniform
Relocation Assistance and Real Property Acquisition
Policies Act of 1970 (P.L. 91-646) which provide for
fair and equitable treatment of persons displaced or
whose property is acquired as a result of Federal or
federally -assisted programs. These requirements
apply to all interests in real property acquired for
project purposes regardless of Federal participation in
purchases.
8. Will comply, as applicable, with provisions of the
Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328)
which limit the political activities of employees whose
principal employment activities are funded in whole
or in part with Federal funds.
Previous Edition Usable Standard Form 4248 (Rev. 7-97)
Authorized for Local Reproduction Prescribed by OMB Circular A-102
9. Will comply, as applicable, with the provisions of the Davis -
Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act
(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract
Work Hours and Safety Standards Act (40 U.S.C. §§327-
333), regarding labor standards for federally -assisted
construction subagreements.
10. Will comply, if applicable, with flood insurance purchase
requirements of Section 102(a) of the Flood Disaster
Protection Act of 1973 (P.L. 93-234) which requires
recipients in a special flood hazard area to participate in the
program and to purchase flood insurance if the total cost of
insurable construction and acquisition is $10,000 or more.
11. Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National
Environmental Policy Act of 1969 (P.L. 91-190) and
Executive Order (EO) 11514; (b) notification of violating
facilities pursuant to EO 11738; (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards in
floodplains in accordance with EO 11988; (e) assurance of
project consistency with the approved State management
program developed under the Coastal Zone Management
Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of
Federal actions to State (Clean Air) Implementation Plans
under Section 176(c) of the Clean Air Act of 1955, as
amended (42 U.S.C. §§7401 et seq.); (g) protection of
underground sources of drinking water under the Safe
Drinking Water Act of 1974, as amended (P.L. 93-523);
and, (h) protection of endangered species under the
Endangered Species Act of 1973, as amended (P.L. 93-
205).
12. Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. §§1271 et seq.) related to protecting
components or potential components of the national
wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance
with Section 106 of the National Historic Preservation
Act of 1966, as amended (16 U.S.C. §470), EO 11593
(identification and protection of historic properties), and
the Archaeological and Historic Preservation Act of
1974 (16 U.S.C. §§469a-1 et seq.).
14. Will comply with P.L. 93-348 regarding the protection of
human subjects involved in research, development, and
related activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of
1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et
seq.) pertaining to the care, handling, and treatment of
warm blooded animals held for research, teaching, or
other activities supported by this award of assistance.
16. Will comply with the Lead -Based Paint Poisoning
Prevention Act (42 U.S.C. §§4801 et seq.) which
prohibits the use of lead-based paint in construction or
rehabilitation of residence structures.
17. Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit
Act Amendments of 1996 and OMB Circular No. A-133,
"Audits of States, Local Governments, and Non -Profit
Organizations."
18. Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations, and policies
governing this program.
19. Will comply with the requirements of Section 106(g) of
the Trafficking Victims Protection Act (TVPA) of 2000, as
amended (22 U.S.C. 7104) which prohibits grant award
recipients or a sub -recipient from (1) Engaging in severe
forms of trafficking in persons during the period of time
that the award is in effect (2) Procuring a commercial
sex act during the period of time that the award is in
effect or (3) Using forced labor in the performance of the
award or subawards under the award.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
TITLE
Jennifer Poirrier, City Manager
APPLICANT ORGANIZATION
City of Clearwater, Florida (CDBG Program)
DATE SUBMITTED
07/20/2023
Standard Form 4248 (Rev. 7-97) Back
OMB Number: 4040-0007
Expiration Date: 02/28/2025
ASSURANCES - NON -CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND
IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances.
If such is the case, you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant:
1. Has the legal authority to apply for Federal assistance
and the institutional, managerial and financial capability
(including funds sufficient to pay the non -Federal share
of project cost) to ensure proper planning, management
and completion of the project described in this
application.
2. Will give the awarding agency, the Comptroller General
of the United States and, if appropriate, the State,
through any authorized representative, access to and
the right to examine all records, books, papers, or
documents related to the award; and will establish a
proper accounting system in accordance with generally
accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal or organizational
conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding
agency.
5. Will comply with the Intergovernmental Personnel Act of
1970 (42 U.S.C. §§4728-4763) relating to prescribed
standards for merit systems for programs funded under
one of the 19 statutes or regulations specified in
Appendix A of OPM's Standards for a Merit System of
Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statutes relating to
nondiscrimination. These include but are not limited to:
(a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race, color
or national origin; (b) Title IX of the Education
Amendments of 1972, as amended (20 U.S.C.§§1681-
1683, and 1685-1686), which prohibits discrimination on
the basis of sex; (c) Section 504 of the Rehabilitation
Previous Edition Usable
Act of 1973, as amended (29 U.S.C. §794), which
prohibits discrimination on the basis of handicaps; (d)
the Age Discrimination Act of 1975, as amended (42 U.
S.C. §§6101-6107), which prohibits discrimination on
the basis of age; (e) the Drug Abuse Office and
Treatment Act of 1972 (P.L. 92-255), as amended,
relating to nondiscrimination on the basis of drug
abuse; (f) the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) §§523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290
ee- 3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the Civil
Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
amended, relating to nondiscrimination in the sale,
rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statute(s)
under which application for Federal assistance is being
made; and, (j) the requirements of any other
nondiscrimination statute(s) which may apply to the
application.
7. Will comply, or has already complied, with the
requirements of Titles II and III of the Uniform
Relocation Assistance and Real Property Acquisition
Policies Act of 1970 (P.L. 91-646) which provide for
fair and equitable treatment of persons displaced or
whose property is acquired as a result of Federal or
federally -assisted programs. These requirements
apply to all interests in real property acquired for
project purposes regardless of Federal participation in
purchases.
8. Will comply, as applicable, with provisions of the
Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328)
which limit the political activities of employees whose
principal employment activities are funded in whole
or in part with Federal funds.
Standard Form 424B (Rev. 7-97)
Authorized for Local Reproduction Prescribed by OMB CircularA-102
9. Will comply, as applicable, with the provisions of the Davis -
Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act
(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract
Work Hours and Safety Standards Act (40 U.S.C. §§327-
333), regarding labor standards for federally -assisted
construction subagreements.
10. Will comply, if applicable, with flood insurance purchase
requirements of Section 102(a) of the Flood Disaster
Protection Act of 1973 (P.L. 93-234) which requires
recipients in a special flood hazard area to participate in the
program and to purchase flood insurance if the total cost of
insurable construction and acquisition is $10,000 or more.
11. Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National
Environmental Policy Act of 1969 (P.L. 91-190) and
Executive Order (EO) 11514; (b) notification of violating
facilities pursuant to EO 11738; (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards in
floodplains in accordance with EO 11988; (e) assurance of
project consistency with the approved State management
program developed under the Coastal Zone Management
Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of
Federal actions to State (Clean Air) Implementation Plans
under Section 176(c) of the Clean Air Act of 1955, as
amended (42 U.S.C. §§7401 et seq.); (g) protection of
underground sources of drinking water under the Safe
Drinking Water Act of 1974, as amended (P.L. 93-523);
and, (h) protection of endangered species under the
Endangered Species Act of 1973, as amended (P.L. 93-
205).
12. Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. §§1271 et seq.) related to protecting
components or potential components of the national
wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance
with Section 106 of the National Historic Preservation
Act of 1966, as amended (16 U.S.C. §470), EO 11593
(identification and protection of historic properties), and
the Archaeological and Historic Preservation Act of
1974 (16 U.S.C. §§469a-1 et seq.).
14. Will comply with P.L. 93-348 regarding the protection of
human subjects involved in research, development, and
related activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of
1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et
seq.) pertaining to the care, handling, and treatment of
warm blooded animals held for research, teaching, or
other activities supported by this award of assistance.
16. Will comply with the'Lead-Based Paint Poisoning
Prevention Act (42 U.S.C. §§4801 et seq.) which
prohibits the use of lead-based paint in construction or
rehabilitation of residence structures.
17. Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit
Act Amendments of 1996 and OMB Circular No. A-133,
"Audits of States, Local Governments, and Non -Profit
Organizations."
18. Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations, and policies
governing this program.
19. Will comply with the requirements of Section 106(g) of
the Trafficking Victims Protection Act (TVPA) of 2000, as
amended (22 U.S.C. 7104) which prohibits grant award
recipients or a sub -recipient from (1) Engaging in severe
forms of trafficking in persons during the period of time
that the award is in effect (2) Procuring a commercial
sex act during the period of time that the award is in
effect or (3) Using forced labor in the performance of the
award or subawards under the award.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
TITLE
Jennifer Poirrier, City Manager
APPLICANT ORGANIZATION
City of Clearwater, Florida (HOME Program)
DATE SUBMITTED
07/20/2023
Standard Form 424B (Rev. 7-97) Back
ASSURANCES - CONSTRUCTION PROGRAMS
OMB Number: 4040-0009
Expiration Date: 02/28/2025
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0042), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT
AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
Awarding Agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional
assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant:, I certify that the applicant:
1. Has the legal authority to apply for Federal assistance,
and the institutional, managerial and financial capability
(including funds sufficient to pay the non -Federal share
of project costs) to ensure proper planning,
management and completion of project described in
this application.
2. Will give the awarding agency, the Comptroller General
of the United States and, if appropriate, the State,
the right to examine all records, books, papers, or
documents related to the assistance; and will establish
a proper accounting system in accordance with
generally accepted accounting standards or agency
directives.
3. Will not dispose of, modify the use of, or change the
terms of the real property title or other interest in the
site and facilities without permission and instructions
from the awarding agency. Will record the Federal
awarding agency directives and will include a covenant
in the title of real property acquired in whole or in part
with Federal assistance funds to assure non-
discrimination during the useful life of the project.
4. Will comply with the requirements of the assistance
awarding agency with regard to the drafting, review and
approval of construction plans and specifications.
5. Will provide and maintain competent and adequate
engineering supervision at the construction site to
ensure that the complete work conforms with the
approved plans and specifications and will furnish
progressive reports and such other information as may be
required by the assistance awarding agency or State.
6. Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding agency.
7. Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal or organizational
conflict of interest, or personal gain.
Previous Edition Usable
8. Will comply with the Intergovernmental Personnel Act
of 1970 (42 U.S.C. §§4728-4763) relating to prescribed
standards of merit systems for programs funded
under one of the 19 statutes or regulations specified in
Appendix A of OPM's Standards for a Merit System of
Personnel Administration (5 C.F.R. 900, Subpart F).
9. Will comply with the Lead -Based Paint Poisoning
Prevention Act (42 U.S.C. §§4801 et seq.) which
prohibits the use of lead-based paint in construction or
rehabilitation of residence structures.
10. Will comply with all Federal statutes relating to non-
discrimination. These include but are not limited to: (a)
Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race,
color or national origin; (b) Title IX of the Education
Amendments of 1972, as amended (20 U.S.C. §§1681
1683, and 1685-1686), which prohibits discrimination
on the basis of sex; (c) Section 504 of the
Rehabilitation Act of 1973, as amended (29) U.S.C.
§794), which prohibits discrimination on the basis of
handicaps; (d) the Age Discrimination Act of 1975, as
amended (42 U.S.C. §§6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse
Office and Treatment Act of 1972 (P.L. 92-255), as
amended relating to nondiscrimination on the basis of
drug abuse; (f) the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) §§523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee
3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the
Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
amended, relating to nondiscrimination in the sale,
rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statue(s)
under which application for Federal assistance is being
made; and (j) the requirements of any other
nondiscrimination statue(s) which may apply to the
application.
Authorized for Local Reproduction Standard Form 424D (Rev. 7-97)
Prescribed by OMB Circular A-102
11. Will comply, or has already complied, with the
requirements of Titles II and III of the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of
1970 (P.L. 91-646) which provide for fair and equitable
treatment of persons displaced or whose property is
acquired as a result of Federal and federally -assisted
programs. These requirements apply to all interests in real
property acquired for project purposes regardless of
Federal participation in purchases.
12. Will comply with the provisions of the Hatch Act (5 U.S.C.
§§1501-1508 and 7324-7328) which limit the political
activities of employees whose principal employment
activities are funded in whole or in part with Federal funds.
13. Will comply, as applicable, with the provisions of the Davis -
Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act
(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract
Work Hours and Safety Standards Act (40 U.S.C. §§327-
333) regarding labor standards for federally -assisted
construction subagreements.
14. Will comply with flood insurance purchase requirements of
Section 102(a) of the Flood Disaster Protection Act of 1973
(P.L. 93-234) which requires recipients in a special flood
hazard area to participate in the program and to purchase
flood insurance if the total cost of insurable construction
and acquisition is $10,000 or more.
15. Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National
Environmental Policy Act of 1969 (P.L. 91-
190) and Executive Order (EO) 11514; (b) notification
of violating facilities pursuant to EO 11738; (c)
protection of wetlands pursuant to EO 11990; (d)
evaluation of flood hazards in floodplains in accordance
with EO 11988; (e) assurance of project consistency
with the approved State management program
developed under the Coastal Zone Management Act of
1972 (16 U.S.C. §§1451 et seq.); (f) conformity of
Federal actions to State (Clean Air) implementation
Plans under Section 176(c) of the Clean Air Act of
1955, as amended (42 U.S.C. §§7401 et seq.); (g)
protection of underground sources of drinking water
under the Safe Drinking Water Act of 1974, as
amended (P.L. 93-523); and, (h) protection of
endangered species under the Endangered Species
Act of 1973, as amended (P.L. 93-205).
16. Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. §§1271 et seq.) related to protecting
components or potential components of the national
wild and scenic rivers system.
17. Will assist the awarding agency in assuring compliance
with Section 106 of the National Historic Preservation
Act of 1966, as amended (16 U.S.C. §470), EO 11593
(identification and protection of historic properties), and
the Archaeological and Historic Preservation Act of
1974 (16 U.S.C. §§469a-1 et seq).
18. Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit
Act Amendments of 1996 and OMB Circular No. A-133,
"Audits of States, Local Govemments, and Non -Profit
Organizations."
19. Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations, and policies
governing this program.
20. Will comply with the requirements of Section 106(g) of
the Trafficking Victims Protection Act (TVPA) of 2000, as
amended (22 U.S.C. 7104) which prohibits grant award
recipients or a sub -recipient from (1) Engaging in severe
forms of trafficking in persons during the period of time
that the award is in effect (2) Procuring a commercial
sex act during the period of time that the award is in
effect or (3) Using forced labor in the performance of the
award or subawards under the award.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
TITLE
Jennifer Poirrier, City Manager
APPLICANT ORGANIZATION
City of Clearwater, Florida (CDBG Program)
DATE SUBMITTED
07/20/2023
SF -424D (Rev. 7-97) Back
ASSURANCES - CONSTRUCTION PROGRAMS
OMB Number: 4040-0009
Expiration Date: 02/28/2025
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0042), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT
AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
Awarding Agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional
assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant:, I certify that the applicant:
1. Has the legal authority to apply for Federal assistance,
and the institutional, managerial and financial capability
(including funds sufficient to pay the non -Federal share
of project costs) to ensure proper planning,
management and completion of project described in
this application.
2. Will give the awarding agency, the Comptroller General
of the United States and, if appropriate, the State,
the right to examine all records, books, papers, or
documents related to the assistance; and will establish
a proper accounting system in accordance with
generally accepted accounting standards or agency
directives.
3. Will not dispose of, modify the use of, or change the
terms of the real property title or other interest in the
site and facilities without permission and instructions
from the awarding agency. Will record the Federal
awarding agency directives and will include a covenant
in the title of real property acquired in whole or in part
with Federal assistance funds to assure non-
discrimination during the useful life of the project.
4. Will comply with the requirements of the assistance
awarding agency with regard to the drafting, review and
approval of construction plans and specifications.
5. Will provide and maintain competent and adequate
engineering supervision at the construction site to
ensure that the complete work conforms with the
approved plans and specifications and will furnish
progressive reports and such other information as may be
required by the assistance awarding agency or State.
6. Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding agency.
7. Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal or organizational
conflict of interest, or personal gain.
Previous Edition Usable
8. Will comply with the Intergovernmental Personnel Act
of 1970 (42 U.S.C. §§4728-4763) relating to prescribed
standards of merit systems for programs funded
under one of the 19 statutes or regulations specified in
Appendix A of OPM's Standards for a Merit System of
Personnel Administration (5 C.F.R. 900, Subpart F).
9. Will comply with the Lead -Based Paint Poisoning
Prevention Act (42 U.S.C. §§4801 et seq.) which
prohibits the use of lead-based paint in construction or
rehabilitation of residence structures.
10. Will comply with all Federal statutes relating to non-
discrimination. These include but are not limited to: (a)
Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race,
color or national origin; (b) Title IX of the Education
Amendments of 1972, as amended (20 U.S.C. §§1681
1683, and 1685-1686), which prohibits discrimination
on the basis of sex; (c) Section 504 of the
Rehabilitation Act of 1973, as amended (29) U.S.C.
§794), which prohibits discrimination on the basis of
handicaps; (d) the Age Discrimination Act of 1975, as
amended (42 U.S.C. §§6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse
Office and Treatment Act of 1972 (P.L. 92-255), as
amended relating to nondiscrimination on the basis of
drug abuse; (f) the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) §§523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee
3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the
Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
amended, relating to nondiscrimination in the sale,
rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statue(s)
under which application for Federal assistance is being
made; and (j) the requirements of any other
nondiscrimination statue(s) which may apply to the
application.
Authorized for Local Reproduction Standard Form 424D (Rev. 7-97)
Prescribed by OMB Circular A-102
11. Will comply, or has already complied, with the
requirements of Titles II and III of the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of
1970 (P.L. 91-646) which provide for fair and equitable
treatment of persons displaced or whose property is
acquired as a result of Federal and federally -assisted
programs. These requirements apply to all interests in real
property acquired for project purposes regardless of
Federal participation in purchases.
12. Will comply with the provisions of the Hatch Act (5 U.S.C.
§§1501-1508 and 7324-7328) which limit the political
activities of employees whose principal employment
activities are funded in whole or in part with Federal funds.
13. Will comply, as applicable, with the provisions of the Davis -
Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act
(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract
Work Hours and Safety Standards Act (40 U.S.C. §§327-
333) regarding labor standards for federally -assisted
construction subagreements.
14. Will comply with flood insurance purchase requirements of
Section 102(a) of the Flood Disaster Protection Act of 1973
(P.L. 93-234) which requires recipients in a special flood
hazard area to participate in the program and to purchase
flood insurance if the total cost of insurable construction
and acquisition is $10,000 or more.
15. Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National
Environmental Policy Act of 1969 (P.L. 91-
190) and Executive Order (EO) 11514; (b) notification
of violating facilities pursuant to EO 11738; (c)
protection of wetlands pursuant to EO 11990; (d)
evaluation of flood hazards in floodplains in accordance
with EO 11988; (e) assurance of project consistency
with the approved State management program
developed under the Coastal Zone Management Act of
1972 (16 U.S.C. §§1451 et seq.); (f) conformity of
Federal actions to State (Clean Air) implementation
Plans under Section 176(c) of the Clean Air Act of
1955, as amended (42 U.S.C. §§7401 et seq.); (g)
protection of underground sources of drinking water
under the Safe Drinking Water Act of 1974, as
amended (P.L. 93-523); and, (h) protection of
endangered species under the Endangered Species
Act of 1973, as amended (P.L. 93-205).
16. Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. §§1271 et seq.) related to protecting
components or potential components of the national
wild and scenic rivers system.
17. Will assist the awarding agency in assuring compliance
with Section 106 of the National Historic Preservation
Act of 1966, as amended (16 U.S.C. §470), EO 11593
(identification and protection of historic properties), and
the Archaeological and Historic Preservation Act of
1974 (16 U.S.C. §§469a-1 et seq).
18. Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit
Act Amendments of 1996 and OMB Circular No. A-133,
"Audits of States, Local Governments, and Non -Profit
Organizations."
19. Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations, and policies
governing this program.
20. Will comply with the requirements of Section 106(g) of
the Trafficking Victims Protection Act (TVPA) of 2000, as
amended (22 U.S.C. 7104) which prohibits grant award
recipients or a sub -recipient from (1) Engaging in severe
forms of trafficking in persons during the period of time
that the award is in effect (2) Procuring a commercial
sex act during the period of time that the award is in
effect or (3) Using forced labor in the performance of the
award or subawards under the award.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
TITLE
Jennifer Poirrier, City Manager
APPLICANT ORGANIZATION
City of Clearwater, Florida (HOME Program)
DATE SUBMITTED
07/20/2023
SF -424D (Rev. 7-97) Back
CERTIFICATIONS
In accordance with the applicable statutes and the regulations governing the consolidated plan regulations,
the jurisdiction certifies that:
Affirmatively Further Fair Housing --The jurisdiction will affirmatively further fair housing.
Uniform Relocation Act and Anti -displacement and Relocation Plan -- It will comply with the
acquisition and relocation requirements of the Uniform Relocation Assistance and Real Property
Acquisition Policies Act of 1970, as amended, (42 U.S.C. 4601-4655) and implementing regulations at
49 CFR Part 24. It has in effect and is following a residential anti -displacement and relocation assistance
plan required under 24 CFR Part 42 in connection with any activity assisted with funding under the
Community Development Block Grant or HOME programs.
Anti -Lobbying --To the best of the jurisdiction's knowledge and belief:
1. No Federal appropriated funds have been paid or will be paid, by or on behalf of it, 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, it will complete and submit Standard Form -LLL,
"Disclosure Form to Report Lobbying," in accordance with its instructions; and
3. It will require that the language of paragraph 1 and 2 of this anti -lobbying 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.
Authority of Jurisdiction --The consolidated plan is authorized under State and local law (as applicable)
and the jurisdiction possesses the legal authority to carry out the programs for which it is seeking
funding, in accordance with applicable HUD regulations.
Consistency with plan --The housing activities to be undertaken with Community Development Block
Grant, HOME, Emergency Solutions Grant, and Housing Opportunities for Persons With AIDS funds are
consistent with the strategic plan in the jurisdiction's consolidated plan.
Section 3 -- It will comply with section 3 of the Housing and Urban Development Act of 1968 (12
U.S.C. 1701u) and implementing regulations at 24 CFR Part 75.
Signature of Authorized Official
Jennifer Poirrier
City Manager, City of Clearwater
Title
7/20/2023
Date
Specific Community Development Block Grant Certifications
The Entitlement Community certifies that:
Citizen Participation -- It is in full compliance and following a detailed citizen participation plan that
satisfies the requirements of 24 CFR 91.105.
Community Development Plan -- Its consolidated plan identifies community development and housing
needs and specifies both short-term and long-term community development objectives that that have been
developed in accordance with the primary objective of the CDBG program (i.e., the development of viable
urban communities, by providing decent housing and expanding economic opportunities, primarily for
persons of low and moderate income) and requirements of 24 CFR Parts 91 and 570.
Following a Plan -- It is following a current consolidated plan that has been approved by HUD.
Use of Funds -- It has complied with the following criteria:
1. Maximum Feasible Priority. With respect to activities expected to be assisted with CDBG
funds, it has developed its Action Plan so as to give maximum feasible priority to activities
which benefit low- and moderate -income families or aid in the prevention or elimination of
slums or blight. The Action Plan may also include CDBG-assisted activities which the grantee
certifies are designed to meet other community development needs having particular urgency
because existing conditions pose a serious and immediate threat to the health or welfare of the
community, and other financial resources are not available (see Optional CDBG Certification).
2. Overall Benefit. The aggregate use of CDBG funds, including Section 108 guaranteed loans,
during program year(s) 2023 (one program year) [a period specified by the grantee of one,
two, or three specific consecutive program years], shall principally benefit persons of low and
moderate income in a manner that ensures that at least 70 percent of the amount is expended for
activities that benefit such persons during the designated period.
3. Special Assessments. It will not attempt to recover any capital costs of public improvements
assisted with CDBG funds, including Section 108 loan guaranteed funds, by assessing any
amount against properties owned and occupied by persons of low and moderate income,
including any fee charged or assessment made as a condition of obtaining access to such
public improvements.
However, if CDBG funds are used to pay the proportion of a fee or assessment that relates to the
capital costs of public improvements (assisted in part with CDBG funds) financed from other
revenue sources, an assessment or charge may be made against the property with respect to the
public improvements financed by a source other than CDBG funds.
In addition, in the case of properties owned and occupied by moderate -income (not low-income)
families, an assessment or charge may be made against the property for public improvements
financed by a source other than CDBG funds if the jurisdiction certifies that it lacks CDBG funds
to cover the assessment.
Excessive Force -- It has adopted and is enforcing:
1. A policy prohibiting the use of excessive force by law enforcement agencies within its
jurisdiction against any individuals engaged in non-violent civil rights demonstrations; and
2. A policy of enforcing applicable State and local laws against physically barring entrance to or
exit from a facility or location which is the subject of such non-violent civil rights
demonstrations within its jurisdiction.
Compliance with Anti -discrimination laws -- The grant will be conducted and administered in
conformity with title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d) and the Fair Housing Act (42
U.S.C. 3601-3619) and implementing regulations.
Lead -Based Paint -- Its activities concerning lead-based paint will comply with the requirements of 24
CFR Part 35, Subparts A, B, J, K and R.
Compliance with Laws -- It will comply with applicable laws.
7/20/2023
Signatuof thorized Official Date
Jennifer Poirrier
City Manager, City of Clearwater
Title
Specific HOME Certifications
The HOME participating jurisdiction certifies that:
Tenant Based Rental Assistance -- If it plans to provide tenant -based rental assistance, the tenant -based
rental assistance is an essential element of its consolidated plan.
Eligible Activities and Costs -- It is using and will use HOME funds for eligible activities and costs, as
described in 24 CFR §§92.205 through 92.209 and that it is not using and will not use HOME funds for
prohibited activities, as described in §92.214.
Subsidy layering -- Before committing any funds to a project, it will evaluate the project in accordance
with the guidelines that it adopts for this purpose and will not invest any more HOME funds in
combination with other Federal assistance than is necessary to provide affordable housing;
7/20/2023
Siiatufe of Authorized Official Date
Jennifer Poirrier
City Manager, City of Clearwater
Title
APPENDIX TO CERTIFICATIONS
INSTRUCTIONS CONCERNING LOBBYING CERTIFICATION:
Lobbying Certification
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.