12 Attachment 1 - DRAFT Grant Agreement - TR24109 (2)8/25/2023 9:38:11 AM Page 1 of 13
State of California – Office of Traffic Safety
GRANT AGREEMENT
GRANT NUMBER
TR24109
1.GRANT TITLE
Traffic Records Improvement Project
2.NAME OF AGENCY 3.Grant Period
Los Gatos From:
To:
10/01/2023
09/30/2024 4.AGENCY UNIT TO ADMINISTER GRANT
Los Gatos Monte Sereno Police Department
5.GRANT DESCRIPTION
State and local agencies need timely, accurate, complete, accessible, and uniform traffic records to identify
and prioritize traffic safety issues, to choose appropriate safety countermeasures and evaluate their
effectiveness. Traffic records improvement grants provide traffic safety stakeholders with the ability to plan
and initiate traffic records improvement projects such as the purchase and implementation of traffic crash
reporting systems as well as electronic citation equipment and software.
6.Federal Funds Allocated Under This Agreement Shall Not Exceed:$76,700.00
7.TERMS AND CONDITIONS: The parties agree to comply with the terms and conditions of the following which are by
this reference made a part of the Agreement:
Schedule A – Problem Statement, Goals and Objectives and Method of Procedure
Schedule B – Detailed Budget Estimate and Sub-Budget Estimate (if applicable)
Schedule B-1 – Budget Narrative and Sub-Budget Narrative (if applicable)
Exhibit A – Certifications and Assurances
Exhibit B* – OTS Grant Program Manual
Exhibit C – Grant Electronic Management System (GEMS) Access
*Items shown with an asterisk (*), are hereby incorporated by reference and made a part of this agreement as if
attached hereto.
These documents can be viewed at the OTS home web page under Grants: www.ots.ca.gov.
We, the officials named below, hereby swear under penalty of perjury under the laws of the State of California that we
are duly authorized to legally bind the Grant recipient to the above described Grant terms and conditions.
IN WITNESS WHEREOF, this Agreement has been executed by the parties hereto.
8.Approval Signatures
A.GRANT DIRECTOR B.AUTHORIZING OFFICIAL
NAME:
TITLE:
EMAIL:
PHONE:
ADDRESS:
Clinton Tada
Captain
ctada@losgatosca.gov
408-827-3218
110 East Main Street
Los Gatos, CA 95030
NAME:
TITLE:
EMAIL:
PHONE:
ADDRESS:
Laurel Prevetti
Town Manager
lprevetti@losgatosca.gov
(408) 354-6832
110 East Main Street
Los Gatos, CA 95030
(Signature) (Date) (Signature) (Date)
C.FISCAL OFFICIAL D.AUTHORIZING OFFICIAL OF OFFICE OF TRAFFIC SAFETY
NAME:
TITLE:
EMAIL:
PHONE:
ADDRESS:
Heather St. John
Senior Administrative Analyst
hstjohn@losgatosca.gov
404-354-6834
110 East Main Street
Los Gatos, CA 95030
NAME:
TITLE:
EMAIL:
PHONE:
ADDRESS:
Barbara Rooney
Director
barbara.rooney@ots.ca.gov
(916) 509-3030
2208 Kausen Drive, Suite 300
Elk Grove, CA 95758
(Signature) (Date) (Signature) (Date)
Attachment 1
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10. PROJECTED EXPENDITURES
FUND CFDA ITEM/APPROPRIATION F.Y. CHAPTER STATUTE PROJECTED
EXPENDITURES
AGREEMENT
TOTAL $76,700.00
AMOUNT ENCUMBERED BY THIS DOCUMENT
I CERTIFY upon my own personal knowledge that the budgeted
funds for the current budget year are available for the period and
purpose of the expenditure stated above.
$76,700.00
PRIOR AMOUNT ENCUMBERED FOR THIS
AGREEMENT
$ 0.00
OTS ACCOUNTING OFFICER’S SIGNATURE DATE SIGNED TOTAL AMOUNT ENCUMBERED TO DATE
$76,700.00
E. ACCOUNTING OFFICER OF OFFICE OF TRAFFIC SAFETY 9. SAM INFORMATION
NAME: Carolyn Vu
SAM #:
REGISTERED
ADDRESS:
CITY:
ZIP+4:
MPQTKTQ7N4L4
Physical Address:
110 E MAIN ST
Los Gatos
95030-6943
ADDRESS: 2208 Kausen Drive, Suite 300
Elk Grove, CA 95758
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State of California – Office of Traffic Safety
GRANT AGREEMENT
Schedule A
GRANT NUMBER
TR24109
1. PROBLEM STATEMENT
The Los Gatos-Monte Sereno Police Department needs to address a traffic collision software and electronic
citation solution which will produce timely, accurate, complete, accessible, and uniform traffic crash records.
In addition to documenting traffic crashes reports, the solution software products should be utilized to
identify, prioritize and predict traffic safety issues, analyze appropriate safety countermeasures, record traffic
safety enforcement efforts, and produce data to evaluate their effectiveness. Currently, the California
Highway Patrol collects a portion of this data via the Statewide Integrated Traffic Records System (SWITRS)
from law enforcement agencies throughout the state.
The Los Gatos-Monte Sereno Police Department utilizes the CHP 555 traffic collision form (a PDF format) to
collect and document local traffic crash data for manual review, approval, and input into SWITRS, which
negatively impacts the efficient use of staff resources. In 2022, a total of 190 traffic crash reports were
documented and investigated by officers and processed by Records personnel, all of which were typed in a
PDF formatted application or word processing document. The implementation and use of a traffic collision
reporting software system which interfaces with both SWITRS and the Department’s current Records
Management System would increase workflow efficiencies (by officers and support staff) and decrease
current backlog of unprocessed crash reports with increased accuracy. In addition, data entered into a
robust traffic crash software system could be used to effectively to analyze, educate, and promote traffic
safety engineering improvements and traffic enforcement efforts.
In 2020, the Police Department purchased a new Records Management System (RMS) which does not
provide an adequate traffic crash reporting module or an efficient method of conducting statistical analysis of
crash data to address traffic safety needs and directed enforcement areas within the Town. The Police
Department and Town of Los Gatos Public Works Departments currently have a licensed subscription to
Crossroads Reporting and Crossroads Analytics software systems. Although, due to the lack of necessary
interface software and other featured applications, Crossroads cannot be used at this time to document,
analyze or report required statistics related to collision data. The Police Department needs to fund the
purchase of one-time software application and set up from Crossroads and the appropriate interface set up
applications with current RMS and SWITRS databases. The Department has conducted research with other
law enforcement agencies within the Santa Clara County and other Sunridge RMS user agencies, with the
majority of departments utilizing Crossroads Collision software with positive results.
In addition, the Los Gatos-Monte Sereno Police Department is seeking to purchase and integrate an
electronic citation software program which interfaces with the current RMS system. Currently, citations are
hand-written, manually reviewed, entered individually into RMS systems, and mailed to the judicial courts for
disposition. This labor-intensive process causes a backlog of citation processing by Records personnel, a
reduction in the efficiency of officer enforcement time, and the inability for the Traffic Division Officers and
Town’s Engineering Department to identify the frequency of violations by specific area, violation type, etc.
The Department has identified Crossroads E-Citation Software system which incorporates the ability to
interface with the Crossroads Traffic Collision Reporting software system requested and the Department’s
current RMS system. Crossroads E-Citation application would be installed on existing individual Officers'
department issued mobile devices and would supplant existing methods of hand-written citations for traffic
and criminal citations.
2. PERFORMANCE MEASURES
A. Goals:
1. Reduce the number of persons killed in traffic crashes.
2. Reduce the number of persons injured in traffic crashes.
B. Objectives: Target Number
1. Purchase a new electronic crash reporting program or upgrade an existing
electronic crash reporting program to the latest version available that includes the
capability of exporting complete crash report records to a departmental records
management system (RMS) and the California Highway Patrol’s Statewide
Integrated Traffic Records System (SWITRS).
1
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2. Purchase and implement a new complete electronic citation solution or upgrade an
existing electronic citation solution that includes the capability of exporting data to
both a departmental records management system (RMS) as well as the local court
records system if and when the local court can receive electronic citation data.
1
3. METHOD OF PROCEDURE
A. Phase 1 – Program Preparation (1st Quarter of Grant Year)
Determine specific system requirements.
Determine specific equipment requirements.
Request vendor price quotation per host agency requirements.
Procure an electronic crash reporting system with the following functionalities:
System licensing with installation and training.
GIS based mapping.
Segment crash diagraming tool.
Ability to create or import crash reports.
Ability to import and export agency RMS files.
Ability to perform complete analysis of crash reports.
Secure database accessible by appropriate agency personnel.
Ability to export complete crash report to the California Highway Patrol’s Statewide
Integrated Traffic Records System.
Procure an electronic citation system with the following functionalities:
System licensing with installation and training.
Ability to import and export to agency RMS files.
Ability to perform complete analysis of citation reports.
Secure database accessible by appropriate agency personnel.
Ability to export complete citation reports to the local county court.
B. Phase 2 – Program Operations (Throughout Grant Year)
Select vendor for system development, implementation, and installation.
Monitor and oversee progress of system/software development.
The Department has identified Crossroad as a preferred vendor for this product for the
xxxxxxxxxxxxxxxx
C. Phase 3 – Data Collection & Reporting (Throughout Grant Year)
Prepare and submit grant claims invoice (due January 30, April 30, July 30, and October 30).
Successful project completion and confirmation of successful transmission of crash
reports by the California Highway Patrol is required before submission of invoice claims
seeking reimbursement from OTS.
Prepare and submit quarterly performance reports (due January 30, April 30, July 30, and
October 30).
Collect and report quarterly appropriate data that supports the progress of goals and
objectives.
Provide a summary of quarterly accomplishments and explanations for objectives not
completed.
Collect, analyze, and report statistical data relating to the grant goals and objectives.
4. METHOD OF EVALUATION
Using the data compiled during the grant, the Grant Director will complete the “Final Evaluation” section in
the fourth/final Quarterly Performance Report (QPR). The Final Evaluation should provide a brief summary
of the grant’s accomplishments, challenges and significant activities. This narrative should also include
whether goals and objectives were met, exceeded, or an explanation of why objectives were not completed.
5. ADMINISTRATIVE SUPPORT
This program has full administrative support, and every effort will be made to continue the grant activities
after grant conclusion.
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State of California – Office of Traffic Safety
GRANT AGREEMENT
Schedule B
GRANT NUMBER
TR24109
FUND NUMBER CATALOG
NUMBER (CFDA)
FUND DESCRIPTION TOTAL AMOUNT
405c TR-24 20.616 State Traffic Safety Information
System Improvements
$76,700.00
COST CATEGORY FUND
NUMBER
UNIT COST OR
RATE
UNITS TOTAL COST TO
GRANT
A. PERSONNEL COSTS
Straight Time
$0.00
Overtime
$0.00
Category Sub-Total $0.00
B. TRAVEL EXPENSES
$0.00
$0.00
Category Sub-Total $0.00
C. CONTRACTUAL SERVICES
$0.00
Category Sub-Total $0.00
D. EQUIPMENT
Complete Traffic Crash and Electronic
Citation Data Collection System
405c TR-
24
$76,700.00 1 $76,700.00
Category Sub-Total $76,700.00
E. OTHER DIRECT COSTS
$0.00
Category Sub-Total $0.00
F. INDIRECT COSTS
$0.00
Category Sub-Total $0.00
GRANT TOTAL $76,700.00
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State of California – Office of Traffic Safety
GRANT AGREEMENT
Schedule B-1
GRANT NUMBER
TR24109
BUDGET NARRATIVE
PERSONNEL COSTS
-
TRAVEL EXPENSES
-
CONTRACTUAL SERVICES
-
EQUIPMENT
Complete Traffic Crash and Electronic Citation Data Collection System - A combination traffic crash and
electronic citation data collection system will handle both traffic crash and traffic citation data collection and
processing. The traffic crash database system will collect, analyze, and display crash and enforcement data,
including a full featured module for analysis, allowing queries for top ranking lists of locations, breakdowns
by cause, type, injury, conditions, and many other attributes. Queries and Reports will be provided in a
variety of formats including pie charts, bar charts, and summaries. The system provides for crash mapping
on Google Earth, ESRI GIS, or similar mapping products. Costs may include laptop/desktop computers,
software and licenses, printers, accessories, training, and associated shipping and taxes. The traffic citation
system will collect citation data electronically in the field, print a violator copy of the citation, and transfer the
information electronically to the agency RMS system and the courts for prosecution. The system will be used
by traffic officers to improve the efficiency and accuracy of writing traffic citations. Costs may include the
purchase of electronic citation devices, mag-strip readers, fingerprint readers, audio recorders, cameras,
docking/charging stations, laptop/desktop computers, software, licenses, printers, accessories, training, and
associated shipping and taxes.
OTHER DIRECT COSTS
-
INDIRECT COSTS
-
STATEMENTS/DISCLAIMERS
There will be no program income generated from this grant.
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State of California – Office of Traffic Safety
GRANT AGREEMENT
Exhibit A
GRANT NUMBER
TR24109
Certifications and Assurances for Fiscal Year 2024 Highway Safety Grants (23 U.S.C. Chapter 4 or Section 1906,
Public Law 109-59, as amended by Section 25024, Public Law 117-58)
The officials named on the grant agreement, certify by way of signature on the grant agreement signature page,
that the Grantee Agency complies with all applicable Federal statutes, regulations, and directives and State rules,
guidelines, policies, and laws in effect with respect to the periods for which it receives grant funding. Applicable
provisions include, but are not limited to, the following:
GENERAL REQUIREMENTS
The State will comply with applicable statutes and regulations, including but not limited to:
23 U.S.C. Chapter 4—Highway Safety Act of 1966, as amended;
Sec. 1906, Public Law 109-59, as amended by Sec. 25024, Public Law 117-58;
23 CFR part 1300—Uniform Procedures for State Highway Safety Grant Programs;
2 CFR part 200—Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal
Awards;
2 CFR part 1201—Department of Transportation, Uniform Administrative Requirements, Cost Principles, and Audit
Requirements for Federal Awards.
NONDISCRIMINATION
(applies to all subrecipients as well as States)
The State highway safety agency [and its subrecipients] will comply with all Federal statutes and implementing regulations
relating to nondiscrimination (“Federal Nondiscrimination Authorities”). These include but are not limited to:
Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq., 78 stat. 252), (prohibits discrimination on the
basis of race, color, national origin);
49 CFR part 21 (entitled Non-discrimination in Federally-Assisted Programs of the Department of
Transportation—Effectuation of Title VI of the Civil Rights Act of 1964);
28 CFR 50.3 (U.S. Department of Justice Guidelines for Enforcement of Title VI of the Civil Rights Act of 1964);
The Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, (42 U.S.C. 4601),
(prohibits unfair treatment of persons displaced or whose property has been acquired because of Federal or
Federal-aid programs and projects);
Federal-Aid Highway Act of 1973, (23 U.S.C. 324 et seq.), and Title IX of the Education Amendments of 1972,
as amended (20 U.S.C. 1681-1683 and 1685-1686) (prohibit discrimination on the basis of sex);
Section 504 of the Rehabilitation Act of 1973, (29 U.S.C. 794 et seq.), as amended, (prohibits
discrimination on the basis of disability) and 49 CFR part 27;
The Age Discrimination Act of 1975, as amended, (42 U.S.C. 6101 et seq.), (prohibits discrimination on the
basis of age);
The Civil Rights Restoration Act of 1987, (Pub. L. 100-209), (broadens scope, coverage, and applicability of Title
VI of the Civil Rights Act of 1964, The Age Discrimination Act of 1975 and Section 504 of the Rehabilitation Act of
1973, by expanding the definition of the terms “programs or activities” to include all of the programs or activities
of the Federal aid recipients, subrecipients and contractors, whether such programs or activities are Federally-
funded or not);
Titles II and III of the Americans with Disabilities Act (42 U.S.C. 12131-12189) (prohibits discrimination on the
basis of disability in the operation of public entities, public and private transportation systems, places of public
accommodation, and certain testing) and 49 CFR parts 37 and 38;
Executive Order 12898, Federal Actions to Address Environmental Justice in Minority Populations and Low-
Income Populations (preventing discrimination against minority populations by discouraging programs,
policies, and activities with disproportionately high and adverse human health or environmental effects on
minority and low-income populations);
Executive Order 13166, Improving Access to Services for Persons with Limited English Proficiency (requiring that
recipients of Federal financial assistance provide meaningful access for applicants and beneficiaries who have
limited English proficiency (LEP));
Executive Order 13985, Advancing Racial Equity and Support for Underserved Communities through the
Federal Government (advancing equity across the Federal Government); and
Executive Order 13988, Preventing and Combating Discrimination on the Basis of Gender Identity or
Sexual Orientation (clarifying that sex discrimination includes discrimination on the grounds of gender
identity or sexual orientation).
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The preceding statutory and regulatory cites hereinafter are referred to as the “Acts” and “Regulations,” respectively.
GENERAL ASSURANCES
In accordance with the Acts, the Regulations, and other pertinent directives, circulars, policy, memoranda, and/or
guidance, the Recipient hereby gives assurance that it will promptly take any measures necessary to ensure that:
“No person in the United States shall, on the grounds of race, color, or national origin, be excluded from participation in, be
denied the benefits of, or be otherwise subjected to discrimination under any program or activity, for which the Recipient
receives Federal financial assistance from DOT, including NHTSA.”
The Civil Rights Restoration Act of 1987 clarified the original intent of Congress, with respect to Title VI of the Civil Rights
Act of 1964 and other non-discrimination requirements (the Age Discrimination Act of 1975, and Section 504 of the
Rehabilitation Act of 1973), by restoring the broad, institutional-wide scope and coverage of these nondiscrimination
statutes and requirements to include all programs and activities of the Recipient, so long as any portion of the program is
Federally assisted.
SPECIFIC ASSURANCES
More specifically, and without limiting the above general Assurance, the Recipient agrees with and gives the following
Assurances with respect to its Federally assisted Highway Safety Grant Program:
1. The Recipient agrees that each “activity,” “facility,” or “program,” as defined in 49 CFR
part 21 will be (with regard to an “activity”) facilitated, or will be (with regard to a “facility”) operated, or will be
(with regard to a “program”) conducted in compliance with all requirements imposed by, or pursuant to the
Acts and the Regulations.
2. The Recipient will insert the following notification in all solicitations for bids, Requests For Proposals for work,
or material subject to the Acts and the Regulations made in connection with all Highway Safety Grant
Programs and, in adapted form, in all proposals for negotiated agreements regardless of funding source:
“The [name of Recipient], in accordance with the provisions of Title VI of the Civil Rights Act of 1964 (78 Stat.
252, 42 U.S.C 2000d to 2000d-4) and the Regulations, hereby notifies all bidders that it will affirmatively
ensure that in any contract entered into pursuant to this advertisement, disadvantaged business enterprises
will be afforded full and fair opportunity to submit bids in response to this invitation and will not be
discriminated against on the grounds of race, color, or national origin in consideration for an award.”
3. The Recipient will insert the clauses of appendix A and E of this Assurance (also referred in every contract or agreement subject to the Acts and the Regulations.
4. The Recipient will insert the clauses of appendix B of DOT Order 1050.2A, as a covenant running with the land,
in any deed from the United States effecting or recording a transfer of real property, structures, use, or
improvements thereon or interest therein to a Recipient.
5. That where the Recipient receives Federal financial assistance to construct a facility, or part of a facility, the
Assurance will extend to the entire facility and facilities operated in connection therewith.
6. That where the Recipient receives Federal financial assistance in the form of, or for the acquisition of, real
property or an interest in real property, the Assurance will extend to rights to space on, over, or under such
property.
7. That the Recipient will include the clauses set forth in appendix C and appendix D of this DOT Order 1050.2A,
as a covenant running with the land, in any future deeds, leases, licenses, permits, or similar instruments
entered into by the Recipient with other parties:
a. for the subsequent transfer of real property acquired or improved under the applicable activity,
project, or program; and
b. for the construction or use of, or access to, space on, over, or under real property acquired or
improved under the applicable activity, project, or program.
8. That this Assurance obligates the Recipient for the period during which Federal financial assistance is extended
to the program, except where the Federal financial assistance is to provide, or is in the form of, personal
property, or real property, or interest therein, or structures or improvements thereon, in which case the
Assurance obligates the Recipient, or any transferee for the longer of the following periods:
a. the period during which the property is used for a purpose for which the Federal financial assistance is
extended, or for another purpose involving the provision of similar services or benefits; or
b. the period during which the Recipient retains ownership or possession of the property.
9. The Recipient will provide for such methods of administration for the program as are found by the Secretary of
Transportation or the official to whom he/she delegates specific authority to give reasonable guarantee that it,
other recipients, sub-recipients, sub- grantees, contractors, subcontractors, consultants, transferees,
successors in interest, and other participants of Federal financial assistance under such program will comply
with all requirements imposed or pursuant to the Acts, the Regulations, and this Assurance.
10. The Recipient agrees that the United States has a right to seek judicial enforcement with regard to any matter
arising under the Acts, the Regulations, and this Assurance.
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By signing this ASSURANCE, the State highway safety agency also agrees to comply (and require any sub-recipients,
sub-grantees, contractors, successors, transferees, and/or assignees to comply) with all applicable provisions governing
NHTSA's access to records, accounts, documents, information, facilities, and staff. You also recognize that you must
comply with any program or compliance reviews, and/or complaint investigations conducted by NHTSA. You must keep
records, reports, and submit the material for review upon request to NHTSA, or its designee in a timely, complete, and
accurate way. Additionally, you must comply with all other reporting, data collection, and evaluation requirements, as
prescribed by law or detailed in program guidance.
The State highway safety agency gives this ASSURANCE in consideration of and for obtaining any Federal grants, loans,
contracts, agreements, property, and/or discounts, or other Federal-aid and Federal financial assistance extended after the
date hereof to the recipients by the U.S. Department of Transportation under the Highway Safety Grant Program. This
ASSURANCE is binding on the State highway safety agency, other recipients, sub-recipients, sub-grantees, contractors,
subcontractors and their subcontractors', transferees, successors in interest, and any other participants in the Highway
Safety Grant Program. The person(s) signing below is/are authorized to sign this ASSURANCE on behalf of the Recipient.
THE DRUG-FREE WORKPLACE ACT OF 1988 (41 U.S.C. 8103)
The Subgrantee will 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 a 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;
4. The penalties that may be imposed upon employees for drug violations occurring in the workplace;
5. Making it a requirement that each employee engaged in the performance of the grant be given a
copy of the statement required by paragraph (a);
c. 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;
2. Notify the employer of any criminal drug statute conviction for a violation occurring in the
workplace no later than five days after such conviction;
d. Notifying the agency within ten days after receiving notice under subparagraph (c)(2) from an employee or
otherwise receiving actual notice of such conviction;
e. Taking one of the following actions, within 30 days of receiving notice under subparagraph (c)(2),
with respect to any employee who is so convicted—
1. Taking appropriate personnel action against such an employee, up to and including
termination;
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;
f. Making a good faith effort to continue to maintain a drug-free workplace through implementation of all
of the paragraphs above.
POLITICAL ACTIVITY (HATCH ACT)
(applies to all subrecipients as well as States)
The State will comply with provisions of the Hatch Act (5 U.S.C. 1501-1508), which limits the political activities of
employees whose principal employment activities are funded in whole or in part with Federal funds.
CERTIFICATION REGARDING FEDERAL LOBBYING
(applies to all subrecipients as well as States)
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS, AND COOPERATIVE AGREEMENTS
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;
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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
sub-awards at all tiers (including subcontracts, subgrants, and contracts under grant, 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.
RESTRICTION ON STATE LOBBYING
(applies to subrecipients as well as States)
None of the funds under this program will be used for any activity specifically designed to urge or influence a State or local
legislator to favor or oppose the adoption of any specific legislative proposal pending before any State or local legislative
body. Such activities include both direct and indirect (e.g., “grassroots”) lobbying activities, with one exception. This does
not preclude a State official whose salary is supported with NHTSA funds from engaging in direct communications with
State or local legislative officials, in accordance with customary State practice, even if such communications urge
legislative officials to favor or oppose the adoption of a specific pending legislative proposal.
CERTIFICATION REGARDING DEBARMENT AND SUSPENSION
(applies to all subrecipients as well as States)
INSTRUCTIONS FOR PRIMARY TIER PARTICIPANT CERTIFICATION (STATES)
1. By signing and submitting this proposal, the prospective primary tier participant is providing the certification set
out below and agrees to comply with the requirements of 2 CFR parts 180 and 1200.
2. The inability of a person to provide the certification required below will not necessarily result in denial of
participation in this covered transaction. The prospective primary tier participant shall submit an explanation of
why it cannot provide the certification set out below. The certification or explanation will be considered in
connection with the department or agency's determination whether to enter into this transaction. However,
failure of the prospective primary tier participant to furnish a certification or an explanation shall disqualify
such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which reliance was placed when the
department or agency determined to enter into this transaction. If it is later determined that the prospective
primary tier participant knowingly rendered an erroneous certification, in addition to other remedies available to
the Federal Government, the department or agency may terminate this transaction for cause or default or may
pursue suspension or debarment.
4. The prospective primary tier participant shall provide immediate written notice to the department or agency to
which this proposal is submitted if at any time the prospective primary tier participant learns its certification
was erroneous when submitted or has become erroneous by reason of changed circumstances.
5. The terms covered transaction, civil judgment, debarment, suspension, ineligible, participant,
person, principal, and voluntarily excluded, as used in this clause, are defined in 2 CFR parts 180 and
1200. You may contact the department or agency to which this proposal is being submitted for assistance
in obtaining a copy of those regulations.
6. The prospective primary tier participant agrees by submitting this proposal that, should the proposed covered
transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person
who is proposed for debarment under 48 CFR part 9, subpart 9.4, debarred, suspended, declared ineligible, or
voluntarily excluded from participation in this covered transaction, unless authorized by the department or
agency entering into this transaction.
7. The prospective primary tier participant further agrees by submitting this proposal that it will include the clause
titled “Instructions for Lower Tier Participant Certification” including the “Certification Regarding Debarment,
Suspension, Ineligibility and Voluntary Exclusion—Lower Tier Covered Transaction,” provided by the
department or agency entering into this covered transaction, without modification, in all lower tier covered
transactions and in all solicitations for lower tier covered transactions and will require lower tier participants to
comply with 2 CFR parts 180 and 1200.
8. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier
covered transaction that it is not proposed for debarment under 48 CFR part 9, subpart 9.4, debarred,
suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification
is erroneous. A participant is responsible for ensuring that its principals are not suspended, debarred, or
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otherwise ineligible to participate in covered transactions. To verify the eligibility of its principals, as well as the
eligibility of any prospective lower tier participants, each participant may, but is not required to, check the
System for Award Management Exclusions website
(https://www.sam.gov/).
9. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order
to render in good faith the certification required by this clause. The knowledge and information of a participant is
not required to exceed that which is normally possessed by a prudent person in the ordinary course of business
dealings.
10. Except for transactions authorized under paragraph 6 of these instructions, if a participant in a covered
transaction knowingly enters into a lower tier covered transaction with a person who is proposed for debarment
under 48 CFR part 9, subpart 9.4, suspended, debarred, ineligible, or voluntarily excluded from participation in
this transaction, in addition to other remedies available to the Federal Government, the department or agency
may terminate the transaction for cause or default.
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS—
PRIMARY TIER COVERED TRANSACTIONS
1. The prospective primary tier 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 participating in 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 tier participant is unable to certify to any of the Statements in this certification,
such prospective participant shall attach an explanation to this proposal.
INSTRUCTIONS FOR LOWER TIER PARTICIPANT CERTIFICATION
1. By signing and submitting this proposal, the prospective lower tier participant is providing the certification set
out below and agrees to comply with the requirements of 2 CFR parts 180 and 1200.
2. The certification in this clause is a material representation of fact upon which reliance was placed when this
transaction was entered into. If it is later determined that the prospective lower tier participant knowingly
rendered an erroneous certification, in addition to other remedies available to the Federal Government, the
department or agency with which this transaction originated may pursue available remedies, including
suspension or debarment.
3. The prospective lower tier participant shall provide immediate written notice to the person to which this
proposal is submitted if at any time the prospective lower tier participant learns that its certification was
erroneous when submitted or has become erroneous by reason of changed circumstances.
4. The terms covered transaction, civil judgment, debarment, suspension, ineligible, participant, person,
principal, and voluntarily excluded, as used in this clause, are defined in 2 CFR parts 180 and 1200. You
may contact the person to whom this proposal is submitted for assistance in obtaining a copy of those
regulations.
5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered
transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person
who is proposed for debarment under 48 CFR part 9, subpart 9.4, debarred, suspended, declared ineligible, or
voluntarily excluded from participation in this covered transaction, unless authorized by the department or
agency with which this transaction originated.
6. The prospective lower tier participant further agrees by submitting this proposal that it will include the clause
titled “Instructions for Lower Tier Participant Certification” including the “Certification Regarding Debarment,
Suspension, Ineligibility and Voluntary Exclusion—Lower Tier Covered Transaction,” without modification, in
all lower tier covered transactions and in all solicitations for lower tier covered transactions and will require
lower tier participants to comply with 2 CFR parts 180 and 1200.
7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier
covered transaction that it is not proposed for debarment under 48 CFR part 9, subpart 9.4, debarred,
suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification
is erroneous. A participant is responsible for ensuring that its principals are not suspended, debarred, or
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otherwise ineligible to participate in covered transactions. To verify the eligibility of its principals, as well as the
eligibility of any prospective lower tier participants, each participant may, but is not required to, check the
System for Award Management Exclusions website
( https://www.sam.gov/).
8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order
to render in good faith the certification required by this clause. The knowledge and information of a participant is
not required to exceed that which is normally possessed by a prudent person in the ordinary course of business
dealings.
9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered
transaction knowingly enters into a lower tier covered transaction with a person who is proposed for debarment
under 48 CFR part 9, subpart 9.4, suspended, debarred, ineligible, or voluntarily excluded from participation in
this transaction, in addition to other remedies available to the Federal Government, the department or agency
with which this transaction originated may pursue available remedies, including suspension or debarment.
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION—
LOWER TIER COVERED TRANSACTIONS
1. The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is
presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participating in covered transactions by any Federal department or agency.
2. Where the prospective lower tier participant is unable to certify to any of the statements in this certification,
such prospective participant shall attach an explanation to this proposal.
BUY AMERICA
(applies to subrecipients as well as States)
The State and each subrecipient will comply with the Buy America requirement (23 U.S.C. 313) when purchasing items
using Federal funds. Buy America requires a State, or subrecipient, to purchase with Federal funds only steel, iron and
manufactured products produced in the United States, unless the Secretary of Transportation determines that such
domestically produced items would be inconsistent with the public interest, that such materials are not reasonably
available and of a satisfactory quality, or that inclusion of domestic materials will increase the cost of the overall project
contract by more than 25 percent. In order to use Federal funds to purchase foreign produced items, the State must
submit a waiver request that provides an adequate basis and justification for approval by the Secretary of Transportation.
CERTIFICATION ON CONFLICT OF INTEREST
(applies to subrecipients as well as States)
GENERAL REQUIREMENTS
No employee, officer, or agent of a State or its subrecipient who is authorized in an official capacity to negotiate, make,
accept, or approve, or to take part in negotiating, making, accepting, or approving any subaward, including contracts or
subcontracts, in connection with this grant shall have, directly or indirectly, any financial or personal interest in any such
subaward. Such a financial or personal interest would arise when the employee, officer, or agent, any member of his or
her immediate family, his or her partner, or an organization which employs or is about to employ any of the parties
indicated herein, has a financial or personal interest in or a tangible personal benefit from an entity considered for a
subaward. Based on this policy:
1. The recipient shall maintain a written code or standards of conduct that provide for disciplinary actions to be
applied for violations of such standards by officers, employees, or agents.
a. The code or standards shall provide that the recipient's officers, employees, or agents may neither
solicit nor accept gratuities, favors, or anything of monetary value from present or potential
subawardees, including contractors or parties to subcontracts.
b. The code or standards shall establish penalties, sanctions, or other disciplinary actions for
violations, as permitted by State or local law or regulations.
2. The recipient shall maintain responsibility to enforce the requirements of the written code or standards of
conduct.
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DISCLOSURE REQUIREMENTS
No State or its subrecipient, including its officers, employees, or agents, shall perform or continue to perform under a
grant or cooperative agreement, whose objectivity may be impaired because of any related past, present, or currently
planned interest, financial or otherwise, in organizations regulated by NHTSA or in organizations whose interests may be
substantially affected by NHTSA activities. Based on this policy:
1. The recipient shall disclose any conflict of interest identified as soon as reasonably possible, making an
immediate and full disclosure in writing to NHTSA. The disclosure shall include a description of the action
which the recipient has taken or proposes to take to avoid or mitigate such conflict.
2. NHTSA will review the disclosure and may require additional relevant information from the recipient. If a conflict
of interest is found to exist, NHTSA may (a) terminate the award, or (b) determine that it is otherwise in the best
interest of NHTSA to continue the award and include appropriate provisions to mitigate or avoid such conflict.
3. Conflicts of interest that require disclosure include all past, present, or currently planned organizational,
financial, contractual, or other interest(s) with an organization regulated by NHTSA or with an organization
whose interests may be substantially affected by NHTSA activities, and which are related to this award. The
interest(s) that require disclosure include those of any recipient, affiliate, proposed consultant, proposed
subcontractor, and key personnel of any of the above. Past interest shall be limited to within one year of the
date of award. Key personnel shall include any person owning more than a 20 percent interest in a recipient,
and the officers, employees or agents of a recipient who are responsible for making a decision or taking an
action under an award where the decision or action can have an economic or other impact on the interests of a
regulated or affected organization.
PROHIBITION ON USING GRANT FUNDS TO CHECK FOR HELMET USAGE
(applies to all subrecipients as well as States)
The State and each subrecipient will not use 23 U.S.C. Chapter 4 grant funds for programs to check helmet usage or to
create checkpoints that specifically target motorcyclists.
POLICY ON SEAT BELT USE
In accordance with Executive Order 13043, Increasing Seat Belt Use in the United States, dated April 16, 1997, the
Grantee is encouraged to adopt and enforce on-the-job seat belt use policies and programs for its employees when
operating company-owned, rented, or personally-owned vehicles. The National Highway Traffic Safety Administration
(NHTSA) is responsible for providing leadership and guidance in support of this Presidential initiative. For information
and resources on traffic safety programs and policies for employers, please contact the Network of Employers for
Traffic Safety (NETS), a public-private partnership dedicated to improving the traffic safety practices of employers and
employees. You can download information on seat belt programs, costs of motor vehicle crashes to employers, and
other traffic safety initiatives at www.trafficsafety.org. The NHTSA website (www.nhtsa.gov) also provides information
on statistics, campaigns, and program evaluations and references.
POLICY ON BANNING TEXT MESSAGING WHILE DRIVING
In accordance with Executive Order 13513, Federal Leadership On Reducing Text Messaging While Driving, and DOT
Order 3902.10, Text Messaging While Driving, States are encouraged to adopt and enforce workplace safety policies
to decrease crashes caused by distracted driving, including policies to ban text messaging while driving company-
owned or rented vehicles, Government-owned, leased or rented vehicles, or privately-owned vehicles when on official
Government business or when performing any work on or behalf of the Government. States are also encouraged to
conduct workplace safety initiatives in a manner commensurate with the size of the business, such as establishment of
new rules and programs or re-evaluation of existing programs to prohibit text messaging while driving, and education,
awareness, and other outreach to employees about the safety risks associated with texting while driving.