LSTA EZ Literacy Lifelong Learning Grant Award- Story Place $30,000GRANT AGREEMENT
LSTA EZ LITERACY & LIFELONG LEARNING GRANT
This is an agreement by and between New Hanover County Public Library, hereinafter referred to as "the
Library," and the State Library of North Carolina, Department of Cultural Resources, hereinafter referred
to as the "State Library."
The State Library has agreed to fund this grant with federal Library Services and Technology Act (LSTA)
funds in the amount of $30,000 to be disbursed through North Carolina Accounting System accounting
fluid 46011495410145. The Catalog of Federal Domestic Assistance (CFDA) number for this grant is
45.310. This agreement is in effect upon signing by all parties, but no earlier than July 1, 2013, and will
terminate on June 30, 2014, unless amended by mutual consent.
Institution and/or Library Name: New Hanover County Public Library
Mailing Address: QCA c1_ e.,V.n "V ' ,
City, State, ZIP: `I 1 f n1 n gz+orl , !) i- g p4 d
U
Project manager name/title: -&sga &Aci (`Gd , U,6rr, n ca n
Project manager telephone: 9 lb ., `t P _ (D 3 S
Project manager email: She
DUNS Number: _ 9 _ Q
Federal Employer Identification Number: j _ _ + f _ 060 3 2—V
Library fiscal year ending date: 30, zo 13
IN CONSIDERATION OF RECEIVING THE ABOVE REFERENCED GRANT FUNDING,
THE LIBRARY HEREBY AGREES TO:
1. Accept and administer an LSTA grant from the State Library in the amount of $30,000 for
costs associated with the project represented in the Library's grant application, grant award
letter, and any amendments thereto.
2. Abide by all Grant Provisions as certified in this document and the grant application; including any
certifications submitted with this grant agreement such as Children's Internet Protection Act (CIPA)
Compliance and Certification Regarding Debarment and Suspension; Lobbying; Federal Debt Status;
Nondiscrimination.
3. Regularly inform the State Library on the progress of project activities as defined in the grant
application.
4. Encumber and expend project (grant and matching) funds
• only upon or after the effective date of this grant agreement and before its termination;
• in accordance with the project budget as submitted with the project application, or as modified in
the grant award letter, or as amended and approved by the State Library; and
• in accordance with all applicable local, state and federal laws and regulations.
2013 -2014 LSTA EZ Literacy & Lifelong Learning Grant Agreement page 1 of 5
5. Expend project funds in a manner that ensures free and open competition.
6. Submit grant reimbursement requests with appropriate documentation of eligible project (grant and
matching) expenditures as defined in the grant application, at least quarterly, on or before October 15,
January 15, and April 15.
7. On or before April 15, 2014, request a minimum of seventy -five percent (75 %) of the award amount
and provide documentation for seventy -five percent (75 %) of the required match; provide a list of
remaining activities with an estimate of remaining grant and matching expenditures as defined in the
grant application.
8. Complete all project (grant and matching) expenditures by June 30, 2014, or by the termination date
of this agreement as amended by mutual consent.
9. On or before July 15, 2014, submit a final request for reimbursement.
10. If eligible, the Library and all subgrantees shall: (a) ask the North Carolina Department of Revenue
for a refund of all sales and use taxes paid by them in the performance of this Contract, pursuant to
N.C.G.S. 105 - 164.14; and (b) exclude all refundable sales and use taxes from all reportable
expenditures before the expenses are entered in their reimbursement reports.
11. Request prior written approval from the State Library for any equipment with a unit price above
$5,000. If fair market value at the time of surplus or disposal exceeds $5,000, disposal will be cleared
with the State Library.
12. Acknowledge the Institute of Museum and Library Services in all related publications and activities
in conjunction with the use of the grant funds, with a credit acknowledgement as follows: "This
publication /activity /program/etc was supported by grant funds from the Institute of Museum and
Library Services under the provisions of the federal Library Services and Technology Act as
administered by the State Library of North Carolina, a division of the Department of Cultural
Resources." Submit a copy of any publications or materials produced under the grant to the State
Library.
13. Provide library services resulting from the grant to all members of the community served, in
compliance with all Federal statutes relating to non - discrimination on the basis of race, color, national
origin, sex, handicap, or age.
14. Request prior written approval from the State Library for any subcontracting or assignment to any
subgrantee or assignee. Neither the Library nor any subgrantee or assignee is relieved of the duties
and responsibilities of this agreement. Subgrantees and assignees agree to abide by the terms of this
agreement and must provide all information necessary for the Library to comply with the terms of this
agreement.
15. Only approved, awarded expenditures are allowable; any funds not expended as defined in the grant
application will be repurposed by the State Library upon termination of this agreement.
16. Submit a final report to the State Library by September 30, 2014, providing a summary of project
expenditures, a narrative of project activities, evaluative elements, and an assessment of the goals
achieved as defined in the grant application.
17. Certify upon completion of the grant that grant funds were received, used, and expended for the
purposes for which they were granted.
2013 -2014 LSTA EZ Literacy & Lifelong Learning Grant Agreement page 2 of 5
18. Maintain adequate financial records to ensure complete reporting, and retain programmatic, financial,
and audit records relating to the grant for a minimum of five years from the due date of the final grant
report or until all audit exceptions have been resolved, whichever is longer. Provide access upon
request to the Department of Cultural Resources, Office of the State Auditor, Institute of Museum and
Library Services and the Comptroller General or their designees, to all records and documents related
to the award, including audit work papers in possession of any auditor of the Library.
19. Ensure that grant funds are audited in compliance with state and federal audit requirements for local
governments and public authorities, institutions of higher education, and non -profit organizations,
and, as applicable, according to the standards of the federal Single Audit Act of 1984 as amended
1996 and 2003, and Circular A -133 "Audits of States, Local Governments, and Non - Profit
Organizations" as supplied by the Executive Office of the President, Office of Management and
Budget, Washington, DC.
20. Comply with the requirements of North Carolina General Statute 143C -6 -23: "State grant funds:
administration; oversight and reporting requirements" and the corresponding rules of North Carolina
Administrative Code, Title 9, Subchapter 03M, "Uniform Administration of State Grants," including
submission of required financial reports within six months (or nine months for $500,000 threshold) of
the end of the Library's fiscal year(s) in which grant funds are received.
21. The State Auditor and the using agency's internal auditors shall have access to persons and records as
a result of all contracts or grants entered into by State agencies or political subdivisions in accordance
with General Statute 147 -64.7 and Session Law 2010 -194, Section 21 (i.e., the State Auditors and
internal auditors may audit the records of the contractor during and after the term of the contract to
verify accounts and data affecting fees or performance).
22. File with the State Library a copy of the Library's policy addressing conflicts of interest that may
arise involving the Library's management employees and members of its board of directors,
commissions, or other governing body. The policy shall address situations in which any of these
individuals may directly or indirectly benefit, except as the Library's employees or members of its
board, commissions, or other governing body, from the Library's disbursing of grant funds and local
matching funds and shall include actions to be taken by the Library or the individual, or both, to avoid
conflicts of interest and the appearance of impropriety. (N.C.G.S. 143C- 6- 23(b)). The policy shall be
filed before the State Library may disburse the grant funds, unless the Library is covered by the
provisions of N.C.G.S. 160A- 479.11 and 14 -234.
23. File with the State Library the Library's sworn written statement completed by the Library's board of
directors or other governing body stating that, pursuant to N.C.G.S. 143C- 6- 23(c), the Library does
not have any overdue tax debts, as defined by N.C.G.S. 105 - 243.1, at the federal, State, or local
level. The policy shall be filed before the State Library may disburse the grant funds, unless the
Library is covered by the provisions of G.S. 160A- 479.11 and 14 -234.
THE STATE LIBRARY AGREES TO:
1. Award LSTA grant funds to the Library in the amount and under the terms and conditions stated
above, subject to the availability of funds.
2. Pay LSTA grant funds upon receipt of reimbursement requests for approved, awarded expenditures
submitted quarterly by the Library. Pay by June 30, 2014, all approved requests received on or before
April 15, 2014, and by August 31, 2014, all approved requests received by July 15, 2014.
3. Assist the Library as appropriate and necessary with the implementation of this project. Provide
monitoring and oversight through a combination of periodic emails, calls, visits, and review of
reimbursement requests and reports.
2013 -2014 LSTA EZ Literacy & Lifelong Learning Grant Agreement page 3 of 5
4. Report on this project to the federal funding agency, the Institute of Museum and Library Services,
and the North Carolina Office of State Budget and Management in accordance with all applicable
federal and state requirements.
THIS AGREEMENT may be amended, if necessary, upon the mutual acceptance of a written
amendment to this agreement signed and dated by the Library and the State Library. Such amendment(s)
shall state any and/or all change(s) to be made. This agreement may be terminated by mutual consent
with 60 days' prior written notice or as otherwise provided by law.
Returning signed agreements signifies accepting the grant award; awards not accepted by September
30, 2013 may be withdrawn.
[Please sign in blue ink. ]
Signature, Li`lat ireXacr-q
(Printed Name) j
x ✓
Signature, oval Government or Institutional Representative
(Printed Name / Title) A�1 C i L _1.44, P c tldef - mi`
X
Signature, Cal Shepard, State Librarian
Date O( -- 26— 13
Date I / 1:11 1 "R
Date
Return two complete sets of this form •Adth original signatures in blue ink to
LST.•', Grant Agreements. Libraty Development Section, State L ibiaty of North Carolina.
4640 Mail Seivice Center, Raleigh, NC 2 7649 -4640
2013 -2014 LSTA EZ Literacy & Lifelong Learning Grant Agreement page 4 of 5
GRANT PROVISIONS
The following state and federal provisions apply to the LSTA
grant program. Libraries awarded grants must agree to comply
with these provisions.
1. Grant Agreement and Timing of Expenditures
Official notification of the grant award must be received from the
State Library and a grant agreement (formal agreement between
the grantee and the State Library) signed by both the
representatives of the library and the State Librarian before any
funds may be encumbered or expended for the project.
2. Allowable and Unallowable Costs
Grantees must carry out the grant project according to the
approved grant proposal, and all federal funds must be
expended solely for the purpose for which a grant was awarded.
The following costs are unallowable and may not be
proposed as grant project costs: bad debts, contingencies,
contributions and donations, entertainment, fines and penalties,
under recovery of costs under grant agreements (excess costs
from one grant agreement are not chargeable to another grant
agreement).
3. Le al and Regulatory Compliance
Grantees must expend grant funds in accordance with all
applicable local, state, and federal laws and regulations.
4. Budget Revisions and Proarammatic Changes
Grantees must not deviate from the approved budget and plan
for carrying out the grant project as contained in the approved
grant application unless prior approval is obtained from the State
Library.
5. Records Retention
Grantees must maintain adequate records to ensure complete
reporting, and retain programmatic and financial records relating
to the grant for a minimum of three years from the due date of
the final grant report at the end of the Five Year Plan, or until all
audit exceptions have been resolved, whichever is longer.
6. Free and Open Competition
Purchases made from grant funds must be carried out to ensure
free and open competition to the extent possible. Libraries
eligible to purchase under state contract may use this option for
grant purchases.
7. Debarment & Suspension
Transactions for the purposes of this grant will not knowingly be
made with parties who have been debarred or suspended from
receiving Federal financial assistance under Federal programs
and activities (Debarment and Suspension Certification). See
Excluded Parties List System at hops: / /www.epis.aov .
8. Equipment Purchases and Inventory
Equipment with a unit price above $5,000 requires advance
written approval. If fair market value at the time of surplus or
disposal exceeds $5,000, disposal must be cleared with the
State Library.
9. Publicizing & Acknowledging Funds
Grantees are required to credit IMLS /LSTA in all related
publications and activities in conjunction with use of the grant
funds. Grantees should publicize grant - supported activities in
available and appropriate media. The following
acknowledgement statement must be used when meeting these
requirements: "This publication /activity/ program was supported
by grant funds from the Institute of Museum and Library Services
a division of the Department of Cultural Resources." Copies of any
publications or materials produced under the grant must be
submitted to the State Library. IMLS logos are available at
http: / /www.imis.aov /recipients /imis acknowledoement.aspx
10. Lobbying
Grantees are prohibited by federal law from using grant funds to
pay costs associated with lobbying Congress or the public for
purposes of influencing elections, legislation, or the award of any
federal funds. Grantees receiving an award of over $100,000 must
file a certification regarding lobbying.
11. Non - discrimination
All library services provided as a result of the federal grant funds
must be available without discrimination to all members of the
community served. Participation may not be denied on the basis of
race, color, national origin, handicap, age, or sex.
Relevant legislation includes but is not limited to the following:
Title VI of the Civil Rights Act of 1964, as amended (42 U.S.C. §
2000 et seq.); Section 504 of the Rehabilitation Act of 1973, as
amended (29 U.S.C. § §701 et seq.); Title IX of the Education
Amendments of 1972, as amended (20 U.S.C. § §1681 -83, and
1685 -86); the Age Discrimination in Employment Act of 1975, as
amended (42 U.S.C. § §6101 et seq.).
12. Traffickinq in Persons
Grantees must comply with 22 U.S.C. § 7104(g) which prohibits
engaging in trafficking in persons, procuring a commercial sex act,
or using forced labor.
13. Audit and Financial Reporting Requirements
LSTA grants must be audited in compliance with federal and state
audit requirements for local governments and public authorities,
institutions of higher education, and non - profit organizations. The
following source documents outline the standards and
requirements:
• United States Office of Management and Budget: (OMB)
Circular A-1 33 - Audits of States, Local Governments, and
Non - Profit Organizations.
• North Carolina General Statute 143Cr6 -23 "State grant funds:
administration; oversight and reporting requirements," and the
corresponding rules of North Carolina Administrative Code,
Title 09, Chapter 03M, "Uniform Administration of State
Grants."
LEGAL REFERENCES:
• 2 CFR 220 - Cost Principles for Educational Institutions
(formerly OMB Circular A -21)
• 2 CFR 225 - Cost Principles for State, Local, and Indian Tribal
Governments (formerly OMB Circular A -87)
• 2 CFR 230 - Cost Principles for Non -Profit Organizations
(formerly OMB Circular A -122)
• 45 CFR 1110 - Nondiscrimination in Federally Assisted
Programs
• 45 CFR 1170 - Nondiscrimination on the Basis of Handicap in
Federally Assisted Programs and Activities
• 45 CFR 1183 - Uniform Administrative Requirements for
Grants and Cooperative Agreements to State and Local
Governments
• 45 CFR 1185 - Governmentwide Debarment and Suspension
(Nonprocurement) and Governmentwide Requirements for
Drug -Free Workplace (Grants)
OMB Circular A -102 — Grants and Cooperative Agreements
with State and Local Governments
• OMB Circular A -110 — Uniform Administrative Requirements
for Grants and Agreements with Institutions of Higher
Education, Hospitals, and Other Non -Profit Organizations
2013 -2014 LSTA EZ Literacy & Lifelong Learning Grant Agreement page 5 of 5
a�
North Carolina Department of Cultural Resources
State Library of North Carolina
Library Development Section
Pat McCrory, Governor
Susan W. Kluttz, Secretary
June 20, 2013
Susan DeMarco
New Hanover County Public Library
201 Chestnut Street
Wilmington, North Carolina 28401
Dear Ms. DeMarco:
Cal Shepard, State Librarian
The State Library is pleased to confirm that New Hanover County Public Library's application for a 2013 -2014
LSTA EZ Literacy & Lifelong Learning Grant has been awarded in the amount of $30,000, with $7,500
match.
There are several forms that need to be completed, signed, and returned in one packet before you can begin your
project; a Grant Agreement Documents Checklist is provided on page 2. When the required documents have
been received, your Grant Agreement will be presented to the State Librarian for signature. Once the Grant
Agreement has been signed you will be notified promptly.
Please remember that you must obtain prior approval from the State Library for any budget or programmatic
changes. Prior to the purchase of equipment, be aware that IMLS and the grant agreement require awardees to:
• Request prior written approval from the State Library for any equipment with a unit price above $5,000.
• List this equipment on the Annual Equipment Tracking Survey as requested by the State Library for five
years following the purchase.
We remind you that you cannot encumber or spend grant or local matching funds until you have been notified
that the State Librarian has signed the grant agreement. The Catalog of Federal Domestic Assistance (CFDA)
number for this grant is 45.310.
This grant is made possible by funding from the federal Institute of Museum and Library Services (IMLS) under
the provisions of the Library Services and Technology Act as administered by the State Library of North
Carolina, a division of the Department of Cultural Resources. You are required to credit RVILS and the State
Library/Department of Cultural Resources in all related publications and activities in conjunction with the use of
the grant funds (see url below). <htto:llwww.imis. ovg /recipients /imis acknowlcdgement.aspx >.
Please let me know if you have any questions.
Sincerely,
gj-
Raye Oldham, Federal Programs Consultant
rave.oldham(amcdcr.gov
919 -807 -7423
MAILING ADDRESS LOCATION
4640 Mail service Center Telephone 919 - 807 -7400 109 East Tones Street
Raleigh, NC 27699 -4640 Fax 919 -733 -8748 Raleigh, NC
Grant Agreement Documents Checklist
Review the following documents, sign in blue ink, and mail together in one packet
with this checklist to the State Library.
New Hanover County Public Library
2013 -2014 LSTA EZ Literacy & Lifelong Learning Grant
Susan DeMarco
910- 798 -6353
sdemarco@nhcgov.com
Enclosed?
Document
Grant Agreement — print and sign two complete copies
CIPA Compliance Certification Form, public libraries
httl2://statelibLaa.ncdcr.gov/ld/grants/Ista/13 14/Forms\CIPACert. df
Certification Regarding Debarment and Suspension; Lobbying; Federal Debt Status;
Nondiscrimination b : / lstatelibr .ncdcr: ov/ld/ ants /Ista/13' 14/FormslCertDebarEtc. df
Conflict of Interest Policy
Locate your institution's policy; copy and paste it onto letterhead.
No Overdue Tax Debts Statement
h :I /statelibr .ncdcr. ov/ld/ rants /Ista/13 14/FormslNoOverdueTaxDebts.doc
W -9 Request for Taxpayer Identification Number and Certification
`�` t'
h :/lstatelibr .ncdcr. ov/ld/ ants/Ista/13 14/FonnslW -9. df
LSTA Partner Statement, if applicable
bnp:HstatelibM.ncdcr. og v/ Id/ grants/ lsta /13_14/FormslPartnerState.doc
To qualify non-digitization projects for a reduced match, partners must contribute a deliverable.
To assure prompt receipt by the State Library, libraries may prefer to use a commercial service for delivery to
the Jones Street address. Packages sent via US Postal Servir.P tn t1,P Taa;1 co.� =:.. ___ _ a , ;ss (even Express
Mail) frequently encounte � r � a Street address.
_ -
Commercial Service Adc
(e.g. FedEx, UPS, or phy
LSTA Grant Agreements
Library Development Sect
State Library of North Car-- -
Archives & State Library l L� bpci rV .r. tvd prnor
109 E. Jones Street
Raleigh, NC 27601 `J
Attn: Vicki Wheeler 'S-jr'-kz_ 'jam, [) AA)H� Cc rcS'1cj
lie"
UGI �on� jf��-
1P AFL a'4 tD 0
June 25, 2013
TO WHOM IT MAY CONCERN:
NEW HANOVER COUNTY
PUBLIC LIBRARY
201 CHESTNUT STREET
WILMINGTON, NORTH CAROLINA 28401 -3942
TELEPHONE (910) 798 -6300
The New Hanover County Public Library is a unit of local government.
The Tax ID number for New Hanover County is 56- 6000324.
Our DUNS number is 04 -002 -9563.
The Library's fiscal year ending date June 30, 2013.
Harry Tuchmayer, Library Director
State Library of North Carolina
LSTA CIPA COMPLIANCE INFORMATION, 2013 -2014
Libraries that are neither public libraries nor public elementary or secondary school libraries are
not subject to CIPA and do not have to comply with the law.
OVERVIEW
CIPA is the Children's Internet Protection Act, which applies to public libraries and public
elementary and secondary school libraries seeking funds under the federal Universal Service
(E -rate) program or the Library Services and Technology Act (LSTA) grant programs funded by
the Institute of Museum and Library Services (IMLS) and administered by the State Library of
North Carolina.
AFFECTED LIBRARIES
The following types of libraries applying for LSTA grants from the State Library of North Carolina
must submit the Internet Safety Certification document as. part of the application process.
• Public libraries
• Consortia with public and/or public school libraries
If a library of a type listed above is already compliant with CIPA under the rules for receiving E-
rate funds, that library is not affected by the rules established for LSTA grant recipients.
Accordingly, the compliance information in this document applies ONLY to libraries meeting
ALL THREE of the following conditions. The library
1. is a public library or public elementary or secondary school library,
2. is NOT required to comply with CIPA through the federal Universal Service (E -rate)
program, and
3. seeks LSTA funds for the purchase of computers used to access the Internet and/or
for the payment of direct costs associated with accessing the Internet.
Libraries that are required to comply with CIPA because of the receipt of funds from the
Universal Service (E -rate) program must adhere to a different and more stringent set of
requirements. More information about those requirements may be found at
http: / /statelibrary.dcr. state .nc.us /hottopic /cipa /cipa.htm. The compliance information in this
document does not apply to libraries that must comply with CIPA under the Universal Service
(E -rate) rules.
PURCHASES THAT REQUIRE CIPA COMPLIANCE
A library that is subject to CIPA under the rules for LSTA must comply with the law when either
of the following are approved for purchase with LSTA funds:
• computers used to access the Internet, or
• direct costs associated with accessing the Internet (i.e., the costs of connecting to an
Internet service provider [ISP]).
REQUIREMENTS FOR COMPLIANCE
To receive LSTA funds for purchases of the above types, the library must have in place a policy
of —
(a) Internet safety for minors that includes the operation of a technology protection measure with
respect to any of its computers with Internet access that protects against access through such
LSTA CIPA Compliance Information, 2013 -2014 Page 1 of 2
State Library of North Carolina
computers to visual depictions that are (1) obscene; (II) child pornography; or (III) harmful to
minors; and is enforcing the operation of such technology protection measure during any use of
such computers by minors; and
(b) Internet safety that includes the operation of a technology protection measure with respect to
any of its computers with Internet access that protects against access through such computers
to visual depictions that are (1) obscene; (11) child pornography; and is enforcing the operation of
such technology protection measure during any use of such computers."
Note that the difference between (a) and (b) is that (a) applies to minors and includes the
category of "visual depictions" that are "harmful to minors ", while (b) applies to adults
and does not include the category "harmful to minors ".
For purposes of CIPA, a "minor" is someone under 17 years of age.
The policy requires that some form of "technology protection measure" be in use on all
computers used to access the Internet. This includes computers that were not purchased with
LSTA funds but that are used to access the Internet. The law provides no other guidance on
technology protection measures; According.to the. CIPA legislation, the technology protection
measure may be disabled upon the request of the user for "bona fide research or other lawful
purposes." The law as applied to LSTA grant recipients does not differentiate between minors
and adults when a request is made to disable the technology protection measure or unblock a
website. Anyone may make such a request.
LSTA CIPA Compliance Information, 2013 -2014 Page 2 of 2
State Library of North Carolina
CIPA COMPLIANCE CERTIFICATION
for Public Libraries
As the authorized library representative, I hereby certify that the library is
(check only one of the following boxes)
A. CIPA Compliant
The applicant library has complied with the requirements of Section 9134(f)(1) of the Library
Services and Technology Act.
M
B. ❑ The CIPA requirements do not apply because no funds made available under the LSTA program
will be used to purchase electronic equipment capable of accessing the Internet or to pay for
direct costs associated with accessing the Internet.
Printed name of library director
Signatu f racy d'
7C - -Z�- 3
Date
State Library of North Carolina
CERTIFICATION REGARDING DEBARMENT AND SUSPENSION; LOBBYING;
FEDERAL DEBT STATUS; AND NONDISCRINIINATION
1. DEBARMENT AND SUSPENSION
The grantee shall comply with 2 CFR Part 3185. The undersigned, on behalf of the grantee, certifies to
the best of his or her knowledge and belief that neither the grantee nor any of its principals:
(a) Are presently excluded or disqualified;
(b) Have been convicted within the preceding three years of any of the offenses listed in 2 CFR
section 180.800(a) or had a civil judgment rendered against you for one of those offenses within that
time period;
(c) Are presently indicted for or otherwise criminally or civilly charged by a governmental entity
(Federal, State or local) with commission of any of the offenses listed in 2 CFR section 180.800(a);
or
(d) Have had one ormore-public- transactions (Federal, State, or local) terminated within the
preceding three years for cause or default.
Where the grantee is unable to certify to any of the statements in this certification, he or she shall
attach an explanation to this submission.
The grantee is required to communicate the requirement to comply with 2 CFR Part 180 Subpart C
(Responsibilities of Participants Regarding Transactions Doing Business With Other Persons) to persons
at the next lower tier with whom the grantee enters into covered transactions.
2. LOBBYING
As required by Section 1352, Title 31 of the United States Code, and implemented for persons entering
into a grant or cooperative agreement over $100,000, the grantee certifies to the best of his or her
knowledge and belief that:
(a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned,
to any person for influencing of 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
m connection with The awarding of a Federal contract, the making of a Federal grant, the making of a
Federal loan, the entering into of a cooperative agreement, or the extension, continuation, renewal,
amendment, or modification of a Federal contract, grant, loan, or cooperative agreement.
(b) If any funds other than appropriated Federal funds have been paid or will be paid to any person
(other than a regularly employed officer or employee of the grantee) 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 request, complete, and submit Standard Form
LLL, "Disclosure of Lobbying Activities," in accordance with its instructions.
(c) The undersigned shall require that the language of this certification be included in the award
documents for all subawards at all tiers [including subcontracts, subgrants, and contracts under
grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose
accordingly.
page 1 of 2
3. FEDERAL DEBT STATUS
The undersigned, on behalf of the grantee, certifies to the best of his or her knowledge and belief that the
grantee is not delinquent in the repayment of any Federal debt.
4. NONDISCRDUNATIUN
As required by the Civil Rights Act of 1964, the Rehabilitation Act of 1973, the Education Amendments
of 1972, and the Age Discrimination in Employment Act of 1975, as implemented at 45 C.F.R. Part
1180.44, the undersigned. on behalf of the grantee, certifies that the grantee will comply with the
following nondiscrimination statutes and their implementing regulations:
(a) Title VI of the Civil Rights Act of 1964, as amended (42 U.S.C. § 2000 et seg.), which provides
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 otherwise be subject to discrimination
under any program or activity receiving Federal financial assistance;
(b) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. § 701 et seq.), which
prohibits discrimination on the basis of disability in Federally- assisted programs (c) Title, 1X of the
Education Amendments of 1972, as amended (20 U.S.C. §§ 1681 -83, 1685- 86), which prohibits
discrimination on the basis of sex in education programs and activities receiving Federal financial
assistance;
(d) The Age Discrimination in Employment Act of 1975, as amended (42 U.S.C. § 6101 et seq.),
which prohibits discrimination on the basis of age in Federally- assisted programs;
The undersigned further provides assurance that it will include the language of these certifications in all
subawards and that all subrecipients shall certify and disclose accordingly.
As the duly authorized representative of the grantee, I hereby certify that the grantee will comply with the
above certifications.
Print Name and Title of
Certification Regarding Debarment and Suspension; Lobbying; etc. page 2 of 2
NEW HANOVER COUNTY
PUBLIC LIBRARY
201 CHESTNUT STREET
WILMINGTON, NORTH CAROLINA 28401 -3942
TELEPHONE (910) 798 -6300
Institution's Letterhead
No Overdue Tax Debts' Statement
Certification Statement
We certify that the New Hanover County Public Library does not have any overdue tax debts, as
defined by N.C.G.S. 105 - 243.1, at the federal, State, or local level. We further understand that any
person who makes a false statement in violation ofN.C,G.S. 143C- 6 -23(c) is punishable as provided
by N.C.G.S. 143- 34(b).
If there are any questions, please contact the state agency that provided your grant. If needed, you may
contact the North Carolina Office of State Budget and Management at NCGrants @osbm.nc.gov or
919 - 807 -4795.
Certification and Signatures (Please sign below in blue ink.)
We confirm that the foregoing certification is true, accurate, and complete to the best of our
knowledge. We also acknowledge and understand that any misuse of State funds will be reported to
the appropriate authorities for further action.
Printed name oV Iibrary director
Signature T ary rrec
CJ - as'- 13
Date
State Library of North Carolina
\&(Yjq-
Printed name & title of local government or
insti tional authorizin official
X
St of above official
Date
1 G.S. 105 -243.1 defines: "Overdue tax debt. — Any part of a tax debt that remains unpaid 90 days or more after the notice of final
assessment was mailed to the taxpayer. The term does not include a tax debt, however, if the taxpayer entered info an installment agreement
for the tax debt under G.S. 105 -237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments
due under the installment agreement."
Form w -9
Request for Taxpayer
Give Form to the
(Rev. December 2011)
Identification Number and Certification
requester. Do not
Department of the Treasury
send to the IRS.
Internal Revenue Service
Name (as shown on your Income tax return)
NEW HANOVER COUNTY
Business name/disregarded entity name, if different from above
ni
o,
NEW HANOVER COUNTY PUBLIC LIBRARY
Check appropriate box for federal tax classification:
❑ Individual/sole proprietor ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate
m
m
❑ Exempt payee
❑ Limited liability company. Enter the tax classification (C =C corporation, S =S corporation, P= partnership) ►
C
❑✓ Other (see instructions) ► LOCAL GOVERNMENT
u
!@
Address (number, street, and apt. or suite no.)
Requester's name and address (optional)
u
IL
201 CHESTNUT STREET
co
City, state, and ZIP code
WILMINGTON NC 28403
List account number(a) here (optional)
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" line
Social seoufrgr number
-
m -
to avoid backup withholding. For individuals, this is your social security number pag However, for a
resident alien, sole proprietor, or disregarded entity, see the Part 1 instructions on page 3. For other
—wioa it la v t it Qmninvwr idwntlfiratinn number (EIN1. If you do not have a number. see Now to vet a
TIN on page 3.
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose I Employer identifloation number
number to enter.
5 6- 6 o a o 3 2 4
Under penalties of perjury, I certify that:
The number shown on this form Is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding, and
3. 1 am a U.S. citizen or other U.S. person (defined below).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all Interest and dividends on your tax return. For real estate transactions, Item 2 does not apply. For mortgage
interest paid, acquisition or abandon , �f secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and
generally, payments other than i ° rd nd u�re not relied to sign the certification, but you must provide your correct TIN. See the
instructions on page 4. r_
ary=l Signature of
Here I U.S. person ►
General Instructions " 4Iff,
Section references are to the internal Revenue Code unless otherwise
noted.
Purpose of Form
A person who is required to file an Information return with the IRS must
obtain your correct taxpayer Identification number (TIN) to report, for
example, income paid to you, real estate transactions, mortgage interest
you paid, acquisition or abandonment of secured property, cancellation
of debt, or contributions you made to an IRA.
Use Form W -9 only If you are a U.S. person (Including a resident
alien), to provide your correct TIN to the person requesting it (the
requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you are waiting for a
number to be issued),
2. Certify that you are not subject to backup withholding, or
Date IN-
Note. If a requester gives you a form other than Form W -9 to request
your TIN, you must use the requester's form if it is substantially similar
to this Form W -9.
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
• An Individual who is a U.S. citizen or U.S. resident alien,
• A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United States,
• An estate (other than a foreign estate), or
• A domestic trust (as defined in Regulations section 301.7701 -7).
Special rules for partnerships. Partnerships that conduct a trade or
business In the United States are generally required to pay a withholding
tax on any foreign partners' share of income from such business.
Further, in certaln cases where a Form W -9 has not been received, a
partnership is required to presume that a partner is a foreign person,
and pay the withholding tax. Therefore, If you are a U.S. person that is a
nd U ' ed
3. Claim exemption from backup withholding if you are a U.S. exempt partner in a partnership co ucting a trede or business in the nit
payee. If applicable, you are also certifying that as a U.S. person, your States, provide Form W -9 to the partnership to establish your U.S.
allocable share of any partnership income from a U.S. trade or business status and avoid withholding on your share of partnership income.
is not subject to the withholding tax on foreign partners' share of
effectively connected income.
Cat. No. 10231X Form W-9 (Rev. 12 -2011)