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Eligibility Requirements: <br />Statement of Assurances Form 1 <br />Debarment, Suspension, Ineligibility and Voluntary Exclusion <br />Lower Tier Covered Transactions (Sub -Recipient) Form 2 <br />Certification Regarding Lobbying, Debarment, Suspension and <br />Other Responsibility Matters; and Drug -Free Workplace Requirements Form 3 <br />National Environmental Policy Act (NEPA) Form 4 <br />Acknowledgement of Federal Funds Form 5 <br />Acknowledgement of Allowable and Unallowable Costs Form 6 <br />Compliance with Relevant Federal and State Laws Form 7 <br />Civil Rights Training Form 8 <br />Civil Rights Requirements Form 9 <br />Equal Employment Opportunity Plan (EEOP) Certification Form 10 <br />Office of Civil Rights Compliance Checklist Form 11 <br />Federal Funding Accountability and Transparency Act Certificate Form 12 <br />Commercial Insurance, Risk Pool or Self Insurance Form 13 <br />General Information Regarding Risk Assessment Form 14 <br />Customer Satisfaction and Improvement: <br />Customer Satisfaction and Improvement Form Form 15 <br />SUBMISSION OF THIS PACKET <br />One electronic copy of these Certifications and Assurances must be completed and <br />submitted to be eligible to receive reimbursement with federal funds (any funds under <br />this program). <br />DUE DATE <br />The Federal Eligibility Package should be received by COMMERCE no later than <br />November 15, 2021 for those agencies which have been selected for funding. <br />Submission after this date will cause delay in your being eligible to receive <br />reimbursement under this program. <br />SUBMIT APPLICATION FORMS To: <br />abigail.snyder@commerce.wa.gov <br />Note1: Emailed copies must still <br />be signed <br />Note2: PDF is the preferred format <br />for electronic submission <br />If you have questions regarding the application or need technical assistance, please <br />contact Abigail Snyder at (360) 515-6205 (email: abigail.snyder@commerce.wa.gov). <br />1 <br />