WA ST Dept of Commerce 10/15/2021

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