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Certification & Agreement Statement (Including Conditions, Reservations and Restrictions):
<br />(f)THE DONEE AGREES TO THE FOLLOWING ADDITIONAL SPECIAL TERMS AND CONDITIONS APPLICABLE TO THE DONATION OF AIRCRAFT AND VESSELS (50 FEET OR MORE IN LENGTH) HAVING AN ACQUISITION COST OF $5,000 OR MORE, AND FOREIGN GIFTS OR OTHER ITEMS OF PROPERTY REQUIRING SPECIAL HANDLING OR USE LIMITATIONS, REGARDLESS OF THE ACQUISITION COST OR PURPOSE FOR WHICH ACQUIRED: (1)The donation shall be subject to the additional special terms, conditions, reservations, and restrictions set forth in the Conditional Transfer Document or other agreement executed by the authorized donee representative, as well as the conditions set forth in C, at a minimum.
<br />Sample Restriction Periods:* These are the general restriction periods for most types of property received. It is the applicant's responsibility to research, understand and comply with the specific restrictions placed upon each piece of property received.
<br />Property must be placed into use within 12 months and used for a minimum compliance or restriction period of 12 months depending on the type of property. Special restrictions are applied to items with an original government unit acquisition cost of $5,000 or more, passenger motor vehicles, NASA artifacts, noncombat aircraft and vessels over 50', noncombat flyable aircraft, combat aircraft and vessels 50' and greater, and firearms. See the SASP for specific restrictions and questions on all items acquired, including the following:
<br />Property with an original gov't unit acquisition cost of less than $5,000 or more= 12 months Property with an original gov't unit acquisition cost of $5,000 or more and passenger motor vehicles = 18 months NASA artifacts = 60 months & Perpetuity Noncombat Aircraft and Vessels 50' and greater= 60 months Combat Aircraft and Vessels over 50' = Perpetuity Firearms = Perpetuity
<br />Note: SEAs can QDJy acquire DOD property and are QDJy subject to a 12 month restrict ion period! SBA activities can acquire c ivilian agency and DOD property, but must use the property during its term of participation in the SBA program plus one year!
<br />Nondiscrimination Assurance Statement:
<br />ASSURANCE AND COMPLIANCE WITH GSA REGULATIONS under Title VI of the Civil Rights Act of 1964, Section 606 of Title VI of the Federal Property and Administrative Service Act of 1949, as amended, Section 504 of the Rehabilitation Act of 1973, as amended, and Section 303 of the Age Discrimination Act of 1975.
<br />Hereinafter called the "Donee", agrees that the program for or in connection with which any property is donated to the Donee will be conducted in compliance with, and the Donee will comply with and will provide services or benefits under said program to comply with all requirements imposed by or pursuant to the regulation of the General Service Administration (41 CFR 101.6-2, PR 101-8) issued under the provisions of Title VI of the Civil Rights Act of Rehabilitation Act of 1973, as amended, Title IX of the Education Amendments of 1972, as amended, and Section 303 of the Age Discrimination Act of 1975. To the end that no person in the United States shall on the grounds of race, color, national origin, sex or age, or that no person with disabilities shall solely by reason of their disability, be excluded from participation in or be denied the benefits of, or be subject to discrimination under any program or activity for which the Do nee receives Federal Assistance from the General Services Administration.
<br />The Donee hereby gives assurance that it will immediately take any measure necessary to effectuate this agreement.
<br />Certification Regarding Debarment, Suspension, and Other Responsibility Matters -Primary Covered Transactions
<br />(1) The prospective primary 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 covered transactions by anyFederal department or agency;(b)Have not within a 3-year period preceding this proposal been convicted of or had a civil judgement rendered against them for commission of fraud ora 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 Governmental entity (Federal, State, or local) with commission of any of theoffenses enumerated in paragraph (1) (b) of this certification; and (d)Have not within a 3-year period preceding this application/proposal had one or more public transactions (Federal, state, or local) terminated for cause of default.
<br />(2) Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall draw a line through the statement(s) above-(1 )(a), (1 )(b), (1 )(c), (1 )(d) for which the prospective applicant cannot certify and attach a detailed explanation to this application.
<br />My signature below represents that I have read and understand all of the information contained in this application (including the fine print). My signature below represents that I have accurately completed this form to the best of my ability and that my agency, organization, business and representatives will abide by the aforementioned agreements, certifications, assurances and statements.
<br />Print Name and Title of Applicant's Head Aut horized Off ic ial �I c_a _ss _i_eF_ra_n_k_li _n _________________________ __.l I�-----� Date (DD/MMIYYYY) Signature r--=---=========---.
<br />-(Intern al SASP Use Only) Print Name and Title of SASP Reviewing/Processing Official (Opt ional) Date (DD/MM/YYYY) Signature I I 11 Print Name and Title of SASP Head Approving Official Date (DD/MM/YYYY) Signature I I I I Approved: License/Accreditation/Approval Date: Eligibility Expiration Date: Notes DYES □NO I I I I I
<br />GENERAL SERVICES ADMINISTRA TJON 41Page GSA FORM JG MAY 09, 2021
<br />, Mayor Cassie Franklin06/27/2023
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