HomeMy WebLinkAboutReso 113-23 Accepting the Office of Traffic Safety Selective Traffic Enforcement Program GrantReso. No. 113-23 Item 5.2, Adopted 11/07/2023 Page 1 of 2
RESOLUTION NO. 113 – 23
A RESOLUTION OF THE CITY COUNCIL
OF THE CITY OF DUBLIN
ACCEPTING THE OFFICE OF TRAFFIC SAFETY SELECTIVE TRAFFIC ENFORCEMENT
PROGRAM GRANT
WHEREAS, injuries and fatalities resulting from traffic collisions are frequently caused by
preventable factors such as driver impairment; and
WHEREAS, On July 14, 2023, a Grant Agreement with the State of California Office of
Traffic Safety was awarded to conduct a multi-year Selective Traffic Enforcement Program
(STEP); and
WHEREAS, the City was advised after the adoption of the Fiscal Year 2023-24 Budget of
the award of $81,000 to be made under the STEP Grant; and
WHEREAS, the total award for the STEP Grant will span Fiscal Years 2023-24 and
2024-25 as described in the Staff Report presented to the City Council on November 7, 2023;
and
WHEREAS, the enforcement grant is dedicated to reducing the number of fatal and injury
traffic collisions by funding supplemental saturation patrols as well as providing for additional
public safety awareness activities; and
WHEREAS, the City Council of the City of Dublin has agreed DUI enforcement,
distracted driving enforcement, seat belt enforcement, and awareness are important elements in
improving overall public safety.
NOW, THEREFORE, BE IT RESOLVED that the City Council of the City of Dublin
confirms the Grant Agreement with the State of California Office of Traffic Safety attached
hereto as Exhibit A.
BE IT FURTHER RESOLVED that the City Council accepts the grant award of $81,000.
{Signatures on the following page}
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Reso. No. 113-23 Item 5.2, Adopted 11/07/2023 Page 2 of 2
PASSED, APPROVED AND ADOPTED this 7th day of November 2023, by the following
vote:
AYES: Councilmembers Hu, Josey, McCorriston, Qaadri and Mayor Hernandez
NOES:
ABSENT:
ABSTAIN:
______________________________
Mayor
ATTEST:
_________________________________
City Clerk
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State of California Office of Traffic Safety
GRANT AGREEMENT GRANT NUMBER
PT24059
1.GRANT TITLE
Selective Traffic Enforcement Program (STEP)
2.NAME OF AGENCY 3.Grant Period
Dublin From:
To:
10/01/2023
09/30/20244.AGENCY UNIT TO ADMINISTER GRANT
Dublin Police Department
5.GRANT DESCRIPTION
Best practice strategies will be conducted to reduce the number of persons killed and injured in crashes
involving alcohol and other primary crash factors. The funded strategies may include impaired driving
enforcement, enforcement operations focusing on primary crash factors, distracted driving, night-time seat belt
enforcement, special enforcement operations encouraging motorcycle safety, enforcement and public
awareness in areas with a high number of bicycle and pedestrian crashes, and educational programs. These
strategies are designed to earn media attention thus enhancing the overall deterrent effect.
6.Federal Funds Allocated Under This Agreement Shall Not Exceed:$81,000.00
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:
William Chase
Sergeant
wchase@acgov.org
(925) 556-4562
6361 Cark Avenue
Dublin, CA 94568
ADDRESS: Nathan Schmidt
Chief of Police
nschmidt@acgov.org
(925) 833-6685
6361 Clark Avenue
Dublin, CA 94568
{{_es_signer2_signature}} {{_es_signer2_date}}{{_es_signer4_signature}} {{_es_signer4_date}}
(Signature)(Date)(Signature)(Date)
C.FISCAL OFFICIAL D.AUTHORIZING OFFICIAL OF OFFICE OF TRAFFIC SAFETY
ADDRESS: Jay Baksa
Finance Director
jay.baksa@dublin.ca.gov
(925) 833-6648
100 Civic Plaza
Dublin, CA 94568
ADDRESS: Barbara Rooney
Director
barbara.rooney@ots.ca.gov
(916) 509-3030
2208 Kausen Drive, Suite 300
Elk Grove, CA 95758
{{_es_signer3_signature}} {{_es_signer3_date}}{{_es_signer6_signature}} {{_es_signer6_date}}
(Signature)(Date)(Signature)(Date)
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E. ACCOUNTING OFFICER OF OFFICE OF TRAFFIC SAFETY 9. SAM INFORMATION
NAME: Carolyn Vu SAM#:
REGISTERED
ADDRESS:
CITY:
ZIP+4:
H7R6FXBY88V5
100 Civic Plaza
Dublin CA 94568
Dublin
94568-7735
ADDRESS: 2208 Kausen Drive, Suite 300
Elk Grove, CA 95758
10.PROJECTED EXPENDITURES
FUND CFDA ITEM/APPROPRIATION F.Y. CHAPTER STATUTE PROJECTED
EXPENDITURES
164AL-24.1 20.608 0521-0890-101 2022 43/22 BA/22 $17,000.00
402PT-24.1 20.600 0521-0890-101 2022 43/22 BA/22 $10,540.00
164AL-24 20.608 0521-0890-101 2023 12/23 BA/23 $33,000.00
402PT-24 20.600 0521-0890-101 2023 12/23 BA/23 $20,460.00
AGREEMENT
TOTAL $81,000.00
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.
$81,000.00
PRIOR AMOUNT ENCUMBERED FOR THIS
AGREEMENT
$ 0.00
OTS DATE SIGNED TOTAL AMOUNT ENCUMBERED TO DATE
{{_es_signer5_signature}} {{_es_signer5_date}} $81,000.00
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State of California Office of Traffic Safety
GRANT AGREEMENT
Schedule A
GRANT NUMBER
PT24059
1. PROBLEM STATEMENT
The City of Dublin is a city with a residential population of 71,674 as of 07/01/21. The U.S Census Bureau
ranked the City of Dublin as the third fastest growing city with a population over 30,000 by percentage in
California over the past ten years! In addition, Dublin is the number one fastest growing city by percentage
in the entire 9-county San Francisco Bay Area. Through a growing light industry, existing retail business,
and planned future residential, retail, and commercial development, the day-time population of Dublin
can increase by over 85%.
The City of Dublin currently has 126 miles of roadway, with more being planned. The vehicular traffic in
Dublin can increase to 115,000 vehicles coming in-and-out of the city on an average day. There are four
major roadways thru Dublin which allow for a high volume of vehicular traffic during all hours from the
neighboring cities of San Ramon, Pleasanton, and Livermore. All three of these cities are growing as fast, if
not faster, than Dublin with retail, commercial, and residential development. Dublin is bordered on the south
by Interstate 580 and on the west with Interstate 680 running north and south thru Dublin. Due to the
increasing volume of traffic crashes are on the rise while staffing levels remain stagnant.
In 2022, the Dublin Police Services (DPS) saw an increase of 14% percent in reported traffic crashes with a
total of 423. This increase includes a total of 132 persons injured in 2022. Dublin Police also saw an
increase in injury crash and DUI related crashes from 2021 to 2022.
the Primary Crash Factor increased from 71 in 2021 to 88 in 2022, this is a 21 percent increase. These
number have been increasing since post pandemic roadway travel has not only returned, but there visibility
more vehicles traveling on roadways in the City of Dublin daily.
With the support from OTS, the DPS Traffic Unit will effectively and systemically address some of the
concerns associated with the rise in injury and DUI related crashes in the City of Dublin. There will be
targeted enforcement for speed violators, distracted driving violators, and the apprehension of impaired
drivers.
Dublin Police will conduct 2 DUI Checkpoints with the City, which will bring community awareness and
education about DUI related crimes. These targeted enforcement engagements should have a significate
The DPS Traffic Unit is staffed with four Traffic Officers and one Sergeant. With the assistance of OTS
funding, the DPS Traffic Units will aggressively address driving problems during the hours which they most
occur. The Traffic Unit will also address other major primary crash factors. The normal day-to-day Traffic
Unit objective will continue without interruption.
In closing, the Dublin Traffic Unit with collaborate with surrounding Alameda County agencies, specifically
within the Tri-Valley Cities of Livermore, Pleasanton, and Dublin to address staffing shortages to conduct
enforcement operations.
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.
3. Reduce the number of pedestrians killed in traffic crashes.
4. Reduce the number of pedestrians injured in traffic crashes.
5. Reduce the number of bicyclists killed in traffic crashes.
6. Reduce the number of bicyclists injured in traffic crashes.
7. Reduce the number of persons killed in alcohol-involved crashes.
8. Reduce the number of persons injured in alcohol-involved crashes.
9. Reduce the number of persons killed in drug-involved crashes.
10. Reduce the number of persons injured in drug-involved crashes.
11. Reduce the number of persons killed in alcohol/drug combo-involved crashes.
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12. Reduce the number of persons injured in alcohol/drug combo-involved crashes.
13. Reduce the number of motorcyclists killed in traffic crashes.
14. Reduce the number of motorcyclists injured in traffic crashes.
15. Reduce hit & run fatal crashes.
16. Reduce hit & run injury crashes.
17. Reduce nighttime (2100 - 0259 hours) fatal crashes.
18. Reduce nighttime (2100 - 0259 hours) injury crashes.
B. Objectives: Target Number
1. Issue a press release announcing the kick-off of the grant by November 15. The
kick-off press releases and media advisories, alerts, and materials must be
emailed to the OTS Public Information Officer at pio@ots.ca.gov, and copied to
your OTS Coordinator, for approval 14 days prior to the issuance date of the
release.
1
2. Participate and report data (as required) in the following campaigns; Quarter 1:
National Walk to School Day, National Teen Driver Safety Week, NHTSA Winter
Mobilization; Quarter 3: National Distracted Driving Awareness Month, National
Motorcycle Safety Month, National Bicycle Safety Month, National Click it or Ticket
Mobilization; Quarter 4: NHTSA Summer Mobilization, National Child Passenger
Safety Week, and California's Pedestrian Safety Month.
10
3. Develop (b
and traffic officers to be on the lookout for identified repeat DUI offenders with a
suspended or revoked license as a result of DUI convictions. Updated DUI BOLOs
should be distributed to patrol and traffic officers monthly.
12
4. Send law enforcement personnel to the NHTSA Standardized Field Sobriety
Testing (SFST) (minimum 16 hours) POST-certified training.
2
5. Send law enforcement personnel to the NHTSA Advanced Roadside Impaired
Driving Enforcement (ARIDE) 16 hour POST-certified training.
2
6. Send law enforcement personnel to the Drug Recognition Expert (DRE) training. 1
7. Send law enforcement personnel to the DRE Recertification training. 1
8. Send law enforcement personnel to SFST Instructor training. 1
9. Conduct DUI/DL Checkpoints. A minimum of 1 checkpoint should be conducted
during the NHTSA Winter Mobilization and 1 during the Summer Mobilization. To
enhance the overall deterrent effect and promote high visibility, it is recommended
the grantee issue an advance press release and conduct social media activity for
each checkpoint. For combination DUI/DL checkpoints, departments should issue
press releases that mention DL's will be checked at the DUI/DL checkpoint. Signs
for DUI/DL checkpoints should read "DUI/Driver's License Checkpoint Ahead."
OTS does not fund or support independent DL checkpoints. Only on an exception
basis and with OTS pre-approval will OTS fund checkpoints that begin prior to
1800 hours. When possible, DUI/DL Checkpoint screeners should be DRE- or
ARIDE-trained.
2
10. Conduct DUI Saturation Patrol operation(s). 19
11. Conduct Traffic Enforcement operation(s), including but not limited to, primary
crash factor violations.
12
12. Conduct highly publicized Distracted Driving enforcement operation(s) targeting
drivers using hand held cell phones and texting.
4
13. Conduct highly publicized pedestrian and/or bicycle enforcement operation(s) in
areas or during events with a high number of pedestrian and/or bicycle crashes
resulting from violations made by pedestrians, bicyclists, and drivers.
4
14. Conduct Traffic Safety educational presentation(s) with an effort to reach
community members. Note: Presentation(s) may include topics such as distracted
driving, DUI, speed, bicycle and pedestrian safety, seat belts and child passenger
safety.
2
15. Participate in highly visible collaborative DUI Enforcement operations. 4
16. Participate in highly visible collaborative Traffic Enforcement operations. 3
17. Send law enforcement personnel to DUI Checkpoint Planning and Management
training.
1
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3.METHOD OF PROCEDURE
A. Phase 1 Program Preparation (1st Quarter of Grant Year)
outlined in the objectives section.
All training needed to implement the program should be conducted in the first quarter.
All grant related purchases needed to implement the program should be made in the first quarter.
dress, DOB,
description, current license status, and the number of times suspended or revoked for DUI. DUI
BOLOs should be updated and distributed to traffic and patrol officers at least monthly.
Implementation of the STEP grant activities will be accomplished by deploying personnel at high
crash locations.
Media Requirements Issue a press release approved by the OTS PIO announcing the kick-off of the
grant by November 15, but no sooner than October 1. The kick-off release must be approved by the
OTS PIO and only distributed after the grant is fully signed and executed. If you are unable to meet the
November 15 deadline to issue a kick-off press release, communicate reasons to your OTS coordinator
and OTS PIO.
B. Phase 2 Program Operations (Throughout Grant Year)
The department will work to create media opportunities throughout the grant period to call
attention to the innovative program strategies and outcomes.
Media Requirements
The following requirements are for all grant-related activities:
Send all media advisories, alerts, videos, graphics, artwork, posters, radio/PSA/video scripts,
storyboards, digital and/or print educational materials for grant-related activities to the OTS PIO
at pio@ots.ca.gov for approval and copy your OTS coordinator. Optimum lead time would be 7
days before the scheduled release but at least 3 business days prior to the scheduled release
date for review and approval is appreciated.
The OTS PIO is responsible for the approval of the design and content of materials. The agency
understands OTS PIO approval is not authorizing approval of budget expenditure or cost. Any
cost approvals must come from the Coordinator.
Pre-approval is not required when using any OTS-supplied template for media advisories, press
releases, social media graphics, videos or posts, or any other OTS-supplied educational material.
However, copy the OTS PIO at pio@ots.ca.gov and your OTS coordinator when any material is
distributed to the media and public, such as a press release, educational material, or link to social
media post. The OTS-supplied kick-off press release templates and any kickoff press releases
are an exception to this policy and require prior approval before distribution to the media and
public.
If an OTS-supplied template, educational material, social media graphic, post or video is
substantially changed, the changes shall be sent to the OTS PIO at pio@ots.ca.gov for approval
and copy to your OTS Coordinator. Optimum lead time would be 7 days prior to the scheduled
release date, but at least 3 business days prior to the scheduled release date for review and
approval is appreciated.
Press releases, social media posts and alerts on platforms such as NextDoor and Nixle reporting
immediate and time-sensitive grant activities (e.g. enforcement operations, day of event
highlights or announcements, event invites) are exempt from the OTS PIO approval process. The
OTS PIO and your Coordinator should still be notified when the grant-related activity is
happening (e.g. car seat checks, bicycle rodeos, community presentations, DUI checkpoints,
etc.).
Enforcement activities such as warrant and probation sweeps, court stings, etc. that are
embargoed or could impact operations by publicizing in advance are exempt from the PIO
approval process. However, announcements and results of activities should still be copied to the
OTS PIO at pio@ots.ca.gov and your Coordinator with embargoed date and time or with
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Any earned or paid media campaigns for TV, radio, digital or social media that are part of a
specific grant objective, using OTS grant funds, or designed and developed using contractual
services by a subgrantee, requires prior approval. Please send to the OTS PIO at
pio@ots.ca.gov for approval and copy your grant coordinator at least 3 business days prior to the
scheduled release date.
Social media posts highlighting state or national traffic safety campaigns (Distracted Driving
Month, Motorcycle Safety Awareness Month, etc.), enforcement operations (DUI checkpoints,
etc.), or any other grant-related activity such as Bicycle rodeos, presentations, or events, are
highly encouraged but do not require prior approval.
Submit a draft or rough-cut of all digital, printed, recorded or video material (brochures, posters,
scripts, artwork, trailer graphics, digital graphics, social posts connected to an earned or paid
media campaign grant objective) to the OTS PIO at pio@ots.ca.gov and copy your OTS
Coordinator for approval prior to the production or duplication.
Use the following standard language in all press, media, and printed materials, space permitting:
Funding for this program was provided by a grant from the California Office of Traffic Safety,
through the National Highway Traffic Safety Administration.
Space permitting, include the OTS logo on all grant-funded print materials, graphics and paid or
earned social media campaign grant objective; consult your OTS Coordinator for specifics,
format-appropriate logos, or if space does not permit the use of the OTS logo.
Email the OTS PIO at pio@ots.ca.gov and copy your OTS Coordinator at least 21 days in
advance, or when first confirmed, a short description of any significant grant-related traffic safety
event or program, particularly events that are highly publicized beforehand with anticipated media
coverage so OTS has sufficient notice to arrange for attendance and/or participation in the event.
If unable to attend, email the OTS PIO and coordinator brief highlights and/or results, including
any media coverage (broadcast, digital, print) of event within 7 days following significant grant-
related event or program. Media and program highlights are to be reflected in QPRs.
Any press releases, work plans, scripts, storyboards, artwork, graphics, videos or any
educational or informational materials that received PIO approval in a prior grant year needs to
be resubmitted for approval in the current grant year.
Contact the OTS PIO or your OTS Coordinator for consultation when changes from any of the
above requirements might be warranted.
C. Phase 3 Data Collection & Reporting (Throughout Grant Year)
1. Prepare and submit grant claim invoices (due January 30, April 30, July 30, and October 30)
2. Prepare and submit Quarterly Performance Reports (QPR) (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 brief list of activity conducted, procurement of grant-funded items, and significant
media activities. Include status of grant-funded personnel, status of contracts, challenges, or
special accomplishments.
Provide a brief summary of quarterly accomplishments and explanations for objectives not
completed or plans for upcoming activities.
Collect, analyze and report statistical data relating to the grant goals and objectives.
4. METHOD OF EVALUATION
the fourth/final Quarterly Performance Report (QPR). The Final Evaluation should provide a brief summary
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
PT24059
FUND NUMBER CATALOG
NUMBER (CFDA)
FUND DESCRIPTION TOTAL AMOUNT
164AL-24 20.608 Minimum Penalties for Repeat
Offenders for Driving While
Intoxicated
$50,000.00
402PT-24 20.600 State and Community Highway
Safety
$31,000.00
COST CATEGORY FUND
NUMBER
UNIT COST OR
RATE
UNITS TOTAL COST TO
GRANT
A.PERSONNEL COSTS
Straight Time
$0.00
Overtime
DUI/DL Checkpoints 164AL-24 $12,178.53 2 $24,357.00
DUI Saturation Patrols 164AL-24 $936.81 19 $17,799.00
Collaborative DUI Enforcement 164AL-24 $936.81 4 $3,747.00
Traffic Enforcement 402PT-24 $936.81 12 $11,242.00
Distracted Driving 402PT-24 $936.81 4 $3,747.00
Pedestrian and Bicycle Enforcement 402PT-24 $936.81 4 $3,747.00
Traffic Safety Education 402PT-24 $936.81 2 $1,874.00
Collaborative Traffic Enforcement 402PT-24 $936.81 3 $2,810.00
Category Sub-Total $69,323.00
B.TRAVEL EXPENSES
In State Travel 402PT-24 $4,880.00 1 $4,880.00
$0.00
Category Sub-Total $4,880.00
C.CONTRACTUAL SERVICES
$0.00
Category Sub-Total $0.00
D.EQUIPMENT
$0.00
Category Sub-Total $0.00
E. OTHER DIRECT COSTS
DUI Checkpoint Supplies 164AL-24 $4,097.00 1 $4,097.00
Lidar Device 402PT-24 $2,700.00 1 $2,700.00
Category Sub-Total $6,797.00
F.INDIRECT COSTS
$0.00
Category Sub-Total $0.00
GRANT TOTAL $81,000.00
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State of California Office of Traffic Safety
GRANT AGREEMENT
Schedule B-1
GRANT NUMBER
PT24059
BUDGET NARRATIVE
PERSONNEL COSTS
DUI/DL Checkpoints - Overtime for grant funded law enforcement operations conducted by appropriate
department personnel.
DUI Saturation Patrols - Overtime for grant funded law enforcement operations conducted by appropriate
department personnel.
Collaborative DUI Enforcement - Overtime for grant funded Collaborative DUI Enforcement operations
conducted by appropriate department personnel
Traffic Enforcement - Overtime for grant funded law enforcement operations conducted by appropriate
department personnel.
Distracted Driving - Overtime for grant funded law enforcement operations conducted by appropriate
department personnel.
Pedestrian and Bicycle Enforcement - Overtime for grant funded law enforcement operations conducted by
appropriate department personnel.
Traffic Safety Education - Overtime for grant funded traffic safety presentations or campaigns conducted by
appropriate department personnel.
Collaborative Traffic Enforcement - Overtime for grant funded Collaborative Traffic Enforcement operations
conducted by appropriate department personnel
TRAVEL EXPENSES
In State Travel - Costs are included for appropriate staff to attend conferences and training events
supporting the grant goals and objectives and/or traffic safety. Local mileage for grant activities and
meetings is included. Anticipated travel may include the California Traffic Safety Summit (November 7-8,
2023 in Orange County) and the OTS Traffic Safety Law Enforcement Forum. All conferences, seminars or
training not specifically identified in the Budget Narrative must be approved by OTS. All travel claimed must
be at the agency approved rate. Per Diem may not be claimed for meals provided at conferences when
registration fees are paid with OTS grant funds.
CONTRACTUAL SERVICES
-
EQUIPMENT
-
OTHER DIRECT COSTS
DUI Checkpoint Supplies - On-scene supplies needed to conduct sobriety checkpoints. Costs may include
28" traffic cones, MUTCD compliant traffic signs, MUTCD compliant high visibility vests (maximum of 10),
traffic counters (maximum of 2), generator, gas for generators, lighting, reflective banners, electronic flares,
PAS Device/Calibration Supplies, heater, propane for heaters, fan, anti-fatigue mats, and canopies.
Additional items may be purchased if approved by OTS. The cost of food and beverages will not be
reimbursed. Each item must have a unit cost of less than $5,000 (including tax and shipping).
Lidar Device - Light detection and ranging device used to measure the speed of motor vehicles. This device
will be used for speed enforcement. Costs may include lidar devices, batteries, tax, and shipping.
INDIRECT COSTS
-
STATEMENTS/DISCLAIMERS
Program Income default statement:
There will be no program income generated from this grant.
Enforcement Grant Quota Disclaimer:
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enforcement officer issue a specified or predetermined number of citations in pursuance of the goals and
objectives here under.
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State of California Office of Traffic Safety
GRANT AGREEMENT
Exhibit A
GRANT NUMBER
PT24059
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
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 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).
The preceding statutory and
GENERAL ASSURANCES
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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:
be denied
the benefits of, or be otherwise subjected to discrimination under any program or activity, for which the Recipient receives Federal
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:
1.49 CFR part 21
will be (with regard to an facilitated,
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:
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
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.
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
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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;
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,
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.
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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
th 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
Ineligibility and Voluntary Exclusion Lower Tier Covered 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 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
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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
Ineligibility and Voluntary Exclusion 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 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.
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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.
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.
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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.
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INSTRUCTIONS FOR ADDING OR UPDATING GEMS USERS
1. Each agency is allowed a total of FIVE (5) GEMS Users.
2. GEMS Users listed on this form will be authorized to login to GEMS to complete and submit Quarterly
Performance Reports (QPRs) and reimbursement claims.
3. Complete the form if adding, removing or editing a GEMS user(s).
4. The Grant Director must sign this form and return it with the Grant Agreement.
CURRENT GEMS USER(S)
1. William Chase
Title: Sergeant Media Contact: Yes
Phone: (925) 556-4562
Email: wchase@acgov.org
2. Raelyn Miranda
Title: Administrative Aide Media Contact: No
Phone: (925) 556-4580
Email: raelyn.miranda@dublin.ca.gov
3. Kevin Monaghan
Title: Lieutenant Media Contact: Yes
Phone: (925) 556-4562
Email: kmonaghan@acgov.org
4. Nathan Schmidt
Title: Chief of Police Media Contact: Yes
Phone: (925) 833-6685
Email: nschmidt@acgov.org
State of California Office of Traffic Safety
OTS-55 Grant Electronic Management System (GEMS) Access
Exhibit C
GRANT NUMBER
PT24059
GRANT DETAILS
Grant Number: PT24059
Agency Name: Dublin Police Department
Grant Title: Selective Traffic Enforcement Program (STEP)
Agreement Total: $81,000.00
Authorizing Official: Nathan Schmidt
Fiscal Official: Jay Baksa
Grant Director: William Chase
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Complete the below information if adding, removing or editing a GEMS user(s)
GEMS User 1
Add/Change {{[]c11_es_:signer1}} Remove Access {{[] c12_es_:signer1}}
Add as a media contact? Yes {{[]c1_es_:signer1}} No{{[]c2_es_:signer1}}
{{UserName1_es_:signer1 }} {{UserTitle1_es_:signer1 }}
Name Job Title
{{UserEmail1_es_:signer1 }} {{UserPhone1_es_:signer1 }}
Email address Phone number
GEMS User 2
Add/Change {{[]c13_es_:signer1}} Remove Access {{[]c14_es_:signer1}}
Add as a media contact? Yes {{[]c3_es_:signer1}}No {{[]c4_es_:signer1}}
{{UserName2_es_:signer1 }} {{UserTitle2_es_:signer1 }}
Name Job Title
{{UserEmail2_es_:signer1 }} {{UserPhone2_es_:signer1 }}
Email address Phone number
GEMS User 3
Add/Change {{[]c15_es_:signer1}} Remove Access {{[]c16_es_:signer1}}
Add as a media contact? Yes {{[]c5_es_:signer1}}No {{[]c6_es_:signer1}}
{{UserName3_es_:signer1 }} {{UserTitle3_es_:signer1 }}
Name Job Title
{{UserEmail3_es_:signer1 }} {{UserPhone3_es_:signer1 }}
Email address Phone number
GEMS User 4
Add/Change {{[]c17_es_:signer1}} Remove Access {{[]c18_es_:signer1}}
Add as a media contact? Yes {{[]c8_es_:signer1}}No {{[]c7_es_:signer1}}
{{UserName4_es_:signer1 }} {{UserTitle4_es_:signer1 }}
Name
Job Title
{{UserEmail4_es_:signer1 }} {{UserPhone4_es_:signer1 }}
Email address Phone number
GEMS User 5
Add/Change {{[]c19_es_:signer1}} Remove Access {{[]c20_es_:signer1}}
Add as a media contact? Yes {{[]c9_es_:signer1}}No {{[]c10_es_:signer1}}
{{UserName5_es_:signer1 }} {{UserTitle5_es_:signer1 }}
Name Job Title
{{UserEmail5_es_:signer1 }} {{UserPhone5_es_:signer1 }}
Email address
Phone number
Form completed by: {{Sig_es_:signer1:signature}} Date: {{Dte1_es_:signer1:date}}
As a signatory I hereby authorize the listed individual(s) to represent and have GEMS user access.
{{Sig_es_:signer2:signature}} {{Name1_es_:signer2:fullname }}
Signature Name
{{Dte2_es_:signer2:date}} Grant Director
Date Title
DocuSign Envelope ID: 436662E0-865B-4C59-8558-09F98105B3D7
DocuSign Envelope ID: 436662E0-865B-4C59-8558-09F98105B3D7
DocuSign Envelope ID: 436662E0-865B-4C59-8558-09F98105B3D7