HomeMy WebLinkAboutIowa Department of Natural Resources-8/8/20111 I. APPLICANT'S SIGNATURE
Upon signing in the space provided below, the applicant agrees to conform with the requirements in the following two paragraphs
pertaining to ADA/Section 504 accessibility guidelines and civil rights assurance.
Assurance of Compliance with Americans with Disabilities Act (ADA), Section 504
1, the undersigned, certify that the [City of Waterloo] or [ County Conservation Board] has reviewed the
ADA/Section 504 accessibility guidelines for persons with disabilities as required by the Iowa Department of Natural
Resources. Requirements put forth in the guidelines will be complied with as applicable to our proposed Resource
Enhancement and Protection (REAP) grant project. Additionally, any new facilities built or acquired by the [city or
county conservation board] will comply with the guidelines where applicable.
Civil Rights Assurance of Compliance
The [City of Waterloo] or [ County Conservation Board] hereby agrees that it will comply with Title VI of the
Civil Rights Act of 1964, 1973 and the Age Discrimination Act of 1975 and all requirements imposed by or pursuant to
the Iowa Department of Natural Resources to the end that no person in the United States shall on the grounds of race,
color, national origin, age, or handicap be excluded from participation in, be denied the benefits of, or otherwise
subjected to discrimination under any program or activity for which the Applicant -Recipient receives grant funds or other
assistance from the Iowa Department of Natural Resources and hereby gives assurance that it will immediately take any
measures to effectuate this agreement.
This assurance is binding on the Applicant -Recipient, its successors, transferees, and assignees, and the person or persons whose
signature appears below are authorized to sign this assurance on behalf of the Applicant -Recipient.
Applicant's Signature
Applicant's Title
Date
12. CITY COUNCIL OR COUNTY CONSERVATION BOARD APPROVAL (For City and County Projects Only)
1, the undersigned, certify that the city council of Waterloo or the County Conservation Board has on
the date . /11 reviewed this pr•posed dproject and approved its submittal for Resource Enhancement and Protection
(REAP, r nt consider ion.
Sture: City Mayor or County Conservation Board Chairperson
64— ii'aiti
13. COUNTY RESOURCE ENHANCEMENT COMMITTEE REVIEW/COMMENTS - Required for private/public
open spaces acquisition projects, as well as city and county grant requests.
I, the undersigned, verify that the Black Hawk County Resource Enhancement Committee reviewed the proposed project
for which this application is submitted. A summary of all comments made by the Committee has been provided on a
separate sheet of paper to the applicant for attachment to this application. My signature and the date of signature are also
on the separate sheet of comments.
A mark on this line indicates that the project was reviewed, but the Committee did not make any comments for
attachment to the application.
Signature: Chairperson, County Resource Enhancement Committee Date
4 of9
Minority Impact Statement
Pursuant to 2008 Iowa Acts, HP 2393, Iowa Code Section 8.11, all grant applications submitted to the State of Iowa which are due
beginning January 1, 2009 shall include a Minority Impact Statement. This is the state's mechanism to require grant applicants to
consider the potential impact of the grant project's proposed programs or policies on minority groups.
Please choose the statement(s) that pertains to this grant application. Complete all the information requested for the chosen
statement(s).
❑ The proposed grant project programs or policies could have a disproportionate or unique positive impact on minority persons,
Describe the positive impact expected from this project
Indicate which group is impacted:
❑ Women
❑ Persons with a Disability
❑ Blacks
0 Latinos
0 Asians
0 Pacific Islanders
0 American Indians
0 Alaskan Native Americans
0 Other
0 The proposed grant project programs or policies could have a disproportionate or unique negative impact on minority persons.
Describe the negative impact expected from this project
Present the rationale for the existence of the proposed program or policy.
Provide evidence of consultation of representatives of the minority groups impacted.
Indicate which group is impacted:
❑ Women
❑ Persons with a Disability
❑ Blacks
0 Latinos
0 Asians
(] Pacific Islanders
0 American Indians
7 of 9
❑ Alaskan Native Americans
0 Other
Et The proposed grant project programs or policies are not expected to have a disproportionate or unique impact on minority
persons.
Present the rationale for determining no impact.
The Sherwood Park Recreation Area will be open to all persons who choose to
use it. Therefore, no disproportionate or unique impact on minority persons
is anticipated.
1 hereby certify that the information on this form is complete and accurate, to the best of my knowledge:
Name: Ernest G. Clark
Title: Mayor
8 of 9