> **ATTACHMENT A**
>
> **VETTING FORM**

+----------------------------------+--------+-------------------------+
| **Part A: Information About      |        |                         |
| Proposed Activities** (to be     |        |                         |
| completed by USAID CTO)          |        |                         |
+----------------------------------+--------+-------------------------+
| 1\. Name of the prime            |        |                         |
| contractor, grantee or recipient |        |                         |
| proposing the award or other     |        |                         |
| assistance:                      |        |                         |
+----------------------------------+--------+-------------------------+
| 2\. Type of proposed award or    |        |                         |
| other assistance (check one):    |        |                         |
|                                  |        |                         |
| \_\_\_\_\_contract or            |        |                         |
| subcontract \_\_\_\_\_grant or   |        |                         |
| subgrant \_\_\_\_\_training      |        |                         |
| \_\_\_\_\_other benefit          |        |                         |
+----------------------------------+--------+-------------------------+
| 3\. Dollar amount and duration   |        |                         |
| of proposed award or assistance: |        |                         |
| \$                               |        |                         |
+----------------------------------+--------+-------------------------+
| 4\. Purpose of proposed award or |        |                         |
| assistance:                      |        |                         |
+----------------------------------+--------+-------------------------+
| 5\. Organization (if any)        |        |                         |
| proposed to receive award or     |        |                         |
| other assistance:                |        |                         |
+----------------------------------+--------+-------------------------+
| a.  Name:                        |        |                         |
+----------------------------------+--------+-------------------------+
| b.  Address:                     |        |                         |
+----------------------------------+--------+-------------------------+
| c.  Telephone:                   | d\.    |                         |
|                                  | Fax:   |                         |
+----------------------------------+--------+-------------------------+
| e.  Brief statement of proposed  |        |                         |
|     awardee's mandate:           |        |                         |
+----------------------------------+--------+-------------------------+
| 6\. Full four-part name of each  |        |                         |
| individual to receive training   |        |                         |
| or other direct benefits, or     |        |                         |
| full name and title of each "key |        |                         |
| individual" (as defined below)   |        |                         |
| of the organization named in 5   |        |                         |
| above, plus other identifying    |        |                         |
| data when available, such as ID  |        |                         |
| number, date of birth and/or     |        |                         |
| place of birth:                  |        |                         |
+----------------------------------+--------+-------------------------+
| a\. Name & title:                |        | Other ID data:          |
+----------------------------------+--------+-------------------------+
| b\. Name & title:                |        | Other ID data:          |
+----------------------------------+--------+-------------------------+
| c\. Name & title:                |        | Other ID data:          |
+----------------------------------+--------+-------------------------+
| d\. Name & title:                |        | Other ID data:          |
+----------------------------------+--------+-------------------------+
| e\. Name & title:                |        | Other ID data:          |
+----------------------------------+--------+-------------------------+
| f\. Name & title:                |        | Other ID data:          |
+----------------------------------+--------+-------------------------+
| g\. Name & title:                |        | Other ID data:          |
+----------------------------------+--------+-------------------------+
| h\. Name & title:                |        | Other ID data:          |
+----------------------------------+--------+-------------------------+
| "Key individual" means (a) the   |        |                         |
| program manager or chief of      |        |                         |
| party for the USAID-financed     |        |                         |
| program; (b) the principal       |        |                         |
| officer and deputy principal     |        |                         |
| officer of the organization      |        |                         |
| (e.g., executive director,       |        |                         |
| deputy director, president, vice |        |                         |
| president); (c) principal        |        |                         |
| officers of the organization's   |        |                         |
| governing body (e.g., chairman,  |        |                         |
| vice chairman, treasurer and     |        |                         |
| secretary of the board of        |        |                         |
| directors or board of trustees); |        |                         |
| and (d) any other person with    |        |                         |
| significant responsibilities for |        |                         |
| administration of USAID-financed |        |                         |
| activities or resources. Note    |        |                         |
| that this definition differs     |        |                         |
| from the definition of "key      |        |                         |
| personnel" under contracts and   |        |                         |
| cooperative agreements.          |        |                         |
+----------------------------------+--------+-------------------------+

  ----------------------- -----------------------------------------------
  **Part B: Submission    
  details** (to be        
  completed by USAID      
  vetting official)       

  Vetting request number  

  CTO who initiated       
  request                 

  Strategic Objective     
  number                  

  Date submitted to       
  Embassy                 
  ----------------------- -----------------------------------------------

  ----------------------- -----------------------------------------------
  **Part C: Summary of    
  screening results** (to 
  be completed by USAID   
  vetting official)       

  Date returned by        
  Embassy                 

  Summary of results      
  ----------------------- -----------------------------------------------

**ATTACHMENT C**

**CERTIFICATION**

By signing and submitting this application, the prospective recipient
provides the certification set out below:

1\. The Recipient, to the best of its current knowledge, did not
provide, within the previous ten years, and will take all reasonable
steps to ensure that it does not and will not knowingly provide,
material support or resources to any individual or entity that commits,
attempts to commit, advocates, facilitates, or participates in terrorist
acts, or has committed, attempted to commit, facilitated, or
participated in terrorist acts, as that term is defined in paragraph 3.

2\. The following steps may enable the Recipient to comply with its
obligations under paragraph 1:

(a) Before providing any material support or resources to an individual
    or entity, the Recipient will verify that the individual or entity
    does not (i) appear on the master list of Specially Designated
    Nationals and Blocked Persons, which list is maintained by the U.S.
    Treasury's Office of Foreign Assets Control (OFAC) and is available
    online at OFAC's website:
    <http://www.treas.gov/offices/eotffc/ofac/sdn/t11sdn.pdf>, or (ii)
    is not included in any supplementary information concerning
    prohibited individuals or entities that may be provided by USAID to
    the Recipient.

(b) Before providing any material support or resources to an individual
    or entity, the Recipient also will verify that the individual or
    entity has not been designated by the United Nations Security
    Council (UNSC) sanctions committee established under UNSC Resolution
    1267 (1999) (the "1267 Committee") \[individuals and entities linked
    to the Taliban, Usama bin Laden, or the Al Qaida Organization\]. To
    determine whether there has been a published designation of an
    individual or entity by the 1267 Committee, the Recipient should
    refer to the consolidated list available online at the Committee's
    website:
    <http://www.un.org/Docs/sc/committees/1267/1267ListEng.htm>.

(c) Before providing any material support or resources to an individual
    or entity, the Recipient will consider all information about that
    individual or entity of which it is aware and all public information
    that is reasonably available to it or of which it should be aware.

(d) The Recipient also will implement reasonable monitoring and
    oversight procedures to safeguard against assistance being diverted
    to support terrorist activity.

3\. For purposes of this Certification --

(a) "Material support and resources" means currency or monetary
    instruments or financial securities, financial services, lodging,
    training, expert advice or assistance, safehouses, false
    documentation or identification, communications equipment,
    facilities, weapons, lethal substances, explosives, personnel,
    transportation, and other physical assets, except medicine or
    religious materials."

(b) "Terrorist act" means --

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(i) an act prohibited pursuant to one of the 12 United Nations
    Conventions and Protocols related to terrorism (see UN terrorism
    conventions Internet site:
    <http://untreaty.un.org/English/Terrorism.asp>); or

(ii) an act of premeditated, politically motivated violence perpetrated
     against noncombatant targets by subnational groups or clandestine
     agents; or

(iii) any other act intended to cause death or serious bodily injury to
      a civilian, or to any other person not taking an active part in
      hostilities in a situation of armed conflict, when the purpose of
      such act, by its nature or context, is to intimidate a population,
      or to compel a government or an international organization to do
      or to abstain from doing any act.

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(c) "Entity" means a partnership, association, corporation, or other
    organization, group or subgroup.

(d) References in this Certification to the provision of material
    support and resources shall not be deemed to include the furnishing
    of USAID funds or USAID-financed commodities to the ultimate
    beneficiaries of USAID assistance, such as recipients of food,
    medical care, micro-enterprise loans, shelter, etc., unless the
    Recipient has reason to believe that one or more of these
    beneficiaries commits, attempts to commit, advocates, facilitates,
    or participates in terrorist acts, or has committed, attempted to
    commit, facilitated or participated in terrorist acts.

(e) The Recipient's obligations under paragraph 1 are not applicable to
    the procurement of goods and/or services by the Recipient that are
    acquired in the ordinary course of business through contract or
    purchase, e.g., utilities, rents, office supplies, gasoline, etc.,
    unless the Recipient has reason to believe that a vendor or supplier
    of such goods and services commits, attempts to commit, advocates,
    facilitates, or participates in terrorist acts, or has committed,
    attempted to commit, facilitated or participated in terrorist acts.

This Certification is an express term and condition of any agreement
issued as a result of this application, and any violation of it shall be
grounds for unilateral termination of the agreement by USAID prior to
the end of its term.

**Signed:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

(*Typed Name and Title*) Date

(*Name of Organization*)

**ATTACHMENT D**

**MANDATORY CLAUSE**

**Prohibition against Support for Terrorism**

(a) The Contractor/Recipient is reminded that U.S. Executive Orders and
    U.S. law prohibits transactions with, and the provision of resources
    and support to, individuals and organizations associated with
    terrorism. It is the legal responsibility of the
    Contractor/Recipient to ensure compliance with these Executive
    Orders and laws.

(b) One of the applicable orders is Executive Order 13224, dated
    September 24, 2001. The website of the Office of Foreign Assets
    Control (OFAC) of the Department of Treasury contains the text of
    that order and a list of the individuals and entities designated
    thereunder. It also contains lists of individuals and entities
    designated under other anti-terrorism statutes, regulations and
    Executive Orders. See
    <http://www.treasury.gov/offices/enforcement/ofac/sdn/>.

(c) USAID reserves the right to review, and either approve or reject,
    the following subawards if proposed under this
    contract/agreement: (i) any contract or subcontract in excess of
    \$25,000 with a non-U.S. organization or individual; and (ii) any
    grant or subgrant to a non-U.S. organization or individual,
    regardless of the dollar value. Furthermore, the written consent of
    USAID is required before certain other forms of assistance may be
    provided to a non-U.S. organization or individual. These include
    in-kind assistance such as renovation of an NGO's facilities, repair
    or replacement of a company's equipment, and certain training
    activities. The details of these requirements are described in
    notices issued by USAID/West Bank & Gaza from time to time. No
    approval (or failure to disapprove) by USAID shall relieve the
    Contractor/Recipient of its legal obligation to comply with
    applicable Executive Orders and laws.

(d) USAID reserves the right to rescind approval for a subaward in the
    event that USAID subsequently becomes aware of information
    indicating that the subaward is contrary to U.S. law or policy
    prohibiting support for terrorism. In such cases, USAID's
    Contracting Officer will provide written instructions to the
    Contractor/Recipient to terminate the subaward.

(e) The Contractor/Recipient agrees to promptly notify USAID's Cognizant
    Technical Officer (CTO) in the event of any change in the identity
    of its "key individuals" or in the identity of "key individuals" of
    any recipient of a subaward described in paragraph (d). For purposes
    of this requirement, "key individuals" means (i) the program manager
    or chief of party for the USAID-financed program; (ii) the principal
    officer and deputy principal officer of the organization (e.g.,
    executive director, deputy director, president, vice
    president); (iii) principal officers of the organization's governing
    body (e.g., chairman, vice chairman, treasurer and secretary of the
    board of directors or board of trustees); and (iv) any other person
    with significant responsibilities for administration of
    USAID-financed activities or resources. Note that this definition
    differs from the definition of "key personnel" under contracts and
    cooperative agreements.

(f) Before awarding any grant or subgrant under this contract/agreement,
    the Contractor/Recipient shall (1) obtain from the proposed
    subawardee the certification required under USAID's Acquisition and
    Assistance Policy Determination 04-14 (AAPD 04-14), "Certification
    Regarding Terrorist Financing Implementation E.O. 13224 (Revision
    2)," and (2) provide a copy of the certification to USAID's
    Agreement/Contracting Officer.

(g) USAID reserves the right to terminate this contract/agreement if
    USAID determines that the Contractor/Recipient is involved in or
    advocates terrorist activity or has failed to comply with any of the
    requirements of this provision.

(h) This provision, including this paragraph (h), shall be included in
    all contracts, subcontracts, grants and subgrants issued under this
    contract/agreement. The Contractor/Recipient shall promptly provide
    to USAID's Contracting/Agreement Officer a copy of the pages from
    each subaward that contain this provision.

> **ATTACHMENT F**
>
> **RESTRICTION ON FACILITY NAMES**

(a) No assistance shall be provided under this contract/agreement for
    any school, community center or other facility that is named after
    any person or group of persons that has advocated, sponsored or
    committed acts of terrorism. This includes any facility that has
    "shuhada" or "shaheed" ("martyr" or "martyrs") in its name, unless
    an exception is approved by the USAID Mission Director. In any case
    where assistance is proposed for a facility that is named after, or
    is planned to be named after, a person or group of persons, the
    Contractor/Recipient shall provide to USAID's cognizant technical
    officer (CTO) written information about the person(s) or group and
    shall not proceed with the assistance unless or until the CTO has
    provided written approval therefor. This restriction applies to all
    forms of cash or in-kind assistance, including construction
    services, equipment, supplies, technical assistance, and training.

(b) In case of any failure to comply with this restriction, USAID may
    disallow any or all costs incurred by the Contractor/Recipient with
    respect to the facility and, if necessary, issue a bill for
    collection for the amount owed. This is in addition to any other
    remedies that may be available to USAID for such noncompliance.

(c) This provision, including this paragraph (c), shall be included in
    all contracts, subcontracts, grants and subgrants issued under this
    contract/agreement. The Contractor/Recipient shall promptly provide
    to USAID's Contracting/Agreement Officer a copy of the pages from
    each subaward that contain this provision.