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## **CALIFORNIA RUS/CF REFERENCE GUIDE NO. 3**

**Exhibit A Page 1**

### **CONTENTS OF A COMMUNITY FACILITIES GRANT APPLICATION**

Applicants for a Community Facilities (CF) grant should provide two
copies of the following information to the USDA Rural Development office
serving your county:

[Forms are available at: http://www.rurdev.usda.gov/ca]{.underline}

1.  Standard Form (SF) 424-2, Application for Federal Assistance. The
    Federal Catalog Number is 10.766, which needs to be inserted in
    block 10 of this form.

2.  Execute Page 2 of this Exhibit, Community Facilities Grant
    Certification.

3.  Evidence that the State and Local Clearinghouses have been notified.
    You will need to file a Notice of Intent with the State
    Clearinghouse and Local Clearinghouse in your area by forwarding a
    copy of the front page of Form SF 424.2. A list of Clearinghouses
    follows.

4.  A copy of your most recent audit or financial statement. Form RD
    442-2, "Statement of Budget, Income, and Equity," and Form RD 442-3,
    "Balance Sheet," may be used in lieu of your financial statements.

5.  Copy of organizations legal existence (Charter, Certificate of Legal
    Existence, etc.)

6.  Form RD 1942-54, Applicant's Feasibility Report.

7.  Evidence of a commitment of Non-Federal matching funds.

8.  Detailed cost estimate for the total project.

9.  Form RD 442-7, Initial Operating Budget or similar form.

10. Map showing the service area boundary.

11. List of Board/Council Members and their terms.

12. Form AD-1047, Certification Regarding Debarment...

13. Form AD-1049, Certification Regarding Drug-Free Workplace
    Requirements.

14. Form RD 400-1, Equal Opportunity Agreement.

15. Form RD 400-4, Assurance Agreement.

16. RD Instruction 1940-Q, Exhibit A-1, Certification for Contracts,
    Grants and Loans.

17. Form RD 1940-20, Request for Environmental Information (for Class I
    & Class IIs only)

18. [Additional items to be submitted only by non-profit
    organizations:]{.underline}

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a.  Copy of current By-laws (certified by Corporate Secretary) and
    Articles of Incorporation (with Secretary of State Reproduction
    Certification).

b.  Certificate of Support from each affected local government in your
    service area.

*USDA Rural Development is an equal opportunity Lender, Provider and
Employer.*

*Complaints of discrimination should be sent to:*

USDA Director, Office of Civil Rights, Washington, D.C. 20250

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## **CALIFORNIA RUS/CF REFERENCE GUIDE NO. 3**

**Exhibit A Page 2**

#  

#### COMMUNITY FACILITIES GRANT CERTIFICATION

The undersigned certifies that:

1\. The organization is aware of and in compliance with other Federal
statute requirements including but not limited to:

a\. Section 504 of the Rehabilitation Act of 1973.

b\. Civil Rights Act of 1964.

c\. The Americans with Disabilities Act (ADA) of 1990.

> d\. Age Discrimination Act of 1975.

2.  The organization is unable to finance the proposed project from its
    own resources or through commercial credit at reasonable rates and
    terms.

3.  The organization has no known relatives or close associates that are
    current USDA Rural Development employees.

4.  Prior to USDA Rural Development approval, you will not take action
    (e.g., initiation of construction) or incur obligations which would
    limit the range of alternatives to be considered or which would have
    an adverse effect on the environment.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name of Organization

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature of Authorized Official Date

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## **CALIFORNIA RUS/CF REFERENCE GUIDE NO. 3**

**Exhibit A Page 3**

**STATE AND LOCAL CLEARINGHOUSE LIST**

Applicants must submit a copy of the front page of Form SF 424.2 along
with a cover letter requesting a review under Executive Order 12372 to
the appropriate Clearinghouse listed below:

+-----------------------------------+-----------------------------------+
| California State Clearinghouse    | Kings Co Regional Planning Kings  |
| All Counties                      |                                   |
|                                   | Agency                            |
| 1400 10thStreet                   |                                   |
|                                   | 1400 W lacey Blvd                 |
| Sacramento CA 95814               |                                   |
|                                   | Hanford CA 93230                  |
| \(916\) 445-0113                  |                                   |
|                                   | \(559\) 582-3221, ext. 2670       |
+-----------------------------------+-----------------------------------+
| Association of Bay Area Alameda,  | Merced County Association Merced  |
| Marin,                            |                                   |
|                                   | of Governments (MCAG)             |
| Governments (ABAG) Santa Clara,   |                                   |
| Solano                            | 369 West 18^th^ Street            |
|                                   |                                   |
| 1010 8^th^ St Metrocenter Somona, | Merced CA 95340                   |
| San Mateo                         |                                   |
|                                   |                                   |
| Oakland CA 94604-2050 Contra      |                                   |
| Costa,                            |                                   |
|                                   |                                   |
| \(510\) 464-7900 San Francisco    |                                   |
+-----------------------------------+-----------------------------------+
| Association of Monterey Bay       | Sacramento Area COG Placer (part) |
| Monterey, Santa                   |                                   |
|                                   | 3000 S St Ste 300 Sacramento,     |
| Area Governments (AMBAG) Cruz\    |                                   |
| 445 Reservation Rd Ste G          | Sacramento CA 95814 Sutter        |
|                                   |                                   |
| Marina CA 93933-0838              | \(916\) 457-2264 Yolo, Yuba       |
|                                   |                                   |
| \(831\) 883-3750                  |                                   |
+-----------------------------------+-----------------------------------+
| Central Sierra Planning Council   | San Diego Association San Diego   |
| Alpine, Amador                    |                                   |
|                                   | of governments                    |
| 100 South Green St Calaveras,     |                                   |
|                                   | 401 B St Ste 800                  |
| Sonora CA 95370 Tuolumne          |                                   |
|                                   | First Interstate Bank             |
| \(627\) 532-8768                  |                                   |
|                                   | San Diego CA 92101                |
+-----------------------------------+-----------------------------------+
| Council of Fresno Co Governments  | San Joaquin County COG San        |
| Fresno                            | Joaquin                           |
|                                   |                                   |
| 2100 Tulare St Ste 619            | P O Box 1010                      |
|                                   |                                   |
| Fresno CA 93721                   | Stockton CA 95201-1010            |
|                                   |                                   |
| \(559\) 532-8168                  | \(209\) 468-3913                  |
+-----------------------------------+-----------------------------------+
| Humboldt County Humboldt          | Santa Barbara County Santa        |
|                                   | Barbara                           |
| Association of Governments        |                                   |
|                                   | Association of Governments        |
| 235 4^th^ St Ste F                |                                   |
|                                   | 260 N San Antonio Rd Ste B        |
| Eureka CA 95501                   |                                   |
|                                   | Santa Barbara CA 93110            |
| \(707\) 444-8208                  |                                   |
|                                   | \(805\) 961-8900                  |
+-----------------------------------+-----------------------------------+
| Kern Council of Governments Kern  | Sierra Planning Organization      |
|                                   | Sierra, Nevada                    |
| 1401 19^th^ St Ste 200            |                                   |
|                                   | 1230 High St Ste 224 El Dorado    |
| Bakersfield CA 93301              |                                   |
|                                   | Auburn CA 95603 Placer (part)     |
| \(661\) 861-2191                  |                                   |
|                                   | \(916\) 823-4703                  |
+-----------------------------------+-----------------------------------+
| Southern California Association   | Stanislaus Area Association       |
| Imperial, Orange                  | Stanislaus                        |
|                                   |                                   |
| of Governments (SCAG) Los         | of Governments (SAAG)             |
| Angeles,                          |                                   |
|                                   | 1315 I St                         |
| 838 West 7^th^ St 12 Fl San       |                                   |
| Bernardino,                       | Modesto CA 95354                  |
|                                   |                                   |
| Los Angeles CA 90017 Riverside,   | \(209\) 558-78930                 |
| Ventura                           |                                   |
|                                   |                                   |
| \(213\) 236-1800                  |                                   |
+-----------------------------------+-----------------------------------+
| Tulare County Association Tulare  |                                   |
|                                   |                                   |
| of Governments (TCAG)             |                                   |
|                                   |                                   |
| 221 S Mooney Blvd                 |                                   |
|                                   |                                   |
| Visalia CA 93291 (559) 733-6256   |                                   |
+-----------------------------------+-----------------------------------+