Small MatchHISTORICAL RESOURCES GRANTS-IN-AID APPLICATION PAGE 1 I
ATTACHMENT CHECKLIST
31) The following supporting documents are attached to this application:
^ Attachment A: Civil Rights Assurance of Compliance form.
^ Attachment B: Documentation of Confirmed Match
^ Attachment C: Letters of Support, Endorsement, or Resolutions.
^ Attachment D: Photographs describing the existing condition (interior, exterior, surroundings, and
problem areas) of the historical property or archaeological site.
^ Attachment E: A photograph showing the principal view of the subject property or an image that
conveys the purpose of the project. This image will be shown in the public meeting when the Grant
Review Panel or Florida Historical Commission is reviewing your project. This image may be
submitted in an electronic format.
^ Attachment F: If completed, architectural project schematics or construction documents (ONE SET
ONLY) (ACQUISITION AND DEVELOPMENT PROJECTS).
^ Attachment G: Copy of Florida Master Site File Form.
^ Attachment H: For Acquisition projects only: A complete summary appraisal prepared by a Florida
State Certified General Real Estate Appraiser (two appraisals are required if the value of the first
appraisal exceeds $500,000), an ownership and encumbrance search, an executed option or purchase
agreement, property survey, and (if applicable) a copy of a professional archaeological survey if the
property is being proposed for purchase as a significant archaeological site.
^ Attachment I: For historic marker projects only: Florida Historic Marker Application Form No.
HR3E171294 and verification of review and approval by the Florida Marker Council
^ Attachment J: For non-profit organizations only: documentation of non-profit status.
^ Attachment K: Optional Attachments
HISTORICAL RESOURCES GRANTS-IN-AID APPLICATION
ATTACHMENT A
U.S. DEPARTMENT OF THE INTERIOR
NATIONAL PARK SERVICE
CIVIL RIGHTS ASSURANCE OF COMPLIANCE
PAGE 12
(hereinafter called "Applicant-Recipient") hereby agrees that it will comply with Title VI of the Civil Rights Act of
1964 (P.L. 88-352) and all requirements imposed by or pursuant to the Department of the Interior Regulations (43 CFR 17)
issued pursuant to that title, to the end that, in accordance with Title VI of the Act and the Regulations, no person in the
United States shall, on the grounds of race, color, or national origin be excluded from participation in, be denied the benefits
of, or be otherwise subjected to discrimination under any program or activity for which the Applicant-Recipient receives
financial assistance from the Florida Department of State and hereby gives assurance that it will immediately take any
measures to effectuate this agreement.
The Applicant-Recipient also agrees to comply with Section 504 of the Rehabilitation Act of 1973 and the Age
Discrimination Act of 1975 and all requirements imposed by or pursuant to the Department of the Interior Regulations (43
CFR 17) issued pursuant to these titles, to the end that, no person in the United States shall, on the grounds of disability or age
be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or
activity for which the Applicant-Recipient receives financial assistance from the National Park Service and hereby gives
assurance that it will immediately take any measures to effectuate this agreement.
If any real property or structure thereon is provided or improved with the aid of Federal financial assistance extended to the
Applicant-Recipient by the Florida Department of State, this assurance obligates the Applicant-Recipient, or in the case of any
transfer of such property, any transferee for the period during which the real property or structure is used for a purpose
involving the provision of similar services or benefits. If any personal property is so provided, this assurance obligates the
Applicant-Recipient for the period during which it retains ownership or possession of the property. In all other cases, this
assurance obligates the Applicant-Recipient for the period during which the Federal financial assistance is extended to it by
the Florida Department of State.
This assurance is given in consideration of and for the purpose of obtaining any and all Federal grants, loans, contracts,
property discounts or other Federal financial assistance extended after the date hereof to the Applicant-Recipient by the
bureau or office, including installment payments after such date on account of arrangements for Federal financial assistance
which was approved before such date. The Applicant-Recipient recognizes and agrees that such Federal financial assistance
will be extended in reliance on the representations and agreements made in this assurance, and that the United States shall
reserve the right to seek judicial enforcement of this assurance. 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.
Dated Applicant-Recipient
By
(President, Chairman of Board or
Comparable authorized Official)
APPLICANT-RECIPIENT'S MAILING ADDRESS