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USAID Punjab Enabling Environment Project (USAID PEEP)

Request for Applications (RFA) No. CDS Grants/RFA#002.3/2016

Capacity Development Support to Private Sector Policy Research Institutes

Issuance Date: April 10, 2016

Dear Applicant:

USAID Punjab Enabling Environment Project (USAID PEEP), implemented by Chemonics International, is seeking grant applications for implementation of its Capacity Development Support Program (CDS). PEEP entails provision of technical assistance and grants under its “Capacity Development Support” program. The CDS is part of PEEP efforts to strengthen institutional and human capacity development in Punjab based entities contributing to policy and regulatory reforms related research, implementation of reforms or delivery of support services to the private sector enterprises in the horticulture, livestock and dairy sub-sectors. The grants will be awarded and implemented in accordance with USAID and US Government regulations governing grants under contracts and PEEP’s internal grant management policies.

Project and Chemonics employees may not ask for, and applicants are prohibited from offering, any money, fee, commission, credit, gift, gratuity, thing of value, or compensation to obtain or reward improper favorable treatment regarding this solicitation. Any improper request from a project employee should be reported to the chief of party or [email protected].

Annexes included with this Request for Applications:

- Annex A - Grant Application Form - Annex B – Grant Application Budget Form (Excel File)- Annex C – Implementation Timeline - Annex D – Applicant Self-Assessment Form - Annex E – Required Certifications

Certification of “Representation by Organization Regarding a Delinquent Tax Liability or a Felony Criminal Conviction (AAPD 14-03, August 2014)”

Prohibition on Providing Federal Assistance to Entities that Require Certain Internal Confidentiality Agreements – Representation (April 2015)

Additionally, applicants must sign the following required certifications prior to receiving a grant. The cer-tifications are attached to this solicitation (Annex E) and PEEP will review them with applicants

Certification Regarding Terrorist Financing Participant Certification Narcotics Offenses and Drug Trafficking Certification of Recipient

- Annex F: Initial Environmental Examination Form

GRAN.FT.031, Rev.002, 6 July 2015FO.FOGM.FT.003

mailto:[email protected]

SECTION I. PROGRAM DESCRIPTION

IA. OBJECTIVE.

PEEP is awarding grants to private sector policy research institutes working on horticulture, livestock and dairy sub-sectors in Punjab. The grants are for conducting market growth analysis with the objective to improve the business environment by reducing the cost and time of doing business and influencing policy and regulatory reforms through consultative mechanisms. This will help spur private sector investment leading to increased employment and incomes in the target subsectors. PEEP stakeholders include private sector entrepreneurs, civil society actors, including local universities, business service agencies and the Government of Punjab.

The USAID PEEP is seeking applications through this Request for Applications (RFA) to disseminate information with an aim to encourage competition in the award of grants under contract (GUC). Issuance of this RFA is part of the PEEP processes for soliciting, evaluating and awarding grants support based on predefined processes and evaluation criteria to ensure transparent and competitive processes for the selection of sub-grantees and projects in line with PEEP program goals. The Recipient will be responsible for ensuring achievement of the program objectives.

IB. BACKGROUND

Punjab Enabling Environment Project (PEEP) is a five-year project financed by USAID and implemented by Chemonics International to support the Government of Punjab in improving business environment for the livestock, dairy, and horticulture sub-sectors. The project is working to build a strong business enabling and policy environment to help boost private sector investment in the three sub-sectors.

The project efforts will contribute towards USAID’s development objective of Increased Incomes and Employment in target sectors.

PEEP’s aim, therefore, is to focus on the following:

a) Accelerate advocacy for policy, regulatory and institutional reforms through the private sector, leading to early adoption and implementation of reforms;

b) Support institutional capacity building to sustain enabling environment reforms; c) Mobilize major private sector investments in livestock, dairy, and horticulture projects in

support of changes in the business environment.

PEEP’s goal is to improve the enabling environment for the agriculture sector in Punjab to promote private sector led growth, especially focusing on the horticulture, livestock and dairy sub-sectors.

Policy research institutes play an important role in providing inputs for evidence based policy formulation or reforms. They can undertake inter-disciplinary research on policy issues, scrutinizing the evidence base for policy and practice, and enlarging the policy options under debate, so as to contribute to public understanding and the common good.


IC. DETAILED PROGRAM DESCRIPTION

This Request for Applications (RFA) is published to disseminate information with an aim to encourage competition in the award of grants under contract (GUC). Issuance of this RFA is part of the USAID PEEP processes for soliciting, evaluating and awarding grants support based on predefined processes and evaluation criteria to ensure transparent and competitive processes for the selection of sub-grantees and projects in line with USAID PEEP program goals.

USAID Punjab Enabling Environment Project’s goals will be achieved through this grants program by extending support for the following activities:

1. Building and training inter-disciplinary research teams to address complex policy problems, im-prove processes, and plan for enhanced capacities relating to the livestock, dairy and horticulture sub-sectors in Punjab.

2. Deploying a range of analytical frameworks and toolkits to help determining risk management ef-fectiveness and, analyzing how government policy affects risk management strategies in the tar -get sub-sectors.

3. Working together with GoPb on new policy approaches at provincial and national levels, by providing early warning and solutions of new policy challenges.

4. Analyzing alternative policies and external factors for implications on production, utilization, retail prices, and value-chain additions.

5. Developing and undertaking capacity development programs to enhance the capacity of stake-holders including government agencies, business associations, chambers of commerce and private businesses.

6. Developing and conducting capacity development programs to enhance capacity of its human resources.

7. Developing public engagement processes that connect the various stakeholders through an inter-active public forum.

8. Disseminating research results through printed reports, staff presentations, and on the web.

The above is an illustrative list of areas for support through this RFA. It is by no means exclusive and creativity is encouraged from applicants.

Expected Outcomes:

Improved institutional facilities, human resources and processes are expected to enhance capacities of policy research institutes, which in turn would contribute to strengthening evidence based policy formulation and reforms in the target sub-sectors.

Inclusion of the researchers and policy experts in the policy research are expected to improve availability of research data to support evidence based research, leading to improved policy formulation in the target sectors in Punjab.


PEEP recognizes that some grantees may need technical assistance to more effectively carry out the activity. Consequently applicants are encouraged to specify their needs for technical assistance and/or training in their application.

ID. AUTHORITY/GOVERNING REGULATIONS

PEEP grant awards are made under the authority of the U.S. Foreign Affairs Act and USAID’s Advanced Directive System (ADS) 302.3.5.6, “Grants Under Contracts.” Awards made to non-U.S. organizations will adhere to guidance provided under ADS Chapter 303, “Grants and Cooperative Agreements to Non-Governmental Organizations” and will be within the terms of the USAID Standard Provisions for Non-U.S. Non-Governmental Recipients, as well as the PEEP grants procedures.

ADS 303 references one additional regulatory document issued by the U.S. Government’s Office of Management and Budget (OMB) and the U.S. Agency for International Development:

- 2 CFR 200 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, Subpart E (U.S. applicants are subject to 2 CFR 200 in its entirety)

Full text of 2 CFR 200 can be found at http://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title02/2cfr200_main_02.tpl and 2 CFR 700 at http://www.ecfr.gov/cgi-bin/text-idx?SID=531ffcc47b660d86ca8bbc5a64eed128&mc=true&node=pt2.1.700&rgn=div5. PEEP is required to ensure that all organizations receiving USAID grant funds comply with the guidance found in the regulations referenced above, as applicable to the respective terms and conditions of their grant awards.

Under the PEEP grant program, USAID retains the right at all times to terminate, in whole or in part, PEEP grant-making authorities.

SECTION II. AWARD INFORMATION

PEEP anticipates awarding grants to Research and academic institutes for market growth analysis amounting to minimum of PKR 1,000,000 and upto PKR 2,500,000.The award funding can be increased depending on the nature and size of the project/grant. Duration of grant awards under this solicitation will vary depending on the nature and size of the project/grant. It is expected that initially these grants will be issued for 12 months. PEEP may increase the period of grant and funding depending on performance of the project, availability of funds and USAID approval. The estimated start date of grants awarded under this solicitation is to be determined.

The type of grant will be determined during the negotiation process.

SECTION III. ELIGIBILITY

IIIA. ELIGIBLE RECIPIENTS

The Applicant must meet the following eligibility criteria:

Registered in Pakistan as a private sector research institute, academic institute, private sector or -ganization, non-governmental organization, and think tank under applicable laws and regulations, and should be compliant with mandatory laws and regulations.

Substantial experience of research and market growth analysis especially in the area of horticul -ture, livestock and dairy sub-sectors in Punjab province.


http://www.ecfr.gov/cgi-bin/text-idx?SID=531ffcc47b660d86ca8bbc5a64eed128&mc=true&node=pt2.1.700&rgn=div5

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http://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title02/2cfr200_main_02.tpl

http://www.ecfr.gov/cgi-bin/text-idx?SID=2e11c56f4c402a68fd92aee657de8475&mc=true&node=sp2.1.200.e&rgn=div6

http://www.ecfr.gov/cgi-bin/text-idx?SID=2e11c56f4c402a68fd92aee657de8475&mc=true&node=sp2.1.200.e&rgn=div6

https://www.usaid.gov/ads/policy/300/303mab

https://www.usaid.gov/ads/policy/300/303mab

https://www.usaid.gov/ads/policy/300/303

Have strong presence in PEEP priority areas and have done similar work with other international or national agencies.

Applicants must be able to demonstrate successful past performance in implementation of inte-grated development programs related to PEEP’s priority areas.

Applicants must have established outreach capabilities with linkages to the beneficiary groups, farmers and value chain players.

The proposed activity must respond to the goals and objectives of the PEEP project. When applicable, applicant must provide an environmental assessment and mitigation report to

comply with USAID environmental regulations. Applicants must display sound management in the form of financial, administrative, and technical

policies and procedures and present a system of internal controls that safeguard assets; protect against fraud, waste, and abuse; and support the achievement of program goals and objectives. PEEP will assess this capability prior to awarding a grant.

The following are required to be submitted as part of the application package in response to an RFA found in Annex E.

o Certification of “Representation by Organization Regarding a Delinquent Tax Liability or a Felony Criminal Conviction (AAPD 14-03, August 2014)”

Additionally, applicants must sign the following required certifications prior to receiving a grant. The certifications are attached to this solicitation (Annex E) and PEEP will review them with ap-plicants

Certification Regarding Terrorist Financing Participant Certification Narcotics Offenses and Drug Trafficking Certification of Recipient

For any grant award(s) resulting from this solicitation that is other than in-kind and equivalent to $25,000 USD or more, grantees will be required to provide a Data Universal Numbering System (DUNS) number at the time of award. If the applicant already has a DUNS number it should be included in their application. Otherwise, applicants will be expected to get a DUNS number be-fore an award is made. PEEP will assist successful applicants with this process. DUNS numbers can be obtained online at http://fedgov.dnb.com/webform/pages/CCRSearch.jsp

The project will work with the successful grantee to draft a marking and branding plan which will be annexed to the grant agreement.

Faith-based and community groups will receive equal opportunity for funding in accordance with the mandated guidelines laid out in ADS 303.3.28 except for faith-based organizations whose ob-jectives are for discriminatory and religious purposes, and whose main objective of the grant is of a religious nature.

PEEP encourages applications from new organizations who meet the above eligibility criteria.

SECTION IV – APPLICATION AND SUBMISSION INFORMATION

IVA. INSTRUCTIONS TO APPLICANTS

Applicants must propose strategies for the implementation of the program description described above, introducing innovations that are appropriate to their organizational strengths.

IVA1. APPLICANT SELF-ASSESSMENT


http://fedgov.dnb.com/webform/pages/CCRSearch.jsp

All organizations selected for award are subject to a pre-award risk assessment conducted by PEEP, to ascertain whether the organization has the minimum management capabilities required to handle US government funds. The applicant self-assessment is the first step in the pre-award risk assessment process. The Applicant Self-Assessment Form is contained in Annex D.

Instructions and a template for the full application are in Annex D. Applicants that submit full applications that meet or exceed the merit review criteria will be notified of next steps in the application process.

IVA2. GRANT APPLICATION Templates to be utilized when developing the application are provided in Annex , A, B and C. Applicants shall present their technical application and budget in the formats provided and shall follow the instructions and guidelines listed in these annexes.

All grant activity costs must be within the normal operating practices of the Applicant and in accordance with its written policies and procedures. For applicants without an audited indirect cost rate, the budget may include direct costs that will be incurred by the Applicant to provide identifiable administrative and management costs that can be directly attributable to supporting the grant objective.

The application must be signed by an authorized agent of the Applicant.

IVA3 INELIGIBLE EXPENSES

PEEP grant funds may not be utilized for the following: Construction or infrastructure activities of any kind. Note that Per ADS 303.3.30 and the ADS

303 Mandatory Reference entitled, “USAID Implementation of Construction Activities” dated August 22, 2013, construction is not eligible for reimbursement under grants resulting from this solicitation. Construction also includes improvements, renovation, alteration, and refurbishment.

Ceremonies, parties, celebrations, or “representation” expenses. Purchases of restricted goods, such as: restricted agricultural commodities, motor vehicles

including motorcycles, pharmaceuticals, medical equipment, contraceptive products, used equipment; without the previous approval of PEEP, or prohibited goods, prohibited goods under USAID regulations, including but not limited to the following: abortion equipment and services, luxury goods, etc.

Alcoholic beverages. Purchases of goods or services restricted or prohibited under the prevailing USAID source/

nationality (Burma (Myanmar), Cuba, Iran, North Korea, (North) Sudan and Syria). Any purchase or activity, which has already been made. Purchases or activities unnecessary to accomplish grant purposes as determined by the PEEP

Project. Prior obligations of and/or, debts, fines, and penalties imposed on the Grantee. Creation of endowments.


IVB APPLICATION AND SUBMISSION INFORMATION

Applications shall be submitted in English and may not be more than 10-15 pages (excluding Annexes).

Applications (Technical and budget proposals and supporting documentation) should be submitted in electronic copy to the PEEP office at the address below and should reference RFA No. CDS Grants/RFA#002.3/2016 Applications must be submitted no later than 18:00 hours local time, on 16 th May, 2016,. Late or unresponsive applications will not be considered.

Punjab Enabling Environment Project (PEEP)E-mail: For Application Submission Electronically: [email protected]

In addition to the application forms and budget, applicants should submit the following to PEEP: - Implementation Plan (Annex C)- Copy of valid Pakistani registration certificate and related GOP documentation- Copy of last 3 annual financial report, income and expenditure report audited by licensed au-

dit firm or practitioner, if available- Applicant Self-Assessment Form (Annex D)- Signed copies of the required certification package (included in the Annex E)- CVs of proposed project personnel- Copy of the organization's charter and by-laws.

Please submit all questions concerning this solicitation to the attention of Grants Manager, via email to [email protected] . PEEP will assist applicants in understanding the application process, and can provide coaching in application development at the request of applicants. Please note that no applications shall be accepted by hand.

SECTION V. APPLICATION EVALUATION

VA1. MERIT REVIEW CRITERIA

Grants applications shall be evaluated based on defined criteria in ADS 303.3.6.3. All applications should be reviewed by Technical Evaluation Committee (TEC) of PEEP project as per the evaluation criteria in the table below.

Evaluation Category Rating (Points)Design & Approach 25Impact on Target Group 20Management & Programmatic Capacity 15Sustainability 20Cost efficiency 10Past Performance 10Overall Rating (out of 100 points) 100

These evaluation criteria elements are described more fully below.A. Design & Approach. The quality and feasibility of the application, in terms of the appropriateness of the proposed methodology, innovativeness, and the work plan for achieving program objectives such as creating an internationally competitive horticulture, livestock and dairy sector in Punjab and improving the quality and quantity of domestic markets. Proposed mechanisms for monitoring and evaluation with objectively measurable indicators will also be appraised. 25 points.




B. Impact on target group. The extent to which the proposed activity corresponds to the needs of the target group and will directly benefit that group. This includes the participation of and benefit of women in income-generating opportunities. Also, the degree to which it will directly or indirectly stimulate other organizations and resources to develop or implement activities supporting the objectives of the project. 20 points.

C. Management and Programmatic Capacity. Evidence of the capability to undertake and accomplish the proposed activities. Appraisal will be based principally on reference checks by program staff; the background, qualifications, reputation, and skills of its key personnel; and the “track record,” reputation, achievements (including development of self-sufficient, sustainable activities) of the organization involved. 15 points.

D. Sustainability. The extent to which the funded activity will result in building and strengthening the capacity of the community and local organizations, and whether the activity itself is sustainable or will stimulate sustainability of the organization. 20 points.

E. Cost efficiency. The degree to which budgeting is clear and reasonable and reflects best use of organizational and grant resources. The grantee contribution reflects commitment to the program by the targeted beneficiaries and local institutions. 10 points.

F. Past Performance. Previous or ongoing experience implementing similar activities. This examines an Applicant’s track-record, which is a critical factor in assessing the capacity of the Grantee to implement the activity. Demonstrated ability carrying out policy advocacy, government monitoring and oversight, and other activities in support of targeted reforms. 10 points.

Additionally, PEEP will ensure environmental soundness and compliance in design and implementation as required by 22 CFR 216.

SECTION VI. AWARD AND ADMINISTRATION INFORMATION

All grants will be negotiated, denominated and funded in Pak Rupees. All costs funded by the grant must be allowable, allocable and reasonable. Grant applications must be supported by a detailed and realistic budget as described in Section IV.

Issuance of this RFA and assistance with application development do not constitute an award or commitment on the part of PEEP, nor does it commit PEEP to pay for costs incurred in the preparation and submission of an application. Further, PEEP reserves the right to accept or reject any or all applications received and reserves the right to ask further clarifications from the offerors. Applicants will be informed in writing of the decision made regarding their application.

LIST ANNEXES

- Annex A – Grant Application Form - Annex B – Grant Application Budget Form (Excel File)- Annex C – Implementation Timeline - Annex D – Applicant Self-Assessment Form - Annex E – Required Certifications- Annex F – Initial Environmental Examination Form


ANNEX A GRANT APPLICATION TEMPLATE

A.1. General Instructions

PEEP will assist applicants in understanding the application process, answer questions from applicants, and may provide coaching in application development at the request of applicants. Annex B includes a detailed budget format that must be completed and submitted with your application. Annex C, Implementation Timeline should also be completed at the time of submission of the grant application.This application may not exceed 10-15 pages in length. Pages exceeding this limit will not be reviewed (does not include Annex B, Detailed Grant Budget, or Annex C, Implementation Plan Timeline).

A.2. Instructions by Section

Templates for presentation of both the technical and budget aspects of the application are provided in Annexes A-C. Applicants shall present their proposals in the formats provided. Those applications that are not submitted according to the formats requested and in accordance with the instruction in this RFA will be considered as non-responsive and will be disqualified.

The application elements and guidelines are summarized below:

Section I (Basic Information). The Applicant provides basic contact information and information regarding the status of the organization.

Items 1-2: Organization’s name, date organization was founded, and current registration status.

Item 3: Contact Information— Contact name, title, address, telephone, fax, e-mail, etc. The contact person (agent) is responsible for communications between PEEP and the Applicant. This applies to all aspects of the grant, from initial application, negotiation, award, and close out. The agent must have full authority and responsibility to act on behalf of the Applicant. The agent should be someone who will be directly involved with the grant activity and has a proven, established relationship with the Applicant.

Item 4: Organizational Structure— List board members (or founding members if you do not have a formal board of directors) and key staff (president, directors, treasurer, etc). If available, please attach an organizational chart.

Item 5: Briefly describe the organization and its activities — Should introduce the Applicant and its background: how it was formed, its mission or purpose, major accomplishments in the area of the targeted activity, current activities, past related experience, and clients. This section must not exceed 1 page in length.

Item 6: References—List three donors, partner organizations, or community leaders that can provide references for your organization’s ability to successfully carry out the financial, administrative, and technical requirements of the grant activity. Briefly describe your relationship to the reference and the nature and duration of your work together. If the reference is a previous donor, list the activity and location of the activity(s) they funded. Be sure to provide complete information, including a point of contact, with telephone and email address.


Section II (Program Description). The Applicant describes overarching program elements such as objective of the grant and the linkage to PEEP’s objectives, results, the activity’s beneficiaries, and plan for disseminating activity deliverables. This section must not exceed 3 pages in length.

Item 7: Grant Activity Title—The title given to the activity should relate to the grant activity objective.

Item 8: Background—Identify the problem that the grant activity proposes to address. This section must not exceed 1 pages in length.

Item 9: Grant Objective – Briefly state the objective of the proposed grant activity.

Items 10: Grant Activity Detail – Provide a thorough, detailed description of the activity, including how the activity links to PEEP’s objectives, and the expected results. This section must not exceed 2 pages in length. Please refer closely to the merit review criteria and program description sections of the RFA.

Item 11: Beneficiaries – Identify beneficiaries/participants, disaggregated by gender if possible, estimated number, and location. Identify how the grant activities will reach the intended beneficiaries, how they will benefit from the grant, and how the beneficiaries will be identified or selected.

Section III (Program Implementation Plan). This section covers information regarding activity implementation, including proposed personnel and descriptions of each task. This should be the most detailed section and must not exceed 3pages in length, depending on the nature of the grant activity and tasks involved.

Item 12: Anticipated duration should be stated with a degree of accuracy of plus or minus two weeks.

Item 13: Main tasks of the activity— Provide details regarding the specific tasks of the activity in Annex C. The implementation plan must be supported by Annex C, Implementation Plan Timeline, listing all identified main tasks over the duration of the activity. Please include all events, trainings, publications, etc. For each task, provide the following information:

Task # / Title 1. Task description 2. Target Audience3. Grant-financed resource required & detailed explanation of use 4. Non-grant-financed resources required5. Start and end dates6. Person(s) responsible

Each task must be: Complete and sound Integrated and scheduled with dependent tasks Assigned to a responsible party Defined in terms of resources required Concluded with a viable milestone of achievement—milestones must be linked to

results.

The tasks listed must show a logical, thoughtful approach to the overall implementation plan. Tasks should describe actions and be logically sequenced. The Applicant should also describe


any relevant material assumptions made and/or conditions or precedent required for the achievement of the tasks.

Item 14: Applicant lists the location(s) of the activity, adding rows as needed.

Item 15: Applicant lists the personnel who will be involved in implementing the grant activity. Attach updated CVs for all grant activity personnel.

Section IV (Experience and Capacity).

Item 16: Applicant should describe past experience or on-going carrying out similar technical activities. This is a critical factor in assessing the capacity of the applicant to implement the activity. If the applicant does not have similar experience, state that here and describe any other relevant qualifications that will allow you to successfully implement the grant activity.

Section V (Cost). This is a summary of the information provided in the application budget forms, and includes total grant request, Grantee's cash or in-kind contributions for the activity and contributions from other sources (co-funding) for the activity. Applicant also describes any other US Government funding they are currently receiving for other purposes. Applicant must identify any long-term, recurrent commitments resulting from activity, and Applicant’s plan for sustainable coverage.

Item 17: Detailed cost of this activity (cash, in-kind [i.e. donated goods or services], and third-party sources)

Item 18: Discuss strategies for ensuring the sustainability of the proposed activity and organization, expected program income generation (if any), and third party leveraging of funds (if any). Program income is defined as gross income earned by the Grantee that is directly generated by a supported activity or earned as a result of this grant, during the period of the grant.

Item 19: List any major donor-funded activities (U.S. and other) that your organization has managed in the last two years, currently receives, or expects to receive within the duration of the grant activity.

Applications must be supported by Annex B, Detailed Grant Budget. This excel budget template, when properly completed, reviewed, and approved by PEEP, will serve as the mutually agreed-upon guide for activity financial management. All activity costs must be identified. Cost data must be accurate; proposed amounts should not be unrealistically high or low.

It is important that the budget clearly indicate where specific project funds are to come from (from USAID, co-funding by another donor, or the applicant’s contribution). Furthermore, contribution from other donors and Applicant resource commitment will be investigated and documented. In order to avoid double financing/ billing, PEEP will require full disclosure by all involved parties and will maintain contact with co-funders to verify their contributions. Budgeted amounts must also be supported by justification, and the applicant must be able to provide such backup to Project Name if requested.

All grant activity costs must be within the normal operating practices of the Applicant and in accordance with its written policies and procedures. For applicants without an audited indirect cost rate, the budget may include direct costs that will be incurred by the Applicant to provide identifiable administrative and management costs that can be directly attributable to supporting the grant objective.


Section A.3. Grant Application Form

The application must be signed by an authorized agent of the Applicant.

This application is in response to RFA No._ CDS Grants/RFA#002.3/2016

Section I. Basic Information

1. Organization name:

2. Date organization was founded and registration status:

3. Contact information:

Key contact person(s) and title: Office address: Office phone: Mobile: Fax:Email: Website:

4. Organizational Structure – List board members (or founding members if you do not have a formal board of directors) and key staff (president, directors, treasurer, etc). If available, please attach an organizational chart.

5. Briefly describe the organization, its purpose, and past related experience:

6. List contact information for three (3) references from previous donors or organizations (U.S. and other) that your organization has collaborated with in the last two years:

Donor Agency or

Organization

Nature of Relationship orTitle of Project, Location Start & End Dates of

CollaborationContact Person

Name & Position:

Email: Tel: Name & Position:

Email: Tel: Name & Position:

Email: Tel:

Section II. Program Description

7. Title of the proposed grant activity:


8. Background: What is the issue or problem that the activity will address? Why is it critical to address this issue?

9. Objective of the proposed grant activity:

10. Describe the proposed activity and expected results in detail (or attach a project description). Describe the main tasks that are proposed to meet the grant objective, the expected results to be achieved, and how the tasks are linked to the grant objective. Describe any relevant material assumptions made and/or conditions or precedent required for the achievement of the grant objective. This activity detail should keep in mind the merit review criteria contained in the solicitation:

11. Describe the proposed participants and/or beneficiaries, and your method for identifying or selecting participants and beneficiaries:

Section III. Implementation Plan

12. Anticipated duration of the grant activity:

Overall length (total number of months)

Start and end date (day, month, and year)

13. All implementation plans must be supported by Annex C that lists all identified tasks over the duration of the activity.

14. Location(s) of the activity (add rows as needed).

# Community Municipality Department State12345

15. List personnel who will be involved in implementing this project. CVs & salary history forms are required for all project personnel.

Section IV. Experience and Capacity

16. Describe the organization’s experience implementing similar activities:

Section V. CostNote: All applications must be supported by the attached Annex B, Detailed Grant Budget.

17. Cost in local currency per the attached budget:


18.

Discuss strategies for ensuring the sustainability of the proposed activity and organization, including expected program income generation (if any), and third party leveraging of funds (if any).

19. List any major donor-funded activities (U.S. and other) that your organization has managed in the last two years, currently receives, or expects to receive within the duration of the grant activity. Add additional lines if necessary:

Donor Agency

Title of Project, Location, & Start & End Dates

Total Funding (in local

currency)

Donor Contact Person

Name: Email: Tel: Name: Email: Tel: Name: Email: Tel:

By affixing my signature below, I certify that to the best of my knowledge, the information provided in this application is accurate and correct:

Submitted by (name and title): ____________________________________________________

Signature: _____________________________________ Date: __________________________FOR PROJECT USE ONLY

Date received _______________ Grant Reference No. ____________________

The undersigned hereby certifies that: (a) the prospective grantee has received an official delivery receipt for its Grant Application, (b) a copy of that receipt has been filed, (c) a reference number has been assigned, and (d) a grant application file has been opened. In addition, the prospective grantee has been advised as to the review and appraisal process, and its primary project point of contact.

Operations and Grants Director_____________________ Date ________________


Amount requested from PEEP project:

In-kind (i.e. donated goods or services) or other contribution from organization:

Other donors or third-party resources:

Total Estimated Grant Activity Cost:

ANNEX C - Sample Implementation Plan Timeline

IMPLEMENTATION PLAN

TaskList each task. Please be as specific as possible. Use additional pages if necessary.

Target AudienceWho is the audience targeted for the task?

Grant Resources Required and Detailed Explanation of Use

Non-Grant Resources Required (Grantee or Third Party Contribution) and Detailed Explanation of Use

12 Month TimelinePlace an X in the appropriate box to indicate the first and last month of the task, with approximate start and end dates. (Add more months if necessary)

Person(s) ResponsibleWho is responsible for overseeing and implementing the task?

Evaluation Indicators and MilestonesHow will you measure the success of the task?

1 2 3 4 5 6 7 8 9 10 11 12

GRAN.FT.024, Rev.004, 9/02/2015

FO.FOGM.FT.001

Annex D – Applicant Self-Assessment Form

If required in a given solicitation, this form is completed by the Applicant and submitted to PEEP along with the grant application. It is used as part of PEEP’s assessment of a given Applicant adherence to eligibility requirements as well as capacity to adequately handle grant funds. It may be used in lieu of or in conjunction with other pre-award responsibility determination tools.

------------------------------------------------------------------------------------------------------------------------PEEP

Applicant Self-Assessment Form

Accepting a grant from PEEP creates a legal duty for the grantee to use the funds according to the grant agreement and United States federal regulations. Prior to awarding a grant, PEEP must assess the adequacy of the financial and accounting systems of a prospective grantee (and, if applicable, any sub recipients) to ensure accountability if a grant is awarded.

In filling out the Questionnaire, each question should be answered as completely as possible, using extra pages if necessary. Please return your completed questionnaire to PEEP.

APPLICANT INFORMATION

Name of Organization

Activity Title:

Name, Title, Contact Information of Individual Completing Questionnaire:

SECTION A: INTERNAL CONTROLS

Internal controls are procedures that ensure: a. financial transactions are approved by an authorized individual and follow laws, regulations and the

organization's policies, b. assets are kept safely, c. accounting records are complete, accurate and kept on a regular basis.

Please complete the following questions concerning your organization's internal controls:

1. List the name, position/title, and telephone number for the individuals responsible for checking expenditures to make sure they are allowable:

2. Responsible for maintaining accounting records:_____________________________________

3. Responsible for preparing financial reports:_________________________________________

4. Responsible for preparing narrative reports:_________________________________________

5. Are timesheets kept for each paid employee? Yes: __ No: __GRAN.FT.024, Rev.004, 9/02/2015

FO.FOGM.FT.001

6. Is your organization familiar with U.S. government regulations concerning costs which can be charged to U.S. grants (OMB Circular A-122 "Cost Principles for Nonprofit Organizations" or OMB Circular A-21 "Cost Principles for Educational Institutions")?

Yes: __ No: __

SECTION B: ACCOUNTING SYSTEM

The purpose of an accounting system is to 1) accurately record all financial transactions, and 2) ensure that all financial transactions are supported by invoices, timesheets and other documentation. The type of accounting system often depends on the size of the organization. Some organizations may have computerized accounting systems, while others use a manual system to record each transaction in a ledger. In either case, PEEP grant funds must be properly authorized, used for the intended purpose and recorded in an organized and regular manner.

1. Briefly describe your organization's accounting system including: a) any manual ledgers used to record transactions (general ledger, cash disbursements ledger, suppliers ledger etc.); b) any computerized accounting system used (please indicate the name); and c) how transactions are summarized in financial reports, (by the period, project, cost categories)? ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

2. Does your organization have written accounting policies and procedures? Yes: __ No: __

3. Are your financial reports prepared on a: Cash basis: __ Accrual basis: __(Accrual - bill for costs before they are incurred)

4. Can your accounting records separate the receipts and payments of the PEEP grant from the receipts and payments of your organization's other activities? Yes: __ No: __

5. Can your accounting records summarize expenditures from the PEEP grant according to different budget categories such as salaries, rent, supplies and equipment?

Yes: __ No: __

6. How do you allocate costs that are “shared” by different funding sources, such as rent, utilities, etc.? ______________________________________________________________________________

______________________________________________________________________________

GRAN.FT.024, Rev.004, 9/02/2015FO.FOGM.FT.001

7. How often are financial reports prepared? Monthly: __ Quarterly: __ Annually: __ Not Prepared: __ (explain)

8. How often do you input entries into the financial system? a. daily __ b. weekly __ c. monthly __ d. ad hoc/as needed __ 9. How often do you do cash reconciliation? a. daily __ b. weekly __ c. monthly __ d. by accountant’s decision __ 10. Do you keep invoices, vouchers and timesheets for all payments made from grant funds?

Yes:__ No: __

SECTION C: FUNDS CONTROL

PEEP grantees and recipients who receive advances of grant funds must maintain a separate bank account registered in the name of the organization for the purpose of keeping only PEEP grant funds. The bank account must be in local currency. PEEP normally pays grantees monthly by bank transfer to the separate account. Access to the bank account must be limited to authorized individuals. Bank balances should be compared each month with your accounting records. For petty cash, it is very important to keep the cash in a strong safe and have strict controls over cash maintenance and disbursement.

1. Do you have a bank account registered in the name of your organization?

Yes: __ No: __

2. Will the bank account draw interest:Yes: __ No: __

3. Are all bank accounts and check signers authorized by the organization's Board of Directors or Trustees or other authorized persons?Yes: __ No: __

4. Will any cash from PEEP grant funds be kept outside the bank account (in petty cash funds, etc.)?

Yes: __ No: __

4.a. If yes, please explain the amount of funds to be kept and the name and position/title of the person responsible for safeguarding cash.

SECTION D: AUDIT

PEEP may require an audit of your organization's accounting records. An audit is a review of your accounting records by an independent accountant who works for an accounting firm. An audit report contains your financial statements as well as an opinion by the accountant that your financial statements are correct. Please provide the following information on prior audits of your organization.

1. Does your organization have regular independent audits that you contract and pay for?Yes: __ (please provide the most recent copy) No audits performed: __


2. If yes, who performs the audit?______________________________________________________________________________

3. How often are audits performed?

Quarterly: __ Yearly: __ Every 2 years: __ Other: __ (explain) __________________

4. If your organization does not have a current audit of its financial statements, please provide a copy of the following financial information, if available:

a. A "Balance Sheet" for your prior fiscal or calendar year; and b. A "Revenue and Expense Statement" for your prior fiscal or calendar year.

5. Are there any reasons (local conditions, laws, or institutional circumstances) that would prevent an independent accountant from performing an audit of your organization? Yes: __ No: __

If yes, please explain: ________________________

CHECKLIST AND SIGNATURE PAGE

PEEP requests that your organization submit a number of documents along with this completed questionnaire. Complete this page to ensure that all requested information has been included.

Please complete the checklist below, then sign and return the questionnaire and any other requested documents to PEEP.

1. Complete the checklist:

__ Incorporation Papers or Certificate of Registration and Statute have been provided to PEEP __ Organizational chart, if available, has been provided to PEEP (if applicable). __ Copy of your organization's most recent audit has been provided to PEEP (If no recent audit, a "Balance Sheet" and "Revenue and Expense Statement" for the prior fiscal year).__ All questions have been fully answered. __An authorized individual has signed and dated this page.

The Accounting Questionnaire must be signed and dated by an authorized person who has either completed or reviewed the form.

Approved by:

__________________________GRAN.FT.024, Rev.004, 9/02/2015

FO.FOGM.FT.001

Print Name Signature __________________________

Annex E – Required Certifications

[To be submitted as part of an Applicant’s application. To be signed by an authorized agent of the applicant at the end of this Section]


REPRESENTATION BY ORGANIZATION REGARDING A DELINQUENT TAX LIABILITY OR A FELONY CRIMINAL CONVICTION (August 2014)

(a) In accordance with section 7073 of the Consolidated Appropriations Act, 2014 (Pub. L. 113-76) none of the funds made available by that Act may be used to enter into an assistance award with any organization that –

(1)Was “convicted of a felony criminal violation under any Federal law within the preced-ing 24 months, where the awarding agency has direct knowledge of the conviction, un-less the agency has considered, in accordance with its procedures, that this further ac-tion is not necessary to protect the interests of the Government”; or

(2)Has any “unpaid Federal tax liability that has been assessed for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability, where the awarding agency has direct knowledge of the unpaid tax liabil-ity, unless the Federal agency has considered, in accordance with its procedures, that this further action is not necessary to protect the interests of the Government”.

For the purposes of section 7073, it is USAID’s policy that no award may be made to any orga-nization covered by (1) or (2) above, unless the M/OAA Compliance Division has made a deter-mination that suspension or debarment is not necessary to protect the interests of the Govern-ment.

(b) Applicant Representation:

(1)The Applicant represents that it is [ ] is not [ ] an organization that was convicted of a felony criminal violation under a Federal law within the preceding 24 months.

(2)The Applicant represents that it is [ ] is not [ ] an organization that has any unpaid Federal tax liability that has been assessed for which all judicial and administrative remedies have been ex-hausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability.

_________________________Signature

_________________________ Type or Print Name

_________________________Position Title

_________________________Date of Execution


Prohibition on Providing Federal Assistance to Entities that Require Certain Internal Confidentiality Agreements – Representation (April 2015)

PROHIBITION ON PROVIDING FEDERAL ASSISTANCE TO ENTITIES THAT REQUIRE CERTAIN INTERNAL CONFIDENTIALITY AGREEMENTS – REPRESENTATION (APRIL 2015)

(a) In accordance with section 743 of Division E, Title VII, of the Consolidated and further Continuing Resolution Appropriations Act, 2015 (Pub. L. 113-235), Government agencies are not permitted to use funds appropriated (or otherwise made available) under that or any other Act for providing federal assistance to an entity that requires employees, subawardees or contractors of such entity seeking to report fraud, waste, or abuse to sign internal confidentiality agreements or statements prohibiting or otherwise restricting such employees, subawardees, or contractors from lawfully reporting such waste, fraud, or abuse to a designated investigative or law enforcement representative of a Federal department or agency authorized to receive such information.

(b)The prohibition in paragraph (a) of this provision does not contravene requirements applica-ble to Standard Form 312, Form 4414, or any other form issued by a Federal department or agency governing the nondisclosure of classified information.

(c) By submission of its application, the prospective recipient represents that it does not require employees, subawardees, or contractors of such entity seeking to report fraud, waste, or abuse to sign internal confidentiality agreements or statements prohibiting or otherwise restricting such employees, subawardees, or contractors from lawfully reporting such waste, fraud, or abuse to a designated investigative or law enforcement representative of a Federal department or agency authorized to receive such information.

_________________________Signature

_________________________ Type or Print Name

_________________________Position Title

_________________________Date of Execution


Certification Regarding Terrorist Financing

Certification Regarding Terrorist Financing, Implementing Executive Order 13224

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. The Certification in the preceding sentence will not be deemed applicable to material support or resources provided by the Recipient pursuant to an authorization contained in one or more applicable licenses issued by the U.S. Treasury’s Office of Foreign Assets Control (OFAC).

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 (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.”


(i) “Training" means instruction or teaching designed to impart a specific skill, as opposed to general knowledge.

(ii) “Expert advice or assistance" means advice or assistance derived from scientific, technical, or other specialized knowledge.

b. “Terrorist act” means-

(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.

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.

Grantee Name______________________________________________________________________

Grantee’s Authorized Representative Name________________________________________________

Grantee’s Authorized Representative Title_________________________________________________

Grantee Authorized Representative Signature______________________________________________


Date____________________________


Participant Certification Narcotics Offenses and Drug Trafficking

1. I hereby certify that within the last ten years:

a. I have not been convicted of a violation of, or a conspiracy to violate, any law or regu-lation of the United States or any other country concerning narcotic or psychotropic drugs or other controlled substances.

b. I am not and have not been an illicit trafficker in any such drug or controlled sub-stance.

c. I am not or have not been a knowing assistor, abettor, conspirator, or colluder with others in the illicit trafficking in any such drug or substance.

2. I understand that USAID may terminate my training if it is determined that I engaged in the above conduct during the last ten years or during my USAID training.

Signature: ___________________________________

Name: ______________________________________

Date: _______________________________

Address: ______________________________________________________________

Date of Birth: __________________________________

NOTICE:1. You are required to sign this Certification under the provisions of 22 CFR Part 140, Prohibi-tion on Assistance to Drug Traffickers. These regulations were issued by the Department of State and require that certain participants must sign this Certification.

2. If you make a false Certification you are subject to U.S. criminal prosecution under 18 U.S.C. 1001.


Certification of Recipient

To: Chemonics International

I,______________________, _____________________, as a legally authorized Name (Printed or Typed) Title

representative of ________________________________Organization Name

do hereby certify that, to the best of my knowledge and belief, this organization's management and other employees responsible for their implementation are aware of the requirements placed on the organization by 2 CFR 200, and Federal and USAID regulations with respect to the management of, among other things, personnel policies (including salaries), travel, indirect costs, and procurement under this agreement and I further certify that the organization is in compliance with those requirements and other applicable U.S. laws and regulations.

I, we, understand that a false, or intentionally misleading certification could be the cause for possible actions ranging from being found not responsible for this award, termination of award, or suspension or debarment of this organization in accordance with the ADS 303 Standard Provision for Non-U.S. Nongovernmental Organizations (for in-kind, standard, and simplified grants) entitled “Award Termination and Suspension” and the ADS 303 Standard Provision for Fixed Amount Awards to Nongovernmental Organizations entitled “Debarment and Suspension.”

I, we, further agree that by signing below, we provide certification and assurance for the following:

(1) Certification Regarding Terrorist Financing(2) Participant Certification Narcotics Offenses and Drug Trafficking(3) Certification of Recipient

These certifications and assurances are given in consideration of and for the purpose of obtaining any and all U.S. Federal grants, loans, contracts, property, discounts, or other U.S. Federal financial assistance extended after the date hereof to the recipient by Chemonics, including installment payments after such date on account of applications for U.S. Federal financial assistance which was approved before such date. The recipient recognizes and agrees that such U.S. Federal financial assistance will be extended in reliance on the representations and agreements made in these assurances, and that the United States will have the right to seek judicial enforcement of these assurances. These assurances are binding on the recipient, its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign these assurances on behalf of the recipient.

I declare under penalty of perjury that the foregoing is true and correct.

_________________________ _________________________Signature Position Title

_________________________ _________________________Type or Print Name Date of Execution


Requirement and Guidelines for obtaining Data Universal Numbering System (DUNS) number

(To be submitted with the sub-award application)

Data Universal Numbering System (DUNS) Number

(a) In the space provided at the end of this provision, the recipient should supply the Data Universal Numbering System (DUNS) number applicable to that name and address. Recipients should take care to report the number that identifies the recipient's name and address exactly as stated in the proposal.

(b) The DUNS is a 9-digit number assigned by Dun and Bradstreet Information Services. If the recipient does not have a DUNS number, the recipient should call Dun and Bradstreet directly at 1-800-333-0505. A DUNS number will be provided immediately by telephone at no charge to the recipient. The recipient should be prepared to provide the following information:

(1) Recipient's name. (2) Recipient's address. (3) Recipient's telephone number. (4) Line of business. (5) Chief executive officer/key manager. (6) Date the organization was started. (7) Number of people employed by the recipient. (8) Company affiliation.

*(c) Recipients located outside the United States refer to the appended guidelines for obtaining DUNS number which is a web-enabled process. The information in clause b (1) to b (8) must be available even for filing the form online.

The DUNS system is distinct from the Federal Taxpayer Identification Number (TIN) system.

DUNS: ________________________________________ (Provide your DUNS # here)

Guidelines for obtaining DUNS number

Definition

The Data Universal Numbering System, abbreviated as DUNS or D-U-N-S, is a system developed and regulated by Dun & Bradstreet (D&B), that assigns a unique nine-character numeric identifier, referred to as a "DUNS number" to a single business entity.

Purpose

The DUNS number is entered into a publicly available, searchable website that contains information of each Federal award and the entities receiving US Government funds through Federal awards such as Federal contracts and their sub-contracts and Federal grants and their sub-grants.

Form and Instructions


http://en.wikipedia.org/wiki/Dun_%26_Bradstreet

Obtaining a DUNS number is FREE. Do not trust any website that requires a payment.

Click on the link below to request your DUNS number http://fedgov.dnb.com/webform/pages/CCRSearch.jsp The website will first determine whether your organization already have a DUNS number.

The screen will firsts prompt you to select the country where your company is physically lo -cated. Once you select the country, you will be prompted to enter the name of your company.

If you do not see your company listed, click on Request for a New DUNS number”. Fill out the form to request the DUNS number and click on the “Submit Your Request” but -

ton at the bottom of the page.

Help

Send an e-mail to [email protected]

Please be sure to include your contact information and a brief description of the problem you experienced.



http://fedgov.dnb.com/webform/pages/CCRSearch.jsp

Annexure F: Initial Environmental Examination Form

(To be submitted with the sub-award application)

A. Applicant information

Grantee(organization)

Individual contact and title

Activity (brief de-scription)

Location of activity

B. Activities, screening results, and recommended determination.

TABLE 1 Screening result(Step 3 of instruc-tions)

Recommended Determi-nations(Step 6 of instructions. Complete for all moderate and high-risk activities)

Proposed Sub-activities

Ver

y

Low

R

isk

Mod

erat

e R

isk

Hig

h R

isk

No

si

gnifi

-ca

nt a

dver

se

impa

ct

With

sp

eci-

fied

miti

ga-

tion,

no

sig

-

Sign

ifica

nt

Adv

erse

C. Summary of recommended determinations

The activity contains. . . (equivalent regulation 216 terminology) Very low risk sub-activities categorical exclusion(s) After environmental review, sub-activities deter-

mined to have no significant adverse impacts negative determination(s)

After environmental review, sub-activities deter-mined to have no significant adverse impacts, given appropriate mitigation and monitoring

negative determination(s) with conditions

After environmental review, sub-activities deter-mined to have significant adverse impacts positive determination(s)


D. Certification:

I, the undersigned, certify that:

1. The information on this form is correct and complete

2. The following actions have been and will be taken to assure that the activity complies with environmental requirements for the Punjab Enabling Environment Project under the Code of Federal Regulations 22 CFR 216:

These design elements and best practices will be followed in implementing this activity, except with the approval of PEEP.

Any specific mitigation or monitoring measures described in the attached information will be im-plemented in their entirety.

Compliance with these conditions will be regularly confirmed and documented by on-site inspec-tions during the activity and at its completion.

Solicitation Number: N.A________________________________________Grant Agreement Number (if applicable): ___________________________Date of Application: ____________________________________________

Name of Grantee Organization:

Name and Title of authorized representative:

Signature: ______________________________ Date: _________________


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