Grants to Support the Journey from Cash to Digital

REQUEST FOR APPLICATIONS
PROGRAM:
NetHope / Global Broadband and Innovations
(GBI) Alliance, Grants to Support the Journey
from Cash to Digital Payments in Cambodia
RFA NO:
RFA-PI-02-2015
DATE OF ISSUANCE:
Thursday, April 23, 2015
DUE DATE FOR QUESTIONS:
Thursday, April 30, 2015
RESPONSE TO QUESTIONS:
Tuesday, May 5, 2015
CLOSING DATE:
Monday, May 22, 2015
ESTIMATED AWARD DATE:
June 2015
USAID NetHope / GBI
TABLE OF CONTENTS
1
PURPOSE STATEMENT ................................................................................................................................................. 3
2
PROGRAM DESCRIPTION .......................................................................................................................................... 3
3
INSTRUCTIONS TO APPLICANTS........................................................................................................................ 4
4
3.1
Grantee Eligibility ........................................................................................................................................................ 4
3.2
Funding ............................................................................................................................................................................. 4
3.3
Application Submission Deadline ...................................................................................................................... 4
3.4
Submission Method for Applications .............................................................................................................. 4
3.5
Review Process ............................................................................................................................................................ 5
3.6
Application Contents ............................................................................................................................................... 5
3.7
Evaluation Criteria ...................................................................................................................................................... 7
3.8
Grant Deliverables ..................................................................................................................................................... 9
TERMS AND CONDITIONS ...................................................................................................................................... 9
4.1
Grant Agreement ....................................................................................................................................................... 9
4.2
Grant Provisions .......................................................................................................................................................... 9
4.2.1
Late Submissions, Modifications, and Withdrawals of Applications .................................... 9
4.2.2
False Statements in Offer ............................................................................................................................. 9
4.2.3
Conflict of Interest Clause ........................................................................................................................ 10
4.2.4
Prohibited Goods and Services ............................................................................................................. 10
4.2.5
Restricted Goods ........................................................................................................................................... 10
4.2.6
Certifications for Non-US, Non-Governmental Recipients .................................................. 10
4.2.7
Disclaimers......................................................................................................................................................... 10
4.2.8
Permission for Use and Disclosure...................................................................................................... 11
ATTACHMENT A .................................................................................................................................................................... 12
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1
PURPOSE STATEMENT
The purpose of this Request for Applications (RFA) is to solicit applications for funding from
prospective grantees to support NetHope’s work through the Global Broadband and
Innovations Alliance (GBI). GBI is a program funded by the United States Agency for
International Development (USAID); NetHope is the implementing partner of the GBI. One
focus project area for GBI is to develop tools and support the transition of USAID
implementing partners and other development organizations from cash to digital payments.
NetHope is issuing this RFA to USAID implementing partners and other non-governmental
organizations working in Cambodia to support their transition from cash to digital
payments1 and to document those lessons learned. This RFA follows on the training on
digital payments and the NetHope/USAID e-Payments Toolkit delivered to USAID
Implementing Partners in Phnom Penh, Cambodia on March 10-12, 2015.
This RFA is issued as a public notice to ensure that all interested, qualified, and eligible
organizations have a fair opportunity to submit applications for funding. For the purposes of
this RFA, “organizations” are defined as local and international development organizations
currently implementing USAID projects in Cambodia as primary or sub award recipients
(NGOs, Civil Society Organizations, and contractors).
2
PROGRAM DESCRIPTION
This RFA is designed to solicit applications to award up to 3 fixed obligation grants (FOGs)
to provide support to development organizations with programs in Cambodia in
transitioning their payments from cash to digital payments. To be considered for funding,
grant applications must propose a method for answering the questions in Section 3.6,
Application Contents, which can be found below.
Grant Recipients will be required to:
1. Complete a survey to scope/map their cash and digital payment streams in a
program or programs implemented in Cambodia using the Payment Scoping Survey
Tool included in Step 2 of the USAID/NetHope e-Payments Toolkit. Step 2 can be
accessed here;
2. Utilize and modify the USAID/NetHope e-Payments Toolkit to evaluate and
implement the transition from cash to digital payments in the initial program area;
3. Compare the cost of cash versus digital payments (before and after the transition) in
the program area of focus using the Cash Utility Analysis Tool included in Step 3 the
NetHope/USAID e-Payments Toolkit, available here;
4. Detail any challenges encountered (both on the side of the grantee and the
recipients of payments) throughout the comparative study and transition from cash
to digital payments and steps taken to address them. This should include, but not be
limited to, problems having to do with the digital payments product, constraints
related to gender, technological access and/or literacy, and financial literacy. This is
meant to assist our ability to develop use cases from your organization's
experiences;
5. Document key lessons learned, and provide a 2-page case snapshot for publication;
1
Digital Payments are defined as: electronic fund transfers through banks, payments made using the
mobile phone, and payments made through a prepaid or debit card.
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6. Follow the transition process with several select recipients, and provide a 2-page
“success story” of their journey for publication;
7. Identify next steps for scaling and replicating the organization’s use of digital
payments instead of or in parallel with cash; and
8. Work closely with NetHope who will be providing additional technical assistance as
your organization makes the transition from cash to digital payments.
3
INSTRUCTIONS TO APPLICANTS
3.1 GRANTEE ELIGIBILITY
This competition is open to any non-governmental, non-US organization, non-profit or forprofit entity. To be minimally eligible for funding, applicants must comply with the following
conditions:
• Organizations must be legally registered or otherwise authorized to conduct
business in their country or countries of operation.
• Organizations must have a DUNS number.
• Organizations must submit their application in English.
• Organizations must be able to complete implementation within the stated timeframe
of between six and nine months.
• Organizations must be currently implementing a USAID program as a primary or sub
award recipient and/or must have attended the USAID funded workshop on how to
transition from cash to electronic payments in March of 2015.
3.2 FUNDING
The mechanism for funding will be fixed obligation grants. The most recent USAID
provisions relating to FOGs may be found at http://www.usaid.gov/ads/policy/300/303mat.
NetHope anticipates awarding up to three (3) FOGs to grantees under this RFA.
The maximum funding amount for an individual grant under this RFA will be USD $20,000.
Each grant will have a term of no more than nine months. The assistance is intended to
provide support to selected organizations with costs associated with implementing a
transition towards digital payments while also comparing and documenting the costs,
challenges, and benefits associated with said transition. Payment will be issued for
satisfactory completion of the milestones outlined in the grant agreement.
3.3 APPLICATION SUBMISSION DEADLINE
Applications may be submitted at any time before 17:00 pm UTC+6 on the date specified on
page 1 of this RFA. Submissions received after the deadline will not be considered.
Additional opportunities for applying, however, may be made available in the future.
3.4 SUBMISSION METHOD FOR APPLICATIONS
Submit Questions and Applications electronically to: [email protected]
NetHope is not receiving paper applications for this RFA. All questions and answers will be
shared via email with all interested applicants.
The email subject line should read “Application for Grants to Support the Journey from
Cash to Digital Payment Adoption in Cambodia – [Name of Organization submitting
application]”.
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Technical applications and attachments may be submitted in Microsoft Word or Adobe PDF.
Budgets must be submitted in Microsoft Excel.
3.5 REVIEW PROCESS
Grant applications will be reviewed and grants awarded by an evaluation panel. NetHope
will lead and coordinate the evaluation panel. A technical evaluation committee will review
all technical applications on their Technical Approach, Scalability, Cost Application,
Personnel, using the Evaluation Criteria detailed below.
It is anticipated that awards will be made within three months after the submission deadline,
as stated on the cover of this RFA. Final negotiations and awards will be managed by
NetHope.
NetHope reserves the right to make any number of awards or none at all. NetHope is not
responsible for any costs associated with the development of applications.
3.6 APPLICATION CONTENTS
Applicants will develop their applications based on their understanding of how a transition
to digital payments would work, their prior institutional experience and their determination
of the approaches that would be feasible and successful. In all cases, applicants shall clearly
explain the rationale for the proposed approaches chosen.
Submissions must clearly state the objectives and the expected results of the program
within the life of the funding period, and define an implementation plan with a proposed
time frame and budget. Ongoing monitoring and reporting of the funded activities will be the
responsibility of the applicant.
Technical applications should not exceed 5 pages and should be written in English.
Applications should include submission of a technical application with attachments and a
cost application. Applications must remain valid for at least six (6) months. The format
should be as follows:
Part A: Technical Application (Limit 5 pages)
Cover page (approximately 1 page)
1.
2.
3.
4.
5.
6.
7.
8.
Organization’s name:
Technical contact name:
Technical contact person’s position:
E-mail address:
Telephone number:
Name of the USAID funded program or project that your organization is implementing:
Proposed initial area of focus location:
Proposed period of performance
Technical Approach (approximately 4 pages)
1. Motivation for Responding to this RFA:
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Describe key reasons why your organization is applying for this grant. What are the key
reasons why you are interested in transitioning away from cash and adopting digital
payments? Describe specifically how this grant will assist your organization in pursuing this
goal?
2. Payment Stream Scoping:
Using the payment scoping survey in Step 2 of the USAID/NetHope e-Payments Toolkit,
please analyze the extent and nature of your organization’s use of cash in the initial program
area of focus or operations. Describe details of your payment streams including: the value
and volume (number of transactions) of cash payments your organization currently makes,
and number of unique recipients. Describe which payment streams you plan to transition to
digital payments, and why. Include any other findings that occur from the survey (i.e. the
profile of your payment recipients, location of where cash payment streams occur most,
etc.).
3. Analysis of Your Costs of Cash
Using the Costing Utility Analysis Tool in Step 3 of the USAID/NetHope e-Payments
Toolkit, conduct a cash analysis and establish a baseline including the costs associated with
your organization's cash disbursements. You may provide the final analysis in the technical
attachments section as highlighted below.
4. Payment Service Provider Selection
Describe the digital payment system(s) (i.e. WING, ACLEDA Bank, AMK) you plan to
evaluate and use as a replacement for cash, and explain why you identified this one/these.
Describe any prior experience you have with these systems. [Note: You can choose to
evaluate more than one system; prior experience is not a pre-requisite for responding to
this RFA].
5. Implementation Plan
Describe the steps your organization will take to implement a transition from cash to digital
payments, including timelines, milestones and responsibilities assigned. Describe the type of
training that will be needed both internally as well as externally. Describe how you will you
manage any potential resistance to adoption of digital payments you receive both internally
and externally.
6. Defining Success and Measurement
Describe how you will define success for the use of digital payments in the proposed initial
program area of focus. Describe how you will measure and evaluate success (e.g., will you
do a control case or evaluate either retrospectively or prospectively)?
7. Scalability
Describe how you plan to expand and scale the initial payment streams that you transition
to other parts of the organization’s programs and operations.
Technical Attachments (Please submit the following attachments with the Technical Application.
Note that they do not count towards the 6-page limit)
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1. Please complete “Tab 3 – Financial Costs” of the Costing Utility Analysis Tool
included in Step 3 of the NetHope/USAID e-Payments Toolkit.
2. Please provide a timeline of key activities and milestones you will take to implement,
monitor and evaluate your organization’s transition from cash to digital payments.
3. Please provide the CV of the staff person who will oversee the implementation of
this grant (maximum 3 pages).
Part B: Cost Application
1. Please submit a summary and detailed budget with budget notes in Microsoft Excel
identifying how you will allocate the grant funds during the grant term, including
proposed level of effort of any staff who will be working on this grant. Applicants can
include any costs associated with supporting their transition to mobile/digital
payments (such as training, outreach, awareness raising, etc.) as long as they are
adequately justified in the budget narrative, with the exception of ongoing
transaction costs (i.e. bank fees, mobile money tariffs, etc.), which will not be
covered by this grant.
2. Please include a signed bio data form USAID Form 1420 for any proposed staff or
consultants who have a daily rate greater than $50 USD.
3.7 EVALUATION CRITERIA
The criteria presented below have been tailored to the requirements of this RFA. A total of
100 points are possible for the complete application. The relative importance of each
criterion is indicated by approximate weight by points.
In evaluating the applications, the review committee will examine overall merit and
feasibility, as well as specific criteria relevant to each component as elaborated below. Up to
three (3) awards will be made to the overall highest scores amongst the applicants.
Applicants should note that these criteria: (1) serve as the standard against which all
applications will be evaluated, and (2) serve to identify the significant criteria which
applicants should address in their applications.
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EVALUATION CRITERIA
Technical Approach
Motivation for Responding - Why does your organization want to
transition to digital payments?
Points
Payment Stream Scoping - What are the key payment streams
your organization hopes to transition to digital payments. What
is the volume and value of these payment streams, and what is
the profile of the recipients?
Analyzing the Costs of Cash - What is the baseline cost of cash
associated to the payment streams you hope to transition to
digital payments?
Payment Service Providers - What service providers will you
engage in the market and why?
Implementation - How will you implement the transition?
55 points
Defining Success - How will you define and measure success?
Scalability
The extent to which the use of digital payments could be
expanded within the program beyond the initial area (i.e., the
ability to scale) and to different programs (for example, from
health to education) or in different geographies within Ghana
(i.e., the ability to replicate)
Personnel
Relevant skills and experience of the proposed staff person who
will be responsible for implementing this FOG
Cost Application
Reasonableness of proposed budget based on scope of activities
being proposed
25 points
5 points
Proposed price reflects a clear understanding of the
requirements stated in this RFA, and is consistent with the
various elements of the grantee’s application.
Proposed price is reasonable in comparison with proposed
prices received in response to the solicitation.
15 points
Proposed price is reasonable in comparison with prices with the
independent cost estimate.
Unrealistically low or high proposed prices, initially or
subsequently, may be grounds for eliminating an application from
competition either on the basis that the applicant does not
understand the requirement or the applicant has provided an
unrealistic application.
TOTAL
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100 points
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Supporting Documentation for Pre-Award Assessment/Site visits
At the conclusion of the evaluation process, any selected firm will be required to complete a
Financial Pre-Award Assessment in order for NetHope to ascertain that the organization
has the capacity to perform successfully under the terms and conditions of the proposed
grant. As part of the Pre-Award Assessment process the firm will also be requested to
submit their incorporated papers, certificate of registration and/or Tax ID number (TIN).
Applicants may be asked to submit additional documentation to illustrate that the
organization has the capacity to implement the grant. Site visits may be conducted by
NetHope to evaluate the organization in these areas.
3.8 GRANT DELIVERABLES
Under a FOG, payment is made against established milestones. Upon selection, NetHope
will work with the recipient to establish an appropriate milestone table that reflects the
activities and timeframes to be completed in the program description.
Because a primary goal of the grant facility is to encourage other organizations to transition
to digital payments by demonstrating both how to do so (e.g., suggested steps and
procedures) and the benefits from doing so including before and after scenarios, grant
recipients will be required to share their final report deliverables. Sensitive data may be
protected by agreement between each grant recipient and NetHope. In addition, a 2-page
snapshot and 2-page end recipient profile ready for publication will be required. In addition,
grant recipients may be called upon to participate in a webinar to showcase their
experience.
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TERMS AND CONDITIONS
4.1 GRANT AGREEMENT
A grant agreement will include the approved project description, approved budget,
reporting requirements and relevant provisions. Once executed it is a legally binding
agreement between NetHope and the recipient organization. Once the grant agreement is
signed, it cannot be modified without prior written approval from NetHope.
4.2 GRANT PROVISIONS
NetHope is required to respect the provisions of the United States Foreign Assistance Act
and other United States laws and regulations. The grant program will be administered
according to NetHope’s policies and procedures as well as USAID’s regulations for non-U.S.
non-governmental recipients.
4.2.1 Late Submissions, Modifications, and Withdrawals of Applications
At the discretion of NetHope, any application received after the exact date and time
specified for the receipt may be considered ineligible for consideration.
Applications may be withdrawn by written notice via email received at any time before
award. Applications may be withdrawn in person by an organization or his authorized
representative, if the representative’s identity is made known and the representative signs a
receipt for the application before award.
4.2.2 False Statements in Offer
Vendors must provide full, accurate and complete information as required by this
solicitation and its attachments.
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4.2.3 Conflict of Interest Clause
Applicants must provide disclosure of any past, present or future relationships with any
parties associated with the issuance, review or management of this solicitation and
anticipated award. Failure to provide full and open disclosure may result in NetHope having
to re-evaluate selection of a potential applicant.
4.2.4 Prohibited Goods and Services
Under no circumstances shall the recipient procure any of the following under this award, as
these items are excluded by the Foreign Assistance Act and other legislation which govern
USAID funding. Programs which are found to transact in any of these shall be disqualified:
a)
b)
c)
d)
e)
f)
military equipment;
surveillance equipment;
commodities and services for support of police or other law enforcement activities;
abortion equipment and services;
luxury goods and gambling equipment; and
weather modification equipment.
4.2.5 Restricted Goods
Only those goods necessary for the accomplishment of milestone goals are explicitly
approved in the grant award and may be acquired and are subject to the provisions
provided in the Standard Provisions for Fixed Obligation Grants to Nongovernmental
Organizations.
4.2.6 Certifications for Non-US, Non-Governmental Recipients
Certifications provided in Attachment A are required by NetHope and USAID and must be
signed by the authorized official, dated and included in the application.
Recipients will be required to comply with the content of the certifications as a part of the
grant agreement when/if funding is approved.
4.2.7 Disclaimers
• NetHope may cancel solicitation and not award
• NetHope may reject any or all responses received
• Issuance of solicitation does not constitute award commitment by NetHope
• NetHope reserves the right to disqualify any offer based on offeror failure to follow
solicitation instructions
• NetHope will not compensate offerors for response to solicitation
• NetHope reserves the right to issue award based on initial evaluation of offers without
further discussion
• NetHope may choose to award only part of the activities in the solicitation, or issue
multiple awards based on the solicitation activities.
• NetHope reserves the right to waive minor application deficiencies that can be
corrected prior to award determination to promote competition
• NetHope will be contacting all offerors to confirm contact person, address and that the
bid was submitted for this solicitation.
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4.2.8 Permission for Use and Disclosure
By way of submitting an application under this RFA, the applicant consents to the disclosure
of the documents submitted by the applicant to the reviewers involved in the selection
process within NetHope. NetHope reserves the right to not fund any of the applications
submitted.
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ATTACHMENT A
Certifications, Assurances, Other Statements of the Grant Recipient
Part I – Certifications and Assurances
1. Assurance of Compliance with Laws and Regulations Governing Non-Discrimination in
Federally Assisted Programs
2. Certification Regarding Lobbying
3. Prohibition on Assistance to Drug Traffickers for Covered Countries and Individuals
(ADS 206)
4. Certification Regarding Terrorist Financing, Implementing Executive Order 13224
5. Certification of Recipient
Part II – Key Individual Certification: Narcotics Offenses and Drug Trafficking
Part III – Participant Certification: Narcotics Offenses and Drug Trafficking
Part IV – Other Statements of Recipient
1. Authorized Individuals
2. Taxpayer Identification Number (TIN)
3. Data Universal Numbering System (DUNS) Number
Certifications, Assurances, Other Statements of the Recipient and Solicitation
Standard Provisions
Part I – Certifications and Assurances
1. Assurance of Compliance with Laws and Regulations Governing Non Discrimination in
Federally Assisted Programs
a. The Recipient hereby assures that no person in the United States will, on the bases
set forth below, be excluded from participation in, be denied the benefits of, or be
otherwise subjected to discrimination under, any program or activity receiving
financial assistance from USAID, and that with respect to the Cooperative
Agreement for which application is being made, it will comply with the requirements
of:
i. Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352, 42 U.S.C. 2000-d),
which prohibits discrimination on the basis of race, color or national origin,
in programs and activities receiving Federal financial assistance;
ii. Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), which
prohibits discrimination on the basis of handicap in programs and activities
receiving Federal financial assistance;
iii. The Age Discrimination Act of 1975, as amended (Pub. L. 95-478), which
prohibits discrimination based on age in the delivery of services and benefits
supported with Federal funds;
iv. Title IX of the Education Amendments of 1972 (20 U.S.C. 1681, et seq.),
which prohibits discrimination on the basis of sex in education programs and
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activities receiving Federal financial assistance (whether or not the programs
or activities are offered or sponsored by an educational institution); and
v. USAID regulations implementing the above nondiscrimination laws, set forth
in Chapter II of Title 2 of the Code of Federal Regulations.
b. If the Recipient is an institution of higher education, the Assurances given herein
extend to admission practices and to all other practices relating to the treatment of
students or clients of the institution, or relating to the opportunity to participate in
the provision of services or other benefits to such individuals, and must be applicable
to the entire institution unless the recipient establishes to the satisfaction of the
USAID Administrator that the institution's practices in designated parts or programs
of the institution will in no way affect its practices in the program of the institution
for which financial assistance is sought, or the beneficiaries of, or participants in,
such programs.
2. Certification Regarding Lobbying
a. The Recipient certifies, to the best of Recipient’s knowledge and belief, that:
i. No Federal appropriated funds have been paid or will be paid, by or on
behalf of the undersigned, to any person for influencing or attempting to
influence an officer or employee of any agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress
in connection with the awarding of any Federal contract, the making of any
Federal Cooperative Agreement, the making of any Federal loan, the
entering into of any cooperative agreement, and the extension, continuation,
renewal, amendment or modification of any Federal contract, grant, loan, or
cooperative agreement.
ii. If any funds other than Federal appropriated funds have been paid or will be
paid to any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of
Congress, or an employee of a Member of Congress in connection with this
grant, the Recipient must complete and submit Standard Form-LLL,
“Disclosure of Lobbying Activities,” in accordance with its instructions.
iii. The Recipient shall require that the language of this certification be included
in the award documents for all subawards at all tiers (including subcontracts,
subgrants, and contracts under grants, loans, and cooperative agreements)
and that all subrecipients must certify and disclose accordingly.
b. This certification is a material representation of fact upon which reliance was placed
when this transaction was made or entered into. Submission of this certification is a
prerequisite for making or entering into this transaction imposed by section 1352,
title 31, United States Code. Any person who fails to file the required certification
will be subject to a civil penalty of not less than $10,000 and not more than
$100,000 for each such failure.
c. Statement for Loan Guarantees and Loan Insurance: The Recipient states, to the
best of the Recipient’s knowledge and belief, that: If any funds have been paid or will
be paid to any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of
Congress, or an employee of a Member of Congress in connection with any
commitment providing for the United States to insure or guarantee a loan to
NetHope, the Recipient shall complete and submit Standard Form-LLL, “Disclosure
From to Report Lobbying,” in accordance with its instructions. Submission of this
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statement is a prerequisite for making or entering into this Agreement by the
Contractor under Section 1352, title 31, U.S. Code. Any person who fails to file the
required statement shall be subject to civil penalty of not less than $10,000 and not
more than $100,000 for each such failure.
3. Prohibition on Assistance to Drug Traffickers for Covered Countries and Individuals (ADS
206)
a. NetHope reserves the right to terminate the Grant, to demand a refund or take
other appropriate measures if the Recipient is found to have been convicted of a
narcotics offense or to have been engaged in drug trafficking as defined in 22 CFR
Part 140. The Recipient must review USAID ADS 206 to determine if any
certifications are required for Key Individuals or Covered Participants.
b. If there are Covered Participants: NetHope reserves the right to terminate
assistance to or take other appropriate measures with respect to the Recipient if the
Recipient or any of its employees or subcontractors (if any) is found to have been
convicted of a narcotics offense or to have been engaged in drug trafficking as
defined in 22 CFR Part 140.
4. Certification Regarding Terrorist Financing, Implementing Executive Order 13224
a. 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 (c) below.
b. The following steps may enable the Recipient to comply with its obligations under
paragraph (a).
i. 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 is maintained by the U.S. Treasury’s Office of Foreign Assets
Control (OFAC), or (ii) is not included in any supplementary information
concerning prohibited individuals or entities that may be provided by USAID
to the Recipient.
ii. 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 AlQaida 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
Web site http://www.un.org/Docs/sc/committees/1267/1267ListEng.htm.
iii. 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.
iv. The Recipient also will implement reasonable monitoring and oversight
procedures to safeguard against assistance being diverted to support
terrorist activity.
c. For purposes of this Certification –
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i. “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.”
ii. “Terrorist act” means –
1. 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);
2. an act of premeditated, politically motivated violence perpetrated
against noncombatant targets by subnational groups or clandestine
agents; or
3. 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.
iii. “Entity” means a partnership, association, corporation, or other
organization, group or subgroup.
iv. References in this certification to the provision of material support and
resources must 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.
v. The Recipient’s obligations under paragraph (a) 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 the grant
application, and any violation of it will be grounds for unilateral termination of the agreement by
NetHope prior to the end of its term.
5. Certification of Recipient
By signing below the Recipient provides certifications and assurances for (1) the Assurance of
Compliance with Laws and Regulations Governing Non Discrimination in Federally Assisted
Programs, (2) the Certification Regarding Lobbying, (3) the Prohibition on Assistance to Drug
Traffickers for Covered Countries and Individuals (ADS 206) and (4) the Certification Regarding
Terrorist Financing Implementing Executive Order 13224 above.
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USAID NetHope / GBI
This certification and assurance is given by the Recipient in consideration for the purpose of
obtaining a grant from NetHope that is funded by funds provided by USAID. The Recipient
recognizes and agrees that Federal financial assistance has been or will be extended to NetHope in
reliance on the representations and agreements made in this assurance, and that the United States
and NetHope shall have the right to seek judicial enforcement of this assurance and certification.
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.
Name of Grant Program
_________________________________
Date of Grant Application
_________________________________
Name of Recipient
_________________________________
Typed Name and Title
_________________________________
Signature
_________________________________
Date
_________________________________
Part II – Key Individual Certification: Narcotics Offenses and Drug Trafficking
The Recipient hereby certifies that within the last ten years:
1. The Recipient is not and has not been convicted of a violation of, or a conspiracy to violate,
any law or regulation of the United States or any other country concerning narcotic or
psychotropic drugs or other controlled substances.
2. The Recipient is not and has not been an illicit trafficker in any such drug or controlled
substance.
3. The Recipient is not and has not been a knowing assistor, abettor, conspirator, or colluder
with others in the illicit trafficking in any such drug or substance.
Signature:
_________________________________
Date:
_________________________________
Name:
_________________________________
Title/Position: _________________________________
Organization: _________________________________
Address:
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_________________________________
_________________________________
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USAID NetHope / GBI
NOTICE:
1. The Recipient is required to sign this Certification under the provisions of 22 CFR Part 140,
Prohibition on Assistance to Drug Traffickers. These regulations were issued by the
Department of State and require that certain key individuals of organizations must sign this
Certification.
2. If the Recipient makes a false Certification the Recipient is subject to U.S. criminal
prosecution under 18 U.S.C. 1001.
Part III – Participant Certification: Narcotics Offenses and Drug Trafficking
1. The Recipient hereby certifies that within the last ten years:
a. The Recipient is not and has not been convicted of a violation of, or a conspiracy to
violate, any law or regulation of the United States or any other country concerning
narcotic or psychotropic drugs or other controlled substances.
b. The Recipient is not and has not been an illicit trafficker in any such drug or
controlled substance.
c. The Recipient is not and has not been a knowing assistor, abettor, conspirator, or
colluder with others in the illicit trafficking in any such drug or substance.
2. The Recipient understands that NetHope may terminate the Grant if it is determined that
the Recipient engaged in the above conduct during the last ten years or during the term of
the Grant.
Signature:
_________________________________
Name:
_________________________________
Date:
_________________________________
Address:
_________________________________
_________________________________
Date of Birth: _________________________________
NOTICE:
1. The Recipient is required to sign this Certification under the provisions of 22 CFR Part 140,
Prohibition 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 the Recipient makes a false Certification you are subject to U.S. criminal prosecution under 18
U.S.C. 1001.
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USAID NetHope / GBI
Part IV – Other Statements of Recipient
1. Authorized Individuals
The Recipient represents that the following persons are authorized to negotiate on its
behalf with NetHope and to bind the recipient in connection with this application or grant:
Name
Title
Telephone No.
Facsimile No.
Email Address
2. Taxpayer Identification Number (TIN)
If Recipient is a U.S. organization, or a foreign organization which has income effectively
connected with the conduct of activities in the U.S. or has an office or a place of business or
a fiscal paying agent in the U.S., please indicate Recipient’s TIN:
TIN: ________________________________
3. Data Universal Numbering System (DUNS) Number
a) Unless otherwise specified in the solicitation using an applicable exemption, 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.
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USAID NetHope / GBI
c) Recipients located outside the United States may e-mail Dun and Bradstreet at
[email protected] to obtain the location and phone number of the local Dun and
Bradstreet Information Services office.
The DUNS system is distinct from the Federal Taxpayer Identification Number (TIN)
system.
DUNS: ________________________________________
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