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NATURAL AREA FORM

ChallengeCost-Share Agreement

betweenShawnee National Forest

andIllinois Department of Conservation

THIS CHALLENGE COST-SHARE AGREEMENT, is hereby made and entered into by andbetween Illinois Department of Conservation, hereinafter referred to as theCooperator and the Shawnee National Forest, U .S . Department of AgricultureForest Service, hereinafter referred to as the Forest Service (FS), under theprovisions of the Interior and Related Agencies Appropriations Act, Pub . L .102-154 .

I . INTRODUCTION

The Forest Service and the Cooperator have established this agreement to helpone another accomplish mutually beneficial objectives related to gainingadditional information concerning the areas recently listed in the IllinoisNatural Areas Inventory and listed as Natural Areas in the Shawnee Land andResource Management Plan, signed May 1992 .

II . MUTUAL BENEFITS

Both parties agree that information concerning the floral and faunal resourcesof the newly listed Illinois Natural Areas on the Shawnee National Forest arepresently lacking, and that a survey of these areas is needed . Thisinformation will significantly increase the level of knowledge regarding theseareas' unique resources . The areas that will be inventoried are Crow Knob(Vienna R .D ., 15 acres), Dean Cemetery East (Vienna R .D ., 20 acres), DogBarrens (Vienna R .D ., 74 acres), Dutch Creek Chert Woodlands (Jonesboro R .D .,126 acres), Jackson Hole (Vienna R .D ., 116 acres), Kickasola Cemetery (ViennaR .D ., 36 acres), Poco Cemetery East (Vienna R .D ., 34 acres), Poco CemeteryNorth (Vienna R .D ., 22 acres), Reid's Chapel (Vienna R .D ., 134 acres), RobnettBarrens (Vienna R .D ., 21 acres), Gibbons Creek (Elizabethtown R .D ., 95 acres),Big Brushy Ridge (Jonesboro R .D ., 150 acres), and Provo Cemetery (JonesboroR . D ., 50 acres) . Additional information to be gained, which will be of mutualbenefit, are the identification of significant and exceptional features, thequality of these features, the location of threatened, endangered, andsensitive plant species, the establishment of long-term monitoring plots, andthe collection of baseline data . Information gathered will also includepotential threats to threatened, endangered, and sensitive plant species, andto the various plant communities . The information obtained on these sites willaid in the management of these newly designated natural areas .

III . THE FOREST SERVICE SHALL :

1 . Inventory each of the recent additions to the Illinois Natural AreasInventory as listed above .

2 . Establish a minimum of one long-term monitoring plot for vegetation oneach site, to be determined on site .

No . 93-090800-020 CCS

93-090800-020

2

3 . Collect and identify plant voucher specimens as representatives of thespecies encountered at said sites during surveys . Photos may be taken in lieuof voucher specimens when deemed necessary.

4 . Map the natural communities at each site surveyed .

5 . Provide a final report which will include a completed inventory form,natural communities map indicating the plant communities, a plant species listof the areas inventoried, monitoring plot information, a list of potentialthreats to the inventoried sites, and management suggestions for eachinventoried site .

6 . Match the Challenger's $5,000 with $5,000 of in-kind contributions .

IV . THE CHALLENGER SHALL :

1 . Reimburse the Shawnee National Forest $5,000 for salary and expensesrelated to the natural areas inventory as shown in the Financial Plan,Attachment "A" . The Challenger will make payment of $4,000 at the time ofproject initiation, and the remaining $1,000 will be paid upon the completionof the project .

2 . Provide the Shawnee National Forest with the inventory methodology andthe appropriate forms and maps for the areas to be inventoried .

3 . Give the Forest Service or Comptroller General, through any authorizedrepresentative, access to and the right to examine all books, papers, ordocuments related to this agreement .

V . IT IS MUTUALLY AGREED AND UNDERSTOOD BY THE FOREST SERVICE AND CHALLENGERTHAT :

1 . Both parties will arrange for a continuing consultation to discuss theconditions covered by this agreement and agree to actions necessary toimplement and further the stated goals of the agreement .

2 . The Forest Service, in writing, may terminate the agreement in whole,or in part, at any time before the date of expiration, whenever it isdetermined that the other party(s) has materially failed to comply with theconditions of this agreement .

3 . The cooperator shall comply with all Federal statutes relating tonondiscrimination and all applicable requirements of all other Federal laws,executive orders, regulations and policies . These include but are not limitedto : (a) Title VI of the Civil Rights Act of 1964 (40 U .S .C . 2000), whichprohibits discrimination on the basis of race, color, handicap, or nationalorigin ; (b) Title IX of the Education amendments of 1972, as amended (20U .S .C . 1681-1683, and 1685-1686), which prohibits discrimination on the basisof sex .

4 . Improvements placed on National Forest land at the direction of eitherof the parties, shall thereupon become property of the United States, and shallbe subject to the same regulations and administration of the Forest Service asother National Forest improvements of a similar nature .

93-090800-020

3

5 . This agreement in no way restricts the Forest Service fromparticipating in similar activities with other public or private agencies,organizations, and individuals .

6 . No part of this agreement shall entitle the Challenger to any share orinterest in the project other than the right to use and enjoy the same underthe existing regulations of the Forest Service .

7 . No member of, or Delegate to Congress shall be admitted to any share orpart of this agreement, or any benefits that may arise therefrom ; but thisprovision shall not be construed to extend to this agreement if made with acorporation for its general benefit .

8 . Nothing herein shall be considered as obligating the Forest Service toexpend or as involving the United States in any contract or other obligationsfor the future payment of money in excess of appropriations authorized by lawand administratively allocated for this work .

9 . This agreement may be revised as necessary by mutual consent of bothparties, by the issuance of a written amendment, signed and dated by bothparties .

10 . Either party may terminate the agreement by providing 60 days writtennotice, unless terminated by the Forest Service unilaterally for cause inaccordance with Article 2 of this section .

11 . The work under this agreement shall be completed no later than March1, 1994 .

VI . PROJECT COORDINATORS : Administration of this agreement shall beaccomplished by :

Elizabeth L . ShimpUSDA Forest ServiceShawnee National Forest901 S . CommercialHarrisburg, IL 62946(618) 253-7114

IN WITNESSETH WHEREOF, the partieslast date written below .

USDA Forest Service

BY : DaJo 67~DATE :C)8/o-"/93

Todd E . FinkIllinois Department of ConservationFerne Clyffe State ParkP .O . Box 67Goreville, IL 62939(618) 995-2568

hereto have executed the agreement as of the

Illinois Department of Conservation

DATE :OS//o/9 .3

BY :

ATTACHMENT A

FINANCIAL PROJECT PLAN(PROJECT TITLE)

PROJECT TOTAL $ 10,000 .00

Management Code(s) Established by FS : 226005226700

1/ Estimated payment to Challenger2/ Amount to be collected from Challenger

FOREST SERVICE CONTRIBUTIONFS IN-KIND

FUNDING TOCONTRIBUTION CHALLENGER TOTAL

SALARIES

$ 4,500 .00

$

1/

$ 4,500 .00TRAVEL

$

$ $SUPPLIES

$

$ $EQUIPMENT USE

$ 500.00

$ $

500 .00TOTAL DIRECT COST

$

$ $

ADD: INDIRECT COST

$

TOTAL FS CONTRIBUTION $ 5,000 .00 $ 5,000 .00

CHALLENGER CONTRIBUTIONFUNDING TO

CHALLENGERFS

IN-KIND TOTAL

SALARIES

$ 3,000 .00

$ $ 3,000 .00TRAVEL

$

$ $SUPPLIES/CONTRACT

$ 2,000 .00 $ $ 2,000 .00EQUIPMENT USE

$

$ $TOTAL DIRECT COST

$

2/ $ $

ADD : INDIRECT COST

$ $ 5,000 .00

ADD : VALUE OF CONTRIBUTIONS WHERE THECHALLENGER INCURS NO COST (i .e ., voluntary labor)(May be used only to satisfy matchingrequirement - not reimbursable)

TOTAL CHALLENGER CONTRIBUTION $ 5,000 .00 $ 5,000 .00

OTHER SOURCES

Other Federal ContributionsOther Non-Federal Contributions

Total FS Share 50 % of Project ValueChallenger Share 50 % of Project Value

STATE OF ILLINOIS, DEPARTMENT OF CONSERVATION

VENDOR'S CONTRACT CERTIFICATIONS

1 . Vendor certifies that it has not been convicted under the laws of Illinois or any other state ofbribery or attempting to bribe an officer or employee of the State of Illinois or in any other statein that officer or employee's official capacity ; or has made an admission of guilt of such conductwhich is a matter of record but has not been prosecuted for such conduct . Section 10 .1 of theIllinois Purchasing Act .

2. Vendor certifies it has not been barred from being awarded a contract with a unit of State orlocal government as a result of a violation of Section 33E-3 or 33E-4 of the Criminal Code of1961 (bid rigging or bid rotating) .

3. Vendor certifies that, if this contract is with an individual or individuals, such individual or individualsis not barred from receiving State contracts as a result of default on any educational loan. (Section2 of An Act in Relation to Educational Loans, 111 . Rev. Stat., 1989, Ch . 127, par 3553) .

4. The vendor shall maintain, for a minimum of 5 years after the completion of the contract, adequatebooks, records, and supporting documents to verify the amounts, recipients, and uses of alldisbursements of funds passing in conjuction with the contract ; the contract and all books,records, and supporting ducuments related to the contract shall be available for review and auditby the Auditor General ; and the contractor agrees to cooperate fully with any audit conductedby the Auditor general and to 'provide full access to all relevant materials . Failure to maintainthe books, records, and supporting documents required by this Section shall establish a presump-tion in favor of the State for the recovery of any funds paid by the State under the contract forwhich adequate books, records, and supporting documentation are not available to support theirpurported disbursement .

5. The following certification is required by the Drug Free Workplace Act . (111 . Rev. Stat., ch. 127,par. 152.311). The Drug Free Workplace Act, effective January 1, 1992, requires that no granteeor contractor shall receive a grant or be considered for the purposes of being awarded a contractfor the procurement of any property or services from the State unless that grantee or contractorwill provide a drug free workplace. False certification or violation of the certification may resultin sanctions including, but not limited to, suspension of contract or grant payments, terminationof the contract or grant and debarment of contracting or grant opportunities with the State for atleast one (1) year but not more than five (5) years .

For the purpose of this certification, "grantee" or "contractor" means a corporation, partnership, orother entity with twenty-five (25) or more employees at the time of issuing the grant, or a department,division, or other unit thereof, directly responsible for the specific performance under a contract orgrant of $5,000 or more from the State .

The contractor/grantee certifies and agrees that it will provide a drug free workplace by :

(a) Publishing a statement :(1) Notifying employees that the unlawful manufacture, distribution, dispensing, pos-

session or use of a controlled substance, including cannabis, is prohibited in thegrantee's or contractor's workplace .

(2) Specifying the actions that will be taken against employees for violations of suchprohibition .

(3) Notifying the employee that, as a condition of employment on such contract orgrant, the employee will :

(A) abide by the terms of the statement ; and(B) notify the employer of any criminal drug statute conviction for

a violation occurring in the workplace no later than five (5)days after such conviction .

(b) Establishing a drug free awareness program to inform employees about :(1) the dangers of drug abuse in the workplace ;(2) the grantee's or contractors policy of maintaining a drug free workplace ;(3) any available drug counseling, rehabilitation, and employee assistance programs ;

and(4) the penalties that may be imposed upon an employee for drug violations .

(c) Providing a copy of the statement required by subparagraph (a) to each employeeengaged in the performance of the contract or grant and to post the statement in aprominent place in the workplace.

(d) Notifying the contracting or granting agency within ten (10) days after receiving noticeunder part (B) of paragraph (3) of subsection (a) above from an employee otherwisereceiving actual notice of such conviction .

(e) Imposing a sanction on, or requiring the satisfactory participation in a drug abuseassistance or rehabilitation program by, any employee who is so convicted, as requiredby section 5 of the Drug Free Workplace Act.

(f) Assisting employees in selecting a course of action in the event drug counseling,treatment, and rehabilitation is required and indicating that a trained referral team isin place .

(g) Making a good faith effort to countinue to maintain a drug free workplace throughimplementation of the Drug Free Workplace Act .

THE UNDERSIGNED AFFIRMS, UNDER PENALTIES OF PERJURY, THE HE OR SHE ISAUTHORIZED TO EXECUTE THIS CERTIFICATION ON BEHALF OF THE DESIGNATEDORGANIZATION .

USDA -PcC Sarlce „ SHA<JA16c- uPPrinted Name of Organization

Signature of Authoded'Representative

Requistion/Contract/Grant ID Number

ThWDL . PS,ez-s , 8-r1 iXa F-z-ESC "zx-yvc2Printed Name and Title

Date

The nY a7arcy b rRasWh ds of iUpmfv4m that a n y m a¢mpaa fM atiNdy Paposs a wbu0 at Q+yar 127. pwafffyfr 1321-13271Disdo n 07th inbmucon a REONRW. Faire b pfor~GS any vdannaEOn ri imu¢ in Cfa lam roe Osvg pamsl The fan h Cawf .Pp v d by 9 Fame Alan.agonws Car.

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Signed

~

~

Vendor's Federal Taxpayer Identification NumberDisclosure Certification

Instructions :

The form of this certification is established by the Internal Revenue Service . The following instructions.to vendors are for use in completing the below certification :

Enter your taxpayer identification number (TIN) in the appropriate space . For individualsand sale proprietors, this is your social security number . For other entities, it is your employeridentification number. Federal Employer Identification Numbers (FEIN's) must not be usedfor sole proprietorships.

If you do not have a TIN, apply for one immediately. To apply, get Form - SS-5, Applicationfor a Social Security Number Card (for individuals) from your local office of the SocialSecurity Administration, or Form Ss-4, Application for Employer Identification Number (forbusinesses and all other entities), from your local Internal Revenue Service Office .

To complete the certification if you do not have a TIN, fill out the certification indicating thata TIN has been applied for, sign and date the form, and return it to this agency . As soonas you receive your TIN, fill out another such form including your TIN, sign and date theform, and give it to this agency.

If you fail to furnish your correct TIN to this agency, you are subject to an IRS penalty of$50 for each such failure unless your failure is due to reasonable cause and not to willfulneglect.

Willfully falsifying certifications or affirmations may subject you to criminal penaltiesincluding fines and/or imprisonment

Certification :

Under penalties of perjury, I certify that72 - 056y8-3`/Fis mycorrect Federal Taxpayer Identification Number. I am doing business as a (please check one) :

•

Individual•

Sole ProprietorshipQ Partnership•

Corporation•

Not-for-Profit Corporation•

Trust or Estate

•

Real Estate Agent® Government Entity•

Tax Exempt Organization(ICR 510(a) only)

•

Medical and Health CareServices Provider Corporation

Firm Name: USDA--EW si52v1c_e, S1 /+ 3&Lccc n.L 'c-7

OH/OZ,~g3Date

FY93 NONGAME WILDLIFE CONSERVATION FUND PROPOSAL

PROJECT TITLE : Illinois Natural Areas Update in the Shawnee NationalForest

ESTIMATED COST : $5,000 .00 with potential for Challenge Grant fundsfrom the USFS

JUSTIFICATION : A number of high-quality areas in the Shawnee NationalForest have been provisionally accepted as additions to the IllinoisNatural Areas Inventory pending further evaluation . These areasinclude Crow Knob, Pope Co ; Bell Pond, Johnson Co ., and Double BranchHole, Pope Co . (as a Category I site) . Additional sites consideredworthy of evaluation include Kickasola Barrens and Spivey LimestoneBarrens (both Pope Co .) . The time needed to complete these evaluationsis beyond the manpower capability of the Division of Natural Heritage .A timely evaluation and addition of these areas to the Inventory willhelp assure their protection and management by the USFS .

DURATION : 1993 growing season

PROPOSED BY: Todd Fink

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