ADECA - SPD - Surplus Property Eligibility Application

A. Public Agency including Public Schools_______________________( Complete all sections, except IV )

B. Non-Profit, Tax-Exempt Educational or Health Organization_____ ( Complete all sections except III )

B. Attach a copy of the law, ordinance, agreement, etc. creating the agency.

C. Attach a narrative describing the functions and service provided by your agency / organization - to include hours of operation , number of staff and their qualifications, and number of individuals served daily/weekly, etc.

D. Attach evidence of funding. If from more than one source, give percentage received from each.

C. Attach copy of IRS ruling letter declaring applicant to be a non-profit, tax exempt organization under Section 501 (c)(3) of the U.S. Internal Revenue Code of 1954.

D. Attach evidence of funding. If more than one source, give percentage received from each:

E. Attach a brief narrative description of your program (for schools include level of courses, enrollment, facilities, staff, etc. : for hospitals or health care facilities, include type of service, number of beds and/or patients served, facilities, staff, etc. : for libraries, number of volumes, population served, facilities, staff, etc. : for museums, type, population served, facilities, research aids, staff, hours open to the public, etc. and for others, similar types of information that help us understand your program.)

, hereinafter called the "donee" hereby agrees that the program for or in connection with which any property is acquired by donee will be conducted in compliance with, and the donee will comply with and will require any other person (any legal entity) who through contractual or other arrangements with the donee is authorized to provide services or benefits under said program to comply with all requirements imposed by or pursuant to the regulations of the General Services Administration (41 CFR 101-6.2 or 101-8) issued under the provisions of Title VI of the Civil Rights Act of 1964, Section 606 of Title VI of the Federal Property and Administration Services Act of 1949, as amended, Section 504 of the Rehabilitation Act of 1973, as amended, Title IX of the Education Amendments of 1972, as amended, and Section 303 of the Age Discrimination Act of 1975, to the end that no person in the United States shall on the grounds of race, color, national origin, sex, or age, or that no otherwise qualified handicapped person shall solely by reason of handicap, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity for which the donee received Federal assistance from the General Services Administration; and hereby gives assurance that it will immediately take any measures necessary to effectuate this agreement.

The donee further agrees that this agreement shall be subject in all respects to the provisions of said regulations; that this agreement shall obligate the donee for the period during which it retains ownership or possession of any such property; that the United States shall have the right to seek judicial enforcement of this agreement; and, this agreement shall be binding upon any successor in interest of the "donee" as used herein, including any such successor in interest.

Relative Property Needs, Resources and Abilities To Utilize Requested Property.

In accordance with the requirements of Part 1, D (I) (iii) of the Application For Eligibility To Participate in The Federal Surplus Property Donation Program, this is a statement of the relative property needs, resource and abilities to utilize requested property.

Applicant, please note that general categories of the property in great demand and not readily available in the surplus property distribution centers include, but are not limited to, aircraft, and aircraft components; vessel & vessel components; construction equipment; construction material; material handling equipment; machine shop and woodworking shop equipment; generators; compressors; vehicles; highly specialized equipment and small common use items in large quantities. Requests for items in these categories are accepted by the State Agency and placed on a "want list." When items that fall within these categories become available, donation is made by the State Agency on the basis of each requesting donees' relative needs, resources and abilities to utilize requested property. Needs for items that do not fall within the listed categories may be filled by donee representatives visiting the surplus property distribution centers on a regularly scheduled basis

A. Be specific; list quantities needed and a complete description of the items that are needed. (Requests for items that cannot be readily identified or requests for items that are usually available in the surplus property distribution centers will not be placed on a "want list". Items such as a firetrucks, ambulances and other types of rolling stock , including heavy equipment, please attach a letter of request on your organizations letterhead for each of your request to this application.

(use "Tab Key or mouse" to move to next line, do not overwrite allocated space)

3. Property requested is needed for purpose as stated and when acquired will be utilized on a:

4. Property acquired through donation will be maintained and repaired in the following manner;

and have the authority to approve and certify purchases for this agency/organization. I agree to be responsible for all Surplus Property acquired by this agency/organization through the State of Alabama Department of Economic and Community Affairs - Surplus Property Division and hereby give assurance that the property will be utilized in accordance with the terms and conditions shown on the eligibility application.

The following Selectors are approved and certified to acquire and utilize Surplus Property on behalf of the above named agency/organization:

I understand that ONLY the AUTHORIZED representative may give a one time letter of authorization to an individual not listed above to present as identification and use as authorization to purchase on behalf of the Agency/Organization. The letter should be dated for the date of purchase.

Any changes to the above list must be made in writing by the Authorized Representative.

VIII. CERTIFICATIONS AND AGREEMENTS (INCLUDING TERMS, CONDITIONS, RESERVATIONS AND RESTRICTIONS) TO BE INCLUDED ON THE STATE AGENCY ISSUE OR DISTRIBUTION DOCUMENT.

(1) it is a public agency or a nonprofit institution or organization exempt from taxation under section 501 of the Internal Revenue Code of 1954 within the meaning of section 203 (j) of the Federal Property and Administration Services Act of 1949, as amended, and/or the regulation of the General Services Administration (GSA)

(2) if a public agency, the property is needed by the recipient for carrying out or promoting for the residents of a given political area and one or more public purposes, or, if a nonprofit, tax exempt institute or organization, the property is needed for and will be used by the recipient for educational or public health purposes, including research for any such purpose, or for programs for older individuals. The property is not being acquire for any other use or purpose, or for sale or other distribution, or for permanent use outside of the State, except with prior written approval of the State Agency.

(4) This transaction shall be subject to the nondiscrimination regulations governing the donation of surplus personal property issued under title VI of the Civil Rights Act of 1964, section 606 of the title VI of the Federal Property and Administrative Services Act of 1949, as amended, section 504 of the Rehabilitation Act of 1973, as amended, title IX of the Education Amendments of 1972, as amended, and Section 303 of the Age Discrimination Act of 1975.

(1) All items of property shall be placed in use for the purpose(s) for which acquired within 1 year of receipt and shall be continued in use for such purpose(s) for 1 year from the date the property was placed in use. In the event the property is not so placed in use, or continued in use, the donee shall immediately notify the State Agency and, at the donee's expense, return such property to the State Agency or otherwise make the property available for transfer or other disposal by the State Agency, provided the property is still available as determined by the State Agency.

(2) Such special handling or use limitations as are imposed by GSA on any item(s) of property listed hereon.

(3) In the event the property is not so used or handled as required by: (b)(1) and (2), title and the right to the possession of such property shall at the option of GSA revert to the United States of America upon demand, the donee shall release such property to such person as GSA or its designee shall direct.

(C) THE DONEE AGREES TO THE FOLLOWING CONDITIONS IMPOSED BY THE STATE AGENCY, APPLICABLE TO ITEMS WITH A UNIT ACQUISITION COST OF $5000.00 OR MORE AND PASSENGER MOTOR VEHICLES, REGARDLESS OF ACQUISITION COST, EXCEPT VESSELS 50 FEET MORE IN LENGTH AND AIRCRAFT, FOREIGN GIFTS, OR OTHER ITEMS OF PROPERTY REQUIRING SPECIAL HANDLING OR USE LIMITATIONS, REGARDLESS OF THE ACQUISTION COST OR PURPOSE ACQUIRED.

(1) The property shall be used only for the purpose(s) for which acquired and for no other purpose(s).

(2) There shall be a period of restriction which will expire after such property has been used for the purpose(s) which acquired for a period of 18 months unless otherwise designated.

(3) In the event the property is not so used as required by (C) (1) and (2), and Federal restrictions (B)(1) and (2) have expired, right to the possession of such property shall at the opinion of the State Agency revert to the State of Alabama and the donee show release such property to such person as the state agencies shall direct.

(1) From the date it receives the property listed hereon and through the period(s) of time the conditions imposed by (B) and (C) above remain in effect, the donee shall not sell, trade, lease, bail, cannibalalize, encumber, or otherwise dispose of such property, or remove it permanently, for use outside the State, without prior approval of GSA under (B) or the State Agencies under (C). The proceeds from any sale, trade, lease, loan, bailment, encumbrance or other disposal of the property, when such action is authorized by GSA or by the State Agency, shall pay to be remitted promptly by the donee to GSA or the State Agency, as the case may be.

(2) In the event any of the property listed hereon it sold, traded, leased, loaned, bailed, cannibalized, encumbered, or otherwise disposed of by the donee from the date it is received the property through the period(s) of time the conditions imposed by (B) and (C) remain in effect, without the prior approval of GSA for the State Agency, the donee, at the option of GSA or the State Agency, the donee, at the of GSA or the State Agency, shall pay to Gsa or the State Agency, as the case may be, the proceeds of the disposal or the fair market value or the fair retail value of the property at the time of such disposal, as determined by GSA for the State Agency.

(3) If at any time, from the date it receives the property through the period(s) of time the conditions imposed by (B) and (C) remain in effect, any of the property listed hereon is no longer suitable, usable, or further needed by the donee for the purpose(s) for which acquired, the donee shall promptly notify the State Agency, and shall, as directed by the State Agency, return the property to the State Agency, release the property to another donee or another State Agency, a department or agency of the United States, sell or otherwise dispose of the property. The proceeds from any sale shall be remitted promptly by the donee to the State Agency.

(4) The donee shall make reports to the State Agency on the use, conditions, and location of the property listed hereon, and on other pertinent matters as may be required from time to time by the State Agency.

(5) At the option of the State Agency, the donee may abrogate the conditions set forth in (C) and the terms, reservations and restrictions pertinent thereto in (D) by payment of an amount as determined by the State Agency.

(E) THE DONEE AGREES TO THE FOLLOWING CONDITIONS, APPLICABLE TO ALL ITEMS OF PROPERTY PROCURED:

(1) The property acquired by the donee is on an "as is/where is" basis, without warranty of any kind.

(2) Where a donee carries insurance against damages to or loss of property due to fire or other hazards and where loss of, or damage to, donated property without expired terms, conditions, reservations, or restrictions occur, the State Agency will be entitled to reimbursement from the donee out of a insurance proceeds, of an amount equal to the unamortized portion of the fair value of the damaged or destroyed donated items.

(F) THE DONEE AGREES TO THE FOLLOWING ADDITIONAL SPECIAL TERMS AND CONDITIONS APPLICABLE TO THE DONATION OF AIRCRAFT AND VESSELS (50 FEET OR MORE IN LENGTH) HAVING AN ACQUISITION COST OF $5,000.00 OR MORE, AND FOREIGN GIFTS OR OTHER ITEMS OF PROPERTY REQUIRING SPECIAL HANDLING OR USE LIMITATIONS, REGARDLESS OF THE ACQUISITION COST OR PURPOSE FOR WHICH ACQUIRED.

(1) The donation shall be subject to the additional special terms, conditions, reservations and restrictions set forth in the Conditional Transfer Document or other agreement executed by the authorized donee representative.

(G) NO PERSON IN THE UNITED STATES SHALL ON THE GROUNDS OF AGE, BE DENIED THE BENEFITS OF, OR BE SUBJECTED TO DISCRIMINATION UNDER ANY PROGRAM OR ACTVITY FOR WHICH TRANSFEREE RECEIVES FEDERAL ASSISTANCE FROM GSA.