Section 501

Section 501.APPENDIX A Wording of the Block Grant Agreement

The wording of a block grant agreement, which is entered into by the Department and local governments for the payment of funds in advance of anticipated expenditures to be incurred by local governments for their participation in the planning and response activities as specified in Section 501.90 of this Part, shall contain the following provisions except that the instructions in parentheses are to be replaced with the relevant information and the parentheses deleted:

STATE OF ILLINOIS

DEPARTMENT OF NUCLEAR SAFETY

INTERGOVERNMENTAL GRANT AGREEMENT

NO.
This Agreement is made and entered into by and between the Illinois Department of Nuclear Safety, 1035 Outer Park Drive, Springfield, IL 62704, hereinafter referred to as
DEPARTMENT, and the		(name and address of the local governmental entity)		,
hereinafter referred to as	(VILLAGE, THE DISTRICT, ETC)		.

Introductory Statement

The Illinois Nuclear Safety Preparedness Act [420 ILCS 5] (the Act) authorizes DEPARTMENT to compensate local governments from fees collected pursuant to Section 4 of the Act for expenses incurred in activities defined as necessary by the Director of the DEPARTMENT to implement and maintain the plans and programs authorized by the Act. The Intergovernmental Cooperation Act [5 ILCS 220] authorizes the creation of intergovernmental agreements and contracts between public agencies of this State. Both DEPARTMENT and (NAME AS SHOWN IN THE REFERENCE CLAUSE, i.e., VILLAGE, THE DISTRICT, ETC) are public agencies of this State. The Grant Funds Recovery Act [30 ILCS 705] provides for the recovery by DEPARTMENT of unused block grant funds.

Terms of Agreement

DEPARTMENT and

(VILLAGE, THE DISTRICT, ETC)

hereby agree as follows:

1)	Purpose: The purpose of this grant is to encourage participation by
		(VILLAGE, THE DISTRICT, ETC)		in the emergency planning and
	Response activities conducted by DEPARTMENT pursuant to the Act. Under
	this grant, DEPARTMENT hereby agrees to compensate				(VILLAGE, THE
		DISTRICT, ETC)	for expenses incurred in implementing plans and
	programs to deal with the possibility of a nuclear accident, as authorized by the Act.

2) Term: This grant shall provide for compensation of funds expended between July 1, ______, through June 30, ______.

3)	Use: Permissible expenditures by	(VILLAGE, THE DISTRICT, ETC)
	for which compensation will be made under this Agreement shall be those expenditures which are in accordance with the terms of the Act and with the standards set forth in 32 Ill. Adm. Code 501.90.

4)	Method of Payment: As soon as practicable after execution of this Agreement,
	DEPARTMENT shall disburse to				(VILLAGE, THE DISTRICT, ETC)
		(SPELL OUT DOLLAR AMOUNT)				($	, an amount
	equal to the DEPARTMENTALLY approved grant expenses that are anticipated
	to be incurred by			(VILLAGE, THE DISTRICT, ETC)				in State
	fiscal year		. Payments under this Agreement shall be directed to:

(name and address of the Village,

Village, District, etc)

5)		(VILLAGE, THE DISTRICT, ETC)	shall maintain documentation of
	actual compensable expenditures made in accordance with Article 3 above. Such documentation shall be on forms provided by DEPARTMENT and subject to the provisions of 32 Ill. Adm. Code 501.80.

6)	Amount of Grant: The maximum amount payable to					(VILLAGE, THE
		DISTRICT, ETC)	under this Agreement shall be			(SPELL OUT
		DOLLAR AMOUNT)		($	.

7)	Recovery of Funds: As required by Section 4 of the Illinois Grant Funds Recovery Act [30 ILCS 705], all funds remaining at the end of this Agreement shall be returned to DEPARTMENT within 45 days. In the event that
		(VILLAGE, THE DISTRICT, ETC)		is compensated by DEPARTMENT
	in excess of expenditures actually and legitimately compensable under this
	Agreement,		(VILLAGE, THE DISTRICT, ETC)		shall return said
	excess compensation to DEPARTMENT within 45 days after the date that DEPARTMENT makes such a request for payment. In addition, DEPARTMENT may pursue other recovery actions as specified in Section 6 of the Illinois Grant Funds Recovery Act [30 ILCS 705].

8) Audit: DEPARTMENT may audit records required to be maintained under 32 Ill. Adm. Code 501.80 to verify that grant monies are being spent for permissible uses as specified in Article 3 of this grant agreement.

9)	Records and Reports:			(VILLAGE, THE DISTRICT, ETC)
	shall maintain, for a minimum of 5 years after the completion of this Agreement, adequate books, records, and supporting documents to verify the amounts, recipients, and uses of all disbursements passing in conjunction with this
	Agreement.	(VILLAGE, THE DISTRICT, ETC)			shall make
	available, on request, all books, records, and supporting documents related to this Agreement for review and audit by the Auditor General and/or the
	DEPARTMENT.		(VILLAGE, THE DISTRICT, ETC)			agrees
	to cooperate fully with any audit conducted by the Auditor General or the DEPARTMENT and to provide full access to all relevant materials.

10)	Independence of		(VILLAGE, THE DISTRICT, ETC)				: Any
	personnel, including contractors, who may be employed by						(VILLAGE,
		THE DISTRICT, ETC)		in connection with this Agreement shall not be
	considered for any purpose to be agents or employees of DEPARTMENT.
	Nothing in this Agreement shall be construed to render					(VILLAGE,
		THE DISTRICT, ETC)			an agent or employee of DEPARTMENT.

11) Assignment: This Agreement shall not be assigned.

12) Modification: No modification of this Agreement may be made unless agreed to in writing by both parties.

13) Illinois Law: This Agreement shall be interpreted in accordance with Illinois law.

14) Non-appropriation of Funds: This Agreement will cease immediately and without further liability, if in any fiscal year the Illinois General Assembly fails to appropriate or otherwise make available sufficient funds for this Agreement. In

this event,

(VILLAGE, THE DISTRICT, ETC)

will be paid for

expenditures made during the period for which funds were available.

15) Termination: Each party reserves the right to terminate this Agreement upon 30 days written notice.

16)	International Anti-Boycott Certification:				(VILLAGE, THE DISTRICT,
		ETC)	certifies that neither	(VILLAGE, THE DISTRICT, ETC)
	nor any substantially-owned affiliated company is participating or shall participate in an international boycott in violation of the provisions of the U.S. Export Administration Act of 1979 or the regulations of the U.S. Department of Commerce promulgated under that Act (see 30 ILCS 582).

17)	Taxpayer Identification Number and Legal Status Disclosure:			(VILLAGE,
		THE DISTRICT, ETC)	shall complete the form entitled
	"CONTRACTOR'S FEDERAL TAXPAYER IDENTIFICATION NUMBER AND LEGAL STATUS DISCLOSURE CERTIFICATION FORM," which shall be provided by DEPARTMENT and made a part of this grant agreement.

18) Contact persons and notices: DEPARTMENT's contact person for matters related to this Agreement is:

Illinois Department of Nuclear Safety

Division of Planning & Analysis

Head of Emergency Preparedness and Local Government Support Section

1035 Outer Park Drive

Springfield, IL 62704

217/785-9863

(VILLAGE, THE DISTRICT, ETC)

's contact person is:

(NAME OF PERSON)

(NAME OF ENTITY)

(ADDRESS)

(PHONE NUMBER)

DEPARTMENT and

(VILLAGE, THE DISTRICT, ETC)

may,

from time to time, designate in writing different contact persons or addresses. Unless otherwise specifically provided herein, all notices or submittals required or permitted pursuant to this Agreement shall be deemed given when personally delivered or upon three (3) days after being posted by certified or registered mail, return receipt requested, postage prepaid, to the designated contact person at the designated address.

IN WITNESS HEREOF, the parties hereto have caused this Agreement to be executed by their duly authorized representatives.

STATE OF ILLINOIS				(NAME OF ENTITY)
DEPARTMENT OF NUCLEAR SAFETY				(ADDRESS)
1035 Outer Park Drive
Springfield, IL 62704

BY:				BY:
TITLE:				TITLE:
DATE:				DATE:
				FEIN: