Medical Office Registration Form s7

OPM-NOGA-2015 rev 06/04/15 STATE OF CONNECTICUT | OFFICE OF POLICY AND MANAGEMENT Division of Transportation, Conservation, and Development Policy and Planning 450 Capitol Avenue | MS# 54ORG | Hartford, CT 06106-1379 NOTICE OF GRANT AWARD

The Office of Policy and Management, Division of Transportation, Conservation, and Development Policy and Planning, hereby makes the following grant award in accordance with CGS Sec. 4-124s and in accordance with the grant solicitation and the attached grant application, if applicable. Grantee: Capitol Region Town Code: NA Council of Government s Street State address: 241 Agency DUNS No. (if applicable): NA Main Street Code: NA 4th Floor City: ZIP Code: State: CT FEIN (required): 06-0845880 Hartford 06106 OPM Grant Grant Program Name: Regional Performance Incentive Grant Program No.: RPI 16-1 Project Title: Next Steps in Engaging Anchor Institutions and Neighborhoods in Transit-Oriented Development (TOD) Date of Award: Category (if applicable): NA June 24, 2016 Period of Start Date: ☒ The date Notice of Grant Award is signed by both Grantor & Grantee (whichever is later). Award: End Date: 24 months from the execution of the grant award by both grantor and grantee Amount of Federal: $ State: Interest: $ NA Award NA $200,000.00 State Match: Grantee Other: $ NA Specify: $ NA Match: $ NA Total Budget: Catalog of Federal Domestic Assistance (CFDA) Number: NA $200,000.00 Federal Grant No.: Grantee Fiscal Year: From: July 1 To: June 30 NA

My signature below, for and on behalf of the above named grantee, indicates acceptance of the above referenced award and further certifies that: 1.) I have the authority to execute this agreement on behalf of the grantee; and 2.) The grantee will comply with all attached Grant Conditions.

BY: ______Signature of Authorized Grantee Official Date Typed Name Typed Title of of Authorized Authorized Grantee Grantee Official Official

FOR THE OFFICE OF POLICY AND MANAGEMENT:

BY: ______Signature of OPM Secretary or OPM Deputy Secretary Date Benjamin Barnes, Secty. or Susan Weisselberg, Depty. Secty. OPM-NOGA-2015 rev 06/04/15

For OPM Business Use Only

AMOUNT FUND DEPT SID PROG ACCT CHART 1 CHART 2 BR YR PROJECT OPM $200,000.00 12060 20600 35457 13046 55050 NA NA 2016 OPM00000000 1111 OPM-NOGA-2015 rev 06/04/15 STATE OF CONNECTICUT | OFFICE OF POLICY AND MANAGEMENT Division of Transportation, Conservation, and Development Policy and Planning 450 Capitol Avenue | MS# 54ORG | Hartford, CT 06106-1379 NOTICE OF GRANT AWARD

The Office of Policy and Management, Division of Transportation, Conservation, and Development Policy and Planning, hereby makes the following grant award in accordance with CGS Sec. 4-124s and in accordance with the grant solicitation and the attached grant application, if applicable. Grantee: Lower CT River Valley Town Code: NA Council of Government s Street State address: 145 Agency DUNS No. (if applicable): NA Dennison Code: NA Road ZIP Code: City: Essex State: CT FEIN (required): 45-5533305 06426 OPM Grant Grant Program Name: Regional Performance Incentive Grant Program No.: RPI 16-2 Project Title: Development of a Regional Wetlands Data Set Date of Award: Category (if applicable): NA June 24, 2016 Period of Start Date: ☒ The date Notice of Grant Award is signed by both Grantor & Grantee (whichever is later). Award: End Date: 42 months from the execution of the grant award by both grantor and grantee Amount of Federal: $ State: Interest: $ NA Award NA $95,000.00 State Match: Grantee Other: $ NA Specify: $ NA Match: $ NA Total Budget: Catalog of Federal Domestic Assistance (CFDA) Number: NA $95,000.00 Federal Grant No.: Grantee Fiscal Year: From: July 1 To: June 30 NA

The Office of Policy and Management, Division of Transportation, Conservation, and Development Policy and Planning, hereby makes the following grant award in accordance with CGS Sec. 4-124s and in accordance with the grant solicitation and the attached grant application, if applicable. Grantee: Naugatuck Valley Town Code: NA Council of Government s Street address: 49 State Leavenworth Agency DUNS No. (if applicable): NA Street 3rd Code: NA Floor #303 City: ZIP Code: State: CT FEIN (required): 47-1630360 Waterbury 06702 OPM Grant Grant Program Name: Regional Performance Incentive Grant Program No.: RPI 16-3 Project Title: Wastewater Treatment Consolidation Study Date of Award: Category (if applicable): NA June 24, 2016 Period of Start Date: ☒ The date Notice of Grant Award is signed by both Grantor & Grantee (whichever is later). Award: End Date: 26 months from the execution of the grant award by both grantor and grantee State: Amount of Federal: $ $1,350,000.0 Interest: $ NA Award NA 0 State Match: Grantee Other: $ NA Specify: $ NA Match: $ NA Total Budget: Catalog of Federal Domestic Assistance (CFDA) Number: NA $1,350,000. 00 Federal Grant No.: Grantee Fiscal Year: From: July 1 To: June 30 NA

BY: ______Signature of Authorized Grantee Official Date Typed Name Typed Title of of Authorized Authorized Grantee Grantee Official Official OPM-NOGA-2015 rev 06/04/15 FOR THE OFFICE OF POLICY AND MANAGEMENT:

BY: ______Signature of OPM Secretary or OPM Deputy Secretary Date Benjamin Barnes, Secty. or Susan Weisselberg, Depty. Secty.

AMOUNT FUND DEPT SID PROG ACCT CHART 1 CHART 2 BR YR PROJECT OPM $1,350,000.00 12060 20600 35457 13046 55050 NA NA 2015 OPM00000000 1111 OPM-NOGA-2015 rev 06/04/15 STATE OF CONNECTICUT | OFFICE OF POLICY AND MANAGEMENT Division of Transportation, Conservation, and Development Policy and Planning 450 Capitol Avenue | MS# 54ORG | Hartford, CT 06106-1379 NOTICE OF GRANT AWARD

The Office of Policy and Management, Division of Transportation, Conservation, and Development Policy and Planning, hereby makes the following grant award in accordance with CGS Sec. 4-124s and in accordance with the grant solicitation and the attached grant application, if applicable. Grantee: Northeaster n Connecticut Town Code: NA Council of Government s Street State address: 125 Agency DUNS No. (if applicable): NA Putnam Pike Code: NA City: ZIP Code: State: CT FEIN (required): 06-0850466 Dayville 06241 OPM Grant Grant Program Name: Regional Performance Incentive Grant Program No.: RPI 16-4 Project Title: Pre-Hospital Emergency Care Study, Phase II Date of Award: Category (if applicable): NA June 24, 2016 Period of Start Date: ☒ The date Notice of Grant Award is signed by both Grantor & Grantee (whichever is later). Award: End Date: 15 months from the execution of the grant award by both grantor and grantee Amount of Federal: $ State: Interest: $ NA Award NA $100,000.00 State Match: Grantee Other: $ NA Specify: $ NA Match: $ NA Total Budget: Catalog of Federal Domestic Assistance (CFDA) Number: NA $100,000.00 Federal Grant No.: Grantee Fiscal Year: From: July 1 To: June 30 NA

The Office of Policy and Management, Division of Transportation, Conservation, and Development Policy and Planning, hereby makes the following grant award in accordance with CGS Sec. 4-124s and in accordance with the grant solicitation and the attached grant application, if applicable. Grantee: Northeaster n Connecticut Town Code: NA Council of Government s Street State address: 125 Agency DUNS No. (if applicable): NA Putnam Pike Code: NA City: ZIP Code: State: CT FEIN (required): 06-0850466 Dayville 06241 OPM Grant Grant Program Name: Regional Performance Incentive Grant Program No.: RPI 16-5 Project Title: Regional Household Hazardous Waste Facility Date of Award: Category (if applicable): NA June 24, 2016 Period of Start Date: ☒ The date Notice of Grant Award is signed by both Grantor & Grantee (whichever is later). Award: End Date: 27 months from the execution of the grant award by both grantor and grantee Amount of Federal: $ State: Interest: $ NA Award NA $708,500.00 State Match: Grantee Other: $ NA Specify: $ NA Match: $ NA Total Budget: Catalog of Federal Domestic Assistance (CFDA) Number: NA $708,500.00 Federal Grant No.: Grantee Fiscal Year: From: July 1 To: June 30 NA

The Office of Policy and Management, Division of Transportation, Conservation, and Development Policy and Planning, hereby makes the following grant award in accordance with CGS Sec. 4-124s and in accordance with the grant solicitation and the attached grant application, if applicable. Grantee: Northeaster n Connecticut Town Code: NA Council of Government s Street State address: 125 Agency DUNS No. (if applicable): NA Putnam Pike Code: NA City: ZIP Code: State: CT FEIN (required): 06-0850466 Dayville 06241 OPM Grant Grant Program Name: Regional Performance Incentive Grant Program No.: RPI 16-6 Project Title: Enhanced Regional Animal Services Facility Date of Award: Category (if applicable): NA June 24, 2016 Period of Start Date: ☒ The date Notice of Grant Award is signed by both Grantor & Grantee (whichever is later). Award: End Date: 21 months from the execution of the grant award by both grantor and grantee Amount of Federal: $ State: Interest: $ NA Award NA $608,000.00 State Match: Grantee Other: $ NA Specify: $ NA Match: $ NA Total Budget: Catalog of Federal Domestic Assistance (CFDA) Number: NA $608,000.00 Federal Grant No.: Grantee Fiscal Year: From: July 1 To: June 30 NA

The Office of Policy and Management, Division of Transportation, Conservation, and Development Policy and Planning, hereby makes the following grant award in accordance with CGS Sec. 4-124s and in accordance with the grant solicitation and the attached grant application, if applicable. Grantee: Northwest Hills Council Town Code: NA of Government s Street address: 59 State Torrington Agency DUNS No. (if applicable): NA Road Suite Code: NA A-1 City: ZIP Code: State: CT FEIN (required): 38-3917142 Goshen 06756 OPM Grant Grant Program Name: Regional Performance Incentive Grant Program No.: RPI 16-7 Project Title: Rural Broadband & Mobile Enhancement: Technology and Business Model Study Date of Award: Category (if applicable): NA June 24, 2016 Period of Start Date: ☒ The date Notice of Grant Award is signed by both Grantor & Grantee (whichever is later). Award: End Date: 22 months from the execution of the grant award by both grantor and grantee Amount of Federal: $ State: Interest: $ NA Award NA $200,000.00 State Match: Grantee Other: $ NA Specify: $ NA Match: $ NA Total Budget: Catalog of Federal Domestic Assistance (CFDA) Number: NA $200,000.00 Federal Grant No.: Grantee Fiscal Year: From: July 1 To: June 30 NA

The Office of Policy and Management, Division of Transportation, Conservation, and Development Policy and Planning, hereby makes the following grant award in accordance with CGS Sec. 4-124s and in accordance with the grant solicitation and the attached grant application, if applicable. Grantee: Northwest Hills Council Town Code: NA of Government s Street address: 59 State Torrington Agency DUNS No. (if applicable): NA Road Suite Code: NA A-1 City: ZIP Code: State: CT FEIN (required): 38-3917142 Goshen 06756 OPM Grant Grant Program Name: Regional Performance Incentive Grant Program No.: RPI 16-8 Project Title: Regional Animal Shelter Facility Design and Engineering Date of Award: Category (if applicable): NA June 24, 2016 Period of Start Date: ☒ The date Notice of Grant Award is signed by both Grantor & Grantee (whichever is later). Award: End Date: 22 months from the execution of the grant award by both grantor and grantee Amount of Federal: $ State: Interest: $ NA Award NA $110,000.00 State Match: Grantee Other: $ NA Specify: $ NA Match: $ NA Total Budget: Catalog of Federal Domestic Assistance (CFDA) Number: NA $110,000.00 Federal Grant No.: Grantee Fiscal Year: From: July 1 To: June 30 NA

The Office of Policy and Management, Division of Transportation, Conservation, and Development Policy and Planning, hereby makes the following grant award in accordance with CGS Sec. 4-124s and in accordance with the grant solicitation and the attached grant application, if applicable. Grantee: Southeaster n Connecticut Town Code: NA Council of Government s Street State address: 5 Agency DUNS No. (if applicable): NA Connecticut Code: NA Avenue City: ZIP Code: State: CT FEIN (required): 06-0770236 Norwich 06360 OPM Grant Grant Program Name: Regional Performance Incentive Grant Program No.: RPI 16-11 Project Title: Development of a Community Rating System Date of Award: Category (if applicable): NA June 24, 2016 Period of Start Date: ☒ The date Notice of Grant Award is signed by both Grantor & Grantee (whichever is later). Award: End Date: 18 months from the execution of the grant award by both grantor and grantee Amount of Federal: $ State: Interest: $ NA Award NA $200,000.00 State Match: Grantee Other: $ NA Specify: $ NA Match: $ NA Total Budget: Catalog of Federal Domestic Assistance (CFDA) Number: NA $200,000.00 Federal Grant No.: Grantee Fiscal Year: From: July 1 To: June 30 NA

The Office of Policy and Management, Division of Transportation, Conservation, and Development Policy and Planning, hereby makes the following grant award in accordance with CGS Sec. 4-124s and in accordance with the grant solicitation and the attached grant application, if applicable. Grantee: Southeaster n Connecticut Town Code: NA Council of Government s Street State address: 5 Agency DUNS No. (if applicable): NA Connecticut Code: NA Avenue City: ZIP Code: State: CT FEIN (required): 06-0770236 Norwich 06360 OPM Grant Grant Program Name: Regional Performance Incentive Grant Program No.: RPI 16-12 Project Title: Study and Recommendations for Shared Services and Staff by Southeastern Connecticut Human Service Providers Date of Award: Category (if applicable): NA June 24, 2016 Period of Start Date: ☒ The date Notice of Grant Award is signed by both Grantor & Grantee (whichever is later). Award: End Date: 21 months from the execution of the grant award by both grantor and grantee Amount of Federal: $ State: Interest: $ NA Award NA $150,000.00 State Match: Grantee Other: $ NA Specify: $ NA Match: $ NA Total Budget: Catalog of Federal Domestic Assistance (CFDA) Number: NA $150,000.00 Federal Grant No.: Grantee Fiscal Year: From: July 1 To: June 30 NA

The Office of Policy and Management, Division of Transportation, Conservation, and Development Policy and Planning, hereby makes the following grant award in accordance with CGS Sec. 4-124s and in accordance with the grant solicitation and the attached grant application, if applicable. Grantee: Western Connecticut Town Code: NA Council of Government s Street State address: 1 Agency DUNS No. (if applicable): NA Riverside Code: NA Road City: Sandy ZIP Code: State: CT FEIN (required): 47-1841490 Hook 06482 OPM Grant Grant Program Name: Regional Performance Incentive Grant Program No.: RPI 16-14 Project Title: Snow Plow Routing Study and Development Date of Award: Category (if applicable): NA June 24, 2016 Period of Start Date: ☒ The date Notice of Grant Award is signed by both Grantor & Grantee (whichever is later). Award: End Date: 17 months from the execution of the grant award by both grantor and grantee Amount of Federal: $ State: Interest: $ NA Award NA $254,782.00 State Match: Grantee Other: $ NA Specify: $ NA Match: $ NA Total Budget: Catalog of Federal Domestic Assistance (CFDA) Number: NA $254,782.00 Federal Grant No.: Grantee Fiscal Year: From: July 1 To: June 30 NA

The Office of Policy and Management, Division of Transportation, Conservation, and Development Policy and Planning, hereby makes the following grant award in accordance with CGS Sec. 4-124s and in accordance with the grant solicitation and the attached grant application, if applicable. Grantee: South Central Regional Town Code: NA Council of Government s Street address: 4th State Floor West Agency DUNS No. (if applicable): NA 127 Code: NA Washington Avenue City: North ZIP Code: State: CT FEIN (required): 06-0770103 Haven 06473 OPM Grant Grant Program Name: Regional Performance Incentive Grant Program No.: RPI 16-13 Project Title: Regional Open Space Inventory Date of Award: Category (if applicable): NA June 24, 2016 Period of Start Date: ☒ The date Notice of Grant Award is signed by both Grantor & Grantee (whichever is later). Award: End Date: 21 months from the execution of the grant award by both grantor and grantee Amount of Federal: $ State: Interest: $ NA Award NA $74,228.00 State Match: Grantee Other: $ NA Specify: $ NA Match: $ NA Total Budget: Catalog of Federal Domestic Assistance (CFDA) Number: NA $74,228.00 Federal Grant No.: Grantee Fiscal Year: From: July 1 To: June 30 NA

AMOUNT FUND DEPT SID PROG ACCT CHART 1 CHART 2 BR YR PROJECT $74,228.00 12060 OPM 20600 35457 13046 55050 NA NA 2016 OPM00000000 1111