Natural Gas Distribution Infrastructure Safety and Modernization (NGDISM) Grant Program

> Download PDF file: FY 2026 NGDISM Grant Application Checklist.pdf

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> Download PDF file: FY 2026 NGDISM Grant Program NOFO.pdf

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Title VI Assurance (Required)

U.S. Department of Transportation (USDOT) 693JK326NF0013
Pipeline and Hazardous Materials Safety Administration (PHMSA) Attachment #6
_____________________________________________________________________________________
The United States Department of Transportation (USDOT)
Standard Title VI/Nondiscrimination Assurances
The ( )
(herein referred to as the “Recipient”), HEREBY AGREES THAT, as a condition to receiving any
Federal financial assistance from the U.S. Department of Transportation (DOT), through the Pipeline
and Hazardous Materials Safety Administration (PHMSA), the Recipient is subject to, and will
comply with, the following:
Statutory/Regulatory Authorities
• Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et seq., 78 stat. 252), (prohibits
discrimination on the basis of race, color, national origin);
• 49 CFR Part 21 (entitled Nondiscrimination in Federally-Assisted Programs of the
Department of Transportation—Effectuation of Title VI of The Civil Rights Act of
1964);
• 28 CFR § 50.3 (U.S. Department of Justice Guidelines for Enforcement of Title VI of
the Civil Rights Act of 1964);
• Section 504 of the Rehabilitation Act of 1973, (29 U.S.C. § 794 et seq.), as amended,
(prohibits discrimination on the basis of disability); and 49 CFR Part 27;
• The Age Discrimination Act of 1975, as amended, (42 U.S.C. § 6101 et seq.), (prohibits
discrimination on the basis of age);
• The Civil Rights Restoration Act of 1987, (PL 100-209), (Broadened the scope,
coverage and applicability of Title VI of the Civil Rights Act of 1964, The Age
Discrimination Act of 1975 and Section 504 of the Rehabilitation Act of 1973, by
expanding the definition of the terms “programs or activities” to include all of the
programs or activities of the Federal-aid recipients, sub-recipients and contractors,
whether such programs or activities are Federally funded or not);
• Titles II and III of the Americans with Disabilities Act, which prohibit discrimination
on the basis of disability in the operation of public entities, public and private
transportation systems, places of public accommodation, and certain testing entities
(42 U.S.C. §§ 12131–12189) as implemented by Department of Transportation
regulations at 49 C.F.R. parts 37 and 38;
• Title IX of the Education Amendments of 1972, as amended, which prohibits you from
discriminating because of sex in education programs or activities (20 U.S.C. 681 et seq).
The preceding statutory and regulatory cites hereinafter are referred to as the “Acts” and
“Regulations,” respectively.
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U.S. Department of Transportation (USDOT) 693JK326NF0013
Pipeline and Hazardous Materials Safety Administration (PHMSA) Attachment #6
_____________________________________________________________________________________
General Assurances
In accordance with the Acts, the Regulations, and other pertinent directives, circulars, policy,
memoranda, and/or guidance, the Recipient hereby gives assurance that it will promptly take
any measures necessary to ensure that:
“No person in the United States shall, on the grounds of race, color, national origin,
gender, age, or disability be excluded from participation in, be denied the benefits of, or
be otherwise subjected to discrimination under any program or activity,” for which the
Recipient receives Federal financial assistance from DOT, including PHMSA.
The Civil Rights Restoration Act of 1987 clarified the original intent of Congress, with respect
to Title VI and other Nondiscrimination requirements (The Age Discrimination Act of 1975,
and Section 504 of the Rehabilitation Act of 1973), by restoring the broad, institutional-wide
scope and coverage of these nondiscrimination statutes and requirements to include all
programs and activities of the Recipient, so long as any portion of the program is Federally
assisted.
Specific Assurances
More specifically, and without limiting the above General Assurance, the Recipient agrees with and
gives the following Assurances with respect to its Federally assisted PHMSA Natural Gas Distribution
Infrastructure Safety and Modernization (NGDISM) Grant:
Please note: You DO NOT need to complete Appendices B, C, or D unless your grant project
involves acquisition, improvement, or transfer of real property, land, or facilities with federal
funds. If your project includes real property or facility construction, improvement, or transfer
(including deeds, leases, or permits), please contact us for additional guidance.
1. The Recipient agrees that each “activity,” “facility,” or “program,” as defined in §§
21.23 (b) and 21.23 (e) of 49 CFR § 21 will be (with regard to an “activity”)
facilitated, or will be (with regard to a “facility”) operated, or will be (with regard to a
“program”) conducted in compliance with all requirements imposed by, or pursuant
to the Acts and the Regulations.
2. The Recipient will insert the following notification in all solicitations for bids,
Requests for Proposals for work, or material subject to the Acts and the Regulations
made in connection with all PHMSA NGDISM Grant and, in adapted form, in all
proposals for negotiated agreements regardless of funding source:
“The Recipient, in accordance with the provisions of Title VI of the Civil Rights Act
of 1964 (78 Stat. 252, 42 U.S.C. §§ 2000d to 2000d-4) and the Regulations, hereby
notifies all bidders that it will affirmatively ensure that with respect to any contract
entered into pursuant to this advertisement, disadvantaged business enterprises will
be afforded full and fair opportunity to submit bids in response to this invitation and
will not be discriminated against on the grounds of race, color, or national origin in
consideration for an award.”
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U.S. Department of Transportation (USDOT) 693JK326NF0013
Pipeline and Hazardous Materials Safety Administration (PHMSA) Attachment #6
_____________________________________________________________________________________
3. The Recipient will insert the clauses of Appendix A and E of this Assurance in every
contract or agreement subject to the Acts and the Regulations.
4. The Recipient will insert the clauses of Appendix B of this Assurance, as a covenant running
with the land, in any deed from the United States effecting or recording a transfer of real
property, structures, use, or improvements thereon or interest therein to a Recipient.
5. That where the Recipient receives Federal financial assistance to construct a facility,
or part of a facility, the Assurance will extend to the entire facility and facilities
operated in connection therewith.
6. That where the Recipient receives Federal financial assistance in the form, or for the
acquisition of real property or an interest in real property, the Assurance will extend
to rights to space on, over, or under such property.
7. That the Recipient will include the clauses set forth in Appendix C and Appendix D
of this Assurance, as a covenant running with the land, in any future deeds, leases,
licenses, permits, or similar instruments entered into by the Recipient with other
parties:
a. for the subsequent transfer of real property acquired or improved under the
applicable activity, project, or program; and,
b. for the construction or use of, or access to, space on, over, or under real
property acquired or improved under the applicable activity, project, or
program.
8. That this Assurance obligates the Recipient for the period during which Federal
financial assistance is extended to the program, except where the Federal financial
assistance is to provide, or is in the form of, personal property, or real property, or
interest therein, or structures or improvements thereon, in which case the Assurance
obligates the Recipient, or any transferee for the longer of the following periods:
a. the period during which the property is used for a purpose for which the
Federal financial assistance is extended, or for another purpose involving
the provision of similar services or benefits; or
b. the period during which the Recipient retains ownership or possession of
the property.
9. The Recipient will provide for such methods of administration for the program as are
found by the Secretary of Transportation or the official to whom he/she delegates
specific authority to give reasonable guarantee that it, other recipients, sub-recipients,
sub-grantees, contractors, subcontractors, consultants, transferees, successors in
interest, and other participants of Federal financial assistance under such program will
comply with all requirements imposed or pursuant to the Acts, the Regulations, and
this Assurance.
10. The Recipient agrees that the United States has a right to seek judicial enforcement
with regard to any matter arising under the Acts, the Regulations, and this Assurance.
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U.S. Department of Transportation (USDOT) 693JK326NF0013
Pipeline and Hazardous Materials Safety Administration (PHMSA) Attachment #6
_____________________________________________________________________________________
By signing this ASSURANCE, the Recipient also agrees to comply (and require any sub-recipients, sub-
grantees, contractors, successors, transferees, and/or assignees to comply) with all applicable provisions
governing the PHMSA access to records, accounts, documents, information, facilities, and staff. You
also recognize that you must comply with any program or compliance reviews, and/or complaint
investigations conducted by PHMSA. You must keep records, reports, and submit the material for
review upon request to PHMSA, or its designee in a timely, complete, and accurate way. Additionally,
you must comply with all other reporting, data collection, and evaluation requirements, as prescribed by
law or detailed in program guidance.
The Recipient gives this ASSURANCE in consideration of and for obtaining any Federal grants, loans,
contracts, agreements, property, and/or discounts, or other Federal-aid and Federal financial assistance
extended after the date hereof to the recipients by the U.S. Department of Transportation under the
PHMSA NGDISM Grant. This ASSURANCE is binding on the Recipient, other recipients, sub-
recipients, sub-grantees, contractors, subcontractors and their subcontractors’, transferees, successors in
interest, and any other participants in the PHMSA NGDISM Grant. The person(s) signing below is
authorized to sign this ASSURANCE on behalf of the Recipient.
(Name of Recipient)
__________________________________________________
(Signature of Authorized Official)
DATED
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U.S. Department of Transportation (USDOT) 693JK326NF0013
Pipeline and Hazardous Materials Safety Administration (PHMSA) Attachment #6
_____________________________________________________________________________________
APPENDIX A
During the performance of this contract, the contractor, for itself, its assignees, and
successors in interest (hereinafter referred to as the “contractor”) agrees as follows:
1. Compliance with Regulations: The contractor (hereinafter includes consultants) will
comply with the Acts and the Regulations relative to Nondiscrimination in Federally-
assisted programs of the U.S. Department of Transportation, PHMSA, as they may be
amended from time to time, which are herein incorporated by reference and made a part
of this contract.
2. Nondiscrimination: The contractor, with regard to the work performed by it during the
contract, will not discriminate on the grounds of race, color, or national origin in the
selection and retention of subcontractors, including procurements of materials and leases
of equipment. The contractor will not participate directly or indirectly in the
discrimination prohibited by the Acts and the Regulations, including employment
practices when the contract covers any activity, project, or program set forth in
Appendix B of 49 CFR Part 21.
3. Solicitations for Subcontracts, Including Procurements of Materials and
Equipment: In all solicitations, either by competitive bidding, or negotiation made by
the contractor for work to be performed under a subcontract, including procurements of
materials, or leases of equipment, each potential subcontractor or supplier will be
notified by the contractor of the contractor’s obligations under this contract and the Acts
and the Regulations relative to Nondiscrimination on the grounds of race, color, or
national origin.
4. Information and Reports: The contractor will provide all information and reports
required by the Acts, the Regulations, and directives issued pursuant thereto and will
permit access to its books, records, accounts, other sources of information, and its
facilities as may be determined by the Recipient or PHMSA to be pertinent to ascertain
compliance with such Acts, Regulations, and instructions. Where any information
required of a contractor is in the exclusive possession of another who fails or refuses to
furnish the information, the contractor will so certify to the Recipient or PHMSA, as
appropriate, and will set forth what efforts it has made to obtain the information.
5. Sanctions for Noncompliance: In the event of a contractor’s noncompliance with the
Nondiscrimination provisions of this contract, the Recipient will impose such contract
sanctions as it or PHMSA may determine to be appropriate, including, but not limited to:
a. withholding payments to the contractor under the contract until the
contractor complies; and/or,
b. cancelling, terminating, or suspending a contract, in whole or in part.
6. Incorporation of Provisions: The contractor will include the provisions of paragraphs
one through six in every subcontract, including procurements of materials and leases of
equipment, unless exempt by the Acts, the Regulations and directives issued pursuant
thereto. The contractor will take action with respect to any subcontract or procurement
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U.S. Department of Transportation (USDOT) 693JK326NF0013
Pipeline and Hazardous Materials Safety Administration (PHMSA) Attachment #6
_____________________________________________________________________________________
as the Recipient or PHMSA may direct as a means of enforcing such provisions
including sanctions for noncompliance.
Provided, that if the contractor becomes involved in, or is threatened with litigation by a
subcontractor, or supplier because of such direction, the contractor may request the Recipient to enter
into any litigation to protect the interests of the Recipient. In addition, the contractor may request the
United States to enter into the litigation to protect the interests of the United States.
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U.S. Department of Transportation (USDOT) 693JK326NF0013
Pipeline and Hazardous Materials Safety Administration (PHMSA) Attachment #6
_____________________________________________________________________________________
APPENDIX B CLAUSES FOR DEEDS TRANSFERRING UNITED STATES PROPERTY
The following clauses will be included in deeds effecting or recording the transfer of real property,
structures, or improvements thereon, or granting interest therein from the United States pursuant to the
provisions of Assurance 4:
NOW, THEREFORE, the U.S. Department of Transportation as authorized by law and upon
the condition that the Recipient will accept title to the lands and maintain the project
constructed thereon in accordance with the Infrastructure Investment and Jobs Act (IIJA) (Pub.
L. 117-58)), the Regulations for the Administration of Natural Gas Distribution
Infrastructure Safety and Modernization (NGDISM) Grant Program, and the policies and
procedures prescribed by PHMSA of the U.S. Department of Transportation in accordance and
in compliance with all requirements imposed by Title 49, Code of Federal Regulations, U.S.
Department of Transportation, Subtitle A, Office of the Secretary, Part 21, Nondiscrimination
in Federally-assisted programs of the U.S Department of Transportation pertaining to and
effectuating the provisions of Title VI of the Civil Rights Act of 1964 (78 Stat. 252; 42 U.S.C.
§ 2000d to 2000d-4), does hereby remise, release, quitclaim and convey unto the Recipient all
the right, title and interest of the U.S. Department of Transportation in and to said lands
described in Exhibit A attached hereto and made a part hereof.
(HABENDUM CLAUSE)
TO HAVE AND TO HOLD said lands and interests therein unto the Recipient and its
successors forever, subject, however, to the covenants, conditions, restrictions and
reservations herein contained as follows, which will remain in effect for the period during
which the real property or structures are used for a purpose for which Federal financial
assistance is extended or for another purpose involving the provision of similar services or
benefits and will be binding on the Recipient, its successors and assigns.
The Recipient, in consideration of the conveyance of said lands and interests in lands, does
hereby covenant and agree as a covenant running with the land for itself, its successors and
assigns, that (1) no person will on the grounds of race, color, or national origin, be excluded
from participation in, be denied the benefits of, or be otherwise subjected to discrimination
with regard to any facility located wholly or in part on, over, or under such lands hereby
conveyed [,] [and]* (2) that the Recipient will use the lands and interests in lands and
interests in lands so conveyed, in compliance with all requirements imposed by or pursuant to
Title 49, Code of Federal Regulations, U.S. Department of Transportation, Subtitle A, Office
of the Secretary, Part 21, Nondiscrimination in Federally-assisted programs of the U.S.
Department of Transportation, Effectuation of Title VI of the Civil Rights Act of 1964, and as
said Regulations and Acts may be amended[, and (3) that in the event of breach of any of the
above-mentioned nondiscrimination conditions, the Department will have a right to enter or
re-enter said lands and facilities on said land, and that above described land and facilities will
thereon revert to and vest in and become the absolute property of the U.S. Department of
Transportation and its assigns as such interest existed prior to this instruction].*
(*Reverter clause and related language to be used only when it is determined that such a clause is
necessary in order to make clear the purpose of Title VI.)
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U.S. Department of Transportation (USDOT) 693JK326NF0013
Pipeline and Hazardous Materials Safety Administration (PHMSA) Attachment #6
_____________________________________________________________________________________
APPENDIX C CLAUSES FOR TRANSFER OF REAL PROPERTY ACQUIRED OR
IMPROVED UNDER THE ACTIVITY, FACILITY, OR PROGRAM
The following clauses will be included in deeds, licenses, leases, permits, or similar instruments
entered into by the Recipient pursuant to the provisions of Assurance 7(a):
A. The (grantee, lessee, permittee, etc. as appropriate) for himself/herself, his/her heirs,
personal representatives, successors in interest, and assigns, as a part of the consideration
hereof, does hereby covenant and agree [in the case of deeds and leases add “as a
covenant running with the land”] that:
1. In the event facilities are constructed, maintained, or otherwise operated on the
property described in this (deed, license, lease, permit, etc.) for a purpose for which
a U.S. Department of Transportation activity, facility, or program is extended or for
another purpose involving the provision of similar services or benefits, the (grantee,
licensee, lessee, permittee, etc.) will maintain and operate such facilities and
services in compliance with all requirements imposed by the Acts and Regulations
(as may be amended) such that no person on the grounds of race, color, or national
origin, will be excluded from participation in, denied the benefits of, or be
otherwise subjected to discrimination in the use of said facilities.
B. With respect to licenses, leases, permits, etc., in the event of breach of any of the above
Nondiscrimination covenants, the Recipient will have the right to terminate the (lease,
license, permit, etc.) and to enter, re-enter, and repossess said lands and facilities thereon,
and hold the same as if the (lease, license, permit, etc.) had never been made or issued.*
C. With respect to a deed, in the event of breach of any of the above Nondiscrimination
covenants, the Recipient will have the right to enter or re-enter the lands and facilities
thereon, and the above described lands and facilities will there upon revert to and vest in
and become the absolute property of the Recipient and its assigns.*
(*Reverter clause and related language to be used only when it is determined that such a clause
is necessary to make clear the purpose of Title VI.
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U.S. Department of Transportation (USDOT) 693JK326NF0013
Pipeline and Hazardous Materials Safety Administration (PHMSA) Attachment #6
_____________________________________________________________________________________
APPENDIX D CLAUSES FOR CONSTRUCTION/USE/ACCESS TO REAL PROPERTY
ACQUIRED UNDER THE ACTIVITY, FACILITY OR PROGRAM
The following clauses will be included in deeds, licenses, permits, or similar instruments/agreements
entered into by the Recipient pursuant to the provisions of Assurance 7(b):
A. The (grantee, licensee, permittee, etc., as appropriate) for himself/herself, his/her heirs,
personal representatives, successors in interest, and assigns, as a part of the consideration
hereof, does hereby covenant and agree (in the case of deeds and leases add, “as a
covenant running with the land”) that (1) no person on the ground of race, color, or
national origin, will be excluded from participation in, denied the benefits of, or be
otherwise subjected to discrimination in the use of said facilities, (2) that in the
construction of any improvements on, over, or under such land, and the furnishing of
services thereon, no person on the ground of race, color, or national origin, will be
excluded from participation in, denied the benefits of, or otherwise be subjected to
discrimination, (3) that the (grantee, licensee, lessee, permittee, etc.) will use the premises
in compliance with all other requirements imposed by or pursuant to the Acts and
Regulations, as amended, set forth in this Assurance.
B. With respect to (licenses, leases, permits, etc.), in the event of breach of any of the above
Nondiscrimination covenants, the Recipient will have the right to terminate the (license,
permit, etc., as appropriate) and to enter or re-enter and repossess said land and the
facilities thereon, and hold the same as if said (license, permit, etc., as appropriate) had
never been made or issued.*
C. With respect to deeds, in the event of breach of any of the above Nondiscrimination
covenants, the Recipient will there upon revert to and vest in and become the absolute
property of the Recipient and its assigns.*
(*Reverter clause and related language to be used only when it is determined that such a clause is
necessary to make clear the purpose of Title VI.)
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U.S. Department of Transportation (USDOT) 693JK326NF0013
Pipeline and Hazardous Materials Safety Administration (PHMSA) Attachment #6
_____________________________________________________________________________________
APPENDIX E
During the performance of this contract, the contractor, for itself, its assignees, and successors in
interest (hereinafter referred to as the “contractor”) agrees to comply with the following non-
discrimination statutes and authorities; including but not limited to:
Pertinent Nondiscrimination Authorities:
• Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et seq., 78 stat. 252),
(prohibits discrimination on the basis of race, color, national origin); and 49 CFR Part
21.
• The Uniform Relocation Assistance and Real Property Acquisition Policies Act of
1970, (42 U.S.C. § 4601), (prohibits unfair treatment of persons displaced or whose
property has been acquired because of Federal or Federal-aid programs and projects);
• Federal-Aid Highway Act of 1973, (23 U.S.C. § 324 et seq.), (prohibits discrimination
on the basis of sex);
• Section 504 of the Rehabilitation Act of 1973, (29 U.S.C. § 794 et seq.), as amended, (prohibits
discrimination on the basis of disability); and 49 CFR Part 27;
• The Age Discrimination Act of 1975, as amended, (42 U.S.C. § 6101 et seq.), (prohibits
discrimination on the basis of age);
• Airport and Airway Improvement Act of 1982, (49 U.S.C. § 471, Section 47123), as
amended, (prohibits discrimination based on race, creed, color, national origin, or sex);
• The Civil Rights Restoration Act of 1987, (PL 100-209), (Broadened the scope,
coverage and applicability of Title VI of the Civil Rights Act of 1964, The Age
Discrimination Act of 1975 and Section 504 of the Rehabilitation Act of 1973, by
expanding the definition of the terms “programs or activities” to include all of the
programs or activities of the Federal-aid recipients, sub-recipients and contractors,
whether such programs or activities are Federally funded or not);
• Titles II and III of the Americans with Disabilities Act, which prohibit discrimination
on the basis of disability in the operation of public entities, public and private
transportation systems, places of public accommodation, and certain testing entities (42
U.S.C. §§ 12131 – 12189) as implemented by Department of Transportation regulations
at 49 CFR parts 37 and 38;
• The Federal Aviation Administration’s Nondiscrimination statute (49 U.S.C. § 47123)
(prohibits discrimination on the basis of race, color, national origin, and sex);
• Executive Order 14173, Ending Illegal Discrimination and Restoring Merit-Based
Opportunity, which ensures the end of illegal preferences and discrimination.
• Title IX of the Education Amendments of 1972, as amended, which prohibits you from
discriminating because of sex in education programs or activities (20 U.S.C. 1681 et
seq).
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