Item 3.5 Accepting Grant and Approve a Grant Agreement Drinking Water Protection
Request for
City Council Action
DEPARTMENT INFORMATION
ORIGINATING DEPARTMENT REQUESTOR: MEETING DATE:
Utilities Utility Manager Neidermeier April 27, 2026
PRESENTER(s) REVIEWED BY: ITEM #:
Consent City Administrator/Finance Director Flaherty 3.5 – Grant Agreement
STRATEGIC VISION
MEETS: THE CITY OF OTSEGO:
Is a strong organization that is committed to leading the community through innovative communication.
X Has proactively expanded infrastructure to responsibly provide core services.
Is committed to delivery of quality emergency service responsive to community needs and expectations in a
cost-effective manner.
Is a social community with diverse housing, service options, and employment opportunities.
Is a distinctive, connected community known for its beauty and natural surroundings.
AGENDA ITEM DETAILS
RECOMMENDATION:
City staff recommend the City Council accept a grant and approve a grant agreement.
ARE YOU SEEKING APPROVAL OF A CONTRACT? IS A PUBLIC HEARING REQUIRED?
Yes No
BACKGROUND/JUSTIFICATION:
Utility staff applied for a Minnesota Department of Health, Source Water Protection; Implementation Grant Program
to locate a water source as an action item within the City’s Wellhead Protection Plan. The City received sufficient
points to qualify and be awarded maximum funding amount of $15,000.00 supporting a test well drilling in 2026, with
completion before February 26, 2027, in accordance with the grant agreement.
The Grant Agreement has been reviewed by City staff and the City Attorney, providing recommendation of
consideration of acceptance.
SUPPORTING DOCUMENTS ATTACHED:
• Grant Agreement
POSSIBLE MOTION
PLEASE WORD MOTION AS YOU WOULD LIKE IT TO APPEAR IN THE MINUTES:
Motion to accept a Drinking Water Protection grant in the amount of $15,000, and to approve a Grant Agreement
between the City of Otsego and the State of Minnesota Department of Health.
BUDGET INFORMATION
FUNDING: BUDGETED:
Fund 601 – Drinking Water Utility
Yes
Standard Grant Template - Version Nov 2025
SWIFT Contract Number 284162
Between MDH and City of Otsego
REQ: 4026 Page 1 of 19
Minnesota Department of Health
Grant Agreement Cover Sheet
You have received a Grant Agreement from the Minnesota Department of Health (MDH). Information
about the Grant Agreement, including funding details, are included below. Contact your MDH Grant
Manager if you have questions about this cover sheet.
Attachment: Grant Agreement
Contact for MDH: Eddie Wojski, 651-201-4576, eddie.wojski@state.mn.us
Grantee SWIFT Information Grant Agreement Information Program & Funding Information
Name of MDH Grantee
(as it appears in SWIFT):
City of Otsego
SWIFT Contract Number:
284162
MDH Program Name:
Drinking Water Protection
SWIFT Vendor Number:
0000200937
SWIFT Vendor Location Code:
001
Effective Date:
February 27, 2026, OR the date all
signatures are collected, and the
agreement is fully executed, whichever
is later.
Expiration Date:
February 26, 2027
Total State Grant Funds: $15,000.00
Total Federal Grant Funds: $0
Total Grant Funds (all funds):
$15,000.00
Docusign Envelope ID: BF9E6588-429C-49CF-99B1-B454BED552DD
Standard Grant Template - Version Nov 2025
SWIFT Contract Number 284162
Between MDH and City of Otsego
REQ: 4026 Page 2 of 19
Minnesota Department of Health
Grant Agreement
This Grant Agreement is between the State of Minnesota, acting through its Commissioner of the
Department of Health (“MDH”) and City of Otsego (“Grantee”). Grantee’s address is 13400 90th Street
NE, Otsego, MN 55330.
Recitals
1. MDH is empowered to enter into this Grant Agreement under Minn. Stat. §§ 144.05, 144.0742 and
§114D.50 Clean Water Fund.
2. MDH is in need of assisting public water suppliers to protect the source of drinking water.
3. The vision of MDH is for health equity in Minnesota, where all communities are thriving and all
people have what they need to be healthy. Health equity is achieved when every person has the
opportunity to attain their health potential. Grantee agrees, where applicable, to perform its work
with advancing health equity as a goal.
4. Grantee represents that it is duly qualified and will perform all the activities according to the terms
of this Grant Agreement.
Grant Agreement
1. Term of Agreement
1.1. Effective Date
February 27, 2026, or the date MDH obtains all required signatures under Minn. Stat.
§ 16B.98, subd. 5, whichever is later. Per Minn. Stat. § 16B.98, subd 7, no payments will be
made to the Grantee until this Grant Agreement is fully executed. Grantee must not begin
work until this Grant Agreement is fully executed and MDH’s Authorized Representative has
notified Grantee that work may commence. No costs may be incurred prior to the Grant
Agreement being fully executed.
1.2. Expiration Date
February 26, 2027, or until all obligations have been fulfilled to the satisfaction of MDH,
whichever occurs first.
1.3. Survival of Terms
The following clauses survive the expiration or cancellation of this Grant Agreement:
Liability; Financial Examinations; Government Data Practices; Tax Compliance Verification;
Docusign Envelope ID: BF9E6588-429C-49CF-99B1-B454BED552DD
Standard Grant Template - Version Nov 2025
SWIFT Contract Number 284162
Between MDH and City of Otsego
REQ: 4026 Page 3 of 19
Ownership of Equipment and Supplies; Intellectual Property; Publicity and Endorsement;
and Governing Law, Jurisdiction, and Venue.
2. Activities
2.1. MDH’s Activities
MDH activities, in accordance with the Minnesota Department of Administration's Office of
Grants Management's policies and federal regulations, may include but are not limited to
financial reconciliations, site visits, programmatic monitoring of activities performed, and
grant activity evaluation.
2.2. Grantee’s Activities
Grantee, who is not a state employee, shall conduct the activities specified in Exhibit A,
which is attached and incorporated into this Grant Agreement.
3. Time
Grantee is required to perform all of the activities stated in this Grant Agreement, and any
incorporated exhibits, within the Grant Agreement period. MDH is not obligated to extend the
Grant Agreement period. Failure to meet a deadline may be a basis for a determination by MDH’s
Authorized Representative that Grantee has not complied with the terms of the Grant Agreement.
4. Award and Payment
MDH will award funds to Grantee for all activities performed in accordance with this Grant
Agreement.
4.1. Grant Award
Reimbursement will be in accordance with the agreed upon budget contained in Exhibit B,
which is attached and incorporated into this Grant Agreement.
4.2. Administrative Costs.
Grantee agrees that administrative costs must be necessary and reasonable as a condition
of this Grant Agreement pursuant to Minn. Stat. § 16B.98, subd 1. Administrative costs will
be reimbursed in accordance with the agreed upon budget.
4.3. Travel Expenses
Grantee will be reimbursed for mileage at the current IRS rate in effect at the time the
travel occurred; meals and lodging expenses will be reimbursed in the same manner and in
no greater amount than provided in the current “Commissioner’s Plan” promulgated by the
Commissioner of Minnesota Management and Budget (“MMB”); or, at the Grantee’s
established rate (for all travel related costs), whichever is lower, at the time travel occurred.
Grantee will not be reimbursed for travel and subsistence expenses incurred outside
Minnesota unless Grantee has received MDH’s prior written approval for out-of-state
travel. Minnesota will be considered the home state for determining whether travel is out-
of-state.
4.4. Budget Modifications
Docusign Envelope ID: BF9E6588-429C-49CF-99B1-B454BED552DD
Standard Grant Template - Version Nov 2025
SWIFT Contract Number 284162
Between MDH and City of Otsego
REQ: 4026 Page 4 of 19
Grantee may modify any line item in the most recently agreed-upon budget by up to 10
percent without prior written approval from MDH. Grantee must notify MDH of any
modifications up to 10 percent in writing no later than the next invoice. Grantee must
obtain prior written approval from MDH for line-item modifications greater than 10
percent. Grantee’s failure to obtain MDH’s prior approval may result in denial of
modification request, loss of funds, or both. The total obligation of MDH for all
compensation and reimbursements to Grantee shall not exceed the total obligation listed
under “Total Obligation.”
4.5. Total Obligation
The total obligation of MDH for all compensation and reimbursements to Grantee under
this Grant Agreement will not exceed $15,000.00.
4.6. Terms of Payment
4.6.1. Invoices
MDH will promptly pay Grantee after Grantee presents an itemized invoice for the
activities actually performed and MDH’s Authorized Representative accepts the invoiced
activities. Invoices must be submitted at least quarterly or according to a schedule
agreed upon by the Parties. The final invoice is due 30 calendar days after the expiration
date of the Grant Agreement.
4.7. Contracting and Bidding Requirements
4.7.1. Municipalities
A grantee that is a municipality, as defined in Minn. Stat. § 471.345, subd. 1, is subject to
the contracting requirements set forth under Minn. Stat. § 471.345. Projects that
involve construction work are subject to the applicable prevailing wage laws, including
those under Minn. Stat. § 177.41, et. seq.
4.7.2. Non-municipalities
Grantees that are not municipalities must adhere to the following standards in the
event that activities assigned to Grantee are to be subcontracted out to a third party:
i. Any services or materials that are expected to cost $100,000 or more must
undergo a formal notice and bidding process.
ii. Services or materials that are expected to cost between $25,000 and $99,999 must
be competitively awarded based on a minimum of three verbal quotes or bids or
awarded to a targeted vendor.
iii. Services or materials that are expected to cost between $10,000 and $24,999 must
be competitively awarded based on a minimum of two verbal quotes or bids or
awarded to a targeted vendor.
iv. Grantee must take all necessary affirmative steps to assure that targeted vendors
from businesses with active certifications through the following entities are used
when possible:
1) Minnesota Department of Administration’s Certified Targeted Group,
Economically Disadvantaged and Veteran-Owned Vendor List
Docusign Envelope ID: BF9E6588-429C-49CF-99B1-B454BED552DD
Standard Grant Template - Version Nov 2025
SWIFT Contract Number 284162
Between MDH and City of Otsego
REQ: 4026 Page 5 of 19
(https://mn.gov/admin/osp/government/procuregoodsandgeneralservices/tge
dvo-directory/);
2) Metropolitan Council’s Targeted Vendor list: Minnesota Unified Certification
Program (https://mnucp.metc.state.mn.us/); or
3) Small Business Certification Program through Hennepin County, Ramsey
County, and City of St. Paul: Central Certification Program
(https://cert.smwbe.com/).
v. Grantee must maintain written standards of conduct covering conflicts of interest
and governing the actions of its employees engaged in the selection, awarding and
administration of contracts.
vi. Grantee must maintain support documentation of the purchasing or bidding
process utilized to contract services in their financial records, including support
documentation justifying a single/sole source bid, if applicable.
vii. Notwithstanding parts (i) through (iv) above, MDH may waive the formal bidding
process requirements when:
• Vendors included in response to a competitive grant request for proposal
process were approved and incorporated as an approved work plan for the
Grant Agreement or
• There is only one legitimate or practical source for such materials or services
and Grantee has established that the vendor is charging a fair and reasonable
price.
viii. Projects that involve construction work of $25,000 or more, are subject to
applicable prevailing wage laws, including those under Minn. Stat. §§ 177.41
through 177.50.
ix. Grantee must not contract with vendors who are suspended or debarred by the
State of Minnesota or the federal government. The list of debarred vendors in
Minnesota is available at: Suspended/Debarred Vendors
(https://mn.gov/admin/osp/government/suspended-debarred/). The list of
suspended and debarred entities by the federal government is available at
www.sam.gov.
5. Conditions of Payment
All activities performed by Grantee pursuant to this Grant Agreement must be performed in
accordance with the terms of this Grant Agreement, as determined in the sole discretion of MDH’s
Authorized Representative. Furthermore, all activities performed by Grantee must be in
accordance with all applicable federal, state, and local laws, ordinances, rules, and regulations.
Applicable state laws include, but are not limited to, the Minnesota Human Rights Act (Minn. Stat.
ch. 363A) which prohibits discrimination on the basis of race, color, creed, religion, national origin,
sex, gender, identity, sexual orientation, age, marital status, public assistance status, familial status,
and disability. MDH will not pay Grantee for work that MDH determines is noncompliant with the
terms and conditions of this Grant Agreement or performed in violation of federal, state, or local
law, ordinance, rule, or regulation.
6. Requirements for Other Legal Agreements
Docusign Envelope ID: BF9E6588-429C-49CF-99B1-B454BED552DD
Standard Grant Template - Version Nov 2025
SWIFT Contract Number 284162
Between MDH and City of Otsego
REQ: 4026 Page 6 of 19
6.1. Grantee must utilize a formal legal agreement if it engages with another party to carry out a
portion of the activities listed in this Grant Agreement. Grantee must provide timely notice
to MDH of any such agreement prior to the other party/ies performing work under this
Grant Agreement. Such notice must include the name of the other party; description of the
activities to be performed; dates activities will be performed; and the total budget.
6.2. Grantee must monitor the activities of the other party/ies to ensure funds are used for
authorized purposes; is in compliance with the terms and conditions of the legal agreement,
Minn. Stat. § 16B.97, subd. 4(a)(1), and other relevant statutes and regulations; and that
performance goals are achieved.
6.3. If MDH becomes aware of unsatisfactory performance and or noncompliance, MDH
reserves the right to require Grantee to terminate the legal agreement with the other party.
6.4. No legal agreement with any other party shall terminate or in any way affect the legal
responsibility of the Grantee to MDH for timely and satisfactory performance of the Grant
Agreement.
6.5. Grantee and the other party must not enter into a legal agreement with vendors who are
suspended or debarred by the State of Minnesota or the federal government. The list of
debarred vendors in Minnesota is available at: Suspended/Debarred Vendors
(https://mn.gov/admin/osp/government/suspended-debarred/). The list of suspended and
debarred entities by the federal government is available at www.sam.gov.
7. Authorized Representatives
7.1. MDH’s Authorized Representative
MDH’s Authorized Representative for purposes of administering this Grant Agreement is
Eddie Wojski, SWP Grant Coordinator, 625 Robert Street N., PO Box 64975, St. Paul, MN
55164-0975, 651-201-4576, and eddie.wojski@state.mn.us, or their successor, and has the
responsibility to monitor Grantee’s performance and the final authority to accept the
activities performed under this Grant Agreement. If the activities performed are
satisfactory, MDH’s Authorized Representative will certify acceptance on each invoice
submitted for payment.
7.2. Grantee’s Authorized Representative
Grantee’s Authorized Representative is Kurt Neidermeier, Utilities Manager, 13400 90th
Street NE, Otsego, MN 55330, 763-235-3165, and kneidermeier@otsegomn.gov, or their
successor. Grantee’s Authorized Representative has full authority to represent Grantee in
fulfillment of the terms, conditions, and requirements of this Grant Agreement. If Grantee
selects a new Authorized Representative at any time during this Grant Agreement, Grantee
must immediately notify MDH’s Authorized Representative in writing, via e-mail or letter.
8. Assignment, Amendments, Waiver, and Grant Agreement Complete
8.1. Assignment
Docusign Envelope ID: BF9E6588-429C-49CF-99B1-B454BED552DD
Standard Grant Template - Version Nov 2025
SWIFT Contract Number 284162
Between MDH and City of Otsego
REQ: 4026 Page 7 of 19
Grantee shall neither assign nor transfer any rights or obligations under this Grant
Agreement.
8.2. Amendments
If there are any amendments to this Grant Agreement, they must be in writing.
Amendments will not be effective until they have been executed and approved by MDH and
Grantee.
8.3. Waiver
If MDH fails to enforce any provision of this Grant Agreement, that failure does not waive
the provision or MDH’s right to enforce it.
8.4. Grant Agreement Complete
This Grant Agreement, and any incorporated exhibits, contains all the negotiations and
agreements between MDH and Grantee. No other understanding regarding this Grant
Agreement, whether written or oral, may be used to bind either party.
9. Liability
Grantee must indemnify and hold harmless MDH, its agents, and employees from all claims or
causes of action, including attorneys’ fees incurred by MDH, arising from the performance of this
Grant Agreement by Grantee or Grantee’s agents or employees. This clause will not be construed
to bar any legal remedies Grantee may have for MDH’s failure to fulfill its obligations under this
Grant Agreement. Nothing in this clause may be construed as a waiver by Grantee of any
immunities or limitations of liability to which Grantee may be entitled pursuant to Minn. Stat.
ch. 466, or any other statute or law.
10. Financial Examinations
The relevant books, records, documents, and accounting procedures and practices of Grantee and
any entity with which Grantee has engaged in carrying out the purpose of this Grant Agreement are
subject to examination under Minn. Stat. § 16B.98, subd. 8. Examinations may be conducted by
MDH, the Minnesota Commissioner of Administration, the Minnesota State Auditor, Attorney
General, or and the Minnesota Legislative Auditor, as appropriate, for a minimum of six years from
the end of this Grant Agreement, receipt and approval of all final reports, or the required period of
time to satisfy all state and program retention requirements, whichever is later.
11. Government Data Practices
MDH, Grantee, and any other entity that the Grantee has contracted with to fulfill the purpose of
this Grant Agreement, must comply with the Minnesota Government Data Practices Act, Minn.
Stat. ch. 13, as it applies to all data provided by MDH under this Grant Agreement, and as it applies
to all data created, collected, received, stored, used, maintained, or disseminated by Grantee
under this Grant Agreement pursuant to Minn. Stat. § 13.05, subd. 11(a). The civil remedies of
Minn. Stat. § 13.08 apply to the release of the data referred to in this clause by either Grantee or
MDH.
If Grantee receives a request to release the data referred to in this clause, Grantee must
immediately notify MDH. MDH will give Grantee instructions concerning the release of the data to
Docusign Envelope ID: BF9E6588-429C-49CF-99B1-B454BED552DD
Standard Grant Template - Version Nov 2025
SWIFT Contract Number 284162
Between MDH and City of Otsego
REQ: 4026 Page 8 of 19
the requesting party before any data is released. Grantee’s response to the request must comply
with the applicable law.
12. Tax Compliance Verification
Pursuant to Minn. Stat. § 270C.65, subd. 3, and all other applicable laws, Grantee consents to
disclosure of its Social Security Number (SSN), Individual Tax Identification Number (ITIN), Employer
Identification Number (EIN), and Minnesota Tax Identification Number (TIN), all of which have
already been provided to MDH, federal and state tax agencies, and state personnel involved in the
payment of state obligations. As may be applicable, these identification numbers may be used in
the enforcement of federal and state tax laws which could result in action requiring the Grantee to
file tax returns and pay delinquent tax liabilities, if any, or pay other state liabilities.
13. Ownership of Equipment and Supplies
13.1. Equipment
“Equipment” is defined as tangible personal property having a useful life of more than one
year and a per-unit acquisition cost which equals or exceeds $10,000. MDH shall have the
right to require transfer of all Equipment purchased with grant funds (including title) to
MDH or to an eligible non-State party named by MDH. MDH may require the transfer of
Equipment if the grant program is transferred to another grantee. At the end of this Grant
Agreement, grantee must contact MDH’s Authorized Representative for further instruction
regarding the disposition of Equipment.
13.2. Supplies
“Supplies” is defined as all tangible personal property other than those described in the
definition of Equipment. Grantee must notify MDH’s Authorized Representative regarding
any remaining Supplies with an aggregate market value of $10,000 or more for further
instruction regarding the disposition of those Supplies. For the purpose of this section,
Supplies includes but is not limited to computers and incentives.
14. Ownership of Materials and Intellectual Property Rights
14.1. Ownership of Materials
“Materials” is defined as any inventions, reports, studies, designs, drawings, specifications,
notes, documents, software, computer-based training modules, and other recorded
materials in whatever form. Grantee shall own all rights, title, and interest in all of the
materials conceived, created, or otherwise arising out of the performance of this Grant
Agreement by it, its employees, or subgrantees, either individually or jointly with others.
Grantee hereby grants to MDH a perpetual, irrevocable, no-fee license and right to
reproduce, modify, distribute, perform, make, have made, and otherwise use the Materials
for any and all purposes, in all forms and manners that MDH, in its sole discretion, deems
appropriate. Grantee shall, upon the request of MDH, execute all papers and perform all
other acts necessary to document and secure this right and license to the Materials by
MDH. At the request of MDH, Grantee shall permit MDH to inspect the original Materials
and provide a copy of any of the Materials to MDH, without cost, for use by MDH in any
manner MDH, in its sole discretion, deems appropriate.
Docusign Envelope ID: BF9E6588-429C-49CF-99B1-B454BED552DD
Standard Grant Template - Version Nov 2025
SWIFT Contract Number 284162
Between MDH and City of Otsego
REQ: 4026 Page 9 of 19
14.2. Intellectual Property Rights
Grantee represents and warrants that Materials produced or used under this Grant
Agreement do not and will not infringe upon any intellectual property rights of another
including but not limited to patents, copyrights, trade secrets, trade names, and service
marks and names. Grantee shall indemnify and defend MDH, at Grantee’s expense, from
any action or claim brought against MDH to the extent that it is based on a claim that all or
parts of the materials infringe upon the intellectual property rights of another. Grantee shall
be responsible for payment of any and all such claims, demands, obligations, liabilities,
costs, and damages including, but not limited to, reasonable attorney fees arising out of this
Grant Agreement, amendments and supplements thereto, which are attributable to such
claims or actions. If such a claim or action arises or in Grantee’s or MDH’s opinion is likely to
arise, Grantee shall at MDH’s discretion either procure for MDH the right or license to
continue using the materials at issue or replace or modify the allegedly infringing materials.
This remedy shall be in addition to and shall not be exclusive of other remedies provided by
law.
15. Workers’ Compensation
Grantee certifies that it is in compliance with Minn. Stat. § 176.181, subd. 2, which pertains to
workers’ compensation insurance coverage. Grantee’s employees and agents, and any contractor
hired by Grantee to perform the work required by this Grant Agreement and its employees, will not
be considered State employees. Any claims that may arise under the Minnesota Workers’
Compensation Act on behalf of these employees, and any claims made by any third party as a
consequence of any act or omission on the part of these employees, are in no way MDH’s
obligation or responsibility.
16. Publicity and Endorsement
16.1. Publicity
Any publicity given to the program, publications, or activities performed resulting from this
Grant Agreement, including but not limited to, websites, social media platforms, notices,
informational pamphlets, press releases, research, reports, signs, and similar public notices
prepared by or for Grantee or its employees individually or jointly with others, or any
subgrantees, must identify MDH as the sponsoring agency. If publicity is not specifically
authorized under this Grant Agreement, Grantee must obtain prior written approval from
MDH’s Authorized Representative. If federal funding is being used for this Grant Agreement,
the federal program must also be recognized.
16.2. Endorsement
Grantee must not claim that MDH endorses its products, services, or activities.
17. Governing Law, Jurisdiction, and Venue
This Grant Agreement, amendments and supplements to it, shall be governed by the laws of the
State of Minnesota. Venue for all legal proceedings arising out of this Grant Agreement, or for
breach thereof, must be in the state or federal court with competent jurisdiction in Ramsey County,
Minnesota.
Docusign Envelope ID: BF9E6588-429C-49CF-99B1-B454BED552DD
Standard Grant Template - Version Nov 2025
SWIFT Contract Number 284162
Between MDH and City of Otsego
REQ: 4026 Page 10 of 19
18. Clerical Error
Notwithstanding Clause “Assignment, Amendments, Waiver, and Grant Agreement Complete” of
this Grant Agreement, MDH reserves the right to unilaterally fix clerical errors, defined as
misspellings, minor grammatical or typographical mistakes or omissions, that do not have a
substantive impact on the terms of the Grant Agreement without executing an amendment. MDH
must inform Grantee of clerical errors that have been fixed pursuant to this paragraph within a
reasonable period of time.
19. Lobbying
19.1. Grantee must ensure that grant funds are not used for lobbying, which includes paying or
compensating any person for influencing or attempting to influence legislators or other
public officials on behalf or against proposed legislation, in connection with the awarding of
any federal contract, the making of any federal grant, the making of any federal loan, the
entering into of any cooperative agreement, or the extension, continuation, renewal,
amendment, or modification of any federal contract, grant, loan, or cooperative agreement.
19.2. In accordance with the provisions of 31 USC § 1352, if Grantee uses any funds other than
federal funds from MDH to conduct any of the aforementioned activities, Grantee must
complete and submit to MDH the disclosure form specified by MDH. Further, Grantee must
include the language of this section in all contracts and subcontracts, and all contractors
and subcontractors must comply accordingly.
19.3. Providing education about the importance of policies as a public health strategy, however,
is allowed. Education includes providing facts, assessment of data, reports, program
descriptions, and information about budget issues and population impacts, but stopping
short of making a recommendation on a specific piece of legislation. Education may be
provided to legislators, public policy makers, other decision makers, specific stakeholders,
and the general community.
19.4. By signing this Grant Agreement, Grantee certifies that it will not use any funds received
from MDH to employ, contract with, or otherwise coordinate the efforts of a lobbyist, as
defined in Minn. Stat. § 10A.01, subd. 21. This requirement also applies to any
subcontractors or subgrantees that Grantee may engage for any activities pertinent to this
Grant Agreement.
20. Voter Registration Requirement
Grantee will comply with Minn. Stat. § 201.162, by providing voter registration services for its
employees and for the public served by Grantee.
21. Debarment, Suspension and Responsibility Certification
Federal regulation 2 CFR § 200.214 prohibits MDH from purchasing goods or services with federal
money from any party that has been suspended or debarred by the federal government. Similarly,
Minn. Stat. §§ 16C.03, subd. 2, and 16B.97, subd. 3, provides the Commissioner of Administration
with the authority to debar and suspend any party that seeks to contract with MDH.
Anyone may be suspended or debarred when it is determined, through a duly authorized hearing
process, that they have abused the public trust in a serious manner. In particular, the federal
Docusign Envelope ID: BF9E6588-429C-49CF-99B1-B454BED552DD
Standard Grant Template - Version Nov 2025
SWIFT Contract Number 284162
Between MDH and City of Otsego
REQ: 4026 Page 11 of 19
government expects MDH to have a process in place for determining whether a vendor has been
suspended or debarred, and to prevent such vendors from receiving federal funds.
By signing this Grant Agreement, Grantee certifies that it and its principals:
a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from transacting business by or with any federal, state or local
governmental department or agency;
b) Have not within a three-year period preceding this Grant Agreement: a) been convicted of or
had a civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain or performing a public (federal, state or local)
transaction or contract; b) violated any federal or state antitrust statutes; or c) committed
embezzlement, theft, forgery, bribery, falsification or destruction of records, making false
statements or receiving stolen property;
c) Are not presently indicted or otherwise criminally or civilly charged by a governmental entity
for: a) commission of fraud or a criminal offense in connection with obtaining, attempting to
obtain or performing a public (federal, state of local) transaction; b) violating any federal or
state antitrust statutes; or c) committing embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statement or receiving stolen property; and
d) Are not aware of any information and possess no knowledge that any subcontractor(s) that will
perform work pursuant to this Grant Agreement are in violation of any of the certifications set
forth above.
22. Incentives
When included in the approved Work Plan or Budget, the following language applies.
22.1. Handling of Incentives
Grantee is required to have policies and procedures in place addressing the purchasing,
security, distribution, and asset tracking of incentives. All grantee staff involved in the
purchase, distribution, security, and reconciling of incentives must be trained on the
grantee’s policies and procedures prior to the grantee placing any order for incentives.
Those policies and procedures must, at a minimum, include the provisions outlined in this
section.
22.2. Separation of duties
More than one Grantee staff person must be involved in the management and handling of
the incentives. The Grantee staff who authorizes the purchase of incentives must not have
sole physical access to the incentives. The Grantee staff who will have physical access to the
incentives cannot have sole access to modify the incentives records. Handoff of incentive
from one person to another must be documented.
22.3. Distribution of Incentives
Incentives may only be used for approved purposes by MDH.
a) Only one incentive can be given to an individual per occurrence/event.
Docusign Envelope ID: BF9E6588-429C-49CF-99B1-B454BED552DD
Standard Grant Template - Version Nov 2025
SWIFT Contract Number 284162
Between MDH and City of Otsego
REQ: 4026 Page 12 of 19
b) Undistributed incentives must always be kept in a secure location. Incentive instruments
must never be stored in any personal homes, they must always be securely stored in the
grantee’s business space.
c) Grantee will purchase and have on hand no more than three months’ worth of
incentives at any given time. The three months’ worth must be based off the most
currently approved workplan. All incentives must be distributed prior to grantee
purchasing additional incentives.
d) Grantee will be responsible for the costs of any incentives that remain undistributed at
the end of the Grant Agreement.
e) If MDH provided the grantee with the incentives, the return of undistributed incentives
to MDH must occur in person with the MDH’s Authorized Representative within 30
calendar days of the grant expiration date. If in-person return is not possible, the
grantee must return undistributed incentives via courier or via US Mail that requires
signatures and a tracking number within 30 calendar days of the grant expiration date.
f) The tracking log must be returned separately from the physical cards. Electronic return
is the preferred method for the tracking log.
22.4. Incentive tracking documentation
The tracking documentation the Grantee is required to maintain must not contain any
private data. The tracking system must record the following:
a) Number of incentives on hand, including starting balance and any additional incentives
purchased;
b) description of the incentives;
c) quantity of incentive(s) distributed to each participant;
d) the last four digits of any pre-paid card number;
e) value/amount;
f) a unique non-identifiable data point for each participant (e.g. case number, file
number);
g) date participant received incentive(s); and
h) signature of Grantee staff member providing incentive(s) to participant(s).
22.5. Reconciliation
At least two different Grantee staff must reconcile the incentives at least quarterly. The
Grantee staff conducting the reconciliation must not also be the handlers of the incentives.
The reconciliation must include the dates and signature of the two people who perform the
reconciliation. Grantee must submit the reconciliation documentation to MDH’s Authorized
Representative no less than two weeks after each reconciliation.
22.6. Subcontracting/Subgranting
The Grantee must communicate and verify that their subcontracts/subgrants will only use
incentives for MDH approved purposes. The Grantee will be responsible for monitoring,
oversight, and reconciliation of any incentives that its subcontractors or subgrantees
Docusign Envelope ID: BF9E6588-429C-49CF-99B1-B454BED552DD
Standard Grant Template - Version Nov 2025
SWIFT Contract Number 284162
Between MDH and City of Otsego
REQ: 4026 Page 13 of 19
purchase and distribute and will include this same language in any of its subgrants or
subcontracts that it enters as part of its work for MDH.
22.7. Lost or stolen incentives
The Grantee bears all financial responsibility for any unaccounted for, lost, or stolen
incentives.
22.8. Invoicing
If the Grantee purchased the incentives themselves, the Grantee must only invoice MDH for
the incentives after they’ve been distributed.
22.9. Failure to Comply
For grantees who do not have effective written policies and procedures in place before
purchasing incentives, MDH reserves the right to withhold payment and or request
reimbursement in the amount equal to the unallowable costs. Withheld payments will be
released when the grantee provides documentation to MDH that it has written effective
policies and procedures in place. Grantees who do not comply with this requirement may
be subject to increased monitoring and will be offered technical assistance. MDH also
reserves the right to terminate a Grant Agreement for failure to comply with these
requirements.
23. Conflict of Interest
Grantee will notify MDH’s Authorized Representative when they become aware of any potential,
perceived, or actual conflict of interests as it relates to this Grant Agreement.
24. Mandatory Disclosures
An applicant, recipient, or subrecipient of funding under this Grant Agreement must promptly
disclose whenever, in connection with this Grant Agreement (including any activities or subawards
thereunder), it has credible evidence of the commission of a violation of criminal law involving
fraud, conflict of interest, bribery, or gratuity violations found in Title 18 of the United States Code
or Minn. Stat., ch. 609, or a violation of the civil False Claims Act (31 U.S.C. 329–3733) or Minn. Stat.
§ 609.465 (prohibiting the presentation of false claims to a public officer or body). The disclosure
must be made in writing to the Federal agency (if applicable), the Federal agency’s Office of
Inspector General (if applicable), and MDH. Applicants, recipients, and subrecipients are also
required to report matters related to recipient integrity and performance in accordance with
Appendix XII of 2 CFR § 200. Failure to make required disclosures can result in any of the remedies
described in 2 CFR § 200.339. (See also 2 CFR § 180, 31 U.S.C. 3321, and 41 U.S.C. 2313.)
25. Whistleblower Protections
An employee of a recipient or subrecipient must not be discharged, demoted, or otherwise
discriminated against as a reprisal for disclosing to a representative of MDH or a person or body
described in paragraph (a)(2) of 41 U.S.C. 4712 information that the employee reasonably believes
is evidence of gross mismanagement of a Federal or state contract or grant, a gross waste of
Federal or state funds, an abuse of authority relating to a Federal or state contract or grant, a
substantial and specific danger to public health or safety, or a violation of law, rule, or regulation
related to a Federal or state contract (including the competition for or negotiation of a contract) or
Docusign Envelope ID: BF9E6588-429C-49CF-99B1-B454BED552DD
Standard Grant Template - Version Nov 2025
SWIFT Contract Number 284162
Between MDH and City of Otsego
REQ: 4026 Page 14 of 19
grant. The recipient and subrecipient must inform their employees in writing of employee
whistleblower rights and protections under 41 U.S.C. 4712 and Minn. Stat. §§ 15C.145 and 181.932
- .935. See statutory requirements for whistleblower protections at 10 U.S.C. 4701, 41 U.S.C. 4712,
41 U.S.C. 4304, and 10 U.S.C. 4310.
26. Suspension for Insufficient Funding
In the event of temporary lack of funding or appropriation, MDH may suspend its obligations under
this Grant Agreement without terminating it. This suspension will be for the duration of the lack of
funding or appropriation and shall not be considered a termination of the Grant Agreement. MDH
will not be assessed any penalty if the Grant Agreement is terminated because of the decision of
the Minnesota Legislature, or other funding source, not to appropriate funds.
26.1. Grantee will be notified in writing of the temporary suspension, and Grantee’s ability to
perform under the Grant Agreement will be suspended during this period. MDH will provide
reasonable notice to Grantee of the lack of funding or appropriation and shall notify
Grantee once funding is restored or appropriated, and at MDH’s discretion, performance
under the Grant Agreement may resume.
26.2. MDH may convert the suspension for insufficient funding to termination under clause 27.3.
upon written notice to Grantee.
26.3. Grantee may reject MDH’s suspension for insufficient funding by written response to the
notice of suspension. If Grantee rejects suspension, the notice of suspension shall be
effective as a notice of termination under clause 27.3 with the same effective date as was
provided for the suspension.
27. Termination
27.1. Termination by MDH or Grantee
MDH or Grantee may terminate this Grant Agreement without cause, with at least 21
calendar days’ written notice (i.e., by mail, email, or both) to the other party. Upon
termination, Grantee will be entitled to payment, determined on a pro rata basis, for
activities satisfactorily performed.
27.2. Termination for Cause
MDH may immediately terminate this Grant Agreement if MDH finds there has been a
failure to comply with the provisions of this Grant Agreement, that timely progress has not
been made, or that the purposes for which the funds were granted have not been or will
not be fulfilled. MDH may take action to protect the interests of the State of Minnesota,
including the refusal to disburse additional funds and requiring the return of all or part of
the funds already disbursed.
27.3. Termination for Insufficient Funding
MDH may immediately terminate this Grant Agreement if it does not obtain funding from
the Minnesota Legislature or other funding sources; or if funding cannot be continued at a
level sufficient to allow for the payment of the work scope covered in this Grant Agreement.
Termination must be by written notice to Grantee; i.e., mail, email, or both. MDH is not
obligated to pay for any work performed after notice and effective date of the termination.
Docusign Envelope ID: BF9E6588-429C-49CF-99B1-B454BED552DD
Standard Grant Template - Version Nov 2025
SWIFT Contract Number 284162
Between MDH and City of Otsego
REQ: 4026 Page 15 of 19
However, Grantee will be entitled to payment, determined on a pro rata basis, for activities
satisfactorily performed to the extent that funds are available.
MDH will not be assessed any penalty if this Grant Agreement is terminated because of the
decision of the Minnesota Legislature, or other funding source, not to appropriate funds.
MDH must provide Grantee notice of the lack of funding within a reasonable time of MDH
receiving notice of the same.
27.4. Termination by Commissioner of Administration
The Commissioner of Administration may immediately and unilaterally terminate this Grant
Agreement if further performance under the Grant Agreement would not serve MDH’s
purposes or performance under the Grant Agreement is not in the best interests of the
State of Minnesota.
Exhibits
The following Exhibits are attached and incorporated into this Grant Agreement. In the event of a
conflict between the terms of this Grant Agreement and its Exhibits, or between Exhibits, the order of
precedence is first the Grant Agreement, and then in the following order:
1. Exhibit A – Grantee’s Activities / Scope of Work
2. Exhibit B – Grantee’s Budget
[Signatures on following page]
Docusign Envelope ID: BF9E6588-429C-49CF-99B1-B454BED552DD
Standard Grant Template - Version Nov 2025
SWIFT Contract Number 284162
Between MDH and City of Otsego
REQ: 4026 Page 16 of 19
APPROVED:
1. State Encumbrance Verification
Individual certifies that funds have been encumbered as required by Minn. Stat. §§ 16A.15 and 16C.05.
Signature:
SWIFT Contract & Initial PO:
2. Grantee
Grantee certifies that the appropriate persons(s) have executed the Grant Agreement on behalf of Grantee as required by applicable articles, bylaws,
resolutions, or ordinances.
Signature:
Title:
Date:
Signature:
Title:
Date:
Signature:
Title:
Date:
Signature:
Title:
Date:
3. Minnesota Department of Health
Grant agreement approval and certification that State funds have been encumbered as required by Minn. Stat. §§ 16A.15 and 16C.05.
Signature:
(with delegated authority)
Title:
Date:
Distribution:
All parties on the DocuSign envelope will receive a copy of the fully executed Grant Agreement.
284162/3000130258/REQ 4026
Rachel LeBlanc Digitally signed by Rachel LeBlanc
Date: 2026.02.18 12:23:12 -06'00'
Docusign Envelope ID: BF9E6588-429C-49CF-99B1-B454BED552DD
Utility Manager
2/24/2026 | 8:54:53 AM CST
Director, Grants Office
2/24/2026 | 4:30:18 PM CST
Standard Grant Template - Version Nov 2025
SWIFT Contract Number 284162
Between MDH and City of Otsego
REQ: 4026 Page 17 of 19
Exhibit A – Grantee’s Activities / Scope of Work
Grantee is expected to perform the following activities. Modifications to Exhibit A must be discussed
with MDH. MDH will communicate, in writing, with Grantee as to whether modifications are approved
or require a formal grant amendment.
Activity/Work Plan Anticipated Outcome
Drill a test well. Drilling a test well will provide information
to support a new water source to minimize
contaminants.
Terms and Conditions Additional Notes/Requirements
1. Grantee shall contact David Weum, (MDH) Plan Review
Engineer at 651-201-4684 or david.weum@state.mn.us
for plan review process and information only if the test
well will be converted to a Public Water Supply well.
In compliance with MDH standards.
2. Grantee agrees that no system of water supply for
public use shall be installed, altered or extended until
complete plans and specifications for the installation,
alteration or extension have been submitted and
approved by the State, and no construction shall take
place except in accordance with the approved plans. No
grant funds can be used prior to approval of the plans.
Failure to submit plans for approval within the first two
months from the effective date of the grant may result in
termination of the grant award.
In compliance with MDH standards
3. Grantee agrees that work shall take place only in the
MDH approved Drinking Water Supply Management Area
(DWSMA). Grantee will be reimbursed only for work that
takes place in the DWSMA.
In Compliance with MDH standards
4. Grantee shall pay in full any licensed contractor or
consultant hired for the purpose of completing any work
under this Grant Agreement.
In Compliance with MDH standards
5. On or before the end date of this Agreement, the
Grantee shall provide MDH with one electronic copy of all
final products produced under this Grant Agreement,
including reports, publications, software and videos. If
required by the nature of the project, data collected
during the project shall be reported in a format
acceptable to MDH.
In Compliance with MDH standards
Docusign Envelope ID: BF9E6588-429C-49CF-99B1-B454BED552DD
Standard Grant Template - Version Nov 2025
SWIFT Contract Number 284162
Between MDH and City of Otsego
REQ: 4026 Page 18 of 19
Terms and Conditions Additional Notes/Requirements
6. In the event the Grantee is unable to satisfactorily
complete all the duties specified in this grant agreement,
the Grantee will forfeit payment. A Grantee who has not
satisfactorily fulfilled the grant obligations, including but
not limited to paying the contractor in full for all work
performed by the contractor, will be denied participation
in the next grant cycle.
In compliance with MDH standards
7. In accordance with Minn. Stat. § 16B.98, subd. 5(d),
Grantee must clearly post on Grantee’s website the
names of, and contact information for, the Grantee’s
leadership and the employee or other person who
directly manages and oversees this Grant Agreement on
behalf of the Grantee.
In compliance with MDH standards
8. Any digital materials created, and shared outside of
the grantee’s organization, Grantee is required to comply
with State of Minnesota’s Digital Accessibility Standard.
This requirement flows down to any subcontractors and
or any third-party entity the Grantee may utilize and
compensate with MDH grant funds. The statewide
Standard can be viewed online at Accessibility | Policies
& Standards / Minnesota IT Services
In compliance with MDH standards
Grantee is subject to a variety of compliance activities, as outlined below.
Report Type Reporting Period / Due Date Due Date
Grant Narrative
Report
Upon completion of the project, Grantee shall complete and submit an
itemized Grant Invoice and a Grant Narrative Report to MDH SWP in the
Fluxx portal system. The Grant Narrative Report and the Grant Invoice
shall be due no later than the expiration day of this Grant Agreement.
2/26/2027
Docusign Envelope ID: BF9E6588-429C-49CF-99B1-B454BED552DD
Standard Grant Template - Version Nov 2025
SWIFT Contract Number 284162
Between MDH and City of Otsego
REQ: 4026 Page 19 of 19
Exhibit B – Grantee’s Budget
The budget shown below is for reference only and is non-binding.
Category Budget Period Total
Contractual 2/27/2026 to 2/26/2027 $15,000.00
Grantee’s Indirect Cost Rate for this Grant Agreement is as follows:
Indirect costs are not allowed by Funder.
Permitting fees payable to MDH (i.e. well construction fee; well sealing fee) are not eligible and will be
deducted from the final invoice, before reimbursement.
Pressure tanks are grant eligible, as part of a new well construction and pump system project. The
pressure tank must be appropriately sized for the pump being proposed for the new well and not sized
for additional water storage. Pressure tank designed to serve the purpose of water storage, as well as
the replacement or maintenance of pressure tanks, remains ineligible for grant reimbursement.
Water lines may be reimbursed only from the well to the pressure tank or to the building, whichever
comes first.
Docusign Envelope ID: BF9E6588-429C-49CF-99B1-B454BED552DD