HomeMy WebLinkAboutRES.1423.12-21-1998 BILL N0. 98-253 RESOLUTION N0. ���,?;
A RESOLUTION AUTHORIZING THE CITY MANAGER TO
APPLY FOR A PROJECT IMPACT: BUILDING DISASTER
RESISTANT COMMUNITIES GRANT THROUGH THE
FEDERAL EMERGENCY MANAGEMENT AGENCY
BE IT RESOLVED BY THE COUNCIL OF THE CITY OF CAPE GIRARDEAU,
MISSOURI, AS FOLLOWS :
ARTICLE l . The City Manager, for and on behalf of the City of
Cape Girardeau, Missouri, is hereby authorized to apply for a
Project Impact: Building Disaster Resistant Communities Grant
through the Federal Emergency Management Agency. A copy of said
Grant Application is attached to this Resolution and made a part
hereof.
ARTICLE 2 . The City Manager is hereby authorized to sign any
and all grant documents necessary and required in said grant
application process .
PASSED AND ADOPTED THIS ,-,�1,�- DAY OF 'I � � , 19�.
A. M. Spradling, III, Mayo
ATTEST:
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; �,i Federal Emergency Management Agency
°��o�y � ���'� Washington, D.C. 20472
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The Honorable Albert M. Spradling, III �=!=r``
401 Independence Street `� �9Q�
P.O. Box 617
Cape Girardeau, MO 63702 -
Dear Mayor Spradling:
The U.S. Congress gave authority to the Federal Emergency Management Agency
(FEMA) Director to carry out an initiative that would put into place a national pre-
disaster miti�ation effort. The initiative is ca(led Project Impact: Building Disaster
Resistant Communities. We are pleased that your community has indicated a
commitment to working with FEMA and other partners for this important effort. As part
of your overall effort, you are invited to submit an application to participate in this
initiative.
Your application and two (2) copies must be received not later than NOVEMBER 6,
1998, 3:00 p.m. to the issuing of�ice. The issuing of�ice and place designated for receipt
of your ap�lication is:
Federal Emergency Management A�ency
Office of Financial Management �
Grants& Acquisition Support Division
500 C Street, SW., Room 350
Washington, DC 20472
ATTN: Sylvia A. Carroll
Eligible activities and objectives are described in the Statement of Work (Attachment A).
You will find materials and instructions needed for formally applying to FEMA for a
grant that will support your community's disaster resistant goals. The following
attachments are incorporated herein and made a part thereof
Attachment A— Statement of Work Guidance
Attachment B —Application for Federal Assistance (SF-424)
Attachment C —Program Narrative
Attachment D —Assurances and Certifications
FEMA expects to be able to provide between $�9�A96land 500,00 to your community
under this initiative. Therefore, the completed budget submi or this initiative should
be within this range. We would like you to examine the enclosed package, prepare your
application response and mail it back to us for review.
-2-
You are advised that this request for Federal assistance does not commit the Government
to fund your application or to pay any costs incuned in the prepazation of an application.
The Government reserves the right to accept, reject, or revise your application, if it is in
the best interest of the Government to do so.
If you have specific questions about completing the grant package, please call Sylvia A.
Carroll at (202) 646-3503 or me at (202) 646-3118.
Sincerely,
�%�Q��1d� �
Chandra G. Lewis
Assistance Officer
Attachments
STATEMENT OF WORK
The attached Statement of Work should 6e used in preparing
the Program Narrative to be submitted with the application
package.
Disaster Resistant Community
Mitigation Grant
Statement of Work
I. Background
With Project Impact, FEMA is carrying out an initiative aimed at bringing greater
emphasis and improved focus to activities that communities can take to reduce
their vulnerability to disaster losses. Under the initiative, FEMA collaborates with
selected communities to demonstrate the partnership process, support specific
mitigation projects and actions, and bring attention to the consequent successes
and lessons. Mitigation measures generally are those that reduce in a
permanent or long-term manner the potential losses from natural hazard events.
In reflecting the approach that FEMA has been able to accomplish with its State
partners, the initiative relies on the development of a mitigation partnership
agreement. This agreement includes the mitigation actions supported by this
grant as well as the broader mitigation strategy and actions that will be
undertaken within the community.
II. Objectives and Need•
1) The principal purpose of the funds awarded under this grant should be the
implementation of a mitigation project that reduces the existing risk of
natural hazard losses within the geographic location of the subject
community. Such projects can be categorized as:
A. Mitigation for existing structures; or
B. Mitigation of existing utility facilities or systems that are publicly
owned and operated on a non-profit basis.
Projects, which can be considered to fall under category A. or B., are explained
in furtfier detail in section 2) below
A project that falls under A. or B. should demonstrate benefit to the President's
disaster relief fund, the National Flood Insurance Fund, or both. FEMA may, in
addition to providing financial assistance to support a Project under A. or 6., be
able to provide technical assistance. Technical assistance would not require the
specified non-federal cost share.
In those instances where a community is undertaking flood mitigation project(s)
that benefit the National Flood Insurance Fund and are funded by the flood
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mitigation fund (estabiished pursuant to 42 U.S.C. 4104), a mitigation plan,
adopted in public forum, will be completed before the eligibie project is begun.
[Additiona� guidelines for the identification of eligible projects along with other
relevant information can be found in the Code of Federal Regulations for the
Flood Mitigation Assistance program.]
2) A portion of the funds (not to exceed 25%) awarded under this grant may be
used to support and stimulate short and longer-term risk reduction activities
within the jurisdiction. These activities should be undertaken by those
organizations or individuals with an explicitly acknowledged interest in the
disaster resistance of the community, including State agencies and departments,
local government agencies or departments, regional planning organizations, local
businesses, national businesses, constituency groups, academic institutions,
community based volunteer organizations or other non-profit institutions. FEMA
can also support each of these activities with technical assistance, which would
not require the specified non-federal cost share.
The projects supported should be categorized under:
C. Adoption of policies or practices for mitigation in existing
structures, development or redevelopment;
D. Activities that lead towards building or sustaining public/private
partnerships;
E. Hazard identification and risk assessment;
� F. Niitigation of new construction;
G. Personnel support
Grant cost share: The cost share on the projects carried out under 1) & 2) above
will be 75% Federal/25% non-Federal. However, communities are encouraged
to utilize the Project Impact community effort to leverage additional resources
from the private sector, State and Federal agencies to support its mitigation
goals, beyond the 25% non-federal match.
In submitting the budget for the grant, the budget will identify and justify
expenses in these categories. Given the nature of the Project Impact initiative,
as the partnerships mature and the effort evolves, should a partner offer to fund
an item afready proposed in the budget submittal, the grant recipient is
encouraged to modify the budget and use the newly identified resource to
further leverage the FEMA grant.
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III. Sco�e of Effort
A• Existing structures and redevelopment: Over a long period of time,
hazard resistant new construction will take the place of older hazardous
construction. A disaster resistant community, however, wishes to accelerate the
pace of its mitigation efforts by addressing existing risks. The eligible activities
include but are not necessarily limited to: .
• A prioritization of at-risk public buildings for replacement or retrofit. If the
community has significant flood risk, it should develop and have approved a
flood mitigation plan that addresses existing flood risks to insurable
properties.
• Implementation of structural and non-structural (e.g., architectural,
mechanical systems) loss reduction projects or measures in conformance with
the community's mitigation project priorities. Implementation may be carried
out through means that do not require direct local government direction and
control. The community may decide, for example, to offer incentives (either
on its own or in partnership with financial institutions or other private
institutions) to its homeowner and business sector to carry out mitigation of
their structural or non-structural risks.
• Adoption and enforcement of a "trigger" or set of "triggers" that, based on
change of use or occupancy, substantial damage or improvement, or other
actions cause the building to be rehabilitated to improve its resistance to
natural hazards present in the community.
• Establishment of a community-adopted plan of redevelopment that includes
risk based decisions for redevelopment actions, in both the siting and
construction of new or improved buildings and facilities.
B. Utility and transportation systems (new and existing):
The criticality of utilities and transportation systems to the conduct of daily
community commerce and residential activities has been demonstrated often in
the after math of natural hazard events. Some of these systems wilf be privately
owned others publicly. Privately owned utilities should be present in the
development of the community's mitigation plans. Activities that can be
supported include, though are not necessarily limited to: �
• Development and adoption of a plan of natural hazards risk reduction-
oriented replacement or retrofit of those utility or transportation systems the
community owns or regulates. For those over which it does not have any
direct control, the disaster,resistant community should have a partnership
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with privately owned local utilities for emergency management purposes.
Future utilifies and transportation are located to avoid hazardous areas. This
is usual�y included within the comprehensive community development pian
cited earlier.
• The community may decide to adopt a means of intemalizing the cost of risk
for those member� of its community who choose to live in at risk, or higher-
risk areas. An example - by increasing the cost of public services (e.g.,
water, sewage) in those areas in order to offset the eventual cost of
providing those areas additional disaster services.
C. Adoptio� of policies or practices for mitigation in existing
structures, development or redevelopment:
A community will not be able to carry out the effective risk reduction measures
that make it more disaster resistant without knowledge of the e�cisting threats
posed to itself and the areas at greatest risk. Eligible activities that may be
undertaken in this category include but are not necessarily limited to:
• Identifying and prioritizing risk reduction actions within the community.
• Preparing a lo�g-term plan that specifies a strategy for accomplishing the
community's mitigation goals under Project Impact. . ,
• Adoption of ordinances or guidelines that will ensure that development and �
redevelopment leads towards reducing probable losses.
• Streamlining local procedures and offering incentives to encourage voluntary
compliance with enhanced risk reduction standards.
• Creating a process to consider codes draf�ed by outside organizations and to
gamer endorsement from the local engineering community.
• Surveying the building safety department to determine whether resources
and competencies are suffiaent to carry out plan review and construcfion
inspection needed to assure quality and compliant construction.
• Identification of potential resources for carrying out priorities.
• Providing public information and education activities.
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D• Activities that lead towards building or sustaining public/private
partnerships;
A key part of building a disaster resistant community is creating the alliances that
will make it happen. Activities that lead towards developing and strengthening a
partnership such as bringing together the experiences and resources and policies
already in place in the community to reduce redundancy, identify weaknesses
and strengths, and ensure the most effective partnership.
Eligible activities that may be undertaken in this category include but are not
necessarily limited to:
• Establishing committees or broad-based task forces composed of local
officials, business professionals, and other stakeholders with a shared interest
in and obligation to protecting the safety and economic stability of the
community for the future.
� Activities that assist these committees in coming together to build consensus
and build upon the views of everyone involved.
• Identificat;on and support for a local designated community leader for Project
Impact activities. .
E. Hazard Identification and Risk Assessment: A community will not be
able to carry out the effective risk reduction measures that make it more disaster
resistant without a knowledge of the threats posed to itself, and the areas at
greatest risk. Eligible activities that may be undertaken in this category include
but are not necessarily limited to:
• Graphic illustration of hazard impact areas, and articulation or delineation of
areas of highest potential loss. Losses will be categorized such that the
interests of the community's partners can identify their priorities for
mitigation actions.
• Beyond hazard identification, depicction graphically of natural hazard risks to
the community's residential, commercial and public structures, and to its
utility and transportation systems. Analysis of risks will include prioritization of
the measures for addressing existing exposure to losses.
F. Mitigation of New Construction: disaster resistant communities have
in place some means of ensuring that new development and new constrvction
will adequately resist the natural hazards identified for the jurisdiction. Eligible
activities that may be undertaken in this category include, but are not necessarily
limited to:
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• The adoption and enforcement of building codes. Building codes are typically
used to ensure that new construction resists natural hazards. Adopted codes
in a community must be enforced in order to be effective. The grant funds
cannot be used for direct support of the resource needs for plan checking,
permitting and inspection, but they can be used to leverage such resources
utilizing engineering expertise available to the jurisdiction from either the
academic, non-profit or public sectors.
Mitigation of risk to infrastructure is a high priority. A disaster resistant
community should ensure that all new public infrastructure and buildings
resist natural hazards and are constructed in conformance with performance
criteria or codes that provide for continued functionality, reparable damage
or, at least, life safety.
• From a more comprehensive point of view, all new construction in a
community should resist the natural hazards with which it is confronted.
Communities which have progressed beyond the first priority of life safety in
the public buildings of a community, should adopt and can enforce new
construction building codes that include provisions for resistance to natural
hazards (earthquake, wind, flood, fire, winter storms, etc.). To do so, they
may undertake activities that will ensure that:
■ Tfieir capacity for enforcement of code requirements is su�cient.
• They have in place penalties for non-compliance.
■ They have identified critical facilities and high occupancy buildings and
require appropriately higher levels of hazard resistance in them.
• They allow for new construction incentives such as reduced permit fees or
tax breaks.
G. Personnel Support: The purpose of Project Impact is to create a sustained
community based effort. As such, an organization suitable to the community to
perpetuate the focus and coordination is a key element. A portion of the grant
may be used to support the staff needs for implementation, if there is a written
commitment on the part of the community partners which identifies how the
organization will be sustained once the grant expires. Some communities
consider a local coordinator to be an effective way to "jump start" the process.
Others in lieu of a single coordinator may choose intermittent staff augmentation
for a short-term specific need.
Conditions of the Grant:The Grant recipient is being requested to meet the
following conditions:
�
1. Mentoring: To help ensure sustainability, we are encouraging community
members to mentor their peers in other communities. As a condition of receiving
the grant, �he Project Impact recipients will be required to look for opportunities
within professional associations other communities to further the concept of
community based partnering in support of disaster reduction. In order to assist
with accomplishing this requirement, FEMA will provide each community with an
additional $5,000 for travel purposes. FEMA will also maintain a list of inentors
who can be called upon to assist communities interested in becoming disaster
resistant.
2. Evaluation: The success of the Project Impact initiative in the
community will be demonstrated by the public and private partnership actions
taken that demonstrate lives and property are at less risk from the natural
hazards that threaten them. FEMA is currently developing several methods in
which to measure short- and long-term risk reduction in Project Impact
communities. FEMA will be looking at specific indicators within each Project
Impact community that demonstrate mitigation is working and true risk reduction
is occurring. The CEO of the community will be asked to submit a "report card"
of the type of mitigation advancements that have occurred as a result of the
Project Impact designation.
Application Instructions
When preparing your application, budget forms and narrative
statements, consider the performance for the Project Impact
Initiative to be twenty-four (24) months long. FEMA will
negotiate in-kind and cash match with each applicant. The
Catalog of Federal Domestic Assistance (CFDA) number for
the Project Impact Initiative witt be 83.551.
If you desire to claim indirect costs, you must submit, atong
with your application, a copy of an indirect cost rate proposal
and related documentation to support those costs. (For details
see OMB Circular A-87, Cost Principles for State, Local and
Indian Tribal Governments, Attachme�t E, State and�Local �
Indirect Cost Rate Proposats.)
At the time an award is approved, the grantee will receive a
grant award document to be signed and additional instructions
for requesting reimbursement; out(ay(financial) and
performance reporting; closeout and grantee requirements.
Please call Sylvia A. Carroll on (202) 646-3503, if you have any
questions or need additional information.
APPLICATION FOR oMg APa�o�ai No.oaaa-ooas
FEDERAL ASSISTANCE 2.DATE SUBMITTED Applicant Identifier
i.TYPE OF SUBMISSION: 3.DATE RECEIVED BY STATE State Application Iden6fier
�plication Preapplication
Construction �Construction 4.OATE RECEIVED BY FEDERAL AGENCY Federal Identifier
❑ Non-Construction ❑Non-Construction �
5.APPLtCANT INFORMATION
Legai Name: OrganizaGonal Unit:
Address(give city,counry,State,and zip aode): Name and telephone number of person to be contacted on matters involvin
this application(give area codeJ
6.EMPLOYER IDENTIFICATION NUMBER(EIN): 7.TYPE OF APPLICANT:(enter appropriafe letler in boxJ
� —� A.State H.independent School Dist. �
8.TYPE OF APPLICATION: 8.County I.State Controlled Institution of Higher Learning
❑New ❑Contfnuation ❑Revision C.Municipal J.Private University
O.Township K.�ndian Tribe
If Revision,enter appropriate letter(s)in box(es) ❑ � E.Interstate L.I�dividuat
F.Intermunicipal M.Profit Organization
A.Increase Award B.Decrease Award C.Increase�uration G.Special District N.Other(Speci(y)
O.Decrease Duration Other(specily):
9.NAME OF FEDERAL AGENCY:
10.CATALOG OF FEOERAL DOMESTIC ASSISTANCE NUMBER: 11.DESCRIPTIVE TfTLE OF APPLICANT'S PROJECT:
L�1�—�
TITLE:
12.AREAS AFFECTEO BY PROJECT(Cities,Counties,States,etc.):
13.PROPOSED PROJECT 14.CONGRESSIONAL DISTRICTS OF: �
Start Oate E�ding Oate a.Applicant b.Project
15.ESTIMATED FUNDING: 16.IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE
ORDER 12372 PROCESS?
a.Federal $ 0°
a.YES. THIS PREAPPLICATIOWAPPLICATION WAS MADE
b.Applicant $ °O AVAILABLE TO THE STATE EXECUTIVE OADER 12372
PROCESS FOR REVIEW ON:
c.State $ 00
DATE
d.Local g 00
b.No. ❑ PROGRAM IS NOT COVERED BY E.0.12372
e.Other g .00 ❑OR PROGRAM HAS NOT BEEN SELECTED BY STATE
FOR REVIEW
f.Program Income $ 00
17.IS THE APPLICANT DELINQUENT ON ANY FEOERAL DEBT?
g.TOTAL S � �Yes If"Yes,'attach a�explanation. �No
18.TO THE BEST OF MY KNOWLEDGE ANO BELIEF,ALL DATA IN THIS APPLICATIOWPREAPPLICATION ARE TRUE AND CORRECT,THE
DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE
ATTACHED ASSURANCES IF THE ASSISTANCE IS AWAROED.
a.Type Name of Authorized Representative b.Title c.Telephone Number
d.Signature of Authorized Representative e.Date Signed
Previous Edition Usable Standard Form 424(Rev.7-97)
Authorized for Local Reproduction Presc�bed by OMB Circular A-102
INSTRUCTIONS FOR THE SF-424
Pub�ic reporting burden for this coliection of information is estimated to average 45 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed,and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project(0348-0043), Washington, �C 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
SEND IT TO THE ADDRESS PROVfDED BY THE SPONSORING AGENCY.
This is a standard form used by applicants as a required facesheet for preapplications and applications submitted fo� Federal assistance. It
will be used by Federal agencies to obtain applicant certification that States which have established a review and comment procedure in
response to Executive Order 12372 and have selected the program to be included in their process, have been given an opportunity to review
the applicanYs submission.
Item: Entry: Item: Entry:
1. Self-explanatory. 12. List only the largest political entities affected (e.g., State,
counties,cities).
2. Date application submitted to Federal agency(or State if
applicable)and applicant's control number(if applicable). 13. Self-explanatory.
3. State use only(if applicable). 14. List the applicanYs Congressionaf District and any
District(s)affected by the program or project.
4. If this application is to continue or revise an existing award,
enter present Federal identifier number. If for a new project, 15. Amount requested or to be contributed during the first
leave blank. funding/budget period by each contributor.Value of in-
kind contributions should be included on appropriate
5. Legal name of applicant, name of primary organizational unit lines as applicable. If the action will result in a dollar
which will undertake the assistance activity,complete address of change to an existing award,indicate only the amount
the applicant,and name and telephone number of the person to of the change. For decreases, enclose the amounts in
contact on matters related to this application. pare�theses. If both basic and supplemental amounts
are included,show breakdown on an attached sheet.
6. Enter Employer ldentification Number(EIN)as assigned by the For multiple program funding, use totals and show
Intemal Revenue Service. . . . . breakdown using same categories as item 15.
7. Enter the appropriate letter in the space provided. 16. Applicants should contact the State Single Point of
Contact(SPOC)for Federal Executive Order 12372 to
8. Check appropriate box and enter appropriate letter(s)in the determine whether the application is subject to the
space(s)provided: State intergovernmental review process.
--"New"means a new assistance award. 17. This question applies to the applicant organization, not
the person who signs as the authorized representative.
--"Continuation' means an extension for an additional Categories of debt include delinquent audit
funding/budget period for a project with a projected disallowances,loans and taxes.
completion date.
18. To be signed by the authorized representative of the
-- "Revision" means any change in the Federal applicant.A copy of the governing body's
GovernmenYs financial obligation or contingent authorization for you to sign this application as official
liability from an existing obligation. representative must be on file in the applicanYs office.
(Certain Fede�al agencies may require that this
9. Name of Federal agency from which assistance is being authorization be submitted as part of the application.)
requested with this application.
10. Use the Catalog of Federal Domestic Assistance number and
title of the program under which assistance is requested.
11. Enter a brief descriptive title of the project. If more than one
program is involved,you should append an explanation on a
separate sheet. If appropriate (e.g.,construction or real
property projects), attach a map showing project location. For
preapplications,use a separate sheet to provide a summary SF-424(Rev.7-97)Back
description of this project.
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N
INSTRUCTIONS F'OR THE SF-424A
Public rzponing burden for this collection of infamation is estimated ro average 180 minutts pet rzsponse, including time for
I reviewing insvuctions,searthing existing data sourccs,gathering and maintaining the data netd�d,and compieting and rtvitw•ing
1 the collettion of information. Send comments rcgarding the b�aden estimate or any otha atpxt of this collection of infortnation,
including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction
Project (0348-0044), Washington. DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMEIYT AND BUDCEt,
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
General Inatructione f'or conrinuing grant program applicaaons,submit th�se forms
This form is designed s� that application can be msde for funds �O��e end of each fun�ing period a4 rr,quired by the grantor
imm one or more grant programs. In preparing the budget, aB��Y• Enter in Columns(c) and (c� the estimatcd amounts of
adhere eo any exisdng Federal grantar agency guidelines which funds which will remai� unobligated at the end of the grant
prescribe how and whether bvdgeted amounts should be funding period only if the Federal grantor agency instn2ctions
scparauly shown for differznt functions or activiries within the Pro�de for this. Otherwisc,lcave these columns biank.Enter in
program. For some programs, grantor agencics may requirz columns (e) and (� the amounu ot funds ncedcd for the
budgeu to be separauly shown by function or acavity.For ott�a upcoming paiod. The amo�mt(s)-in Colvmn (g) should be the
programs, grantor agencios may require a breakdown by sum of amounts in Columns(e)and(�.
funcdon or activity. Sxtions A, B, C. and D should includc
budget esamates.for the whole project excxpt when apptying for For supplen�enral granu ond changes to ezisting grants,do not
assistance which requires Federal authorization in annusl or �Columns(c)and'(d).Enoer in Column(e)tf�e amount of the
other funding period i�cremenu. In the iatter ca9e,Sections A, ���� °r �� of Federal funds and enter in Column (�
B, C, and D shouid provide the budget for the first budget �8mount of the increase a d�crease of noo-Federal fund4. In
period (usually a yeac) and Section E should present the nad Column (g) enter the new total budgetcd amount (Ftdcral and
for Federal assistance in the subsequent budget periods. All non-Federal) which includes the tota( previous authorized
appiications should contain a breakdown by the object ctass budgeted amounts plus or minus; as appropriatt, the amounts
categories shown in Lines a-k oE Section B. shown in Columns (e) and (�. Thc amount(s) in Column (g)
should not equal the sum oF amouncs in Columns(e)and(Q.
Section A.Budget Summary Lines 1-4 Columns(a)and(b)
For applications pertaining to a single FedCral grant program Line 5—Show the totals for all columns uscd.
(Federal Domestic Assistance Catalog number) and no[
requiring a funccional or activity br�calcdown, entu on Line 1 Section i3 Budget Categories
under Column (a) the catalog program title and the catalog
number in Column(b). In the column headings (1) through (4)� enter the tides of the
same programs, funcrions, and activides shown on Lincs 1-4,
For applicadons pataining to a single program rrqr�iring budget Column (a),Section A.Whrn additional sheets.arz pr�arrd for
amounts by multiple functions or activiaes, enter the name of Section A,provide similar column tx.adings on each sha� For
each acvviry or function on each line in Column (a),and enter pch program,funetion or acdvity, fill in the total requirunenu
the catalog number in Column(b).For applications pertaining to for funds (both Federal and non-Federal) by object class
multiple programs where none of the programs require a
breakdown by function or activity, enter the catalog progtam ��g°��'
citle on each tine in Co(wnn (a) and the respective catalog Lina 6a-i--Show the taals of Lines 6a to 6h in each column.
number on each line in Column(b),
Lint 6j -Show the amoant of indiroct cost.
For a�plicadons percaining to ,r�,iltiple programs where one or
more programs requiie a bneakdown by function or activity, Line 6k -Entes the t,otal o(amo�nts on Lines 6i and 6j.For all
prepare a separate sheet for each program requiring the applications for new grantt and continuadon grants the total
breakdown. Addidonal shoeu should be used when one focm amount in cdumn (�,line 61c,should be the same as the ootHl
does noc provide adec�uau space for all brcakdown of data amount shown in Section A, Column (g), Lint S. For
required. However, when more than one sheet is used, the first supplemental grants and changes to grancs, ihe tntal amount of
page should provide the summary totats by programs. the increase or decrease as shown in Columns (1)-(4), Line 6k
shouid be the same as the sum of the amounts in Sxtion A,
Lines 1-4,Columns{c)through(g) Columns(e)and(�oo Line 5.
For ncw applications, leave Columns (c) and (d) blank. For Line 7 -Enter the estimaoed amount of income,if any,ezpected
each line enuy in Columns(a)and(b),entcr in Columns(e),(�, to be generated from this projoct. Do not add or subvact this
and (g) the appropriate amounts of funds needed to support tt�c amount from the total project amounc_ Show unda the program
pmject for the first funding paiod(usually a year).
SF 424A(Rev.4-92) Page 3
i iNSTRUCTIONS FOR THE SF-424A �continued)
' narrative statement the nature and source of income. The Line 15-Enter the totals of amounu on Lines 13 and 14.
� estimated amount of program income may be considered by the
� Federal grantor agency in determining the total amount of the Sectio� E. 8udget Estimates of Federai Funds fYeeded for
��_ Balance of the Project
Section C.Non-Federal Resources L+nes 16-19-Enter in Column(a)the same grant program tides
shown in Column (a), Sectior� A. A brealcdown by function or
_Lina 8-11 Enecr amouncs of non-Federal rzsour�es that will be activiry is not nect,ssary.For n�w app�cadans and conUnuation
used on the grant. If in-Idnd contributions are included, provide grant applications, enter in the proper columns amounts of
a brief ezplanaaon on a separaee shx� Federal funds which will be nceded to comptete the program or
Colmm� e Enter the ProJxt over the succuding funding periodq (usuallY in Years).
( )- program tides identical w This sxtion need not be completed for revisions (amendments,
Column(a),Section A. A brcakdown by function or changes, or supplements) to funds for the current year of
activity is not nxcssary.
ezisting gran�.
Column(b)-F�r►ter the contribution to be made by If more than fout lines are ncedcd co list the program titics,
the applicant. submit additional schedules as neccs.sary.
Column(c)-Enter the amount of the State's cash �
and in-kind con�ibution if the applicant is not a State Line 20 - Enter the tota! for each oF the Columrt4 (b){e).When
additional schedules are prepared for this Section, annotate
or Stace agency. AppGcants which are a State or �����g�y�d show the ovcsall totals on this line.
State agencies should leave this co�umn blank.
Colomn(d)-Eattr the amount of cash and in-kind Sectbn F.Other Budget Informatan
cona-ibutions oo be made from all other sources. Line 21 -Use thu space to exp�ain amounts for individual dirut
Column(e)-Enter totals of Columns object-class cost categorias that may eppcar eo be out of the
(b),(c),and ordinary or to ezplain the details as required by the Federal
�d�� grantor agency.
Line 12—Enter the total for each of Columns (b)-(e). The ,. ���t 22 _ 6nter the type of indirect rate (provisional,
amounr in Column(e)should be equat to the amount on Line 5,
Column(�Section A. P��«nined. final or fixed) that will be in effxt during the
funding period. the atimated arnount of the base to which the
Sectioe D. Forecaaoed C�h Needs rate is appiied,and the total indirect ezpense.
Line 13- Enxr the amo�mt o(cash neoded by quarter from the Line 23- Provide any othcr explanation�pr o�mments deemed
Sraneor agency during the first year, necessary.
Line 14 - Ent�r the amount of cash from all other sources
nxded by quarter during the 6rst year.
SF d21A(Rev.4-92) Page 4
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r. N P1 � � tC h m OI O � N Pf � N 10 � S
INSTRUCTIONS FOR TNE SF 424C
Public repocting burden fa this cotlection of infocmation is estirr�atM ro averagn 180 minutes per��irKluding tirne for
reviewing inswctions, searching existing da�a sourc�s, gathering �nd maintaining the data rteaded, ac� cc�replcting ind
reviewing the collxtion of information. Send comments regarding �h�bub�estimate or any aha sspect af this�co[ixtion of
information, includidg suggestioru for reducing this burdcn, ro the Office of Management and Budge� Psperworlc Reduction
Projxt(0348-0041),Wathington.DC 20503.
PLEASE DO NOT RETURN YOUR COMP[.E'TED FORM TO THE OFFICE OF MANAGEMENT AND BUDCET,
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSOR[NG AGENCY.
This shat is to be usui for the following types of applications: (1) "New" (means a new (previous linfu�] a�istance
award):{2) "Continuation"(mearu funding in a succxding budget period whicii sttmmed frorn a prior agretm�nt to fund);and
(3) "Revistd" (means any changcs in the Frderal government's Finux.iaJ obligations or contingent liability from nn ezisting
obligation). If thcrz is no change in the award amount there is no need to complete this form. Certain Federai ag�encies may
rcquire only an ezplanetory letta to the effect minor (no cost) chang�s. If you have questions please contact the Federsl
agency.
Colu,nn a.—If this is an application for a "New" project, I.ine 4—Enter estimated basic engineering fets rtlated to
cncer the total estimated cost of each of the items lisu� on consuuction (this includes start-up services and preperation
lines 1 through 16 (as applicable) under "COST of project performanct work plan).
C1.ASSIFICATIONS."
Line S—Enter estimaoed eriginecring costs, such as surveys,
If this application entails a change to an ezisting award, tests,soil borings,otc,
enter the eligible amounW approv�d under rhe previo�s
awa.d for the items unda"COST CLASSIFICATION." Line 6—Enter estimated engineering inspection costs.
Column b-1f this is an application for a "New" project, Line 7—Enter estimated costs of site preparation and
enter that portion of the cost of �acfi item in Column a. restoralion which are not included in the basic construction
which is nor allowable for Federa] assistance. Contact the convact.
Federal agency for assistance in determining the
allov�ability of spccific costs. Line 9—Enter esumated cost of ihe consaucaon conQact.
If this application entails a change to an eaisting award, Line IQ—Enter estimated cost of office, shop, laboratay,
entu the adjustment ( +a(-j) to the previously approved saiety equipment,etc. to be used at the facility, if such coscs
cos[s(from column a.)retlected in this application. are not includad in the construction contract
Co(u,nn c—This is the net of lines 1 through 16 in columns Line 11—�nter estimat�d misc�llaneous costs.
•.a."and.�b•.
Line 12—Total of items 1 thougfi 11.
Line 13 —Enter estimated contingency costs. (Consult the
Line 1—Enter estimated amounts needed to cover Federal agency for the percentage of the estimated
administrative ezpenses. Do not include costs which are constn�ction cost ro use.)
�lated co the norma] funcdons of governmenG Allowable
legal costs are generally only those associated with the Line 14—Enter the rotal of li�es 12 and 13.
purchase of land which is allowable for Federal
P���peuon and catain services in suppon of conswcaon Line LS—Enter estimated progtam income to be earned
of the project durin the nt
8 S� P�nod.e.g..salvagcd macerials.etc.
Line 2—Enter estimated site and right(s)-of-way Line 16—Subtract line 15 from line 14.
acquisition costs (th�s includes purchase, lease, and/or
�����' Line 17—This block is fa the computation of the Federal
sharL. Muluply the cotal allowable projoct cosu from tine 16,
Line 3—Enter esamated cosu related to relocation advisory column"c."by the Ftderal percentage share(this may be up
assistance, replacement housing, relocation payments to to 100 percent; consult Federal agency for Federal
�SP�°d P��ns and businesses,etc. percentage share)and enter the product on line 17.
SF<2lC (Aw.4-92)Baek
ATTACHMENT C: Guidance for Preparing the Program Narrative
The purpose of the program narrative is to provide a brief description of the need,
objectives, method of accomplishment, the geographical location of the project and the
benefits expected to be obtained from the assistance in support of the Memorandum of
Agreement.
This document outlines the need for the program and its projected outcomes in addition
to the information contained in the attached forms.
Grantees shall submit a program narrative that includes:
OBJECTIVES AND NEED FOR TAIS ASSISTANCE:
• Identify the vulnerabilities to your community from natural hazards. These may
include physical, economic, social, financial and institutional wlnerabilities.
• Demonstrate the need for assistance and state the principle and subordinate objectives
ofthe project. Describe how this project will lead to integrating mitigation into
sustained community activities.
RESULTS OR BENEFITS EXPECTED:
� Describe how the proposed actions will lead to building a disaster resistant
community. Identify anticipated results and benefits to be derived.
APPROACH:
� Outline a plan of action pertaining to the scope and detail of how the proposed work
will be accomplished in support of the Memorandum of Agreement.
• Cite factors for taking this approach as opposed to others and note any factors that
might accelerate or decelerate the work.
• Describe any unusual features of the program such as design or technological
innovations, reductions in cost or time, or extraordinary social and community
involvement.
• Provide for each function or activity, project milestones of projected
accomplishments. This may include project completion dates, number of people or
structures affected, and the geographic area served.
• When accompiishments cannot be quantified by activity or function, such as public
awareness activities, list them in chronological order to show the schedule of
accomplishments and their target dates.
• Explain the methodology that will be used to determine if the needs identified and
discussed are being met. Discuss the criteria to be used to evaluate the results and
- successes of the project and identify the kinds of data to be collected and maintained.
• List each organization, cooperator, consultant, or other key individuals who will work
on the projects directly associated with this funding along with a short description of
the nature of their effort or contribution.
Supporting documentation or other testimonies may be used. Any relevant data based on
planning studies should be included or footnoted.
GEOGRAPHIC LOCATION:
• Give the community or multi jurisdiction area to be served by the project or activity,
and, if applicable, the specific location of a project.
NOTE TO APPLICANT:
� Between�the required performance reporting�dates, events may occur that have significant
impact upon the program. In such instances, the grantee shall inform the PM and the
Regional Contracting Officer as soon as the following types of conditions become
known:
1. Problems, delays, or adverse conditions that will materially affect the ability
to attain program objectives or prevent the meeting of time schedules. This
disclosure shall be accomplished by a statement of the action taken, or
contemplated.
2. Favorable developments or events that enable time schedules to be met sooner
than anticipated.
� FEDERAL EMERGENCY MANAGEMEIYT AGENCY
NARRATIVE STATEMENT OMB No.3067.pypg ,
PAPERWORK BURDEN DISCLOSURE NOTICE � �r�Se tembe�30, �9yg
"Public repoRing burden for this foRn is esGmated to average 42 hours per response. The burden estimate includes the time for reviewing
instructions,searching existing data sources,gathering and maintaining the data needed,and completing,reviewing,and submitting the
form. Send comments regarding the accuracy of the burden estimate and any suggesiions for reducing the burden to: Infortnation
Collections Management,Federal Emergency Management Agency,500 C Street,SW,Washington,DC.
�• � PROGRAM NARRATNE STATEMENT � pERFORMANCE REPORT NARRATNE
2. PROGRAMS - 3. GRANTS � 4. COOPERATNE AGREEMENTS
� Preparedness � pA � Legal.Services � SLA 100 � CAPSSSE
� Mitigation � IFG � Fire Suppression � SLA 50 w/o EOC � Mqp
� Response � CC � Disaster Fiousing � SLA 50 w/EOC � FMA PL
� Recovery � DUA � DRCG(Project Impact) � qT�(' � FMA TA
� HMGP � DRCG(State Funds) � NAPI � FMA PJ
❑ Cora Brown � SARA � CSEPP w/o EOC
� DPIG � CSEPP w/EOC
� NDSP
5, RECIPIENT 6. REPORTING PERIOD 7. CONTROL NUMBER(S)
8. PERFORMING ORGANIZATION
9. NARRATIVE STATEMENT
A. Obiectives and Need•
B. Results or Benefit:
C• Aoproach:
D. Geoqraohic Location-
FEMA Form 20-22,MAY 98 pREVIOUS EDITlONS OBSOLETE
�Ns�UcnoNs
FEMA Form 20-22� Narrative StatemeM, is to be used as the header sheet and completed once. A sepacate FEMA
Form 20-22 is not to be prepared for each program� each activity. each task o�eact�project.
1. Check appropriate box Chedc Program Narrative Statement if submiftin�with application. Chedc
Performance Report Narrative if submitting with outJay reporL If the �arrative statemertt wi(1 not frt on
FEMA FoRn 20-22, continue the narrative statement on an attachment s` �� �
� i ,.�:,_ _..., ,.,....���
developed. ' �
2 Check applicable program(s)being repo�ted on in this submission.
3_ Chedc all applicable grarrts contributing funds. - .
4. Checic all applicable cooperative agneemerrts or disaster grarrts contn'buting funds.
5. Enter name of recipiertt
6. Errter reporting period.
7. Errter control number(s)�if applicable.
8. Errter nane of perfortning or�ganization, if othet than�cipierrt.
FEDERAI EMERGENCY MANAGEMENT AGENCY O.M.� No. 3067-0206
SUMMARY SHEET FOR ASSURANCES AND CERTIFICATIONS Expii�s✓une 30, 1998
FOR CA FOR lName of Stete/
FY 199
This summary sheet includes Assurances and Certifications that must be read, signed, and submitted as a parc of the Application
for Federal Assistance. �
An applicant must check each item that they are certifying to:
Part I ❑ FEMA Form?A-16A Assurances-Nonconstrucrion Programs
Part II � FEMA Form 20-16B Assurances-Construction Programs
Part III � FEMA Form 20-16C Certification Regarding Lobbying;
Debarment, Suspension, and Other Responsibility
Matters; and Drug-Free Worl�lace Requirements
Part IV � SF LLL Disclosure of Lobbying Activides (If applicable)
As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the identified attached
assurances and certi5cadons.
'Iypod Name of Authoriud Rep:escnutive Tide
Signaturo of Autho:ized Reprssenutive Date Signed
NOTE: By signing the certifica6on regarding debarment, suspension, and other responsibiliry matters for primary covered
transaction, the applicant agrees that, should the proposed covered transaction be entered inw, it shall not Imowingiy enter inw any
lower der covered tran.Sacdon with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from
participation in this covered transaction, unless authorized by FEMA entering into this transaction.
The applicant further agrees by submitting ihis application that it will include the clause titled "Certification
Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-I.ower Tier Covered Transacdon,' provided by the
FEMA Regional Office entering into ttus covered uansacdon, without modification, in ali lower der covered transactions and in all
solicitations for lower tier covered aansactions. (Refer to 44 CFR Part 17,)
Pape�nrork Burden Disclosure Notice
'Pubiic �eporting burden for this form is esiimated to average 1.7 hours per�esponse. The bu�den estimate inciudes
the time fo��eviewi�g insuuctions, searching existin� data sources, gatherine and maintaining the data needed, and
completing, reviewing, and maintaining the data needed, and completing and submittinp the form. Send comments
regardi�g the accuracy of the bu�den estimate and any suggestions for reduci�g the burden to: Informatio� �
Collections Management, Federal Emergency Management Agency, 500 C Sveet, SW, Washington DC 20472.'
�nna,F«m 2a�s,JUL 95
FEDERALEMERGENCY MANAGEMENT AGENCY
ASSURANCFS-NON-CONSTRUCTION PROGRAMS
Note: Certain of these assurances may not be applicable to your project or program. [f you have any questions,please
contact the awarding agency.Further,certain Federa!awarding agencies may require applicants to certify to
additional assurances. If such is the case,you wil!be not,ified.
As the duly authorized representative of the applicant, I certify that the applicant:
1. Has the legal authority to apply for Federal assisl,ance, as amended, relating to nondiscrimination in the sale,
and the instituLional, managerial and financial capability rental or financing of housing; (i) any other
(inrluding funds sufjccient to pay the non-Federal share oj nondiscrimination provision in the specific statute(s)
project costs) to ensure proper planning, management and under which application for Federal assistance is being
completionoftheprojectdescribedinthisapplication. made; and (j) the requirements of any other
nondiscrimination statute(s) which may apply to the
2. Will give the awarding agency,the comptroller application.
General oF the United States, and if appropriate, the State,
through any suthorized representative, access to and the 7. Will comply,or has already complied,with the
right to examine all records, books, papers, or documents requirements of Title I1 and III of the Uniform
relaLed to the award;and will establish a proper accounting Relocation Assistance and Real Property Acquisition
system in accordance with generally accepted accounting Policies Act of 1970(P.L.91-646)which provide for fair
standards or agency directives. and equitable treatment of persons displaced or whose
property is acquired as a result of Federal or Federally
3. Will establish safeguards to prohibit employees from assisted programs. These requirements apply to all
using their positions for a purpose that constitutes or interest in real property acquired for project purposes
presents the appearance of personal gain. regardless of Federal participation in purchase.
�. Will initiate and complete the work within the 8. Will comply with provisions of the Hatch Act(5
applicable time frame after receipt of approval of the U.S.C. Sections 1501-1508 and 7324-?328) which limit
awarding agency. the political activities of employees whose principal
employment activities are funded in whole or in part
5. Will comply with the Intergovernmental Personnel with Federal funds.
Act of 1970 (42 U.S.C.Section 4727-4763) relaLing to
grescribed standards for merit systems for programs funded 9. Will comply,as applicable�with the provisions of
under one of the nineteen statues or regulations spec�ed in the Davis-Bacon Act(40 U.S.C.Sections 276a to 276a- �
Appendix A of OPM's Standards for a Merit System of 7), �e �pe]and Act (40 U.S.C. Section 276c and 18
Personnel Administrataon)5 C.F.R. 900,Subpart F). U.S.C. Sections 874), and the Contract Work Hours
and Safety Standards Act(40 U.S.C.Sections 32?-333),
6_ Will comply with all Federal statutes relating to regarding labor siandards for federally assisLed
nondiscrimination.These include but are not limited to: (a) ���ction subagreements_
Title VI of the Civil Rights Act of 1964(P.L. 88-352) which
prohibits discrimination on the basis of race, color� or 10. Will comply,if applicable with flood insurance
national origin;(b) Title IV of the Education Amendments purchase requirements of Section 102a of the Flood
of 1972, as amended (20 U.S.C. Sections 1681-1683, and Disaster Protection Act of 1973 (P.L. 93-234) which
1685-1686), which prohibits discrimination on the basis of requires recipients in a special llood hazard area to
sex; (c) Section 504 of the Rehabilitation Act of 1973, as participate in the program and to purchase flood
amended (29 U.S.C. Section 794), which prohibits insurance if the total cost of insurable construction and
discrimination on the basis of handicaps; (d) the Age acquisition is$10,000 or more.
Discrimination Act of 1975, as amended (42 U.S.C.
Sections 6101-6107), which prohibits discrimination on the
basis of age; (e)the Drug Abuse ORce and Treatment Act of
1972 (P.L. 92-255), as amended, relating to
nondiscrimination on the basis of drug abuse; (� the
Comprehensive Alcohol Abuse and Alcoholism Prevention,
Treatment and Rehabilitation Act of 1970 (P.L_ 91=616),as
amended, relating to nondiscrimination on the basis oC
alcohol abuse or alcoholism;(g)Sections 523 and 527 of the
Public Health Service Act of 1912 (42 U.S_C. 290�Id-3 and
290 ee-3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the Civil
Rights Acts of 1968 (42 U.S.C.SecLion 3601 et seq.),
fEMA Form 20-16A,JUN 9A
11. Will comply with environmental standards which 15. Will comply with the Laboratory Animal Welfare
may be prescribed pursuant Lo the following: (a? Act of 1966 (P.L. 89-544, as amended, ? U.S.C. 2131 et
institution of environmental quality control measures seq.) pertaining to the care, handling, and treatment of
under the National Environmental Policy Act of 1969 warm blooded animals held for research. teaching, or
(P.L. 91-190) and Execntive Order (EO) 11514; (b) other activities supported by this award ofassistance.
notification of violating facilities pursuant to EO 11738;
(c) protection of wetlands pursuant to EO 11990; (d) 16. Will comp]y with the Lead-Based PaintPoisoning
evaluation of flood hazards in floodplains in accordance Prevention Act (42 U.S.C. Sections 4801 et seq.) which
with EO 11988; (e) assurance of project consistency with prohibits the use of lead based paint in construction or
the approved State management program developed rehabilitation of residence structures.
under the Coastal Zone Management Act of 1972 (16
U.S.C. Sections 1451 et seq.); (� conformity of Federa] 17. Will cause to be performed the required financial
actions to State (Clear Air) Implementation Plans under and compliance audits in accordance with the Single
Section 176 (c) of the Clear Air Act of 1955, as amended Audit Act of 1984. '
(42 U.S.C. Section et seq.); (g) protection underground
sources of drinking water under the Safe Drinking Water 18• Will comply with all applicable requirements ofall
Act of 1974,as amended, (P.L. 93-523);and (h) protection other Federal laws, executive orders, regulations and
of endangered species under the Endangered Species Act Policies governing this program.
of 1973,as amended,(P.L.93-205).
19. It will comply with the minimum wage and
12. Will comply with the Wild and Scenic Rivers Act of maximum hours provisions of the Federal Fair Labor
1968 (16 U.S.C. Sections 1271 et seq.) related to Standards Act(29 U.S.C.201),as they apply to employees
protecting components of the national wild and scenic af institutions of higher education,hospitals,and other
rivers systems. non-profit organizations.
13. Will assist the awarding agency in assuring
compliance with Section 106 of the National Historic
�reservation Act of 1966,as amended(16 U.S.C.470),EO
11593 (identification and protection of historic
properties), and the Archaeological and Historic
Preservation Act of 1974(16 U.S.C_469a et seq.).
14. Will comply with P.L. 93-348 regarding the •
�rotection of human subjects involved in research,
development, and related activities supported by this
award of assistance.
FEDERALEMERGENCY MANAGEMENT AGENCY
ASSURANCES-CONSTRUGTION PROGRAMS
NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please
contact the Awarding Agency. Further, certain federal assistance awarding agencies may require applicants to
certify to additional assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant:
1. Has the legal authority to apply for Federal 9. Will comply with the Lead-Based Paint Poisoning
assistance,and the institutional,managerial and financial Prevention Act (42 U.S.C. Sections 4801-et seq.) which
capability (inc[r�ding funds s�cfftcient to pay the non- prohibits the use of lead based paint in construction or
ederal share oj project cost) to ensure proper planning, rehabilitation of residence structures.
management, and completion of the project described in
this application. 10. Will comply with all Federal statutes relating to
non-discrimination. These include but are not limited to:
2. Will give the awarding agency,the comptroller (a) Title VI of the Civil Rights Act of 1964 (P.L_ 88-352)
General of the United States,and if appropriate,the State, which prohibits discrimination on the bases of race, color
through any suthori`zed representative, access to and the or nationa] origin; (b) Title IX of the Education
right to examine all records, books, papers, or documents Amendments of 1972, as amended (20 U.S.C. Sections
related to the assistance; and will establish a paper �1681-1683, and 1685-1686) which prohibits
accounting system in accordance with generally accepted discrimination on the basis of sex; (c) Section 504 of the
accountingstandardsoragencydirectives. Rehabilitation Act of 1973, as amended (29 U.S.C.
Section ?94) which prohibits discrimination on the basis
3. Will not dispose of, modify the use of,or change the of; (d) the Age Discrimination Act of 1975, as amended
terms of the real property title,or other interest in the site (42 U.S.C. Sections 6101-61-7) which prohibits
and facilities without permission and instructions from discrimination on the basis of age; (e) the Drug Abuse
the awarding agency. Will record the Federal interest in Off`ice and Treatment Act of 1972 (P.L. 93-255), as
the title of real property in accordance with awarding amended, relating to non-discrimination on the basis of
agency directives and will include a covenant in the title of drug abuse; (fl the Comprehensive Alcohol Abuse and
real property acquired in whole or in part with Federal Alcoholism Prevention, Treatment and Rehabilitation
assistance funds to assure nondiscrimination during the Act of 1970 (P.L. 91-616), as amended, relating -to
� useful life of the groject. � � nondiscrimination on the basis of alcohol abuse or
alcoholism;(g)Sections 523 and 52'7 of the Public Health
4. Will comply with the requirements of the assistance ��ce Act of 1912(42 U.S.C. 290 dd-3 and 290 ee-3),as
awarding agency with regazd to the drafting, review and a�ended, relating to confidentiality of alcohol and drug
approval of construction plans and specifications. abuse patient records; (h) Title VIII of the Civil Rights
Act of 1968 (42 U.S.C. Section et seq.), as amended,
5. Will provide and maintain competent and adequate relating to non-discrimination in the sale, rental or
engineering supervision at the construction site to ensure �ancing of housing; (i) any other non-discrimination
that the complete work conforms with the approved plans provisions in the specific statutes(s) under which
and specifications and will furnish progress reports and application for Federal assistance is being made, and (j)
such other information as may be required by the the requirements on any other non-discrimination
assistance awarding agency or state_ Statute(s)which may apply to the application.
6. Will initiate and complete the work within the 11. Will comply,or has already complied,with the
applicable time frame after receipt of approval of the requirements of Title II and III of the Uniform Relocation
awarding agency. Assistance and Real Property Acquisition Policies Act of
7. Will establish safeguards to prohibit employees from 1970 (P.L. 91-646) which provides for fair and equitable
treatment of persons displaced or whose property is
using their positions for a purpose that constitutes or acquired as a result of Federal and Federally assisted
presents the appearance of personal or organizational Programs. These requirements apply to all interests in
conflict of interest,or personal gain_
real property acquired for project purposes regardless of
8. Will comply with the Intergovernmental Personnel F�eral participation in purchases.
Act of 1970 (42 U.S.C. Sections 4728-4763) relating to 12. Will comply with the provisions of the Hatch Act(5
prescribed standards for merit systems for programs U.S.C. Sections 1501-1508 and 7324-7328) which limit
funded under one of the nineteen statutes or regulations the political activities of employment activities are
specified in Appendix A of OYM's standards for a Merit funded in whole or inpart with Federal funds_
System of Personnel Administration (5 C.F.R. 900-
subpart F).
FEMA Fo�m 20-168,JUN 94
13. Will comply,as applicable,with the provisions of 20. It will comply with the minimum wage and
the Davis-Bacon Act (40 U.S.C. Sections 276a to 276a-7), malcimum hours provisions o£ the Federal Fair Labor
the Copeland Act (40 U.S.C. Section 276c and 18 U.S.C. Standards Act(29 U.S.C.201),as they apply to employees
Section 874), the Contract Work Hours and Safety of institutions of higher education, hospitals, and other
Standards Act (40 U.S.C. Sections 327-333) regarding non-profitorganizations.
labor standards for Federally assisted construction
subagreements. - 21. It will obtain approval by the appropriate Federal
agency of the final working drawings and specifications
14. Will comply with the flood insurance purchase before the project is advertised or placed on the market
requirements of Section 102(a) of the Flood Disaster for bidding; that it will consult the project, or cause it to
Protection Act of 1973 (P.L. 93-234) which requires be constructed,to final completion in accordance with the
recipients in a special flood hazard area to participate in application and approved plans and specifications; that it
the program and to purchase flood insurance in the total will submit to the appropriate Federal agency for prior
cost of insurable construction and acquisition is $ 10,000 approval changes that alter the cost of the project, use of
or more_ space, or functional layout, that it will not enter into a
construction contract(s)for the project or undertake other
15. Will comply with environmental standards which activities until the conditions of the construction grant
may be prescribed pursuant to the following: (a) program(s)have been met.
institution of environmental quality control measures
under the National Environmental Policy Act of 1969 22. It will operate and maintain the facility in
(P.L. 91-190) and Executive Order (EO) 11514; (b) accordance with the minimum standards as may be
notif`ication of violating facilities pursuant to EO 11738; required or prescribed by the applicable Federal, State,
(c) protection of wetlands pursuant to EO 11990; (d) and local agencies for the maintenance and operation of
evaluation of flood hazards in floodplains in accordance such facilities.
with EO 11988; (e) assurance of project consistency with
the approved State management program developed under 23. lt will require the facility to be designed to comply
the Coastal Zone Management Act of 1973 (16 U.S.C. with the "American Standard Specifications for Making
Sections 1451 et seq.); (fl conformity of Federal actions to guildings and Facilities Accessible to, and Useable by,
State (Clean Air) Implementations Plans under Section �e Physically Handicapped," Number A117. -1961, as
176(c)of the Clean Air Act of 1955,as amended(42 U.S.C. modified (41 CFR 101-17.703). The applicant will be
Section?401 et seq.);(g)protection of underground sources responsible for conducting inspections to ensure
of drinking water under the Safe Drinking Water Act of compliance with thEse specifications by the contractoi•.
1974, as amended, (P.L. 93-523); and (h) protection of
endangered species under the Endangered Species Act of 24. If any real property or structure thereon is provided �
1973,as amended,(P.L.93-205). or improved with the aid of Federal financial assistance
extended to the applicanl, this assurance shall obligate
16. Will comply with the Wild and Scenic Rivers Act of the applicant, or in the case of any transfer or such
1968(16 U.S.C. Sections 1271 et seq.)related to protecting property, any transfer, for the period during which the
components or potential components of the national wild real property or structure is used for a purpose for which
and scenic rivers system. the Federal financial assistance is extended or for
another purpose involving the provision of similar
17. Will assist the awarding agency in assuring services or benetits.
compliance with Section 106 of the Naf,ional Historic
Preservation Act of 1966,as amended (16 U.S.C. 470), EO 25. In making subgrants with nonprofit institutions
11593 (identification and preservation of historic under this Comprehensive Cooperative Agreement, it
properties), and the Archaeological and Historic agrees that such grants will be subject to OMB Circular
Preservation Act,of 1974(16 U.S.C_46s-1 et seq.). A-122,"Cost Principles for non-profit Organization"
including in vol. 49, Federa] Register, pages 18260
18. Will cause to be performed the required financial through 18277(Apri127, 1984).
and compliance audits in accordance with the Single Audit
Act of 1984.
19. Will comply with all applicable requirements of all
other Federal laws, Executive Orders, regulations and
policies governing this program.
FEOERALEMERGENCY MANAGEMENT AGENCY
CERTIFIGAT10N5 REGARDING LOBBYING;DEBARMENT,SUSPENSION AND
OTHER RESPONSIBIIITY MATTERS;AND ORUG-FREE WORKPLACE REQUIREMENTS
Applicants should refer to the regulations cited below to determine the certification to which they are required to attest.
Applicants should also review the instructions for certification included in the regulations before completing this form.
Signature of this form provides for compliance with certification requirements under 44 CFR Part 18,"New Restrictions
on Lobbying"and 28 CFR Part 17,"Government-wide Debarment and Suspension(Nortprocurement)and Government-
wide Requirements for Drug-Free Workplace(Grants)." The certifications shall be treated as a material representation
of fact upon which reliance will be placed when the Federal Emergency Management Agency (FEMA) determines to
award the covered transaction,grant,or cooperative agreement.
1.LOBBYING obtaimng,attempt�ng to obtain,or perform a public(Federal,State,
or lotal)t�ansaction or contract under a publit transaRion;violation
As�equired by sedion 1352,Title 31 of the U.S.Code,and of Federal o�State ant�trust statutes or commission of
impleme�ted at 44 CFR Part 18,for persons entering into a embezzlement,theft,forgery,bribery,falsification or destruttion of
grant or cooperative agreement over S 100,000,as defined at records,maki�g false statemenu,or receiving stolen property;
44 CFR Part 18,the applicant certifies that:
(c)Are not p►esently�nd�cted for or otherwise criminally or civilly
(a)No Federal appropriated funds have been paid or will be paid,by or charged by a governmental entity(Federal,Siafe,or loca�with
o� behalf of the undersigned, to any person for �nfluencing or commiss�o�of any of the offenses enumerated in paragraph(t)(b}
attempting to �nfluence an officer or emptoyee of any agency, a ofthiscertif�cation;and
Member of Co�gress, an officer or employee of Congress, or an (d)Have not w�thin a three-year period preceding this application
employee of a Member of Congress in connection w�th the making of had one or more publ�c transact�ons(Federal,State,or local)
any Federol g�ant,the entenng�nto of any coope�atrve agreement,and term�nated for cause or default;and
the extens�on, tontinuat+on, renewal, amendment, or modif�wtion of
any Federal grant or cooperative agreement; 8.Where the appl�cant is unable to certify to any of the statemenu
in th�s certrficaUon,he or zhe shall attach a�explanation to this
(b)If any other funds than Federal approp��ated funds have been paid or applicat�on
wil!be paid to any penon for influenu�g or attempting to influence an
officer or employee of any agency,a Member of Congreu,an officer or
an employee of Congress, or employee of a member of Congress in
con�ect�on w�th th�s Federat grant or cooperat�ve agreement, the 3.DRUG•FREE WORKPLACE
undersigned shall tomplete and submit Standa�d Form-lll,'Disclosure �GRANTEES OTHER THAN INDIVIDUALS)
of Lobbying ACtivit�es,"in actorda�te with itt�nstructions; As requved by the Drug-Free Work place Ad of 1988,and
(c)The undersigned shall require that the language of this certification �mplemented at 44 CFR Part 17,Subpart F,for grantees,as defined
at 44 CFR Part 17 Sect�ons 17.615 a�d 17.620-
be �ncluded in the award documents for all subawards at all t�ers
(induding subgrants, contracts under granis and cooperative A.The appl�cant certifies that it will continue to provide a drug-
agreements,and wbcontracu)and that all wbreup�enu shall certify and free workplace by;
disclose accord��gly.
(a)Publishing a statement notifying employees that the unlawful
❑Standard Form-LLL'Disclosure of Lobbying Activities"attached. manufacture,distnbution,dispens�ng,possess�on,or use of a
tontrolled substance�s prohibrced�n the grantee's workplace and
(This form musc be attached to certific�iion ifnonappropriated funds Spe�ifying the act�o�s that will be take�aga�nst empfoyees for
are to be used to influence activitiez) violation of such proh�brtion;
2.DEBARMENT SUSPENSION AND OTHER (b)Establish�ng an on-going drug free awareness program to
• • inform employees about-
RESPONSIBIUTY MATTERS
(DIRECf RECIPIEN� (1)The dangers of drug abuse�n the workplace;
(2)The grantee's policy of ma�ntaining a drug-free work place;
As required by Execut�ve Order 12549,Oebarment and Suspension,and (3)Any ava�lable drug counseling,rehabilitat�on,and
implemented at 44 CFR Part 67,for prospective part�cipanu�n primary employee au�stance programs;and
tove�ed transactions,as defined at 44 CFR Part 17,Section 17.510-A. (a)The penalties that may be imposed upon employees for
The applicant certifies that it and its principals: drug abuse v�olatio�s occurrmg in the workplace;
(c)Making it a requ�rement that each employee to be engaged in
(a)Are not presently debarred,suspended,proposed for debarment, the perfo�mance of the g�ant to be given a copy of the statement
declared ineligible,sentenced to a denial of Federal benefits by a State required by paragraph(a);
or Federal court, or voluntariiy excluded from tovered transactions by
(d)Notifying the employee in the statement required by
any Federal department or agency; paragraph(a)that,as a condrtion of employment under the grant,
(b)Have�ot within a three-year penod p�eCeding this applitatio�been the employee w�ll-
convicted of or had a uvilian judgmeni rendered against them fo�
commiss�on of f�aud or a aiminal oifense�n connecuon with '
FEMA Form 20-16C,JUN 94 .
(1)Abide by the terms of the statement;and Place of Performance(Streei address,City,Counry,Siate,Zip code)
(2)Notify the em ployee in writing of h�s or her cooviction for a
violation of a triminal drug scatute otturring in the workplate no later
than five wlendar days after such convection;
{e)Notifying the agency,in v�rciting,within 10 talendar days after
receiving notice under wbparagraph(d)(2)from an employee or Check ❑ if there are workplaces on tile that are not identified here.
otherwise receiving actual not�ce of such conviRion.Employen of
convicted employees must provide notice,including positio�title,to the
applicable FEMA awarding office,i.e_,regional office or FEMA office. Section 17.630 of the regulations provide that a grantee that is a State
may elect to make one certification in each Federal fiscal year_A copy of
(�Taking one of the following actions,within 30 calendar days of �,�rhich should be included with each applicaUon for FEMA funding.
receiving notice under subparagraph(d}(2),with respecc to any employee States and State agenues may elect to use a state wide certification
who�s so convicted-
(1)Taki�g appropriate personnel action against such an employee.
up to and including termination,consistent with the requiremenu of the
Rehabilitaiion Act of 1973,as amended;or
(2)Requiring such em ployee to participate satisfactorily in a drug
abuse assistance or rehabilitation program approved for such purposes by
a Federal,State,or local heahh,taw enforcement,or other app�opriate
agency;
(g)Making a good faith effort to conti�ue to maintain a drug free
workplace through implementation of paragraphs(a),(b),(t),(d),(e),
and(f).
B.The grantee may insert in the space provided below the site(s)forthe
performance of work done in connection with the specific grant: .
DISCLOSURE OF LOBBYING ACTIVITIES np�by onae
Compiete this fonn to disdose lobbying act"rvities pursuant to 31 U.S.C. 1352 osas-ooas
See reverse for blic burden disdosu�e.
1.Type of Federal Action: 2 Status of Federal Action: 3.Report Type: .
�a contrad aa bid/offer/application � a. initial filing
b.grant b.initial award b.material change
a cooperative agreement c.post-award For Matertal Change Onfy:
d. loan year quartet
e. loan guarantee date of last rep�rt
f. loan insuranee
4. Name and Address of Reporting Entity: 5.ff Reporting Entity in No.4 is a Subawardee,Enter Name
❑P� ❑S++�w� and Address cf Prime:
Tier if Imown: �
Co� sional Distrlct, iflmown: Con ressfonal District, iflmown:
6. Federal OeparbnenVAgency: 7.Federal Program Name/Descriptlon: .
CFDA Numbe�, if applicable: .
8.Federal Actio�� Number, iflar�own: 9.Award Amount,iflvwwn: .
S
1Q a Name and Address of Lobbyfng Regfstrant . .b.Mdividuafs Performing�Services (induding address if� . .
(if indrvidual,last Rame, fitst name,Mn_ d�lfe�nt fram No. 10a)
(last name,fi�st name, Mn:
11.'''°'"'�'°"�.a�.a�v+.+�a��.�r�.a dr w r u.s.c.� Si ture: .
t]�. 71�Is 4adawM�d IobOyYq acti�ii�is a m�id wpnswrirlon a/1r3 9�
upa�vM�kll aino�s pl�c�d Oy M i�r abow vdMn Iliu 1�ns�ction wc e�
o..ir..a«�n Tis s.aow. ia nauk.a w...+b,11 u.s.a am n:. . . Pri�1t.Name:
YMo�nMfd�M b�w�po�hd b rr Cap�s w�i�rrr�ly and uA b�Mi�Ob 1or
a�� Mr v+�+�ws b w�n.war,.e arJonr.r.r a . TItIe:
�e1 r�d�Owrky d mt ho�=10A00�d na1 wn�Nan I1G4000 br
� .
��� - Telephone No.: pate:
; ,.,w , . .- _ S�;c y -. �_ .,�,szt� - ,. ��t,s��,..,,,����-�* .. ..; , 11�Ahorized tor Lacal Rep�ckic5o��
y�� - S-t'h���`'�
} - - ��`` ;�•� - Smndafd FOfRI l.lL' .7�
INSTRUCTIONS FOR COMPLETION OF SF-LLI,DISCLOSURE OF LOBBYING ACTIVITIES
This disdosure iortn shafl be oompleted by the reporting e�tity.rrheth�subawa�dee or p�ime Fsderat recipient,at the YY�i�tiation or�eceipt ot a aovered Fede�al
ac4on.or a roa�cnange so a Exe,aa,s�.pu�suant to title 31 U.S.C.sec.fio�1352.The fiGnp of a form is required(or each payment or agreeme�t�o�e
PaYm�b�Y�Yk►9 e^MY��9 or attemp6ng to kHtuerxa an offioer or emP���Y a9��Y.a Member of Ca�yress,an offioa or ertiployeeof
Co�press,or an employeeof a Memberof Conpness in oonnec.�onwith a oavered Federal actio�.Cample�e aq bems that apply for bolh f�e inl�iat Kncj and material
d�ange t�ort.Refer b the implemenf�9 9��P�bY tlie Offioa ot Managemerrt and Budget for addtional inio�mation.
�. id�may��or oo�ad�derar�o„fa wr,��o�y�,��ay�a�«n��n Se«ned a wn,�a�o�,��o�a�.�d���,.
z Ide�r ffie status ot the oovered Federal acbon.
3- �^�Y�aPP�'oP��dassificatf�on of tf�s report. If tl�is is a Idlowup raport caused by a matertat change lo the infonna5on PreviouslY reported.ente�
the yearand quarter in wtrich 1he chanpe ocarmed.En1e�the date of the last previousfysubmitted neport bjr tltis reportinp en6ty for this oovered Federat
actia�.
4. 6►�1he kiM name.address,dtY.State�nd rip oode cf the reportin9��Y-���D���astricf.if lu�owr�.G�edc 1he apQropriatedasslfication
d the reportin9 e�tY Ihat desiynates if ft is,or e�eats to be,a prime or subaward reapientldentitythe tier o(the subavrandee,e.g�fhe first subawardee
af the p�ime is 1he tst tier.Subawards incfude but ere�ot irnited�u wbcantracts.subgratrts and oo�Hrad awards w�der grants.
5. If tl�e organkation fil�p tl�e report in ltam 4 checks'Subavratdee,'H►en enter fhe fuU name.addte�s.dlY.State md rip cade of the prime Federal
recipient IncNde Conpress7a�a1 Oistrict,d ipww��. .
6 Enter the name d the Faderal aQerK,y maldrp 1he avrard or loan comntitrnent Indude at leazt aw aganira6o�llevel belowage�u.y name.H loww�.For
exart�P�e.�epartrneM of Trarupo�tion.Ur�iEed States Coast Guard. �
7.�1he Fede�l propram name a desaiption for the oovered Federal action('Aem 1).H�y e�the iur Catabg ot Federal Qomsstic Assistance
- (CFDN n�snber ior�.coopera6vs a9�eert�e�s.foarts.and ban coRunibme�. .
8.Entet 1he most appropriats Federal idaetityirg nurt�bsr tvaAadefor the Federal adlo�WentiGed in ifem 1 (e.�..Request fo�Proposal(RF��mber:
Ir„rltatlon for Bld(IFB) number;grant annoia�entant number;ths contract, qranf,or loan award number;1he appFcatiordproposal ootitrol nanber
ess�W�bY����►�.kKiude p�eft�oes,e.p.,'RFp-OE�3D-0Ol' .
9.For a oovered Federal action where 1he�e has been an arraid or bari oomnwOmerk by ths Federal apw�.y.on�the Federal anau�rt d the award�ban
ownmihr�ant br 1he prims entity ide�qified h item 4 or 5.
10.(�E�Mr rie tup�ame.address.cilf.Sta1s and ilp oods d the lobbyirp�egistrant under the Lobbying Oiacio�xs Ad d 1995 enpaysd bY���^9
e�ity Idenfified in item 4 b iMlua�oe�+e oovwed Federat actio�. � .
(b)6►�r sie fuM names or r,s i�drofdualcs�veA�xnw�p s�nices,and Y,aude fuN address M a�IFene�trom to�.EMar Last wme,Fusc Nan,e,and
�Aidde kwtial(�AI).
11.The oertl(yk�p ofGciel sha�slgn and date the torm.Print hlslfier name.�itle.and telephons nuntber
A000�g to 1he Paperwak Reduclion Acx as amended no ps�sons ars�equired tio�espo�d b a caectian of fnbnrtafon�it d�sptaps a v�Gd OMB(:on
tJurnber. The vaW OMB oontrol numbs�for this i�om�ation co0ection is OMB No.0348-004G. Pubic�eportlnp bwden tor 1Ftis aoNection d'ntom�ation is
estimated b ave�aye 10 minutes P��.�fl����9�.�W�data sour�.9atl�r�9 and mahtaininp 1he
needed.and compledn9 and�evievring the oopection o!adonna�on. Se��d comrt�enls�egandu�g the bwden estimate or arry dher aspect at lhis cotledion oi
info�rnatian.indudu�0 su�pes0ons tor reducirp tl�is bu�derti tn the Olf7oe ot Nlat►agenbntand 8ud9e�.Paperwak Reduction Projsd(0318'00167.Waswn9ton.
OC 205R3_
CERTIFICATION AND DISCLOSURE REGARDING PAYMENTS
TO INFLUENCE FEDERAL TRANSACTIONS
The undersigned certifies, to the best of his or her
knowledge and belief, that; ,
(1) No Federal appropriated funds have been paid or will be
paid, by or on behalf of the undersigned, to any person for
influencing or attempting to influence an officer or employee of
any agency, a Member of Congress, an officer or "employee of
Congress 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, and the extension,
continuation, renewal, amendment, or modification of any Federal
contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have
been paid, or will be paid to any person for influencing or
attempting to influence an officer or employee of any agency, a �
Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with this Federal
contract, grant, loan, or cooperative agreement, the undersigned '
shall complete and submit, Standard Form LLL, "Disclosure Form to
Report Lobbying,�� in accordance with its instructions.
(3) The undersigned shall require that the language �
certification be included in the award docwnents for all subawards
at all tiers (including subcontracts, sur�yrants, and. contracts •
under grants, loans, and cooperative agreements) and all
subrecipients shall certify ancl disclose accordingly.
This certification is a material representation of fact .upon
which reliance was placed khen this transaction wa:, made or entered
l:lt0_ �»�tnicclOTl Of �11� ^ertificatio;. 1� :i prerec�u�sl'_� f�r
�•.::�;cing .or entering i���.o this transaction imposed by section 13 52,-
Title 31, United States Code. Any person who fails tc file the
required certificati�n shall be subject to a civil penalt�� of not
less than $10,000, not more than $100,000, for each such failure.
ORGANIZATION NAME APPLICATION NUMBER
PRINTED NAME
SIGNATURE DATE