R-04-09-23-13D1 - 9/23/2004 RESOLUTION NO. R-04-09-23-13D1
WHEREAS, the Texas Department of Public Safety, Division of
Emergency Management has grant funds available to cities to assist in
developing and carrying out emergency management programs, and
WHEREAS, Emergency Management Performance Grant funds are
available to partially fund two Emergency Management Coordinator
personnel, and
WHEREAS, the City Council wishes to make application for the
above-described grant, Now Therefore
BE IT RESOLVED BY THE COUNCIL OF THE CITY OF ROUND ROCK, TEXAS,
That the Mayor is hereby authorized and directed to make the
necessary application for the above-described grant.
The City Council hereby finds and declares that written notice of
the date, hour, place and subject of the meeting at which this
Resolution was adopted was posted and that such meeting was open to the
public as required by law at all times during which this Resolution and
the subject matter hereof were discussed, considered and formally acted
upon, all as required by the Open Meetings Act, Chapter 551, Texas
Government Code, as amended.
RESOLVED this 23rd day of September, 2004 .
ELL, Mayor
City of Round Rock, Texas
CHRISTINE R. MARTINEZ, City Secr ary
@PFDesktop\::ODMA/WORLDOX/O:/WDOX/RESOLUTI/R409231)1.WPD/sc
Fiscal Year 2005
EMERGENCY MANAGEMENT PERFORMANCE GRANT(EMPG)
APPLICATION
PLEASE PRINT OR TYPE
1. APPLICANT NAME (Jurisdiction): City of Round Rock
2. COUNTY:Williamson 3. DISASTER DISTRICT: 6b
4. EMPG STATUS: [X] Current EMPG Program participant [ ] New EMPG Program applicant
5. PROGRAM PARTICIPANT: (List all jurisdictions that are participants in your emergency management
program. Identify any jurisdictions that have joined or withdrawn from your program in the last year.)
City of Round Rock only
6. CHECKLIST OF APPLICATION ATTACHMENTS: (See the FY 2005 Local Emergency Management Program Guide for
further information on completing these forms.)
[
X] Designation of Grant Officials(form DEM-17A)
[ X] Statement of Work&Progress Report(form DEM-176). This form should be signed by the EMC.
[
X] Application for Federal Assistance(form DEM-66). The Authorized Official should sign this form.
[ X] EMPG Staffing Pattern(form DEM-67).
[ X ] EMPG Staff Job Description(form DEM-68). An updated job description must be provided for each staff member listed
in the FY 04 EMPG Staffing Pattern who works less than 50 percent of their time in emergency management duties.
[ X] FEMA Form 20-16,Summary Sheet for Assurances&Certifications,must signed by an Authorized Official. Attach
FEMA Form 20-16A,Assurances—Non-Construction Programs&FEMA Form 20-16C,Certifications Regarding
Lobbying,Debarment,Suspension,&Other Responsibility Matters;and Drug-Free Workplace Requirements, to the
FEMA Form 20-16.
[ J If the applicant performs lobbying to influence federal actions,a completed Disclosure of Lobbying Activities(SF LLL)
must be completed and included in the grant application package.
[ Direct Deposit Authorization(form 74-146). The Grant Financial Officer should sign this form. If the jurisdiction has
been receiving EMPG reimbursements through Direct Deposit,a new Direct Deposit Authorization is not required.
[ X] Travel Policy Certification(form DEM-69). The Grant Financial Officer should sign this form.
7. CERTIFICATION: This A . ation together with the attached EMPG Statement of Work & Progress Report
(form DEM-17B) constitu the annual work plan for the emergency management program whose participants are
listed above. he n rsigned agree to exert their best efforts to accomplish all activities listed in the EMPG
S� me of Progress eport approved by the Division of Emerg cy Management.
rized Official Date Emergency Management Coordinator Date
si nature si nature
„ _ r DEM.USE ONLY
8. APPROVAL: The attached Fiscal Year 2005 EMPG Statement of Work&Progress
Report is approved.
[ ] State Coordinator Date
( ] Assistant State Coordinator
DEM-17
7/04
DESIGNATION OF GRANT OFFICALS
Grant Program FY 05 Emergency Management Performance Grant (EMPG)
Applicant Name City of Round Rock
h. ,.. .E Envier`'enc ;M , a` etrient Cporctinator ,,,; . .
Name [Xj Mr. Ms. Keith Tanner
Official 203 Commerce
Mailing Round Rock, TX 78664
Address
Daytime Phone Number 512-218-6632
Fax Number 512-218-5594
E-mail Address ktanner@round-rock.tx.us
Idu:...y.. u 3 Grath Flnt�Ctal,Officef ..,.
Name Mr. [X] Ms. Cheryl Delaney
Title Budget Supervisor
Official 221 East Main
Mailing Round Rock, TX 78664
Address
Daytime Phone Number 512-218-5445
Fax Number 512-218-5442
E-mail Address cdelaney@round-rock.tx.us
u. '. . _ . . Auethofizcaffic�al Ma ororCoun Jud c , g
Name X Mr. Ms. Nyle Maxwell
Title Mayor
Official 221 East Main
Mailing Round Rock, TX 78664
Address
Daytime Phone Number 512-218-5401
Fax Number 512-218-7097
E-mail Address mayor@round-rock.tx.us
DEM-17A
7-04
Fiscal Year 2005
EMPG STATEMENT OF WORK & PROGRESS REPORT
Pae 1 of 5
Applicant Name: City of Round Rock
This is our: X Statement of Work Progress Report#1 Progress Report#2
Submitted By Date DEM Review By Date
Statement of Work Keith Tanner 9/08/04
Progress Report#1
Progress Report#2
Task 1 Work Plan &Semiannual Progress Report
Work Plan X We will submit an EMPG Application, two Progress Reports, and quarterly Financial Reports.
Progress [ ] This Progress Report# 1 is being submitted to the GDEM Preparedness Section.
Report#1 First & Second Quarter Financial Reports have been submitted to GDEM Support Services.
Progress ( ] This Progress Report#2 is being submitted to the GDEM Preparedness Section.
Report#2 Third & Fourth Quarter Financial Reports have been submitted to GDEM Support Services.
Task 2 Legal Authorities for Emergency Management Program
Work Plan [X] We will maintain current legal documents establishing our emergency management program.
[X] Our legal documents are current&on file with GDEM; no additional action is required.
( ] We will prepare or update & submit to our Regional Liaison Officer:
[ ] Commissioner's Court Order
[ ] City Ordinance(s)for:
Updated Joint Resolution
Progress [ ] We completed &submitted to our Regional Liaison Officer:
Report#1 [ ] Commissioner's Court Order
[ ] City Ordinance(s)for:
Updated Joint Resolution
Progress [ ] We completed &submitted to our Regional Liaison Officer:
Report#2 [ ] Commissioner's Court Order
[ ] City Ordinance(s)for:
Updated Joint Resolution
Task 3 Public Education/Information
Work Plan [X] Option 1: We will conduct 30 hours of hazard awareness activities for local citizens.
OR
[ ] Option 2: We will prepare &distribute public education/information materials to a substantial
portion of the community. In the space below describe the materials to be distributed:
Progress [ ] We completed the following hazard awareness or public education/information activities:
Report#1
Progress [ ] We completed the following hazard awareness or public education/information activities:
Report#2
If you chose Option Z a copy of the materials you distributed must be attached to your Progress Report
DEM-17B
7/04
FY 2005 Page 2 of 5
Applicant Name: City of Round Rock
Task 4 Emergency Management Planning Documents
Work Plan [X] We have reviewed our emergency management plan & its annexes for currency.
[ ] We will develop or update by revision or change these planning documents:
( ] Basic Plan Annexes: [ ] A [ ] B [ ] C [ ] D [ ] E [ ] F [ ] G [ ] H ( ] I [ ] J
[ l K [ l L [ ] M [ l N [ l o [ l P [ l Q [ l R [ l S { l T [ l U ( l V
Other documents:
NOTE: Plans&annexes dated September 30, 2000, &earlier should be revised/updated this year.
Progress [ ] We developed or updated and submitted to our RLO the following documents, together with
Report#1 the appropriate planning standards checklists:
[ ] Basic Plan Annexes: [ ] A [ ] B [ ] C [ j D [ ] E ( ] F [ ] G ( ] H [ ] J
I l K [ ] L [ ] M ( l N I l o [ l P ( l Q [ l R [ l S [ l T ( ] U { ] V
Other documents:
Progress [ ] We developed or updated and submitted to our RLO the following documents, together with
Report#2 the appropriate planning standards checklists:
[ ] Basic Plan Annexes: [ ] A [ ] B [ ] C [ ] D [ ] E [ ] F [ ] G [ ] H [ ] I ( ] J
[ ] K [ ] L [ ] M ( ] N [ ] O [ ] P ( ] Q [ ] R [ ] S ( ] T [ ] U ( ] V
Other documents:
Task 5 Exercise Participation & Schedule
Work Plan [X] We will develop & submit a two year exercise schedule(below).
[X] We will conduct& report participation in a tabletop exercise and a functional or full-scale
exercise this fiscal year or obtain exercise credit for actual events for these exercises.
EXERCISE SCHEDULE
Period Exercise Tye Exercise Scenario * Quarter of Year
This Fiscal Year(FY 05) [X] Tabletop [ ] NH [ ] TH [X] NS [ ]TR P(]1 [ ] 2 [ ] 3 [ ] 4
(Oct. 2004—Sept. 2005) [XI Functional Full-Scale [X] NH [ TH [ INS TR 1 2 3 4
Next Fiscal Year(FY 06) L.LXJ Tabletop NH [ ]TH [ INS X TR 1 2 3 4
(Oct. 2005-Sept. 2006) 1 [XI Functional Full-Scale NH X TH NS TR 1 [X] 2 3 4
A Full-Scale exercise must be conducted every three 3 ears
Our last Full-Scale exercise was conducted on (date): Scenario*:
*Exercise Scenarios: NH = Natural Hazard, TH =Technological Hazard, NS=National Security, TR=Terrorism
—71
Progress [ ] We conducted a tabletop exercise and provided documentation to GDEM.
Report#1 [ ] We conducted a [ ] functional, [ ]full-scale exercise and provided documentation to GDEM.
[ ] We requested functional or full-scale exercise credit for an actual occurrence from GDEM
and our request was approved.
Progress ( ] We conducted a tabletop exercise and provided documentation to GDEM.
Report#2 [ ] We conducted a [ ]functional, [ ]full-scale exercise and provided documentation to GDEM.
[ ] We requested functional or full-scale exercise credit for an actual occurrence from GDEM
and our request was approved.
DEM-17B
7104
FY 2005 Page 3 of 5
Applicant Name: City of Round Rock
Task 6 Training for Emergency Management Personnel
Work Plan [X] EMPG-funded emergency management personnel will participate in the following training:
Position/Name Course Name(s)or Number(s)
1. EMC/Keith Tanner G290, G362
2. Ass't EMC/Mark Selby G202, G362
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Progress [ ] Emergency management personnel completed the following training:
Report#1 Position/Name Course Name(s)or Number(s)
1.
2.
3.
4.
5.
6.
7.
8.
9.
Progress [ ] Emergency management personnel completed the following training:
Report#2 Position/Name Course Name(s)or Number(s)
1.
2.
3.
4.
5.
6.
7.
8.
9.
DEM-17B
7104
FY 2005 Page 4 of 5
Applicant Name: City of Round Rock
Task 7 Emergency Management Training for Other Personnel
Work Plan [X] We will conduct or arrange emergency management-related training for elected officials,
other local officials, & support agencies.
Progress The following individuals completed the training indicated:
Report#1 (Enter position/name and training completed)
1.
2.
3.
4.
5.
6.
7.
8.
9.
Progress The following individuals completed the training indicated:
Report#2 (Enter position/name and training completed)
1.
2.
3.
4.
5.
6.
7.
8.
9.
Task 8 Emergency Management Staff Development
Work Plan [X] We will participate in the following emergency management staff development activities:
Attend area/regional planning meetings and attend conferences
Progress We completed the following staff development activities:
Report#1
Progress We completed the following staff development activities:
Report#2
DEM-17B
7/04
FY 2005 Page 5 of 5
Applicant Name: City of Round Rock
REMARKS
(Use a Continuation Sheet if necessary)
DEM-17B
7104
APPLICATION FOR FEDERAL ASSISTANCE (Instructions on Reverse)
1. NAME OF PROGRAM/ASSISTANCE: 2. CFDA NUMBER: 3. APPLICANT STATUS:
EMERGENCY MANAGEMENT [ ] New Applicant
PERFORMANCE GRANT EMPG 97.042 [X] Renewal
4. FEDERAL FISCAL YEAR: 5. START DATE: 6. END DATE:
2005 October 1, 2004 September 30, 2005
7. APPLICANT INFORMATION
A. Legal Name of Applicant Organization (as it appears on B. Name&Telephone Number of Emergency
the EMPG Application/DEM-17): Management Coordinator:
Keith Tanner
City of Round Rock 512-218-6632
C. Mailing Address: D. Physical Address(if different from Mailing Address):
203 Commerce
Round Rock, TX 78664
8. EMPG PERSONNEL SUMMARY include only those staff that will be paid with EMPG funds):
A. Number of EMPG Staff&Percentage of Time Worked in Emergency Management Duties:
Full-time Employees: 2 staff at 50 percent. _staff at percent. _staff at percent.
_staff at percent. _staff at percent. _staff at percent.
Part-time Employees: _staff.
B. Total number of EMPG-funded personnel = 2
9. ESTIMATED EXPENSES:
A. Salary& Benefits from line 19, form DEM-67 86,409.70
B. Travel Expenses from line 20 form DEM-67
C. Other Expenses from section 11 on reverse
D. Total Expenses A + B + C 86,409.70
E. Federal Share D x .50 43,204.85
10. CERTIFICATION: I certify that to the best of my knowledge and belief this application and its attachments are true
and correct.
A. Typed Name of Authorized Official: Nle Maxwell
B. Title of Authorized Official: Mayor_,,
C. Signature of Authorized Official:
D. Date Signed:
FOR DEM USE ONLY:
DEM-66
7/04
INSTRUCTIONS FOR FRONT SIDE OF THIS FORM
1. Except as indicated below,entries are self-explanatory.
2. Item 7A: Enter the legal name of your jurisdiction. Your entry should match the Applicant Name used on the EMPG Program
Application(form DEM-17).
3. Item 8A: Indicate the number of full-time employees who work specific percentages of time in emergency management duties.
Example: 1 staff @ 100 percent, 2 staff @ 50 percent. Also indicate the number of part-time employees. Include only staff
members whose salary and benefits will be supported by EMPG funding. The data in this section should agree with the
information included on the EMPG Staffing Pattern(form DEM-67).
4. Item 10 A, B,&C. This form must be signed by an Authorized Official,who is a person authorized by the governing body of the
jurisdiction to apply for grants and accept grants and execute agreement and contracts on behalf of the jurisdiction. Authorized
Officials are typically county judges, mayors,and many city managers—not emergency management coordinators.
11. OTHER ALLOWABLE EXPENSES:
Describe the other allowable expenses of your emergency management program that you are requesting be supported by
EMPG funding and provide an estimate of the amount of those expenses. Continue on a separate sheet if necessary.
Transfer the Total calculated below to line 9C on the front of this form. See the DEM pamphlet Summary of Allowable and
Unallowable Costs for the EMPG Program(DEM-200)to determine whether a planned expense is allowable or not.
Description of Expense Estimated Amount
Be specific—do not use broad general categories, such as operating expenses.)
TOTAL
DEM-66
7/04
EMERGENCY MANAGEMENT PERFORMANCE GRANT (EMPG)
STAFFING PATTERN
(Instructions on reverse)
1. Applicant Name (as it appears on EMPG Application): 2. County: 3. Fiscal Year
City of Round Rock Williamson 05
4. 5. 6. 7. 8. 9. 10.
FULL-TIME EMPLOYEES Gross Gross Gross %of Salary& Est.
(including those who work all Annual Annual Salary& Work in Benefits EM
or only a portion of their time in Salary Benefits Benefits EM for EM Travel
emergency management duties) 5+6 Duties 7x8 Costs
Name: Keith Tanner 75,108.80 19,948.79 95,057.59 50.00 47,528.79
Position: EMC
Name: Mark Selby 60,569.60 17,192.22 77,761.82 50.00 38,880.91
Position: Ass't EMC
Name: 0.00
Position:
Name: 0.00
Position:
Name: 0.00
Position:
Name: 0.00
Position:
Name: 0.00
Position:
Name: 0.00
Position:
Name: 0.00
Position:
Name: 0.00
Position:
A. SUBTOTAL 86,409.70
11. 12. 13. 14. 15. 16. 17. 18.
PART-TIME % of Gross Gross Gross %of Salary& Est.
EMPLOYEES Full Annual Annual Salary& Work in Benefits EM
Time Salary Benefits Benefits EM For EM Travel
13+14 Duties 15 x 16 Costs
Name: 0.00 0.00
Position:
Name: 0.00 0.00
Position:
Name: 0.00 0.00
Position:
B. SUBTOTAL
TOTAL 19. 120.
Add Subtotals in A & B above 86,409.70
DEM-67
7/04
INSTRUCTIONS
For Form DEM-67
1. Applicant Name: The name of your organization as reflected in your EMPG Application(DEM-17).
2. County: Self-explanatory
3. Fiscal Year: Enter the fiscal year as a 4 digit number(2004, 2005, etc.)
4. Full-time Employees: List the name and position title of each EMPG-funded full-time staff member. This section of
the form should be used for all full-time employees --whether they work all or only a portion of their time in
emergency management duties. If a position is vacant during the period when this form is prepared, indicate
"Vacant"for the name.
5. Gross Annual Salary: Use whole dollars—round up if necessary.
6. Gross Annual Benefits: Use whole dollars—round up if necessary.
7. Gross Salary&Benefits: Add the values in columns 5&6.
8. %of Work in EM Duties: The percentage of overall work time that the full-time employee named in the first column
spends on emergency management duties, stated as a decimal. For example, 25% = .25, 50% = .50, 100% = 1.00.
9. Salary&Benefits for EM: Multiply the values in columns 7&8. Use whole dollars—round up if necessary. Enter a
subtotal at the bottom of the table.
10. Est. EM Travel Costs: Enter estimated emergency management-related travel costs for each employee. Do not
include travel costs that will be reimbursed by another state or federal program. Enter a subtotal at the bottom of the
table.
11. Part-time Employees: List the name and position title of each EMPG-funded staff member who is a part-time
employee. If a position is vacant during the period when this form is prepared, indicate"Vacant'for the name.
12. %of Full Time: The percentage of full-time that the person named in the first column works, stated as a decimal.
For example, 40 percent of full-time should be entered as .40.
13. Gross Annual Salary: Gross annual salary for the percent of part-time work as indicated in item 12. Use whole
dollars—round up if necessary.
14. Gross Annual Benefits: Gross annual benefits for part-time work as indicated in item 16. Use whole dollars—
round up if necessary.
15. Gross Salary&Benefits: Add the values in columns 13 and 14.
16. % of Work in EM Duties: The percentage of overall work time that the person named in the first column spends on
emergency management duties, stated as a decimal. For example, 25% = .25, 50% = .50, 100% = 1.00.
17. Salary&Benefits for EM: Multiply the values in columns 15& 16. Enter a subtotal at the bottom of the table.
18. Est. EM Travel Costs: Enter estimated emergency management-related travel costs for each employee. Do not
include travel costs that will be reimbursed by another state or federal program. Enter a subtotal at the bottom of the
table.
19. TOTAL Salaries and Benefits for EM. Add the subtotals at the bottom of both tables to obtain this figure. Transfer
this total to line 9A of form DEM-66.
20. TOTAL Est. EM Travel Costs.Add the subtotals at the bottom of both tables to obtain this figure. Transfer this total
to line 9B of form DEM-66.
DEM-67
7/04
EMPG STAFF JOB DESCRIPTION
Jurisdiction Name City of Round Rock
Staff Members Names Keith Tanner
Position Title EMC
Description Prepared By Keith Tanner
Date Prepared
JOB DESCRIPTION
(If you have an existing job description which provides the information requested below,
fill out the header data above and attach the existingdescription to this form
A. Provide a general description of the duties performed by this staff member.
SUMMARY OF POSITION
Serve as head of Prevention Division. Conduct/supervise the fire/life safety inspection program for the city.
Conduct/supervise fire investigations. Coordinate public fire and life safety program for the city. Serve as
Emergency Management Coordinator for City's Disaster Management Plan. Administer and develop budget
for Prevention Division programs.
ORGANIZATIONAL RELATIONSHIPS
1. Reports to: Fire Chief on FD related task, City Manager on Emergency Management responsibilities.
2. Directs inspection staff, investigation staff, public education staff and advise Mayor, City Council, City
Manager and Department Heads on Emergency Management matters.
B. If this staff member performs both emergency management duties and other duties, identify the specific
emergency management duties performed.
Provide guidance and support to City Staff and elected officials on matters involving Emergency Management.
Provide coordination of development and revisions of planning documents.
Develop and submit financial documents and workplans as required.
Provide information to citizens regarding Emergency Management
DEM-68 Retain a copy of this description for future use.
7/04
EMPG STAFF JOB DESCRIPTION
Jurisdiction Name City of Round Rock
Staff Members Names Mark Selby
Position Title Ass't EMC
Description Prepared By Keith Tanner
Date Prepared 9/8-04
JOB DESCRIPTION
(If you have an existing job description which provides the information requested below,
fill out the header data above and attach the existing description to this form
A. Provide a general description of the duties performed by this staff member.
SUMMARY OF POSITION
This position is responsible for assisting the Fire Marshal in determination of fire cause and origin, conducting
routine inspections on a regular basis to insure the fire hazards are detected and abated; enforcing the
adopted fire code; monitoring fire drills; testing of house lines, sprinkler systems, fire detection and warning
systems, flammable liquid installations, or other equipment/systems involving fire protection and safety. Also,
this position serves as Assistant Emergency Management Coordinator and relief firefighter as needed.
ORGANIZATIONAL RELATIONSHIPS
1. Reports to: Fire Marshal
B. If this staff member performs both emergency management duties and other duties, identify the specific
emergency management duties performed.
Assist in providing guidance and support to City Staff and elected officials on matters involving Emergency
Management.
Assist in coordination of development and revisions of planning documents.
Develop and submit financial documents and workplans as required.
Assist in providing information to citizens regarding Emergency Management.
DEM-68 Retain a copy of this description for future use.
7/04
TRAVEL POLICY
CERTIFICATION
Jurisdiction Name: City of Round Rock
Check one of the two blocks below
® This jurisdiction has no qualifying travel regulations and EMPG participants
requesting reimbursement for travel expenditures will do so in accordance with
State of Texas travel regulations and rates. The State Travel Allowance Guide
and the State of Texas Mileage Guide are available on the Comptroller of Public
Accounts web site: http://www.cpa.state.tx.us.
OR
❑ This jurisdiction has its own qualifying travel policy, a copy of which is attached.
EMPG participants requesting reimbursement for travel expenditures will do so in
accordance with that policy.
Name of Grant Financial Officer Cheryl Delaney
Printed or Typed)
Signature of Grant Financial Officer
Date Signed
DEM-69
7/03
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.No. 3067-0206
SUMMARY SHEET FOR ASSURANCES AND CERTIFICATIONS Expires February 29, 2004
FOR CA FOR (Name of Applicant)
FY 5 City of Round Rock
This summary sheet includes Assurances and Certifications that must be read,signed, and submitted as a part of the
Application for Federal Assistance.
An applicant must check each item that they are certifying to:
Part I FENIA Form 20-16A,Assurances-Nonconstruction Programs
Part II FEMA Form 20-1613,Assurances-Construction Programs
Part III FEMA Form 20-16C,Certifications Regarding Lobbying;
Debarment,Suspension,and Other Responsibility
Matters; and Drug-Free Workplace Requirements
Part IV SF LLL,Disclosure of Lobbying Activities (If applicable)
As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the identified
attached assurances and certifications.
Nyle Maxwell Mayor
Typed Name of Authorized Representative Title
do;_V�9
g re of ut orized a entative Date Signed
NOTE: By signing the certification regarding debarment,suspension, and other responsibility matters for primary covered
transaction, the applicant agrees that,should the proposed covered transaction be entered into,it shall not knowingly enter
into any lower tier covered transaction 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 this application that it will include the clause titled "Certification
Regarding Debarment,Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered Transaction," provided by
the FERIA Regional Office entering into this covered transaction,without modification,in all lower tier covered transactions
and in all solicitations for lower tier covered transactions. (Refer to 44 CFR Part 17.)
Paperwork Burden Disclosure Notice
"Public reporting burden for this form is estimated to average 1.7 hours per response. Burden means the time, effort and
financial resources expended by persons to generate, maintain,retain, disclose, or to provide information to us. You may
send comments regarding the burden estimate or any aspect of the form, including suggestions for reducing the burden
to: Information Collections Management, Federal Emergency Management Agency, 500 C Street, SW,Washington, DC 20472,
Paperwork Reduction Project(3067-0206). You are not required to respond to this collection of information unless a valid
OMB control number appears in the upper right corner of this form. Please do not send your completed form to the above
address.
FEMA Form 20-16,FEB 01
FEDERAL EMERGENCY MANAGEMENT AGENCY
ASSURANCES-NON-CONSTRUCTION PROGRAMS
Note: Certain of these assurances may not be applicable to your project or program. If you have any questions,please
contact the awarding agency. Further,certain Federal 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 assistance, alcohol abuse or alcoholism;(g)Sections 523 and 527 of
and the institutional,managerial and financial capability the Public Health Service Act of 1912(42 U.S.C.290-dd-3
(including funds sufficient to pay the non-Federal share of and 290-ee-3),as amended,relating to confidentiality of
project costs)to ensure proper planning,management and alcohol and drug abuse patient records;(h)Title VIII of the
completion of the project described in this application. Civil Rights Acts of 1968(42 U.S.C.Section 3601 et seq.),
as amended,relating to nondiscrimination in the sale,
2. Will give the awarding agency,the Comptroller rental or financing of housing;(i)any other
General of the United States,and if appropriate,the State, nondiscrimination provisions in the specific statute(s)
through any authorized representative,access to and the under which application for Federal assistance is being
right to examine all records,books,papers,or documents made;and(j)the requirements of any other
related to the award;and will establish a proper accounting nondiscrimination statute(s)which may apply to the
system in accordance with generally accepted accounting application.
standards or agency directives.
7. Will comply,or has already complied,with the
3. Will establish safeguards to prohibit employees from requirements of Title lI and III of the Uniform
using their positions for a purpose that constitutes or Relocation Assistance and Real Property Acquisition
presents the appearance of personal gain. Policies Act of 1970(P.L.91-646)which provide for fair
and equitable treatment of persons displaced or whose
4. Will initiate and complete the work within the property is acquired as a result of Federal or Federally
applicable time frame after receipt of approval of the assisted programs. These requirements apply to all
awarding agency. interest in real property acquired for project purposes
regardless of Federal participation in purchases.
5. Will comply with the Intergovernmental Personnel
Act of 1970(42 U.S.C.Section 4728-4763)relating to 8. Will comply with 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 employees whose principal
specified in Appendix A of OPM's Standards for a Merit employment activities are funded in whole or in part
System of Personnel Administration)5 C.F.R.900, with Federal funds.
Subpart F).
9. Will comply,as applicable,with the provisions of
6. Will comply with all Federal statutes relating to the Davis-Bacon Act(40 U.S.C.Sections 276a to 276a-
nondiscrimination. These include but are not limited to: 7),the Copeland Act(40 U.S.C.Section 276c and 18
(a)Title VI of the Civil Rights Act of 1964(P.L.88-352) U.S.C.Sections 874),and the Contract Work Hours
which prohibits discrimination on the basis of race,color and Safety Standards Act(40 U.S.C.Sections 327-333),
or national origin;(b)Title IX of the Education Amendments regarding labor standards for federally assisted
of 1972,as amended(20 U.S.C.Sections 1681-1683,and construction subagreements.
1685-1686),which prohibits discrimination on the basis of
sex;(c)Section 504 of the Rehabilitation Act of 1973,as 10. Will comply,if applicable,with flood insurance
amended(29 U.S.C.Section 794),which prohibits purchase requirements of Section 102(a)of the Flood
discrimination on the basis of handicaps;(d)the Age Disaster Protection Act of 1973(P.L.93-234)which
Discrimination Act of 1975,as amended(42 U.S.C. requires recipients in a special flood hazard area to
Sections 6101-6107),which prohibits discrimination on the participate in the program and to purchase flood
basis of age;(e)the Drug Abuse Office and Treatment Act insurance if the total cost of insurable construction and
of 1972(P.L.92-255),as amended,relating to acquisition is$10,000 or more.
nondiscrimination on the basis of drug abuse;(f)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 of
FEMA Form 20-16A,JUN 94 mmmmma
11. Will comply with environmental standards which may 14. Will comply with P.L.93-348 regarding the
be prescribed pursuant to the following: (a)institution protection of human subjects involved in research,
of environmental quality control measures under the development,and related activities supported by this
National Environmental Policy Act of 1969(P.L.91-190) award of assistance.
and Executive Order(EO)11514;(b)notification of violating
facilities pursuant to EO 11738;(c)protection of wetlands 15. Will comply with the Laboratory Animal Welfare Act
pursuant to EO 11990;(d)evaluation of flood hazards in of 1966(P.L.89-544,as amended,7 U.S.C.2131 et seq.)
floodplains in accordance with EO 11988;(e)assurance of pertaining to the care,handling,and treatment of warm
project consistency with the approved State management blooded animals held for research,teaching,or other
program developed under the Coastal Zone Management activities supported by this award of assistance.
Act of 1972(16 U.S.C.Section 1451 et seq.);(f)conformity
of Federal actions to State(Clean Air)Implementation 16. Will comply with the Lead-Based Paint Poisoning
Plans under Section 176(c)of the Clean Air Act of 1955, Prevention Act(42 U.S.C.Section 4801 et seq.)which
as amended(42 U.S.C.Section 7401 et seq.);(g)protection prohibits the use of lead based paint in construction or
of underground sources of drinking water under the Safe rehabilitation of residence structures.
Drinking Water Act of 1974,as amended,(P.L.93-523);
and(h)protection of endangered species under the 17. Will cause to be performed the required financial
Endangered Species Act of 1973,as amended, and compliance audits in accordance with the Single
(P.L.93-205). Audit Act of 1984.
12. Will comply with the Wild and Scenic Rivers Act of 1S. Will comply with all applicable requirements of all
1968(16 U.S.C.Section 1271 et seq.)related to other Federal laws,executive orders,regulations and
protecting components or potential components of policies governing this program.
the national wild and scenic rivers system.
19. It will comply with the minimum wage and maximum
13. Will assist the awarding agency in assuring hours provisions of the Federal Fair Labor Standards
compliance with Section 106 of the National Historic Act(29 U.S.C.201),as they apply to employees of
Preservation Act of 1966,as amended(16 U.S.C.470), institutions of higher education,hospitals,and other
EO 11593(identification and protection of historic non-profit organizations.
properties),and the Archaeological and Historic
Preservation Act of 1974(16 U.S.C.469a-1 et seq.).
FEMA Form 20-16A(BACK)
'FEDERAL EMERGENCY MANAGEMENT AGENCY
ASSURANCES-CONSTRUCTION PROGRAMS
NOTE: Certain of these assurances may not be applicable to your project or program. If you have any 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 assistance, 9. Will comply with the Lead-Based Paint Poisoning
and the institutional,managerial and financial capability Prevention Act(42 U.S.C.Sections 4801 et seq.)which
(including funds sufficient to pay the non-Federal share of prohibits the use of lead based paint in construction or
project costs)to ensure proper planning,management and rehabilitation of residence structures.
completion of the project described in this application.
10. Will comply with all Federal statutes relating to
2. Will give the awarding agency,the Comptroller non-discrimination. These include but are not limited to:
General of the United States,and if appropriate,the State, (a)Title VI of the Civil Rights Act of 1964(P.L.88-352)
through any authorized representative,access to and the which prohibits discrimination on the basis of race,color
right to examine all records,books,papers,or documents or national origin; (b)Title IX of the Education Amendments
related to the assistance; and will establish a proper of 1972,as amended(20 U.S.C.Sections 1681-1683,and
accounting system in accordance with generally accepted 1685-1686),which prohibits discrimination on the basis of
accounting standards or agency directives. sex;(c)Section 504 of the Rehabilitation Act of 1973,as
amended(29 U.S.C.Section 794),which prohibits
3. Will not dispose of,modify the use of,or change the discrimination on the basis of handicaps; (d)the Age
terms of the real property title,or other interest in the site Discrimination Act of 1975,as amended(42 U.S.C.
and facilities without permission and instructions from Sections 6101-6107),which prohibits discrimination on the
the awarding agency. Will record the Federal interest in basis of age; (e)the Drug Abuse Office and Treatment Act
the title of real property in accordance with awarding of 1972(P.L.92-255),as amended,relating to
agency directives and will include a covenant in the non-discrimination on the basis of drug abuse; (f)the
title of real property acquired in whole or in part with Comprehensive Alcohol Abuse and Alcoholism Prevention,
Federal assistance funds to assure nondiscrimination Treatment and Rehabilitation Act of 1970(P.L.91-616),as
during the useful life of the project. amended,relating to non-discrimination on the basis of
alcohol abuse or alcoholism; (g)Sections 523 and 527 of
4. Will comply with the requirements of the assistance the Public Health Service Act of 1912(42 U.S.C.290 dd-3
awarding agency with regard to the drafting,review and and 290 ee-3),as amended,relating to confidentiality of
approval of construction plans and specifications. alcohol and drug abuse patient records; (h)Title VIII of the
Civil Rights Acts of 1968(42 U.S.C.Section 3601 et seq.),
5. Will provide and maintain competent and adequate as amended,relating to non-discrimination in the sale,rental
engineering supervision at the construction site to ensure or financing of housing; (i)any other non-discrimination
that the complete work conforms with the approved plans provision in the specific statute(s)under which application
and specifications and will furnish progress reports and for Federal assistance is being made; and(j) the
such other information as may be required by the requirements of any other non-discrimination statute(s)
assistance awarding agency or state. which may apply to the application.
6. Will initiate and complete the work within the applicable 11. Will comply,or has already complied,with the
time frame after receipt of approval of the awarding agency. requirements of Title H and III of the Uniform
Relocation Assistance and Real Property Acquisition
7. Will establish safeguards to prohibit employees from Policies Act of 1970(P.L.91-646)which provide for fair
using their positions for a purpose that constitutes or and equitable treatment of persons displaced or whose
presents the appearance of personal or organizational property is acquired as a result of Federal or Federally
conflict of interest,or personal gain. assisted programs. These requirements apply to all
interest in real property acquired for project purposes
8. Will comply with the Intergovernmental Personnel Act regardless of Federal participation in purchase.
of 1970(42 U.S.C.Sections 4728-4763)relating to prescribed
standards for merit systems for programs funded under one 12. Will comply with provisions of the Hatch Act(5 U.S.C.
of the nineteen statutes or regulations specified in Sections 1501-1508 and 7324-7328)which limit the
Appendix A of OPM's Standards for a Merit System of political activities of employees whose principal employment
Personnel Administration(5 C.F.R.900,Subpart F). activities are funded in whole or in part with Federal funds.
FEMA Form 20-16B,JUN 94
13. Will comply,as applicable,with the provisions of the 20. It will comply with the minimum wage and maximum
Davis-Bacon Act(40 U.S.C.Sections 276a to 276a-7), hours provisions of the Federal Fair Labor Standards
the Copeland Act(40 U.S.C.Section 276c and 18 U.S.C. Act(29 U.S.C.201),as they apply to employees of
Section 874),the Contract Work Hours and Safety institutions of higher education,hospitals,and other
Standards Act(40 U.S.C.Sections 327-333)regarding non-profit organizations.
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 construct 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 if 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 may activities until the conditions of the construction grant
be prescribed pursuant to the following: (a)institution program(s)have been met.
of environmental quality control measures under the
National Environmental Policy Act of 1969(P.L.91-190) 22. It will operate and maintain the facility in accordance
and Executive Order(EO) 11514;(b)notification of violating with the minimum standards as may be required or
facilities pursuant to EO 11738; (c)protection of wetlands prescribed by the applicable Federal,State,and local
pursuant to EO 11990; (d)evaluation of flood hazards in agencies for the maintenance and operation of such
floodplains in accordance with EO 11988; (e)assurance of facilities.
project consistency with the approved State management
program developed under the Coastal Zone Management 23. It will require the facility to be designed to comply
Act of 1972(16 U.S.C.Section 1451 et seq.); (f)conformity with the"American Standard Specifications for Making
of Federal actions to State(Clean Air)Implementation Buildings and Facilities Accessible to,and Usable by,
Plans under Section 176(c)of the Clean Air Act of 1955, the Physically Handicapped," Number A117.- 1961,as
as amended(42 U.S.C.Section 7401 et seq.); (g)protection modified(41 CFR 101-17.703). The applicant will be
of underground sources of drinking water under the Safe responsible for conducting inspections to ensure
Drinking Water Act of 1974,as amended,(P.L.93-523); compliance with these specifications by the contractor.
and(h)protection of endangered species under the
Endangered Species Act of 1973,as amended,(P.L.93-205). 24. If any real property or structure thereon is provided
or improved with the aid of Federal financial assistance
16. Will comply with the Wild and Scenic Rivers Act of extended to the applicant,this assurance shall obligate
1968(16 U.S.C.Section 1271 et seq.)related to the applicant,or in the case of any transfer of such
protecting components or potential components of the property,any transfer,for the period during which the
national wild and scenic rivers system. real property or structure is used for a purpose for which
the Federal financial assistance is extended or for
17. Will assist the awarding agency in assuring another purpose involving the provision of similar
compliance with Section 106 of the National Historic services or benefits.
Preservation Act of 1966,as amended(16 U.S.C.470),
EO 11593(identification and preservation of historic 25. In making subgrants with nonprofit institutions
properties),and the Archaeological and Historic under this Comprehensive Cooperative Agreement,it
Preservation Act of 1974(16 U.S.C.469a-1 et seq.). agrees that such grants will be subject to OMB Circular
A-122, "Cost Principles for Non-profit Organizations"
18. Will cause to be performed the required financial included in Vol.49,Federal Register,pages 18260
and compliance audits in accordance with the Single Audit through 18277(April 27, 1984).
Act of 1984.
19. Will comply with all applicable requirements of all
other Federal laws,Executive Orders,regulations and
policies governing this program.
FEMA Form 20-16B(BACK)
FEDERAL EMERGENCY MANAGEMENT AGENCY
. CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND
OTHER RESPONSIBILITY MATTERS; AND DRUG-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 on 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(Nonprocurement)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 (b) Have not within a three-year period preceding this application been
convicted of ar had a civilian judgment rendered against them for
A. As required by section 1352,Title 31 of the U.S.Code,and commission of fraud or a criminal offense in connection with
implemented at 44 CFR Part 18,for persons entering into a grant obtaining,attempting to obtain,or perform a public(Federal,State,
or cooperative agreement over$100,000,as defined at 44 CFR or local)transaction or contract under a public transaction;violation
Part 18,the applicant certifies that: of Federal or State antitrust statutes or commission of embealement,
theft,forgery,bribery,falsification or destruction of records,
(a) No Federal appropriated funds have been paid or will be paid, making false statements,or receiving stolen property;
by or on behalf of the undersigned,to any person for influencing or
attempting to influence an officer or employee of any agency,a (c) Are not presently indicted for or otherwise criminally or civilly
Member of Congress,an officer or employee of congress,or an charged by a governmental entity(Federal,State,or local)with
employee of a Member of Congress in connection with the making commission of any of the offenses enumerated in paragraph(1 xb)
of any Federal grant,the entering into of any cooperative agreement, of this certification;and
and the extension,continuation,renewal,amendment,or modification
of any Federal grant or cooperative agreement-, (d) Have not within a three-year period preceding this application
had one or more public t ransactions(Federal,State,or local)
(b) if any other funds than Federal appropriated funds have been terminated for cause or default;and
paid or will be paid to any person for influencing or attempting to
influence an officer or employee of any agency,a Member of B. Where the applicant is unable to certify to any of the statements
Congress,an officer or an employee of Congress,or employee in this certification,he or shall shall attached an explanation to this
of a member of Congress in connection with this Federal grant or application.
cooperative agreement,the undersigned shall complete and submit
Standard Form LLL,"Disclosure of Lobbying Activities,"in 3. DRUG-FREE WORKPLACE
accordance with its instructions; (GRANTEES OTHER THAN INDIVIDUALS)
(c) The undersigned shall require that the language of this certification As required by the Drug-Free Workplace Act of 1988,and
be included in the award documents for all subawards at all tiers implemented at 44 CFR Part 17,Subpart F,for grantees,as defined
(including subgrants,contracts under grants and cooperative at 44 CFR Part 17,Sections 17.615 and 17.620:
agreements,and subcontract(s)and that all subrecipients shall
certify and disclose accordingly. A. The applicant certifies that it will continue to privide a drug-
free workplace by.
Standard Form LLL,"Disclosure of Lobbying Activities"attached.
(This form must be attached to certification if nonappropriated funds (a) Publishing a statement notifying employees that the unlawful
are to be used to influence activities.) manufacture,distribution,dispensing,possession,or use of a
controlled substance is prohibited in the grantee's workplace and
2. DEBARMENT,SUSPENSION,AND OTHER specifying the actions tht will be taken against employees for
RESPONSIBILITY MATTERS violation of such prohibition;
(DIRECT RECIPIENT)
(b) Establishing an on-going drug free awareness program to
As required by Executive Order 12549,Debarment and Suspension, inform empoyees about:
and implemented at 44 CFR Part 67,for prospective participants in
primary covered transactions,as defined at 44 CFR Part 17, (1) The dangers of drug abuse in the workplace;
Section 17.510-A. The applicant certifies that it and its principals: (2) The grantee's policy of maintaining a drug-free workplace;
(3) Any available drug counseling,rehabilitation,and
(a) Are not presently debarred,suspended,proposed for debarment, employee assistance programs;and
declared ineligible,sentenced to a denial of Federal benefits by a State (4) the penalties that may be imposed upon employees for
or Federal court,or voluntarily excluded from covered transactions by drug abuse violations occurring in the workplace;
any Federal department or agency,
FEMA Form 20-16C,JUN 94
(c) Making it a requirement that each employee to be engaged in (2) Requiring such employee to participate satisfactorily in a
the performance of the grant to be given a copy of the statement drug abuse assistance or rehabilitation program approved for
required by paragraph(a); such purposes by a Federal,State,or local health,law enforcement,
or other appropriate agency.
(d) Notifying the employee in the statement required by
paragraph(a)that,as a condition of employment under the grant, (g) Making a good faith effort to continue to maintain a drug free
the employee will: workplace through implementation of paragraphs(a),(b),(c),(d),(e),
and(f).
(1) Abide by the terms of the statement;and
8. the grantee may insert in the space provided below the site(s)for
(2) Notify the employee in writing of his or her conviction for a the performance of work done in connection with the specific grant:
violation of a criminal drug statute occurring in the workplace no later
than five calendar days after such conviction. Place of Performance(Street address,City,County,State,Zip code)
(e) Notifying the agency,in writing,within 10 calendar days after
receiving notice under subparagraph(d)(2)from an employee or
otherwise receiving actual notice of such conviction. Employers of
convicted employees must provide notice,including position title,
to the applicable FEMA awarding office,i.e.,regional office or
FEMA office.
Check [—]if there are workplaces on file that are not identified here.
(f) Taking one of the following actions,within 30 calendar days of
receiving notice under subparagraph(dx2),with respect to any
employee who is so convicted: 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
(1) Taking appropriate personnel action against such an employee, of which should be included with each application for FEMA funding.
up to and including termination,consistent with the requirements States and State agencies may elect to use a Statewide certification.
of the Rehabilitation Act of 1973,as amended;or
FEMA Form 20-16C(BACK)
DATE: September 17, 2004
SUBJECT: City Council Meeting - September 23, 2004
ITEM: 13.D.1. Consider a resolution authorizing the Mayor to make the necessary
grant application to the Texas Department of Public Safety, Division
of Emergency Management to partially fund two Emergency
Management Coordinator positions.
Department: Fire Department
Staff Person: David Smith, Interim Fire Chief
Justification:
The City of Round Rock has participated in this grant since the early 1980's. This application
will serve as the City's request to continue the grant for the 04-05 Fiscal Year.
The Emergency Management Performance Grant application (EMPG) program provides
federal funding to assist states and local governments in developing and carrying our
emergency management programs. States receive EMPG funding from FEMA, and, in turn,
pass through a majority of the EMPG funding to local reimburse them for emergency
management program expenses. Currently, the Emergency Management Coordinator and
Assistant Coordinator spend 50% of their time on emergency management activities. This
program will reimburse the City for 50% of the time spent on emergency management
activities, which equates to 25% of the salaries for the emergency management staff.
Funding•
Cost: N/A
Source of funds: N/A
Outside Resources: N/A
Background Information: N/A
Public Comment: N/A
EXECUTED
DOCUMENT
FOLLOWS
Fiscal Year 2005
EMERGENCY MANAGEMENT PERFORMANCE GRANT(EMPG)
APPLICATION
PLEASE PRINT OR TYPE
1. APPLICANT NAME (Jurisdiction): City of Round Rock
2. COUNTY: Williamson 3. DISASTER DISTRICT: 6b
4. EMPG STATUS: [X ] Current EMPG Program participant [ ] New EMPG Program applicant
5. PROGRAM PARTICIPANT: (List all jurisdictions that are participants in your emergency management
program. Identify any jurisdictions that have joined or withdrawn from your program in the last year.)
City of Round Rock only
6. CHECKLIST OF APPLICATION ATTACHMENTS: (Seethe FY 2005 Local Emergency Management Program Guide for
further information on completing these forms.)
[
X] Designation of Grant Officials(form DEM-17A)
[ X] Statement of Work&Progress Report(form DEM-176). This form should be signed by the EMC.
[ X] Application for Federal Assistance(form DEM-66). The Authorized Official should sign this form.
[ X] EMPG Staffing Pattern(form DEM-67).
[ X] EMPG Staff Job Description(form DEM-68). An updated job description must be provided for each staff member listed
in the FY 04 EMPG Staffing Pattern who works less than 50 percent of their time in emergency management duties.
[ X] FEMA Form 20-16,Summary Sheet for Assurances&Certifications,must signed by an Authorized Official. Attach
FEMA Form 20-16A,Assurances—Non-Construction Programs&FEMA Form 20-16C,Certifications Regarding
Lobbying,Debarment,Suspension,&Other Responsibility Matters;and Drug-Free Workplace Requirements, to the
FEMA Form 20-16.
[ If the applicant performs lobbying to influence federal actions,a completed Disclosure of Lobbying Activities(SF LLL)
must be completed and included in the grant application package.
[ Direct Deposit Authorization(form 74-146). The Grant Financial Officer should sign this form. If the jurisdiction has
been receiving EMPG reimbursements through Direct Deposit,a new Direct Deposit Authorization is not required.
[
X] Travel Policy Certification(form DEM-69). The Grant Financial Officer should sign this form.
7. CERTIFICATION: This Application together with the attached EMPG Statement of Work & Progress Report
(form DEM-178) constitute the annual work plan for the emergency management program whose participants are
listed above. The unde ' agree to exert their best efforts to accomplish all activities listed in the EMPG
St me of rk rogress eport approved by theDivision of E erg cy Management.
orized icia Date Emergency Management Coordinator Date
si
nature) si nature
8. APPROVAL: The attached Fiscal Year 2005 EMPG Statement of Work&Progress Report is approved.
[ ] State Coordinator Date
[ ] Assistant State Coordinator
DEM-17
7/04
DESIGNATION OF GRANT OFFICALS
Grant Program FY 05 Emergency Management Performance Grant(EMPG)
Applicant Name it of Round Rock
Nam [Xj Mr. F Ms. Keith Tanner
Official 203 Commerce
Mailing Round Rock, TX 78664
Address
Daytime Phone Number 512-218-6632
Fax Number 512-218-5594
E-mail Address ktanner@round-rock.tx.us
10
;s
Ad
NameMr X I Ms. Che!yl Delane
Title Budget Supervisor
Official 221 East Main
Mailing Round Rock, TX 78664
Address
Daytime Phone Number 512-218-5445
Fax Number 512-218-5442
E-mail Address cdelaney@round-rock.tx.us
it AliM
Name X Mr. Ms. Nyle Maxwell
Title Ma or
Official 221 East Main
Mailing Round Rock, TX 78664
Address
Daytime Phone Number 512-218-5401
Fax Number 512-218-7097
E-mail Address ma or round-rock.tx.us
DEM-17A
7-04
j a.
Fiscal Year 2005
EMPG STATEMENT OF WORK & PROGRESS REPORT
NA licant Name: Ci of Round Rock Page 1 of 5
This is our: Statement of Work Progress Report#1 Progress Report#2
Submitted By Date DEM Review Bv Date
Statement of Work Keith Tanner 9/08/04
Progress Report#1
Progress Report#2
Task 1 Work Plan & Semiannual Progress Report
Work Plan [XI We will submit an EMPG Application, two Progress Reports, and quarterIv Financial Re orts.
Progress [ ] This Progress Report# 1 is being submitted to the GDEM Preparedness Section.
Report#1 First& Second Quarter Financial Reports have been submitted to GDEM Support Services.
Progress [ ] This Progress Report#2 is being submitted to the GDEM Preparedness Section.
Report#2 F I Third & Fourth Quarter Financial Reports have been submitted to GDEM Support Services.
Task 2 Legal Authorities for Emergency Management Program
Work Plan [X] We will maintain current legal documents establishing our emergency management program.
[X] Our legal documents are current&on file with GDEM; no additional action is required.
[ ] We will prepare or update & submit to our Regional Liaison Officer:
[ ] Commissioner's Court Order
[ ] City Ordinance(s)for:
Updated Joint Resolution
Progress [ ] We completed & submitted to our Regional Liaison Officer:
Report#1 [ ] Commissioner's Court Order
[ ) City Ordinance(s)for:
Updated Joint Resolution
Progress [ ) We completed & submitted to our Regional Liaison Officer:
Report#2 [ ) Commissioner's Court Order
[ ) City Ordinance(s)for:
Updated Joint Resolution
Task 3 Public Education/Information
Work Plan [X] Option 1: We will conduct 30 hours of hazard awareness activities for local citizens.
OR
[ ] Option 2: We will prepare &distribute public education/information materials to a substantial
portion of the community. In the space below describe the materials to be distributed.-
Progress [ ] We completed the following hazard awareness or public education/information activities:
Report#1
Progress [ ] We completed the following hazard awareness or public education/information activities:
Report#2
If you chose Option 2, a copy of the materials you distributed must be attached to your Progress Report
DEM-17B
7/04
r
FY 2005 Page 2 of 5
Applicant Name: City of Round Rock
Task 4 Emergency Management Planning Documents
Work Plan [X] We have reviewed our emergency management plan & its annexes for currency.
[ ] We will develop or update by revision or change these planning documents:
[ ] Basic Plan Annexes: [ ) A [ ] B [ ] C [ ] D [ lE [ ] F [ } G [ ] H [ ] I [ ] J
[ ] K [ ] L [ ] M [ l N [ I O [ ) P [ ) Q [ ] R [ ] S [ ] T [ ) U [ ] v
Other documents:
NOTE: Plans & annexes dated September 30, 2000, &earlier should be revised/updated this year.
Progress [ ] We developed or updated and submitted to our RLO the following documents, together with
Report#1 the appropriate planning standards checklists:
[ ] Basic Plan Annexes: [ ] A [ ] B [ ] C [ ] D [ ] E [ ] F [ ] G [ ] H [ JI [ ] J
[ lK [ ] L [ ] M I } N [ lo [ lP [ JQ [ lS [ IU [ } v
Other documents:
Progress [ ) We developed or updated and submitted to our RLO the following documents, together with
Report#2 the appropriate planning standards checklists:
[ ] Basic Plan Annexes: [ ] A [ ] B [ ] C [ ] D [ l E [ } F [ } G [ ] H [ J I [ ] J
[ lK [ ] L [ ] M [ JN [ l0 [ lP [ lQ [ lS [ } U [ ] v
Other documents:
Task 5 Exercise Participation & Schedule
Work Plan [X] We will develop & submit a two year exercise schedule (below).
[X] We will conduct & report participation in a tabletop exercise and a functional or full-scale
exercise this fiscal year or obtain exercise credit for actual events for these exercises.
EXERCISE SCHEDULE
Period Exercise Type Exercise Scenario * Quarter of Year
This Fiscal Year(FY 05) [X] Tabletop [ ] NH [ ]TH [X] NS [ ]TR [XJ 1 [ ] 2 [ ] 3 [ ] 4
(Oct. 2004—Sept. 2005) [XI Functional F I Full-Scale NH TH [ INS TR 11 2 3 4
Next Fiscal Year(FY 06) Tabletop NH [ ITH [ ] NS TR 12 3 14
(Oct. 2005-Sept.2006) X Functional Full-Scale NH TH NS TR 1 X 2 3 LL
A Full-Scale exercise must be conducted every three 3 ears
Our last Full-Scale exercise was conducted on (date): Scenario*:
*Exercise Scenarios: NH = Natural Hazard, TH=Technological Hazard, NS=National Security, TR=Terrorism
Progress [ ]We conducted a tabletop exercise and provided documentation to GDEM.
Report#1 [ l We conducted a [ ]functional, [ ]full-scale exercise and provided documentation to GDEM.
[ )We requested functional or full-scale exercise credit for an actual occurrence from GDEM
and our request was approved.
Progress [ ]We conducted a tabletop exercise and provided documentation to GDEM.
Report#2 [ ] We conducted a [ ] functional, [ ]full-scale exercise and provided documentation to GDEM.
[ ] We requested functional or full-scale exercise credit for an actual occurrence from GDEM
and our request was approved.
DEM-17B
7/04
FY 2005 Page 3 of 5
Applicant Name: City of Round Rock
Task 6 Training for Emergency Management Personnel
Work Plan [X] EMPG-funded emergency management personnel will participate in the following training:
Position/Name Course Names) or Number(s)
1. EMC/Keith Tanner G290, G362
2. Ass't EMC/Mark Selby G202, G362
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Progress [ ] Emergency management personnel completed the following training:
Report#1 Position/Name Course Name(s) or Number(s)
1.
2.
3.
4.
5.
6.
7.
8.
9.
Progress [ ] Emergency management personnel completed the following training:
Report#2 Position/Name Course Name(s) or Number(s)
1.
2.
3.
4.
5.
6.
7.
8.
9.
DEM-17B
7/04
FY 2005 Page 4 of 5
A licant Name: City of Round Rock
Task 7 Emergency Management Training for Other Personnel
Work Plan [X] We will conduct or arrange emergency management-related training for elected officials,
other local officials, & support agencies.
Progress The following individuals completed the training indicated:
Report#1 (Enter position/name and training completed)
1.
2.
3.
4.
5.
6.
7.
8.
9.
Progress The following individuals completed the training indicated:
Report#2 (Enter position/name and training completed)
1.
2.
3.
4.
5.
6.
7.
8.
9.
Task 8 Emergency Management Staff Development
Work Plan [X] We will participate in the following emergency management staff development activities:
Attend area/regional planning meetings and attend conferences
Progress We completed the following staff development activities:
Report#1
Progress We completed the following staff development activities:
Report#2
DEM-17B
7/04
FY 2005 Pa e 5 of 5
Applicant Name: City of Round Rock
REMARKS
(Use a Continuation Sheet if necessary)
DEM-17B
7/04
APPLICATION FOR FEDERAL ASSISTANCE (Instructions on Reverse)
1. NAME OF PROGRAM/ASSISTANCE: 2. CFDA NUMBER: 3.APPLICANT STATUS:
EMERGENCY MANAGEMENT [ ] New Applicant
PERFORMANCE GRANT EMPG 97.042 [X] Renewal
4. FEDERAL FISCAL YEAR: 5. START DATE: 6. END DATE.
2005 October 1, 2004 September 30, 2005
7. APPLICANT INFORMATION
A. Legal Name of Applicant Organization (as it appears on B. Name&Telephone Number of Emergency
the EMPG Application/DEM-17): Management Coordinator:
Keith Tanner
City of Round Rock 512-218-6632
C. Mailing Address: D. Physical Address(if different from Mailing Address):
203 Commerce
Round Rock, TX 78664
8. EMPG PERSONNEL SUMMARY include only those staff that will be paid with EMPG funds):
A. Number of EMPG Staff&Percentage of Time Worked in Emergency Management Duties:
Full-time Employees: 2 staff at 50 percent. _staff at percent. _staff at percent.
_staff at percent. —staff at percent. —staff at percent.
Part-time Employees: _staff.
B. Total number of EMPG-funded personnel = 2
9. ESTIMATED EXPENSES:
A. Salary& Benefits from line 19, form DEM-67 86,409.70
B. Travel Expenses from line 20 form DEM-67
C. Other Expenses from section 11 on reverse
D. Total Expenses A + B + C 86,409.70
E. Federal Share D x .50 43,204.85
10. CERTIFICATION: I certify that to the best of my knowledge and belief this application and its attachments are true—]
and correct.
A. Typed Name of Authorized Official: Nle Maxwell
B. Title of Authorized Official: Ma or
C. Signature of Authorized Official:
D. Date Signed:
FOR DEM USE ONLY:
DEM-66
7/04
INSTRUCTIONS FOR FRONT SIDE OF THIS FORM
1. Except as indicated below,entries are self-explanatory.
2. Item 7A: Enter the legal name of your jurisdiction. Your entry should match the Applicant Name used on the EMPG Program
Application(form DEM-17).
3. Item 8A: Indicate the number of full-time employees who work specific percentages of time in emergency management duties.
Example: 1 staff @ 100 percent, 2 staff @ 50 percent. Also indicate the number of part-time employees. Include only staff
members whose salary and benefits will be supported by EMPG funding. The data in this section should agree with the
information included on the EMPG Staffing Pattern(form DEM-67).
4. Item 10 A,B,&C. This form must be signed by an Authorized Official,who is a person authorized by the governing body of the
jurisdiction to apply for grants and accept grants and execute agreement and contracts on behalf of the jurisdiction. Authorized
Officials are typically county judges,mayors,and many city managers—not emergency management coordinators.
11. OTHER ALLOWABLE EXPENSES:
Describe the other allowable expenses of your emergency management program that you are requesting be supported by
EMPG funding and provide an estimate of the amount of those expenses. Continue on a separate sheet if necessary.
Transfer the Total calculated below to line 9C on the front of this form. See the DEM pamphlet Summary of Allowable and
Unallowable Costs for the EMPG Program(DEM-200)to determine whether a planned expense is allowable or not.
Description of Expense Estimated Amount
Be specific—do not use broad general categories, such as operating expenses.)
TOTAL EIEEEHEE�
DEM-66
7/04
EMERGENCY MANAGEMENT PERFORMANCE GRANT (EMPG)
STAFFING PATTERN
(Instructions on reverse)
1. Applicant Name (as it appears on EMPG Application): 2. County: 3. Fiscal Year
City of Round Rock Williamson 05
4. 5. 6. 7. 8. 9. 10.
FULL TIME EMPLOYEES Gross Gross Gross %of Salary& Est.
(including those who work all Annual Annual Salary& Work in Benefits EM
or only a portion of their time in Salary Benefits Benefits EM for EM Travel
emergency management duties) 5+6 Duties 7x8 Costs
Name: Keith Tanner 75,108.80 19,948.79 95,057.59 50.00 47,528.79
Position: EMC
Name: Mark Selby 60,569.60 17,192.22 77,761.82 50.00 38,880.91
Position:Ass't EMC
Name: 0.00
Position:
Name: 0.00
Position:
Name: 0.00
Position:
Name: 0.00
Position:
Name: 0,00
Position:
Name: 0.00
Position:
Name: 0.00
Position:
Name: 0.00
Position:
A. SUBTOTAL 86,409.70
11. 12. 13. 14. 15. 16. 17. 18.
PART-TIME %of Gross Gross Gross %of Salary& Est.
EMPLOYEES Full Annual Annual Salary& Work in Benefits EM
Time Salary Benefits Benefits EM For EM Travel
13+14 Duties 15 x 16 Costs
Name: 0.00 0.00
Position:
Name: 0.00 0.00
Position:
Name: 0.00 0.00
Position:
B. SUBTOTAL
FA
OTAL 19. 20.
dd Subtotals in A & B above 86,409.70
DEM-67
7/04
INSTRUCTIONS
For Form DEM-67
1. Applicant Name: The name of your organization as reflected in your EMPG Application (DEM-17).
2. County: Self-explanatory
3. Fiscal Year: Enter the fiscal year as a 4 digit number(2004, 2005, etc.)
4. Full-time Employees: List the name and position title of each EMPG-funded full-time staff member. This section of
the form should be used for all full-time employees—whether they work all or only a portion of their time in
emergency management duties. If a position is vacant during the period when this form is prepared, indicate
"Vacant"for the name.
5. Gross Annual Salary: Use whole dollars—round up if necessary.
6. Gross Annual Benefits: Use whole dollars—round up if necessary.
7. Gross Salary&Benefits: Add the values in columns 5&6.
8. %of Work in EM Duties: The percentage of overall work time that the full-time employee named in the first column
spends on emergency management duties, stated as a decimal. For example, 25% = .25, 50% = .50, 100% = 1.00.
9. Salary&Benefits for EM: Multiply the values in columns 7&8. Use whole dollars—round up if necessary. Enter a
subtotal at the bottom of the table.
10. Est. EM Travel Costs: Enter estimated emergency management-related travel costs for each employee. Do not
include travel costs that will be reimbursed by another state or federal program. Enter a subtotal at the bottom of the
table.
11. Part-time Employees: List the name and position title of each EMPG-funded staff member who is a part-time
employee. If a position is vacant during the period when this form is prepared, indicate"Vacant"for the name.
12. %of Full Time: The percentage of full-time that the person named in the first column works, stated as a decimal.
For example,40 percent of full-time should be entered as .40.
13. Gross Annual Salary: Gross annual salary for the percent of part-time work as indicated in item 12. Use whole
dollars—round up if necessary.
14. Gross Annual Benefits: Gross annual benefits for part-time work as indicated in item 16. Use whole dollars—
round up if necessary.
15. Gross Salary&Benefits: Add the values in columns 13 and 14.
16. % of Work in EM Duties: The percentage of overall work time that the person named in the first column spends on
emergency management duties, stated as a decimal. For example, 25% = .25, 50% = .50, 100% = 1.00.
17. Salary&Benefits for EM: Multiply the values in columns 15& 16. Enter a subtotal at the bottom of the table.
18. Est. EM Travel Costs: Enter estimated emergency management-related travel costs for each employee. Do not
include travel costs that will be reimbursed by another state or federal program. Enter a subtotal at the bottom of the
table.
19. TOTAL Salaries and Benefits for EM. Add the subtotals at the bottom of both tables to obtain this figure. Transfer
this total to line 9A of form DEM-66.
20. TOTAL Est. EM Travel Costs.Add the subtotals at the bottom of both tables to obtain this figure. Transfer this total
to line 96 of form DEM-66.
DEM-67
7/04
EMPG STAFF JOB DESCRIPTION
Jurisdiction Name City of Round Rock
Staff Members Names Keith Tanner
Position Title EMC
Description Prepared By Keith Tanner
Date Prepared
JOB DESCRIPTION
(If you have an existing job description which provides the information requested below,
fill out the header data above and attach the existing description to this form
A. Provide a general description of the duties performed by this staff member.
SUMMARY OF POSITION
Serve as head of Prevention Division. Conduct/supervise the fire/life safety inspection program for the city.
Conduct/supervise fire investigations. Coordinate public fire and life safety program for the city. Serve as
Emergency Management Coordinator for City's Disaster Management Plan. Administer and develop budget
for Prevention Division programs.
ORGANIZATIONAL RELATIONSHIPS
1. Reports to: Fire Chief on FD related task, City Manager on Emergency Management responsibilities.
2. Directs inspection staff, investigation staff, public education staff and advise Mayor, City Council, City
Manager and Department Heads on Emergency Management matters.
B. If this staff member performs both emergency management duties and other duties, identify the specific
emergency management duties performed.
Provide guidance and support to City Staff and elected officials on matters involving Emergency Management.
Provide coordination of development and revisions of planning documents.
Develop and submit financial documents and workplans as required.
Provide information to citizens regarding Emergency Management
DEM-68 Retain a copy of this description for future use.
7/04
EMPG STAFF JOB DESCRIPTION
Jurisdiction Name ' City of Round Rock
Staff Members Names Mark Selby
Position Title Ass't EMC
Description Prepared B Keith Tanner
Date Prepared 9/8-04
JOB DESCRIPTION
(If you have an existing job description which provides the information requested below,
fill out the header data above and attach the existing description to this form
A. Provide a general description of the duties performed by this staff member.
SUMMARY OF POSITION
This position is responsible for assisting the Fire Marshal in determination of fire cause and origin, conducting
routine inspections on a regular basis to insure the fire hazards are detected and abated; enforcing the
adopted fire code; monitoring fire drills; testing of house lines, sprinkler systems, fire detection and warning
systems, flammable liquid installations, or other equipment/systems involving fire protection and safety. Also,
this position serves as Assistant Emergency Management Coordinator and relief firefighter as needed.
ORGANIZATIONAL RELATIONSHIPS
1. Reports to: Fire Marshal
B. If this staff member performs both emergency management duties and other duties, identify the speck
emergency management duties performed.
Assist in providing guidance and support to City Staff and elected officials on matters involving Emergency
Management.
Assist in coordination of development and revisions of planning documents.
Develop and submit financial documents and workplans as required.
Assist in providing information to citizens regarding Emergency Management.
DEM-68 Retain a copy of this description for future use.
7/04
TRAVEL POLICY
CERTIFICATION
Jurisdiction Name: City of Round Rock
Check one of the two blocks below
® This jurisdiction has no qualifying travel regulations and EMPG participants
requesting reimbursement for travel expenditures will do so in accordance with
State of Texas travel regulations and rates. The State Travel Allowance Guide
and the State of Texas Mileage Guide are available on the Comptroller of Public
Accounts web site: http://www.cpa.state tx us.
OR
❑ This jurisdiction has its own qualifying travel policy, a copy of which is attached.
EMPG participants requesting reimbursement for travel expenditures will do so in
accordance with that policy.
Name of Grant Financial Officer Cheryl Delaney
Printed or Typed)
Signature of Grant Financial Officer
Date Signed 16
DEM-69
7/03
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0206
SUMMARY SHEET FOR ASSURANCES AND CERTIFICATIONS Expires February 29, 2004
FORCA FOR (Name of Applicant)
FY 5 City of Round Rock
This summary sheet includes Assurances and Certifications that must be read,signed,and submitted as a part of the
Application for Federal Assistance.
An applicant must check each item that they are certifying to:
Part I FEMA Form 20-16A,Assurances-Nonconstruction Programs
Part I1 FEMA Form 20-16B,Assurances-Construction Programs
Part III El FEMA Form 20-16C,Certifications Regarding Lobbying;
Debarment,Suspension,and Other Responsibility
Matters; and Drug-Free Workplace Requirements
Part IV SF LLL,Disclosure of Lobbying Activities (If applicable)
As the duly authorized representative of the applicant,I hereby certify that the applicant will comply with the identified
attached assurances and certifications.
Nyle Maxwell Mayor
Typed Name of Authorized Representative Title
g_� Gg — I
Si a re olAuthorize`&Ropretentative Date Signed
NOTE: By signing the certification regarding debarment,suspension,and other responsibility matters for primary covered
transaction,the applicant agrees that,should the proposed covered transaction be entered into,it shall not knowingly enter
into any lower tier covered transaction 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 this application that it will include the clause titled "Certification
Regarding Debarment,Suspension,Ineligibility and Voluntary Exclusion-Lower Tier Covered Transaction,"provided by
the FEMA Regional Office entering into this covered transaction,without modification,in all lower tier covered transactions
and in all solicitations for lower tier covered transactions. (Refer to 44 CFR Part 17.)
Paperwork Burden Disclosure Notice
"Public reporting burden for this form is estimated to average 1.7 hours per response. Burden means the time,effort and
financial resources expended by persons to generate, maintain, retain, disclose,or to provide information to us. You may
send comments regarding the burden estimate or any aspect of the form, including suggestions for reducing the burden
to: Information Collections Management, Federal Emergency Management Agency, 500 C Street, SW,Washington, DC 20472,
Paperwork Reduction Project(3067-0206). You are not required to respond to this collection of information unless a valid
OMB control number appears in the upper right corner of this form. Please do not send your completed form to the above
address.
FEMA Form 20-16,FEB 01
FEDERAL EMERGENCY MANAGEMENT AGENCY
ASSURANCES-NON-CONSTRUCTION PROGRAMS
Note: Certain of these assurances may not be applicable to your project or program. If you have any questions,please
contact the awarding agency. Further,certain Federal 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 assistance, alcohol abuse or alcoholism;(g)Sections 523 and 527 of
and the institutional,managerial and financial capability the Public Health Service Act of 1912(42 U.S.C.290-dd-3
(including funds sufficient to pay the non-Federal share of and 290-ee-3),as amended,relating to confidentiality of
project costs)to ensure proper planning,management and alcohol and drug abuse patient records;(h)Title VIII of the
completion of the project described in this application. Civil Rights Acts of 1968(42 U.S.C.Section 3601 et seq.),
as amended,relating to nondiscrimination in the sale,
2. Will give the awarding agency,the Comptroller rental or financing of housing;(i)any other
General of the United States,and if appropriate,the State, nondiscrimination provisions in the specific statute(s)
through any authorized representative,access to and the under which application for Federal assistance is being
right to examine all records,books,papers,or documents made;and(j)the requirements of any other
related to the award;and will establish a proper accounting nondiscrimination statute(s)which may apply to the
system in accordance with generally accepted accounting application.
standards or agency directives.
7. Will comply,or has already complied,with the
3. Will establish safeguards to prohibit employees from requirements of Title II and III of the Uniform
using their positions for a purpose that constitutes or Relocation Assistance and Real Property Acquisition
presents the appearance of personal gain. Policies Act of 1970(P.L.91-646)which provide for fair
and equitable treatment of persons displaced or whose
4. Will initiate and complete the work within the property is acquired as a result of Federal or Federally
applicable time frame after receipt of approval of the assisted programs. These requirements apply to all
awarding agency. interest in real property acquired for project purposes
regardless of Federal participation in purchases.
5. Will comply with the Intergovernmental Personnel
Act of 1970(42 U.S.C.Section 4728-4763)relating to S. Will comply with 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 employees whose principal
specified in Appendix A of OPM's Standards for a Merit employment activities are funded in whole or in part
System of Personnel Administration)5 C.F.R.900, with Federal funds.
Subpart F).
9. Will comply,as applicable,with the provisions of
6. Will comply with all Federal statutes relating to the Davis-Bacon Act(40 U.S.C.Sections 276a to 276a-
nondiscrimination. These include but are not limited to: 7),the Copeland Act(40 U.S.C.Section 276c and 18
(a)Title VI of the Civil Rights Act of 1964(P.L.88-352) U.S.C.Sections 874),and the Contract Work Hours
which prohibits discrimination on the basis of race,color and Safety Standards Act(40 U.S.C.Sections 327-333),
or national origin;(b)Title IX of the Education Amendments regarding labor standards for federally assisted
of 1972,as amended(20 U.S.C.Sections 1681-1683,and construction subagreements.
1685-1686),which prohibits discrimination on the basis of
sex;(c)Section 504 of the Rehabilitation Act of 1973,as 10. Will comply,if applicable,with flood insurance
amended(29 U.S.C.Section 794),which prohibits purchase requirements of Section 102(x)of the Flood
discrimination on the basis of handicaps;(d)the Age Disaster Protection Act of 1973(P.L.93-234)which
Discrimination Act of 1975,as amended(42 U.S.C. requires recipients in a special flood hazard area to
Sections 6101-6107),which prohibits discrimination on the participate in the program and to purchase flood
basis of age;(e)the Drug Abuse Office and Treatment Act insurance if the total cost of insurable construction and
of 1972(P.L.92-255),as amended,relating to acquisition is$10,000 or more.
nondiscrimination on the basis of drug abuse;(f)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 of
FEMA Form 20-16A,JUN 94
11. Will comply with environmental standards which may 14. Will comply with P.L.93-348 regarding the
be prescribed pursuant to the following: (a)institution protection of human subjects involved in research,
of environmental quality control measures under the development,and related activities supported by this
National Environmental Policy Act of 1969(P.L.91-190) award of assistance.
and Executive Order(EO)11514;(b)notification of violating
facilities pursuant to EO 11738;(c)protection of wetlands 15. Will comply with the Laboratory Animal Welfare Act
pursuant to EO 11990;(d)evaluation of flood hazards in of 1966(P.L.89-544,as amended,7 U.S.C.2131 et seq.)
floodplains in accordance with EO 11988;(e)assurance of pertaining to the care,handling,and treatment of warm
project consistency with the approved State management blooded animals held for research,teaching,or other
program developed under the Coastal Zone Management activities supported by this award of assistance.
Act of 1972(16 U.S.C.Section 1451 et seq.);(I)conformity
of Federal actions to State(Clean Air)Implementation 16. Will comply with the Lead-Based Paint Poisoning
Plans under Section 176(c)of the Clean Air Act of 1955, Prevention Act(42 U.S.C.Section 4801 et seq.)which
as amended(42 U.S.C.Section 7401 et seq.);(g)protection prohibits the use of lead based paint in construction or
of underground sources of drinking water under the Safe rehabilitation of residence structures.
Drinking Water Act of 1974,as amended,(P.L.93-523);
and(h)protection of endangered species under the 17. Will cause to be performed the required financial
Endangered Species Act of 1973,as amended, and compliance audits in accordance with the Single
(P.L.93-205). Audit Act of 1984.
12. Will comply with the Wild and Scenic Rivers Act of 18. Will comply with all applicable requirements of all
1968(16 U.S.C.Section 1271 et seq.)related to other Federal laws,executive orders,regulations and
protecting components or potential components of policies governing this program.
the national wild and scenic rivers system.
19. It will comply with the minimum wage and maximum
13. Will assist the awarding agency in assuring hours provisions of the Federal Fair Labor Standards
compliance with Section 106 of the National Historic Act(29 U.S.C.201),as they apply to employees of
Preservation Act of 1966,as amended(16 U.S.C.470), institutions of higher education,hospitals,and other
EO 11593(identification and protection of historic non-profit organizations.
properties),and the Archaeological and Historic
Preservation Act of 1974(16 U.S.C.469a-1 et seq.).
FEMA Form 20-16A(BACK)
FEDERAL EMERGENCY MANAGEMENT AGENCY
ASSURANCES-CONSTRUCTION PROGRAMS
NOTE: Certain of these assurances may not be applicable to your project or program. If you have any 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 assistance, 9. Will comply with the Lead-Based Paint Poisoning
and the institutional,managerial and financial capability Prevention Act(42 U.S.C.Sections 4801 et seq.)which
(including funds sufficient to pay the non-Federal share of prohibits the use of lead based paint in construction or
project costs)to ensure proper planning,management and rehabilitation of residence structures.
completion of the project described in this application.
10. Will comply with all Federal statutes relating to
2. Will give the awarding agency,the Comptroller non-discrimination. These include but are not limited to:
General of the United States,and if appropriate,the State, (a)Title VI of the Civil Rights Act of 1964(P.L.88-352)
through any authorized representative,access to and the which prohibits discrimination on the basis of race,color
right to examine all records,books,papers,or documents or national origin;(b)Title IX of the Education Amendments
related to the assistance; and will establish a proper of 1972,as amended(20 U.S.C.Sections 1681-1683,and
accounting system in accordance with generally accepted 1685-1686),which prohibits discrimination on the basis of
accounting standards or agency directives. sex;(c)Section 504 of the Rehabilitation Act of 1973,as
amended(29 U.S.C.Section 794),which prohibits
3. Will not dispose of,modify the use of,or change the discrimination on the basis of handicaps;(d)the Age
terms of the real property title,or other interest in the site Discrimination Act of 1975,as amended(42 U.S.C.
and facilities without permission and instructions from Sections 6101-6107),which prohibits discrimination on the
the awarding agency. Will record the Federal interest in basis of age;(e)the Drug Abuse Office and Treatment Act
the title of real property in accordance with awarding of 1972(P.L.92-255),as amended,relating to
agency directives and will include a covenant in the non-discrimination on the basis of drug abuse;(f)the
title of real property acquired in whole or in part with Comprehensive Alcohol Abuse and Alcoholism Prevention,
Federal assistance funds to assure nondiscrimination Treatment and Rehabilitation Act of 1970(P.L.91-616),as
during the useful life of the project. amended,relating to non-discrimination on the basis of
alcohol abuse or alcoholism; (g)Sections 523 and 527 of
4. Will comply with the requirements of the assistance the Public Health Service Act of 1912(42 U.S.C.290 dd-3
awarding agency with regard to the drafting,review and and 290 ee-3),as amended,relating to confidentiality of
approval of construction pians and specifications. alcohol and drug abuse patient records; (h)Title VIII of the
Civil Rights Acts of 1968(42 U.S.C.Section 3601 et seq.),
5. Will provide and maintain competent and adequate as amended,relating to non-discrimination in the sale,rental
engineering supervision at the construction site to ensure or financing of housing; (i)any other non-discrimination
that the complete work conforms with the approved plans provision in the specific statute(s)under which application
and specifications and will furnish progress reports and for Federal assistance is being made;and(j)the
such other information as may be required by the requirements of any other non-discrimination statute(s)
assistance awarding agency or state. which may apply to the application.
6. Will initiate and complete the work within the applicable 11. Will comply,or has already complied,with the
time frame after receipt of approval of the awarding agency. requirements of Title II and III of the Uniform
Relocation Assistance and Real Property Acquisition
7. Will establish safeguards to prohibit employees from Policies Act of 1970(P.L.91-646)which provide for fair
using their positions for a purpose that constitutes or and equitable treatment of persons displaced or whose
presents the appearance of personal or organizational property is acquired as a result of Federal or Federally
conflict of interest,or personal gain. assisted programs. These requirements apply to all
interest in real property acquired for project purposes
S. Will comply with the Intergovernmental Personnel Act regardless of Federal participation in purchase.
of 1970(42 U.S.C.Sections 4728-4763)relating to prescribed
standards for merit systems for programs funded under one 12. Will comply with provisions of the Hatch Act(5 U.S.C.
of the nineteen statutes or regulations specified in Sections 1501-1508 and 7324-7328)which limit the
Appendix A of OPM's Standards for a Merit System of political activities of employees whose principal employment
Personnel Administration(5 C.F.R.900,Subpart F). activities are funded in whole or in part with Federal funds.
FEMA Form 20-16B,JUN 94
,13. Will comply,as applicable,with the provisions of the 20. It will comply with the minimum wage and maximum
Davis-Bacon Act(40 U.S.C.Sections 276a to 276a-7), hours provisions of the Federal Fair Labor Standards
the Copeland Act(40 U.S.C.Section 276c and 18 U.S.C. Act(29 U.S.C.201),as they apply to employees of
Section 874),the Contract Work Hours and Safety institutions of higher education,hospitals,and other
Standards Act(40 U.S.C.Sections 327-333)regarding non-profit organizations.
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 construct 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 if the total
riate Federal agency for rior
cost of insurable construction and acquisition is$10,000 approval changes that at to the lter the cost of the p of ctpuse 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 may activities until the conditions of the construction grant
be prescribed pursuant to the following: (a)institution program(s)have been met.
of environmental quality control measures under the
National Environmental Policy Act of 1969(P.L.91-190) 22. It will operate and maintain the facility in accordance
and Executive Order(EO) 11514; (b)notification of violating with the minimum standards as may be required or
facilities pursuant to EO 11738; (c)protection of wetlands prescribed by the applicable Federal,State,and local
pursuant to EO 11990; (d)evaluation of flood hazards in agencies
floodplains in accordance with EO 11988;(e)assurance of facilities for the maintenance and operation of such
project consistency with the approved State management
program developed under the Coastal Zone Management 23. It will require the facility to be designed to comply
Act of 1972(16 U.S.C.Section 1451 et seq.); (f)conformity with the"American Standard Specifications for Making
of Federal actions to State(Clean Air)Implementation Buildings and Facilities Accessible to,and Usable by,
Plans under Section 176(c)of the Clean Air Act of 1955, the Physically Handicapped,"Number A117.- 1961,as
as amended(42 U.S.C.Section 7401 et seq.); (g)protection modified(41 CFR 101-17.703). The applicant will be
of underground sources of drinking water under the Safe responsible for conducting inspections to ensure
Drinking Water Act of 1974,as amended,(P.L.93-523); compliance with these specifications by the contractor.
and(h)protection of endangered species under the
Endangered Species Act of 1973,as amended,(P.L.93-205). 24. If any real property or structure thereon is provided
16. Will comply with the Wild and Scenic Rivers Act of or improved with the aid of Federal financial assistance
extended to the applicant,this assurance shall obligate
1968(16 U.S.C.Section 1271 et seq.)related to the applicant,or in the case of any transfer of such
protecting components or potential components of the property,any transfer,for the period during which the
national wild and scenic rivers system. real property or structure is used for a purpose for which
the Federal financial assistance is extended or for
17. Will assist the awarding agency in assuring another purpose involving the provision of similar
compliance with Section 106 of the National Historic services or benefits.
Preservation Act of 1966,as amended(16 U.S.C.470),
EO 11593(identification and preservation of historic
25. In making subgrants with nonprofit institutions
properties),and the Archaeological and Historic under this Comprehensive Cooperative Agreement,it
Preservation Act of 1974(16 U.S.C.469a-1 et seq.). agrees that such grants will be subject to OMB Circular
18. Will cause to be performed the required financial A-122, "Cost Principles for Non-profit Organizations"
and compliance audits in accordance with the Single Audit through 18277(April 27included in Vol.49, e Register,pages 18260
1984)
Act of 1984.
19. Will comply with all applicable requirements of all
other Federal laws,Executive Orders,regulations and
policies governing this program.
FEMA Form 20-16B(BACK)
FEDERAL EMERGENCY MANAGEMENT AGENCY
CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND
OTHER RESPONSIBILITY MATTERS; AND DRUG-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 on 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(Nonprocurement)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 (b) Have not within a three-year period preceding this application been
convicted of ar had a civilian judgment rendered against them for
A. As required by section 1352,Title 31 of the U.S.Code,and commission of fraud or a criminal offense in connection with
implemented at 44 CFR Part 18,for persons entering into a grant obtaining,attempting to obtain,or perform a public(Federal,State,
or cooperative agreement over$100,000,as defined at 44 CFR or local)transaction or contract under a public transaction;violation
Part 18,the applicant certifies that of Federal or State antitrust statutes or commission of embezzlement,
theft,forgery,bribery,falsification or destruction of records,
(a) No Federal appropriated funds have been paid or will be paid, making false statements,or receiving stolen property,
by or on behalf of the undersigned,to any person for influencing or
attempting to influence an officer or employee of any agency,a (c) Are not presently indicted for or otherwise criminally or civilly
Member of Congress,an officer or employee of congress,or an charged by a governmental entity(Federal,State,or local)with
employee of a Member of Congress in connection with the making commission of any of the offenses enumerated in paragraph(1 xb)
of any Federal grant,the entering into of any cooperative agreement, of this certification;and
and the extension,continuation,renewal,amendment,or modification
of any Federal grant or cooperative agreement; (d) Have not within a three-year period preceding this application
had one or more public t ransactions(Federal,State,or local)
(b) If any other funds than Federal appropriated funds have been terminated for cause or default;and
paid or will be paid to any person for influencing or attempting to
influence an officer or employee of any agency,a Member of B. Where the applicant is unable to certify to any of the statements
Congress,an officer or an employee of Congress,or employee in this certification,he or shall shall attached an explanation to this
of a member of Congress in connection with this Federal grant or application.
cooperative agreement,the undersigned shall complete and submit
Standard Form LLL,"Disclosure of Lobbying Activities,"in 3. DRUG-FREE WORKPLACE
accordance with its instructions; (GRANTEES OTHER THAN INDIVIDUALS)
(c) The undersigned shall require that the language of this certification As required by the Drug-Free Workplace Act of 1988,and
be included in the award documents for all subawards at all tiers implemented at 44 CFR Part 17,Subpart F,for grantees,as defined
(including subgrants,contracts under grants and cooperative at 44 CFR Part 17,Sections 17.615 and 17.620:
agreements,and subcontract(s)and that all subrecipients shall
certify and disclose accordingly. A. The applicant certifies that it will continue to privide a drug-
free workplace by
Standard Form LLL,"Disclosure of Lobbying Activities"attached.
(This form must be attached to certification if nonappropriated funds (a) Publishing a statement notifying employees that the unlawful
are to be used to influence activities.) manufacture,distribution,dispensing,sp g,possession,or use of a
controlled substance is prohibited in the grantee's workplace and
2. DEBARMENT,SUSPENSION,AND OTHER specifying the actions tht will be taken against employees for
RESPONSIBILITY MATTERS violation of such prohibition;
(DIRECT RECIPIENT)
(b) Establishing an on-going drug free awareness program to
As required by Executive Order 12549,Debarment and Suspension, inform empoyees about:
and implemented at 44 CFR Part 67,for prospective participants in
primary covered transactions,as defined at 44 CFR Part 17,
(1) The dangers of drug abuse in the workplace;
Section 17.510-A. The applicant certifies that it and its principals: (2) The grantee's policy of maintaining a drug-free workplace;
(3) Any available drug counseling,rehabilitation,and
(a) Are not presently debarred,suspended,proposed for debarment, employee assistance programs;and
declared ineligible,sentenced to a denial of Federal benefits by a State (4) the penalties that may be imposed upon employees for
or Federal court,or voluntarily excluded from covered transactions by drug abuse violations occurring in the workplace;
any Federal department or agency;
FEMA Form 20-16C,JUN 94
(c) Making it arequirement that each employee to be engaged in (2) Requiring such employee to participate satisfactorily in a
the performance of the grant to be given a copy of the statement drug abuse assistance or rehabilitation program approved forrequired by paragraph(a);
such purposes by a Federal,State,or local health,law enforcement,
(d) Notifying the employee in the statement required by or other appropriate agency.
paragraph(a)that,as a condition of employment under the grant, (g) Making a good faith effort to continue to maintain a drug free
the employee will: workplace through implementation of paragraphs(a),(b),(c),(d),(e),
(1) Abide by the terms of the statement;and and(f).
8. the grantee may insert in the space provided below the site(s)for
(2) Notify the employee in writing of his or her conviction for a the performance of work done in connection with the specific grant:
violation of a criminal drug statute occurring in the workplace no later
than five calendar days after such conviction. Place of Performance(Street address,City,County,State,Zip code)
(e) Notifying the agency,in writing,within 10 calendar days after
receiving notice under subparagraph(d)(2)from an employee or
otherwise receiving actual notice of such conviction. Employers of
convicted employees must provide notice,including position title,
to the applicable FEMA awarding office,i.e.,regional office or
FEMA office.
C
(f) Taking one of the following actions,within 30 calendar days of heck Dif there are workplaces on file that are not identified here.
receiving notice under subparagraph(d)(2),with respect to any
employee who is so convicted: 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
(1) Taking appropriate personnel action against such an employee, of which should be included with each application for FEMA funding.
up to and including termination,consistent with the requirements States and State agencies may elect to use a Statewide certification.
of the Rehabilitation Act of 1973,as amended;or
FEMA Foran 20-16C(BACK)
Q�Aoc-
Mti x
v\ N
GRANT APPLICATION/PROPOSAL REVIEW (GAPR)
This form must be completed and presented to Department Leadership for review prior to:
a) the submission of a grant application;
b) the renewal of a grant; or,
c) a change in the budgeted amount of the grant
Following review by Departmental Leadership, this form should be submitted to the City Budget
Supervisor(218-5445)for Budget Office Approval.
The GAPR form is due to the Budget Office for approval at least five(5)working days prior to
the City Council agenda deadline.
All grant applications require City Council approval to before submission, this form should be
completed by the department and submitted with the Council Action requesting approval to apply
and the"Request for Finance Approval'form. Once a grant is awarded, a copy of this GAPR
along with the Grant Application notification form should be submitted with the Council Action
requesting authorization to accept the grant and the"Request for Finance Approval'form.
NOTE: NO GRANT APPLICATION, RENEWAL, OR INCREASE IN GRANT FUNDING WILL
BE CONSIDERED WITHOUT THE SUBMISSION AND APPROVAL OF THIS FORM.
Grantor Division of Emergency Management
Texas Department of Public Safety
Grant
Title: EMPG (Emergency Management Performance Grant
Grant Amount: Grant Grant Match:
FTEs:
$43,204.85 2 $129,614.56
PROGRAM BUDGET
Fiscal Year FY:05 FY: FY: FY: FY: TOTAL
Grant
Funding 43204.85
Required 129614.56
City Match
TOTAL 172819.41
Please complete the sentences listed below by filling out the boxes:
Page 1
This is the list year): First year I of a list ear One year Grant.
This Grant will be appropriated in FY: 05
Other In-Kind Match Provided: $
Total Program Budget: $ 172819.41
Proposed Positions (FTE's) to be Funded:
[Indicate Title(s) and Status (regular/temporary). Please add rows if number is
insufficient.
TITLE STATUS Re ./Tem Estimated Cost
1. Emergency Management Coordinator(Fire Regular $95,057.59
Marshal
2. Ass't Emergency Management Coordinator(Fire Regular $77,761.82
Prevention Specialist)
3.
TOTAL: 172,819.41
Should we subcontract? If so, why?
This grant proposal/application is a: New Grant x_Renewal Grant Revision
Type of Funds: _Federal _X_Federal Pass-Through _State _Private/Other
Funding Source: Texas Division of Emergency Management; Texas Department of
Public Safety
GRANT TERM DATES
TERM YEAR MONTH/DAY/YEAR THROUGH MONTH/DAY/YEAR
Year One: 10-1-04 Through 9-30-05
Year Two: Through
Year Three: Through
Year Four: Through
Year Five: Through
Collaborations with other Agencies/Departments: All City Departments
List the Departmental Goal or Strategy that will be supported by this grant(as included in the
Approved Budget Document):
Maintain a safe environment for all Citizens. Evaluate and target homeland security measures.
Associated Program/Program Objective: The City's Emergency Management program insures
that the City has the ability to respond quickly and efficiently to emergencies, regardless of the
type.
Page 2
PLANNED PERFORMANCE MEASURES (List Maior Three)):
1. Maintain an"Advanced"level of Preparedness as designated by the State Division of Emergency Management.
2. Submit timely reports and documents as required.
3. Maintain all planning documents current and to reflect the way the City will deal with emergencies and disasters.
Brief description of proposed grant program:
The EMPG program provides federal funding to assist states and local governments in developing
and carrying out emergency management programs. States receive EMPG funding from FEMA and,
in turn, pass through a majority of the EMPG funding to local reimburse them for emergency
management program expenses. Currently,the Emergency Management Coordinator(EMC)and
Ass't. Coordinator(Ass't EMC)spend 50%of their time on emergency management activities. This
program will reimburse the city for 50%of the time spent on emergency management activities
which equates to 25%of the salaries for the emergency management staff.
Contingency Plan if Grant Funding Discontinued (Check Appropriate Box, or Detail in
"Other."):
A If this grant project's goals and objectives are reached, the Department will request
funding from the General Fund to continue the program if grant funding ends.
B XXX This grant-funded project is considered a baseline program that must be continued
with or without grant funding.
C This grant-funded project is not considered a baseline program that must be
continued with or without grant funding.
This one-time grant-funded project intended to cease at the grant-term end. No
D. other funding will be requested from alternative grant sources or General Fund
dollars
If this grant-funded project's performance (for in the example of a pilot or
E demonstration grant) indicates the need for the Department to apply for follow-up
grant funding, the project may require supplemental funding from the General
Fund to cover the cost of the follow-up project.
F.
Other:
DEPARTMENTAL REVIEW/APPROVAL
(To be completed by the submitting Department)
Dept. Director Review/Approval: `2vt�_ _ Date: y t
Date Application Due(if Applicable):_09-25-04—Date Forwarded: 09-08-04
CITY BUDGET OFFICE REVIEW APPROVAL
(To be completed by the City Budget Office)
Date Received: Date Approved/Disapproved:
i
Budget/Accounting Supervisor Review/Approval: f ii, Date:
Finance Director Review/Approval: Date:
Page 3