CM-07-02-021Fiscal Year 2007 EMPG STATEMENT OF WORK & PROGRESS REPORT
Nage 1 of 6
Applicant Name: City of Round Rock, Texas
This is our: /1 Statement of Work ❑ Progress Report #1 ❑ Progress Report #2
Submitted By
Date
GDEM Review By
Date
Statement of Work
Richard
Rago
1/29/07
Progress Report #1
Progress
Report #2
Task 1
Work Plan & Semiannual Progress Report
Work Plan
' We will submit
an EMPG Application, two Progress Reports, and quarterly Financial
Reports.
Progress
Report #1
❑ This Progress Report # 1 is being submitted to the GDEM Preparedness Section
❑ First & Second Quarter Financial Reports have been submitted to GDEM Support
Services.
Progress
Report #2
❑ This Progress Report # 2 is being submitted to the GDEM Preparedness Section.
❑ Third & Fourth Quarter Financial Reports have been submitted to GDEM Support
Services.
Task 2
Legal Authorities for Emergency Management Program
Work Plan
We will maintain
current legal documents establishing our emergency management
are current & on file with GDEM; no additional action is required.
or update & submit to our Regional Liaison Officer:
Court Order
for: City of Round Rock
Joint Resolution
program.
❑ Our legal documents
/r We will prepare
❑ Commissioner's
a City Ordinance(s)
❑ Updated
❑ NIMS Adoption
Progress
Report #1
❑ We completed & submitted to our Regional Liaison Officer:
❑ Commissioner's Court Order
❑ City Ordinance(s) for:
❑ Updated Joint Resolution
❑ NIMS Adoption
Progress
Report #2
❑ We completed & submitted to our Regional Liaison Officer:
❑ Commissioner's Court Order
❑ City Ordinance(s) for:
❑ Updated Joint Resolution
❑ NIMS Adoption
01- c 1
DEM 17A
12/06
Task 3
Work Plan
Progress
Report #1
Progress
Report #2
Task 4
Work Plan
Progress
Report #1
Progress
Report #2
Public Education/Information
® 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:
❑ We completed the following hazard awareness or public education/information
activities:
❑ We completed the following hazard awareness or public education/information
activities:
Emergency Management Planning Documents
® 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 ®An nexes: A ®B ❑ C ®D ❑ E ®F ❑ G ®H ❑ 1
K ❑ L ®M ®N ®O ®P ®Q ®R ❑ S ❑ T ®U ®V ❑
Other documents:
J
NOTE: Plans & annexes dated September 30, 2002, & earlier should be revised/updated
this year. Plans requiring revisions for NIMS should have been completed by
September 30, 2006.
❑ 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 ❑
KOL❑ M❑ N❑ O❑ P❑ Q❑ R❑ S❑ T❑ U❑ V❑
Other documents:
❑ We have reviewed our emergency management plan & its annexes for currency.
❑ We will develop or update by revision or change these planning documents:
BasicPlan❑Annexes:A❑B❑C❑D❑E❑F ❑G❑H❑I❑J ❑
KOL❑ M❑ N❑ O❑ P❑ Q❑ R❑ S❑ T❑ U❑ V❑
Other documents:
DEM 17A
12/06
Task 5
Work Plan
Exercise Participation & Schedule
® We will develop & submit a two-year exercise schedule (below).
❑ 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.
Period
EXERCISE SCHEDULE
This Fiscal Year (FY
06)
(Oct. 2006— Sept. 2007)
Next Fiscal Year (FY
08)
(Oct. 2007— Sept. 2008)
Exercise Type
® Tabletop
Exercise Scenario *
® Functional
❑ Full -Scale
® Tabletop
❑ NH ❑ TH ❑ NS ® TR
Quarter of Year
❑ 1®2 03 ❑ 4
❑ NH ❑ TH ❑ NS ® TR
❑ 1®2❑3❑4
® Functional
® Full -Scale
❑ NH ® TH ❑ NS ❑ TR
❑ 1❑2®3❑4
NH ❑ TH ❑ NS ❑ TR
❑ 1❑2❑3®4
NOTE: A Full -Scale exercise must be conducted every three (3) years.
Our last Full -Scale exercise was conducted on (date): Scenario*:
*Exercise Scenarios: NH = Natural Hazard, TH = Technological Hazard, NS = National Security, TR
= Terrorism
Progress
Report #1
Progress
Report #2
Task 6
Work
Plan
❑ We conducted a tabletop exercise and provided documentation to GDEM.
❑ 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.
❑ # of Participating Jurisdictions # of People Participating
❑ We conducted a tabletop exercise and provided documentation to GDEM.
❑ 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.
❑ # of Participating Jurisdictions # of People Participating
Training for Emergency Management Personnel
® EMPG-funded emergency management personnel will participate in the
following training during
Position/Name
EMC Richard Rago
Richard Johnson
Course name(s) or Number(s) Date
G610 7/10/07-7/12/07
G710 8/28/07-8/30/07
1S300
G920 6/25/07-6/29/07
G202 6/11/07-6/15/07
G288 5/1/07-5/3/07
G290 6/12/07-6/15/07
DEM 17A
12/06
Progress
Report #1
Progress
Report #2
Task 7
❑ Emergency management personnel completed the following training:
Position/Name
Course name(s) or Number(s) Date
❑ Emergency management personnel completed the following training:
Position/Name
A.
B.
C.
D.
E.
Course name(s) or Number(s) Date
Work Plan
Progress
Report #1
Progress
Report #2
Emergency Management Training for Other Personnel
® We will conduct or arrange emergency management related training for elected
officials, other local officials, & support agencies.
The following formal training courses were taught or contracted:
Course Taught # of People Trained
A.
B.
C.
D.
E.
The following formal training courses were taught or contracted:
Course Taught # of People Trained
A.
B.
C.
D.
E.
DEM 17A
12/06
Task 8
Work Plan
Progress
Report #1
Progress
Report #2
Emergency Management Organizational Development
® We will participate in the following emergency management organizational
development activities:
Various conferences as they become available
We completed the following staff development activities:
We completed the following staff development activities:
DEM 17A
12/06
Applicant Name:
REMARKS
(Use a Continuation Sheet if necessary)
DEM 17A
12/06
Fiscal Year 2007
EMERGENCY MANAGEMENT PERFORMANCE GRANT (EMPG)
APPLICATION
PLEASE TYPE OR PRINT
1. APPLICANT NAME (Jurisdiction): City of Round Rock, Texas
2. COUNTY: Williamson
3. DISASTER DISTRICT: 6b
4. EMPG STATUS: /1 Current EMPG Program participant
❑ New EMPG Program applicant
5. PROGRAM PARTICIPANTS: (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.)
a. City of Round Rock, Texas Only
b.
c.
d.
6. CHECKLIST OF APPLICATION ATTACHMENTS: (See the FY 2007
for information on completing these forms.)
Local Emergency Management Program Guide
form should be signed by the EMC.
Official should sign this form.
description must be provided for each
works 50 percent or more of their time
►1 Designation of Grant Officials (form DEM-17).
/1 Statement of Work & Progress Report (form DEM-17B). This
i1 Application for Federal Assistance (form DEM-67). The Authorized
EMPG Staffing Pattern (form DEM-66).
►1 EMPG Staff Job Description (form DEM-68). An updated job
staff member listed in the FY 07 EMPG Staffing Pattern who
in emergency management duties.
must be signed by an
— Non-Construction Programs & FEMA
Suspension, & Other Responsibility
Form 20-16.
a completed Disclosure of Lobbying
application package.
Officer should sign this form. If the
Direct Deposit, a new Direct Deposit
Officer should sign this form.
0 FEMA Form 20-16, Summary Sheet for Assurances & Certifications
Authorized Official. Attach FEMA Form 20-16A, Assurances
Form 20-16C, Certifications Regarding Lobbying, Debarment,
Matters; and Drug-Free Workplace Requirements, to the FEMA
❑ If the applicant performs lobbying to influence federal actions,
Activities (SF LLL) must be completed and included in the grant
❑ Direct Deposit Authorization (form 74-146). The Grant Financial
jurisdiction has been receiving EMPG reimbursements through
Authorization is not required.
/1 Travel Policy Certification (form DEM-69). The Grant Financial
7. CERTIFICATION: This Application together with the attached EMPG Statement of Work & Progress Report
(form DEM-17B) constitute the annual work plan for the emergency management program whose participants are
listed above. The undersigned agree to exert their best efforts to accomplish all activities listed in the Statement of
& Progress Report approved by the Division of Emergency Management.
a R-7
(Au\orized Official Date Emergency Management Coordinator Date
.,,. (Signature) (Signature)
G EM USE O ?LY
8. APPROVAL. The attached Fiscal Year 2006 Statement of Work & Progress Report is approved.
❑ Chief Date
❑ State Coordinator of Preparedness and Operations
DEM 17
12/06
DEM 17
12/06
DESIGNATION OF GRANT OFFICIALS
Grant Program
1 FY 07 Emergency Management Performance Grant (EMPG)
Applicant Name
City of Round Rock
Emergency Management Coordinator
Name
' Mr. ❑ Ms.
Official
Mailing
Address
Richard Rago
203 Commerce Blvd
Round Rock, Texas. 78664
Daytime Phone Number
512-218-3200
Fax Number
512-218-5594
E-mail Address
rrago@round-rock.tx.us
Grant Financial Officer
Name
i1 Mr. ❑ Ms.
Title
Treasury & Finance Supervisor
Official
Mailing
Address
Elaine Wilson
221 East Main St
Round Rock, Texas. 78664
Daytime Phone Number
512-218-5444
Fax Number
512-218-5442
E-mail Address
ewilson@round-rock.tx.us
Authorized Official (Mayor, County Judge, City Manager)
Name
Mr. ❑ Ms.
Title
- -b• mL� tie--
Official
Mailing
Address
w.nies aCkluse,
221 East Main St
Round Rock, Texas. 78664
Daytime Phone Number
512-218-5401
Fax Number
512-218-7097
E-mail Address
c.irnti eroa
ty � round: rocEc.+x, us
DEM 17
12/06
EMERGENCY MANAGEMENT PERFORMANCE GRANT (EMPG)
STAFFING PATTERN
(Instructions on reverse)
DEM 66
12/06
1. Applicant Name (as it appears on EMPG
Application):
City of Round Rock, Texas
2. County:
Williamson
3. Fiscal Year
2007
4.
FULL-TIME EMPLOYEES
(including those who work all or
only a portion of their time in
emergency management duties)
5.
Gross
Annual
Salary
6.
Gross
Annual
Benefits
7.
Gross
Salary &
Benefits
(5+6)
8.
% of
Work in
EM
Duties
9.
Salary &
Benefits
for EM
(7x8)
10.
Est.
EM
Travel
Costs
Name: Richard Rago
Position: EMC
100%
Name: Richard Johnson
Position: Ass't EMC
25%
Name:
Position:
%
Name:
Position:
Name:
Position:
%
Name:
Position:
%
Name:
Position:
Name:
Position:
Name:
Position:
Name:
Position:
SUBTOTAL
11.
PART-TIME
EMPLOYEES
12.
% of
Full
Time
13.
Gross
Annual
Salary
14.
Gross
Annual
Benefits
15.
Gross
Salary &
Benefits
(13+14)
16.
% of
Work in
EM
Duties
17.
Salary &
BenefitsF
or EM (15
x 16)
18.
Est.
EM
Travel
Costs
Name:
Position:
Name:
Position:
Name:
Position:
B. SUBTOTAL
TOTAL
Add Subtotals in A & B above
I 19.
20.
DEM 66
12/06
APPLICATION FOR FEDERAL ASSISTANCE
DEM 67
12/06
Instructions on Reverse
1. NAME OF PROGRAM/
ASSISTANCE:
EMERGENCY MANAGEMENT
PERFORMANCE GRANT (EMPG)
2. CFDA NUMBER:
3. APPLICANT
New Applicant
Renewal
STATUS:
❑
/1
4. FEDERAL FISCAL YEAR:
2007
5. START DATE:
October 1, 2006
6. END DATE:
September 30, 2007
7. APPLICANT INFORMATION
a. Legal Name of Applicant Organization (as it
appears on the EMPG Application/DEM-17):
City of Round Rock, Texas
b. Name & Telephone Number of Emergency
Management Coordinator:
Richard Rago, 512-218-3200
c. Mailing Address:
221 East Main St
Round Rock, Texas. 78664
d. Physical Address (if different from Mailing
Address):
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:
# Staff
Percent
# Staff
Percent
# Staff
Percent
1) Full Time:
1
100
1
25
2) Part Time
b. Total Number of EMPG-Funded Personnel
9. ESTIMATED EXPENSES:
a. Salary & Benefits (from line 19, form DEM -66)
97,647
b. Travel Expenses (from line 20 form DEM -66)
0
c. Other Expenses (from section 11 on reverse)
d. Total Expenses (A + B + C)
97,647
e. Federal Share (D x .50)
48,823.50
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-Maxwcff- Qames R. &S u56.)
b. Title of Authorized Official:
a
c. Signature of Authorized Official:
\ jr
\ ��..TT'��
d. Date Signed:
Q191 , ‘i,7
DEM 67
12/06
Instructions on Reverse
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 -66).
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
GDEM pamphlet Summary of Allowable and Unallowable Costs for the EMPG Program to determine
whether a planned expense is allowable or not.
Description of Expense
(Be specific — do not use broad general categories, such as operating expenses.)
Estimated Amount
TOTAL
DEM 67
12/06
EMPG STAFF JOB DESCRIPTION
12/06
uture use.
Jurisdiction Name
City of Round Rock, Texas
Staff Members Name(s)
Richard Rago
Position Title
EMC
Description Prepared By
Richard Rago
Date Prepared
1/29/07
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:
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
ORGANIZATIONAL RELATIONSHIPS
1. Reports to: Fire Marshal Wusterhausen on Emergency Management responsibilities.
2. Advises 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
DEM -68
12/06
uture use.
TRAVEL POLICY
CERTIFICATION
Jurisdiction Name:
City of Round Rock, Texas
x
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: 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
(Printed or Typed)
Signature of Grant Financial Officer
Date Signed
Elaine Wilson
DEM -69
12/06
DATE: February 7, 2007
SUBJECT: City Council Meeting - February 22, 2007
ITEM: Consider a resolution authorizing the Mayor to sign an
Emergency Management Performance Grant
Application.
Department: Fire Department
Staff Person: Larry Hodge
Justification: States receive EMPG funding from the Department of
Homeland Security and, in turn, pass through a majority of the EMPG
funding to local governments to reimburse them for emergency
management program expenses. States, including Texas, require local
governments that wish to participate in the program to submit EMPG
program application that include a statement of work and budget. This
program will reimburse the city for 50% or less of the salaries for the
emergency management staff. This application will serve as the City's
request to continue the grant for the 06-07 fiscal year.
Funding:
Cost: $0.00
Source of funds: N/A
Outside Resources: N/A
Background Information: The City of Round Rock has participated in
this grant since the early 1980's.
Public Comment: N/A
To: City Manager Jim Nuse
From: Richard Rago
Date: May 23, 2007
Re: FY 07 EMPG CM -07-02-021
The following paperwork has been approved by J Kay Gayle and is in addition to the following
existing file. CM -07-02-021. This document is a federal document that must coexist with the
State documents on file. Please call with any questions. 218-3200.
dilx t:wiA,
WakLot,-W
Gyp ol-o),-cal
U.S. Department of Homeland Security
SUMMARY SHEET FOR ASSURANCES AND CERTIFICATIONS
O.M.B. No. 3067-0206
Expires February 28, 2007
FOR
FY
CA FOR (Name of Applicant)
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 X FEMA Form 20-16A, Assurances-Nonconstruction Programs
Part II
Part III p
FEMA Form 20-168, Assurances -Construction Programs
FEMA Form 20-16C, Certifications Regarding Lobbying;
Debarment, Suspension, and Other Responsibility
Matters; and Drug -Free Workplace Requirements
Part IV El 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.
James R. Nuse. P.E
City Manager
Typed Name of Authorized Representative Title
f ' iI' A5) 1001 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.
Form 20-16, FEB 01
U.S. DEPARTMENT OF HOMELAND SECURITY
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,
and the institutional, managerial and financial capability
(including funds sufficient to pay the non -Federal share of
project costs) to ensure proper planning, management and
completion of the project described in this application.
2. Will give the awarding agency, the Comptroller
General of the United States, and if appropriate, the State,
through any authorized representative, access to and the
right to examine all records, books, papers, or documents
related to the award; and will establish a proper accounting
system in accordance with generally accepted accounting
standards or agency directives.
3. Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal gain.
4. Will initiate and complete the work within the
applicable time frame after receipt of approval of the
awarding agency.
5. Will comply with the Intergovernmental Personnel
Act of 1970 (42 U.S.C. Section 4728-4763) relating to
prescribed standards for merit systems for programs
funded under one of the nineteen statutes or regulations
specified in Appendix A of OPM's Standards for a Merit
System of Personnel Administration) 5 C.F.R. 900,
Subpart F).
6. Will comply with all Federal statutes relating to
nondiscrimination. These include but are not limited to:
(a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race, color
or national origin; (b) Title IX of the Education Amendments
of 1972, as amended (20 U.S.C. Sections 1681-1683, and
1685-1686), which prohibits discrimination on the basis of
sex; (c) Section 504 of the Rehabilitation Act of 1973, as
amended (29 U.S.C. Section 794), which prohibits
discrimination on the basis of handicaps; (d) the Age
Discrimination Act of 1975, as amended (42 U.S.C.
Sections 6101-6107), which prohibits discrimination on the
basis of age; (e) the Drug Abuse Office and Treatment Act
of 1972 (P.L. 92-255), as amended, relating to
nondiscrimination on the basis of drug abuse; (0 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
alcohol abuse or alcoholism; (g) Sections 523 and 527 of
the Public Health Service Act of 1912 (42 U.S.C. 290-dd-3
and 290-ee-3), as amended, relating to confidentiality of
alcohol and drug abuse patient records; (h) Title VIII of the
Civil Rights Acts of 1968 (42 U.S.C. Section 3601 et seq.),
as amended, relating to nondiscrimination in the sale,
rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statute(s)
under which application for Federal assistance is being
made; and (j) the requirements of any other
nondiscrimination statute(s) which may apply to the
application.
7. Will comply, or has already complied, with the
requirements of Title II and III of the Uniform
Relocation Assistance and Real Property Acquisition
Policies Act of 1970 (P.L. 91-646) which provide for fair
and equitable treatment of persons displaced or whose
property is acquired as a result of Federal or Federally
assisted programs. These requirements apply to all
interest in real property acquired for project purposes
regardless of Federal participation in purchases.
8. Will comply with provisions of the Hatch Act (5
U.S.C. Sections 1501-1508 and 7324-7328) which limit
the political activities of employees whose principal
employment activities are funded in whole or in part
with Federal funds.
9. Will comply, as applicable, with the provisions of
the Davis -Bacon Act (40 U.S.C. Sections 276a to 276a-
7), the Copeland Act (40 U.S.C. Section 276c and 18
U.S.C. Sections 874), and the Contract Work Hours
and Safety Standards Act (40 U.S.C. Sections 327-333),
regarding labor standards for federally assisted
construction subagreements.
10. Will comply, if applicable, with flood insurance
purchase requirements of Section 102(a) of the Flood
Disaster Protection Act of 1973 (P.L. 93-234) which
requires recipients in a special flood hazard area to
participate in the program and to purchase flood
insurance if the total cost of insurable construction and
acquisition is $10,000 or more.
Form 20-16A, JUN 94
11. Will comply with environmental standards which may
be prescribed pursuant to the following: (a) institution
of environmental quality control measures under the
National Environmental Policy Act of 1969 (P.L. 91-190)
and Executive Order (EO) 11514; (b) notification of violating
facilities pursuant to EO 11738; (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards in
floodplains in accordance with EO 11988; (e) assurance of
project consistency with the approved State management
program developed under the Coastal Zone Management
Act of 1972 (16 U.S.C. Section 1451 et seq.); (t) conformity
of Federal actions to State (Clean Air) Implementation
Plans under Section 176(c) of the Clean Air Act of 1955,
as amended (42 U.S.C. Section 7401 et seq.); (g) protection
of underground sources of drinking water under the Safe
Drinking Water Act of 1974, as amended, (P.L. 93-523);
and (h) protection of endangered species under the
Endangered Species Act of 1973, as amended,
(P.L. 93-205).
12. Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. Section 1271 et seq.) related to
protecting components or potential components of
the national wild and scenic rivers system.
13. Will assist the awarding agency in assuring
compliance with Section 106 of the National Historic
Preservation Act of 1966, as amended (16 U.S.C. 470),
EO 11593 (identification and protection of historic
properties), and the Archaeological and Historic
Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.).
14. Will comply with P.L. 93-348 regarding the
protection of human subjects involved in research,
development, and related activities supported by this
award of assistance.
15. Will comply with the Laboratory Animal Welfare Act
of 1966 (P.L. 89-544, as amended, 7 U.S.C. 2131 et seq.)
pertaining to the care, handling, and treatment of warm
blooded animals held for research, teaching, or other
activities supported by this award of assistance.
16. Will comply with the Lead -Based Paint Poisoning
Prevention Act (42 U.S.C. Section 4801 et seq.) which
prohibits the use of lead based paint in construction or
rehabilitation of residence structures.
17. Will cause to be performed the required financial
and compliance audits in accordance with the Single
Audit Act of 1984.
18. Will comply with all applicable requirements of all
other Federal laws, executive orders, regulations and
policies governing this program.
19. It will comply with the minimum wage and maximum
hours provisions of the Federal Fair Labor Standards
Act (29 U.S.C. 201), as they apply to employees of
institutions of higher education, hospitals, and other
non-profit organizations.
Form 20-16A (BACK)
U.S. DEPARTMENT OF HOMELAND SECURITY
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
A. As required by section 1352, Title 31 of the U.S. Code, and
implemented at 44 CFR Part 18, for persons entering into a grant
or cooperative agreement over $100,000, as defined at 44 CFR
Part 18, the applicant certifies that:
(a) No Federal appropriated funds have been paid or will be paid,
by or on behalf of the undersigned, to any person for influencing or
attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of congress, or an
employee of a Member of Congress in connection with the making
of any Federal grant, the entering into of any cooperative agreement,
and the extension, continuation, renewal, amendment, or modification
of any Federal grant or cooperative agreement;
(b) If any other funds than Federal appropriated funds have been
paid or will be paid to any person for influencing or attempting to
influence an officer or employee of any agency, a Member of
Congress, an officer or an employee of Congress, or employee
of a member of Congress in connection with this Federal grant or
cooperative agreement, the undersigned shall complete and submit
Standard Form LLL, "Disclosure of Lobbying Activities," in
accordance with its instructions;
(c) The undersigned shall require that the language of this certification
be included in the award documents for all subawards at all tiers
(including subgrants, contracts under grants and cooperative
agreements, and subcontract(s) and that all subrecipients shall
certify and disclose accordingly.
Standard Form LLL, "Disclosure of Lobbying Activities" attached.
(This form must be attached to certification if nonappropriated funds
are to be used to influence activities.)
2. DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS
(DIRECT RECIPIENT)
As required by Executive Order 12549, Debarment and Suspension,
and implemented at 44 CFR Part 67, for prospective participants in
primary covered transactions, as defined at 44 CFR Part 17,
Section 17.510-A. The applicant certifies that it and its principals:
(a) Are not presently debarred, suspended, proposed for debarment,
declared ineligible, sentenced to a denial of Federal benefits by a State
or Federal court, or voluntarily excluded from covered transactions by
any Federal department or agency;
(b) Have not within a three-year period preceding this application been
convicted of ar had a civilian judgment rendered against them for
commission of fraud or a criminal offense in connection with
obtaining, attempting to obtain, or perform a public (Federal, State,
or local) transaction or contract under a public transaction; violation
of Federal or State antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records,
making false statements, or receiving stolen property;
(c) Are not presently indicted for or otherwise criminally or civilly
charged by a governmental entity (Federal, State, or local) with
commission of any of the offenses enumerated in paragraph (1)(b)
of this certification; and
(d) Have not within a three-year period preceding this application
had one or more public t ransactions (Federal, State, or local)
terminated for cause or default; and
B. Where the applicant is unable to certify to any of the statements
in this certification, he or shall shall attached an explanation to this
application.
3. DRUG-FREE WORKPLACE
(GRANTEES OTHER THAN INDIVIDUALS)
As required by the Drug -Free Workplace Act of 1988, and
implemented at 44 CFR Part 17, Subpart F, for grantees, as defined
at 44 CFR Part 17, Sections 17.615 and 17.620:
A. The applicant certifies that it will continue to privide a drug-
free workplace by:
(a) Publishing a statement notifying employees that the unlawful
manufacture, distribution, dispensing, possession, or use of a
controlled substance is prohibited in the grantee's workplace and
specifying the actions tht will be taken against employees for
violation of such prohibition;
(b) Establishing an on-going drug free awareness program to
inform empoyees about:
(1) The dangers of drug abuse in the workplace;
(2) The grantee's policy of maintaining a drug-free workplace;
(3) Any available drug counseling, rehabilitation, and
employee assistance programs; and
(4) the penalties that may be imposed upon employees for
drug abuse violations occurring in the workplace;
Form 20-16C, JUN 94