CM-08-01-005DATE: December 11, 2007
SUBJECT: City Manager Approval
ITEM: Emergency Management Performance Grant.
Department: Police Department
Staff Person: Bryan Williams
Justification: Consider a resolution authorizing the City Manager to
sign a Grant application for the renewal of an
Emergency Management Performance Grant. This
grant is from the Governor's Division of Emergency
Management and will partially fund salaries for the
Emergency Management Coordinator and Assistant
Emergency Management Coordinator.
Funding:
Cost: N/A
Source of funds: N/A
Background
Information: Staff recommends the signing of this Grant application, so
that we may receive additional funding to help defray
budgeted salaries for the position of Emergency
Management Coordinator and Assistant Emergency
Management Coordinator. The Texas Governors Division of
Emergency Management has awarded the City of Round
Rock this grant in previous years and it is recommended
that we renew this Grant for FY 08. Participation in the
Emergency Management Performance Grant also requires
the City to perform those functions deemed essential by
the Governor's Division of Emergency Management for the
fiscal year.
Updated 3-10-05
FISCAL YEAR 2008
EMERGENCY MANAGEMENT PERFORMANCE GRANT APPLICATION
1. APPLICANT NAME (Jurisdiction): City of Round Rock, Texas
2. COUNTY: Williamson 3. DISASTER DISTRICT: 6b
4. EMPG STATUS: 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 Identify any jurisdictions that have joined or withdrawn from your program in the last year.)
City of Round Rock, Texas Only
6. CHECKLIST OF APPLICATION ATTACHMENTS: (See the FY 2008 Local Emergency Management Program
Guide for information on completing these forms.)
►1 Designation of Grant Officials (DEM -17B)
►1 Statement of Work & Cumulative Progress Report (DEM -17A). This form must be signed by the EMC.
Application for Federal Assistance (DEM -67). The Authorized Official must sign this form.
►1 EMPG Staffing Pattern (DEM -66).
EMPG Staff Job Description (DEM -68). A current job description must be for
provided each staff member
listed in the FY 2008 EMPG Staffing Pattern (DEM -66).
/1 FEMA Form 20-16, Summary Sheet for Assurances & Certifications must be by Authorized
signed an Official.
Attached
FEMA Form 20-16A, Assurances - Non -Construction Programs
►1 FEMA Form 20-16C, Certifications Regarding Lobbying, Debarment, Suspension, & Other Responsibility
Matters; and Drug -Free Workplace Requirements.
❑ FEMA Form SF LLL, Disclosure of Lobbying Activities signed by the Authorized Official required only if the
applicant performs lobbying to influence federal actions
❑ Direct Deposit Authorization (form 74-146). The Grant Financial Officer must sign this form.
i1 Travel Policy Certification (DEM -69). The Grant Financial Officer must sign this form.
7. CERTIFICATION: This Application, together with the approved EMPG Statement of Work & Cumulative
Progress Report (DEM -17A), constitutes the annual work plan for the emergency management program whose
participants are listed above. The undersigned agree to exert th :'r best efforts to accomplish all activities listed in
e Statement of Work & Cumulative Progress Report approve. .y the Division of Emergency Management.
1-I 1- Q 40° IJ ii o
A. uth. rized Official (Original Date Em - • ency Management Coordinator Date
''9 .ture) (Original Signature)
GDEM USE ONLY
8. APPROVAL: The attached Fiscal Year 2008 Statement of Work & Cumulative Progress Report is approved.
❑ Chief Date
❑ State Coordinator of Preparedness and Operations
IIFM-17
11/07
Mail completed forms and application materials to:
t
EMPG Program Administrator
Preparedness Section
Governor's Division of Emergency Management
Texas Department of Public Safety
PO Box 4087
Austin, TX 78773-0223
Page 1 of 1
FISCAL YEAR 2008
DESIGNATION OF EMPG GRANT OFFICIALS
APPLICANT NAME (Jurisdiction): City of Round Rock
EMERGENCY MANAGEMENT COORDINATOR*
NAME
►1 Mr. ❑ Ms. *If newly appointed attach form DEM -147
Official Mailing Address
Richard Johnson
616 East Palm Valley Blvd.
Round Rock, Texas 78664
Daytime Phone Number
(512) 218-5528
Fax Number
(512) 218-5539
E-mail Address
richardj@round-rock.tx.us
GRANT FINANCIAL OFFICER
NAME
❑ Mr. Ms. Elaine Wilson
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
/1 Mr. ❑ Ms. Jim Nuse
Title
City Manager
Official Mailing Address
Jim Nuse
221 East Main St.
Round Rock, Texas 78664
Daytime Phone Number
(512) 218-4410
Fax Number
(512) 218-7097
E-mail Address
'IF ftA_17R
citymanager@round-rock.tx.us
11/07
Page 1 of 1
FISCAL YEAR 2008
EMPG STATEMENT OF WORK AND PROGRESS REPORT
APPLICANT NAME (Jurisdiction): City of Round Rock, Texas
Document
Submitted By
Date
GDEM Review By
Date
Statement of Work
Richard Johnson
12/10/07
Progress Report #1
Progress Report #2
TASK 1 -WORK PLAN & SEMIANNUAL PROGRESS REPORT
We
will submit an EMPG Application, two Progress Reports, and quarterly Financial
►1 Work Plan
Reports.
• This
Progress Report # 1 is being submitted to the GDEM Preparedness Section
& Second Quarter Financial Reports have been submitted to GDEM Support
■ Progress Report #1
• First
Services.
• This
Progress Report # 2 is being submitted to the GDEM Preparedness Section.
& Fourth Quarter Financial Reports have been submitted to GDEM Support
■ Progress Report #2
■ Third
Services.
TASK 2 -LEGAL AUTHORITIES FOR EMERGENCY MANAGEMENT PROGRAM
• We
will maintain current legal
legal documents are current
will prepare or update &
documents establishing our emergency management
& on file with GDEM; no additional action is
submit to GDEM:
Order
Ridgeway
completed and resources entered
program.
►1 Our
required.
• We
►1 Work Plan
• Commissioner's Court
• City Ordinance(s) for:
• Updated Joint Resolution
❑ NIMS Adoption
►� TRRN registration
• Our
legal documents are current
completed & submitted
& on file with GDEM, no additional action is
to GDEM:
Order
Ridgeway
completed and resources entered
required.
• We
• Progress Report #1
(Oct. 1 -Mar. 31)
• Commissioner's Court
• City Ordinance(s) for:
■ Updated Joint Resolution
• NIMS Adoption
• TRRN registration
IN Our
legal documents are current
completed & submitted to
& on file with GDEM, no additional action is
GDEM:
Order
completed and resources entered
required.
• We
II Progress Report #2
(Apr. 1 -Sept. 30)
fPne_17n
• Commissioner's Court
IICity Ordinance(s) for:
1 Updated Joint Resolution
IN NIMS Adoption
❑ TRRN registration
11/07
Page 1 of 6
TASK 3 -PUBLIC EDUCATION/INFORMATION
►� Work Plan
►��
■
substantial
distributed:
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
portion of the community. In the space below, describe the materials to be
• Progress Report #1
(Oct.1-Mar. 31)
•
activities:
We completed the following hazard awareness or public education/information
•
(Apr.
Progress Report #2
1 -Sept. 30)
■
activities:
We completed the following hazard awareness or public education/information
TASK 4 -EMERGENCY MANAGEMENT PLANNING DOCUMENTS
►1 Work Plan
►�I
NIMS
■
NOTE:
this
We have
compliance.
We will
year.
■
Annexes:
■N■O■P■Q■R■S■T■U■V
■
Plans
reviewed our
develop, update,
Basic Plan
•A
Other documents:
& annexes
All Plans and
■B
dated
Annexes
emergency
or
change
■C
management plan & annexes
these planning documents:
■D •E •F ■G •H ■1
prior to September 30, 2003, must
must be NIMS compliant.
■J
be
for currency
•K
revised
■L
or
and
■M
updated
• Progress Report #1
(Oct. 1 -Mar. 31)
•
NIMS
•
■
We have
compliance.
Our
We updated
emergency
❑
Annexes:
■N■O
•
reviewed
Basic
Other
our emergency management
management plan & all annexes
by revision or change these planning
Plan
■A •B ■C ■D •E •F
IMP ■Q■R■s■T■U■V
documents:
■G
plan & annexes
are current
documents:
•H
11111J
and
for
NIMS
currency
•K
compliant
•L
and
•M
• Progress Report #2
(Apr. 1 -Sept. 30)
nPM_17A
•
NIMS
■
■
We have
compliance.
Our emergency
We updated
■
Annexes:
•N
■
reviewed
by
Basic
■O
Other documents:
management
revision
Plan
■
■P
our
A
■
■Q
emergency
or
B
change
■
plan
C
■R
■
management plan & annexes for currency and
& all annexes are current and NIMS compliant
these planning documents:
D ■ E ■ F •G ■ H •i ■ J ■ K ■ L ■ M
■S ■T ■U ■V
11/07
Page 2 of 6
TASK 5—EXERCISE PARTICIPATION & SCHEDULE
Work Plan
►�
■
•
scale
exercises.
NOTE:
Our required three-year exercise schedule is listed below.
Our required exercise schedule includes make up exercises from FY 2007.
We will conduct & report participation in a tabletop exercise and a functional or full -
exercise this fiscal year or obtain exercise credit for actual events for these
A Full -Scale exercise must be conducted every three (3) years.
REQUIRED EXERCISE SCHEDULE
Period I
Exercise Type
I Exercise Scenario*
Quarter of Year
Fiscal Year 2008
►�
Tabletop
I
NH •TH
■ NS • TR ■ HM
■ 1 ■ 2 3 ■ 4
(Oct. 2007 -Sept. 2008)
►Z�
Functional
►1 NH ■TH
• NS
■
TR • HM
• 1 ■ 2 3 ■ 4
•
Full -Scale
■
NH
NTH
• NS • TR • HM
• 1 • 2 ■ 3 ■ 4
Fiscal Year 2009
►1 Tabletop
•
NH •TH IN NS
►1
TR •
HM
■ 1 ■ 2 ■ 3 4
(Oct. 2008 -Sept. 2009)
►Z/ Functional
•
NH
■TH
• NS
►1
TR
■
HM
■ 1 ■ 2 ■ 3 4
• Full -Scale
■
NH
■TH
■ NS
■
TR
•
HM
• 1 ■ 2 • 3 • 4
Fiscal Year
►� Tabletop
•
NH
•TH
■ NS
■
TR
►1
HM
■ 1 ■ 2 ■ 3 ■ 4
2010
(Oct. 2009 -Sept. 2010)
►�I Functional
■
NH
NTH ■ NS
•
TR
►1
HM
■ 1 IN 2 • 3 ■ 4
• Full -Scale
■ NH ■TH ■ NS
■
TR
IN
HM
■ 1 • 2 ■ 3 1 4
Our last Full -Scale exercise was conducted on (date): Scenario*:
*Scenarios: NH=Natural Hazard, TH=Technological Hazard, NS=National Security, TR=Terrorism, HM=Public Health or Medical
We conducted the following exercises and provided documentation to GDEM:
Exercise
Date
# of Participants
# of Jurisdictions
■
•
•
Tabletop
Functional
Full -Scale
IIProgress Report #1
(Oct. 1 -Mar. 31)
❑
■
•
Tabletop
Functional
Full -Scale
•
•
•
Tabletop
Functional
Full -Scale
•
and
attached.
We requested
our request
functional or full-scale exercise credit for an actual event on
1 is pending ■ was approved and documentation of approval is
We
conducted the following exercises and
provided documentation to GDEM:
Exercise
Date
# of Participants
_
# of Jurisdictions
•
•
•
Tabletop
Functional
Full -Scale
• Progress Report #2
(Apr. 1 -Sept. 30)
•
■
II
Tabletop
Functional
Full -Scale
•
•
•
Tabletop
Functional
Full -Scale
r M.17A
• We requested functional or full-scale exercise credit for an actual event on
and our request • is pending ■ was approved and documentation of approval is
attached.
11/07
Page 3 of 6
TASK 6-TRAINING FOR EMERGENCY MANAGEMENT PERSONNEL
►1 EMPG-funded emergency
management personnel will participate in the following
training during FY 2008:
Position/Name
Course Name or Number
Richard Johnson
Richard Johnson
Richard Johnson
Ken Evans
Ken Evans
G197 Emerg Planning & Spec Needs 2/11/08-2/13/08
G290 Basic PIO Course 3/24/08-3/27/08
G310 Hurricane Readiness for Inland Comm 2/19/08
G197 Emerg Planning & Spec Needs 6/3/08-6/5/08
G386 Mass Fatalities 3/25/08-3/27/08
►1 Work Plan
• Emergency management personnel
completed the following training and
documentation is attached:
Position/Name
Course Name or Number Date
• Progress Report #1
(Oct. 1-Mar. 31)
■ Emergency management personnel
completed the following training and
documentation is attached:
Position/Name
Course Name or Number Date
■ Progress Report #2
(Apr. 1-Sept. 30)
nFM-17
11/07
Page 4of6
TASK 7 -EMERGENCY MANAGEMENT TRAINING FOR OTHER PERSONNEL
We will conduct or arrange emergency management related training for
.1 Work Plan
elected
officials, other local officials, & support agencies.
The following formal training courses were taught or contracted:
Date Course Taught # of Individuals Trained
• Progress Report #1
(Oct. 1 -Mar. 31)
The following formal training courses were taught or contracted:
Date Course Taught # of Individuals Trained
• Progress Report #2
(Apr. 1 -Sept. 30)
TASK 8 -EMERGENCY
MANAGEMENT ORGANIZATIONAL DEVELOPMENT
►1 We will participate in the following emergency management organizational
development activities: Attend various conferences.
Work Plan
❑ Progress Report #1
(Oct. 1 -Mar. 31)
• We completed the following staff development activities:
• We completed the following staff development activities:
• Progress Report #2
( Apr. 1 -Sept. 30)
flPP _17A
11/07
Mail completed forms and application materials to:
EMPG Program Administrator
Preparedness Section
Governor's Division of Emergency Management
Texas Department of Public Safety
PO Box 4087
Austin, TX 78773-02231
Page 5of6
APPLICANT NAME: City of Round Rock, TX
REMARKS
(Use an Additional Sheet if Necessary)
Richard Johnson is the interim Emergency Management Coordinator until the full-time
vacancy is filled. Lt. Ken Evans is the Assistant Emergency Management Coordinator.
DEM -17A
Page 6 of 6
FISCAL YEAR 2008
EMPG STAFFING PATTERN
1. APPLICANT NAME (as it appears on EMPG Application):
CITY OF ROUND ROCK, TEXAS
2. COUNTY: WILLIAMSON
3. FULL-TIME EMPLOYEES
(including those who work all
or only a portion of their time in
emergency management duties)
4. Gross
Annual
Salary
5. Gross
Annual
Benefits
6. Gross
Salary &
Benefits
(4+5)
7. %
Work in
EM
Duties
8. Salary &
Benefits
for EM
(6x7)
9. Est.
EM
Travel
Costs
Name: Kenneth Evans
84,377.02
24,810.26
109187.28
50%
54,593.64
0.00
Position: Assistant EMC
Name: Richard Johnson
64,698.20
18,418.92
83,117.12
50%
41,558.56
0.00
Position: EMC
Name:
Position:
Name:
Position:
Name:
Position:
Name:
Position:
A. SUBTOTAL
96,152.20
0.00
10. PART-TIME
EMPLOYEES
11. %
of
Full
Time
12. Gross
Annual
Salary
13. Gross
Annual
Benefits
14.
Gross
Salary &
Benefits
(12+13)
15. %
Work in
EM
Duties
16. Salary
& Benefits
For EM
(14x15)
17. Est.
EM
Travel
Costs
Name:
Position:
Name:
Position:
Name:
Position:
Name:
Position:
Name:
Position:
Name:
Position:
B. SUBTOTAL
TOTAL
Add Subtotals in A & B above
-)FRA-AR
96,152.20
0.00
11/07
Page 1 of 1
FISCAL YEAR 2008
APPLICATION FOR FEDERAL ASSISTANCE
(Instructions on Reverse)
1. NAME OF PROGRAM/ ASSISTANCE:
EMERGENCY MANAGEMENT
PERFORMANCE GRANT
2. CFDA NUMBER:
97.042
3. APPLICANT
New Applicant
Renewal
STATUS:
•
►Z�
4. FEDERAL FISCAL YEAR: 2008
5. START DATE: OCT 1, 2007
6. END DATE: SEP 30, 2008
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 JOHNSON,
(512) 218-5528
c. Mailing Address:
615 E. PALM VALLEY BLVD
ROUND ROCK, TEXAS 78664
Employer Identification Number/Tax
ID# 74-6017485
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:
2
50%
2) Part Time
b. Total Number of EMPG-Funded Personnel
9. ESTIMATED EXPENSES:
a. Salary & Benefits (from line 19, form DEM -66)
96 152.20
b. Travel Expenses (from line 20 form DEM -66)
0.00
c. Other Expenses (from section 11 on reverse)
0.00
d. Total Expenses (A + B + C)
96,152.20
e. Federal Share (D x .50)
48,076.10
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:
Jim Nuse
b. Title of Authorized Official:
Cit Manager
c. Original Signature of Authorized Official:
d. Date Signed:
1--k, _ 13
11/07
Page 1 of 2
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 (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 (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 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. To determine if an
expense is allowable under EMPG, refer to the DHS authorized equipment list available on the Responder
Knowledge Base at https://www.rkb.mipt.org/mel.cfm?subtypeid=549. You must be a registered user to access this
listing.
Specific Description of Expense
(Descriptions must be specific — do not use broad or general categories, such as operating or
administrative expenses)
Estimated Amount
Total
DEM -67
11/07
Page 2of2
EMPG STAFF JOB DESCRIPTION
Jurisdiction Name
CITY OF ROUND ROCK, TEXAS
Staff Members Name(s)
RICHARD JOHNSON ,
Position Title
EMERGENCY MANAGEMENT COORDINATOR
Description Prepared By
RICHARD JOHNSON
Date Prepared
12/11/2007
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: Captain Alain Babin on Emergency Management responsibilities.
2. Advises Mayor, City Council, City Manager and Department Head on Emergency Management matters.
B. If this staff member performs both emergency management duties and other duties, identify the specific
emergency management duties performed.
f]FM.R
12/06
ton for future use.
EMPG STAFF JOB DESCRIPTION
12/06
or future use.
Jurisdiction Name
CITY OF ROUND ROCK, TEXAS
Staff Members Name(s)
LIEUTENANT KENNETH EVANS
Position Title
ASSISTANT EMERGENCY MANAGEMENT COORDINATOR
Description Prepared By
LIEUTENANT KENNETH EVANS
Date Prepared
12/11/2007
(If you have
fill out
JOB DESCRIPTION
an existing job description which provides the information requested below,
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: Captain Chris Bratton on Emergency Management responsibilities.
2. Advises Mayor, City Council, City Manager and Department Head on Emergency Management matters.
B. If this staff member performs both emergency management duties and other duties, identify the specific
emergency management duties performed.
DEM -68
12/06
or future use.
FOR
FY 2008
U.S. Department of Homeland Security
SUMMARY SHEET FOR ASSURANCES AND CERTIFICATIONS
O.M.B. No. 3067-0206
Expires February 28, 2007
CA FOR (Name of Applicant)
CITY OF ROUND ROCK, TEXAS
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 II LJ
Part III LJ
FEMA Form 20-16B, 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
ignature of Authorized Representative 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 comer 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; (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
Form 20-16A, JUN 94
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.
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 (PL. 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.); (f) 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
(c) Making it a requirement that each employee to be engaged in
the performance of the grant to be given a copy of the statement
required by paragraph (a);
(d) Notifying the employee in the statement required by
paragraph (a) that, as a condition of employment under the grant,
the employee will:
(1) Abide by the terms of the statement; and
(2) Notify the employee in writing of his or her conviction for a
violation of a criminal drug statute occurring in the workplace no later
than five calendar days after such conviction.
(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.
(f) Taking one of the following actions, within 30 calendar days of
receiving notice under subparagraph (d)(2), with respect to any
employee who is so convicted:
(1) Taking appropriate personnel action against such an employee,
up to and including termination, consistent with the requirements
of the Rehabilitation Act of 1973, as amended; or
(2) Requiring such employee to participate satisfactorily in a
drug abuse assistance or rehabilitation program approved for
such purposes by a Federal, State, or local health, law enforcement,
or other appropriate agency.
(g) Making a good faith effort to continue to maintain a drug free
workplace through implementation of paragraphs (a), (b), (c), (d), (e),
and (f).
8. the grantee may insert in the space provided below the site(s) for
the performance of work done in connection with the specific grant:
Place of Performance (Street address, City, County, State, Zip code)
Check nif there are workplaces on file that are not identified here.
Section 17.630 of the regulations provide that a grantee that is a State
may elect to make one certification in each Federal fiscal year. A copy
of which should be included with each application for FEMA funding.
States and State agencies may elect to use a Statewide certification.
Form 20-16C (BACK)
TRAVEL POLICY
CERTIFICATION
Jurisdiction Name:
CITY OF ROUND ROCK
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)
ELAINE WILSON
Original Signature of Grant Financial
Officer
r
,,,,.,.,
Date Signed
i 24 t 3 C ,,J
DEM -69
1 1 -07