CM-08-12-284FISCAL YEAR 2009
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 Identify any jurisdictions that have joined or withdrawn from your program in the last year.)
6. CHECKLIST OF APPLICATION ATTACHMENTS: (See the FY 2009 Local Emergency Management Program
Guide for information on completing these forms.)
1 Designation of Grant Officials (DEM -17B)
0 Statement of Work & Cumulative Progress Report (DEM -17A). This form shall be signed by the EMC.
PA Application for Federal Assistance (DEM -67). The Authorized Official shall sign this form.
a EMPG Staffing Pattern (DEM -66). The Authorized Official shall sign this form.
0 EMPG Staff Job Description (DEM -68). A current job description is required for each staff member listed in
the FY 2009 EMPG Staffing Pattem (DEM -66).
Cil FEMA Form 20-16, Summary Sheet for Assurances & Certifications shall be signed by an Authorized Official.
Attached
G! FEMA Form 20-16A, Assurances — Non -Construction Programs
til 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 shall sign this form.
til Travel Policy Certification (DEM -69). The Grant Financial Officer shall 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 their best efforts to accomplish all activities listed in the Statement of Work & Cumulative Progress
Report approved by the Division of Emergency
�Mfaanagement.
It'll
orized Official Date Eme ency Management Coordinator Date
' •�inal Signature) (Original Signature)
GDEM USE ONLY
8. APPROVAL: The attached Fiscal Year 2009 Statement of Work & Cumulative Progress Report is approved.
❑ Chief Date
❑ State Coordinator of Preparedness and Operations
11/08
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
Page 1 of 1
FISCAL YEAR 2009
DESIGNATION OF EMPG GRANT OFFICIALS
APPLICANT NAME (Jurisdiction): CITY OF ROUND ROCK, TEXAS
NAME
Official Mailing Address
Daytime Phone Number
Fax Number
X Mr. ❑ Ms. *If newly appointed attach form DEM -147
THOMAS L. BRADFORD III
2701 N. MAYS
ROUND ROCK, TEXAS 78665
(512) 341-3106
E-mail Address
NAME
Title
(512) 218-3267
bbradford • round-rock.tx.us
❑ Mr.X Ms.
Official Mailing Address
Treasury & Finance Supervisor
Elaine Wilson
221 East Main St.
Round Rock, Texas 78664
Daytime Phone Number
(512) 218-5444
Fax Number
E-mail Address
(512) 218-5442
ewilson • round-rock.tx.us
NAME
Title
X Mr. ❑ Ms.
Official Mailing Address
City Manager
Jim Nuse
221 East Main St.
Round Rock, Texas 78664
Daytime Phone Number
Fax Number
(512) 218-4410
E-mail Address
DEM -17B
11/08
(512) 218-7097
citymanager@round-rock.tx.us
Page 1 of 1
FISCAL YEAR 2009
EMPG STATEMENT OF WORK & CUMULATIVE PROGRESS REPORT
APPLICANT NAME (Jurisdiction): CITY OF ROUND ROCK, TEXAS
Document
Submitted By
Date
GDEM Review By
Date
Statement of Work
Thomas L. Bradford III
12/5/08
Progress Report #1
Progress Report #2
TASK 1—WORK PLAN & SEMIANNUAL PROGRESS REPORT
X Work Plan
Our jurisdiction will submit an EMPG Application, two Progress Reports, two Staffing
Commitment Certifications, and four quarterly Financial Reports.
Our jurisdiction has appointed a NIMSCAST point of contact, established a NIMSCAST
account, and is 100% compliant with FY 2008 NIMSCAST objectives and metrics.
• 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
X Work Plan
Our jurisdiction
management
X Our
will maintain current
program.
legal documents are current
NIMSCAST account is 100%
jurisdiction will prepare or
legal documents establishing our emergency
& on file with GDEM; no additional action is required.
compliant with all objectives and metrics.
update & submit to GDEM:
Order #
dated:
and resources entered
■ Our
• Our
X TRRN
• Commissioner's Court
• City Ordinance(s) for:
• Updated Joint Resolution
• NIMS Adoption dated:
registration completed
■ Our
legal documents are current
NIMSCAST account is 100%
jurisdiction completed &
& on file with GDEM, no additional action is
compliant with all objectives and metrics.
submitted to GDEM:
Order #
dated:
and resources entered
required.
■ Our
• Progress Report #1
■ Our
(Oct. 1 -Mar. 31)
• Commissioner's Court
• City Ordinance(s) for:
■ Updated Joint Resolution
■ NIMS Adoption dated:
■ TRRN registration completed
• Our
legal documents are current
NIMSCAST account is 100%
jurisdiction completed &
& on file with GDEM, no additional action is
compliant with all objectives and metrics.
submitted to GDEM:
Order #
dated:
and resources entered
required.
• Our
• Progress Report #2
■ Our
(Apr. 1 -Sept. 30)
• Commissioner's Court
■ City Ordinance(s) for:
• Updated Joint Resolution
• NIMS Adoption dated:
■ TRRN registration completed
r CLA 17A
11/08
Mail completed form to:
EMPG Program Administrator
Preparedness Section
Governor's Division of Emergency Management
Texas Department of Public Safety
P 0 Box 4087
Austin, TX 78773-0223
Page 1 of 6
TASK 3—PUBLIC EDUCATION/INFORMATION
X Work Plan
X Option 1: Our jurisdiction will conduct 30 hours of hazard awareness activities for
local citizens.
OR
■ Option 2: Our jurisdiction 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 Report #1
(Oct.1-Mar. 31)
• Our jurisdiction completed the following hazard awareness or public
education/information activities:
■ Progress Report #2
(Apr. 1-Sept. 30)
•
Our jurisdiction completed the following hazard awareness or public
education/information activities:
TASK 4—EMERGENCY MANAGEMENT PLANNING DOCUMENTS
X Work Plan
X Our jurisdiction
and
X Our emergency
X We will
NOTE:
this year.
NIMS
•
Annexes:
■N
•
Plans
All
reviewed our
compliance.
management
develop, update, or
Basic Plan
■A •B INC
■O X P ■Q
Other documents:
& annexes dated
Plans and Annexes
emergency
plan
change
•R
prior
must
and
these
•D
■s
to September
be
management
all annexes
planning
■E
IT
NIMS
are
documents:
■F ■G
■u ■v
30, 2004,
compliant.
plan & annexes for currency
current and NIMS compliant.
■H ■I ■J ■K ■L ■M
must be revised or updated
• Progress Report #1
(Oct. 1-Mar. 31)
•
■
■
Our jurisdiction
and
Our
We updated
NIMS
emergency
• Basic
Annexes:
•N
•Other
reviewed
compliance.
management
by revision
Plan
■A
■O ■P
documents:
•B
■Q
our
or
•c
emergency
plan
change
❑D
■R
and
these
DE
■S
management
all
planning
■T
annexes
•F
■U
•G
are
documents:
■V
plan
current
•H
& annexes
■I
and
■J
for
NIMS
•K
currency
compliant
•L
•M
■ Progress Report #2
(Apr. 1-Sept. 30)
f1C\A_17A
■
■
■
Our jurisdiction reviewed our
and NIMS compliance.
Our emergency management
We updated by revision or
■ Basic Plan
Annexes: ■A ■B
■N■O■P■Q■R■S■T■U■V
■ Other documents:
emergency
plan and
change these
■C •D
management plan & annexes for currency
all annexes are current and NIMS compliant
planning documents:
•E ■F •G •H ■I ■J ■K ■L ■M
11/08
Page 2 of 6
TASK 5—EXERCISE PARTICIPATION & SCHEDULE
X Work Plan
X Our required three-year exercise schedule is listed 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.
■ Our required exercise schedule includes make up exercises from FY
NOTE: A Full -Scale exercise must be conducted every three (3) years.
REQUIRED EXERCISE SCHEDULE V
Period
Exercise Type
Exercise Scenario*
Quarter of Year
Fiscal Year 2009
x Tabletop
X NH DTH ■ NS ❑ TR
■ HM
• 1 X 2 ❑ 3 ■ 4
(Oct. 2008 -Sept. 2009)0
X Functional
X NH •TH ■ NSIII TR
• HM
1❑ 2 X 3■ 4
X Full -Scale
■
NH
■TH X NS X TR X HM
X 1 0 2 0 3 0 4
Fiscal Year 2010
x Tabletop
•
NH
•TH
• NS
• TRX HM
0 1 X 2 ❑ 3 ❑ 4
( Oct. 2009 -Sept. 2010)
X Functional
•
NH
•TH ■ NS
■ TR X HM
0 1 ❑ 2 X 3 1 4
X Full -Scale
•
NH
■ TH X NS X TR X HM
X 1 0 2■ 3 0 4
Fiscal Year 2011
x Tabletop
•
NH
•TH ■ NS X TRX HM
0 1 X 2 ■ 3 ❑ 4
(Oct. 2010 -Sept. 2011)
X Functional
■
NH
•TH ■ NS X TR X HM
■ 1 ❑ 2 X 3 ❑ 4
X Full -Scale
■
NH
■TH X NS X TR X HM
X 1 0 2 0 3 0 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
4
We conducted the following exercises and provided documentation to GDEM:
Exercise
Date
# of Participants
# of Jurisdictions
■
•
■
Tabletop
Functional
Full -Scale
• Progress Report #1
•
•
•
Tabletop
Functional
Full -Scale
(Oct. 1 -Mar. 31)
•
■
•
Tabletop
Functional
Full -Scale
•
•
Our jurisdiction completed NO exercise and requested credit for an actual event.
Our jurisdiction 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.
We
conducted the following exercises and provided documentation to GDEM:
Exercise
Date
# of Participants
# of Jurisdictions
•
•
■
Tabletop
Functional
Full -Scale
• Progress Report #2
•
•
•
Tabletop
Functional
Full -Scale
(Apr. 1 -Sept. 30)
■
■
•
Tabletop
Functional
Full -Scale
■
•
Our jurisdiction completed NO exercise and
Our jurisdiction requested functional or full-scale
on and our request • is pending
requested credit for an actual event.
exercise credit for an actual event
• was approved and documentation
nPM-17A
of
approval is attached.
11/08
Page 3 of 6
11/08
Page 4 of 6
TASK 6
-TRAINING FOR EMERGENCY MANAGEMENT PERSONNEL
X Work Plan
EMPG-funded emergency management personnel will participate in the following
training during FY 2009:
Position/Name Course Name or Number
Thomas L. Bradford III IMT Position Specific - Planning
Thomas L. Bradford III IMT Position Specific - Logistics
Richard Johnson ICS300
Richard Johnson ICS400
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)
DEM -17A
11/08
Page 4 of 6
11/08
Page 5 of 6
TASK 7—EMERGENCY MANAGEMENT TRAINING FOR OTHER PERSONNEL
X Work Plan
Our jurisdiction 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:
Date
Course Title 1 Class Description 1 # Trained
■ Progress Report #1
(Oct. 1 -Mar. 31)
The following formal training courses were taught or contracted:
Date Course Title 1 Class Description 1 # Trained
• Progress Report #2
(Apr. 1 -Sept. 30)
TASK 8—EMERGENCY MANAGEMENT ORGANIZATIONAL DEVELOPMENT
X Work Plan
Our jurisdiction will participate in the following emergency management
organizational development activities: Texas Homeland Security &
Hurricane Conference, LEPC, WCEC — County Emergency Planning
Committee, CAPCOG, CTPG — Counter Terrorism Planning Committee,
HUREX'09 IPC & ROC (Planning Committee and Rehearsal of Concept).
■ Progress Report #1
(Oct. 1 -Mar. 31)
Our jurisdiction completed the following staff development activities:
■ Progress Report #2
( Apr. 1 -Sept. 30)
Our jurisdiction completed the following staff development activities:
DEM -17A
11/08
Page 5 of 6
APPLICANT NAME: CITY OF ROUND ROCK, TEXAS
DEM -17A
11/08
REMARKS
(Use an Additional Sheet if Necessary)
Page 6 of 6
FISCAL YEAR 2009
APPLICATION FOR FEDERAL ASSISTANCE
(Instructions on Reverse)
NAME OF PROGRAM/ ASSISTANCE:
EMERGENCY MANAGEMENT
PERFORMANCE GRANT (EMPG)
1. CFDA NUMBER:
97.042
2. APPLICANT STATUS:
New Applicant ❑
Renewal X
3. FEDERAL FISCAL YEAR:
FY 2009
4. START DATE:
OCTOBER 1, 2008
5. END DATE:
SEPTEMBER 30, 2009
6. 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: THOMAS L. BRADFORD
III
c. Mailing Address:
2701 N. MAYS
ROUND ROCK, TX 78665
Employer Identification Number/Tax ID# 74-6017485
d. Physical Address (if different from Mailing Address):
7. 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
50%
2) Part Time
b. Total Number of EMPG-Funded Personnel
8. ESTIMATED EXPENSES:
a. Salary & Benefits (from line 18, form DEM -66)
$169,597.13
b. Travel Expenses (from line 19 form DEM -66)
0
c. Other Expenses (from section 11 on reverse)
0
d. Total Expenses (A + B + C)
$169,597.13
e. Federal Share (D x .50)
$84,798.57
9. 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:
ity Manager
c. Original Signature of Authorized Official:
d. Date Signed:
IZ . 12- , jib
DEM -67
11/08
Page 1 of 2
INSTRUCTIONS
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. These costs must comply
with 2 CFR, Part 225, Cost Principles for State. Local, and Indian Tribe Governments (OMB Circular A-87). Salaries
and expenses for elected officials are not allowed. Any proposed expenditure in the amount of $5,000.00 or more
must be listed in this section. 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.orq/mel.cfm?subtvpeid=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
11/08
Page 2 of 2
FISCAL YEAR 2009
EMPG STAFFING PATTERN
1. APPLICANT NAME (as it appears on EMPG Application): CITY
OF ROUND ROCK, TEXAS
2. COUNTY: WILLIAMSON
3. FULL-TIME EMPLOYEES
(induding 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: THOMAS L. BRADFORD III
$26,865.29
$108,858.89
100%
$108,858.89
0
Position: EMERGENCY
MANAGEMENT COORDINATOR
$81,993.60
Name: RICHARD JOHNSON
$30,684.49
$121,476.49
50%
$60,738.25
0
Position: ASSISTANT
EMERGENCY MANAGEMENT
MANAGER
$90,792.00
Name:
Position:
Name:
Position:
Name:
Position:
Name:
Position:
A. SUBTOTAL
':
12. Gross
Annual
Salary
S! 8
15. %
Work in
EM Duties
$169,597.13
16. Salary &
Benefits
For EM
(14x15)
0
17.
Est.
EM
Travel
Costs
10. PART-TIME
EMPLOYEES
11. %
of
Full
Time
13. Gross
Annual
Benefits
..,::
14. Gross
Salary &
Benefits
(12+13)
Name:
Position:
Name:
Position:
Name:
Position:
Name:
Position:
Name:
Position:
Name:
Position:
B. SUBTOTAL`°,
TOTAL'.
Add Subtotals in A & B above
18.
$169,597.13
19.
0
CERTIFICATION: / certify that no individual li ed a ve holds an elected office.
Signature of Authorized Official:
I
Date Signed:
SEM -66
)Z' 1Z 'O9)
11/08
age 1 of 1
EMPG STAFF JOB DESCRIPTION
11/08
is aescnption for future use.
Jurisdiction Name
CITY OF ROUND ROCK, TEXAS
Staff Member Name
Thomas L. Bradford III
Position Title
EMERGENCY MANAGEMENT COORDINATOR
Description Prepared By
Thomas L. Bradford III
Date Prepared
12/05/08
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:
Develops, reviews, and updates emergency operation plans to prepare for potential emergency or disaster
situations.
Coordinates staffing of the Emergency Operations Center with designated dept personnel,
and coordinates EOC activities.
Prepares and submits program funding documentation and coordinates grant proposal activities
related to Emergency Preparedness.
Develops, coordinates and leads emergency management training, coordinates and evaluates
emergency operations drills and actual disasters; makes recommendations to improve
operations and/or response.
Advises department on their emergency plans and coordinates interdepartmental activities.
Communicates emergency operations plans to appropriate local groups to coordinate response
planning with City operations.
Evaluates EOC operations during and after emergency operations exercises and/or emergencies
and actual disasters; makes recommendations to the City Manager and appropriate depts.
ORGANIZATIONAL RELATIONSHIPS
1. Reports to: Jim Nuse, City Manager on Emergency Management responsibilities.
2. Advises Mayor, City Council, and City Manager on Emergency Management matters.
B. If this staff member performs both emergency management duties and other duties, identify the specific
emergency management duties performed.
nCIA_QQ .. _._ -
11/08
is aescnption for future use.
Jurisdiction Name
EMPG STAFF JOB DESCRIPTION
Staff Member Name
Position Title
CITY OF ROUND ROCK, TEXAS
LT. RICHARD JOHNSON
Description Prepared By
Date Prepared
ASSISTANT EMERGENCY MANAGEMENT COORDINATOR
RICHARD JOHNSON
12/05/08
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:
Designated as the Emergency Management Coordinator for the Police Department to meet accreditation
guidelines. Participate in various regional committees such as the critical infrastructure and key resources
committee, the technical response committee, HAZMAT strike team command and the counter terrorism
planning group.
ORGANIZATIONAL RELATIONSHIPS
1. Reports to: Captain Willlie Richards on Lieutenant responsibilities.
B. If this staff member performs both emergency management duties and other duties, identify the specific
emergency management duties performed.
IN
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
1. Reports to: Thomas L. Bradford 111 on Emergency Management responsibilities.
DEM -68 Retain a copy of this description for future use.
11/08
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 El FEMA Form 20-16A, Assurances-Nonconstruction Programs
Part II 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 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.
Typed Name of Authorized Representative
•
nature of Authorized Representative
CITY MANAGER
Title
12.IZ.J�i
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; (1) 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 1I 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.); (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
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,
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 assistance; and will establish a proper
accounting system in accordance with generally accepted
accounting standards or agency directives.
3. Will not dispose of, modify the use of, or change the
terms of the real property title, or other interest in the site
and facilities without permission and instructions from
the awarding agency. Will record the Federal interest in
the title of real property in accordance with awarding
agency directives and will include a covenant in the
title of real property acquired in whole or in part with
Federal assistance funds to assure nondiscrimination
during the useful life of the project.
4. Will comply with the requirements of the assistance
awarding agency with regard to the drafting, review and
approval of construction plans and specifications.
5. Will provide and maintain competent and adequate
engineering supervision at the construction site to ensure
that the complete work conforms with the approved plans
and specifications and will furnish progress reports and
such other information as may be required by the
assistance awarding agency or state.
6. Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding agency.
7. Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal or organizational
conflict of interest, or personal gain.
8. Will comply with the Intergovernmental Personnel Act
of 1970 (42 U.S.C. Sections 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).
FEMA Form 20-16B, JUN 94
9. Will comply with the Lead -Based Paint Poisoning
Prevention Act (42 U.S.C. Sections 4801 et seq.) which
prohibits the use of lead based paint in construction or
rehabilitation of residence structures.
10. Will comply with all Federal statutes relating to
non-discrimination. 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
non-discrimination 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 non-discrimination 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 non-discrimination in the sale, rental
or financing of housing; (i) any other non-discrimination
provision in the specific statute(s) under which application
for Federal assistance is being made; and (j) the
requirements of any other non-discrimination statute(s)
which may apply to the application.
11. 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 purchase.
12. 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.
13. 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.
Section 874), the Contract Work Hours and Safety
Standards Act (40 U.S.C. Sections 327-333) regarding
labor standards for federally assisted construction
subagreements.
14. Will comply with the 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.
15. 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.); (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).
16. 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.
17. 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 preservation of historic
properties), and the Archaeological and Historic
Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.).
18. Will cause to be performed the required financial
and compliance audits in accordance with the Single Audit
Act of 1984.
19. Will comply with all applicable requirements of all
other Federal laws, Executive Orders, regulations and
policies governing this program.
20. 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.
21. It will obtain approval by the appropriate Federal
agency of the final working drawings and specifications
before the project is advertised or placed on the market
for bidding; that it will construct the project, or cause it to
be constructed, to final completion in accordance with the
application and approved plans and specifications; that it
will submit to the appropriate Federal agency for prior
approval changes that alter the cost of the project, use of
space, or functional layout, that it will not enter into a
construction contract(s) for the project or undertake other
activities until the conditions of the construction grant
program(s) have been met.
22. It will operate and maintain the facility in accordance
with the minimum standards as may be required or
prescribed by the applicable Federal, State, and local
agencies for the maintenance and operation of such
facilities.
23. It will require the facility to be designed to comply
with the "American Standard Specifications for Making
Buildings and Facilities Accessible to, and Usable by,
the Physically Handicapped," Number A117. - 1961, as
modified (41 CFR 101-17.703). The applicant will be
responsible for conducting inspections to ensure
compliance with these specifications by the contractor.
24. If any real property or structure thereon is provided
or improved with the aid of Federal financial assistance
extended to the applicant, this assurance shall obligate
the applicant, or in the case of any transfer of such
property, any transfer, for the period during which the
real property or structure is used for a purpose for which
the Federal financial assistance is extended or for
another purpose involving the provision of similar
services or benefits.
25. In making subgrants with nonprofit institutions
under this Comprehensive Cooperative Agreement, it
agrees that such grants will be subject to OMB Circular
A-122, "Cost Principles for Non-profit Organizations"
included in Vol. 49, Federal Register, pages 18260
through 18277 (April 27, 1984).
FEMA Form 20-16B (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.
f]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;
Form 20-16C, JUN 94
(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;
(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
Form 20-16C (BACK)
(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.
DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 Aby OMB
033prov48 00044 6
(See reverse for public burden disclosure)
1. Type of Federal Action:
Fla. contract
b. grant
c. cooperative agreement
d. loan
e. loan guarantee
f. loan insurance
2. Status of Federal Action:
Fla. bid/offer/application
b. initial award
c. post -award
4. Name and Address of Reporting Entity:
[]Prime nSubawardee
Tier
Congressional District, if known:
6. Federal Department/Agency:
3. Report Type:
ria. initial filing
b. material change
For Material Change Only:
year quarter
date of last report
,ifknown:
5. If Reporting Entity in No. 4 is Subawardee, Enter Name
and Address of Prime:
Congressional District, ifknown:
8. Federal Action Number, ifknown:
7. Federal Program Name/Description:
CFDA Number, if applicable:
10. a. Name and Address of Lobbying Registrant
(if individual, last name, first name, MI):
9. Award Amount, if known:
$
11. Information requested through this form is authorized by title 31
U.S.C. section 1352. This disclosure of lobbying activities is a material
representation of fact upon which reliance was placed by the tier
above when this transaction was made or entered into. This
disclosure is required pursuant to 31 U.S.C. 1352. This information
will be reported to the Congress semi-annually and will be
available for public inspection. Any person who fails to file the
required disclosure shall be subject to a civil penalty of not less
than $10,000 and not more than $100,000 for each such failure.
b. Individuals Performing Services (including address if
different from No. 10a)
(last name, first name, MI):
Signature:
Print Name:
Title:
Telephone No.:
Date:
Authorized for Local Reproduction
Standard Form LLL (Rev. 7-97)
Jurisdiction Name:
TRAVEL POLICY
CERTIFICATION
CITY OF ROUND ROCK, TEXAS
X
Check one of the two blocks below
This jurisdiction has no qualifying travel regulations. EMPG participants
requesting reimbursement for travel expenditures will do so in accordance with
State of Texas travel regulations and rates as published in The State Travel
Allowance Guide and State of Texas Mileage Guide.
(The Texas Comptroller of Public Accounts website maintains both documents.
State of Texas Mileage Guide: http://ecpa.cpa.state.tx.us/mileage/Mileage.isp
and the The State Travel Allowance Guide:
https://fmx.cpa.state.tx.us/fm/pubs/travallow/index.php)
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)
Original Signature of Grant Financial
Officer
Date Signed
DEM -69
11/08
ELAINE WILSON
City of Round Rock
Finance Department
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 acceptance of a grant;
c) the renewal of a grant; or,
d) a change in the budgeted amount of the grant
Following review by Departmental Leadership, this form should be submitted to the City Budget
Supervisor (499-2869) for Budget Office Approval.
The GAPR form is due to the Budget Office for approval at least three (3) working days prior to
the grant application due date or any City Council -related deadline.
If a grant application requires prior City Council approval to submit, 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. If a grant is awarded, a copy of this GAPR 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
Governor's Division of Emergency management
Grant
Title:
FY 2009 Emergency Management Performance Grant
1
Grant Amount:
$84,798.57
Grant
FTEs:
1.5
Grant Match:
0.00
Fiscal Year
Grant
Funding
Required
City Match
TOTAL
PROGRAM BUDGET
' FY: 07-08.
$84,798.57
FY:
FY:
FY:
TOTAL
$84,798.57
0.00
0.00
$84,798.57
Please complete the sentences listed below by filling out the boxes:
$84,798.57
1 This is the (list year):1 First Year 1 of a (list year) 1
one year
Grant.
Page 1
j
City of Round Rock
Finance Department
This Grant will be appropriated in FY: (Calendar Yr 2008-2009) 1 FY 2009
Other In -Kind Match Provided: $ 0.00
Total Program Budget $
$84,798.57
Proposed Positions (FTE's) to be Funded:
[Indicate Title(s) and Status (regular/temporary). Please add rows if number is
insufficient. ]
3.
TITLE
Police Lieutenant (Assistant Emergency
Management Coordinator)
Emergency Management Coordinator
STATUS.(Reg./Temp.)
Reg
Reg
TOTAL:
Estimated Cost
$30,369.12
$54,429.45
" These are current positions funded out of the General fund. This grant allows us to gaiin8partal 57
state -funding for these positions. The estimated cost is the portion the State will cover.
Should we subcontract? NO
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: Governor's Division of Emergency Management
GRANT TERM DATES
TERM YEAR
Year One:
Year Two:
MONTH/DAY/YEAR
THROUGH
10/1/2008
Through
MONTH/DAY/YEAR
9/30/2009
Year Three:
Year Four:
Year Five:
Through
Through
Through
Through
Collaborations with other Agencies/Departments:
None
List the Departmental Goal or Strategy that will be supported by this grant (as included in the
Approved Budget Document):
The goal of this grant is to support Emergency Management personnel who provide guidance and
support to City Staff and elected officials on matters involving Emergency Management, provide
coordination of development and revisions of planning documents, and provide information to
citizens regarding Emergency Management This supports the goals stated in the Police
Department's Strategic Plan to "Plan For And Adapt To Change". The Department strategy
supported by this grant is to actively plan the Department's response to maior incidents by
enhancing the Department's capacity to provide emergency management leadership.
Associated Program/Program Objective:
Page 2
City of Round Rock
Finance Department
PLANNED PERFORMANCE MEASURES (List Major Three)):
1. Submit an EMPG Application, Iwo Progress Reports, and quarterly Financial Reports.
2. Conduct 30 hours of hazard awareness activities for local citizens.
3. Conduct Natural Hazard, Terrorism, and Public Health or Medical exercises.
Brief description of proposed grant program: This program is administered by the Texas
Governors Division of Emergency Management Participation in this grant program will partially
fund salaries for the Emergency Management Coordinator and Assistant Emergency
Management Coordinator. 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. The Police Department will administer this grant, as
the Emergency Management function now resides in our department
Contingency Plan if Grant Funding DiscontinuedChk
"Other."). ecAPPropriate Box, or Detail in
A.
B.
C.
D.
E.
F.
X
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.
This grant -funded project is considered a baseline program that must be continued
with or without grant funding.
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
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
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.
Other: None, since these are already positions funded by the General fund. Without
this grant, these positions would still be covered in the budget.
DEPARTMENTAL REVIEW/APPROVAL
(To be co ted by the st.bmittin Department)
Dept. Director Review/Approval: 1 te: n /Ly;� i p� —d g— e)?j
Date Application Due (if Applicable): b Date Forwarded:
CITY BUDGET OFFICE REVIEW APPROVAL
2 T be completed by the City Budget Office)
Date Received: f �I Dat Approved/Disapproved:
City Budget Supervisor Review/Approval: r,
Date:
Finance Director Review/Approval:$ , 1 / e lb! , ( j
. _ j/ _ .Date: t :, i r� r
Page 3
DATE: December 8, 2008
SUBJECT: City Manager Approval — December 12, 2008
ITEM: FY 2009 EMPG Grant Renewal.
Department: Police Department
Staff Person: Bryan Williams
Justification: Consider executing various required documents in
application packet for "Fiscal Year 2009 Emergency
Management Performance Grant Application"
Funding:
Cost: N/A
Source of funds: N/A
Outside Resources: 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 09. 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.
Public Comment:
UPDATED APRIL 2008