CM-09-12-247r 2
FISCAL YEAR 2010 V
iluf
EMERGENCY MANAGEMENT PERFORMANCE GRANT APPLICATION
Iri
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 Identify any jurisdictions that have joined or withdrawn from your program in the last year)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 2010 Emergency Management Performance
Grant (EMPG)Guide for information on completing these forms)
IZI Designation of Grant Officials (TDEM-17B)
Statement of Work & Cumulative Progress Report (TDEM-17A) - This form shall be signed by the EMC
./ Application for Federal Assistance (TDEM-67) -The Authorized Official shall sign this form
EMPG Staffing Pattern (TDEM-66) - The Authorized Official shall sign this form
EMPG Staff Job Description (TDEM-68) - A current job description is required for each listed
staff member in
the FY 2010 EMPG Staffing Pattern (TDEM-66)
►/ FEMA Form 20-16 Summary Sheet for Assurances & Certifications - Shall be signed by Authorized Official
an
Attached:
/.1 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) or Application for Payee ID Number (form AP The Grant
-152) -
Financial Officer shall sign this form
Travel Policy Certification (TDEM-69) - The Grant Financial Officer shall sign this form
7. CERTIFICATION: This Application, together with the approved EMPG Statement of Work & Cumulative Progress Report
(TDEM-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 Texas Division of Emergency Management.
A th rized Officia S�. ta,,E.Date Emergency Management Coordin. or Date
( rigi I Signature) (Original Signature)
TDEM USE ONLY
8. APPROVAL: The attached Fiscal Year 2010 Statement of Work & Cumulative Progress Report is approved
❑ Assistant Director/Chief Date
❑ State Coordinator for Preparedness and Operations
TrIFKA_l 7
11/09
Mail completed forms and application materials to:
CM -0c1- Li 7
EMPG Program Administrator
Preparedness Section
Texas Division of Emergency Management
Texas Department of Public Safety
PO Box 4087
Austin, TX 78773-0223
Page 1 of 1
FISCAL YEAR 2010
DESIGNATION OF EMPG GRANT OFFICIALS
APPLICANT NAME (Jurisdiction): City of Round Rock, Texas
EMERGENCY MANAGEMENT COORDINATOR*
NAME
/1 Mr. ❑ Ms. *If newly appointed attach form DEM -147
Official Mailing Address
Thomas L. Bradford III
2701 N. Mays
Round Rock, Texas 78665
Daytime Phone Number
(512) 341-3106
Fax Number
(512) 218-3267
E-mail Address
bbradford@round-rock.tx.us
GRANT FINANCIAL OFFICER (CANNOT BE EMC)
NAME
❑ Mr. /1 Ms. Elaine Wilson
Title
Treasury & Finance Supervisor
Official Mailing Address
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
a Mr. ❑ Ms. James R. Nuse, P.E.
Title
City Manager, City of Round Rock, Texas
Official Mailing Address
221 East Main St.
Round Rock, Texas 78664
Daytime Phone Number
(512) 218-4410
Fax Number
(512) 218-7097
E-mail Address
MCI 4,n
citymanager@round-rock.tx.us
vuvr
11/09
Page 1 of 1
TASK 3-PUBLIC EDUCATION/INFORMATION
Work Plan
■ Option 1: Our jurisdiction will conduct 30 hours of hazard awareness activities for
local citizens
OR
►1 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: The City will continue to expand its "Public
Emergency Contact' program, which allows our citizens and businesses to provide
the City with their emergency contact names and their personal phone numbers
(standard and cell phones) for use should an emergency arise in their home or
business. Distribution of the related cards are distributed by our Fire, Police and EM
Departments, as well as at other opportunities to reach out to our citizens, such as
Homeowner Association meetings. The City will also publish and distribute brochures
for our "National Night Out" program; and continue to provide other public
education/information programs to our community, including those in conjunction with
the National Weather Service.
■ Progress Report #1
October 1 —
March 31
IN Our jurisdiction completed the following hazard awareness or public
education/information activities:
■ Progress Report #2
April 1 —
September 30
• Our jurisdiction completed the following hazard awareness or public
education/information activities:
TASK 4-EMERGENCY MANAGEMENT PLANNING DOCUMENTS
4 Work Plan
►� Our jurisdiction reviewed our emergency management plan & annexes for currency
and NIMS compliance
• Our emergency management plan and all annexes are current and NIMS compliant
►5 We will develop, update, or change these planning documents:
■ Basic Plan
Annexes: ■A ■B ■C ■D ■E ■F •G •H ■I ■J ■K •L ■M
■N■O►/P■Q■R■S■T■U■V
I Other documents: Our Plan is current at the Intermediate level; and with the
completion of updating Annex P, the Plan will return to Advanced. Annex G is
current, however is being revised to reflect current operational practices. Also,
efforts are underway to review and revise all Annexes in a manner that will allow
for an annual, rolling review of Annexes, precluding having a large number of
Annexes come up for review in any single year.
NOTE: Plans & annexes dated prior to September 30, 2005, must be revised or
updated this year. All Plans and Annexes must be NIMS compliant.
II Progress Report #1
October 1 —
March 31
■ Our jurisdiction reviewed our emergency management plan & annexes for currency
and NIMS compliance
MIOur emergency management plan and all annexes are current and NIMS compliant
• We updated by revision or change these planning documents:
• Basic Plan
Annexes: ■A IIB■C ■D •E 'IF ■G •H ■I ■J •K •L
•N ■O ■P •Q •R ■S •T ■U ■V
■Other documents:
•M
• Progress Report #2
April 1 —
September 30
rninn_ 17A
■ Our jurisdiction reviewed our emergency management plan & annexes for currency
and NIMS compliance
• Our emergency management plan and all annexes are current and NIMS compliant
• We updated by revision or change these planning documents:
• Basic Plan
Annexes: INA •B ■C ■D •E •F ■G •H ■I ■J •K IV •M
■N NO ■P ■Q ■R ■S ■T ■U ■V
• Other documents:
11/09
Page 2 of 6
TASK 5—EXERCISE PARTICIPATION & SCHEDULE
XWork Plan
Our required three-year exercise schedule is listed below
Our jurisdiction 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
Period
Exercise Type
Exercise Scenario*
Quarter of Year
Fiscal Year 2010
1 Tabletop
A NH ■TH • NS • TR ..1 HM
0 1 ®2 e 3 ❑ 4
(October 1, 2009 -
Functional
• NH ■TH • NS ■ TR HM
❑ 1 ■ 2 0 3 ® 4
September 30, 2010)
►4 Full -Scale
• NH PITH ►Z1 NS 0 TR 0 HM
® 1 ❑ 2 ❑ 3 ❑ 4
Fiscal Year 2011
►5
Tabletop
►5 NH ■TH ■ NS • TR N HM
® 1 ® 2 ■ 3 ❑ 4
(October 1, 2010 -
►ZI
Functional
• NH •TH • NS • TR r HM
0 1 • 2 0 3 ® 4
September 30, 2011)
—
Full -Scale
■ NH @TH ..A NS ►5 TR ►5 HM
® 1 ❑ 2 ❑ 3 ❑ 4
Fiscal Year 2012
►5
Tabletop
1 NH ■TH • NS ■ TR El HM
® 1 ❑ 2 ❑ 3 ❑ 4
(October 1, 2011 —
►5
Functional
1 NH •TH ■ NS • TR ►5 HM
0 1 ❑ 2 0 3 ® 4
September 30, 2012)
►5 Full -Scale
• NH ►STH e NS
►5 TR >5 HM
® 1 ❑ 2 ■ 3 • 4
Our last Full -Scale exercise was conducted on (da
e): 11.03.09 Scenario*: NS/TR/HM/
*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 TDEM:
Exercise
Date
# of Participants
# of Jurisdictions
■ Tabletop
• Functional
• Full -Scale
• Progress Report #1
October 1 —
IN Tabletop
• Functional
■Full Scale
March 31
■ Tabletop
■ Functional
■ Full -Scale
• Our jurisdiction completed NO exercise and did not request 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 TDEM:
Exercise
Date
# of Participants
# of Jurisdictions
• Tabletop
• Functional
IN Full -Scale
IIProgress Report #2
April 1 —
II Tabletop
■ Functional
• Full -Scale
September 30
■ Tabletop
■ Functional
• Full -Scale
■ Our jurisdiction completed NO exercise and did not request credit for an actual event
• Our jurisdiction requested functional or full-scale exercise credit for an actual event
on and our request 1 is pending • was approved and documentation
Tr1CRA_47A
of
approval is attached
11/09
Page 3of6
TASK 6 -TRAINING FOR EMERGENCY MANAGEMENT PERSONNEL
EMPG-funded emergency management personnel will participate in the following
training during FY 2010:
Position/Name Course Name or Number
Thomas L. Bradford, EMC G-358 - Evac & Re -Entry
G-620 - Texas Disaster Recovery
G-920 - Ex Design & Eval
Richard Johnson, AEMC G-358 - Evac & Re -Entry
4 Work Plan
Emergency management personnel completed the following training and documentation
is attached:
Position/Name Course Name or Number Date Completed
• Progress Report #1
October 1 —
March 31
Emergency management personnel completed the following training and documentation
is attached:
Position/Name Course Name or Number Date Completed
• Progress Report #2
April 1 —
September 30
TDEM-17A
11/09
Page 4 of 6
TASK 7 -EMERGENCY
MANAGEMENT TRAINING FOR OTHER PERSONNEL
Our jurisdiction will conduct or arrange emergency management related training for
elected officials, other local officials, & support agencies.
Work Plan
The following
formal training courses were taught or contracted:
Date
Course Title 1 Class Description 1 # Trained
■ Progress Report #1
October 1 —
March 31
The following formal training courses were taught or contracted:
Date Course Title 1 Class Description 1 # Trained
■ Progress Report #2
April 1 —
September 30
TASK 8 -EMERGENCY
MANAGEMENT ORGANIZATIONAL DEVELOPMENT
Our jurisdiction will participate in the following emergency management organizational
development activities: CAPCOG Homeland Security Task Force; Texas Homeland
Security Conference; WCEPG/LEPC; CTPG; FBI InfraGard; HUREX'10 ROC; CASHP;
CAIMT; LESET; UASI Planning/Coordinating Group; Others
1Work Plan
Our jurisdiction completed the following staff development activities:
• Progress Report #1
October 1 —
March 31
Our jurisdiction completed the following staff development activities:
■ Progress Report #2
April 1 —
September 30
Tr1CRA 17A
11/09
Page 5 of 6
APPLICANT NAME: City of Round Rock, Texas
TDEM-17A
11/09
REMARKS
(Use an Additional Sheet if Necessary)
Page 6 of 6
FISCAL YEAR 2010
APPLICATION FOR FEDERAL ASSISTANCE
(Instructions on Reverse)
NAME OF PROGRAM/ ASSISTANCE:
EMERGENCY MANAGEMENT
PERFORMANCE GRANT (EMPG)
1. CFDA NUMBER:
97.042
2. APPLICANT
New Applicant
Renewal
STATUS:
❑
//
3. FEDERAL FISCAL YEAR:
FY 2010
4. START DATE:
OCTOBER 1, 2009
5. END DATE:
SEPTEMBER 30, 2010
6. APPLICANT INFORMATION
a. Legal Name of Applicant Organization (as it appears
on the EMPG Application (TDEM-17): City of Round
Rock, Texas
b. Name & Telephone Number of Emergency
Management Coordinator: Thomas L. Bradford 111,
512-341-3106
c. Mailing Address:
City Hall, 221 East Main St., Round Rock, TX 78664
Employer Identification Number/Tax ID# 74-6017485
d. Physical Address (if different from Mailing Address):
Round Rock Police Department - Thomas L. Bradford III,
2701 N. Mays, Round Rock, TX 78665
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 TDEM-66)
$169,393.29
b. Travel Expenses (from line 19 form TDEM-66)
0
c. Other Expenses (from section 11 on reverse)
0
d. Total Expenses (A + B + C)
$169,393.29
e. Federal Share (D x .50)
$84,696.65
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:
James R. Nuse, P.E.
b. Title of Authorized Official:
• Manager, City of Round Rock
c. Original Signature of Authorized Official:
d. Date Signed:
V2- .24.0 1
TDEM-67
11/09
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 (TDEM-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 (TDEM-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 the EMPG program, refer to the DHS
Authorized Equipment List (AEL) available on the Responder Knowledge Base at
https:i/www.rkb.us/contentdetail.cfm?content id=210237&GetAELSELCats=1. 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
TDEM-67
11/09
Page 2 of 2
FISCAL YEAR 2010
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: THOMAS L. BRADFORD III
$81,993.60
$26,841.37
$108,835.97
100%
$108,835.97
0
Position: EMERGENCY
MANAGEMENT COORDINATOR
Name: RICHARD JOHNSON
$90,792.00
$30,324.65
$121,116.65
50%
$60,558.33
0
Position: ASSISTANT EMERGENCY
MANAGEMENT MANAGER
Name:
Position:
Name:
Position:
Name:
Position:
Name:
Position:
A. SUBTOTAL
$172,785.60
$57,166.02
$229,951.62
$169,393.29
0
10. PART-TIME EMPLOYEES
11.
% of
Full
Tim
e
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
18.
$169,393.29
19.
0
CERTIFICATION: / certify that no individual listed above holds an elected office.
Signature of Authorized Official:
--T
Date Signed: 12. •2d • 041
TrICRI CC
_ Ja es . Nuse, P.E.
11/09
Page 1 of 1
EMPG STAFF JOB DESCRIPTION
Jurisdiction Name
City of Round Rock
Staff Member Name
Thomas L. (Brad) Bradford
Position Title
Emergency Management Coordinator (EMC)
Description Prepared By
Thomas L. Bradford
Date Prepared
12.11.09
❑ Current Job
JOB DESCRIPTION
Description Attached See Below
A. Provide a general description of the duties performed by this staff member.
The City of Round Rock's Emergency Management Coordinator (EMC) is responsible for planning, organizing
and directing activities for the City's Emenergency Management Program.
B. If this staff member performs both emergency management duties and other duties, identify the specific
TDEM-68 Retain a copy of this description for future use.
11/09
EMPG STAFF JOB DESCRIPTION
Jurisdiction Name
City of Round Rock, Texas
Staff Member Name
Richard Johnson
Position Title
Assistant Emergency Management Manager
Description Prepared By
Richard Johnson
Date Prepared
12/11/09
❑ Current Job
JOB DESCRIPTION
Description Attached See Below
A. Provide a general description of the duties performed by this staff member.
As the Assistant Emergency Manangement Manager, participates 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.
ORGANIZATION RELATIONSHIP
1. Reports to: Captain Willie Richards on Lieutenant responsibilities.
B. If this staff member performs both emergency management duties and other duties, identify the specific
emergency management duties performed.
Provide guidance and support to City Staff and elected officials on matters involving Emergency Management.
Provide coordination of development and revisions of planning documents.
Develop and submit financial documents and workplans as required.
Provide information to citizens regarding Emergency Management.
1. Reports to: Thomas L. Bradford III on Emergency Management responsibilities.
TIICAA RQ -
11/09
in a copy of this description for future use.
U.S. DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
SUMMARY SHEET FOR ASSURANCES AND CERTIFICATIONS
FOR
FY
2010
CA FOR (Name of Recipient)
City of Round Rock, Texas
O.M.B. No. 1660-0025
Expires July 31, 2007
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 I1-jj FEMA Form 20-16A, Assurances-Nonconstruction Programs
Part II FEMA Form 20-16B, Assurances -Construction Programs
Part III FEMA Form 20-16C, Certification Regarding Lobbying;
IIS Debarment, Suspension, and Other Responsibility
Matters; and Drug -Free Workplace Requirements
Part IV SF LLL, Disclosure of Lobbying Activities (If applicable)
As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the identified
attached assurances and certifications.
James R. Nuse, P.E. City Manager, City of Round Rock
Typed Name of Authorized Representative Title
12 . Z(. D°I
Signature of AuthonLed 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. The burden estimate includes the time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing,
reviewing, and maintaining the data needed, and completing and submitting the form. Send comments regarding the
accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, U.S.
Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington DC 20472.
You are not required to complete this form unless a valid OMB control number is displayed in the upper corner on this form.
Please do not send your completed form to the above address.
FEMA Form 20-16, OCT 04
PREVIOUS EDITION OBSOLETE
U.S DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
ASSURANCES-NONCONSTRUCTION PROGRAMS
O.M.B. No. 1660-0025
Expires July 31, 2007
Paperwork Burden Disclosure Notice
Paperwork reporting burden for this form is estimated to average 1.7 hours per response The burden estimate includes the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing, reviewing, and submitting the form. You are not required to
respond to this collection of information unless a valid OMB control number appears in the upper right corner of this form. Send comments regarding the
accuracy of the burden estimate and any suggestions for reducing the burden estimate to: Information Collection Management, U. S. Department of
Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472. NOTE: Do not send your completed form to
the above address.
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 4727-4763) relating to prescribed standards for merit
systems for programs funded under one of the nineteen statues or
regulations specified in Appendix A of OPM's Standards for Merit System
of Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statues 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 IV 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 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; (1) any other nondiscrimination provision in the
specific statue(s) under which application for Federal assistance is being
made; and (j) the requirements of any other nondiscrimination statue(s)
which may apply to the application.
7. Will comply, or has already complied, with the requirements of Title II
and III of the Uniformed Relocation Assistance and Real Property
Acquisition Policies Act of 1970 (P.L. 91-646) which provides 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.
8. Will comply with provisions of Hatch Act (5 U.S.C. Sections 1501-1508
and 7324-7328) which limit the political activities of employees whose
principle 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 102a 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 (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. Sections 1451 et seq.); (f) conformity of Federal
actions to State (Clear Air) Implementation Plans under Section 176 (c) of
the Clear Air Act of 1955, as amended (42 U.S.C. Section et seq.); (g)
protection underground sources of drinking water under 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.
Sections 1271 et seq.) related to protecting components of the national
wild and scenic rivers systems.
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 -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 Poising 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.
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 goveming 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.
FEMA Form 20-16A, OCT 04
PREVIOUS EDITION OBSOLETE
U. S. DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND
OTHER RESPONSIBILITY MATTERS; AND DRUG-FREE WORKPLACE REQUIREMENTS
O.M.B. No. 1660-0025
Expires July 31, 2007
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 1.7 hours per response. The burden estimate includes the time for reviewing instructions and
searching existing data sources, gathering and maintaining the data needed and completing, and submitting the form. You are not required to respond to
this collection of information unless a valid OMB control number appears in the upper right corner of this form. Send comments regarding the accuracy of
the burden estimate and any suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Federal
Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Project (1660-0001). NOTE: Do not send your
completed form to this address.
Applicants should refer to the regulations cited below to determine the certification to which they are required to attest. Applicants should also review the
instructions for certification included in the regulations before completing this form. Signature of this form provides for compliance with certification
requirements under 44 CFR Part 18, "New Restrictions on Lobbying" and 28 CFR Part 17, "Government -wide Debarment and Suspension (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 transaction, grant, or cooperative agreement.
1. LOBBYING
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 cooperating
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 other 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 Stand 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
subcontracts) and that all subrecipients shall certify and disclose
accordingly.
LiStandard 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 a or 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 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 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 transactions (Federal, State, or local) terminated for cause of
default; and
B. Where the applicant is unable to certify to any of the statements in this
certification, he or she shall attach an explanation to this application.
3. DRUG-FREE WORKPLACE
(GRANTEE 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 17.615
and 17.620-
A. The applicant certifies that it will continue to provide a drug-free
workplace by;
(a) Publishing a statement notifying employees that the unlawful
manufacture, distributions
(b) Establishing an on-going drug free awareness program to inform
employees 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 term of the statement; and
(2) Notify the employee in writing of his or her conviction for a
violation of a criminal drug statute occurring ion the workplace no
later than five calendar days after such convections;
(e) Notifying the agency, in writing, with 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.
FEMA Form 20-16C, OCT 04
PREVIOUS EDITION OBSOLETE
(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
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 an 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).
B. 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 ❑ If 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
state wide certification.
74-176
(Rev.1-07/5)
VENDOR DIRECT DEPOSIT AUTHORIZATION
For Comptroller's use only
Under Ch. 559, Govemment Code, you are entitled to review, request, and correct information we have on file about you, with limited exceptions in accordance
with Ch. 552, Govemment Code.
INSTRUCTIONS
• Use only BLUE or BLACK ink.
• Alterations must be initialed.
TRANSACTION TYPE
• Check all appropriate box(es).
• For further instructions, see the back of this form.
SECTION 1
❑ New setup
❑ Cancellation
❑ Interagency transfer
(Sections 2, 3 & 4)
(Sections 2 & 3)
(Sections 2, 3 & 4)
❑ Change financial institution
❑ Change account number
❑ Change account type
(Sections 2, 3 & 4)
(Sections 2, 3 & 4)
(Sections 2, 3 & 4)
PAYEE IDENTIFICATION
SECTION 2
1. Soaal Security number or
10 Authoritedgneture
L� ' v
4 1
6
1 0 1 1 1
7 1
4 1
17. Customer account number (Dashes required
101014171915181 4 1 6 1 8 1
2. Mail code (If not known, will be
completed byPayingState Agency) 1 0
1 0 1 0
1
Federal Employer's Identification(FEI)
71
8 1 5
3 Name
City of Round Rock
Kathaleen Ford -Smith
20. Title
Sr. Vice
President
21. Representative signature (Optional)
4. Business phone number
( 512 ) 218-5400
23. Date
5. Mailing address
221 E. Main Street
6. City
Round Rock
7. State
TX
8. ZIP code
78664
AUTHORIZATION FOR SETUP, CHANGES OR CANCELLATION
co
Z
Z
H
U
Lu
9. I authorize the Comptroller of Public Accounts to deposit my payments from the state of Texas to my financial institution electronically. I further
understand that the Comptroller of Public Accounts will reverse any payments made to my account in error.
I also agree to comply with the National Automated Clearing House Association's rules and the Texas Comptroller of Public Accounts' rules for
electronic payments at all times.
10 Authoritedgneture
L� ' v
(; r'"' r
t ^ . '
11. Printed name
Elaine S. Wilson
12. a /
t, tl J`%
FINANCIAL INSTITUTION (Completion by financial institution is recommended.
SECTION 4
13. Finanaal institution name
Bank of America
14. City
Austin
15. State
TX
16. Routing transit number
1 1 1 1 1 1 1 0 1-1 0 1 0 1
0 1 2 1-1 5 1
17. Customer account number (Dashes required
101014171915181 4 1 6 1 8 1
■ YES)
I I
x188... Type of account
Checking
31. Phone number
(
2 1 1) I 1 1
■ Savings
19. Representative name (Please pint)
Kathaleen Ford -Smith
20. Title
Sr. Vice
President
21. Representative signature (Optional)
22. Phone number
( 512 ) 397-2026
23. Date
CANCELLATION BY AGENCY
LJ
w
rn
24. Reason
25. Date
PAYING STATE AGENCY
Z
p
H
0
w
rn
26. Signature
27. Printed name
28. Agency name
29. Agency number
1 1
1
1
30. Comments
31. Phone number
(
32. Date
Note: A vendor can receive email or fax notifications providing one (1) business day advance notice of the payment posting to the
vendor's account. The Advance Payment Notification is available to vendors receiving direct deposit payment(s) from the State of Texas.
To enroll in this free service, complete the Advance Payment Notification Authorization, Form 74-193, available on the Internet at:
http://www.window.state.tx.us/taxinfo/taxforms/74-193.odf
For additional information or assistance, please contact the Claims Division by:
Email: claims.pin@cpa.state.tx.us
Phone: 512/936-8138 in Austin or 800/531-5441 Ext. 6-8138 toll free
TRAVEL POLICY
CERTIFICATION
Jurisdiction Name:
City of Round Rock, Texas
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 reimbursement rates as published by the
Texas Comptroller of Public Accounts. State travel regulations are available at
https://fmx.cpa.state.tx.us/fmx/travel/textravel/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)
Elaine S. Wilson, Finance Prog Mgr
Original Signature of Grant Financial
Officer
1 •
���0,�
Date Signed
12/14/2009
TDEM-69
11/09
DATE: December 11, 2009
SUBJECT: City Manager Approval — December 18, 2009
ITEM: FY 2010 EMPG Grant Renewal
Department:
Staff Person:
Police Department
Bryan Williams
Justification: Consider executing various required documents in application packet for "Fiscal
Year 2010 Emergency Management Performance Grant Application"
Strategic Plan Relevance: SAFETY AND SECURITY Goal 30.0 Residents, Visitors and Businesses
continue to experience a high and timely level of public safety and security. 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 2010. 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.
Funding:
Cost: Max. expected is % of $84,697 or $42,348.50.
Source of funds: General Fund
Outside Resources (if applicable): N/A
Public Comment (if applicable):
UPDATED: October 19, 2009
10.19.09
Request for City Council/City Manager Action
lu1
City Council fr11 City Manager
Submit completed form for all City Manager and City Council approvals.
Department Name: Police Department
Contact Person: Tricia McFerran / Sherrill Voll / Rick White
Project Mgr/Resource: Brad Bradford
Project Coordinator: Brad Bradford
Assigned Attomey: 1 Kay Gayle
City Council or City Manager Approval Date:
Agenda Wording
Fdf%1 dl�irffs�r�{idm Like ONLY
Received: DEC 1 6 2009 on,W'-d'-
Tag#: exn- Oct- !a."ay L
Original Documents Received: 3
Project Name: FY 2010 EMPG Grant Renewal
ContractorNendor: Texas DPS - Governor's Emergency Management
Funding Source: General Fund
Additional funding Source:
Amount:Max.expected is 1/2 of $84,697 or
$42,384.50
Account Number: N/A
12/18/2009
Consider executing various required documents in application packet for "Fiscal Year 2010 Emergency Management Performance Grant Application".
Finance Information
Is Funding Required?
Yes
101
Initial Construction Contract
Construction Contract Amendment #
Change Order n
nChangein Quantity =Unforeseen Circumstances
EJInitial Professional Services Agreement
Supplemental Professional Service Agreement
Purchasing/Service Agreement
Purchase Order
Item(s) to be purchased
No j
Other (Please clearly identify action below)
Amount
FINANCE
N/A Approved
00
El CI
LJ
Finance/CIP
Finance/Acct
Purchasing
Budget
APPROVALS
(to be completed ONLY by Finance)
Final Finance Approval R
APpioved
Date
Date
Date
Date
Once approvals have been obtained, please forward the RFA. blue sheet back up information and originals to City Secretary, Sara tun
ITEMS WILL NOT BE PLACED ON THE COUNCIL AGENDA WITHOUT FINANCE AND LEGAL APPROVAL PRIOR TO SUBMISSK
Required for Submission of ALL City Council and City Manager Items
Project Mgr. Signature: Brad Bradford
Dept. Director Signature:
*City Attomey Signature:
City Manager Signature:
Date:
Date:
Date:
12/11/2009
t2/1‘112,01
*City Attorney signature is required for all items.
REVISED 12/14/2009
10.19.09
Request for City CounciUCity Manager Action
I'M City Council ED City Manager
Submit completed form for all City Manager and City Council approvals.
Department Name: Police Department
For Administration Use ONLY
Received:
Tag #:
Original Documents Received:
Project Name: FY 2010 EMPG Grant Renewal
Contact Person: Tricia McFerran / Sherrill Voll / Rick White ContractorNendor: Texas DPS - Governor's Emergency Management
Project Mgr/Resource: Brad Bradford
Project Coordinator: Brad Bradford
Assigned Attorney: i Kay Gayle
City Council or City Manager Approval Date:
Agenda Wording
Funding Source: General Fund
Additional funding Source:
Amount: Max. expected is 1/2 of $84,697 or $42,348.50
Account Number: N/A
12/18/2009
Consider executing various required documents in application packet for "Fiscal Year 2010 Emergency Management Performance Grant Application".
Finance Information
Is Funding Required?
Yes n No n
Initial Construction Contract
Construction Contract Amendment a
Change Order g
EJChangein Quantity =Unforeseen Circumstances
Initial Professional Services Agreement
Supplemental Professional Service Agreement
Purchasing/Service Agreement
Purchase Order
Item(s) to be purchased
Other (Please clearly identify action below)
Amount
FINANCE
WA Approved
ED CD Finance/CIP
aFinance/Acct
El El Purchasing
O I= Budget
Date
APPROVALS
(to be completed ONLY by Finance)
Final Finance Approval Required
APP oved
E. Wilson Date 12/15/2009
P. Bryan
Date
Date 12/15/2009
Cheryl Delaney 12/16/2009
Finance Director Date
Once approvals have been obtained, please forward the RFA. blue sheet, back up information and originals to CHy Secretary, Sara White.
ITEMS WILL NOT BE PLACED ON THE COUNCIL AGENDA WITHOUT FINANCE AND LEGAL APPROVAL PRIOR TO SUBMISSION.
Required for Submission of ALL City Council and City Manager Items
Project Mgr. Signature: Brad Bradford
Dept. Director Signature: See Attached
'City Attorney Signature:
City Manager Signature:
Date:
Date:
Date:
Date:
12)11/2009
City Attorney signature is required for all items.
REVISED 12/16/2009
LEGAL DEPARTMENT APPROVAL FOR CITY COUNCIL/CITY MANAGER ACTION
Required for Submission of ALL City Council and City Manager Items
Department Name: Police
Project Mgr/Resource: Sherrill Voll
J]Council Action:
ORDINANCE
Agenda Wording
Project Name: FY 2010 EMPG Grant Renewal
ContractorNendor: Texas DPS - Governor's Emerg. Mgmt.
r--1 RESOLUTION
City Manager Approval
CMA Wording
Consider executing various required documents in application packet for "Fiscal Year 2010 Emergency Management
Performance Grant Application"
Attorney Approval
Attorney
Notes/Comments
Date
O: \wdox\S C C I n is\0121 \0902\ M I S 0\00178787
Updated 6/3/08