Agenda 11/09/2010 Item #16C 1
Agen<ialtem No. 16C1
November 9, 2010
Page 1 of 32
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.~IVES~
Rewm....ation thattbe~ofCounty C~dir-eet. CIl..... to provide
after-th&-'-'Jl'PnJVaI for- the s...... of a Pre-~'MItig~>...~Dto the
State of FIG.....>>ivis.. ofE......ey MaJlaaem..t,toiIJ.....h....~.....tters and
~upporting equJpm~tollthe.Nortb.C.ty RegionaljW.. 'Frea~l'...tfol',.~cost of
$30,634.21. Tber.al.grant woJdlbe<,for $22,97S.~..l1Vi~JI~~qf $7,6580$5. TIle local
share would be fiuad_ from,fuDcl 4,12 with the NqtWl'P'I'~S.pcn1.PI"oje.;t, pt'Ojef;t
11066. ' .
o~: To receiveafter-the-iact approval tromthe~BoardofColJnty COmroissiPhetS(Board)
to submit a Pre-Disaster Mitigation (PDM) grant applicati;on totl1~StateofFlori~DiVision of
Emergency Malulge1l1ent to fund the installation ofllwriqule ~utters~d~ppQrtingequip1nent on the
North County Regional Water Treatment Plant (NCj{WTP> forthcrtQtai'cost of $3Q,634.21. The
federal grantwopld/betbr$22,915.66with a 1~sbare()f$1,()~8.5S. The local share>would be
funded tTotniUnd 41awitht1teJ:l~RWfP TecbnicalSupport Pl'ojCct,project71066. .
CONSII).nONj; 11le NCRWTP CU1Tentlyhasfi~l()U~.~i~and' sixventijation fan
openings that are unprotectedduringhunicane eVf;llts. ~are also ~<>fticewil14ows and one door
that baveremovable abnnmum shuttets(thatarenotupto code. Tbisp,oj= willbtjng<the entire
NCRWTP main building up tOcodean4 reduce ,or eljty1in~.thejo~oflife,publi.cproperty, public
healtl1,safetyand welfilre due to BatJJral (i)r man-made di~ters.The project proposestoit1$taUeleven
motorized shutters on the five louver<<lopeningsandsix ventilation fan openings, andrcplace the
~ removable al\11l1inum panels for sixofficewin4owsand.Q.D,e;door.
The PDMar.ntPro~ isa nati()n\Vide~petitivegt1mtprogra1l1CfC8.ted toassist~Ulte andJocal
governments, ~luding Indian ,1'ribegovernments,with.theinlpletllentation' of cost-effective hazard
mitigation activities prior to disasters. The intent of this program is tQre4~overall risk topeopleand
property, while.also minil11izing the cost of disaster recover,)'. '1'his>PI()jectand C<)l1ier CQunty are
eligible for tbis ,granLprogram because the. project>is listed,QnCollierCounty's Lo~ Mitigation
Strategy, and "local gQvernments" are listed as eligibleentiti~. ThePJ)}4i6rantPrQgramprovides 15
percent of ~projeqtcost funding. The total costJor the proJect is S30)634.Zh > The federal grant
would be S24,915.66,withalocalshareof$1,658.55. .Thelo~<share;wouldbe fundedftot11 fund 412
with the NCRWTP Technlcal$upportProjec4 proj= 11066.
The deadline for submttUngFY 2010 PDM, grantappli~tio~w~,FridaY"'October8, 2QIO. . Interested
participants,we1"erequemed to submit, via ettl8il,.a NQticeof.IntenttoParticipate FormbyAug\lst 13,
2010. ,Public Utilities DivisionstaffsubnUUed therqq~teddoc~onthe duedaW.The state
representative for thesrantprogram provided commentstilat'requ1r.eci,staffto reviewtbeexisting
building's .hurricane prot~on.The,reqttiredr~view d~aYeclstaft'"s/_li~tQcomplete .the ..grant
application for Board, approval prior to the deadline.> COUir:rCount3'iCMA #S3~Oauth()rizes the
County Manaptoapprovethe subnlittaiof grant appli~ons\VitbSllb$eq~Board.a<:tionat the
next av",lable. Boardmeetin,g, toratifytb.eapprovalas~~~-th&-faet.."\'The. COUlltyManagerreviewed
and signedtheapp-liqation on October 1, 2010.Th:e application wa.s-Sl.1lmlitted on October 8, 2010.
0, , If tbisiproject is selected to receive funding fromtheFY'2010PDlvfGrar1t.~gram, staff will bring the
grantagreemeQt_$lJ.bsequentpudgetamendmentsto the Board for 8pprQyal.
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Agenda Item No. 16C1
November 9, 2010
Page 2 of 32
FISC~IMtACT: The~cost for the projeoti$$~()~634.2.~federalgrant would be
$22,975.66 with a localshareof$1,6S8.SS.The local>sbat~ WQu1dbe fi~i~om fund 412 with the
NCRWTP TechnicalSuppQrtProject,ipf9ject 71066.
GROWTH '~~fll~IIfPA~:. This gr@nt,:wiU>~the U8er fee projC9t that is.
consistent with current Growth Mana~ Plan ~..to'.~.the vi~itity of public facilitie!;.
LEGAL CONSJDEJAl'l~N~:. TbeBoard win havetheoppo~t(l)~ or reject the funds.if
the grant is approved. Accordingly,tbis Office has no iSsuewith~ttQthelega1 sufficiency of this
request, which is appropriatefot Board action. -JBW
~CQMME1t9>~:J:'ON: That the 130ard of CountyCpll)tWss.ioners~ove, and ,authorize .tIleChair
to provide after-the-fact"approval for the submittal ofaPre..~tet Mitig~ongrant app~catioll to tb~
State of Flori~ Division.. of ,Emergency ManageD)eat,to~hurri~e.$hutter$< ands-upporting
equipment on the North County Regional Water Treatrn.el1tJ?~ '
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PREP~I)r: NIlflwtBeais, . Associate Proj~h-f~,. PublictJtilities ,Planning and Project
Management Departnl~t.
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Agenda Item No. 16C1
November 9,2010
Page 3 of 32
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COLLIER COUNTY
BOARD OF COUNTY COMMISSIONERS
Item Number:
Item Summary:
16C1
Recommendation that the Board direct the Chairman to provide after-the-fact approval for the
submittal of a Pre-Disaster Mitigation grant application to the State of Florida. Division of
Emergency Management. to install hurricane shutters and supporting equipment on the
North County Regional Water Treatment Plant for the total cost of $30,634.21. The federal
grant would be for $22,975.66 with a local share of $7,658,55. The local share would be
funded from fund 412 with the NCRWTP Technical Support Project, project 71066.
11/9/20109:00:00 AM
Meeting Date:
Prepared By
Nathan Beals
Project Manager, Associate
Date
Public Utilities Division
Public Utilities Engineering
10/21/201012:30:24 PM
Approved By
Nathan Beals
Project Manager, Associate
Date
Public Utilities Division
Public Utilities Engineering
10/21/201012:27 PM
Approved By
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Mark Sunyak
Project Manager, Principal
Date
Public Utilities Division
Public Utilities Engineering
10/21/201012:31 PM
Approved By
AaronCromer
Project Manager, Principal
Date
Public Utilities Engineering
10/21/20106:02 PM
Approved By
Marlene J. Foord Grant Development & Mgmt Coordinator Date
Administrative Services
Division Administrative Services Division 10/22/201010:16 AM
Approved By
Paul Mattausch Director - Water Date
Public Utilities Division Water 10/22/201011 :23 AM
Approved By
Jennifer White Assistant County Attorney Date
County Attorney County Attorney 10/22/20101:45 PM
Approved By
~ James W. DeLony Public Utilities Division Administrator Date
Public Utilities Division Public Utilities Division 10/25/201012:54 PM
Approved By
Agenda Item No, 16C1
November 9,2010
Page 4 of 32
Margie Hapke
Operations Analyst
Date
Public Utilities Division
Public Utilities Division
10/25/20101:06 PM
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Approved By
OMB Coordinator
Date
County Manager's Office
Office of Management & Budget
10/25/20104:21 PM
Approved By
Jeff Klatzkow
County Attorney
Date
10/28/2010 11 :44 AM
Approved By
Susan Usher
Management/Budget Analyst, Senior
Date
Office of Management &
Budget
Office of Management & Budget
11/1/20101:59 PM
Approved By
Mark Isackson
Management/Budget Analyst, Senior
Date
Office of Management &
Budget
Office of Management & Budget
11/2/20102:22 PM
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Agenda Item No. 16C1
November 9,2010
Page 5 of 32
TO:
Leo Ochs, County Manager
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date
After-the-Fact Approv e BCC is required
atthe November 9. 2010 BCC meeting
CC:
Nathan Beals, Public Utilities
Marlene Foor~ants Coordinator
FROM:
DATE:
October 7,2010
SUBJECT: County Manager Review and Approval of201O Pre-Disaster Mitigation Grant
application sponsored by FEMA in the amount of $30,634.21
The Collier County Public Utilities Division is applying for a Pre-Disaster Mitigation Grant that
will provide hurricane shutters to the North County Regional Water Treatment Plant. Hurricane
shutters will be installed on six windows and one door that currently has aluminum panels that
are not up to 2007 Florida Building Code. The installation of the shutters will provide protection
to the building from high winds and rain. The NCRWTP provides up to 20 million gallons per
day of potable water to the interconnected potable water system in Collier County. Protecting the
water plant from hurricanes is vital to the citizens of Collier County.
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The grant requires a 25% match, which will be paid using funds from the Collier County Public
Utilities Division, Fund 412 the total match amount is $7,658.55. The remaining 75% is the
federal share in the amount of $22,975.66.
The application is due on October 8, 2010, and since the decision to apply was made at the last
minute, we are requesting your approval to be followed by after-the-fact approval by the Board
of County Commissioners.
Once you have reviewed the proposal, please sign in the box above and call me for pickup at
252-4768.
Thank you and please let me know if you have any questions regarding this request.
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3301 East Tamiami Trail. Naples, Florida 34112 . marlenefoord@collierl!ov.net . (239) 252-4768 . (239) 252-8720 (fax)
Print Application
Ag-g~8S h~~o. 16C1
November 9,2010
Page 6 of 32
subgrant Project Application
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Application Title: Co~ier County Waler Department North Water Plant Hurricane Shulters Project
subgrant Applicant: Collier County Govemment
Application Number:
Application Year: 2010
Grant Type: Project Application
Address: 3301 East Tamiami Trail Bldg. H. 3rd Floor. Naples. FL 34112.4902
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Aggft~ fieoJ;~o. 16C1
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Page 7 of 32
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Beals
Associate Project Manager
Collier County Government
3301 East Tamiami Trail
Bldg. H, 3rd Floor
Naples
FL
34112 - 4902
239-252-2583 Ext.
nathanbeals@colliergov.net
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Agg~ tleW;~o. 16C1
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Page 8 of 32
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FL
COLLIER COUNTY *
FLORIDA
COLLIER COUNTY
120067
021
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PARTICIPATING
t!m
07-1~1970
07-17-2001
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Agg~ ~e?K ~o. 16C1
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What is the name of the plan?
What is the type of plan?
When was the current multihazard
mitigation plan approved by FEMA?
Describe how the proposed activity
relates to or is consistent with the
FEMA-approved mitigation plan.
Collier County Local Mitigation Strategy
Local MultiJurisdidional Multihazard Mitigation Plan
01-10-2005
Adding hunicane shutters to the Collier County North County Regional Water
Treatment Plant is consistent with the Collier County Local Mitigation Strategy
because it will reduce the vulnerability of critical and public facilities from the
effects of natural disasters.
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What is the name of the plan?
What is the type of plan?
When was the current multi hazard
mitigation plan approved by FEMA?
Describe how the proposed activity
relates to or is consistent with the
StatefTribe's FEMA-approved mitigation
plan.
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Agf~ ~eW;t.?o. 16C1
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AggrV& ~e%Ni. 16C1
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The North County Regional Water Treatment Plant's (NCRWTP) first floor offices have removable aluminum panels that aren't up to
2007 Florida Building Code. There are six windows and one door that need the aluminum panels replaced. The NCRWTP's process
room has five fixed louvers with 5' X 25' openings and six ventilation fans with 5' X 5' openings that are unprotected from high winds.
The process room contains four 350 HP motors, six 200 HP motors, an overhead crane, reverse osmosis treatment membranes, and
membrane support structures that could be damaged by rain. If high speed wind enters the room, it could force the roof off the building
damaging the equipment. The NCRWTP provides up to 20 million gallons per day of potable water to the interconnected potable water
system in Collier County. If the plant is shut down, service will not be lost but water pressure in the northern portions of the service area
will be greatly reduced. Reduced water pressure can limit a fire sprinkler systems ability to suppress fires. Reduced water pressure can
also cause a backflow situation with the risk of contaminating the potable water. The NCRWTP is located about 9 miles from the coast
of the Gulf of Mexico at 8005 Vanderbilt Beach Rd. Naples, FL 34120.
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12021C0425G
Electronic map attached
Area of minimal flood hazards (C, X)
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Non-residential - Public
Slab on Grade
No
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Yes
Area of moderate flood hazards (6, X), Area of minimal flood hazards
(C,X)
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Af~llle~fui. 16C1
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Purchase and Install Shutters (1) Construction And Project Improvement 5,00 Each $ 3,955.05 $19,775.25
Purchase and Install Shutters (2) Construction And Project Improvement 6.00 Each $1,219.16 $ 7,314.96
Purchase and Install Shutters (3) Construction And Project Improvement 1.00 Each $ 700.00 $ 700.00
Purchase and Install Shutters (4) Construction And Project Improvement 6.00 Each $ 424.00 $ 2,544.00
Purchase and Install Shutters (pennit) Construction And Project Improvement 1.00 Each $ 300.00 $ 300.00
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Alf~lJte?tf~. 16C1
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Local Agency Funding
Collier County Public Utilities
Cash
$ 7,658.55
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Afemra~~Rf~~. 16C1
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The property address and original date of construction for each property affected (unless this information is already
noted in the Properties section),
A minimum of two color photographs showing at least three sides of each structure (Please label the photos
accordingly),
A diagram or USGS 1 :24,000 scale quadrangle map displaying the relationship of the property(s) to the project area.
Information gathered about potential historic properties in the project area, including any evidence indicating the age
of the building or structure and presence of buildings or structures that are listed or eligible for listing on the National
Register of Historic Places or within or near a National Register listed or eligible historic district. Sources for this
information may include the State Historic Preservation Officer, and/or the Tribal Historic Preservation Officer
(SHPOrrHPO), your local planning office, historic preservation organization, or historical society.
Consideration of how the project design will minimize adverse effects on known or potential historic buildings or
structures, and any alternatives considered or implemented to avoid or minimize effects on historic buildings or
structures. Please address and note associated costs in your project budget.
For acquisition/demolition projects affecting historic buildings or structures, any data regarding the consideration and
feasibility of elevation, relocation, or flood proofing as alternatives to demolition.
Attached materials or additional comments.
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A description of the ground disturbance by giving the dimensions (area, volume, depth, etc.) and location
The past use of the area to be disturbed, noting the extent of previously disturbed ground,
A USGS 1 :24,000 scale or other site map showing the location and extent of ground disturbance.
Any information about potential historic properties, including archeological sites, in the project area. Sources of this
information may include SHPOrrHPO, and/or the Tribe's cultural resources contact if no THPO is designated. Include, if
possible, a map showing the relation of any identified historic properties to the project area.
Attached materials or additional comments.
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Any request for information and associated response from the U~FWS, th7 N~tional Ma~ne Fisheries Service ~NMFS) (for
affected ocean-going fish), or your State Wildlife Agency, regardmg potential listed speCIes present and potential of the
project to impact those species.
Attached materials or additional comments.
Description of the amount (area) and type of vegetation to be removed or affected.
A site map showing the project area and the extent of vegetation affected.
- Photographs or digital images that show both the vegetation affected and the vegetation in context of its surroundings.
A USGS 1 :24,000 scale quadrangle map showing the project activities in relation to all nearby water bodies (within 200
feet).
Any information about the type of water body nearby including: its dimensions, the proximity of the project activity to the
water body, and the expected and possible changes to the water body. if any. Identify all water bodies regardless
whether you think there may be an effect
ru, A photograph or digital image of the site showing both the body of water and the project area.
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A~ewa~~ffi~. 16C1
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Request for information and response letter from the US Army Corps of Engineers and/or State resource agencies
regarding the potential for wetlands, and applicability of permitting requirements.
Evidence of alternatives considered to eliminate or minimize impacts to wetlands.
Attached materials or additional comments.
Hydrologiclhydraulic information from a qualified engineer to demonstrate how drainage and flood flow patterns will
be changed and to identify down and upstream effects.
Evidence of any consultation with US Army Corps of Engineers (may be included under Part D of the Environmental
Information).
Request for information and response letter from the State water resource agency, if applicable, with jurisdiclion
over modification of waterways.
Attached materials or additional comments.
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. . t St t cy that implements the coastal zone management
~r~~~i:;:~~~~n~h:~i~e:~:dctoft~ t~~oj:J'~~~s~ste~~ ;hn the State's coastal zone plan and any potential
requirements affecting the cost or design of the proposed activity.
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. 1. Will the project convert more than 5 acres of .prime or unique" farmland outside city limits to a non-agricultural No
use?
Comments and any relevant documentation.
Results of any consultations with State or local agency to obtain permit with requirements for handling, disposing of or
addressing the effects of hazardous or toxic materials related to project implementation.
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Attached materials or additional comments.
Results of any consultations with State or local agency to obtain permit with requirements for handling, disposing of or
addressing the effects of hazardous or toxic materials related to project implementation.
Attached materials or additional comments.
.3. Does any project construction or operation activities involve the use of hazardous or toxic materials?
Comments and any relevant documentation.
Results of any consultations with State or local agency to obtain permit with requirements for handling, disposing of or
addressing the effects of hazardous or toxic materials related to project implementation.
Attached materials or additional comments.
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Comments and any relevant documentation.
Results of any consultations with State or local agency to obtain permit with requirements for handling, disposing of or
addressing the effects of hazardous or toxic materials related to project implementation.
Attacnm"E!
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Description of the population affected and the portion of the population that would be disproportionately and
adversely affected. Please include specific efforts to address the adverse impacts in your proposal narrative and
budget.
-: Attached materials or additional comments.
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Evaluated these potential effects and provided the materials required in Parts A through J that identify the nature and
extent of potential impacts to environmental resources and/or historic properties.
_., Consulted with appropriate parties to identify any measures needed to avoid or minimize these impacts.
Considered alternatives that could minimize both the impacts and the cost of the project.
Made certain that the costs of any measures to treat adverse effects are realistically reflected in the project budget
estimate. .....
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Minimal maintenance is required for the hurricane shutters and any cost will be
covered by the standard operating budget.
Collier County Public Utilities
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By checking the Not Applicable box and not providing the information in this section, I understand that this
application may not be selected for the Pre-Disaster Mitigation - Competitive Grant Program.
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EHP-F-
Coastal Zone
Management
Act
Florida's coastal zone is the entire state but our
project is located about nine miles from the coast of
the Gulf of Mexico.
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A~i~f)f~~. 16C1
~ "'Novemb-er 9,2010
Page 28 of 32
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Part II: FEMA Form20-16B. Assurances Construction Programs.
Part II: FEMA Form 20-16C, Certifications Regarding Lobbying; Debarment, Suspension and Other
Responsibilities Matters; and Drug-Free Workplace Requirements.
Part III: SF-LLL. Disclosure of Lobbying Activities (Complete only if applying for a grant of more than $100.000 and have
lobbying activities using Non-Federal funds. See Form 20-16C for lobbying activities definition.)
Incomolete
Incomolete
Not Applicable
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A~2!t1lPffl6. 16C1
- fiJovember 9,2010
Page 29 of 32
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APPLICATION FOR
FEDERAL ASSISTANCE
(SF 424)
1k~I\'ig,Ill~
COnstrudi~n . ,
J;~TEiSW3t;;lil'lf~' ~f~"
~~i!;;jEC~lllYi$T).tli st8lli;~og~
~-=~Et~,ay,;fE~' f(illri'~
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Collier County Government
Address
3301 East Tamiami TraM, Bldg. H, 3rd Floor
Naples, FL 34112-4902
iI,Et.1l"~O"'~R'~I~.~i3~:l~ .LI!_$i!~lJg
50-6000558
B:'TYPE'OFAe~N
Project Application
4p:iC>>oTrAl;QG~E.a;j:)E~~~"'.
o~'tIOriiiI'l'm1t
Collier Couniy Governmant
=~~~~~~.~.~'
Nathan Beals, 239-252-2583
7;m~OF~~~
Local Government
9:~lbF.;FeOERAl.A'GeN~
Federal Emergency Management Aoency
~i, OesCfllP:itlVE'ltrGQf~Pt.~~:Mm~
Co/lier County Water Department North W81er Plant Hurricane Shutters Project
1~;~~_f!i€l$!)WlJ~:~~.!~1
COLLIER COUNTY
13;;PRl:)~~
Start Date:
End Date:
i4;qPN~SS~~j'Q1!
a. Applicant FL14
b, Project FL 14
16.tS APf'L1CATI0f4'~-r'IP:flE\IlaWlly:s;r4\.lE il)CE~O'RD!R
1m2 PROCE$S:?
$ 22,075.66 No, Pl'09ram has not been selected by stale for review
a. Federal
b. Applicant
$0.00
~
C. State
$0.00
d. Local
$ 7,656.55 17, tS>>EAPPWC~tl!lElljNQtf~jq!.IJiIY'F~'DEE!if?
No
e. Other
$0.00
f. Program Income
$0.00
g. TOTAl
$ 30,634,21
23'1'ZS z, g3K oS
.;~a"SlOnea
~
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A~'~Rf~8.16C1
November 9,2010
Page 30 of 32
13. Will assist the awarding agency in assuring compliance with Section 106 of the National
Historic Preservation Act of 1966, as amended (16 use Section 470), EO 11593
(identification and protection of historic properties), and the Archaeological and Historic
Preservation Act of 1974 (16 use Section 469a-1 et seq.)
14. Will comply with PL 93-348 regarding the protection of humah 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 (Pl89-544, as amended, 7 use
2131 et seq.) pertaining to the care, handling, treatment of warm blooded animals held
research, teaching, or other activities supported by this award of assistance.
16. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 use 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 USC Section 201), as they apply to employees of institutions of
higher education, hospitals, and other non-profit organizations.
~
1, ~?~rebYSi9nthiSform.sof rb!7lro
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FEMA Form 20-16C
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 (Non-procurement) 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 the section 1352, Title 31 of the US 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 I 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 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 employee of Congress, or an 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;
o
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Print Application
A~~~Rf ~~. 16C1
November 9,2010
Page 31 of 32
r Standard Form LLL Disclosure of Lobbying Activities Attached
(c) The undersigned shall require that the language of this certification be included in the ,award
documents for all the sub awards at all tiers (including subgrants, contracts under grants and
cooperative agreements, and subcontract(s)) and that all subrecipients shall certify and disclose
accordingly.
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 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 (Federal I 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 locally) 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 or 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.
Explanation:
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 17.623:
(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,
distribution, dispensing, possession, or use of a controlled substance is prohibited in
the grantee's workplace and specifying the actions that will be taken against
employees for violation of such prohibition;
(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
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.1>alle 15 of16
,A';genaa Item No. 16C1
November 9,2010
Page 32 of 32
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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 against such an employee, within 30 calendar
days of receiving notice under subparagraph (d)(2). with respect to any employee
who is so convicted:
(1) Taking appropriate personnel action against such an employee, up
to and including termination, consistent with the requirements of the
Rehabilitation Act of 1973, as amended; or
(2) Require 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.
r"..
(g) Making a good 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
Zip
Street
City
State
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 shouid be included with each application for FEMA funding. States and
State agencies may elect to use a Statewide certification.
I. ~ '<'" D ~ . ~eret>y sign this form as of (f)! 7/r ()
Standard Fonn LLL: Disclosure of Lobbying Activities ~
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