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Backup Documents 01/11/2011 Item #16F 1ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 F 1 TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper. Attach to original document. Original documents should be hand delivered to the Board Office. The completed routing slip and original documents are to be forwarded to the Board Office only after the Board has taken action on the item.) ROUTING SLIP Complete routing lines #1 through #4 as appropriate for additional signatures, dates, and/or information needed. if the document is already complete with the .. ... . _ _,- _ c__ .�. ._.......9-- G__ at .I,...,.,,h xu �....,..Iatr H,r. rheckiist. and foaward m Sue Filson (line #5). exec ima ut me umun -u a a. �m�..., .. -- - ...... ......- ..__ Route to Addressee(s) -- --- _ ... ____ ._ .., ___ Office Initials Date (List in routing`order) Contact (Initial) Applicable) lr�_ I. C4�1rtt1 �i`Ft� / CG `k, \,\ 7 d Cal� , -�� -�► 2. Agenda Item Number ._ 3. A roved b the d 4. resolutions, etc. signed by the County Attorney's Office and signature pages from 5. Ian Mitchell, BCC Office Board of County Commissioners Number of Original Documents Attached 1 Supervisor Attached 6. Minutes and Records Clerk of Court's Office PRIMARY CONTACT INFORMATION (The primary contact is the holder of the original document pending BCC approval. Normally the primary contact is the person who created/prepared the executive summary. Primary contact information is needed in the event one of the addressees above, including Sue Filson, need to contact staff for additional or missing information. All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the Name of Primary Staff Initial the Yes column or mark "N/A!' in the Not Applicable column, whichever is \6 S Phone Number Z 2 Contact (Initial) Applicable) I. Original document has been signed/initialed for legal sufficiency. (All documents to be was Agenda Date Item was , ' I I Agenda Item Number ._ A roved b the d resolutions, etc. signed by the County Attorney's Office and signature pages from Type of Document p p _ T\ S f t `A t ©� ,_� fc('.A, �c Number of Original Documents Attached Attached 2. All handwritten strike- through and revisions have been initialed by the County Attorney's Y/ Mpv�,ry INSTRUCTIONS & CHECKLIST 1: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip W WS Original 9.03.04, Revised 1.26.05, Revised 2.24.05, Revised 9.18.09 Initial the Yes column or mark "N/A!' in the Not Applicable column, whichever is Yes N/A (Not appropriate. (Initial) Applicable) I. Original document has been signed/initialed for legal sufficiency. (All documents to be _ signed by the Chairman, with the exception of most letters, must be reviewed and signed by the Office of the County Attorney. This includes signature pages from ordinances, resolutions, etc. signed by the County Attorney's Office and signature pages from contracts, agreements, etc. that have been fully executed by all parties except the BCC Chairman and Clerk to the Board and possibly State Officials.) 2. All handwritten strike- through and revisions have been initialed by the County Attorney's Office and all other parties except the BCC Chairman and the Clerk to the Board 3. The Chairman's signature line date has been entered as the date of BCC approval of the document or the final negotiated contract date whichever is applicable. 4. "Sign here" tabs are placed on the appropriate pages indicating where the Chairman's signature and initials are required. 5. In most cases (some contracts are an exception), the original document and this routing slip should be provided to Ian Mithchell in the BCC office within 24 hours of BCC approval. Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of our deadlines! 6. The document was approved by the BCC on - (enter date) and all changes P t f made during the meeting have been incorporated in the attached document. The J County Attorney's Office has reviewed the changes, if a licable. 1: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip W WS Original 9.03.04, Revised 1.26.05, Revised 2.24.05, Revised 9.18.09 16F I MEMORANDUM DATE: January 12, 2011 TO: Josh Thomas, Grants Support Specialist Administrative Services Department FROM: Martha Vergara, Deputy Clerk Minutes and Records RE: Grant Application Terms and Conditions — Volunteer Fire Assistance - Foam Attached for your records is a copy of the original document, referenced above (Agenda Item #16F1), approved by the Board of County Commissioners on Tuesday, January 11, 2011. The original has been kept by the Minutes and Records Department for the Board's records. If you should have any questions, please contact me at 252 -7240. Thank you. Attachment (1) 16F 1 EXECUTIVE SUMMARY Recommendation to approve and authorize the Chairman to sign the submittal of a Volunteer Fire Assistance Grant Application in the amount of $4125 to the Florida Division of Forestry for the purpose of purchasing fire hose for the Brush Vehicles and Class A Foam. OBJECTIVE: To obtain Board of County Commissioners approval to submit and authorize the Chairman to sign the Volunteer Fire Assistance matching (50/50) grant in the amount of $4125 for the purpose of purchasing fire hose for the Brush Vehicles and Class A Foam. CONSIDERATIONS: Ochopee Fire Control District has submitted and received this type of grant from the Florida Division of Forestry for the past 32 years. The grant has been used to purchase equipment to improve firefighter safety and firefighting capabilities. Ochopee Fire Control District currently has two 6x6 five ton vehicles on loan from the Division of Forestry that the Department is outfitting. The fire hose to be purchased would be used on these vehicles. The Class A Foam would also be used for brush fire containment. The 50/50 grant will allow Ochopee Fire Control District to complete outfitting the Forestry vehicles and increase the Departments suppression power by acquiring more foam for brush fire season. This equipment is also a potential boost of resources for Ochopee Fire Control District increasing fire protection of life and property especially during the current budget constraints making the grant most beneficial. FISCAL IMPACT: The total cost of the fire hose and Class A Foam is $4125. As this is a 50/50 matching grant, the division of Forestry will pay $2062.50 leaving the Ochopee Fire Control district to provide $2062.50 from Reserves Fund 146 ( Ochopee Fire Control). Following award, budget amendments will be needed to recognize grant funds in Fund 713, Bureau of Emergency Services Grants and to transfer matching funds to Fund 714, Bureau of Emergency Services. GROWTH MANAGEMENT IMPACT: None. LEGAL CONSIDERATION: This item has been reviewed by the County Attorney's Office, requires majority vote, and is legally sufficient for Board Action. -CMG 16F 1 RECOMMENDATION: That the Board of County Commissioners approves and authorizes the Chairman to sign the submittal of a Volunteer Fire Assistance Grant application in the amount of $4125 to purchase Fire Hose and Class A Foam. Prepared by: Alan McLaughlin, Fire Chief 16F 1 . � Iw�t�wl+thl I'll Depadnaniof/1pdorli and Conaumarftr*0e DNlslon of Foral VOLUNTEER PIRG A9888TAN0110RANT APPLICATION Ocilopoe Fire Control Dlallrol "ll"Unvowill l=111FORNMOMill -*5mrRWIjM-4M- Dependent Fire Control District Box 70 CITY Everglades City a FI 94139 Coker e 6 9 6 0 0 0 5 3 8 sFIR r l O CORPO T L Y8801 NOE) IrYEe,NU18OFTOVRk erg EvladosClly NINTIO7XlhRl OEPMTMENTI }O MTRLO7 `� POPUUl110N OP TOW, 3� 1 IaFIRECEPMTIAENTIOMOOLIrLtV "YEsm NOp PROTEoud MEk E81 POPIILA"o - EIIE: aO. MA.IE)j '� 4 00 r CLIPAWITCOOP £MIMAORCEMEXTWHIUOF7 Y£em HOD „'�� INATANC£OFC101F87MUtUALNO FlRE DEPMTA1ENn I"ROFnIteOEI•MmeN ,ast Na eaFrEtl DTet�'r` HUMOEROFFIRFEIOHTIUM PAW: 17 VOLVNrEENa: IB HABAPPL IONL TIWMMUORANTFUIIWFRWIMY80URCS111 NO.OFINOIOEHIB PAOT YFM; MLOIANONRF. Oml r 478 THl PAOTifNO MIr— YES l0 IF YM YA1ERlI F orida Will on of Forestry N0, OF nREF10H7Efle CERIIfI�EyD� FAL°LANDFLRemsFenI fLL LNLOIAWFIMONrEl l AMOUNT. 0 p g •' . LIST 70TAL FUNWaEOEIV[D FROM OIHER7ARRLOAUTHOhITIEe BC�IHATLUOTOfhU117dena+l AMOU artounr. s List FF TYPE Eh ne 3 IAARMXLIOUEL Er�Tae an n One 9g 06 05 PUMPOAPACl/Y. OPMj 1 WATF1t0APAgTY(OAL.) ke 1Nel a ?60 760 1000 $00 ar h 2 6 xg 73 260 7G / goo Attack Dod a 6600 26 3 114nL1A1:O0NAN[FUHOIHORLTIUEOT; 26 tIeTOFE0110,IEN70118UPPU08 TO PURMIASUVATH OIlMTFUM FEOEML 02002,60 HIIMOER CEs"NON AMOUNT APFMCMT s g2,g 1 re Hose foT lintel~ i unito q COUNT a 2 _ Glass foam 1 q26 TOTAL 04 126 cOeX ncl lneroCbn 00% a11014 APPYanlolluNOaA or dot H MriMa Wnat.) to Corm & lagat sulgclenay ATTEST. �� ®A�YYI tlJl� nVAIiNTI3. Warmw Till Assistant County Anomay �tla1lt � tl� � •i�t>fn en1 0A pproval No. 0340.0040 ASSURANCES.. NON- CONSTRUCTION PROGRAMS 0M Notes Certain a ribose assurances may not be a�plhableIo your project or program. Ifyou have questions, please carried the Invoicing agency. Further, certain Pedeial mwrdtng egene 8 may require applicants to ctnli • to additional assurances. If sorb is she case, you will he satilled. dn1L' aulhafixd mmreselhhlWt oRhe mm�ttonf 1 e 1. Has file legal authority to apply for Federal assistance, and ilia Institutional, managerial and Ihiancial capability (Including limits sufficient to pay the non -Fe &mi share or project cos(s) to enmra prop9r planning, ntanogehfieo and, completion' of the project described In this application. 2. Will Elie the mvordhhg agency, the Comptroller eeuetal critic United Slates, and If appropriate, the State, lluough any nuthorizcd rtpresenlolive, across to and The fight to examine All records, books, papers, qr documents related to the riword; and will establish a pro per accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will establish nftguofds to probibb employees from using their positions for it purpose That constitutes or presets The nppenrnace of personal or organizational conflict of Initresl, or personal gain. 4. Will Initiate and complete (he work mdthln flit applicable time frmne after receipt of approval of the amsrding agcndy. S. Will comply with the hdergovensmental Personnel Ad of 1970 (42 U.S.C. §§ 4729.4761) rciadng to prescribed 'standards for meril systems for programs funded under one of rise nindeet sialutes or regutntiom sta"Mcd ht Appendix A orOMI's 5)nndmils for a Merit System of Perrounc( Administration (5 C.F.E. 000, Sabpml P). 6. Will comply Oils all Federal stotmes relating to nondiscrimination. These include but Ott not limited to; (n)Tille VI, of the Civil Rights Act of 1964 (P.L. 08452) which prohibits discrimination on the basis ofrace, color or national origin; (b) Title IX of the pdocadon Amendments of 1972, as muended (20 U.S.C. §§ 1681.1683, and 16854686), which prohibits discrimination on the Wish; of sex; (c) Seddon $04 bf the Rehabilitation Act of 1973, as amended (29 U.S.C, § 794), v3'hlch prohiblts r1kcrindnallon on Ike basis of handicaps; (df rate Age Discrimination Act of 1975, as omended (42 U.S.C: §§ 6101. 6107), which prohibits discrinri lnual on the basis close; (e) the Drug Abase Ofllco and Trealment Actof 1972 (P.L; 92- 255), as amended, totaling to nondiscrimination on the basis of drug abuse; (0 the Comprehensive Alcohol Abuse and Alcoholism Freveollon, Trealnnenl and Rehabilitation Act or 1970 (P.L. 91'6!6), as amended, relating to nondisermdnallon on the basis of alcohol Obese or alcoholism; (g) % $23 and 527 of tha Public Health Sen'ice Adof 1912 (42 U.S.C. 290 dd3 and 290 et -3), as anheadcd, relmbtg to confidentiality of alcohol and drug abuse patient recants; (h) Title VIII of Ilse Civil Rights Art or 1968 (42 U.S.C. § 3601 or seq.). as amended, totaling to nondiscrimination In the sole, rental or fl,rancing of housing; O any of er nondlstrimrnption provisions In the spedfle slotule(s) under which application for Pedeml assistance Is being wade; and 0) the requirements of any other nordiscrindnnthm slalute(s) which may apply to the application. 7. Will comply, or hall already compiled, wish the requirements of Titles it Bali III of the UnitLms Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 961.616) which provide for Ibir and equitable treatment of prisons displaced cc kitten Property Is acquired IS 0 result 000 &M or federally assisted programs Then requirements apply to oil Interests to real property acquired for project purposes rcgordiese of Federal participation in purchases. B. WI II comply with Ills provisions of the Health Act (5 U.S.C. §§ 1501.1508 and 7324.1328) n'hicb limit the political activities of employees vwlwse PAMPA unploymt0l ndiVltles Pro lnded in Whole or in pan wills Fcdenl Rmds. 9. Will cosmply, Or splitlwble, will, the provisions of the Dm•Is- Hacon Act (40 U.S.C. §§ 276n to 276a -7), the Copeland Act (40 U.S,C. § 2760 and 18 U.S.C. §§ 874), and the Contract Work Hours will Solely Standards Act (40 U.S.C, §§ 327.333), regarding labor standards for R &ndlly insisted cohnmc(ion subagrcements. 10. Will comply, If applicable, with flood Invitance purchase szqutrements of section 102 (a) or tint Flood llisaster Protection Act of 1973 (P.L. 93.234) Wdeh requires recipleius In a special flood hazard area to participate lot the program end (o pur61wele good Insumnet iftise lolal coil dr hhsmablo muslmdiat and acgaishion of 310,000 or nmrr. 11. 14111 comply vdlh cnvirarmscnhnl standards which may be proscribed Punctual to (he following: (a) inslimton orgovini meglal quality control measures under the fimlonn) Frivimmshenlai Policy Act of 1969 (P.L. 91.190) and Hxecuthc Order (EO) 11514; (6) notiRcallon of violating Ibcltdes pununsu to EO 1(738; (o) pproitdlon of wxilandf punµ',nl to Ell 11990; (d) m'alnnton of florid hnirards in floodplalns In accordance with FO 11988; (e) assumncc of project comislency with thR approved Stare ntnnag<nsenl pmgnryn developed under the Coastal Zone Managemcnl Act or 1972 (16 U.S,C. §§ 1151 CI sell.); (I) conformlly of Federal actions to Slate (Clear Air) lmplemenlntion Plans under Section 176(0 of the Clear allocated Act of 1955, no ocated (•12 U.$.C. § 7401 cl se_q.); (g) protecion of va&rgroond sburce's of drinking pater under the Safe Drinking %Vale( Act of 1974, as onttndad, (P.L. 93.523); and (h) protection of endangered specles under the Fndangered Species Act of 1913, ns Omen &d, (P.L.93 -205). 12. Will comply ehb Ilia Wild mid Santo Rivers Act of 1968 (16 U.S.C. §§ 1271 et s<q.) rclotid to prolcdhno componeals or polenllal componculs of the notional vwlld and scenic rivers system. V,8. 5(02/08) Authorized for Local Reproduction 81-ndai Fmm124B (903)Pferni6ed 6y 0 \IBCircular A -102 1 16F . .... ...J- .. -.... .- x.J_.l fool +)::. . ":'_... .a-.FQ ; ".n... .u. ,i.f..,, .�'• 0A pproval No. 0340.0040 ASSURANCES.. NON- CONSTRUCTION PROGRAMS 0M Notes Certain a ribose assurances may not be a�plhableIo your project or program. Ifyou have questions, please carried the Invoicing agency. Further, certain Pedeial mwrdtng egene 8 may require applicants to ctnli • to additional assurances. If sorb is she case, you will he satilled. dn1L' aulhafixd mmreselhhlWt oRhe mm�ttonf 1 e 1. Has file legal authority to apply for Federal assistance, and ilia Institutional, managerial and Ihiancial capability (Including limits sufficient to pay the non -Fe &mi share or project cos(s) to enmra prop9r planning, ntanogehfieo and, completion' of the project described In this application. 2. Will Elie the mvordhhg agency, the Comptroller eeuetal critic United Slates, and If appropriate, the State, lluough any nuthorizcd rtpresenlolive, across to and The fight to examine All records, books, papers, qr documents related to the riword; and will establish a pro per accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will establish nftguofds to probibb employees from using their positions for it purpose That constitutes or presets The nppenrnace of personal or organizational conflict of Initresl, or personal gain. 4. Will Initiate and complete (he work mdthln flit applicable time frmne after receipt of approval of the amsrding agcndy. S. Will comply with the hdergovensmental Personnel Ad of 1970 (42 U.S.C. §§ 4729.4761) rciadng to prescribed 'standards for meril systems for programs funded under one of rise nindeet sialutes or regutntiom sta"Mcd ht Appendix A orOMI's 5)nndmils for a Merit System of Perrounc( Administration (5 C.F.E. 000, Sabpml P). 6. Will comply Oils all Federal stotmes relating to nondiscrimination. These include but Ott not limited to; (n)Tille VI, of the Civil Rights Act of 1964 (P.L. 08452) which prohibits discrimination on the basis ofrace, color or national origin; (b) Title IX of the pdocadon Amendments of 1972, as muended (20 U.S.C. §§ 1681.1683, and 16854686), which prohibits discrimination on the Wish; of sex; (c) Seddon $04 bf the Rehabilitation Act of 1973, as amended (29 U.S.C, § 794), v3'hlch prohiblts r1kcrindnallon on Ike basis of handicaps; (df rate Age Discrimination Act of 1975, as omended (42 U.S.C: §§ 6101. 6107), which prohibits discrinri lnual on the basis close; (e) the Drug Abase Ofllco and Trealment Actof 1972 (P.L; 92- 255), as amended, totaling to nondiscrimination on the basis of drug abuse; (0 the Comprehensive Alcohol Abuse and Alcoholism Freveollon, Trealnnenl and Rehabilitation Act or 1970 (P.L. 91'6!6), as amended, relating to nondisermdnallon on the basis of alcohol Obese or alcoholism; (g) % $23 and 527 of tha Public Health Sen'ice Adof 1912 (42 U.S.C. 290 dd3 and 290 et -3), as anheadcd, relmbtg to confidentiality of alcohol and drug abuse patient recants; (h) Title VIII of Ilse Civil Rights Art or 1968 (42 U.S.C. § 3601 or seq.). as amended, totaling to nondiscrimination In the sole, rental or fl,rancing of housing; O any of er nondlstrimrnption provisions In the spedfle slotule(s) under which application for Pedeml assistance Is being wade; and 0) the requirements of any other nordiscrindnnthm slalute(s) which may apply to the application. 7. Will comply, or hall already compiled, wish the requirements of Titles it Bali III of the UnitLms Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 961.616) which provide for Ibir and equitable treatment of prisons displaced cc kitten Property Is acquired IS 0 result 000 &M or federally assisted programs Then requirements apply to oil Interests to real property acquired for project purposes rcgordiese of Federal participation in purchases. B. WI II comply with Ills provisions of the Health Act (5 U.S.C. §§ 1501.1508 and 7324.1328) n'hicb limit the political activities of employees vwlwse PAMPA unploymt0l ndiVltles Pro lnded in Whole or in pan wills Fcdenl Rmds. 9. Will cosmply, Or splitlwble, will, the provisions of the Dm•Is- Hacon Act (40 U.S.C. §§ 276n to 276a -7), the Copeland Act (40 U.S,C. § 2760 and 18 U.S.C. §§ 874), and the Contract Work Hours will Solely Standards Act (40 U.S.C, §§ 327.333), regarding labor standards for R &ndlly insisted cohnmc(ion subagrcements. 10. Will comply, If applicable, with flood Invitance purchase szqutrements of section 102 (a) or tint Flood llisaster Protection Act of 1973 (P.L. 93.234) Wdeh requires recipleius In a special flood hazard area to participate lot the program end (o pur61wele good Insumnet iftise lolal coil dr hhsmablo muslmdiat and acgaishion of 310,000 or nmrr. 11. 14111 comply vdlh cnvirarmscnhnl standards which may be proscribed Punctual to (he following: (a) inslimton orgovini meglal quality control measures under the fimlonn) Frivimmshenlai Policy Act of 1969 (P.L. 91.190) and Hxecuthc Order (EO) 11514; (6) notiRcallon of violating Ibcltdes pununsu to EO 1(738; (o) pproitdlon of wxilandf punµ',nl to Ell 11990; (d) m'alnnton of florid hnirards in floodplalns In accordance with FO 11988; (e) assumncc of project comislency with thR approved Stare ntnnag<nsenl pmgnryn developed under the Coastal Zone Managemcnl Act or 1972 (16 U.S,C. §§ 1151 CI sell.); (I) conformlly of Federal actions to Slate (Clear Air) lmplemenlntion Plans under Section 176(0 of the Clear allocated Act of 1955, no ocated (•12 U.$.C. § 7401 cl se_q.); (g) protecion of va&rgroond sburce's of drinking pater under the Safe Drinking %Vale( Act of 1974, as onttndad, (P.L. 93.523); and (h) protection of endangered specles under the Fndangered Species Act of 1913, ns Omen &d, (P.L.93 -205). 12. Will comply ehb Ilia Wild mid Santo Rivers Act of 1968 (16 U.S.C. §§ 1271 et s<q.) rclotid to prolcdhno componeals or polenllal componculs of the notional vwlld and scenic rivers system. V,8. 5(02/08) Authorized for Local Reproduction 81-ndai Fmm124B (903)Pferni6ed 6y 0 \IBCircular A -102 1 ...: _... ..... _.... ...a ...n. u.+F.v saw. .. a. ._ � n'F ...rt _... i• .. .. .._ ...ia .... ... .: .0.n ... research, leaching, of other n.Hvilies suppled by this asmrd of 13. Will mshl file agardhsg agency hl assurhtg compliance Will assistance. _. Section 106 of the National 111slorie Preservation Act of 1966, as amended (16 U.S.C. 470), ED 11593 (identineadun and prokclion or 16. Will comply rigs the Lead -Bored Point Poisoning Prowlion historic psopnatks), unit the Archeological said Historic Preservation Act (42 U.S.C. lif 4801 el seq.) which prohibits the use offend based Aclof1974(I6U,S.C.4694-1 etseq.). Ndnl In wmlrurdon or rehabilh ¢tionofresldenco smsemrer. 14. Will comply with P.L. 93.348 regarding tlw pmtedion of 17. Will cause to be pedbsned (Inc required financial end human subjects Involved In research, development, and related complinnceaudits In¢ccordance pith Um Single Audit Act of 1984. activities supported by this award of assistance. 18. Will comply vvi10 all appilcabte requlramems of all other 15. Will comply voids die Labomtoq• Auhml %Vellbre Acl of 1966 Federal lans, ts"wice orders, regulations and polides governing (P.L. 89444, as amended, 7 U.S.C. 2131 et seq.) perlalning to the IhI, progrnm. care, handling, and ucniment of warm blooded anhuals held for SIGNATURE F AUTHORII1ZED�� CERTIFYING OflF11FICIAL e TITLE _tt IN { .r , Sj- chairman, Board of County Commissioners y _ APPLICANT ORGANIZATION DATE Collier County Board of Commissioners SUBMITTED *Aproved as to form & legal sufficiency Colleen Qreena, Assistant County Attorney Y, a-6 (6210S) Authorized for Loyal Repproduction) Srandat�Fomrd24B (903 Ne.tibfd by O%lB Cin.la A -102 ir.,; 4T E. BROOK. Clef j twtwe 04 ® M r'r. \�•_.fa ... � r•i .. . I .xa t' ... . � -.: v :.. .. .l n..' ...:r. .. y'. air:. frintAD-1047pan Responslblifty Matters - PrlmaryCovered h- ansactions This cedifcatiom is required by the regulations Implementing Executive Order 12549, Debarment and binpenslon, 7 CFR Part 3017, Section 3017, 510, Participanis' responsibilities. The regulations were published as Pat TV of the Jaauary 30, 1989, Federal Reels /ef(pages 4722. 4733). Copies of the regudetimss maybe obtained by contacting the Deparlmenl oFAgriculhne agency offering the proposed covered tratsnetlon. t (Tichim conrplettng certlticallon• read Instructions on reverse) (1) The prospeciva primnryparticipa t ceriifes to ilia best of Its knowledge and belief, that it and its principals: (a) me not presently debarred, suspended, proposed for debarment, declored luellgible, or voluntarily excluded from covered Iransactions by any Federal department or agency; {b) have nut within n three-yrar period preceding this proposal been convicted of or had a civil judgnfcat rendered agn(nst them for convn(ssion of raid or n crtmhtal ofleasa In camcclion with o6lnlning, hitennpfigg to ob[nhr, or perfomning n public (Federal, Sinle or Local) transaction or contact under n public transaction; violation of Federal or State mditntst statutes or conuuission of cntbczzlenneml, then, largely, leibery, falsification or destmctbon ofrecords, making false statenncots, or receiving stolen property; (c) ore not presently indicted far or othuMse crindnnily or civilly charged bydgovartnrcntni entity (Federal, State or Local) whh colubnission or any of ilia ofenses cinnncrhted In paragraph (1)(b) of this certiflewon; and (d) have not odlbht a three -year period prccedhng this npplicatlon /proposal )tad one of more public trgnsnctions (Federal, Slate or Local) lehsduoled for cause or defagt. (2) Wherc the prospective prhnary paritcipaol is unable to certify to any of the statements fix Jhis certification, such prospective participant shot ntlach nn expieuation In this prop6501. Collier County Board of County Commissionero Fred W. Coyle, Chairman Ochopee Fire Control District Approved as to form & legal sufficiency ��� Colleen e, Assistant County Attorney A• -Asr. DWIGHT E. OR K. g Awl Kt� ®1�IMtN1Pf: bo'l e u Form AD•10d7 pan qs vEese INSTRUCTIONS FOR h By slgnWg slid submildng tills form, the prospective ptlmwrypodlcipaal Is providing the cerrilieation set out on the inverse aide in accordance vhlh These Watnuliaus, 2. Tire inability of It person (oprovide the cerll(icodou required betmvwiii riot necessarily result In dental of participation In this covered Iransaclion. The prospective parlkpant shall submit an exppinnofiyn of vvh If cannot provide the verification setout on tills form. The cerlificnllou or expplmroliar vJlll be considettd fit connection with the deparouentorageneyrsdderminationwhelirerto enter lutorhlslmdsaer ion, However, fidhueof the prospective primaryporikipaut to Danish a cerlification or on explanation shall disqual ify such Pelson from participation In this transaction. 3. The certification In this clause is a material representation of fact upon which reliance was placed when the (it pparunenl oragency determined to enter into [his transaction. If it is later determined that lha prosppective primnry participant knowingly rendered on erroneous certification, ht addition to other rentediaa avnf Inble to Cite Federal Govdmrnent, the department or agency may tenninate this transaction for cause or dehult. 4. The pros ppectivo Primary Participant shg lt provide Immediate w ritten notice tothedeparlmetor • agency to whom This proposal is submitted ifal any i4ne the prospective primary participant Ienms [list its certi fucntion was erroneous when submlted or has become erroneous by reason of changed circumslanoes. S. Tire terms "covered transaction," "debirred," "suspended," "Ineligible," "totter tier covered Transact ton;' "particlpanl;' "person," "prfmaty covered Imnsacdon, "'principal; "'proposal;' unit "voiuitatily excluded," ns used W tills clause, have fire meanings set out fu lite Mullions and Coverage sections of the rules hnplemealhtgExecalf O Order 12549. Youmayconlaclliedepadmentoragencytowhlchihtspmposnlls Tieing subiuilled for assistance In obtaining a copy of those regnladonq. 6. Theprospeetiveprinmryparticipantngieespysnbniillinglhisfprinlhat ,shouldlLepraposedcovrred transaction be entered into, it Shull not knowmrglyenler Into any baser tier covered transaction with a person vvlro is debarred, suspended, declared ineligible, or voluntarily exchided limn portidpntion hn Ih1s covered tranmctlmr, unless nufhorizcd by thedcµnrtmcid or ngancy entering h(lo tills IrausaG[od. 7. ThepvospectirepsiurgryparlicipantC urlberagrccsbysu�mittiu�Ihisformlhathvv4111nclndelhisclanse tilled "Ccrtificnlion hcgnrdiug Aebanncnt, Suspension, Luctlgibu lity and Vohmlory Exclusion • Lower Tier Covered Transactions," provided by file dcprUhncol or ugencyenlering Into th15 covered Iransaclion, without modification, in all lower tier covered transaction and in all solicitations for lower tier covered Imnsnctimns. 8. A participant iu n covered imnsacilon nrnyrely upon n cerlllicotion of it pospective po liclpant In a louver tier covered Iransaclion that It Is not debarred, suspended, ineligible, or volowanly excluded from the covered transaction, unless If kuovvs that the certification Is erroneous. A parlicipqui may decide the ntelhod and frequency by which it determines the eligibility of Its principals. Each participanlmay, bntisnotrequircdto, check the Nonpraeurement List. 9. Nothing contained In the Nregoing shall be construed (a require%fablishment of it system of records hn order to render hr good faith the cerlifreollou required by fills Clauso. The knowledge and Information are participial Is not required to exceed that which is uomtaliypossessed by a prudent person in the ordinary course of business dealings. 10. Except for transactions authorized under paragraph 6ofllrese instructions, ire parfc(panl bt n covered transaction kum'iingly rulers Into a loner tier covered transaction with a person who Is suspended, debarred, Ineligible, or voluntarily excluded from participation In this transaction, In addition to other remedies available to the Federal Govermnent, lire department or agency may leruiome this transaction for cause or Mauit, item 0 l Q?` 2 Agenda 11 1) Date Date 1 WE- Rec'd ,