Backup Documents 03/10/2009 Item #16F 3
MEMORANDUM
Date:
March 11, 2009
To:
Christine Chase
Emergency Management
From:
Teresa Polaski, Deputy Clerk
Minutes & Records Department
Re:
Volunteer Fire Assistance Grant Application
Enclosed please find an original Application, referenced above,
(Agenda Item #16F3), approved by the Collier County Board of
County Commissioners on Tuesday, March 10,2009.
Please forward a fullv executed oril!:inal to the Minutes and Records
Department for the Board's Records.
If you should have any questions, please call 252-8411.
Thank you.
Enclosure
16F3
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Florida Department of Agriculture and Consumer Services
Dlv,sion of Forestry
VOLUNTEER FIRE ASSISTANCE GRANT APPLICATION
.
C~"'"tfSlt[lROiISml
CO_~"'I$S!01JER
.__.____~_m____ FORM OF ORGf,N!LATION: 1~/ur,'c:pal,-Fire O,!',lrict NOIl.Profit, County)
LEGAL NAME Collier County Board of Cc[timissioners
ADDRESS PO '_--0 Ochope e Fire Control District
Box 70
_n iF COUNIY, LIST VFD'S BENEF;TING FROM GRANT
e,TY Evel."glades City
ZIP .--.-'..
STATE Florida 34139
COUNTY .- COUNTY it
Collier
EMPLOYER IDENTlFICAlION NUMBER (E1N)
rs-r;-r[7~T~T;-rs-1s""0
IS FIRE DEPARTMENT lOCATED IN AN INCORPORATED TOWN?
YES iii NO 0 IFYFS,NAMEOFTOWN Everglades City
POPULATION OF TOWN: rm~f6(i-
PROlECTEDAREA: EST POPUlATlON'1 4,iOo SIZE. (SQ. M/lESJfI, 166
NUMBER OF FIREFIGHTERS
PAID r DC
VOLUNTEERS
!J
/605
NO. OF INCIDENTS PAST YEAR WILDLAND FIRFI41
NO. OF FIREFIGHTERS CERTIFIED AS
WILDLAND FIREFfGHTE,q I r 17
OTHER
WILDLAND FIREFIGHTER f/ I
WHAT IS THE FIRE DEPARTMENT ISO RATING? r 6
IS FIRE DEPARTMENT NIMS COMPLIANT? YES ~ NO 0
CURRENT COOPERATIVE AGREEMENT WITH OOF? YES [3. NO 0
DISTANCE OF CLOSEST MUTUAL AID FIRE DEPARTMENTf':fT"'"
NAME OF F~RE DEPARTMENT: IE'.ist:.' niipl'esFi"ren bfst-
HAS APPLICANT RECEIVED GRANT FUNDS FROM ANY SOURCE IN
lHE PAST 12 MONTHS? YES ~ NO'-'
IF YES. WHERE? r lJi?~n~O~!:!~EO~f Fil:eAs.sLsta e
AMOUNT, S I 5220
LIST TOTAL FUNDS RECEIVED FROM OTHER TAXING AUTHORITIES
SUCH AS CITY, COUNTY, TAXING DISTRICTS (Past 12 Months)
AMOUNT' S I
i LIST OF FIREFIGHTING VEHICLES
I .- MAKEIYRMODEL PUMP CAPACITY /GP,\1/
I TYPE WATER CAPACITY (GAL.)
,Engine (2 ) Emergency One Comm 05 1000 1000
i Engine Emel-gency One Comm 98 1000 1000
-
Brush Ford/Elite 08 300 150
, .---
i - .-----
!-;:;"sTiMATE()GAANT FUNDING REQUEST LIST OF EQUIPMENT OR SUPPLIES TO PURCHASE WITH GRANT FUNDS:
-
FEDERAL S 5,250 NUMBER DESCRIPllON AMOUNT
I APPLICANT ~_.. -~ Outf~ttjng of Tr."lIcks --
S 5,250 2 6X6 S 10,500
"~....- ..
~~~TY _ S
.-
TOTAL $10,500
f-. .....
(Federal not more than ';,0% of lolal Applicant fit least 50% of .. ..
total in rnatchin;j funds.)
..-.. -
We understand that Ulis is a 50 percent maximull cost. share program (Cooperative Fores1ry Assistance Ac! of 1978, PL 95-313), and tllat funds on
deposit up to 50 percer,! of the actual pLlrch?se price of the items approved v,ilI be cOlllmilteo to our project. TO TI iE BEST OF MY KNQVVlEDGE AND
BELIEF, All DATA IN THIS APPLICATION ARE TRUE AND CORRECT THE GOVERNING BODY OF THE APPLICANT HAS DULY AUTHORIZED
THIS DOCUMENT
Donn~~iala
sgt7t::::;p'''e:'''~ 4-4-
DIICS.11484 REV,_3106
A TTE:ST: . Approved as to form & legal sufficiency
DWI.&:,. E.13ftOCK~.ierk k- t~~ _
~ '- Colleen Greene,
.__.___~..___._ I J_. .~_______._____~__ ,.._...._.,..,...._..._.__..,_._
Type Name of Author~Zlld Representative
Title
Chainnnn
Date Signed and Suo'l1illed
.3 lIe Ie/?
Telephone NUlrbe: (239) 695-4114
FAX (239 ) 695-.347_1
Emal
___L____._.___...
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(J.\IU.\ppl'u\":lI ,'\0. f)J-I8.0U-iO
:\oft':
'\SSI'R\~C~S u ~O~.('O~S ITlII 'II()~ PJ{Or.R'\'IS
Certain oft!J<;:s..: :Js~llrallc~':: mil) not be npplk:lblc If) your proj":":l or proglallL. If)ou have- questiolJs. pk,lSC cont:lC! the <1wr,rding ag..:ncy.
rllrlh.:r. ccrtall1 Federal a\\ardil1~ ngt'Il\:ies may rcquirt.' applirallls to C(:IIi1~ to ilddilion:ll assurances. If sneh is lhe (<lSC. YOll will be
Jl(ltified
I\s_lh~_dlll\ authorized relJn.'~cnlnli\c of till: J!lilll.!s!l)lJ~~!;il\ that the <IJ21!~.-
I. Has Ihe leg.1I ;lllthoril) to apply for Fedclalllssislance, dnd the
in~titlltinllal, Illmwgcrinl [lnd jill:mci;J] capabilily (im:ludin~ IImds
sllftidel1t to pay the nOI1"Federnl shart: uf proje<.:( (OS15) to ensure
prop<:r planning. 1ll:llIagclllent and completion of the project
described in this appli\'alioTl
2. Will gin.' the awarding agency, the Comptroller General of tile
United Statcs, and if appropriate, Ihe Slille, through ally .mlhorized
rcpr..:sentfltiye, Iln:ess to alld tht' right (0 c\amine 011 rCl'ord.;:, books.
pflper:>. or documents related to lht.:' .l.\\ard; and will establish a proper
accollnting sy:-tcm in accllrdulll.:e wilh gcncrally accep:cd accounting
slandards or agenc)' directives.
3. Will establish safeguards to prohibit employees from Ilsing
their positions for a purpose Ih:lt (tlmlilutes or pn.:sents the
llppcanmce of personal or org:.lIli/,-ltionnl cont1ict of interest. or
p.:rson3l guin.
4. Will initiate and complete the work within the applicahle time
Irmnt' lIller rClcipt ofapproY<l1 of the 3wardil1g agency
5. Will comply with tllC Inlcrgo\'colllICnlalPer:>0I1l1c1 Act of 1970
(..\2 U.S.c. *~ 4728-47(3) rdating to pres~:ribcd standards for Illt'ril
systems for progmJlls fuodcd umkr OIK of the nineteen statutes or
ll.:gulaliolls specified in Appendi\ A of OPi\l's St:lIldnrds for:J t>1crit
Sy~tem ()fPerSOllllel t\dministr,ltioll () C.F_R. 900, Suhpart F).
6. Will compl) \\itb :111 Federal stntutes reLlting to
nOlldiscrimination l'hest' incllldc bul arc !lot limited to: (a)Title VI
of Ihe Ci\'il Rights Act of l%.l (P.L. 88-352) which pmhibits
discriminnlioll on the basis of JiKl', color or 11<\tion..1 origin; (h) Tille
IX oftht' Education Amendments of 1912, os :lIl1end~d (20 ll.S.C. ~~
1681- J(18J. alld 1635~ 1686). \\ hkh prohihils dist:dmillatioll Ull the
b,l~is of sex: (c) Seclion 504 l,f the R...Ilahilitatioll I\Ct of 1973, as
JJl1ended (29 U.S.c. ~ 794), which prohibits discrilllinotion un the
basis ,If handicaps: (d) tll:: Agc niscrinlinalion Act of 1975. as
:lJ1lcntlcd (-12 USe. ~~ 6101-6107), \\11ich prohibits disniminalitlll
Olllh<;, ha;;is ofllge;
(c) the Drug AhLl~e OfJicC" ~lnd Tr~'<l\J1H:Jlt Ad or 1972 (P.L. 92-
15:5). ns aJll('J!lkd, rdating to n(Jndi~crill1inntion on the basis of dnrg
nb\l~e: (I) the COlllprc!lt'l1,;i\e Alcohol Abllse illld Alcoholi51ll
Pre\entioll, TI'<;':lll11enl nnd Rehahilit(ltion Act of !lJ70 lP.L. 91-(16),
:l~ mnendcd. relating to l1Ol1di~nil11iJlalion OJ! th<.' b;lsis of ,lkuhol
~18\l$e or :I1c(lh()li~1\]; (g) ~~ :523 ;lI1d 527 (lfthl: Public Heallh So;:nicc
..\('101' 1912 (-t1U.s.c. 290.dd-J nnd 290 ee-3). uS 3mcndetl. rdating
hI cOlltidentialit~ ofak,lhol ;llld dlUg. abu.';c patient record~; (ill litk
VIII or the ('i\ll Rigllts Ad of I9/iR (42 U.S.C. ~ 3601 et ~cq.). (I;;
a11lC"r~ded. r~I:l!ing 10 tlontliscrimin:Jlion ill the salt'. renti'll or tinandl1!!
ot'lwusing: (() aJ1Y uther t\\1l1lli"crimiu:ltiuJl provisions in thc .."pecille
stltute(s) umkr \\hich applil.:;:1tion for rt'dcml a~,>istancc is heing
made: and (il the rcqllircl1l,;nt~ of :my other nondiscrill1inatioJJ
~1:ll11te{s) \\hich l11ay <11'1'1) 10 lile application
7 Will LOlllply. {'r has alTendy complied. with the requirement:,; of
rillts J! and III of the Pillion\} R<;,lnca!ioll /\ssiSI<lm:c and Re..l
Property Aequi:-:itioll Policies Act pf 1970 (P.L. %1-()46) \\!lich
plOyide tix fair and equiwbk treatment of pnsolls displaced or
WllDS(' property is acquired ns a result of Federal or fcderally assisled
progrnrns. rhese rC1]lliretllents apply to al] inten::s.ts in real properl)
aCi.juircd for prqjed purpnses tegard\c:;s uf Federal pOlrlicipalioll in
p\trdlaS('~.
8. \\'ill compl) \,ith the pl'O\'isions uflhe Health Ad (5 U.S.C. ~~
1501-1508 and 732-1-7328) which limit the polilical activities of
employees who:;e principal employmellt ndi\itics are funded in
whole or in part with Federal funds.
9. \\'ill campi), as applicable. \\ilh the provisions of Ihe Davis.-
Hnco!l Ad (.to U.S.c. ~* 276a to 276a-7), the Copeland Act (40
U.S.c. ~ 276c :IllJ 18 use. 9~ 874). and thc Contrad Work Hours
Hud Safet) Slandards Ad (..\0 U.S.c. ~* 327-333). regarding lnbor
standards fill fl'l_ltrnll) assisted construction subagreell1enN.
10. Will comply, if applicable. \\itll Ilood illS11nmCC purdmse
feqllin:lllenls of Seclion 102 (n) ofth~ Flood Disastl'r Protection Act
ur 197.l (I'.L. 9.1-2.)4) which rt:quir,,"s recipients ill a speciJI nond
hil/,lHl :lIC~IIO palticipatc:: !lIthe
progWJl1 ,l!ld to purch.lse !looa inHlrjllCe if the tot..1\.'0:;.1 of !nsUTilbk
cunsll11\.!ioll and .1'.'quisltion of S 1 0,000 OT more.
II Will eompl) with environmental standards which lllay be
pr~'5cribcd pllfSllant 10 the following: (a) institution of endronmcJllal
11U<llily co111rol meil5lm:s UJldcr the N,llional Environlllcntal Polky
Ad of 1909 W.L. 91-1(0) and F:\eclllin~ Order (EO) 115H; (11)
notitic:ltion of \'1olming: facilities pur~llanl to EO 11738; (c)
protection uf wet1311ds pursuant 10 EO 11990; (d) eyaili:ltio!l or Huod
h;l/ards in floodplains in accord:lnc~ with EO 11988; (e) aSSllrtlnCC of
prnjecl consbtency wilh the Ilppro\ed State m:lnag\.'lllt'llt progmm
tkn~lor('d under the C03stal Zone M:111ngcmenl Act of 1972 (16
CSt:. ~s 1451 <;,1 ~\'q.): (1) conformity of f'<;'th:r:\1 actions to Slate
(Clear Air) Implemcntation PhHIS lInd<;'r Section 176(c) of the Ckar
Air ,\ct of 1955, aj illl1Cl\tkd (42 U.S.C. ~ 7..\01 et seq.); (f?)
prok(.'tiOlI o/' \llllkrgr01lr1d ~()llfC;;:; of drinking waler ullder the Safe
Drinking Water Att of 1974, :1S alllcnd~d, (P.L. 93.523); and (Il)
pWketiotl of Cl1tlangcrL'd species under the Endangcled Species Act
of 1')73. ,1s;1I1lctllbl. (P.L. 93-205).
12 \Vill \.'omply \\'ith the \Vild and S~'ellic Rivers Act of 1968 (16
use. ~~ 1271 (.t seq.) related /(l protecling component:: or potential
compollcnb Ill' the national \\ ild and ~(~nio.: riyers sysl~m.
V, 8.5 (02105)
Authorized for Local Reproduction
~t;mdJ.rd form ....2.W i')-Oj)pr~~crit>ed by o~m CirculJr kiO.!
13. \\'ill :tssi~t the J1\\:lI'Jing agl'TlC)' in fl~';\lrillg c\llllpli<lnc~ with
Scction 106 of the Nillion:ll Hbtoric Pr~ser\:\lion Act of 19M, ,h
,lI11emkd (16 USe. .nO), EO 115!)] (idcnlitlcalioll and protectwfl of
hi...tnric properties). <lnd tlK' Archcologkill :1110 Hi'.IIHic Pn.'sennlioJl
Act of 1974 (1611.S.C 469.1-1 d .'cq )
14. Will comp!) \\ith I'.L ()~\.3.1R regarding the protection of
hnlnall subjects ill\"oln.'d ill re~~arch. dt'\d('pl11l:l1l. ami r~l"tcd
activities supported by this l1\\:lrd qf'<)<;<;isti\lKC.
15, \Vill comply with tlte L1boratory Animal Wdfare Act of 1966
(P.t. 8<)-5.14, llS illl~Cl1ded. 7 USe. 2131 ct seq,) pl.'d~linjng to the
c<lre. handling, i\nd lrc:l!mcnt of\\arm blOlH.led animals held for
AUTHORIZED CER/YIN~ OFFICIAL
~~4.
APPLICANT ORGANIZATION
Collier County Board of Commissioners
'. ;--'
,
',f':
\~~::t~ C~rk k
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Il:'~alf\::h. IC<lchin)!. or olhn ncti\il:t.''' ~\Irrortcd I)) this il\\Jrd of
aS5btamt.
16. \Viii comply with the ll:'ad-Hi1s.:d Paint Poisoning Prevention
Act H2 use ~~ ,lUll c1 scq.) which prlJhibib the I:S~' uflead based
p;1in( in c()I1~lrlldi(11l or re1,:lhilitatioll of !I..'sideth:e slrm:turcs.
17. \Vill cause 10 be perlimllco the rcq\lireJ linancial :lllU
compli;1I1":( alldit) in accordallce with the Single Audit Aet of 1984.
18. Will comply \\ilb nil ilpplicablt: requirements or nil other
redeLlI lil\'1$ c\"ct;IJti\'l' mdt'rs, regulntiollS :lntl policies gOH:rning
this program
TITLE
Chairman, Soard of County Commissioners
DATE . I
SUBMITTED 3/ tD/ C 7
\',11.6(02/05)
Authorized for Local Reproduction)
Sl<llldard Foml '12.111 {9-03
['rl'scril:,~.d b\' 0:--'18 C'rc\llar A-I 02
Approved as to form & legal sufficiency
Q~~
CoU"'n Greene,
Assistant County Attorney
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FOlll1AD-J047u :);~i
US, DEPAR1AIHNT OF A GRlCULTURE
C'ertification Regarding Debarment, Suspension. and Other
Responsibility lV/allelS - Primal)' Covered Ji-ansaclions
This certification is required by the regulations implementing Executive Order 125-~9, De:,nrmelll and Suspension,
7 CFR Part 3017, Section 30l7.S I 0, Participants' responsibilities. The regulations \vere IHlblished ns Part IV of the
January 30, 1984, fl'deral ReJ!/slcr(pagcs 4722A733), Copies of the regulations may be obtained by contacting the
Department of Agriculture ngcncy offering the proposed covefeo transaction
(Before completing arti(jet1tiofJ. read instrucriof15 on reFerse)
(1) The prospecli\'c primnry participant certifies to the best of its knowledge and belieC that it :md its principals:
(n) arc not presently debarred, suspended, proposed for deb:ument, declared ineligible, or voluntarily
excluded from covered transactions by <Iny Federal depflrtment or agency;
(b) have not within tl three~year period preceding this proposal been convicted of or had a civil judgment
rendered ngainst them for commission offbud or a criminal offense in connection wilh obtflining,
attempting to obtain, or pcrfimning a public (Federal, Slate or local) Irans,H:tion or contractl1llder a
public transaction; violation of Federal or State antitnlst stntutcs or commission ofcmbcl.llement, theft,
forgery, bribery, falsification or destruction of records, making false statements, or reL'eiyjllg ~tolen
property:
(c) arc nol presently indicted for or otherwise criminnlly or civilly charged by n governmental enlity
(Federal, State or LocHI) wilh cOlTImis$ion of any orlhe oflense5 enumerated ill palagraph (I )(b) of this
ctllification; ami
(d) have 1I0! \vithin tI three-year period preceding this application/proposal had one or more public
transactiolls (Federal. Stale or Local) terminated for cause or default,
(2) Where tht: prospective primary parliL'jpallt is llllable to cenii)' to any of the statements ill this certificatioll,
such pruspective pnrticipant shall att<Jch all explanallon to this proposal.
ORGANIlAJWX ,VAlfF PRiA Il'rlRD NUI/BER OR PROJECT N:UfF:
Co11icr County Boat-d of Commissioners Ochopee Fire Control District
N,L\/l::A:\'V TIlL!:' OFAti/fIORi/ED REI'RI::JEN[:ITll'l,
Donna Fiala, Chai.nllan
SIQ,I.\[URE
,Utili
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'l9Ritur.' 011 t.
.~i'r()ved as to form & legal sufficiency
~p~
. Colle n Greene,
Assistant County Attorney
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FormAL> ]fJ47 {i/})j (kL\LJ':5G
fiV'iTlWCT/O!VS FOR CERTlFICA TfCW
J. By :;ignillg <lntl submitting this fOllll, the prospective prilllllry IJlHtlcipallt is providing the ccrtilicatioll set out
on the I'c\"ersc side ill accordance with these instrllCtlOlls.
2. The inilbjli~y of a person to provide the ccrtiJkation required below will not necessarily resull in denial of
Pilrticipatioll in this covered transaction. The prospective pnrticipnllt shnll submit <Ill cxpl:Jnation of why it
canllol provide the cenification set uut Oll this l()[lll. The cerlifiL'alioll or c,xphlJlation will be considered in
C011ncction with the department or agcrH:Y's detennmatiull whether to enler illto this tr.111SaClion. Ho\','c\'cr.
fuilllle iJflhe prospective primary participant to tilf11i"h a certitication or an explanation shall disqualifY such
persoll from pimicipatioll in Ihis transactio!l.
J. The certification in this clause is a materi"j represcnt.ltioa of flet upon which reliance \vas pl<lccd when the
department or ngcncy determined to enler into this tr;msactioll. Ifit is later determined that the prospective
primary pnrticipant knowingly rendered an erroneOllS certificalion, in nddition to other remedies available t()
the Federal Government, the department or agency may terminate lhis trunsaction for cause or def.1ult.
4. The prospective primary participant shall provide immediate written notice to tbe department or agency to
whom this proposal is submitted ifat any time the prospective primary participanllcarns that its certification
\HIS errOlleOllS when submitted or has become erroneol1s by rea.son of changed circumstances.
5. The terms "covered tJ'ilH::>actioll,.' "debarred," "susptndetl," "ineligible," "lower lier (.:owred transaction,"
"pnrticip.lll1." "person," "primary covered tlal1sat.:lioll," "principal," "proposal," <lnrl "voluntarily excluded," liS
u:;ed in this clause, have the meanings set out ill tbe DdllliliuJls and Coverage sectIons orlhe rules
implementing Executive Order [2549. You lllilY nmtact the department or agency tn which this proposnl is
being sllblllitt~d for assistance in obt<lilling a n1py ot'lhose regulaliolls.
6. The prospective prnnary parlicip:mt agrees by sublllitltng tllis lorm that, ~hould the propos(.'d covered
trllnsaction be cnicred into, it shall not knowingly enter intn nny lower tier covcred transaction with a persoll
\\ho is debarred. sllspended, declared indigible, or voluntarily excluded from panicipation in this covered
transaction, unless authorized by the departlllcllt or dgClICY entering into this trans,lclion,
7. The prospel"liw primary pllrticipant further agrees by submitting this form that it will include this clause
tilled "Certification Regarding Debarment. S\lspcn:-;ion, Ineligibilityand Volulltary Ext'lllSioll ~ Lower Tier
Covered Transactions," provided by the dep<lrtmcnt or agency entering into this covered transaction, without
modification, in alllo\\'cr ticr covered transactions and in all solicitations for lower tier covered transactions.
8. A participant in a covered trallsaction may rely upon a cerlification o1'a prospecti\c participant in a lower tier
co\'ered transactionlhat it is 1101 debarred, sllsp;;;,nded, ineligible, or voluntarily excluded tTollllhc covered
transaction, unless it knows that the certilication is erroneous. A partit.:ipant Illay decide the method and
heqltcnc)' by which it determines the eligibility ofils pnnclpals Eal'h participant may, but is !lot required to,
check the Nonprocur~lIlent List.
9. ]\nlhillg t.:lmtaincd in the foregoing shall he construed to rCCJuire estnblishnwllt of a sy:;tem of rccord~ in order
to render in good hlith thL' certitication required by tillS c1nu~e. The knowledge and inlorml1tioll orn
pilltit.:ipilllt is not required III exrced that which IS normally possessed by a prudelll person in the ordinary
C(;\lISC ofbusinl.ss tkalings.
10. r::xcCpl t(Jr transacliws <luthorized under paragraph () of these instructions, if a p<lrticipant ill a covered
IrallSJClion knowingly enters into a lower tier cowred llansaction with:l person who is suspended, debarred,
ineligible, or voluntarily excluded from p;\rticipalioll in this tral\saclioll, in addition to olher remedies
:l'..ailable to the Federal (iovernmcllt, the dCflanmcll1 or agency may terminate this transat.:tion for l'iHlse or
ddiHIIt.
2