Agenda 05/25/2010 Item #16F 4Agenda Item No. 16F4
May 25, 2010
Page 1 of 21
EXECUTIVE SUMMARY
Recommendation to approve the submittal of a Federal Emergency Management
Agency Assistance to Firefighters Grant in the amount of $16,000 for the purchase of
fitness equipment for the Isles of Capri Fire Rescue District and authorize on-line
submittal of the application.
OBJECTIVE: To receive approval to submit an application for a Federal Emergency
Management Agency Assistance to Firefighters Grant in the amount of$16,000.
CONSIDERATIONS: The Isles of Capri Fire Rescue District has received this type of
grant from the Federal Emergency Management Agency (FEMA) in past years. At this
time, the district is in need of gym equipment to institute our formal fitness and injury
prevention program. This program will enable the department to comply with NFP A
(National Fire Protection Association) 1583: Standard on Health-Related Fitness
Programs for Fire Department Members and NFPA 1500: Standard on Fire Department
Occupational Safety and Health Program.
FISCAL IMPACT: The total cost of the fitness equipment is $16,000. As this is a 95/5
matching grant, FEMA will pay 95% of the costs at $15,200, leaving the Isles of Capri Fire
Rescue District to provide $800 from the Isles of Capri Fire Rescue Fund (144) Reserves.
If awarded, a subsequent item will be brought before the Board to accept the grant and
authorize the necessary budget amendments.
LEGAL CONSIDERATIONS: This item has been reviewed by the County Attorney's
Office and is legally sufficient for Board Action. - CMG
GROWTH MANAGEMENT IMPACT: There is no Growth Management Impact
resulting from this action.
RECOMMENDATION: To approve the submittal of a Federal Emergency Management
Agency Assistance to Firefighters Grant application in the amount of $16,000 for the
purchase of fitness equipment and authorize the on-line submittal of the application.
PREPARED BY: Emilio Rodriguez, Fire Chief, Isles of Capri Fire Rescue District
Item Number:
Item Summary:
Meeting Date:
Agenda Item No. 16F4
May 25, 2010
Page 2 of 21
COLLIER COUNTY
BOARD OF COUNTY COMMISSIONERS
16F4
Recommendation to approve the submittal of a Federal Emergency Management Agency
Assistance to Firefighters Grant in the amount of $16,000 for the purchase of fitness
equipment for the Isles of Capri Fire Rescue District and authorize on-line submittal of the
application.
5/25/20109:00:00 AM
Fire Chief
Date
Prepared By
Rod Rodriguez
Isle of Capri Fire Control District
5/11/20109:26:33 AM
Date
Approved By
Marlene J, Foard
Administrative Services
Division
Grant Development & Mgmt Coordinator
Administrative Services Division
5/11/20101:01 PM
Approved By
Fire Chief
Date
Rod Rodriguez
Isle of Capri Fire Control District
5/11/20102:43 PM
Date
Approved By
Dan E. Summers
Bureau of Emergency
Services and Emergency
Management
Director of Emergency Services
Bureau of Emergency Services and
Emergency Management
5/12/2010 11 :00 AM
Date
Approved By
Jeff Klatzkow
County Attorney .
5/13/20104:39 PM
OMS Coordinator
Date
Approved By
County Manager's Office
Office of Management & Budget
5/14/20102:58 PM
Approved By
Randy Greenwald
Office of Management &
Budget
Management/Budget Analyst
Date
Office of Management & Budget
5/14/20105:11 PM
Leo E. Ochs, Jr.
Date
Approved By
County Managers Office
County Manager
County Managers Office
5/15/20104:53 PM
Preparer Information
nRAFT
Page 1 of I
Agenda IterrrNo. 16F4
May 25,2010
Page 3 of 21
Overview
.Did you attend one of the workshops conducted by DHS's regional fire program specialist?
No, I have not attended workshop
'Are you a member, or are you currently involved in the management, of the fire department
or non-affiliated EMS organization applying for this grant with this application?
Yes, I am a member/officer of this applicant
.
If you are a grant writer or otherwise not affiliated with this applicant, please complete the information below.
Fields marked with an . are required.
If you are a member/officer of this applicant, please do not complete the information requested below,
Preparer Information
. Preparer's Name
. Address 1
Address 2
. City
. State
. Zip
't
L..........._.II____~:__~ .f'"~~~ ~~...rc................r:_"'r:.............+I_l_';_"""'..."....t/;"'...../_h....A"'){)l (\1<:>T'\.....l~.....':lti"n/npu.T r."pn'l~u.r;
~171?1\1O
Contact Infonnation
Contact Information
Agenda IkWlf.Jb'lrU4
May 25, 2010
Page 4 of 21
. Title
Prefix
. First Name
Middle Initial
. Last Name
. Business Phone
.Home Phone
Mobile Phone/Pager
Fax
'Email
. Title
Prefix
. First Name
Middle Initial
. Last Name
. Business Phone
'Home Phone
Mobile Phone/Pager
Fax
'Email
Alternate Contact Information Number 1
Fire Chief
N/A
Emilio
11Il.I.Y~."""
239-394.8770 Ex!.
239-642-9588 Ex!.
239-253-9710
239-394-5B62
rod rodriguez@colliergov.net
Alternate Contact Information Number 2
Admin. Assistant
N/A
Barbara
Shea
239-394-B770 Ex!.
239-597-2927 Ex!.
239-394-5B62
Bar..r_ _~v.net
..~.lL
tuU~ _
httnC'./lpcoP"""lropC' -rpm~ n-........,/t:;p.........P;...~r:-....".....t/f';...C>n-.....,.....tJ;~..../.f"....A'){)l ()/Q,.........l;.....,...;"'..../"'ro......t"'".+ ;....f"..... ;.......... .c;;:/7/')f\1 f)
Applicant Information
Applicant Information
Agenda lfe'fflf-Jl ~t~4
May 25,2010
Page 5 of 21
. Organization Name
. Type of Applicant
. Type of Jurisdiction Served
If other, please enter the type of Jurisdiction
. Emplover Identification Number
. What is your organization's DUNS Number?
Headquarters or Main Station Physical Address
. Physical Address 1
Physical Address 2
. City
. State
. Zip
Mailing Address
. Mailing Address 1
Mailing Address 2
, City
, State
'Zip
Isles of Capri Fire Rescue
Fire Department/Fire District
Other (Explain)
Dependent fire district
138275594 (call 1-866-705-5711 to get a DUNS
number)
175 Capri Blvd
Naples
Florida
34113 - 8678
h!ep.dhf_lf:J.~
175 Capri Blvd
Naples
Florida
34113 - 8678
";j("ed !ii"T' for ?1P~.4?
Account Information
, Type of bank account _ j
Bank routing number - 9 d"lll number on the botton"
left hand corner of your check
'Your account number .-.
Additional Information
. For this fiscal year (Federal) is your organlzalion
receiving Federal funding from any other grant No
program that may duplicate the purpose and/or scope
of this grant request?
If awarded the AFG grant, will your organization
expend more than $500.000 in Federal funds during No
your organization's fiscal year In which this AFG grant
was awarded?
Is the applicant deJirlOuent on an\! !="~der3: debt? No
If you answered yes to any of the additional questions
above, please provide an explanation in the space
prOVided below:
'h++..-....../lo....o.....,;,,"".... ('co.,.......... n^.'/L'=......." r;;....L~r;.............i I-f";...".............t /;........../f':...CI.')(\ 1 {)1"..........l;..........,.;^.../n.........l;"........+ ;.....f'''' ;
,,/"7/')(\1(\
Fire Department Characteristics (Part I)
Deparbnent Characteristics (Part I)
Agenda Ife,*~b~~~4
May 25, 2010
Page 6 of 21
No
. How many active firefighters does your department have 19
who perform firefighting duties?
How many ALS level trained members do you have in your 0
department/organization?
. How many stations are operated by your organization?
. Do you currently report to the National Fire Incident
Reporting System (NFIRS)?
If you answered yes above, please enter your FDiN/cDIQ 64041
~ What services does your organization provide?
Structural Fire Suppression Medical First Response
Wildland Fire Suppression Basic LITe Support
Airport Rescue Firefighting (ARFF) Advanced Life Support
Occasional Fire Prevention Program
. Are you a member of a Federal Fire Department or
contracted by the Federal government and solely
responsible for suppression of fires on Federal property?
. What kind of organization do you represent?
If you answered combination, above, what is the
percentage of career members in your organization?
If you answered volunteer or combination or paid on-call,
how many of your volunteer Firefighters are paid members
from another career department?
. What type of community does your organization serve?
. What is the square mileage of your first-due response
area?
. What percentage of your response area is protected by
hydrants?
, In what county/parish is your organization physically
located? If you have more than one station, in what
county/parish is your main station located?
Does your organization protect critical infrastructure of the No
state?
. How much of your jurisdiction's land use is for agriculture,
wild land, open space, or undeveloped properties?
What percentage of your jurisdiction's land use is for
commercial, industrial, or institutional purposes?
. What percentage of your jurisdiction's land is used for
residential purposes?
. How many occupied structures (commercial. industrial,
residential, or institutional) in your jurisdiction are more than 10
four stories tall?
. What is the permanent resident population of your
Primary/First-Due Response Area or iurisdiction served?
Combination .
63%
o
Suburban
20
100%
Collier
5%
10%
85%
3000
Yes
Hazmat Operational Level
Rescue Operational Level
'I-..+f...."./IL't.<'.".......;....<1C' +'.a~<,> ....^...tr:''''n-\.....:r::....",n_.......+/.f':..''''OYP....''''+-/:........../.f':....''''.,1I1 nl"".........I:.......+;,-"..../ro-a..... .....noo.... ;"....0...,;
.l;;/"7/'}{\ln
Fire Department Characteristics (Part II)
Fire Department Characteristics (Part II)
Agenda IFeWflf.J!o4t4
May 25,2010
Page 7 of 21
. What is the total number of fire-related civilian fatalities in your
jurisdiction over the last three years?
. What is the total number of fire-related civilian injuries in your
jurisdiction over the last three years?
. What is the total number of line of duty member fatalities in your
jurisdiction over the last three years?
. What is the total number of line of duty member injuries in your
jurisdiction over the last three years?
. Over the last three years, what was your organization's average
operating budget?
. What percentage of your TOTAL budget is dedicated to
personnel costs (salary, overtime and fringe benefits)?
. What percentage of your annual operating budget is derived from:
Enter numbers only. percentages must sum up to 100%
Taxes?
EMS Bllllnq7
Grants?
Donations?
Fund drives?
Fee for Service?
2009
2008
2007
o
o
o
o
o
o
o
o
o
o
o
1245426
82 %
100%
0%
0%
0%
0%
0%
Other? 0 %
If you entered a value into Other field (other than 0). please
explain
. How many vehicles does your organization have in each of the types or class of vehicle listed below? You
must include vehicles that are leased or on long-term loan as well as any vehicles that have been
ordered or otherwise currently under contract for purchase or lease by your organization but not yet in
your possession. (Enter numbers only and enter 0 if you :)0 not havo::! any of the vehicles belov.r)
Type or Class of Vehicle
Engines or Pumpers (pumping capacity of 750 gpm or greater and
water capacity of 300 gallons or more):
Pumper, PumperfTanker. Rescue/Pumper, Foam Pumper CAFS Pumper, Quint
(Aerial deVice of less than 76 feet), Type I or Type II Engine Urban lntetiace
Tankers (pumping capacity of less than 750 gallons per minute
(gpm) and water capacity of 1,000 gallons or more)
Tanker, Tender. TankerfTender
Aerial Apparatus'
Aerial Ladder Truck, Telescoping, Articuiating Ladder Towers Platform, Tiller
Ladder Truck. Quint (Aerial device of 76 feet or greater)
Brush/QUick attack (pumping capacity of less than 750 gpm and
water carrying capacity of at least 300 gallons)'
Brush Truck. Patrol Unit (Pick up wi Skid Unit), Quick Attack Unit Mini-Pumper
Type II! Engine, Type IV Engine, Type V Engine, Type VI Engine Type VI! Engine
Total Number of
Total Number
Riding Positions
2
8
o
o
o
o
2
h+f....". //"'''<>0''''';'''<>0''' +<>o~.." ....,."...,Jl:'<>o...."" r;'~..."'r:....."....+I-h..."'......."....1- 1;,......./?':...o'1() 1 "1.."..........1;"''''...;"..../"...,... ",h"... ; "....'J... ,~
,/71'1[\1[\
Fire Department Characteristics (Part II)
Page 2 of2
Agenda Itertr No. 161"4
May 25,2010
Page 8 of 21
Rescue Vehicles:
Rescue Squad, Rescue (Light, Medium, Heavy), Technical Rescue Vehicle.
Hazardous Materials Unit
o
o
Ambulances for transport, emergency Dr scheduled
Other:
EMS Chase Vehicle, Air/Light Unit, Rehab Units, Bomb Unit, Technical Support
(Command, Operational Support/Supply), Hose Tender, Salvage Truck, ARFF
(Aircraft Rescue Firefighting), CommandlMobile Communications Vehicle, Other
Vehicle
o
o
3
4
1-.++-...... f/A....O'...~';....A.... f"o.......n ro-"".., rr:;""'........" J;;...""f':..............-/f1...""n-r.u...t/;<<....f.(.';...o'101 n/.~..........l;/,...+;^'t'\/^...n ....1-........ ;........')..,;
"l7nnl{)
Fire Department Call Volume
Department Call Volume
Pagel of 1
Agenda Itertr No. 16F4
May 25, 2010
Page 9 of 21
2009
2008
2007
. How many responses per year by category? (Enter whole numbers onrY',lf you have no calls for any of the categories, enter 0)
Working Structural Fires
False Alarms/Good Intent Calls
Vehicle Fires
Vegetation Fires
EMS-BLS Response Calls
EMS-ALS Response Calls
EMS-BLS Scheduled Transports
EMS-ALS Scheduled Transports
Vehicle Accidents w/o
Extrication
Vehicle Extrications
Other Rescue
Hazardous Condition/Materials
Calls
Service Calls
Other Calls and Incidents
Total
What is the total acreage of all
vegetation fires?
In a particular year, how many
times does your organization
receive mutual/automatic aid?
In a particular year, how many
times does your organization
provide mutual/automatic aid?
(Please indicate the number of
times your department provides
or receives mutual aid. Do not
include first-due responses
claimed above.)
3
42
1
8
146
o
o
o
19
4
28
1
1
95
o
o
o
20
3
9
3
2
43
1
3
104
o
o
o
16
o
6
o
4
5
10
35
275
5
9
27
200
10
19
207
5
47
32
33
388
418
513
1...++........./ !",......,....-.,;,.."".... +'"""........... n-""~,!1:'Q.""""'" 'C';...""r.......,........../-f:...""o..."...<t-';......./+::...""'1A1 f\!....,........1;,.......i-:.......1...a.e>.................."" :..........h ,;
,/'7nlllfl
Request Information
Agenda ll'em'fJl9t~4
May 25, 2010
Page 10 of21
Request Information
. 1. Select a program for which you are applying. If you are interested in applying under both Vehicle Acquisition
and Operations and Safety, and/or regional application you will need to submit separate applications.
Program Name
Operations and Safety
. 2. Will this grant benefit more than one organization?
Yes
If you answered Yes to Question 2 above, please explain.
Collier
. 3. Enter Grant-writing fee associated with the preparation of this request. Enter 0 if there is no fee.
$0
httnc;:. / /pc;:.pn,;l'p<;: fpm~ ar'IV/Fpm~ Virpr'f1"tlnt/firp(Jr~ntJi ~n/f1rp ')01 O/!:Innl i(>~tif'\n/rpnllP(:!tApt!=li I~ 11'
,/7/')(11(1
Fire Operations and Firefighter Safety Request Details
Page 1 of 1
Agenda Itertf No. 16F4
May 25, 2010
Page 11 of21
Request Details
The activities for program Operations and Safety are listed in the table below.
Activity Number of Entries Total Cost
Equipment 0 $0
Modify Facilities 0 $0
Personal Protective Equipment 0 $0
Training 0 $0
Wellness and Fitness Programs 4 $ 16,000
Additional Funding Action
View Details
$ 0 View Additional Fundinq
$ 0 View Details
View Details
$ 0 View Additional Fundinq
$ 0 View Details
$ 0 View Details
Grant-writing fee associated with the preparation of this request.
$0
)..,ttnC'. / !,a.(.'P""";.....A(.' -f,o,Tl"'l-::t rrn.'llm p,M'\Q ~,T'Ponr':\nt/f1rpoTQnt/lC'T"I/fTrp'){) 1 ()/gTn~l;.....<::IItir\nlrp{1llpct,1pto::li 1~/~
<;17/")()] ()
Budget
Agenda Ife~Wf~~oM4
May 25,2010
Page 12 of 21
Budget
Budqet Obiect Class
a. Personnel
b. Fringe Benefits
c. Travel
$0
$0
$0
d. Equipment
$ 16,000
$0
e. Supplies
f. Contractual
$0
g. Construction
$0
h. Other
$0
i. Indirect Charges
Federal and Applicant Share
Federal Share
Applicant Share
Federal Rate Sharing (%)
"Non-Federal Resources (The combined Non,-FeOeral ReSDuroes must equal tf1ff A.pplicant StWfe of $ 800)
$0
$ 15,200
$ 800
95/5
a. Applicant
b. State
c. Local
$ 800
$0
$0
$0
d. Other Sources
If you entered a value in Other Sources other than zero (0), include your explanation below, You can use this
space to provide information on the project, cost share match, or if you have an indirect cost agreement with a
federal agency.
Total Budget
$ 16,000
httnC'.//pcp...'nr-p(;! -f"",-rn-::. n-n"fl:;'p't'nQ:):;';~.,.gntlfi?,pcrr'.:lont/1C',..../-f1.,.p.,)fl1 O!gnnl,....gtlnnlhllr1rTpt tn+';lll i"......
<;/7 /')fl1 (\
Narrative Statement
Agenda ft:rf11<~of6'h
May 25, 2010
Page 13 of 21
Narrative Statement
Project Description
. Please indicate which of these Target Capabilities your request outlined in this application will satisfy. Check all
that apply:
Responder Safety and Health
. Please provide your narrative statement in the space provided below. Include in your narrative, details
regarding (1) your project's description and budget (2) your organization's financial need, (3) the benefit to be
derived from the cost of your project, and (4) how the activities requested in your application will help your
organization's daily operations and how this grant will protect life and property.
Our system has determined that you are a Rural community while you have entered that you are a Suburban
community. In addition to your narrative statement. please explain why you feel that you are a Suburban
community.
Program discription and budget:
Isles of Capri Fire Rescue (ICFD) is requesting a grant in the amount of $16,000.00 to fund the purchase of gym
equipment for a health and physical fitness program. This program will enable ICFD to meet NFPA Standards
1583, Health-Related Fitness Programs for Fire Department Members and NFPA 1500, Health and Fitness.
ICFD's Health and Fitness program will be overseen by a formal fitness and injury prevention program
superviser assigned by ICFD's Chief. This individual will insure that ICFD fire suppression staff have access to
up to date materials regarding jOb related health and injury hazards as well as advances in fitness programs
which will enable suppression staff to maximize their benefit while utilizing ICFD fitness/gym equipment as well
as when performing duties out in the field. The formal fitness and injury prevention program superviser will work
hand in hand with a designated representative from Life Scan, an organization currently performing NFPA 1582
annual physical evaluations and making individual health and fitness recommendations for ICFD staff. Our
overall goal will be to maintain levels of fitness set forth by Life Scan in conjunction with our formal fitness and
injury prevention program officer that will reflect each individual's assigned job functions and day to day activities
in an effort to reduce the probability and severity of occupational injuries and illnesses.
Organization's Financial Need:
Isles of Capri Fire Rescue is funded through ad-valorem taxes for fire suppression activities and basic
emergency medical activities. Personnel costs currently account for 82% of our total operating budget with the
remainder going towards reserves and operating expenses. This enables ICFD to maintain adequate reserves
required by State Statue for contingencies. Current economic uncertainty and our limited budget do not allow for
the purchase of physical fitness equipment which is vital to establishing our Formal fitness and injury prevention
program.
Benefit to be derived from the Cost of Project:
Isles of Capri Fire Rescue is requesting funds to purchase a complete set of gym equipment which will include
the following: a treadmill, elliptical machine, functional strength trainer, Smith machine, two benches, a dumbbell
set (5-801b.) with rack, and a set of elliptic free weights. This equipment is paramount to the success of ICFD's
formal fitness and injury prevention program, since it will enable fire suppression staff to remain in optimum
health and fitness. For a onetime expenditure of $16,000.00 our retum on investment will manifest itself as a
reduction in the probability and severity of injuries during training and while on emergency calls,
Activities benefit to Organization's Daily Operations and how this grant will Protect Life and Property:
Isles of Capri Fire Rescue's Formal fitness and injury prevention program will benefit daily operations in several
ways. By implementing this Formal fitness and injury prevention program ICFD will become current with
standards set forth through NFPA 1500 and 1583. This program will also enable suppression personnel to
maintain a level of formal fitness and injury prevention program which will reduce illness and injury; thus
reducing absences. In turn, this will enable ICFD keep current with NFPA minimum manning standards while
reducing costs by minimizing the probability of occupational injuries, illnesses and creation of overtime due to
minimum manning standards. Most importantly, this program will help protect life and property in the
communities ICFD serves by serving as a catalyst of positive change in our department's culture. In order to
httnC'. / JpC'prvippC' -fprn~ n(nJ}T;'pn"l~ J:;'irpl;-r'.lnt l-flrp.rrr'.lnt/, cn/f1rp")f) 1 O/~nT\1-iI'~t-i{)n/n'.l1T!=lti"p l<::n?v
~11 ()f')()! ()
Narrative Statement
Agenda ~JW11lo0f~4
May 25, 2010
Page 14 of 21
meet NFPA fitness standards fire suppression staff have to drive out of the district, off duty to utilize a full service
gym. Through the addition of gym equipment fire suppression staff will be able to meet these standards in
house. Moreover, their participation in this program will fine tune their physical capabilities which will help them
maintain consistency during training and on emergency scenes, thus increasing protection to property as well as
the survivability of accident victims,
Suburban vs, Rural:
Isles of Capri Fire Rescue is a department that serves a suburban community with a population area of greater
density than a rural department However, our population density is less than that of an urban area. There are
hydrants in all of the Isles of Capri Fire District. The response area has several buildings 7 stories to 22 stories in
height. Therefore, geographically and demographically ICFD's district is a suburban community by definition.
" Please describe all grants that you have received from DHS including any AFG grants received from DHS or
FEMA, for example, 2002 AFG grant for vehicle or 2003 ODP grant for exercises. (Enter "N/A" if Not Applicabie)
2004 for fire engine
2006 for SCBA's
hH-nco.//p,;:,p.'M.r;r-pC' f'.,.7THIl fT^,,!RPTnuJ:;'l1"'Pr...-rQ-nt/-h-rp.nT'.lnt/;con/f'irp"')()1 ()1..:u"\nl;""~1;ron/ng""'C1t;1.7p. 1cn')"
"/11\/")111 ()
Assurances and Certifications
Pagelof7
Agenda Itertr No. 16F4
May 25,2010
Page 15 of 21
Assurances and Certifications
Form 20-16A
You must read and sign these assurances. These documents contain the Federal requirements attached to all
Federal grants including the right of the Federal govemment to review the grant activity. You shoUld read over the
documents to become aware of the requirements. The Assurances and Certifications must be read, signed, and
submitted as a part of the application,
Note: Fields marked with an . are required.
Assurances Non-Construction Programs
Note: Certain of these assurances may not be applicable to your project or program. If you have any questions,
please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to
certify to additional assurances, If such is the case, you will be notified.
As the duly authorized representative of the applicant I certify that the applicant:
1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and
financial capability (including funds sufficient to pay the non-Federal share of project costs) to
ensure proper planning, management and completion of the project described in this
application.
2, Will give the awarding agency, the Comptroller General of the United States, and if
appropriate, the State, through any authorized representative, access to and the right to
examine all records, books, papers, or documents related to the award; and will establish a
proper accounting system in accordance with generally accepted accounting standards or
agency directives.
3, Will establish safeguards to prohibit employees from using their positions for a purpose that
constitutes or presents the appearance of personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of
the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. Section 4728-4763)
relating to prescribed standards for merit systems for programs funded under one of the
nineteen statutes or regulations specified in Appendix A of OPM's Standards for a Merit
System of Personnel Administration (5 C.F.R. 900, Subpart F)
6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not
limited to; (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits
discrimination on the basis of race, color or national origin; (b) Title IX of the Education
Amendments of 1972, as amended (20 U.S.C. Sections 1681-1683, and 1685-1686), which
prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973,
as amended (29 U.SC. 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; (I) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment
and Rehabilitation Act of 1970 (P.L 91-616), as amended, relating to nondiscrimination on
the basis of alcohol abuse or alcoholism; (g) Sections 523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. 290-dd-3 and 290-ee-3), as amended, relating to
confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Acts
of 1968 (42 U.S.C. Section 3601 et seq.), as amended, relating to nondiscrimination in the
sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific
statute(s) under which application for Federal assistance is being made; and U) the
requirements of any other nondiscrimination statute(s) which may apply to the application.
htt~'//p~PMrir>p.~ fpm!:l (T("\vfJ:;'pm~r;'irp.nr!ll1t/f1Tp.(Tr:lnt/i~n/f1rp.,)()l O/~nnl1("!:lti()-n/~<:'l;;:l1r~n(,,pl;1 f01"
~l7n()10
Assurances and Certifications
Agenda It~fW~t. 9t?4
May 25, 2010
Page 16 of 21
7. Will comply, or has already complied, with the requirements ofTitle II and III of the Uniform
Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which
provide for fair and equitable treatment of persons displaced or whose property is acquired
as a result of Federal or Federally assisted programs. These requirements apply to all
interest in real property acquired for project purposes regardless of Federal participation in
purchases.
8. Will comply with provisions of the Hatch Act (5 U.S.C. Sections 1501-1508 and 7324-7328),
which limit the political activities of employees whose principal employment activities are
funded in whole or in part with Federal funds.
9. Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C. Sections
276a to 276a- 7), the Copeland Act (40 U,S.C. Section 276c and 18 U.S.C. Sections 874),
and the Contract Work Hours and Safety Standards Act (40 U.S.C. Sections 327-333),
regarding labor standards for Federally assisted construction sub agreements.
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of
the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special
flood hazard area to participate in the program and to purchase flood insurance if the total
cost of insurable construction and acquisition is $10,000 or more.
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 flood plains in accordance with EO 11988; (e) assurance of
project consistency with the approved State management program developed under the
Coastal Zone Management Act of 1972 (16 U.S.C. Section 1451 et seq.); (I) conformity of
Federal actions to State (Clean Air) Implementation Plans under Section 176(c) of the Clean
Air Act of 1955, as amended (42 U.S.C. Section 7401 et seq.); (g) protection of underground
sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-
523); and (h) protection of endangered species under the Endangered Species Act of 1973,
as amended, (P.L. 93-205).
12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C Section 1271 et seq.)
related to protecting components or potential components of the national wild and scenic
rivers system.
13. Will assist the awarding agency in assuring compliance with Section 106 of the National
Historic Preservation Act of 1966, as amended (16 U.S.C. 470), EO 11593 (identification and
protection of historic properties), and the Archaeological and Historic Preservation Act of
1974 (16 U.S.C. 469a-1 et seq.).
14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research,
development, and related activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7
U.S.C. 2131 et seq,) pertaining to the care, handling, and treatment of warm blooded animals
held for research, teaching, or other activities supported by this award of assistance.
16. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. Section 4801 et
seq.) which prohibits the use of lead based paint in construction or rehabilitation of residence
structures,
17. Will cause to be perlormed the required financial and compliance audits in accordance with
the Single Audit Act of 1984.
18. Will comply with all applicable requirements of all other Federal laws, executive orders,
regulations and policies governing this program.
19. It will comply with the minimum wage and maximum hours provisions of the Federal Fair
Labor Standards Act (29 U.s.C. 201), as they apply to employees of institutions of higher
education, hospitals, and other non-profit organizations.
hHn~.IIp.t'Prtrir"p.r>! f'pmQ. rTrlO1.11'Rp.n"l<;1J;;Tp.r~n.,./fi..""n..",,..,.:t/;C'-nJh..,,,,")()l {\/~.....r.l;r>..,.+;......rol..,."""",.~....",~ f'........
,/'7f"')(\lA
Assurances and Certifications
Page 3 of?
Agenda ItenlNo. 16F4
May 25,2010
Page 17 of 21
Signed by Emilio Rodriguez on 05/05/2010
L.......-_. JI__~_.~....~~ .('....__~ ..........7.fC'............... I:'~_""I"'::._,.,....-/-h...,...'''r............T I;"....I+;..."""'){\ 1 f\1............l~ro"'..;.......... !......C"1............,..,OC" f',....,.
,n/')r\1()
Assurances and Certifications
Agenda It~iW~~ ~t?4
May 25, 2010
Page 18 of 21
Form 20-16C
You must read and sign these assurances.
Certifications Regarding Lobbying, Debarment, Suspension and Other Responsibility Matters and Drug-Free
Workplace Requirements.
Note: Fields marked with an . are required.
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 44 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
Department of Homeland Security (DHS) 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 44CFR 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 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.
(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 sub grants, contracts under grants and
cooperative agreements and sub contract(s)) and that all sub recipients shall certify and disclose
accordingly,
2. Debarment, Suspension and other Responsibility Matters (Direct Recipient)
A. As required by Executive Order 12549, Debarment and Suspension, and implemented at 44CFR 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, 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 government entity
(Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1)(b) of
this certification: and
hi+n.c<.I/p~p.~r;~p.Q -tprn'::l n-^,I/r:;a.T1'\Q}:;';,..prw<ra.ntlf';'f"p.ey.,.<:1nt/;"n/fi...",.,/()l f\1Q.nnl;""'Qt;^n/uc:>coll~n.rop.l." -fro.,.
~l7n()l()
Assurances and Certifications
Agenda Itr~9-S05 fl~
May 25,2010
Page 19 of 21
(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
8. 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 (Grantees other than individuals)
As required by the Drug-Free Workplace Act of 1988, and implemented at 44CFR Part 17, Subpart F, for
grantees, as defined at 44 CFR part 17, Sections 17.615 and 17.620:
(A) The applicant certifies that it will continue to 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 grantees policy of maintaining a drug-free workplace;
(3) Any available drug counseling, rehabilitation and employee
assistance programs; and
(4) The penalties that may be imposed upon employees for drug abuse
violations occurring in the workplace;
(c) Making it a requirement that each employee to be engaged in the performance of
the grant to be given a copy of the statement required by paragraph (a);
(d) Notifying the employee in the statement required by paragraph (a) that as a
condition of employment under the grant, the employee will:
(1) Abide by the terms of the statement and
(2) Notify the employee in writing of his or her conviction for a violation
of a criminal drug statute occurring in the workplace no later than five
calendar days after such conviction.
(e) Notifying the agency, in writing within 10 calendar days after receiving notice
under subparagraph (d)(2) from an employee or otherwise receiving actual notice of
such conviction. Employers of convicted employees must provide notice, including
position title, to the applicable DHS awarding office, I.e. regional office or DHS office.
(I) 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) Requiring such employee to participate satisfactorily in a drug abuse
assistance or rehabilitation program approved for such purposes by a
Federal, State, or local health, law enforcement or other appropriate
agency.
(g) Making a good faith effort to continue to maintain a drug free workplace through
implementation of paragraphs (a), (b), (c), (d), (e), and (I).
(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:
)...1+0-0......//"""'''''7'"'<,;,.,.''''''' ('''''..-roo ...-....~,/1:'''''..-n''''R;<t''''''r~ntl-F...''''n-..'''nt/;...ro./.r;;..''''....,()l fI/.............l;"...t;",n!..,coC"11....-:l.....roAC' 4".......
~J'7/")()1fl
Assurances and Certifications
Page 6 of?
Agenda Item No. 16F4
May 25, 2010
Page 20 of 21
Place of Performance
Street
City
State
Zip
Action
If your place of performance is different from the physical address provided by you in the Applicant Information,
press Add Place of Performance button above to ensure that the correct place of performance has been
specified, You can add multiple addresses by repeating this process multiple times.
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 DHS funding. States and State
agencies may elect to use a Statewide certification.
Signed by Emilio Rodriguez on 05/05/2010
httnc;o'//pcp.,.,;rif"p(,;' fpm<;l n-rn,[l:;'''''TY\<;I piT'pr.-r'U"ltlflrplTT'ant/i",n/f1T'p')f'I1 f1/Qnn);f"<::lf;nn!Q(;.'C'111"<:11n,...AC' f........
,17f'){) 1 ()
Assurances and Certifications
Page? of7
Agenda Item No. 16f=4
May 25,2010
Page 21 of 21
FEMA Standard Form LLL
Only complete if applying for a grant for more than $100,000 and have lobbying activities. See Form 20-16C for
lobbying activities definition.
This form is not applicable
httn~.IIp.~pr"i('p<;: f'pm~ (J('n,IVpm~ Pirpnr~nt/firp.or::lnt/;(:n/f1rp')() 1 ()/~nnlil'~ti(")n/::l(:~H~ni"P<': for
"17 /')m n