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Home My WebLink AboutC-8607-1 - AFG Application (SCBA Grant)Applicant's Acknowledgements Page 1 of 1 DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency AFG Application (General Questions and Narrative) OMB No.: 1660-0054 Expiration Date: August, 312019 PAPERWORK BURDEN DISCLOS Public reporting burden for this data collection is estimated to -av EMA Form 080-0-2 "AFG Application (General Questions and Narrative)". T time for reviewing instructions, searching existing data sources, gatherir ed, and completing and submitting this form. This collection of inform6tii You are not required to respond to this collection of informatic (Vt e -s 60--4-51 >. benefits. mber is displayed on this form. Send comments regarding the accuracy of _ ggestiions for reducing the burden to: Information Collections Management, _, _::.. � ; ivjnic aria recur ty, Federal Emergency Management Agency, 500 C Street, SW., Washington, DC 20472-3100, Paperwork Reduction Project (1660-0054) NOTE: Do not send your completed form to this address. Applicant's Acknowledgements I certify the DUNS number in this application is our only DUNS number and we have confirmed it is active in SAM.gov as the correct number. As required per 2 CFR � 25, 1 certify that prior to submission of this application I have checked the DUNS number listed in this application against the SAM.gov website and it is valid and active at time of submission. I certify that the applicant organization has consulted the appropriate Notice of Funding Opportunity and that all requested activities are programmatically allowable, technically feasible and can be completed within the award's one (1) year Period of Performance (POP). I certify that the applicant organization is aware that this application period is open from 09/24 to 10/26/2018 and will close at 5 PM EST; further that the applicant organization is aware that once an application is submitted, even if the application period is still open, a submitted application cannot be changed or released back to the applicant for modification. I certify that the applicant organization is aware that it is solely the applicant organization's responsibility to ensure that all activities funded by this award(s) comply with Federal Environmental planning and Historic Preservation (EHP) regulations, laws, and Executive Orders as applicable. The EHP Screening Form designed to initiate and facilitate the EHP Review is available at: http://www.fema.gov/media-library- data/1431970163011-80ce3cd907072a91295b1627c56d8fd2/qpd ehp screening form 51815pdf I certify that the applicant organization is aware that the applicant organization is ultimately responsible for the accuracy of all application information submitted. Regardless of the applicant's intent, the submission of information that is false or misleading may result in actions by FEMA that include, but are not limited to: the submitted application not being considered for award, an existing award being locked pending investigation, or referral to the Office of the Inspector General. Signed by Justin Carr on 2018 10 25 13 40 34:0 https://eservices.fema.gov/FemaFireGrant/firegrant/j sp/share/acknowledgement.j sp?sysA... 10/25/2018 Overview Overview Did you attend one of the workshops conducted by an AFG regional fire program _... _ -__ ._......._.. No I have not attended workshop Did you particlpate In a webinar that was conducted by AFG? No Are you a member, or are you currently Involved In the management, of the fire tepartment or nonaffiliated EMS organization or a State Fire Training Academy applying or this grant with this application? No, I am a grant writer or otherwise not affiliated with this Page 1 of 2 If you answered "No", please complete the Information below. If you answered "Yes", please skip the Preparer Information section. Fields marked with an • are required. Preparer Information1,41 Preparer's Name Vickers Consulting Services Address 1 10601 Grant Rd Address 2 Ste 216 City Houston State Texas ZJP 77070-4476 Need help for ZIP+4? In the space below please list the person your organization has selected to be the primary point of contact for this grant. This should be a department officer or member of the organization who will see this grant through completion, Including closeout. Reminder: if this person changes at any time during the period of performance please update this Information. Please list only phone numbers where we can get In direct contact with the POC raRo-'. �Pfllnary Po11.11t • Title Training Battalion Chief Prefix (select one) N/A w First Name Justin Middle Initial • Last Name Carr • Primary Phone 949-644-3368 Ext. Type work ^Secondary Phone Optional Phone Type Fax • Email jcam®nbfd.net https://eservices.fema.gov/FeluOireGrant/firegrmt/jsp/fire2018lapplicationlnew_overvie... 10/25/2018 Overview Page 2 of 2 FEMA Form 080-0-2 https://eservices.fema.gov/FemaFireGrant/firegrant/jsp/fire2018/application/new overvie... 10/25/2018 Alternate Contact Information Page 1 of 1 Contact Information AlternateContacflnfo7mationN ?sloi)Nymne.[K 3 k4 4 b k Y *Title Assistant Chief Prefix (select one) N/A ' First Name Jeff Middle Initial * Last Name * Last Name Boyles ' Primary Phone 949-644-3040 Ext. Type work * Secondary Phone Optional Phone Optional Phone. Type Fax *Email * Email jboyles@nbfd.net AlternateContacflnfo7mationN a T Vn�W " *Title Administrative Manager Prefix (select one) N/A *First Name Angela Middle Initial ' * Last Name Crespi *Primary Phone 949-644-3352 Ext Typework 'Secondary Phone Optional Phone Type Fax *Email acrespi@nbfd.net FEMA Form 080-0-2 https://esemices.fema.gov/FemaFimGrant/firegrmt/jsp/fire2018lapplicatioulcontact_info.... 10/25/2018 Applicant Information Applicant Information Page 1 of 3 Organ¢ation Name�. Newport Beach Fire Department Fire Departmeni District *Type of Applicant', x Fre Department/District, .Non Affiliated EMS, and Regional applicants Select type of Jurisdiction (City Served if Other please enter the type of Jurisdiction a,.. SAM aov(System For Award Management) .. ,. �yz f" xP *What is the legal name of your Entity as it appears' in SAM govv Note This information must match your SAM sov Newport Beach Inc, City Of pro`he If Your organization is using the DUNS number of your Jurisdiction'; What is the: legal business address ofyour Entity as It appears in SAM.gov? Note This information must match your SAM.gov profile if your organization is using the DUNS number of your Jurisdiction * Mailing Address 1 100 Civic Center rive Mailing Address 2 * City Newport Beach *State - California '_,; 92660-3267 •', Noed Z ' Emolo4er ldentification Number (a g 12-3456789) Note This information must match your SAMgov profile * Is your organisation using the DUNS number of e-'�--`- ----- your Junichan�sd Yes ' j ( certify that my organization is authorized to use the [A DUNS number of my Jurisdiction provided In this application (Required if you selected Yes above) * What is your 9 digit DUNS number9 (call 1-866-705-5711 to get a DUNS number) If you were issued a 4 digit number (DUNS plus 4) by your Jurisdiction m addition to your'9 digh number please enter it here Note This is only required if you are using your Jurisdiction's DUNS number and have a separate - bank account from your Jurisdiction Leave the field blank If you are using your. Jurisdictions bank account or have your own DUNS number and bank account separate from your Jurisdiction Yes https://eservices,fema.gov/FemaFireGrantlfrregrmt jsp/flre2018/applicationlapplicant_in£.. 10/25/2018 Applicant Information Page 2 of 3 - IS your DUNS Number registered In SA, .M qov (System for Award Management previously CCR gov)? ' ` I certify that my organization/entity is registered and active at SAM doe and; registration will be renewed annually in compliance with Federal regulations l acknowledge that the Information submitted in this application is accurate current and consistent with my organization s/entity sSAM gov record Headquarters or Main Station Physical Address Physical Address 1 `. 100 Civic Center Drive Physical Address 2 city'< Newport Beach -State California • Zip ' 92660-8915 , '. Nood help for ZIP+49 Mailing Address • Mailing Address 1 100 Civic Center Drive Mailing Address 2`rtz.?'c City - Newport Beach State California . Zip 92660-8916 Ncetl help for ZIP+4P Bank Account Information The bank account being used Is (Please select one from the right) i Maintained by my Jurisdiction Note The following banking must match your SAM go v profle .information Type of bank account Checking - Bank routing number ,9 di,., d number on the bottom left hand comer of your cheek Your account numder - Additiogaflnformatiun 6 `For this fisgl year (Federal) Is your organization receiving Federal funding from any other grant ""- - ' �` -'- -� --------- — program that may duplicate the purpose and/or No scope of this grant requests * Is the applicant delinquent on any Federal debts No I If you answered yes to any of the additional questions above please provide an explanation In the space provided below _ FEMA Form 080-0-2 https://eservices.fema.gov/FenmFireGrant/fi grantrisp/fim2018lapplicationlapplicant_inf.. 10/25/2018 Applicant Information Page 3 of 3 https://eservices.fema.gov/FemaFireGrant/firegrant/jsp/fire2Ol8/applicationlapplicant in£.. 10/25/2018 Fire Department/Fire District Department Characteristics (Part I) Pagel of 3 Fire Department/Fire District Department Characteristics (Part 1) https://eservices.fema.govIFemaFireGrantlfiregrant/j sp/fire2O l 8lapplicationlgen_ques.j sp... 10/25/2018 Fire Department/Fire District Department Characteristics (Part I) Page 2 of 3 uoes:your gepartment nave a.UommunitV Faramedic'program� Yes How'rmany personnel are grained to the Community Paramedic 16 levei9 (whole numb"ers only) * How many stations are operated, by your organization? (whole numbers on-ly) 8 Management standard forthe National Incident Management . Yes * Do..you currently reportvto the National Fire.lncident Reporting System (NFIRS)? 1 Note You will be required to report to NFIRS for the entire period of ;Yes tho giant AFG does not require NFIRS reporting for nonaffiliated EMS!Orgariizations'and State,Fire Training Academy. ; If you answe""red "Y'es" above, please enteryour FDIN/FDID 30055 Firefighter I (or lent equiva? (whole Inumbers only) 117 Ifyou indicated that less than 1005o'of yourfirefighters are trained to,the Firefighter II level and you are not asking for training funds to bring everyone to,the Firefighter I level in this application, please describe in the ...... _...... _...... .. __...... ..... ... .._. _ . _._..., ................ Advanced Life Support Emergency Medical Responder Rescue Ope'rational Level Haz-Mat Operational Level Rescue Technical Level Basic Life Support Haz-Mat Technical Level Structural Fire Suppression Community Paramedic Maritime Operations/Firefighting Wildland Fire Suppression Newport Beach is a coastal city located in Southern California about 10 miles south of Anaheim. Our city boasts a wide range of recreational and tourism related attractions including 6.2 miles of ocean beaches and 2,5 miles of bay beaches along the largest recreational harbor on the west coast. Balboa Peninsula has 2 piers, Newport Beach Pier and Balboa Pier, plus the Balboa Fun Zone, an old -school amusement park with a Ferris wheel and ocean views. Local beaches include the Wedge, known for its big waves, and Corona del Mar State Beach. The Orange County Museum of Art exhibits modern and contemporary works. Restaurants, hotels, small shops, stores and recreational opportunities are abundant in our city. The permanent population of our 52 square mile area is 87,249 but swells to well over 100,000 with a steady stream of visitors who enjoy the benefits of our setting. To put the seasonal population and tourism levels in perspective during 2017 over 10,604,000 beach visitors were recorded in attendance between all of our protected beach areas. The Newport Beach Fire Department has been serving our community since 1911. We are an all risk, all hazard response agency. The department is divided into two main divisions: Fire Operations and Marine Operations. Fire operations consists of 117 sworn firefighters and officers and is supported by an administrative staff that handles all clerical work, oversees budgeting, EMS reporting, ambulance billing and Fire and Lifeguard Training. We have 38 members on duty 24/7, 365 days a year, staffing 8 engines, 2 ladders and 3 ambulances. We provide fire and emergency medical services from eight fire stations located strategically throughout the City. The fire operations division is responsible for fire suppression, fire training, emergency medical services (EMS), life safety/fire prevention and the community emergency response team (CERT). The fire operations division responded to over 12,800 calls for service within our city during 2017. These calls included fires, medical, technical rescues, hazardous material response, and public assists. We provided automatic aid to other jurisdictions for 533 incidents and mutual aid for an additional 55 incidents. Our call volume has increased approximately two percent annually since 2012. The average response time for our fire https://eservices.fema.gov/FemaFireGrant/firegrant/j sp/fire2O l 8/applicationlgen_ques.j sp... 10/25/2018 Fire Department/Fire District Department Characteristics (Part I) Page 3 of 3 units is 4 minutes and 22 seconds. Marine operations provides open water rescue, rescue boats, lifeguard training and coordinates one of the most successful Junior Lifeguard programs in the world. Our permanent staff of professional lifeguards is 15. Marine Operations employs an additional 210 seasonal lifeguards during the summer staffing period. Since 1975, the Newport Beach Fire Department has been the sole provider of Paramedic services for the City. Our Paramedics have a well-deserved reputation for providing high quality patient care among the medical community and the public. Our department demonstrates their commitment to this level of service by providing extensive training, utilizing quality control measures, and purchasing the most technically advanced medical supplies and equipment available. All Firefighters and career Lifeguards are trained as Emergency Medical Technicians. They assist our Paramedics, who have more advanced medical training, on every 911 medical call. The department staffs three Paramedic Ambulances 24/7 and has the capability of putting in three additional ambulances in service promptly if needed. FEMA Form 080-0-2 https:Heservices.fema.gov/FemaFireGrant/firegrant/j sp/fire20l 8/application/gen_ques.j sp... 10/25/2018 Fire Department Characteristics (Part II) Fire Department Characteristics (Part II) Pagel of 3 https://eseryices.fema.govlFcmaFireGrrantlfiregrmtrjjsp/fire2018lapplicationlorg_char jsp?... 10/25/2018 2016 2015 w What is the total number offire-related civilian fatalities in your jurisdiction over the last thFee��— p �,. calendar years? _.. _. _..-_ 'What is the total number of fire -related civilian-'-" - 1njOn@s in you r jurisdiction over the last three �� 2 7F 0��1 pale,ri years? I __ . 11_ _ _I I__. ' What is the total number of line of duty member — -- -- --- --- ---' fatalities in your jurisdiction over the last three 0 0 1 calendar years? .._.... - _j � What is the total number of line of duty member - --- ---- - ---- - 19 21 34 i Irhuries inyourjygOiction over the last three�_ :gaiendir year's?,; - _. _.._._.__ �___._— _..i tpverfhe(as€three years what was your - organization's operating audget? ' How much of your TOTAL budget is dedicated to personnel costs (salary, overtime and fringe benefits)? TDoes your department have any rainy day reserves olnergency funds or capital. outlay? No _... _._ If Yes what is tha total amount currently set aside? lives describe the planned purpose of this fund • What percentage of your annual operating budget Is derived from Enter numbers only, percentages must sum up to 2017 2016 2015 00% Taxes? ° I .. 93 %, �:. 93% 93% Band Issues? � 0 % 0% 0 % aloi�-�$ EM58illing? 'x .,y 6% 6% 6% Grants? "^,; 0% 0% 0 Donations?`. 0% 0% 0%i Fund drives? .0% 0 % 0% i LFeofor 9erGlce? 1 % ' Applicants should de scribe' their fmancialneed and howconsistent it is with the intent of the AFG Program This statement should include details describing the applicants Finanoialdistress, including summarizing , budget constraints unsuccessful attempts to obtain vehicle and outside funding and proving the trouble is out of their control. As mentioned earlier the Newport Beach Fire Department is an all risk, all hazard response agency. Our overall budget contains all of the expenses needed to provide fire suppression, fire training, emergency medical services (EMS), life safety/fire prevention, the community emergency response team (CERT) and marine operations which provides open water rescue, rescue boats, lifeguard training and coordinates one of the most successful Junior Lifeguard programs In the world, The overall annual department cost to provide these services Is $50,514,086. Total personnel related expenses across all of our divisions, duties, functions and services provided is $43,126,819. This is 85% of the total annual funding which must be dedicated to https://eseryices.fema.govlFcmaFireGrrantlfiregrmtrjjsp/fire2018lapplicationlorg_char jsp?... 10/25/2018 Fire Department Characteristics (Part II) Page 2 of 3 maintaining our workforce alone. The remaining 15% of our funding covers all of the operating expenses for each of our operating divisions. The operations budget for each individual division include all operating expenses which are needed to maintain their daily operations and provide the high level of service our city's residents and visitors require. These division totals include: Marine Division- $1,500,702 EMS Division - $1,481,972 Administration- $200,183 CERT- $110,895 This leaves $4,093,516 or just 8% of the entire annual budget to meet all operating expenses of the fire division. This may seem like a lot at first glance but it disappears very quickly, long before we have any hope of making any headway with our long list of needed equipment, PPE and SCBA upkeep or replacement. Mandatory costs which we have little or no control over include: Vehicle Maintenance/Repair/Replacement- $1,183,052 Dispatch Fees- $694,072 Comm unications/IT- $451,987 General Insurance- $420,305 Building Maintenance/Repairs- $227,120 Building Utilities/Supplies- $226,357 Professional Services/Physicals- $96,698 When you get down to it there isn't much at all left to put into our firefighters minds, hands and safety. Our budget is only able to dedicate funds to training, PPE and equipment as follows: Uniform/PPE $215,562 Training- $134,344 New Large Equipment- $117,441 Equipment Maintenance- $96,486 Small Tools/Equipment- $20,000 Our department, city and state are facing dire financial restrictions and severe unfunded liabilities which are choking any attempts to improve funding levels. Whether it is healthcare or pension cost increases these mandated expenses get passed through all levels of our government onto the shoulders of the taxpayers without our ability to alter them in any way. This results in constant cost increases which must be absorbed through maintaining our current spending level without increase and delaying capital improvements in hopes of better times. Our department works very closely with our city leadership to maintain the full level of response capability and high level of service required to meet the needs of our community. This is imperative as our city relies on the thriving businesses which in turn rely on a thriving recreation and tourism customer base which in turn relies on our protective services to keep them safe, comfortable and able to enjoy the many attributes our city provides. If we lose any pieces of this puzzle the financial impact to our city would be disastrous. We have looked for other funding options to address our. needed SCBA replacement, but have found no other means of obtaining funding or financing to accomplish this. The AFG is our only remaining option available to complete this replacement program. While the entire cost is far beyond our financial ability, the 10% cost share can and will be provided. No https:Heservices.fema.gov/FemaFireGrant/firegrant/j sp/fire20l 8/applicationlorg_char.j sp?... 10/25/2018 Fire Department Characteristics (Part 11) Page 3 of 3 -- ---- --- -- FEMA Form 080-0-2 https:.Heservices.fema.gov/FemaFireGrant/firegrant/jsp/fire2Ol8/application/org_charjsp?... 10/25/2018 Fire Department Call Volume Fire Department Call Volume Page 1 of 2 uuu - - S ecial Incident Type - NFIRS Series 900 7 8 g Of the NFIRS Series 100 calls, how many are 101 97 72 "Structure Fire" NFIRS Codes 111-120 1 Of the NFIRS Series 100 calls, how many are "Vehicle Fire" (NFIRS Codes 130-138) 25 24 22 Of the NFIRS Series 100 calls, how many are 45 21 17 ;'Vegetation Fire" (NFIRS Codes 140-143 I hat is the total acreage of all vegetation fires? 14 12 17 How many times did your organization receive Mutual Aid? 43 27 26 How many times did your organization receive Automatic Aid? 598 522 741 55 62 �R https://eservices.fema.gov/FemaFireGrant/firegrant/j sp/fire2018/application/response.j sp?... 10/25/2018 Fire Department Call Volume Page 2 -of 2 How many times did your organization provide Mutual Aid? How many times did your organization provide Automatic Aid? 533 919 737 Of the Mutual and Automatic Aid responses, how man were structure fires? 65 70 72 FEMA Form 030-0-2 https:Heservices.fema.gov/FemaFireGrant/firegrant/j sp/fire20l 8/applicationlresponse.j sp?... 10/25/2018 Request Information Request Information Page 1 of 1 FEMA Form 080-0-2 https:%/eservices.fema. gov/FemaFireGrant/firegrant/j sp/fire2018/applicationlrequestdetail... 10/25/2018 Fire Operations and Firefighter Safety Request Details Page 1 of 1 DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency Activity Specific Questions for AFG Operations and Safety Applications OMB No.: 1660-0054 Expiration Date: August, 312019 PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this data collection is estimated to average 4.6 hours per response for FEMA Form 080-0-2b "Activity Specific Questions for AFG Operations and Safety Applications". The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting this form. This collection of information is required to obtain or retain benefits. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW., Washington, DC 20472-3100, Paperwork Reduction Project (1660-0054) NOTE: Do not send your completed form to this address. Request Details The activities for program Operations and Safety are listed in the table below. Activity' Number of.Entnes Total Cost Additional Funding ......- Action Equipment 0 $ 0 $ 0 View Details Modify Facilities 0 $ 0 $ 0 View Details Personal Protective Equipment 2 $ 584,025 $ 45,262 View Details View Additional Funding, Narratives Training 0 $ 0 $ 0 View Details Wellness and Fitness Programs 0 $ 0 $ 0 View Details Grant -writing fee associated with the preparation of this request. $0 https://eservices.fema.gov/FemaFireGrant/firegrant/j sp/fire2018/applicationlrequestdetail... 10/25/2018 Budget Page 1 of 1 Budget Budget Object Class a. Personnel $ 0 b. Fringe Benefits $ 0 c. Travel $ 0 d. Equipment $ 584,025 e. Supplies $ 0 f. Contractual $ 0 g. Construction $ 0 h. Other $ 0 i. Indirect Charges $ 0 j. State Taxes $ 45,262 Federal and Applicant Share Federal Share $ 572,080 Applicant Share $ 57,207 Applicant Share of Award (%) 10 Non -Federal Resources (The combined Non -Federal Resources must equal the Applicant Share of $ 57,207) a. Applicant $ 57207 b. State $0 c. Local $0 d. Other Sources $0 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 $629,287 FEMA Form 080-0-2b https://eservices.fema.gov/FemaFireGrant/firegrant/j sp/fire2O l 8/applicationlbudget_total.... 10/25/2018 Assurances and Certifications Assurances and Certifications FEMA Form SF 4248 Page 1 of 7 You must read and sign these assurances. These documents contain the Federal requirements attached to all Federal grants including the right of the Federal government 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. O.M.B Control Number 4040-0007 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 or organizational conflict of interest, or 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.S.C. Section 794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. Sections 6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §§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 https://eservices.fema.gov/FemaFireGrant/firegrant/jsp/fire2Ol8lapplicationlassurances f.. 10/25/2018 Assurances and Certifications Page 2 of 7 provisions in the specific statute(s) under which application for Federal assistance is being made; and 0) the requirements of any other nondiscrimination statute(s) which may apply to the application. 7. Will comply, or has already complied, with the requirements of Title 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, as applicable, with provisions of the Hatch Act (5 U.S.C. §§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. §§276a to 276a-7), the Copeland Act (40 U.S.C. §276c and 18 U.S.C. §874), and the Contract Work Hours and Safety Standards Act (40 U.S.C. §§327-333), regarding labor standards for federally -assisted construction subagreements. 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 floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. §§1451 et seq.); (f) 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. §§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 performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A-133, "Audits of States, Local Governments, and Non -Profit Organizations." 18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies governing this program. https://eservices.fema.gov/FemaFireGrant/firegrant/j sp/fire2O l 8/applicationlassurances_f... 10/25/2018 Assurances and Certifications Signed by Jdstin;Carr on Page 3 of 7 https://eservices.fema.gov/FemaFireGrant/firegrarit/jsp/fire2018/applicationlassurances f... 10/25/2018 Assurances and Certifications Page 4 of 7 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. O.M.B Control Number 1660-0025 Applicants should refer toahe r6gulations cited below fo determine the certification ao which they are required to aftest ;Applicants should 1.also revjew the instructions for certification meluded in the.regulations before.,. completing this form Signature on this form provitle`s for compliance with certification requirements under 44 CFR Para18 "New Restrictions on Lobbying and 44 CFR, Part 17, "Government wideDebar men t Arid Suspension (Non procurement) and Government wide`Requiremeri, 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 cooperatNe agreement 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) z s4 y 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. https://eservices.fema.gov/FemaFireGrant/firegrant/j sp/fire20l 8/applicationlassurances_E.. 10/25/2018 Assurances and. Certifications Page 5 of 7 (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 (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. 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. (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) 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 (f). https:Heservices.fema.gov/FemaFireGrant/firegrant/jsp/fire2Ol8/applicationlassurances f... 10/25/2018 Assurances and Certifications Page 6 of 7 (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: 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 byJustin Garr on https:Heservices.fema.gov/FemaFireGrant/firegrant/j sp/fire20l 8/application/assurances_f... 10/25/2018 Assurances and Certifications Page 7 of 7 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. https://eservices.fema.gov/FemaFireGrant/firegrant/j sp/fire20l 8/applicationlassurances_f... 10/25/2018