:

STATE OF MISSOURI APPLICATION FORFEDERAL/f>'TATE PUBLIC ASSISTANCE

(PL 93-288 AS AMENDED/RS1\1o. CHAPTER 44)

L DATESUllMlTIJi:P: }. (APPLICANT) SUB: 4. DECLARATION NUMBER AND DATE: REClPIENTID NUMBER:

2. DATERECJnVED: . FEMA -4490. DR. !\10 Dated:26 March 2020

5. (APPUCANT) SUB-RECIPJENT · 6. TYPE OF (APPLICAN1) SUJlsRECIPIENT: Check appropriate hox or boxes INFORMATJON: fxl

· A, f .P>C"al Nnme:·, A. State A<wncv · f B, Countv f C. Citv D. Townshin r

B. FEINlf: E. Sr.ccilll District F. Privllle Non-Profit r C. Dl!NSII: G. Other (Snecilv)

D. (AppliClllll's) Sub•Tl'Cipicnt'.s Fiscal Year: FROM: TO:

E. Address (St./POB/City/State!Zip); · . 7. lNClDE:NTPERIOD:.20January, 2020 and ongoing ll State Agenoy [I) Receive Requo,t State Emergency. l\fanagcme11t Agei1t)'

P, O. Box 116, l30l Militl• Drive ,Jefferson City, MO 65102 Phone: 573-526-92.34

9. TO Tiffi BEST OF MY KN0\\'1,.EDGE AND BELIEF, ALL DATA IN THlS APPLICATION 1S TRUE ANO CORllECT, Till! DOCUMENT HAS llEEN TRULY AUTHORIZE!) BY THE GOVERNING BODY OF Tl!E (Al'PLICAN1) SUB-RECIPIENT AND THE (APPLICANT) SUB·REClPIENTW!Ll.CQMPI.Y \VITfl ALL ASSURANCES IF THE ASSISTANCE IS AWARDED. A . Nome of Auth<>rized Rep!e$(l11ta!ive B. Tille: C. Telephone Number (faclude Area

. (Typed or Printed):· Code):

D. Si!,lllature of E. Date Signed: Authorized Reoresentaiive:

BELOW. THIS LINE FOR SEMA USE ONLY

FUNDJNG REQUEST: BUNDLE#; SA# and Version#:

A. Federnl: B, State: C. Totat

9. SEMA REVIEW '

PREPARED BY: Signature: 'IJtle: Date ofAppro\'a!;

Alternate GAR

SEMAPA-2FORM DR - 4490

• STATE OF MISSOURI R-4490 OFFICE OF ADMINISTRATION VENDOR INPUJ/ACH-EFT APPLICATION

! •REQUIRED FIELDS

D

'NAl.te(ADDR.ESS AS Si-lOWH ('N f'EPC'fW. TAX RETURN ~AAI. TA?t 10 ~t,t~Ell OR SOQAL SECURflY' NUMbtfft

·m-~ o;, i,mrt

0 Corpor;,tion 0 Sole Proprietor 01noividt1<!I D Stale Employee

Dathe, DATE Of' CfW.4GE

..

Rf:V.>'1'10-NAMe'ADOOf.$$ IF" -00:FERENTfflARAB~ PREVIOUS f~IU,I. TAX D NIJMD:ER OR socw. s~m N\JMSER.

PREVIOUS NAMS

PREViOUS AOOHE$S-

Cqh11JJENTS

f'l,JRCHASE Olill!':A. "NAMEJAOOR~S iF ~Fmlmfi'HJ.NABQVE

TO BECOMPLETED BY F!NANCIALINSTIT\JTION . ··.•·--···· ,: 0 I (:Ne) hereby authorize fue State of Missouri, to iniliate credit . . •• ,,,_7c-< ••••

N.W:EINJOAES-S OF FJNANCrALINSmlJTION eritrles to my (our) ac<:0unt at the depository fmancial institution named and to credit the same. such accounl I ry,le) acknowledge lllal the origination of ACH transactions to my (our) account must comply wlth the provision of U.S. !aw.

This authotiz:alion is to remain in Ml force and etfect until !he Slate

OOPOSl'fO.tl "Out ING MJMEIE:R. · of Missouri, Office of Administration, has received written notifica-lion from me (us) of if$ termination in such fune and in such manner as to afford the State of Missouri and the financial instl!ullon a rea-

l.lePO$lTQflA~NT NUMBER sonable opportunity to act on it

!iAMEONACCO\.INT [] I (We) hereby cancel my (our) ACH/E:FT amhorlzalion. --VE.ff'OOR. stGHATUffe

TYPE OF ACCOU){f X □CHECKING □SAVINGS SH3N-A.TUR£ OF RS'RESENY.11\IE OF t1NANCW~ ,:¢Tn'U'fl¢N "P81NTNAME

.

PRINT W.ME. · 11TLE

rm,, E.t,\Alt. M)l)Rl:al&

.. 'JE.EPHONB. Nut.e!:R. IDATE •TELEPHONE I~ C!SRTIFICATION FOR INTERNAL REVENUE $ERV!Co ~RS) □ Ex.ttlnpt from Baekup Wl1:hm4dm-g Untmr panalti.M of perjury', l oetttfy that t Tne re.tmoot 'shttwn on 1hls form l!ii.my ootrett ~•er i:ientblkm numbs {or r l\1ti Vtalling fat .a num!:)er to bu Issued to me). and U. I am W-'11 itlij,ect 10 baekup ~nil tieeauie,:; Ill I am exempt from baOOJp wlthho:ding, « th} J haw_ not batti ~lflid b'f ttie Inta:-Olti Revenue Se.wb!. ({RS} trust I _am wbj¢d b tia~wiihl1¢ti1111 aJ 1:1 r~ of a failure- to repott al:.lnltil.t:slordlvl~en~. -or {eJ 1he.lRS '11:!-!i n:;,!ifledm! Uw.tl mm !Mger S'J~to b~~withholang. ind tli. I am a U.S..~ (Including a U,S, ~~ alien)~ Certttlctttlon lmittuetkms.. Y01,1 ~st C;!'QS,11 out item ff abPVe H you ruM! b&e:n nob11~ by 1ho lRS tntlt you we ~ntiy Sl.lbje::t to bad«Q W'i!htwlt!mg ~ you h!we~ to repOO, af, itlterest Md di~Md~ Q;l your _tax retu..~ For all raal esfale transaefii:mt, ikim ·If does-not a?P4', ~or ~e ll'ltetel psid, ;:n;:qu!sition or abandotm'lem of ~ -p~rfy~ ~Won of deb!,_ oonltibufir,M,_ ~ a:nnttvldur.i! r(!liremenf ~t {IAA}t ani! gl:?Mlra!}f, p;tymf.llllt otht!r tl'ltn lrt.ereit ffl'Jd dlvid~. yoo are nO\ rci~cd b f!SJI\ th1t C~t:mlM, but you mu!1.1 pl'tMde-your COttolJli nN.. (Seer.W.!il lnztrucUon, on b..90v webs~ for .ff1QTe r.fotmaf!O."I.} The L'llemal Re\~ ~ dtiet nO\ t!!'qoire ~ur 17-0tlli~ b any pl"cAAeOtJ of M ckicume-i'it other than- tht!, eettilieallons ~d \ti avol:1.backtlp wilhhokii.lg. SfGN,t,;,1URa"

VENDOR INPUT FORM INSTRUCTIONS .

The purpoS<> of this form is to add.a vendor record orto make changes I<> a vendor record. A vendor ls a person or business being paid by the State of Missouri.

THESE FIELDS ARE REQUIRED TO BE COMPLETEti FOR ALL ClRCUMSTANCE!!JSHAOEO FIELDS\

Ente, NAME/ADDRESS AS $\-lOWN ON FEDERAL TAX RETURN.

Enter the FEDERAL TAX lD NUMBER OR SOCIAL SECURITY NUMBER that is used for income taxes for Iha name entered.

Chee!< the ¢0ITectTYPE OF ENTfTY.

Signa!\lre is required etVENOOR SIGNATURE alon9 wlth PRINT NAME, TITLE, TELEPHO!IIE; and DATE,

.

CONDffiONAL FIELDS .

If payme!l1s are to be s<!nl to a different address,. enter a REM ff TO NAME/ADDRESS.

ff purchase orders are to be sent lo a different address, enter a P\JRCHASE ORDER NAME/ADDRESS.

If you are maki09 a change to your vendor record; fill out these addlliona1 fields:

DATE OF CHANGE. is lhe effective date of the chall(l(! In business struc\ure/activity

PREVIOUS FEDERALTAJ( ID NUMBER OR SOCIAL SECURITY NUMBER

PREVIOUS NAME

PREVIOUS ADDRESS

COMMENTS are for additional information that may be helpful including reason for the change.

TO SET UP OR TO CHANGE DIRECT DEPOSIT INFORMATION, RLL IN THE FOLLOWING, INCLUDtNG THE REQUIRED FIELDS FROM ABOVE.

NAME/ADDRESS OF FINANCIAL INSTITUTION whero you want the money to be depostted. A representaji\l~ from Jhe financial Institution· . .

m~fil complete and sign thfs se;ptkm.,. __

Check appropriate box tor electronic deposits .

. 11 cflan91ng bank aocountlnformatlon, fill in O,'\TE OF CHANGE.

. .

CERTIFICATION FOR INTERNAL REVENUE SERVICE (IR$1. .

This cerlifles that the Taxpayer Identification Number (TIN) on this form is the correct number and. whether bacl<up v,;thhotding applies,

. SAMII

State ofl\'lis:souri Public Assistance Grant Certifications Form

The individuals identified below are hereby authorized to execute and file Application for Public Assistance on behalf of the designated iurisdiction for the purpose of obtaining and administering available slate and federal financial as.,istance under the Robert T. Stafford Disaster Relief and Emergency Assisinnce Act, {PublicLaw 93~288 as amended) or otherwise available. These indhiduals arc authorized to repr~ent and act for this jurisdietion in all dealings with the State of Missouri for au mattcl'il pertaining to such disaster assisfance required by the agreements and lks.~urances listed on '[,'EMA Form 20-16, the SEMA Public Assistance Program Checklist, and the SEMA Audit Compliance Requirements Checklist. Bv si@ing this certification we are verifying that we have read and understand the information and remdrements listed on the three doeuments mentioned above. We further understand tliat we remain respgnsible for compliance with all other pertinent federal, state. and local policies and procedll'.res in the administration of Public Assistance funds received "" a result of tltis application. Failure to coinelywith these reguiremclits will resull in the de-obligation of federal/state . funds associated with that non-compliance.

Senior Elected Official

Narne&Title

Signature

Telephone Number·

Email

fax Number

SEMA PA-1 FORM

Jurisdiction (County/Ciiy/District)

Mailing Address:

Chier Financial Officer

Name&Tiile

Signature

Telephone Number

Email

Fax Number

Authorized Representative

..

Name&Title

Signature

Telephone Number

Email

Fax Number

DR- 4490

MISSOllRI STATE EMERGENCY MANAGEMENT AGENCY (SEMA) PUBLIC ASSISTANCE PROGRAM CllECKLIST

1. 'l11e (applicant) sub-recipient must identify and report all Disasterrelated damage within si~1y days of their Scoping meeting with FEMA Damages identified after FEMA has conducted the (applicant) sub-recipient exit briefing must be reported to SEMA.

2.

3.

(Project Worksheets/PWs/SA's) Sub-award;s are ,vritten to restore disaster damaged eligible facilities to their pre-disasterconditi,m and. function.

. - ..

Codes and Standard.~ which change the pre-disaster construction of a facility are eligible for considemtion only if they are in writing and they were fonnally adopted by the (applicant) sub-recipient PRlOR fo the disaster declaration date or if' they are a legal Federal or State requirement applicable to die type of restoration.

4, (Applican~) Sub-recipients must follow the Scope of Work (SOW) in the approved (PW/SA) sub-a\vard. Work not identified in the scope ofwork is ineligible. 1he (applicant) sub-recipient is responsil,,le for informing SEMA ofanycondition(s) that create a need to change the Scope of Work BEFORE incuiring co~is or proceeding with the work.

5. All project work must be completed by the project completion deadline a'lSigned lo the applicable (J.>W/SA) sub-award. Only costs incurred up to the approved completion date will be considered for reinibursement. If additional tinie is needed, due to circumstances beyond the control of the ( applicant) sub-recipient, a written request must be sent to SEMA

6. '[he ( applicant) sub-recipient MUST Sllbmit a written request for ao Improved or Alternate project to SEMA and receive a vvritten approval prior to starting construction.

7. An ( appl!cant) sub-recipient may submit an appeal for additional small project funding if lhe actual cost for ALL small projects c~cecds the approved project amount for ALL small projects by 15% or more .. The written appeal must be S\lbmitted to SEMA no later than 60 days after the last small project work was completed, 'The appeal must include cost documentation for ALL small projects.

8. The FEMA Project Completion and Certification Report P .4 mu.~ be completed, signed and returned to SEMA once the project work of the (PWs/SAs) sub-awards on the P.4 is completed-

9. Suspended (PWs/SAs) sub-awards will not receive funding until ALL the requirements identified in the comments sectionoflhe (J'W/SA) sub-award are met

10, (Applicants) Sub-recipients \\~th large (PWslSAs) sub-awards mu~i submit a project crn,1 summary and all associated invoices to SEMA following the completion of each large project 11ie project cost summary must list all labor, equipment, materials, and contract costs associated with lhe{PW's/SA's) sub-award's scope of. work.

11. Tue (applicant) sub-recipient understarids and accepts responsibility under the Code of Federal Regulations (CFR) Section 13.21 to minimize !lie time elapsing heh\leell the trabsfer of funds to us and the disbursement of those funds.

12. The ( applicant) sub-recipient shalt promptly, but at least quarterly, remit interest earned to SEMA for re tum to

FEMA.

SEMA PA-1 FOR,¼ DR- 4490

i

t

! i

13. 'The Missouri State Prevailing Wage Laws are applicable for all public works construction that would have previously been rovered, The Governor will detennirle the applicability of 1he M'issouri State Prevailing Wage Laws for each disaster.

14.

15.

16.

17.

The(applicant) subsrecipient certifies that they will not contract with any entity identitied on the General Services Administration System for Award Management (SAM), Ii ttps:1/www .sam.gov/portal'SAM/#1, Ex<.'luded Parties Lbt (Debarred List) or 1he Missouri State Attorney General's Know MO web link, bttps://ago.mo,gov/app/searcli.

The ( applicant) sub-recipient certifies they \.\-ill adhere to Revised Statutes of Missouri (RS Mo) Sections 285.525 through 285.555 regarding the hiring of Illegal hnmigrants by die (applicant) ,uh-recipient or any. conlJ'mltor or subcontractor. We understand that fuilure to comply with this requirement will subject u.~ to the penalties de$Crlbed in the references mentioned above.

The (applicant) sulrrecipie11t is required to submit quarterly reports to SEMA on all projects that have not received final. payment.

The (applicant) sub-recipient may appeal any deteonination previously made by FEMA or SEMA. The (applicant's) sub-recipient's appeal.mtIStbe made in writing and submitted to SEMA v.1thin sixty (60) days after receipt of notice of the action which is being appealed.

18. If an{applicant) ~uh-recipient expends $750,000.00 or more in total Federal financial assistance in one ( applicant) sub-recipient fiscal year (including ALL Federal funds, not just disa.'lter assistance) a copy of the Single Audit or Program Audit (as required by the Single Audit Act of 1984) must be submitted to SEMA.

l 9. Complete records and rost documents for al! approved work and reimbursements must be maintained for at least three (3) years :from the date the !re,t project was completed or :from the date the final payment ,vas · received, whichever ls later. During this time, all approved (PW s/ SA' s) sub-awards are subject to State and Federal audit review.

20. No payments will be made on projects requiring a Corps of Engineers permit or Missouri Department of Natural Rcsoorces. 401 permit until the approved permits are rereh•ed at SF.MA.

21. 'The (applicant) Sllb-recipient will immediately notify SEMA iilwhen they receive any other funds (insuranc~, CDBG, DNR, USACE, donations, etc.) tliat will be applied to the (PW/SA) sub-award Scope of Work or non­Federal share.

22. Contracting v.>ith small and minority businesses, women's bllSiness enteiprises, and labor surplus are.a fmns. The (applicant) $Uh-recipient l1lllSt. take all necessary affinnative steps to assure that minority businesses, women's business enterprises, and Jabot surplus area finns are used when possible. See 2 CFR §200.321 for additional details.

DR· 4490 SE.MA PA,1 FORM

Misso11ri State Emergency Management Agency (SEMA) Audit Compliance Requirements Checklist

As a result of recent decisions by the U.S. Department of Homeland Security Office of the fospector General (OIG) it has become necessary to obtain additional certification of each Public Assistance (applicants') su~ redpienls' understanding of federal requirements associated with the receipt and expending of federal· granis,

(IMPORTA1','T: Approval of your procurement procedures, cost documentation, souree documents, etc ... , by representatives of theI'ederal Emergency Management Agency {FEMA) does NOT provide any assurance that the U.S. Department of Homeland Security OIG auditors will not require that you return disaster grant funds should tb.ey(OfG)dis11gree with those procedures.)

These procedures have beenimplementcd as a direct result of U.S. DHS OIG audit reports and to prevent the potentially devastating effects of having to return federal funds following a disaster.

The State Emergency Management Agency reserves t11e right (as the (grantee) recipient for federal disaster funds) to coi1duct periodic records reviews of any ( subgrantecs ') sub0recipi ent's records and to cease: payments . to any (subgrantee) sub-recipient found to be non-compliant with these requirements,

Toe following items must be read and understood by each (applicant) sub-recipient BEFORE signing the certification, NO payments will be made on any (project worksheet) sub-award until this and all otherre{\uired documents/forms have been completed, signed, and provided to Missouri SEMA,

1. The (applicant's) sub-recipient's accounting practice.~ must identify the application of federal fund~ or account for costs by specific project as required by federal regulations and FE!v1A guidelines .. The Oxle of Federal .. Regulations (CFR) 44 1320(b) states that (subgrantees) sub-recipients must maintain records tbafadequatcly identify the oou:rce and application offunds for financially re.'Sisted activities.

2. Effective control and accountability must be maintained for all (grant) award and ( subgrant) sub-award cash; real and personal property, and other assets.

3. The (appli~t) sulr-recipient must establish a project file (or site file for multiple-site projects) containing the C-Orre.',p()nding (projett worksheet/PW) sub-award and. all documentation pertaining to the project ( or site). ·

4. The ( applicant) sub-recipient must follow the same or tnore stringent internal controls when oc.::ounting for and expending disaster grant funds as it does for its annual operating revenue.

5. The (appliciint) sub-recfpientmust maintain documentation by project, reconcile source documentation lo invoices, and determine the validity of all project invoices before filing claims.

6. The (applicant) sub-recipientmustfollow federal procurement st1lndards as set forth in Code of Federal Regulations {CFR) 44 and 2 CFR Part 200, to include:

b.

SEMAPA-1 FORM

Perfonnance of procurement transactions in a manner pro\1ding full and open competition except under certain circumstances.

(Subgrantees) Sub-recipients must maintain records sufficient to detail the signific;mt history of the procurement, including rationale for the method of procurement, the ba,_'iis of contractor selection, and basis for the contract price.

DR- 4490

e. (Subgrantees) Sub-recipients must document a cost or price apalysis in com1ection with every procurement action including contract modifications.

d. Time and material iype oontracts are prohibili!d 1mless no other contract is suitable and the contract includes a ceiling price that the e-0ntnictor exceeds at its ov.'!l risk. FE'.MA also generally limits these contracts to seventy (70) hours.

c. The ( subgrantee) sub-recipient must negotiate profits as a separate element for contracts Jacking price competition and in all cases where cost analyses are performed.

f.. The (subgrantee) sub-recipient musi1ake the affirmative steps, as established in 2 C.F .R . • § 200.32l(a).

7. The (applicant) sub-recipient understmds that improperly contracted 'l'i•ork will result in the total ineligibility for the project.

8. nus checklist is NOT all inclusive and each (subgrtmtee) sub-recipient should be familiar with 1he requirements ofC.ode of Federal Regulation (2 CFR Part 200 and 44 C'FR). Particularly important are Part 13 (Unifonn Administrntive Requirements for Grants and C'.ooperative Agreements to State and Local Governments) and Part 206 ll'ederal Disaster Assistance for Disasters Declared On or After November 23, 1988),

DR- 4490 SEMA PA-I FOR..'vl

Assurance of Compliance with 2 CFR 200.317 - 200.326

lhis Assu,once of C<>tnpllunce fom> (SEMA-PA4) satisfies the requirement, of 2 CFR 200.331. which stipulates thai SEMA, es a P""'•through entity, p_tovidc rcquked.i:nfom:iatkm i:dated to, hul not thnjk(}._ to~ -procure.1.rent. as follow~_ _ _

· (1) All requirements iinposc:d by lhi: pass-through .entity tm· tht::Sub-rccipicnt so that ,he Federal uwlird iS u..~d ht' at:~ordancc· ,yi1b. Fc&rnl stanites, regulations and the terms and conditions of.the-Federal award; (3d) Monitor tlic activities of the sub-recipient-as .neceSSllr}' ~o ensure th.at lh~ s.ub-;iw;an1 ii! used for ~ulhorized p\!rp-.}se5;. in oomplia.n_i,:-c with Federal Sfatute~ regulations. mid the terms and conditions ofthe subMaward; and that sub-award· ~orma"nce _goals-urc achieved..

t. Review· yollf PrOCurement Policy foi--compfian.ee with Fedetal Procurement Poticy Standards a"iid-2 CFR 200.317 -200.326_ and SUbniii your. Jurl.«lictlonal 11..,,1ew to SE.MA;

2. Submit a copy of your Procu.nmtnl Potky fo SEMA., with the submission of ~'tale Forms, for-rt:~•itw of Comp Hane.ct

3. SE?-.1A will n::Vic-W your Pn>turt-m.tsnt Policy, in accordl1n¢¢ with your Jutisitktlonal Review, !Or OOmpliat1ee and wiU teeorruht!t\d sOlUtions· for any issue(s) which m.ay cause ri~ to the preservation of eligibility. ·

C®IIJloq m:u~!" "fgf (:Q~idrntion include. but •rt: not lhnikd 101 0) The Feckta1 uwatding a.gene)' uc pas:s-tluougb entity expressly a~tbc;ri7.cs t • .2ll0.31B (a) 'The non-,,Fedend entity mu~t use its O\\-'ll documcuLed procuren1cnt noncompetitive propos.'11$ in response to a written_ (l!quei;t from _tht t.O~·FOOeral prooedur.::swhfoh refkct -applicable- Stat-e:. local, and ~rt"bill l.1:1w5 md. n:gtJiRtions. entity; (If

provided thlil ~ procurc:D1¢00: ~mtbrm «I 1!f!pJi~le Fo.,ie,at l{IW and !he. {4) After wticlqitioiro(a 11w.1;bd ot.wurce$, competi•iQn 1$. _&;tt:O),im:d standar(b'. iden1aii:d in thh; $e«i,;m, inndequnte. :2. 20&.l20 {h) Pn.)CUttlOOlt by small puteba.~ procedures. Small putl'.:hnse S. l00.3:21 {-a) 111e nott.federal entity most hike 11fl nt~sw:r:?.i:rltttifilh•e $,1trui. kl-_proc:edute! ate tliose. rel-alfl'e:ly simtllc Md tnfoonal procurement methods for as~urc ·durt mintlfily bu~ines.scs, Y.'Omen~ bt1sll1¢Ss_-~u::1priScs1 nnd foOOr sm!J'l'llls-$CCuring. 5-CfViees, suppiks.,-or other property chat -do not cost more:- tlnu.1 the 11n:a fttms MC l.®thi1h.ai possible; Simplifii:d hqt1lsition 'fhr~hoid. If 1im1tll putclra.w pr-0C.tdurti art ,k~r pticc. at. 6. W0.3il (b) Aflh-iuati\i-e· step$ mus!. itlclud~ ralc; quotations mw.t be obtcined from un adequate nUnibtt of qualified sour~ (I} Plucing qu:ilifK'<I small lll:1d minority tmsinCss'es and W(lfflcn1s business: 3. 200.JlO {c} Proeu:rero.entbyseaierl b-id~ (fonmd adw:ttisrt1g.). Bids are publlet;• ~1\crprists 01nolir;:iu1tion list!:; _ · snlidtcd and_ a fitJtt frx-ed price OOfitl'Q(:l (lump ~•m (I( uo-it prfoc) is f!;\\'~rded 1o th~ Cl) ~uring itwl sm~ :md mtnt>rity hu$"lU¢5:$~: ~d 'ffl>rucn1

i. ~:S\0¢$:i ent-erprises -~ponsible b'jdrkr ~-bos-c bid, -omifonnffig with 11n !lie nurt.erial t~ and Bre- ~licited wh.ernw« they nre polenLial ~ur~ oonditkms of the fovkm_i<m foe bids,, ii the lnwes1 in price. The seuled bid mcthod · (3) Dividibg totel tt(luirtfflent-i,. when coonomieally· feasible_;- iilfu s«iiiUi:t tasks Or is the prefetted meihod !Of pmcuring <:Ot1$troc1.ion. Ir 1he <.•onditlons in ~aph. quantities to pmnit ma.-..:imum part\CipMion by· sanall and m.blority busi-ntis~. ind ic)(lJ ofthl, section apply, women's IJ.usfnc:ss c-ntcrpriscs; 4. 200.320 (0 ProcOO:mcnt hy noocomp:t,Jtl\-e juti,pos.als, l"roi;;umncnt_by (4) l:!$ab1imfni l;idlttfY $.i::hr;duks, wbcrr th; rr(IUht:menl ~rmin;. wlikt noncompr;titi.V¥ prop~ls }$ flWW~)tU{ UtnmS,b SQlicitatfon uf a proposal fi01n crtc:0urage._pmicipa1ion 1;,y small ·nnd nllum:1t)' l:Jusine$ies., aud WOUlttt's busfoeS¼ only one sonree Md tm_y be us:ed only when ont-ot mol'C of the fo!luwittg enterprises; ciranns~ apply. (S) lltlittg ihe services and J,~i~a»r.e-1 as ~p-roprfa1c:, of $U~\ O.rgani1...1tJons as the (!) 'lb-e. ilen:1 iz -avaittib~ cnly from. 3 sirigle sour~i Small Bui.lness.Ad1ni.il~tr:rtioll and the t-.1inority Bmines, lkvcl-Opm-.."'fit Ag.ency (2):'.lbc public-exigency Or r:mergr:JlC)-· for the requirement will n()l penni1 ii dcl3:y ofthi Oepartmmt ur Cummctce; and:-rmihins from cumpetb:ivc solidtafttm; (6} Requiring the pritht oontraew. -if ~libcOntrtlClS are to he let. to lake lhe

affitnUWve sleoS fu.100 in. p:aragraJ.llS {J) through {5\ of lIUs setlion. We, th, responslblo p•rtles of th• Sttb-Redpi•n~ hereby «rtify full compllnnte ."ith :Z CFR 200,317 • 200326, as •pplkoble to oor Pt-ocuttmtnt Policy, with tbe ·bs.ttution t,( »rei.cryine tbe elig!hlli!I or fnndiD:g llS obi iv.ltd hr. the J'.ll!derttl _Public Assistance grant

A[!nlicanf Jurisdiction: Authorized Representative Senior ,Jurisdictional Authority *

Print Name Print Name

Title Title

... Signature Signature

Date Date

Phone Number Phone Number

Email Address Email Address

"' If the Autb-orllcd Rt'flrti.tlltatlve nls.o h0ld.S the POSitioiOf ~llior-Jurisdictiena! Auth~~rity please include the sigllature and eontnct information Or another ju:risdktional ~~tborlty who cnn e.Crtify ('.OttlPUf.-me. (Euimpii: rounty dcrk. ~1 mana:~r, ~tc.)

SE?IU • PA 4 FOR,'lf

DR- 4490

FOR

FY

U.S. OEPARTh!EN:r OF HOMEL/\ND S~CU!lliY F'EDERAI. EMERGENCY MANAGEMENT AGENCY

SUr,'!MARY'SHEET FOR ASSURANCES AflD CERTIFICATIONS

CA FOR (Nome of Re<:lpleit)

DR-4490 OJJ.8. No. 1/;$/J-QQW 8:pm Ju/y $1, ~1

This svmma,y sheet includes AsS'IJrai\ces arid Certifications that must be read, signed, and submitted as a part of the Appllcalion for Federal Assistance.

An applicant must check each l!em that they are certifying to,

Partl

PartJI

Partlll

□ □ 0

FEMA Form 20·16A. Ass11rances-Nonconstrudlon Programs

FEMI\ Form 20-168. Assurance.s-Construction Prr,grams

FEMA Form2Q..iSC, Certification Regarding Lobbying; Debarment Suspension,an<J other Re$p()l)sibility Mattern; and Drug-Free Workplace Requirements

Part IV O SP UL, Disclosura of LobbyingAc!MUes (If app//cab/o)

As·lhe duly authotil:ed representaUve of the applicant, I hereby certify that the applicant will comply with the identified atta.ched lissuranoes tjnd certifications.

Typed Nome of Au1horizJl<I Represen\B!lV!> Tttl•

l;ll;iriaturaof A- R,,prtlsilntaiws

NOTE: By signing the oertifica\io11tegarding debatn)etlf. s4spensklJ1, and other responsibif4y matt!;!fll for primary <»vered transaction, the' applicant agrees ina~ should tha proposed covered transaotlon be entered Into, it shall not knowingly etiler Inti> any lowartie!' covered trarrsaction with a person who is debarred, sµspended, declared lne!lglble, or voiuhtarily excluded fiom partic:ipallon In Ihis covered tra.,sacllon, unless autllotized by FEMA enteting into !l)is transact\011.

The applicant further agreo...s by suhmilting this i,ppfication that It will lnciude tl1e clause li!led •eeraficatlon Regaroing Debamienl, Suspension, lnefigibllityaod VoliJntary Exclusion-LoweriierCo,-ered rransaotlon," provided by the . FEMA Regional Office entering into this covered tta~n. W11hout JTIQdific:ation, ln aU lower tier covered transactions and in aH ~ for lower lier OO'Jered l!aosactiorn:. (Refer 10 44 CFR Part 17.)

PapelW<>t'k Burden Disclosure lllotlee

Publlc raporting burden !'or this form ls estimated to average. 1. 7 noon, per response. The bu men estimate includes the time for reviewing instriJaions, rearching existing data sources; gathering and rn;,inlaining !he.data needed, and eornplellng, reviewing, aQd :maintaining the data needed, and completing and submitting lhe foon. Send comments regarding the ~cy of!he burden eslimate and any suggestions for reducing the burden to: Information Collecil,;,ns Management, U.S. Depar.mentof Homeland Security, Federal Emergency Management Ag13ncy, 500 C streat. SW, Washington DC 20472. You are not required to complete this form unless a vafid 0MB control n\.1111ber is &.splayed in the upper comer on this form Please do not ,;end y,;,ur completed form to tile above address •

.

PREVIOUS EDlTIOII OBSOl..Etl!

U.SOS'AATMENTOFHOME!.AND SEQ)Rf!Y DR 4490 F""°EAAL EM!aRG!lHCY MAW\l38MENT P.G!;NC\' •

o.tll.a. No. t661;.®25 Expiros July 31, MOl' ASSURANCES·NONCON.S'TRUCTION. PROGRAMS

. l"apetwork Bu~den Disclosure NojlOG . . . . . Paperwtlrll "'l'Qillng ~forlhin fo,m i•dmated ro overoge 1.7 t>outo per"""°""• ~ burclen e.uinam ~es.lhe'ime lor ,"'6"""'9 inotiu,11¢n,i, •-9 exlslin9 dBlB '°""""'· ~ and molnlafofag 1ho data needed, an:! completing, -~ i,,d "'1bn,itting !he form. You are.not~ io ""'""ntl 1<> ti». co!lod'>¢1 of~ u-. • volld O!Ail COl'lito! ilutnfJer._,. ln the uppe, light cornor or 1h!s iorm. $000 rommento regar6iflg 1110 ""'"""'>' of Jhe bur<let1 -..r;, and any sliggeslions fo< re"""'1!) lhe buroen osUmah! kl: !nf<lnnatlO<l CO!!e<!lon MSM!l""""1t. U, S. Oe;,arlmont of Homeland $eotlrW, F•d!rtal l',ru,lll"!lOY Managemem Agency, ~ C S1reel, lm, \'/a<lllnglon, DC 20412. NOTE: Oo nof.sena your COl'/Jple~ fomit,;i ftJ6 a.bow a.ddrRS:. · · · ·

Nore . _ . ,_ . __ - . Certain ofthess _,,ramm lllllY not be applicable lo your project orp,<>;,ram, Jf ~ hove any <rJeS!lor,0, pleaso oonta<.tlha ewatdir,g "9'>f1Cll, Further, oeitain Fod...t _,d!ng aganclet may req\Jlr~ applicant< to "'"1fy lo addil!onal .. """'"""'· ff"""" ill tho °""'• you. wlll bo notlfled.

As !he d<lly - r-lallve of the opplicant, I certify that lho appUconl:

1. Hos1h• lejjal authorily to •ppty for f«le!lll ,...;,,lance, and tho ln!ll!Minnal, marn,g.erlol •n<l. wnolol cap,blll;y·{lrn:lud!'lg iunds si,/1/oiom · to pay tho m,n.Fede!o/ sha,o cl profr,d co,d,;/ 1n ensure p,oper plammg; """"'9emont &nd oomple!loo of !he p1'ljccloesaibed 1n n.~ ~-

::i. W!I glvo !tie awarding !!Jlancy; lhe oomptroller <>•-I ofltie Unlled Stales, an<I ~ apf'IOl'rlate, the Slate. lhlt>\!9h "'1Y aulhotlt(,!j · .,,,,,.,,elll;iUvo. "°"""s lo and lhe ~ght to examloe al ,,,,ords, books, /"'l"'J$;, (:( ~ related lo fllO awanl: end Wil establish a prop,r ~ gy~orn lo aCCOll!"""° v.lth gor,,m,Hy •"""i'!Od =uot1ng 1itatt:J.ards 0( ~ lfirncttvcs~

3. Wik e>l>biish-safu;iuards 1o prohlbil employees. !tom u>ln;l lh<ilr posillOM IOI a ptu!)oso Jha!\ionstillll,. orp!ll$1!!l!•·Jhe appearano,, of i,e,>onalgaln. ·

4. Wtt lnll!ate ..-.r e<!ltlpl<l!<,llle worl( >w.'unlhe appllcabl• !Im• frame aft"' reooipt ohpl>JlJVal of th<> awaidlo, -·

s, w,u complyvillh the lnte,gover""""1laf !'enronnol Act cf 1970 (42 U,S.C. Seollon 4727-4763) reta1!ng ID pi .. "'11»:1 Star<latll• formedt '-)/Sleim lor pr- fu<lded "°'""one of!ha nlna-·•latu .. or ieg$!1""" spe<llle<! ln /lpp,,nd!x A of OPM's S<anda,d> for Mttlt System otp......,,,., Admin1watlon [S C.F.R. 900, Subpa,1 F).

a. Will oomply wi.n ojf Fe<lor.,J !l\<llla$ m~ lo noodl>crim!nalicn. ihl,$e lncloiehut.,.notlimi!ed 1o, (a)111leVJ o!th8 CMI Rt;illtsAclof 1W4 (P. L !J8.352) wlilet, prohibll< dio,xl!r/mllon on tho ba•\6 of raoe, i,o!or; or na!loo•l Ollgln; !bl 1111<> IV or u,o -!loo Ameoomms of rnn. .. •maoded 120 u.s.c; Seclioos 16111-1883, am! 1685-1665), Whkb prontilb <!l~n o0 ll1e b- cl $t!Xi (c) SaeUon 50\ of the Rehablilstion M or 1m, .. arnonded (~ u.s.c. Snclion 704), which prohibits . dl"""""°"!lon oo the bails td han:!i::opo; (1lJ !he A!!• Dlsolimlnalion Act of 1©75. .. an•ll•w.1 (42 U.s.c. seotionS 610H1Q7),_ll proh­atstdmina\lrill o,; the !>•s!a llf oge; {ej !tie Dl\1Sf Ain.... OMO& """ :rt,,atm,.J11 Aotot191l' {1'.L !!2-255), •• amended, ,elal!og ta nondl$Crirrina6on on.111n lmls of <inllJ illla,e; t~ !hit Co~"" A!co~ol Abo•• and Alooooii>m ·~ TrealmonJ Md Rehab1fJ!alloo Ad of197GJ P,L 91-516). M ....,de:!, re1allng lo nondlsalmina1lon C'1

Iba b!is\• of alcohol - ot •looholltm: (g) seclioM 523 ,md 527 of lM PooiccHealih Solvk:e I'd. of 1912, (42 U.S.C. 2!!0<ld-S and 2!)il ..,'3), 0$ amonde<l, """11ng lo oomldentlamy .ot alcohc>I and diug abus• pstie.,r r-, ~ Title VIII o( lhaCl\ol!<ighb"°""of 19611t42 UJW, Secliori 3601 et.""!:), .. ameo;led, rela!lo:i 10 nOildlscrtmlna!lon in !he &ala, rental or -9 ofhooslng: (i) JI!'! olher nondl&Ollmlnallon prw.,ion i1 Ille .. •P•offlo slatuejs) underwblth app!ioatlon ftlr fodera1..-1s boln9. imwe;and (I) lhe ,e~<>f ant olh"1 -•!atue(s) Whltllmay•pµlylol>tco~

7. \'WI CQ!llJ)!y, orhao akeadycom~ with lh!,r,,qul1em<mt&ofT!Uell OM l!l ol'lhe Unlfom>od Relocalioo --and Real Property AGQl!1$illon Policles Act nf 1970 {P,l.. 91-il<lll) v,!w.:h '"""d .. for 1lllr am! etrJftable lre;ltrr'<o!llof - dlsp,'8ood ot V/ho$e !ffl)PO!ly Is >"1'-U<e~ 2S • """'1f o!Fed""'1 or F..,,rallym,sisled ptogram,; 11,eso ~IDO!l!s a:,;,!J 1o aK lnlel<,sl ln r,,a1 proporly-Jired lor proJe,:! fnl'P""" reganfless of !'<Jder.!l participation In purchase,

&,\'viii co.T.;,iy Wlltl pro\!lsloM ofHatcll Act (5 U.S.C. Sediom 1501-!S-J8 am! 732+7328) Wlik:b lltllt tho p:,iitl(21] actMlies ol employoes"'"""' prim:lp!e emplaymont adlli!li .. a,~ i.n:101! In IM>!l!e ot in !>'<Ill Will Fe~oral 1urrds.

9, Wi• !:!inlply, .. .appll<,a!,le, wllh th• p1oviolans of 1he Oov!s-llacon Act. (40 U.S.C. Seclio!ls 276a lo 27(!,(,'I} tt1eCopelarnl Act{-ID u_.ac. SeclTon 27So all'l 1i \,1.$.C, $~•· 874]. and IM CanlractWOrl( Hours and 8a1ety S\aadard$ /\IA (Ml uac. Soc(IMI! 52.7.,;33), regamifw labor •!Bod•rds. fut federally a,slslod construd!;,n whagreem--..n(s.

1 O. lNil eotnpty, ~ ,wRoeble wi!.~ 1IQOQ Jn>iJi-aoo,. pu,<!ialle requlremenle of s.ction 1Q2a of !ha flood IJ,sSS!ot Pr-Ad of1'973 (P.L SS.234) vt.,fcli requires Teclpie(lt$ In a special flood twu"1 ama to partlcip,fe In !he . pro!!ffil!l and tor,:rchaso flood..........., 11 lhe lo1al oosl cf insurable consbudkln ap acqutsiti,Jri is $1"0~000 ai more.

11, Will comp~•~ e~ttl stond1"d, whltl1 moy bs prescibe;J pu,.uant to tho fcllowlng: (o) r,1$\ltu\ion"f onvf,cr,monfal qunlify coolrol """'"'""' urider the NaliooBI Envlrollll'.onlal Pofiq .>.cl of 19:;g (? .L 91-100) ~ ~Ord,o-(EO) 11~1•; (b) notifltatk>n ot\'l$1lng ladli!ios pursuant to go 11738; (,) ptolOdioo al wetiarids l",l(!ll!3!ll lo EO · 11990; ({!) evato.i;on of flood - h fJoodjJ!1lins in ar:ctlldal10!l v,ltb EO 119SB;{e) ••-or pro)oct oensmlooC'f Vlllh th• approv..."d stale management fl'Oijram d<vcloped onder lhe Coastal Zon• Mw,agement Actof 1972 (16) U.S.C. Sedloosl451et•"4t 11)-imlty oll"<ederaJ acllont lo stale (Clear NI) lmplemoJl!l!l!Qn PIM> unoor Secllon 176 (c) of U.. Ctoar Air Actofi955, as emonded (4ZU.S,C. Se"'1on etseqJ: (g) protedloo urnleqJround ~''" cf drlolilng w.tor ilO<!« Safe Odnlllng Water Act ot 197 '4. as """""1od. (P .L !\3,5Zl): orul (J-q pmtecilon o! en~"""""" llnderll,e Endongeto<! Spede•Act of)f173, .. amended. (P,L 00-205).

1~. Wll Cl)l!JJ)1yl'lith thewllli81)11Soenlc Rivers Act of186e {16 U.S,C, Sediono 1271ot seq.) ..:.tod to protedin;/oomp;:,nents of tha notloncl wildmd$cer,i,;f\v0r>sy$!n<; . .

13., Will at""1f. the owan:!lng •s,,ney In """"'1ng compllooce Wllfl S.OU01l '1-05 <If lho N&llonal !ils!<J<11; ~ati!>'l Aci on 955, as alfl"..ndeil {16 u,s.c. 470}, EO mm 1.-uon and f)fOiedioo o.ftilslotie prcpe,tieS). anll tne Archaeolo;!cal ard tt..\<llio p-M <11974 (18 U.S,O~ 46-seq,), · ·

14; \~I comp\)' ._"lh P.l.!1~•348 _,ilog 1"• pnt.ectlon o( t,um,,n •~ inv,:,J;""" In r......,;,, de11elopmoot, and related _,, .Upported \>Y lhls awa!d «I ..,..lll.;ce. ·

·t5;\MII oompfy with tit>~ Mlmol Welfura tv;;. of 1965 !f'.1.. SQ.544. as amended, 7U.$,C.2t31 d. .. q.) peru.Jniag tolll•"""'· haodir,g,ond trem,sn! of ¼"1TII blOO<:lod orilm* hold fer 1,,.,11,rch, -\l, « other ao!M!ies •upp(lll<,<l by lh1< •-d of 0$Slruince,

16. WIii oomplyv,,tt, the t,,,ul'!!asi,d Palm Po!,!og _ Ad (42 U.S.O. s,,dlons-<801 e!seq}\'Jhldl ~ !ho u .. of Lsadbased pliint In oonslroc!i<>rt or-liitation of "'51:leneo Sl!!Jtl_.,.., 11, Will """'"''° bo peJformOt! ll>o req,.ii<ed Msnclal and ®mpl"'""" auoits kl ""'°-ce ""1h !he $1rTgle /\Udit At! or 1984.

15.1'\ltl ¢0!!,p!)' ~h al! IJ!l)llioable r,,qtliTeliienls 1'1fatt O!hi,r Fodarot 1'lws. - OI<!'"'- m9;,lallom aoo pooci"" gtwem1ns w. ---1 s. ff vi.I comply with ttio ,nJn1mum wage sno rmoomum hour• p­of tne F....,.1 Fo\'1.a\Jor Sl>adaro• /\Ol {29 U.s.c. 201), as lh•Y •ppty to emp]O}"'OS ,,/i151ill!Uon, oflllgf)OredU<Sllon, hospitals, 31\d other nWr<piDS\ ~om..

PRE\110\JS EOmON OBSOl.ETe

• U_ $_ OB>ARTMENr OF HOMELAND SECURITY

FEDJ;Rf,,l EMERG!"N(:Y MANAGEMcllT I\GliNGY ASSURANCES-CONSTRUCTION PROGAAM

DR-.4490 OM.a, No. 1Gt;o.Gll2$. aipfnis JuJys11 ·2001

PAPERWORK BURDEN D!SClOSURE NOTICE

N>UC reporting bUrdeo for lhls form is esllmo!e:! to av-1.7 hoUra pe, re,jl<)nu. The bUl!lon estlmate includes the lime ib! re~a.w,g l!\$lrui:!lofl5 arid. ~reh!ng •~ <fata sourais, gali>e!lng am! mo~g Ille efala needed am! eompJoling, w1d submlillng Iha 1orn\. You a,e notn,qulred la respond !O 111\s oo!lec!lon of lo!Ormatian uo!e<s • md 0MB totmt number 1'1'1"'""' ln Ill» -rrlghl """'"' ot lh!s t= Send com._,1' reg,,rdilg 11>• aeewacy of • !he - estima\o and antsuooeslions for n,,luclng It,, bunlen lo: lnform.Uon CO!lo<)llor,g M;om,gement, U. S, Departmont of t;arne!and Seo.r.ify, federal E.'nC19"""l' M"""llOtMnt Ageooy, 500 C S1reet. SW, Wasli~!on, OC 2\l472, !'a-l<Redudi<m ~ {111/jG<lOQi). IIOTe: Do not soud )lour cornpla:ted torm to ~hts a:ddf4"." · · · ·

NOTE" . . . .. . . . . . . Cert.., of lhese """'""°""' may MIila applicable to JO!Jr p~!'} orll!')g!alll, tt :,ou mW• qu~•. plc.;t0e too!a<:t Iha Award'.,ogAgency. fUJlflO!. ciortnln f&leml all$1$fane» ~ agencies may mquim •l'l'li<:aolo lO cetll()I a¢ll\lOQal ""'"""""'" If O'.Jdl i• In~.,.,.., you ,,,;u be notified.·

N. !he duly alilhmized ropr,,soo!.>tlve of !he •pPitar,, ! l)!)r!Jf}' ttr.il Iha opplloa!d:

1. Hn>lho 1"ii,,I aulhOl!ly to "l'Ply for Federal ...istance, and !he ins!lwfiomal, mena9•tlal 01id (,iaoclal e.apab!llty (inclw:fii>g kind• ,vfflc/orJt to P•r u., 11011-FodemE Sn&. .. ot:pmjoct"'""9 to """""' proper planning, man,,yement,_aod romplot!oo ofllia proj,,c! described in tti¼s ~jcallon. :·

2. WII. glY• lhe av,atdlng agency, .th<i complro!et Gel>Ot,l ct !ho United Stale$, ,md If appropriate, th!! staie..· lh<oogll any aulholl>.00 tt,pre.""'10!U.,., """""' to and ih• ll!Jhtto """"""'all rocord•, booli>, piijloto, or~ related lo tho """'lance; ,nd viii oslablrsh a paper a~ •)'Stom in at:t:Mlaooewffll -Uya=pled aceoutlllng stuoiloo:ts er~ dlmc!Jve,,,

3. v.11 t»l dl,pQOe m;mod,ylhe u,o o~ orohange lhe lcmn of '1n1> real proµe1l\' Ill!•. or othef lntereOl. lo tho .no ml lad!l!!es. \\llhoU! p,,,mtsslon and in.trudi<n< 1rom lhe-1 •!lllllOI'• Will ieoord !ho Fodera! inlMl,stin lh!I titlo of real prt1pe;ly in a<ooTdanoo 1'11!11 awardinl! egency dlle<;lll'Qa a!l!l wlil ildude a oownant ln th• tlll<HJf relJlproperty acqUlre<I in vmol• or Iii P"ll \\itli Fedora! a;slslarlee Mds IQ ""'""' llOl"dloal."llinalion during lhe usof,Hfe of lho·pt<je<t.

4. Will C"'1]piyWllh !ho requm,,it.,1$ of th• assl,!ance awotdlng ageno)' lli1t! regard \n·lhe drafflng, "'11iew "'14 Sl'JlM'il of o:milllutllon plans •nd ,pod-._ ii. Wilf p,ovido ;iiid maln!:1'111 ,,,,-r,;,olclll arnl a:!equa\e en;jltleoting $UpO<Vlsloo ot·lho"'"1S1rudlan -t,,""'""" l!Jat ih•""""'""" ,""'1<oontoll1l&wllh tho a~pla<l~ ah<!~ and Vii1l 'fumlsli ;,rog"'!l' rep011!! ,and s<tdt ofuor lnfomla\lOO .. may ~ ,aguired by lhe ... 1slam:e awatll'r,g <$•ney or •tale.

A Wll lnll!alo a"ld ,;ornple!e lhe Woll< wl\l:lln. lhe appicalJ!o.llm<> trrun• all,t n,oeipt of epprov;i! af lhe aw;mling agency.

1. win estab!llm ~-., plQ!l,'),;t ~1oyees 1rom oolng .-..1r posiliOna fora pu,poo,,lhlltOX>slitu\OS or~ lh• . app- of pmonal or~onol-conlllt:t l• loi,,,,,.t. or ~ gain.

a. Wll c,;,mpjy\\'111, ~l'iiiwnne!Mrif-070(4i. u.s,c. SoC!lOfl$ 47:i&4763l relating I<>,._ ~ fur meri! ~f;>!P!'OQ<ams mdcd~e,=o!!bonlnoleen <lalues or JO:Julafilmi $peollle:l ln Appendix A<>fOPJ.I'• s!BM .... fora Mi.it System C>f i'ommnel Admlnlslr;ilion (!i CF ;R.

~art F).

9. \'vii a,mp!yw!tl the ~-aasad Point Pol""'1!ng Provi,nlion /4 (42 u.s.c. Sec!IM• 4001-e\ $"'I~ ,.;,foo p,chi!,ll, !he""° of Ieatt \$M palnt: in oohstr.Jdio,n ot rababllftfmon 9f rn;tdeooo sb'Udilres:.

1 o. Wil oomply l'lilli all R,dl,ral '111itles relallng to . . --These lllG!ud• bu! am Mt limited to: (a) 11Ue Vjof lh•CMI RightOAd'of 191>~ (Pl.. si>352) wllicll µrolllb!\> <ll>,:rimlnallon,., the basis of race, oo!of Q! nal\QMI oriJiln; (b) Tl!le (l( or u.. E'ducattoo MIBffliment> oi 1972, .. ameildcd \20 U.S.C; Sedlon• 1681'1663, and 18BS-1686] -.1,!cli.prohlbiu; ~ oolt.e !Jaslso/se,; (c) Se.lion 504 oftJie Rellabiliia!iOn Ad. of 11l73. •• 3l!l00ded (29 U.S.C. Soctlon• 794) wfilc!l prohlliil< iiisortminal!O<\ oo·th• i,,,;,, of,. (d) 1he Age: Dlscdmioation Ad. of 1975. es ameooed {42 U.S.C. S""1ioos .6101-6F(l whicb prohlbil> disC1l{TI)Mllall on lho basis of •go; (e) the Drug AbUS\l Ollioe T realineo\ ,11.ct of 1972 (1'.L 93,255), •• ~- lQ!aUng \o noo~crlrritlaUon.on. the bas_es of .a_Me; -(f) fue Corr!>reblln$lvo Alco.'lol Abuse .,,d Alcoholi,m ?reve:>1lcri, Traa!meotanil Rellabllllafion Ari of 1970 (P .L. 91-615), os amended, relalira 11> nondi.crimina!lon m tho b .... of.alcohol,wuse ur"1co!lali>m: (!i) S,,otio,1, t;23 and 527 of Iha Plll>llo Heallh $<,vice t<d:d 1!l.12 (-12 u:s.c. 290 dd-3 aoo m....s), as aim,rodell, ieiof1091Q ~U•lily of ab>hol and Q[UQ abu"' 1$\lenl rooonls: {ll) 'TIiie VIII of Iha CM! Rigl,\s Ad; of 1008 (42 U.S.C; S.olion> el"",~, •• 1lll>'t>:ied; re!a!,,g lo no~n lo 1he •ala. renlal prfi~ qi btMlir,g;-~). PM -,io,xll~ provisi""' ln lhb spedfl<: -(a) unde,>mlcll appliOllilon fo, Federal._ .. ls being nw,Ja, and · (I) I\>&~-·on l"'l' olhernon-<ii>aimlnaiion $1slll.0>l•l which mey l!!'PlY1a 1he a;,plkl,lioo.

11. \\lilf <)l)~fy. Of ita, alrcadyr:ompieo, w.th 1111! r-.~flfl)Olll,. of 'i!U. li.1\<l<l ID oftt,e l.Jniform ~ ~.., .. and Ro,,[ f',oport)' Acqul&l!lon policies Ni, of 1 !170 (P,L 91-641,) "1n!d\ p'(olrii!es fllr lalf and eqlll!able ltoalm>!( of po,sono (lispl•\te<f or who,;e pn,perty Is otql'°""1 a& a .reSIJll of Federal an<! foo.,,;Jy as¢ioi! _,.. These r,,qolroll>O!I\• apply to aQ irt1$1'asl In real propeny acqiored r., proje,t Pllll>"'• mga.~ of Federai partldpa!ion In pu~

12. WI o:,mply with 1he pn,W;ii>IU o!IMH•l<:h Aot (511,S,C. • Seciion< -1501-il/oa "'10 732+7Jl2l!).wffichlimil Im> po1111eal ·..rilffles of empl\)')m\Ol'l! a<:!Mlle& ore_ In - Ofim;,art "'1!11Feoora!funda.

13, Wii coropl1;as.opp1looble, -·Iha provi.ton, or1be Dallis,,B-,= /v.i {40 U.S.C, Soalan& 27a lo !?oa-7), ln<!­Cop.e!aod .N:f. (~ IJ;S.i;t&dlon 27!Jl,;md 1a?J.S.C. Seolion ;>14), 1115 Coriiract Woit. Hallfi ontl s.t.!y SlaJidar;J. Act l 40 U.S.C. Sotllons :m-~ t8JjMllng labOf "1arl:lairl$ [Of Fl>!l<)rally ess!ttM conslrWloii ouilagn,!,malls.

ra'AA F<>lltl 20-1'18, OCT04 PREVIOUS s,moH OBSOLETE

'f 4. 'l,M:11 ComPJy \'Dlh the-ikXld' Jl'l$1lr.30Ce pun::bM~ teqllt.-nrnool$ of Sotjloo 102(0) of !ho F100<t Diso,ioo, Prol-M of 11373 (I'> .L. 93-234) '\'mlch requ!ro• ,ocl;rlenls lll • special 11oot1 lu!z!ITTl """' 10 pmcipetG lo lha-m and to ]l\Jll:hlme fiaod l...,rance ln lhe 1o1a1 cost oflnwllll!!e oooSl:uotfon and aor.tsUk>ri lo $10,000 or

""""· 1s. Wili complj< wllh erwlroomeotal •landaros vmieh may be presaibed Jt.irs<rant to tho !oTiowln;i: (a) !:I-or envlrorunootilf quality c;onlrol mea,~res Wldor Iha l-la!lonal Em<J~·Policy AO! of195!1 (P.L 91-190} aod c><eaJllve Order (E,O.) 11S1'!; \\>) nofifia,~011 al llfb)atlng - J)'JrSUOnt to EO 11738; (ol ptOlo,;llM of~jlU1lOJa!l!!o EO 1199!1; (d) ""'1u,!llon of !lood rn=rds In lloodpl,riM In """'1i"""" \',ill) EO 11988.; (e) "'5~ranca <>I p<ojo<,t et:miStency wl1h the appn,ved S\>1<> ma~ pcogr.ms d•l'Oloped "'1del lho Coa>i,,! Zooe Ml!pll90!)1llflt Act or 1973 (16 o.s.c. Scdlcms 1451 et ooq.); (Q <:001i,rrn!!y of Federal ilcilOn> lo $!Bio (Clean All) lmpleme<llafions . 1'!ans U!Jder Secliori 116(cJ 0ftlie Clean Afr M of t955, •• •""'nood (42 U.S.C. Sedion T401<!tsoq.);(9) pro,'eOli0.1 of und"'ll.rot<ld souroeso! dtW;lnjjw.orer ~• Safe Pri:llrn,g '\'/ale< NJ! of 1974, "" amen;ll:d. (P .l. 93·6Z3); C!lJ f>OOloclion of lcnllang,,rod species Act of \WS, aumonded, (P:L, 93-205).

18. Will C0JIW lM'lh w., W!d and S,,,tli:) ~ M of 1866 (16 U.S.C. S.cllans 1271 ol se<i1 rela!¢d to profucilng com;,onr,-au,r poten!ial components <>ftne national wild aoo ..,,,.c,i.m <y•bml.

1 r. Will .. ,.,Ill,.. aw.,,tf.,g ogency in assu"'I! oomplla,r.e willt Seo\lon 1'05 of the Nat\onlll ftislo!ic l'tes-.MtlonAc\ ol 1\lOO, •• llm/lndod (16 u.s.c. ,m,), EO 11593 (<lonllflcaflon and preserv,mon aOllstorlc proportloo), and !he Afcli~ en:l H"-cPtesetY.O!ion.Aclol1974 {18 u:s.c.45'"1 etseqJ.

18. Will cm,"" to be pelformo:l the rcqulred lin""'1al ond c:ofup1iance a\Jdibi in. ""°""""'ce - tho Slngle Autll A<:! of 19!14.

19: Wl!I oomp!y'llllh all appf<Obl• i<qulrem- of all o!hel' f-1-. e-uth,•• Orosra, ~- and ppli°""' governing lhl• progran,,

20. It wD! comply ,eJ!lh lh• mlnlmum ¥"9earul .,;,,,,&'riUm h<Jun, provision,·ofjt,e fe<ie<a! F..- Labor Standa!O$ Ad. (2D,U,$.C. Zll)(BS they apply'lo employaes ol lnsfflll!i:la• ·or 1'igtlllr .OUOlillon, ho:;pi\a,S, an. alhoc -olit O!lJSnj;:al'IO_,,

2!, ltwill ob1aln ~ bylhe approptiatl. Fed•ral a900olos of ttti, finalwoo<lng d"'11<irJG& ond •~ bclo«> lhopr<ijed 1$

· "'""'fl>ad or p\alled on tho ""'""'1 fcr bid<ll,\g; lhat ltwil <O!lSlruc1 Ille ~r<!j!ill!. or .catlS& It krbs carn;IRl®d, to nnal ~on in~-lhe-.ppllo!\l!On <md e;,prllVOd pJ0no e.'l!I $!>(!C1Jl::ations: 1ha\ t w!l! :iUbm1t to tho ")ll>"JPrial<': Ft<!eral 3!F.rn:y li>r prior~~ Iha! -~cos! ollh\> ' • 1m>J,,,1.-« ·'-'""°' or-«ona! l"J,'Olt; 'lllarn \'!II not enter 1nto • =-oonlrao!(s) fur the projocl o;uodert>ke olh!lr -• U!11lllhecorullD,M of !!le oons'JUCl!olt grant _.,m(s) ...... ~mot

~ Jl 'Ml\ c;,orale m,'11mlritaln'llle fdit In """'1«la= wllh Jt,a mlnirnum s1a.-s •• may bo roqu1red or pr.,.,;!bed by the opi>bi>fe F•i!Om\, SIJ\t<!, and 1"°"' agern;\eo fur~ ~'" an<! opo!lltioo or •uab fae!lllk:&.

DR-4490

ZJ. n v.i! r"'luim lh• laciify lo bo deslgnell t~ ~omply v.ifh .ihe • American staodard Sp,,cl!icalkJns fur Maldilg Bulld'1fls a"4 fadlllm ~1" 10. and UaotM,y, the l'hy,,"'11Y H;,ndlcaPJl!'d.' N\lrl1iler A11H001 ;oo modified (41CFR 101;17.700). Th• aJlllllcont ;'1ij bo ,eopon,i!>le for cooduii/ng 1•,peclbm l<t en'""' """1,l!looce With lbeso opeollicaUons by tho cnntmcior,

24. ff '"1Y ""11-o<1)' or slrOOwra.lhereon ts provided orlmi,row,,! Wl!h tho aid of Fedoral tmaooiol ass1$.'°• .,..r,;J>d to lhe applioant, \tis . .,..,raooe shaU o!>ll,lole !he~\ odo tho .... of any!nmsfer of ""<ti propell)', . .,.,, tnt!!Sf....._ !o< lhe J)t<lo<I ~u,u,g.Wi'lioh tho teal propeny or , . •trudU!e i. used 1"ra pucposa fof \\llldl 1he Fodo,a fini!!l(;la! $$$1- ts e)I\Gn:!8!l or lbr nnolherpu'P""" lnvol\lioji \ha pl'O\'l,;on of <iinllar sONl,;os or b.,,.\ts;

25.lo tnll~ >ohgrants wflh noJlµiont i,is!ilutlonl! ut>:iorW. . , Comprei>enSOle co~~~. U egroes thSIS.\lth grants w,I bo subjecllo 0MB Cir<>i& A-122, 'Cost~ for Noi>-p,o!it · O:,Janlr>!io<t Including bu! nol HmffO<l to. tho ~lliij Roll¾!o<>" poi>llshed., ,rol 49, Fe<Je,al Regrorer, -1= ttirough 1am (Aprll T/,1984),

U.S. DE?AA1MENTOFH01,1£1.AN0$1;CUR!TY DR -4490 FEDaW- EMERGENcY·MANll(lEM!;ITT AGENCY (l,l>f.lt, }Va, 166Q.;)025

i!,.-p;,e. July :;1, 21107 . CERTIFICATIONS REGARDING LOBBYING• DEBARMENT SUSPENSION AND OiHER R.ESPONS!BIUTY MATTERS: ANO DRUG-FR.EEWORKPLACE REQU{REMENiS

PAPERWOR~ BI/ROJ;N DlSCLOSI/IJI! llO'llCE

Public_ ,.po,11r,; IYJO!eii fur. l1lls form l$ <!$tlmo\b0 lo •\'eraSO 1.7 hoios ""' ""'P_ =_ · 1ll• h:itd<l11 ""11mate ~ Iha_. ilai~ <or revi~ lnot!UOllo~_sand sna,ming exi!dlog data saurco,, ga'.h6ting ana,nalruam~ the !late noedc<l :mo """1jlle,'ln9; <md S1.lbmi111ng !he fuim. Yau ore not required 10 n,spon<I to tlil•oolle<ml at'tnrm:r,.,itlol> un.,.. • valid 0MB c.or,rot numberappem 1n lhe upper ri;)!l! corner at'thls form. S•Mooinmon\11 ,egor(foig !he ,.,,."""'If or lho burden esllmate aw.I eny ~,. far roduo!ng !he bual"" lo: lilfo:mati<ln CoQe~ t>.ai,agernert; U.S, !lopiulm,.,t cf Home!atl\l Se<>.!rlly, F!l®lw • emergenOj' MaA$g«nenl~e,,cy. 500 C Slfocl, sw,v>llshingl"'1, O(; 2Q.l12, ?ap•rwork.Re<!uctlon Frojed. (1660-0001). NOTE: oo not &lffld yaur eomploloo romi lo ihl'S ad.,,,.s. .

App;oan1" should rere.-la \ha mgulalions clled l>Olow!o d0lom1ine !he COlllfitalion lo ..nlol) !h,;y ere tequirod lo al!eoL A!'pft6,ms ,;hoWd also ra-.iew the insl(udloo< !or ""'1ifioatk>n lnc1udud in the "'IJ'Jlallons befor• oampJefing !Ill$ form. l)lgnature of 1lil< form provlda$ far compl!ari<:o ·wllh cerllficat;on requl""110llt.uru!er 44 CFR P"'1 13, 'New Restrlcifon, o., Lobbw,g" and 28 Cffi Part 17, 'Gol>'Ommant~~ Debarme<ll and Sl.!sp,11101on {N<lnproour,,mant) ang GoV"'1'ffion!.- Requ1""""'"" far o,ug.Fre<> l'l'orl<placo (~,-.tsJ_' ™ teltlllcaUons shal be treated as •.matartol ~ll!11on of faQ, upon whicll • · reliance 1~ be ptaced "'1etl lho Fodenll E,nrugency )J.,...;•manl Ageru:y (FSM,) <le!<>~ to •ward the -Ion, g"'1~ or ~IM> agreernen!,

1,1.0BBYlNG

As required by ••<li«>.1352, T,tie 31 bf the U.S. C<>.la, an:i lmpiemell!od at 44 CfR Pmt 1a, forp-=n> "'1lolinll iril• a 9'a"! on:ooperotlng ,greemon! aver i 100,000, as refined at 41 CFR \'311 HI, !he appJJcanl -··-(a) No Fodorol •p;l!Ollflatod funds hliVebe"'1 paltl o<Wil bo paid, by or oo beh>lf-<>1 lliO U!ldo,signad,.\o ,my P""""' for fn!luondng or atrempung lo t,ff_ an olfirerar~ of miy <>gency, a Memborof Congte,s, an omcor·orornpJoyee of Congress. orm employee oh Member of Congress io t,:,nned.io,j wl:I> lhe making of all)' f'•- gr.mt, the en!.ering Joto of any oooperanw &gr4o.wn.t. ant:! the exteostoo, cont!rnJatIM i ,~. a,nerdment. or~ of any F-ederal gr-aot or coopemnva agreement

(b) If any oltler/wlds fllan ~-I approprlatettrurtds have boon pekl or will-be.paid lo any oit,ar """"'1• lilr IO\luotlcl1lg orallempling lo ln:W•tr-" .,, ,,m,,,r <it emptey,,,, of any agency, a member of Congress, M offi<:el' or on em;,loyee of Congo,"'-, or"''lljllo~of a rnomb<!< or C<ingreu In co~nootion<Mlil lhll Federal Grant or ooopora!Mi ag_reemeol !hi! under,,lgnea shaB oom)>le!e and submit $tln4 Farm-ill., "Disdosure or lobbying Adiville$," ll1 l!CCOiu&11r:e 'Wi!h ii> il\$1-,

(q 'll,e un:iec,!g;,od oliO!l n,quire lhat·the 1"19""!1" i>f Ibis cerlitiea11on be lnc!ildO<f in lhe award documents lot au $U-at all Im(~

~. ""- tm:iergrarm, "1_ld ~-agreemeot;, •~d sllb~) ""'1 lhal ,ul Stlbrecljll- lll\al cor111y and <i'scio!le acconling!y.

Q ~ Foim.U.L 'O!s®s"" oll.<t,!,)'lllg AtlM!les'·,t1aclwd (T1liB futm ·aru,;tb• illt,,dv,/11" -!Ian If~ fwd$ are hi b• usedt,,- t.1dM1i,,,,

Z. llEBl\llMeNT;SUSPS'IS!ON, /IND OTHER RES?ONSlBIU)Y MATTEF-1 (DIREC'.f Rs;Jl'larr) .

Id "'qutrod by - Clrooi'125411, lle!lmment and Suspension, <nd lmp!O(lliiniell a!M CFil Part &'r, ·for~~ In ,nna,y -tr.inSJ!Ctlor>S, .. delroed al 4'4 Cffi Part 17, S<,dlon 11..StO-A. The'applioant t<!!jlfies l!'rl!l It and l!t pMrdpal,r.

(a) I'!<• npt _..ur <iebamld. 1111SJ)Ol1d'et!. !)TOl)O>«l fur d•barmenl. __ d &,ilgib)e, ..,nreooed·ti>•• - of Federal - by a Slatoor Federal OOUtt. or wlunlaiily ex<'.!lld«l ftool""""""' lransac!lo,,. b)' ar,y federal dopa,!m!,nloi'- .

(bl 1-!lm oot~ ~~rpeoodpn,o,diog fili<apJjlicallon oocii - !)! a or h~ a t:Mlia> ju\l;.<riant ,,.,.,,,,oo e;iai!>.st lhatn !,r

"""""1s,;ion of!r""'1<>r •--·Jn cbnnoclioo ..mi~ allcmptloa., Qbtain. or pedorm a pubr» a pu!,llo (Fedeml ,Slale. or-oo~ llo!n<aolion <ii conlnlci unds' ~ publio lrama<:llon; violall:m of Fe:leral or Sbru, uoH!nr.>l .tatu\e! or"""""""'"" of ~e,11, l!<lft. ft>lgo,y, bri!»!y,•~ c,r desDU,..1ion Qf-re~ ~ ~ $Ul\ement"$~ or

"""'1\/lfll! ·-proporly,

(c) /Ire not p,esenlly lodlded lot ollu1N.i .. cil:nID!!lly occMUy 1'h!lt!l00 by:a go~ entJly (Fi,d,ial, state, or for:a.1 "'11> oammisslt;rt ol any of th!> <>lfeo,.,. •~ in p,ragll>J)h (ii {I)) Qf this -lil.>n; and ·

(d) Ha'"> (lot wllliln ii lh~yea.r pa,lod P"""""S this applicaflon had one o/ """"' put.lo -on, (f<1dora( -Slale, or loooQ tetmm11te<1 for cause of · default; antr · ·

B, . Where fne applicant is ~ lo ·""111fy to any of the •la\0"""11• In u,i. eori~icirl,m, he or sh• shldl -.tt>cll an ei<pO!llalmn I<) tt,ls applica!ion.

3. ORUG.fRE!= WORKPLACE {GRAITTa'.O'(HER THAN INDIVIDUAi.SJ

As r,,qutred by !he Drug.Fl1!0 Woo:plaee NJ. of ISBS, nod implemonted a\ 44 Cffi Part 17, Subpart F, for: 9-. a, !lafir>¢<! al 44 CF~ Pait 17.615 . and 17 .6211'

A. The opplicanl. wtifi .. !het Ii \\111. tor,llooe lo pro-• drug.fr<>e •woil<plote by: . . (!l) Publishing~ - no!lfying emp!oyee> that th• utllawli.!l mJ!U.f.acture_. ~ (bl !;slablish<ig -~ 01>1!alng dillll Ire•~ .. program·n,(riform employo"' about-

()) lhe~of dt<Q ~• In ltio ""'#l"""'-(2) The IJ@Jll .. '• ~o!icy of malrnaWng a drug.free W01Jq>1aoo: (3) Any a\/!lflat.e drus ~. -n. Bl'id -emp!o;,eo ... 1a1anre jm,gram<; •n~ (4) n,o ~ L'iat may bo imt>O><>d upo,i enlployeea for d!U.!J abuse viol;dio<\l o=/rifll! in Ille'~

(q 1,~lnJj ff,a ~ ll>ateaohempioyl!e•fo oo.ongagedJn !he porfo'°"""" 0fll,olJf"l'l\1<l bli given a oapy oflho sla!emeot requrred 1'y ~h!a);

(c!J No!lfy!n\J lne ~in ttie11talen'iorl! r<>qtJired oy p,,,q,ph (a) !ha\, as a """dl!\o:t of~ qnde,111<,gre.,t, !he omploye,; will- ,

(1}Abiile Ii\< U.,lermof!hO.e!a\emont; oho

(2) Nol!fy lho.om;,!O)'Oe in ~ of hi< or her CQIMClion 1'>r a. ,to_ of• trimirnlt drug st.Me """""'l! loo tt,ewarl<placo no 1a1Sr-tilan flvo i;aian:!ar <!,,,.. alt,hU<ih ~nl;;

(<j Notl!)'lng !he "IJ"fl<l)', 111,<m11ng.YJil!110 caien:latd/!y!i a.'la-~ riOli!:11 urni., ,.,t,pan,g<a;>hid)(2) lro:n on on,p!oyeeor otherwl .. recelv~ aoloal ,-or,,..,;, ~n. Empl- of oofllllciO<f ~,nu,;l. p.v,1ld• nofic:o. la<lumng poomon. 1\!le, lo th• applicable FEMA liWarding <>lla.'t..~ u,gio.'lal ollioo or FEMA offioe.

FE.!AAFonn 20.!ilC, OCT 04 PREVIOUS eo.'TION 0SSO'..ET£

14. Will comply with the t16ocl Insurance purchase requirements of Section 102(a) of !he Flood Disaster Protection Act.of 1973 (P .L 93-234) which requires recipients In a special flood hazard area to partlqlpate fn the program and to purchase flood insurance In 1he total cost of insurable construction and acqulsltlon ls $10,0.00 or more.

15. Wlll comply wilh envlronmentaf standards which may be prescribed pursuant to the following: (a) lnstitutlon of envtronmental quality control measures under the National. Environmental Policy Actol1969 (P.L 91-190) and Executive Order (E.O.J 'ti 514; (b) notfficafion of violating farnllties pursuant to ED 11738; (c) protection olweHands pursuant to EO 11990;(d) evaluation.of flood hazards In floodplains in•accordarrce with EO 11988; {e) assurance of project consistency with the approved Slate manag.emerit programs developed under the Coastal Zone Management Act of 1973· (16 U.S.CLSections 1451 et seq.); (I) conrormity of Federal actions to State (Clean Air) Implementations Plans tinder SecUori 176(c) of the Clean Air Act of 1955,. as amen~ed·(42 u.s.c. Section 7401et seq.); (g) protection of um:letgtound sources of drinking water under-the Safe Drinklng Water Abt of 1974, as amended, (P.L 93-523); (HJ ProtecUon of Endangemd species.Act of 1973,.as :amended, .(P;L 93-205).

16. Will comply, wittlthe Wi!dand scenic Rivers.Act of 196B (16 V.s.c. Sections 1271 et seq;) refated to pr.otecllng components or potential components of the national wild and scenic ri\l'ers system.

17. Wit assistthe :awardlng agen:cy fn assuring ootnpliancewith Secfion 106 Of the Natlohal Hfstoric Pre!Seriratiian Act of 1966, as amended·(16 U.s.c. 470), EO 11593 Qden!ilicafion and preservation of historic properties), and the Archaeological and Historic Preservatidn Act of 1974 {16 U:S.G. 46s·1 et seq,).

18. WI! cause 1o be performed the required iinancia1 and QOrripllance audits 11'1 accol"dance With the Single-Audit Act of 1984,

19. \Nill complywfth all applicable retjulrements.of all other Federal laws,. Exeoutive Orders, ~gulatlons and ppl_lcies gt1veming this program.

20. lt.wm comply wtth llle minimum y,,age and m~•lmum hours provisions of the Federal Fair labor Standards.Ao! (29.U.S:C. 201), as they apply to employees ofinstitufions ·of ~igher eduPat1011, hospital$., and oth~r non-pi:ofit-o·rganjzatlons,

21. l! will oblaln .a)lprmtal by the appropriate Federal ~gencies of the iiriaf-Wotidrig drawings and sp~icafioflS befoi'e the·project ls advertised .or placed pn the market for bidrJlng;. "tt1al it will construct the project, or .cause It to be constructed, to final -completion in accordance with the·applioa_tton and apProvect "plans and speoiflCations; that }t wm submit to the appropriate· Federaf agency forp.rior approval ahan.9·es that alterihe cost Df the ,project, ·US!'.61 '!Pace, or functional layout; lh~t tt will not enterlnto a construction contract(/,) for !he projector undertake o1her acti\,,ifies unULthtrnonditions of the construction nrant program(s) have beE!n met:. ·

22 .. It will operate and-maintain "the facility .fr.I accordance withlbe· minimum slandan:ls as maybe required or·prescfibed bythe appn"cable F~deral, state. arid focat agenGi_es forttie mairrtenaitce and operation of such facifities.

DR-4490

23. It Yiill require the facility to be designed to comply with the "American Standard Specifications for Making Buildings ·and Fadlilles Accessible to, and Usable by~ the Physica[ly Handicapped/ Number A117-1961, as mod'rlied (41CFR 101-17 .703). The applicant will be responsible for conducting inspections to ensure compliance wfth these specifications by the contracior.

24, If any real property or structure thereon 1s provided or improved with the aid of Federal financial assistance extended to the applicant, this assurance shall obligate the applicant. or in the case of any transfer of such property, any transferee, for the period during which the real property or stn.Jcture Is used far a purpose for whlch the Federal financial essistance is extended or for another purpose lnvohtlng the provtSion of similar services or benefits.

25. In making subgrants with nonprofit institutions under this Comprehensive Cooperatlve·AgreemenL It agrees that such grants will be subject to 0MB Circular A· 122, "Cost Principles for Non;:,mfit Organization" Including but not limited ta. the ."Lobbylrm Revision" publfshed in vol 49, Federal Register, pages 18260 through 18277 (April Z/, 1984)..

{f) Taking one of the following aciions, v..4thin 30 calendar days of recefving noUce Under subparagraph (d}{2). with respect to any employee who fs convicte:d-

{1) Taking appropriate personnel action against such an employee. up to and inc1uding termin~fion, consistent with the requirements of the Rehabilitation act of 1.9n, as amended; or

(2) Reqohing such an employee to participate safisfactorily In a drug abuse assistance or rehabifitatian program approved for such pUTposes by a Federal, Stale, or lo cat heam,. law enfon::ement. or other appropriate agency;

(g) Making ·a good· faith effort to continue to maintain a drug itee wort,place lhroo;1h implementation <>f paragraphs (a),(b),(c),{d),{e) and (ij.

B. The grantee may insert In ~e space provided below the site(s) for the perforrnahce of work done In connection with the.speclfie grant

DR-4490

Place of Performance (Street address, City. County, state, Zip code)

Check CJ: If there are workplaces on file that are not identified here.

Section 17 .630 of ihe regulations provide that a grantee· that is a State may elect lo make one certification in each Federal ff seal year. A copy of which should be included with each application fur FEMA funding. states and State agencies may elect to use a state wide certification.

DISCLOSURE OF LOBBYlNG ACTIVITIES

Complete this. form to disclose lobbying activities pursuant to 31 U.S,C.1352

2. ' Status of Federal Action: □ a. l:idfutk1!J!;lpll~

3. • Report Typo: {8J a, i!!IUal llffl!i

18} b.i!,Jlialawa«:I

□ C.l)OU-l¼'M'ilfd

4. Name and Address of Reporting Entity:

!ls]M,~ □•-~ .,,._ f':,,·.·

□•·"""""""""'

5.1! Reporting Entity in No.4 is Subawardee, Enter Name and Address of Prime:

7. • f<lderal Program Name/Description:

8. Federal Action Number, Jf known: 9. Award Amount, if known: $ ._ _____ __,

10. a. Name and Address of Lobbying Registrant:

,_ ,--

DR-4490

Appt4VOd by 0MB

0348-0048

.,.,,,.,,::-,,,,-::-;,=,>= .. =::!...--.!:::========:::!.....1 - -====-----J ·-, ,_=::::::::::::::::::::::::::::::::======::-:-~,, ~-=====-----------b. Individual Performing Services f""""""""""'"'--•~ 10,)

""" I I"""'"'"" 1, > 1-•N""" --===---..... ,,,.,,, , I """'I -====~------"" I

1 t. ~tion ~ ttvwu,\'i ttim iorm 15 IW~ ~l!Oi! 31 u,s..c, ~ 1:152. Thitd~ Qf~ ~iu Ui .o ~m;irm,1m!iifk")!'l of fuel \l$-Oll ~ t!!litlttco "'1::1$;:ila:od bylhll. ~.:lbow:l'dlrm Iha ~O!I Wll$ mW r, ii!Mtad Mil. Tik ~ i! ~td~ ~ l1 U.S.,C. 1:!S2, nili:inh:.mni60,1 \llilfb, ~~ tQ ttm G~ aemi-<!intW&Uy s'ld wt!: W' ~~r~ fer p.illlk: ln~ /t.s'1y~ ~tail;W~ l.tmro~d~im; ~ ll!'.!1rul~ le s ci.vl petmlly O'frul le!!! thltll tlll.000 Uld:-nol!Mf\l mon S:1(l{UID(l lt;r~wcll taliurii,

"Slg!\atUNi: jc.1;.1!111,h:·tiXi tm ~u:;i.oo to G::ruu:l'..9ew

~fltl"l~~pr.;,d~ -!ul>'™<l~~LLL(ltW.}-ll-1)