HomeMy WebLinkAboutR-2005-063 Firefighters vehicle exhaust system grant RESOLUTION NO. 2005-063
A RESOLUTION OF THE CITY OF DANIA BEACH, FLORIDA,
AUTHORIZING THE PROPER CITY OFFICIALS TO APPLY FOR, ACCEPT
IF AWARDED AND EXECUTE AN AGREEMENT FOR THE 2005
ASSISTANCE TO FIREFIGHTERS GRANT FOR THE PURCHASE AND
INSTALLATION OF A VEHICLE EXHAUST SYSTEM IN THE AMOUNT
OF $77,640.00; AUTHORIZING MATCHING FUNDS IN THE AMOUNT OF
$7;764.00 AND FURTHER AUTHORIZING TIME EXTENSIONS IF
NEEDED; PROVIDING FOR CONFLICTS; FURTHER, PROVIDING FOR
AN EFFECTIVE DATE.
WHEREAS, the City of Dania Beach Fire Department is in need of a vehicle exhaust
system to meet the minimum standards of the National Institute of Occupational Safety & Health
(NIOSH), the American Conference of General Industrial Hygienists (ACGIH), the U.S.
Department of Health (USDOH), and the Occupational Safety and Health Administration
(OSHA); and
WHEREAS,FEMA/USFA has a grant program which offers financial assistance for such
projects; and
WHEREAS, the Fire Department would like to apply for the 2005 Assistance to
Firefighters Grant Program to cover ninety percent (90%) of the cost of a vehicle exhaust
system;
NOW,THEREFORE,BE IT RESOLVED BY THE CITY COMMISSION OF THE
CITY OF DANIA BEACH, FLORIDA.
Section 1. That the Fire Department is authorized to apply for the 2005 Assistance to
Firefighters Grant Program in the amount of$77,640.00, attached as Exhibit "A".
Section 2. That the 10% match requirement in the amount of$7,764 will be funded from
the FY 2006 operational budget.
Section 3. That upon the 2005 Assistance to Firefighters Grant Program being awarded to
the City, the appropriate City Officials are authorized to accept the award and execute the Grant
Agreement and all other relevant documents in a form acceptable to the City Manager and
approved as to form and legality by the City Attorney. The City Manager and City Attorney are
authorized to make minor revisions and approve time extensions, if needed, to related documents
• as are deemed necessary and proper for the best interests of the City.
Section 4. That upon the 2005 Assistance to Firefighters Grant Program being awarded
to the City the Finance Director is authorized to appropriate the budget by the award amount in
grant revenue and appropriate expenditure account.
Section 5. That all resolutions or parts of resolutions in conflict with this Resolution are
repealed to the extent of such conflict.
Section 6. That this Resolution shall be in force and take effect immediately upon its
passage and adoption.
PASSED AND ADOPTED on April 26, 2005.
D',a,-T,
ANNE CASTRO
MAYOR—COMMISSIONER
ATTEST: ROLL CALL:
'T COMMISSIONER ANTON - YES
COMMISSIONER BERTINO —YES
• LOU.'ISE STILSON COMMISSIONER MCELYEA - YES
CITY CLERK VICE-MAYOR FLURY - YES
MAYOR CASTRO - YES
APPROVED AS TO FORM AND CORRECTNESS:
BY: 1'\,"aAe
THOM�S N BRO
CITY ATTORNEY
2 RESOLUTION #2005-063
Agenda Request Form
City of Dania Beach
Agenda Item. 9
Date of Commission meeting: 4/26/2005
Description of Agenda Item: FEMA 2005 Assistance to Firefighters Grant Program
Commission action being requested:
Adopt Resolution or Ordinance ® Expenditure ❑ Award BID /RFP ❑
Presentation ❑ General approval of item ❑ Continued from meeting
Other(Please'ezplam)
Summary explanation antl background
Staff requests authorization to apply for, accept if award, and have proper City officials execute an agree-
ment and for the FEMA 2005 Assistance to Firefighters Grant Program for the purchase of a vehicle
• exhaust system in the amount of$77,640.00. This grant will provide 90% of the cost with $7,764.00
(10%) match to be funded from the FY2006 operational budget.
'ttachetl exhibits a'd additional backup materials (Please list):
Resolution - paper attachment
Grant Application - paper attachment
For purchasing requests ONLY
Department: Amount:
Fund: General: ❑ Water: ❑ Sewer: ❑ Stormwater: ❑ Grants: ❑ Capital: ❑
Account Name: Account Number:
Submitted by: btemchuk Date: 4/18/2005
Department Director: btemchuk Date: 4/18/2005
Admin. Services Director: Date:
Finance Director. �t:- "" Date.-
City Manager _ Date: 7_ /T�7qc j
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Contact Information
Alternate Contact Information Number 1
Title Captain
Prefix N/A
•First Name Bruce
Middle Initial A
Last Name Caruso
Business Phone 954-924-3725 Ext.
-Home Phone 954-962-4186 Ext.
Mobile Phone/Pager 954-651-5029
Fax 954-921-2604
-Email bcaruso@ci.dania-beach.fl.us
Alternate Contact Information Number 2
Title Chief
Prefix N/A
•First Name Ken
Middle Initial
Last Name Land
Business Phone 954-924-3720 Ext.
•Home Phone 954-921-3723 Ext.
Mobile Phone/Pager 954-651-5022
Fax 954-921-2604
-Email kland@ci.dania-beach.fl.us
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Applicant Information
W-2005-FG-17139
finally submitted on 04/08/2005 by Bonnie Temchuk(Userid: bt7460)
Contact Information:
Address: 100 W. Dania Beach Blvd.
City: Dania Beach
State: Florida
Zip: 33004
Day Phone: 954-924-3613
Evening Phone: 954-924-3613
Cell Phone: 954-924-3613
Email: btemchuk@ci.dania-beach.fl.us
Application number is EMW-2005-FG-17139
•Organization Name City of Dania Beach Fire Department
•Type of Applicant
Fire Department
•Type of Jurisdiction Served City
If other, please enter the type of Jurisdiction
• Employer Identification Number 59-6000302
• Does your organization have a DUNS Number? Yes
James, please enter the DUNS.-Number 098525728
dquarters Physical Address
.Physical Address 1 116 W. Dania Beach Blvd.
Physical Address 2
•City Dania Beach
-State Florida
•Zip 33004 -3699
Need help for ZIP+47
Mailing Address
• Mailing Address 1 100 W. Dania Beach Blvd.
Mailing Address 2
•City Dania Beach
• State Florida
•Zip 33004 - 3699
Need help for ZIP+4?
Account Information
•Type of bank account Checking
• Bank routing number- 9 di it number on the bottom left hand 067006432
corner of your check
'Your account number 2000143220046
Otional Information
• For this fiscal year (Federal) is your jurisdiction receiving
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Federal funding from any other grant program that may No
duplicate the purpose and/or scope of this grant request?
If awarded this grant, will your jurisdiction expend greater
Oan $300,000 in Federal share funds during the Federal fiscal No
ar in which the grant was awarded?
• Is the applicant delinquent on any federal debt? No
If you answered yes to any of the additional questions above,
please provide an explanation in the space provided below:
•
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Department Characteristics (Part 1)
re you a member of a Federal Fire Department or
ntracted by the Federal government and solely responsible No
for suppression of fires on Federal property?
'What kind of organization do you represent? All Paid/Career
If you answered combination, above, what is the percentage %
of career members in your organization?
What type of community does your organization serve?
Urban
What is the square mileage of your primary response area? 8.64
What percentage of your response area is protected by 100
hydrants?
' In what county/parish is your organization physically located?
If you have more than one station, in what county/parish is Broward
your main station located?
Does your organization protect critical infrastructure of the Yes
state?
' How much of your jurisdiction's land use is for agriculture, 5 %
wild land, open space, or undeveloped properties?
'What percentage of your jurisdiction's land use is for 35
commercial, industrial, or institutional purposes?
at percentage of your jurisdiction's land is used for 60
dential purposes?
• How many commercial, industrial, residential, or institutional 40
structures in your jurisdiction are more than four stories tall?
What is the permanent resident population of your 28000
Primafy/First Due-Response Area or urisdiction served?
'How many active firefighters does the department have who 53
perform firefighting duties?
' How many personnel provide only EMS service delivery? 0
' How many stations are in your organization? 2
M Do you currently report to the National Fire Incident Yes
Reporting System (NFIRS)?
If you answered yes above, please enter your FDIN/FDID 10032
' What services does your organization provide?
Structural Fire Suppression
Basic Life Support
Advanced Life Support
•
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Department Characteristics (Part II)
What is the total number of fire-related civilian fatalities in your jurisdiction 0
over the last three years?
'What is the total number of fire-related civilian injuries in your jurisdiction 15
over the last three years?
.What is the total number of line of duty member fatalities in your jurisdiction 0
over the last three years?
What is the total number of line of duty member injuries in your jurisdiction 39
over the last three years?
In an average year, how many times does your organization receive 876
mutual/automatic aid?
In an average year, how many times does your organization provide 1392
mutual/automatic aid?
What was your organization's estimated average annual operating budget 7500000
over the last three years?
What percentage of your annual operating budget is dedicated to 85 %
personnel costs (salary, overtime and fringe benefits)?
*What percentage of your annual operating budget is derived from:
Enter numbers only, percentages must sum up to 100%
Taxes? 100 %
Grants? 0 ova
Donations? 0
Wdrives? 0
Other? 0
If you entered a value into Other field (other than 0), please explain
*How many vehicles does your organization have in each of the categories below? Enter numbers only and enter 0 if you do not
have any of the vehicles below
Total Number
Engines (or pumpers):
Pumper,Pumper/Tanker,Rescue/Pumper, Foam Pumper,CAFS Pumper,Quint(Aerial device 4
of less than 76 feet), Fire Boats(more than 13 feet long),Type I,Type Il,Type III Engine,
Tanker, Tender,Foam Tanker/Tender(greater than 1,200 gallon tank capacity)
Aerial Apparatus:
Aerial Ladder Truck,Telescoping,Articulating,Ladder Towers, Platform,Tiller Ladder Truck, 0
Quint(Aerial device of 76 feet or greater)
Brush/Quick attack : 0
Brush Truck, Patrol Unit(Pick up w/Skid Unit),Quick Attack Unit, Mini-Pumper,Type IV Engine
Rescue Vehicles.-
Rescue Squad, Rescue(Light, Medium,Heavy),Technical Rescue Vehicle, Hazardous 5
Materials Unit
Other:
EMS Chase Vehicle, Air/Light Unit,Rehab Units, Bomb Unit,Technical Support(Command, 10
Operational Support/Supply),Hose Tender, Salvage Truck,ARFF (Aircraft Rescue Firefighting),
Command/Mobile Communications Vehicle, Other Vehicle
Provide in the space below the following information only if you are applying for a vehicle:
*cable,
have 15 emergency response vehicles or less, list all vehicles providing the type, the age, the pump capacity (GPM) if
and the carrying capacity (gallons) if applicable.
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If you have more than 15 emergency response vehicles, provide us with the oldest, newest, and the average age of the vehicles
per type or class of vehicle.
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Department Call Volume
Wow many responses per year by category? (Enter whole numbers only: If you have no calls for any of the categories,enter0)
Structural Fires 47
Vehicle Fires 80
Vegetation Fires 50
EMS Response Call 6600
Rescue 150
Hazardous Condition/Materials Calls 174
Service Calls 34
Good Intent Calls/False Alarms 280
Other Calls and Incidents 470
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Request Information
laSelect a program for which you are applying. Remember, you can only apply for one program this year. You can apply for as
ny activities within a program as you need.
(If you modify your selection,you will lose data entered under the original activity.)
Program Name
Operations and Safety
2. Will this grant benefit more than one organization?
No
If you answered Yes to Question 2 above, please explain.
Request Details
The activities for program Operations and Safety are listed in the table below.
Activity Number of Entries Total Cost Additional Funding
Equipment 0 $ 0 $0
Modify Facilities 1 $ 77,640 $0
Personal Protective Equipment 0 $ 0 $0
Training 0 $ 0 $0
Wellness and Fitness Programs 0 $ 0 $0
•
Modify Facilities
`1. On what type of modification will the funds be spent? Exhaust System(s)
Please provide further description of the item selected above STRA-90 Straight Rail system for drive thru
application, 8 vehicles; SBT 7.5hp Fan, 3PH, 8
drop, spark resistant blowers, AMCA Type A
(attaches to exhast pipe of vehicle); OS-3 Control
Operation System for 7.5hp-208V-240V, 3ph; EPA
Unifilter system; High speed exit shock absorber
`2. What is the age of the facility that is being modified? 40 years
"3. What type of facility will be modified? Station(s)
If you answered other, above, please specify.
*4. What is the level of occupancy for the facility you wish
to modify? Note:The occupancy is defined by the number of hours Full-Time
the facility is used within a single 24 hour time period
`5. What is the maximum occupancy of the building or 35 number of people
facility to be modified?
*6. Is the facility that you wish to modify open for use by other organizations No
or community groups on a regular (i.e., weekly, monthly) basis?
I& answered Yes, above, please explain
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Budget Item
l0em Vehicle Exhaust System
Select Object Class Equipment
If you selected other above, please specify
" Number of units 3 (Whole number only)
Cost per unit $ 25880 (Whole dollar amounts only)
Budget
Budget__Object Class
a. Personnel $ 0
b. Fringe Benefits $ 0
c. Travel $ 0
d. Equipment $ 77,640
e. Supplies $ 0
f. Contractual $ 0
g. Construction $0
Wther
$ 0
i. Indirect Charges $ 0
Federal and Applicant Share
Federal Share $69,876
Applicant Share $ 7 764
Federal Rate Sharing (%) 90/10
Non-Federal Resources (The combined Non-Federal Resources must equal the Applicant Share of $ 7,764)
a. Applicant $ 7,764
b. State $ 0
c. Local $ 0
d. Other Sources $ 0
If you entered a value in Other Sources, include your explanation below. You can use this space to provide information on the
project, cost share match, or if you have a indirect cost agreement with a federal agency.
Total Budget $77,640
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Hppiication Number: EMW-2065-FG-17139 Page 11 of 1
Narrative Statement
• Project Description
* Please provide your narrative statement in the space provided below. Include in your narrative, details regarding (1) your
project's description and budget, (2) your organization's financial need, (3) the benefit to be derived from the cost of your project,
and (4) how the activities requested in your application will help your organization's daily operations and how this grant will
protect life and property.
PROJECT NEED AND GOAL DESCRIPTION:
It is the desire of City of Dania Beach Fire Department to obtain an AFG Grant under the Fire Operations and Firefighters Safety
Program which would be used to modify our only fire station under the category Section e) titled "Modifications to Fire Stations
and Facilities". The City of Dania Beach currently leases additional space from the City of Hollywood Fire Department, which
consists of two bays located in the City of Hollywood. Because of this, we are requesting to install a vehicle exhaust extraction
system, which would be attached to each one of our fire apparatus in the station owned by the City. Our fire department has
been actively pursuing the purchase of a vehicle exhaust extraction system in order to protect our station personnel and daily
general public visitors from cancer causing effects of vehicle exhaust emissions. Our apparatus generates these emissions
during startup, return to quarters and routine pump testing in our facilities. We have been repeatedly unable to obtain funding
due to the constraints of our financial budget. Financial funding through an AFG Grant will allow us to eliminate this hazardous
exposure and comply with NFPA 1500-2002 Edition, section A.9.1.6.
Current changes in health and safety standards have clearly identified that vehicle exhaust emissions, in particular, whole diesel
exhaust (PM10) is a cancer causing substance. Agencies documenting the hazards of diesel exhaust include but are not limited
to The National Institute of Occupational Safety & Health (NIOSH), The American Conference of General Industrial Hygienists
(ACGIH), The U.S. Department of Health (USDOH), The Occupational Safety and Health Administration (OSHA). The above
listed agencies have led to the implementation of NFPA 1500—2002 Edition Standard 9.1.6 on facility safety regarding exhaust
emissions. Guidelines for vehicle exhaust elimination state: "Local exhaust ventilation that remove harmful fumes at their source,
hoses at tailpipe or stack exhaust" as listed in the OSHA Health and Safety Fact Sheet; " Motor vehicles that are operated shall
provided with a source capture system that connects directly to the motor vehicle's exhaust system. In addition, recirculation
it is prohibited", as stated in the IMC Code 2003. The Agencies listed•and the above quoted statements support our request
and the justification for the vehicle exhaust extraction system for the health and safety of our firefighters, administrative
personnel, employees of other departments and visitors.
Over the years our personnel have strongly voiced their concerns about the hazard of diesel exhaust and how it may be affecting
their health, presently and long term. Many of our department members are aware that there is a solution available, but in the
past the implementation of the vehicle exhaust extraction system was not considered a fundable mandate. Now that AFG funds
are available we see more pressure to act in the firefighter's best interest, especially on all aspects of health and safety issues.
The accumulation of exhaust contamination is evident throughout the station. Some of the effects of this cross contamination
pertain to sleeping quarters, training area, meeting rooms, dispatch center, food preparation area, medical supplies and
equipment including firefighter's turnout gear, which are stored on the apparatus or in the lockers to the rear of the apparatus.
These areas are used by fire personnel 24/7/365. Our station is also used as the EOC (Emergency Operation Center) for the
City of Dania Beach.
If we allow the continuation of toxic build up in our station, it will lead to serious health and financial crisis affecting our
community and taxpayers. Occupational asthma or cancer related illness claims for workmen's compensation, line of duty
related illness and medical insurance claims can clearly be tracked and attributed to exposure to vehicle exhaust emissions.
Such a crisis would have significant impact on the financial operations of our department, the moral of department members, the
ability to recruit new firefighters, and impact neighboring fire department firefighters who enter our building during mutual aid
operations.
The proposed system provides not only protection from exhaust emissions but long term financial savings as well. Savings will
be seen in the form of the potential reduction of insurance premiums, reduced building maintenance cost, reduced liability and
lower energy bills by enabling the bay doors to remain closed. Besides protecting our members from exhaust e rnissions, our
department will achieve direct financial savings by reducing energy consumption while complying with the U.S. Green Building
Oncil Standards (USGBC).
believe our firefighters are our most valuable asset and that protecting them from the hazards of diesel exhaust is our
highest priority. Although our firefighters are subjected to work related exposures on an intermittent basis, vehicle exhaust
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emissions are the only work related carcinogen that they are exposed to consistently and which can be eliminated.
Homeland Security is also a great concern to our Department. After a recent alert issued by the International Association of Fire
iftiefs (IAFC) regarding station security, our department would like to implement more stringent operating procedures for
ecuring our station at all times. Installing the vehicle exhaust extraction systems, would allow us to keep our station doors
closed during routine maintenance, vehicle checks and training drills, enabling us to fulfill security procedures.
PROJECT DESCRIPTION:
The proposed PlymoVent system that we will purchase if AFG Grant money is received has been independently tested and
verified to be capable of capturing 100% of the vehicle exhausts emissions at the point of generation (tailpipe)by making an
airtight seal to the tailpipe of our apparatus. This fulfills the current NFPA 1500—2002 Edition requirement"the need for
elimination and containment of all vehicle exhaust emissions to a level of no less than 100% effective capture." The vehicle
exhaust extraction system will utilize an auto start electrical control box which is UL tested and certified. This controller will
automatically energize an exhaust blower upon the starting of the vehicle and in turn will extract all exhaust emissions out of the
building. Fulfillment of this grant will allow us to comply with NIOSH, OSHA, IMC (International Mechanical Code), UMC (Uniform
Mechanical Code) standards and codes for hazardous material exhaust control systems. A source capture system as defined by
IMC 2003 is "A mechanical exhaust system designed and constructed to capture air contaminants at their source and exhaust
such contaminants to the outdoor atmosphere". The system that we have selected for purchase fulfills all these requirements
and is recognized as the leader in vehicle exhaust extraction systems and is certified by UL, ISO-9001, and Air Movement and
Control Association (AMCA) performance and quality assurances. This system was designed to specifically meet the needs of
emergency response vehicles and is fully automatic so as not to interfere with firefighter response time.
Our grant request for the PlymoVent vehicle exhaust extraction systems is in complete compliance of the 2005 Program
Guidance for the Assistance to Firefighter's Grant Program requirements as stated "Any vehicle exhaust extraction system
obtained should be extensive enough to extract all toxic vapors and particulates emitted from internal combustion engines".
The station consists of three bays housing three engines, two EMS units and two incident command vehicles, The depth of the
area is approximately 95'. All apparatus would be connected to the vehicle exhaust extraction system. The cost for the
installation of the described vehicle exhaust extrication system is $77,640.00.
ift proposed system can utilize a particulate filter, which will reduce up to 99% of the diesel exhaust being emitted to the
osphere while the vehicles are being run in quarters, and during daily maintenance checks. This would put our department in
a position to comply with the Clean Air Act of 1990 and protect the surrounding community from airborne contamination our fire
apparatus generate and will fulfill environmental requirements.
To better serve the intended purpose of this grant program, we have elected to internally fund the retrofitting of all of our vehicles
exhaust system's to adapt to the PlymoVent system, so that a greater portion of grant funds may be awarded to more fire
departments nationwide, therein protecting a greater number of firefighters from these diesel carcinogens. These items are not
included in the cost of our grant request.
BENEFIT FROM THE COST TO OUR DEPARTMENT AND THE COMMUNITY:
1. The vehicle exhaust extraction system would be used on a daily basis which would have a financial cost savings to our
Department not only from the health and safety aspect of our personnel but also in reducing maintenance costs related with
painting, furniture and fixture replacement, and most of all infiltration of carbon soot particles which contaminate and short out
sensitive electronic devices such as station computers, EMS equipment, and smoke/heat detectors.
2. Reduced exposure to workmen's compensations and medical insurance claims and line of duty related illnesses.
3. Reduced energy costs.
FINANCIAL NEED OF OUR DEPARTMENT:
The City of Dania Beach is a coastal community located in Broward County (in south-east Florida). It is the oldest City in
Broward County and is located directly south of the Ft. Lauderdale/Hollywood International Airport and Port Everglades Cruise
*Ian.
Cargo facilities. The Department provides automatic aid to the City of Hollywood and participates in the County wide mutual
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The City of Dania Beach is the oldest City in Broward County, Florida (established in 1904). Our population consists mostly of
low to moderate income families and senior citizens. The City of Dania Beach is feeling the economic crunch,much like all areas
of government, but even more so this year than the past several years. Under the Save Our Homes Amendment, Florida
Afionstitution states the assessed value of Homestead property can be no greater that 3% more than last year's assessed value
consumer price index, whichever is less. The Department of Revenue certifies the consumer price index.
With a recent annexation, which increased our population from 19,500 to 28,000, the need for service's rose,yet the revenues
from this annexation were minimal. This recent annexation consisted of low income and/or senior citizens, which adversely
affected the Fire Department by increasing the call volume yet limiting our revenues due to the Save our Homes Amendment,
the standard $25,000 Homestead Exemption and the additional$25,000 Senior Homestead Exemption.
The economic result to the Department budget has been a slight reduction yet with an increase in population,square miles and
alarms. Staffing and funding for equipment and building maintenance have suffered.
The current and proposed funding allocation for purchases and building maintenance does not provide for the purchase of a
vehicle exhaust extraction system.
CONCLUSION:
The goal of this application is to purchase equipment to protect the health and safety of the personnel of this department as well
as the civilians that have need to visit the fire station.
The City of Dania Beach Fire Department is committed to provide the 10% cost share of this project as well as the retrofitting and
all related costs for this equipment. The funding will be made available through the yearly budget process.
' Please describe any grants that you currently have with DHS including the AFG, for example, 2002 AFG grant for vehicle or
2003 ODP grant for exercises. (Enter"NIA" if Not Applicable)
NIA
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Assurances and Certifications
em 20-16A
You must read and sign these assurances by providing your password and checking the box at the bottom of this page.
Note: Fields marked with an ' are required.
Assurances Non-Construction Programs
Note: Certain of these assurances may not be applicable to your project or program. If you have any questions, please contact
the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If
such is the case, you will be notified.
As the duly authorized representative of the applicant I certify that the applicant:
1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial
capability (including funds sufficient to pay the non-Federal share of project costs) to ensure proper planning,
management and completion of the project described in this application.
2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State,
through any authorized representative, access to and the right to examine all records, books, papers, or
documents related to the award; and will establish a proper accounting system in accordance with generally
accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or
presents the appearance of personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding
agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. Section 4728-4763) relating to
prescribed standards for merit systems for programs funded under one of the nineteen statutes or regulations
specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900,
Subpart F).
6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a)
Title VI of the Civil Rights Act of 1964 (P.L. 88-352)which prohibits discrimination on the basis of race, color
or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. Sections 1681-
1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation
Act of 1973, as amended (29 U.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) Sections 523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. 290-dd-3 and 290-ee-3), as amended, relating to confidentiality of alcohol and
drug abuse patient records; (h) Title VIII of the Civil Rights Acts of 1968 (42 U.S.C. Section 3601 et seq.), as
amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being
made; and 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 a nd
equitable treatment of persons displaced or whose property is acquired as a result of Federal or Federally
assisted programs. These requirements apply to all interest in real property acquired for project purposes
regardless of Federal participation in purchases.
8. Will comply with provisions of the Hatch Act (5 U.S.C. Sections 1501-1508 and 7324-7328), which I imit the
political activities of employees whose principal employment activities are funded in whole or in part with
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Federal funds.
9. Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C. Sections 276a to 276a-7),
the Copeland Act (40 U.S.C. Section 276c and 18 U.S.C. Sections 874), and the Contract Work Ho urs and
0 Safety Standards Act (40 U.S.C. Sections 327-333), regarding labor standards for Federally assisted
construction sub agreements.
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster
Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in
the program and to purchase flood insurance if the total cost of insurable construction and acquisition is
$10,000 or more.
11. Will comply with environmental standards which may be prescribed pursuant to the following: (a)institution of
environmental quality control measures under the National Environmental Policy Act of 1969 (P.L.91-190)
and Executive Order(EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of
wetlands pursuant to EO 11990; (d) evaluation of flood hazards in flood plains in accordance with EO 11988;
(e) assurance of project consistency with the approved State management program developed under the
Coastal Zone Management Act of 1972 (16 U.S.C. Section 1451 et seq.); (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. Section 7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking
Water Act of 1974, as amended, (P.L. 93-523); and (h) protection of endangered species under the
Endangered Species Act of 1973, as amended, (P.L. 93-205).
12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. Section 1271 et seq.) related to protecting
components or potential components of the national wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation
Act of 1966, as amended (16 U.S.C. 470), EO 11593 (identification and protection of historic properties), and
the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.).
14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development,
and related activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. 2131 et
seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or
other activities supported by this award of assistance.
16. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. Section 4801 et seq.)which
prohibits the use of lead based paint in construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit
Act of 1984.
18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and
policies governing this program.
19. It will comply with the minimum wage and maximum hours provisions of the Federal Fair Labor Standards Act
(29 U.S.C. 201), as they apply to employees of institutions of higher education, hospitals, and other non-profit
organizations.
Signed by Bonnie Temchuk on 04/07/2005
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Form 20-16C
You must read and sign these assurances byproviding your passwordand checking the box at the bottom of this page.
Ote: Fields marked with an * are required.
Certifications Regarding Lobbying, Debarment, Suspension and Other Responsibility Matters and Drug-Free Workplace
Requirements.
Applicants should refer to the regulations cited below to determine the certification to which they are required to attest.
Applicants should also review the instructions for certification included in the regulations before completing this form. Signature
on this form provides for compliance with certification requirements under 44 CFR Part 18, "New Restrictions on Lobbying; and
28 CFR Part 17, "Government-wide Debarment and Suspension (Non-procurement) and Government-wide Requirements for
Drug-Free Workplace (Grants)." The certifications shall be treated as a material representation of fact upon which reliance will be
placed when the Department of Homeland Security (DHS) determines to award the covered transaction, grant, or cooperative
agreement.
1. Lobbying
A. As required by the section 1352, Title 31 of the US Code, and implemented at 44 CFR Part 18 for persons(entering) into a
grant or cooperative agreement over$100,000, as defined at 44CFR Part 18, the applicant certifies that:
(a) No Federal appropriated funds have been paid or will be paid by or on behalf of the undersigned to any person
for influencing or attempting to influence an officer or employee of any agency, a Member of Congress,an officer or
employee of congress, or an employee of a Member of Congress in connection with the making of any Federal
grant, the entering into of any cooperative agreement and extension, continuation, renewal amendment or
modification of any Federal grant or cooperative agreement.
(b) If any other funds than Federal appropriated funds have been paid or will be paid to any person for influencing
or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of
congress, or an employee of a Member of Congress in connection with this Federal grant or cooperative
agreement, the undersigned shall complete and submit Standard Form LLL, "Disclosure of Lobbying Activities", in
accordance with its instructions.
(c) The undersigned shall require that the language of this certification be included in the award documents for all
the sub awards at all tiers (including sub grants, contracts under grants and cooperative agreements and sub
contract(s)) and that all sub recipients shall certify and disclose accordingly.
2. Debarment, Suspension and Other Responsibility Matters (Direct Recipient)
A. As required by Executive Order 12549, Debarment and Suspension, and implemented at 44CFR Part 67, for prospective
participants in primary covered transactions, as defined at 44 CFR Part 17, Section 17.510-A, the applicant certifies that it and its
principals:
(a)Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of
Federal benefits by a State or Federal court, or voluntarily excluded from covered transactions by any Federal
department or agency.
(b) Have not within a three-year period preceding this application been convicted of or had a civilian judgment
rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to
obtain or perform a public (Federal, State, or local) transaction or contract under a public transaction; violation of
Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property.
(c) Are not presently indicted for or otherwise criminally or civilly charged by a government entity (Federal, State, or
local)with commission of any of the offenses enumerated in paragraph (1)(b) of this certification: and
(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
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this application.
3. Drug-Free Workplace (Grantees other than individuals)
required by the Drug-Free Workplace Act of 1988, and implemented at 44CFR Part 17, Subpart F, for grantees, as defined at
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).
(8) The grantee may insert in the space provided below the site(s) for the performance of work done in connection
with the specific grant:
Place of Performance
Street City State Zip Action
If your place of performance is different from the physical address provided by
you in the Applicant Information, press Add Place
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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.
Action 17.630 of the regulations provide that a grantee that is a State may elect to make one certification in each Federal fiscal
r. A copy of which should be included with each application for DHS funding. States and State agencies may elect to use a
Statewide certification.
Signed by Bonnie Temchuk on 04/07/2005
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FEMA Standard Form LLL
oinition.
ly complete if applying for a grant for more than $100,000 and have lobbying activities. See Form 20-16C for lobbying activities
This form is not applicable
•
•
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