HomeMy WebLinkAboutPR 20572: APPLY FOR HARVEY DISASTER HAZARD MITIGATION GRANTS DERRICK FREEMAN,MAYOR t„e,r,. =r HARVEY ROBINSON
THOMAS J.KINLAW,III,MAYOR PRO TEM City of c., INTERIM CITY MANAGER
COUNCIL MEMBERS: 40.1 VAL TIZENO
CITY ATTORNEY
RAYMOND SCOTT,JR. ri rt r t h u r
CAL J.JONES SHERRI BELLARD
HAROLD DOUCET,SR. Texas CITY SECRETARY
CHARLOTTE MOSES
KAPRINA RICHARDSON FRANK
Date: November 13, 2018
To: Harvey Robinson, Interim City Manager
From: Rebecca Underhill, Assistant City Manager
RE: Proposed Resolution No. 20572
Nature of Request:
As a part of the "Harvey" recovery efforts, staff has evaluated opportunities for Hazard Mitigation Funding.
The Hazard Mitigation Grant Program (HMGP) provides funding at a 75/25 cost share for projects designed
to prevent or reduce future loss of lives and property. Five (5) projects have been identified with a total cost
of$36,758,150. Should the City be successful with all of the applications; the City's required match (25%)
would be $9,189,537. Staff is recommending that the City Council authorize application to the HMGP for
these projects. In the event the applications are successful, City Council will be asked to authorize
acceptance of the grant(s)at that time.
The projects are:
Total Cost City Match
Wastewater Treatment Plant Aqua Filters $4,530,000 $1,132,500
El Vista Drainage Improvements $3,100,000 $ 775,000
Port Acres Drainage Improvements $9,459,000 $2,364,750
Stonegate Retention $13,752,750 $3,438,187
Stonegate Drainage Improvements $5,916,400 $1,479,100
$36,758,150 $9,189,537
In addition, the staff is working with Drainage District #7 to review and evaluate the potential of partnering
on two other projects:
Total Cost Local Match
Main C Canal Conversion $74,280,000 $18,570,000
Port Acres Detention $12,840,000 $3,210,000
$87,120,000 $21,780,000
This agenda item does not authorize application for these two projects. Staff will return to the Council with
information on these projects at a later date.
P.O BOX 1089•PORT ARTHUR,TEXAS 77641-1089 •409/983-8101 • FAX 409/982-6743 • www.portarthurtx.gov
Recommendation:
I recommend City Council approve Proposed Resolution 20572 authorizing the Interim City Manager to
apply for Harvey Disaster Mitigation grants for five projects with total project cost of$36,758,150.
Budget Considerations:
No funding is required at this time. In the event that the City is successful in application, the 25%required
match will be identified before City Council is asked to authorize acceptance of the grant. Potential sources
of funding include the CDBG-DR (Harvey Recovery—Infrastructure Program).
P.O BOX 1089•PORT ARTHUR,TEXAS 77641-1089 •409/983-8101 • FAX 409/982-6743 • www.portarthurtx.gov
P .R. No. 20572
11-15-2018 RU
RESOLUTION NO.
A RESOLUTION AUTHORIZING THE INTERIM CITY MANAGER TO
APPLY FOR HARVEY DISASTER HAZARD MITIGATION GRANTS
WITH THE TEXAS DIVISION OF EMERGENCY MANAGEMENT; TOTAL
PROJECT COSTS OF UP TO $36, 758 , 150 WITH A POTENTIAL
GRANT AWARD OF 75% OF PROJECT COST AND A GRANT MATCH
REQUIREMENT OF UP TO 25% OF THE PROJECT COST
WHEREAS, the Hazard Mitigation Grant Program (HMGP) assists
states and local communities in implementing long-term hazard
mitigation measures following major disasters; and
WHEREAS, in order to receive the aforesaid funding, it is
necessary that the City of Port Arthur (City) apply through the
Texas Division of Emergency Management (TDEM) ; and
WHEREAS, HMGP program is designed to: prevent or reduce
future loss of lives and property through the identification and
funding of cost-effective mitigation measures and to minimize
the costs of future disaster response and recovery; and
WHEREAS , the City has identified water utility and drainage
systems improvements that meet the program criteria; and
WHEREAS, the Hazard Mitigation Grant Program (HMGP) as
authorized by Section 404 of the Robert T. Stafford Disaster
Relief and Emergency Assistance Act is 75% funded with a 25%
local funding grant match requirement; and
WHEREAS, the City Council finds it in the best interest of
the citizens of the City of Port Arthur that application be made
for the projects outlined in Exhibit A of this resolution.
NOW THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE
CITY OF PORT ARTHUR:
Section 1 . That the facts and opinions in the preamble are
true and correct .
Section 2 . That the Interim City Manager is authorized to
apply to the Texas Division of Emergency Management for Hazard
Mitigation Grant Program (HMGP) funding for the projects
outlined in Exhibit A of this resolution.
Section 3 . That the TDEM application will be completed in
the required form as attached hereto as Exhibit B of this
resolution.
Section 4 . That a copy of the Resolution shall be spread
upon the Minutes of the City Council .
READ, ADOPTED AND APPROVED on this day of ,
A. D. , 2018 , at a Regular Meeting of the City Council of the City
of Port Arthur, Texas, by the following vote: AYES:
Mayor: ,
Councilmembers : ,
NOES:
Derrick Freeman, Mayor
ATTEST:
Sherri Bellard, City Secretary
APPROVED AS TO FORM:
//4/e
Val Tizeno, Cit j� torne
APPROVED FOR ADMINISTRATION:
Harvey Robinson, Interim City Manager
"Exhibit B"
Grant Application Form Packet
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Section 404 Hazard Mitigation Grant Program (HMGP)
Application Introduction, Instruction, and Information
INTRODUCTION
The Hazard Mitigation Grant Program (HMGP) assists states and local communities in implementing long-term hazard
mitigation measures following a major disaster. The funding for this program is based on a 75/%federal and 25% local
cost share. Further information concerning Texas' involvement in the HMGP can be found in the current Texas Division
of Emergency Management (TDEM) Hazard Mitigation Grant Administrative Plan.
If you require technical assistance with this application, or to request a copy of the current TDEM Hazard Mitigation Grant
Program Administrative Plan please contact Texas Division of Emergency Management, Recovery, Mitigation and
Standards (TDEM/RMS), Mitigation Section at (512) 377-0023 or TDEM-Mitigationt dps.texas.gov.
INSTRUCTIONS
The application and attachments can be found on the following websites:
http://www.dps.texas.gov/dem/ThreatAwareness/h urricaneHarveylnfo.htm
https://grants.dps.texas.gov/
Please complete ALL sections and provide the documents requested. All questions must be answered completely and
accurately. TDEM and the Federal Emergency Management Administration (FEMA) staff reviewing the application will not
be familiar with your community, the specific project area, and the need for the proposed project. Therefore, it is the
responsibility of the applicants to ensure the application addresses all of the questions and requirements. This is
particularly important given the competitive nature of the grant program. If you are unsure as to the meaning of a particular
question, contact TDEM for clarification.
ELIGIBILTY
TDEM, as the grantee, is responsible for ensuring applicants meet the eligibility requirements and projects are eligible for
HMGP funding.
Applicant Eligibility:
1. HMGP projects must be from an eligible applicant. (i.e., Municipality, City, County, Special District, Tribe, Eligible
Nonprofit Agency, or Organization).
2. Applicant must have an approved hazard mitigation plan. For private non-profit organizations, the community
where the project is located must have an adopted plan.
Project Eligibility:
1. Projects cannot be retroactively funded through HMGP. Therefore, projects already in progress or completed will not be
considered.
2. HMGP projects must comply with the FEMA approved state and applicable local hazard mitigation plan.
3. HMGP projects must meet all applicable codes and standards for the project locale (i.e., construction, public
notifications, etc.).
4. HMGP projects must have a direct beneficial impact upon the designated disaster area, whether or not the project is
located in the designated area.
5. HMGP projects must comply with 44 Code of Federal Regulations (CFR) part 9, Floodplain Management and Protection
of Wetlands and 44 CFR, part 10, Environmental Considerations.
6. HMGP projects must solve a problem independently or constitute a functional portion of a solution where there is
assurance that the project as a whole will be completed. Projects that merely identify or analyze hazards or problems
are not eligible.
7. HMGP projects must be cost effective and substantially reduce the risk of future damage, hardship, loss, or suffering
resulting from a major disaster.
8. HMGP projects must provide the best solution. Sub-applicants must demonstrate that after consideration of a range of
options for the mitigation measure, it has been determined that the proposed project is the most practical, effective, and
environmentally sound solution.
Project Eligibility -Continued
9. HMGP projects must contribute to a long-term solution that is the most practicable. Ideally, it should integrate
hazard mitigation principles with existing programs and overall community planning.
10. HMGP projects must consider long-term effects. Projects should address, when applicable, long-term changes to the
areas and entities it protects, and ensure manageable future maintenance and modification requirements.
11. HMGP projects must address a problem that has been repetitive or that possesses a significant risk if left unsolved.
12. HMGP projects must cost less than the anticipated value of the reduction in both direct damage and subsequent
negative impacts to the area if future disasters occur.
ATTACHMENTS
Below are the attachments related to this application. You can access the attachments by clicking the paper clip
symbol on the left side of the form (see image below).
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Attachment List
1. Budget Worksheet
2. Budget Worksheet Instructions
3. Designation of Subrecipient Agent (DSA) Form (Note: See Grant Management System for additional information below)
4. Environmental Historical Preservation (EHP) Checklist
5. FEMA Benefit Cost Analysis (BCA)Toolkit Instructions to Install
6. Property Site Inventory Worksheet(Required for Acquisition, Elevation, and Mitigation Reconstruction projects)
7. Three SF424 Forms (SF424-Application for Federal Assistance, SF424B-Non-Construction Assurances and
SF424D-Construction Assurances)
8. FEMA Form Certifications Regarding Lobbying
9. FEMA Form Disclosure of Lobbying Activities
REQUIRED DOCUMENTATION
Below is the minimum required documentation that must be submitted with the application.
Note: This is not an all inclusive list since requirements may vary depending on project type and the sub-applicant.
1. Application (with supporting documents used for additional space or to clarify answers)
2. Map(s), Photo(s), Drawing(s), etc. as required in the application
3. EHP Checklist
4. FEMA Insurance Rate Map (FIRM) per the EHP Checklist
5. Supporting Documentation per EHP Checklist
6. Budget Worksheet
7. Property Site Inventory Worksheet (Required for Acquisition, Elevation and Mitigation Reconstruction projects)
8. BCA zip file
9. Certification and Signature of Authorized Agent (page 10 of the application)
10. Floodplain Manager Authorization Form (page 11 of the application)
11. DSA Form
12.All three SF424 forms (SF424, SF424B and SF424D)
13. FEMA Form Certifications Regarding Lobbying (also includes Debarment, Suspension and Other Responsibility Matters;
and Drug Free Workplace Requirements)
14. FEMA Form Disclosure of Lobbying Activities (Complete to disclose lobbying activities pursuant to 31U.S.C.1352)
GRANT MANAGEMENT SYSTEM (GMSI
The Division of Emergency Management uses the GMS on-line system to manage the HMGP and other FEMA grant
programs. For more information and to register for access please visit https://grants.dps.texas.gov/index.cfm.
Note: The DSA Form provides the information needed to set up the contact information in the system.
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Texas Division of Emergency Management
* m Recovery, Mitigation and Standards
Section 404 Hazard Mitigation Grant Program (HMGP)
Application Form
Disaster Declaration #: FEMA-4332-DR-TX Declaration Date: August 25, 2017
SUB-APPLICANT INFORMATION
Name of Sub-applicant Organization/Agency:
Address:
City: County: State: TX Zip:
Primary Contact Name: Title:
Email: Office Phone: Cell:
Secondary Contact Name: _Title:
Email: Office Phone: Cell:
Check One:
❑State Government U Local Government ❑ Federally Recognized Tribe Private Non-Profit
Tax ID#: DUNS#: FIPS Code:
(Data Universal Numbering System)
State Legislative House District(s): State Legislative Senate District(s):
Congressional House District(s):
National Flood Insurance Program (NFIP) Community Identification #:
(This number can be obtained from the FIRM map for your area)
NFIP Community Rating System Class#(if available):
PROJECT INFORMATION
Project Title:
Application Type: (select from the following)
❑ Standard HMGP ❑ 5% Initiative ❑ Planning ❑ Phased Project
Project Type: (select from the following)
❑ Acquisition ❑ Elevation ❑ Residential Saferoom ❑ Community Saferoom
❑ Drainage ❑ Generator ❑ Wildfire ❑ Structural Retrofit
❑ Other:
Hazards to be Mitigated: (select from the following)
U Flood ❑Wind ❑ Wildfire ❑ Subsidence ❑ Storm Surge
❑ Other:
Note: A Property Site Inventory Worksheet(see attached)is required for Acquisition, Elevation, and Mitigation Reconstruction projects)
Page 3 of 12
SCOPE OF WORK
Project Description:
Description must include: what hazard(s) the project will address, type of project(drainage, safe room, fuel reduction, buy-
out, etc., and/or infrastructure), step by step description of the major elements of the project
(contracting, construction elements, close-out, etc.), and how the project will be accomplished by the end of the 36 month
period of performance(PoP). Attach extra pages as necessary.
Page 4 of 1
Project Objectives - Problem Solutions/Hazard Reduction:
Description must include: how the project will independently solve the problem, the level of protection provided by the
project, how the project will increase the level of protection to the citizens and/or properties, the number of people and
properties that will directly benefit from the project, and how the project will ultimately reduce the costs associated with
recovery from future disasters. Attach extra pages as necessary.
Project Objectives - Outcome, Level of Effort and Milestones:
Description must include: major milestones for the project(contracting complete, final engineering/design complete,
mobilization for construction, construction phase(s), activities associated with these steps, percentage of total project
budget or dollar amounts associated with these steps. Attach extra pages as necessary.
Page 5 of 1
Milestones/Timeline:
List the major milestones (e.g. designing, engineering, permitting, etc.)for the project by providing an estimated timeline for
the critical activities not to exceed a 36 months. These milestones should correspond with the Project Objective description
above and budget. For the Starting Month column below, please enter the month (1 through 24)you will begin this milestone
once once you receive your award (i.e. Month 1 would be the same month as your performance period start date, Month 36 is
the last month of your performance period.) For the Mos. to Complete column, please enter the number of months it will take
to complete the milestone. (See examples below)
Milestone Starting Est. Mos.to
Month Complete
1. Month# #Mos to Comp
2. Month# #Mos to Comp
3. Month# #Mos to Comp
4 Month# #Mos to Comp
5 Month# # Mos to Comp
6. Month# # Mos to Comp
7. Month# # Mos to Comp
8. Month# # Mos to Comp
9. Month# # Mos to Comp
10. Month# #Mos to Comp
Project Objectives - Project Staff and Management:
Description must include:how the sub-applicant will organize and manage the project to ensure successful completion within
the project period of performance, a brief description of all staff associated with the project by position and what their role
and responsibilities are for completing the project within the period of performance. Attach extra pages as necessary.
Page 6 of 1
Damage History -Overview of Past Damage:
Provide a detailed past history of damages in the project area including approximate costs. Include information for
Presidential or Federal level disasters as well as State or local level declarations.Attach any supporting documents. Costs
should include damages to structures and infrastructure in the project area as a result of the hazard. Additional costs should
include the cost to the local government to respond to victims of the hazard in the project area, any interruption to local
businesses, losses of public services, and costs for temporary housing of the affected population, etc. This section helps
demonstrate the need for the project.
Note:Acquisition, Relocation, Elevation, or Demolition Project:
Complete a listing of specific damages to each property on a separate spreadsheet and include as an attachment.
Date Level of Event Type or Extent of Damage Total Cost of Damage
Project Location:
Fully describe the location of the proposed project. Describe the area and/or population affected or protected by this project.
Include the location if possible (street address with numbers or neighborhood, city, county with zip codes, Lot, Block or Survey).
Provide GPS reading (Lat/Long) of the project site in degrees decimal minutes to 5 places if possible (i.e.: 30.326958/
-97.724750). Attach a separate spreadsheet for multiple latitude/longitude coordinates and descriptions as needed.
Latitude: Longitude:
Description:
Population and Structures Affected by Project:
Indicate the approximate number of people affected by this project to include residents, customers, commuters, or visitors,
etc. Provide the number of each type of structure (listed below) in the project area. Include all structures directly affected in
project area.
Number of people affected
Number of residential properties
Number of businesses/commercial properties
Number of public buildings
Number of schools
Number of hospitals/medical clinics
Other(List):
Pale'of 1
MAPS
Two maps must be provided with your application. One must show the general location of the project site and the other
must show the specific project site. In certain cases when there are no maps available, substitute with an overview
photo, drawing or sketch. Ensure it is legible, shows magnetic north, and has major landmarks noted for orientation.
Map Depicting Project Site: (check the boxes to indicate what type of maps are attached)
nCity, County, or District scale map showing the entire project area with the project site and structures marked
on the map.
❑ USGS 1:24,000 topographical map with project site marked on the
map.(Map depicting relationship to existing features—natural and
otherwise)
1. Rivers, lakes, streams, wetlands, saltwater, etc.
2. Geologic features, steep slopes, unstable
areas
3. Roads, bridges, buildings, etc.
❑ For acquisition or elevation projects, include a copy of the Parcel Map (Tax Map, Property Identification
Map, etc). with each property in the project clearly marked on the map. Use SAME ID number as in the
Property Site Inventory Worksheet.
NOTE: On one or both of the maps and depending on the type of project, you may depict multiple requirements
that are listed below, instead of a separate map for each.
Photos, Sketches, Drawings, Engineer Designs, etc:
These help clarify the project setting and the potential impacts of the project on the environment (soils, vegetation,
hydrology, wildlife) and they assist in understanding the written description of the project, especially if contours and
elevations are provided. The photographs should be representative of the project area, including any relevant streams,
creeks, rivers, drainage areas, etc; which affect the project site or will be affected by the project. If photos are provided, then
FEMA may not need to conduct a site visit, thereby, reducing the review time. Include ALL engineering calculations and
quantity determinations for this project. These are in addition to any map substitutions. Please check the box below for the
items you are attaching to your applicaiton, if any:
nPhotographs ❑ Engineering Designs(including calculation and quantity determinations)
❑ Sketches/Drawings ❑ Other
ENVIRONMENTAL HISTORICAL PRESERVATION(EHP) COMPLIANCE
Please complete the EHP Checklist (see attachment) and include in the application submission.
As a Federal agency, the Department of Homeland Security(DHS)/Federal Emergency Management Agency (FEMA) is
required to consider the effects of its actions on the environment and/or historic properties to ensure that all activities and
programs funded by the agency, including grants-funded projects, comply with Federal EHP regulations, laws, and
Executive Orders, as applicable. Grant recipients proposing projects that have the potential to impact the environment,
including but not limited to construction of communication towers, modification or renovation of existing buildings, structures
and facilities (including installation of equipment), or new construction including replacement of facilities, must participate in
the DHS/FEMA EHP review process. More information about the EHP requirement can be found at the following links:
https://www.fema.gov/environmental-planning-and-historic-preservation-compliance
https://www.fema.gov/media-library/assets/documents/26621
Maps will also be required for this portion of the application. If you have photos, sketches, drawings, engineer designs,
etc. that will help clarify the project location and structures, please be sure to include them with your application.
Page 8 of 12
BUDGET INFORMATION
Please complete the Budget Worksheet attachment by following the attached "Budget Worksheet Instructions". You
can access the attachment by clicking on the paper clip on the left side of the form.
Once the budget has been completed, provide the following information from the worksheet:
(Note:Enter numbers only(no$or comma's)as the fields is automatically formated)
Total Project Costs:
Applicants Cost Share:
Federal Amount:
Reminder.'Applicant must include the Budget Worksheet when submitting the application
BENEFIT COST ANALYSIS
Applicants must demonstrate mitigation projects are cost effective. The Benefit Cost Tool Version 5.3 is used to perform
benefit cost analysis for applications submitted under FEMA's Hazard Mitigation Assistance Grant Programs. To use this
tool, you must first download the file from the website (see link below). If you have any questions about the new BCA
software program, please contact the BC Helpline at bchelpline(cadhs.gov or at 1-855-540-6744.
https://www.fema.gov/media-library/assets/documents/128334
Once the BCA has been completed, provide following information from the BCA:
(Note:Enter numbers only(no$or comma's)as the fields is automatically formated)
Total Project Cost:
Total Value of Project Benefits:
Benefit Cost Ratio:
Reminder.' Applicant must include a zip file of the BCA when submitting the application
BCA Exceptions
• Acquisition Projects -The acquisition of structures that are declared Substantially Damaged (from any origin) and
located in a riverine Special Flood Hazard Area (SFHA) on a preliminary or effective FIRM is considered cost effective.
• Residential Safe Room Projects -The pre-calculated benefit provides standardized Benefit-Cost Analysis (BCA)
benefit values associated with residential safe rooms so that individual BCAs are not required, as long as the project
costs do not exceed $5,421.32 (in Texas).
• Acquisition and Elevation Projects-The national average for benefits for acquisition and elevation projects is
$276,000 for acquisition projects and $175,000 for elevation projects. FEMA determined the acquisition or elevation
of a structure located in the 100-year floodplain for which costs are equal to or less than the amount of benefits
noted above is cost effective. For projects that contain multiple structures, the average cost of all structures in the
project must meet this criterion. There is no need for recipients to conduct a separate BCA for a structure that meets this
criterion.
• A wind retrofit project is considered cost effective as long as the total project costs are less than the costs listed below:
Mitigation Package Type Roof Replacement Project Maximum Costs
Intermediate Protection No $13,153
Intermediate Protection Yes $24,920
Advanced Protection No $40,252
Advanced Protection Yes $52,018
CERTIFICATION AND SIGNATURE OF AUTHORIZED AGENT FORM
The Chief Elected Official (jurisdiction) or Executive Director(non-jursidiction) must certify the following statements before the
project listed below will be considered for Hazard Mitigation Grant Program (HMGP)funding.
Name of Sub-Applicant(jurisdiction/non-jurisdiction) Identified in the Application:
(auto-populated from the first page of the application)
Project Titles Identified in the Application:
(auto-populated from the first page of the application)
To certify, please check the boxes and sign below:
The undersigned will ensure all State and Federal requirements related to the HMGP funding are fulfilled.
7The undersigned understands that the jurisdiction/non-jursdiction applying for this grant is liable for the
required matching funds (local share) related to the project listed above.
The undersigned has reviewed and approved the project and information contained in the application.
Signature of the Authorized Agent
Name:
Title:
Signature: Date:
image 10 of I
FLOODPLAIN MANAGER AUTHORIZATION FORM
Please provide the following information for the designated Floodplain Manager for the project listed below.
Date:
Sub-Applicant:
Disaster Declaration: FEMA 4332-DR-TX
Project Title:
Project Number(if known):
Floodplain Manager Contact Information:
Name: Title:
Organization:
Address:
City: State: Zip :
Email: Office Phone: Cell:
Floodplain Manager Certification Information:
CFM Certification Number:
If not a CFM, pleased enter the date of attendance for:
CFM - 1 Week Course:
Floodplain 101 Course:
Ceritification:
By signing below, the above Floodplain Manager is authorized to represent and act on behalf of the sub-applicant in all
floodplain matters related to the project and grant listed above
Signature of Authorized Official/Project Officer Date
Printed Name Title
Please submit completed form(s) with the application email as an attachment.
SUBMITTAL INSTRUCTIONS:
• Review the application and ensure all questions are answered and all documents are attached. Below is the
minimum required documentation. Note:This is not an all inclusive list since requirements may vary depending on
project type and the subgrantee.
1. Application (with supporting documents used for additional space or to clarify answers)
2. Map(s), Photo(s), Drawing(s), etc. as required in the application
3. EHP Checklist
4. FIRM Map(s) per the EHP Checklist
5. Supporting Documentation per EHP Checklist
6. Budget Worksheet
7. Property Site Inventory Worksheet(Required for Acquisition, Elevation, and Mitigation Reconstruction projects)
8. BCA zip file
9. Certification and Signature of Authorized Agent(page 10 of the application)
10. Floodplain Manager Authorization Form (page 11 of the application)
11. DSA Form
12. All three SF424 forms (SF424, SF424B and SF424D)
• Upon completion of the application, save your file by clicking the Save As button below and name your file with the
following structure:
Disaster#Grant-Jurisdiction/Organization Name- Project Type
Example:4332 HMGP- Test, City of- Generator
Save As
• Submit completed application via email by clicking on this link: TDEM-Mitigations dps.texas.gov
Page 12 of 12
Designation of Subrecipient Agent — Primary Contacts
Texas Department of Public Safety-Texas Division of Emergency Management
Subrecipient:
Disaster Number(s): Grant Program: Grant Program
Primary Agent
Serves as the primary point of contact for projects.
Name: Office Number:
Position/Job Title: Fax Number:
Organization/employer: Cell Number:
Email* The Primary Agent will have full GMS access
Secondary Agent
Serves as the secondary point of contact for projects.
Name: Office Number:
Position/Job Title: Fax Number:
Organization/employer: Cell Number:
Email* The Secondary Agent will have full GMS access
Primary Finance Agent
Serves as the primary point of contact for financial matters.
Name: Office Number:
Position/Job Title: Fax Number:
Organization/employer: Cell Number:
Email* The Primary Finance Contact will have full GMS access
Certifying Official
Serves as the official representative of the organization.
Must possess the authority to obligate funds &enter into contracts for the organization.
Name: Office Number:
Position/Job Title: Fax Number:
Organization/employer: Cell Number:
Email* GMS Access (pick 1) Full Read Only None
The above Primary and Secondary Agents are hereby authorized to execute and file the application on behalf of this
organization for the purpose of obtaining certain state and federal financial assistance under the Robert T. Stafford
Disaster Relief& Emergency Assistance Act, (Public Law 93-288 as amended)or otherwise available. Primary Financial
Agent and the Certifying Official are authorized to represent and act for this organization in all financial operations
pertaining to this grant with the State of Texas.
*Note: All email addresses must be unique to user
Signature of Certifying Official Print Name Date
(Must be a Mayor,Judge,or Executive Director with the authority
to obligate funds&enter into contracts for the organization)
Designation of Subrecipient Agent — Additional Contacts (Optional)
Texas Department of Public Safety-Texas Division of Emergency Management
Subrecipient:
Disaster Number(s): Grant Program: Grant Program
Additional Contact
List any additional contact here
Name: Office Number:
Position/Job Title: Fax Number:
Organization/employer: Cell Number:
Email* GMS Access (pick 1) Full ❑ Read Only ❑ None ❑
If this contact replaces an existing contact, write their name below. Otherwise, leave blank or mark N/A
Additional Contact
List any additional contact here
Name: Office Number:
Position/Job Title: Fax Number:
Organization/employer: Cell Number:
Email* GMS Access (pick 1) Full ❑ Read Only ❑ None ❑
If this contact replaces an existing contact, write their name below. Otherwise, leave blank or mark N/A
Additional Contact
List any additional contact here
Name: Office Number:
Position/Job Title: Fax Number:
Organization/employer: Cell Number:
Email* GMS Access (pick 1) Full ❑ Read Only ❑ None ❑
If this contact replaces an existing contact, write their name below. Otherwise, leave blank or mark N/A
Additional Contact
List any additional contact here
Name: Office Number:
Position/Job Title: Fax Number:
Organization/employer: Cell Number:
Email* GMS Access (pick 1) Full ❑ Read Only ❑ None ❑
If this contact replaces an existing contact, write their name below. Otherwise, leave blank or mark N/A
Additional Contacts are authorized to represent and act for this organization in all operations pertaining to this grant
with the State of Texas.
*Note: All email addresses must be unique to user
Signature of Certifying Official Print Name Date
(Must be a Mayor,Judge,or Executive Director with the authority
to obligate funds&enter into contracts for the organization)
ENVIRONMENTAL AND HISTORICAL PRESERVATION CHECKLIST
Please provide the following information as it appears on your application.
Disaster Declaration #: FEMA-4332-DR-TX
Name of Sub-Applicant Organization/Agency:
Project Title:
MAINTENANCE ASSURANCE DESCRIPTION:
1. Identify any maintenance activities required to preserve the long-term mitigation effectiveness of the project. Below
provide the annual cost of maintenance before mitigation and what the maintenance will include. Not needed if project is
not tied to an existing capital improvement. (Either describe in 1,500 characters or less or attach a separate Word
document).
2. Attach a maintenance schedule, estimated costs, and a signed maintenance commitment letter, if required, to the
application submission. (See sample Maintenance letter on page 8 of this document).
NATIONAL FLOOD INSURANCE PROGRAM (NFIP)
1. Is the community where the project is located participating in the NFIP? ❑YES ❑ NO
If"YES", are they in good standing? ❑ YES ❑ NO
NFIP Community ID Number:
❑YES LINO
2. Is this project located in a floodplain/floodway designated on a FEMA Flood Insurance Rate Map (FIRM)?
(Note: Maps can be obtained from the Map Service Center at https://msc.fema.gov/portal.)
If"YES", please mark the project location(s) and structure(s) on the FIRM and attach with the application and provide the
following information:
A. FIRM Panel Number(s):
B. FIRM Zone Designations:
Special Flood Hazard Area (SFHA):
❑A ❑ AO ❑AH ❑A1-30 ❑ AE ❑A99 ❑AR ❑AR/AE
❑AR/AO ❑AR/A1-30 ❑AR/A El V ❑VE ❑V1-30
Moderate Flood Hazard Area (shaded): ❑B ❑X
Minimal Flood Hazard Area (unshaded): ❑C ❑ X
Floodway: ❑
Coastal Barrier Resource Act(CBRA)Zone: ❑
(Federal regulations strictly limit Federal funding for projects in this Zone. Coordinate check with your state agency before
submitting an application for a CBRA Zone project)
C. If a FIRM map is not available, please check the box: 0
Page 1 of 9
ENVIRONMENTAL QUESTIONNAIRE
SECTION I—REGULATIONS
The Council on Environmental Quality (CEQ) has developed regulations to implement the National Environmental Policy
Act(NEPA). These regulations, as set forth in Title 40, Code of Federal Regulations (CFR), Parts 1500-1508, require an
investigation of the potential environmental impacts of a proposed federal action and an evaluation of alternatives as part
of the environmental assessment process. The FEMA regulations that establish the agency-specific process for
implementing NEPA are set forth in 44 CFR, Part 10. FEMA will assist in obtaining NEPA clearance.
Environmental data is required for project applications when submitting a project to the Texas Division of Emergency
Management for the FEMA Hazard Mitigation Grant Program.
Please Note: Environmental review is typically the most time consuming aspect of project funding approval.
SECTION II - ENVIRONMENTAL CHECKLIST
Environmental Checklist Instructions
Select appropriate answer by clicking the appropriate box(an X should appear in the box).
Provide a detailed response to each question and attach supporting documentation in order to comply with FEMA's front
loading requirements discussed in Hazard Mitigation Assistance Unified Guidance 2015.
YES NO N/A NATIONAL HISTORIC PRESERVATION ACT
❑ ❑ ❑ Are any structures involved in the project? If yes, provide construction dates of all structures
Dates:
❑ ❑ ❑ Was consultation with the State Historic Preservation Officer(SHPO) conducted?
If yes, provide date and attach all formal correspondence with application.
❑ ❑ ❑ Was consultation with the Tribal Historic Preservation Officer(THPO) conducted?
If yes, provide date and attach all formal correspondence with application.
Coordinating Agency: The SHPO and/or THPO
YES NO N/A ARCHEOLOGICAL RESOURCES PRESERVATION ACT
❑ ❑ ❑ Will there be any ground disturbance?
❑ ❑ ❑ Will there be any potential disturbance to cultural resources?
❑ ❑ ❑ Was consultation with SHPO/THPO conducted?
If yes, provide date and attach all formal correspondence with application.
Coordinating Agency: The SHPO and/or THPO
YES NO N/A ENDANGERED SPECIES ACT
❑ ❑ ❑ Will there be any disturbance to the physical environment?
❑ ❑ ❑ Are any threatened or endangered species present in the project area?
❑ ❑ ❑ Has critical habitat been identified in the project area?
❑ ❑ ❑ Was consultation with U.S. Fish and Wildlife Service (USFWS) and Texas Parks and Wildlife
Department(TPWD) conducted?
If yes, provide date and attach all formal correspondence with application.
Coordinating Agency: The USFWS and TPWD
Page 2 of 9
YES NO N/A FISH AND WILDLIFE COORDINATION ACT
❑ ❑ ❑ Is the project located in or near a waterway or body of water?
❑ ❑ ❑ Will the project cause any modification to the waterway or body of water?
❑ ❑ ❑ Was consultation with USFWS, National Marine Fisheries Service (NMFS), and TPWD conducted?
If yes, provide date and attach all formal correspondence with application.
Coordinating Agency: USFWS, TPWD and NMFS
YES NO N/A FARMLANDS PROTECTION POLICY ACT
❑ ❑ ❑ Is the project located in or near designated prime and unique farmlands?
❑ ❑ ❑ Will the project convert any designated prime and or unique farmlands?
❑ ❑ ❑ Was consultation with Natural Resources Conservation Service (NRCS) conducted?
If yes, provide date and attach all formal correspondence with application.
Coordinating Agency: U.S. Dept. of Agriculture's NRCS, Dept. of Conservation (Division of Land Resource Protection)
YES NO N/A CLEAN AIR ACT
❑ ❑ ❑ Will the project result in temporary or permanent air emissions?
❑ ❑ ❑ Was consultation Texas Commission on Environmental Quality(TCEQ) conducted?
If yes, provide date and attach all formal correspondence with application. Coordinating
Agency:Environmental Protection Agency(EPA) and TCEQ
YES NO N/A CLEAN WATER ACT(Section 404), RIVERS AND HARBORS ACT (Section 10)
❑ ❑ ❑ Will the project involve dredging or disposal of dredged material, excavation, adding fill material or
result in any modification to waters*of the U.S.?
❑ ❑ ❑ Will the project involve bank stabilization or installing transmission in waters*of the U.S.?
❑ ❑ ❑ Will the project be near or in navigable waters*?
❑ ❑ ❑ Was consultation with the U.S. Army Corps of Engineers (USACE) conducted?
If yes, provide date and attach all formal correspondence with application.
❑ ❑ ❑ Willa permit be required?
❑ ❑ ❑ Have you submitted an application to the USACE?
If yes, attach all formal correspondence with application.
❑ ❑ ❑ Does a nationwide permit apply?
❑ ❑ ❑ Does a general permit apply?
* "waters"includes waters subject to ebb and flow of tide, wetlands, lakes, rivers, streams, mudflats, sloughs,prairie potholes, wet
meadows, playa lakes, natural ponds, impoundments, tributaries, territorial seas, and wetlands adjacent to waters previously identified.
Coordinating Agency: USA CE
Page 3 of 9
YES NO N/A WILD AND SCENIC RIVERS ACT
❑ ❑ ❑ Is the project located near or in a designated wild or scenic river?
❑ ❑ ❑ Was consultations TPWD ro USFWS conducted?
If yes, provide date and attach all formal correspondence with application.
Coordinating Agency: USFWS and the U.S. Forest Service within their jurisdiction and TPWD.
YES NO N/A WILDERNESS ACT
❑ ❑ ❑ Is the project located near or in a designated wilderness or coastal wildlife area?
❑ ❑ ❑ Was consultations with TPWD or USFWS conducted?
If yes, provide date and attach all formal correspondence with application.
Coordinating Agency: USFWS, National Park Service and the Bureau of Land Management(BLM), General Land Office
and TPWD.
YES NO N/A OTHER RELEVANT LAWS AND ENVIRONMENTAL REGULATIONS
❑ ❑ ❑ Do any other laws and/or regulations apply to the project?
If yes, please reference the regulation below and attach proper documentation to application.
Regulation:
Coordinating Agency:Applicable State Statutory Requirements, Executive and Administrative Orders and any local
environmental requirements.
EXECUTIVE ORDERS
YES NO N/A E.O. 11988—FLOODPLAINS
❑ ❑ ❑ Is the project located in a FEMA-identified 100-year or 500-year floodplain?
❑ ❑ ❑ Is the project located in a FEMA-identified floodway?
❑ ❑ ❑ Is the project depicted on a FEMA Flood Insurance Rate Map (FIRM)?
If yes, attach the map with application
❑ ❑ ❑ Was consultation with local floodplain administrator and state water control agency conducted?
If yes, provide date and attach all formal correspondence with application.
Comments:A letter is required from the State Community Assistance Program Coordinator indicating the community is in good
standing with the NFiP.
Coordinating Agency:Loca/community floodplain administrator and the Texas Water Development Board.
YES NO N/A E.O. 11990—WETLANDS
❑ ❑ ❑ Is the project in an area that is inundated or saturated by surface or ground water(e.g. swamps,
marshes, bogs, etc.) or in or near identified wetlands*?
❑ ❑ ❑ Is the project depicted on a National Wetlands Inventory (NWI) map?
If yes, attach the map and all formal correspondence with application
*"Wetlands"are identified by obtaining a National Wetlands inventory(NWi)map from the USFWS, the USACE, or their websites. The
Natural Resource Conservation Service also has wetland maps for agricultural land.
Coordinating Agency: USFWS, USACE and NRCS
Page 4 of
YES NO N/A E.O. 12898—ENVIRONMENTAL JUSTICE
❑ ❑ ❑ Is the project in an area of low income or minority populations?
❑ ❑ ❑ Will the project disproportionately impact any low income or minority populations?
❑ ❑ ❑ Is any socio-economic data attached?
Comments:If the project would disproportionately adversely affect low income or minority populations, or would
disproportionately assist higher income populations at the exclusion of lower income or minority populations, then E.O.
12898 must be addressed.
Coordinating Agency: Local census office
EXTRAORDINARY CIRCUMSTANCES (FEMA 44 CFR§10.8 (d)(3))
If Extraordinary Circumstances exist within an area affected by an action, such that an action that is categorically excluded
from NEPA compliance may have a significant adverse environmental impact, an environmental assessment shall be
prepared. Please answer"Yes" or"No"to the questions below:
YES NO
❑ ❑ Greater scope or size than normally experienced for a particular category of action;
❑ ❑ Actions with a high level of public controversy;
❑ ❑ Potential for degradation, even though slight, of already existing poor environmental conditions;
❑ ❑ Employment of unproven technology with the potential adverse effects or actions involving unique or
unknown environmental risks;
❑ ❑ Presence of endangered or threatened species or their critical habitat, or archaeological cultural, historical
or other protected resources;
❑ ❑ Presence of hazardous or toxic substances at levels which exceed Federal, State, or local regulations or
standards requiring action or attention;
❑ ❑ Actions with the potential to affect special status areas adversely or other critical resources such as
wetlands, coastal zones, wildlife refuge and wilderness areas, wild and scenic rivers, sole or principal
drinking water aquifers;
❑ ❑ Potential for adverse effects on health or safety; and
❑ ❑ Potential to violate a Federal, State, local, or tribal law or requirement imposed for the protection of the
environment.
❑ ❑ Potential for significant cumulative impact when the proposed action is combined with other past, present
and reasonably foreseeable future actions, even though the impacts of the proposed action may not be
significant by themselves.
Page 5 of 9
SECTION III -ALTERNATIVES NARRATIVE
Alternative#1 —No Action Alternative-evaluates the consequences of taking no action and leaving conditions as
they currently exist. Please describe the benefits of this action and the shortfalls or gaps associated with this
action. (Either describe in 1,500 characters or less or attach a separate Microsoft Word document)
ALTERNATIVE#2- Proposed Action— this is the sub-applicant's proposed project. Explain why the proposed action is the
preferred alternative. Identify how the preferred alternative would solve a problem, why the preferred alternative is the best
solution and benefits the community, why and how the alternative is environmentally preferred and why the project is the
economically preferred alternative. Also include the shortfalls or gaps associated with the proposed action. (Either describe
in 1,500 characters or less or attach a separate Microsoft Word document)
ALTERNATIVE#3—Second Alternative- is the second alternative to the Proposed Project above and would also solve
the problem. It would be a viable project that could be substituted in the event the proposed project is not chosen. Identify
how this project would solve the problem, the community benefits and why it is an environmental and economical
alternative. Also include the shortfalls or gaps associated with this action. (Either describe in 3,500 characters or less or attach a
separate Microsoft Word document.)
Page B of
SECTION IV— PUBLIC NOTICE PROCEDURES
NEPA is a planning and disclosure process. Therefore both NEPA and ED 11988 require notification of the public
A. when a project and its alternatives are initially being developed and scoped; and
B. after the completion of the final draft environmental assessment, and before the signing of the Finding of No
Significant Impacts (FONSI) and any action taken.
The requirements of(A), which is referred to as a NOTICE OF INTENT, can usually be met by one of the following:
1. Publishing at the beginning of a disaster FEMA's General Notice for a Presidential Declaration, which issues
notification that funds will be provided under the Stafford Act to undertake projects.
2. Publishing a NOTICE OF INTENT in a local newspaper to undertake a project, providing the alternatives, and then
giving the public 15 days to respond.
3. Holding one or more public meetings on the project to solicit public comments.
Exactly which of the above vehicles is used to meet the requirements of(A) will usually be determined by the scope of the
proposed project, agency coordination, and previous notification and scoping work performed by the applicant. Any
comments received during this phase of notification should be addressed in the Environmental Assessment(EA).
The requirements of(B), which is referred to as a FINAL NOTICE, can usually be met by the following:
1. Publishing a FINAL NOTICE in a local newspaper and giving the public 15 days to respond.
2. If no comments are received, the FONSI can be signed and the project can proceed.
3. If comments are received they can be addressed individually and/or in a rewrite of the EA.
4. If significant negative comments are received, the project should be put on hold until the issues are resolved.
An example of a Final Public Notice can be found on page 9.
Note: The above requirements are also to be applied to a project deemed to be a categorical exclusion(CATEX)from the preparation
of an EA, but involves EO 11988(floodplains)and/or EO 11990(wetlands)and/or potentially or existing contentious issues.
SECTION V—PROJECT CONDITIONS AND CERIFICATIONS
Indicate by checking each box below that you will adhere to these listed project conditions.
If during implementation of the project, ground-disturbing activities occur and artifacts or human remains are
uncovered, all work will cease and FEMA, TDEM, and the State Historic Preservation Officer(SHPO) will be notified.
If deviations from the approved scope of work result in design changes, the need for additional ground disturbance,
additional removal of vegetation, or will result in any other unanticipated changes to the physical environment, FEMA
will be contacted and a re-evaluation under NEPA and other applicable environmental laws will be conducted.
If wetlands or waters of the U.S. are encountered during implementation of the project, not previously identified
during project review, all work will cease and FEMA will be notified.
Print Name: Title:
(Name of Authorized Official/Project Officer)
Signature: Date:
Page 7 of 9
Sample Maintenance Letter
Agency Letterhead
Date
Texas Department of Public Safety
Texas Division of Emergency Management
Hazard Mitigation Grants Program Unit
P.O. Box 4087
Austin, TX 78773-0270
RE: Name of Grant Sub-applicant and Project Title
Dear State Hazard Mitigation Officer:
This is to confirm that the name of agency/sub-applicant is committed to performing the necessary maintenance for the
entire useful life of this project which is currently estimated for #years once completed. The name of agency/sub-
applicant has allocated an annual budget which will allow maintenance to occur as needed to ensure the building/facility
remains in good repair and operational. Below are the details of the maintenance:
Entity responsible for the maintenance:
Maintenance Task:
Maintenance Schedule:
Cost of Maintenance:
Associated Budget:
Please contact name and contact information if you have any questions.
Sincerely,
Name
Title
Address
Page 8 of 9
(EXAMPLE) FINAL PUBLIC NOTICE
IMPORTANT NOTE: When describing the project, do not use addresses or names, as this would violate the Privacy Act.
PUBLIC NOTICE OF A PROJECT PENDING FUNDING BY THE
FEDERAL EMERGENCY MANAGEMENT AGENCY (FEMA)
Notification is hereby given of the Federal Emergency Management Agency's (FEMA's) pending intent to provide Hazard
Mitigation Grant Program funding for community name to short project description. Funds will be provided in accordance
with the Robert T. Stafford Disaster Relief and Emergency Assistance Act, Public Law 93-288, as amended.
Under the National Environmental Policy Act (NEPA) and EO 11988, FEMA is required to provide public notice of any
proposed actions in or affecting floodplains or wetlands.
Community, county, Texas proposes to detailed project description including location, impact on the floodplain and/or
wetlands, and why it is the best and/or only solution to the problem.
FEMA's review has determined that no significant impact to the existing floodplain will result from this project.
Within 15 days, interested persons may submit comments, obtain more detailed information about the action, or request a
copy of the findings by contacting FEMA's Region VI office which is located at 800 North Loop 288, Denton, Texas, 76209.
Requests can also be made to local program person-phone number-e-mail address or to XXXXXXXX, FEMA Regional
Environmental Officer at (PHONE) or(EMAIL).
Page 9 of 9
OMB Number:4040-0004
Expiration Date: 10/31/2019
Application for Federal Assistance SF-424
*1.Type of Submission: *2.Type of Application: *If Revision,select appropriate letter(s):
Preapplication ®New
0 Application Continuation 'Other(Specify):
Changed/Corrected Application Revision L
3. Date Received: 4.Applicant Identifier:
5a.Federal Entity Identifier: 5b. Federal Award Identifier:
P
State Use Only:
6.Date Received by State: 7.State Application Identifier:
S.APPLICANT INFORMATION:
*a. Legal Name:
*b. Employer/Taxpayer Identification Number(EIN/TIN): *c.Organizational DUNS:
d.Address:
*Street!:
Street2:
*City:
County/Parish:
*State: TX: Texas
Province
*Country: USA: UNITED STATES
•Zip/Postal Code:
e.Organizational Unit:
Department Name: Division Name.
f.Name and contact information of person to be contacted on matters involving this application:
Prefix: 'First Name.
Middle Name:
*Last Name:
Suffix
Title:
Organizational Affiliation:
Telephone Number Fax Number
Email:
Application for Federal Assistance SF-424
*9.Type of Applicant 1:Select Applicant Type:
A: State Government
Type of Applicant 2:Select Applicant Type:
Type of Applicant 3:Select Applicant Type:
•Other(specify):
*10.Name of Federal Agency:
11.Catalog of Federal Domestic Assistance Number:
CFDA Title:
•12.Funding Opportunity Number:
Title:
13.Competition Identification Number:
Title:
14.Areas Affected by Project(Cities,Counties,States,etc.):
Add Attachment Delete Atta Ve,v ata;l-rec.
•15.Descriptive Title of Applicant's Project:
Attach supporting documents as specified in agency instructions.
Add Attachments Delete Attachments View Attachments
1
Application for Federal Assistance SF-424
16.Congressional Districts Of:
`a.Applicant *b.Program/Project
Attach an additional list of Program/Project Congressional Districts if needed.
Add Attachment tt:
17.Proposed Project:
`a.Start Date: `b End Date:
18.Estimated Funding($):
'a.Federal I
`b.Applicant
'c.State
`d.Local
•e.Other
f. Program Income
'g.TOTAL
*19.Is Application Subject to Review By State Under Executive Order 12372 Process?
E a.This application was made available to the State under the Executive Order 12372 Process for review on
E b.Program is subject to E.O. 12372 but has not been selected by the State for review.
• c. Program is not covered by E.O. 12372.
*20.Is the Applicant Delinquent On Any Federal Debt? (If"Yes,"provide explanation in attachment.)
El Yes ❑No
If"Yes",provide explanation and attach
21.*By signing this application, I certify(1)to the statements contained in the list of certifications**and(2)that the statements
herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to
comply with any resulting terms if I accept an award.I am aware that any false,fictitious,or fraudulent statements or claims may
subject me to criminal,civil,or administrative penalties.(U.S.Code,Title 218,Section 1001)
**I AGREE
**The list of certifications and assurances, or an intemet site where you may obtain this list, is contained in the announcement or agency
specific instructions.
Authorized Representative:
Prefix: *First Name:
Middle Name:
*Last Name.
Suffix:
•
Title:
`Telephone Number: Fax Number:
*Email:
*Signature of Authorized Representative: *Date Signed:
OMB Number:4040-0007
Expiration Date:01/31/2019
ASSURANCES - NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden,to the Office of Management and Budget, Paperwork Reduction Project(0348-0040),Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND
IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE: Certain of these assurances may not be applicable to your project or program. If you have 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 Act of 1973, as amended (29 U.S.C. §794),which
and the institutional, managerial and financial capability prohibits discrimination on the basis of handicaps; (d)
(including funds sufficient to pay the non-Federal share the Age Discrimination Act of 1975, as amended (42 U.
of project cost)to ensure proper planning, management S.C. §§6101-6107), which prohibits discrimination on
and completion of the project described in this the basis of age; (e)the Drug Abuse Office and
application. Treatment Act of 1972 (P.L. 92-255), as amended,
relating to nondiscrimination on the basis of drug
2. Will give the awarding agency, the Comptroller General abuse; (f)the Comprehensive Alcohol Abuse and
of the United States and, if appropriate,the State, Alcoholism Prevention, Treatment and Rehabilitation
through any authorized representative, access to and Act of 1970(P.L. 91-616), as amended, relating to
the right to examine all records, books, papers, or nondiscrimination on the basis of alcohol abuse or
documents related to the award; and will establish a alcoholism; (g)§§523 and 527 of the Public Health
proper accounting system in accordance with generally Service Act of 1912(42 U.S.C. §§290 dd-3 and 290
accepted accounting standards or agency directives. ee-3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h)Title VIII of the Civil
3. Will establish safeguards to prohibit employees from Rights Act of 1968(42 U.S.C. §§3601 et seq.), as
using their positions for a purpose that constitutes or amended, relating to nondiscrimination in the sale,
presents the appearance of personal or organizational rental or financing of housing; (i)any other
conflict of interest, or personal gain. nondiscrimination provisions in the specific statute(s)
under which application for Federal assistance is being
4. Will initiate and complete the work within the applicable made, and, (j)the requirements of any other
time frame after receipt of approval of the awarding nondiscrimination statute(s)which may apply to the
agency. application.
5. Will comply with the Intergovernmental Personnel Act of 7. Will comply, or has already complied, with the
1970(42 U.S.C. §§4728-4763)relating to prescribed requirements of Titles II and III of the Uniform
standards for merit systems for programs funded under Relocation Assistance and Real Property Acquisition
one of the 19 statutes or regulations specified in Policies Act of 1970(P.L. 91-646)which provide for
fair and equitable treatment of persons displaced or
Appendix A of OPM's Standards for a Merit System of whose property is acquired as a result of Federal or
Personnel Administration(5 C.F.R. 900, Subpart F). federally-assisted programs.These requirements
apply to all interests in real property acquired for
6. Will comply with all Federal statutes relating to project purposes regardless of Federal participation in
nondiscrimination.These include but are not limited to: purchases.
(a)Title VI of the Civil Rights Act of 1964(P.L. 88-352)
which prohibits discrimination on the basis of race, color 8. Will comply, as applicable,with provisions of the
or national origin; (b)Title IX of the Education Hatch Act(5 U.S.C. §§1501-1508 and 7324-7328)
Amendments of 1972, as amended (20 U.S.C.§§1681- which limit the political activities of employees whose
1683, and 1685-1686),which prohibits discrimination on principal employment activities are funded in whole
the basis of sex; (c)Section 504 of the Rehabilitation or in part with Federal funds.
Previous Edition Usable Standard Form 424B(Rev.7-97)
Authorized for Local Reproduction Prescribed by OMB Circular A-102
9. Will comply, as applicable,with the provisions of the Davis- 13. Will assist the awarding agency in assuring compliance
Bacon Act(40 U.S.C. §§276a to 276a-7), the Copeland Act with Section 106 of the National Historic Preservation
(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract Act of 1966, as amended (16 U.S.C. §470), E0 11593
Work Hours and Safety Standards Act(40 U.S.C. §§327- (identification and protection of historic properties), and
333), regarding labor standards for federally-assisted the Archaeological and Historic Preservation Act of
construction subagreements. 1974 (16 U.S.C. §§469a-1 et seq.).
10. Will comply, if applicable,with flood insurance purchase 14. Will comply with P.L. 93-348 regarding the protection of
requirements of Section 102(a)of the Flood Disaster human subjects involved in research, development, and
Protection Act of 1973(P.L. 93-234)which requires related activities supported by this award of assistance.
recipients in a special flood hazard area to participate in the
program and to purchase flood insurance if the total cost of 15. Will comply with the Laboratory Animal Welfare Act of
insurable construction and acquisition is$10,000 or more. 1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et
seq.) pertaining to the care, handling, and treatment of
11. Will comply with environmental standards which may be warm blooded animals held for research, teaching, or
prescribed pursuant to the following: (a) institution of other activities supported by this award of assistance.
environmental quality control measures under the National
Environmental Policy Act of 1969(P.L. 91-190)and 16. Will comply with the Lead-Based Paint Poisoning
Executive Order(EO) 11514; (b)notification of violating Prevention Act(42 U.S.C. §§4801 et seq.)which
facilities pursuant to EO 11738; (c)protection of wetlands prohibits the use of lead-based paint in construction or
pursuant to EO 11990; (d)evaluation of flood hazards in rehabilitation of residence structures.
floodplains in accordance with EO 11988; (e)assurance of 17 Will cause to be performed the required financial and
project consistency with the approved State management compliance audits in accordance with the Single Audit
program developed under the Coastal Zone Management Act Amendments of 1996 and OMB Circular No.A-133,
Act of 1972(16 U.S.C. §§1451 et seq.); (f)conformity of "Audits of States, Local Governments, and Non-Profit
Federal actions to State(Clean Air) Implementation Plans Organizations."
under Section 176(c)of the Clean Air Act of 1955, as
amended (42 U.S.C. §§7401 et seq.); (g)protection of 18. Will comply with all applicable requirements of all other
underground sources of drinking water under the Safe Federal laws, executive orders, regulations, and policies
Drinking Water Act of 1974, as amended (P.L. 93-523); governing this program.
and, (h)protection of endangered species under the
Endangered Species Act of 1973, as amended (P.L. 93- 19. Will comply with the requirements of Section 106(g)of
205). the Trafficking Victims Protection Act(TVPA)of 2000, as
amended (22 U.S.C. 7104)which prohibits grant award
12. Will comply with the Wild and Scenic Rivers Act of recipients or a sub-recipient from (1) Engaging in severe
1968(16 U.S.C. §§1271 et seq.)related to protecting fomes of trafficking in persons during the period of time
components or potential components of the national that the award is in effect(2) Procuring a commercial
wild and scenic rivers system. sex act during the period of time that the award is in
effect or(3)Using forced labor in the performance of the
award or subawards under the award.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE
APPLICANT ORGANIZATION DATE SUBMITTED
Standard Form 4248(Rev.7-97)Back
ASSURANCES - CONSTRUCTION PROGRAMS OMB Number:4040-0009
Expiration Date:01/31/2019
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden,to the Office of Management and Budget, Paperwork Reduction Project(0348-0042),Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT
AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
Awarding Agency. Further, certain Federal assistance 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, 8. Will comply with the Intergovernmental Personnel Act
and the institutional, managerial and financial capability of 1970(42 U.S.C. §§4728-4763) relating to prescribed
(including funds sufficient to pay the non-Federal share standards of merit systems for programs funded
of project costs)to ensure proper planning, under one of the 19 statutes or regulations specified in
management and completion of project described in Appendix A of OPM's Standards for a Merit System of
this application. Personnel Administration (5 C.F.R. 900, Subpart F).
2. Will give the awarding agency, the Comptroller General 9. Will comply with the Lead-Based Paint Poisoning
of the United States and, if appropriate,the State, Prevention Act(42 U.S.C. §§4801 et seq.)which
the right to examine all records, books, papers, or prohibits the use of lead-based paint in construction or
documents related to the assistance; and will establish rehabilitation of residence structures.
a proper accounting system in accordance with
generally accepted accounting standards or agency 10. Will comply with all Federal statutes relating to non-
directives. discrimination. These include but are not limited to: (a)
Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
3. Will not dispose of, modify the use of, or change the which prohibits discrimination on the basis of race,
terms of the real property title or other interest in the color or national origin; (b)Title IX of the Education
site and facilities without permission and instructions Amendments of 1972, as amended(20 U.S.C. §§1681
from the awarding agency.Will record the Federal 1683, and 1685-1686), which prohibits discrimination
awarding agency directives and will include a covenant on the basis of sex; (c)Section 504 of the
in the title of real property acquired in whole or in part Rehabilitation Act of 1973, as amended (29) U.S.C.
with Federal assistance funds to assure non- §794),which prohibits discrimination on the basis of
discrimination during the useful life of the project. handicaps; (d)the Age Discrimination Act of 1975, as
4. Will comply with the requirements of the assistance amended (42 U.S.C. §§6101-6107),which prohibits
awarding agency with regard to the drafting, review and discrimination on the basis of age, (e)the Drug Abuse
approval of construction plans and specifications. Office and Treatment Act of 1972 (P.L. 92 255), as
amended relating to nondiscrimination on the basis of
5. Will provide and maintain competent and adequate drug abuse; (f)the Comprehensive Alcohol Abuse and
engineering supervision at the construction site to Alcoholism Prevention, Treatment and Rehabilitation
ensure that the complete work conforms with the Act of 1970(P.L. 91-616), as amended, relating to
approved plans and specifications and will furnish nondiscrimination on the basis of alcohol abuse or
progressive reports and such other information as may be alcoholism; (g)§§523 and 527 of the Public Health
required by the assistance awarding agency or State. Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee
3), as amended, relating to confidentiality of alcohol
6. Will initiate and complete the work within the applicable and drug abuse patient records; (h)Title VIII of the
time frame after receipt of approval of the awarding agency. Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
7. Will establish safeguards to prohibit employees from amended, relating to nondiscrimination in the sale,
rental or financing of housing; (i)any other
using their positions for a purpose that constitutes or nondiscrimination provisions in the specific statue(s)
presents the appearance of personal or organizational under which application for Federal assistance is being
conflict of interest, or personal gain. made; and (j)the requirements of any other
nondiscrimination statue(s)which may apply to the
application.
Previous Edition Usable Authorized for Local Reproduction Standard Form 424D(Rev.7-97)
Prescribed by OMB Circular A-102
11. Will comply, or has already complied,with the Federal actions to State (Clean Air)implementation
requirements of Titles II and III of the Uniform Relocation Plans under Section 176(c)of the Clean Air Act of
Assistance and Real Property Acquisition Policies Act of 1955, as amended (42 U.S.C. §§7401 et seq.); (g)
1970(P.L. 91-646)which provide for fair and equitable protection of underground sources of drinking water
treatment of persons displaced or whose property is under the Safe Drinking Water Act of 1974, as
acquired as a result of Federal and federally-assisted amended (P.L. 93-523); and, (h)protection of
programs.These requirements apply to all interests in real endangered species under the Endangered Species
property acquired for project purposes regardless of Act of 1973, as amended(P.L. 93-205).
Federal participation in purchases.
16. Will comply with the Wild and Scenic Rivers Act of
12. Will comply with the provisions of the Hatch Act(5 U.S.C. 1968(16 U.S.C. §§1271 et seq.) related to protecting
§§1501-1508 and 7324-7328)which limit the political components or potential components of the national
activities of employees whose principal employment wild and scenic rivers system.
activities are funded in whole or in part with Federal funds.
17. Will assist the awarding agency in assuring compliance
13. Will comply, as applicable,with the provisions of the Davis- with Section 106 of the National Historic Preservation
Bacon Act(40 U.S.C. §§276a to 276a-7), the Copeland Act Act of 1966, as amended(16 U.S.C. §470), E0 11593
(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract (identification and protection of historic properties), and
Work Hours and Safety Standards Act(40 U.S.C. §§327- the Archaeological and Historic Preservation Act of
333) regarding labor standards for federally-assisted 1974(16 U.S.C. §§469a-1 et seq).
construction subagreements.
18. Will cause to be performed the required financial and
14. Will comply with flood insurance purchase requirements of compliance audits in accordance with the Single Audit
Section 102(a)of the Flood Disaster Protection Act of 1973 Act Amendments of 1996 and OMB Circular No.A-133,
(P.L. 93-234)which requires recipients in a special flood "Audits of States, Local Governments, and Non-Profit
hazard area to participate in the program and to purchase Organizations."
flood insurance if the total cost of insurable construction
and acquisition is$10,000 or more. 19. Will comply with all applicable requirements of all other
15. Will comply with environmental standards which may be Federal laws, executive orders, regulations, and policies
governing this program.
prescribed pursuant to the following: (a)institution of
environmental quality control measures under the National 20. Will comply with the requirements of Section 106(g)of
Environmental Policy Act of 1969 (P.L. 91- the Trafficking Victims Protection Act(TVPA)of 2000, as
190)and Executive Order(E0) 11514; (b)notification amended (22 U.S.C. 7104)which prohibits grant award
of violating facilities pursuant to EO 11738; (c) recipients or a sub-recipient from (1) Engaging in severe
protection of wetlands pursuant to EO 11990; (d) forms of trafficking in persons during the period of time
evaluation of flood hazards in floodplains in accordance that the award is in effect(2) Procuring a commercial
with EO 11988; (e)assurance of project consistency sex act during the period of time that the award is in
with the approved State management program effect or(3)Using forced labor in the performance of the
developed under the Coastal Zone Management Act of award or subawards under the award.
1972(16 U.S.C. §§1451 et seq.); (f)conformity of
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE
APPLICANT ORGANIZATION DATE SUBMITTED
SF-424D(Rev.7-97)Back
DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION
AND OTHER RESPONSIBILITY MATTERS; AND DRUG-FREE WORKPLACE O.M.B NO. 1660-0025
REQUIREMENTS Expires September 30, 2017
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 1.7 hours per response.The burden estimate includes the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing, and submitting the form. This
collection of information is required to obtain or retain benefits. You are not required to submit to this collection of information unless it displays
a valid OMB control number. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to:
Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street SW,
Washington, DC 20472-3100, and Paperwork Reduction Project(1660-0025). NOTE: Do not send your completed form to this address.
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 of 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 (Nonprocurement)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 Federal Emergency Management Agency(FEMA)determines to
award the transaction, grant, or cooperative agreement.
1.LOBBYING (a)Are not presently debarred, suspended, proposed for debarment,
declared ineligible, sentenced to a denial of Federal benefits by a State or
As required by section 1352, Title 31 of the U.S. Code, and Federal court, or voluntarily excluded from covered transactions by any
implemented at 44 CFR Part 18, for persons entering into a grant Federal department or agency:,
or cooperating agreement over$ 100,000, as defined at 44 CFR
Part 18, the applicant certifies that: (b) Have not within a three-year period preceding this application been
convicted of a or had a civilian judgment rendered against them for
(a) No Federal appropriated funds have been paid or will be paid, commission of fraud or a criminal offense in connection with obtaining,
by or on behalf of the undersigned,to any person for influencing or attempting to obtain, or perform a public a public(Federal ,State, or local)
attempting to influence an officer or employee of any agency, a transaction or contract under a public transaction, violation of Federal or
Member of Congress, an officer or employee of Congress, or an State antitrust statutes or commission of embezzlement,theft, forgery,
employee of a Member of Congress in connection with the making bribery, falsification or destruction of records, making false statements, or
of any Federal grant, the entering into of any cooperative receiving stolen property;
agreement, and the extension, continuation, renewal,amendment, (c)Are not presently indicted for otherwise criminally or civilly charged
or modification of any Federal grant or cooperative agreement. by a governmental entity(Federal, State, or local)with commission of any
of the offenses enumerated in paragraph (1)(b)of this certification; and
(b)If any other funds than Federal appropriated funds have been (d) Have not within a three-year period preceding this application had
paid or will be paid to any other person for influencing or one or more public transactions (Federal, State, or local)terminated for
attempting to influence an officer or employee of any agency, a cause of default, and
member of Congress, an officer or an employee of Congress, or
employee of a member of Congress in connection with this B. Where the applicant is unable to certify to any of the statements in this
Federal Grant or cooperative agreement, the undersigned shall certification, he or she shall attach an explanation to this application.
complete and submit Stand Form-LLL, "Disclosure of Lobbying 3. DRUG-FREE WORKPLACE(GRANTEE OTHER THAN
Activities,"in accordance with its instructions. INDIVIDUALS)
c)The undersigned shall require that the language of this As required by the Drug-Free Workplace Act of 1988, and implemented at
certification be included in the award documents for all subawards 44 CFR Part 17, Subpart F, for grantees, as defined at 44 CFR Part
at all tiers(including subgrants, contracts under grants and 17.615 and 17.620-
cooperative agreements, and subcontracts)and that all
subrecipients shall certify and disclose accordingly.
A.The applicant certifies that it will continue to provide a drug-free
workplace by;
Standard Form-LLL"Disclosure of Lobbying Activities"
❑ attached (a) Publishing a statement notifying employees that the unlawful
(This form must be attached to certification if non- manufacture, distribution, dispensing, possession, or use of a controlled
appropriated funds are to be used to influence activities.) substance is prohibited in the grantee's workplace and specifying the
actions that will be taken against employees for violation of such
2. DEBARMENT, SUSPENSION,AND OTHER prohibition;
RESPONSIBILITY MATTERS (DIRECT RECIPIENT) (b)Establishing an on-going drug free awareness program to inform
As required by Executive Order 12549, Debarment and employees about-
Suspension, and implemented at 44 CFR Part 67, for prospective (1)The dangers of drug abuse in the workplace;
participants in primary covered transactions, as defined at 44 CFR
Part 17, Section 17.510-A.
(2)The grantee's policy of maintaining a drug-free workplace;
A. The applicant certifies that it and its principals:
FEMA Form 112-0-3C(9/14) Master Page 1 of 2
(3)Any available drug counseling, rehabilitation, and
employee assistance programs; and
0 There are workplaces on file that are not identified
(4)The penalties that may be imposed upon employees
for drug abuse violations occurring in the workplace; Sections 17.630 of the regulations provide that a grantee that is a
State may elect to make one certification in each Federal fiscal year.
(c)Making it a requirement that each employee to be engaged in A copy of which should be included with each application for FEMA
the performance of the grant to be given a copy of the statement funding. States and State agencies may elect to use a state wide
required by paragraph (a); certification.
(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 term of the statement; and
(2) Notify the employee in writing of his or her conviction
for a violation of a criminal drug statute occurring ion the
workplace no later than five calendar days after such convictions;
(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 FEMA awarding office, i.e., regional office or
FEMA office.
(f)Taking one of the following actions, within 30 calendar days of
receiving notice under subparagraph (d)(2),with respect to any
employee who is 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 an 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).
B. The grantee may insert in the space provided below the site(s)
for the performance of work done in connection with the specific
grant:
Place of Performance(Street address, City, County, State, Zip
code)
Signature of Applicant Agent Date:
FEMA Form 112-0-3C(9/14) Master Page 2 of 2
DISCLOSURE OF LOBBYING ACTIVITIES
Approved by OMB
Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352 4040-0013
1.*Type of Federal Action: 2.*Status of Federal Action: 3.*Report Type:
O a.contract ❑ a.bid/offer/application ®a.initial filing
b.grant ® b.initial award {J b.material change
c.cooperative agreement ❑ c.post-award
▪d.loan
e.loan guarantee
f. loan insurance
4. Name and Address of Reporting Entity:
Prime ElSubAwardee
Name
•Street 1 Street 2
City State Zip
Congressional District.if known:
5. If Reporting Entity in No.4 is Subawardee, Enter Name and Address of Prime:
6.*Federal Department/Agency: 7.*Federal Program Name/Description:
CFDA Number,if applicable:
8. Federal Action Number,if known: 9.Award Amount,if known:
10.a. Name and Address of Lobbying Registrant:
Prefix •First Name Middle Name
Last Name Suffix
'Street 1 Street 2
'City State Zip
b.Individual Performing Services(including address if different from No.10a)
Prefix 'First Name Middle Name
•Last Name Suffix
•Street 1 Street 2
•City State Zip
11. Information requested through this form is authorized by title 31 U.S.C.section 1352. This disclosure of lobbying activities is a material representation of fact upon which
reliance was placed by the tier above when the transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C.1352.This information will be reported to
the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subiect to a civil penalty of not less than
$10,000 and not more than$100,000 for each such failure.
•Signature:
'Name: Prefix 'First Name _ -- Middle Name
Last Name Suffix
Title: r Telephone No.: Date:
Authorized for Local Reproduction
Standard Form-LLL(Rev.7-971