04-1048Presented By:
Referred To:
Council File #
RESOLUTION
iAINT PAUL, MINNESOTA
Green Sheet #
oy-Ioy
3023603
0
Committee: Date
i WHEREAS, the Department of Fire and Safety Services is seeking a grant of $33,000.00 to provide fire
z sprinkler systems in ten Habitat for Humanity homes and purchase 500 smoke detectors, and
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a W HEREAS, the City of Saint Paul is required to pay a 30% matching fund contribution of $9,900.00, and
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s WHEREAS, upon receipt of this grant, the City is obligated to appropriate the grant amount of
� $23,100.00, and
s
s NOW THEREFORE IT BE RESOLVED, that the proper City officials are hereby authorized and directed to
io execute an application for the City of Saint Paul's Department of Fire and Safety Services to apply for a
i� Federai Emergency Management Agency (FEMA) fire prevention grant;
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BE IT FURTHER RESOLVED, that the Ciiy of Saint Pauf Depariment of Fire and Safety Services is requesting
assistance in providing fire sprinkler systems in ten Habitat for Humanity homes and purchasing 500 smoke
detectors; a copy of said application is to be kept on file and of record in the Office of Financiai Services.
Requested by Department of:
Fire & Safe Services
By: ,�
Approval Recommended by Director of Financial Services:
�
Adopted by Council: Date,NovBm�l 3 , ��
Adoption Certified by Council Secretary:
�
Approved b�r �il�yo�Date, � � ��
�
by City
for
����
' � Green Sheet Green Sheet
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Green She�t Green Sheet Green Sheet Green Sheet �
DepartmenUO�celcouncil: Date Initiated:
FR -�� ,¢o�� Green Sheet NO: 3023603
Contact Person 8 Phone: DeoartmeM Sent To Person : I""a1lDate �
Steve Zacprd � 0 �re � �
ZZ8-620� AsSigO 1 re __ _. Depar[ment Director
Must Be on Council Agenda by (Date): Numher '� �
2 i Att me
For
RoUting 3 a or's Otfice � Ma oNAssistant
Order 4 0o cil
5 ' Clerk i Cierk
Total # of Signature Pages _(Clip NI Locations for Signature)
Action Requested:
To approve the attached Council Resolution authorizing the Depamnem of Fire and Safety Services to apply for a Federal Emergency
Management Agency (FEMA) fire prevention gant.
Recommendations: Approve (A) or Reject (R): Personal Service Contracts Must Mswer the Following Questions:
Planning Commission 1. Has this person/firm ever urorked under a conVact for this department?
" CIB Committee Yes No
Civil Service Commission 2. Has this person/firm ever been a city employee?
Yes No
3. Does this person/firm possess a skill not normally possessed by any
, current city employee?
Yes No
F�cplain all yes answers on separate sheet and attach to green sheet
initiating Problem, issues, Opportunity (Who, What, When, Where, Why):
The Department of Fire and Safety Services is applying for a grant of $33,000.00 to provide fue sprinkler systems in ten Habitat for
Hnmanity homes and purchase 500 smoke detectors. The gant includes a 70% federal match of $23,100.00 and the City is requued to
pay a 30% matcLing fund contdburion of $9,900.00.
Advantages If Approved:
The Department of Fue and Safety Services will be able to accept the grant money to provide fire sprinkler systems and purchase
smoke detectors.
DisadvantapeslfApproved: "
None. � Pa��43�6'G� �
��� � � ��T
Disadvantageslf NotApproved:-
I,ost opportunity to obtain fixnds to provide fire sprinkler systems in Habitat for Hnmanity homes and purchase smoke detectors.
7otal Amount of 33000 CosURevenue Budgeted:
Trensadion: � � � � � � �
Fundinst Source: Grant Activitv Number: 05110
Financiallnformation: FederalShare $23,100.00 �CT 19 2004
(Explain) City Share $ 9,900.00
Total $33,000.00 �r�� fl ������
@ �9
� Pnrt Application
Preparer Information
Prefix
First Name
Middfe lnitiaS
Last Name
Organization Name
Address 1
City
State
Zip
Business Phone
Home Phone
Mobife Phone/Pager
Email
Entire Appiication
Preparerinformation
Mr.
Steve
o�- ta�f�
Page 1 of I S
Zaccard
Saint Paul Department of Fire and Safety Services
100 E. 11th St.
Saint Paul
Minnesota
55101 -
651-228�201 Ext.
651�159-4499
651-214-5593
steve. zacca rd @ci. stp a u I. m n. u s
� Are you the person to be contacted on matters involving this application? Yes
If yes, please specify: Primary Contact
<
Prin[ Application
Contact Information
� Title
Prefix
i First Name
Middle Initial
- Last Name
� Business Phone
•Home Phone
Mobile PhonelPager
Fax
�Emai{
^ Titfe
Prefix
° First Name
Middle initiai
� Last Name
^ Business Phone
°Home Phone
Mobile Phone/Pager
Fax
^Email
Prim� Contact Information
Fire Marshal
Mr.
Steve
L
Zaccard
651-228-6201 Ext.
651-459-4499 Ext.
651-214-5593
651-228-6241
steve.zaccard @ci.stpaui. mn. us
Aiternate Contact Information
Accountant
Mr.
John
Swanson
651-228-6256 Ext.
651-228-6257 Ext.
651-228-6241
john.swanson@ci.stpaul. mn. us
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?ririt Application
Applicant Information
EMW-2004-FP-03193
Originally submitted on 09/30/2004 by Steve Zaccard (Userid: zaccard)
Contact Infortnation:
Address: 100 E. 11th St.
City: Saint Paut
State: Minnesota
Zip: 55101
Day Phone: 651-228-6201
Evening Phone: 651-459-4499
Cell Phone: 651-214-5593
Email: steve.zaccard@ci.stpaui.mn.us
Application number is EMW-2004-FP-03193
x Organization Name
� Type of Applicant
If other piease enter the type of Appiicant
` En�4�e_ttlertifieaticr tdcmber
` What is your ouvs r;�m�sr?
Headquarters Physical Address
� Physical Address 1
Physical Address 2
� City
° State
� Zip
Mailing Address
• Mailing Address1
MaiGng Address2
` City
- State
. Zip
Accountinformation
• Type of bank account
° Bank routing number - 9�it number on the bottom
left hand corner of your check
�Your account number
Add itional I nformation
� This fiscal year are you receiving Federal funding
from any other grant program for the same purpose
for which you are app(ying for this grant?
� This fiscal year, are you receiving Federa! funding
from any other grant program regardiess of purpose?
Department of Fire and Safety Services
Fire Department
41-6005521
153857347
100 E. 11th St.
Saint Paul
Minnesota
55101 - 2227
100 E. 11th St.
Saint Paul
Minnesota
55101 - 2227
Checking
091000022
180111054532
No
Yes
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Page 3 of 15
Prini Appl'acation
� is the applica�t delin uent on any federal debt? No
if you answered yes to any of the additior�ai questions
above, please provide an explanation in the space
provided below:
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Page 4 of 15
Received a$34,832 FEMA grant for smoke detectors for the hearing-impaired and to expand our Risk Watch
program in the schoois.
Pririt Application
Request Information
' Are you an international or national organization? No
If No, what is the p�ulatioNconstiTuencv served by your organization? 287000
Project Information
'1. Project Title
`2. Who is the target audience tor the planned project?
'3. What is your estimated size of the target audience?
= How was this target audience determined?
Briefly describe method used (required if selected other
than "None of the above" above)
'4. Does your proposal include partnerships? (i.e. Fire
Departments, community origanizations or
national/state/Iocai organizations)
Residential Sprinkler Program
Other Residential
homeowners/occupants
2040
Formal Assessment
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Page 5 of 15
10 "Habitat for Humanity" homes & 500 smoke dete�
Yes
if you answered Yes to question 4 above, please specify
the partner(s): Habitat for Humanity
'S. is it the applicanYs intention to continue delivering this
program after the grant year? N�
`6. Will your organization periodically evaluate the
programs impact on the community? Yes
if you answered Yes to question 6 above, please specify: We wiil track performance of these sprinklers and de
impact on fire loss and casualties.
'7. In the space provided below, please explain the experience you have in managing the type of project you are
We have been providing smoke detectors to our public for 15 years. We had approx. 125 residential sprinkler syst
1988 - 1998.
'8. In the space provided below, please provide a brief project synopsis:
We will take bids for fire sprinklers to be installed in local Ha6itat for Humanity homes constructed in our city. We �
free smoke detectors in homes in areas of the city targeted for high rates of fires, fire losses, and casualties.
Targeted Mitigation Program (Estabiish a new program)
Item
Fire sprinkiers
Totai Cost
Object Class
Construction
Number of units
10
Cost per unit
$ 3,000
Total Cost
$ 30,000
$ 30,006
Prin't Application
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Page 6 of 15
Project Information
*1. Project TiUe
*2. Who is the target audience for the planned project?
*3. What is your estimated size of the target audience?
How was this target audience determined?
Briefly describe method used (required if selected other
than "None of the above" above)
`4. Does your proposal include partnerships? (i.e. Fire
Departments, community origanizations or
nationai/state/local organizations)
Residential Smoke Detector Giveaway
2000
Formal Assessment
High risk c
Areas of the city with the greatest residential fire pro
No
lf you answered Yes to question 4 above, please specify
the partner(s):
`5. Is it the applicanYs intention to continue delivering this Yes
program afterthe grantyear?
'6. Will your organization periodicaily evaluate the yes
programs impact on the community?
if you answered Yes to question 6 above, please specify: We wiil evaluate the effect on fires, fire losses, and t
*7. In the space provided below, please explain the experience you have in managing the type of project you are
We've given away and installed thousands of free smoke detectors from various sources to our residents for the F
*8. In the space provided below, please provide a brief project synopsis:
The fire dept. wiil provide and install singie-station, battery-powered smoke detectors in target-area homes that dc
annuaily to remind the residents to replace the battery.
Smoke Alarm Campaign (Expand an existing program into new areas)
Item
Smoke detectors
Total Cost
Object Class
Supplies
Number of units
500
Cost per unit
$6
Total Cost
$ 3,000
$ 3,000
Print Application
Budget
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Page 7 of 15
Budget Object Class
a. Personnel $ p
b. Fringe Benefits $ p
c. Travei g p
d. Equipment $ p
e. Supplies $ 3,000
f. Contractuai $ p
g. Construction $ 30,000
h. Other $ p
i. Ind3rect Charges $ p
Indirect Cost Details
Agency Indirect Cost Agreement with
Indirect Cost Rate %
Agreement Summary
Federal and Applicant Share
Federai Share $ 23,100
Appiicant Share $ 9,900
Federal Rate Sharing (%} 70/30
' NO�_ F@d2�al R250UlC25 (The combined Non-Federal Resources must equai the Appticant Share of $ 9.900)
a. Applicant $ 9900
b. State $ p
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.
Total Budget $ 33,000
Pririt Application
Narrative Statement
Project Description
Please provide your narrative statement in the space provided below:
Our project is comprised of two components:
1. RESIDENTIAL FIRE SPRINKLERS
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Page 8 of I S
We propose to provide residentiai fire sprink{ers conforming to NFPA 13D in up to ten singfe-family dwellings
built by the local chapter of Habitat for Humanity.
The processes will inciude: a) A Request for Proposais RFP mailed to all licensed sprinkler contractors in the
State of Minnesota, b) Bids received by interested contractors, c) contract(s) awarded to the lowest qualifying
bidder(s), and d) plan review/inspection/approval by the Saint Paul Fire Marshal's office.
The RFP will be issued as soon as there can be confirmation of a grant award and a City Council Resolution is
passed to accept an award. The project will continue until all ten houses are sprinklered.
Fire sprinklers are the most cost-effective fire protection available. This is well documented. The most telling
documentation is a study done by the City of Scottsdale, Arizona, 15 years after passage of their own residential
sprinkier ordinance. The average fire loss in a sprinklered home was $2,166 compared to $45,019 in homes
without sprinklers. More importantly, there were no lives lost from fires in sprinklered homes. Fire sprinklers are
96% effective in controlling or extinguishing a fire, and with a lot less water damage than a fire hose.
The Saint Paul Department of Fire and Safety Services has delivered public fire protection for over 150 years.
Today, it is a full-service safety organizations delivering services in fire prevention, fire suppression, emergency
pre-hospital care, hazardous materiais, and advanced tactical rescue.
The target audience is the owners of new homes built by Habitat for Humanity. These homes are provided to
low-income families who can least afford to pay for their own fire sprinkler systems, yet they typicaliy have the
most fires.
The success of this component of the project will be evaluated by comparing fire losses and casualties between
sprinkiered and unsprinklered homes. The evaluation wili continue until such time as there is sufficient data for a
valuable comparison.
2. SMOKE DETECTOR GIVEAWAY PROGRAM
Grant funds wiil allow us to continue our long-standing smoke detector giveway program where we will focus our
giveaway on targeted neighbo�hoods of the city that experience the highest fire rates and losses.
We wili provide, deliver, and install up to 500 battery-powered, single station smoke detectors. We will register
each smoke detector in our database so we can send them a �eminder each year to repiace the smoke detector
batteries. This registration will also enable us to document the success of this program.
This program wiil continue as long as supplies last.
Pririt Application
Assurances and Certifications
FEMA porm 20-16A
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Page 9 of 15
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 appiicants to
certify to additional assurances. If such is the case, you wiil be notified.
As the duly authorized representative of the appiicant I certify that the applicant:
1. Has the Iegai authority to apply for Federal assistance, and the institutional, managerial and
financial capability (inciuding funds su�cient 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 ail records, books, papers, or documents related to the award; and will estabiish a
proper accounting system in accordance with generaNy 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; (� the Comprehensive Alcohoi 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 Pubiic Heaith
Service Act of 1912 (42 U.S.C. 290-dd-3 and 290-ee-3), as amended, relating to
confidentiality of alcohoi and drug abuse patient records; (h) Title VIII of the Civii 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) u�der which application for Federat ass+stance is being made; and Q} 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 Iil of the Uniform
Pririt Application
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Page 10 of 15
Relocation Assistance and Real Property Acquisiiion Policies Act of 1970 (P.L. 91-646)
which provide for fair and equitable treatment of persons displaced or whose property is
acquired as a resuit of Federal or Federaily assisted programs. These requirements apply to
all interest in real property acquired for project purposes regardless of Federal participation in
purchases.
8. Wiii comply with provisions of the Hatch Act (5 U.S.C. Sections 1501-1508 and 7324-7328),
which limit the politicai activiiies of employees whose principal empioyment activities are
funded in whole or in part with Federal funds.
9. Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C. Sections
276a to 276a- 7), the Copeland Act (40 U.S.C. Section 276c and 18 U.S.C. Sections 874),
and the Contract Work Hours and Safety Standards Act (40 U.S.C. Sections 327-333),
regarding labor standards for federally assisted construction sub agreements.
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of
the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a speciai
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. Wiii compiy with environmental standards which may be prescribed pursuant to the foliowing:
(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
tacilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d)
evaluation of flood hazards in floodpiains 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.); (� 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 nationai 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. Wiii compYy with P.L. 93-348 regarding the protection of human subjecis invoived in research,
development, and related activities supported by this award of assistance.
15. Will comply with the Laboratory Animai 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 biooded 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. Wili 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 goveming this program.
19, It will compiy with the minimum wage and maximum hours provisions of the Federal Fair
Labor Standards Act (29 U.S.C. 201), as they apply to empioyees of institutions of higher
education, hospitals, and other non-profit organizations.
Pririt Application
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Page 11 of 15
Signed by Steve Zaccard on O9/34/2004
Print Application
Form 20-16C
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Page 12 of 15
You must read and sign these assurances by providing your password and checking the box at the
bottom of this page.
Note: Fietds marked with an * are required.
Certifications Regarding Lobbying; Debarment, Suspension and Other Responsibilities Matters; and Drug-Free
Workplace Requirements.
Applicants should refer to the regulations cited below to determine the certification to which they are requirsd to
attest. Appticants should a{so review the instrucfions for certification induded in the reguiations before
compieting 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 shali be treated as a materiai representafion of fact upon which reliance wiii be piaced when the
Federai Emergency Management Agency (FEMA) 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
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 o�cer or employee of any agency, a
Member of Congress, an officer or empioyee of congress, or an employee of a Member of
Congress in connection with the making of any federai grant, the entering into of any cooperative
agreement and extension, continuation, renewaf amendment or modification of any Federal Grant
or cooperative agreement.
(b) If any otherfunds 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 emp{oyee of a Member of Congress in
connection with this Federal grant or cooperative agreement, the undersigned shall complete and
submit Standard Form LL�, "Disclosure of Lobbying Activities", in accordance with its instructions.
(c) The undersigned shali require that the language of this certification be included in the award
documents for afl the sub awards at all tiers (including sub grants, contracts under grants and
cooperative agreements and sub contract(s)) and that ail sub recipients shall certify and disclose
accordingly.
2. Debarment, Suspension and Other Responsibility Matters (Direct Recipient)
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 taenefits 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 transadion; violation of Federal or State antitrust statutes or
commission of embezzlement, theft, forgery, bribery, faisification 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 locaf) with commission of any of the offenses enumerated in paragraph (1)(b) of
this certification: and
o �I- ���g
Print Application Page 13 of 15
(d) have not within a three-year period preceding this appiication had one or more public
transactions (Federal, State, or local) terminated for cause or default; and
B. Where the appiicant is unable to certify to any of the statements in this certification, he or she shall attach an
exptanation to this application.
3. Drug-Free Workpiace (Grantees other than individuals)
As required by the Drug-Free Workplace Act of 1988, and implemented at 44CFR Part 17, Subpart F, for
grantees, as defined at 44 CFR part 17, Sections 17.615 and 17.620:
(A) The applicant certifies that it will continue to provide a drug-free worlcplace by:
(a) Publishing a statement notifying employees that the unlawful manufacture,
distribution, dispensing, possession, or use of a controlied substance is prohibited in
the grantee's workplace and specifying the actions that will be taken against
employees tor 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 workpiace;
(2) The grantees policy of maintaining a drug-free workplace;
(3) Any available drug counseling, rehabilitation and empioyee
assistance programs; and
(4) The penalties that may be imposed upon employees for drug abuse
violations occurring in the workpiace;
(cj 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 empioyee 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 empioyee in writing of his or her conviction for a violation
of a criminai 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 actuai notice of
such conviction. Empioyers of convicted empioyees must provide notice, inciuding
position titie, to the applicabie FEMA awarding office, i.e. regionel office or FEMA
office.
(� Taking one of the foilowing 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 empioyee to participate satisfactorily in a drug abuse
assistance or rehabilitation program approved for such purposes by a
Federal, State, or local heaith, 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 (�.
Print Application
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Page 14 of 15
(8) The grantee may insert in the space provided below the site(s) for the pertormance of work
done in connection with the specific grant:
Piace of Pertormance
Str2et City
State Zip
Action
If your place of pertortnance is different from the physical address provided by you in the Applicant
lnformation, click on Add Place of Pertormance button above to ensure that the correct place of
performance has been specified. You can add multipte addresses by repeating this process muttiple
times.
Section 17.630 of the regulations provide that a grantee that is a State may elect to make one certification in each
Federal fiscal year. A copy of which should be included with each appiication for FEMA funding. States and State
agencies may elect to use a Statewide ce�tification.
Signed by Steve Zaccard on �9I30(2Q04
` ' Print Application
Standard Form LLL
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Page 15 of 15
Only complete if applying for a grant for more than $100,000 and have lobbying activities. See Form 20-16C for
tobbying activities definition.
This form is not applicable