HomeMy WebLinkAboutResolutions - 2010.03.25 - 10182GENERAL GOVERNMENT COMMITTEE
MISCELLANEOUS RESOLUTiON #10052 March 25, 2010
By: General Government Committee, Christine Long, Chairperson
IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES — HOMELAND SECURITY DIVISION -
ACCEPTANCE FOR 2007 FEMA STATE HOMELAND SECURITY GRANT PROGRAM-MICHIGAN TASK
FORCE I EQUIPMENT
TO: OAKLAND COUNTY BOARD OF COMMISSIONERS
Chairperson, Ladies and Gentlemen:
WHEREAS funding was released under the U. S. Department of Homeland Security, through the Federal
Emergency Management Agency (FEMA), for the State Homeland Security Grant Program; and
WHEREAS the State has designated Homeland Security Region 2 in the State which includes, but is not
limited to the following political subdivisions: City of Detroit and Macomb, Monroe, Oakland, St. Clair, Washtenaw,
and Wayne Counties; and
WHEREAS the Michigan Homeland Protection Board continues to support Regional Homeland Security
Planning Boards throughout the state and has charged them to identify and prioritize how regionally awarded
grant funds will be used within the regions; and
WHEREAS the Regional Homeland Security Planning Board for Region 2 is comprised of the
representatives from the above-listed political subdivisions, is not a legal entity that can be a subgrantee for the
Homeland Security Grant or that can manage and distribute the grant funds, and has chosen Oakland County to
serve as fiduciary and subgrantee for this award; and
WHEREAS funding from the FY 2006 and FY 2007 State Homeland Security Grant Program has been
used to support the development of a regional Urban Search and Rescue task force, known as Michigan Task
Force 1; and
WHEREAS the State of Michigan wishes to further support the development of the task force and has
awarded Oakland County, serving as fiduciary for Region 2, reimbursement for qualified expenses up to, but not
exceeding $125.000 from the State Homeland Security Grant Program to support the development of Michigan
Task Force 1 during the period of January 1, 2010 through May 30, 2010: and
WHEREAS this funding will be leveraged to purchase (1) refrigerated box truck, which will be used to
transport supplies and equipment to the scene of an incident necessitating the deployment of the task force; and
WHEREAS the grant agreement has been reviewed and approved through the County Executive
Contract Review Process.
NOW THEREFORE BE IT RESOLVED that the Oakland County Board of Commissioners accepts the
grant funding from the State of Michigan in an amount up to $125,000 with no county match or in-kind match
required.
BE IT FURTHER RESOLVED that the Oakland County Board of Commissioners authorizes its
Chairperson or his designee to execute and enter into this agreement on behalf of the County of Oakland.
BE IT FURTHER RESOLVED that the Chairperson of the Board of Commissioners is authorized to
execute the grant agreement and to approve any grant extensions or changes, within fifteen percent (15%) of the
original award, which are consistent with the original agreement as approved.
BE IT FURTHER RESOLVED that acceptance of this grant does not obligate the County to any future
commitment.
Chairperson, on behalf of the General Government Committee, I move the adoption of the foregoing
resolution.
GENERAL GOVERNMENT COMMITTEE
Motion carried unanimously on a roll call vote.
Executive Order 11593 - Protection and enhancement of the cultural environment
http://www ,gsa.gov/PorteligsalevicoutentView.do?coatentTGM, j3ASIC&content1d,--12094
Archeological and Historic Preservation Act (16 U.S.C. 469)
h ://vit o /local-law/MK, ArchilistPreu pg,
The National Environmental Policy Act of 1969 (42 U.S.C. 4321)
htto://www.nepa.govinepairegsincpainesiaeqin.htm
Omnibus Crime Control and Safe Streets Act of 1968
IiMvw.usdo" ..ljt_.,___142use3789d.htrn
Victims of Crime Act (42 ISSC Section 10604)
htto://www usdoi gsgicrticoribvageny/do1060,1.1van
Juvenile Justice and Delinquency Prevention Act
fit1p://olitipmejrs.arg1alyou1lijdpa2002titiev.pcif
Federal Civil Rights Act of 1964
tatp.//www.usdoigoviert/corfindex.htm
The Rehabilitation Act of 1973
http://www.dol.g!)vicornpliancetlaw5/comp-rehab.h1m
The Americans with Disabilities Act of 1990 (42 U.S.C., Sec 12131-34)
http://frwebgate4.access ,g)o.govkzi-bio/waisgatc,cta.i2WAISdocID42030427315+0+0 -FO&WAISacti on-retrieve
The Education Amendments of 1972 (20 U.S.C., Sec 1681, 1683, 1685-86)
littp://www.usdvj.gpvierticortcoord/titteixstat.htm
Age Discrimination Act of 1975 (42 U.S.C. Sections 6101-6107)
littp://wivw.dol.govioasain/re/statutese actinin
Executive Order 13279 - Equal Protection of the Laws for Faith-based and Community Organizations
bttp://www.whitchouse.govinewsireleasest2002112/20021212.6.html
Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970(42 ES.C. Sec 4601)
http://ecfr.gpoaccess.gov/c_g_iftitextitext-
idx?c---ecfr&sid=764d9d5c1380f106e9acana07flOd36f78crvi=div58Eyiew-text&riode-18:2.0,4.3.7&idno=18
Federal 'latch Act - Political Activity of Certain State and Local Employees
http://www.osc.govihatchact.htin
Restrictions on Lobbying (28 CFR part 69)
http//www.acces's.ogov/naraJcfi -/sidx 04/28cfr69 04,1mrl
Executive Order 12549- Debarment and Suspension
httpil/www.arch'Ives.goviletieral-registericodificationiexecutife-order112549.htnal
Government-Wide Debarment and Suspension (28 CFR, Part 67)
w:LgoIL____Iara/cfrirwaisicix 04/2Sce67 04.htm1
Drug-Free Workplace Act of 1988
htvPfrwebgdte.access.gpogovkgj-bjn/kstdo.cg,i?itnarae-=brovfse wcikdocid=Cite:+41:LTSC701
FISCAL NOTE (MISC. 110052) March 25, 2010
BY: FINANCE COMMITTEE, TOM MIDDLETON, CHAIRPERSON
IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES - HOMELAND SECURITY DIVISION —
ACCEPTANCE FOR 2007 FEMA STATE HOMELAND SECURITY GRANT PROGRAM — MICHIGAN TASK
FORCE *I EQUIPMENT
TO THE OAKLAND COUNTY BOARD OF COMMISSIONERS
Chairperson, Ladies and Gentlemen:
Pursuant to Rule XII-C of this Board, the Finance Committee, has reviewed the above referenced
resolution, and finds:
1. The State of Michigan has awarded funding from the State Homeland Security Grant Program to
Oakland County, who serves as fiduciary for Region 2, in an amount up to $125,000.
2. Funds will be used towards the purchase of a refrigerated box truck for use by the region's Urban
Search ald Rescue Task Force to transport equipment and supplies to the scene of an incident
involving a building collapse or similar incident.
3 The refrigerated box truck will not tipe purchased until a funding source has been identified to
support t'e asset including the ongoing maintenance costs.
4. The grant period is January 1, 2010, through May 30, 2010.
5. The grant funds in the amount up to $125,000 will require no county match or in-kind match.
a. The FY 2 Adopted Budget is amended as follows:
FY 2010
FY 2010 Amended
Budget Amend. Budget
2,1=1_429340 Domestic P -eparedness Equip. GR#0000000487
Revenues
1060601-115127-610313 -ederal Grant Rev. $ 0 $125,000 $125,000
Total Revenues $ 0 $125,000 $125,000
Expenditures
1060601-115127-760156 Vehicles $ 0 $125,000 $125,000
—otal Expenditures $ 0 $125,000 $125,000
FIN CE CO"AITTEE
f
FINANCE COMMITTEE
Motion carried unaninously on a roil call vote with Long absent,
GRANT REVIEW SIGN OFF — Homeland Security Division
GRANT NAME: 2007 State Homeland Security Grant Program — Michigan Task Force I Equipment
FUNDING AGENCY: Michigan State Police Emergency Management and Homeland Security Division
DEPARTMENT CONTACT PERSON: Brandon Lewis 8-1598
STATUS; Grant Acceptance
DATE: March 4, 2010
Pursuant to Misc. Resolution 401320, please be advised the captioned grant materials have completed internal
grant review. Below are the returned comments.
Th captioned grant materials and grant acceptance package (which should include the Board of
Commissioners' Liaison Committee Resolution, the grant agreement/contract, Finance Committee Fiscal Note,
and this Sign Off email containing grant review comments) may be requested to be placed on the appropriate
Board of Commissioners' committee(s) for grant acceptance by Board resolution.
DEPARTMENT REVIEW
Department of Management and Budget:
Approved with the following condition: Before this truck is purchased, funding must be provided for ongoing
maintenance and support (Atli() asset. — Laurie Van Pelt (313/2010)
Department of Human Resources:
Approved. — Cathy Shallal (311/2010)
Risk Management and Safety:
Approved by Risk Management Julie Secontine (3/2./2010)
Corporation Connsel:
After reviewing the above-referenced Grant Agreement, I found no legal that must he made before the grunt is
executed. — Jody S. Hall (3/4/2010)
COMPLIANCE
The grant agreement references a number of specific federai and state regulations. Below is a list of these
specifically cited compliance related documents for this grant.
Federal Office of Management and Budget (OMB) Circular N. A-n, A-87, A-102, A-110, A-122 and A-133
buti://www.whitehou se. goviombicircularsiindcx.html
Emergency Management and assistance Regulations (44 CFR)
http://www.access.gpo.govinaTaicfriwaisidx 00/44eftv I 00,htall
Adinthistrative Guide to State Government
littp://www m i zap. govidiab/0,1607,7-150 -9131 9347-.00.1)ml
State of Michigan Financial Management Guide (FMG)
LIM://www,rnithiggLg_i, ovibudget10,1607,7- 157-1310 27707-99757-.00.km!
Single Audit Act of 1984 (With amendments in 1994)
ktgrl/www.whileimuse.gov/orilb/fmancial/fia single auditlittni
Executive Order 13347 - Individuals With Disabilities in Emergency Preparedness
http://www.ttna.govipdtemergency/rfirnQinrrEs 47.
Michigan Freedom of Information Act 442 of 1976 (MCI 15.231)
ligruffuniol. Ilyjclatrrin. priwif(rnylitio-risfivh-slihavi ert,3x0efl p/milczarx?nat_c —aetObieet8cobiectName --me1-15-23 1
Title VI of the 1964 Civil Rights Act (42 U.S.0 Section 2000d)
http://www.usdoi.zovicrtieoriccord/titlevistat.htm
Michigan Elliott-Larseu Civil Rights Act — "Act 453 of 1976"
bAirethArlmui iptiqsitilrpriIvi(In; 1 Yr, efi-mrtS75571lliwv41:triile.q.asirm?uan=eetobi ect&ohiectname—mcl-Act-453-of-
1976&quervid=14718540
Michigan Persons with Disabilities Civil Rights Act — "Act 220 of 1976"
/2uiwv4511mile asoVnage=getobiect&oblectriame=mel-Act-220-of-
1976&queryid=14718589
Michigan State Contracts with Certain Employers Prohibited — Act 278 of 1980
ipoidAturp mirynviiqt ea frarTv4nnni gbv h I Os2135511im ileE.aspx?nafe=zetObiect&obiectName—Incl- Act-278-
of-1980
Department of homeland Security — Protected Critical Infrastructure Information (6 CFR Part 29)
jittr e:rf r poar.ceqs. vic i ititext/text-idx?e ,,ecfr&tD1=/ec frbrowseiTitle06/6cV9 main 02.tpl
Department of Homeland Security — Protection of Sensitive Security Information (49 CFR Part 1520)
htIp://www.access.aoo.eov/nara/cfr/waiidx 04/49cfrl 520 04 11=1
Executive Order 12372 - intergovernmental review of Federal programs
htty:fiwww.fws.8ov/oolicvilibraoilrReo12372,ixif
US Do,! Uniform Administrative Requirements for Grants and Cooperative Agreements (28 CFR Part 66 and 28
CFR Part 70)
htto:www.access.no.govinara/cfr/waisidx o4r2scfr v2 04.1itml
Office of Justice Programs Hearing and Appeal Procedures (28 CFR Part 18)
://etiv.access. o.00viriara tmi
COP fidentia lity of Identifiable Research and Statistical Information (28 CFR Part 22)
J-Lttp://www.access.gpo,gov/mara/cfr/waisidx 04/28cfr22 04.html
Criminal Intelligence Systems Operating Policies (28 CFR Part 23)
htm://www.access gph.govinara/cfr/waisidx 01/28cfr23 01-html
Intergovernmental Review of Department of Justice Programs and Activities (28 CFR Part 30)
tittp://www access. goo.govinaraicfrhvaisdx 01128cfr30 01.html
Nondiscrimination of the basis of Disability in State and Local Government Services (28 CFR Part 35)
linvi/www.access g-no.govinara/cfriwaisidx 01/28cfr35_ 01.html
Equal Treatment for Faith Based Organizations (28 CFR Part 38)
htin://www usdoi.goviovw/docsiasilinernoreimplementationof28cfmart38.pdf
Nondiscrimination; Equal Employment Opportunity; Policies and Procedures (28 CFR Part 42)
littp://www.access.gøoov/rmraJc.ft/waisidx 01/28cfr42 01.htm1
Procedures for Implementing the National Environmental Policy Act (28 CYR Part 61)
http:gwww.access.gpo.gov/hara/cfriwaisidx 01/2Scfr61 _01.html
Floodplain Management and Wetland Protection Procedures (28 CFR Part 63)
littp://www.p.teess,gpo.govina.ra/cfriwaisidx 01/28cfr63 01.html
National Historic Preservation Act of 1966 (16 U.S.C. 470)
http://www.ops_govihistory/loeal-iaw/nhpal966.htm
Social security number
or
Employer Identification number
j 38 6004876W
FQ•ff, 1A1•9
pev, October 2007;
Depw1,0 o iii Traasury
Irwle Rovvi-e arpVc.a
Request for Taxpayer
Identification Number and Certification
Give form to the
requester. Do not
send tO the IRS.
harre (as sticw7 on y01..1' ircuie tax 7etuli-,i
_County of Oakland
13u5rE*5 mrre. c Verew `rdr- tfzove
Crirr,t appropriate bcx iii Ilciv...lirat/Soe proarietdr — COepuratIvi PartnereeP
ddriTany. E-.:sr V7e tax ..tass:ical..vn (EI---d:sr-egarded entty, C=Gcrporaton, P=parriersrip,
')tr7u .1SirLCI** II' Government Entity
ACW!'e55' (-MTr.n4r . street, ar.ci art, dr suito oc,)
C.tv. stair,. and ZID code
Pontiac, MI 48341
List 8.;;CCJ'It 71.irrleer:5) liars ;cptcral)
Taxpayer Identification Numbe r
Enter your TIN in the EipprOpr ate ocx. The TIN provided must match the rame given on Line 1 to avoid
backup withnoiding, For individuals, th .s is your social security number (SSN). However, for a resident
alien, sole Propnetor, c- disregarded ent:ty, see the Par; I instructions on page 3. For other entities. it
your employer icentification -umber (E.N‘,, If you no not have a number, see Haw to get a T/N on page .3,
Note,. If the account is hi more her one name, see tne chart on page 4 for guidelines on whose
number to enter,
0
c i71- 0
02
t
a.
Co a:
Part I
Exa--,dt
payee
liECI0C5ter'S narre ad address rcpiEd"a)
Part II Certification
Under penalties of perjury. I certify that:
1. Tie number snown on trie form is my correct taxpayer identifcation number for I am waiting for a number to be issued to me). and
2, 1 am net subject to oack..p withholding because: (a) am exempt from backup wkhholdIng, or (b) I have rot been notified by the internal
Revenue Service (lns) tnat I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has
notified me that am no longer subject to backup withholding, anc
3. I am a U.S, citizen or other J.S. person (defiled be(ow).
Certification instructions. You must cross pot item 2 above if you have been notified by the IRS that you are cuncrtly subject to backup
withreiding because yo,., neve Wadi to reprzt all interest and dividends on your tax return.. For real estate transactions, item 2 does not apply.
For mortgage interest paid, acquisition or ah.Frincorment of sec;.zed property, cancellation of debt, contributions to an retirement
arrangement (IRA), and geheraly. payments other than interest and dividends, you are not required to sign the Certification, but you must
provide your correct TiN. See the instructions on page 4.
Sign
Here
Sivnatvre Of
U.S. pOrson Date
General Instructions
Section references are to the Internal Revenue Cede unless
otherwise, noted.
Purpose of Form
A person who is required to de an irformation return WM the
IRS must obtain your correct taxpayer :dontification number (TIN)
to report, for example, income pad to you, rea„ estate
transactions, mortgage ilterest you paid, acquisition or
abandonment of secured property, carcelstion of oebt, or
contr butions you mace to an IRA.
Use Form VV-9 orry you are a U.S. persor (noluding
resident alien), to provlde your correct TIN to the person
requesting :1 (the requester) and, when app!ea.b.e, to:
1. Cern' tnat the TIN you are glving :s correct (or you are
waiting for a number to be issued),
2. Certif'y that you are rot sub)eot te backup withholding, or
3. Cam exempton from backup wWlhod:ng you are a U.S.
exempt payee. If applicable, you are aiso cerffying that as a
U.S. person, your atiocao e share of any partnersNp income from
a U.S. trace or buslness is net subect to tne withho.dlrg tax or
foreign partners sham of effectively connected 'ncorne.
Note. If a requester gves you a form other than Form W-9 to
request your TIN, you must use the rec.uester's form If
substantialy scmi.'ar to th:s Form W-9.
efinition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are;
• An individual who ls a U.S. citizen or U.S. resident a
• A partnership, corporation, company, or association created or
organized in the United States or under the laws of the: United
States,
• An estate (other than a foregn estate), o -
• A domtic trust )as defined in Regu,atons seam -.
301,7701-7).
Special rules for partnerships. Partnerships that corduct a
trade or business in the United States are generety rca.,ired to
pay a withholding tax on any fordign partners' share of licoma
from such business. Further, in cortan cases where a Fern W-9
has not been received, a partnership is required to presume that
a partner is a foreign person, and pay the withnoking taN.
Therefore, if you are a U.S, person that is a partner n a
partnership conducting a trade or business +rt the united States :
provide Form MS to the partnership to estabrsh your U.S.
status and avoid withholding on your share of partrwsp
!name.
The person who gives Form W-9 to the partnership for
purposes of estaolishirg its U.S. status and avold:ng w-thnolding
on its alloCable share of net income from the partnership
.,-,onaucting a trade or business 4N. the U7ited States s in the
timing cases:
• The U.S. owner of a Oisregarcied entity and not the ertity,
Cat. No. 10231K TT - (Rev. 13-2007)
For W. peefo-eacej Page 2
• The U.S. grantor or ether owner of a grantor trust and not the
trust, ane
• The U.S. trust (ether teen a reactor trust) and ect the
beneficeet es of the 'suet_
Foreign person. If you are a fererge pereon, do riot use Form
leti-9. Instead, t(Ge tpe appropriai, Fcrm W-8 (see PubJcaleon
515, Withhold ng of Tax on Nonees.cent ;does ann Fo7eign
Entitles).
Nonresident alien who becomes a resident alien. Geriefaliy,
only 8 norresdent Wier: .ncier dual may use the tern-s ef a tax
treaty to reouce or e:irerate U.S. tax oe certain types of eeome.
However, most tax treaties coetaie a provision known as a
"saving clatise," Excepeons epece ed in the saving cause may
permit an exemption from tax to continue for certain types of
income ever after tre payee has oteerwise become a U.S.
resident alien 'or tax ourposes.
If you are a U.S. resideet aren who is reeyng on art exception
coetained in the saving teause of a tax treaty to claim an
exemption from U.S. tax on certein types of rricome, you must
attach a statement to Form W-9 that epecifies the foeoeeng five
items.
1. The treaty couetry. Generaey, this must be the seine treaty
under which you claimed exert-peer.. from tax as a nonresident
aece.
2. The treaty artic,e addressirg toe income.
3. The artice number (or location) in the tax treaty that
contains the saving c!ause and as exceptions.
4. The type and amount of income that quagfies for the
exemption from tax.
5. Sufficient facts to justify the exemption from tax under the
terms of tie treaty articte.
Example. Article 20 of the U.S.-Chlea lecorne tax treaty allows
an exemptioe from tax fo7 scholarehio income received by a
Chinese student temporarily present in the Unite d States, Under
U.S. law. tnis student wid become a resident alien for tax
purposes if his or her stay •,n the United States exceeds 5
calendar years. However, paragraph 2 of the first Protocol to the
U.S.-Ciena treaty (dated April 30, 1954) allows the provisions of
Article 20 to continue to apply even after the Chinese student
becomes a reseeent alien of the Uneed States. A Chinese
student who qualifies for this exception (under paragraph 2 of
the feet protocol) and is relying on this exception to c aim an
exemption from tax on his or her scholarship or feilowerep
ncieme woted attach to orm W-9 a statement that includes the
informaton described above to support tat exemption.
if you are a rienreseiere slier or a foretgn eetty riot sublect to
backup withhold'ne, give the reauester the appropriate
completeo Form W-B.
What is backup withholding? Persons making certain payments
to you must ende7 certaet c;nna.T,Crls with!nolo ono pay to tee
IRS 25% of suce oayrnents. This ;$ called "paeledp withholding."
Payments that may be subject to backup withholdirg include
interest, tax-exempt interest. c.iecierds, broker aid barter
exchange transactIons. rents, royat:es, nonemployee nay, and
certan payments from fleeing coat operators. Real estate
transactions are not subject to backup welnho.deig.
You we not be sJb;ect to boueup We:Adding on payments
you receive ie you give the requester your correct TIN, maKe the
proper eerie:caters, and repoe all your taxale.e interest and
dividends on your tax 'etern.
Payments you receive will be subject to backup
withholding it
i. You do not furn.sh your TN to tee requester,
2. You dc not certev eour TIN when reetered J'eree the Peet If
lestructons or. page 3 for dotalse
3.Ine IRS tea tne reclueeter teat you furn.sned an incorrect
4. The IRS tells you that you are sub sot to backup
wthholding because you red not report ail your interest and
civ;dends on your tax return (for reoorteble interest and
divicends only), or
5. You do not certify to the requester that you are not subject
to backup withholding under 4 above for teem-table ttereet arc
divieerei accounts opened after 198e.
Certain payees arid payments are exempt frcfn backup
vethholding. See the irstreetens below and the sepurate
netructions for the Requester of Form W-9.
Aso see Special rules at partnerships on page 1.
Penalties
Failure to furnish TIN. If you fail to furreue you'- correct. TN to a
requester, you are subject to a penalty of $5C for eacn such
fai.ure unless your faiiure is due to reasenatee cause and not to
wiieul neglect.
Civil penalty for false information with respect to
withholding. If you maee a false statement with no reasonable
basis that results in no backup withholding, you are sebjeet to a
$500 penalty.
Criminal penalty for falsifying Information. Wilifuey falsifying
certifications or affirmations may subject you to erirerra:
penalties including fines anti/or imprtsaernset.
Misuse of TTNs. If the requester discloses or uses TINS in
violation of federal law, the requester may be subject to vh and
criminal penalties.
Specific Instructions
Name
If you are an individual, you must generally enter the name
shown on your income tax return. However, if you have cnanged
your last name, for instance, due to marriage without intem!ng
the Social Security Administration of the name change, enter
your feet name, the last name shown on your social security
card, arid your new last name.
If the account is in joint names, list first, and then Circle, tee
name of the person or enety whose number you ertereo in Part I
of the form.
Sole proprietor. Enter your indivelual name as shown on your
income tax return on the "Name' !ine. You may enter your
business. trade, or "doeig busmess as pl3A)" rame on tee
"Business name" ene.
Limited liability company (LLC). Check the "Lerlited liability
company" box only and enter the approprate cede for the tax
classification ("D" 'kir disregarded entity , "C' for corporation, "P"
for partnership) in the space provided.
For a single-member LLC (inciudirg a foreign eLC with a
domestic owner) that ;s disregarded as an entity separate from
its owner under Regulations section 3e1.7701-3, enter the
owner's name on tic 'Name" line. Enter the LLO's name on the
"Business name" line.
For an LLO classified as a partnership or a corporation ., enter
the LLC's name on the "Name' line and any business, vacie, or
DBA name on the "Business name" Inc.
Other entities. Enter your business eerne as shown on reeteeed
federal tax documents on the "Name" iMe. This name shouic
meters the name shown on the charter or other 'ego.: document
creating the entity. Yoe rosy enter any business, trace, or DBA
name on the "Business name"
Note. You are requested to check the appropriate box for your
status endtvidual/sole proprietor, cormation, etc.).
Exempt Payee
If you are exempt team backup withholding, erter your name as
described above and check tne appropriate box. for your status
then check the 'Exempt payee" box P, the itre fohowing the
business name, sign and date the form,
Exempt payees 1 t'rough
[3ene,ally. exempt payees
1 thrcJgh
Page 3 f , W-4 iP. In flTh
Genere'ly, ind)vdue,s (ircluOing so e proprietors are not exempt
from backup withino:dng. Corporations are exempt from backup
withholdng for certain Payments, such as 'rterest and tieldends
Note. If yo ,J ac exempt hor-7 backup withholding, you shou d
WI compete this form to avod pass[b'e erroneous backup
withno!dieg
The fo,ow ng payees are exempt from backup Wthhoiding:
An orgarzatior exerept 4rom tax uncer section 501(a). any
IRA. Or a custod.al account under section 4G3(b)(7) if the account
satisf es the Tqu'rereents o section 401Xj;2,
2. The United States or any o' its agenc es or
instrumertalites,
3. A state the District of Columbia. e pOSSeSS:09 0' the Un;teo
States, or any of tne:r pol.t.ca subcivis.ors or inStrUrnelta. t es,
4. A foreign government or any of its pc:itical suudiv aims,
agencies, or instrumenta 'ties, or
5. An •nternational organlatior or ary of its agencies or
instrumentalities.
Other payees that cray be exempt from backup withholding
ino,ude:
5. A corporation.
7. A foreign centre,' bank of issue.
8. A dealer n securtes or conviodities required to register in
the United States. the Distr ct of Co umb(a., or a possessior of
the UrAid States.
9. A futures commssion mei.chant registered w.th the
Commodity Futures Trading Commisson,
10. A real estate irvestment trust,
11. An ent ty registered at al trnes during the tax year under
the Investment Company Act of 1 g4.3
"`.2. A common trust turd operated by a bank Under section
584(a),
13. A financial inst tution.
14. A middleman known :n the !nve-strrent community as a
nominee or custodian. or
A trust exernot from tax under section 664 o: describeo .n
section 4947.
The chart be;ow shows types of payments that may be
exempt from backup withhoid ng, The chart epp;ies to the
exempt payees Isted above, ' through 15.
IF the payment is for ... THEN the payment is exempt
for. .
interest and dividend payments Al! exempt payees except
for 9
Exemot oayees 1 through 13.
Also, a person registered uncier
; tie rvestrnent Adv.sers Act of
:340 who nags.il,any acts as a
broke'
Barter exchange transactiom
and patronage dividends
Dayments over 5600 recOred
to be reported ancl direct
sales over $5,300
,See Fe—. lcs9 -Kb-a misce IW100.15 ir'_Or.".e, and Iis .nstructions.
.1-1.oweve7, tne fotowtig pay–et s '-de Lo a corporot -on ;.ncit,dirtg gross
procsed5 pat to al attorney wider t-AcVor, 5,..::45(r,„ even it tne attorney s a
corpdreton) arid reportable on Forffi 1099-MI5C are not exeirpt trOin
backLp wttino ding n•edica at-A tieditn Care paytnerts. attorneys' tees, and
payments or services paid by a rectral execotve agency_
Part I. Taxpayer Identification
Number (TIN)
Enter your TIN in the appropriate box. if you are a res.cent
alien and you do not have and are not dig b a to get an S5N,
you!' TIN is your IRS nd;vd ...;a: taxpayer identif:cat on nunncor
(ITIN). Enter it in the social security number box. If you do not
have dr 'TIN, see How to get a TIN be.ow .
If you are a sole brovietor and you have an EN, you ray
enter either your SSN or ON. However, tile IRS prefers that you
use your SSN.
t' MI are a single-member LLG that :5 disregarded as an
entity separate from its owner (see Limited liability company
ILO on page 2), enter the owner's SSN (or EIN, if the owner
has one). Do not enter tie d'sregarced entity's EIN. if the LLG Is
ciassiiied as a corporation or partneriship. enter the ent.ty's FIN,
Note. See the chart on page 4 fa- further ciar!fication of name
and TIN combinations.
How to get a TIN. If you do not lave a TIN, apply for one
mrnediately. To apply or an SSN, get Form 56-5, Anprcatior
for a &Oat Security Card, from your iocal Socal Security
Administration office or get th:s form. online at www.ssa.g04.
may also get this form by call:rg 1-800-772-1213. Use Form
W-7, Application for IRS Individual Taxpayer Inerliftation
Number, to apply for an ITIN, or Form 55-4, Appicatioe for
Employer Identificaton Number, to apoy for ar EIN. You can
apply for an EN online by accessing the IRS website at
www.Irs,gpv/businesses and click:ng cr Erp oyer Identfleetion
Number (EIN) under Starting a Business. You car get Forms W-7
and SS-4 from the IRS by visiting wwwirs.gov or by caLr
1-890-TAX-FORM 0-800-829-3616).
If you are asked to corno,ete Form W-g but do not have a 'IN,
write "Applied For" in tic space for the TIN, s ign and date the
form, and give it to the requester_ For interest and de,rdena
payments, and certain payments made with respect to readily
tradable instruments, generally you WiL have 60 days to get a
TIN and give it to the requester before you are subject to bacKup
withholding on payments. The 60-day rt.le does not apoty to
other types of payments. You will be subject to backup
withholding on al Suci payments until you provide your 7.4 to
the requester.
Note. Entering "Applied For' means that yu have aready
applied for a TIN or that you Intend to apply for one soon.
Cetrtion: A disregarded domestic entity that has a foreign owner
must use the appropriate Form W-8.
Part II. Certification
To establish to the withholding agent that you are a U.S. person,
or resident alien, s'on Form W-9. Yet., be requested to sign
by the withhoiclieg agent even it items I. 4, and 5 beow Indicate
otherwise.
For a joint account, only the pe-son whose TIN is shown Ti
Part I should sign (when requ'red). Exempt payees, see Exempt
Payee on page 2.
Signature requirements. Complete the oertificator as !na cated
in 1 through 5 below.
1. Interest, dividend, and barter exchange accounts
opened before 1984 and broker accounts considered active
during 1983. You must give your correct TIN, but you do not
have to sign the certification.
2. Interest, dividend, broker, and barter exchange
accounts opened after 1983 and broker accounts considered
Inactive during 1983. You must s:gn the certrcaton or backup)
withiolding will apply. If you are subject to backup w trhoodirg
and you are merey provding your correct TIN to the reouester,
you must cross out item 2 in the certification before 5gnirg me
form.
Broker transactions
oh* name and SSN of:
Tliu actua ow-ar of The ecLow-ri or
GOrriPliRd funds the f-at
i'iG v an ',he
The —sinar
The grentor-trostee
The actJa owne,
The ow^er
Give sterns and Esit
-"r1,0 OWI1E,
Legs witty
Tot) Wr0Gratio-
7ne organiaaton
The palr,ership
The broxer or rioreinee
The mibiic entity
Form W-9 Tlev. 3-2C.C.7:i Page 4
3. Real estate transactions. You most sign the certi ftlt!on.
You may uross out ter 204 the cert,ticaton.
4. Other payments. Yo.. must give your correct TN,Out you
do nof have to sln the certi f:eat.on un'ess you have veer
notif ed that you have Qrev-cus.y giver an ncorrect TIN, "Other
payments irclude payments made in the coarse of the
requester's trade or busTess for rerts, royalties, goods (other
than bil:s for meronandisel, —ec:ica and health care senices
(incluthng payments to, c,orperat Ions;. payments to a
nonerrp!oyee or serves, payments to Certain •tsti;rtg boat crew
members and fishermen, ard gross proceeds dald to attorneys
(irclucirg payment to CorporZI,ConS;.
5. Mortgage interest paid by you, acquisition or
abandonment of secured property, cancellation of debt,
qualified tuition program payments (under section 529), IRA,
°overdraft ESA, Archer !ASA or I4SA contributions or
distributions, and pension distributions. Vad MUSt g:ve your
correct TIN, but you do rot have ro sIgn the certif:cat;on
What Name and Number To Give the Requester
Far this type ot account:
redvidual
2 Two o! "rtOst iaO vrc1L.3. or-t
accoAt
3. Custodait accoant of a i-rilac
(Unifvirr (3!4ic Minor At
a. The us..ial rovocab'e savAgs
trust igre'ito a a'so trustee;
P. Ecioa.led trust aCGC..111 that is
a latia vale trust. „leder
State aw
5 : 5010 propretoriri:O or d:sregardel
entity 0Wres1 by BO
For this type al accoUntt
6. Olsragarded e-tity riot awned by ah.
indiviCual
7, A yaw Irs, estate, or pe,-.So-i rjst
O. Corporate or LLC eiecting
corporate 3latus on Form F1832
9. Associato,, Oub, re7giOus .
charleo'a 0duziatiora', or other
tas-eioarnpt argarizat
a. partuarshu or multi-men-bet LIL.0
1 1 . A orsiier Or reir4 stored norr-E noe
'2, Accoant the epriirtrredt of
AgiritStureir the 7.am9 ral a puto'c,c
eritity I5...Ch Q.5 a state or iocal
dovommont, sr.,hcio cistr.ot, Or
orispol trial receives agricultural
program psyTents
Secure Your Tax Records from Identity Theft
Identity theft occurs when someone Uses your persona,
information such as your name, soc:ao security number (SSN), or
other 'clentity'rg tili.01T-latiOrt, Without your permission, to comma
fraud or other crimes. An iciert,ty thie f may use your SSN to get
a job or may file a tax return us'ng your aSN to receive a refund.
To reduce your risk:
e Protect your SSN,
• Ensure your employer is pieteetng your SSN. and
• Be careful when. choosing a tax preparer.
Call the IRS at 1-80a•E29-1040 if you tn.ink your :Identity has
been used inappropriately for tax pLIFPOSCS.
V:ctirns of identity theft who are experencing ecorornic
or a system prob.em, Or are see$s;rg help in rescnvng lax
orooleits that have not been resolved through normal channels.
may on eligible for Taxpayer Advocate Servee (TAS) assistance.
Yot.: car, reach TAS by call'ng the TAS tii-free case intake line
at 1-877-777-477B or rryrrao 1-800-B29-4059.
Protect yourself from suspicious ernes or phishing
schemes. Phishing is the creator+ and use of ema,, and
websites designed to rvmic .egItimMe business emails and
wecsites. The most common act is sending art emaii to a usor
falsely claiming to be an establ,shed leglimate enterprise n an
attempt to seam the user Tito surrendering private information
that will be used for identity theft.
The IRS does not initiate contacts w!th taxpayers via erriaiis.
Also, the IRS Coes not request persona! detailed irformation
through email or aak taxpayers for the Plti numbers, passwords,
or similar secret access information for (her credit card, bank, or
other financial accounts.
I' you receive an unsolcited email claming to be from the IRS,
forward this message to phishingrOirs,gov: You may also report
misuse of the IRS name, logo, or other IRS persoral property to
the Treasury Inspector General for Tax Administration at
-81:10-356-4484. VU can forward suspicious emails to the
Federal Trade Commission at: spamOuce.gov oroortact them at
www.consurnergovlicrtheft or 1-877-1DTHEFT(4313-4338).
Visit the IRS website at www.irs.gov to learn more about
Identity theft and how to reduce your risk.
'List fisr ails ova tea -ams or rs panel rombtnn you a^ly j^a Dewar
an a pm/ accau l hag SSN, 1,10, Llara:.,11 's rrivr be iitzviished
1..I:+9 r.sPie arO Ii.m oh ire rr .5.5N
'YOu VLSI rtow yOAr roliv.dual 7ELITV a,r1 yui., may also e^tei, your bsuiusso• JBA'
name c lie saGaiv lame tray 55N Or "O. N l earwi'it 0,55,
lltirt ire ms eniuvvages NU 10 J5e yDUI 551.4
LFI f rsi are ci-ale vis name ct ire Irish, usiate CfD2-5:0,1rJ81. ICO1C1'.4,1,51- (frit) ir
of Ine pvrsontil 'uormerint ve a in, Slue arias IN legal Wily asei s desirfoled I"
accouri see bor14.7/,13,-V-iv..5 or page 1•
Note. If no name is circled when more than one name 'a i:sted,
the number will be considered to be that of the first name listed.
Privacy Act Notice
SettiOn et a9 cf the internal Revenue Code requiras }KW to rt.-Q.0;de your correct 11151 to persons who must file irforrnetion retOMS w.th the 'FiS to report ilterest.
dvitionts, and oarte.r, other rcome pal to yet., "hortgago -"threat you paid, the acclusition or abandonment 0! secured property, cavellation of debt. or
contribA005 yoa Tade to ii IRA, or Arcor M.SA ar rISA The IRS uses the larbers for identification purOoces add to help vasty the accuracy ot yo,r tan rettin,
7eolFIS may eso prov:Ce this in'orrraton to the Department of Jirstroe for clvil and criminal litigation, and to cities, states, the District of Col.:al:1a, Und
possessions to carry oat trier tax hews We may also disclose this j.7:fOIr1elt:0rl to °tries countries under a tax treaty, to fedora! and Male agencies to enforce federal
nontax corriha Jaws, or to Federal ow enforcement and hteligeitoe agencies to combat terrorism.
Yoa must oroV:Pe your TIN whetr or or hot you are redi red to fe a tax return. Payers must generally wilt:hold 26% of taxable :merest d videtid, arid certairi diner
Par-nerds to a payee Who does not give a TTh to a payer. Carter, penalties Tay tied apply,
Give name and B.Strl of:
Toe 'Idly:duo
actual owner of The aCCOUrrt
it corroined funds, the first
vidua cr. tre account'
The .nincr
The grantor-trustee
Tne actua owner
GIve name and EIN of:
Legal entity
oorporaton
The organ zat oi
The partrorsr p
The Prue! or rorninee
'he pub.ic entity
For IFIev. 1C-207)
3. Real estate transactions. You must sign tre cenificaten.
You may cross out item 2 of tie centificat on.
4. Other payments. You must give your correct TIN, but you
co rot nave to sgn the certlfLiAton unless you have been
notified that you have pitevicusly giver ar icurrect TIN. 'Other
payments" rioiu.de payments mace in t7e course of the
requester's ti-&de or business for itents. royalties, goods (other
than bills or rnedica and health care servces
(including payments to coroorations, payments to a
nonernployee for services, Da yrnentS to certain fishing boat crew
members and 7`i5nertirien. anc gross proceeds paid to attorneys
(ino:uding payments to corporations).
5. Mortgage interest paid by you, acquisition or
abandonment of secured property, cancellation of debt,
qualified tuition program payments (under section 529), IRA,
Coverdell ESA, Archer MSA or FISA contributions or
distributions, and pension distributions. You must iVie your
correct -IN, out you do not have to sir the certification.
What Name and Number To Give the Requester
.11•n
For this type of account:
1, ndivodusr
2. Two Or moire tdvicluais Ije 'it
account)
3.Ctistodati account of a minur
tUreforrc Gift to ;Mirrors Act)
4, a. The uses' revocable savings
trust igrattor .s aso trustee;
o. &o-called tr.,st account that .a
not a ieal or void trust ...index
state law
5. Sale proprietorship or cisrogarded
rant ly owned Oy an individ,,a.
For this type of account:
6. Disregarded entity rot owned oy alil Tho owns.
indly'rdval
7. A yid trust. estate, or pens:on ;rust
8. Corporate or L,LC a eang
corporate status on Form e652
9. Associetior. club, re.g,ous,
charitable. educational, or other
11,$x-exiempl o:gerrizaticrr
ID, Partnership or mu:I.-member LLC
11, A broor or re.gistered nomirtee
12. Accoom wnrr ire Ccoartrrert or
Agncuiture ir the come or a PiKiiC
entKty i*.r;i1 as a state or !coal ;
government, schoot district, or
prtsarn tnot rece:ves agriou,tura.
program oar-or: to
Pn-e 4
Secure Your Tax Records from Identity Theft
lc:entity theft occurs when someone uses your personal
.nforrration such as your name, soc:a security number (SSN), or
°the, identifying in'ormation„ without your perrriss_on, to coremit
fraud or other crimes. An idently thief may use your SSN to get
a job or may file a tax return using your SSN to receive a refund,
To reduce your risk:
• Protect your SSN,
• Ensure your employer is protecting your SSN. and
• Be careful when choosing a tax preparer.
Cal the IRS at 1-800-829-1040 ,f you think your icertity has
been used inappropriately for tax purposes.
Victims of identity theft woo are experiencing economic harm
or a system problem, or are seeking neip in resoving tax
problems that have not been resolved through normal channels,
may be eligible for Taxpayer Advocate Service (TAS) assistance.
You can reach TAS by call rig the TAS to l-free case intake Eine
at 1-877-777-4770 (xi TTYTTDO i-800-02g-4059-
Protect yourself from suspicious emails or phishing
schemes. Phishing is the creation and use of email anc
websites designed to mimic legitimate business emails are
websites. The most common act is sending an ema;. to a user
1alsely claiming to be an established ieg timate enterprise .n or
attempt to scam the user into surrendering !private information
that will be used for identity theft.
The IRS does not initiate contacts with taxpayers via ernails.
Also, the IRS does not request persona' detaiied information
through emaii or ask taxpayers for the PIN numbers, password's,
or similar secret access ieformation for their credit card, bank, or
other financ;al accounts.
If you receive an unsolicited erre I claiming to be from the IRS,
forward this message to phishioggirs.gov. You may also report
misuse of the IRS name, logo or other IRS personal property to
the Treasury Inspector General for Tax Administration at
1-800-366-4484. You can forward suspicious erneiis to the
Federal Trade Commission at spwri@uce.gov or contact them at
wwW.consumergovildthett or 1-877-IDTREFT(438-4338).
Visit the IRS Website at WWW.irageW to ;earn more about
identity theft and how to reduce your risk.
ittist and once the rains 01 the purson wts:se o-ly one
on a ,unri account ti55 ci SSP* 1,101 person s ft.iribrn iriust be ritarisned
'Cove tie ^YiOns lam ariC t.,,,nsh a —.7:el 551,,
3 Y1Siia tniatASVON, at's], ytt..0 T5), 5i313. yQUI *1.4M55 O .C5BA'
^ame snrniil lame 1ire. YO,.1 Mai/ Cour your 55si v yoL i,aye olb
...,111.e a-cow-ages you to use yoz Si3N.
Lst frs1 aro cimleOne naro oi the :roll eslote, O Re-ison .i.D2 not ',lin V-, One
ot the perserat leoresentatve OF Irjstee Jrleo the ieini gritty 11.5..*,5 int designated in
ins occourt Iiita.t Also nee Ves Oil pap 1.
Note. l' no Tame is circled when more than one name is iisted,
the nurrber WI be corsieered to be tnat of tie first name listed.
Privacy Act Notice
Sect on 81C9 of the Internal Reveniuo Code reou:res you to provide your correct TIN to persons weep must file information returns witr the RS to reboit merest,
UN:dent:is, and certain otner -come paid to you, mortgage interest you pad, the emus ticri or abandonment of secured oroperty, cancellation of debt. 0'
CentrOutions you made to ar IPA, or Aroner MSA or HSA IRS uses the numbers for Ioeitlflcatn purposes aria to help verily tie accuracy of your tax return.
Tha IRS may also provide th 5 !FstOrM2t107 ';(2 Department of Uustice for civil and oinminal litigation. and to cit as states, the District of Dolumb.a. and LIZ,
PoSSia.'5-5iCria cc Carry (Lit their tax .aws. We may also otac cse Via rformation to other countries under a tax treaty. to federal and slate agencies to enforce fedora
crolinai :awn or to ferinrof raw enforcement and ntelligence agencies to combat terrorism.
You must orov:de yo'..r TIN wretner or rot you are reiou:red to fi e a tax return, 'oyeirs must generiviy withhold 28% of taxaole Merest. Cividend. and cella? chief
portents to a payee WN., does -ot give a —IN to a payer. Certain perzites may asp apply,
OMB APPROVAL NO. 1121-0140
EXPIRES 01/31/2006
STANDARD ASSURANCES
Date
The Applicant hereby assures and certifies compliance with all applicable Federal statutes, regulations,
policies, guidelines, and requirements, including 0.MB Circulars A-21, A-87, A-02, A-110, A-122, A-
133; Ex, Order 12372 (intergovernmental review of federal programs); and 28 C.F.R. pts. 66 or 70
(administrative requirements for grants and cooperative agreements). The applicant also specifically
assures and certifies that:
1. It has the legal authority to apply for federal assistance and the institutional, managerial, and financial
capability (including funds sufficient to pay any required non-federal share of project cost) to ensure
proper planning, management, and completion of the project described in this application.
2. It will establish safeguards to prohib:t employees from using their positions for a purpose that
constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain.
3. It will give the awarding agency or the General Accounting Office, through any authorized
representative, access to and the right to examine all paper or electronic records related to the financial
assistance.
4. It will comply with all lawful requirements imposed by the awarding agency, specifically including
any applicable regulations, such as 28 C.F.R. pts. 18, 22, 23, 30, 35, 38, 42, 61, and 63.
5. It will assist the awarding agency (if necessary) in assuring compliance with section 106 of the
National Historic Preservation Act of 1966 (16 U.S.C. § 470), Ex. Order 11593 (identification and
protection of historic properties), the Archeological and Historical Preservation Act of 1974 (16 U.S.C.§
469 a-1 et alq.), and the National Environmental Policy Act of 1969 (42 U.S.C. § 4321).
6. It will comply (and will require any subgrantees or contractors to comply) with any applicable
statutorily-imposed nondiscrimination requirements, which may include the Omnibus Crime Control and
Safe Streets Act of 1968 (42 U.S.C. § 3789d); the Victims of Crime Act (42 U.S.C. §10604(e)); The
Juvenile Justice and Delinquency Prevention Act of 2002 (42 U.S.C. § 5672(b)); the Civil Rights Act of
1964 (42 U.S.C. § 2000d); the Rehabilitation Act of 1973 (29 U.S.C. §7 94); the Americans with
Disabilities Act of 1990 (42 U.S.C.§ 12131-34); the Education Amendments of 1972 (20 U.S.C. §§1681,
1683, 1635-86): and the Age Discrimination Act of 1975 (42 U.S.C. §§ 6101-07); see Ex. Order 13279
(equal protection of the laws for faith-based and community organizations).
7. If a governmental entity--
a) it will comply with the requirements of the Uniform Relocation Assistance and Real Property
Acquisitions Act of 1970 (42 U.S.C.§ 4601 et 5.2.), which govern the treatment of persons displaced as a
result of federal and federally-assisted programs; and
b) it will comply with requirements of 5 U.S.C.§§ 1501-08 and §§7324-28, which limit certain
political activities of State or local government employees whose principal employment is in connection
with an activity financed in whole or in part by federal assistance.
U.S. [DEPARTMENT OF JUSTICE
OFFICE OF JUSTICE PROGRAMS
OFFiCE OF THE COMPTROLLER
CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND
OTHER RESPONSIBILITY MATTERS; AND DRUG-FREE WORKPLACE REQUIREMENTS
Applicants should 7e ver to the regulations cited below to determine the certification to which they are re.cHired to
attest. Applicants should also -eview the ,rstructicris for certTheatior Included in the regulationS before ocinpieting this
fOrrn Signature of Ir+8 form provides for compliance With certification. requirements Under 28 CFR Part 69, "New
Restrictiors on I_ obby,rg . and 28 CFR Part 67, "Government-wide Debarment and Suspension (hlonpro-curernent) and
Government-wide Requirements for Drug-Free Workplace (Grants)." The certifications shall he treated as a material
representation of fact upon which reliance will he paced wien the Department of Justice determines to award toe
covered transaction„ grant„ or cooperative agreement,.
1. LOBBYING
As required by Section 1352, Title 3'. of the U.S. Come, anc
implemented at 28 CF R Part 69, for persons entering into a
grant or cooperative agreement over $100,003, as defined at
28 CFR Part 69, the applicant certifies that
(a) Federal appropriated funds have been paid or will be
paid, by or on ochalf of the undersigned, to any person o in-
ruencing or attempting to influence an officer or empIoyee of any
agency, a Member of Congress, an officer or employee of
Congress, or an employee of a Member of Cergress in con-
nection with the making of any recieta: grant, the entering into
of any Cooperative agreement, and the extension, continuation,
renewal, amendment, or moditicaton of any Fecteral grant or
cooperative agreement:
f,b) If any funds other than ed:ij. apprcoriated funds have
been paid or will ba oiaCL to any person for influencing or at-
tempting to influence an officer or emoioyee of any agency. a
Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connect:op with this
Federal grant or coopm-ative agreement. the undersigneu shall
complete and submit Standaro ForTri LL.L, 'Disclosure of
Lobbying Activities," in aoccroance witn tsi instructions;
(o) The undersigned shall rea.ire that the language of thi$ cer-
tification be Inoluned in the award doornents for ail subawands
at all tiers (including sucgrents, contracts urvaor grants and
cooperative agreements, and sobocntractst and that all sub-
reolplents shah certify and disclose accordingly.
2. DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS
(DIRECT RECIPIENT)
As required by Executive Order 12549, Debarment and
Si.ispension, and imple.rner.ted at 25 CFR. Part 67, for prospec-
tive participants in primary covered transactions. as defined at
28 CFR Part 67, Section 67.5)3—
A. The applicant certir:es that it and its ploht;:pals:
•.at Are not presentiy debarred, 5.-sperided. proposed for deosr-
merit, decared Eoeiigibe , sentenced to d deniai of Federal
benefits by a State. or Federal court, or volunteriiy excluded
from covered transact ass uy arv Federa: dope-di-lent
or agency;
(b) Have not within a three-year period preceding this acplica-
tier been convicted of or had a civil iougment rendered against
therr for commission of fraud or a criminal offense lin cunneo-
lian with oblaininq, attempt:TT to obtain, or performing a
oxalic (Federal. State, or local) transaction or contract under a
public transaction; violation of Federal or State antitrust etalutes
or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, mak,ing false
statements, or receiving stolen property:
(c) Are not presently indicted for or otherwise criminally or
civilly charged by a governmental entity ;Fedora, State Or
Social) with commission of any of the offenses enumerated in
paragraph (1)(b)of this certification; and
(d) Have not with's' a three-year period preceding this applica-
tion had one or more public fransact)or s (Fedocal. State, or
local) terminated for cause or default; and
B. Where the applicant is unable to certify to .any of tire
statements in this certification he or she shall attach an
explanation to this application.
3. DRUG-FREE WORKPLACE
(GRANTEES OTHER THAN INDIVIDUALS)
As required by the Drug-Free Workplace At of 1988, and
implemented at 28 CFR Part 67, Subpart F, for grantees, as
defined at 28 CFR Part 67 Sections 67.515 and 57.62J—
A. The applic.ant certifies that it will or wit continue to provide
a drug-tree worltplace by
(a) Publishing a statement notifying emplcyaes that the
an awful manufacture, distribution, dispensing, possession, or
use of a controlled substance IS Ord:IDIte0 intne grantee's
workplace and specifying the actiors that will be taken against
employees for violation of st.L.7.h prohibition;
{la) Establishing an on-going drug-free awareness program to
inform employees about—
(1) The dangers of drug abuse irt the workplace
(2) The grantee's policy of rna,ntaining a drug-free workpiace,
cd4 Any available drug counseling, rehabiiiiation, and employee
assistance programs; and
(2 ) The penalties that may be Imposed twon employees for
drug abuse violations occurring in the workplace;
(c) Making It a requirement that each employee to Se engaged
in the performance of the grant be given a copy cf If's state-
ment required by paragrach (a):
(d) Notifying the employee in the statement required by para-
graph (a) that, as a condition of employment under the grant,
the employee will-
OJP FORM 4C5' /6 (3-91) RroLAC:ES CAP FOV9 406%1'2 406113 AND 4051/4 CF. ARE OeS V.ETE.
CLorie 38-60046-76W
:3 Grantee IRS/Veneer Number 2. Application Number airiror Project Name
s l as-ho
6. Cate
(1) Abide by the terms of the state 7erj; arid
(2) Notify the erno.oyer in !writing cf t)sorIV corv!cten for a
violatior of a uhrninat dnJg statute oocuring in the workplace
no iater then five oaiertear cays aher sucn convictlen;
(e) NotifyIng lie agency. 'In writing, within t 0 celerCer days
after receiving ret,ce uncler: subparagraph (02) from an
employee or otherwise receiving actuai no:!ce of such convic-tlot)
Empioyers of convicted errh,oyees must provte notice, ,ncluding
position title, to! Dcpartmert 3t Justice, Off!tte of
Justice. Programs, Control Desk, 633 inoiana Avenue,
N.W., Washu-gtort, D. 2C53'. , Notice shall iroluce th.e iden-
hficution ilumper(s) of each affectec grant;
(f) Taking one of the folowng ect1cris, wnin 30 cale.nciar
days of receiving notice under suoparagrapn (d){2), wit1
respect to ary employee who is so convicted—
(1) Tak:ng appropriate personnel action against sucti an
employee, up to arc nicluding terminal:cm, conalstent with the
requirements of the Rehabilitation Act of "973, as amended; or
(2) Requiring such employee to partIcioate satisfactorily in a
drug abuse assistance or rehabikatIon program approved for
Such purposes by a Feeera , State, or local healtn, law entorne-
merit, or other appropriate agency,
(g) Making a good faith, effort to contiPue to maintain a drug-
free workplace through implementation of paragraphs (a), b),
(u), (d), (e), and (O.
S. The grantee may inseet r the space provicoc be!ow ti:e
Site(s) for the performance of work done In connectior with
the specific grant:
Pace of Performance (Street aecress, city, county, state, zip
code)
Check :2 if there are workplaces on tie that ye no; !noertified
here.
Section 67, 630 of the regulations crovices that a grantee that
is a State may elect to make one certification in eaun Federa.
fiscal year. A copy of which should ho inciuced with each ap-
plication for Department of Justice runuing States and State
agencies may elect to use OP Form 406117
Check if the State has e:ected to complete OJP Form
40617.
DRUG-FREE WORKPLACE
(GRANTEES WHO ARE INDIVIDUALS)
As required by the Drug-Free Workplace Act of 1088 and
implemented at 26 CFR Part 67, Subpart F, for grantees, as
defined at 28 CFR Part 67; Sectlons 67.616 and 67.62-
A. AS a condition of the grant. I certify that I WI not engage
In the unlawful manufacture, Cistribution, eispensir g, posses-
sion, or use Of a controlled substance in c.criclucting any
activity with the grant; anc
B, If convicted of a criminal erug offense resulting from e
violation occurring during the cLonOuct of ay grant activity. I
will report the convictlor, in writing, within 13 calendar days
of the conviction, to: Department of Justice. Office of Justice
Programs, ATTN: Control Desk, 610 Seventh Street NW.
Washington, DC 20531,
As the ddiy authorized representative of Me applicant. I hereby certify that the applicant will comply with the above certifications.
1. C.iraritee Name arid Address: County of Oakland, 1200 N. Telegraph, Pontiac, MI 4834
Bill Bullard Jr, Chair., Bpard of Commissioners
4. Typeo Name and Title of AutharIed Representative
f.,LLar itaeet.4
5. 5-gnature
Gaymi,--kEd PrIrOg c00,4) 195t - 405-037:4)3 , 4
•
EIVIM-03 (C3-2004)
MICHIGAN STATE POLICE
STATE OF MICHIGAN
AUDIT CERTIFICATION
Federal Audit Requirements
Fiscal Years Beginning After June 30, 1996
Non-Federal organizations which expend $500,000 or more in Federal funds during their fiscal year are required to
have an audit performed in accordance with the Single Audit Act of 1984, as amended, and Office of Management
and Budget (OMB) Circular A-133. Subgrantees must submit a Copy of their audit report to: Budget and Financial
Services Division, Michigan Department of State Police. 714 South Harrison Road. East Lansing, Michigan 48823
for each year they meet the nding threshold
Program: meland Security Grant Pro ram
CFDA Number: 97.067
Subgrantee Information
Jurisdiction Name: Count of Oakland —
Street Address: _ 1200 N. Teleo-ra.ph_Edft_._.
City, State, Zip Code: Pontiac, Mi 4 8 3 4 4
Certification for Fiscal Year Ending (mmidd/yyyy):
(Check appropriate box)
I certify that the subgrantee shown above does not expect it will be required to have an audit performed under
the Single Audit Act of 1984, as amended, and the ora Circulars as revised, for the above listed program
7A
I certify that the subgrantee shown above expects it will be required to have an audit performed under the Single
Audit Act of 1984, as amended, and the OMB Circulars as revised, during at least one fiscal year funas are
received for the above listed program. Amizu,audit i-lort wid be submitted to: Budget and Financial
Services Division, Michigan Department of State Police, 714 South Harrison Road, East Lansing, Michigan
48823. ,
gt-fL e- g )1 fl% igsil 0 _
(Signature of Subgrantee's Authorized Representative) (Date)
Please mail completed form to: Michigan Department of State Police
Emergency Management and Homeland Security Division
Financial Section
4000 Collins Road
Lansing, Michigan 48910
For MSP-EMD Use Only
Reviewed By: Date:
Authority: Act 390 P. A. of 1976, as amended
Completion: Voluntary, tut completion
necessary to be considered for
assistance.
State of Michigan
2007 Homeland Security Grant Program
Grant Agreement
January 1,2010 to May 30, 2010
CFDA Number: 97.067
Grant Number. 2007-GE-T7-0029
This Homeland Security Grant Program (HSGP) Grant Agreement is hereby entered into between the Michigan
Department of State Police, Emergency Management and Homeland Security Division (hereinafter called the
Subgrantor), and
COUNTY OF OAKLAND
(hereinafter cal ed the Subgrantee)
I. Purpose
The purpose of this Grant Agreement is to provide federal funds to the Subgrantee for preventing, deterring,
responding to, and recovering from Incidents of National Significance, including threats and incidents of terrorism.
The 2007 HSGP is a primary funding mechanism, operated by the United States Department of Homeland Security
(DHS) for building and sustaining national preparedness capabilities. HSGP is comprised of four separate grant
programs, of which one, the State Homeland Security Program (SHSP) is covered by this grant agreement. The
State Homeland Security Program (SHSP) is a core homeland security assistance program that provides funds to
build capabilities at the State and local leveis through planning, equipment, training, and exercise activities and to
implement the goals and objectives included in State Homeland Security Strategies and initiatives in the Program
and CapabOity Enhancement Plan. SHSP funding also supports the four mission areas of homeland security—
prevent, protect, respond, and recover—and addresses all of the National Priorities and the 37 Target Capabilities,
as they relate to terrorism. The allowable scope of SHSP activities includes catastrophic events, provided that
activities implemented also build capabilities that relate to terrorism. Many of the capabilities included within the
TCL are dual-use in nature, in that they can apply to both terrorism preparedness as well as other hazards.
Activities implemented under SHSP must support terrorism preparedness and build or enhance capabilities that
reiate to terrorism in order to be considered eligible, even if the capabilities themselves do not focus exclusively on
terrorism. For example, mass evacuation planning supports terrorism preparedness but also other types of
catastrophic events. Planning for pandemic influenza and linking that effort to a larger bioterrorism Preparedness
effort offers another example. Grantees must demonstrate the dual-use nature of any activities implemented
Objectives
The principal objective of this Grant Agreement is to provide financial assistance to the Subgrantee for allowable
costs in the following program areas:
• Planning
• Organ2ation
• Equipment
• Training
• Exercise
• Personnel
For guidance on allowable costs for these Program areas, please refer to the 2007 HSGP Guidance : located at
http://www.fema.gov/pdfigovernment/grant/hsgpify07_hsgp_guidance,pdf.
To assist Subgrantees, the Subgrantor, in conjunction with the Michigan Homeland Security Preparedness
Committee, has created a of priority projects that Subgrantees shall use their 2007 HSGP funds to support.
These projects were derived from the Investment justifications developed by Michigan that are to be implementeo
at the regional/local level. Additional information is provided in the Michigan FY 2007 HSGP Supplemental
2007 HSGP Grant Agreement
County of Oakland
Page 5 of 10
are aimed at orotecting our nation's water, air, coastal, wildlife, land, agricultural, historical and cultural
resources, as well as minimizing potential adverse effects to children, low-income and minority populations.
Failure to comply with these laws could result in project delays and denial of funding. FEMA through the
Environmental and Historic Preservation Program engages in a review process to ensure that FEMA
funded activities comply with these laws.
VI. Responsibilities of Subgrantor
The Subgrantor, in accordance with the general purposes and objectives of this Grant Agreement, will:
A. Administer the FY07 HSGP in accordance with all applicable federal and state regulations and guidelines
and provide quarterly reports documenting this administration.
B. Provide direction and technical assistance to the Subgrantee.
C. Provide any special report foTris and reporting formats (templates) required by the Subgrantor for operation
of the program.
D. Reimburse the Subgrantee in accordance with this Grant Agreement based on appropriate documentation
submitted by the Subgrantee.
E. Independently, or in conjunction with the U.S. Department of Homeland Security (DRS), conduct random
on-site reviews with Subgrantee(s).
F. Subgrantor and Subgrantee FY07 HSGP information constitutes records subject to the Michigan Freedom
of information Act (FOIA), MCL 15.231 et seq. However, section 13(1)(u) and (y), MCL 15.243(1)(u) and
(y) of the FOIA permits the exemption from public disclosure of the records of a public body's "security
measures, including security plans, security codes and combinations, passwords, passes, keys, and
security procedures, to the extent that the records relate to the ongoing security of the public body;" and "of
measures designed to protect the security or safety of persons or property. whether public or private,
including, but not limited to, building, public works, and public water supply designs to t.ne extent that those
designs relate to the ongoing security measures of a public body, capabilities and plans for responding to a
violation of the Michigan anti-terrorism act,.. emergency response plans. risk planning documents, threat
assessments, and domestic preparedness strategies, unless disclosure would not impair a public body's
ability to protect the security or safety of persons or property or unless the public interest in disclosure
outweighs the public interest in nondisclosure in the particular instance."
Much of the information submitted in the course of applying for funding under this program, or provided in
the course of grant management activities, may be considered law enforcement sensitive or otherwise
critical to national security interests. This may include threat, risk, and needs assessment information; and
discussions of demographics, transportation, public works, and industrial and public health infrastructures.
Therefore, each Su ograntee agency Freedom of Information Officer will need to determine wnat
information is to be withheld on a case-by-case basis.
VII. Payment and Reporting Procedures
The Suograntee agrees to prepare the Reimbursement Cover Sheet (EMD-054) and all required attached
documentation, including all required authorized signatures, and submit it at a minimum at the end of each quarter
(or more frequently, as needed) if there are eligible expenses to be reimbursed. See below quarterly report
schedule for due dates Please note: One Reimbursement Cover Sheet and related forms must be
completed for each grant project, solution area, allocation type, and individual exercise. Please refer to the
Reimbursement Requirements in order to meet the documentation requirements.
2007 HSGP Grant Agreement
County of Oakland
Page 6 of 10
Drawdown of Funds in Advance: Subgrantees may request funds up to 120 days prior to expenditure. Ail of the
following requirements must be met to obtain advanced funds: 1) The Subgrantee must complete a letter statieg
the reason they are requesting an advance; 2) The Subgrantee must submit a copy of an approved purchase order
showing the delivery date for the items ordered to be within 120 days of the purchase order date; 3) These funds
must be placed in an interest-bearing-account. The Subgrantee may keep interest up to S100 per year for
administrative expenses for all Federal Grants combined. Funds cannot be advanced for more than 120 days. If
the Subgrantee is notified by the vendor of delays in the celivery date of equipment, funds must be returned to the
Subgrantor. Advances cannot be outstanding for more tnan 120 days; 4) Any interest earned over 5100 must
promptly, but at least quarterly, pe remitted to: Michigan State Police, Emergency Management and Homeland
Security Division, Financial Section, 4000 Collins Road, Lansing, Michigan 48910-5883. The Subgrantee must also
notfy the Subgrantor in writing of any interest earned over S100 quarterly.
THE QUARTERS ARE AS FOLLOWS:
1 51 Quarter: January 1, 2010 to May 30, 2010 (this quarter is five months long)
DEADLINES TO SUBMIT QUARTERLY REQUESTS FOR REIMBURSEMENT AND WORK REPORTS ARE AS
FOLLOWS:
151 Quarter: June 31, 2010
In the event of an of an extension of the grant performance period, additional reporting quarters and quarterly
reporting deadlines may be added to as specified by the grantor.
Reporting Requirements
The reporting requirements are designed to provide the EMHSID with sufficient information to monitor project
implementation and ensure proper use of federal funds. Accounting systems must allocate costs to the project
activities. Expenditures must be summarized, correspond with the project budget detail, scope of the project. or
work plan attacned to the award, and be supported with source documentation, as appropriate.
Subgrantees are required to submit Quarterly Progress Reports by Project and supporting documentation for
expenditures in accorcance with their project budget detail and project scope of work. Progress reports compare
actual expenditures to the project budget detail for the reporting period. Any significant cost ceviations from the
approved budget detail and subsequent impact on the project, etc. shall be reported in the Narrative Progress
Report.
The Quarterly Progress Report must support the expenditures and financial activity in financial progress reports
and reimbursement requests, The information on this form will be used by the Subgraetor to monitor grantee cash
flow and encumbrances, grantee performance, project implementation, and compliance with 2 CFR, Part 215 (OlvlB
Circular A-110); 2 CFR, Part 220 (OMB Circular A-21); 2 CFR, Part 225 (OMB Circular A-87); and 2 CFR, Part 230
(OMB Circular 122). This information will also be used to monitor compliance with OMB Circulars A-102 and A-
133, and with the U.S. Dept, of Homeland Security/Office of Grant Operations Financial Guide, to ensere proper
use of federal funds.
Quarterly Progress Reports are required whether or not expenditures are incurred.
Suegrantees failure to fulfill the quarterly reporting requirements, as required by the grant, may result in the
suspension of grant activities until reports are received.
2007 HSGP Grant Agreement
County of Oakland
Page 7 of 10
Reimbursement requests and work reports should be mailed to the Michigan State Police, Emergency
Management and Homeland Security Division, 4000 Collins Road, Lansing MI 48910, unless the Subgrantee
is otherwise notified by the Subgrantor. Please refer to the Reimbursement Requirements in order to meet
the documentation requirements.
: SUBGRANTEE WILL NOT BE REIMBURSED FOR FUNDS UNTIL ALL REQUIRED SIGNED DOCUMENTS
mmmim mighatillaillgraWIT DOCUMENTS ARE RECEIVED.
VIII. Memorandum of Understanding Procedure
The Subgrantee may enter into Memorandums of Understanding (MOU) with the Subgrantor for the Subgrantor to
pay other local jurisdictions within Homeland Security Region 2 directly in accordance with current DHS guidance.
An MOU must be initiated by the Subgrantee. The Subgrantee must submit an MOU every time it would like
another jurisdiction to receive direct reimbursement from the Subgrantor. Each MOU must be signed by the
authorized representative for the Subgrantee and Subgrantor and agreed to prior to a payment beng made to a
jurisdiction other than the Subgrantee.
IX. Employment Matters
Subgrantee shall comply with Title VI of the Civil Rights Act of 1964, as amended, the Elliott-Larsen Civil Rights
Act, 1976 PA 453, as amended, MCL 37.2101 et seq., the Persons with Disabilities Civil Rights Act, 1976 PA 220.
as amended, MCL 37.1101 et seq., and all other federa , state and local fair employment practices and equal
opportunity laws and covenants that it shag not discriminate against any employee or applicant for employment, to
De employed in the performance of this Grant Agreement, with respect to his or her hire, tenure, terms, conditions,
or privileges of employment; or any matter directly or indirectly related to employment because of his or her race,
religion, color, rational origin, age, sex, height, weight, marital status, limited English proficiency, or handicap that is
unrelated to the individual's abi:ity to perform the duties of a particular job or position. Suograntee agrees to
include in every subcontract entered into for the performance of this Grant Agreement this covenant not to
discriminate in employment. A breach of this covenant is a material breach of the Grant Agreement.
The Subgrantee shall ensure that no subcontractor, manufacturer, or supplier of Subgrantee on this Project
appears in the register compiled by the Michigan Department of Labor and Economic Growth, Bureau of
Commercial Services, Licensing aria Enforcement Divisions, pursuant to 1980 PA 278, as amended. MCL 423.321
at seq. (State Contractors with Certain Employers Prohibited Act), or on the Federal excluded party list system
database located at www.epls.gov.
X. Limitation of Liability
Subgrantor and Suograntee to this Grant Agreement agree that each must seek its own lege; representative and
bear its own costs. including judgments, in any litigation that may arise from performance of this contract. It is
specifically understood ano agreed that neither party vv,Il indemnify the other party in such litigation.
This is not to be construed as a waiver of governmental immunity.
Xl. Third Parties
This Grant Agreement is not intended to make any person or entity, not a party to this Grant Agreement, a third
party beneficiary hereof or to confer on a third party any rights or obligations enforceable ii their favor.
2007 HSGP Grant Agreement
County of Oakland
Page 8 of 10
XII. Grant Agreement Period
This Grant Agreement is in full force and effect from January 1, 2010 through May 30, 2011. No costs eligible
Linger this Grant Agreement shall be incurred before the starting date of this Grant Agreement except with prior
written approval, This Grant Agreement consists of two identical sets simultaneously executed: each is considered
an original having identical legal effect. This Grant Agreement may be terminated by either party by giving thirty
3131) days written notice to the other party stating reasons for termination and the effective date, or anon the faiure
of either party to carry out the terms of the Grant Agreement. Upon any such termination, the Subgrantee agrees
to return to the Subgrantor any funds not authorized for use, and Subgrantee shall have no further obligation to
make payments.
XIII. Entire Grant Agreement
This Grant Agreement is governed by the laws of the state of Michigan and supersedes all prior agreements,
documents, and representations between Subgrantor and Subgrantee, whether expressed, implied, or oral. This
Grant Agreement constitutes the entire agreement between the parties and may not be amended except by written
instrument executed by both parties prior to the termination date set forth in Section XII above. No party to this
Grant Agreement may assign this Grant Agreement or any of his/her/its rights, interest, or obligations hereunder
without the prior consent of the other party. Subgrantee agrees to inform Subgrantor in writing immediately of any
proposed changes of dates, budget, or services indicated in this Grant Agreement, as well as changes of address
or personnel affecting this Grant Agreement. Changes in dates, budget, or services are subject to prior written
approval of Subgrantor. If any provision of this Grant Agreement shall be deemed void or unenforceable, the
remainder of the Grant Agreement shall remain valid.
The State may suspend or terminate sub-graet funding, in whole or in part, or other measures may be imposed for
any of the following reasons:
• Failure to expend funds in a timely manner consistent with the grant milestones, guidance and assurances.
• Failure to comply with the requirements or statutory objectives of federal or state law.
• Failure to make satisfactory progress toward the goals or objectives set forth in the sub-grant application.
• Failure to follow grant agreement requirements or special conditions.
• Proposal or implementation of substantial plan changes to the extent that, if originally submitted, the project
would not have been approved for funding.
• Faiiure to submit requiree reports.
• Filing of a false certification in the application or other report or document,
• Failure to adequately manage, monitor or direct the grant funding activities of their sub-recipients.
Before taking action. the Subgrantor will provide the SuJgrantee reasonable notice of intent to impose corrective
measures and will make every effort to resolve the problem informally.
XIV. Business Integrity Clause
The Subgrantor may immediately cancel the grant without further liability to the Subgraritcr or its employees if the
Subgrantee, an officer of the Subgrantee, or an owner of a 25% or greater share of the Subgrantee is corvicted of
a criminal offense incident to the application for or performance of a State, public, or private grant or subcontract; or
convicted of a criminal offense, including but not limited to any of the following: embezzlement, theft, forgery,
bribery, falsification or destruction of records, receiving stolen property, attempting to influence a public employee
to breach the ethical conduct standards for State of Michigan employees; convicted under State or Federal antitrust
statutes; or convicted of any other criminal offense which, in tne sole discretion of the Subgrantor. reflects on the
Subgrantee's business integrity.
2007 HSGP Grant Agreement
County of Oakland
Page 9 of 10
XV. Freedom of Information Act (FOIA)
DHS recognizes that much of the information submitted in the course of applying for funding under this program, or
provided in the course of its grant management activities, may be considered law enforcement sensitive or
otherwise important to national security interests. This may include threat, risk, and needs assessment information,
and discussions of demographics, transportation, public works, and industrial and public health infrastructures.
While this information, under Federal control, is subject to requests made pursuant to the Freedom of Information
Act (FOIA), 5. U.S.C. §552. all determinations concerning the release of information of this nature are made on a
case-by-case basis by the DHS FOIA Office, and may iikely fall within one or more of the available exemptions
under the Act. The applicant is encouraged to consult its own State and local laws and regulations regarding the
release of information, which should be considered when reporting sensitive matters in the grant application, needs
assessment and strategic planning process. The applicant may also consult the DHS Office of Grants and Training
regarding concerns or questions about the release of information under State and local laws. The grantee should
be familiar with the regulations governing Protected Critical Infrastructure Information (6 CFR, Part 29) and
Sensitive Security Information (49 CFR, Part 1520), as these designations may provide additional protection to
certain classes of homeland security information.
611 1 &Mord
Printed Name
,1 ir,?...•ci tr earfliffit5Sijne
Title
Date
Capt. W. Thomas Sands
Printed Name
Deputy State Director of Emergency
Management and Homeland Security
Title
2007 HSGP Grant Agreement
County of Oakland
Page 10 of 10
XVI. Official Certification
For the Sub grantee. The individual or officer signing this Grant Agreement certifies by his or her signature that he
or she is authorized to sign this Grant Agreement on behalf of the jurisdiction he or she represents.
County of Oakland
Name of Jurisdiction
iLk L&Q6 4)(/
Signature
For the Subgrantor (Michigan State Police — Emergency Management and Homeland Security Division)
tK
SignStur-e • Date
Resolution #10052 March 25,2010
Moved by Schwartz supported by Potter the resolutions (with fiscal notes attached) on the amended
Consent Agenda be adopted (with accompanying reports being accepted.)
AYES: Burns, Capello, Coleman, Coulter, Douglas, Gershenson, Gingell, Gosselin, Greirnel,
Hatchett, Jackson, Jacobsen, Long, McGillivray, Middleton, Nash. Potter, Potts, Runestad,
Schwartz, Scott, Taub, Zack, Bullard. (24)
NAYS: None. (0)
A sufficient majority having voted in favor, the resolutions (with fiscal notes attached) on the amended
Consent Agenda were adopted (with accompanying reports being accepted.)
HEREBY APPROVE 1I4EFOREGO!NG RESOLUT:ON
ACTING PURSUANT TO 1973 PA 139
STATE OF MICHIGAN)
COUNTY OF OAKLAND)
I. Ruth Johnson, Clerk of the County of Oakland, do hereby certify that the foregoing resolution is a true
and accurate copy of a resolution adopted by the Oakland County Board of Commissioners on March 25.
2010, with the original record thereof now remaining in my office.
In Testimony Whereof, I have hereunto set my hand and affixed the seal of the County of Oakland at
Pontiac, Michigan this 25th day of March, 2010.
eat
Ruth Johnson, County Clerk