HomeMy WebLinkAboutResolutions - 2015.05.06 - 21827MISCELLANEOUS RESOLUTION # 15124 May 6, 2015
BY: General Government Committee, Christine Long, Chairperson
IN RE: HEALTH AND HUMAN SERVICES - HOMELAND SECURITY DIVISION — STATE OF
MICHIGAN PUBLIC ASSISTANCE GRANT AGREEMENT - OAKLAND COUNTY VEHICLE -
ACCEPTANCE
To the Oakland County Board of Commissioners
Chairperson, Ladies and Gentlemen:
WHEREAS the President of the United States declared a disaster for Macomb, Oakland and Wayne
Counties on September 25, 2014, under the authority of the Robert T. Stafford Disaster Relief and
Emergency Assistance Act; and
WHEREAS the disaster declaration is a result of damage resulting from severe storms and flooding
during the period of August 11-13, 2014; and
WHEREAS the Project Application Grant Report breaks down all the expenditures Oakland County
requested reimbursement for due to storm damage of a vehicle; and
WHEREAS the Project Application Grant Report submitted for a total of $8,431.09; and
WHEREAS a 25% match of $2,107.77 is required; and
WHEREAS the grant agreement has completed the Grant Review Process in accordance with the Board
of Commissioners Grant Acceptance Procedures.
NOW THEREFORE BE IT RESOLVED that the Oakland County Board of Commissioners authorizes
acceptance of the State of Michigan Public Assistance Grant Agreement in the amount of $6,323.32
from the Michigan Department of State Police, Emergency Management and Homeland Security
Division.
BE IT FURTHER RESOLVED that the Chairperson of the Oakland County Board of Commissioners is
authorized to execute the grant agreement of $6,323.32 and a 25% match of $2,107.77 for a total of
$8,431.09 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
CI\
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GENERAL GOVERNMENT COMMITTEE
Motion carried unanimously on a roll call vote with Fleming absent.
GRANT REVIEW SIGN OFF — Homeland Security
GRANT NAME: Public Assistance Grant Agreement (Vehicles)
FUNDING AGENCY: Michigan State Police Emergency Management and Homeland Security
Division
DEPARTMENT CONTACT PERSON: Sara Stoddard 248 858-5080
STATUS: Grant Acceptance
DATE: April 16, 2015
Pursuant to Misc. Resolution #13180, please be advised the captioned grant materials have completed
internal grant review. Below are the returned comments.
The 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 place on the
appropriate Board of Commissioners' committee(s) for grant acceptance by Board resolution.
DEPARTMENT REVIEW
Department of Management and Budget:
Approved. — Laurie Van Pelt (4/15/2015)
Department of Human Resources:
HR Approved (No Committee) — Lori Taylor (4/16/2015)
Risk Management and Safety:
Approved by Risk Management. — Robert Erlenbeck (4/16/2015)
Corporation Counsel:
Corporation Counsel has approved both agreements. — Stephen Rideout (4/16/2015)
From: VanPelt, Laurie
To: West. Catherine A; Secontine, Julie L; Taylor, Lori; Davis, Patricia G
Cc: Ouisenberry, Theodore H; Stoddard, Sara 0; Pisacreta, Antonio S
Subject: RE; GRANT REVIEW: Health & Human Services, Homeland Security Division - State of Michigan Public Assistance
Grant Agreement - Vehicles - Acceptance
Date: Wednesday, April 15, 2015 5:01:31 PM
Approved.
From: West, Catherine [mailto:westca@oakgov.corn]
Sent: Wednesday, April 15, 2015 3:33 PM
To: Secontine, Julie L; Van Pelt, Laurie M; Taylor, Lori; Davis, Patricia G
Cc: Quisenberry, Theodore H; Stoddard, Sara D; Pisacreta, Antonio S
Subject: GRANT REVIEW: Health & Human Services, Homeland Security Division - State of Michigan
Public Assistance Grant Agreement - Vehicles - Acceptance
GRANT REVIEW FORM
TO: REVIEW DEPARTMENTS— Laurie Van Pelt — Lori Taylor —Julie Secontine — Pat Davis
RE: GRANT CONTRACT REVIEW RESPONSE— Health gt Human Services, Homeland Security
Division
State of Michigan Public Assistance Grant Agreement - Vehicles
Michigan State Police Emergency Management and Homeland Security Division
Attached to this email please find the grant document(s) to be reviewed. Please provide your
review stating your APPROVAL, APPROVAL WITH MODIFICATION, or DISAPPROVAL, with
supporting comments, via reply (to all) of this email.
Time Frame for Returned Comments: April 17, 2015
GRANT INFORMATION
Date: April 15, 2015
Operating Department: Health & Human Services, Homeland Security Division
Department Contact: Sara Stoddard
Contact Phone: 248 858-5080
Document identification Number: FEMA-4195-DR-MI / 125-UJZPI-00
REVIEW STATUS: Agreement - Resolution required
Funding Period: 8/11/14 through 3/25/16
New Facility/Additional Office Space Needs: None
IT Resources (New Computer Hardware /Software Needs or Purchases): None
M/WBE Requirements: Yes, Compliance with OMB Circular A-102
State of Michigan
Public Assistance Grant Agreement
FEMA-4195-DR-MI
CFDA Number: 97.036
This Public Assistance Grant Agreement is hereby entered into between the Michigan Department of State Police,
Emergency Management and Homeland Security Division (hereinafter called the Grantee), and
Oakland County Water Resources Commissioner
(hereinafter called the Subgrantee)
Public Assistance ID Number 125-UJZPI-00
I. Purpose
The purpose of this grant agreement is to provide supplementary financial assistance for disaster relief in eligible
areas within the state including funds for emergency and permanent work, Eligible costs are per Federal
Emergency Management Agency (FEMA) guidance,
Statutory Authority
The President of the United States declared a disaster for Macomb, Oakland, and Wayne Counties in Michigan on
September 25, 2014, under the authority of the Robert T. Stafford Disaster Relief and Emergency Assistance Act,
42 U.S.C.§§ 5121-5207 (Stafford Act), in accordance with 44 CFR § 206.44. This disaster declaration is a result of
damage resulting from severe storms and flooding during the period of August 11-13, 2014.
The Subgrantee agrees to comply with all program requirements in accordance with FEMA guidance. The
Subgrantee also agrees to comply with regulations, including, but not limited to the following, as applicable:
A. Administrative Requirements
• 1. 44 CFR, Part 13, Uniform Administrative Requirements for Grants and Cooperative Agreements to
State and Local Governments (OMB Circular A-102)
2. 2 CFR, Part 215, Uniform Administrative Requirements for Grants and Agreements with Institutions of
Higher Education, Hospitals, and Other Non-Profit Organizations (OMB Circular A-110)
3. 44 CFR, Part 10, Environmental Considerations
B. Cost Principles
1. 2 CFR, Part 225, Cost Principles for State, Local, and Indian Tribal Governments (OMB Circular A-87)
2. 2 CFR, Part 220, Cost Principles for Educational Institutions (OMB Circular A-21)
3. 2 CFR, Part 230, Cost Principles for Non-Profit Organizations (OMB Circular A-122)
4. 48 CFR, Part 31 Federal Acquisition Regulations (FAR), Contract Cost Principles and Procedures
C. Audit Requirements and Other Assessments
1. OMB Circular A-133, Audits of States, Local Governments, and Non-Profit Organizations located at
http://www.whitehouse.goviombicirculars default
2. Public Law 107-300, Improper Payments InformationAct (IPIA) of 2002 located at
http://www.dol.gov/ocfo/media/regs/IPIA.pdf
Code of Federal Regulations (CFR) documents are located online at http://wvvw.ecfr.gov ,
III. Award Amount and Restrictions
FEMA will determine eligibility for the program and the grant amounts. Federal assistance will be made available,
within the limits of funds available from Congressional appropriations for such purposes, in accordance with the
Stafford Act, Executive Orders 12148, as amended, and 12673, and applicable regulations found in Title 44 of the
Code of Federal Regulations (CFR), and applicable policy and guidance. Federal funds provided under the
Stafford Act for Public Assistance will be limited to 75% of total eligible costs in the designated area. The federal
share is 75% of the costs and the Subgrantee is responsible for providing the remaining 25% matching funds.
FEMA-4195-DR-MI
Oakland County Water Resources Commissioner
Page 2 of 8
Reimbursement amounts will be based on approved FEMA Project Worksheets (PW). Payment will not be made
until the Grantee receives all required documentation described in paragraph IV (B) of this grant agreement.
The Subgrantee shall comply with all applicable state and local ordinances, laws, regulations, and building codes
and standards. Prior to the start of any construction activity, the Subgrantee shall obtain all applicable federal,
state, and local permits and clearances, and comply with all regulations including FEMA compliance with the
National Environmental Policy Act, the National Historic Preservation Act, the Endangered Species Act, and all
other environmental laws and executive orders. Any activities that have been initiated without the necessary
Environmental and Historic Preservation (EHP) review and approval will result in a non-compliance finding
and will not be eligible for federal funding.
Disaster recovery work, for which federal funds have been approved, is subject to completion by these deadlines:
Emergency Work (Categories A & B) March 25, 2015
Permanent Work (All Other Categories) March 25, 2016
All time frames are set by regulation; however, if extenuating circumstances or unusual project conditions exist, a
time extension may be requested through the Grantee.
IV. Responsibilities of the Subgrantee
A. Grant funds must supplement, not supplant, state or local funds. Federal funds must be used to
supplement existing funds, not replace (supplant) funds that have been appropriated for the same
purpose. Potential supplanting will be carefully reviewed in subsequent monitoring reviews and audits.
The Subgrantee may be required to supply documentation certifying that it did not reduce non-federal
funds because of receiving federal funds. Federal funds cannot be used to replace a reduction in non-
federal funds or solve budget shortfalls in general fund programs.
B. In addition to this grant agreement, the Subgrantee shall complete, sign, and submit to the Grantee the
following documents, which are incorporated by reference into this grant agreement:
1, Standard Assurances
2. Certifications Regarding Lobbying; Debarment, Suspension and Other Responsibility Matters; and
Drug-Free Workplace Requirements
3, State of Michigan Audit Certification (EMD-053)
4. Request for Taxpayer identification Number and Certification (W-9)
5. Project Completion and Certification Report (P4), certifying project expenditures and completion within
the grant period
6. Other documents that may be required by federal or state officials
7. Permits or Waivers. (For those project worksheets, including work that requires MDEQ review, we will
need either the MDEQ permit that was issued or a written statement or email (waiver) from your
region's MDEQ representative to document the crossing/site does not require a permit. This will be
required prior to the release of FEMA payments to your agency.)
C. Comply with the requirements of the Stafford Act and all FEMA Public Assistance policies.
D. Comply with applicable financial and administrative requirements set forth in the current edition of 44 CFR,
Part 13, including, but not limited to, the following provisions:
1. Account for receipts and expenditures, maintain adequate financial records, and refund expenditures
disallowed by federal or state audit.
2. Retain all financial records, statistical records, supporting documents, and other pertinent materials for
at least three years after the grant is closed by the awarding federal agency for purposes of federal
and/or state examination and audit.
3. Perform the required financial and compliance audits in accordance with the Single Audit Act of 1984,
as amended in 1996, and Office of Management and Budget (OMB) Circular A-133, Audits of States,
Local Governments, and Non-Profit Organizations, as further described in 44 CFR, Part 13.
FEMA-4195-DR-MI
Oakland County Water Resources Commissioner
Page 3 of 8
E. Cooperate with the federal government in seeking recovery of funds that are expended in alleviating the
damages and suffering caused by this disaster against any party or parties whose intentional acts or
omissions caused or contributed to the damage or hardship for which federal assistance is provided
pursuant to the Presidential declaration of this disaster.
F. Quarterly Progress Reports on all large projects (over $120,000) are also required and should be
submitted to the Michigan State Police, Emergency Management and Homeland Security Division each
calendar quarter. Deadlines for quarterly report submissions are: January 15, April 15, and July 15, and
October 15.
G. Permit FEMA access and rights to examine and copy records, accounts, other documents, and other
sources of information related to the grant; and permit access to facilities, personnel, and other individuals
and information as may be necessary, as required by FEMA regulations, by other applicable laws, or by
program guidance.
H. The Appeals process is the opportunity for Subgrantee to request reconsideration of decisions regarding
the provision of assistance. The Subgrantee must file an appeal with the Grantee within 60 days of receipt
of notice of the action or decision being appealed. However, an appeal for a significant net small project
overrun must be filed within 60 days of completion of the Subgrantee's last small project.
Integrate individuals with disabilities into emergency planning in compliance with Executive Order 13347
and the Rehabilitation Act of 1973,
J. Complete federally-mandated reporting requirements, including, but not limited to, requirements related to
the Federal Funding Accountability and Transparency Act of 2006 (FFATA) (Public Law 109-282), as
amended by Section 6202(a) of the Government Funding Transparency Act of 2008 (Public Law 110-252),
V. Responsibilities of the Grantee
The Grantee, in accordance with the general purposes and objectives of this grant agreement, will:
A. Administer the Public Assistance Grant Program.
B. Provide to the Subgrantee a copy of all required documents, including approved Project Worksheets.
C. Reimburse the Subgrantee in accordance with this agreement for the federal share of allowable
expenditures based upon the signed Project Completion and Certification Report (P4).
Vi Reporting Procedures
Submit quarterly progress reports to the MSP/EMHSD on the status of all large projects. Quarterly progress
reports are required whether or not expenditures are incurred.
Failure by the Subgrantee to fulfill quarterly reporting requirements as required by the grant may result in the
suspension of grant activities until reports are received.
Reporting periods and due dates for each year are as follows:
January 1 through March 31; Due April 15
April 1 through June 30; Due July 15
July 1 through September 30; Due October 15
October 1 through December 31; Due January 15
FEMA-4195-DR-MI
Oakland County Water Resources Commissioner
Page 4 of 8
Quarterly progress reports are to be submitted by the 15th of the month following the end of each quarter.
Quarterly progress reports should be mailed to: Attention: Ms. Sandy Long, Michigan State Police,
Emergency Management and Homeland Security Division, 4000 Collins Road, Lansing MI 48910, unless
the Subgrantee is otherwise notified by the Grantee.
VII. Payment Procedures
Reimbursement amounts will be based on approved FEMA Project Worksheets (PW). Payment will not be made
until the Grantee receives all required documentation described in paragraph IV (B) of this grant agreement.
The maximum amount that can be reimbursed by FEMA is 75 percent of the total eligible costs detailed in the
enclosed Project Completion and Certification Report (P4). The P4 report is a listing of at approved Project
Worksheets (PWs) indicating the approved amount and percentage of work completed at the time of the initial
inspection.
Payment for Small Projects (under $120,000) - The 75 percent federal share of the total eligible project estimate
will be made as a final payment after the Subgrantee has returned the required forms and documentation as listed
in the Project Close-out Procedures section below.
Payment for Largo Projects (over $120,000) - For projects that are 100 percent complete at project formulation, the
75 percent federal share of the total eligible project estimate will be made as a final payment after the Subgrantee
has returned the required forms and documentation as listed in the Project Close-out Procedures section below.
For Large projects that are at least 50 percent complete, the federal share to be reimbursed will be based on actual
expenditures by the date of reimbursement submission, as verified by the Michigan State Police, Emergency
Management and Homeland Security Division. Approved funding will be processed for payment after the
Subgrantee has returned the required forms and documentation listed in the Project Close-out Procedures section
below. The Subgrantee will also need to submit a written request for payment, all required quarterly progress
reports, and documentation that 60 percent or more of the estimated project costs have been expended. The
remainder of the federal share will be reimbursed upon completion and resubmission of a current Project
Completion and Certification Report (P4) certifying the claimed final project costs, in addition to supplying a listing
and detail of all cost documentation. The state wiil perform a subsequent review to verify actual costs and work
completed.
Project Close-Out Procedures:
A. Make a copy of the attached P4 form and retain it at your work site.
B. If each project is less than $120,000, please complete and sign the P4 form when all projects are
completed and return to the MSP/EMHSD,
C. The MSP/EMHSD will schedule further field review and final inspections as necessary. When final
inspections are completed, the balance of eligible funds will be reimbursed,
D. Perform the required financial and compliance audits in accordance with the Single Audit Act of 1984, as
amended in 1996 and OMB Circular A-133, as revised. All documentation must be retained for at least
three years after the grant is closed by the awarding federal agency for purposes of federal and/or state
examination and audit, If an audit is required, submit a copy of the annual audit report to: Michigan
Department of State Police, Grants and Community Services Division, 333 South Grand Avenue, Lansing,
Michigan 48909. For federal audit purposes, the CFDA number of the grant is 97.036 and is titled
Public Assistance Grants. The award is passed through the MSP/EMHSD from FEIVIA. The disaster
award number is FEMA-4195-DR-MI.
E. If claiming Direct Administrative Costs as part of the Project Worksheet (PW), actual cost documentation
must be provided; i.e., cost of compiling damages and cost information, maintaining financial and project
records, monitoring project, preparing reimbursement requests and quarterly progress reports.
FEMA-4195-DR-MI
Oakland County Water Resources Commissioner
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VIII. Employment Matters
The Subgrantee shall comply with Title VI of the Civil Rights Act of 1964, as amended; Title VIII of the Civil Rights
Act of 1968; Title IX of the Education Amendments of 1972 (Equal Opportunity in Education Act); the Age
Discrimination Act of 1975; Titles I, II and Ill of the Americans with Disabilities Act of 1990; the Elliott-Larsen Civil
Rights Act, 1976 PA 453, as amended, MCL 37.2101 at seq.; the Persons with Disabilities Civil Rights Act, 1976
PA 220, as amended, MCL 37.1101 et seq., and all other federal, state and local fair employment practices and
equal opportunity laws and covenants. The Subgrantee shall not discriminate against any employee or applicant
for employment, to be 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, national origin, age, sex, height, weight, marital status, limited English proficiency,
or handicap that is unrelated to the individual's ability to perform the duties of a particular job or position. The
Subgrantee 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 the Subgrantee for approved
projects related to this grant agreement appears on the Federal Excluded Parties List System located at
http://www.sam.gov.
The Subgrantee shall comply with regulation 2 CFR Part 17, Subpart F relating to maintenance of a Drug-Free
Workplace (see related certification form contained in this grant agreement package).
The Subgrantee shall comply with regulation 44 CFR Part 18 relating to New Restrictions on Lobbying (see related
certification form contained in this grant agreement package).
IX. Construction Requirements
The Subgrantee shall comply with all applicable state and local ordinances, laws, regulations, and building codes
and standards. Prior to the start of any construction activity, the Subgrantee shall obtain all applicable federal,
state, and local permits and clearances, and comply with all regulations including FEMA compliance with the
National Environmental Policy Act, the National Historic Preservation Act, the Endangered Species Act and all
other environmental laws and executive orders. Any activities that have been initiated without the necessary
EHP review and approval will result in a non-compliance finding and will not be eligible for federal funding.
The Subgrantee shall ensure that any work done under this grant complies with the barrier free design
requirements of 1966 PA 1, as amended, MCL 125.1351 et seq. (Utilization of Public Facilities by Physically
Limited Act).
The Davis-Bacon Act requires federal agencies to pay workers under contract to them the "prevailing wage" based
on the local union wage scale defined by the U.S. Department of Labor. Generally, the provisions of the Davis-
Bacon Act do not apply to state or local contracts for work completed using public assistance funds under the
Stafford Act. However, the provisions may apply to contracts let by other federal agencies, such as the U.S. Army
Corps of Engineers. If a state or local government incorporates prevailing wage rates of the U.S. Department of
Labor as part of its normal practice for all contracts, regardless of funding source, then those rates would be
eligible.
X. Insurance
In compliance with P.L. 103-325, Title V National Flood Insurance Reform Act of 1973, section 582 requires that
any person who receives federal assistance for the repair, replacement, or restoration for damage to any personal,
residential, or commercial property, at any time, must maintain flood insurance if the property is located in a
Special Flood Hazard Area.
FEMA-4195-DR-MI
Oakland County Water Resources Commissioner
Page 6 of 8
XI. Limitation of Liability
The Grantee and the Subgrantee to this grant agreement agree that each must seek its own legal representative
and bear its own costs, including judgments, in any litigation that may arise from performance of this contract. It is
specifically understood and agreed that neither party will indemnify the other party in such litigation.
This is not to be construed as a waiver of governmental immunity for either party.
XII. 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 in their favor.
XIII. Grant Agreement Period
The effective date of this grant agreement is September 25, 2014; and is in full force and effect from September
25, 2014 until the completion of approved FEMA projects per guidelines stipulated in Section 111 (Award Amount
and Restrictions). This grant agreement package consists of two identical grant agreements, simultaneously
executed; each is considered an original having identical legal effect. This grant agreement may be terminated by
either party by giving thirty (30) days written notice to the other party stating reasons for termination and the
effective date, or upon the failure of either party to carry out the terms of the grant agreement. Upon any such
termination, the Subgrantee agrees to return to the Grantee any funds not authorized for use, and the Grantee
shall have no further obligation to reimburse the Subgrantee.
XIV. 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 the Grantee and the 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 grant end date. 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. The Subgrantee agrees to inform the Grantee 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 the
Grantee. If any provision of this grant agreement shall be deemed void or unenforceable, the remainder of the
grant agreement shall remain valid.
The Grantee may suspend or terminate grant funding to the Subgrantee, in whole or in part, or other measures
may be imposed for any of the following reasons:
A. Failure to comply with the requirements or statutory objectives of federal or state law.
B. Failure to make satisfactory progress toward the goals or objectives set forth in the subgrant application.
C. Failure to follow grant agreement requirements or special conditions.
D. Proposal or implementation of substantial plan changes to the extent that, if originally submitted, the
project would not have been approved for funding.
E. Failure to submit required reports.
F. Filing of a false certification in the application or other report or document.
Before taking action, the Grantee will provide the Subgrantee reasonable notice of intent to impose corrective
measures and will make every effort to resolve the problem informally.
FEMA-4195-DR-MI
Oakland County Water Resources Commissioner
Page 7 of 8
XV. Business Integrity Clause
The Grantee may immediately cancel the grant without further liability to the Grantee or its employees if the
Subgrantee, an officer of the Subgrantee, or an owner of a 25% or greater share of the Subgrantee is convicted 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 the sole discretion of the Grantee, reflects on the
Subgranteers business integrity.
XVI. Freedom of Information Act (FOIA)
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
Subgrantee agency Freedom of Information Officer will need to determine what information is to be withheld on a
case-by-case basis. The Subgrantee 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.
3/13/2015
Date
FEMA-4195-DR-M1
Oakland County Water Resources Commissioner
Page 8 of 8
XVII. Official Certification
For the Subgrantee
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 organization he or she represents. The Subgrantee agrees to complete
all requirements specified in this grant agreement.
Subgrantee Name Subgrantee's DUNS Number
Printed Name Title
Signature Date
For the Grantee (Michigan State Police, Emergency Management and Homeland Security Division)
Anthony Katarsky
Governor's Authorized Representative
Printed Name Title
U. S. DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
ASSURANCES-CONSTRUCTION PROGRAM
O.M.B. No. 1660-0025
Expires July 31, 2007
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 1.7 hours per response. The burden estimate includes the time for reviewing Instructions and
searching existing data sources, gathering and maintaining the data needed and completing, and submitting the form. You are not required to respond to
this collectien of Information unless a valid OMB control number appears in the upper right corner of this form. Send comments regarding the accuracy of
the burden estimate and any suggestions for reducing the burden to: Information Collections Management, D. S. Department of Homeland Security, Federal
Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Project (1660-0001). NOTE; Do not send your
completed form to this address.
NOTE"
Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the Awarding Agency. Further, certain
federal assistance awarding agencies may require applicants to certify additional assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant:
1. Has the legal authority to apply for Federal assistance, and the
Institutional, managerial and financial capability (including funds
sufficient to pay the non-Federal Share of project cost) 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 States, through any
authorized representative, access to and the right to examine all
records, books, papers, or documents related to the assistance;
and will establish a paper accounting system in accordance with
generally accepted accounting standards or agency directives.
3, Will not dispose of, modify the use of, or change the terms of
the real property title, or other interest in the site and facilities
without permission and Instructions from the awarding agency.
Will record the Federal interest in the title of real property in
accordance with awarding agency directives and will include a
covenant in the title of real property acquired in whole or in part
with Federal assistance funds to assure nondiscrimination during
the useful life of the project
4. Will comply with the requirements of the assistance awarding
agency with regard to the drafting, review and approval of
construction plans and specifications,
5. Will provide and maintain competent and adequate engineering
supervision at the construction site to ensure that the complete
work conforms with the approved plans and specifications and will
furnish progress reports and such other information as may be
required by the assistance awarding agency or state,
6. Will initiate and complete the work within the applicable time
frame after receipt of approval of the awarding agency.
7. Will establish safeguards to prohibit employees from using their
positions for a purpose that constitutes or presents the
appearance of personal or organizational conflict to Interest, or
personal gain.
8. Will comply with intergovernmental Personnel Act of 1970 (42
U.S.C. Sections 4728-4763) relating to prescribed standards for
merit systems for programs funded under one of the nineteen
statues or regulations specified in Appendix A of OPM's standards
for a Merit System of Personnel Administration (5 C.F.R.
900-subpart F).
9. Will comply with the Lead-Based Paint Poisoning Prevention
Act (42 U.S.C. Sections 4801-et seq.) which prohibits the use of
lead based paint in construction or rehabilitation of residence
structures.
10. Will comply with all Federal statues relating to
non-discrimination. These include but are not limited to: (a) Title
VI of the Civil Rights Act of 1984 (Pl. 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. Sections 794)
which prohibits discrimination on the basis of; (d) the Age
Discrimination Act of 1975, as amended (42 U.S.C. Sections
6101-61-7) which prohibits discrimination on the basis of age; (e)
the Drug Abuse Office Treatment Act of 1972 (Pl. 93-255), as
amended, relating to non-discrimination on the bases of abuse;
(f) the Comprehensive Alcohol Abuse and Alcoholism Prevention,
Treatment and Rehabilitation Act of 1970
(Pt. 91-616), as amended, relating to nondiscrimination on the
bases of alcohol abuse or alcoholism; (g) Sections 523 and 527 of
the Public Health Service Act of 1912 (42 U.S.C. 290 dd-3 and
290 ee-3), as amended, relating to confidentiality of alcohol and
drug abuse patient records; (h) Title VIII of the Civil Rights Act of
1968 (42 U.S.C. Sections at seq.), as amended, relating to
non-discrimination in the sale, rental or financing of housing; (I)
and other non-discrimination provisions In the specific statutes(s)
under which application for Federal assistance is being made, and
(j) the requirements an any other non-discrimination Statues(s)
which may apply to the application.
11. Will comply, or has already complied, with the requirements of
Title li and III of the Uniform Relocation Assistance and Real
Property Acquisition policies Act of 1970 (10.L. 91-646) which
provides for fair and equitable treatment of persons displaced or
whose property is acquired as a result of Federal and Federally
assisted programs. These requirements apply to all interest in
real property acquired for project purpose regardless of Federal
participation in purchases.
12. Will comply with the provisions of the Hatch Act (5 U.S.C.
Sections 1501-1508 and 7324.7328) which limit the political
activities of employment activities are funded in whole or impart
with Federal funds.
13. Will comply, as applicable, with the provisions of the
Davis-Bacon Act (40 U.S.C. Sections 27a to 276a-7), the
Copeland Act (40 U.S.C. Section 276c and 18 U.S.C. Section
874), the Contract Work Hours and Safety Standards Act (40
U.S.C. Sections 327-333) regarding labor standards for Federally
assisted construction subagreements.
FEMA Form 20-16B, OCT 04 PREVIOUS EDITION OBSOLETE
U.S DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
ASSURANCES-NONCONSTRUCTION PROGRAMS
041.B. No. 1660-0025
Expires July 31, 2007
Paperwork Burden Disclosure Notice
Paperwork reporting burden for this form is estimated to average 1.7 hours per response The burden estimate includes the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing, reviewing, and submitting the form. You are not required to
respond to this collection of information unless a valid OMB control number appears in the upper right corner of this form. Send comments regarding the
accuracy of the burden estimate and any suggestions for reducing the burden estimate to: Information Collection Management, U. S. Department of
Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472. NOTE: Do not send your completed form to
the above address.
NOTE:
Certain of these assurances may not be applicable to your project or program. If you have any questions, please contact the awarding agency. Further,
certain Federal awarding agencies may require applicants to certify to additional assurances. if such Is the case, you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant:
1. Has the legal authority to apply for Federal assistance, and the
institutional, managerial and financial capability (including fonds sufficient
to pay the non-Federal share of project costs) to ensure proper planning,
management and completion of the project described in this application.
2. Will give the awarding agency, the comptroller General of the United
States, and if appropriate, the State, through any authorized
representative, access to and the right to examine all records, books,
papers, or documents related to the award; and will establish a proper
accounting system in accordance with generally accepted accounting
standards or agency directives.
3. Will establish safeguards to prohibit employees from using their
positions for a purpose that constitutes or presents the appearance of
personal gain.
4. Will initiate and complete the work within the applicable time frame after
receipt of approval of the awarding agency.
5. Wifi comply with the Intergovernmental Personnel Act of 1970 (42
U.S.C. Section 4727-4763) relating to prescribed standards for merit
systems for programs funded under one of the nineteen statues or
regulations specified in Appendix A of OP M's Standards for Merit System
of Personnel Administration (5 C.F.R. 900, Subpart F).
6. VVilt comply with all Federal statues 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 IV of the Education Amendments of 1972, as
amended (20 U.S.C. Sections 1681-1683, and 1685-1686), which prohibits
discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act
of 1973, as amended (29 U.S.C. Section 794), which prohibits
discrimination on the basis of handicaps; (d) the Age Discrimination Act of
1975, as amended (42 U.S.C. Sections 6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse Office and
Treatment Act of 1972 (P.L. 92-255), as amended, relating to
nondiscrimination on the basis of drug abuse; (f) the Comprehensive
Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970,) P.L. 91-616), as amended, relating to nondiscrimination on
the basis of alcohol abuse or alcoholism; (g) Sections 623 and 627 of the
Public Health Service Act of 1912, (42 U.S.C. 290-dd-3 and 290 ee-3), as
amended, relating to confidentiality of alcohol and drug abuse patient
records; (h) Title VIII of the Civil Rights Acts of 1968 (42 U.S.C. Section
3601 et, seq.), as amended, relating to nondiscrimination in the sale, rental
or financing of housing; (1) any other nondiscrimination provision in the
specific statue(s) under which application for Federal assistance is being
made; and (j) the requirements of any other nondiscrimination statue(s)
which may apply to the application.
7. Will comply, or has already complied, with the requirements of Title II
and III of the Uniformed Relocation Assistance and Real Property
Acquisition Poticies Act of 1970 (Pl. 91-646) which provides for fair and
equitable treatment of persons displaced or whose property is acquired as
a result of Federal or Federally assisted programs. These requirements
apply to all interest in real property acquired for project purposes
regardless of Federal participation in purchase.
8. Will comply with provisions of Hatch Act (5 U.S.C. Sections 1501-1508
and 7324-7328) which limit the political activities of employees whose
principle employment 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.Q. 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 subagreements.
10. Will comply, if applicable with flood insurance purchase requirements
of Section 102a of the Flood Disaster Protection Act of 1973 (P.L. 93-234)
which requires recipients in a special flood hazard area to participate In the
program and to purchase flood insurance if the total cost of insurable
construction and acquisition is $10,000 or more.
1 I. Will comply with environmental standards which may be prescribed
pursuant to the following: (a) institution of environmental quality control
measures under the National Environmental Policy Act of 1969 (FL.
91-190) and Executive Order (EO) 11514; (b) notification of violating
facilities pursuant to 50 11738; (c) protection of wetlands pursuant to E0
11990; (d) evaluation of flood hazards in floodplains in accordance with BO
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. Sections 1451 et seq.); (f) conformity of Federal
actions to State (Clear Air) Implementation Plans under Section 176 (c) of
the Clear Air Act of 1955, as amended (42 U.S.C. Section at seq.); (g)
protection underground sources of drinking water under Safe Drinking
Water Act of 1974, as amended, (Pt. 93-523); and (h) protection of
endangered species under the Endangered Species Act of 1973, as
amended, (FL. 93-205).
12. Will comply with the wild and Scenic Rivers Act of 1968 (16 U.S.C.
Sections 1271 at seq.) related to protecting components of the national
wild and scenic rivers systems.
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), EC 11593 (Identification and protection of historic properties),
and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C.
469a-et seq.).
14. Will comply with FL 93-348 regarding the protection of human subjects
involved in research, development, and related activities supported by this
award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L.
80-544, as amended, 7 U.S.C. 2131 et seq.) pertaining to the care,
handling, and treatment of warm blooded animals held for research,
teaching, or other activities supported by this award of assistance.
16. Will comply with the Lead-Based Paint Poising Prevention Act (42
U.S.C. Sections 4801 et seq.) which prohibits the use of lead based paint
in construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and compliance
audits in accordance with the Single Audit Act of 1984.
18. Will comply with all applicable requirements of all other Federal laws,
executive orders, regulations and policies governing this program,
19. It will comply with the minimum wage and maximum hours provisions
of the Federal Fair Labor Standards Act (29 U.S.C. 201), as they apply to
employees of institutions of higher education, hospitals, and other
non-profit organizations.
FEIVIA Form 20-16A, OCT 04 PREVIOUS EDITION OBSOLETE
14. Will comply with the flood insurance purchase requirements of
Section 102(a) of the Flood Disaster Protection Act of 1973 (FL.
93-234) which requires recipients In a special flood hazard area to
participate in the program and to purchase flood Insurance in the
total cost of Insurable construction and acquisition is $ IC 000 or
more.
15. Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National
Environmental Policy Act of 1969 (Pl. 91-190) and Executive
Order (6.0.) 11514; (b) notification of violating facilities pursuant
to FO 11738; (c) protection of wetlands pursuant to E0 11990; (d)
evaluation of ficioci hazards In floodplains in accordance with EO
11988; (e) assurance of project consistency with the approved ,
State management programs developed under the Coastal Zone
Management Act of 1973 (16 U.S.C. Sections 1451 et seq.); (t)
conformity of Federal actions to State (Clean Air) Implementations
Plans under Section 176(c) of the Clean Air Act of 1955, as
amended (42 U.S.C. Section 7401et seq.); (g) protection of
underground sources of drinking water under the Safe Drinking
Water Act of 1974, as amended, (Pl. 93-523); (H) Protection of
Endangered species Act of 1973, as amended, (FL. 93-205).
16. Will comply with the Wild and Scenic Rivers Act of 1968 (16
U.S.C. Sections 1271 et seq.) related to protecting components or
potential components of the national witd and scenic rivers
system.
17. 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
preservation of historic properties), and the Archaeological and
Historic Preservation Act of 1974 (16 U.S.C, 468-1 et seq.).
18. Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit Act of
1984.
19, Will comply with all applicable requirements of all other
Federal laws, Executive Orders, regulations and policies
governing this program,
20. It will comply with the minimum wage and maximum hours
provisions of the Federal Fair Labor Standards Act (29 U.S.C.
201), as they apply to employees of institutions of higher
education, hospitals, and other non-profit organizations.
21. It will obtain approval by the appropriate Federal agencies of
the final working drawings and specifications before the project Is
advertised or placed on the market for bidding; that It will
construct the project, or cause it to be constructed, to final
completion in accordance with the application and approved plans
and specifications; that it will submit to the appropriate Federal
agency for prior approval changes that alter the cost of the
project, use of space, or functional layout; that it will not enter into
a construction contract(s) for the project or undertake other
activities until the conditions of the construction grant program(s)
have been met.
22. It will operate and maintain the facility in accordance with the
minimum standards as may be required or prescribed by the
applicable Federal, State, and local agencies for the maintenance
and operation of such facilities.
23. It will require the facility to be designed to comply with the "American
Standard Specifications for Making Buildings and Facilities Accessible to,
and Usable by, the Physically Handicapped,' Number A117-1961, as
modified (41CFR 101-17.703). The applicant will be responsible for
conducting inspections to ensure compliance with these specifications by
the contractor.
24. if any real property or structure thereon is provided or improved with
the aid of Federal financial assistance extended to the applicant, this
assurance shall obligate the applicant, or in the case of any transfer of such
property, any transferee, for the period during which the real property or
structure is used for a purpose for which the Federal financial assistance is
extended or for another purpose Involving the provision of similar services
or benefits.
25.1n making subgrants with nonprofit institutions under this
Comprehensive Cooperative Agreement, it agrees that such grants will be
subject to OMB Circular A-122, "Cost Principles for Non-profit
Organization" including but not limited to, the "Lobbying Revision"
published in vol 49, Federal Register, pages 18260 through 18277 (April
27, 1984).
EMD-053 (12/2014)
MICHIGAN STATE POLICE
Emergency Management and Homeland Security Division
AUDIT CERTIFICATION
AUTHORITY: 1976 PA 390, MCL 30.407a, Single Audit Act of 1984, PL 98-502, as amended;
COMPLIANCE: Voluntary, but necessary to be considered for grant assistance
Federal Audit Requirements
Non-federal organizations which expend $500,000 or more in federal funds during their current fiscal year or expend
$750,000 or more in federal funds 4.1a fiscal year beginning on or after December 26, 2014, 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 or 2 CFR 200 after December 26, 2014. Subgrantees MUST submit a copy of their audit report for each
year they meet the funding threshold to: Michigan State Police, Grants and Community Services Division, 333 South
Grand Avenue, Lansing, Michigan 48933.
Program Name CFDA Number
I, Subgrantee Information
Jurisdiction Name
Street Address City State ZIP Code
II. Certification for Fiscal Year
Subgrantee Fiscal Year Period: to .
it will be required to have an audit
Circular, as revised, for the above listed
be required to have an audit performed
as revised, during at least one fiscal year
will be submitted to: Michigan State
Lansing, Michigan 48933.
performed under
program.
under the Single
funds are received
Police, Grants
Date
111 I certify that the subgrantee shown above does NOT expect
the Single Audit Act of 1984, as amended, and the OMB
[ certify that the subgrantee shown above expects it will
Audit Act of 1984, as amended, and the OMB Circular
for the above listed program. A copy of the audit report
and Community Services Division, 333 South Grand Avenue,
Signature of Subgrantee's Authorized Representative
Submit Completed Document To:
Emergency Management and Homeland Security Division
Michigan Department of State Police
Attention: Grants Development Unit
4000 Collins Road
Lansing, Michigan 48910
U. S. DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY I 0.M.B. No. 1660-0025
CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND I Expires July 31, 2007 OTHER RESPONSIBILITY MATTERS; AND DRUG-FREE WORKPLACE REQUIREMENTS
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 1.7 hours per response. The burden estimate includes the time for reviewing instructions and
searching existing data sources, gathering and maintaining the data needed and completing, and submitting the form. You are not required to respond to
this collection of Information unless a valid OMB control number appears in the upper right corner of this form. Send comments regarding the accuracy of
the burden estimate and any suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Federal
Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Project (1660-0001). NOTE: Do not send your
completed form to this address.
Applicants should refer to the regulations cited below to determine the certification to which they are required to attest. Applicants should also review the
instructions for certification included in the regulations before completing this form. Signature of this form provides for compliance with certification
requirements under 44 CFR Part 18, "New Restrictions on Lobbying" and 28 CFR Pact 17, "Government-wide Debarment and Suspension (Nonprocurement)
and Government-wide Requirements for Drug-Free Workplace (Grants),.' The certifications shall be treated as a material representation of fact upon which
reliance will be placed when the Federal Emergency Management Agency (FEMA) determines to award the transaction, grant, or cooperative agreement.
1. LOBBYING
As required by section 1352, Title 31 of the U.S. Code, and implemented
at 44 CFR Part 18, for persons entering into a grant or cooperating
agreement over $ 100,000, as defined at 44 CFR Part 18, the applicant
certifies that:
(a) No Federal appropriated funds have been paid or will be paid, by or on
behalf of the undersigned, to any person for influencing or attempting to
Influence an officer or employee of any agency, a Member of Congress,
an officer or employee of Congress, or an employee of a Member of
Congress in connection with the making of any Federal grant, the entering
into of any cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any Federal grant or cooperative
agreement.
(b) If any other funds than Federal appropriated funds have been paid or
will be paid to any other person for influencing or attempting to influence
an officer or employee of any agency, a member of Congress, an officer
or an employee of Congress, or employee of a member of Congress in
connection with this Federal Grant or cooperative agreement, the
undersigned shall complete and submit Stand Form-LLI, "Disclosure of
Lobbying Activities,' In accordance with its instructions
(c) The undersigned shall require that the language of this certification be
included in the award documents for all subawards at all tiers (including
subgrants, contracts under grants and cooperative agreements, and
subcontracts) and that all subrecipients shall certify and disclose
accordingly.
Standard Form-LL. "Disclosure of Lobbying Activities" attached
(This form must be attached to certification if nonapproprlated funds are to
be used to influence activities.)
2. DEBARMENT,SUSPENSION, AND OTHER RESPONSIBILITY
MATTERS (DIRECT RECIPIENT)
As required by Executive Order 12549, Debarment and Suspension, and
implemented at 44 CFR Part 67, for prospective participants in primary
covered transactions, as defined at 44 CFR Part 17, Section 17.510-A.
The applicant certifies that it and its principals:
(a) Are not presently debarred, suspended, proposed for debarment,
declared ineligible, sentenced to a denial of Federal benefits by a State or
Federal court, or voluntarily excluded from covered transactions by any
Federal department or agency;
(b) Have not within a three-year period preceding this application been
convicted of a 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 a public (Federal ,State, or local)
transaction or contract under a public transaction; violation of Federal or
State antitrust statutes or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or
receiving stolen property;
(c) Are not presently indicted for otherwise criminally or civilly charged by a
governmental entity (Federal, State, or local) with commission of any of the
offenses enumerated in paragraph (1) (b) of this certification; and
(ml) Have not within a three-year period preceding this application had one or
more public transactions (Federal, State, or local) terminated for cause of
default; and
B. Where the applicant is unable to certify to any of the statements In this
certification, he or she shall attach an explanation to this application.
3. DRUG-FREE WORKPLACE
(GRANTEE OTHER THAN INDIVIDUALS)
As required by the Drug-Free Workplace Act of 1988, and implemented at
44 CFR Part 17, Subpart F, for grantees, as defined at 44 CFR Part 17.615
and 17.620-
A. The applicant certifies that it will continue to provide a drug-free
workplace by;
(a) Publishing a statement notifying employees that the unlawful
manufacture, distributions
(b) Establishing an on-going drug free awareness program to inform
employees about-
(1) The dangers of drug abuse in the workplace;
(2) The grantee's policy of maintaining a drug-free workplace;
(3) Any available drug counseling, rehabilitation, and
employee assistance programs; and
(4) The penalties that may be imposed upon employees
for drug abuse violations occurring in the workplace;
(c) Making it a requirement that each employee to be engaged in the
performance of the grant to be given a copy of the statement required by
paragraph (a);
(d) Notifying the employee In the statement required by paragraph (a) that,
as a condition of employment under the grant, the employee will-
(1) Abide by the term of the statement; and
(2) Notify the employee in writing of his or her conviction for a
violation of a criminal drug statute occurring ion the workplace no
later than five calendar days after such convections;
(e) Notifying the agency, in writing, with 10 calendar days after receiving
notice under subparagraph (d)(2) from an employee or otherwise receiving
actual notice of such conviction. Employers of convicted employees must
provide notice, including position, title, to the applicable FEMA awarding
office, i.e., regional office or FEMA office.
FEMA Form 20-16C, OCT 04 PREVIOUS EDITION OBSOLETE
(f) Taking one of the following actions, within 30 calendar days of receiving
notice under subparagraph (d)(2), with respect to any employee who Is
convicted-
(1) Taking appropriate personnel action against such an employee,
up to and including termination, consistent with the requirements of
the Rehabilitation act of 1973, as amended: or
(2) Requiring such an employee to participate satisfactorily in a
drug abuse assistance or rehabilitation program approved for such
purposes by a Federal, State, or local health, law enforcement, or
other appropriate agency,
(g) Making a good faith effort to continue to maintain a drug free workplace
through Implementation of paragraphs (a),(b),(c),(d),(e) and (f).
B. The grantee may insert in the space provided below the site(s) for the
performance of work done in connection with the specific grant:
Place of Performance (Street address, City, County, Stale, Zip code)
Check If there are workplaces on file that are not identified
here.
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 application for
FEMA funding. States and State agencies may elect to use a
state wide certification.
DISCLOSURE OF LOBBYING ACTIVITIES
Approved by OMB
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046
(See reverse for public burden disclosure.)
1. Type of Federal Action: 2. Status of Federal Action:
award
a. bid/offer/application
3. Report Type:
change
Change Only:
quarter
a. contract a. initial filing
b. grant
c. cooperative agreement
d, loan
e. loan guarantee
f, loan insurance
b. initial
c, post-award
b. material
For Material
year
date of last report
4. Name and Address of Reporting
0 Prime 0 Subawardee
Tier
Entity:
, if known:
40
5. If Reporting Entity in No. 4 is a Subawardee, Enter Name
and Address of Prime: .
Congressional District, if known: Congressional District, if known:
6. Federal Department/Agency: 7. Federal Program
CFDA Number, if
Name/Description:
applicable:
8. Federal Action Number, if known: 9, Award Amount, if known:
$
10. a. Name and Address of Lobbying Registrant
(if individual, last name, first name, MI):
b. Individuals Performing Services (including address if
different from No. 10a)
(last name, first name, 1141):
11. Information requested through this form is authorized by Me 31 L.I.3.0, section
1352. This disclosure of lobbying activities is a material representation of fact
upon which reliance was placed by the her above when this transaction was made
or entered Into. This disclosure is required pursuant to 31 U.S.C. 1352. This
information will be available for public inspection. Any person who fails Is tile the
required disclosure shall be subject to a civil penalty of not lass than $10,500 and
not more than $100,500 for each such failure,
Signature:
Print ame: N
Title:
Telephone No.: Date:
Federal Use Only: Authorized for Local Reproduction
Standard Form LLL (Rev. 7-97)
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal
action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make
payment to any lobbying entity for influencing or attempting to influence an officer or empioyeeof any agency, a Member of Congress, an officer or employee of
Congress, or an employeeof a Memberof Congress in connection with a covered Federal action, Complete all items that apply for both the initial filing and material
change report, Refer to the implementing guidance published by the Office of Management and Budget for additional information.
1. identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this Is a followup report caused by a material change to the information previously reported, enter
the year and quarter in which the change occurred. Enter the date of the last previouslysubmitted report by this reporting entity for this covered Federal
action.
4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification
of the reporting entity that designates if it Is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardoe, e.g., the first subawardee
of the prime is the 1st tier. Subawards Include but are not limited to subcontracts, subgrants and contract awards under grants.
5, If the organization filing the report in item 4 checks "Stibawardee,' then enter the full name, address, city, State and zip code of the prime Federal
reelpient. Include Congressional District, if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizationallevei below agency name, if known. For
example, Department of Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance
(C FDA) number for grants, cooperative agreements, loans, and loan commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identified In item 1 (e.g., Request for Proposal (RFP) number;
Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number
assigned by the Federal agency). Include prefixes, e.g., 'RFP-DE-90-001."
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan
commitment for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting
entity identified in item 4 to Influence the covered Federal action.
(b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a), Enter Last Name, First Name, and
Middle Initial (MI).
11, The certifying official shall sign and date the form, print his/her name, title, and telephone number.
According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB Control
Number. The valid OMB control number for this information collection is OMB No. 0348-.0046. Public reporting burden for this collection of information is
estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington,
DC 20503.
U.S. DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
SUMMARY SHEET FOR ASSURANCES AND CERTIFICATIONS
0.114.2. No. 1660-0025
Expires July 31, 2007
FOR CA FOR (Name of Recipient)
FY
This summary sheet includes Assurances and Certifications that must be read, signed, and submitted as a part of the
Application for Federal Assistance.
An applicant must check each item that they are certifying to:
Part I
Part II
Part III
Part IV
FEMA Form 20-16A, Assurances-Nonconstruction Programs
FEMA Form 20-16B, Assurances-Construction Programs
FEMA Form 20-16C, Certification Regarding Lobbying;
Debarment, Suspension, and Other Responsibility
Matters; and Drug-Free Workplace Requirements
SF LLL, Disclosure of Lobbying Activities (If applicable)
As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the identified
attached assurances and certifications,
Typed Name of Authorized Representative Title
Signature of Authorized Representative Date Signed
NOTE: By signing the certification regarding debarment, suspension, and other responsibility matters for primary
covered transaction, the applicant agrees that, should the proposed covered transaction be entered into, it shall not
knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or
voluntarily excluded from participation in this covered transaction, unless authorized by FEMA entering into this transaction.
The applicant further agrees by submitting this application that it will include the clause titled "Certification
Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered Transaction," provided by the
FEMA Regional Office entering into this covered transaction, without modification, in all lower tier covered transactions and in
all solicitations for lower tier covered transactions, (Refer to 44 CFR Part '17.)
Paperwork Burden Disclosure Notice
Public reporting burden for this form is estimated to average 1.7 hours per response. The burden estimate includes the time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing,
reviewing, and maintaining the data needed, and completing dnd submitting the form. Send comments regarding the
accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, U.S.
Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington DC 20472.
You are not required to complete this form unless a valid OMB control number is displayed in the upper corner on this form.
Please do not send your completed form to the above.address.
FEMA Form 20-IS, OCT 04 PREVIOUS EDITION OBSOLETE
Form W.9
(Rev. December 2014)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
Identification Number and Certification
Give Form to the
requester. Do not
send to the IRS. Print or type See Specific Instructions on page 2. i Name (as shown on your income tx return). Name is required on this lino; do not leave this line blank.
2 Business name/disregarded e ntity name, if different 'from above
3 Check appropriate box for federal tax classification; check only one of the following seven boxes:
0 Individual/sole proprietor or D C Corporation • S Corporation • Partnership 0 Trust/estate
single-member LLc D Limited liability company. Enter the tax classification (C—C corporation, S-S corporation, P—partnership} 1
4 Exemptions (codes apply only to
certain entities, not individuals; see
Instructions on page 3):
Exempt payee code (if any)
Exemption from FATCA reporting
code (if any)
Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for
the tax classification of the single-member owner.
• Other (see lrtslrucftions) le (Appries to account.' maintained outsrde the WS
5 Address (number, street, and apt, or suite no.) Requester's name and address (optional)
6 City, state, and ZIP code
7 LIst account number(s) here (optional)
Part I Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (53L'N). 1 lowever, for a
resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other
entities, It is your employer identification number (DIN). If you do not have a number, see How to get a
social security number
-
1 .
TIN on page 3.
Note. If the account is in more than one name, see the Instructions for tine 1 and the chart on page 4 for
guidelines on whose number to enter.
or
Employer identification number
GMII Certification
Under penalties of perjury, I certify that
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the internal Revenue
Service (IRS) that 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 I am
no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATOA code(s) entered on this form (If any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and dividends an your tax return. For real estate transactions, item 2 does not apply. For mortgage
interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and
generally, 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 3.
Sign Signature of Here U.S. person 1. Date 1-
General Instructions
Section references are to the Internal Revenue Code unless otherwise noted,
Future developments. Information about developments affecting Form W-9 such
as legislation enacted after we release it) is at wwwirs.godfw9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an Information
return with the IRS must obtain your correct taxpayer identification number (TIN)
which may be your Social security number (SSN), Individual taxpayer identification
number (11-11,1), adoption taxpayer Identification number (ATIN), or employer
identification number (FIN), to report on an Information return the amount paid to
you, or other amount reportable on an information return. Examples of information
returns include, but are not limited to, the following:
• Form1099-INT (interest earned or paid)
• Form1099-DIV (dividends, including those from stocks or mutual funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)
• Form 1099-B (stock or mutual fund sales and certain other transactions by
brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third patty network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T
(tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident alien), to
provide your correct TIN.
if you do not return Form W-9 to the requester with a TIN, you might be subject
to backup withholding. See What is backup withholding? on page 2.
By signing the filled-out form, you:
I. Certify that the TIN you are giving is correct (or you are waiting for a number
to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt payee. If
applicable, you are also certifying that as a U.S. person, your allocable share of
any partnership income from a U.S. trade or business Is not subject to the
withholding fax on foreign partners' share of effectively connected Income, and
4. Certify that FATCA code(s) entered on this form (if any) indicating that you are
exempt from the FATCA reporting, is correct. See What is FATCA repotting? on
page 2 for further information,
Cat. No, 10231X Form W-9 (Rev. 12-2014)
Form W-9 (Rev. 12-2014) Page 2
Note. If you are a U.S. person and a requester gives you a form other than Form
W-9 to request your TIN, you must use the requester's form if it is substantially
similar to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are considered a U.S.
person if you are:
• An individuai who is a U.S. citizen or U.S. resident alien;
• 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 foreign estate); or
• A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or business in
the United States are generally required to pay a withholding tax under section
1446 on any foreign partners' share of effectively connected taxable income from
such business. Further, in certain cases where a Form W-9 has not been received,
The rules under section 1446 rewire a partnership to presume that a partner Is a
foreign person, and pay the section 1446 withholding tax. Therefore, if you are a
U.S. person that Is a partner In a partnership conducting a -trade or business In the
United States, provide Form W-9 to the partnership to establish your U.S. status
and avoid section 1446 withholding on your share of partnership income,
In the oases below, the following person must give Form W-9 to the partnership
for purposes of establishing its U.S. status and avoiding withholding on its
allocable share of net income from the partnership conducting a trade or business
In the United States:
• in the case of a disregarded entity with a U.S. owner, the U.S. owner of the
disregarded entity and not the entity;
• In the case of a grantor trust with a U.S. grantor or other U.S, owner, generally,
the U.S. grantor or other U.S. owner of the grantor trust and not the trust; and
* In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a
grantor trust) and not the beneficiaries of the trust.
Foreign person. If you are a foreign person or the U.S. branch of a foreign bank
that has elected to be treated as a U.S. person, do not use Form W-9. Instead, use
the appropriate Form W-8 or Form 8233 (see Publication 515, Withholding of Tax
on Nonresident Aliens and Foreign Entities).
Nonresident alien who becomes a resident alien. Generally, only a nonresident
alien individual may use the terms of a tax treaty to reduce or eliminate U,S, tax on
certain types of income. However, most lax treaties contain a provision known as
a "saving clause." Exceptions specified in the saving clause may permit an
exemption from tax to continue for certain types of income even after the payee
has otherwise become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception contained in the
saving clause of a tax treaty to claim an exemption from U.S. tax on certain types
of income, you must attach a statement to Form W-9 that specifies the following
five items:
1. The treaty country. Generally, this must be the same treaty under which you
claimed exemption from tax as a nonresident alien.
2. The treaty article addressing the Income.
3. The article number (or location) in the tax treaty that contains the saving
clause and its exceptions.
4. The type and amount of Income that qualifies for the exemption from tax.
5. Sufficient facts to justify the exemption from tax under the terms of the treaty
article.
Example. Article 20 of the U.S.-China income tax treaty allows an exemption
from tax for scholarship Income received by a Chinese student temporarily present
In the United States. Under U.S. law, this student will become a resident alien for
tax purposes If his or her stay in the United States exceeds 5 calendar years.
However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 3D,
1384) allows the provisions of Article 20 to continue to apply even after the
Chinese student becomes e resident alien of the United States, A Chinese student
who qualities for this exception (under paragraph 2 of the first protocol) and is
relying on this exception to claim an exemption from tax on his or her scholarship
or fellowship income would attach to Form W-9 a statement that includes the
Information described above to support that exemption.
If you are a nonresident alien or a foreign entity, give the requester the
appropriate completed Form W-8 or Form 8233,
Backup Withholding
What is backup withholding? Persons making certain payments to you must
under certain conditions withhold and pay to the IRS 28% of such payments, This
Is oared "backup withholding," Payments that may be subject to backup
Withholding include Interest, tax-exempt interest, dividends, broker and barter
exchange transactions, rents, royalties, nonempioyee pay, payments made in
settlement of payment card and third party network transactions, and certain
payments from fishing boat operators. Real estate transactions are not subject to
backup withholding.
You will not be subject to backup withholding on payments you receive If you
give the requester your correct TIN, make the proper certifications, and report all
your taxable Interest and dividends on your fax return.
Payments you receive will be subject to backup withholding If:
I. You do not furnish your TIN to the requester,
2. You do not certify your TIN when required (see the Part II instructions on page
13 for details),
3. The IRS tells the requester that you furnished an Incorrect TIN,
4. The IRS tells you that you are subject to backup withholding because you did
not report at your interest and dividends on your tax return (for reportable interest
and dividends only), or
5. You do not certify to the requester that you are not subject to backup
withholding under 4 above (for reportable interest and dividend accounts opened
after 1983 only).
Certain payees and payments are exempt from backup withholding, See Exempt
payee code on page 3 and the separate Instructions for the Requester of Form
W-9 for more Information.
Also see Special rules for partnerships above.
What is FATCA reporting?
The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign
financial institution to report at United States account holders that are specified
United States persons. Certein payees are exempt from FATCA reporting. See
Exemption from FATCA reporting code on page 3 and the Instructions for the
Requester of Form W-9 for more information.
Updating Your Information
You must provide updated information to any person to whom you cialrred lo be
an exempt payee if you are no longer an exempt payee and anticipate receiving
reportable payments in the future from this person. For example, you may need to
provide updated information if you are a C corporation that elects to be an S
corporation, or if you no longer are tax exempt. In addition, you must furnish a new
Form W-9 lithe name or TIN changes for the account; for example, if the grantor
of a grantor trust dies.
Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are
subject to a penalty of $50 for each such failure unless your failure is due to
reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. If you make
false statement with no reasonable basis that results in no backup withholding,
you are subject to a $500 penalty,
Criminal penalty for falsifying information. Wilfully falsifying certifications or
affirmations may subject you to criminal penalties including fines and/or
imprisonment.
Misuse of Ms. If the requester discloses or uses TiNs in violation of federal law,
the requester may be subject to civil and criminal penalties.
Specific Instructions
Line -1
You must enter one of the following on this line; do not leave this line blank. The
name should match the name on your tax return.
If this Form W-9 is for a joint account, list first, and than circle, the names of the
person or entity whose number you entered in Part I of Form W-9.
a. individual. Generally, enter the name shown on your tax return, If you have
changed your last name without informing the Social Security Administration (SSA)
of the name change, enter your first name, the last name as shown on your social
security card, and your new last name.
Note. ITIN applicant: Enter your Individual name as it was entered on your Form
W-7 application, line la. This should also be the same as the name you entered on
the Form 1040/1040A/1040EZ you filed with your application.
b. Sole proprietor or single-member LLC. Enter your individual name as
shown on your 1040/1040A/1040E7. on line 1. You may enter your business, trade,
or "cleing business as" (DBA) name on lino 2.
G. Partnership, LLC that is not a single-member LLC, C Corporation, or S
Corporation. Enter the entity's name as shown on the entity's tax return on line I
and any business, trade, or USA name on line 2.
d. Other entities. Enter your name as shown on required U.S. federal tax
documents on line I. This name should match the name shown on the charter or
other legal document creating the entity. You may enter any business, trade, or
USA name on line 2.
e. Disregarded entity. For U.S. federal tax purposes, an entity that is
disregarded as an entity separate from its owner is treated as a "disregarded
entity." See Regulations section 301.7701-2(c)(2)(1i1). Enter the owner's name on
line 1. The name of the entity entered on line I should never be a disregarded
entity, The name on line 1 should be the name shown on the income tax return on
which the income should be reported. For example, if a foreign LUG that is treated
as a disregarded entity for U.S. federal tax purposes has a single owner that Is a
U.S. person, the U.S. owner's camels required to be provided on line 1. If the
direct owner of the entity is also a disregarded entity, enter the first owner that Is
not disregarded for federal tax purposes. Enter the disregarded entity's name on
line 2, "Business name/disregarded entity name." if the owner of the disregarded
entity is a foreign person, the owner must complete an appropriate Form W-8
Instead of a Form W-R. This Is the case even if the foreign person has a U.S. TIN.
Form W-9 (Rev. 12-2014) Page 3
Line 2
If you have a business name, trade name, DBA name, or disregarded entity name,
you may enter Ron line 2.
Line 3
Check the appropriate box in line 3 for the U.S. federal tax classification of the
person whose name is entered on line 1. Check only one box in line 3.
Limited Liability Company (LLC). lithe name on line 1 Is an LLC treated as El
partnership for U.S. federal tax purposes, check the "Limiteetiability Company"
box and enter "P" In the space provided. If the LLC has filed Ferns 8832 or 2553 to
be taxed as a corporation, check the "Limited Liability Company" box and in the
space provided enter "C" for C corporation or "S" for S corporation, If it is a
single-member LLO that is a disregarded entity, do not check the "Limited Liability
Company" box; Instead check the first box in line 3 "Individual/sole proprietor or
single-member LLC."
Line 4, Exemptions
If you are exempt from backup withholding and/or FATCA reporting, enter In the
appropriate space in line 4 any code(s) that may apply to you.
Exempt payee code.
• Generally, Individuals (Including sole proprietors) are not exempt from backup
withholding.
• Except as provided below, corporations are exempt from backup withholding
for certain payments, including Interest and dividends,
• Corporations are not exempt from backup withholding for payments made in
settlement of payment card or third party network transactions.
• Corporations are not exempt from backup withholding with respect to attorneys'
fees or gross proceeds paid to attorneys, and corporations that provide medical or
health care services are not exempt with respect to payments reportable on Form
1090-MISC.
The following codes Identify payees that are exempt from backup withholding.
Enter the appropriate code in the space In line 4.
1—An organization exempt from tax under section 501(a), any IRA, or a
custodial account under section 403{6)(7) if the account satisfies the requirements
of section 401(f)(2)
2—The United States or any of its agencies or Instrumentalities
3—A state, the District of Columbia, a U.S. commonwealth or possession, or
any of their political subdivisions or Instrumentalities
4—A foreign government or any of Its political subdivisions, agencies, or
Instrumentalities
5—A corporation
6—A dealer In securities or commodities required to register in the United
States, the District of Columbia, or a U.S. commonwealth or possession
7—A futures commission merchant registered with the Commodity Futures
Trading Commission
8—A real estate Investment trust
9—An entity registered at all times during the tax year under the Investment
Company Act of 1940
10—A common trust fund operated bY a bank under section 584(a)
11—A financial institution
12—A middleman known in the investment community as a nominee or
custodian
13—A trust exempt from tax under section 664 or described in section 4947
The following chart shows types of payments that may be exempt from backup
withholding. The chart applies to the exempt payees listed above, 1 through 13.
IF the payment Is for ... THEN the payment is exempt for,,.
Interest and dividend payments Ail exempt payees except
for 7
Broker transactions Exempt payees i through 4 and 6
through 1'1 and all C corporations. 8
corporations must not enteran exempt
payee code because they are exempt
only for sales of noncovered securities
acquired prior to 2012.
Barter exchange transactions and
patronage dividends .
Exempt payees 1 through 4
Payments over $600 required to be
reported and direct sales over $5,000 1
Generally, exempt payees
1 through e
Payments made in settlement of
payment card or third party network
transactions
Exempt payees 1 through 4
I See Farm 1090-MISC, Miscellaneous Income, and its instructions.
2 However, the following payments made toe corporation and reportable on Form
1099-MISC are not exempt from backup withholding: medical and health care
payments, attorneys' fees, gross proceeds paid to an attorney reportable under
section 6045(0, and payments for services paid by a federal executive agency.
Exemption from FATCA reporting code. The following codes identify payees
that are exempt from reporting under FATCA. These codes apply to persons
submitting this form for accounts maintained Outside of the United States by
certain foreign financial institutions. Therefore, if you are only submitting this form
for an account you hold in the United States, you may leave this field blank.
Consult with the person requesting this form if you are uncertain little financial
institution is subject to these requirements. A requester may incileate that a code is
not required by providing you with a Form W-9 with "Not Applicable' (or any
similar Indication) written or printed on the line for a FATCA exemption code.
A—An organization exempt from tax under section 501(a) or any individual
retirement plan as defined In section 7701(a)(37)
B—The United States or any of Its agencies or instrumentalities
C —A state, the District of Columbia, a U.S. commonwealth or possession, or
any of their political subdivisions or instrumentalities
D—A corporation the stock of which is regularly traded on one or more
established securities markets, as described in Regulations section
1.1472-1(c)(1)(1)
E—A corporation that is a member of the same expanded affiliated group as a
corporation described in Regulations section 1.1472-1(c)(1)(e
F—A dealer in Securities, commodities, or derivative financial Instruments
(including notional principal nontracts, futures, forwards, and options) that is
registered as such under the laws of the United States or any state
C —A real estate investment trust
H—A regulated Investment company as defined in section 851 or an entity
registered at all tries dudrig tire tax year under lire li west eel hi. Con lam iy Act or
1940
I—A common trust fund as defined In section 584(a)
J—A bank as defined in section 581
K—A broker
L—A trust exempt from tax under section 664 or described In section 4947(a)(1)
M —A tax exempt trust under a section 403(b) plan or section 457(g) plan
Note. You may wish to consult with the financial Institution requesting this form to
determine whether the FATCA code and/or exempt payee code should be
completed.
Line 5
Enter your address (number, street, and apartment or suite number). This Is where
the requester of this Form W-9 will mall your Information returns.
Line 6
Enter your city, state, and ZIP code.
Part I. Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. If you are a resident alien and you do not
have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer
Identification number (ITIN). Enter it in the social security number box. If you do not
have an ITIN, see How to gets TIN below.
If you area sole proprietor and you have an EIN, you may enter either your SSN
or EiN. However, the IRS prefers that you use your SSN.
If you are a single-member LLC that is disregarded as an entity separate from its
owner (see Limited Liability Company (L1c) on this page), enter the owner's SSN
(or EIN, if the owner has one). Do not enter the disregarded entity's EIN. if the LLC
Is classified as a corporation or partnership, enter the entity's EIN.
Note. Sao the chart on page 4 for further clarification of name and TIN
combinations.
How to get a TIN. If you do not have a TIN, apply for one Immediately. To apply
for an SSN, get Form SS-5, Application for a Social Security Card, from your local
SSA office or get this form online at www.ssa.gov, You may also get this form by
calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer
identification Number, to apply for an ITIN, or Form 59-4, Application for Employer
Identification Number, to apply for an EIN. You can apply for an EIN online by
accessing the IRS website at www.irs.govibusinesses and clicking on Employer
Identification Number (EIN) under Starting a Business. You can get Forms W-7 and
53-4 from the IRS by visiting IRS.gov or by calling 1-800-TAX-FORM
(1-800-820-3676).
If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN
and write "Applied For" in the space for the TIN, sign and date the form, and give it
to the requester. For interest and dividend payments, and certain payments made
with respect to readily tradable Instruments, generally you will have 60 days to get
a TIN and give it to the requester before you are subject to hookup withholding on
payments. The 60-day rule does not apply to other types of payments. You will be
subject to backup withholding on all such payments until you provide your TIN to
the requester.
Note, Entering "Applied For" means that you have already applied for a TIN or that
you intend to apply for one soon.
Caution :A disregarded U.S. entity that has a foreign owner must use the
appropriate Form W-8.
Form W-9 (Rev. 12-2014)
Page 4
Part IL Certification
To establish to the withholding agent that you are a U.S. person, or resident den,
sign Form VV-9. You may be requested to sign by the withholding agent even If
items 1, 4, or 5 below indicate otherwise,
For a joint account, only the person whose TIN Is shown in Part I should sign
(when required). In the case of a disregarded entity, the person Identified on line 1
must sign. Exempt payees, see Exempt payee code earlier.
Signature requirements. Complete the certification as Indicated in items 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 better exchange accounts opened after
1983 and broker accounts considered Inactive during 1983. You must sign the
certification or backup withholding will apply. if you are subject to backup
withholding and you are merely providing your correct -RN to the requester, you
must cross out item 2 in the certification before signing the form.
3. Reel estate transactions. You must sign the certification. You may cross out
Item 2 of the certification.
4. Other payments. You must give your correct TIN, but you do not have to sign
the certification unless you have been notified that you have previously given an
incorrect TIN. 'Other payments" include payments made in the course of the
requester's trade or business for rents, royalties, goods {other than bills for
merchandise), medical and health care services (Including payments to
corporations), payments to a nonemployee for services, payments made in
settlement of payment card and third party network transactions, payments to
certain fishing boat crew members and fishermen, and gross proceeds paid to
attorneys (including 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, Goverdell ESA, Archer IVISA or NSA contributions or
distributions, and pension distributions. You must give your correct TIN, but you
do not have to sign the certification.
What Name and Number To Give the Requester
For thls type of account: Give name and SSN of:
1, Individual
2, Two or more individuals &tint
account)
3. Custodian account of a minor
(Uniform Gift to Minors Act)
4. a. The usual revocable savings
trust (grantor Is also trustee)
b. So-called trust account that is
not a legal or valid trust under
site law
5. Sole proprietorship or disregarded
entity owned by an individual
6. Grantor trust tiling under Optional
Form 1099 Filing Method 1 (see
Regulations section 1,671-4(b)(2)(1)
(A))
The individual
The actual owner of the account or,
if combined funds, the first
individual on the account'
The minor'
The grantor-trustee'
The actual owner'
The owner'
The grantor'
For this type of account: Give name and MN of:
7. Disregarded entity not owned by an
Individual
B. A valid trust, estate, or pension trust
9. Corporation or LTC electing
corporate status on Form 8832 or
Form 2553
10. Association, club, religious,
charitable, educational, or other tax-
exempt organization
11. Partnership or multi-member LLC
12. A broker or registered nominee
13. Account with the Department of
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
14. Grantor trust filing under the Form
1041 Filing Method or the Optional
Form 1099 Filing Method 2 (see
Regulations section 1.671-4(b)(2)(i)
(B))
The owner
Legal entity'
The corporation
The organization
The partnership
The broker or nominee
The public entity
The trust
List first and circle the name of the person whose number you furnish. If only one person on a
Joint account has an SSN, that person's number must be furnished.
2 Circle the mfuor's name and furnish the minor's SSN.
'You must show your Individual name and you may also enter your business or DE3Anarna on
the 'Business name/disregarded entity" name line. You may use either your SSN or SIN CH you
have one). but Its IRS encourages you to use your SW.
4 List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the
personal representative or trustee unless the legal entity Itself Is not designated Inthe account
title.) Also see Special alias for partnershIps on page 2,
'Note. Grantor also must provide a Form W-9 to tresins of trust
Note. If no name Is circled when more than one name is listed, the number will be
considered to be that of the first name listed.
Secure Your Tax Records from Identity Theft
Identity theft occurs when someone uses your personal Information such as your
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PA-05-MI-4185-PW-00057(0) 2
Applicant Name: Application Title:
OAKLAND (COUNTY) 9912502 Equipment (vehicles)
Period of Performance Start: Period of Performance End:
09-25-2014 03-25-2015
Subgrant Application - Entire Application
Application Title: 9912002 Equipment (vetiicies)
Application Number PA-05-141l-4195-PW-00007(0)
Application Type: Subgrant Appimnon (PW)
. Preparer Information
Prefix Mr.
First Name IAN
Middle Initial S
Last Name SECHERER GERRIE
Title PROJECT SEPECIAUST
Agency/Organization Name FEMA
Address 1 536 S CLARK ST.
Address 2 6TH FLOOR
City CHICAGO
State IL
Zip 60605
Email msp-emhsd@michigen.gov
Is the application preparer the Point of Contact? No
Point of Contact Information
Prefix Mr.
First Name ART
Middle Initial
Last Name HOLDSWORTH
Title DIRECTOR OF FACILITIES MANAGEMENT
Agency/Organization OAKLAND COUNT(
Address 1 1200 N TELEGRAPH RD
Address 2
City PONTJAC
State MI
ZIP 48341
Phone 248-858-0160
Fax 248-952-2250
Email holdswartha@oakgov.com
Alternate Paint of Contact Information
Prefix
First Name
Middle Initial
Last Name.
Title
Agency/Organization
Address 1
Address 2 .
City
State
ZIP
Phone
FaX
Email
Project Description
Disaster Number 4195
Pre-Application Number .• PA-05-MI-4195-RPA-0041
Applicant ID: 125-99125-00
Applicant Name: OAKLAND (COUNTY)
Subdivision:
Project Number . 9912502
Standard Project Number/Title: 599 -Repair Damages to Public Buildings and Facilities
Please Indicate the Project Type: Neither Alternate nor Improved
Application Title: 9912502 Equipment (vehicles)
Category: E.PUBLIC BUILDINGS
Percentage Work Completed? 100.0 %
As of Date: 09-12-2014
Comments
Attachments
User Date Document Type Description Hard Copy File Reference File Name Action
IAN BECHERER GERRIE 11-10-2014 Map 9912502 equipment Map Location 9912502 equipment Map Locationjpg(136.36 kb) View
Damage Facilities Part 1 of 2
Facility Number Facility Name Address County City State . ZIP Site Previously
Damaged? .
Action
1 Equipment (vehicles) Oakland MI 48341 No
Comments
Attachments
User Date Document
Type Description Hard Copy File
Reference File Name Action
IAN BECHERER
GERRIE
11-10-
2014 Photos 9912502 equipment Photo Flooded Trucks 9912502 equipment Photo Flooded Trucksjpg(1.92 Mb) View
IAN BECHERER
GERRIE
11-10-
2014 Photos 9912502 equipment photo of repaired truck 9912502 equipment photo of repaired truck.JPG(102.82 kb) View
IAN BECHERER
GFRRIF
11-10-
20i 4 Photos 9912502 equipment Truck Intenor 9912502 equipment Truck intericriPn(1.n3 Mb) Vie,.v
IAN BECHERER
GERRIE
11-10-
2014 Miscellaneous 9912502 equipment Work Order 2004 Sierra 9912502 equipment Work Order 2004 Siona.pdf(206,83 kb) View
IAN BECHERER
GERRIE
11-10-
2014 Photos 9912502 equipment water height 9912502 equipment water height.JPG(514.10 kb) View
IAN BECHERER
GERRIE
11-10-
2014 Miscellaneous 9912502 equipment Medical Examiner
Statement (Oakland County)
9912502 equipment Medical Examiner Statement (Oakland
County).pdf(154.87 kb) View
IAN BECHERE
GE R RIE
R 11-20-
2014 Miscellaneous 9912502- Parts-Supplies justification
spreadsheet 9912502- Parts-Supplies justification
spreadsheet.pdf(297.52 kb) View
IAN BECHERER
GERRIE
11-20-
2014 Miscellaneous 9912502- Parts-Supplies justification
spreadsheet 9912502- Parts-Supplies justification
spreadsheetpdf(297.52 kb) View
JAMES
RUSSELL
11-24-
2014
Additional
Information Work Order Impala 9912502_equipment Work_Order Impala[1].pdf(100.85 kb) View
JAMES
RUSSELL
11-24-
2014
Additional
Information 9912502 Equipment WO 2006 Sierra 9912502_equipment Work_Order 2006 Sierra[1].pdf(174.15
kb)
vi w
Facility Name: Equipment (vehicles)
Address 1:
Address 2:
County: Oakland
City:
State: MI
ZIP: 48341
Was this site previously damaged? No
Percentage Work Completed? . 100.00 %
Location:
PA-05-MI-4195-PW-00057(0):
1200 N Telegraph Rd, Pontiac, Mi
Damage Description and Dimensions:
PA-05-MI-4195-PW-00057(0):
Incident period, August 11, 2014, through August 13, 2014. As a direct result of severe storms and flooding, three
vehicles owned by Oakland County suffered damage.
.2007 Chevrolet Impala (VIN: 2GIWB58K579280725), flooded when the driver was required to return to his office
during the storm after responding to a suicide in Hazel Park MI. The vehicle stalled in 16 inches of water near the
intersection of Lennox Street and Mapledaie Avenue in Femdale, Mk Damages to the vehicle were the result of
subsequent flooding.
-The 2004 GMC Sierra 2500 UTI (VIN: 1GDHK24004E287764), flooded to the roofline (approximately 61t) in its
assigned parking place inside of the George W. Kuhn Retention Treatment Basin plant at 1400 Ajax Road, Madison
Heights, MI.
-The 2006 GMC Sierra 2500 UTI (1GDHK24U86E244489), flooded to the roofline (approximately 6f I) in its assigned
parking place inside of the George W. Kuhn Retention Treatment Basin plant at 1400 Ajax Road, Madison Heights,
MI.
The Chevrolet Impala was assigned to the Oakland County Medical Examiner, and the two GMC Sierra 2500 utility
trucks were assigned to the Oakland County Water Resources Commission.
GPS coordinates are for the county offices located at 1200 N Telegraph Rd. Pontiac, MI. 48341
Is ffeetive mitigation feasiblecn this projee:
;! '!i For :cate:d -&:11 :0,1.E;',f•i•O.!) :iP
: 1 N
Scope d Wati-::
•
•.
PA-05-MI4195-PW-00057( j:
Statement of Work
Oakland County (subgrantee) repaired all three flood damaged vehicles -in the county fleet operations garage. Force account labor hours are outlined In individual mechanic log hours and can be found in the supporting documents
attached to this project. Parts and supplies are outlined in work orders submitted as an attachment to this project.
• Work Otder Number 0000015467 - 2007 Chevrolet Impala (Medical Examiner)
• Work Order N umber 0000015480 -2004 GMC Sierra UTI (Water Resource Commission)
. Work Order Number 0000015481 -2006 GMC Sierra UTI (Water Resource Commission)
Comments
Oakland County maintains liability insurance torahl vehicles owned by the county, but only insures physical damage
to vehicles valued at over 550,000. This practice Is outlined in the Oakland County insurance Practice E-Mail dated
11/3/2014 submitted as an attachment to this project. The practice and value of the damaged vehicles are also
supported by the insurance documentation end 2014 County Automobile Fleet Schedule that identifies vehicles
valued at more than 550,000.
Replacement parts used to repair the vehicles are individually noted on the Work Orders provided by the county
garage. Part costs were randomly surveyed and compared to similar parts available from NAPA Auto Parts to evaluate reasonableness, See Parts and Supplies Justification Spreadsheet attached to this project.
Benefits for farce account labor were provided by the applicant and are explained in the attached spreadsheet titled
Motor Pool Saiaries and Fringe Benefits.
No Direct Administrative Costs Claimed for SubGrantee
The Subgrantee chooses not to claim costs to manage and administer this project as part of the Public Assistance
Program's grant award. Declining such costs does not exempt the Subgrantee from maintaining records adequately
and documenting the source and application of funds as required in 44 CFR - 1122.
As described in 44 CFR 13.42 (2) (b),, 3(c), Sub-grantee must maintain all work-related records for a period of three
(3) years from Subgrantee closure (final payment), all records relative this project woncsheet are subject to
examination and audit by the State, FEMA and the Comptroller General of the United States and must reflect work
misted to disaster specific casts.
• Work Order Number 0000015467- 2007 Chevrolet Impala (Medical Examiner) is not recommended for funding, as
the vehicle was not damaged while doing disaster related work. FEMA 0AP9625.8, "Damage to applicant-owned
equipment performing emergency work. 2. Equipment must have been operated in severe or unusual
conditions. during emergency operation." FEMA 322, Public Assistance Guide, page 84, "When a piece of
applicant-owned equipment is performing eligible disaster work, extraordinary damage to the equipment that is
caused by the disaster may be eligible. FEMA 322, Page 31 'Damage cause by applicants actions, if unavoidable,
may rot necessarily be negligence, especially where the damage occurs during emergency response
efforts" Since, in this case the damage was hot as a result of emergency response efforts, the driver could have
time to find an alternate route, and avoided driving through the high water
: : Hazard MitigaticOproPOSal
f Is effective mitigation fe sible on this site? , , . No
If you answered 70*..ta the above Odiealicin;':ther,ekt gaisilonris,reUtrired
Will mitigation be performed on thissite? X
If yot;r**0-ted yee.ta"*obovklijiesti0:,41.e:heXt cLeittOrrI!-1*(i0;ted. • . . . . • Do you wish to attach a.Hazard Mitigation Proposal?..! No . :. . If yeid answered 7i.1es.-toitbe above questiort,'Ethe ne*ilwo questions Or.ft re.gi re
Please provide the Sedpe Of Wotk for the -estimate: . - ' - (maximure4055 cr./alders) ' . . .
Would you like to add:the Ha4ard'rlitigation ,
Proposal aS: a char lihe•item ;tope project doer? No
GIS Coordinates
S. Project Lacation .1: I.,atitticie ]::::;; • ; -!- Longitude 1200 N Telegraph Rd. 42.656 -83.327
, ., . .. ... ...... • . . _ 8peP;a1;Genaideratiens. -..
1. Dees the darnaged fecilitYbr item of work havelhsurahoe coverage afid/Or% it an Insurable dak,'*g.;;:huildiiiga, egpipmentv
e
h
r
O
l
e
,
s
,
e
t
c
)
?
Yes • ' '- ' • - - - • 2.. ts the damaged facility located Within .a floodpiain or coiastal highhazard -UreaahdicrdOraS it have an irriPhet on 'a ftoodplain or Wetlahd7,., .. No . . . . ... . . . . .. . . .
3; is the damaged facility or item of work leeatedwtthin or'adjacent.to ,a.:Coastat Barrier Resource:ystem Unit or an Otherwise Protected-Area7;• • ;'' No 4. Will the preposed facility repaimireconatruction 6hange,the pre4dise.ster conditions (e.gi,. faitprint, material; location; oaPacitY,:use of f
u
n
c
t
i
o
n
)
?
:
:
.
:
No 5. Does the applicant have a hazard mitigation -proposal or Wouid.the appilUarrt like -technical assistance fora -hazard mitigatioh•praposel? - i No 6. Is the damaged facility on the National Register' of Hiatorib -Placea Or the state historic listing? IS it eider than 50 years? Are thereimore.sirnilac . ; buildings hear the &ter.; ;;;,;:•; : :. ; r ; : ,-; . , :;-;;;':.,iI;;;.,:;;:;L:. : : i'::: :: ' :":: :;:; .; :: - - i, : -, .: " ' ; ; ' - , ' ? l ', ' :,:;::'',.::.;;;-;;•!: :::i -• ' ' ;• :. ; -.; •', ,_ No
7. Are there any pristine or undisturbed areas. an, or near, the project site? Are there large tecte of forest/and?
Na 8. Amthere ahly hazatticus.materiaia etar adjacent tO the damaged facility bitrikeitem of work?.
No 9. Are there any other enviromitental or Controversial ESSUeS aSacciateldWith the defeat* faCilitY and/or itet e i•:.tric7 No A,ttachmentS ;
_User. :Date'. l:'!:: ' :DoCufnerit:717:06::'.' DeSOtiPtro-
,..., , . _. .... ...„.. . !fotTo.::Pcipy;;File Refer9l1Pe.il. 'lroe Name. -:-•': .._ . . . • :,Actrom KATHLEEN BROWN 11-25-2014 Floodpiain Flood Map 6912502 equipment Map Flood.jpg(141.77 kb) View
If you answered Yes to the above question, the next question is required
Will mitigation be performed on any sites in this project? No
If you answered Yes to the above question, the next question is required
Do you wish to attach a Hazard Mitigation Proposal? No
If you answered Yes to the above question, the next two questions are required
Please provide the Scope of Work
for the estimate:
Would you like to add the Hazard Mitigation
Proposal as a cost line Item to the project cost? No .
Comments
Attachments
Cost Estimate
Is this Project Worksheet for
(Preferred) Repair
Sequence Code Material and/or Description Unit
Quantity
Unit of
Measure Lint Price Subgrant
Budget Class Type Cost Estimate Action
Version 0 ***
Work Completed
1 9007 Labor 1 LS $ 4,573.94 PERSONNEL Work Completed $ 4,573.94
2 9009 Material 1 LS $ 5,243.91 SUPPLIES Work Completed $ 5,243.91
Other
3 I 9999 Less ineligible Repairs-Determination Memo 1 I LS j_ $ -1,386.76 OTHER I Other $ -1,386.76
T,.,:al Ct5Si; S 0.43 i.ota
Insurance Adjustments (Deductibles, Proceeds and Settlements) - 5900/5901
Sequence Code Material and/or Description Unit
Quantity
Unit of
Measure Unit Price Subgrant
Budget Class Type Cost Estimate Action
Total Coat: $ 0.00
Total Cost Estimate: (nreforred Eramate Type 4- Insurance AdjuPteerits} $ 8,431.09
Comments
Attachments
User Date Document
Type Description Hard Copy File Reference , File Name Action
KATHLEEN
BROWN
11-26-
2014 Force Account Force 9912502 - Timesheets -04 equipment 04 GMC Truck Timesheets[1].pdf(2.90
Mb)
. View
KATHLEEN
BROWN
11-26-
2014 Force Account 9912502 - Time Sheets 06 9912502_equipment 06 GMC Truck Timesheets[11.pdf(6.31
MI) View
KATHLEEN
BROWN
11-26-
2014 Force Account 9912502 - Time Sheets - 07 9912502 equipment 07_Impala Timesheets[1].pdf(2.41 Mb) View
IAN
BECHERER
GERRIE
12-01-
2014
Additional
Information
9912502 equipment - Wages and
Benefits 9912502 equipment Wages and Benetits.pdf(141.73 kb) View
IAN
BECHERER
GERRIE
12-05-
2014
Additional
Information
9912502 equipment -Motor Fool
Salaries and Fringe Benefits
9912502 equipment - Motor Pool Salaries and Fringe
Benefits.xls(254.51 kb) View
IAN
BECHERER
GERRIE
12-05-
2014 Miscellaneous 9912502 equipment - Cost Summary
Report 9912502 equipment - Cost Summary Report.pd(7.31 kb) View
IAN
BECHERER
GERRIE
12-05-
2014
Additional
Information 9912502 equipment - Force Account 9912502 equipment - Force Account.pdf(29.60 kb) View
IAN
BECHERER
GERRIE
12-07-
2014
Additional
Information 9912502 equipment -Cost Summary 9912502 equipment - Cost Summary,pdf(7,31 kb) View
IAN
BECHERER
GERRIE
12-07-
2014
Additional
Information
9912502 equipment -Motor Pool
Salaries and Fringe Benefits
9912502 equipment - Motor Pool Salaries and Fringe
Benefits.xls(254.51 kb) View
JUDITH
CHASTAIN
12-31-
2014 Miscellaneous PW400057 Determination Memo —
PW400057 Determination
Memo PW00057_Determination Memo.pdf(365.29 kb) View
Existing Insurance Information
Insurance Type Policy No. Bldg/Property
Amount
Content .
Amount
Insurance
Amount
Deductible
Amount
Years
Required
Comments
Attachments .
• U. " Def.-
•
'Ooetiment . : -
''--;TYP -- DeScdplion Hiird:C* File . - - , -- - . ' Referegc0 -•:
:- - He Name
IAN BECHERER
GERRIE
11-10-
2014
Insurance
Document
9912502 equipment Insurance - Oakland
County Vehicle Policy
9912502 equipment Insurance - Oakland County Vehicle
Policy.PDF(1.78 Mb) ),/en.k.'
IAN BECHERER
GERRIE
11-10-
2014 miscell,aneous 9912542 equipment 2014 Master Automobile
Fleet Schedule
9912502 equipment 2014 Master Automobile Fleet
Schedule.xls(236,51 kb) View
IAN BECHERER
GERRIE
11-10-
2014 Miscellaneous 9912502 equipment Oakland County
Insurance Practice E-Mail
9912502 equipment Oakland County Insurance Practice
E-Mail,pdf(107.90 kb)
view
CORLISS
TOOTLE
12-18-
2014
Insurance
Document Repair Estimates Repair Estimate for Vehicles PW1 57 Oakland
County.msg(43.00 kb) View
- Comments and Attachments
:Name of Section Comment Attachment • —
Project Description 9912592 eauloment Man Location.iog
age Dam Facilities
9912502 eguiPment Photo Flooded Trucks.ipg
Countv).Odf
99 250 -.:.tif wm •..to of re....1rd true .JPG
9912502 equipment Truck interior.JPG
9912592 equipment Work Order 2004 Sierra•Pdf
9912502 equipment water heioht.JPG
9912502 equipment Medical Examiner Statement (Oakland
9912502 - Parts-Supplies justification spreadsheet.ndf
9912502 - Parts-Supplies justification spreadsheethrlf
9912502 e ul ment Work Order im.ale 1 a.
9912502 orpiment Work Order 2000 S erraf11.ndf
Special Considerations 9912502 equipment Map Flood-11aq
Cost Estimate
9912502 - .ui.nient 04- GM Truck 'flmesh-ets 1 .df
f 9912502 - .0 .ment $6 GM Truck Timeshoets 1
9912502 eguipmen1 07 impala Timesheets1-11.pdf
9912502 equipment Wages and Benefits.pdf
9912542 eguipment - Motor Pool Salaries and Fringe Benetits.xis
9-12 02 -. 'orient S mma "e... ..
9912502 Regiment - Force Account.ortf
9912502 emiernent - Cost Summary odf
99125C12 eauiPment - Motor Pod Salaries and Fringe Beneflts.xls
pW00057 Determination Merno.pdf
insurance Information
9912502 eaciipment Insurance - Oakland County Vehicle Policy.POF
9912 02 e. i.ment 2014 Master Aut.mobile Fleet Sch-...ule.xls
9912502 equiPment Oakland County Insurance Practice E-Maii.Pdf
Repair Estimate for Vehicles PW457 Oakland County.resq
Form 90-91 9912502 equipment - Signed 90-91.pdf
9912502 equipment - Exit Brief.pdf
Bundle Reference # (Amendment'#) • . Date Awarded • ' PA-05-M1-4195-State-0011(10) 01 -1442015
Subgrant Application - FEW Form 90-91
Note: The Effective Cost Share for this application is 75%
FEDERAL EMERGENCY MANAGEMENT AGENCY
PROJECT WORKSHEET
DISASTER PROJECT NO.
9912502
PA ID NO.
125-65125-00 DATE
11-10-2014 CATEGORY
E MIA 14195 I" IDR I -MI
APPLICANT: OAKLAND (COUNTY) WORK COMPLETE AS OF:
09-12-2514:150%
Site 1 of 1
DAMAGED RACILITY:
Equipment (vehicles) COUNTY: Oakland
LOCATION:
PA-06-MI-4196-PW-00057(0):
1200 N Telegraph Rd, Pontiac, Mi
LATRUDE:
41656
LONGITUDE
-83,327
DAMAGE DESCRIPTION AND DIMENSIONS:
PA-05-MI-4195.PW-00057(0):
Incident perlod, August 1L2014, through August 13, 2014, As a direct result of severe storms and Sanding, three vehicles owned by Oakland County suffered damage.
•2007 Chevrolet Impala (VIN: 2GIWB56K579280725), flooded when the driver was required to return to his office during tho storm after responding to a suldde in Hazel Park Ml. The vehicle stalled in 16 inches of water near the intersection of Lennox Street and Mapledale Avenue In Ferndale, Mi. Damages to the vahlde were the result of subsequent flooding, 'The 2504 GM Sierra 2500 UTI (VIM ICDHK24004E207764), flooded to the reellthe {approximately 66) in Is assigned parking place inside of the George W. Kuhn Retengen Treatment Basin plant at 1400 Ajax Road, Madison Heights, Nit.
-The 2006 GMC Sierra 2500 Xi (190FIK24U86E244469). Seeded to the manna (approximately aft) In its assigned parking plant iriside or the George W. Kuhn Retention Treatment Basin pksnt at 1400 Ajax Read, Madison Heights, Mi.
The Chevrolet Lopata was aeeigned to the Oakland Camay Medical EXarelner, and the true WC Sierra 2550 utrrty trucks were assigeed to the Oakland County Water Resources Commission,
GPS coordinates are for the ieounty offices located at 1200 N Telegraph Rd. POTIUM, ML 48341
SCOPE OF WORK.
PA-05-MI-4195-PW-00057(0):
,
LIMIT PRICE COST
$ 4,573.94 $ 4,573.94
$ 5,243.91 $ 5,243.91
$ -1,386.76 $ -1,385.76
TOTAL COST $ 8,431.09
SIGNATURE
SIGNATURE
PREPARED BY IAN S BECHERER GERRIE TITLE PROJECT SEPECIALlST
APPLICANT REP. ART HOLDSINCRTH TITLE DIRECTOR OF FACILITIES MANAGEMENT
Hazard kiligetion proposal included? Yes fffl No is there Insurance coverage on this facility? Yes No
PROJECT COST
ITEM I CODE
9007
9009
9999
NARRATIVE
•" Version 0
Work Completed
Labor
Material
Other
Less ineligible Repairs-Determination Memo
QUANTITY/UNIT
1/LS
1,11.5
1/LS 3
Statement of Work
OaHand County (subgrantee) repaired all three -Rood damaged vehicles In the county fleet operations garage. Force account labor hours are outlined in individual mechanic log hours and can be found in the supporting documents attached to this project. Parts and supplies we outlined In work orders submitted an an attachment to this project.
• Work Order Number 0000015467 - 2007 Chevrolet Impala (Medical Examiner)
- Work Order Numbar0000015460 -2004 GMC Sierra UTI (Water Resource Commission)
• Work Order Number 0000015481 - 2006 GMC Sierra OTT (Water Resource Commission)
Comments
Oakland County maintains liability insurance for all vehicles owned by the county, but only insures physical damage to vehicles valued at over $50,000, This practice is outlined in the Oakland County Insurance Practice Ea
Mail dated 11)512014 submitted as an attachment to this project, The practice and value at the damaged vehicles are also supported by the insurance documentation and 2014 County Automobile Reel Schedule that
identifies vehicles valued at more than $50,000,
Replacement parts used to repair the vehicles are indkidually noted on the Work Orders presided byline county garage. Part costs were randomly surveyed and compared to similar parts availabte from NAPA Auto Parts
to evaluate reasonableness. See Parts and Supplies Justification Spreadsheet attached to this proect,
Benefits for force account labor were provided by the opplicant and are explained in the attached spreadsheet titled Motor Pool Salaries unit Fringe Benefits.
No Direct Administrative Costs Claimed for SubGrantee
The Subgrantee cheeses sells claim costs to manage and administer this project as part of the Public Assistance Program's grant award. Declining such costs does not exempt the Subgrantee from maintaining records
adequately mid documenting the source and application of funds as 'stirred in 44 CFR - 1122.
As described in 44 CPA 13,42 (2) (6), 3(c), Sub-grantee must rnaintath all work-related records for a periled of three (S) years from Subgranthe closure (final payment), all records relative this project worksheet are subject to examination and audit by the State, FEMA and the Comptroller General of the United States and must reflect work related to disaster specific costs.
• Work order Number 0006015467 - 7007 Chevrolet Impala (Medical Examiner) is not recommended for funding, es the vehicle was net damaged while doing disaster related work_ FEMA DARg625,6. "Carnage to
applicant-owned equipment perforating emergency work 2. Equipment must have been operated in severe or unusual conditions...during emergency operation." FEMA 322, Public Assistance Guide, page 64, 'When a
piece of applicant.ewned equipment is performing eligible disaster work, extraordinary damage to the equipment that Is caused by the disaster may be ettyiblV. FEMA 322, Page 31 "Damage cause by applicants actions,
if unavoldab, may net necessarily he negligence, especially where the damage occurs during emergency response offarte—Since, in this case the damage was not as a result of emergency response efforts, the driver could have time to Ind an alternate route, and avoided driving through the high water.
Does the Scope of Work change the pre-disaster conditions at the Site?
Yes Pt No Special Considerations incbded? if. Yes No
OAKLAND ..(COLINTYI: PA-05-MI-4196-PW-00057 .
. Conditions Information ; ' .
Review Name Condition Type Condition Name Description Monitored Status '-
Final Review Other (5HP) Standard
Condition #1
Any change to the approved scope of work will require re-evaluation for compliance with NEPA
and other Laws and Executive Orders. No Approved
Final Review Other (EHR) Standard
Condition #3
If ground disturbing activities occur during construction, applicant will monitor ground disturbance
and if any potential archeological resources are discovered, will immediately cease construction
in that area and notify the State and FEMA.
No Approved
Final Review Other (EIHP) Standard
Condition #2
This review does not address all federal, state and local requirements. Acceptance of federal
funding requires recipient to comply with all federal, state and local laws. Failure to obtain all
appropriate federal, state and local environmental permits and clearances may leopardize federal
funding.
No Approved
EHP Review Other (EHP) Standard
Condition #8
If ground disturbing activities occur during construction, applicant will monitor ground disturbance
and if any potential archeological resources are discovered, will immediately cease construction
in that area and notify the State and FEMA. No Recommended
EHP Review 0th er (EHF) Standard
Condition #2
This review does not address all federal, state and local requirements. Acceptance of federal
funding requires recipient to comply with all federal, state and local laws. Failure to obtain all
appropriate federal, state and local environmental permits and clearances may jeopardize federal
funding.
No Recommended
EHP Review Other (EHP) Standard.
Condition #itl
Any change to the approved scope of work will require re-evaluation for compliance with NEPA and other Laws and Executive Orders. No Recommended
Insurance
Review
Conditions
(Grant Specific)
Insurance
Requirement
12/18/2014 The Applicant asserts that during the incident period, August 11, 2014, through
August 15, 2014. As a direct result of severe storms and flooding, three vehicles owned by
Oakland County suffered damage. Vehicles for Oakland County are only insured for physical
damage if the vehicle is valued for more than $50K (see attached email). The following vehicles
were not covered by insurance therefore there are no insurance proceeds to be deducted and it is recommended that FEMA fund these repairs: 1. 2007 Chevrolet Impala (Medical Examiner)
$14482. 2004 GMC Sierra UTI (Water Resource Commission) $3,550 3. 2006 GMC Sierra UTI
(Water Resource Commission) $4820 The requirement to purchase insurance is waived when the
eligible scope of work costs do not exceed $5,000.00, should the repair coats exceed $5,000.00, the applicant will be required to submit documentation as to the proof of insurance purchase to
the recovery coordination office. This is in accordance with 44 c,f,r, section 206.252 and
206.253. Corliss Tootle PA Ins, Specialist
No Recommended
Internal. Comments !
No • ...,:..1.ueue . . ; User Date/Time ' Reviewr Comment
14 Find Review CHASTAiN JUDITH 01-13-2015 05:44 PM GMT
On HOLD - Pending Deterrnintation memo for vehicle not
damaged as a result of flood related work. Jchastain
12/31/2014
Page 31 of the Public Assistance Guide references negligence
13 Gramm Review BRIGGS BRIANNA 01-13.2015 04:12 PM GMT
and the possibility for the applicant to reasonably avoid the
damage to the Medical Examiner's vehicle (2007 Chevrolet
Impala), B Briggs
The acceptance of federal funding requires recipient to comply
with all federal, state and local laws. Failure to obtain all
appropriate federal, state and local environmental permits and
clearances may jeopardize federal funding.
In addition, applicant must maintain all grant-related records for
a period of three (3) years following receipt of your grant
closeout packet. All records relative to the grant are subject to
examination and audit by the State and FEMA.
The applicant must comply with relevant local, state and federal
procurement laws and regulations. Federal rules are found in the
44 Code of Federal Regulations (CFR) 13.36 for State and Local
Governments or 2 CFR Part 215 for Institutions of Higher
Education, Hospitals and Non-Profit Organizations.
12 Grantee Review BRIGGS BRIAN NA 01-13-2015 04:02 PM GMT
B. Briggs first review, J. Eickholt second review.
The acceptance of federal funding requires recipient to comply
with all federal, state and local laws. Failure to obtain all
appropriate federal, state and local environmental permits and
clearances may jeopardize federal funding.
In addition, applicant must rneintain all grant-related records for
a period of three (3) years following receipt of your grant
closeout packet All records relative to the grant are subject to
examination and audit by the State and FEMA.
The applicant must comply with relevant local, state and federal
procurement laws and regulations. Federal rules are found in the
44 Code of Federal Regulations (C FR) 13,36 for State and Local
Governments or 2 CFR Part 215 for Instftetions of Higher
Education, Hospitals and Non-Profit Organizations.
11 Grantee Review PEPPER JOEL. 01-13-2015 02:22 PM GMT
B. Briggs first review, J. Eickhoft second review.
The acceptance of federal funding requires recipient to comply
With all federal, state and local laws. Failure to obtain all
appropriate federal, state and local environmental permits and
clearances may jeopardize federal funding.
In addition, applicant must maintain all grant-related records for
a period of three (3) years following receipt of your grant
closeout packet. All records relative to the grant are subject to
examination and audit by the State and FEMA.
The applicant must comply with relevant local, state and federal
procurement laws and regulations. Federal rules are found in the
44 Code of Federal Regulations (CFR) 13,36 for State and Local
Governments cr 2 CFR Part 215 for Institutions of Higher
Education, Hospitals and Non-Profit Organizations.
10 Grantee Reyiew PEPPER JOEL 01-13-2015 02:21 PM GMT
-
E. Briggs first review, J. Eickholt second review.
The acceptance of federal funding requires recipient to comply
with all federal, state and local laws. Failure to obtain all
appropriate federal, state and local environmental permits end
clearances may jeopardize federal funding.
In addition, applicant must maintain all grant-related records for
a period of three (3) years following receipt of your grant
closeout packet. All records relative to the grant are subject to
examination and audit by the State and rom. The applicant must cc:reply with relevant local, state and federal
procurement laws and regulations. Federal rules are found in the
44 Code of Federal Regulations (CFR) 13.36 for State and Local
Governments or 2 CFR Fart 215 for Institutions of Higher
Education, Hospitals and Non-Profit Organizations.
9 Final Review CHASTAIN JUDITH 01-05-2015 07:44 PM GMT Determintation memo for vehicle not damaged as a result of flood related work. Johestain 12/31/2014
8 Final Review CHASTAIN JUDITH 01-05-2015 07:42 PM GMT
On HOLD - Pending Determintation memo for vehicle not
damaged as a result of flood related work. Jchastaln
12131/2014
7 Final Review CHASTAIN JUDITH 12-31-2014 05:06 PM GMT
On HOLD - Pending Determintation memo for vehicle not
damaged as a result of flood related work. Jehastain
12/31/2014
6 Final Review CHASTAIN JUDITH 12-31-201404:62 PM GMT
On HOLD - Pending Deterrnintatian memo for vehicle not
damaged as a result of flood related work. Jchastain
12/31/2014
5 Final Review CHASTAIN JUDITH 12-31-2014 02:28 PM GMT
On HOLD - Fending Detemnintation memo for vehicle not
damaged as a result of flood related work. Jchastain
12131/2014
4 Grantee Review EICKHOLT JAY 12-22-2014 09:17 PM GMT
B. Briggs first review, J. Eickholt second review.
The acceptance of federal funding requires recipient to comply with all federal, state and local laws. Failure to obtain all
appropriate federal, state and local environmental permits and clearances may jeopardize federal funding,
in addition, applicant must maintain all great-related records for
ari three ) years following receipt of your grant peod of (3
clesecut packet All records relative to the grant are subject to
examination and audit by the State and FEMA.
The applicant must comply with relevant local, state arid federal
procurement laws and regulations. Federal rules are found in the
44 Code of Federal Regulations (CFR) 13.36 for State and Local
Governments or 2 CFR Part 215 for Institutions of Higher
Education, Hospitals and Non-Profit Organizations,
.
Oakland County. As a direct result of severe stoats end
flooding, three vehicles owned by Oakland County suffered
damage. This project is for the repair of these damaged
vehIcles.1200 N Telegraph Rd. 42.656 / -83.327.
Based on Information provided by the applicant, the scope of
3 EHP Review LAMBDIN III WILLIAM 12-18-2014 05:52 PM GMT
work for this project qualifies as a statutory exclusion (STATEX)
under 44 CFR Part 10. Any change to the approved scope of
work will require resubmission for reevaluation for compliance with the National Environmental Policy Act. Non-compliance
with this requirement may jeopardize the receipt of federal
funding. The applicant is required to obtain and comply with all
/coal state and federal permits.
- wlambdin - 12/18/2014 17:37:14 GMT
The project is for vehicle repair and does not affect floodplain
values. - wlambdin - 12/18/2014 17:33;37 GMT
Scope-of-work (vehicle repair) does not have the potential to
affect histonc properties, - wlarnbdin - 12/18/201417:26:37 GMT
2 Insurance Review TOOTLE CORLISS 12-18-201424:09 PM GMT
12/18/2014 The Applicant asserts that during the incident
period, August 11, 2014, through August 13, 2014. As a direct
result of severe storms and flooding, three vehicles owned by
Oakland County suffered damage. Vehicles for Oakland County
are only insured for physical damage if the vehicle is valued for
more than $50K (see attached email). The following vehicles
were not covered by insurance therefore there are no insurance
proceeds to be deducted and it is recommended that FEMA fund
these repairs:
1. 2007 Chevrolet Impala (Medical Examiner) $1446
2. 2004 GMC Sierra UTI (Water Resource Commission)
$3,560
a 2006 GMC Sierra UTI (Water Resource Commission)
$4820
The requirement to purchase insurance is waived when the
eligible scope of work costs do not exceed $2,000.00, should
the repair costs exceed $5,000.00, the applicant will be required
to submit documentation as to the proof of insurance purchase
to the recovery coordination office. This is in accordance with
44 c.f.r. section 206.262 and 206.253. Cadiss Tootle PA Ins.
Specialist
1 Mitigation ROS/j2 WORKMAN JAMES 12-16-2014 04:27 PM GMT
This project he been reviewed for mitigation opportunities and
there were no 406 mitigation opportunities identified at for
repairs. J. WORKMAN 12/16/14
Capture Date: 01/31/2 01 5 15:59 — •-•
Federal Emergency Management Agency.
Project Application Grant Report (P.2)
Disaster: FELLA-4195-0114J
Number of Records: 1
Applicant ID: 125-99 1 25-00 Bundle*: PA-054.1-4195-State-0011(10) , • Applicant; OAKLAND (COUNTY) PW * I Cat Cost Shire Projected Completion Date ' I Approved PW Amount (S)
E N 03-25-2016
I Equipment (vehicles)
1200 N Telegraph Rd, Pontiac, Ml
Statement of Work
Oakland County (subgrantee) repaired all three Rood damaged vehicles in the county fleet operations garage. Force account labor hours are outlined in individual
mechanic log hours and can be found in the supporting documents attached to this project. Parts and supplies are outlined in work orders submitted as an
attachment to this project.
• Work Order Number 000001 5467 - 2007 Chevrolet Impala (Medical Examiner)
• Work Order Number 0000015480- 2004 GMC Siena UTI (Water Resource Commission)
• Work Order Number 0000015481 -2006 GMC Sierra UTI (Water Resource Commission)
Comments
Oakland County maintains liability insurance fora vehicles owned by the county, but only insures physical damage to vehicles valued at over 550.000. This practice
is outlined in the Oakland County Insurance Practice E-Mall dated 11/3/2014 submitted as an attachment to this project The practice and value of the damaged
vehicles are also supported by the insurance documentation and 2014 County Automohile Fleet Schedule that identifies vehicles valued at more than 550,000.
Replacement parts used to repair the vehicles are individually noted on the Work Orders provided by the county garage. Part costs were randomly surveyed and
compared to similar parts available from NAPA Auto Pans to evaluate reasonableness. See Parts and Supplies Justification Spreadsheet attached to this project
Benefits for force account labor were provided by the applicant and are explained in the attached spreadsheet titled Motor Peal Salaries and Fringe Benefits.
No Direct Administrative Costs Claimed for SubGrantee
1Scope of Wade
The Subgrantee chooses not to claim costs to manage and administer this project as part of the Public Assistance Program's grant award. Declining such costs does
not exempt the Subgrantee from maintaining records adequately and documenting the source and application of funds as required in -44 CFR -13.22.
As described in 44 CFR 13A2 (2) (b), 3(c), Sub-grantee must maintain all workrrelated records for a period of three 13) years from Subgrantee closure (final
payment), all records relative this project worksheet are subject to examination and audit by the State, FEMA and the Comptroller General of the United States and
must reflect wadi related to disaster specific costs.
• Work Order Number 0000015467- 2007 Chevrolet Impala (Medical Examiner) is not recommended for funding, as the vehicle was not damaged while doing disaster
related work. FEMA DAP9525.8, "Damage to applicant-owned equipment performing emergency work. 2. Equipment must have been operated in severe or unusual
canditians—during emergency operation." FEMA 322, Public Assistance Guide, page 84, When a piece of applicant-owned equipment is perforrning eligible disaster
work, extraordinary damage lathe equipment that is caused by the disaster may he eligible". FEMA 322, Page 31 "Damage cause by applicants actions, if
unavoidable, may not necessarily be negligence, especially where the damage occurs during emergency response efforts".....Since, in this case the damage was not
as a resutt of emergency response efforts, the driver could have time to find an alternate route, and avoided driving through the high water.
PW ($1 Subgranteepdmin Exp. (S) ; ; ['Total ($)
Amount Eligible (5) 8,431.09 0.001 8,431.091
Federal Share ($) 6 323 32 6,323.32,
PA-05-14-41954W-00057(0)
Facility Number: '
Facility Name:
Location:
8,431.09
Page 1 of 2
Generated Date: 01/31/2015 17:25
Federal Emergency Management Agency
Project Completion and Certification Report (P.4)
Disaster: FErv1A--4195-DR-M1
Applicant F1FS ID: 125-99125-00 Applicant/Subdivision Name: OAKLAND (COUNTY)
Approved nt App Projected pwo Amendme Cost Cat Work co. .L'orp_a
Share — 11:No.ely3 at Amount Amt.
Bundle
Date
Actual Date Amt Claimed by
Completed Applicant Comments
PA-05-
MI-
4195- 0 18,431.09 N
PW-
00057
Total for 1 PWs: $8,431.09
Subgrantee Admin: 50.00
Grand Total: $8,431.09
FA-0S-
M1-1195-
State-0011
(10)
03-25-
2016 100 98,431.09
COPY
https://isource.fema.gov/emmie/common/view/p4Report.j sp ?printRtn=print& appi ds 125.. 1/31/2015
Page 2 of 2
Generated Date: 01/31/2015 17:25
Federal Emergency Management Agency
Project Completion and Certification Report (PA)
Disaster: FEVIA-4195-DR-MI Applicant PIPS ID; 125-99125-00 Applicant/Subdivision Name: OAKLAND (COUNTY)
Certification
Icertify that all funds were expended in accordance with the provisions of the I hereby certify that to the best of my kaowledgeand belief all work and costs claimed are eligible
signed FEMA-State Agreement and I recommend an approved amount of in accordance with the grant conditioirilTork cIelintreq has been completed, and all costs
claimed hat been paid in full.
Signed: tn )4.-^-1Zne: " k
Applicant's Authorized Representative
Govemor's Authorized Representative .
Signed: Date:
https://isource.fema.gov/enumie/common/view/p4Report.j sp?printB-ba=print&app jds=125... 1/31/2015
FISCAL NOTE (MISC . #15124) May 6, 2015
BY: Finance Committee, Tom Middleton, Chairperson
IN RE: HEALTH AND HUMAN SERVICES - HOMELAND SECURITY DIVISION — STATE OF MICHIGAN
PUBLIC ASSISTANCE GRANT AGREEMENT - OAKLAND COUNTY VEHICLE - ACCEPTANCE
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. Pursuant to the President of the United States declaring a disaster for Macomb, Oakland and
Wayne Counties as a result of damage from severe storms and flooding during the period of
August 11-13, 2014, a Project Application Grant Report was submitted and Oakland County has
been notified by the Michigan Department of State Police, Emergency Management and
Homeland Security Division that $6,323 of funding is eligible for costs related to damaged
vehicles.
2. The purpose of this agreement is to provide supplementary financial assistance for disaster relief
including funds for emergency and permanent work.
3. Funding received from the grant award has been used to repair and restore three County
vehicles.
4. This grant requires a 25% match of $2,108 in Motor Pool Fund expenses, bringing the total
program costs to $8,431.
5. The FY 2015 Budget is amended as follows to reflect the grant award:
MOTOR POOL FUND (#66100) FY 2015
Revenues
1030811-184010-650106 Contributions-Federal Grants $ 6,323
1030811-184010-665882 Planned Use of Balance ($ 6,323)
Total Revenues $ 0
FINANCE COMMITTEE VOTE:
Motion carried unanimously on a roll call vote.
/.)
Resolution #15124 May 6, 2015
Moved by Fleming supported by McGillivray the resolutions (with fiscal notes attached) on the amended
Consent Agenda be adopted (with accompanying reports being accepted).
AYES: Fleming, Gershenson, Gingell, Gosselin, Hoffman, Jackson, KowaII, Long, Matis,
McGillivray, Middleton, Scott, Spisz, Taub, Weipert, Woodward, Zack, Bowman, Crawford. (19)
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).
11 HEREBY APPROVE THIg RESOLUTION
CHIEF DEPUTY COUNTY EXECUTIVE
ACTING PURSUANT TO MCL 45,559A (7)
STATE OF MICHIGAN)
COUNTY OF OAKLAND)
I, Lisa Brown, 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 May 6, 2015,
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 6th day of May 2015.
Lisa Brown, Oakland County