HomeMy WebLinkAboutResolutions - 2016.07.20 - 22433MISCELLANEOUS RESOLUTION #16167 July 20, 2016
BY: General Government Committee, Christine Long, Chairperson
IN RE: HEALTH AND HUMAN SERVICES - HOMELAND SECURITY DIVISION — EMERGENCY
MANAGEMENT PERFORMANCE GRANT AGREEMENT FOR FISCAL YEAR 2016 ACCEPTANCE
To the Oakland County Board of Commissioners
Chairperson, Ladies and Gentlemen:
WHEREAS the State of Michigan Department of State Police, Emergency Management and Homeland
Security Division has awarded Oakland County the 2016 Emergency Management Performance Grant
(EMPG) funding in the amount of $52,557 for the period of October 1,2015 through September 30,2016;
and
WHEREAS the Homeland Security Division was notified of available grant funding via a letter dated June
20, 2016; and
WHEREAS this is the 44 th year of grant acceptance for this program; and
WHEREAS the purpose of the program is to encourage the development and comprehensive disaster
preparedness and assistance plans, programs, capabilities, and organizations by the states and local
governments; and
WHEREAS this grant is pass-through of Federal funds and represents a reimbursement for a portion of
salaries with a required 50% match in the amount of $52,557; and
WHEREAS the FY2016 award is an increase of $213.00 from the FY2015 award; and
WHEREAS the grant agreement has completed the Grant Review Process according to the Board of
Commissioners Grant Procedures.
NOW THEREFORE BE IT RESOLVED that the Oakland County Board of Commissioners accepts grant
funding from the State of Michigan Department of State Police, Emergency Management and Homeland
Security Division for the 2016 Emergency Management Performance Grant (EMPG) in the amount of
$52,557 with a 50% match from the County in the amount of $52,557 for total funding of $105,114 for the
period of October 1, 2015 through September 30, 2016.
BE IT FURTHER RESOLVED that the Chairperson of the Oakland County Board of Commissioners is
authorized to execute the grant agreement and to approve any grant extensions or changes, within fifteen
percent (15%) of the original award, which are consistent with the original agreement as approved.
BE IT FURTHER RESOLVED that acceptance of this grant does not obligate the County to any future
commitment including continuation of any special revenue positions if/when the grant expires.
Chairperson, on behalf of the General Government Committee, I move the adoption of the foregoing
resolution.
GENERAL GOVERNMENT COMMITTEE
GENERAL GOVERNMENT COMMITTEE
Motion carried unanimously on a roll call vote with Woodward and Quarles absent.
GRANT REVIEW SIGN OFF Homeland Security Division
GRANT NAME: 2016 Emergency Management Performance Grant (EMPG)
FUNDING AGENCY: Michigan Department of State Police, Emergency Management and Homeland
Security Division
DEPARTMENT CONTACT PERSON: Sara Stoddard 248 858-5080
STATUS: Grant Acceptance
DATE: June 27, 2016
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 placed 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 (6/24/2016)
Department of Human Resources:
HR Approved (No Committee) Continues partial funding of position— Lori Taylor (6/27/2016)
Risk Management and Safety:
Approved by Risk Management. — Robert Erletheck (6/27/2016)
Corporation Counsel:
I did not find any legal concerns with this Agreement and I approve this Agreement. — Robert C. Rottach
(6/27/2016)
From:
To:
Cc:
Subject:
Date:
Attachments:
Bottach. Robert C
West. Catherine A
Van Pelt. Laurie NI; Taylor. Lori; Schultz. Den J; Quisenberry, Theodore Fl; Stoddard, Sara D; Pisacreta. Antonio
S; ScaIf. Bonnie L
RE: GRAINIT REVIEW: Health & Human Services, Homeland Security Division - 2016 Emergency Management
Performance Grant (EMPG) Agreement - EMC-2016-EP-00001-501
Monday, June 27, 2016 1:20:58 PM
Jmage001.ono
Katie,
did not find any legal concerns with this Agreement and I approve this Agreement. I just started
with the Department of Corporation Counsel and I will work with you in the future.
Thank you,
Robert C. Rottach
Assistant Corporation Counsel
Oakland County, MI
(248) 858-0550
From: West, Catherine A
Sent: Monday, June 27, 2016 10:42 AM
To: Quisenberry, Theodore H; Stoddard, Sara D; Erlenbeck, Robert C; Schultz, Dean J; Rottach, Robert
C; Cullen, Sharon L
Subject: RE: GRANT REVIEW: Health fk Human Services, Homeland Security Division - 2016 Emergency
Management Performance Grant (EM PG) Agreement
Thank you, Ted.
Bob — Please see the attached Agreement Articles Applicable to Sub recipients Fiscal Year 2016
Emergency Management Performance Grants including page #2. Thanks for catching that.
I will include this as part of the complete document with the grant sign off.
Thanks,
Katie West
Oakland County Fiscal Services
Phone (248) 858-2384
Fax (248) 858-9724
westcaPoakgov.corn
Hours: Mon. —Thur. 7:00am — 5:30pm
From: Quisenberry, Theodore H
Sent: Monday, June 27, 2016 10:33 AM
From:
To:
Cc:
Subject:
Date:
Van Pelt. Laurie ri
West, Catherine A; Taylor. Lori; DavIs. Patrirkf-i; Schultz, Dean
Ouisenberrv. Theodotejt Stoddard. Sara D; pisacreta, Antonio S; 5cal{, Bonnie I
RE: GRANT REVIEW: Health &Human Services, Homeland Security Division - 2016 Emergency Management
Performance Grant (EMPG) Agreement
Friday, June 24, 2016 2:46:31 PM
Approved.
From: West, Catherine A
Sent: Friday, June 24, 2016 2:24 PM
To: Van Pelt, Laurie M; Taylor, Lori; Davis, Patricia G; Schultz, Dean J
Cc: Quisenberry, Theodore H; Stoddard, Sara D; Pisacreta, Antonio S; Scalf, Bonnie L
Subject: GRANT REVIEW: Health & Human Services, Homeland Security Division - 2016 Emergency
Management Performance Grant (EMPG) Agreement
GRANT REVIEW FORM
TO: REVIEW DEPARTMENTS — Laurie Van Pelt — Lori Taylor— Dean Schultz — Pat Davis
RE: GRANT CONTRACT REVIEW RESPONSE — Health & Human Services, Homeland Security
Division
2016 Emergency Management Performance Grant (EMPG) Agreement
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: June 29, 2016
GRANT INFORMATION
Date: June 24, 2016
Operating Department: Homeland Security Division
Department Contact: Sara Stoddard
Contact Phone: 8-5080
Document Identification Number: EMC-2016-EP-00001-S01
REVIEW STATUS: Acceptance Resolution Required
Funding Period: 10/1/2015 through 9/30/2016
Original source of funding: FEMA, CFDA #97.042
Will you issue a sub award (make payments to outside agencies) or contract (through
From:
To:
Cc:
Subject;
Date:
Taylor. Lor(
West, Catherine A; Van Pelt, Laurie 14; Davis. Patricia G; Schultz. Dean
Ouisenberrv, Theodore Ll; 5torldard, Sara D; Pisacreta, Antonio S; Suff, Bonnie
RE: GRANT REVIEW: Health & Human Services, Homeland Security Division - 2016 Emergency Management
Performance Grant (EMPG) Agreement
Monday, June 27, 2016 10:41:48 AM
HR Approved (No Committee) Continues partial funding of position
From: West, Catherine A
Sent: Friday, June 24, 2016 2:24 PM
To: Van Pelt, Laurie M; Taylor, Lori; Davis, Patricia G; Schultz, Dean J
Cc: Quisenberry, Theodore H; Stoddard, Sara D; Pisacreta, Antonio S; Scarf, Bonnie L
Subject: GRANT REVIEW: Health & Human Services, Homeland Security Division - 2016 Emergency
Management Performance Grant (EMPG) Agreement
GRANT REVIEW FORM
TO: REVIEW DEPARTMENTS — Laurie Van Pelt— Lori Taylor Dean Schultz — Pat Davis
RE: GRANT CONTRACT REVIEW RESPONSE — Health & Human Services, Homeland Security
Division
2016 Emergency Management Performance Grant (EMPG) Agreement
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: June 29, 2016
GRANT INFORMATION
Date: June 24, 2016
Operating Department: Homeland Security Division
Department Contact: Sara Stoddard
Contact Phone: 8-5080
Document Identification Number: EMC-2016-EP-00001-501
REVIEW STATUS: Acceptance — Resolution Required
Funding Period: 10/1/2015 through 9/30/2016
Original source of funding: FEMA, CFDA1497.042
Will you issue a sub award (make payments to outside agencies) or contract (through
From:
To:
Cc:
Subject:
Date:
Erlenbec • Robert C
West, Catherine it; Van Pelt Laurie M; Taylor. Lori; Davis. PatdciaSi; Schultz, Dean J
Oulsenberry, Theodore It atidarsilara.12; Pisacreta, Antonio_S; Scalf, Bonnie
RE: GRANT REVIEW: Health & Human Services, Homeland Security Division - 2016 Emergency Management
Performance Grant (EMPG) Agreement
Monday, June 27, 2016 10:58:26 AM
Approved by Risk Management. R.E. 6/27/16.
From: Easterling, Theresa
Sent: Friday, June 24, 2016 4:39 PM
To: West, Catherine A; Van Pelt, Laurie M; Taylor, Lori; Davis, Patricia G; Schultz, Dean J
Cc: Quisenberry, Theodore Stoddard, Sara D; Pisacreta, Antonio S; Scalf, Bonnie L
Subject: RE: GRANT REVIEW: Health & Human Services, Homeland Security Division - 2016 Emergency
Management Performance Grant (EMPG) Agreement
Please be advised that your request for Risk Management's assistance has been assigned
to Bob Erlenbeck, (ext. 8-1694). If you have not done so already, please forward all related
information, documentation, and correspondence. Also, please include Risk Management's
assignment number, RM16-0343, regarding this matter.
Thank you.
From: West, Catherine A
Sent: Friday, June 24, 2016 2:24 PM
To: Van Pelt, Laurie M; Taylor, Lori; Davis, Patricia G; Schultz, Dean J
Cc: Quisenberry, Theodore H; Stoddard, Sara D; Pisacreta, Antonio S; Scalf, Bonnie L
Subject: GRANT REVIEW: Health & Human Services, Homeland Security Division - 2016 Emergency
Management Performance Grant (EMPG) Agreement
GRANT REVIEW FORM
TO: REVIEW DEPARTMENTS — Laurie Van Pelt — Lori Taylor— Dean Schultz — Pat Davis
RE: GRANT CONTRACT REVIEW RESPONSE Health & Human Services, Homeland Security
Division
2016 Emergency Management Performance Grant (EMPG) Agreement
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: June 29, 2016
RiCK SNYDER
GOVERNOR
STATE OF MICHIGAN
DEPARTMENT OF STATE POLICE
LANSING
COL. KR1STE KBBEY ETUE
DIRECTOR
June 20, 2016
LI
Enclosed is the Fiscal Year 2016 Emergency Management Performance Grants (EMPG) Grant'AgreeIMent
package, Please return the required grant documentation listed on the enclosed Subrecipientpheciclist to our office at the following address:
Attn: Ms. Mary K. Mankowski
Emergency Management and Homeland Security Division
Michigan Department of State Police
PO Box 30634
Lansing, Michigan 48909
Reimbursement for the EMPG program is contingent upon completion of the activities in the signed
Emergency Management Annual Work Agreement, In order to remain eligible for EMPG funding, current
and adequate plans must be maintained and exercise requirements must be met. If a work activity is not
completed in the designated quarter, reimbursement may not be made until the work is completed. The
Emergency Management and Homeland Security Division District Coordinators may make
recommendations on reimbursement, but final approval remains with the Deputy State Director of
Emergency Management and Homeland Security, who may or may not approve a delay in the completion
of the activity. If work activities (for which funds have been withheld) have not been completed by the end
of the fiscal year, forfeiture of those funds may be required. As a recipient of funding from the U.S,
Department of Homeland Security, you are responsible for the management and fiscal control of all funds.
These responsibilities include accounting for receipts and expenditures, maintaining adequate financial
records, and refunding expenditures disallowed by federal or state audit. For specific responsibilities and
requirements, please refer to Section II (Statutory Authority) and Section IV (Responsibilities of the
Subrecipient) in the Fiscal Year 2016 EMPG Grant Agreement.
This grant agreement and all required attachments must be completed, signed, and returned no later than
August 22, 2016. If this requirement is not met, this grant agreement will be invalid after August 22, 2016,
unless a prior written exception Is provided by the Michigan State Police, Emergency Management and
Homeland Security Division.
Sincerely,
Cair‘n C.1...-11-sarvJas:Le
Capt. Chris A. Kelenske, Commander
Deputy State Director of Emergency Management
and Homeland Security
Enclosures (8)
EMERGENCY MANAGEMENT AND HOMELAND SECURITY DIVISION • PO BOX 31:163e1 • LANSING, MICHIGAN 48909
www.michigan.govimsp • 517-.284-3745
Dear Local Emergency Management Coordinator:
Michigan State Police
Emergency Management and
Homeland Security Division
Grant Agreement
FEDERAL AWARDDENTIFICATION . ,
SUBRECIPIENT NAME
County of Oakland
GRANT NAME
Emergency Management
Performance Grant
CEDA NUMBER
97.042
SUBRECIPIENT IRS/VENDOR NUMBER
38-6004876
FEDERAL AWARD IDENTIFICATION NUMBER
(PAIN)
EMC-2016-EP-00001-501
FEDERAL AWARD DATE
5/31/2016
SUBRECIPIENT DUNS NUMBER
136200362
SUBAWARD FROM TO
PERFORMANCE
PERIOD
10/1/2015 9/30/2016
RESEARCH & DEVELOPMENT
N/A
. -
Funding Total
Federal Funds Obligated by
this Action
$52,557.00
INDIRECT COST RATE
None on file
Total Federal Funds Obligated
to Subrecipient
$52,557.00
Total Amount of Federal
Award
$9,031,286.00
FEDERAL AWARD PROJECT DESCRIPTION
2016 Emergency Management Performance Grant
DETAILS
The 2016 EMPG allocation is 35.6931% of the Subrecipient's emergency program manager's salary and
fringe benefits. The FY 2016 [MPG program has a 50% cost match (cash or in-kind) requirement.
FEDERAL AWARDING AGENCY
Federal Emergency Management Agency
Grant Operations
245 Murray Lane — Building 410, SW
Washington DC 20528-7000
PASS-THROUGH ENTITY (RECIPIENT) NAME
Michigan State Police
Emergency Management and Homeland
Security Division
PO Box 30634
Lansing, MI 48909
State of Michigan
FY 2016 Emergency Management Performance Grant
Grant Agreement
October 1, 2015 to September 30, 2016
CFDA Number: 97.042
Grant Number: EN1C-2016-EP-00001
This Fiscal Year (FY) 2016 Emergency Management Performance Grants (EMPG) grant agreement is hereby
entered into between the Michigan Department of State Police, Emergency Management and Homeland Security
Division (hereinafter called the Recipient), and the
COUNTY OF OAKLAND
(hereinafter called the Subrecipient)
I. Purpose
The purpose of this grant agreement is to provide federal pass-through funds to the Subrecipient for the
development and maintenance of an emergency management program capable of protecting fife, property, and
vital infrastructure in times of disaster or emergency.
The FY 2016 EMPG program plays an important role in the implementation of the National Preparedness System
(NPS) by supporting the building, sustainrnent, and delivery of core capabilities essential to achieving the National
Preparedness Goal of a secure and resilient Nation. The objective of the NPS is to facilitate an integrated, all-of-
nation/whole community, risk driven, capabilities-based approach to preparedness.
In support of the National Preparedness Goal, the FY 2016 EMPG program supports a comprehensive, all-hazard
emergency preparedness system to build and sustain core capabilities across the Prevention, Protection,
Mitigation, Response, and Recovery mission areas.
For more information on NPS, federally designated priorities, and the FY 2016 EMPG objectives, as well as
guidance on allowable costs and program activities, please refer to the FY 2016 EMPG Notice of Funding
Opportunity (NOFO) located at http://www.femagov/grants.
Statutory Authority
Funding for the FY 2016 EMPG is authorized by Section 662 of the Post-Katrina Emergency Management
Reform Act of 2006 (PKEMRA), as amended, (Pub. L. No. 109-296) (6 U.S.C. § 762); the Robert T. Stafford
Disaster Relief and Emergency Assistance Act, as amended (Pub. L. No. 93-288) (42 U.S.C. §§ 5121 et seq.);
the Earthquake Hazards Reduction Act of 1977, as amended (Pub. L. No. 95-124) (42 U.S.C. §§ 7701 et seq.);
and the National Flood Insurance Act of 1968, as amended (Pub. L. No. 90-448) (42 U.S.C. §§ 4001 et seq.).
Appropriation authority is provided by the Department of Homeland Security Appropriations Act, 2016, (Pub L.
No. 114-113).
The Subrecipient agrees to comply with all EMPG program requirements in accordance with the federal FY 2016
EMPG NOFO; the Michigan Emergency Management Act, Act 390, P.A. of 1976, as amended at
http://www.legislature.mi.gov/doc,aspx?mcl-Act-390-of-1976; and the Robert T. Stafford Disaster Relief and
Emergency Assistance Act, as amended (Pub. L. No. 93-288) (42 U.S.C. §§ 5121 et seq.) located at
http://www.fema.gov/robert-t-stafford-disaster-relief-and-emergency-assistance-act-public-law-93-288-amended.
The Subrecipient shall also comply with the most recent version of:
A. 2 CFR, Part 200 of the Code of Federal Regulations (CFR), Uniform Administrative Requirements, Cost
Principles, and Audit Requirements for Federal Awards located at http://www.ecfr.gov.
B. 44 CFR, Part 10, Environmental Considerations.
FY 2016 EMPG
County of Oakland
Page 2 of 8
III. Award Amount and Restrictions
A. The County of Oakland is awarded $52,557.00 under the FY 2016 EMPG. The Recipient determined
the Subrecipients EMPG allocation as 35,6931% of the Subrecipients emergency program manager's
salary and fringe benefits. The Subrecipient may receive less than the allocated amount if the
Subrecipients cost share of wages and fringe benefits paid to the program manager are less than the
total allocation. The Subrecipients EMPG program budget must be documented on the Local Budget for
Emergency Management Performance Grant form (EMD-17).
B. The FY 2016 EMPG covers eligible costs from October 1, 2015 to September 30, 2016. The funds
awarded in the grant agreement shall only be used to cover allowable costs that are incurred during the
agreement period. Grant agreement funds shall not be used for other purposes. For guidance on
allowable costs, please refer to the FY 2016 EMPG NOFO, specifically Appendix B.
C. This grant agreement designates EMPG funds for the administration and oversight of an approved
emergency management program. The Subrecipient may utilize grant funds for the reimbursement
of salary, overtime, compensatory time off, and associated fringe benefits for the program
manager, and up to 5% of the total allocation may be utilized for M&A costs. No other expenditures are allowed. If M&A costs are claimed, a narrative must be submitted detailing the expenses that
are included in these costs.
D. The FY 2016 EMPG program has a 50% cost match (cash or in-kind) requirement, as authorized by the
Robert T. Stafford Disaster Relief and Emergency Assistance Act, as amended, (Pub. L. No. 93-288) (42
U.S.C. §§ 5121 et seq.), specifically, Title VI, sections 611(1) and 613. Federal funds cannot exceed 50%
of eligible costs. Unless otherwise authorized by law, federal funds cannot be matched with other federal
funds.
The Federal Emergency Management Agency (FEMA) administers cost matching requirements in
accordance with 2 CFR § 200.306. To meet matching requirements, the Subrecipient contributions must
be reasonable, allowable, allocable, and necessary under the grant program and must comply with all
federal requirements and regulations.
See the FY 2016 EMPG NOR) for additional match guidance, to include match definitions, basic
guidelines, and governing provisions.
E. All EMPG funded personnel must complete training requirements for the National Incident Management
System (NIMS) and the FEMA Professional Development Series (PDS) and record proof of completion.
All EMPG funded personnel must also participate in no less than three exercises in a 12 month period.
EMPG programs are required to fill out a quarterly training and exercise report (Quarterly Training and
Exercise Reporting Worksheet) identifying training and exercises completed during the quarter. Guidance
for accomplishing these requirements will be provided by the Recipient.
F. Upon request, the Subrecipient must provide to the Recipient information necessary to meet any state or
federal subaward reporting requirements.
IV. Responsibilities of the Subrecipient
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.
Subrecipients may be required to supply documentation certifying that a reduction in non-federal
resources occurred for reasons other than the receipt or expected receipt of federal funds.
FY 2016 EMPG
County of Oakland
Page 3 of 8
B. The Subrecipient agrees to comply with all applicable federal and state regulations; the FY 2016 EMPG
NOFO, the Agreement Articles Applicable to Subrecipients: Fiscal Year 2016 Emergency Management
Performance Grants, and the EMPG Guidebook (EMD-PUB 208) located at
http://www.rnichigan.gov/emhsd . Each of these documents is incorporated by reference into this grant
agreement. The Agreement Articles Applicable to Subrecipients: Fiscal Year 2016 Emergency
Management Performance Grants document is included in the grant agreement packet.
C. In addition to this grant agreement the Subrecipient shall complete, sign, and submit to the Recipient 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. Audit Certification (EMD-053)
4. Request for Taxpayer Identification Number and Certification (W-9)
5. Other documents that may be required by federal or state officials
D. Complete and submit quarterly work reports, the Quarterly Training and Exercise Worksheet, and the
Annual Training and Exercise Plan Worksheet in accordance with the schedule outlined in the FY 2016
EMPG Work Agreement/Quarterly Report (EMD-31).
E. Enact enabling legislation establishing the local emergency management program and ensure a copy of
the local resolution or ordinance is on file with the Recipient.
F. Appoint an emergency management program manager who is able to assume responsibility for the
following functions:
1. Development and maintenance of programs and systems for effective coordination of community
resources in each of the five mission areas: prevention, protection, mitigation, response, and
recovery.
2. Planning and preparation for population protection, including evacuation, shelter/reception, logistics
and resource management. Ensure that Executive Order #13347 entitled Individuals with Disabilities
in Emergency Preparedness and the Rehabilitation Act of 1973 are being addressed. Further
information on disability emergency preparedness programs can be found at http://www.disability ,gov.
3. Planning and preparation for its appropriate role in response to natural and man-made emergencies
and disasters.
4. Exercising the emergency operations plan of the jurisdiction.
5. Emergency management training.
6. Response and recovery from natural and man-made hazards, homeland security related incidents,
and other emergencies that may threaten the safety and well-being of citizens and communities.
7. Promoting public awareness of hazards and encouraging family and individual preparedness.
8. Identifying and implementing measures to mitigate the negative impact of disasters and emergencies.
9. Comply with National Incident Management System (MIMS) requirements to be eligible to receive
federal preparedness funds. NIMS information is available at http://www.femagov/national-incident-
management-system . More information on complying with NIMS is available from the State NIMS
Coordinator.
10. Identify and prioritize needs while simultaneously addressing issues of state and national concern
through implementation of the National Preparedness System and the integration of preparedness
efforts that build, sustain, and deliver the core capabilities necessary to achieve the desired outcomes
identified in the National Preparedness Goal.
G. Provide the Recipient with complete job description for the federally funded EMPG program manager,
including non-EMPG duties.
H. Notify the Recipient immediately of any changes in the EMPG funded program manager's position.
FY 2016 EMPG
County of Oakland
Page 4 of 8
I. The Subrecipient will contribute to the development and maintenance of the state's multi-year Training and
Exercise Plan (TEP) and conduct exercises that comply with local, state, and federal requirements,
including the Homeland Security Exercise and Evaluation Program (HSEEP) to accomplish this goal.
Specific requirements are as follows:
1. Exercises must be conducted by the Subrecipient at least annually.
2. Exercises must comply with the Subreciplent's annual [MPG Work Agreement.
3. The Subrecipient must also submit a three-year exercise plan worksheet reflecting upcoming training
events and exercises which are to be included in the annual state multi-year Training and Exercise
Plan.
4. An After Action Report/Improvement Plan (AAR/IP) shall be completed for each exercise and
submitted to the Michigan State Police (MSP), Emergency Management and Homeland Security
Division (EMHSD) State Exercise Officer.
J. Ensure the EMPG funded program manager completes specific training classes as required by the annual
EMPG Work Agreement.
K. Have an approved and current emergency operations plan on file with the MSP/EMHSD District
Coordinator.
L. TheSubreciplent agrees to prepare the form EMD-007 EMPG Expenses Claimed for Local Program
Contributions. This form is also referred to as the [MPG Quarterly Billing. The Subrecipient agrees to
submit this form with supporting documentation, including all required authorized signatures and required
reimbursement documentation, to the appropriate District Coordinator by the due date following the end of
each quarter. The most current EMD-007 form must be used and can be obtained from the District
Coordinator,
M. Comply with applicable financial and administrative requirements set forth in the current edition of 2 CFR,
Part 200, 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. Non-federal organizations which expend $750,000 or more in federal funds during their current fiscal
year are required to have an audit performed in accordance with the Single Audit Act of 1984, as
amended, and 2 CFR, Part 200.
N. 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)
and Department of Homeland Security (DHS) program specific reporting requirements.
0. The Subrecipient must acknowledge and agree to comply with applicable provisions governing DHS
access to records, accounts, documents, information, facilities, and staff. The Subrecipient also agrees to
require any subrecipients, contractors, successors, transferees, and assignees to acknowledge and agree
to comply with these same provisions. Detailed information on record access provisions can be found in
the DNS Standard Administrative Terms and Conditions located at https://www.dhs.gov/publication/fy15-
dhs-standard-terms-and-conditions, specifically in the DHS Specific Acknowledgements and Assurances
on pages 1.
FY 2016 EMPG
County of Oakland
Page 5 of 8
V. Responsibilities of the Recipient
The Recipient, in accordance with the general purposes and objectives of this grant agreement, will:
A. Administer the grant in accordance with all applicable federal and state regulations and guidelines and
submit required reports to the awarding federal agency.
B. Provide direction and technical assistance to the Subrecipient.
C. Provide to the Subrecipient any special report forms and reporting formats (templates) required for
administration of the program.
D. Reimburse the Subrecipient, in accordance with this grant agreement, based on appropriate
documentation submitted by the Subrecipient.
E. At its discretion, independently, or in conjunction with the federal awarding agency, conduct random on-
site reviews of the Subrecipient(s).
VI. Reporting Procedures
A. The Subrecipient agrees to prepare quarterly work reports using the FY 2016 EMPG Work
Agreement/Quarterly Report (EMD-31) and submit them through EMHSD's online reporting tool by the due
date following the end of each quarter. Reimbursement of expenditures by the Recipient is contingent
upon the Subrecipient's completion of scheduled work activities.
B, If the Subrecipient fails to complete the scheduled work activities during a quarter, the Recipient will
withhold reimbursement until either the work is completed or the Deputy State Director of Emergency
Management and Homeland Security approves a delay in the completion of the activity. If scheduled work
activities are not completed by the end of the fiscal year, September 30, 2016, any balance of the EMPG
award may be forfeited.
C. A Subrecipient that fails to complete the annual exercise requirement, as scheduled within the FY 2016
EMPG.Work Agreement/Quarterly Report may be ineligible for EMPG funding for that quarter and all
subsequent quarters until the qualifying exercise is completed.
D. The Subrecipientis failure to fulfill the quarterly reporting requirements, as required by the grant, may result
in the suspension of grant activities until reports are received.
E. Reporting periods and due dates are listed in the FY 2016 EMPG Work Agreement/Quarterly Report
(EM D-31)located at http://www.michigan.gov/emhsd.
VII. Payment Procedures
A. The Subrecipient agrees to prepare the form EMD-007 EMPG Expenses Claimed for Local Program
Contributions. This form is also referred to as the EMPG Quarterly Billing. The Subrecipient agrees to
submit this form with supporting documentation, including all required authorized signatures and required
reimbursement documentation, to the appropriate District Coordinator by the due date following the end of
each quarter. The most current EMD-007 form must be used and can be obtained from the District
Coordinator.
B. If the Subrecipient submits required quarterly reports that are late or incomplete, the reimbursement may
not be processed until the following quarter.
FY 2016 EMPG
County of Oakland
Page 6 of 8
C. The Subrecipient agrees to return to the Recipient any unobligated balance of funds held by the
Subrecipient at the end of the agreement period or handle them in accordance with the instructions
provided by the Recipient.
VIII. Employment Matters
The Subrecipient shall cornply 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 III of the Americans with Disabilities Act of 1990; the Elliott-Larsen Civil
Rights Act, 1976 PA 453, as amended, MCL 37.2101 et seq.; the Persons with Disabilities Civil Rights Act, 1976
PA 220, as amended, MCL 37.1101 et seq., and all other federal, state and local fair employment practices and
equal opportunity laws and covenants. The Subrecipient 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
Subrecipient 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 Subrecipient shall ensure that no subcontractor, manufacturer, or supplier of the Subrecipient for projects
related to this grant agreement appears on the Federal Excluded Parties List System located at
https://www.sam.gov.
IX. Limitation of Liability
The Recipient and the Subrecipient 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.
X. 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.
XI. Grant Agreement Period
This grant agreement is in full force and effect from October 1, 2015 to September 30, 2016. No costs eligible
under this grant agreement shall be incurred before the starting date of this grant agreement, except with prior
written approval. 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 Subrecipient agrees to return to the Recipient any funds not authorized for use, and the Recipient
shall have no further obligation to reimburse the Subrecipient.
FY 2016 EMPG
County of Oakland
Page 7 of 8
XII. 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 Recipient and the Subrecipient, 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 Subrecipient agrees to inform the Recipient 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 Recipient. If any provision of this grant agreement shall be deemed void or unenforceable, the
remainder of the grant agreement shall remain valid.
The Recipient may suspend or terminate grant funding to the Subrecipient, in whole or in part, or other measures
may be imposed for any of.the following reasons:
A. Failure to expend funds in a timely manner consistent with the grant milestones, guidance, and
assurances.
B. Failure to comply with the requirements or statutory objectives of federal or state law.
C. Failure to make satisfactory progress toward the goals or objectives set forth in the annual EMPG Work
Agreement.
D. Failure to follow grant agreement requirements or special conditions.
E. Failure to submit required reports,
F. Filing of a false certification in the application or other report or document.
Before taking action, the Recipient will provide the Subrecipient reasonable notice of intent to impose corrective
measures and will make every effort to resolve the problem informally.
XIII. Business Integrity Clause
The Recipient may immediately cancel the grant without further liability to the Recipient or its employees if the
Subrecipient, an officer of the Subrecipient, or an owner of a 25% or greater share of the Subrecipient 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 Recipient, reflects on the
Subrecipienrs business integrity.
XIV. 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
Subrecipient agency Freedom of Information Officer will need to determine what information is to be withheld on a
case-by-case basis. The Subrecipient 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.
FY 2016 EMPG
County of Oakland
Page 8 of 8
XV. Official Certification
For the Subrecipient
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 Subrecipient agrees to
complete all requirements specified in this grant agreement.
Subrecipient Name Subreciplent's DUNS Number
For the Chief Elected Official
Printed Name
Title
Signature
Date
For the Local Emergency Program Manager
Printed Name
Title
Signature
Date
For the Recipient (Michigan State Police, Emergency Management and Homeland Security Division)
Chris A. Kelenske, Captain
Deputy State Director of Emergency
Management and Homeland Security
Title Printed Name
c3,,,;„ a. ..c4,,,kat
June 20, 2016
Signature
Date
OMB APPROVAL NO. 1121-0140
EXPIRES 06/30/2009
STANDARD ASSURANCES
The Applicant hereby assures and certifies compliance with all applicable Federal statutes, regulations,
policies, guidelines, and requirements, including 0M13 Circulars A-21, A-87, A-102, A-110, A-122, A-
133; Ex. Order 12372 (intergovernmental review of federal programs); and 28 C.F.R. pts. 66 or 70
(administrative requirements for grants and cooperative agreements). The applicant also specifically
assures and certifies that:
1. It has the legal authority to apply for federal assistance and the institutional, managerial, and financial
capability (including funds sufficient to pay any required non-federal share of project cost) to ensure
proper planning, management, and completion of the project described in this application.
2. It will establish safeguards to prohibit employees from using their positions for a purpose that
constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain.
3. It will give the awarding agency or the General Accounting Office, through any authorized
representative, access to and the right to examine all paper or electronic records related to the financial
assistance.
4. It will comply with all lawful requirements imposed by the awarding agency, specifically including
any applicable regulations, such as 28 C.F.R. pts. 18, 22, 23, 30, 35, 38, 42, 61, and 63, and the award term in
2 C.F.R. § 175.15(b).
5. It will assist the awarding agency (if necessary) in assuring compliance with section 106 of the
National Historic Preservation Act of 1966 (16 U.S.C. § 470), Ex. Order 11593 (identification and
protection of historic properties), the Archeological and Historical Preservation Act of 1974 (16 U.S.C.§
469 a-1 et seq.), and the National Environmental Policy Act of 1969 (42 U.S.C. § 4321).
6. It will comply (and will require any subgrantees or contractors to comply) with any applicable
statutorily-imposed nondiscrimination requirements, which may include the Omnibus Crime Control and
Safe Streets Act of 1968 (42 U.S.C. § 3789d); the Victims of Crime Act (42 U.S.C. §10604(e)); The
Juvenile Justice and Delinquency Prevention Act of 2002 (42 U.S.C. § 5672(b)); the Civil Rights Act of
1964 (42 U. S.C. § 2000d); the Rehabilitation Act of 1973 (29 U.S.C. §7 94); the Americans with
Disabilities Act of 1990 (42 U.S.C.§ 12131-34); the Education Amendments of 1972 (20 U.S.C. §§1681,
1683, 1685-86); and the Age Discrimination Act of 1975 (42 U.S.C. §§ 6101-07); see Ex. Order 13279
(equal protection of the laws for faith-based and community organizations).
7. If a governmental entity—
a) it will comply with the requirements of the Uniform Relocation Assistance and Real Property
Acquisitions Act of 1970 (42 U.S.C.§ 4601 et seq.), which govern the treatment of persons displaced as a
result of federal and federally-assisted programs; and
b) it will comply with requirements of 5 U.S.C.§§ 1501-08 and §§7324-28, which limit certain
political activities of State or local government employees whose principal employment is in connection
with an activity financed in whole or in part by federal assistance.
Signature Date Date
U.S. DEPARTMENT OF JUSTICE
OFFICE OF JUSTICE PROGRAMS
OFFICE OF THE COMPTROLLER
CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND
OTHER RESPONSIBILITY MATTERS; AND DRUG-FREE WORKPLACE REQUIREMENTS
Applicants should 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 28 CFR Part 69, New
Restrictions on Lobbying" and 28 CFR Part 67, "Government-wide Debarment and Suspension (Nonpro-curement) and
Government-wide Requirements for Drug-Free Workplace (Grants)." The certifications shall be treated as a material
representation of fact upon which reliance will be placed when the Department of Justice determines to award the
covered transaction, grant, or cooperative agreement.
1. LOBBYING
As required by Section 1352, Title 31 of the U.S. Code, and
implemented at 28 CFR Part 69, for persons entering into a
grant or cooperative agreement over $100,000, as defined at
28 CFR Part 69, 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 in-
fluencing 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 con-
nection 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 funds other than Federal appropriated funds have
been paid or will be paid to any person for influencing or at-
tempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with this
Federal grant Of cooperative agreement, the undersigned shall
complete and submit Standard Form - LLL, "Disclosure of
Lobbying Activities," in accordance with its instructions;
(c) The undersigned shall require that the language of this oar-
tification 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 sub-
recipients shall certify and disclose accordingly,
2. DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS
(DIRECT RECIPIENT)
As required by Executive Order 12549, Debarment and
Suspension, and implemented at 28 CFR Part 67, for prospec-
tive participants in primary covered transactions, as defined at
28 CFR Part 67, Section 67.510—
A. The applicant certifies that it and its principals:
(a) Are not presently debarred, suspended, proposed for debar-
ment, 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 applica-
tion been convicted of or had a civil judgment rendered against
them for commission of fraud or a criminal offense in connec-
tion with obtaining, attempting to obtain, or performing a
public (Federal, State, or local) transaction or contract under a
public transaction; violation of Federal or State antitrust statutes
or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
(c) Are not presently indicted for or otherwise criminally or
civilly charged by a governmental entity (Federal, State, or
local) with commission of any of the offenses enumerated in
paragraph (1)(b) of this certification; and
(d) Have not within a three-year period preceding this applica-
tion had one or more public transactions (Federal, State, or
local) terminated for cause or default; and
B. Where the applicant is unable to certify to any of the
statements in this certification, he or she shall attach an
explanation to this application.
3. DRUG-FREE WORKPLACE
(GRANTEES OTHER THAN INDIVIDUALS)
As required by the Drug-Free Workplace Act of 1988, and
implemented at 28 CFR Part 67, Subpart F, for grantees, as
defined at 28 CFR Part 67 Sections 67.615 and 67.620—
A. The applicant certifies that it will or will continue to provide
a drug-free workplace by:
(a) Publishing a statement notifying employees that the
unlawful manufacture, distribution, dispensing, possession, or
use of a controlled substance is prohibited in the grantee's
workplace and specifying the actions that will be taken against
employees for violation of such prohibition;
(b) Establishing an on-going drug-free awareness program to
inform employees about—
(1) The dangers of drug abuse In the workplace;
(2) The 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 be given a copy of the state-
ment required by paragraph (a);
(d) Notifying the employee in the statement required by para-
graph (a) that, as a condition of employment under the grant,
the employee will-
CJP FORM 4061/6 (3-911 REPLACES OJP FORMS 4061/2, 4061/S AND 4061/4 WHICH ARE OBSOLETE.
(1) Abide by the terms of the statement; and
(2) Notify the employer in writing of his or her conviction for a
violation of a criminal drug statute occurring in the workplace
no later than five calendar days after such conviction;
(e) Notifying the agency, in writing, within 10 calendar days
after receiving notice under subparagraph (d)(2) from an
employee or otherwise receiving actual notice of such convic-tion.
Employers of convicted employees must provide notice, including
position title, to: Department of Justice, Office of
Justice Programs, ATTN: Control Desk, 633 Indiana Avenue,
NW, Washington, D.C. 20531. Notice shall Include the iden-
tification number(s) of each affected grant;
(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 so convicted—
(1) Taking appropriate personnel action against such an
employee, up to and including termination, consistent with the
requirements of the Rehabilitation Act of 1973, as amended; or
(2) Requiring such employee to participate satisfactorily in a
drug abuse assistance or rehabilitation program approved for
such purposes by a Federal, State, or local health, law enforce-
ment, or other appropriate agency;
(g) Making a good faith effort to continue to maintain a drug-
free workplace through implementation of paragraphs (a), (b),
(e), (d), (e), and (f).
B. The grantee may insert in the space provided below the
site(s) for the performance of work done in connection with
the specific grant:
Place of Performance (Street address, city, county, state, zip
code)
Check D if there are workplaces on file that are not indentified
here.
Section 67, 630 of the regulations provides 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 ap-
plication for Department of Justice funding. States and State
agencies may elect to use OJP Form 4061/7.
Check D if the State has elected to complete OJP Form
4061/7.
DRUG-FREE WORKPLACE
(GRANTEES WHO ARE INDIVIDUALS)
As required by the Drug-Free Workplace Act of 1988, and
implemented at 28 CPR Part 67, Subpart F, for grantees, as
defined at 28 CFR Part 67; Sections 67,615 and 67.620—
A. As a condition of the grant, I certify that I will not engage
in the unlawful manufacture, distribution, dispensing, posses-
sion, or use of a controlled substance in conducting any
activity with the grant; and
B. if convicted of a criminal drug offense resulting from a
violation occurring during the Conduct of any grant activity, I
will report the conviction, in writing, within 10 calendar days
of the conviction, to; Department of Justice, Office of Justice
Programs, ATTN: Control Desk, 810 Seventh Street NW.,
Washington, DC 20531.
As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above certifications.
1. Grantee Name and Address:
2. Application Number and/or Project Name 3. Grantee IRS/Vendor Number
4. Typed Name and Title of Authorized Representative
5. Signature 6, Date
'U.S. Government Printing Office: 1995 - 405-037140014
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, PI: 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 durrent fiscal year or expend
$750,000 or more in federal funds in a 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
Inform ation
Jurisdiction Name
Street Address City State ZIP Code
6i-tifkatio,MOr EL cal Year
Subgrantee Fiscal Year Period: to
El 1 certify that the subgrantee shown above does NOT expect it will be required to have an audit performed under
the Single Audit Act of 1984, as amended, and the OMB Circular, as revised, for the above listed program.
I certify that the subgrantee shown above expects it will be required to have an audit performed under the Single
Audit Act of 1984, as amended, and the OMB Circular as revised, during at least one fiscal year funds are received
for the above listed program. A copy of the audit report will be submitted to: Michigan State Police, Grants
and Community Services Division, 333 South Grand Avenue, Lansing, Michigan 48933,
Signature of Subgrantee's Authorized Representative Date
Submit Completed Document To:
Emergency Management and Homeland Security Division
Michigan Department of State Police
Attention: Grants Development Unit
PLEASE NOTE:
The-Emergency Management and Homeland
Security Division mailing address has changed to:
PO Box #30634
Lansing, MI 48909
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.
e
Do not
send to th IRS. Print or type See Specific Instructions on page 2. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank,
2 Business name/disregarded entity name, if different from above
3 Check appropriate
0 individual/sole
single-member
[j Limited liability
Note. For a single-member
the tax classification
Ei Other (see instructions)
box for federal lax classification; check only one of the following seven boxes: 4 Exemptions
certain
Instructentitlesion,
Exempt payee
Exemption
code (if any)
Opp!) la accaurts
(codes apply only to
not individuais; see
s on page 3):
code (if any)
proprietor or El C Corporation M S Corporation El Partnership • Trust/estate
LLC
company. Enter the tax classification (C---C corporation, 5.5 corporation, P=partnership)
LLC that is disregarded, do not check LLC: check the appropriate box in
of the single-member owner.
l•-
PP-
from FATCA reporting the line above for
maintorirted outsIde the U.S.)
5 Address (number, street, and apt. or suite no.) Requester's name and address (optional)
6 City, state, and ZIP code
it account number(s) ere (options
axpayer 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 (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the Part I Instructions on page 3. For other
entitles, it is your employer identification number (EIN). lf you do not have a number, see Now to get a
TIN on page 3.
Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for
guidelines on whose number to enter.
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 FATCA 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 on 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
Here Signature of
U.S. person n Date W.
Social security number
or
Employer identification number
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.goWfw9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to tile 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 (TN), adoption taxpayer identification number (ATIN), or employer
identification number (EIN), 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:
• Form 1099-INT (Interest earned or paid)
• Form 1099-DIV (dividends, including those from stocks or mutual funds)
• Form 1099-MISC (various types of Income, prizes, awards, or gross proceeds)
• Form 1099-8 (stock or mutual fund sales and certain other transactions by
brokers)
• Form 1099-8 (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party 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 Vi-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:
1. 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 area U.S. exempt payee. It
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 tax 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 reporting? 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 Individual 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).
Speoial 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 cerialn-cases where a Form W-9 has not been received,
the rules under section 1445 require 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 cases 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 tax treaties contain a prevision 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 area 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
live items:
1. The treaty country. Generally, this must be the some 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 wilt 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 30,
1984) allows the provisions of Article 20 to continue to apply even after the
Chinese student becomes a resident alien of the United States, A Chinese student
who qualifies 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 called "backup withholding." Payments that may be subject to backup
withholding include interest, tax-exempt interest, dividends, broker and barter
exchange transactions, rents, royalties, nonemployee 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 subjeot 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 an your tax return,
Payments you receive will be subject to backup withholding if:
1. You do not furnish your TIN to the requester,
2. You do net certify your TIN when required (see the Part II instructions on page
3 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 all 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 all United States account holders that are specified
United States persons. Certain 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 claimed to 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 ior 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 a
false statement with no reasonable basis that results in no backup withholding,
you are subject to a $500 penalty.
Criminal penalty for falsifying information. Willfully falsifying certifications or
affirmations may subject you to criminal penalties including fines and/or
imprisonment,
Misuse of TINs. 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 lax return.
If this Form W-9 is for a joint account, list first, and than circle, the name 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. INN applicant: Enter your individual name salt 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 1040/10404/1o40a on line I. You may enter your business, trade,
or "doing business as" (DBA) name on line 2.
c. Partnership, LLC that is note single-member LLC, C Corporation, or S
Corporation. Enter the entity's name as shown on the entity's tax return on line 1
and any business, trade, or DEA name on line 2.
d. Other entities. Enter your name as shown on required U.S. federal tax
documents on line 1. This name should match the name shown on the charter or
other legal document creating the entity. You may enter any business, trade, or
[IBA 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)(iii), Enter the owner's name on
line 1. The name of the entity entered on line 1 should never be a disregarded
entity. The name on line 1 should baths name shown on the income tax return on
which the income should be reported. For example, if a foreign LLC 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 name Is required to be provided on line 1. lithe
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." lithe owner of the disregarded
entity is a foreign person, the owner must complete an appropriate Form W-8
Instead of a Form W-9. This is the case even if the foreign person has a U.S. TIN,
Form W-9 (Rev. 12-2014) Page 3
Line 2
II you have a business name, trade name, DBA name, or disregarded entity name,
you may enter it on 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 I. Check only one box in line 3.
Limited Liability Company (LLC). If the name on Ilne 1 is an LLC treated as a
partnership for U.S. federal tax purposes, check the 'Limited Liability Company"
box and enter "P" in the space provided. If the LLO has filed Form 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 LLC 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
1099-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(b)(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 All exempt payees except
for 7
Broker transactions Exempt payees 1 through 4 and 6
through 11 and all 0 corporations. S
corporations must not enter an 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 $5,0001
Generally, exempt payees
1 through e
Payments made In settlement of
payment card or third party network
transactions
Exempt payees 1 through 4
1 See Form 1099-ivIISC, Miscellaneous Income, and its instructions.
'However, the following payments made to a corporation and reportable on Form
1099-MISC are not exempt from backup withholding: medical and health care
payments, attorneys' tees, gross proceeds paid to an attorney reportable under
section 6045(t), and payments for services paid by a federal executive agency.
Exemption from FATCA reporting cede. 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 if the financial
institution is subject to these requirements. A requester may indicate 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 601(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)(i)
F—A dealer in securities, commodities, or derivative financial instruments
(including notional principal contracts, futures, forwards, and options) that is
registered as such under the laws of the United States or any state
G—A real estate investment trust
H—A regulated Investment company as defined In section 851 or an entity
registered at all times during the tax year under the Investment Company Act of
1940
I—A common trust fund as defined in section 584(a)
J—A bank as defined in section 681
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 end/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 mail 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 FIN, see How to get a TIN below.
If you are a sole proprietor and you have an FIN, you may enter either your SSN
or EIN. However, the IRS prefers that you use your SSN.
If you are a single-member LW that is disregarded as an entity separate from Its
owner (see Limited Liability Company (EEC) on this page), enter the owner's SSN
(or EIN, if the owner has one). Do not enter the disregarded entity's EIN. It the LLC
Is classified as a corporation or partnership, enter the entity's EIN.
Note. See the chart on page 4 for further clarification of name and Tint
combinations.
Hew to get a TIN. If you do not have a TIN, apply for one immediately. To apply
for an SSN, gat 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 33-4, Application for Employer
Identification Number, to apply for an FIN. You can apply for an EIN online by
accessing the IRS website at wwwirs.govibusinesses and clicking on Employer
Identification Number (EIN) under Starting a Business. You can get Forms W-7 and
SS-4 from the IRS by visiting IRS.gov or by calling 1-800-TAX-FORM
(1-800-829-3676).
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
e TIN and give it to the requester before you are subject to backup 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-11.
Form W-9 (Rev. 12-2014)
Page 4
Part II. Certification
To establish to the withholding agent that you are a U,S. person, or resident alien,
sign Form W-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 cede earlier.
Signature requirements. Complete the certification as Indicated In items 1
through 6 below.
1. Interest, dividend, and barter exchange accounts opened before 1984
and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification.
2. Interest, dividend, broker, and barter exchange accounts opened after
1983 and broker accounts considered inactive during 1983. You must sign the certification or backup withholding will apply, If you are subject to backup
withholding and you are merely providing your correct TIN to the requester, you
must cross out item 2 in the certification before signing the form,
3. Real 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 nonempioyee 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, Coverdell GSA, Archer MSA or NSA contributions or
distributions, and pension distributions. You most give your correct TIN, but you
do not have to sign the certification.
What Name and Number To Give the Requester
For this type of account: Give name and SSN of:
1. Individual
2. Two or more individuals (joint
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 regal or valid trust under
state law
5. Sole proprietorship or disregarded
entity owned by an individual
6. Grantor trust filing under Optional
Form 1099 Filing Method 1 (see
Regulations section 1 ,671-4(b)(2)0
(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 EIN of:
7. Disregarded entity not owned by an
Individual
8. A valid trust, estate, or pension trust
9. Corporation or LLC electing
corporate status on Form 8832 or
Form 2558
10. Association, club, religious,
charitable, educational, or other tax-
exempt organization
11. Partnership or multi-member LL.,C
12. A broker or registered nominee
1a. 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 Fling Method or the Optional
Form 1099 Filing Method 2 (see
Regulations section 1.671-4(b)(2)(1)
PD.
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 en a
jolnt account has an SSN, that person's number most be furnished,
2 Circle the minor's name and furnish the minor's SSN.
3 YOU must show your Individual name and you may also enter your business or DBA name on
the "Business name/disregarded entity" name line. You may use either your BSN or EIN (if you
have one), but the IRS encourages you to use your SSN,
'List first and circle the name of the trust, estate, or pension treat. (Do not furnish the TIN of the personal representative or-trustee unless the legal entity itself is riot designated in the account
Also see Spec/el rules for partnerships on page 2.
'Note. Grantor aiso must provide a Form W-9 to trustee 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 stroll as your
name, SSN, or other identifying Information, without your permission, to commit
fraud or other crimes. An identity thief may use your SSN to get a Job or may file a
tax return using your SSN tO receive a refund.
To reduce your risk:
• Protect your SSN,
• Ensure your employer is protecting your SSN, and
• Be careful when choosing a tax preparer.
It your tax records are affected by identity theft and you receive a notice from
the IRS, respond right away to the name and phone number printed on the IRS
notice or letter.
If your tax records are not currently affected by identity theft but you think you
are at risk due to a lost or stolen purse or wallet, questionable credit card activity
or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit
Form 1403G.
For more Information, see Publication 4536, identity Theft Prevention and Victim
Assistance.
Victims of identity theft who are experiencing economic harm or a system
problem, or are seeking help in resolving tax problems that have not been resolved
through normal channels, may be eligible for Taxpayer Advocate Service (TAS)
assistance. You can reach TAS by calling the TAS toll-free case intake Ilne at
1-877-777-4776 or TTY/TDD 1-800-829-4059,
Protect yourself from suspicious emails or phishing schemes. Phishing la the creation and use of email and websites designed to mimic legitimate business
emails and websites. The most common sot is sending an email to a user falsely
claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for Identity theft.
The IRS does not initiate contacts with taxpayers via ernails. Also, the IRS does not request personal detailed information through email or ask taxpayers for the
PIN numbers, passwords, or similar secret access information for their credit card,
bank, or other financial accounts.
if you reoelve an unsolicited email claiming to be from the IRS, forward this
message to phi$hing@irs.gov. You may also report misuse of the IRS name, logo,
or other IRS property to the Treasury inspector General for Tax Administration
(TIGTA) at 1-800-366-4484. You can forward suspicious emails to the Federal
Trade Commission at: spanrAuce.gov or contact them at wwwitc.govfirithert or 1-877-IDTHEFT (1-877-438-4338).
Visit IFIS,gov to learn more about Identity theft and how to reduce your risk,
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct
TIN to persons (jncluding federal agencies) who are required to file information
returns with the IRS to report Interest, dividends, or certain other income paid to
you; mortgage interest you paid; the acquisition or abandonment of secured
property; the cancellation of debt; or contributions you made to an IRA, Archer
MSA, or HSA. The person collecting this form uses the information on the form to
file Information returns with the IRS, reporting the above information. Routine uses of this Information include giving It to the Department of Justice for civil and
criminal litigation and to cities, states, the District of Columbia, and U.S.
commonwealths and possessions for use in administering their iaws. The
Information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism. You must provide your TIN whether or
not you are required to file a tax return. Under section 3408, payers must generally
withhold a percentage of taxable interest, dividend, and certain other payments to
a payee who does not gives TIN to the payer. Certain penalties may also apply for providing false or fraudulent information.
Agreement Articles Applicable to Subrecipients
Fiscal Year 2016 Emergency Management Performance Grants
Article I - Whistleblower Protection Act
All recipients must comply with the statutory requirements for whistleblower protections (if applicable) at 10 U.S.0
§ 2409, 41 U.S.C. 4712, and 10 U.S.C. § 2324, 41 U.S.C. §§ 4304 and 4310.
Article - Use of DHS Seal, Logo and Flags
All recipients must obtain permission from their financial assistance office, prior to using the OHS seal(s), logos,
crests or reproductions of flags or likenesses of DHS agency officials, including use of the United States Coast
Guard seal, logo, crests or reproductions of flags or likenesses of Coast Guard officials.
Article Ill - USA Patriot Act of 2001
All recipients must comply with requirements of the Uniting and Strengthening America by Providing Appropriate
Tools Required to Intercept and Obstruct Terrorism Act (USA PATRIOT Act), which amends 18 U.S.C. §§ 175§
175c.
Article IV - Universal Identifier and System of Award Management (SAM)
All recipients are required to comply with the requirements set forth in the government-wide Award Term
regarding the System for Award Management and Universal Identifier Requirements located at 2 C.F.R. Part 25,
Appendix A, the full text of which is incorporated here by reference in the terms and conditions of your award.
Article V - Reporting of Matters Related to Recipient Integrity and Performance
If the total value of your currently active grants, cooperative agreements, and procurement contracts from all
Federal assistance office exceeds $10,000,000 for any period of time during the period of performance of this
Federal award, you must comply with the requirements set forth in the government-wide Award Term and
Condition for Recipient Integrity and Performance Matters located at 2 C.F.R. Part 200, Appendix XII, the full text
of which is incorporated here by reference in the terms and conditions of your award,
Article VI - Rehabilitation Act of 1973
All recipients must comply with the requirements of Section 504 of the Rehabilitation Act of1973, 29 U.S.C. § 794, as amended, which provides that no otherwise qualified handicapped individual in the United States will,
solely by reason of the handicap, be excluded from participation in, be denied the benefits of, or be subjected to
discrimination under any program or activity receiving Federal financial assistance.
Article VII - Trafficking Victims Protection Act of 2000
All recipients must comply with the requirements of the government-wide award term which implements Section
106(g) of the Trafficking Victims Protection Act of 2000, (TVPA) as amended (22 U.S.C. § 7104). The award term
is located at 2 CFR § 175.15, the full text of which is incorporated here by reference in the terms and conditions of
your award.
Article VIII - Terrorist Financing
All recipients must comply with E.O. 13224 and U.S. law that prohibit transactions with, and the provisions of
resources and support to, individuals and organizations associated with terrorism. It is the legal responsibility of
recipients to ensure compliance with the Order and laws.
Article IX - SAFECOM
All recipients who receive awards made under programs that provide emergency communication equipment and
its related activities must comply with the SAFECOM Guidance for Emergency Communication Grants, including
provisions on technical standards that ensure and enhance interoperable communications.
Article X - Reporting Subawards and Executive Compensation
All recipients are required to comply with the requirements set forth in the government-wide Award Term on
Reporting Subawards and Executive Compensation located at 2 C.F.R. Part 170, Appendix A, the full text of which is incorporated here by reference in the terms and conditions of your award.
Article XI - Procurement of Recovered Materials
All recipients must comply with Section 6002 of the Solid Waste Disposal Act, as amended by the Resource
Conservation and Recovery Act. The requirements of Section 6002 include procuring only items designated in
guidelines of the Environmental Protection Agency (EPA) at 40 C.F.R. Part 247 that contain the highest
percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition.
1
Article XII - Patents and Intellectual Property Rights
Unless otherwise provided by law, recipients are subject to the Bayh-Dole Act, Pub. L. No. 96-517, as amended,
and codified in 35 U.S.C. § 200 at seq. All recipients are subject to the specific requirements governing the
development, reporting, and disposition of rights to inventions and patents resulting from financial assistance
awards located at 37 C.F.R. Part 401 and the standard patent rights clause located at 37 C.F.R. § 401,14,
Article XIII - Notice of Funding Opportunity Requirements
All of the instructions, guidance, limitations, and other conditions set forth in the Notice of Funding Opportunity
(NOF0) for this program are incorporated here by reference in the terms and conditions of your award. All
recipients must comply with any such requirements set forth in the program NOFO.
Article XIV - Non-supplanting Requirement
All recipients who receive awards made under programs that prohibit supplanting by law must ensure that Federal
funds do not replace (supplant) funds that have been budgeted for the same purpose through non-Federal
sources.
Article XV - Lobbying Prohibitions
All recipients must comply with 31 U.S.C. § 1352, which provides that none of the funds provided under an award
may be expended by the recipient to pay any person to influence, or attempt 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 any Federal action concerning the award or renewal.
Article XVI - Limited English Proficiency (Civil Rights Act of 1964, Title VI)
All recipients must comply with the Title VI of the Civil Rights Act of 1964 (Title VI) prohibition against
discrimination on the basis of national origin, which requires that recipients of federal financial assistance take
reasonable steps to provide meaningful access to persons with limited English proficiency (LEP) to their programs
and services. For additional assistance and information regarding language access obligations, please refer to the
DHS Recipient Guidance https://www.dhs.goviguidance-published-help-department-supported-organizations-
provide-meaningful-access-people-limited and additional resources on http://vvww.lep.gov .
Article XVII - Hotel and Motel Fire Safety Act of 1990
In accordance with Section 6 of the Hotel and Motel Fire Safety Act of 1990, 15 U.S.C. § 2225a, all recipients must ensure that all conference, meeting, convention, or training space funded in whole or in part with Federal
funds complies with the fire prevention and control guidelines of the Federal Fire Prevention and Control Act of 1974, as amended, 15 U.S.C. 2225.
Article XVIII - Fly America Act of 1974
All recipients must comply with Preference for U.S. Flag Air Carriers: (air carriers holding certificates under 49
U.S.C. § 41102) for international air transportation of people and property to the extent that such service is
available, in accordance with the International Air Transportation Fair Competitive Practices Act of 1974 (49 U.S.C. § 40118) and the interpretative guidelines issued by the Comptroller General of the United States in the
March 31, 1981, amendment to Comptroller General Decision 13-138942,
Article XIX - Best Practices for Collection and Use of Personally Identifiable Information (PII)
DHS defines personally identifiable information (PII) as any information that permits the identity of an individual to
be directly or indirectly inferred, including any information that is linked or linkable to that individual. All recipients
who collect Pll are required to have a publically-available privacy policy that describes standards on the usage
and maintenance of Pll they collect, Award recipients may also find as a useful resource the DHS Privacy Impact
Assessments: Privacy Guidance and Privacy template respectively.
Article XX - Americans with Disabilities Act of 1990
All recipients must comply with the requirements of Titles I, II, and III of the Americans with Disabilities Act, which prohibits recipients from discriminating on the basis of disability in the operation of public entities, public and
private transportation systems, places of public accommodation, and certain testing entities, (42 U.S.C. §§ 12101-
12213),
Article )0a - Age Discrimination Act of 1975
All recipients must comply with the requirements of the Age Discrimination Act of 1975 (Title 42 U.S. Code, §
6101 at seq.), which prohibits discrimination on the basis of age in any program or activity receiving Federal
financial assistance
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Article XXII - Activities Conducted Abroad
All recipients must ensure that project activities carried on outside the United States are coordinated as necessary
with appropriate government authorities and that appropriate licenses, permits, or approvals are obtained:
Article XXIII - Acknowledgment of Federal Funding from DHS
All recipients must acknowledge their use of federal funding when issuing statements, press releases, requests
for proposals, bid invitations, and other documents describing projects or programs funded in whole or in part with
Federal funds.
Article XXIV - Federal Leadership on Reducing Text Messaging while Driving
All recipients are encouraged to adopt and enforce policies that ban text messaging while driving as described in
E.O. 13513, including conducting initiatives described in Section 3(a) of the Order when on official Government
business or when performing any work for or on behalf of the federal government.
Article XXV - Federal Debt Status
All recipients are required to be non-delinquent in their repayment of any Federal debt. Examples of relevant debt
include delinquent payroll and other taxes, audit disallowances, and benefit overpayments. See OMB Circular A-
29.
Article XXVI - False Claims Act and Program Fraud Civil Remedies
All recipients must comply with the requirements of 31 U.S.C. § 3729-3733 which prohibits the submission of false
or fraudulent claims for payment to the Federal Government. See 31 U.S.C. § 3801-3812 which details the
administrative remedies for false claims and statements made.
Article XXVII - Energy Policy and Conservation Act
All recipients must comply with the requirements of 42 U.S.C, § 6201 which contain policies relating to energy
efficiency that are defined in the state energy conservation plan issued in compliance with this Act.
Article XXVIII - Education Amendments of 1972 (Equal Opportunity in Education Act) - Title IX
All recipients must comply with the requirements of Title IX of the Education Amendments of 1972 (20 U.S.C. §
1681 et seq.), which provide that no person in the United States will, on the basis of sex, be excluded from
participation in, be denied the benefits of, or be subjected to discrimination under any educational program or
activity receiving Federal financial assistance. OHS implementing regulations are codified at 6 C.F,R. Part 17 and
44 C.F.R. Part 19
Article XXIX - Duplication of Benefits
Any cost allocable to a particular Federal award provided for in 2 C.F.R. Part 200, Subpart E may not be charged
to other Federal awards to overcome fund deficiencies, to avoid restrictions imposed by Federal statutes,
regulations, or terms and conditions of the Federal awards, or for other reasons. However, this prohibition would
not preclude a recipient form shifting costs that are allowable under two or more Federal awards in accordance
with existing Federal statutes, regulations, or the terms and conditions of the Federal award.
Article XXX - Drug-Free Workplace Regulations
All recipients must comply with the Drug-Free Workplace Act of 1988 (41 U.S.C. § 701 et seq.), which requires all
organizations receiving grants from any Federal agency agree to maintain a drug-free workplace. DHS has
adopted the Act's implementing regulations at 2 C.F.R Part 3001,
Article XXXI - Debarment and Suspension
All recipients are subject to the non-procurement debarment and suspension regulations implementing Executive
Orders 12549 and 12689, and 2 C.F.R. Part 180. These regulations restrict awards, subawards, and contracts
with certain parties that are debarred, suspended, or otherwise excluded from or ineligible for participation in
federal assistance programs or activities.
Article XXXII - Copyright
All recipients must affix the applicable copyright notices of 17 U.S.C. §§ 401 or 402 and an acknowledgement of
Government sponsorship (including award number) to any work first produced under Federal financial assistance
awards.
Article XXXII! - Civil Rights Act of 1968
All recipients must comply with Title VIII of the Civil Rights Act of 1968, which prohibits recipients from
discriminating in the sale, rental, financing, and advertising of dwellings, or in the provision of services in
connection therewith, on the basis of race, color, national origin, religion, disability, familial status, and sex (42
U.S.C. § 3601 et seq.), as implemented by the Department of Housing and Urban Development at 24 C.F.R.
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Part 100. The prohibition on disability discrimination includes the requirement that new multifamily housing with
four or more dwelling units-i.e., the public and common use areas and Individual apartment units (all units in
buildings with elevators and ground-floor units in buildings without elevators)§be designed and constructed with
certain accessible features (See 24 C.F.R. § 100.201).
Article XXXIV - Civil Rights Act of 1964 - Title VI
All recipients must comply with the requirements of Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d of seq.), which provides that no person in the United States will, on the grounds of race, color, or national origin, be
excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or
activity receiving Federal financial assistance, DHS implementing regulations for the Act are found at 6 C.F.R.,
Part 21 and 44 C.F.R. Part 7.
Article XXXV - OHS Specific Acknowledgements and Assurances
Al] recipients, sub-recipients, successors, transferees, and assignees must acknowledge and agree to comply
with applicable provisions governing DHS access to records, accounts, documents, information, facilities, and
staff.
1. Recipients must cooperate with any compliance reviews or compliance investigations conducted by DHS.
2. Recipients must give DHS access to, and the right to examine and copy, records, accounts, and other
documents and sources of information related to the award and permit access to facilities, personnel, and other
individuals and information as may be necessary, as required by DHS regulations and other applicable laws or program guidance.
3. Recipients must submit timely, complete, and accurate reports to the appropriate DIAS officials and maintain
appropriate backup documentation to support the reports.
4. Recipients must comply with all other special reporting, data collection, and evaluation requirements, as
prescribed by law or detailed in program guidance.
5. If, during the past three years, the recipient has been accused of discrimination on the grounds of race, color,
national origin (including limited English proficiency), sex, age, disability, religion, or familial status, the recipient
must provide a list of all such proceedings, pending or completed, including outcome and copies of settlement
agreements to the OHS financial assistance office and the OHS Office of Civil Rights and Civil Liberties (CRCL)
by e-mail at crcl@hq.dhs.gov or by mail at U.S. Department of Homeland Security Office for Civil Rights and Civil
Liberties Building 410, Mail Stop #0190 Washington, D.C. 20528.
6. In the event any court or administrative agency makes a finding of discrimination on grounds of race, color,
national origin (including limited English proficiency), sex, age, disability, religion, or familial status against the
recipient, or the recipient settles a case or matter alleging such discrimination, recipients must forward a copy of
the complaint and findings to the DHS financial assistance office and the CRCL office by e-mail or mail at the
addresses listed above. The United States has the right to seek judicial enforcement of these obligations..
Article XXXVI - Assurances, Administrative Requirements, Cost Principles, and Audit Requirements
DHS financial assistance recipients must complete either the OMB Standard Form 424B Assurances § Non-
Construction Programs, or OMB Standard Form 424D Assurances § Construction Programs as applicable.
Certain assurances in these documents may not be applicable to your program, and the DHS financial assistance
office may require applicants to certify additional assurances. Applicants are required to fill out the assurances applicable to their program as instructed by the awarding agency. Please contact the financial assistance office if
you have any questions. DHS financial assistance recipients are required to follow.the applicable provisions of the
Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards located at 2
C.F.R. Part 200, and adopted by DHS at 2 C.F.R. Part 3002. OHS financial assistance recipients must complete
either the OMB Standard .Form 424B Assurances - Non-Construction Programs or OMB Standard Form 424D
Assurances - Construction Programs as applicable.
Certain assurances in these documents may not be applicable to your program, and the DNS financial assistance
office may require applicants to certify additional assurances. Applicants are required to fill out the assurances
applicable to their program as instructed by the awarding agency. Please contact the financial assistance office if
you have any questions.
OHS financial assistance recipients are required to follow the applicable provisions of the Uniform Administrative
Requirements, Cost Principles, and Audit Requirements for Federal Awards located at 2 C.F.R. Part 200, and
adopted by OHS at 2 C.F.R. Part 3002.
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FISCAL NOTE (MISC . #16167) July 20, 2016
BY: Finance Committee, Tom Middleton, Chairperson
IN RE: HEALTH AND HUMAN SERVICES - HOMELAND SECURITY DIVISION — EMERGENCY
MANAGEMENT PERFORMANCE GRANT AGREEMENT FOR FISCAL YEAR 2016 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
resolutions and finds:
1. Oakland County has been awarded grant funding by the State of Michigan in the amount of
$52,557 for the development and maintenance of an emergency management program capable
of protecting life, property and vital infrastructure in times of disaster or emergency with a 50%
grant match in the amount of $52,557 for a total of $105,114 in funding for this program.
2. The funding period is October 1, 2015 through September 30, 2016.
3, This is the 44th year of grant acceptance for this program.
4. The FY 2016 EMPG award granted by the State funds a portion of salary and fringe benefits of
the Homeland Security Manager's salary and fringe benefits, (position #09864).
5. The County's portion of the grant match is comprised of in-kind support from the salary of the
Manager of Homeland Security.
6. A budget amendment is recommended.
GENERAL FUND (#10100)
Project ID 100000001994 Budget Reference 2016
FY 2016
Revenue
1060601-115120-610210 Disaster Control Fed Subsidy $12,557
9010101-196030-665882 Planned Use of Balance ($12,557)
Total Revenue $ 0
FINANCE COMMITTEE VOTE:
Motion carried unanimously on a roll call vote with Woodward and Quarles absent.
-7/4 I,
Resolution #16167 July 20, 2016
Moved by Hoffman supported by Zack the resolutions (with fiscal notes attached) on the Consent Agenda
be adopted (with accompanying reports being accepted).
AYES: Dwyer, Fleming, Gershenson, Gosselin, Hoffman, Kochenderfer, KowaII, Long,
Middleton, Quarles, Scott, Taub, Weipert, Woodward, Zack, Bowman, Crawford. (17)
NAYS: None. (0)
A sufficient majority having voted in favor, the resolutions (with fiscal notes attached) on the Consent
Agenda were adopted (with accompanying reports being accepted).
1H APPROVE THIS 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 July 20, 2016,
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 20 h day of July, 2016.
Lisa Brown, Oakland County