HomeMy WebLinkAboutResolutions - 2021.09.02 - 34853•
BOARD OF COMMISSIONERS
September 2, 2021
MISCELLANEOUS RESOLUTION #21-346
Sponsored By: Penny Luebs
1N RE: Fiscal Year (FY) 2021 Public Assistance Grant Agreement FEMA-4494-DR-MI - Application
Chairperson and Members of the Board:
WHEREAS the President of the United States declared a disaster for the State of Michigan on March 13, 2020,
under the authority of the Robert T. Stafford Disaster Relief and Emergency Assistance Act; and
WHEREAS Oakland County has provided emergency protective measures to its citizens in the form of
Personal Protective Equipment, Public Communications, Food, Testing, Vaccinations, Contact Tracing, and
other services in response to the COVID-19 Pandemic; and
WHEREAS the COVID-19 Pandemic is an ongoing disaster and Oakland County is continuing to provide
emergency protective measures to its citizens; and
WHEREAS thus far Oakland County has documented to FEMA nearly $8.3 million in expenses for emergency
protective measures; and
WHEREAS FEMA will be awarding Oakland County grant funds in the form of individual projects for
expenses related to the COVID-19 Pandemic; and
WHEREAS to date FEMA has approved FEMA Project Worksheets in the amount of $713,777.56; and
WHEREAS each project submission will have a similar but separate grant agreement award from FEMA with
reference to the individual project number and project name; and
WHEREAS the grant agreement has completed the Grant Review Process in accordance with the Grants Policy
approved by the Board at their January 21, 2021 meeting.
NOW THEREFORE BE IT RESOLVED that the Oakland County Board of Commissioners accepts grant
funding from FEMA for projects approved to date in the amount of $713,777.56.
BE IT FURTHER RESOLVED that the Oakland County Board of Commissioners authorizes and directs the
Chairperson of the Board to sign additional grant agreement projects related to FEMA COVID-19 submissions
up to the $8,300,000 of documented FEMA eligible costs.
BE IT FURTHER RESOLVED that acceptance of the FEMA grant funding does not obligate the County to
any future commitment.
BE IT FURTHER RESOLVED that the Oakland County Board of Connnissioners will be provided with a
monthly report on the status of projects submitted to FEMA for reimbursement
BE IT FURTHER RESOLVED a budget amendment is not required.
Chairperson, the following Commissioners are sponsoring the foregoing Resolution: Penny Luebs.
Date. September 15, 2021
Hilarie Chambers, Deputy County Executive II
Date: September 15, 2021
Lisa Brown, County Clerk / Register of Deeds
COMMITTEE TRACKING
2021-08-24 Public Health & Safety - recommend and forward to Finance
2021-08-25 Finance - recommend to Board
2021-09-02 Full Board
VOTE TRACKING
Motioned by Commissioner Michael Gingell seconded by Commissioner William Miller III to adopt the
attached Grant: Fiscal Year (FY) 2021 Public Assistance Grant Agreement FEMA-4494-DR-MI - Application.
Yes: David Woodward, Michael Gingell, Robert Hoffman, Michael Spisz, Karen Joliat, Kristen Nelson,
Christine Long, Philip Weipert, Gwen Markham, Angela Powell, Thomas Kuhn, Marcia Gershenson,
William Miller III, Adam L. Kochenderfer, Yolanda Smith Charles, Charles Cavell, Gary R. McGillivray,
Janet Jackson, Penny Luebs (19)
No: None (0)
Abstain: None (0)
Absent: Commissioner Kowall, Cormnissioner Moss (2)
The Motion Passed.
ATTACHMENTS
1. Grant Review Sign -Off
2. 06 - 20 16a Assurances Non -Construction
3. 07 - 20 16b Assurances Construction
4. 08-20 —1
5. 09 - SF-LLL Disclosure of Lobbying Activities _fillablc
6. 10 - EMHSD-053 Audit Certification 022020
7. 11 - W9 2018
8. 13 - EMHSD-014 PAGP Project Quarterly Progress Report 01.2021
9. 03 - PA Electronic Checklist
10. 04 - GA - Oakland County - 040
11. 05 - 20 16 Summary for Assurances Checklist
STATE OF MICHIGAN)
COUNTY OF OAKLAND)
1, Lisa Brown, Clerk of the County of Oakland, do hereby certify that the foregoing resolution is a true and
accurate copy of a TCSCilutlon adopted by the Oakland County Board of Coaunissioners on September 2, 2021,
with the original record thereof now remaining in my office.
fn Testimony Whereof, 1 have hereunto set my hand and affixed the seal of the Circuit Court at Pontiac,
Michigan on Thursday, September 2, 2021.
Lisa Brown, Oakland CoumY Clerk/ Register of Deeds
GRANT REVIEW SIGN -OFF — Emergency Management & Homeland Security
2021 Public Assistance Grant Program FEMA - Grant Application (Greater than $50,000)
GRANT NAME: 2021 Public Assistance Grant Program FEMA
FUNDING AGENCY: FEMA-Disaster Recovery
DEPARTMENT CONTACT: Thom Hardesty/ 248-452-9578
STATUS: Grant - Application (Greater than $50,000)
DATE: 8/13/2021
Please be advised the captioned grant materials have completed internal grant review. Below are the returned
comments.
The Board of Commissioners' liaison committee resolution and grant application package (which should
include this sign -off and the grant application with related documentation) may be requested to be placed on the
agenda(s) of the appropriate Board of Commissioners' committee(s) for grant acceptance by Board resolution.
DEPARTMENT REVIEW
Management and Budget:
Approved by M & B — 8/12/2021.
I made some suggested edits to the draft resolution. — Lynn Sonkiss (08/12/21)
Human Resources:
Approved by Human Resources. No position implications, so HR action is not needed. — Heather Mason
(08/ 13/21)
Risk Management:
Application approved by Risk Management. — Robert Erlenbeek (08/ 1 1 /21)
Corporation Counsel:
The Application is approved by Corporation Counsel as to there being no unresolved legal issues.— Robert
Rottach (08/ 12/21)
Holly Conforti
Oakland County Fiscal Services
2100 Pontiac Lake Rd
Waterford MI 48328
Office (248) 858-0821
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U.S DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
ASSURANCES-NONCONSTRUCTION PROGRAMS
O.M.B. No. 1660-0025
Expires July 31, 2007
Paperwork Burden Disclosure Notice
Paperwork reporting burden for this form is estimated to average 1.7 hours per response The burden estimate includes the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing, reviewing, and submitting the form You are not required to
'_- respond to this collection of information unless a valid OMB control number appears in the upper right corner of this form, Send comments regarding the
accuracy of the burden estimate and any suggestions for reducing the burden estimate to: Information Collection Management, U. S. Department of
- Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472. NOTE: Do not send your completed form to
the above address.
NOTE:
Certain of these assurances may not be applicable to your project or program. If you have any questions, please contact the awarding agency. Further,
certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant
- 1 Has the legal authority to apply for Federal assistance, and the
institutional, managerial and financial capability (including funds sufficient
to pay the non -Federal share of project costs) to ensure proper planning,
management and completion of the project described in this application.
2. Will give the awarding agency, the comptroller General of the United
States, and if appropriate, the State, through any authorized
= representative, access to and the right to examine all records, books,
_ papers, or documents related to the award, and will establish a proper
accounting system in accordance with generally accepted accounting
standards or agency directives.
3. Will establish safeguards to prohibit employees from using their
_ positions for a purpose that constitutes or presents the appearance of
personal gain.
4. Will initiate and complete the work within the applicable time frame after
receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42
U.S.C. Section 4727-4763) relating to prescribed standards for merit
systems for programs funded under one of the nineteen statues or
regulations specified in Appendix A of OPM's Standards for Merit System
of Personnel Administration (5 C F.R. 900, Subpart F).
6. Will comply with all Federal statues relating to nondiscrimination. These
include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.
L. 88-352) which prohibits discrimination on the basis of race, color, or
national origin; (b) Title IV of the Education Amendments of 1972, as
amended (20 U.S.C. Sections 1681-1683, and 1685-1686), which prohibits
discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act
of 1973, as amended (29 U.S.C. Section 794), which prohibits
discrimination on the basis of handicaps; (d) the Age Discrimination Act of
1975, as amended (42 U.S.C. Sections 6101-6107), which prohibits
discrimination on the basis of age, (a) the Drug Abuse Office and
Treatment Act of 1972 (P.L. 92-255), as amended, relating to
nondiscrimination on the basis of drug abuse; (f) the Comprehensive
Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970,) P.L. 91-616), as amended, relating to nondiscrimination on
the basis of alcohol abuse or alcoholism; (g) Sections 523 and 527 of the
Public Health Service Act of 1912, (42 U.S.C. 290-dd-3 and 290 ee-3), as
amended, relating to confidentiality of alcohol and drug abuse patient
records; (h) Title Vill of the Civil Rights Acts of 1968 (42 U.S.C. Section
3601 et. seq.), as amended, relating to nondiscrimination in the sale, rental
or financing of housing; (I) any other nondiscrimination provision in the
specific statue(s) under which application for Federal assistance is being
made; and 0) the requirements of any other nondiscrimination statue(s)
which may apply to the application.
7. Will comply, or has already complied, with the requirements of Title II
and III of the Uniformed Relocation Assistance and Real Property
Acquisition Policies Act of 1970 (P.L 91-646) which provides for fair and
equitable treatment of persons displaced or whose property is acquired as
a result of Federal or Federally assisted programs. These requirements
apply to all interest in real property acquired for project purposes
regardless of Federal participation in purchase.
8. Will comply with provisions of Hatch Act (5 U S.C. Sections 1501-1508
and 7324-7328) which limit the political activities of employees whose
principle employment activities are funded in whole or in part with Federal
funds.
9, Will comply, as applicable, with the provisions of the Davis -Bacon Act
(40 U.S.C. Sections 276a to 276a-7) the Copeland Act (40 U.S.C. Section
276c and 18 U S C Sections 874), and the Contract Work Hours and
Safety Standards Act (40 U.S C. Sections 327-333), regarding labor
standards for federally assisted construction subagreements.
10 Will comply, If applicable with flood insurance purchase requirements -
of Section 102a of the Flood Disaster Protection Act of 1973 (P.L. 93-234) -
which requires recipients in a special flood hazard area to participate in the -
program and to purchase flood insurance if the total cost of insurable
construction and acquisition is $10,000 or more
11. Will comply with environmental standards which may be prescribed
pursuant to the following, (a) institution of environmental quality control
measures under the National Environmental Policy Act of 1969 (P.L.
91-190) and Executive Order (EO) 11514; (b) notification of violating
facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO
11990, (it) evaluation of flood hazards in floodplains in accordance with EO
11988;(e) assurance of project consistency with the approved State
management program developed under the Coastal Zone Management
Act of 1972 (16) U.S.C. Sections 1451 of sec.); (f) conformity of Federal
actions to State (Clear Air) Implementation Plans under Section 176 (c) of
the Clear Air Act of 1955, as amended (42 U S C Section et seq.); (g)
protection underground sources of drinking water under Safe Drinking
Water Act of 1974, as amended, (P.L 93-523), and (h) protection of
endangered species under the Endangered Species Act of 1973, as
amended, (P.L. 93-205).
12. Will comply with the wild and Scenic Rivers Act of 1968 (16 U.S.0
Sections 1271 et seq.) related to protecting components of the national
wild and scenic rivers systems.
13. Will assist the awarding agency in assuring compliance with Section
106 of the National Historic Preservation Act of 1966, as amended (16
I C. 470), EO 11593 (identification and protection of historic properties),
and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C.
469a-et seq )
14 Will comply with P.L 93-348 regarding the protection of human subjects
involved in research, development, and related activities supported by this
award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L.
89-544, as amended, 7 U.S.C. 2131 et seq.) pertaining to the care,
handling, and treatment of warm blooded animals held for research,
teaching, or other activities supported by this award of assistance
16. Will comply with the Lead -Based Paint Poising Prevention Act (42
U.S.C. Sections 4801 et seq.) which prohibits the use of lead based paint
in construction or rehabilitation of residence structures
17 Will cause to be performed the required financial and compliance
audits in accordance with the Single Audit Act of 1984.
18 Will comply with all applicable requirements of all other Federal laws,
executive orders, regulations and policies governing this program.
19. It will comply with the minimum wage and maximum hours provisions
of the Federal Fair Labor Standards Act (29 U.S.C. 201), as they apply to
employees of institutions of higher education, hospitals, and other
non-profit organizations.
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FEMA Form 20-16A, OCT 04 PREVIOUS EDITION OBSOLETE
U. S. DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
ASSURANCES -CONSTRUCTION PROGRAM
O.M.B. No. 1660-0025
Expires July 31, 2007
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 1 7 hours per response. The burden estimate includes the time for reviewing instructions and
searching existing data sources, gathering and maintaining the data needed and completing, and submitting the form. You are not required to respond to
this collection of information unless a valid OMB control number appears in the upper right corner of this form. Send comments regarding the accuracy of
the burden estimate and any suggestions for reducing the burden to: Information Collections Management, U. S Department of Homeland Security, Federal
- Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Project (1660-0001). NOTE: Do not send your
completed form to this address.
NOTE"
Certain of these assurances may not be applicable to your protect or program. If you have questions, please contact the Awarding Agency. Further, certain =
federal assistance awarding agencies may require applicants to certify additional assurances. If such is the case, you will be notified. -
As the duly authorized representative of the applicant, I certify that the applicant:
1 Has the legal authority to apply for Federal assistance, and the
institutional, managerial and financial capability (including funds
sufficient to pay the non -Federal Share of project cost) to ensure
proper planning, management, and completion of the project
described in this application.
2 Will give the awarding agency, the comptroller General of the
United States, and if appropriate, the States, through any
authorized representative, access to and the right to examine all
records, books, papers, or documents related to the assistance;
and will establish a paper accounting system in accordance with
generally accepted accounting standards or agency directives
3. Will not dispose of, modify the use of, or change the terms of
the real property title, or other interest in the site and facilities
without permission and instructions from the awarding agency.
Will record the Federal interest in the title of real property in
accordance with awarding agency directives and will include a
covenant in the title of real property acquired in whole or in part
with Federal assistance funds to assure nondiscrimination during
the useful life of the project.
4 Will comply with the requirements of the assistance awarding
agency with regard to the drafting, review and approval of
construction plans and specifications
5 Will provide and maintain competent and adequate engineering
supervision at the construction site to ensure that the complete
work conforms with the approved plans and specifications and will
famish progress reports and such other information as may be
required by the assistance awarding agency or state
6. Will initiate and complete the work within the applicable time
frame after receipt of approval of the awarding agency.
7. Will establish safeguards to prohibit employees from using their
positions for a purpose that constitutes or presents the
appearance of personal or organizational conflict to interest, or
personal gain.
8. Will comply with Intergovernmental Personnel Act of 1970 (42
U.S.C. Sections 4728-4763) relating to prescribed standards for
merit systems for programs funded under one of the nineteen
statues or regulations specified in Appendix A of OPM's standards
for a Merit System of Personnel Administration (5 C.F.R.
900-subpart F)
9 Will comply with the Lead -Based Paint Poisoning Prevention
Act (42 U.S.0 Sections 4801-et seq.) which prohibits the use of
lead based paint in construction or rehabilitation of residence
structures.
10 Will comply with all Federal statues relating to
non-discrimination. These include but are not limited to (a) Title
VI of the Civil Rights Act of 1964 IF L. 88-352) which prohibits
discrimination on the basis of race, color or national origin; (b)
Title IX of the Education Amendments of 1972, as amended (20
U.S.C. Sections 1681-1683, and 1685-1686) which prohibits
discrimination on the basis of sex; (c) Section 504 of the
Rehabilitation Act of 1973, as amended (29 U S C. Sections 794)
which prohibits discrimination on the basis of; (d) the Age
Discrimination Act of 1975, as amended (42 U.S.C. Sections
6101-61-7) which prohibits discrimination on the basis of age; (a)
the Drug Abuse Office Treatment Act of 1972 (P.L. 93-255), as
amended, relating to non-discrimination on the bases of abuse;
(f) the Comprehensive Alcohol Abuse and Alcoholism Prevention,
Treatment and Rehabilitation Act of 1970
(P.L 91-616), as amended, relating to nondiscrimination on the
bases of alcohol abuse or alcoholism; (g) Sections 523 and 527 of
the Public Health Service Act of 1912 (42 U.S.C. 290 dd-3 and
290 ee-3), as amended, relating to confidentiality of alcohol and
drug abuse patient records; (h) Title VIII of the Civil Rights Act of
1968 (42 U.S.C. Sections of seq.), as amended, relating to
non-discrimination in the sale, rental or financing of housing, (Q
and other non-discrimination provisions in the specific statutes(s)
under which application for Federal assistance is being made, and
0) the requirements on any other non-discrimination Statues(s)
which may apply to the application.
11. Will comply, or has already complied, with the requirements of
Title II and III of the Uniform Relocation Assistance and Real
Property Acquisition policies Act of 1970 (P.L. 91-646) which
provides for fair and equitable treatment of persons displaced or
whose property is acquired as a result of Federal and Federally
assisted programs These requirements apply to all interest in
real property acquired for project purpose regardless of Federal
participation in purchases.
12. Will comply with the provisions of the Hatch Act (5 U.S.C.
Sections 1501-1508 and 7324-7328) which limit the political
activities of employment activities are funded in whole or impart
with Federal funds.
13. Will comply, as applicable, with the provisions of the
Davis -Bacon Act (40 U S.C. Sections 27a to 276a-7), the
Copeland Act (40 U.S.0 Section 276c and 18 U.S.C. Section
874), the Contract Work Hours and Safety Standards Act (40
U S.C. Sections 327-333) regarding labor standards for Federally
assisted construction subagreements.
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FEMA Form 20-16B, OCT 04 PREVIOUS EDITION OBSOLETE
14. Will comply with the flood insurance purchase requirements of
Section 102(a) of the Flood Disaster Protection Act of 1973 jP L.
93-234) which requires recipients in a special flood hazard area to
participate in the program and to purchase flood insurance in the
a total cost of insurable construction and acquisition is $ 10,000 or
more.
15. Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National
Environmental Policy Act of 1969 (P L 91-190) and Executive
Order (E.O.) 11514; (b) notification of violating facilities pursuant
to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d)
evaluation of flood hazards in floodplains in accordance with EO
11988; (e) assurance of project consistency with the approved
State management programs developed under the Coastal Zone
Management Act of 1973 (16 U.S.C. Sections 1451 et sec.); (f)
conformity of Federal actions to State (Clean Air) Implementations
�_ Plans under Section 176(c) of the Clean Air Act of 1955, as
amended (42 U.S.C. Section 7401 et seq.); (g) protection of
underground sources of drinking water under the Safe Drinking
Water Act of 1974, as amended, (P.L 93-523); (H) Protection of
Endangered species Act of 1973, as amended, (P.L. 93-205).
16. Will comply with the Wild and Scenic Rivers Act of 1968 (16
U.S.C. Sections 1271 et seq.) related to protecting components or
potential components of the national wild and scenic rivers
system.
17. Will assist the awarding agency in assuring compliance with
Section 106 of the National Historic Preservation Act of 1966, as
amended (16 U.S.C. 470), EO 11593 (identification and
preservation of historic properties), and the Archaeological and
Historic Preservation Act of 1974 (16 JLS.0 41 et seq )
18. Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit Act of
1984
19 Will comply with all applicable requirements of all other
Federal laws, Executive Orders, regulations and policies
governing this program.
20. It will comply with the minimum wage and maximum hours
provisions of the Federal Fair Labor Standards Act (29 U S C.
201), as they apply to employees of institutions of higher
education, hospitals, and other non-profit organizations.
21. It will obtain approval by the appropriate Federal agencies of
the final working drawings and specifications before the project is
advertised or placed on the market for bidding; that it will
construct the project, or cause it to be constructed, to final
completion in accordance with the application and approved plans
and specifications; that it will submit to the appropriate Federal
agency for prior approval changes that alter the cost of the
project, use of space, or functional layout, that it will not enter into
a construction contract(s) for the project or undertake other
activities until the conditions of the construction grant programs)
have been met.
22. It will operate and maintain the facility in accordance with the
minimum standards as may be required or prescribed by the
applicable Federal, State, and local agencies for the maintenance
and operation of such facilities.
23. It will require the facility to be designed to comply with the "American
Standard Specifications for Making Buildings and Facilities Accessible to,
and Usable by, the Physically Handicapped,' Number A117-1961, as
modified (41 CFR 101-17.703) The applicant will be responsible for
conducting inspections to ensure compliance with these specifications by
the contractor.
24 If any real property or structure thereon is provided or improved with
the aid of Federal financial assistance extended to the applicant, this
assurance shall obligate the applicant, or in the case of any transfer of such
property, any transferee, for the period during which the real property or
structure is used for a purpose for which the Federal financial assistance is
extended or for another purpose involving the provision of similar services
or benefits.
25. In making subgrants with nonprofit institutions under this
Comprehensive Cooperative Agreement, it agrees that such grants will be
subject to OMB Circular A-122, "Cost Principles for Non-profit
Organization" including but not limited to, the "Lobbying Revision"
published in vol 49, Federal Register, pages 18260 through 18277 (April
27, 1984).
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U S DEI
FEDERAL
Loin. is] uf:11W12 �E9xfl�I:7IV1
PAPERWORK BURDEN DISCLOSURE NOTICE
4 AND
IREMENTS
O.M.B. No. 7660-0025
Expires Jury 31, 2007
Public reporting burden for this form is estimated to average 1.7 hours per response. The burden estimate mcludes the time for reviewing instructions and
searching existing data sources, gathering and maintaining the data needed and completing, and submitting the form. You are not required to respond to
this collection of information unless a valid OMB control number appears in the upper right corner of this form. Send comments regarding the accuracy of
the burden estimate and any suggestions for reducing the burden to: Information Collections Management, U.S. Department of Homeland Security, Federal
Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction Project (1660-0001). NOTE: Do not send your
completed form to this address.
Applicants should refer to the regulations cited below to determine the certification to which they are required to attest Applicants should also review the
4 instructions for certification included in the regulations before completing this form. Signature of this form provides for compliance with certification
requirements under 44 CFR Part 18, "New Restrictions on Lobbying" and 28 CFR Part 17, "Government -wide Debarment and Suspension (Nonprocurement)
and Government -wide Requirements for Drug -Free Workplace (Grants),." The certifications shall be treated as a material representation of fact upon which
reliance will be placed when the Federal Emergency Management Agency (FEMA) determines to award the transaction, grant, or cooperative agreement.
1. LOBBYING
As required by section 1352, Title 31 of the U.S Code, and implemented
at 44 CFR Part 18, for persons entering into a grant or cooperating
- agreement over $ 100,000, as defined at 44 CFR Part 18, the applicant
certifies that:
(a) No Federal appropriated funds have been paid or will be paid, by or on
- behalf of the undersigned, to any person for influencing or attempting to
influence an officer or employee of any agency, a Member of Congress,
an officer or employee of Congress, or an employee of a Member of
Congress in connection with the making of any Federal grant, the entering
into of any cooperative agreement, and the extension, continuation ,
renewal, amendment, or modification of any Federal grant or cooperative
agreement.
I If any other funds than Federal appropriated funds have been paid or
will be paid to any other person for influencing or attempting to influence
an officer or employee of any agency, a member of Congress, an officer
or an employee of Congress, or employee of a member of Congress in
connection with this Federal Grant or cooperative agreement, the
undersigned shall complete and submit Stand Form-LLL, "Disclosure of
Lobbying Activities,' in accordance with its instructions
(c) The undersigned shall require that the language of this certification be
included in the award documents for all subawards at all tiers (including
subgrants, contracts under grants and cooperative agreements, and
subcontracts) and that all subrecipients shall certify and disclose
accordingly.
gStandard Form-LLL "Disclosure of Lobbying Activities" attached
(This form must be attached to certification if nonappropriated funds are to
be used to influence activities.)
2. DEBARMENT,SUSPENSION, AND OTHER RESPONSIBILITY
MATTERS (DIRECT RECIPIENT)
As required by Executive Order 12549, Debarment and Suspension, and
implemented at 44 CFR Part 67, for prospective participants in primary
covered transactions, as defined at 44 CFR Part 17, Section 17.511
The applicant certifies that it and its principals:
(a) Are not presently debarred, suspended, proposed for debarment,
declared ineligible, sentenced to a denial of Federal benefits by a State or
Federal court, or voluntarily excluded from covered transactions by any
Federal department or agency;
(b) Have not within a three-year period preceding this application been
convicted of a or had a civilian judgment rendered against them for
commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or perform a public a public (Federal ,State, or local)
transaction or contract under a public transaction; violation of Federal or
State antitrust statutes or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or
receiving stolen property;
I Are not presently indicted for otherwise criminally or civilly charged by a
governmental entity (Federal, State, or local) with commission of any of the
offenses enumerated in paragraph (1) (b) of this certification; and
(d) Have not within a three-year period preceding this application had one or
more public transactions (Federal, State, or local) terminated for cause of
default, and
B. Where the applicant is unable to certify to any of the statements in this
certification, he or she shall attach an explanation to this application.
3. DRUG -FREE WORKPLACE
(GRANTEE OTHER THAN INDIVIDUALS)
As required by the Drug -Free Workplace Act of 1988, and implemented at
44 CFR Part 17, Subpart F, for grantees, as defined at 44 CFR Part 17.615
and 17.620-
A. The applicant certifies that it will continue to provide a drug -free
workplace by;
(a) Publishing a statement notifying employees that the unlawful
manufacture, distributions
(b) Establishing an on -going drug free awareness program to inform
employees about-
(1) The dangers of drug abuse in the workplace;
(2) The grantee's policy of maintaining a drug -free workplace;
(3) Any available drug counseling, rehabilitation, and
employee assistance programs; and
(4) The penalties that may be imposed upon employees
for drug abuse violations occurring in the workplace;
(c) Making it a requirement that each employee to be engaged in the
performance of the grant to be given a copy of the statement required by
paragraph (a);
(d) Notifying the employee in the statement required by paragraph (a) that,
as a condition of employment under the grant, the employee will-
(1) Abide by the term of the statement; and
(2) Notify the employee in writing of his or her conviction for a
violation of a criminal drug statute occurring ion the workplace no
later than five calendar days after such convections,
(a) Notifying the agency, in writing, with 10 calendar days after receiving
notice under subparagraph (d)(2) from an employee or otherwise receiving
actual notice of such conviction. Employers of convicted employees must
provide notice, including position, title, to the applicable FEMA awarding
office, i.e., regional office or FEMA office.
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FEMA Form 20-16C, OCT 04 PREVIOUS EDITION OBSOLETE
I (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
V convicted-
(1) Taking appropriate personnel action against such an employee,
up to and including termination, consistent with the requirements of
the Rehabilitation act of 1973, as amended; or
(2) Requiring such an employee to participate satisfactorily in a
drug abuse assistance or rehabilitation program approved for such
purposes by a Federal, State, or local health, law enforcement, or
other appropriate agency;
' (g) Making a good faith effort to continue to maintain a drug free workplace
i through implementation of paragraphs (a),(b),(c),(d),(e) and if).
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 y If there are workplaces on file that are not identified
here.
Section 17.630 of the regulations provide that a grantee that is a
State may elect to make one certification in each Federal fiscal
year. A copy of which should be included with each application for
FEMA funding. States and State agencies may elect to use a
state wide certification.
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DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352
1. * Type of Federal Action:
2. * Status of Federal Action:
11 a contract
❑ a, hololferlappticabon
FRIu b grant
❑X b, initial award
11 c cooperative agreement
❑ c. post award
d loan
11 e loan guarantee
f, loan insurance
4. Name and Address of Reporting Entity:
IX-1Pnme F-1SubAwardee
Name E
Street 1
'Illy State'
Congressional District, dknown I
6. * Federal Department/Agency:
P
8. Federal Action Number, if known:
10. a. Name and Address of Lobbying Registrant:
Prefix Firsf Name
'Last Name
Street 1 1
Cry 1 I State 1
Street 2
3. * Report Type:
Xa. initial film,
1-1 U. malone change
Ell ZIP
7. * Federal Program NamelDescription:
CFDA Number, dappl¢able 1
9. Award Amount, if known:
$I I
Approved by OMB
4040-0013
Middle Name I I
1 Suffix �I
Sideef2 u
Zip 0
b. Individual Performing Services (including address if different from No. IOa)
Prefix �� * First Name I ' Middle Name
' Last N�iame I L�J..ii�i i I Suffix
Streel1 1
I Street 2 1
City I I State I I Zip 0
11. Information requested through this form is authorized by title 31 U.S.C. sedmn 1352 This disclosure of lobbying activities is a material representation of fact upon which
reliance was placed by the tier above when the transaction was made or entered into This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to
the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall he subs to a civil penalty of not less than
$10,000 and not more than $100,000 for each such failure.
* Signature: I
'Name: Prefix First Name) Middle Name
'Last Name Suffix
Title: ( Telephone No.: Date: 1
_ _ _ Amnor dforrocal Roaroeumon
SfanJard form - LLLIRev. ]A]l
ICHIGAN STATE POLICE IUD
%rgency Management,
and Homeland SecurityDivision
CERTIFICATION Division
AU®'
AUTHORITY: MCL 30.407a and 2 CFR Part 200, Subpart F,
COMPLIANCE: Voluntary, but necessary to be considered for grant assistance.
Federal Audit Requirements:
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 2 CFR Part 200, Subpart F. Subrecipients 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,
P.O. Box 30634, Lansing, Michigan 48909.
Submit completed document to:
Michigan State Police
Emergency Management,
and Homeland Security Division
PO Box 30634
Lansing, Michigan 48909
I. Program Information _
Program Name CFDA Number
11. Subrecipient Information
Subrecipient Name
Street Address
Ill. Certification for Fiscal Year
City
State ZIP Code
Subrecipient Fiscal Year Period. to
I certify that the Subrecipient shown above does NOT expect it will be required to have an audit performed under 2 CFR Part 200, Subpart F,
for the above listed program.
I certify that the Subrecipient shown above expects it will be required to have an audit performed under 2 CFR Part 200, Subpart F, 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, P.O. Box 30634, Lansing, Michigan 48909.
Signature of Subrecipient's Authorized Representative
Submit Audit Report to:
Michigan State Police
Grants and Community Services Division
PO Box 30634
Lansing, Michigan 48909
Submit this completed audit certification form and return with your grant agreement to:
Michigan State Police
Emergency Management,
and Homeland Security Division
PO Box 30634
Lansing, Michigan 48909
Date
Form ® Request for Taxpayer
(Rev. October 2( Identification Number and Certification
Department of the Treasury
Internal Revenue Service ► Go to www.irs grcv/FonnW9 for instructions and the latest information.
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
Give Form to the
requester. Do not
send to the IRS.
3 Check appropriate box for federal tax classification of the person whose name Is entered on line 1. Check only one of the 4 Exemptions (codes apply only to
following seven boxes. certain entitles, not Individuals; see
instructions on oaae 3).
❑ Individual/sole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate
single -member LLC
Exempt payee code (if any)
❑ Limped liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ►
Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check Exemption from FATCA reporting
LLC if the LLC is classified as a single -member FLC that is disregarded from the owner unless the owner of the LLC is code (if any)
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
❑ Other (see instructions)► feppoe:ma«o��r�ma,ma,�Pn o,nsme rt,�us)
5 Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional)
6 City, state, and ZIP code
7 List account number(s) here (optional)
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
I social security number
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
—
' T
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN, later.
or
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and I Employer identification number
Number To Give the Requester for guidelines on whose number to enter. M
KOM 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. 1 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. 1 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 for Part 11, later.
Sign Signature of
Here I U.S. person►
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who Is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(FIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099-INT (interest earned or paid)
Date ►
• 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-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third 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 W-9 only if you are a U.S. person (Including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
Cat. No. 10231X Form W-9 (Rev. 10-2018)
Form W-9 (Rev. 10-2018)
Paqe 2
By signing the filled -out form, you
1. Certify that the TIN you are giving is correct (or you are waiting fat a
number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt
payee. If applicable, you are also certifying that as a U.S. person, your
allocable share of any partnership income from a U.S. trade or business
is not subject to the withholding 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, later, for further information.
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 put poses, 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).
Special rules for partnerships. Partnerships that conduct a trade or
business in the United States are generally required to pay a withholding
tax under section 1446 on any foreign partners' share of effectively
connected taxable income from such business. Further, in certain cases
where a Form W-9 has not been received, the rules under section 1446
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
Pub. 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 provision known as a "saving clause." Exceptions
specified in the saving clause may permit an exemption from tax to
continue for certain types of income even after the payee has otherwise
become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception
contained in the saving clause of a tax treaty to claim an exemption
from U.S. tax on certain types of income, you must attach a statement
to Form W-9 that specifies the following five items.
1. The treaty country. Generally, this must be the same treaty under
which you claimed exemption from tax as a nonresident alien.
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that contains the
saving clause and its exceptions.
4. The type and amount of income that qualifies for the exemption
from tax.
5. Sufficient facts to justify the exemption from tax under the terms of
the treaty article.
Example. Article 20 of the U.S.-China income tax treaty allows an
exemption from tax for scholarship income received by a Chinese
student temporarily present in the United States. Under U.S law, this
student will become a resident alien for tax purposes if his or her stay in
the United States exceeds 5 calendar years. However, paragraph 2 of
the first Protocol to the U.S.-China treaty (dated April 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 24% 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 subject to backup
withholding.
You will not he subject to backup withholding on payments you
receive if you give the requester your correct TIN, make the proper
certifications, and report all your taxable interest and dividends on your
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 not certify your TIN when required (see the instructions for
Part II 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, later, and the separate Instructions for the
Requester of Form W-9 for more information.
Also see Special rules for partnerships, earlier.
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, later, 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 if
the name or TIN changes for the account; for example, if the grantor of a
grantor trust dies.
Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN to a
requester, you are subject to a penalty of $50 for each such failure
unless your failure is due to reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. If you
make a false statement with no reasonable basis that results in no
backup withholding, you are subject to a $500 penalty.
Fonn W-9 (Rev. 10 2018)
Page 3
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 tax return.
If this Form W-9 is for a joint account (other than an account
maintained by a foreign financial institution (FFI)), list first, and then
circle, the name of the person or entity whose number you entered in
Part I of Form W-9. If you are providing Form W-9 to an FFI to document
a joint account, each holder of the account that is a U.S. person must
provide a Form W-9.
a. Individual. Generally, enter the name shown on your tax return. If
you have changed your last name without informing the Social Security
Administration (SSA) of the name change, enter your first name, the last
name as shown on your social security card, and your new last name.
Note: ITIN applicant: Enter your individual name as it was entered on
your Form W-7 application, line 1 a. This should also be the same as the
name you entered on the Form 1040/1040A/1040EZ you filed with your
application.
b. Sole proprietor or single -member LLC. Enter your individual
name as shown on your 1040/1040A/1040EZ on line 1. You may enter
your business, trade, or "doing business as" (DBA) name on line 2.
c. Partnership, LLC that is not a single -member LLC, C
corporation, or S corporation. Enter the entity's name as shown on the
entity's tax return on line 1 and any business, trade, or DBA 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 DBA 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 be the
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. If
the direct owner of the entity is also a disregarded entity, enter the first
owner that is not disregarded for federal tax purposes. Enter the
disregarded entity's name on line 2, "Business name/disregarded entity
name." If the owner of the disregarded entity is a foreign person, the
owner must complete an appropriate Form W-8 instead of a Form W-9.
This is the case even if the foreign person has a U.S. TIN.
Line 2
If 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 on line 3 for the U.S. federal tax
classification of the person whose name is entered on line 1. Check only
one box on line 3.
IF the entity/person on line 1 is
THEN check the box for. .
a(n) ...
• Corporation
Corporation
• Individual
Individual/sole proprietor or single-
• Sole proprietorship, or
member LLC
• Single -member limited liability
company (LLC) owned by an
individual and disregarded for U S.
federal tax purposes.
• LLC treated as a partnership for
Limited liability company and enter
U.S. federal tax purposes,
the appropriate tax classification.
• LLC that has filed Form 8832 or
(P= Partnership; C= C corporation;
2553 to be taxed as a corporation,
or S- S corporation)
or
• LLC that is disregarded as an
entity separate from its owner but
the owner is another LLC that is
not disregarded for U.S. federal tax
purposes.
• Partnership Partnership
• Trust/estate Trust/estate
Line 4, Exemptions
If you are exempt from backup withholding and/or FATCA reporting,
enter in the appropriate space on 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
Fo, n VV-9 (Rev 10-2018)
Page 4
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
Barter exchange transactions and
patronage dividends
Payments over $600 required to be
reported and direct sales over
$5,000'
Exempt payees 1 through 4 and 6
through 11 and all C corporations
S corporations must not enter an
exempt payee code because they
are exempt only for sales of
noncovered securities acquired
prior to 2012.
Exempt payees 1 through 4
Generally, exempt payees
1 through 52
Payments made in settlement of Exempt payees 1 through 4
payment card or third party network
transactions
t See Form 1099-MISC, Miscellaneous Income, and its instructions
2 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' fees, gross
proceeds paid to an attorney reportable under section 6045(f), and
payments for services paid by a federal executive agency.
Exemption from FATCA reporting code. The following codes identify
payees that are exempt from reporting under FATCA. These codes
apply to persons submitting this form for accounts maintained outside
of the United States by certain foreign financial institutions. Therefore, if
you are only submitting this form for an account you hold in the United
States, you may leave this field blank. Consult with the person
requesting this form if you are uncertain 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 501(a) or any
individual retirement plan as defined in section 7701(a)(37)
B—The United States or any of its agencies or instrumentalities
C—A state, the District of Columbia, a U.S. commonwealth or
possession, or any of their political subdivisions or instrumentalities
D—A corporation the stock of which is regularly traded on one or
more established securities markets, as described in Regulations
section 1.1472-1(c)(1)(i)
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)(1)
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 581
K—A broker
L—A trust exempt from tax under section 664 or described in section
4947(a)(1)
M—A tax exempt trust under a section 403(b) plan or section 457(g)
plan
Note: You may wish to consult with the financial institution requesting
this form to determine whether the FATCA code and/or exempt payee
code should be completed.
Line 5
Enter your address (number, street, and apartment or suite number).
This is where the requester of this Form W-9 will mail your information
returns. If this address differs from the one the requester already has on
file, write NEW at the top. If a new address is provided, there is still a
chance the old address will be used until the payor changes your
address in their records.
Line 6
Enter your city, state, and ZIP code.
Part I. Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. If you are a resident alien and
you do not have and are not eligible to get an SSN, your TIN is your IRS
individual taxpayer identification number (ITIN). Enter it in the social
security number box. If you do not have an ITIN, see How to get a TIN
below.
If you are a sole proprietor and you have an EIN, you may enter either
your SSN or EIN.
If you are a single -member LLC that is disregarded as an entity
separate from its owner, enter the owner's SSN (or EIN, if the owner has
one). Do not enter the disregarded entity's FIN. If the LLC is classified as
a corporation or partnership, enter the entity's EIN.
Note: See What Name and Number To Give the Requester, later, for
further clarification of name and TIN combinations.
How to get a TIN. If you do not have a TIN, apply for one immediately.
To apply for an SSN, get Form SS-5, Application for a Social Security
Card, from your local SSA office or get this form online at
www.SSA.gov. You may also get this form by calling 1-800-772-1213.
Use Form W-7, Application for IRS Individual Taxpayer Identification
Number, to apply for an ITIN, or Form SS-4, Application for Employer
Identification Number, to apply for an FIN. You can apply for an EIN
online by accessing the IRS website at www.irs.gov/Businesses and
clicking on Employer Identification Number (EIN) under Starting a
Business. Go to www.irs.gov/Forms to view, download, or print Form
W-7 and/or Form SS-4. Or, you can go to www.irs.gov/OrderForms to
place an order and have Form W-7 and/or SS-4 mailed to you within 10
business days.
If you are asked to complete Form W-9 but do not have a TIN, apply
for a TIN and write "Applied For" in the space for the TIN, sign and date
the form, and give it to the requester. For interest and dividend
payments, and certain payments made with respect to readily tradable
instruments, generally you will have 60 days to get a TIN and give it to
the requester before you are subject to 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-8.
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 item 1, 4, or 5 below indicates otherwise.
For a joint account, only the person whose TIN is shown in Part I
should sign (when required). In the case of a disregarded entity, the
person identified on line 1 must sign. Exempt payees, see Exempt payee
code, earlier.
Signature requirements. Complete the certification as indicated in
items 1 through 5 below.
Forrn W-9(Rev 10-2018)
Page 5
i. 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 nonemployee for services, payments made in settlement of payment
card and third party network transactions, payments to certain fishing
boat crew members and fishermen, and gross proceeds paid to
attorneys (Including payments to corporations).
5. Mortgage interest paid by you, acquisition or abandonment of
secured property, cancellation of debt, qualified tuition program
payments (under section 529), ABLE accounts (under section 529A),
IRA, Coverdell ESA, Archer MSA or HSA contributions or
distributions, and pension distributions. You must give your correct
TIN, but you do not have to sign the certification
What Name and Number To Give the Requester
For this type of account: Give name and SSN of:
1 Individual The individual
2 Two or more individuals joint
The actual owner of the account or, If
account) other than an account
combined funds, the first individual on
maintained by an FFI
the account'
3. Two or more U.S. persons
Each holder of the account
(jomt account maintained by an FFI)
4. Custodial account of a minor
The mincrz
(Uniform Gift to Minors Act)
5. a. The usual revocable savings trust
the grantor -trustee
(grantor is also trustee)
b. So-called trust account that Is not
The actual owner'
a legal or valid trust under state law
6 Sole proprietorship or disregarded
The owner'
entity owned by an individual
7 Grantor trust filing under Optional
The grantor'
Form 1099 Filing Method 1 (see
Regulations section 1 671-4(b)(21(I)
(A))
For this type of account:
Give name and EIN of:
S. Disregarded entity not owned by an
The owner
individual
9. A valid trust, estate, or pension trust
Legal entity'
10. Corporation or LLC electing The corporation
corporate status on Form 8832 or
Form 2563
11. Association, club, religious, The organization
charitable, educational, or other tax-
exempt organization
12. Partnership or multi -member LLC The partnership
13 A broker or registered nominee The broker or nominee
For this type of account: Give name and EIN of:
14. Account with the Department of The public entity
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
15. Grantor trust filing under the Form The trust
1041 Filing Method or the Optional
Form 1099 Filing Method 2 (see
Regulations section 1.671-4(6)(2)(i)(13))
' List first and circle the name of the person whose number you furnish.
If only one person on a joint account has an SSN, that person's number
must be furnished.
z Circle the minor's name and furnish the minor's SSN.
' 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 SSN 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 trust. (Do
not furnish the TIN of the personal representative or trustee unless the
legal entity itself is not designated in the account title.) Also see Special
rules for partnerships, earlier.
*Note: The grantor also 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
such 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.
If 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 14039.
For more information, see Pub. 5027, Identity Theft Information for
Taxpayers.
Victims of identity theft who are experiencing economic harm or a
systemic 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 line at 1-877-777-4778 or TTY/tDD
1-800-829-4059,
Protect yourself from suspicious emails or phishing schemes.
Phishing is the creation and use of email and websites designed to
mimic legitimate business entails and websites. The most common act
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.
Finn W-9 (Rev. 10-2018)
Page 6
The IRS does not initiate contacts with taxpayers via emails. Also, me
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 receive an unsolicited email claiming to be from the IRS,
forward this message to phishing@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
spam@uce gov or report them at www.ftc.gov/complaint. You can
contact the FTC at www.ftc.gov/idtheft or 877-IDTHEFT (877-438-4338).
If you have been the victim of identity theft, see www IdentrtyTheft.gov
and Pub.5027.
Visit www,irs.gov/identityThaft 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 (including 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 laws. 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 3406, payers
must generally withhold a percentage of taxable interest, dividend, and
certain other payments to a payee who does not give a TIN to the payer.
Certain penalties may also apply for providing false or fraudulent
Information.
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., M
GRANT AGREEMENT
CFDA No: 97.036
Please complete and sign the following items, as necessary,
and email to:
MSP-EMHSD-DisasterPA@Michigan.gov
❑ 1. Grant Agreement.
The grant agreement is enclosed.
Please sign the last page and email the entire document to MSP/EMHSD at the email
above.
❑ 2. FEMA Form 20-16, Summary Sheet for Assurances and Certifications
❑ 3. FEMA Form 20-16A, Assurances Non -Construction Programs
❑ 4. FEMA Form 20-16B, Assurances Construction Programs
❑ 5. FEMA Form 20-16C, Certifications Regarding Lobbying; Debarment, Suspension and
Other Responsibility Matters; and Drug -Free Workplace Requirements
❑ 6. SF LLL, Disclosure of Lobbying Activities (if applicable)
❑ 7. W9, Request for Taxpayer Identification Number and Certification
❑ 8. EMHSD-053, Audit Certification
❑ 9. EMHSD-RA, Subrecipient Risk Assessment Certification
----------------------------------------------------------------
Important Reimbursement Information:
To receive payments from the State of Michigan, the Subrecipient must be registered as a vendor.
To register or check an account's current EFT information, visit the State of Michigan SIGMA Vendor
Self Service (VSS) online at https://sigma.michigan.gov/webapp/PRDVSS2Xl/AltSelfService. Failure to
maintain an active vendor account could delay reimbursement payments.
Post Reimbursement Requirements:
The Subrecipient is required to participate, with the Recipient, in an on -site monitoring of financial
documents. Retain financial records, supporting documents, and all other records pertinent to the grant
for at least three (3) years after the grant is closed by the awarding federal agency. Be sure to comply
with Single Audit requirements of Subpart F of 2 CFR 200. If required, the Subrecipient shall email
an audit copy to the Michigan State Police, Grants and Community Services Division at:
opsommerm2@michigan.gov.
For FEMA Public Assistance Grant Program questions, please contact Ms. Tiffany Vedder at:
VedderT@Michigan.gov or 517-599-5333
Stateof Fa'
Public c (PA) Grant •: i • .:
AgreementGrant
CFDA Number: 97.036
This Public Assistance Grant Agreement is hereby entered in to between the Michigan Department of State Police,
Emergency Management and Homeland Security Division (MSP/EMHSD) (hereinafter called the Recipient), and
OAKLAND (COUNTY)
(hereinafter called the Subrecipient)
Public Assistance ID Number: 125-99125-00
PW Number: PA-05-MI-4494-PW-00040(0)
Purpose
The purpose of this grant agreement is to provide supplementary financial assistance for disaster relief in eligible
areas within the state, including funds for emergency protective measures — actions taken to eliminate or lessen
immediate threats to lives, public health or safety. Eligible costs are outlined in the Federal Emergency
Management Agency's (FEMA), Public Assistance Program and Policy Guide, FP-104-009-2, April 2018 (PAPPG)
and FEMA COVID-19 Fact Sheets and Guidance.
Statutory Authority
The President of the United States declared a disaster for all counties in Michigan on March 27, 2020, under the
authority of the Robert T. Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C.§§ 5121-5207
(Stafford Act), in accordance with 44 CFR § 206.44. This disaster declaration is a result of the Coronavirus
(COVID-19) Pandemic for the incident period beginning January 20,2020.
The Subrecipient agrees to comply with all program requirements in accordance with FEMA guidance including,
but not limited to, FEMA's PAPPG (April 2018) and other guidance specific to COVID-19. Code of Federal
Regulations (CFR) documents are located online at http://www.ecfr.gov. The Subrecipient also agrees to comply
with regulations, including, but not limited to, the following, as applicable.
A. Administrative Requirements, Cost Principles, and Audit Requirements
1. Public Law 93-288, as amended, The Robert T. Stafford Disaster Relief and Emergency Assistance
Act, 42 U.S.C., 5121-5207, its implementing regulations contained in Title 44 of the Code of Federal
Regulations (CFR) and FEMA policy and guidance.
2. 2 CFR, Parts 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for
FederalAwards.
3, 44 CFR, Part 10, Environmental Considerations.
4. 44 CFR, Part 206, Federal Disaster Assistance (including Subparts G, H, and 1) Public Assistance
Project Administration, Public Assistance Eligibility, and Public Assistance Insurance Requirements.
B. FEMA Program Guidance
1. FP 104-009-2, Public Assistance Program and Policy Guide (April 2018).
2. FEMA COVID-19 Fact Sheets and Guidance are located online at
httiDs://www.fema.ciov/coronavirus/fact-sheets.
3. Public Assistance Management Costs Standard Operating Procedures (February 2019).
C. Other Federal Regulations
1. National Environmental Policy Act (NEPA).
2. 16 U.S.C. § 3501, Coastal Barrier Resources Act.
3. 16 U.S.C. § 470, National Historic Preservation Act.
4. 16 U.S.C. § 1531, Endangered Species Act References.
FEMA-4494-DR-MI
OAKLAND (COUNTY)
PA-05-M I-4494-P W -00040 (0 )
Page 2 of 10
5. The Federal Funding Accountability and Transparency Act (FFATA) (Public Law 109-282, as amended
by section 6202(a) of Public Law 110-252).
6. E.O. 11988, Floodplain Management.
7. E.O. 11990, Protection of Wetlands.
8. E.O. 12612, Federalism.
9. E.O. 12898, Environmental Justice.
10. E.O. 12699, Seismic Safety of Federal and Federally Assisted or Regulated New Building
Construction.
Award Amount and Restrictions
The Federal Emergency Management Agency (FEMA) will determine program eligibility and grant amounts.
Federal assistance will be made available, within the limits of funds available from Congressional appropriations
for such purposes, in accordance with the Stafford Act, Executive Orders 12148, as amended, and 12673,
applicable regulations found in Title 44 of the Code of Federal Regulations (CFR), and applicable policy and
guidance. Presidential directive issued February 2, 2021, allows FEMA to pay 100% federal funding (Federal
Share) for total eligible costs. Reimbursement amounts will be based on approved FEMA Project Worksheets
(PW) and are as follows:
PW # Project Number and Project Name PW Amount
(100 /o Federal Sharel
PA-05-MI-4494-PW-00040(0) 141272 - Oakland County Homeland Security $87,120.84
March -May
Total: $87,120.84
The Subrecipient shall comply with all applicable state and local ordinances, laws, regulations, and building codes
and standards. Prior to the start of any construction activity, the Subrecipient shall obtain all applicable federal,
state, and local permits and clearances, and comply with all regulations including FEMA compliance with the
National Environmental Policy Act, the National Historic Preservation Act, the Endangered Species Act, and all
other environmental laws and executive orders. Any activities that have been initiated without the necessary
Environmental and Historic Preservation (EHP) review and approval will result in a non-compliance finding
and will not be eligible for federal funding.
Category B, Emergency Protective Measures work, for which federal funds have been approved, is subject to
completion six months from the declaration date. For this disaster, the project completion deadline date is
extended until further notice by FEMA. All time frames are set by regulation, however, if extenuating
circumstances or unusual project conditions exist, a time extension may be requested through the Recipient.
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. Federal funds
cannot be used to replace a reduction in non-federal funds or solve budget shortfalls in general fund
programs. FEMA will not duplicate assistance provided by the Department of Health and Human
Services (HHS), including the Centers for Disease Control and Prevention, or any other federal
agencies. This includes necessary emergency protective measures for activities taken in response to
COVID-19.
B. The Subrecipient shall not use Coronavirus (COVID-19) Pandemic, Public Assistance Grant Program
funds to generate program income.
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:
I11��i mI ez'sol.IIuzll
OAKLAND (COUNTY)
PA-05-M I-4494-P W-00040(0)
Page 3 of 10
1. Subrecipient Risk Assessment Certification
2. Standard Assurances
3. Certifications Regarding Lobbying; Debarment, Suspension and Other Responsibility Matters; and
Drug -Free Workplace Requirements
4. Audit Certification (EMD-053)
5. Request for Taxpayer Identification Number and Certification (W-9)
6. Project Completion and Certification Report (P.4), certifying project expenditures and completion
within the grant period (complete and submit upon project completion or for partial reimbursement
request as directed by VII. Payment Procedures)
7. Permits or Waivers. (For projects requiring permits or waivers, including work that requires Michigan
Department of Environment, Great Lakes and Energy (EGLE) review, submit either the EGLE permit
that was issued or a written statement or email (waiver) from the Subrecipient's regional EGLE
representative to document the crossing/site does not require a permit.)
8. Any other documents that may be required by federal or state officials
D. Comply with the requirements of the Stafford Act and all FEMA Public Assistance policies, including, but
not limited to, the FEMA COVID-19 Fact Sheets and Guidance located online at
https://www.fema.gov/coronavirus/fact-sheets, the Public Assistance Program and Policy Guide (April
2018) and any policy or guidance document not superseded by the PAPPG.
E. 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. Comply with applicable local, state, and federal procurement rules and regulations, whichever is most
restrictive. Federal procurement rules are found at 2 CFR, Part 200.317-326.
4. 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 200.501.
F. Subrecipients must carry out their programs and activities in a manner that respects and ensures the
protection of civil rights for protected populations. These populations include but are not limited to
individuals with disabilities and others with access and functional needs, individuals with limited English
proficiency, and other diverse racial and ethnic populations, in accordance with Section 504 of the
Rehabilitation Act of 1973, Title VI of the Civil Rights Act of 1964, and Executive Order 13347.
G. Environmental and Historic Preservation (EHP) Compliance. The federal government is required to
consider the effects on the environment and/or historic properties of any federally funded activities and
programs, including grant funded projects. The EHP Program engages in a review process to ensure that
federally funded activities comply with federal EHP regulations, laws, and executive orders as applicable.
The goal of these compliance requirements is to protect the nation's environmental, historic, and cultural
resources. The Subrecipient shall not undertake any project having the potential to impact EHP resources
without prior approval. Any activities that have been initiated without the necessary EHP review and
approval will result in a non-compliance finding and will not be eligible for federal funding.
H. Maintain a valid Data Universal Numbering System (DUNS) number at all times during the performance
period of this grant.
I. Cooperate with the federal government in seeking recovery of funds that are expended in alleviating the
damages and suffering caused by this disaster against any party or parties whose intentional acts or
omissions caused or contributed to the damage or hardship for which federal assistance is provided
pursuant to the Presidential declaration of this disaster.
J. Submit Quarterly Progress Reports on all large projects (over $131,100) to the Michigan State Police,
Emergency Management and Homeland Security Division each calendar quarter. Deadlines for quarterly
report submissions are as follows: January 15, April 15, July 15, and October 15.
K. Notify the Recipient immediately upon completion of each large project and upon completion of the last
small project; do not wait for the Quarterly Progress Report to inform the State to comply with FEMA's 90-
day closeout deadlines.
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PA-05-M I-4494-PW-00040(0 )
Page 4 of 10
L. Ensure the use of PA funding only for eligible work as identified in the approved project. Should the
Subrecipient identify a need to amend the scope of the project, it must submit to Recipient a written
request with detailed justification and documentation to support the eligibility of the requested revision.
M. Permit FEMA or Recipient access and rights to examine and copy records, accounts, other documents,
and other sources of information related to the grant, and permit access to facilities, personnel, and other
individuals and information as may be necessary, as required by FEMA regulations, by other applicable
state or federal laws or regulations, or by program guidance.
N. The Appeals process is the opportunity for Subrecipient to request reconsideration of decisions regarding
the provisions of assistance. The Subrecipient must file an appeal with the Recipient within 60 days of
receipt of notice of the action or decision being appealed. However, an appeal for a significant net small
project overrun must be filed within 60 days of completion of the Subrecipient's last small project.
O. Integrate individuals with disabilities into emergency planning in compliance with Executive Order 13347
and the Rehabilitation Act of 1973.
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).
V1. Reporting Procedures
The Subrecipient must submit quarterly progress reports to the Recipient on the status of all large vroiects (over
131 100). Quarterly progress reports are required whether expenditures are incurred or not. Current forms and
instructions are located at httr)://www.michigan.gov/emhsd or can be requested by sending an email to MSP-
EMHSD-DisasterPA(7o michigan.gov.
Failure by the Subrecipient to fulfill quarterly reporting requirements may result in the suspension of grant activities
until reports are received.
Quarterly progress reports are to be submitted on the EMHSD-014, Public Assistance Grant Program Project
Quarterly Progress Report form, by the 15th of the month following the end of each quarter and should be emailed
to MSP-EMHSD-DisasterPA(a)michigan.gov.
The reporting periods and due dates for each year are as follows
1st Quarter: October 1st through December 31st
Due January 15th
2nd Quarter: January 1st through March 31st
Due April 15th
3rd Quarter: April 1st through June 30th
Due July 15th
4th Quarter: July 1st through September 30th
Due October 15th
VII. Payment Procedures
Reimbursement amounts are based on approved FEMA Project Worksheets (PW) at 100% Federal Share of total
eligible costs and are detailed in the enclosed Project Completion and Certification Report (P.4). The PA identifies
approved PWs, as of the generated date on the most recent report, indicating the approved amount and
percentage of work completed at the time of the initial project approval. Amendments to this Grant Agreement will
be made as additional projects are approved and funds obligated by FEMA with Subrecipient signature required.
FEMA-4494-DR -MI
OAKLAND (COUNTY)
PA-05-M I-4494-PW-00040 (0)
Page 5 of 10
CC.Small Projects ($131,100 or less):
The Stafford Act provides for a small project designation, which is a simplified procedure designed to
speed payment of disaster assistance funds to applicants when the cost is below the small project
threshold. When the PW estimate of eligible costs for a project is below this threshold, payment of the
100% federal share is based on the PW estimate instead of actual costs of the work. In most cases,
Recipient will make pavment of the full federal share of small projects as promptly as possible
after review and receipt of approved PWs from FEMA. The federal share payment for a small project
will not be reduced if all the approved funds are not spent to complete a project. However, failure to
complete a small project will require the federal share be refunded. Subrecipients are also required to
maintain supporting documentation and proof of payment and provide them at any time upon request of
Recipient or FEMA. Small projects will not be amended. Should additional work, items, or time periods be
required, the Subrecipient must submit a new project application.
DD. Large Projects (over $131,100):
1. For large projects that are 100% complete at project formulation, the 100% federal share will be made
as a final payment after the Recipient has received the following items from the Subrecipient:
a. All required Grant Agreement package forms and documentation described in paragraph IV, C, 1
8.
b. A completed and signed Project Completion and Certification Report (P.4).
c. Proof of payment for project costs.
2. For large projects that are estimated or partially complete, Subrecipient may request federal share
reimbursement for actual expenditures, up to 75% of the Federal share, by the date of reimbursement
submission. Approved funding will be processed for payment after Recipient has received the
following items from the Subrecipient:
a. All required Grant Agreement package forms and documentation described in paragraph IV, C, 1
8.
b. A written request for payment.
c. A completed and signed Project Completion and Certification Report (P.4) indicating the claimed
amount requested for reimbursement.
d. All required quarterly progress reports are submitted and up to date.
e. Supporting documentation, including detailed invoices and proof of payment for actual project
costs.
Additional federal share reimbursements will be processed by Recipient upon written request and
resubmission of an updated PA (request through Recipient) certifying the claimed final project costs with
supporting documentation. The Recipient only reimburses up to 75% of the Federal share until FEMA final
review and project close-out approval (see Vill. Project Close -Out). At that time, the remaining funds will
be reimbursed.
EE. Large, Expedited Projects (over $131,100):
The Federal Emergency Management Agency (FEMA) may provide expedited funding for Emergency
Protective Measure projects that exceed the large project threshold ($131,100). For expedited projects,
FEMA will base the funding amount on information provided by the Subrecipient. If cost information is not
available, FEMA estimates the project cost based on limited information about the work activities the
Subrecipient will perform. Expedited projects are limited to defined operational periods (30, 60, 90-days);
awarded at 50% of the estimated cost to complete the work; and federally funded at the disasters' cost
share for the defined operational period.
1. For large, expedited projects, Recipient with make payment of 50% of the estimated project costs as
promptly as possible after review and receipt of approved PWs from FEMA.
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2. FEMA may provide additional funds through a project amendment. Amendment processing requires
Subrecipients to provide documentation to support the expenditure of the originally expedited funding
to Recipient through an amendment request in the FEMA Grants Portal.
3. Recipient will review the amendment request to verify actual costs for work completed.
4. Recipient submits the project to FEMA through Grants Portal for review and approval.
5. Reimbursement for actual costs, approved by FEMA are then reimbursed by Recipient.
FF. Management Costs (Category Z):
A management cost is any indirect cost, any direct administrative cost, and any other administrative
expense associated with a specific project under a major disaster or emergency. Management costs can
be claimed for administering and managing PA awards for up to 5% of the Subrecipient's total award
amount based on actual costs, including Federal and non -Federal cost shares, after insurance and any
other reductions. Management costs are funded at a 100% Federal cost share and are obligated on one
Category Z project. Eligible activities may include, but are not limited to, meetings regarding the PA
Program or overall PA damage claim, preparing correspondence, preparing projects, reviewing PWs,
collecting, copying, filing, or submitting documents to support a claim, requesting disbursement of PA
funds, and training. All Category Z PWs will be reconciled and reimbursed based on actual costs not to
exceed the maximum 5% allowed, including those Category Z PWs that are below the large project
threshold.
For documentation requirements and more detailed information on FEMA's Public Assistance
Management Costs go to FEMA Recovery Policy FP 104-11-2, Public Assistance Management Costs
(Interim) at httos://www.fema.aov/media-library/assets/documents/185811 and Public Assistance
Management Costs Standard Operating Procedures (February 2019) at httos://www.fema.00v/media-
librarv-data/1550159956698-ad232f56e33944a9041726527067fef5/PA Mamt Costs SOP FINAL 2-8-
2019 508.odf1.
Vlll. Project Close -Out
A. The Subrecipient is to notify the Recipient immediately as it completes each large project and when it has
completed its last small project.
B. Upon large project completion, the Subrecipient is to submit to Recipient a written request for project close
out, to complete, sign, and submit the PA form (retain a copy at the work site), and to submit supporting
documentation and proof of payment for costs claimed. Recipient will perform a subsequent review and
will forward its recommendation for closeout along with all documents and proof of payment to FEMA for
final review and approval for closeout. Recipient will notify Subrecipient when its large project is officially
closed by FEMA and any remaining reimbursements will be processed for payment.
C. Upon completion of its last small project, Subrecipient is to notify the Recipient immediately. If
Subrecipient has multiple small projects, Recipient will generate and forward to Subrecipient a Project
Completion and Certification Report (P.4) containing all small projects. Subrecipient will subsequently
complete, sign and submit the PA to Recipient. At that time Recipient and Subrecipient will determine if a
Net Small Project Overrun Appeal is an option for FEMA approval for possible overrun reimbursement(s)
within 60 days of work completion of its last small project. If requesting a Net Small Project Overrun
Appeal, Subrecipient will submit to Recipient a written request and actual cost documentation for all small
projects that FEMA originally funded based on estimated amounts.
D. The Recipient will schedule further field review and final inspections, as necessary. When final
inspections are completed, the balance of eligible funds will be reimbursed.
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E. The Subrecipient will perform the required financial and compliance audits in accordance with 2 CFR 200,
Subpart F. All documentation must be retained for at least three years after the grant is closed by the
awarding federal agency for purposes of federal and/or state examination and audit. If an audit is
required, submit a copy of the annual audit report to:
Michigan Department of State Police,
Grants and Community Services Division,
PO Box 30634,
Lansing, Michigan 48909
F. For federal audit purposes, the CFDA number of the grant is 97.036 and is titled Public Assistance
Grants. The award is passed through the Recipient from FEMA. The disaster award number is FEMA-
4494-D R-M I.
G. If the Subrecipient will be reimbursed for management costs pursuant to the Public Assistance
Management Costs Policy, Subrecipient must provide actual cost documentation with the request for
reimbursement.
IX. Employment Matters
The Subrecipient shall comply with Title VI of the Civil Rights Act of 1964, as amended; Title VIII of the Civil Rights
Act of 1968; Title IX of the Education Amendments of 1972 (Equal Opportunity in Education Act); the Age
Discrimination Act of 1975, Titles I, II and 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 approved
projects related to this grant agreement appears as an excluded party on the Federal System for Award
Management located at httr)://www.sam.ciov.
X. Construction Requirements
The Subrecipient shall comply with all applicable state and local ordinances, laws, regulations, building codes, and
standards. Prior to the start of any construction activity, the Subrecipient shall obtain all applicable federal, state,
and local permits and clearances, and comply with all regulations including FEMA compliance with the National
Environmental Policy Act, the National Historic Preservation Act, the Endangered Species Act and all other
environmental laws and executive orders. Any activities that have been initiated without the necessary EHP
review and approval will result in a non-compliance finding and will not be eligible for federal funding.
The Subrecipient shall ensure that any work done under this grant complies with the barrier free design
requirements of 1966 PA 1, as amended, MCL 125.1351 et seq. (Utilization of Public Facilities by Physically
Limited Act).
The Davis -Bacon Act requires federal agencies to pay workers under contract to them the "prevailing wage' based
on the local union wage scale defined by the U.S. Department of Labor. Generally, the provisions of the Davis -
Bacon Act do not apply to state or local contracts for work completed using public assistance funds under the
Stafford Act. However, the provisions may apply to contracts let by other federal agencies, such as the U.S. Army
Corps of Engineers. If a state or local government incorporates prevailing wage rates of the U.S. Department of
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Labor as part of its normal practice for all contracts, regardless of funding source, then those rates would be
eligible.
XI. Insurance
In compliance with P.L. 103-325, Title V National Flood Insurance Reform Act of 1973, section 582 requires that
any person who receives federal assistance for the repair, replacement, or restoration for damage to any personal,
residential, or commercial property, at any time, must maintain flood insurance if the property is located in a
Special Flood Hazard Area.
XII. 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.
XIII. 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.
XIV. Grant Agreement Period
The effective date of this grant agreement is January 20, 2020, and is in full force and effect from January 20,
2020, until the completion of approved FEMA projects per guidelines stipulated in Section III (Award Amount and
Restrictions). This grant agreement may be terminated by either party by giving 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 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.
XV. 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 follow grant agreement requirements or special conditions.
D. Proposal or implementation of substantial plan changes to the extent that, if originally submitted, the
project would not have been approved for funding.
E. Failure to submit required reports.
F. Filing of a false certification in the application or other report or document.
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G. Failure to adequately manage, monitor or direct the grant funded activities of its Subrecipients.
Before acting, the Recipient will provide the Subrecipient reasonable notice of intent to impose corrective
measures and will make every effort to resolve the problem informally.
XVI. 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 understate or federal antitrust
statutes; or convicted of any other criminal offense which, in the sole discretion of the Recipient, reflects on the
Subrecipient's business integrity.
XVII. 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.
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XVIII. 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.
OAKLAND (COUNTY)
Name of Subrecipient
Printed Name
Signature
For the Recipient
136200362-
Subrecipient's DUNS Number
Title
Date
Michigan State Police, Emergency Management and Homeland Security Division
Alternate Governor's Authorized Representative,
Emergency Management
F/Lt. Gabriel Covey and Homeland Securitv Division
Printed Name Title
41� (��
4/2/2021
Signature
Date
U.S. DEPARTMENT OF HOMELAND SECURITY O M.B No 1660-0025 e
FEDERAL EMERGENCY MANAGEMENT AGENCY Expires July 31, 20(
SUMMARY SHEET FOR ASSURANCES AND CERTIFICATIONS
FOR CA FOR (Name of Recipient)
FY
This summary sheet includes Assurances and Certifications that must be read, signed, and submitted as a part of the
Application for Federal Assistance.
An applicant must check each item that they are certifying to:
Part I J FEMA Form 20-16A, Assurances-Nonconstruction Programs
Part II J FEMA Form 20-16B, Assurances -Construction Programs
Part III 'FEMA Form 20-16C, Certification Regarding Lobbying;
Debarment, Suspension, and Other Responsibility _
Matters; and Drug -Free Workplace Requirements
Part IV SF LLL, Disclosure of Lobbying Activities (If applicable)
As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the identified
attached assurances and certifications.
Typed Name of Authorized Representative Title
Signature of Authorized Representative Date Signed
NOTE: By signing the certification regarding debarment, suspension, and other responsibility matters for primary
covered transaction, the applicant agrees that, should the proposed covered transaction be entered Into, it shall not
knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or
voluntarily excluded from participation in this covered transaction, unless authorized by FEMA entering into this transaction.
The applicant further agrees by submitting this application that it will include the clause titled "Certification
Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transaction," provided by the
FEMA Regional Office entering into this covered transaction, without modification, in all lower tier covered transactions and in
all solicitations for lower tier covered transactions. (Refer to 44 CFR Part 17.)
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Paperwork Burden Disclosure Notice
Public reporting burden for this form is estimated to average 1.7 hours per response. The burden estimate includes the time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing,
reviewing, and maintaining the data needed, and completing and submitting the form. Send comments regarding the
- accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, U.S.
Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington DC 20472.
You are not required to complete this form unless a valid OMB control number is displayed in the upper corner on this form.
Please do not send your completed form to the above address.
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FEMA Form 20-16, OCT 04 PREVIOUS EDITION OBSOLETE