HomeMy WebLinkAboutResolutions - 2022.06.23 - 37430r
BOARD OF COMMISSIONERS
June 23,2022
MISCELLANEOUS RESOLUTION #22-233
Sponsored By: Penny Luebs '
Emergency Management & Homeland Security - Grant Acceptance from the Michigan Department of
State Police for the FI 2021-2022 Hazardous Materials Emergency Preparedness Planning
Chairperson and Members of the Board:
WHEREAS the Superfand Amendment and Reauthorization Act (SARA) of 1986, Title III, requires the
planning and provisions for community right -to -know about extremely hazardous substances in local
conuuuunitics; and
NVHEREAS the Oakland County Local Emergency Planning Committee (LEPC) has been organized and meets
mininnunn criteria in performing planning fuunctions; and
WHEREAS the Hazardous Materials Emergency Preparedness Planning Program (HMEP) grant provides
funds to Oakland County for the purpose of enhancing hazardous material response planning: and
WHEREAS an application was subil fitted, and Oakland County is eligible to receive S11,550 for the submittal
of new and updated plans during the grant period of September 30, 2021 through September 29, 2022: and
WHEREAS the required 25% in -kind match of $2.888 will be met with staff salary to support the LEPC
planning effort; and
WHEREAS the grant will continue partial funding for one (1) FTE PR Technical Office Specialist position
(1?00015356):and
WHEREAS no reports are required and the fluids will be received upon submittal of the plans as a work
product; and '
WHEREAS the grant agreement has completed the Grant Review Process in accordance with Board of
Commissioners Grant Acceptance Procedures,
NOW THEREFORE BE IT RESOLVED that the Oakland County Board of Commissioners accepts the
Hazardous Materials Emergency Preparedness Planning (HMEP) grant in the amount of SI1.550 from the
Michigan Department of State Police, Emergency Management and Homeland Security Division.
BE IT FURTHER RESOLVED to continue partial fandnrg for one (1) FTE PR Technical Office Specialist
position (P00015356) within the Ennergencv Management and Homeland Security Department.
BE IT FLTRTHER RESOLVED that the Chairperson Of the Oakland County Board of Commissioners is
authorized to execute the grunt agreement and to approve any grant amendments, within fifteen percent (15%)
of the oriairral award, which are consistent with the original agreement as approved.
BE IT FURTHER RESOLVED that acceptance of this grant does not obligate the County to any fature
commitment and continuation of this program is contingent upon continued future levels of grant funding.
BE IT FURTHER RESOLVED the FY 2022 budget is amended as detailed in the attached Schedule A.
Chairperson, the following Commissioners are sponsoring the foregoing Resolution: Penny Luebs,
62-2d� Date: June 23, 2022
David Woodward, Commissioner
AU a
WYY
Date: June 24, 2022
Hilarie Chambers, Deputy County Executive II
/ Date: June 27 2022
Lisa Brown, County Clerk d Register of Deeds
COMMITTEE TRACKING
2022-06-14 Public Health &- Safety - recommend to Board
2022-06-23 Full Board
VOTE TRACKING
Motioned by Commissioner Charles Cavell seconded by Commissioner Michael Gingetl to adopt the attached
Grant Acceptance: from the Michigan Department of State Police for the FY 2021-2022 Hazardous Materials
Emergency Preparedness Planning .
Yes: David Woodward, Michael Gingell, Karen Johat. Kristen Nelson, Eileen Kowall, Angela Powell.
Thomas Kuhn, Chuck Moss, Marcia Gershenson, William Miller 111, Yolanda Smith Charles, Charles
Cavell, Penny Luebs, Janet Jackson, Gary McGillivray, Robert Hoffman, Adam Koehenderfer (17)
No: Christine Long, Philip Weipert (2)
Abstain: None (0)
Absent: (0)
Passed
ATTACHMENTS
1. Grant Acceptance Sign -Off
2. EMHS_Homeland Security - HMEP_Schedule A.2
3. Agreement _FY 2021-22 HMEP
4. Application
5, ENID-072
6, MEMORANDLtM
7. NTOTICE OF PUBLIC AVAILABILITY
STATE OF MICHIGAN)
COUNTY OF OAKLAND)
I, Lisa Brown, Clerk of the County of Oakland, do hereby certify that the foregoing resolution is a true and
accurate copy of a resolution adopted by the Oakland County Board of Commissioners on June 23, 2022, Nvith
the original record thereof now remaining in my office.
In Testimony Whereof. I have hereunto set my hand and affixed the seal of the Circuit Court at Pontiac,
Michigan on Thursday, June 23, 2022.
Liso Brown, Oakland Comm, Clerk/ Register gfDeedr
GRANT REVIEW SIGN -OFF — Emergency Management & Homeland Security Department /
Emergency Management Division
GRANT NAME: 2022 Hazardous Materials Emergency Preparedness Planning Program (HMEP-PP)
FUNDING AGENCY: Michigan State Police/Emergency Management and Homeland Security Division
DEPARTMENT CONTACT PERSON: Robert Seeley 248-858-5080
STATUS: Grant Acceptance (Greater than $10,000)
DATE: 06/03/2022
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 acceptance package (which should include
this sign -off and the grant agreement/contract 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 — Lynn Sonkiss 5/26/2022
Human Resources:
Continues partial funding for one (1) FTE PR Technical Office Specialist position (P00015356). Previously, the
grant provided partial funding for one (1) PTNE 1,000 hours per year Technical Office Specialist position
(P00006893). During the FY22 budget, the FTE position was created and the grant funding that was used from
the PTNE position was carried over to the FTE position.
Approved — Heather Mason 06/02/2022
Risk Management:
Approved— Robert Erlenbeck 06/02/2022
Corporation Counsel:
Approved— Heather Lewis 05/31/2022
View Award: AWD00194: 2021-2022 HMEP (Hazardous
Materials Emergency Prep 09/30/2019 (version 0)
Overview
Summary
Prime Grantor Michigan Department of State Police, Emergency Management and Homeland Security Division
Grantor Michigan Department of State Police, Emergency Management and Homeland Security Division
Grantor Direct Cost/ Grantor Indirect Cost 11,550.00 / 0.00
Match Total 2,888.00
CFDA Number 20.703 - Interagency Hazardous Materials Public Sector Training and Planning Grants
Company
Name
Award L'rfecycle Status
Grantor Award Reference Number
Award Date
Award Signed Date
Award Type
Award Tier
Award Status
Version
Version Status
Federal Award Id Number
CFDA Number
CFDA Description
Institutional Id
Award Group
Award Contract Owner
Oakland County
2021-2022 HMEP (Hazardous Materials Emergency Preparedness Planning Grant
Open
09/30/2019
Other Awards
2 - $10,001 - $250,000
Approved
0
Award In Effect
Billing Schedule
693JK31940022HMEP
20.703 - Interagency Hazardous Materials Public Sector Training and Planning Grants
Interagency Hazardous Materials Public Sector Training and Planning Grants
05 - Christie
Robert Seeley (31553)
Award Calendar
Award Schedule HMEP FY 22
Start Date 09/30/2021
End Date 09/29/2022
Contract Start Date
Contract End Date
View Award: AWD00194: 2021-2022 HMEP (Hazardous
Materials Emergency Prep 09/30/2019 (version 0)
Period Name
Period Number
Start Date
Contract Start Date
( End Date
Contract End Date
I Award Posting
Interval Name
I FY 22 1
1 09/30/2021
09/29/2022
Grantor
Is Subaward
No
Prime Grantor
Michigan Department of State Police, Emergency Management and Homeland Security Division
Grantor
Michigan Department of State Police, Emergency Management and Homeland Security Division
Bill -To Grantor
Michigan Department of State Police, Emergency Management and Homeland Security Division
Letter Of Credit
Document ID
Funding Details
Currency
LSD
Grantor Direct Cost
11,550.00
Grantor Indirect Cost
0.00
Grantor Total
11,550.00
Match Total
2,888.00
Match Required by Grantor
Yes
Award Total
14,438.00
Zero Amount Award
No
Entered Line Amount
11,550.00
Authorized Amount
11,550.00
Billing Limit Override
0.00
Billed To Date
0.00
Anticipated Grantor Direct Cost
0.00
Anticipated Indirect Cost
0.00
Anticipated Grantor Total
0.00
Grant Review Information
Grant Review Information
Grant Review Information Type
16. Grantor Submission Due Date:
15. Match/Source (if applicable):
14. Total Budget:
13. Grantor Funds:
12. New Grant Funded Position(s) Request:
Posting Interval
Budget Period
July 5, 2022
2,888.00, - 25% in kind match utilizing the staff ,
14,438.00
11,550.00
#P0001.5356
View Award: AWD00194: 2021-2022 HMEP (Hazardous
Materials Emergency Prep 09/30/2019 (version 0)
Grant Review Information Type
11. Prior Year Total Funding:
10. Funding Continuation:
09. IT Resources (New Computer Hardware/Software Needs or Purchases):
08. New Facility/Office Space Needs:
07. Contract - Indicate Contractor(s) and Service/Product(s):
06. Will you issue subaward(s) — Indicate Agency(ies):
05. Original Source of Funding:_ _ -
04. Document Identification Number:
03. Department Contact Name/Number:_
02. Operating Department:
01 Due Date for Reviewer Comments:
Notes
Award Notes
10,031.00
Continuation
N/A
N/A
N/A
No
FEMA
693JK31940022HMEP
Robert Seeley - 248-858-5080
Emergency Management and Homeland Securi
06'01 /2022
Notes
The purpose of the grant is to assist local communities in preparing federally mandated SARA Title III, Section 302 Extremely Hazardous Materials (EHS) off -site response plans. Allocations
MDEQ paperwork before a plan accepted by MSP EMHSD. No reports are required. We anticipate receiving $1,500 support grant and $3,000 for new plans ($250 x 12 plans) and $7,050 for
$2,010.00 will be utilized using staff salary.
Attachments
attachments
Attachment
EMHSD_040 - signed.pdf
2022 Annual PublicNotice.doc
2022 LEPC Schedule.pdf
emd-072 LEPC Officer Member Records 07.2014.doc
Oakland FY 21-22 HMEP G.A. Packet (002).pdf
2022 MR HMEP Acceotance t002t-doc
Award Lines
Award Lines Overview
View Award: AWD00194: 2021-2022 HMEP (Hazardous
Materials Emergency Prep 09/30/2019 (version 0)
Contract Line
Line
Status
Award Lane
Lifecycle
Company
From Date
To Date
Current
Amount
Billed
Amount
Grant
Billing
Schedule
Contract Line
Type
Current
Rate
Number
Status
AWD00194 1
Active Open Oakland 09/30/2021 09/29/2022 $11,550.00 $0.00
GRN-1003863
Cost 0.00% C
RC610313-
County
2022Hazardous
Reimbursable
Federal Operating
Materials
Grants (Line 1)
Emergency
Preparedness
Planning grant
Award Line Summary
Award Line Summary
I{
Cost Reimbursable
Line
Line
Number
Grant
Revenue
I Category
Line Type
Line Status
Line Amount
Billing Schedule
Scheduled, In Progress,
and Ready To Bill
1
Amount
AWD00194 RC610313 -
1 GRN-1003863 2022 RC610313 - Cost Reimbursable Active
11,550.00
0.00
Federal Operating Grants
Hazardous Materials Federal Operating
(Line 1)
Emergency Grants
Preparedness Planning
❑rant
Award Lines
Authorized Amount 11,550.00
Entered Line Amount 11,550.00
Award Lines
Award Line AWD00194 RC610313 - Federal Operating Grants (Line 1)
Line Number 1
Billed Amount 0.00
Line Status Active
Line Item Details
Company Oakland County
Line Type Cost Reimbursable
Primary Yes
Grant GRN-1003863 2022 Hazardous Materials Emergency Preparedness Planning grant
Line Amount 11,550.00
Revenue Category RC610313 - Federal Operating Grants
Award Line Lifecycle Status Open
Spend Restriction
View Award: AWD00194: 2021-2022 HMEP (Hazardous
Materials Emergency Prep 09/30/2019 (version 0)
Indirect Cost
Additional Information
Budget
Budget Details
Details
Budget Check Options
Line Item Description
Deferred Revenue
Line CFDA Number
Line CFDA Description
Current Rate
Rate Agreement
Basis Type
Object Class Set
Cost Rate Type
Exception
Revenue Allocation Profile
Basis Limit
From Date
To Date
Memo
Cost Center
Program
*Fund
Additional Worktags
Subrecipient
Line Federal Award Id Number
No
20.703 - Interagency Hazardous Materials Public Sector Training and Planning Grants
Interagency Hazardous Materials Public Sector Training and Planning Grants
0.00%
0% Rate (01/01/1900)
Total Direct Costs
Standard
Oakland County
Non -Departmental General Fund & Finance Program
09/30/2021
09/29/2022
FND10101 General Fund -Grants
Budget Template Award -Total Expense by Grant: AWD00194: 2021-2022 HMEP (Hazardous Materials Emergency Prep 09/30/2019 (version 0)
Budget AWD00194: 2021-2022 HMEP (Hazardous Materials Emergency Prep 09/30/2019 (version 0)
Edit Budget Check Enabled Yes
Include Reserved Journal Lines Yes
Allow Credit Transactions to Pass Yes
Budget Check Option Warn
View Award: AWD00194: 2021-2022 HMEP (Hazardous
Materials Emergency Prep 09/30/2019 (version 0)
Evaluation Date
Budget Date
Cumulative Control Periods
Yes
Budget Check Control Periods
Control by Duration
Ledger Types for Budget Check
Actuals
Commitments
Obligations
Allow Budget Check Override
No
Budget Information
Company
Oakland County
Budget Structure
Award - Total Expense by Grant
Years
FY 22 1
Entry Type
Project and Award
Currency
USD
AWD00194: 2021-2022 HMEP (Hazardous Materials Emergency Prep 09/30/2019 (version 0)
Budget Lines
*Ledger Account/Summary
Master Account Set: Expense
Subtotals
Budget Period 11,550.00
Award Tasks
Award Tasks Due Next 90 Days
Status
ITotal
Award Tasks
Award Tasks
Award Tasks Due Next 90 Days or Overdue
Award Amount
11,550.00
*Grant
GRN-1003863 2022 Hazardous Materials Emergency Preparedness
Plannina Grant
Line Number
Billing & Receivables
Schedules
Grantor Billing
I Grant I Start Date I End Date
View Award: AWD00194: 2021-2022 HMEP (Hazardous
Materials Emergency Prep 09/30/2019 (version 0)
Due Date I Role I Assigned Workers
Bill -To Grantor Michigan Department of State Police, Emergency Management and Homeland Security Division
Letter Of Credit
Document ID
Status ( Billing Mi
View Grantor Invoices for Award
Invoice II Award Billing Adjustment Invoice Invoice Amount Due Invoice Is On
Invoice I 1 Sequence I Invoice Date Currency I Collection C
Status mbReason Type Amount Due Date Followup Date I Hold
Nuer
Award Prepayment Summary
I Schedule Total Prepayment Amount Applied I Remaining Prepaid Balance
OCM - Cost Reimbursable Unbilled Transactions
Initiating Spend
Cost Reimbursable Transaction of Indirect Budget Spend Category for
Grantor Billing 9 p
Award Status Spend Line Transaction Cost or Award Accounting Date Date Billable Transactions Grant Cost Center Fund
Source Revenue Operational
Journal
Additional Reports
Award Header Roles
Assigned Roles
I
Grant Roles
Assignable Role
View Award: AWD00194: 2021-2022 HMEP (Hazardous
Materials Emergency Prep 09/30/2019 (version 0)
Line Number
Set Up & History
Set Up
Budget
Spend Restriction
Award Billing Sequence
Process History
Drocess History
Process
Award Event
Award Budget Hub Event
Budget Event
Budget Event
Budget Event
Award Event
Grant
1 GRN-1003863 2022 Hazardous Materials
_ Emergency Preparedness Planning grant
Assignable Role
Grant Accountant- Grant
Grant Budget Specialist - Grant
Grant Financial Analyst
Grant Manager
Default Budget Structure Award - Total Expense by Grant
Default Entry Type Project and Award
Default Balanced Amendment Yes
Spend Restriction Default
Award Billing Sequence Active No
Step
I Status
Award Event
Step -Completed
Award Budget Hub Event
Step Completed
Budget Event
Approved
To Do: Financial Budget Approval
Not Required
Confirmation
Approval by Budget Manager
Not Required
Review Award
Approved
Award Event Review Award Approved
Assigned To
Christie Arnold (33388)
Inherited
Jawun Nelson (33425)
Inherited
Haryy Holland (32921)
Inherited
Lindsay Schwan (31380)
Inherited
Robert Seelev (31553.
Assioned
Role Fro
Completed On I Due Date
( Person (Up to 5)
05/25/2022 09:33:28 AM 05127/2022 _
Robert Seeley (31553)
05/25/2022 10:01:12 AM
Robert Seeley (31553) (Initiator)
05/25/2022 10:01:26 AM
Robert Seeley (31553) (Initiator)
05/25/2022 02:50:30 PM 05/27/2022 Jawun Nelson (33425) (Grant
Budget Specialist)
05/26/2022 04:22:49 PM 05/27/2022 Tifanny Keyes -Bowie (12452)
;Sponsored Proarams Manaaer)
View Award: AWD00194: 2021-2022 HMEP (Hazardous
Materials Emergency Prep 09/30/2019 (version 0)
Process
Step
I Status
I Completed On
Due Date
Person (Up to 5)
Award Event
Review Award
Approved
05/26/2022 07:06:10 PM
05/27/2022
Lynn Sonkiss (18263) (Grant Revie,
Departments)
Award Event
Review Award
Approvers Added
05/27/2022 11:14:53 AM
05/27/2022
Tifanny Keyes -Bowie (12452)
(Sponsored Programs Manager)
Award Event
Review Award
Approved
05/27/2022 11:14:53 AM
05/27/2022
Tifanny Keyes -Bowie (12452)
-
(Sponsored Programs Manager)
Award Event
Review Award
Approved
05/31/2022 02:35:28 PM
Heather Lewis (28550)
Award Event
Approval by Grant Review
Approved
06/02/2022 09:09:41 AM
05/07/2022
Heather Mason (14906) (Grant
Departments (All)
Review Departments)
Award Event
Budget Event
Budget Event
Budget Event
Award Billing Schedule Event
Approval by Grant Review
Approved
Departments (All)
To Do: Enable Budget Check
Not Required
To Do: Enable Budget Check -
Not Required
Financial Budget
To Do: Project Budget has been
Not Required
entered and approved
Award Billing Schedule Event
Awaiting Action
06/02/2022 02:22:18 PM 06107/2022
Robert Erlenbeck (27643) (Grant
Review Departments)
Christie Arnold (33388) (Grant
Arrni inrant - Intersection)
RM I Fund Name
R General Fund
E General Fund
E General Fund
R General Fund
R General Fund
E General Fund
E General Fund
E General Fund
E General l Fund
E Geneml Fund
Oakland County, Michigan
EMERGENCY MANAGEMENT AND HOMELAND SECURITY - HOMELAND SECURITY - HAZARDOUS MATERIALS EMERGENCY PREPAREDNESS PLANNING GRANT
Schedule "A" DETAIL
Ope'tin, Fund Budget Project
Division Name Fund# Division# Program# Account# Unit OU Affiliate Reference Unit Peel ActivityAnalysis Accomd Title
Homeland Security PND10101 CCN1110101 PRG115180 RC610313 2022 GRANT GRN-1003863 GLB GLB Federal Operating Giants
Total Revenue
Homeland Security FND10101 CCN1110101 PRG115180 S0702010 2022 GRANT GRN-1003863 GLB GLB Salaries Regular
Homeland Sewmy FND10101 OCN1110101 PRG115180 SC722900 2022 GRANT GRN-1003863 GLB GLB Fnnge Benefit AdmMerent
Total Expenditures
Homeland Security FND10101 GGN1110101 PRG115180 RC610313 2021 GRANT GRN-1002372 GLB OLD Federal Operating Gams
Non Departmental FND10100 CCN9010101 PRG196030 RCS65382 Planned Use of Balance
Total Revenue
Homeland Security FND10101 CCN1110101 PRG115150 SC702010 2021 GRANT GRN-1002372 GLB GLB Salaries Regular
Homeland Security FND10101 CCN1110101 PRG115180 SC702190 2021 GRANT GRN-1002372 GILD GLB Workers Compensation
Homeland Security FND10101 CCN1110101 PRG115180 SC]22770 2021 GRANT GRN-1002372 GLB GLB Retirement
Homeland Seventy FND10101 CCN1110101 PRG115180 SC722190 2021 GRANT GRN-1002372 GLB GLB Social Security
Homeland Secunty FND10101 CCN1110101 PRG115180 SC722820 2021 GRANT GRN-1002372 GLB GLB Unemployment Insurance
Total ExpendiWres
FY 2022 FY2023 FY 2024
Amendment Amendment Amendment
$ 11550 $ - $ -
$ 11,550 $ $
3780
$ 11.550 $
- $
(11 894)
$ (21.512) $
- $ -
$ (26,447) $
- $ -
(29)
(]27)
(383)
(26)
$ (27.612) $
- $ -
GRETCHEN WHITMER
GOVERNOR
May 6, 2022
STATE OF MICHIGAN
DEPARTMENT OF STATE POLICE
LANsrNG
Dear Emergency Management Coordinator:
COL. JOSEPH M. GASPER
DIRECTOR
Enclosed is the Fiscal Year 2021-22 Hazardous Materials Emergency Preparedness (HMEP) Planning
Program Grant Agreement package for Antrim County. Please return the required grant documentation
listed on the enclosed Subrecipient Checklist to our office via email:
Attention: Mr. Paul Lounsberry
Emergency Management and Homeland Security Division
Michigan Department of State Police
LOUnsberrVP(@michloan.QOV
Additional information on the FY 2021-22 HMEP Grant Program can be found at
www.r)hmsa.dot.aov/hazmat/arants.
This grant agreement and all required documentation must be completed, signed, and returned no later
than July 5, 2022. If this requirement is not met, this grant agreement will be invalid after July 5, 2022
unless a prior written exception is provided by the Michigan Department of State Police, Emergency
Management and Homeland Security Division.
If you have any questions regarding this correspondence or the FY 2021-22 HMEP Planning Grant
Program, please contact Ms. Brenna Roos at RoosB@michigan.gov or 517-582-2846.
Sincerely,
Capt. Kevin Sweeney, Commander
Emergency Management
and Homeland Security Division
EMERGENCY MANAGEMENT AND HOMELAND SECURITY DIVISION • 7150 HARRIS DRIVE a DIMONDALE, MICHIGAN 48821
MAILING ADDRESS • P.O. BOX 30634 e LANSING, MICHIGAN 48909
w ,michigan.govlemhsd • 517-284-3745
FY 2021-22 HAZARDOUS MATERIALS EMERGENCY
PREPAREDNESS (HMEP) PLANNING PROGRAM
GRANT AGREEMENT
CFDA No: 20.703
Email the following items to: LounsberryP@michigan.gov
�,SUBRECIPIENT WILL NOT BE REIMBURSED FOR FUNDS UNTIL ALL REQUIRED SIGNED DOCUMENTS ARE RECEIVEDi
❑ 1. Grant Agreement. Please print and sign the grant agreement. Retain the
signed document for your records and email a scanned copy.
❑ 2. Subrecipient Risk Assessment Certification
❑ 3. HMEP Planning Grant Agreement In -Kind Match form
❑ 4. Standard Assurances
❑ 5. Certifications Regarding Lobbying; Debarment, Suspension and Other Responsibility
Matters; and Drug -Free Workplace Requirements
❑ 6. Audit Certification (EMD-053)
❑ 7. Request for Taxpayer Identification Number and Certification (W-9)
❑ 8. FY 2021-22 SARA Title III Hazardous Materials, Off -site Emergency Response,
Plan Update List
NOTE: The Plan Update List does not need to be completed and returned with your
FY 2021-22 HMEP Planning Program grant agreement. This form is to be used if and when a list
of updated plans is submitted for your grant. The Plan Update List form can be submitted directly
to the SARA Title III Planner at the MSPIEMHSD when you have completed all plan updates for
the grant year.
POST REIMBURSEMENT REQUIREMENTS
Participate with Recipient in an on -site monitoring of financial documents. Also retain financial
records, supporting documents, and all other records pertinent to the grant for at least three 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 submits audit copy to:
Michigan Department of State Police, Grants and Community Services Division, P.O. Box
30634, Lansing, Michigan 48909.
For. GRANT QUESTIONS, PLEASE CONTACT Ms. Brenna Roos
AT itOOSB@MICHIGA)y:GOV OR (517) 294-3727.. +`
Michigan •�Nlilil4arrnG4.
State • `:. ems..
Homeland Security Division
MI[NIG{,y
Emergency Management • <Y:
AWARDFEDERAL IDENTIFICATION
SUBRECIPIENT NAME
Oakland County
SUBRECIPIENT IRS/VENDOR NUMBER
38-6004876
GRANTNAME
Grant Agreement
Hazardous Materials
Emergency Preparedness
Grant Program
FEDERAL AWARD IDENTIFICATION NUMBER
(FAIN)
693J K31940022 H M E P
Assistance Listing Number
20.703
FEDERAL AWARD DATE
09/30/2019
SUBRECIPIENT UEI
SUBAWARD FROM
TO
PERFORMANCE
PERIOD
HZ4EUKDD7AB4
09/30/2021
09/29/2022
RESEARCH & DEVELOPMENT
Funding
Total
N/A
Federal Funds Obligated by
$11550
this Action
INDIRECT COST RATE
Total Federal Funds Obligated
$19575
to Subrecipient
None on file
Total Amount of Federal
Award Committed
$19575
FEDERAL AWARD PROJECT DESCRIPTION
FY 2021-22 Hazardous Materials Emergency Preparedness Planning Program Grant
DETAILS
The Subrecipient must be prepared to match all funds received through this grant agreement (which
equates to 25% of any federal funds received), as noted in Section III, D of the Hazardous Materials
Emergency Preparedness Planning Grant Instructions that are included with this grant agreement. The
match amount is located in part 11LA of this grant agreement.
FEDERAL AWARDING AGENCY PASS -THROUGH ENTITY (RECIPIENT) NAME
U.S. Department of Transportation Pipeline and Hazardous Michigan State Police
Materials Safety Administration Emergency Management & Homeland
1200 New Jersey Avenue, SE, E21-316 Security Division
Washington DC 20590-0001 P.O. Box 30634
Lansing, M148909
State of •
7iscal Year 121-22 Hazardous Materials- •
Preparedness Planning Program Grant Agreement
September 30, 2021 to September 29, 2022
Assistance Listing Number: 20.703
Grant Number: 693JK31940022HMEP
This Fiscal Year (FY) 2021-22 Hazardous Materials Emergency Preparedness (HMEP) Planning Program grant
agreement is hereby entered into between the Michigan Department of State Police, Emergency Management and
Homeland Security Division (MSP/EMHSD) (hereinafter called the Recipient), and the
COUNTY OF OAKLAND
(hereinafter called the Subrecipient)
Purpose
The purpose of this grant agreement is to provide federal pass -through funds to the Subrecipient for the
development of new Superfund Amendments and Reauthorization Act (SARA), Title III, Section 302, hazardous
materials emergency response plans. This grant agreement provides financial assistance to first responders (fire,
law enforcement, emergency medical services, etc.) for allowable costs in the following areas:
A. Provision of assistance to public sector employees through planning grants to states, territories, and
Native American tribes for emergency response.
B. Increased state, territorial, tribal, and local effectiveness in implementation of the Federal Emergency
Planning and Community Right -to -Know Act of 1986.
C. Encouragement of a comprehensive approach to emergency planning by incorporating the unique
challenges of response to transportation situations.
II. Statutory Authority
Funding for the FY 2021-22 HMEP is authorized by the U.S. Department of Transportation (DOT) Pipeline and
Hazardous Materials Safety Administration (PHMSA) and the Federal Hazardous Materials Transportation
Law (49 U.S.C. Section 5101 et. sec.).
The Subrecipient agrees to comply with all FY 2021-22 HMEP program requirements and the most recent
version of:
A. 2 CFR, Part 200 of the Code of Federal Regulations (CFR), Uniform Administrative Requirements,
Cost Principles, and Audit Requirements for Federal Awards located at htto://www.ecfr.aov.
B. 49 CFR, Part 110 Hazardous Materials Public Sector Training and Planning Grants located at
httn://www.ecfr.ciov.
C. 49 U.S.C. 5116 et seq. located at httus://www.aoo.gov/fdsys.
D. Any other applicable Federal statutes and regulations, including those listed within this grant
agreement elsewhere.
FY 2021-22 HMEP Planning Grant
Oakland County
Page 2 of 6
Ill. Award Amount and Restrictions
A. The county of Oakland is awarded up to $11550 under the FY 2021-22 HMEP Planning Program Grant
Agreement. This funding will be awarded as described in Hazardous Materials Emergency Preparedness
Planning Grant Instructions enclosed within this grant agreement packet and is based on information
provided in the HMEP grant application submitted for the FY 2021-22 grant year by Oakland County.
This allocation is dependent upon the level of federal funding and may be reduced if available federal
funding is reduced or if fewer plans are submitted based on the FY 2021-22 application for Oakland
County. Any unused grant funds remaining at the end of the grant year will be used to increase the
reimbursement for accepted new SARA Title III plans submitted by participating Local Emergency
Planning Committees (LEPCs). The Subrecipient's payment per new plan will be recalculated using these
funds and the award to the Subrecipient for the number of new plans submitted will be adjusted. This may
affect the match amount required for this grant.
Based on the Subrecipient's application, a match amount of $2888 is required. However, the Subrecipient
must be prepared to match all funds received through this grant agreement (which equates to 25% of any
federal funds received), as noted in Section 111, D of the Hazardous Materials Emergency Preparedness
Planning Grant Instructions that are enclosed within this grant agreement.
The PHMSA reserves a royalty -free, nonexclusive, and irrevocable license to reproduce, publish, or
otherwise use, and to authorize others to use, for federal government purposes:
1. The copyright in any work developed under this grant, sub -award, or contract under a grant or
sub -award; and
2. Any rights of copyright to which the Recipient, Subrecipient, or a contractor purchases ownership
with grant support.
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.
B. The subrecipient shall not use FY 21-22 HMEP 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:
1. Subrecipient Risk Assessment Certification
2. HMEP Planning Grant Agreement In -Kind Match form (EMD-063)
3. Standard Assurances
4. Certifications Regarding Lobbying; Debarment, Suspension and Other Responsibility Matters; and
Drug -Free Workplace Requirements
5. Audit Certification (EMD-053)
6. Request for Taxpayer Identification Number and Certification (W-9)
7. SARA Title III Hazardous Materials, Off -site Emergency Response Plan Update List (EMD 064). THE
form is located on the MSP/EMHSD website at htto://www.michioan.00v/emhsd under Hazardous
Materials. The form does not need to be completed and returned with the FY 2021-22 HMEP
Planning Program grant agreement. It is to be used if and when a list of updated plans is submitted
for your grant. Submit the Plan Review List directly to the SARA Title III Planner at the MSP/EMHSD
no later than September 15, 2022.
8. Other documents that may be required by federal or state officials
D. The Subrecipient agrees to comply with all applicable federal and state regulations, including, but not
limited to, the following:
FY 2021-22 HMEP Planning Grant
Oakland County
Page 3 of 6
1. Meet the LEPC eligibility requirements, as stated in the Hazardous Materials Emergency
Preparedness Planning Grant Instructions, Section II which is included with this grant agreement
package.
2. In accordance with 2 CFR 200.331, the subrecipient permits the recipient to have access to the
subrecipient's records and financial statements as necessary for the recipient to meet the
requirements of 2 CFR 200.331.
3. Integrate individuals with disabilities into emergency planning in compliance with Executive Order
13347 and the Rehabilitation Act of 1973.
4. 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:
a. Account for receipts and expenditures, maintain adequate financial records, and refund
expenditures disallowed by federal or state audit.
b. 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.
c. Non-federal organizations which expend $750,000 or more in federal funds from all sources 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.
5. Comply with the Department of Transportation's policy for contracting with small, women -owned,
minority disadvantaged businesses, veteran, and HubZone business firms.
V. Responsibilities of the Recipient
The Recipient, in accordance with the general purposes and objectives of this grant agreement, will:
A. Administer the grant in accordance with all applicable federal and state regulations and guidelines and
submit required reports to the awarding federal agency.
B. Provide direction and technical assistance to the Subrecipient.
C. Provide to the Subrecipient any special report forms and reporting formats (templates) required for
administration of the program.
D. Reimburse the Subrecipient, in accordance with this grant agreement, based on appropriate
documentation submitted by the Subrecipient.
E. At its discretion, independently, or in conjunction with the federal awarding agency, conduct random on -
site reviews of the Subrecipient(s).
VI. Reporting Procedures
Submit new and updated SARA Title III (Section 302) community hazardous materials emergency response plans
and identify which facility plans were updated on the attached Plan Update List form as stated in the FY 2021-22
application to MSP/EMHSD, no later than September 15, 2022 to the MSP/EMHSD District Coordinator. The form
for submitting these updates is available on the MSP/EMHSD website located at htto://www.michician.00v/emhsd.
Complete instructions on how and where to submit required reports can be found in the Hazardous Materials
Emergency Preparedness Planning Grant Instructions that are included with this grant agreement package. If a
support grant was requested, the LEPC must meet the requirements stated in the attached Hazardous Materials
Emergency Preparedness Planning Grant Instructions, Section IV.B., or forfeit that portion of the grant award.
VII. Payment Procedures
Upon receipt, review, and acceptance of all work products and other requirements, as referenced in this grant
agreement, the Recipient will calculate the payment to be made to the Subrecipient and will forward this
information to the Subrecipient. See the Hazardous Materials Emergency Preparedness Planning Grant
Instructions document attached within this grant agreement packet for further information.
FY 2021-22 HMEP Planning Grant
Oakland County
Page 4 of 6
All Subrecipients in the HMEP grant program must submit documentation on the associated costs being charged
to the $1,500 HMEP support grant. The eligible expenses are laid out in the HMEP $1,500 Support Grant
Certification Form, which will be sent to each LEPC at the close of the federal fiscal year. When a LEPC enters
information into this form, the cost will need to be supported by a receipt, time sheet (reflecting hours worked on
SARA related planning issues), purchase order or a paid invoice. The support grant form and attachments must
be returned to MSP/EMHSD by the assigned due date.
VIII. 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; the Elliott -Larsen Civil Rights Act, 1976 PA 453, as amended, MCL 37.2101 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 contract or 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 must comply with 2 CFR, Part 1200, Nonprocurement Suspension and Debarment, located at
htto://www.ecfr.00v. The Subrecipient shall ensure that no subcontractor, manufacturer, or supplier of the
Subrecipient for projects related to this grant agreement appears on the Active Exclusions list on the System for
Award Management (SAM) website located at htto://www.sam.gov (previously this search was performed in the
Excluded Parties List System — EPLS).
The Subrecipient must comply with regulation 49 CFR, Part 21, Nondiscrimination in Federally -Assisted Programs
of the Department of Transportation — Effectuation of the Title VI of the Civil Rights Act of 1964 (see related
certification form contained in this grant agreement package).
The Subrecipient must comply with regulation 49 CFR, Part 20, New Restrictions on Lobbying (see related
certification form contained in this grant agreement package).
IX. Limitation of Liability
The Recipient and the Subrecipient to this grant agreement agree that each must seek its own legal representative
and bear its own costs, including judgments, in any litigation that may arise from performance of this grant
agreement. It is specifically understood and agreed that neither party will indemnify the other party in such
litigation.
This is not to be construed as a waiver of governmental immunity for either party.
X. Third Parties
This grant agreement is not intended to make any person or entity, not a party to this grant agreement, a third -
party beneficiary hereof or to confer on a third party any rights or obligations enforceable in their favor.
XI. Grant Agreement Period
This grant agreement is in full force and effect from September 30, 2021 to September 29, 2022. No costs eligible
under this grant agreement shall be incurred before the starting date of this grant agreement, except with prior
written approval. This grant agreement may be terminated by either party by giving thirty (30) days written notice
to the other party stating reasons for termination and the effective date, or upon the failure of either party to carry
out the terms of the grant agreement. Upon any such termination, the Subrecipient agrees to return to the
Recipient any funds not authorized for use, and the Recipient shall have no further obligation to reimburse the
Subrecipient.
FY 2021-22 HMEP Planning Grant
Oakland County
Page 5 of 6
XII. Entire Grant Agreement
This grant agreement is governed by the laws of the State of Michigan and supersedes all prior agreements,
documents, and representations between the Recipient and the Subrecipient, whether expressed, implied, or oral.
This grant agreement constitutes the entire agreement between the parties and may not be amended except by
written instrument executed by both parties prior to the grant end date. No party to this grant agreement may
assign this grant agreement or any of his/her/its rights, interest, or obligations hereunder without the prior consent
of the other party. The Subrecipient agrees to inform the Recipient in writing immediately of any proposed
changes of dates, budget, or services indicated in this grant agreement, as well as changes of address or
personnel affecting this grant agreement. Changes in dates, budget, or services are subject to prior written
approval of the Recipient. If any provision of this grant agreement shall be deemed void or unenforceable, the
remainder of the grant agreement shall remain valid.
The Recipient may suspend or terminate grant funding to the Subrecipient, in whole or in part, or other measures
may be imposed for any of the following reasons:
A. Failure to expend funds in a timely manner consistent with the grant milestones, guidance, and
assurances.
B. Failure to comply with the requirements or statutory objectives of federal or state law.
C. Failure to 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.
XIII. Business Integrity Clause
The Recipient may immediately cancel the grant without further liability to the Recipient or its employees if the
Subrecipient, an officer of the Subrecipient, or an owner of a 25% or greater share of the Subrecipient is convicted
of a criminal offense incident to the application for or performance of a state, public, or private grant or subcontract;
or convicted of a criminal offense, including, but not limited to any of the following: embezzlement, theft, forgery,
bribery, falsification or destruction of records, receiving stolen property, attempting to influence a public employee
to breach the ethical conduct standards for State of Michigan employees; convicted under state or federal antitrust
statutes; or convicted of any other criminal offense which, in the sole discretion of the Recipient, reflects on the
Subrecipient's business integrity.
XIV. Freedom of Information Act (FOIA)
Much of the information submitted in the course of applying for funding under this program, or provided in the
course of grant management activities, may be considered law enforcement -sensitive or otherwise critical to
national security interests. This may include threat, risk, and needs assessment information; and discussions of
demographics, transportation, public works, and industrial and public health infrastructures. Therefore, each
Subrecipient agency Freedom of Information Officer will need to determine what information is to be withheld on a
case -by -case basis. The Subrecipient should be familiar with the regulations governing Protected Critical
Infrastructure Information (6 CFR, Part 29) and Sensitive Security Information (49 CFR, Part 1520), as these
designations may provide additional protection to certain classes of homeland security information.
FY 2021-22 HMEP Planning Grant
Oakland County
Page 6 of 6
XV. Official Certification
For the Subrecipient
The individual or officer signing this grant agreement certifies by his or her signature that he or she is authorized to
sign this grant agreement on behalf of the organization he or she represents. The Subrecipient agrees to
complete all requirements specified in this grant agreement.
Subrecipient Name
Printed Name
Signature
Subrecipient's UEI Number
Title
Date
For the Recipient (Michigan State Police. Emeraency Management and Homeland Securitv Divisionl
Caot. Kevin Sweenev
Printed Name
Commander, Emergency Management
and Homeland Security Division
Title
5/6/22
Signature Date
EMHSD-RA (0412019)
MICHIGAN STATE POLICE
Emergency Management and Homeland Security Division
SUBRECIPIENT RISK ASSESSMENT CERTIFICATION
As required by 2 CFR §200.331(b), the purpose of this assessment is to evaluate subrecipient's risk of noncompliance with
federal statutes, regulations, and the terms and conditions of a subaward, and to determine appropriate subrecipient
monitoring during the grant performance period. Limited program experience, results of previous audits and site monitoring
visits, new personnel or new or substantially changed systems, may increase a subrecipient's degree of risk.
Subrecipient:
County: I DUNS #:
Questions
1. How many federal grant awards has your organization managed in the past 5 years regardless of awarding agency?
❑ No grants
❑ 1-3 grants
❑ 4-5 grants
❑ 6+ grants
2. What percentage of your grant management staff has fewer than 2 years of grant experience?
❑ 0-25% of staff
❑ 26-50% of staff
❑ 51-75% of staff
❑ 76-100% of staff
3. Has your organization had a new or substantially changed financial/accounting system(s) in the past 2 years?
❑ Yes
❑ No
4. What types of findings (audit, site monitoring, etc.) has your organization received within the past 5 years?
(Attach a separate sheet explaining any findings resulting in questioned costs or a return of funds.)
❑ Never Audited or No
❑ Unsupported costs (lack of documentation)
❑ Unreasonable use of funds
❑ Questioned costs or required to return funds
5. Does your agency have staff primarily dedicated (>50%) to grants management activities?
❑ Yes
❑ No
Certification
1 certify the information provided in this assessment is true and accurate, and that all occurrences of prior grant
non-compliance have been disclosed.
Authorized Representative Signature:
Authorized Representative Printed Name:
Date:
Title:
Point of Contact Printed Name: I Title: Email:
EMD-063 (09/2014)
MICHIGAN STATE POLICE
Emergency Management and Homeland Security Division
The Oakland County Local Emergency Planning Committee (LEPC) has been allocated the funding amount specified in the
attached grant agreement. Therefore, a local fund match of $2,888 is required.
The LEPC agrees to use the following as its in -kind match (This can be any non-federal money from a government
jurisdiction, industry, or other organization represented on the LEPC. Staff paid with federal funds, and funds used
as a match for other federal grants CANNOT be used for the HMEP match.):
❑ PLANNING PERSONNEL: (Full Name of Employee) ,
whose salary and fringe benefits cost $ per hour, will work approximately hours on LEPC planning.
❑ SECRETARIAL: (Full Name of Employee or Secretarial Service) ,
whose salary and fringe benefits cost $ per hour, will work approximately hours on LEPC business.
❑ OFFICE SPACE: (Government Jurisdiction or Other Entity) ,
will provide a square foot office located at (Address) to the LEPC at a cost of $ per square foot.
❑ MAILING: (Government Jurisdiction or Other Entity) ,
will provide $ toward LEPC related mailings.
❑ PRINTING: (Government Jurisdiction or Other Entity) ,
will provide $ toward LEPC related printing.
❑ OTHER (Describe):
AUTHORITY: 1976 PA 390, as amended, MCL 30.407a, 42 USC 11002 - 11003
COMPLIANCE: Voluntary, however failure to complete application will result in denial of request
OMB APPROVAL NO. 1121-140
EXPIRES 5/31/2019
STANDARD ASSURANCES
The Applicant hereby assures and certifies compliance with all applicable Federal statutes, regulations, policies,
guidelines, and requirements, including 2 C.F.R. Part 2800 (Uniform Administrative Requirements, Cost
Principles, and Audit Requirements for Federal Awards by the Department of Justice), and Ex. Order 12372
(intergovernmental review of federal programs). The applicant also specifically assures and certifies that:
1. It has the legal authority to apply for federal assistance and the institutional, managerial, and financial
capability (including funds sufficient to pay any required non-federal share of project cost) to ensure proper
planning, management, and completion of the project described in this application.
2. It will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or
presents the appearance of personal or organizational conflict of interest, or personal gain.
3. It will give the awarding agency or the Government Accountability Office, through any authorized
representative, access to and the right to examine all paper or electronic records related to the financial assistance.
4. It will comply with all lawful requirements imposed by the awarding agency, specifically including any
applicable regulations, such as 28 C.F.R. pts. 18, 22, 23, 30, 35, 38, 42, 61, and 63, and the award term in
2 C.F.R. § 175.15(b).
5. It will assist the awarding agency (if necessary) in assuring compliance with section 106 of the National
Historic Preservation Act of 1966 (16 U.S.C. § 470), Ex. Order 11593 (identification and protection of historic
properties), the Archeological and Historical Preservation Act of 1974 (16 U.S.C. § 469a-I et seq.), and the
National Environmental Policy Act of 1969 (42 U.S.C. § 4321).
6. It will comply (and will require any subrecipients or contractors to comply) with any applicable
nondiscrimination provisions, which may include the Omnibus Crime Control and Safe Streets Act of 1968 (42
U.S.C. § 3789d); the Victims of Crime Act (42 U.S.C. § 10604(e)); the Juvenile Justice and Delinquency
Prevention Act of 2002 (42 U.S.C. § 5672(b)); the Violence Against Women Act (42 U.S.C. § 13925(b)(13)); the
Civil Rights Act of 1964 (42 U.S.C. § 2000d); the Indian Civil Rights Act (25 U.S.C. §§ 1301-1303); the
Rehabilitation Act of 1973 (29 U.S.C. § 794); the Americans with Disabilities Act of 1990 (42 U.S.C. §§
12131-34); the Education Amendments of 1972 (20 U.S.C. §§ 1681, 1683, 1685-86); and the Age Discrimination
Act of 1975 (42 U.S.C. §§ 6101-07). It will also comply with Ex. Order 13279, Equal Protection of the Laws for
Faith -Based and Community Organizations; Executive Order 13559, Fundamental Principles and Policymaking
Criteria for Partnerships With Faith -Based and Other Neighborhood Organizations; and the DOJ implementing
regulations at 28 C.F.R. Part 38.
7. If a governmental entity
a) it will comply with the requirements of the Uniform Relocation Assistance and Real Property
Acquisitions Act of 1970 (42 U.S.C.§ 4601 et seq.), which govern the treatment of persons displaced as a result of
federal and federally -assisted programs; and
b) it will comply with requirements of 5 U.S.C.§§ 1501-08 and §§7324-28, which limit certain political
activities of State or local government employees whose principal employment is in connection with an
activity financed in whole or in part by federal assistance.
Signature Date
W
U.S. DEPARTMENT OF JUSTICE
OFFICE OF JUSTICE PROGRAMS
OFFICE OF THE COMPTROLLER
• C 1] *kA I Let 9 NAMT061 N ArNU IWIAGM141ON 6
Applicants should refer to the regulations cited below to determine the certification to which they are required to
attest. Applicants should also review the instructions for certification included in the regulations before completing this
form. Signature of this form provides for compliance with certification requirements under 28 CFR Part 69, "New
Restrictions on Lobbying" and 28 CFR Part 67, "Government -wide Debarment and Suspension (Nonpro-curement) and
Government -wide Requirements for Drug -Free Workplace (Grants)." The certifications shall be treated as a material
representation of fact upon which reliance will be placed when the Department of Justice determines to award the
covered transaction, grant, or cooperative agreement.
1. LOBBYING
As required by Section 1352, Title 31 of the U S. Code, and
implemented at 28 CFR Part 69, for persons entering into a
grant or cooperative agreement over $100,000, as defined at
28 CFR Part 69, the applicant certifies that:
(a) No Federal appropriated funds have been paid or will be
paid, by or on behalf of the undersigned, to any person for in-
fluencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of
Congress, or an employee of a Member of Congress in con-
nection with the making of any Federal grant, the entering into
of any cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any Federal grant or
cooperative agreement;
(b) If any funds other than Federal appropriated funds have
been paid or will be paid to any person for influencing or at-
tempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with this
Federal grant or cooperative agreement, the undersigned shall
complete and submit Standard Form - LLL, "Disclosure of
Lobbying Activities," in accordance with its instructions;
(c) The undersigned shall require that the language of this cer-
tification be included in the award documents for all subawards
at all tiers (including subgrants, contracts under grants and
cooperative agreements, and subcontracts) and that all sub -
recipients shall certify and disclose accordingly.
2. DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS
(DIRECT RECIPIENT)
As required by Executive Order 12549, Debarment and
Suspension, and implemented at 28 CFR Part 67, for prospec-
tive participants in primary covered transactions, as defined at
28 CFR Part 67, Section 67.510—
A. The applicant certifies that it and its principals:
(a) Are not presently debarred, suspended, proposed for debar-
ment, declared ineligible, sentenced to a denial of Federal
benefits by a State or Federal court, or voluntarily excluded
from covered transactions by any Federal department
or agency;
(b) Have not within a three-year period preceding this applica-
tion been convicted of or had a civil judgment rendered against
them for commission of fraud or a criminal offense in connec-
tion with obtaining, attempting to obtain, or performing a
public (Federal, State, or local) transaction or contract under a
public transaction; violation of Federal or State antitrust statutes
or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
(c) Are not presently indicted for or otherwise criminally or
civilly charged by a governmental entity (Federal, State, or
local) with commission of any of the offenses enumerated in
paragraph (1)(b) of this certification; and
(d) Have not within a three-year period preceding this applica-
tion had one or more public transactions (Federal, State, or
local) terminated for cause or default; and
B. Where the applicant is unable to certify to any of the
statements in this certification, he or she shall attach an
explanation to this application.
3. DRUG -FREE WORKPLACE
(GRANTEES OTHERTHAN INDIVIDUALS)
As required by the Drug -Free Workplace Act of 1988, and
implemented at 28 CFR Part 67, Subpart F, for grantees, as
defined at 28 CFR Part 67 Sections 67.615 and 67.620—
A. The applicant certifies that it will or will continue to provide
a drug -free workplace by:
(a) Publishing a statement notifying employees that the
unlawful manufacture, distribution, dispensing, possession, or
use of a controlled substance is prohibited in the grantee's
workplace and specifying the actions that will be taken against
employees for violation of such prohibition;
(b) Establishing an on -going drug -free awareness program to
inform employees about—
(1) The dangers of drug abuse in the workplace;
(2) The grantee's policy of maintaining a drug -free workplace;
(3) Any available drug counseling, rehabilitation, and employee
assistance programs; and
(4) The penalties that may be imposed upon employees for
drug abuse violations occurring in the workplace;
(c) Making it a requirement that each employee to be engaged
in the performance of the grant be given a copy of the state-
ment required by paragraph (a);
(d) Notifying the employee in the statement required by para-
graph (a) that, as a condition of employment under the grant,
the employee will—
OJP FORM 406116 (3-91) REPLACES OJP FORMS 4061/2, 4061/3 AND 4061/4 WHICH ARE OBSOLETE.
(1) Abide by the terms of the statement; and
(2) Notify the employer in writing of his or her conviction for a
violation of a criminal drug statute occurring in the workplace
no later than five calendar days after such conviction;
(a) Notifying the agency, in writing, within 10 calendar days
after receiving notice under subparagraph (d)(2) from an
employee or otherwise receiving actual notice of such convic-tion.
Employers of convicted employees must provide notice, including
position title, to: Department of Justice, Office of
Justice Programs, ATTN Control Desk, 633 Indiana Avenue,
N.W., Washington, D.C. 20531. Notice shall include the iden-
tification number(s) of each affected grant;
(f) Taking one of the following actions, within 30 calendar
days of receiving notice under subparagraph (d)(2), with
respect to any employee who is so convicted —
(1) Taking appropriate personnel action against such an
employee, up to and including termination, consistent with the
requirements of the Rehabilitation Act of 1973, as amended; or
(2) Requiring such employee to participate satisfactorily in a
drug abuse assistance or rehabilitation program approved for
such purposes by a Federal, State, or local health, law enforce-
ment, or other appropriate agency;
(g) Making a good faith effort to continue to maintain a drug -
free workplace through implementation of paragraphs (a), (b),
(c), (d), (e), and (f).
B. The grantee may insert in the space provided below the
site(s) for the performance of work done in connection with
the specific grant:
Place of Performance (Street address, city, county, state, zip
code)
Check ❑ if there are workplaces on file that are not indentified
here.
Section 67, 630 of the regulations provides that a grantee that
is a State may elect to make one certification in each Federal
fiscal year. A copy of which should be included with each ap-
plication for Department of Justice funding. States and State
agencies may elect to use OJP Form 4061/7.
Check ❑ if the State has elected to complete OJP Form
4061 /7,
DRUG -FREE WORKPLACE
(GRANTEES WHO ARE INDIVIDUALS)
As required by the Drug -Free Workplace Act of 1988, and
implemented at 28 CFR Part 67, Subpart F, for grantees, as
defined at 28 CFR Part 67; Sections 67.615 and 67.620—
A. As a condition of the grant, I certify that I will not engage
in the unlawful manufacture, distribution, dispensing, posses-
sion, or use of a controlled substance in conducting any
activity with the grant; and
B. If convicted of a criminal drug offense resulting from a
violation occurring during the conduct of any grant activity, I
will report the conviction, in writing, within 10 calendar days
of the conviction, to: Department of Justice, Office of Justice
Programs, ATTN: Control Desk, 810 Seventh Street NW.,
Washington, DC 20531,
As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above certifications.
1. Grantee Name and Address:
2. Application Number and/or Project Name 3. Grantee IRS/Vendor Number
4. Typed Name and Title of Authorized Representative
5. Signature 6. Date
'U S. G..,,ment Pnnling Office: 1996- 405M7140014
EMD-053 (04/2018)
MICHIGAN STATE POLICE
Emergency Management and Homeland Security Division
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.
1. Program Information
Program Name CFDA Number
11, Subrecipient Information
Subrecipient Name
Street Address I city
Ill. Certification for Fiscal Year
State I 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
P.O. 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
P.O. Box 30634
Lansing, Michigan 48909
Date
Form® Request for Taxpayer
(Rev. October 2g18) Identification Number and Certification
Department of the Treasury
Internal Revenue Service ® Go to www.lrs.gov/FormW9 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
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the
following seven boxes.
❑ Individual/sole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate
single -member LLC
Give Form to the
requester. Do not
send to the IRS.
4 Exemptions (codes apply only to
certain entitles, not Individuals; see
instructions on page S:
Exempt payee code (if any)
❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Pannership)
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 LLC 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)► (A,,);s to eccwpo r„osna,r,eaom„de me US)
5 Address (number, street, and apt or suite no.) See instructions I 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 Social security number
backup withholding. For individuals, this is generally your social security number (SSN). However, for a - m
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
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 Employer identification number
Number To Give the Requester for guidelines on whose number to enter. m
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 coders) 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 II, later.
Sign Signature of
Here 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 (FIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099-INT (interest earned or paid)
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)
page 2
By signing the filled -out form, you:
1. Certify that the TIN you are giving is correct (or you are waiting for a
number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you 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 purposes, you are
considered a U.S. person if you are:
• An individual who is a U.S. citizen or U.S. resident alien;
• A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United States;
• An estate (other than a foreign estate); or
• A domestic trust (as defined in Regulations section 301.7701-7).
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 be subject to backup withholding on payments you
receive if you give the requester your correct TIN, make the proper
certifications, and report all your taxable interest and dividends on your
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.
Form 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
Pan 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: TIN 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)...
r 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
Fc,m W-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
$5,0001
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
1 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)(1)
E—A corporation that is a member of the same expanded affiliated
group as a corporation described in Regulations section 1.1472-1(c)(1)(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 LTC 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 EIN. 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 EIN. 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.im.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 IL 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 Exemptpayee
code, earlier.
Signature requirements. Complete the certification as indicated in
items 1 through 5 below.
Form W-9 (Rev 10-2018)
Page $
1. Interest, dividend, and barter exchange accounts opened
before 1984 and broker accounts considered active during 19133.
You must give your correct TIN, but you do not have to sign the
certification.
2. Interest, dividend, broker, and barter exchange accounts
opened after 1983 and broker accounts considered inactive during
1983. You must sign the certification or backup withholding will apply. If
you are subject to backup withholding and you are merely providing
your correct TIN to the requester, you must cross out item 2 in the
certification before signing the form.
3. Real estate transactions. You must sign the certification. You may
cross out item 2 of the certification.
4. Other payments, You must give your correct TIN, but you do not
have to sign the certification unless you have been notified that you
have previously given an incorrect TIN. "Other payments' include
payments made in the course of the requester's trade or business for
rents, royalties, goods (other than bills for merchandise), medical and
health care services (including payments to corporations), payments to
a nonempioyee for services, payments made in settlement of payment
card and third party network transactions, payments to certain fishing
boat crew members and fishermen, and gross proceeds paid to
attorneys (including payments to corporations).
5. Mortgage interest paid by you, acquisition or abandonment of
secured property, cancellation of debt, qualified tuition program
payments (under section 529), 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 (olnt
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
font account maintained by an FFI)
4. Custodial account of a minor
The Minor
(Uniform Gift to Minors Act)
5. a. The usual revocable savings trust
The grantor -trustee
(grantor is also trustee)
It. So-called trust account that is not
The actual owner'
a legal or valid trust under state law
6. Sole proprietorship or disregarded
The owner3
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)(2)(i)
(A))
For this type of account: Give name and EIN of:
8. Disregarded entity not owned by an The owner
individual
9. A valid trust, estate, or pension trust Legalentity°
10. Corporation or LLC electing The corporation
corporate status on Form 8832 or
Form 2653
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(b)(2)O(0))
' List first and circle the name of the person whose number you furnish.
If only one person on a joint account has an SSN, that person's number
must be furnished.
2 Circle the minor's name and furnish the minor's SSN,
3 You must show your individual name and you may also enter your
business or DBA name on the "Business name/disregarded entity"
name line. You may use either your SSN or FIN (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 disk 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 emails 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.
Form W-9 (Rev. 10-2018)
page 6
The IRS does not initiate contacts with taxpayers via emails. Also, the
IRS does not request personal detailed information through email or ask
taxpayers for the PIN numbers, passwords, or similar secret access
information for their credit card, bank, or other financial accounts.
If you 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.govlidtheft or 877-IDTHEFT (877-438-4338).
If you have been the victim of identity theft, see www.IdentityTheft.gov
and Pub. 5027.
Visit w Jrs.gov/IdentityTheft 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.
EMD-064 (08/2014)
MICHIGAN STATE POLICE
Emergency Management and Homeland Security Division
SARA TITLE III HAZARDOUS MATERIALS, OFF -SITE EMERGENCY RESPONSE PLAN UPDATE LIST
AUTHORITY: 1976 PA 390, MCL 30.407a; 42 USC 11002-11003
COMPLIANCE: Required PENALTY: Civil penalty of not more than $25,000 for each day such violation occurs
This form is used for the recording of updated emergency contact information for sites required under 42 USC 11002 (SARA Title III, Section 302). DO NOT list new
plans on this sheet. Please note that the Michigan State Police, Emergency Management and Homeland Security Division may contact facilities to verify the plan
review.
Local Emergency Planning Committee (LEPC) Name:
MI SARA ID Number
SIGNATURE
Facility Name
Facility Emergency Contact
Date:
Emergency Contact
Phone Number
Date Original Plan
Submitted
(LEPC Chair or Local Emergency Management Coordinator)
January 2022
/TIFRITITaiS%1
Hazardous Materials Emergency Preparedness
Planning Grant Instructions
Grant Program Description
The Michigan State Police, Emergency Management and Homeland Security Division
(MSP/EMHSD) has been designated by the Governor's office to administer the Hazardous
Materials Emergency Preparedness (HMEP) planning grant program. HMEP planning grants
are being made available to Local Emergency Planning Committees (LEPCs) for enhancing
hazardous material response planning.
Eligibility Requirements
To be eligible to receive funding through the HMEP planning grant, LEPCs must:
A. Be formally appointed by the Michigan Citizen -Community Emergency Response
Coordinating Council (MCCERCC);
B. Have an appointed chairperson;
C. Have an appointed information coordinator;
D. Have an appointed emergency management coordinator;
E. Meet virtually at least twice and have an established meeting schedule;
F. Assure that a 20% in -kind match will be available for all funding received through this
grant. In -kind match includes non -federally funded LEPC member time, office space,
secretarial support, LEPC office and administrative expenses, etc. (See item III.D);
G. Assure county or municipal compliance with Title VI of the Civil Rights Act of 1964;
H. Assure county or municipal compliance with lobbying, debarment, suspension, and other
responsibility matters certifications, as well as drug -free workplace requirements.
If individuals holding these positions change, please update the LEPC Roster and submit to
the MSP/EMHSD. The forms are available by contacting Ms. Brenna Roos at
517-582-2846, Roosb@Michigan.gov.
Ill. Application Process
A. Deadline: All applications and 2021-2022 LEPC meeting schedules must be received by
the MSP/EMHSD no later than February 28, 2022.
B. Application Mailing Address: If you are submitting via mail, please address the
package to:
Attention: Ms. Brenna Roos
SARA Title III Program
Michigan State Police, Emergency Management and Homeland Security Division
P.O. Box 30634
Lansing, MI 48909
January 2022
Attachment A
C. Agreement Finalized: The MSP/EMHSD will review all applications for completeness
and accuracy. Local Emergency Management programs with approved applications will
be sent two HMEP Grant Agreements, along with multiple attachments that must be
submitted to the MSP/EMHSD to receive HMEP funding. Funding levels stated in the
agreement are subject to the availability of federal funds. The Local Emergency
Management Coordinator must sign the agreements, return one to the MSP/EMHSD, and
retain one copy for their LEPC files by the date specified in grant agreements.
D. Matching Funds Identified: When the LEPC receives the HMEP Grant Agreement, it
will also receive a form to document its matching funds. Federal grants require matching
funds to be calculated against TOTAL program costs. For grant purposes, total program
costs are calculated by dividing the proposed reimbursements from the HMEP planning
grant by .80. The resulting amount (total program cost) is then multiplied by .20 to
calculate the match required. The "Hazardous Materials Emergency Preparedness
(HMEP) Planning Grant Agreement In -Kind Match" form must be returned to the
MSP/EMHSD with the HMEP Grant Agreement packet. This form is used to estimate
matching funds based on the proposed agreement amount (see Item II.F). However, the
subrecipient must be prepared to match funds based on the amount of grant funding
actually received for the contract period, including additional funding received in excess of
the agreement amount.
Note: Staff positions and/or programs supported by other federal funds cannot be used as
match for this grant.
IV. Allocation Formula
A. New Plan and Plan Update Payments: The MSP/EMHSD will reimburse LEPCs for
new and updated off -site emergency response plans. The reimbursement rate for new
plans in 2021-2022 is $250. Updated plans will receive $30 per update. Facilities
must be on the SARA Title III, Section 302 site list or added to the 302 site list by
September 15, 2022. Plans that are added to the 302 site list after September 15, 2022,
may not receive reimbursement from the 2021-2022 HMEP planning grant. To receive
this funding, items B and/or C on the bottom of the "Local Emergency Planning
Committee Application for Hazardous Material Emergency Preparedness Grant" form
must be completed. This form is included in the application package.
B. Support Grant Payments: Each LEPC is eligible for a $1,500 support grant. To qualify
for the support grant, a LEPC must:
• Meet in -person or virtually at least four times annually and verify that meetings have
been held by sending the MSP/EMHSD a copy of the meeting schedule, or other
verification if requested.
• Annually update the LEPC's officer/membership list and submit the completed form
to the MSP/EMHSD.
• Incorporate completed off -site response plans into the city/county Emergency
Operations Plan (EOP) or Emergency Action Guidelines (EAG).
• Review the city/county EOP/Emergency Action Plan (EAP) annually to make sure
the hazmat response section is current.
6 Complete all updates for existing 302 sites.
Verification of the above items, via a form signed by the LEPC Chair and/or Local
Emergency Management Coordinator, will be requested by the MSP/EMHSD prior to the
end of the grant year.
January 2022
Attachment A
V. Proof of Purchase and Associated Work
All subrecipients in the HMEP planning grant program must submit documentation on the
associated costs being reimbursed by the $1,500 HMEP Support Grant. The eligible
expenses are laid out in the "HMEP $1,500 Support Grant Certification Form," which will be
sent to each LEPC at the close of the fiscal year. Costs entered on this form need to be
supported by a receipt, time sheet (reflecting hours worked on SARA (Superfund Amendment
and Reauthorization Act) related planning issues), purchase order, or a paid invoice. The
"HMEP $1,500 Support Grant Certification Form" and attachments must be returned to the
MSP/EMHSD by the assigned due date.
VI. Planning Grant Requirements
A. Products: The intent of the planning grant is to encourage the development of new
off -site hazardous material response plans and complete updates to previously submitted
off -site response plans for each SARA Title III Section 302 site in Michigan. Plans must be
submitted to the appropriate MSP/EMHSD District Coordinator by the date specified in each
LEPC's Grant Agreement. A list of updated plans for sites on the current 302 site list must
also be submitted by that date. A plan update includes verification and updating of a facility's
emergency contact information, on -site extremely hazardous substances (EHS) and their
quantities, storage locations, and any other items which may have an impact on employee or
community life, health, and safety. The list must include the site name, the Department of
Environment, Great Lakes, and Energy (EGLE) SARA identification number, and name of
facility contact that assisted with the review. The "Plan Review List Form" for submittal is
located on the MSP/EMHSD website and can be submitted directly to the address noted in
Item III.B.
B. Eligible Expenses: HMEP planning grant funds are to be utilized for expenses that
support and facilitate the development and/or updating of required SARA Title III off -site
plans. Expenses can include, but are not limited to:
• Training for LEPC members, as long as it relates to the LEPC's planning mission.
• Development, improvement, and implementation of emergency plans required under
SARA Title I II.
• Exercises that test LEPC plans.
• Enhancement of LEPC plans, e.g., improving the hazard analysis or transportation
of hazardous materials (including radioactive materials) response procedures.
• Commodity flow studies.
• Needs analysis for establishing regional response teams.
• Technical staff to support the planning effort.
• Assessment of local response capabilities.
• Subscription cost for EGLE's Tier II Manager.
Types of eligible costs that must be directly related to SARA Title III planning activities
include:
• Meeting room rental.
• Per Diem for LEPC members.
• Public notices.
• Printing costs.
• Office administrative expenses.
• LEPC staff costs.
• Tier 11 Manager subscription.
Note: Computer hardware or software is not an allowable purchase.
January 2022
Attachment A
C. Off -Site Response Plans:
• New off -site emergency response plans must be submitted to the appropriate
MSP/EMHSD District Coordinator for review by September 15, 2022.
• A list of completed updates must be submitted to the MSP/EMHSD at the address
noted in Item III.B, or electronically to Roosb@michigan.gov by September 15,
2022.
If the LEPC completes fewer updates and/or new off -site response plans than it
proposes, their award will be prorated according to the number of plans/updates
accepted by the MSP/EMHSD.
Note: Upon request, LEPCs may be required to make updated plans available to the
MSP/EMHSD for verification purposes.
D. MSP/EMHSD Information Requests: Upon request, the LEPC must provide the
MSP/EMHSD with information on how HMEP funds were spent and what was
accomplished. Other information requests related to LEPC operations may also be sent
to LEPCs.
E. Federal Reporting of Sub -awards and Executive Compensation: Upon request, the
subrecipient shall supply information to the MSP/EMHSD to address federal reporting
requirements relevant to the Federal Funding Accountability and Transparency Act of
2006 (FFATA) (Public Law 109-282), as amended by Section 6202(a) of the Government
Funding Transparency Act of 2008 (Public Law 110-252).
F. Reporting of Data Universal Numbering System (DUNS) Number: To comply with
federal government reporting requirements, the MSP/EMHSD is required to collect a
DUNS number from any recipient of sub -awards provided through the state of Michigan.
A DUNS number must be submitted before reimbursement of funds can be made.
G. Other Requirements: The subrecipient must comply with the requirements of 2 CFR
200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for
Federal Awards; 2 CFR 1200, Nonprocurement Suspension and Debarment, 49 CFR Part
20, New Restrictions on Lobbying; and 49 CFR Part 21, Nondiscrimination in Federally
Assisted Programs of the Department of Transportation — Effectuation of the Title VI of
the Civil Rights Act of 1964, which can be found at www.ecfr.gov.
VII. Reimbursement Process
Reimbursement to LEPCs (or a prorated portion) will be processed by the MSP/EMHSD
upon acceptance of the LEPC's products, as specified in its contract.
Vill. Items to Include with Application
A. HMEP Planning Grant Application Form: Appropriate boxes for the type of grant
requested must be checked on the application, and Officer/Emergency Manager
information must be included.
B. LEPC Officer/Member Record.
C. LEPC Meeting Schedule for 2021-2022.
Questions concerning the HMEP planning grant should be directed to Ms. Brenna Roos at
517-582-2846, or email at Roosb@michigan.gov.
151
EMHSD-04D (11117)
MICHIGAN STATE POLICE
Emergency Management and Homeland Security Division
,. W NAVA VA a
AUTHORITY: 1976 PA 390, MCL 30.407a; 42 USC 11002-11003;
COMPLIANCE: Voluntary, however failure to complete application will result in denial of request
Send Completed Form To: Application Due Date:
Michigan State Police February 28, 2022
Emergency Management and Homeland Security Division
ATTN: SARA Title III Program QuestionslComments:
P.O. Box 30634 Phone: 517-582-2846
Lansing, Michigan 48909 Email Address: Roosts a2michiaan.aov
I. Application Information
Local Emergency Planning Committee's (LEPC) Name
LEPC Grant Contact's Name
Oakland County LEPC
Robert Seeley
Contact's Daytime Phone Number
Contact's Email Address
248-496-3295
seeleyr@oakgov.com
Name of Government Jurisdiction and Agency to Receive Hazardous Materials Emergency Preparedness (HMEP) Funds
County of Oakland
Fiscal Officer's or Agency's Name Title
Lynn Sonkiss Fiscal Services Officer
Agency's Mailing Address City State ZIP Code
1200 N. Telegraph Bldg 47W _ Pontiac MI 48341
Agency's Daytime Phone Number Federal ID Number Organizational D-U-N-S 0Number
248-858-5300 38-6004876 1136200362
It. Chair, Officer, and Coordinator Information (Completion ofthe following sections is a mandatory condition for grant award approval)
LEPC Cbair
LEPC Chair's Name Phone Number Email Address
Judith Wheeler 248-898-9082 Judith.wheeler(aD.beaumont.ora
Address City
State
ZIP Code
3601 West 13 Mile Rd Royal Oak
MI
48073
Public Information officer
Public Information Officer's Name Phone Number Email Address
Glori Macias maciaso a0oakoov.com
Address City
State
ZIP Code
1200 N, Telegraph, Bldg 47W Pontiac
MI
48341
Emergency Management Coordinator
Emergency Management Coordinator's Name Phone Number Email Address
Thomas Hardesty 248-858-5300 hardestvUaDoakaov.com
Address City
State
ZIP Code
1200 N. Telegraph, Bldg 47W Pontiac
MI
48341
Ill. Grant Award and Site plan Information
The LEPC is applying foran HMEP grant award to support new and/or current off -site emergency response plans (site plans) under
the Emergency Planning and
Community Right -to -Know Act as found in Title III of the Superrund Amendments and Reauthorization Act (SARA Title ill).
Number of complete updates this LEPC proposes to current SARA Title III site plans.
235
Number of new SARA Title III site plans this LEPC proposes tocomplete.
12
This LEPC agrees to comply with the requirements for a support grant as referenced in the HMEP, Planning Grant
® Yes
❑ No
Instructions, Attachment A. Parts II and IV, and requests the $1,500prant.
The LEPC has attached its meeting schedule. (Note: This is required for grant award approval.)
® Yes
❑ No
The LEPC agrees that if it receives a grant award, It will verify that meetings were held as scheduled by submitting
® Yes
❑ No
meeting minutes or a list of attendees to the Michigan State Police Emergency Management and Homeland
Secudtv Division.
EMHSD-040 (11/17)
MICHIGAN STATE POLICE
Emergency Management and Homeland Security Division
i
LEPC hair nature '�
Date
EMD-072 (07/2014)
MICHIGAN STATE POLICE
Emergency Management and Homeland Security Division
AUTHORITY: 1976 PA 390, MCL 30.407a; COMPLIANCE: Voluntary
Complete the following information for the Chairperson, Information Coordinator, and Emergency Management
Coordinator. If there is no change from the previous submission, write "NO CHANGE" in the Name field.
Year LEPC Name
I. Chairperson
Name I Mailing Address
City State ZIP Code Phone Number Email Address
III. Information Coordinator
Name Mailing Address
City State ZIP Code Phone Number Email Address
III. Emergency Management Coordinator (AXA. Community Emergency coordinator)
Name Mailing Address
City State ZIP Code Phone Number Email Address
Member's Name Add Delete Current Group Represented
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EMD-072 (07/2014)
MICHIGAN STATE POLICE
Emergency Management and Homeland Security Division
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(Use additional forms as needed for members' names)
EMD-072 (07/2014)
MICHIGAN STATE POLICE
Emergency Management and Homeland Security Division
Submitted By Title Date
Of1
COUNTY MICHIGAN
DAVID COULTER. OAKLAND COUNTY EXECUTIVE
LOCAL EMERGENCY PLANNING COMMITTEE
UNDER THE AUSPICES OF THE OAKLAND
COUNTY EXECUTIVE AND THE OAKLAND
COUNTY BOARD OF COMMISSIONERS
OAKLAND COUNTY LOCAL EMERGENCY PLANNING COMMITTEE
MONTH DATE
February
May
August 2
November 1
LEPC SCHEDULE
JANUARY - DECEMBER 2022
DAY COMMITTEE TIME
Tuesday LEPC 9:00 a.m. Zoom
PLACE
Tuesday LEPC 9:00 a.m. Berkley Dept. Of
Public Safety (2395
W 12 Mile Rd,
Berkley, MI 48072
Tuesday
LEPC
9:00 a.m.
TBD
Tuesday
LEPC
9:00 a.m.
TBD
For questions please contact Darin Page of the Oakland County Emergency Management Division at
(248) 858-1724 or Daaedd(@.oakciov.com. Due to the uncertainty of when we will be able to meet in -
person because of the COVID-19 pandemic, we will wait to schedule in -person meeting locations until
we are able to confirm that in -person meetings will occur.
*EOC is the Oakland County Emergency Operations Center 1200 N Telegraph, Bldg 47W, Pontiac, MI 48341
*EOB is the Oakland County Executive Office Building Conference Center, 2100 Pontiac Lake Rd, Waterford MI
48328
NOTE: MEETINGS ARE SUBJECT TO CHANGE. PLEASE CALL 248 858-5300 TO CONFIRM.
The County of Oakland does not discriminate on the basis of disability in admission or access to its programs, activities, or services as
required by Title II of the Americans with Disabilities Act of 1990.
BLDG 47 WEST 1200 N TELEGRAPH RD DEPT 410 • PONTIAC MI48341-0410 • (248) 858-5300 • FAX (248) 858-5550
2022 NOTICE OF PUBLIC AVAILABILITY
(Public Notice)
CHEMICALS IN YOUR COMMUNITY
The Oakland County Local Emergency Planning Committee (LEPC) is
publishing this Public Notice In accordance with Section 324 of the
Superfund Amendment and Reauthorization Act (SARA Title III) of 1986.
The following information submitted to the Oakland County LEPC in
accordance with SARA Title III is available for public review at the LEPC
Office:
Safety Data Sheets (SDS) for a hazardous substance
A specific facility's Hazardous Substance Inventory Form
Follow-up Emergency Notices
Requests for an appointment to review the information can be made by
calling the office during normal business hours (Monday through Friday
8:30 a.m. — 5:00 p.m.) at (248) 858-5300 or by writing to the Oakland County
LEPC, c/o Oakland County Emergency Management Division,1200 N
Telegraph, Dept. 410, Bldg. 47W, Pontiac Michigan 48341-0410. Requests for
copies of the information reviewed are subject to the Freedom of
Information Act (FOIA), the Michigan Homeland Security Act and the trade
secret provisions of SARA Title III.
Additional information regarding the LEPC can also be found on our
website at www.oakgov.com or in brochures developed by the Oakland
County LEPC entitled "Chemicals in your Home," "Major Chemical
Emergencies: What to do in case of a Large Chemical Emergency" and
"Sheltering -In -Place."
The County of Oakland does not discriminate on the basis of disability in
admission of access to its programs, activities or services as required by
Title II of the Americans with Disabilities Act of 1990. Please contact us
within five (5) business days prior to the event if you have any special
needs.
2021/11