HomeMy WebLinkAboutYEAR 2008 HOMELAND SECURITY GEORGIA EMERGENCY MANAGMENT AGENCY
GEORGIA EMERGENCY MANAGEMENT AGENCY
SONNY PERDUE
GOVERNOR
CHARLEY ENGLISH
DIRECTOR
January 31, 2008
RE: FIP #245-04196-03
GAN #2007-GE-T7-0054
Budget Worksheet #0979-EQU
Budget Worksheet #0979- TRG
Budget Worksheet #0979-EQU-2
Augusta Fire Department
Chief Howard Willis
Augusta Fire Department
925 Laney Walker Boulevard
Augusta, Georgia 30901
Dear Chief Willis:
Enclosed is the Grantee-Subgrantee Agreement for funding awarded to your agency by
the Georgia Emergency Management Agency (GEMA) from the Department of Homeland
Security (DHS) Fiscal Year 2007 Homeland Security Grant Program/State Homeland Security
Grant Program. This agreement governs the use of funding provided by DHS to help your
agency to build and enhance capabilities to prevent, protect against, respond to, and recover
from terrorist attacks, major disasters and other emergencies in accordance with the goals and
objectives of the State Strategic Plan.
The amount of this agreement is $1,275,000.00. You may not exceed in either quantity
nor total dollar amount the items expressly approved for you to purchase, as shown on the
accompanying detailed budget worksheet(s).
Attached to the Grantee-Subgrantee Agreement are Exhibits A-H. Please review and
return signed originals of the Grantee-Subgrantee Agreement, Exhibit C, F, and Exhibit G, to
the attention of your grants manager within 14 days of receipt of this letter. Keep a copy of
each form for your records.
If you require further information as to the grantee package, please contact Pat Craig,
Grants Manager, at 404-635-7511. Thank you for your work on behalf of the citizens of
Georgia.
~
Angi W. Ford
Public Assistance Director
awf/ddm
Enclosures
Post Office Box 18055 . Atlanta, Georgia 30316-0055
Phone (404) 635-7000 or toll-free in Georgia 1-800-TRY-GEMA. Fax (404) 635-7205
www.gema.state.ga.u5
FISCAL YEAR 2007 HOMELAND SECURITY GRANT PROGRAM
GRANTEE-SUBGRANTEE AGREEMENT
[STATE HOMELAND SECURITY PROGRAM]
The United States Department of Homeland Security (DHS), Preparedness Directorate, Office of Grants and
Training (G&T), approved the application and awarded grant funding from the Fiscal Year 2007 Homeland
Security Grant Program to the Georgia Emergency Management Agency (GEMA) on behalf of the State of
Georgia, in accordance with the Department of Homeland Security Appropriations Act, 2007, Public Law
109-295. GEMA will maintain overall responsibility and accountability to the federal government for the
duration of the program. GEMA, as Grantee, has awarded the amount of $1,275,000.00 to Augusta Fire
Department, as Sub grantee, in accordance with the Fiscal Year 2007 Homeland Security Grant Program
(SHSP), State Homeland Security Program.
Under this Agreement, GEMA will execute the interests and responsibilities of the Grantee. . The individual
designated to represent the State is Charley English, Authorized Grantee Official The State has designated
Ralph Reichert as the Program Manager of this program. The Subgrantee's Authorized Official has
authority to legally bind the Subgrantee and will execute the interests and responsibilities of the Sub grantee.
The Subgrantee's Authorized Official is the person whose name appears on page seven (7) of this agreement
and whose signature appears on page seven (7) of this agreement.
Purpose: The Sub grantee agrees to use allocated funds only as approved, to comply with the terms, conditions
and guidelines as stated within this agreement, and to request reimbursement only for expenditures made in
accordance with the Approved Detailed Budget Worksheet (Exhibit D). Any change to the budget worksheet
must be requested in writing by the Sub grantee and must be approved by the Program Manager prior to the
execution of that change.
Effective Date: From July 1, 2007to February 28,2010.
The Subgrantee agrees that all purchases and expenditures authorized under this program must be completed by
the effective end date.
Exhibits: Exhibits are attached or attainable via the internet and made a part of this agreement:
Exhibit A
United States Department of Homeland Security (DHS), Preparedness Directorate, Office
of Grants and Training (G&T), Office of Grant Operations (OGO) Financial Management
Guide (Financial Guide), available on the DHS Web site at:.
http://www.dhs.gov/xlibrary/assets/Grants _ FinancialManagementGuide. pdf
Exhibit B
United States Department of Homeland Security (DHS), Office of Grants and Training
(G&T), Fiscal Year 2007 Homeland Security Grant Program, Program Guidance and
Application Kit (DHS Guide), located on Office of Justice Program's Web site at
www.ojp.usdoj.gov/odp/docs/fy07_hsgp_guidance.pdf.
Exhibit C
NIMS Compliance Form
Exhibit D
Approved Detailed Budget Worksheet(s)
Exhibit E
Payment Request Form
\
Exhibit F
Standard Assurances - Standard Form 424B (Non-Construction) or Standard Form 424 D
(Construction), as applicable
Exhibit G
Certification Regarding Lobbying; Debarment, Suspension, and Other Responsibility
Matters; and Drug-Free Workplace Requirements. OJP Form 4061/6.
Exhibit H
Financial Status Report (FSR) Reporting Form.
Reimbursement and Reporting Requirements
1. Payment Request Forms: Payments to the Subgrantees will be made only upon presentation of the
approved Payment Request Form (Exhibit E). Reimbursements from invoices and applicable canceled
checks (or other justifying documentation) will only be made for eligible equipment, materials,
expenses and costs upon approval of the Program Manager. Omission of pertinent documentation will
constitute justification for non-payment of any amounts submitted on the Payment Request Forms.
2. Financial Status Report (FSR): The disposition of grarit funds, including all obligations and
expenditures, must be reported to GEMA on a quarterly basis through the FSR, which is due within 45
days of the end of each calendar quarter (i.e. for the quarter ending March 31, FSR is due on May 15).
A copy of this form is attached as Exhibit H to this agreement.
3. The Sub grantee shall complete and submit any other reports as requested by GEMA and cooperate and
assist GEMA in complying with the DHS tracking and reporting requirements. Specifically, without
limitation, Sub grantee shall submit information at GEMA's request and direction to assist GEMA in
submitting Biannual Strategy Implementation Reports, Categorical Assistance Program Reports and any
other necessary reports.
4. Grant Closeout Report: Within 60 days after the ending effective date of the subgrant, the Subgrantee
shall submit a final FSR and fmal program report detailing all accomplishments throughout the project.
After both of these reports have been reviewed and approved by GEMA, a Closeout Report will be
generated indicating the project as being closed and listing any remaining funds that will be deobligated.
Audits, Financial Regulations and Guides
1. Audits: The Sub grantee agrees that federal or state officials and auditors or their duly authorized
representatives may conduct required audits and examinations. The Subgrantee further agrees that such
officials, auditors or representatives shall have access to any books, documents, papers and records of
any recipients of this funding and of any persons or entities which perform any activity which is
reimbursed to any extent with federal or state funds distributed under the authority of the Fiscal Year
2007 Homeland Security Appropriations Act and this Agreement.
2. Code of Federal Regulations (CFR): The Sub grantee agrees to comply with all applicable provisions
of the Code of Federal Regulations, including, without limitation, 28 cFR 66, Uniform Administrative
Requirements for Grants And Cooperative Agreements To State and Local Governments, with 48 CFR
31, Contract Cost Principles and Procedures, and with 2 cFR, Grants and Agreements.
3. Office of Management and Budget (OMB) Circulars: The Sub grantee agrees to comply with all
applicable OMB Circulars, specifically, without limitation, the following applicable OMB Circulars:
OMB Circular A-133, Audits of States, Local Governments, and Non-Profit Organizations; 2 CFR 225,
Cost Principles For State, Local, And Indian Tribal Governments (OMB Circular A-87);
2 cFR 220, Cost Principles For Educational Institutions (OMB Circular A-21); or 2 CFR 230, Cost
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Principles For Non-Profit Organizations (OMB Circular A-I22). The referenced sections of the
Code of Federal Regulations for OMB Circulars A-87, A-21 andA-122 can be found in the Electronic
Code of Federal Regulations, e-cFR, on the Web at http://ecfr.gpoaccess.gov/. OMB Circular A-133
can be found on the Web at http://www.whitehouse.gov/omb/circulars/a133/a133.html.
a. Office of Management and Budget (OMB) Circular A-133: The Sub grantee agrees to comply
with the organizational audit requirements of OMB Circular A-133, Audits of States, Local
Governments, and Non-Profit Organizations, as further described in the current edition of the
Financial Guide (Exhibit A). If the Subgrantee is required under OMB Circular A-133 to conduct a
single audit, the Sub grantee shall provide GEMA with written documentation showing that it has
complied with the single audit requirements. Such documentation shall be returned to GEMA with
this signed Agreement. Subgrantee shall immediately notify GEMA in writing directed to the
Grants Manager at any future time that it is required to conduct a single audit and provide
documentation within a reasonable time period showing compliance with the single audit
requirement. OMB Circular A-133 can be accessed on the Web at
http://www .whitehouse.gov/omb/circulars/a133/a133 .html.
b. Office of Management and Budget (OMB) Circular A-87 Inventory Requirements: The
Sub grantee agrees to comply with the requirements of OMB Circular A-89, and specifically,
without limitation, agrees to comply with the requirement to take physical inventories of any
equipment received through this sub grant at least once every two years.
4. OGO Financial Management Guide: The Subgrantee agrees to comply with the financial and
administrative requirements set forth in the current edition of the United States Department of
Homeland Security, Preparedness Directorate, Office of Grants and Training, Office of Grant
Operations, Financial Management Guide (Exhibit A).
5. Accounting System: The Subgrantee agrees to maintain an accounting system integrated with adequate
internal fiscal and management controls to capture and report grant data with accuracy, providing full
accountability for revenues, expenditures, assets, and liabilities. This system shall provide reasonable
assurance that the sub grantee is managing federal and state fmancial assistance programs in cornpliance
with the current edition of the Financial Guide (Exhibit A) and all applicable laws and regulations.
6. Retention and Maintenance of Records: Subgrantee shall comply with the OMBadministrative
requirements circulars. and the current edition of the Financial Guide (Exhibit A) in retaining and
maintaining records pertinent to the sub grant award. All such records shall be retained by the
sub grantee for at least three years from the date of the final expenditure report by GEMA to DHS to
close out the State of Georgia's 2007 HSGP grant. Refer to the Financial Guide (Exhibit A) for
exceptions which would require longer record retention period.
7. Withholding of Funds: GEMA, as the awarding agency, may withhold payments of grant funds to a
Sub grantee after proper notification or opportunity to remedy if the Sub grantee demonstrates any of the
following:
a. Unwillingness or inability to attain program or project goals or to establish procedures that
will minimize the time elapsing between the cash drawdowns and expenditures;
b. Inability to adhere to guideline requirements or special conditions;
c. Improper award and administration of subawards or contracts; and
d. Inability to submit reliable and/or timely reports.
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Noncompliance by the Subgrantee with the terms or conditions of this Agreement will constitute
justification for non-payment of any amounts submitted on the Payment Request Forms.
National Initiatives
1. Sub grantee agrees to comply with all applicable terms and conditions of the Fiscal Year 2007 Homeland
Security Grant Program Guidance (Exhibit B), including without limitation meeting the minimum
National Incident Management System (NIMS) Fiscal Year 2007 implementation compliance
requirements in the NIMS Compliance section of the DHS Guide and the NIMS Integration Center
(NIC) on the Web at www.fema.gov/emergency/nims/. In order to receive FY 2007 preparedness
funding, applicants will have to certify that they have met the minimum FYs 2005, 2006 and 2007
NIMS requirements. Therefore, all terms and conditions of this agreement are predicated and
conditional upon the Subgrantee's assurance by completing and signing the NIMS Compliance Form
(Exhibit C) and returning the completed and signed form to GEMA along with the signed original
Grantee-Subgrantee Agreement.
2. Subgrantee agrees to institutionalize the use of the Incident Command System (IcS) as required by
Georgia law and the NIMS minimum compliance requirements.
3. Sub grantee agrees that any exercises conducted with grant funds will be managed and executed in
compliance with the Homeland Security Exercise and Evaluation Program (HSEEP). All exercises will
be planned, conducted, and evaluated with implementation of improvement in accordance with the
guidance in the HSEEP manuals, volumes I through IV, available at http://hseep.dhs.gov.
(a) Any exercises implemented with grant funds must be threat- and performance-based and should
evaluate performance of critical tasks required to respond to the exercise scenario.
(b) All funded exercises must be included in the Multiyear Exercise Plan calendar, added to the
National Exercise Schedule through the National Exercise Schedule (NEXS) Application, located at
https://www.hseep.dhs.gov/ and must be preapproved by the GEMA Terrorism Emergency
Response and Preparedness (TERP) Exercise Program Director.
( c) Subgrantee must report to the GEMA TERP Exercise Program Director prior to conducting
scheduled exercises and provide the Program Manager with an After Action Report (AAR) and
Improvement Plan for each exercise conducted within 45 days following completion of the exercise
in accordance with the DHS Guide (Exhibit B).
(d) Exercises conducted using HSGP funding must be NIMS compliant, as defined by the 2007 NIMS
compliance matrices. Further information is available on the NIMS Integration Center Web site at
www .fema.gov/ emergency/nims/.
Special Conditions
The Subgrantee agrees to the following conditions:
1. The Subgrantee agrees to use all grant funding awarded from the FY 2007 Homeland Security Grant
Program (HSGP) for costs related to preparedness activities associated with implementing the 2006
State Strategic Plan for Terrorism and All-Hazards Preparedness, including goals and objectives, and
any respective Urban Area Security Strategies.
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2. The Subgrantee agrees to that all allocations and use of funds un<\er this grant will be in accordance with
the Fiscal Year 2007 Homeland Security Grant Program (HSGP) Guidance and Application Kit (Exhibit
B), comply with all DHS requirements and cooperate with GEMA to comply with federal and state
requirements related to the grant funding.
3. The Sub grantee understands and agrees that any allocations and use of grant funding must support and
may only be used to fund the Investments identified in the Investment Justifications which were
submitted as part of the State of Georgia's FY 2007 HSGP application.
4. . The Subgrantee agrees that federal funds under this award will be used to supplement, but not supplant,
state or local funds for homeland security preparedness.
5. The Subgrantee agrees to cooperate with any assessments, national- evaluation efforts, planning, or
information or data collection requests, including, but not limited to, the provision of any information
required for the assessment or evaluation of any activities within this agreement.
6. Federal funds provided under this grant program are for 100% reimbursement of all eligible
expenditures. Sub grantee will follow procurement standards as stated in the current edition of the
Financial Guide (Exhibit A).
7. Subgrantee understands and agrees that compensation for individual consultant services is to be
reasonable and consistent with the amount paid for similar services in the marketplace. Time and effort
reports for consultant services are required and competitive bidding is encouraged, as explained in the
current edition of the Financial Guide (Exhibit A).
8. Subgrantee understands and agrees that it cannot use any federal funds, either directly or indirectly, in
support of the enactment, repeal, modification of adoption of any law, regulation or policy, at any level
of government, without the express prior written approval of GEM A and G&T.
9. No elected or appointed official or employee of the Subgrantee shall be admitted to any share or part of
any benefit, directly or indirectly, from this agreement or from the grant award. This provision shall not
be construed to extend to any contract made with a corporation for its general benefit.
10. If the Subgrantee violates any of the conditions of this agreement, including any exhibits hereto, or of
applicable federal and state law or regulation, in addition to any other recourse available, GEMA shall
notify the Subgrantee that additional funds for the grant in connection with which the violation occurred
will be withheld until such violation has been corrected to the satisfaction of GEMA. In addition,
GEMA may also withhold or require repayment of all or any portion of the financial award which has
been or is to be made available to the Subgrantee for other projects under this program, this or other
agreements, and applicable federal and state regulations until adequate corrective action is taken.
11. The Sub grantee agrees that all publications created with funding under this grant shall prominently
contain the following statement: "This document was prepared under a grant fromFEMA's National
Preparedness Directorate, U.S. Department of Homeland Security. Points of view or opinions expressed
in this document are those of the authors and do not necessarily represent the official position or policies
ofFEMA's National Preparedness Directorate or the U.S. Department of Homeland Security."
12. Subgrantee acknowledges that FEMA's National Preparedness Directorate (NPD) reserves a royalty-
free, non-exclusive, and irrevocable license to reproduce, publish, or otherwise use, and authorize others
to use, for Federal government purposes: (a) the copyright in any work developed under an award or
sub-award; and (b) any rights of copyright to which a recipient or sub-recipient purchases ownership
- 5 -
with Federal support. The Sub grantee agrees to consult with NPD through GEMA regarding the
allocation of any patent rights that arise from, or are purchased with, this funding.
13. The Subgrantee agrees that, when practicable, any equipment pUrchased with grant funding shall be
prominently marked as follows: "Purchased with funds provided by the U.S. Department of Homeland
Security."
14. Subgrantee shall comply with all applicable Federal, State, and local environmental and historic
preservation (EHP) requirements and shall provide any information requested by FEMA and/or GEMA
to ensure compliance with applicable laws, including: National Environmental Policy Act, National
Historic Preservation Act, Endangered Species Act, and Executive Orders on Floodplains (11988),
Wetlands (11990) and Environmental Justice (12898). Failure of the Subgrantee to meet Federal, State,
and local EHP requirements and obtain applicable permits may jeopardize Federal funding. Subgrantee
shall not undertake any project having the potential to impact EHP resources without the prior approval
of FEMA, through GEMA, including but not limited to communications towers, physical security
enhancements, new construction, and modifications to buildings that are 50 years old or greater and
shall coordinate with GEMA regarding any activities using grant funding that require specific
documentation of compliance with federal laws and/or regulations. Subgrantee must comply with all
conditions placed on the proj ect as the result of the EHP review. Any change to the approved project
scope of work will require re-evaluation for compliance with these EHP requirements. If ground-
disturbing activities may occur during project implementation, the Sub grantee must obtain preapproval
from GEMA and ensure monitoring of any ground disturbance. If any potential archeological resources
are discovered, the Sub grantee will immediately cease construction in that area and notify FEMA,
through GEMA, and the Georgia Department of Natural Resources, Georgia State Historic Preservation
Division. Subgrantee shall not undertake any project to which the National Environmental Policy Act
(NEP A) requirements are applicable without obtaining written approval by FEMA, through GEMA,
prior to use of any HSGP funds for construction or renovation, including without limitation, security
equipment; and to coordinate with GEMA regarding any activities using grant funding that require
specific documentation ofNEP A compliance.
15. Sub grantee agrees to cooperate with GEMA in assuring that any training funded through HSGP funding
is reported on the Web-Forms system as more fully explained in the FY 2007 Homeland Security Grant
Program (HSGP) Program Guidance and Application Kit, pp. 27-32.
16. Subgrantee agrees that the funds utilized to establish or enhance state and local fusion centers must
support the develop~ent of a statewide fusion process that corresponds with the Global
Justice/Homeland Security Advisory Council (HSAC) Fusion Center Guidelines and achievement of a
baseline level of capability as defined by the Fusion Capability Planning Tool. The Global
Justice/HSAc Guidelines can be accessed at http://it.ojp.gov/documents/fusion_center_guidelines.pdf,
and the DHS FY 2007 HSGP Fusion Capability Planning Tool is located on the Web at
http://www.ojp.usdoj.gov/odp/docs/fy07_hsgpJesource _ fusion.pdf.
17. All statewide information sharing and analysis centers leveraging FY 2007 HSGP funds must establish
connectivity with the DHS Homeland Security Operations Center (HSOC) via the Homeland Security
information Network (HSIN). HSIN must serve as the primary vehicle by which information and
intelligence is shared with DHS as part of the fusion process across the federal, state, local, regional,
tribal and private sectors.
18. When implementing NPD-funded activities, the Subgrantee understands and agrees that it must comply
with all federal civil rights laws, to include Title VI of the Civil Rights Act, as amended. The
Sub grantee is required to take reasonable steps to ensure persons of limited English proficiency have
- 6 -
meaningful access to language assistance services regarding the development of proposals and budgets
and conducting NPD-funded activities.
19. The Sub grantee understands that beginning on July 1, 2007, any public contracts and subcontracts that
are funded by the HSGP must comply with the requirements of O.c.G.A. S13-10-90, et seq., and
Georgia Department of Labor Rules 300-10-1, et seq., to verify the contractor's or subcontractor's new
employees' work eligibility through a federal work authorization program.
Changes to Agreement: There shall be no changes to this Agreement unless mutually agreed upon by all
parties to the Agreement.
Termination
This agreement may be terminated for any or all of the following reasons:
1. Cause/Default: This agreement may be terminated for cause, in whole or in part, at any time by the
State for failure of the Subgrantee to perform any of the provisions or to comply with any terms and
conditions herein. If the State exercises its right to terminate this agreement under the provisions of this
paragraph, the termination shall be accomplished in writing and specify the reason and termination date.
The Subgrantee will be required to submit the final invoice not later than 30 days after the effective date
of written notice of termination. Upon termination of this agreement, the State shall not incur any new
obligations after the effective date of the termination and shall cancel as many outstanding obligations
as possible. The above remedies are in addition to any other remedies provided by law or the terms of
this agreement.
2. Convenience: This agreement may be cancelled or terminated by either of the parties without cause;
however, the party seeking to terminate or cancel this agreement must give written notice of its intention
to do so to the other party at least 30 days prior to the effective date of cancellation or termination.
3. Non-Availability of Funding: Notwithstanding any other provision of this agreement, in the event that
either of the sources of funding for reimbursement under this agreement (appropriations from the
General Assembly of the State of Georgia or the Congress of the United States of America) no longer
exist or in the event the sum of all obligations of GEMA incurred under this and all other agreements
entered into for this program exceeds the balance of such funding, then this agreement shall
immediately terminate without further obligation of GEMA as of that moment. The certification by the
Director of GEMA of the occurrence of either of the events stated above shall be conclusive.
AGREED by all parties:
By:
David s. r.openh~ver
Printed or Typed Name of
Subgrantee's Authorized Official
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Augusta Richmond County, Georgia
New Grant Proposal/Application
Before a Department/agency may apply for the grant/award on behalf of Augusta
Richnlond County, they must first obtain approval signature from the Administrator
and the Finance Director. The Administrator will obtain information on the grant
program and requirements from the funding agency and review these for feasibility to
determine if this grant/award will benefit Augusta Richmond County. The Finance
Director will review the funding requirement to determine if the grant will fit within
our budget structure and financial goals.
Date of Grant Request:n ,,~ /2 ..J ~d ~
I
Department Requesting Grant: hA.E. . UE.fi I.
Grant Description: b€",,,,?,"" ~M&"Lw;Y /1'!AAb4fE~J!;!I1 ~ 7 )
7Jo/JA~iNFN-t ~ JI~EiA;"re/ .sE('u.A'7 b.lf~d-
Grant Amount: $;; 27i; ~~o..t>fMatching F~ding Required 0 Yes I2(Nb
Fiscal Year of Grant:
Pl)Zksi
Date
----------------------------------------------------------------------
I.) I have reviewed the grant application and enclosed materials and:
o----:Approve, the Department/Agency to move forward with the application
o Deny the Request:
~//~/ol
, ,
Date
2.) I have reviewed the grant application and enclosed materials and:
o/~ind the grant/award to be feasible to the needs of Augusta Richmond
County
o Deny the Request:
DC/yl/lAt::".,e (.J.PO-,~ /vo
Finance Director
~- 1;)- 0>5
Date
This form will also be used to provide the external auditors with information on all
grants for compliance and certification requirements as required by the State and
Federal Government.
ATB003 Form-I
Exhibit C
NIMS Compliance Form
This NIMS Compliance Form MUST be completed by each agency
requesting or benefiting from funding.
In federal Fiscal Year 2007, state agencies, tribes, and local communities will be required to complete several activities to
comply with the National Incident Management System (NIMS). This document describes the actions that jurisdictions must
have taken by September 30, 2007 to be compliant with NIMS. Homeland Security Presidential Directive 5 (HSPD-5),
Management of Domestic Incidents, requires all federal departments and agencies to adopt and implement the NIMS, and
requires state and local jurisdictions to implement the NIMS to receive federal preparedness funding. Please check the box
next to each action that your organization has completed. For those actions not completed please provide a one-page
summary of the plan to complete these actions and fully implement NIMS. Additional NIMS guidance can be found at:
www.fema.gov/nims
IZICornmunity Adoption: Adopt NIMS at the community
level for all government departments and/or agencies; as
well as promote and encourage NIMS adoption by
associations, utilities, non-governmental organizations
(NGOs), and private sector incident management and
response organizations.
!ZfIncident Command System (IcS): Manage all emergency
incidents and preplanned (recurring/special) events in
accordance with IcS organizational structures, doctrine,
and procedures, as defined in NIMS. IcS
implementation must include the consistent application of
Incident Action Planning and Common Communications
Plans.
~ublic Information System: Implement processes,
procedures, and/or plans to communicate timely, accurate
information to the public during an incident through a
Joint Information System and Joint Information Center.
[dPreparednesslPlanning: Establish the community's NIMS
baseline against the FY 2005 and FY 2006
implementation requirements. (NIMScAST and/or
Implementation Plan)
0Develop and implement a system to coordinate all federal
preparedness funding to implement the NIMS across the
-9Pmmunity.
ltjRevise and update plans and SOPs to incorporate NIMS
components, principles and policies, to include planning,
training, response, exercises, equipment, evaluation, and
corrective actions.
AUthOrize~~
Signature. . Date:
~rticipate in and promote intrastate and interagency
mutual aid agreements, to include agreements with the
private sector and non-governmental organizations (NGO).
..I:dhnplementation plan exists at agency level that identifies
personnel to complete the below listed NIMS training
requirements.
Bcomplete IS-700 NIMS: An Introduction
0Complete IS-800 NRP: An Introduction
EIComplete IcS 100 and ICS 200 Training
~corporate NIMS/IcS into all tribal, local, and regional
training and exercises.
l2J1>articipate in an all-hazard exercise program based on
NIMS that involves responders from multiple disciplines
and multiple jurisdictions.
BIncorporate corrective actions into preparedness and
response plans and procedures.
0fuventory community response assets to conform to
homeland security resource typing standards.
QTo the extent permissible by law, ensure that relevant
national standards and guidance to achieve equipment,
communication, and data interoperability are incorporated
into tribal and local acquisition programs.
-E:IJ\pply standardized and consistent terminology, including
the establishment of plain English communications
standards across public safety sector.
.;J1~3
Ageocy:4'~ ;::.. /Dyl
Exhibit D
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=========
=========
Exhibit E
OMS Approval No. 4040-0007
Expiration Dale 04/30/2008
ASSURANCES. NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information, Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND
IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE:
Certain of these assurances may not be applicable to your project or program, If you have questions, please contact the
awarding agency, Further, certain Federal awarding agencies may require applicants to certify to additional assurances, If
such is the case, you will be notified,
As the duly authorized representative of the applicant, I certify that the applicant:
1, Has the legal authority to apply for Federal assistance
and the institutional, managerial and financial capability
(including funds sufficient to pay the non-Federal share
of project cost) to ensure proper planning, management
and completion of the project described in this
application,
2. Will give the awarding agency, the Comptroller General
of the United States and, if appropriate, the State,
through any authorized representative, access to and
the right to examine all records, books, papers, or
documents related to 'the award; and will establish a
proper accounting system in accordance with generally
accepted accounting standards or agency directives,
3, Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal or organizational
conflict of interest, or personal gain,
4. Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding
agency.
5, Will comply with the Intergovernmental Personnel Act of
1970 (42 U.S.C, 994728-4763) relating to prescribed
standards for merit systems for programs funded under
one of the 19 statutes or regulations specified in
Appendix A of OPM's Standards for a Merit System of
Personnel Administration (5 C.F,R, 900, Subpart F),
6, Will comply with all Federal statutes relating to
nondiscrimination. These include but are not limited to:
(a) Title VI of the Civil Rights Act of 1964 (P,l. 88-352)
which prohibits discrimination on the basis of race, color
or national origin; (b) Title IX of the ,Education
Amendments of .1972, as amended (20 U,S,C. 991681-
1683, and 1685-1686), which prohibits discrimination on
the basis of sex; (c) Section 504 of the Rehabilitation
Previous Edition Usable
Act of 1973, as amended (29 U,S,C, 9794), which
prohibits discrimination on the basis of handicaps; (d)
the Age DisC'fimination Act of 1975, as amended (42
U.S,C, 996101-6107), which prohibits discrimination
on the basis of age; (e) the Drug Abuse Office and
Treatment Act of 1972 (P,l. 92-255), as amended,
relating to nondiscrimination on the basis of drug
abuse; (f) the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) 99523 and 527 of the Public Health
Service Act of 1912 (42 U,S,C, 99290 dd-3 and 290 ee-
3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the
Civil Rights Act of 1968 (42 U,S,C, 993601 et seq.), as
amended, relating to nondiscrimination in the sale,
rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statute(s)
under which application for Federal assistance is being
made; and, (j) the requirements of any other
nondiscrimination statute(s) which may apply to the
application,
7. Will comply, or has already complied, with the
requirements of Titles II and III of the Uniform
Relocation Assistance and Real Property Acquisition
. Policies Act of 1970 (P,l. 91-646) which provide for
fair and equitable treatment of persons displaced or
whose property is acquired as a result of Federal or
federally-assisted programs. These requirements .<:!pply
to all interests in real property acquired for project
purposes regardless of Federal participation in
purchases,
8, Will comply, as applicable, with provisions of the
Hatch Act (5 U,S,C. 991501-1508 and 7324-7328)
which limit the political activities of employees whose
principal employment activities are funded in whole or
in part with Federal funds.
Authorized for Local Reproduction
Standard Form 424B (Rev, 7-97)
Prescribed by OMB Circular A-102
EXHIBIT E
Date:
Georgia Emergency Management Agency
State Homeland Security Grant Program
Payment Request Form
Instructions: All requests for payments must be. supported by documentation supporting actual expenditures, Itemize each
expenditure below to the fullest detail possible. Attach documentation that supports this payment request, such as copies of bills of
sale, invoices, receipts, and canceled checks evidencing payment. Do not send originals. Attach a continuation sheet if necessary.
* Please refer to Budget Worksheet for information needed in the following section *
Budget Worksheet Number:
Name of Jurisdiction:
GAN Number:
FIPs Number:
Area:
Item Number
From Budget
Worksheet
Requested Item to be Reimbursed
Requested
Quantity
Requested Cost
Description of Documentation
Attached in Support of this
Payment Request
(from Continuation sheet attached)
SUBTOTAL
TOTAL
Under penalty of peIjury, I certify that to the best of my knowledge and belief the data above are correct and that all outlays were made
in accordance with the grant conditions or other agreements, comply with procurement regulations contained within the Financial
Guide, and that payment is due and has not been previously requested. I understand that any part of this payment request that is not
supported by cost documents and/or expended within the scope of the approved project will be refunded to the State of Georgia within
30 days of receiving the deobligation notice.
Signature of Sub grantee's Authorized Representative
Printed Name
Contact Phone Number
Exhibit F
9, Will comply, as applicable, with the provisions of the Davis-
Bacon Act (40 U,S,C, ~~276a to 276a-7), the Copeland Act
(40 U.S,C, ~276c and 18 U,S,C, ~874), and the Contract
Work Hours and Safety Standards Act (40 U,S.C, ~~327-
333), regarding labor standards for federally-assisted
construction subagreements.
10, Will comply, if applicable, with flood insurance purchase
requirements of Section 1 02(a) of the Flood Disaster
Protection Act of 1973 (P ,L. 93-234) which requires
recipients in a special flood hazard area to participate in the
program and to purchase flood insurance if the total cost of
insurable construction and acquisition is $10,000 or more.
11, Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the National
Environmental Policy Act of 1969 (P,L. 91-190) and
Executive Order (EO) 11514; (b) notification of violating
facilities pursuant to EO 11738; (c) protection of wetlands
pursuant to EO 11990; (d) evaluation of flood hazards in
floodplains in accordance with EO 11988; (e) assurance of
project consistency with the approved State management
program developed under the Coastal Zone Management
Act of 1972,(16 U,S,C, ~~1451 et seq,); (f) conformity of
Federal actions to State (Clean Air) Implementation Plans
under Section 176(c) of the Clean Air Act of 1955, as
amended (42 U,S,C, ~F401 et seq,); (g) protection of
underground sources of drinking water under the Safe
Drinking Water Act of 1974, as amended (P.L. 93-523);
and, (h) protection of endangered species under the
Endangered Species Act of 1973, as amended (P ,L. 93-
205),
. APPLICANT ORGANIZATION
12 Will comply with the Wild and Scenic Rivers Act of
1968 (16 U,S,C, ~~1271 et seq,) related to protecting
components or potential components of the national
wild and scenic rivers system,
13. Will assist the awarding agency in assuring compliance
with Section 106 of the National Historic Preservation
Act of 1966, as amended (16 U.S,C, ~470), EO 11593
(identification and protection of historic properties), and
the Archaeological and Historic Preservation Act of
1974 (16 U,S,C. ~~469a-1 et seq.),
14, Will comply with P,L. 93-348 regarding the protection of
human subjects involved in research, development, and
related activities supported by this award of assistance,
15,
Will comply with the Laboratory Animal Welfare Act of
1966 (P,L. 89-544, as amended, 7 U.S,C, ~~2131 et
seq,) pertaining to the care, handling, and treatment of
warm blooded animals held for research, teaching, or
other activities supported by this award of assistance,
16,
Will comply with the Lead-Based Paint Poisoning
Prevention Act (42 U,S.C, ~~4801 et seq,) which
prohibits the use of lead-based paint in construction or
rehabilitation of residence structures,
17,
Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit
Act Amendments of 1996 and OMB Circular No, A-133,
"Audits of States, Local Governments, and Non-Profit
Organizations, .
18, Will comply with .all applicable requirements of all other
Federal laws, executive orders, regulations, and policies
governing this program.
. TITLE
~jfJG
~661
Ol), ~~
Completed on submission to Grants,gov
. DATE SUBMITTED
Standard Form 424B (Rev, 7.97) Back
ASSURANCES - G:ONSTRUCTION PROGRAMS OMB Approval No.4040-0009
I Expiration Date 04/30/2008
Public reporting burden for this collection of information ik estimated to average 15 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information, Send comments regarding the burden estirtJate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0042), Washington, DC 20503,
I
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND
I
BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
I
Certain of these assurances may not be aplplicable to your project or program, If you have questions, please contact the
Awarding Agency, Further, certain Federal assistance awarding agencies may require applicants to certify to additional
assurances, If such is the case, you will bJ notified,
As the duly authorized representative of the applicant:, I dertify that the applicant:
1, Has the legal authority to apply for Federal assistance I 8, Will comply with the Intergovernmental Personnel Act
and the institutional, managerial and financial capability of 1970 (42 U.S,C, 994728-4763) relating to prescribed
(including funds sufficient to pay the non-Federal share standards of merit systems for programs funded
of project costs) to ensure proper planning, under one of the 19 statutes or regulations specified in
management and completion of project described in Appendix A of OPM's Standards for a Merit System of
this application. Personnel Administration (5 C.F,R, 900, Subpart F),
NOTE:
2,
Will give the awarding agency, the Comptroller General
of the United States and, if appropriate, th.e State, I
the right to examine all records, books, papers, or
documents related to the assistance; and will establish
a proper accounting system in accordance with
generally accepted accounting standards or agency
directives, '
9; Will comply with the Lead-Based Paint Poisoning
Prevention Act (42 U,S,C. 994801 et seq,) which
prohibits the use of lead-based pain in construction or
rehabilitation of residence structures,
3.
Will not dispose of, modify the use of, or change the
terms of the real property title or other interest in the
site and facilities without permission and instructions
from the awarding agency, Will record the Federal
awarding agency directives and will include a covenant
in the title of real property acquired in whole or in part
with Federal assistance funds to assure non-
discrimination during the useful life of the project.
10, Will comply with all Federal statutes relating to non-
discrimination, These include but are not limited to: (a)
Title VI of the Civil Rights Act of 1964 (P ,L. 88-352)
which prohibits discrimination on the basis of race,
color or national origin; (b) Title IX of the Education
Amendments of 1972, as amended (20 U,S,C. 991681
1683, and 1685-1686), which prohibits discrimination
on the basis of sex; (c) Section 504 of the
Rehabilitation Act of 1973, as amended (29) U,S,C,
9794), which prohibits discrimination on the basis of
handicaps; (d) the Age Discrimination Act of 1975, as
amended (42 U,S.C, 996101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse
Office and Treatment Act of 1972 (P,L. 92-255), as
amended relating to nondiscrimination on the basis of
drug abuse; (f) the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P,L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) 99523 and 527 of the Public Health
Service Act of 1912 (42 U,S,C, 99290 dd-3 and 290 ee
3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the
Civil Rights Act of 1968 (42 U.S,C, 993601 et seq,), as
amended, relating to nondiscrimination in the sale,
rental or financing of housing; (i) any other '
nondiscrimination provisions in the specific statue(s)
under which application for Federal assistance is being
made; and U) the requirements of any other
nondiscrimination statue(s) which may apply to the application,
4.
Will comply with the requirements of the assistance
awarding agency with regard to the drafting, review and
approval of construction plans and specifications,
5,
Will provide and maintain competent and adequate
engineering supervision at the construction site to
ensure that the complete work conforms with the
approved plans and specifications and will furnish
progressive reports and such other information as may be
required by the assistance awarding agency or State. I .
Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding ag~ncy,
6,
7,
Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal or organizational
conflict of interest, or personal gain,
Previous Edition Usable
Authorized for Local Reproduction
Standard Form 4240 (Rev. 7-97)
Prescribed by OMB Circular A-102
11, Will comply, or has already complied, with the
requirements of Titles II and III of the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of
1970 (P,L. 91-646) which provide for fair and equitable
treatment of persons displaced or whose property is
acquired as a result of Federal and federally-assisted
programs, These requirements apply to all interests in real
property acquired for project purposes regardless of
Federal participation in purchases,
12, Will comply with the provisions of the Hatch Act (5 U.5.C,
~~1501-1508 and 7324-7328) which limit the political
activities of employees whose principal employment
activities are funded in whole or in part with Federal funds,
13, Will comply, as applicable, with the provisions of the Davis-
Bacon Act (40 U,S,C, 99276a to 276a-7), the Copeland Act
(40 U,S,C, 9276c and 18 U,5,C, 9874), and the Contract
Work Hours and Safety Standards Act (40 U,S,C. 9~327-
333) regarding labor standards for federally-assisted
construction subagreements,
14, Will comply with flood insurance purchase requirements of
Section 102(a) of the Flood Disaster Protection Act of 1973
(P,L. 93-234) which requires recipients in a special flood
hazard area to participate in the program and to purchase
flood insurance if the tqtal cost of insurable construction
and acquisition is $10,000 or more,
15, Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the
National Environmental Policy Act of 1969 (P,L. 91-
190) and Executive Order (EO) 11514; (b) notification
of violating facilities pursuant to EO 11738; (c)
protection of wetlands pursuant to 'EO 11990; (d)
evaluation of flood hazards in floodplains in accordance
with EO 11988; (e) assurance of project consistency
with the approved State management program
developed under the Coastal Zone Management Act of
1972 (16 U,S,C; 991451 et seq.); (f) conformity of
Federal actions to State (Clean Air) implementation
Plans under Section 176(c) of the Clean Air Act of
1955, as amended (42 U,S,C. 9~7401 et seq,); (g)
protection of underground sources of drinking water
under the Safe Drinking Water Act of 1974, as
amended (P,L. 93-523); and, (h) protection of
endangered species under the Endangered Species Act
of 1973, as amended (P,L. 93-205).
16, Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S,C, 991271 et seq.) related to protecting
components or potential components of the national
wild and scenic rivers system,
17,' Will assist the awarding agency in assuring compliance
with Section 106 of the National Historic Preservation
Act of 1966, as amended (16 U,S,C, 9470), EO) 1593
(identification and protection of historic properties), and
the Archaeological and Historic Preservation Act of
1974 (16 U,S,C, ~9469a-1 et seq).
18. Will cause to be performed the required financial and
compliance audits in accordance with the Single Audit
Act Amendments of 1996 and OMB Circular No. A-133,
"Audits of States, Local Governments, and Non-Profit
Organizations, n
19, Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations, and policies
governing this program.
. TITLE
~ ~ I)
I- ~L [ :d
. DATE SUBMITTED 02J(4?
Completed on submission to Grants.gov
5F-424D (Rev. 7-97) Back
Exhibit G
publlo (Federal, State, or looal) 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 certlficatlon;"and
(d) Have not wUhln 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.
U,S, D~PARTMENT OF JUSTICE
OFFICE OF JUSTICE PROGRAMS
OFFICE OF THE COMPTROLLER
CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND
OTHER RESPONSIBILITY MAITERS; AND DRUG-FREE WORKPLACE REQUIREMENTS
Applicants should refer to the reg.ulatlons 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 fOf compliance with certification requirements under 28CFR Part 69, 'New
Restrictions on Lobbying" and 28 CFR Part 67, 'Government-wlde Debarment and Suspension (Nonpro-curement) and
Governm~nt-wfde Requlreme.nts for Drug-Free Workplace (Grants): The certifications shaWbe 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 cooperat,lve 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 certlfles 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, Of 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 ag~ncy, a
Member of Congress, a.n 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
ClOmplete and stibmlt Standard Form - LLL,-Dlsclosure of
LobbyIng Activities; In acoordance with Its Instructions;
(e) The undersigned shall require that the language of th.ls cer-
tification be Included in the award documents for all subawards
at all tiers (Including sUbgrants, contracts under "grants and
ClOoperatJve agreements, and subcontracts) and that all sub-
recipients shall certify and dlsC/ose accordingly.
2. DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS
(OrRECT RECIPIENT)
As required by Executive Order 12549, Debarment and
Suspension, and Implemented at 28 CFR Part 67, for prospec-
tive partiCipants In prtmary covered transactions, as defined at
28 CFR Part 67, Section 67.510-
A, The applicant certifies that It and its principals:
(a) Are not pre.sently debarred, suspended, proposed for debar-
ment, declared Ineligible, sentenced to a denial of Federal
benefits by a State or Federal oourt, or voluntarily exoluded
from covered transactions by any Federal department
or agency;
(b) Have not within a three-year period preoedlng this applloa-
tlon 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 Ii
3. DRUG-FREE WORKPLACE
(GRANTEES OTHER llfAN INDNlDUAlS)
AJJ required by the Drug-Free Workplace Aot of 1988, and
Implemented at 28 GFR Part 67. Subpart F, for grantees, as
defined at 28 CFR Par~ 67 Sections 67.615 and 67.620-
A The applicant certlfles that It will or will .oontlnue to provide
a drug-free workplaoe by; ,
(a) PUblishing a statement notifying employees that the
unlaWful manufacture, distribution, dispensing, possession, or
use of a oontrolled substance Is prohibited In the grantee's
workplace and specifying the actions that will be taken against
employees for violation of suoh Prohlbltio~;
(b) Establl$hlng an on-golng drug-free awareness program to
Inform employees about-
(1) The dangers of drug abuse In the workplace;
(2) The grantee's polley of maintaining a. drug-free workplace;
(3) Any available drug counseling, rehabilitation, and employee
asslstarice programs; and .
(4) The penalties that may be Imposed upon employees for
drug abuse violations occurring In the workplaoe; .
(c) Making It a requirement that each employee to be engaged
In the performance ofthe grant be given a oopy 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 wlll-
OJP FORM 4061/6 (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 statu~e occurrl"g In the wOrkplace
no later than fI.ve calendar days after slJch conviction;
(e) Notifying the agency, Inwrltlng, within 10 calendar days
after receiving notice under sUbparagraph (d)(2) from an
employee or otherwise receiving actual notice of such convlc-tlon,
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 numb~r(s) of each affected grant;
(f) .Taking one of the follOWing Iilctlons, within 30 calendar
days of r.ecelving notice under subparagraph (d)(2), with .
respect to any employee who Is so convlcted-
(1) Taking appropriate personnel action against such an .
employee, up to and Including term/n,atlon, consistent with the
requirements of the Rehabilitation Act of 1973, as amendea; 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 aQency;
(g) Making a good ~ith effort to continue to maintain a drug-
free workplace through Implementatlon.of paragraphs (a), (b),
(c), (d), (e). and (t).
B. The grantee may Insert In the space provided below the
slte(s) for the performanc;:e of work done In connection with
the specific grant:
Place of Performance (Street address, city; county, state, 1;lp
code)
Check 0 .If there are workplaces on file that are not Indentifled
here,
Section 67, 630 of the regulations provides that a granlee 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 4061n.
,
Check 0 If the State has elected to complete OJP Form
4061n.
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
$leflned at 28 CFR Part 67; Sections 67.615 and 67.620-
A. h a condition of the grant, I ~ertlfy that I will notengage
. In the unlawful manufacture, distribution, dispenSing, posses-
sion, or use of a controlled substance in conducting any
activity with the grant; and .
B. If convicted of a crlmlnal dr!Jg offense resulting from a
violation occurring dUring the conduct of any grant activity, I
will report the conVlction,.'n writing, within 10 calendar days
of the conviction, to: Oepartmet:lt of Justice, OffIce of JUstice
Progran1s, ATTN: Control Desk, 633 Indl.ana Avenue, N.W.,
Washington, D.C. 20531.
As the duly authorized representallve of the applicant, I. hereby certify that the applicant will comply with the above certificatIons.
1. Glllntee Name and Address:
1l1<<'~6~
,-- ,
J-t'~J!
. J)$;&l{.
2. Application Number and/or Project Name
3. Grantee IRSNendor Number
..2A~8'
5. Signature
6. Date
~~jJ:.4~
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