HomeMy WebLinkAboutGEORGIA EMERGENCY MANAGEMENT AGENDY GRANTEE-SUBGRANTEE AGREEMENT FOR THE 2208 HOMELAND SECURITY GRANT PROGRAM (CITY OF AUGUSTA FIRE DEPARTMENT )NATHAN DEAL
GOVERNOR
GEORGIA EMERGENCY MANAGEMENT AGENCY
GEORGIA OFFICE OF HOMELAND SECURITY
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Honorable Deke Copenhaver
Mayor
City of Augusta
Municipal Building
Room 806
530 Greene Street
Augusta, Georgia 30911
Dear Mayor Copenhaver:
aw /td
Enclosures
January 4, 2013
RE: FIPS #245 - 04196 -03
GAN #2008 -GE -T8 -0017
Budget Worksheet #2842
City of Augusta Fire Department
On behalf of Governor Nathan Deal, it is my pleasure to provide you a copy of your
executed Grantee - Subgrantee Agreement for the 2008 Homeland Security Grant Program.
Please adhere to all requirements included in the agreement. In addition, mail request for
reimbursement to our office, Attention: Public Assistance, Post Office Box 18055, Atlanta,
Georgia 30316. Documentation should include copies of invoices, cancelled checks or other
type of justification and an executed Exhibit E.
Quarterly progress reports are due at the end of each calendar quarter. The initial
progress report will cover the period through March 31, 2013 and should be submitted no later
than April 15, 2013.
If you require further information as to the grantee package, please contact Tara Diaz,
Grants Manager, at 404 - 635 -7066 or 1- 800 - TRY -GEMA. Thank you for your work on behalf of
the citizens of Georgia.
P blic Assista ce Division Director
Post Office Box 18055 • Atlanta, Georgia • 30316 -0055
(404) 635 -7000 • Toll -free in Georgia 1- 800 - TRY -GEMA • www.gema.ga.gov
Y j
CHARLEY ENGLISH
DIRECTOR
FISCAL YEAR 2008 HOMELAND SECURITY GRANT PROGRAM
GRANTEE - SUBGRANTEE AGREEMENT
STATE HOMELAND SECURITY PROGRAM
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The States Department of Homeland Security (DHS), Federal Emergency Management Agency
(FEMA), Grant Programs Directorate (GPD), approved the application and awarded grant funding from
the Fiscal Year 2008 Homeland Security Grant Program to the Georgia Emergency Management Agency
(GEMA) on behalf of the State of Georgia, in accordance with the Consolidated Appropriations Act,
2008, Public Law 110 -161. 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
$40,000.00 to City of Augusta Fire Department, as Subgrantee, in accordance with the Fiscal Year
2008 Homeland Security Grant Program (HSGP), 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 Subgrantee. The Subgrantee's Authorized Official is the person whose name appears on page eight
(8) of this agreement and whose signature appears on page eight (8) of this agreement.
Purpose: The Subgrantee 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 Subgrantee and must be approved by the
Program Manager prior to the execution of that change. If a Detailed Budget Worksheet has not been
approved or attached to this agreement, a Budget Worksheet for all funding awarded in this subgrant must
be approved by the Program Manager and this agreement must be amended to add the approved Budget
Worksheet as Exhibit D before any expenditures may be made by or on behalf of the Subgrantee.
Effective Date: From September 1, 2008 to January 31, 2013
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 internee 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 /xIibrary/ assets / Grants _FinancialManagementGuide.pdf
Exhibit B United States Department of Homeland Security (DHS) Fiscal Year 2008
Homeland Security Grant Program Guidance and Application Kit (DHS Guide),
located on the Federal Emergency Management Agency web site at
http: / /www.fema.gov /pdf /government /grant/hsgp /fy08_hsgp guide.pdf.
Exhibit C NIMS Compliance Form
Exhibit D Approved Detailed Budget Worksheet(s)
Exhibit E Payment Request Form
Exhibit H Financial Status Report (FSR) Reporting Form.
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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 I Acknowledgment Form of Receipt of Goods or Services Paid for by the State on
Behalf of Subgrantee
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. State Purchases on behalf of Subgrantee: GEMA may, with the Written Consent of the
Subgrantee, retain and expend grant funding on behalf of the Subgrantee. Before the State will
make purchases on behalf of locals the Subgrantee must provide justification, receive approval
from GEMA and provide GEMA with the Written Consent for GEMA to expend these funds. If
GEMA does agree to retain and expend grant funding on behalf of the Subgrantee, the Subgrantee
is required to submit documentation to verify receipt and acceptance of the goods or services on
the Acknowledgment Form (Exhibit I) and provide any other documentation or information
requested by GEMA. If the Acknowledgement Form is not returned to GEMA in a timely
manner, the Subgrantee will be held accountable for payment to the vendor. The Subgrantee will
also be accountable for submitting Financial Status Reports (FSR) on a timely basis according to
the guidelines in following paragraph.
3. Financial Status Report (FSR): The disposition of grant funds, including all obligations and
expenditures, must be reported to GEMA on a quarterly basis through the FSR, which is due
within 30 days of the end of each calendar quarter (i.e. for the quarter ending March 31, FSR is
due no later than April 30). A copy of this form is attached as Exhibit H to this agreement.
4. Biannual Strategy Implementation Reports (BSIR): The Subgrantee 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, Subgrantee
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.
5. Grant Closeout Report: Within 60 days after the ending effective date of the subgrant, the
Subgrantee shall submit a final FSR and final 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.
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Audits, Financial Regulations and Guides
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1. Audits and Monitoring: The Subgrantee agrees that federal or state officials and auditors or
their duly authorized representatives may conduct programmatic, financial and administrative
monitoring, 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 2008
Homeland Security Appropriations Act and this Agreement.
If your entity receives $500,000 or more in federal assistance (from all federal sources, not just
this grant), during your fiscal year, you are responsible for having an audit conducted as
prescribed by the Single Audit Act and sending a copy to the Georgia Department of Audits and
Accounts. Mail reports to: Departments of Audits and Accounts, Nonprofit and Local
Governments Audits, 270 Washington Street, SW Room I -156, Atlanta, Georgia 30334 -8400
2. Laws, Regulations and Program Guidance: The Subgrantee agrees to comply with all
applicable laws, regulations and program guidance. Specifically without limitation, Subgrantee
must comply with FEMA's codified regulation 44 CFR Part 13, Uniform Administrative
Requirements for Grants and Cooperative Agreements to State and Local Governments. A non-
exclusive list of regulations commonly applicable to DHS grants are listed below, including the
guidance:
A. Administrative Requirements
1) Office of Management and Budget (OMB) Circular A -102, State and Local Govermnents
(10//07/94, amended 08/29/07) (44 CFR Part 13);
2) OMB Circular A -110, Institutions of Higher Education, Hospitals, and Other Non - Profit
Organizations (11/19/93, amended 09/30/99) (2 CFR Part 215)
B. Cost Principles
1) OMB Circular A -87, State and Local Governments (5/10/04)
2) OMB Circular A -21, Educational Institutions (5/10/04)
3) OMB Circular A -122, Non - Profit Organizations (5/10/04)
C. Audit Requirements
OMB Circular A -133, Audits of States, Local Governments, and Non - Profit Organizations
(6/24/97, includes revisions published in the Federal Register 6/27/03)
The subgrantee must comply with the most recent version of the Administrative Requirements,
Cost Principles, and Audit Requirements. Referenced CFR sections can be accessed online at
www.ecfr.gpo.access.gov.
3. OMB Circular A - 133: The Subgrantee 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 Subgrantee
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
National Initiatives
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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.
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 subgrantee is managing federal and state financial
assistance programs in compliance 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 OMB
administrative requirements circulars and the current edition of the Financial Guide (Exhibit A) in
retaining and maintaining records pertinent to the subgrant award. All such records shall be
retained by the subgrantee 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 2008 HSGP grant. Refer to the Financial
Guide (Exhibit A) for exceptions which would require a longer record retention period.
7. Withholding of Funds: GEMA, as the awarding agency, may withhold payments of grant funds
to a Subgrantee after proper notification or opportunity to remedy if the Subgrantee 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.
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.
8. Payment of Funds to GEMA: In addition to any other remedies available, the parties agree that
GEMA will be entitled to payment from the Subgrantee for any funds paid by the state or for
which the state is responsible to pay on behalf of the Subgrantee for which GEMA is unable to
receive payment from or will be required to repay the grant funds due to the Subgrantee's failure
to cooperate in providing the required documentation showing receipt of the goods or services or
other failure on the part of the Subgrantee, including without limitation timely completing and
returning to GEMA the Acknowledgment Form attached as Exhibit I.
1. Subgrantee agrees to comply with all applicable terms and conditions of the Fiscal Year 2008
Homeland Security Grant Program Guidance (Exhibit B), including without limitation meeting
the minimum National Incident Management System (NIMS) Fiscal Year 2008 compliance
requirements in the NIMS Compliance section of the DHS Guide and the NIMS Integration
Center (NIC). State, territory, tribal and local governments are considered to be in full NIMS
compliance if they have adopted and/or implemented the FY 2007 compliance activities, as
determined by the National Incident Management System Capability Assessment Support Tool
( NIMSCAST) or other accepted means. Additional information on achieving compliance is
available through the FEMA NIC at http: / /www.fema.gov /emergency /nims/. In order to assure
compliance with NIMS requirements, 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. For the next grant period, NIMSCAST will
be the required means to report NIMS compliance. For FY 2009 preparedness grant award
eligibility, all grant award recipients will be required to submit their compliance assessment via
the NIMSCAST by September 30, 2008.
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. Subgrantee 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 2008
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 2008 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.
2. The Subgrantee agrees that all allocations and use of funds under this grant will be in accordance
with the Fiscal Year 2008 Homeland Security Grant Program (HSGP) Guidance and Application
Kit (Exhibit B), and to comply with all DHS requirements and cooperate with GEMA to comply
with federal and state requirements related to the grant funding.
3. The Subgrantee 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 2008 HSGP application.
4. The Subgrantee agrees to sign and comply with the terms and conditions of GEMA's Statewide
Mutual Aid and Assistance Agreement and to render mutual aid for a suspected or real attack or
in the case of a weapons of mass destruction event. Subgrantee shall and sign any other Mutual
Aid Agreements GEMA or DHS/FEMA shall deem necessary in order to assure the Subgrantee
will fulfill its obligations to render mutual aid.
5. Any Subgrantee receiving funding for purposes of explosive ordnance disposal (EOD), agrees to
comply with the following:
(a) Each EOD and EOD K -9 team shall report responses via the Georgia Bureau of Investigation
(GBI) Response Reporting automated program. This condition shall take effect as soon as
the program, currently under development, is available for use.
(b) Each local EOD and EOD K -9 team shall contact the GBI by telephone immediately
whenever responding outside of its jurisdiction.
6. The Subgrantee agrees that federal funds under this award will be used to supplement, but not
supplant, state or local funds for the same purposes.
7. The Subgrantee agrees to cooperate with any assessments, national evaluation efforts, 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.
8. Federal funds provided under this grant program are for 100% reimbursement of all eligible
expenditures. Subgrantee will follow procurement standards as stated in the current edition of the
Financial Guide (Exhibit A).
9. 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).
10. 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 GEMA and
GPD.
11. 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.
12. 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
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the financial award which has been or is to be made available to the Subgrantee or retained and
expended or obligated on behalf of Subgrantee for other projects under this program, this or other
agreements, and applicable federal and state regulations until adequate corrective action is taken.
13. The Subgrantee agrees that all publications created with funding under this grant shall
prominently contain the following statement: "This document was prepared under a grant from
FEMA's Grant Program 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 of FEMA's Grant Programs Directorate or the U.S. Department of
Homeland Security."
14. Subgrantee acknowledges that GPD 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 with
Federal support. The Subgrantee agrees to consult with GPD through GEMA regarding the
allocation of any patent rights that arise from, or are purchased with, this funding.
15. 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."
16. 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; Executive Orders on
Floodplains (11988), Wetlands (11990) and Environmental Justice (12898); and Grants Program
Directorate Information Bulletin No. 271. 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 project 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 Subgrantee must obtain preapproval from GEMA and ensure monitoring of
any ground disturbance. If any potential archeological resources are discovered, the Subgrantee
will immediately cease construction in that area and notify FEMA, through GEMA, and the
Georgia Department of Natural Resources, Georgia State Historic Preservation Division. Any
construction activities that have been initiated prior to the full environmental and historic
preservation review will result in a non - compliance finding. Additional information regarding
EHP compliance requirements projects funded by this subgrant can be found in the DHS Guide
(Exhibit B).
17. Subgrantee agrees to cooperate with GEMA in assuring that any training funded through HSGP
funding is reported through the training Information Reporting System ( "Web- Forms "), as more
fully explained in the FY 2008 Homeland Security Grant Program (HSGP) Program Guidance
and Application Kit, Appendix C, page C-4.
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18. Subgrantee agrees that funds from the FY 2008 HSGP utilized to establish or enhance state and
local fusion centers will be used in compliance with the requirements and restrictions in the DHS
Guide (Exhibit B) and with the Grant Programs Directorate Information Bulletin No. 281 dated
March 5, 2008, and Information Bulletin No. 288 dated April 25, 2008. Specifically without
limitation, the Subgrantee receiving funding to be used for costs related to fusion centers agree to
comply with the following:
(a) Use such funds to:
(i) Support the development of a statewide fusion process that corresponds with the "Global
Justice/Homeland Security Advisory Council (HSAC) Fusion Center Guidelines" and
Appendix 1 of the National Strategy for Information Sharing: Establishing a National
Integrated Network of State and Urban Area Fusion Centers
(ii) Support achievement of baseline levels of capability as defined in the fusion capability
planning tool
(iii) Achievement of baseline levels of capability as defined in the fusion capability planning
tool
(b) Provide GEMA with certification stating that Subgrantee will assume responsibility for
supporting the costs of the hired analysts following the three -year federal funding period.
(c) Provide GEMA with certificates of completion of training for each intelligence analyst hired
with grant funding to enable information/intelligence sharing capabilities in accordance with
Global's Minimum Criminal Intelligence Training Standards for Law Enforcement and Other
Criminal Justice Agencies in the United States, as required under the DHS Guide (Exhibit B)
and Information Bulletin 288.
19. All Subgrantees leveraging FY 2008 HSGP funds in support of information sharing and
intelligence fusion and analysis centers are encouraged to leverage available federal information
sharing systems, including Law Enforcement Online (LEO) and the Homeland Security
Information Network (HS1N).
20. When implementing GPD- 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.
21. If using subcontractors or contractors, Subgrantee shall, to the extent practicable, use small,
minority, women -owned or disadvantaged business concerns and contractors or subcontractors.
22. The Subgrantee 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. §13- 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:
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AGREED by all parties:
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.
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By.
ubgrantee's Authorized 0 ` icial
-- Signature Date
Toe eactlrtS, / 3 r P(2)
or Typed Name of
Subgrantee's Authorized Official
Exhibit C
NIMS Compliance Form
This NIMS Compliance Form MUST be completed by each agency
requesting or benefiting from funding.
In federal Fiscal Year 2008, state agencies, tribes, and local governments are considered to be in full NIMSD compliance if
they have adopted and/or implemented the FY 2007 compliance activities as determined by the National Incident
Management System Capability Assessment Support Tool ( NIMSCAST) or other accepted means. This document describes
the actions that jurisdictions must have taken by September 30, 2008 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
['Community 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.
❑Incident 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.
❑Public 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.
:Preparedness/Planning: Establish the community's NIMS
baseline against the FY 2005 and FY 2006
implementation requirements. (NIMSCAST and/or
Implementation Plan)
['Develop and implement a system to coordinate all federal
preparedness funding to implement the NIMS across the
community.
.Revise and update local government emergency
operations plans (EOPs), standard operating procedures
(SOPs), and standard operating guidelines (SOGs) to
incorporate NIMS and National Response Framework
(NRF) components, principles and policies, to include
planning, training, response, exercises, equipment,
evaluation, and corrective actions.
Authorized
Signature:
Date:
[Participate in and promote intrastate and interagency
mutual aid agreements, to include agreements with the
private sector and non- governmental organizations (NGO).
❑Implementation plan exists at agency level that identifies
personnel to complete the below listed NIMS training
requirements.
❑Complete IS -700 NIMS: An Introduction
['Complete IS -800 NRP: An Introduction
❑Complete ICS 100 and ICS 200 Training
['Complete ICS 300 Training
❑Incorporate NIMS/ICS into all tribal, local, and regional
training and exercises.
[Participate in an all- hazard exercise program based on
NIMS that involves responders from multiple disciplines
and multiple jurisdictions.
❑Incorporate corrective actions into preparedness and
response plans and procedures.
❑Inventory community response assets to conform to
homeland security resource typing standards.
['To 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.
['Apply standardized and consistent terminology, including
the establishment of plain English communications
standards across public safety sector.
['Inventory response assets to conform to NIMS National
Resource Typing Definitions, as defined by FEMA's
Incident Management Systems Integration Division.
Agency: Wcitr Q / &,, . i -
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Federal ID No.
58-2204274
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SUBGRANTEE (Agency/ Department)
Augusta Fire Department
STREET ADDRESS: 925 Laney Walker Boulevard, Augusta, Georgia
Investment Justification = 11 Specify on this line the Investment Justification associated with the project to be funded.One per application.
Choose one: 1, National Incident Management System and National Response Plan, 2. Regional Co laboration, 3, National Infrastructure Protection Plan, 4. Information Sharing, 5. Interoperable
Communications, 6. CBRNE, 7. Medical Surge and Mass Prophylaxis, 8, Explosive Device Response Operations, 9. Law Enforcement Operations and Investigations, 10. Citizen Preparedness and Volunteer
Efforts, 11. Georgia Search and Rescue Program, 12, Evacuation Preparedness, 13. Agroterrorism Defense, 14. Planning
Strategic Goal No. = For each requested item, list below the number of the specific State Strategic Plan Goal, Objective and Steps the requested item will further, for example 4.1.1-5.
disci
EMS, EMA, 911,
COST ESTIMATE
•1
Disci
line=
Fire
cif
ITEM NO CATEGORY ITEM
line on this line: Fire, Law Enforcement (LE
he
NOTE: Onl ONE discipline r a
STATE GOAL,
OBJECTIVE, STEP QUANTITY
lication
COST EACH TOTAL COST
001
002
003
007
004
005
006
008
009
GEORGIA EMERGENCY MANAGEMENT AGENCY
FY 2008 DHS State Homeland Security Grant Program (SHADED AREAS ARE FOR GEMA USE ONLY)
Equipment
PREPARED BY: Ronnie Register
Send Contract To (Name/Title): Program Contact (Name/Title):
Mayor Deke Copenhaver
Howard Willis
1 $40,000.00 $ 40,000.00
$
U10
0:4409444,prOripf-, 4:!"'14,117,111..
faiv Watiltf," _ ANttaigtidjggRM TOTAL 40,000.00
TITLE: GEMA Fire Services Coordinator
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
R nested
Quantity
Requested Cost
Description of Documentation
Attached in Support of this
Payment Request
(from Continuation sheet attached)
SUBTOTAL
TOTAL
NET AMOUNT REQUESTED
Under penalty of perjury, 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 Subgrantee's Authorized Representative Printed Name Contact Phone Number
EXHIBIT E
ASSURANCES - NON - CONSTRUCTION PROGRAMS
NOTE:
OMB Approval No. 4040-0007
Expiration Date 04/30/2008
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.
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. § §4728 -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. § §1681-
1683, and 1685 - 1686), which prohibits discrimination on
the basis of sex; (c) Section 504 of the Rehabilitation
Act of 1973, as amended (29 U.S.C. §794), which
prohibits discrimination on the basis of handicaps; (d)
the Age Discrimination Act of 1975, as amended (42
U.S.C. § §6101 - 6107), which prohibits discrimination
on the basis of age; (e) the Drug Abuse Office and
Treatment Act of 1972 (P.L. 92 -255), as amended,
relating to nondiscrimination on the basis of drug
abuse; (f) the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91 -616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) § §523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. § §290 dd -3 and 290 ee-
3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the
Civil Rights Act of 1968 (42 U.S.C. § §3601 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 apply
to all interests in real property acquired for project
purposes regardless of Federal participation in
purchases.
8. WIII comply, as applicable, with provisions of the
Hatch Act (5 U.S.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.
Previous Edition Usable Standard Fonn 424B (Rev. 7 -97)
Authorized for Local Reproduction Prescribed by OMB Circular A -102
* SIGNATU • E OF AUT RIZED C TIFYING OFFICIAL
* TITLE
Comps : submission o rants.gov
jll&jQ l P' -T-e.....4.-..-
* APPLICANT ORGANIZATION
* DATE SUBMITTED
Completed on submission to Grants.gov
A .1 Q A, A' _.g p
9. Wiil 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 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 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. § §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).
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.
MII 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.
Standard Form 424B (Rev. 7 -97) Back
NOTE:
1. Has the legal authority to apply for Federal assistance,
and the institutional, managerial and financial capability
(including funds sufficient to pay the non - Federal share
of project costs) to ensure proper planning,
management and completion of project described in
this application.
2. Will give the awarding agency, the Comptroller General
of the United States and, if appropriate, the State,
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.
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.
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.
6. Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding agency.
7. Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal or organizational
conflict of interest, or personal gain.
ASSURANCES - CONSTRUCTION PROGRAMS
OMB Approval No.4040 -0009
Expiration Date 04/30/2008
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 - 0042), 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.
Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
Awarding Agency. Further, certain Federal assistance awarding agencies may require applicants to certify 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:
8. V1hll comply with the Intergovernmental Personnel Act
of 1970 (42 U.S.C. § §4728 -4763) relating to prescribed
standards of 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).
9. Will comply with the Lead -Based Paint Poisoning
Prevention Act (42 U.S.C. § §4801 et seq.) which
prohibits the use of lead -based pain In construction or
rehabilitation of residence structures.
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. § §1681
1683, and 1685 - 1686), which prohibits discrimination
on the basis of sex; (c) Section 504 of the
Rehabilitation Act of 1973, as amended (29) U.S.C.
§794), which prohibits discrimination on the basis of
handicaps; (d) the Age Discrimination Act of 1975, as
amended (42 U.S.C. § §6101- 6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse
Office and Treatment Act of 1972 (P.L. 92 -255), as
amended relating to nondiscrimination on the basis of
drug abuse; (f) the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91 -616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) § §523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. § §290 dd -3 and 290 ee
3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the
Civil Rights Act of 1968 (42 U.S.C. § §3601 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 (j) the requirements of any other
nondiscrimination statue(s) which may apply to the application.
Previous Edition Usable Authorized for Local Reproduction Standard Form 424D (Rev. 7 -97)
Prescribed by OMB Circular A -102
• SIGNAT E OF UTHOR ZED CERTIFYING OFFICIAL
Comple on submissi to Grants. ov
• TITLE
✓'t.� ___ i a ,, P rw — j C,�^t
-
• APPLICANT ORGANIZATION
•• D�AT
Completed on submission to Grants.gov
A a 4t:4d;•46'
11. WII 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.S.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. § §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.
14. WII 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 total cost of insurable construction
and acquisition is $10,000 or more.
15. Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of
environmental quality control measures under the
National Environmental Policy Act of 1969 (P.L. 91-
190) and Executive Order (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. § §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. ■II 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.
17. Will assist the awarding agency in assuring compliance
with Section 106 of the National Historic Preservation
Act of 1966, as amended (16 U.S.C. §470), EO 11593
(identification and protection of historic properties), and
the. Archaeological and Historic Preservation Act of
1974 (16 U.S.C. § §469a -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."
19. Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations, and policies
governing this program.
SF -424D (Rev. 7-97) Back
U.S. DEPARTMENT OF JUSTICE
OFFICE OF JUSTICE PROGRAMS
OFFICE OF THE COMPTROLLER
CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND
OTHER RESPONSIBILITY MATTERS; AND DRUG -FREE WORKPLACE REQUIREMENTS
Applicants should refer to the regulations cited below to determine the certification to which they are required to
attest. Applicants should also review the instructions for certification included in the regulations before completing this
form. Signature of this form provides for compliance with certification requirements under 28 CFR Part 69, `New
Restrictions on Lobbying" and 28 CFR Part 67, "Government -wide Debarment and Suspension (Nonpro- curement) and
Government -wide Requirements for Drug -Free Workplace (Grants) ' The certifications shall'be treated as a material
representation of fact upon which reliance will be placed when the Department of Justice determines to award the
covered transaction, grant, or cooperative agreement.
1. LOBBYING
As required by Section 1352, Title 31 of the U.S. Code. and
implemented at 28 CFR Part 69, for persons entering into a
grant or cooperative agreement over $100,000, as defined at
28 CFR Part 69, the applicant certifies that
(a) No Federal appropriated funds have been paid or will be
• paid, by or on 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 stibmit 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 shad 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
Of agency;
(b) Have not within a three -year period preceding this applica-
tion been convicted of or had a civil Judgment rendered against
them for commission of fraud or a criminal offense in connec-
tion with obtaining, attempting to obtain, or performing a
public (Federal, State, or local) transaction or contract under a
public transaction; violation of Federal or State antitrust statutes
or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records. making false
statements, or receiving stolen property;
(c) Are not - presently indicted for or otherwise criminally or •
civilly charged by a governmental entity (Federal, State. or
local) with commission of any of the offenses enumerated in
paragraph (1)(b) of this certification; and
(d) Have not within a three -year period preceding this applica-
tion had one or more public transactions (Federal, State, or
local) terminated for cause or default; and
B. Where the applicant is unable to certify to any of the
statements in this certification, he or she shall attach an
explanation to this application.
3. DRUG -FREE WORKPLACE
(GRANTEES OTHER THAN INDIVIDUALS)
As required by the Drug -Free Workplace Act of 1988, and
implemented at 28 CFR Part 87, 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
untaWful 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 avallable 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 4061/2.4081/3 AND 4061/4 WHICH ARE OBSOLETE.
As the duly authorized representative of the applicant, t hereby certify that the applicant will comply with the above certifications.
(1) Abide by the terms of the statement; and
(2) Notify the employer in writing of his or her conviction for a
violation of a criminal drug statute occurring in the workplace
no later than five calendar days after such conviction;
(e) Notifying the agency, In writing, within 10 calendar days
after receiving notice under subparagraph (d)(2) from an
employee or otherwise receiving actual notice of such conic -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)
1. Grantee Name and Address:
Augusta Fire Dept.
3117 Deans Bridge Rd.
Augusta, GA 30906'
2. Application Number and/or Project Name
GAN #2008 -GE -T8 -0017
_ Joe Bowles, Mayor Pro -tem
4. Typed Name and Title of Authorized Representative
5. S' re
rp
—,,:. —.� .►
�1
Check ❑' if there are workplaces on file that are not indentifled
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 Q 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. t 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, 633 Indiana Avenue, N.W.,
Washington. D.C. 20531.
582204274
3. Grantee IRSNendor Number
6. Date
'US. Government Ptlnfing Office: 1996- 405-037140014
is
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AfirkerScaalactarapany
Remit to: GEMA- Georgia Emergency Management Agency
PO Boa 18055, Atlanta, GA 30316
GEMA Order Receipt Acknowledgement
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The subgrantee MUST properly receipt and maintain documentation (I.e. packing slips, purchase orders) for all equipment, supplies, services, etc for all items listed on the approved Budget Worksheet. Receipts or Invoices with order
and delivery dates are required for all equipment items. For all items received directly from the vendor and purchased by the state on behalf of your local jurisdiction, this Order Receipt Acknowledgement Form
must be completed and submitted to GEMA immediately upon receipt. If this form is not submitted to our office, funds associated with the purchased equipment will be deobligated from your grant and must be
reimbursed to the state.
1 off
Order Received Confirmation Signature Date
Airport: Augusta Regional Airport
Owner: City of Augusta /1
A A r 1414%
� .�.. �. I nne�r� �rtin 1 .nm��nv Project Number; 0733-18
Contract Modification #7
Date Initiated: October 25, 2012
Project: Front Door Parking Improvements