Resolution No. 8634
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RESOLUTION NO. 8634
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
VERNON APPROVING AND RATIFYING THE ELECTRONIC
FILING OF A HOMELAND SECURITY FIREFIGHTER SAFETY
GRANT BY THE FIRE DEPARTMENT
6 WHEREAS, the Vernon Fire Department filed with the U.S.
7 Department of Homeland Security, Office for Domestic Preparedness, Fire
8 Operations and Firefighters Safety Program, a FY2004 Assistance to Fire
9 Fighter Grant Application on or about March 16, 2004, Grant No. EMW-
10 2004-FG-OI016 (the "Grant") and on or about October 19, 2004 signed and
11 filed Form 1199A, Direct Deposit Sign-Up Form; and
12 WHEREAS, tne Vernon Fire Department applied for Grant funds
13 in order to install a PlymoVent Vehicle Exhaust Extraction system onto
14 fire apparatus in Fire Station Nos. I, 3 and 4 for the purpose of
15 protecting personnel and the general public visiting the stations from
16 the cancer causing effects of vehicle exhaust emissions; and
17 WHEREAS, in order to receive the Grant, the Vernon Fire
18 Department electronically signed and filed the necessary online forms
19 that would allow the City of Vernon to become a party to the Grant
20 electronic application filing process, subject to ratification by the
21 City Council; and
22 WHEREAS, the U.S. Department of Homeland Security, Office for
23 Domestic Preparedness, sent notification of Grant approval by a letter
24 dated on or about November 23, 2004; and
25 WHEREAS, Vernon's approximate allotment in the foregoing
26 Grant is ten percent (10%) or $13,839.00; and
27 WHEREAS, by letter dated December 27, 2004, Bruce V.
28 Malkenhorst, City Administrator/City Clerk, recommended that the
1 electronic filing of the Grant application by the Fire Department be
2 approved and ratified.
3 NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE
4 CITY OF VERNON AS FOLLOWS:
5
SECTION 1:
The City Council of the City of Vernon hereby
6 finds and determines that the recitals contained hereinabove are true
7 and correct.
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SECTION 2:
The City Council of the City of Vernon hereby
9 approves, authorizes and ratifies the electronic submittal of the Grant
10 by the Fire Department on behalf of the City of Vernon. A copy of the
11 notification of approval letter regarding the Grant and the Grant
.
12 Application are attached hereto as Exhibit A and incorporated by
13 reference.
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SECTION 3:
The City Council of the City of Vernon hereby
15 authorizes the City Administrator, or his designee, to execute any and
16 all documents necessary for the purpose of securing grant funds and to
17 implement and carry out the purposes specified in the Grant application
18 for, and on behalf of, the City of Vernon.
19
SECTION 4:
The City Clerk of the City of Vernon shall
20 certify to the passage of this resolution, and thereupon and thereafter
21 the same shall be in full force and effect.
22 APPROVED AND ADOPTED this 5th day of January, 2005.
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ATTEST:
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8 2005, and
9 Vernon.
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13 (SEAL)
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STATE OF CALIFORNIA
COUNTY OF LOS ANGELES
ss
I, BRUCE V. MALKENHORST, City Clerk of the City of Vernon, do
hereby certify that the foregoing Resolution, being Resolution No.
8634, was duly adopted by the City Council of the City of Vernon at a
regular meeting of the City Council duly held on Wednesday, January 5,
thereafter was duly signed by the Mayor of the City of
BRUCE V. MALKENHORST, City Clerk
- 3 -
EXHIBIT
A
Panel Review
Page 2 of8
u.s. Department of Homeland Security
Office for Domestic Preparedness
Washington, D.C. 20531
Mr. Todd Painton
City of Vernon Fire Deparment
4305 Santa Fe Avenue
Vernon, California 90058-1714
Re: Grant No. EMW-2004-FG-O 1 016
Dear Mr. Painton:
Congratulations, on behalf of the Department of Homeland Security and the Office for Domestic Preparedness.
Your grant application submitted under the FY 04 Assistance to Firefighters Grant has been approved. The
approved project costs amount to $138,396.00. The Federal share is 90 percent or $124,557.00 of the approved
amount and your share of the costs is 10 percent or $13,839.00.
As part of your award package, you will find Grant Agreement Articles. Please make sure you read and
understand the Articles as they outline the terms and conditions of your Grant award. Maintain a copy of these
documents for your official file. You establish acceptance of the Grant and Grant Agreement Articles when
you request and receive any of the Federal Grant funds awarded to you.
The first step in requesting your grant funds is to confirm your correct Direct Deposit Information. Please go on-
line to the AFG eGrants system at https:/Iportal.fema.gov and if you have not done so, complete and submit
your SF 1199A, Direct Deposit Sign-up Form. Please forward the original, completed SF 1199A, Direct Deposit
Sign-up Fonn, signed by your organization and the banking institution to the address below:
Department of Homeland Security
Emergency Preparedness and Response Directorate (FEMA)
Grants Management Branch
500 C Street, SW, Room 334
Washington, DC 20472
Attn: Assistance to Firefighters Grant Program
After your SF 1199A is reviewed and you receive an email indicating the form is approved, you will be able to
request payments online. If you have any questions or concerns regarding the process to request your grant
funds, please call 1-877-510-6762.
Sincerely,
{!-.~~~
C. Suzanne Mencer
Executive Director
Office of State and local Government
Coordination and Planning
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Panel Review
J
Page 4 of8
Agreement Articles
u.s. Department of Homeland Security
Washington, D.C. 20531
AGREEMENT ARTICLES
ASSISTANCE TO FIREFIGHTERS GRANT PROGRAM - Operations and Firefighter Safety program
GRANTEE: City of Vernon Fire Deparment
PROGRAM: Operations and Firefiqhter Safety
AGREEMENT NUMBER: EMW-2004-FG-01016
AMENDMENT NUMBER:
Article I
Article II
Article III
Article IV
Article V
Article VI
Article VII
Article VIII
Article IX
Article X
Article XI
Article XII
Article I - Project Description
TABLE OF CONTENTS
Project Description
Grantee Concurrence
Period of Performance
Amount Awarded
Requests for Advances or Reimbursements
Budget Changes.
Financial Reporting
Performance Reports
DHS Officials
Other Terms and Conditions
General Provisions
Audit Requirements
The grantee shall perform the work described in the approved grant application'S Program Narrative. That
narrative is made a part of these grant agreement articles by reference. The purpose of the Assistance to
Firefighters Program is to protect the health and safety of the public and firefighting personnel against fire and
fire-related hazards. After careful consideration, DHS has determined that the g~antee's project, as detailed in
submitted project narrative and budget information, submitted as part of the grantee's application (and
considered part of this agreement by reference), was consistent with the program's purpose and worthy of
award. As such, any material deviation from the approved program narrative must have prior written approval.
Article II - Grantee Concurrence
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By requesting and receiving Federal grant funds provided by this grant program, the grantee accepts and agrees
to abide by the terms and conditions of the grant as set forth in this document and the documents identified
below. All documents submitted as part of the application are made a part of this agreement by reference.
Article III . Period of Performance
The period of performance shall be from 13-NOV-04 to 12-NOV-oS.
The grant funds are available to the grantee for obligation only during the period of performance of the grant
award. The grantee is not authorized to incur new obligations after the expiration date unless the grantee has
requested, and DHS has approved, a new expiration date. The grantee has 90 days after period of performance
to incur costs associated with closeout or to pay for obligations incurred during period of performance. Award
expenditures are for the purposes detailed in the approved grant application only. The grantee cannot transfer
funds or assets purchased with grant funds to other agencies or departments without prior written approval from
DHS.
Article IV. Amount Awarded
The amount of the award is detailed on the Obligating Document for Award attached to these articles. Following
are the budgeted estimates for object classes for this grant (including Federal share plus grantee match):
Personnel $0.00
Fringe Benefits $0.00
Travel $0.00
Equipment $0.00
Supplies $0.00
Contractual $0.00
Construction $0.00
Other $138,396.00
Indirect Charges $0.00
Total $138,396.00
Article V . Requests for Advances or Reimbursements
Grant payments under the Assistance to Firefighters Grant Program are made on an advance or reimbursable
basis for immediate cash needs. When the grantee needs grant funds and has obtained a user account, the
grantee fills out the on-line Request for Advance or Reimbursement. If the grantee has not obtained a user
account, an account may be obtained by calling the help desk at 1-866-274-0960.
Article VI - Budget Changes
Generally, changes in the budget-line items are permitted, as long as the original program narrative is
accomplished. The only exception to this provision is for grants where the Federal share is in excess of
$100,000.00. In grants where the Federal share exceeds $100,000.00, the budgeted line items can be changed,
but if the cumulative changes exceed ten (10) percent of the total budget, Changes must be pre-approved.
Article VII . Financial Reporting
The Request for Advance or Reimbursement mentioned above, will also be used for interim financial reporting
purposes. At the end of the performance period, or upon completion of the grantee's program narrative, the
grantee must complete, on-line, a final financial report that is required to close out the grant. The Financial
Status Report, is due within 90 days after the end of the performance period.
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Article VIII - Performance Reports
The grantee must submit a semi-annual and a final performance report to DHS. The final performance report
should provide a short narrative on what the grantee accomplished with the grant funds and any benefits derived
there from. The semi-annual report is du~ six months after the award date.
Article IX - DHS Officials
Program Officer: Tom Harrington, Deputy Chief of the Grants Program Office, is the Program Officer for this
grant program. The Program Officer is responsible for the technical monitoring of the stages of work and
technical performance of the activities described in the approved grant application.
Grants Assistance Officer: Christine Torres, is the Assistance Officer for this grant program. The Assistance
Officer is the Federal official responsible for negotiating, administering, and executing all grant business matters.
Grants Management Branch POC: Latoya Larker is the point of contact for this grant award and shall be
contacted for all financial and administrative grant business matters. If you have any questions regarding your
grant please call 202-646-3645.
Article X - Other Terms and Conditions
.
Pre-award costs directly applicable to Jhe awarded grant are allowable if approved in writing by the DHS
Program Office.
Article XI - General Provisions
The following are hereby incorporated into this agreement by reference:
44 CFR, Emergency Management and Assistance
Part 7
Part 13
Nondiscrimination in Federally-Assisted Programs
Uniform administrative requirements for grants and cooperative
agreements to state and local governments
Government-wide Debarment and Suspension (Non-procurement)
and Government-wide Requirements for Drug-free Workplace
(Grants)
New Restrictions on Lobbying
Part 17
Part 18
31 CFR 205.6 Funding Techniques
OMS Circular A-21 Cost Principles for Educational Institutions
OMS Circular A-87 Cost Principles for Statellocal Governments, Indian tribes
OMS Circular A-122 Cost Principles for Non-Profit Organizations
OMS Circular A-
102
Uniform Administrative Requirements for Grants and Agreements With State and Local
Governments Assistance to Firefighters Grant Application and Assurances contained therein.
Uniform Administrative Requirements for Grants and Agreements With Institutions of Higher
Education, Hospitals, and Other NonProfit Organizations Assistance to Firefighters Grant
Application and Assurances contained therein.
OMS Circular A-
110
Article XU. AuditRequirements
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All grantees must follow the audit requirements of OMB Circular A-133, Audits of States, Local Governments,
and Non-Profit Organizations. The main requirement of this OMB Circular is that grantees that expend
$500,000.00 or more in Federal funds (from all Federal sources) must have a single audit performed in
accordance with the circular.
As a condition of receiving funding under this grant program, you must agree to maintain grant files and
supporting documentation for three years upon the official closeout of your grant. You must also agree to make
your grant files, books, and records available for an audit by DHS, the General Accounting Office (GAO), or their
duly authorized representatives to assess the accomplishments of the grant program or to ensure compliance
with any requirement of the grant program.
Additional Requirements if applicable
FEMA is required to ascertain how proposed modifications to fire houses may be impacted by requirements
related to the National Historic Preservation Act and the National Flood Insurance Program regulations.
Modification projects must be evaluated for compliance with applicable statutory and regulatory
environmental/historic preservation requirements and must be approved by FEMA prior to project
implementation. No funds may be requested for construction until all these requirements are fulfilled. If the
Grantee has a building that is 50 years old or older they shall not proceed with proposed modification projects,
other than planning, until being notified by FEMA that all reviews have been completed. Noncompliance may
jeopardize receipt of federal funding. Jacqueline Lee Program Support Assistant Office of Grants Management
Branch Jacquelil1e.Lee@dhs.gov .
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Panel ~eview
1a. AGREEMENT NO.
BMNV-2~FG-01016
6. RECIPIENT NAME AND
ADDRESS
Ciy of Vernon Fire Deparment
4305 Santa Fe Avenue
Vernon
Ca&fomia. 90058-1714
9. NAME OF RECIPIENT
PRO~ECT OFFICER
Todd Painton
11. EFFECTIVE DATE OF
11-IIS ACTION
13-NOV-04
Page 80[8
FEDERAL EMERGENCY MANAGEMENT AGENCY
OBLIGATING DOCUMENT FOR AWARD/AMENDMENT
2. AMENDMENT 3. RECIPIENT NO. 4. TYPE OF 5. CONTROL NO.
NO, 95-6000808 ACTION W395176N
o AVVARD
7. ISSUING OFFICE AND ADDRESS 8. PAYMENT OFFICE AND ADDRESS
ODPlFinancial and Grants Management ODPlFinancial Services Branch
Division 500 C Street, SW., Room 723
500 C Street, S.w., Room 350 VVashington DC, 20472
VVashington DC, 20472
POC: Latoya Larker 202-646-3645
PHONE NO. 10. NAME OF PROJECT COORDINATOR PHONE NO.
323-583-4821 Tom Harrington (202) 307-2790
12. METHOD OF
PAYMENT
SF-270
14. PERFORMANCE PERIOD
~om:13-NOV- To:12-NOV-05
13. ASSISTANCE ARRANGEMENT
Cost Sharing
Budget Period
~m:01-OCT- To:30-SEP-05
PROGRAM
~NAME
ACRONYM
CFDA NO.
15. DESCRIPTION OF ACTION
a. (Indicate funding data for awards or financial changes)
AFG
97.044
ACCOUNTING DATA PRIOR AMOUNT CURRENT CUMMULA TIVE
(MCS CODE) TOTAL AVVARDED THIS TOTAL AVVARD NON-
XXXX-XXX-XXXXXX-XXXXX- AVVARD ACTION FEDERAL
XXXX-XXXX-X + OR (-) COMMITMENT
2Q05-62-0364RE-63000000- $0.00 $124,557.00 $124,557.00 $13,839.00
4101-R
TOTALS $0.00 $124,557.00 $124,557.00 $13,839.00
b. To describe changes other than funding data or financial changes, attach schedule and check here.
N1A
16 a. FOR NON-DISASTER PROGRAMS: RECIPIENT IS REQUIRED TO SIGN AND RETURN THREE (3) COPIES OF THIS DOCUMENT
TO FEMA (See Block 7 for address)
Assistance to Firefighters Grant - Fire Prevention and Safety Program recipients are not required to sign and retum copies of this document.
However, recipients should print and keep a copy of this document for their records.
16b. FOR DISASTER PROGRAMS: RECIPIENT IS NOT REQUIRED TO SIGN
This assistance is subject to terms and conditions attached to this award notice or by incorporated reference in program legislation cited
above.
17. RECIPIENT SIGNATORY OFFICIAL (Name and Title)
N1A
18. FEMA SIGNATORY OFFICIAL (Name and Title)
Pamela Greene
-
DATE
N/A
DATE
08-NOV-04
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SECTION 1 (TO BE COMPLETED BY PAYEE)
Standard Form 1199A - Direct Deposit Sign-Up Form
A ORGANIZATION NAME
City of Vernon Fire Deparment
ADDRESS (street, route, P.O. Box, APO/FPO)
4305 Santa Fe Avenue
SF 1199A - Direct Deposit Sign-Up Form
. .
CITY
Vernon
STATE
California
ZIPCODE
90058-1714
B NAME OF PERSON(S) ENTITLED TO PAYMENT
Todd Painton
C CLAIM OR PAYROLL 10
NUMBER SuffIX
PrefIX 95-6000808
PAYEE/JOINT PAYEE CERTIFICATION
I certify that I am entitled to the payment identified above.
In signing this form, authorize my payment to be sent to
the financial institution named below to be deposited to the
designated account.
;JL::1/d- /'OTE1/11(J4
SIGNATURE
DATE
I
I
Page I of I
-,
OMB No 151-0007
o TYPE OF DEPOSITOR ACCOUNT
Checking
E DEPOSITOR ACCOUNT NUMBER
1459410483
F TYPE OF PAYMENT
Other, Grant Award
ENNV-2004-FGH01016
G THIS BOX FOR ALLOTMENT OF PAYMENT ONLY (if applicable)
TYPE
AMOUNT
JOINT ACCOUNT HOLDERS' CERTIFICATION (optional)
I certify that I have read and understood the instructions, including the SPECIAL
NOTICE TO JOINT ACCOUNT HOLDERS.
SIGNATURE
DATE
I
SIGNATURE
DATE
I
GOVERNMENT AGENCY NAME
SECTION 2
GOVERNMENT AGENCY ADDRESS
Federal Emergency Management Agency
Attn: Assistance to Firefighters Grant Program
Grants Management Branch, Room 350, 500 C Street S.W., Washington, D. C. 20472
SECTION 3 (TO BE COMPLETED BY FINANCIAL INSTITUTION)
NAME AND ADDRESS OF FINANCIAL INSTITUTION ROUTING NUMBER CHECK DIGIT
t3/Jl.JIL d,:: At<f';::'I1/CA
~ '({IU 'S. SA.<JJA F,:;: Aue.
L)/~t.:JO'J CA ?C9() ~g'
I J- lOC)o 66 ,
DEPOSITOR ACCOUNT TITLE
FINANCIAL INSTITUTION CERTIFICATION
I confirm the identity of the above-named payee(s) and the account number and title. As representative of the above-named financial
institution, I certify that the financial institution agrees to receive and deposit the payment identified above in accordance with 31 CFR Parts
240,209, and 210.
PRINT OR TYPE REPRESENTATIVE'S NAME
~~TElEPHQNgNUMBER DATE
· · -: - -- - '37- 3 - :2 7?- 177 '1.
lol;J~/d'f
AILtf1AAI,oo
/(()$140
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10/12/2004
rnm f\pplIcanon
Page I of22
Entire Application
Overview
Are you a member, or are you currently involved in the management, of the fire department Yes
applying for this grant?
If you answered No, please complete the information below and click on the Save and Continue button. If you
answered Yes, please do not complete the information requested below and click on the Save and Continue
button.
Note: If you answered No to the above question, the fields marked with an * are required.
Preparer Information
* Organization Name
* Address 1
Address 2
* City
* State
· Zip
. Is there a grant-writing fee associated with the
preparation of this request?
If you answered yes above, what is the fee?
No
$
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t.nm ApplICation
Contact Information
--
Page 2 of22
* Title
Prefix
. First Name
Middle Initial
"last Name
" Business Phone
'Home Phone
Mobile Phone/Pager
Fax
*Email
. Title
Prefix
. First Name
Middle Initial
. last Name
. Business Phone
"Home Phone
Mobile Phone/Pager
Fax
"Email
Alternate Contact Information Number 1
Fire Chief
Mr.
Steven
Parker
323-583-4821 Ext. 280
949-859-2417 Ext.
323-826-1407
323-826-1407
sparker@ci.vernon.ca.us
Alternate Contact Information Number 2
Battalion Chief
. Mr.
Michael
A
Wilson
323-583-4821 Ext.511
909-688-7523 Ext.
323-353-1062
323-581-1682
mwilson@Ci.vemon.ca.us
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rrmt AppJIcatIon
Applicant Information
Page 3 of 22
EMNV-2004-FG-01016
Originally submitted on 03/16/2004 by Todd Painton (Userid: tpainton)
Based on information you have provided, your department serves an Urban community.
Contact Infonnation:
Address: 4305 Santa Fe Avenue
City: Vernon
State: California
Zip: 90058
Day Phone: 323-583-4821
Evening Phone: 909-817-1182
Cell Phone: 909-966-1293
Email: tpainton@ci.vernon.ca.us
Application number is 01016
- Applicant Name
- Type of Applicant
,
If other, please enter the type of Applicant
- Employer Identification Number
. Does your organization have a DUNS Number?
If yes, please enter the DUNS Number
Headquarters Physical Address
- Physical Address 1
Physical Address 2
-City
- State
-Zip
Mailing Address
- Mailing Address 1
Mailing Address 2
-City
. State
.Zip
Account Information
. Type of bank account
. Bank routing number - 9 digit number on the bottom
left hand corner of your check
.Youraccountnumber
Additional Information
. For this fiscal year (Federal) is your jurisdiction
City of Vernon Fire Deparment
City
95-6000808
Yes
169355430
4305 Santa Fe Avenue
Vernon
California
90058 - 1714
Need help for ZIP+4?
4305 Santa Fe Avenue
Vernon
California
90058 - 1714
Need help for ZIP+4?
Checking
121000358
1459410483
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.Print Application
Page 4 of 22
receiving Federal funding from any other grant
program that may duplicate the purpose and/or scope No
of this grant request?
"If awarded this grant, will your jurisdiction expend
greater than $300,000 in Federal share funds during
the Federal fiscal year in which the grant was
awarded?
No
"Is the applicant delinauent on any federal debt? No
If you answered yes to any of the additional questions
above, please provide an explanation in the space
provided below:
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. Print Application
Department Characteristics (Part I)
Page 5 ot 1:1..
* Vllhat percentage of your response area is protected 100 %
by hydrants?
* Does your department protect critical infrastructure of .N
the State? 0
* How much of your jurisdiction's land use is for
agriculture, wild land, open space, or uQdeveloped
properties?
* Vllhat percentage of your jurisdiction's land use is for
commercial, industrial, or institutional purposes?
* Vllhat percentage of your jurisdiction's land is used
for residential purposes?
* How many commercial, industrial, residential, or
institutional structures in your jurisdiction are more
than four stories tall?
* VVIlat is the permanent resident population of your
Primary/First Due Response Area or iurisdiction
served?
* How many active firefighters does the department
have who perform firefighting duties?
* How many personnel provide only EMS service
delivery?
* How many stations are in your department?
* Do you currently report to the National Fire Incident
Reporting System (NFIRS)?
If you answered yes above, please enter your
FDIN/FDID
* VVIlat services does your department provide?
Structural Fire Suppression Medical First Response
Wildland Fire Suppression Basic Life Support
Advanced Life Support
. Are you a member of a flr@....m;!arjmentor
authorized representative of a fire department?
* Are you a member of Federal Fire Department or
contracted by the Federal government and solely
responsible for suppression of fires on Federal
property?
* Vllhat kind of Department do you represent?
If you answered combination, above, what is the
percentage of career firefighters in your department?
* Vllhat is the square mileage of your primary response
area?
Yes
No
All Paid/Career
%
5.5
0%
98%
2%
10
100
75
o
4
No
Hazmat Operational Level
Hazmat Technical Level
Rescue Operational Level
Rescue Technical Level
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Ynnt ApplIcation
Page 6 of 22
Department Characteristics (Part II)
. What is the total number of fire-related civilian fatalities in your
jurisdiction over the last three years?
. What is the total number of fire-related civilian injuries in your
jurisdiction over the last three years?
. What is the total number of fire-related firefighter fatalities in your 0
jurisdiction over the last three years?
"What is the total number of fire-related firefighter injuries in your
jurisdiction over the last three years?
. In an average year, how many times does your department
receive mutual/automatic aid?
. In an average year, how many times does your department
provide mutual/automatic aid?
" What was your department's estimated average annual operating
budget over the last three years?
. What percentage of your annual operating budget is dedicated to
personnel costs (salary, overtime and fr!nge benefits)?
" What percentage of your annual operating budget is derived from:
Enter numbers only, percentages must sum up to 100%
Taxes?
o
9
49
100
100
7700000
80%
100%
Grants?
Donations?
Fund drives?
0%
0%
0%
Other? 0 %
If you entered a value into Other field (other than 0), please explain
"How many vehicles does your department have in each of the categories below? Enter numbers only and enter
o if you do not have any of the vehicles below
Total Number
a. Engines (or pumpers):
Pumper, PumperlTanker, RescuelPumper, Foam Pumper, CAFS Pumper, Quint 8
(Aerial device of less than 76 feet), Fire Boats (more than 13 feet long), Type I,
Type II, Type III Engine
b. Aerial Apparatus:
Aerial Ladder Truck, Telescoping, Articulating, Ladder Towers, Platform, Tiller 2
Ladder Truck, Quint (Aerial device of 76 feet or greater)
c. Tankers:
Tanker, Tender, TankerlPumper (Pumper with a tank that has a greater than 1,200 0
gallon capacity), Foam TankerlTender (greater than 1,200 gallon tank capacity)
d. Rescue Vehicles:
Rescue Squad, Rescue (Light, Medium, Heavy), Technical Rescue Vehicle
1
e. Brush/Quick attack:
Brush Truck, Patrol Unit (Pick up wi Skid Unit), Quick Attack Unit, Mini-Pumper, 0
Type IV Engine
fo Other.
EMS Transport Unit, EMS Chase Vehicle, AirlLight Unit, Rehab Units, Hazardous
Materials Unit, Bomb Unit, Technical Support (Command, Operational 6
Support/Supply), Hose Tender, Salvage Truck, ARFF (Aircraft Rescue Firefighting),
CommandIMobile Communications Vehicle, Other Vehicle
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.Print Application
Page 70f22
Provide in the space below the following information only if you are applying for a firefighting vehicle: List all your
vehicles by type (for example, engines/pumpers, brush, rescue, etc.). Then provide the year each was
manufactured. If the department has more than two of any type, provide the total number of vehicles in that
category and the years the oldest and the newest were manufactured.
.. I
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Page 8 of 22
Department Call Volume
. How many responses per year by category? (Enter whole numbers only: If you have no calls for any of the categories, enter 0)
Structure Fires 46
Vehicle Fires 25
Vegetation Fires 12
~S ~
Rescue 305
Hazardous Condition/Materials Calls 32
Service Calls 471
Good Intent Calls/False Alarms 53
Other Calls and Incidents 307
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t'nm ApplIcatIOn
Request Information
Page 9 of22
. 1. Select a program for which you are applying. Remember, you can only apply for one program this year. You
can apply for as many activities within a program as you need.
(If you modify your selection, you will lose data entered under the original activity.)
Program Name
Operations and Firefighter Safety
* 2. Will this grant benefit more thah one department?
Yes
If you answered Yes to Question 2 above, please explain. (You can only enter 4000 characters)
The City ofVemon Fire Department is (1) of five Fire Departments located within Area "E". Montebello, Downey,
Santa Fe Springs,and Compton are the other. As part of our Area "E" Mutual Aid agreement these departments
provide mutual aid in the event of greater alarm incidents and often times are assigned as station coverage to
render aid in our absence.
Request Details
The activities for program Operations and Firefighter Safety are listed in the table below.
Activity
Number of Entries
o
1
o
o
o
Equipment
Modify Facilities
Personal Protective Equipment
Training
Wellness and Fitness Programs
Modify Facilities
*1. On what type of modification will the funds be spent?
Please provide further description of the item selected above
*2. What is the age of the facility that is being modified?
*3. What type of facility will be modified?
If you answered other, above, please specify.
*4. What is the level of occupancy for the facility you wish
to modify? Note:The occupancy is defined by the number of hours
the facility is used within a single 24 hour time period
*5. What is the maximum occupancy of the building or
facility to be modified?
*6. Is the facility that you wish to modify open for use by other
departments or community groups on a regular (i.e., weekly,
monthly) basis?
Total Cost
$0
$ 138,396
$0
$0
$0
Additional Funding
$0
$0
$0
$0
$0
Exhaust System(s)
Plymovent Vehicle Exhaust Extraction
System
40 years
Fire Station(s)
Full-Time
100 number of people
Yes
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Budget Item
*Item. Plymovent Vehicle Exhaust Extr
Select Object Class Other
If you selected "Other" above, please specify: Station modification
* Number of units 3 (Whole number only)
* Cost per unit $ 46132 (Whole dollar amounts only)
Budget
Page 10 of22
Budget Obiect Class
a. Personnel
b. Fringe Benefits
c. Travel
d. Equipment
e. Supplies
f. Contractual
g. Construction
h. Other
i. Indirect Charges
Indirect Cost Details
Agency Indirect Cost Agreement with
Indirect Cost Rate
Agreement Summary
Federal and Applicant Share
Federal Share
Applicant Share
Federal Rate Sharing (%)
. Non-Federal Resources (The combined Non-Federal Resources must equal the Applicant Share of $ 13,839)
%
a. Applicant
b. State
c. Local
d. Other Sources
$0
$0
$0
$0
$0
$0
$0
$ 138,396
$0
$ 124,557
$ 13,839
90/10
$ 13,839
$0
$0
$0
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Page 11 01"22
If you entered a value in Other Sources, include your explanation below. You can use this space to provide
information on the project, cost share match.
To better serve the intended purpose of this grant program, The City of Vernon Fire Department has elected to
fund the following items so that a greater portion of grant funds may be awarded to more fire departments
nationwide, there-in protecting a greater number of firefighters from these diesel carcinogens. These items are
not included in the cost of our grant request.
1. Freight costs of equipment.
2. Vehicle tailpipe modifications will be handeled by our fleet maintenance deparment.
3. Extreme Installations- If during the installation we experience difficulties due to building construction or
extreme circumstances, the Depart. will be responsible for additional costs.
Total Budget $138,396
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Narrative Statement
Project Description
* Please provide your narrative statement in the space provided below (1) Project Description, (2) Financial
Need, and (3) Cost-Benefit of Request:
Narrative: VEHICLE EXHAUST E~TRACTION SYSTEM
Dept. of Homeland Security (DHS) Office of Domestic Preparedness (ODP) Assistance to Fire Fighter Grant
(AFG) GRANT CATEGORY: Operations and Firefighters Safety Program section "e" titled Modifications to Fire
Stations and Facilities". Vehicle Exhaust Extraction Systems (exhaust systems)
Project Need and Goal Description for Grant Funding: It is the desire of our Department to obtain an AFG Grant
under the Fire Operations and Firefighters Safety Program which would be used to modify three of our four Fire
Stations under the category Section "e" titled "Modifications to Fire Stations and Facilities. Under this heading it
is our intent to install a PlymoVent Vehicle Exhaust Extraction system onto each of our fire apparatus in the
above mentionedstation(s). For over 10 years our fire department has been actively pursuing the purchase of a
vehicle exhaust extraction system for the purpose of protecting our station personnel and the general public,
who visit our stations on a daily basis, from the cancer causing effects of vehicle exhaust emissions. These
emissions are generated by our apparatus during startup, return to quarters, and routine pump testing in our
facilities. We have been repeatedly unable to obtain funding due to the constraints of our financial budget.
Financial funding through an AFG Grant will allow us to eliminate this hazardous exposure and comply with
NFPA 1500-2002 Edition, section A.9.1.6.
Recent changes in health and safety standards have clearly identified that vehicle exhaust emissions, in
particular, whole diesel exhaust (PM10) is a cancer causing substance. The following organizations support our
request and the justification for the vehicle exhaust extraction system for the health and safety of our firefighters,
administrative personnel and visitors:
U.S. Dept. of Labor I OSHA Right to Know Law, which states that an employer must disclose in writing, to all
employees if they are exposed to a chemical hazard which may be present in their place of employment.
National Institute of Occupational Safety and Health - In accordance with NIOSH pocket guide for chemical
hazards and its documentation for immediately dangerous to life or health concentrations, NIOSH recommends
(Appendix A) "vehicle exhaust fumes are a potential health carcinogen and recommends that occupational
exposure to this carcinogen be lowered to the lowest feasible concentration."
American Conference of General Industrial Hygienist - ACGIH - The threshold limit value (TLV) for diesel has
been proposed to be reduced from 5mg/m3 to a new more aggressive standard of 0.020mg/m3 elemental
carbon.
National Fire Protection Association 1500-2002 edition - A.9.1.6 which states "forthe previously stated reasons
and numerous support documentation, this technical committee recognizes and advocates the need for the
elimination and the containment of all vehicle exhaust emissions to a level of no less than 1 00 percent effective
capture.
American Federation of State, County and Municipal Employees - advocates "local exhaust ventilation is the
best way to reduce potential hazards to diesel exhaust".
International Code Council (IMC) - 502.14 Motor Vehicle Operation "In an area where motor vehicles operate,
mechanical ventilation will be provided in accordance with Section 403. Additionally, areas in which stationary
motor vehicles are operated shall be provided with a source capture system that is connected directly to the
motor vehicle exhaust system".
510.1 Hazardous Exhaust System "Hazardous exhaust systems are exhaust systems designed to capture and
control hazardous emissions generated from product handling or processes and convey those emissions to the
outdoors.
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Pnnt ApphcatlOn
Page 13 of22
Over the years our personnel have strongly voiced their concerns about the hazards of diesel exhaust and how
it may be affecting their health, presently and long term. Many of our department members are aware that there
is a solution available but in the past the implementation of the vehicle exhaust extraction system was
considered an unfunded mandate. Now that AFG funds are available we are seeing more pressure to act in the
fire fighters best interest especially on all aspects of health and safety issues.
If you visited our station, you would see the accumulation of exhaust contamination. This has created a condition
of sick building syndrome. Some of the effects of the sick building syndrome pertain to medical
equipment/supplies, which are stored on the apparatus or in the station. The diesel exhaust is attracted to the
sealed plastic medical supply bags. This creates an avenue of cross contamination to patients when an EMT is
administering services. Furthermore it has contaminated our turnout gear, which is stored in the apparatus bays
as wen as the living quarters and public meeting areas of our station. These areas are not only used by fire
personnel but are routinely used for educating the community on fire safety. In particular, our stations are used
for elementary school fire safety training, emergency shelters, community based youth activities, (Boy Scout and
Girl Scout tours), City and Fire service training classes, (California State Fire Marshals Office Training Site inthe
areas of Rescue Systems I and Confined Space). DMV Class B Licensing for all City employees, holiday events
sponsored by our department for the community and family members, and residents within our city utilize the
facilities on a regular basis for a variety of recreational activities.
On top of our stations being occupied (7) days a week 365 days a year by Fire Department personnel, It is
apparent the members of our department have strong community ties and host activities on a routine basis to
benefit the community in which we work.
If we allow the continuation of toxic build up in our stations, I feel this will lead to a serious health and financial
crisis affecting our city and its taxpayers by exposing them to workmen's compensation and medical insurance
claims that would result from firefighters contracting an illness that can clearly be tracked and attributed to
vehicle exhaust emissions exposure such as occupational asthma or cancer related illnesses. Such a crisis
could have a significant impact on the financial operations of our department as well as the moral of our
department members. It also affects our ability to recruit new firefighters.
This proposal not only protects our members from exhaust emissions but has direct financial savings as well
which are achieved by complying with energy efficient indoor air quality standards that reduce energy
consumption allowing us. to comply with U.S. Green Building Council standards (USGBC).
We believe our firefighters are our most valuable asset and that protection from the hazards of diesel exhaust is
our highest priority. Although our firefighters are subjected to work related exposures on an intermittent basis,
vehicle exhaust emissions are the only work related carcinogen that they are exposed to every day.
Homeland Security is of great concern to our Department. After a recent alert issued by the IAFC (International
Association of Fire Chiefs) regarding station security, our Department is implementing more stringent standard
operating procedures for securing our stations at all times. Part of this new procedure will be to have all station
doors closed and locked at all times. This will require the need for a vehicle exhaust extraction system since we
will be doing routine maintenance and pump checks in more sealed quarters.
Project Description - The proposed Ply movent system that we will purchase if AFG Grant money is received has
been independently tested to be capable of capturing 100% of the vehicle exhausts emissions at the point of
generation (tailpipe) by making an airtight seal to the tailpipe of our apparatus. The exhaust system will utilize an
auto start electrical control box which is UL tested and certified. This controller will automatically energize an
exhaust blower upon the starting of the vehicle and in turn will extract all exhaust emissions out of the building.
The proposed system will include an EPA particulate emission filter, which will reduce up to 99% of the diesel
exhaust being emitted to the atmosphere and fulfills environmental requirements. This would achieve air quality
standards governed by the EPA Clean Air Act and the USGBC to protect the surrounding community from the
airborne contamination the fire apparatus generates. Fulfillment of this grant will allow us to further comply with
NIOSH, OSHA, and new building code ordinances governed by Federal, State and Municipality codes for
hazardous material exhaust control systems. The system that we have selected for purchase is recognized as
the leader in vehicle exhaust extraction and meets UL (Underwriter's Laboratories), ISO-9001 (International
Standards Org.), and AMCA (Air Moving and Control Assoc.) third party performance testing and quality
assurances. This system was designed to specifically meet the needs of emergency response vehicles and is
fully automatic so as not to interfere with firefighter response time. It is compatible to all fire apparatus with
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Page 14 of 22
standard undercarriage exhaust, which is highly important when neighboring departments are called up to our
stations for automatic/mutual aid. We have evaluated all systems and have eliminated those which require non-
compatible vehicle modifications that are not common in the fire service. We require a system that will connect
to any vehicle that meets NFPA 1901 apparatus standard.
Our grant request for the PlymoVent Vehicle Exhaust Extraction system is in complete compliance of the 2004
Program Guidance for the Assistance to Firefighters' Grant Program requirements stating "any vehicle exhaust
extraction system obtained should be extensive enough to extract all toxic vapors and particulates emitted from
internal combustion engines".
To better serve the intended purpose ofthis grant program, we have elected to internally fund the following
items so that a greater portion of grant funds may be awarded to more fire departments nationwide, there-in
protecting a greater number of firefighters from these diesel carcinogens. These items are not included in the
cost of our grant request.
. Freight costs of equipment delivery
. Electrical connection cost of this project (vehicle exhaust extraction system)
. Vehicle tailpipe modifications will be handled in house through our Fleet Maintenance Facility
. Permits & Drawings, if required for mechanical or electrical installation, will be waived to reduce cost.
o Extreme Installations - If during the process of the installation we experience installation difficulties due to
building construction or extreme circumstances, the Dept will be responsible for all extra costs.
Benefit From the Cost to Our Department and the Community:
1. The vehicle exhaust extraction system would be used on a daily basis which wouid have a financial cost
savings to our Department not only from the health and safety aspect of our personnel but also in reducing
maintenance costs related with painting, furniture and fixture replacement, and most of all infiltration of carbon
soot particles which contaminate and short out sensitive electronic devices such as station computers. All four of
our stations have the office areas located within 4 feet of the apparatus floors. The soot that is generated must
continually be cleaned from all surrounding surfaces. Unfortunately this material is making its way into the
internal workings of our computer equipment, electrical equipment, and other furniture in the stations.
2. Reduced exposure to workmen's compensations and medical insurance claims.
The continued build-up of toxic fumes entering our stations has the potential for devastating health and financial
crises to our City. Workmen's Compensation and medical claims resulting from one or several of our firefighters
contracting an illness clearly traced back to the exposure of vehicle exhaust would have a significant impact on
the cities financial operations (It is difficult to put an exact dollar amount on workmen's compensation claims but,
it can be estimated to save several thousands of dollars).
3. As the awareness of the haZards caused by diesel exhaust becomes more apparent, so does the possibility of
employees filing for grievances. It is accepted in our profession that as firefighters we are going to be exposed to
substances that may be harmful to us in performing our jobs to preserve life and property. But, vehicle exhaust
is a substance that can be remedied by placing a Plymovent exhaust system in our stations. This would
eliminate the potential for future litigation do to the exposure of a known carcinogen.
Financial Need of Our Department:
The City of Vernon has (4) stations geographically located throughout the city. Three of the four stations are
over forty years old and the last being over fifty years of age. Each one of these stations is in constant need of
maintenance and repairs. Our community, through tax revenues, has been supporting our budget with regards
to allocating funds in order to facilitate the construction of one of the most dilapidated stations, supporting the
much needed Hazardous Materials Program, and assisting us with our 5-10 year Master Plan of replacing the
next station in line for demolition.
Our City that was once a thriving metropolis for industrial and manufacturing businesses, has in recent years
seen the majority of the large companies relocate their operations out of state or out of the country due to high
operating cost. This has impacted our city and department extensively in that several of the businesses remain
vacant or are now occupied by warehousing businesses. The warehousing of goods does not generate the
same revenues as industrial and manufacturing operations that once was the primary source for tax revenues.
Listed below is the contact information for our deparment and the vendor as well as a cost break down for each
station:
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Page 15 of22
Department Contact:
Engineer Todd Painton
Company: City of Vernon Fire Department
Address: 4305 S. Santa Fe Avenue Vernon, Ca. 90058
Phone: 323583-4821 ext:520
Fax: 323826-1047
Vendor Contact:
Jim Cleary
Company Name: Plymovent Air Cleaning Systems
Address: 4096 Mission Blvd. Montclair, Ca. 91763
Phone: 800 998-1974
Fax: 909 629-3236
email: jim@acs-cal.com
Station #1
Address: 3375 Fruitland Avenue Vernon, Ca. 90058
Phone: 323 583-4821 ext: 510
Total Vehicles: 6
Station Description: Qty.(2)85 ft Drive thru bays (3 vehicles each bay).
Total Price: $68,541.00
Drop Price: $11,423.50
Station #3
Address: 2800 S. Soto Street Vernon, Ca. 90058
Phone: 323583-4821 ext:530
Total Vehicles: 4
Station Description: Qty.(2)55 ft Drive thru bays (2 vehicles each bay).
Total Price: $51,662.00
Drop Price: $12,915.50
Station #4
Address: 4530 Bandini Blvd. Vernon, Ca. 90058
Phone: 323583-4821 ext: 540
Total Vehicles: 2
Station Description: Qty. (2) Single Engine back in bays.
Total Price: $18,191.00
Drop Price: $9095.50
Total Cost and Grant Request: $138,394.00
The City of Vemon Fire Deparment would like to thank you for the time taken to review this grant application and
your consideration in this matter. If I can be of any further assistance, please contact me at your convenience.
Sincerely,
Todd S. Painton
Fire Engineer
* Please describe any grants that you currently have with DHS including the AFG, for example, 2002 AFG grant
for vehicle or 2003 ODP grant for exercises. (Enter "N/A" if Not Applicable)
NA
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Page 16 of 22
Assurances and Certifications
Form 20-16A
You must read and sign these assurances by providing your password and checking the box at the
bottom of this page. I
Note: Fields marked with an .. are required.
Assurances Non-Construction Programs
Note: Certain of these assurances may not be applicable to your project or program. If you have any questions,
please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to
certify to additional assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant I certify that the applicant:
1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and
financial capability (including funds sufficient to pay the non-Federal share of project costs) to
ensure proper planning, management and completion of the project described in this
application.
2. Will give the awarding agency, the Comptroller General of the United States, and if
appropriate, the State, through any authorized representative, access to and the right to
examine all records, books, papers, or documents related to the award; and will establish a
proper accounting system in accordance with generally accepted accounting standards or
agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that
constitutes or presents the appearance of personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval
ofthe awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. Section 4728-4763)
relating to prescribed standards for merit systems for programs funded under one of the
nineteen 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. Sections 1681-1683, and 1685-1686), which
prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973,
as amended (29 U.S.C. Section 794), which prohibits discrimination on the basis of
handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. Sections 6101-
6107), which prohibits discrimination on the basis of age; (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) Sections 523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. 290-dd-3 and 290-ee-3), as amended, relating to
confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Acts
of 1968 (42 U.S.C. Section 3601 et seq.), as amended, relating to nondiscrimination in the
sale, rental or financing of housing; (i) any other nondiscrimination 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 Title II and III of the Uniform
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page 1 I 01 Li.
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 interest in real property acquired for project purposes regardless of Federal participation in
purchases.
8. VViU comply with provisions of the Hatch Act (5 U.S.C. Sections 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.
9. VViII comply, as applicable, with the provisions of the Davis-Bacon Act (40U.S.C. Sections
276a to 276a- 7), the Copeland Act (40 U.S.C. Section 276c and 18 U.S.C. Sections 874),
and the Contract Work Hours and Safety Standards Act (40 U.S.C. Sections 327-333),
regarding labor standards for Federally assisted construction sub agreements.
10. VViII 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 flood plains 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. Section 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. Section 7401 et seq.); (g) protection of underground
sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-
523); 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. Section 1271 et seq.)
related to protecting components or potential components of the national wild and scenic
rivers system.
13. VViIl 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 Actof
1974 (16 U.S.C. 469a-1 et seq.).
14. VViIl 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. Section 4801 et
seq.) which prohibits the use of lead based paint in construction or rehabilitation of residence
structures.
17. Will cause to be performed the required financial and compliance audits in accordance with
the Single Audit Act of 1984.
18. Will comply with all applicable requirements of all other Federal laws, executive orders,
regulations and policies governing this program.
19. It will comply with the minimum wage and maximum hours provisions of the Federal Fair
Labor Standards Act (29 U.S.C. 201), as they apply to employees of institutions of higher
education, hospitals, and other non-profit organizations.
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Page 18 of22
Signed by Todd Painton on 03/1412004
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Page 19 of22
Form 20-16C
You must read and sign these assurances by providing your password and checking the box at the
bottom of this page.
Note: Fields marked with an * are required.
Certifications Regarding Lobbying, Debarment, Suspension and Other Responsibily 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 on this form provides for compliance with certification requirements under 44
CFR Part 18, "New Restrictions on Lobbying; and 28 CFR Part 17, "Government-wide Debarment and
Suspension (Non-procurement) 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 Homeland Security (DHS) determines to award the covered transaction, grant, or cooperative
agreement.
1. Lobbying
A. As required by the section 1352, Title 31 of the US Code, and implemented at 44 CFR Part 18 for persons
(entering) into a grant or cooperative agreement over $100,000, as defined at 44CFR Part 18, ttie applicant
certifies that
(a) No Federal appropriated funds have been paid or will be paid by or on behalf of the
undersigned to any person for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of congress, or an employee of a Member
of Congress in connection with the making of any Federal grant, the entering into of any
cooperative agreement and extension, continuation, renewal amendment or modification of any
Federal grant or cooperative agreement.
(b) If any other funds than Federal appropriated funds have been paid or will be paid to any person
for influencing or attempting to influence an officer or employee of any agency, a Member of
Congress, an officer or employee of congress, or an employee of a Member of Congress in
connection with this Federal grant or cooperative agreement, the undersigned shall complete and
submit Standard Form LLL, "Disclosure of Lobbying Activities", in accordance with its instructions.
(c) The undersigned shall require that the language of this certification be included in the award
documents for all the sub awards at all tiers (including sub grants, contracts under grants and
cooperative agreements and subcontract(s)) and that all sub recipients shall certify and disclose
accordingly.
2. Debarment, Suspension and Other Responsibility Matters (Direct Recipient)
A. As required by Executive Order 12549, Debarment and Suspension, and implemented at 44CFR Part 67, for
prospective participants in primary covered transactions, as defined at 44 CFR Part 17, Section 17.510-A, the
applicant certifies that it and its principals:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced
to a denial of Federal benefits by a State or Federal court, or voluntarily excluded from covered
transactions by any Federal department or agency.
(b) Have not within a three-ye.ar period preceding this application been convicted of or had a
civilian judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain or perform a public (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 government entity
(Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1 )(b) of
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this certification: and
(d) have not within a three-year period preceding this application had one or more public
transactions (Federal, State, or local) terminated for cause 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 44CFR Part 17, Subpart F, for
grantees, as defined at 44 CFR part 17, Sections 17.615 and 17,620:
(A) The applicant certifies that it will continue to provide a drug-free workplace by:
(a) Publishing a statement notifying employees that the unlawful manufacture,
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 grantees policy of maintaining a drug-free workplace;
(3) Any available drug counseling, rehabilitation and employee
assistance programs; and
(4) The penalties that may be imposed upon employees for drug abuse
violations occurring in the workplace;
(c) Making it a requirement that each employee to be engaged in the performance of
the grant to be given a copy of the statement required by paragraph (a);
(d) Notifying the employee in the statement required by paragraph (a) that, as a
condition of employment under the grant, the employee will:
(1) Abide by the terms of the statement and
(2) Notify the employee 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 conviction. Employers of convicted employees must provide notice, including
position title, to the applicable DHS awarding office, i.e. regional office or DHS office.
(f) Taking one of the following actions, against such an employee, 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 enforcement or other appropriate
agency.
(g) Making a good faith effort to continue to maintain a drug free workplace through
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..
implementation of paragraphs (a), (b), (c), (d), (e), and (t).
(8) 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
City
I
State.
Zip
Action
If your place of performance is different from the physical address provided by you in the Applicant
Information, click on Add Place of Performance button above to ensure that the correct place of
performance has been specified. You can add multiple addresses by repeating this process multiple
times.
Section 17.630 of the regulations provide that a grantee that is a State may elect to make one certification in each
Federal fiscal year. A copy of which should be included with each application for DHS funding. States and State
agencies may elect to use a Statewide certification.
Signed by Todd Painton on 03/14/2004
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Page LL 01 LL
. ,
FEMA Standard Fonn LLL
Only complete if applying for a grant for more than $100,000 and have lobbying activities. See Form 20-16C for
lobbying activities definition.
This fonn is not applicable
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