HomeMy WebLinkAbout121916_ca04Consent Agenda
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Bob Hamlin, Program Manager
Department of Emergency Management
DATE: December 19, 2016
SUBJECT: EMERGENCY MANAGEMENT PROGRAM GRANT
STATEMENT OF ISSUE
Homeland Security grant agreement needed to support part time staffing for the Department of Emergency
Management through September 2017.
ANALYSIS/STRATEGIC GOALS/PRO'S and CON'S
Emergency Management Program Grants (EMPG) assist local jurisdictions in preparing for all hazards
through sustainment and enhancements as described in a work plan submitted by the eligible jurisdictions.
EMPG funds are used in Jefferson County for assistance with Department of Emergency Management
staffing support.
FISCAL IMPACT/COST BENEFIT ANALYSIS
The grant provides support in the amount of $18,000 for expenditure during the period June 1, 2016 through
August 31, 2017. 100% of the grant is applied to department clerk hire staffing.
RECOMMENDATION
Approval.
REVIEWED BY:
L �
-hi ip Morley, C unty dministr Date
\\NAC-1\VOL1\HOME\KARENB\.... \WP\SIGNAUTH Revised 3/03
INSTRUCTIONS FOR SIGNATURE AUTHORIZATION FORM
This form identifies the persons who have the authority to sign contracts, amendments,
and requests for reimbursement. It is required for the management of your contract with
the Military Department (MD). Please complete all sections. One copy with original
signatures is to be sent to MD with the signed contract, and the other should be kept with
your copy of the contract.
When a request for reimbursement is received, the signature is checked to verify that it
matches the signature on file. The payment can be delayed if the request is
presented without the proper signature. It is important that the signatures in MD's files
are current. Changes in staffing or responsibilities will require a new signature
authorization form.
Authorizing Authority. Generally, the person(s) signing in this box heads
the governing body of the organization, such as the board chair or mayor. In
some cases, the chief executive officer may have been delegated this
authority.
2. Authorized to Sign Contracts/Contract Amendments. The person(s) with
this authority should sign in this space. Usually, it is the county
commissioner, mayor, executive director, city clerk, etc.
3. Authorized to Sign Requests for Reimbursement. Often the executive
director, city clerk, treasurer, or administrative assistant have this authority.
It is advisable to have more than one person authorized to sign
reimbursement requests. This will help prevent delays in processing a
request if one person is temporarily unavailable.
If you have any questions regarding this form or to request new forms, please call your
MD Program Manager.
Washington State Military Department
14nMFI ANn CFf`I I121TV f_DAMT AhOCORAowM rAnr n, 1e
1. Subrecipient Name and Address:
2. Grant Agreement Amount:
3. Grant Agreement Number:
Jefferson, County of
Department of Emergency Management
$18,000
E17-100
81 Elkins Road
Port Hadlock, WA 98339-9700
4. Subrecipient Contact, phone/email:
Robert W. Hamlin, (360) 385-9368
5. Grant Agreement Start Date:
6. Grant Agreement End Date:
bh mlin co.leff rson.wa.us
June 1, 2016
August 31, 2017
7. Department Contact, phone/email:
Gary Stumph, (253) 512-7483
8. Data Universal Numbering System (DUNS):
9. UBI # (state revenue):
a .stum h mil.wa. ov
179278197
$01-098-110
10. Funding Authority:
Washington State Military Department (the "DEPARTMENT") and the U.S. Department of Homeland Security (DHS)
11. Federal Funding Identification #: 12. Federal Award Date: 13. Catalog of Federal Domestic Assistance (CFDA) # & Title:
1
EMW-2016-EP-00002-501 08/10/2016 97.042 16EMPG
14. Total Federal Amount #: 15. Program Index # & OBJ/SUB-OBJ: 16. TIN: 91-6001322
$7,254,374
763PT N2 91-6001322
17. Service Districts: 18. Service Area by County(ies): 19. Women/Minority-Owned, State
(BY LEGISLATIVE DISTRICT): 24 Certified?: X N/A ❑ NO
(BY CONGRESSIONAL DISTRICT): 6 Jefferson County
❑ YES, OMWBE #
20. Agreement Classification 21. Contract Type (check all that apply):
❑ Personal Services ❑ Client Services X Public/Local Gov't ❑ Contract X Grant X Agreement
❑ Research/Development ❑ A/E ❑ Other ❑ Intergovernmental (RCW 39.34) ❑ Interagency
22. Subrecipient Selection Process: 23. Subrecipient Type (check all that apply)
X "To all who apply & qualify" ❑ Competitive Bidding ❑ Private
Organization/Individual ❑ For -Profit
❑ Sole Source ❑ A/E RCW ❑ N/A X Public Organization/Jurisdiction ❑ Non -Profit
❑ Filed w/OFM? ❑ Advertised? ❑ YES ONO ❑ CONTRACTOR X SUBRECIPIENT ❑ OTHER
24. PURPOSE & DESCRIPTION:
The purpose of the FY 2016 Emergency Management Performance Grant (16EMPG) is to provide U.S. Department of Homeland
Security (DHS)/Federal Emergency Management Agency (FEMA) Federal award funds to local jurisdictions and tribes with
emergency management programs to assist in preparing for all hazards through sustainment and enhancement of those programs
as described in the Work Plan.
The Department is the Recipient and Pass-through Entity of the 16EMPG Award EMW-2016-EP-00002-501, which is incorporated
in and attached hereto as Attachment #1, and has made a subaward of Federal award funds to the Subrecipient pursuant to this
Agreement. The Subrecipient is accountable to the Department for use of Federal award funds provided under this Agreement
and the associated matching funds.
IN WITNESS WHEREOF, the Department and Subrecipient acknowledge and accept the terms of this Agreement, including all referenced
Exhibits and Attachments which are hereby incorporated in and made a part hereof, and have executed this Agreement as of the date below.
This Agreement Face Sheet; Special Terms & Conditions (Exhibit A); General Terms and Conditions (Exhibit B); Work Plan (Exhibit C);
Timeline (Exhibit D); Budget (Exhibit E); and all other documents, exhibits and attachments expressly referenced and incorporated herein
contain all the terms and conditions agreed upon by the parties and govern the rights and obligations of the parties to this Agreement. No
other understandings, oral or otherwise, regarding the subject matter of this Agreement shall be deemed to exist or to bind any of the parties
hereto.
In the event of an inconsistency in this Agreement, unless otherwise provided herein, the inconsistency shall be resolved by giving
precedence in the following order:
1. Applicable Federal and State Statutes and Regulations 4. Special Terms and Conditions
2. DHS/FEMA Award and program documents 5. General Terms and Conditions, and,
3. Work Plan S. Other provisions of the Agreement incorporated by reference
WHEREAS, the parties hereto have executed this Agreement on the day and year last specified below.
FOR THE DEPARTMENT: FOR THE SUBRECIPIENT:
Signature Date Signature Date
Richard A. Woodruff, Contracts Officer David Sullivan
Washington State Military Department Chairman, Board of County Commissioners
APPROVED AS TO FORM:
Signature on File (9/6/2016) APP pV o F M (if applicable):
Brian E. Buchholz, Assistant Attorney General (�
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ate
corm 0b/1212015 MLL
DHS-FEMA-EMPG-FFY 16 Page 1 of 34 Jefferson, County of, E17-100
Exhibit A
SPECIAL TERMS AND CONDITIONS
ARTICLE I. KEY PERSONNEL
The individuals listed below shall be considered key personnel for point of contact under this
Agreement. Any substitution of key personnel by either party shall be made by written notification
to the current key personnel.
SUBRECIPIENT MILITARY DEPARTMENT
Name
Robert W. "Bob" Hamlin
Name
-- - - - -- - -- - - ----- - -
I Gary Stum h
Title
Director
Title
Program Coordinator
E -Mail
bhamlinO-co.iefferson.wa.us
E -Mail
a .stum h mil.wa. ov
Phone
360-344-9729
Phone
253-512-7483
Name
Name
Sierra Wardell
Title
Title
Section Supervisor
E -Mail
E -Mail
sierra.wardell mil.wa. ov
Phone
Phone
253-512-7121
Name
Name
Dalton Gamboa
Title
Title
Program Assistant
E -Mail
E -Mail
dalton. ambos mil.wa. ov
Phone
Phone
253-512-7044
ARTICLE II. ADMINISTRATIVE AND/OR FINANCIAL REQUIREMENTS
The Subrecipient shall comply with all applicable state and federal laws, rules, regulations,
requirements and program guidance identified or referenced in this Agreement and the
informational documents published by DHS/FEMA applicable to the 16EMPG Program, including,
but not limited to, all criteria, restrictions and requirements of the "Department of Homeland
Security (DHS) Notice of Funding Opportunity (NOFO) Fiscal Year 2016 Emergency Management
Performance Grant (EMPG)" document, the DHS Award Letter for Grant No. EMW-2016-EP-
00002-S01, and the federal regulations commonly applicable to DHS/FEMA grants, all of which
are incorporated herein by reference. The DHS Award Letter is incorporated in this Agreement
as Attachment #1.
The Subrecipient acknowledges that since this Agreement involves federal award funding, the
period of performance described herein may begin prior to the availability of appropriated federal
funds. The Subrecipient agrees that it will not hold the Department, the State of Washington, or
the United States liable for any damages, claim for reimbursement, or any type of payment
whatsoever for services performed under this Agreement prior to distribution of appropriated
federal funds, or if federal funds are not appropriated or in a particular amount.
A. STATE AND FEDERAL REQUIREMENTS FOR DHS/FEMA PREPAREDNESS
GRANTS:
The following requirements apply to all DHS/FEMA Preparedness Grants administered by
the Department.
1. SUBAWARDS & CONTRACTS BY SUBRECIPIENT
a. The Subrecipient must make a case-by-case determination whether each
agreement it makes for the disbursement of 16EMPG funds received under
this Agreement casts the parry receiving the funds in the role of a
subrecipient or contractor in accordance with 2 CFR 200.330.
b. If the Subrecipient becomes a pass-through entity by making a subaward
to a non-federal entity as its subrecipient:
i. The Subrecipient must comply with all federal laws and regulations
applicable to pass-through entities of 16EMPG funds, including but
not limited to those contained in 2 CFR 200.
DHS-FEMA-EMPG-FFY 16 Page 2 of 34 Jefferson, County of, E17-100
ii. The Subrecipient shall require its subrecipient to comply with all
applicable state and federal laws, rules, regulations, requirements
and program guidance identified or referenced in this Agreement
and the informational documents published by DHS/FEMA
applicable to the 16EMPG Program, including, but not limited to, all
criteria, restrictions, and requirements of the "Department of
Homeland Security (DHS) Notice of Funding Opportunity (NOFO)
Fiscal Year 2016 Emergency Management Performance Grant
(EMPG)" document, the DHS Award Letter for Grant No. EMW-
2016-EP-00002-S01 in Attachment #1, and the federal regulations
commonly applicable to DHS/FEMA grants.
iii. The Subrecipient shall be responsible to the Department for
ensuring that all 16EMPG federal award funds provided to its
subrecipient are used in accordance with applicable federal and
state statutes and regulations, and the terms and conditions of the
federal award set forth in Attachment #1 of this Agreement.
2. REIMBURSEMENT & BUDGET REQUIREMENTS
a. Within the total Grant Agreement Amount, travel, sub -contracts, salaries,
benefits, printing, equipment, and other goods and services or other budget
categories will be reimbursed on an actual cost basis unless otherwise
provided in this Agreement.
b. The maximum amount of all reimbursement requests permitted to be
submitted under this Agreement, including the final reimbursement
request, is limited to and shall not exceed the total Grant Agreement
Amount.
C. If the Subrecipient chooses to include indirect costs within the Budget
(Exhibit E), an indirect cost rate agreement negotiated between the federal
cognizant agency for indirect costs and the Subrecipient establishing
approved indirect cost rate(s) as described in 2 CFR 200.414 and Appendix
VII to 2 CFR 200 must be submitted to the Department. However, under 2
CFR 200.414(f), if the Subrecipient has never received a negotiated
indirect cost rate agreement establishing federally negotiated rate(s), the
Subrecipient may negotiate a rate with the Department or charge a de
minimis rate of 10% of modified total direct costs. The Subrecipient's actual
indirect cost rate may vary from the approved rate, but must not exceed the
indirect cost rate percentage identified in the Budget (Exhibit E). If a
Subrecipient chooses to charge the 10% de minimis rate, but did not
charge indirect costs to previous subawards, a request for approval to
charge indirect costs must be submitted to the Department Key Personnel
for approval with an explanation for the change.
d. For travel costs, the Subrecipient shall comply with 2 CFR 200.474 and
should consult their internal policies, state rates set pursuant to RCW
43.03.050 and RCW 43.03.060 as now existing or amended, and federal
maximum rates set forth at http://www.asa.gov, and follow the most
restrictive. If travel costs exceed set state or federal limits, travel costs
shall not be reimbursed without written approval by Department Key
Personnel.
e. Reimbursement requests will include a properly completed State A-19
Invoice Form and Reimbursement Spreadsheet (in the format provided by
the Department) detailing the expenditures for which reimbursement is
sought. Reimbursement requests must be submitted to
Reim bursementsa-mil.wa.gov no later than the due dates listed within the
Timeline (Exhibit D), but not more frequently than monthly.
DHS-FEMA-EMPG-FFY 16 Page 3 of 34 Jefferson, County of, E17-100
Reimbursement request totals should be commensurate to the time spent
processing by the Subrecipient and the Department. If the reimbursement
request isn't substantial enough, the Subrecipient should request prior
written approval from Department Key Personnel to waive the due date in
the Timeline (Exhibit D) and instead submit those costs on the next
scheduled reimbursement due date contained in the Timeline.
f. Receipts and/or backup documentation for any approved items that are
authorized under this Agreement must be maintained by the Subrecipient
consistent with record retention requirements of this Agreement and be
made available upon request by the Department and auditors.
g. Any request for extension of a due date in the Timeline (Exhibit D) will be
treated as a request for Amendment of the Agreement and must be
submitted to the Department Key Personnel sufficiently in advance of the
due date to provide adequate time for Department review and
consideration, and can be granted or denied within the Department's sole
discretion.
All work under this Agreement must end on or before the Grant Agreement
End Date, and the final reimbursement request must be submitted to the
Department within 45 days after the Grant Agreement End Date, except as
otherwise authorized by written amendment of this Agreement and issued
by the Department.
No costs for purchases of equipment/supplies will be reimbursed until the
related equipment/supplies have been received by the Subrecipient, its
contractor, or any non-federal entity to which the Subrecipient makes a
subaward and is invoiced by the vendor.
Failure to timely submit complete reports and reimbursement requests as
required by this Agreement (including but not limited to those reports in the
Timeline) will prohibit the Subrecipient from being reimbursed until such
complete reports and reimbursement requests are submitted and the
Department has had reasonable time to conduct its review.
k. Final reimbursement requests will not be approved for payment until the
Subrecipient is current with all reporting requirements contained in this
Agreement.
I. A written amendment will be required if the Subrecipient expects
cumulative transfers to budget categories, as identified in the Budget
(Exhibit E), to exceed 10% of the Grant Agreement Amount. Any changes
to budget category totals not in compliance with this paragraph will not be
reimbursed without approval from the Department.
M. Subrecipients shall only use federal award funds under this Agreement to
supplement existing funds, and will not use them to replace (supplant) non-
federal funds that have been budgeted for the same purpose. The
Subrecipient may be required to demonstrate and document that a
reduction in non-federal resources occurred for reasons other than the
receipt or expected receipt of federal funds.
3. REPORTING REQUIREMENTS
a. With each reimbursement request, the Subrecipient shall report how the
expenditures, for which reimbursement is sought, relate to the Work Plan
activities in the format provided by the Department.
b. In conjunction with the next annual grant cycle application process, the
Subrecipient shall submit to the Department Key Personnel a final report
describing all completed activities under this Agreement. If a Subrecipient
DHS-FEMA-EMPG-FFY 16 Page 4 of 34 Jefferson, County of, E17-100
will not be applying for grant funding during the next annual grant cycle
application process, the Subrecipient will submit a final report with its final
reimbursement request to the Department detailing progress on all
activities listed in the Work Plan.
C. In conjunction with the final report, the Subrecipient shall submit a separate
report detailing how the EMPG Exercise and Training requirements were
met for all personnel funded by federal or matching funds under this
Agreement.
d. The Subrecipient shall comply with the Federal Funding Accountability and
Transparency Act (FFATA) and related OMB Guidance consistent with
Public Law 109-282 as amended by section 6202(a) of Public Law 110-252
(see 31 U.S.C. 6101 note) and complete and return to the Department the
FFATA Form located at httg1/mil.wa.gov/emeraencv-management-
division/grants/reauiredgrantforms, which is incorporated by reference and
made a part of this Agreement.
e. The Subrecipient shall participate in the State's annual capabilities
assessment for the State Preparedness Report.
4. EQUIPMENT AND SUPPLY MANAGEMENT
a. The Subrecipient and any non-federal entity to which the Subrecipient
makes a subaward shall comply with 2 CFR 200.318 — 200.326 when
procuring any equipment or supplies under this Agreement, 2 CFR 200.313
for management of equipment, and 2 CFR 200.314 for management of
supplies, to include but not limited to:
i. Upon successful completion of the terms of this Agreement, all
equipment and supplies purchased through this Agreement will be
owned by the Subrecipient, or a recognized non-federal entity to
which the Subrecipient has made a subaward, for which a contract,
subrecipient grant agreement, or other means of legal transfer of
ownership is in place.
ii. All equipment, and supplies as applicable, purchased under this
Agreement will be recorded and maintained in the Subrecipient's
inventory system.
iii. Inventory system records shall include: a description of the property;
the manufacturer's serial number, model number, or other
identification number; the funding source for the equipment,
including the Federal Award Identification Number (FAIN); Catalog
of Federal Domestic Assistance (CFDA) number; who holds the title;
the acquisition date; the cost of the equipment and the percentage
of Federal participation in the cost; the location, use and condition of
the equipment at the date the information was reported; and
disposition data including the date of disposal and sale price of the
property.
iv. The Subrecipient shall take a physical inventory of the equipment,
and supplies as applicable, and reconcile the results with the
property records at least once every two years. Any differences
between quantities determined by the physical inspection and those
shown in the records shall be investigated by the Subrecipient to
determine the cause of the difference. The Subrecipient shall, in
connection with the inventory, verify the existence, current utilization,
and continued need for the equipment.
DHS-FEMA-EMPG-FFY 16 Page 5 of 34 Jefferson, County of, E17-100
V. The Subrecipient shall be responsible for any and all operational and
maintenance expenses and for the safe operation of their equipment
and supplies including all questions of liability. The Subrecipient
shall develop appropriate maintenance schedules and procedures
to ensure the equipment, and supplies as applicable, are well
maintained and kept in good operating condition.
vi. The Subrecipient shall develop a control system to ensure adequate
safeguards to prevent loss, damage, and theft of the property. Any
loss, damage, or theft shall be investigated and a report generated
and sent to the Department.
vii. The Subrecipient must obtain and maintain all necessary
certifications and licenses for the equipment.
viii. If the Subrecipient is authorized or required to sell the property,
proper sales procedures must be established and followed to ensure
the highest possible return.
ix. If upon termination or at the Grant Agreement End Date, there is a
residual inventory of unused supplies exceeding $5,000 in total
aggregate value which will not be needed for any other Federal
award, or when original or replacement equipment is no longer
needed for the original project or program or for other activities
currently or previously supported by a Federal agency or award, the
Subrecipient must comply with the following procedures:
A. Supplies: The Subrecipient may retain the supplies for use on
other non -Federal related activities or sell them, but must
compensate the Federal sponsoring agency for its share.
B. Equipment: The Subrecipient must dispose of equipment as
follows:
i. Items of equipment with a current per-unit fair market
value of less than $5,000 may be retained, sold, or
otherwise disposed of by the Subrecipient with no further
obligation to the awarding agency.
ii. Items of equipment with a current per-unit fair market
value of more than $5,000 may be retained or sold and
the Subrecipient shall compensate the Federal -
sponsoring agency for its share.
X. Records for equipment shall be retained by the Subrecipient for a
period of six years from the date of the disposition, replacement, or
transfer. If any litigation, claim, or audit is started before the
expiration of the six year period, the records shall be retained by the
Subrecipient until all litigation, claims, or audit findings involving the
records have been resolved.
b. The Subrecipient shall comply with the Department's Purchase Review
Process, which is incorporated by reference and made part of this
Agreement. No reimbursement will be provided unless the appropriate
approval has been received.
C. Allowable equipment categories for the EMPG Program are listed on the
Authorized Equipment List (AEL) located on the FEMA website at
http://www.fema.gov/authorized-equipment-list. It is important the
Subrecipient and any non-federal entity to which the Subrecipient makes a
subaward regard the AEL as an authorized purchasing list identifying items
allowed under the specific grant program, and includes items that may not
DHS-FEMA-EMPG-FFY 16 Page 6 of 34 Jefferson, County of, E17-100
be categorized as equipment according to the federal, state, local, and
tribal definitions of equipment. The Subrecipient is solely responsible for
ensuring and documenting purchased items under this Agreement are
authorized as allowed items by the AEL at time of purchase.
If the item is not identified on the AEL as allowable under EMPG, the
Subrecipient must contact the Department Key Personnel for assistance in
seeking FEMA approval prior to acquisition.
d. Unless expressly provided otherwise, all equipment must meet all
mandatory regulatory and/or DHS/FEMA adopted standards to be eligible
for purchase using Federal award funds.
e. Equipment purchased with DHS federal award funds is to be marked with
"Purchased with funds provided by the U.S. Department of Homeland
Security" when practicable.
As a subrecipient of federal funds, the Subrecipient must pass on
equipment and supply management requirements that meet or exceed the
requirements outlined above to any non-federal entity to which the
Subrecipient becomes a pass through entity by making a subaward of
federal award funds under this Agreement.
5. ENVIRONMENTAL AND HISTORICAL PRESERVATION
The Subrecipient shall ensure full compliance with the DHS/FEMA Environmental
Planning and Historic Preservation (EHP) Program. EHP program information can
be found at https://www.fema.gov/office-environmental-planning-and-historic-
preservation; FP 108-023-1 Environmental Planning and Historic Preservation
Policy Guidance at http://www.fema..qov/media-library/assets/documents/85376;
and FP 108.24.4 Environmental Planning and Historical Preservation Policy at
https://www.fema.gov/media-library/assets/documents/101537, all of which are
incorporated in and made a part of this Agreement.
a. Projects that have historical impacts or the potential to impact the
environment, including, but not limited to construction of communication
towers; modification or renovation of existing buildings, structures and
facilities; or new construction including replacement of facilities, must
participate in the DHS/FEMA EHP review process prior to initiation.
Modification of existing buildings, including minimally invasive
improvements such as attaching monitors to walls, and training or
exercises occurring outside in areas not considered previously disturbed,
also require a DHS/FEMA EHP review before project initiation.
b. The EHP review process involves the submission of a detailed project
description that explains the goals and objectives of the proposed project
along with supporting documentation so FEMA may determine whether the
proposed project has the potential to impact environmental resources
and/or historic properties.
C. The Subrecipient agrees that to receive any federal preparedness funding,
all EHP compliance requirements outlined in applicable guidance must be
met. The EHP review process must be completed and approval
received by the Subrecipient before any work is started for which
reimbursement will be later requested. Expenditures for projects started
before completion of the EHP review process and receipt of approval by
the Subrecipient will not be reimbursed.
DHS-FEMA-EMPG-FFY 16 Page 7 of 34 Jefferson, County of, E17-100
6. PROCUREMENT
a. The Subrecipient shall comply with all procurement requirements of 2 CFR
Part 200.318 through 200.326 and as specified in the General Terms and
Conditions, Exhibit B, A.10.
b. For all sole source contracts expected to exceed $150,000, the
Subrecipient must submit to the Department for pre -procurement review
and approval the procurement documents, such as requests for proposals,
invitations for bids and independent cost estimates. This requirement must
be passed on to any non-federal entity to which the Subrecipient makes a
subaward, at which point the Subrecipient will be responsible for reviewing
and approving sole source justifications of any non-federal entity to which
the Subrecipient makes a subaward.
7. SUBRECIPIENT MONITORING
a. The Department will monitor the activities of the Subrecipient from award
to closeout. The goal of the Department's monitoring activities will be to
ensure that agencies receiving federal pass-through funds are in
compliance with this Agreement, federal and state audit requirements,
federal grant guidance, and applicable federal and state financial
regulations, as well as 2 CFR Part 200 Subpart F.
b. To document compliance with 2 CFR Part 200 Subpart F requirements, the
Subrecipient shall complete and return to the Department the 2 CFR Part
200 Subpart F Audit Certification Form located at
http://mil.wa.goy/emergency-management-
division/grants/reguiredgrantforms with the signed Agreement and each
fiscal year thereafter until the Agreement is closed, which is incorporated
by reference and made a part of this Agreement.
C. Monitoring activities may include, but are not limited to:
i. review of financial and performance reports
ii. monitoring and documenting the completion of Agreement deliverables
iii. documentation of phone calls, meetings, e-mails and correspondence
iv. review of reimbursement requests and supporting documentation to
ensure allowability and consistency with Agreement work plan, budget,
and federal requirements
v. observation and documentation of Agreement related activities, such
as exercises, training, funded events, and equipment demonstrations
vi. on-site visits to review equipment records and inventories, to verify
source documentation for reimbursement requests and performance
reports, and to verify completion of deliverables.
d. The Subrecipient is required to meet or exceed the monitoring activities, as
outlined above, for any non-federal entity to which the Subrecipient makes
a subaward as a pass-through entity under this Agreement.
e. Compliancy will be monitored throughout the performance period to assess
risk. Concerns will be addressed through a Corrective Action Plan.
8. LIMITED ENGLISH PROFIENCY (CIVIL RIGHTS ACT OF 1964 TITLE VI)
a. The Subrecipient must comply with the Title VI of the Civil Rights Act of
1964 (Title VI) prohibition against discrimination on the basis of national
origin, which requires that subrecipients of federal financial assistance take
reasonable steps to provide meaningful access to persons with limited
English proficiency (LEP) to their programs and services. Providing
meaningful access for persons with LEP may entail providing language
DHS-FEMA-EMPG-FFY 16 Page 8 of 34 Jefferson, County of, E17-100
assistance services, including oral interpretation and written translation.
Executive Order 13166, Improving Access to Services for Persons with
Limited English Proficiency (August 11, 2000), requires federal agencies to
issue guidance to recipients, assisting such organizations and entities in
understanding their language access obligations. DHS published the
required recipient guidance in April 2011, DHS Guidance to Federal
Financial Assistance Recipients Regarding Title VI Prohibition Against
National Origin Discrimination Affecting Limited English Proficient Persons,
76 Fed. Reg. 21755-21768, (April 18, 2011). The Guidance provides
helpful information such as how a recipient can determine the extent of its
obligation to provide language services, selecting language services, and
elements of an effective plan on language assistance for LEP persons. For
additional assistance and information regarding language access
obligations, please refer to the DHS Recipient Guidance at
https://www.dhs.gov/guidance-published-help-department-supported-
organizations-provide-meaningful-access-people-limited and additional
resources on http://www.lep.gov.
9. NIMS COMPLIANCE
a. The National Incident Management System (NIMS) identifies concepts and
principles that answer how to manage emergencies from preparedness to
recovery regardless of their cause, size, location, or complexity. NIMS
provides a consistent, nationwide approach and vocabulary for multiple
agencies or jurisdictions to work together to build, sustain, and deliver the
core capabilities needed to achieve a secure and resilient nation.
b. Consistent implementation of NIMS provides a solid foundation across
jurisdictions and disciplines to ensure effective and integrated
preparedness, planning, and response. NIMS empowers the components
of the National Preparedness System, a requirement of Presidential Policy
Directive (PPD) -8, to guide activities within the public and private sector
and describes the planning, organizational activities, equipping, training
and exercising needed to build and sustain the core capabilities in support
of the National Preparedness Goal.
C. The Subrecipient agrees that in order to receive Federal Fiscal Year 2016
federal preparedness funding, to include EMPG, NIMS compliance
requirements for 2016 must be met.
B. EMPG PROGRAM SPECIFIC REQUIREMENTS
1. The Department receives EMPG Program funding from the DHS/FEMA, which is
provided to assist state, local, and tribal governments enhance and sustain all -
hazards emergency management capabilities as authorized by Robert T. Stafford
Disaster Relief and Emergency Assistance Act, as amended (42 U.S.C. §§ 5121
et seq.) and Section 662 of the Post Katrina Emergency Management Act (6
U.S.C. § 762).
2. A portion of the 16EMPG grant was identified by the state to be passed through to
local jurisdictions and tribes with emergency management programs to
supplement their local/tribal operating budgets to help sustain and enhance
emergency management capabilities under WAC 118-09.
3. The Subrecipient shall use the EMPG funds authorized under this Agreement only
to perform tasks as described in the Work Plan of the Subrecipient's application
for funding, as approved by the Department and incorporated into this Agreement.
Funding may not be used to replace or supplant existing local or tribal government
funding of emergency management programs.
DHS-FEMA-EMPG-FFY 16 Page 9 of 34 Jefferson, County of, E17-100
4. The Subrecipient shall provide a fifty percent match of $18,000 of non-federal
origin. To meet matching requirements, the Subrecipient cash matching
contributions must be considered reasonable, allowable, allocable, and necessary
under the grant program and must comply with all Federal requirements and
regulations, including but not limited to 2 CFR Part 200. An appropriate
mechanism must be in place to capture, track, and document matching funds. In
the final report, the Subrecipient shall identify how the match was met and
documented.
5. Exercises that are implemented with EMPG Program funds under this Agreement
must meet the requirements of the 16EMPG Program.
6. All personnel funded in any part through federal award or matching funds under
this Agreement shall:
a. participate in no less than three exercises in a 12 -month period. The
Subrecipient will report exercise participation along with the final report.
b. complete the following training requirements and record proof of completion:
NIMS Training ICS 100, ICS 200, IS 700, and IS 800 and the FEMA
Professional Development Series IS 120, IS 230, IS 235, IS 240, IS 241, IS
242, and IS 244. The Subrecipient will report training course completion by
individual personnel along with the final report.
C. DHS TERMS AND CONDITIONS
As a subrecipient of 16EMPG Program funding, the Subrecipient shall comply with all
applicable DHS terms and conditions of the 16EMPG Award Letter and its incorporated
documents for DHS Grant No. EMW-2016-EP-00002-S01, which are incorporated and
made a part of this Agreement as Attachment #1.
DHS-FEMA-EMPG-FFY 16 Page 10 of 34 Jefferson, County of, E17-100
Exhibit B
Washington State Military Department
GENERAL TERMS AND CONDITIONS
Department of Homeland Security (DHS)/
Federal Emergency Management Agency (FEMA)
Grants
A.1 DEFINITIONS
As used throughout this Agreement, the terms will have the same meaning as defined in
2 CFR 200 Subpart A (which is incorporated herein by reference), except as otherwise set
forth below:
a. "Agreement" means this Grant Agreement.
b. "Department" means the Washington State Military Department, as a state
agency, any division, section, office, unit or other entity of the Department, or any
of the officers or other officials lawfully representing that Department. The
Department is a recipient of a federal award directly from a federal awarding
agency and is the pass-through entity making a subaward to a subrecipient under
this Agreement.
C. "Subrecipient" when capitalized is primarily used throughout this Agreement in
reference to the non-federal entity identified on the Face Sheet of this Agreement
that has received a subaward from the Department. However, the definition of
"subrecipient" is the same as in 2 CFR 200.93 for all other purposes.
d. "Monitoring Activities" means all administrative, financial, or other review
activities that are conducted to ensure compliance with all state and federal laws,
rules, regulations, authorities and policies.
f. "Investment" means the grant application submitted by the Subrecipient
describing the project(s) for which federal funding is sought and provided under
this this Agreement. Such grant application is hereby incorporated into this
Agreement by reference.
A.2 ADVANCE PAYMENTS PROHIBITED
The Department shall make no payments in advance or in anticipation of goods or services
to be provided under this Agreement. Subrecipient shall not invoice the Department in
advance of delivery and invoicing of such goods or services.
A.3 AMENDMENTS AND MODIFICATIONS
The Subrecipient or the Department may request, in writing, an amendment or
modification of this Agreement. However, such amendment or modification shall not be
binding, take effect or be incorporated herein until made in writing and signed by the
authorized representatives of the Department and the Subrecipient. No other
understandings or agreements, written or oral, shall be binding on the parties.
A.4 AMERICANS WITH DISABILITIES ACT (ADA) OF 1990. PUBLIC LAW 101-336. 42
U.S.C. 12101 ET SEQ. AND ITS IMPLEMENTING REGULATIONS ALSO REFERRED
TO AS THE "ADA" 28 CFR Part 35.
The Subrecipient must comply with the ADA, which provides comprehensive civil rights
protection to individuals with disabilities in the areas of employment, public
accommodations, state and local government services, and telecommunication.
A.5 ASSURANCES
The Department and Subrecipient agree that all activity pursuant to this Agreement will be
in accordance with all the applicable current federal, state and local laws, rules and
regulations.
A.6 CERTIFICATION REGARDING DEBARMENT SUSPENSION OR INELIGIBILITY
As federal funds are a basis for this Agreement, the Subrecipient certifies that the
Subrecipient is not presently debarred, suspended, proposed for debarment, declared
DHS-FEMA-EMPG-FFY 16 Page 11 of 34 Jefferson, County of, E17-100
ineligible, or voluntarily excluded from participating in this Agreement by any federal
department or agency.
The Subrecipient shall complete, sign, and return a Certification Regarding Debarment,
Suspension, Ineligibility, and Voluntary Exclusion form located at
http://mil.wa.gov/emergency-management-division/grants/reguiredgrantforms. Any such
form completed by the Subrecipient for this Agreement shall be incorporated into this
Agreement by reference.
Further, the Subrecipient agrees to comply with all applicable federal regulations
concerning the federal debarment and suspension system, including 2 CFR Part 180. The
Subrecipient certifies that it will ensure that potential contractors or subrecipients or any
of their principals are not debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from participation in "covered transactions" by any
federal department or agency. "Covered transactions" include procurement contracts for
goods or services awarded under a non -procurement transaction (e.g. grant or
cooperative agreement) that are expected to equal or exceed $25,000, and subawards to
subrecipients for any amount. With respect to covered transactions, the Subrecipient may
comply with this provision by obtaining a certification statement from the potential
contractor or subrecipient or by checking the System for Award Management
(http://www.sam.gov) maintained by the federal government. The Subrecipient also
agrees not to enter into any arrangements or contracts with any party on the Washington
State Department of Labor and Industries' "Debarred Contractor List"
(http://www.Ini.wa.gov/TradesLicensing/PrevWage/AwardingAgencies/DebarredContract
orso. The Subrecipient also agrees not to enter into any agreements or contracts for the
purchase of goods and services with any party on the Department of Enterprise Services'
Debarred Vendor List
(http://www.des.wa.gov/services/ContractingPurchasing/Business/Pages/Vendor-
Debarment.aspx).
A.7 CERTIFICATION REGARDING RESTRICTIONS ON LOBBYING
As required by 44 CFR Part 18, the Subrecipient hereby certifies that to the best of its
knowledge and belief: (1) no federally appropriated funds have been paid or will be paid
by or on behalf of the Subrecipient to any person for influencing or attempting to influence
an officer or employee of an agency, a Member of Congress, an officer or employee of
Congress, or an employee of a Member of Congress in connection with the awarding of
any federal contract, the making of any federal grant, the making of any federal loan, the
entering into of any cooperative agreement, and the extension, continuation, renewal,
amendment, or modification of any federal contract, grant, loan, or cooperative agreement;
(2) that if any funds other 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 Agreement, grant, loan, or cooperative
agreement, the Subrecipient will complete and submit Standard Form -LLL, "Disclosure
Form to Report Lobbying," in accordance with its instructions; (3) and that, as applicable,
the Subrecipient will require that the language of this certification be included in the award
documents for all subawards at all tiers (including sub -contracts, sub -grants, and contracts
under grants, loans, and cooperative agreements) and that all sub -recipients shall certify
and disclose accordingly. This certification is a material representation of fact upon which
reliance was placed when this transaction was made or entered into, and is a prerequisite
for making or entering into this transaction imposed by section 1352, title 31, U.S. Code.
A.8 CONFLICT OF INTEREST
No officer or employee of the Department; no member, officer, or employee of the
Subrecipient or its designees or agents; no member of the governing body of the
jurisdiction in which the project is undertaken or located; and no other official of the
Subrecipient who exercises any functions or responsibilities with respect to the project
during his or her tenure, shall have any personal or pecuniary gain or interest, direct or
DHS-FEMA-EMPG-FFY 16 Page 12 of 34 Jefferson, County of, E17-100
indirect, in any contract, subcontract, or the proceeds thereof, for work to be performed in
connection with the project assisted under this Agreement.
The Subrecipient shall incorporate, or cause to incorporate, in all such contracts or
subawards, a provision prohibiting such interest pursuant to this provision.
A.9 COMPLIANCE WITH APPLICABLE STATUTES RULES AND DEPARTMENT POLICIES
The Subrecipient and all its contractors and subrecipients shall comply with, and the
Department is not responsible for determining compliance with, any and all applicable
federal, state, and local laws, regulations, executive orders, OMB Circulars, and/or
policies. This obligation includes, but is not limited to: nondiscrimination laws and/or
policies, Energy Policy and Conservation Act (PL 94-163, as amended), the Americans
with Disabilities Act (ADA), Age Discrimination Act of 1975, Title VI of the Civil Rights Act
of 1964, Civil Rights Act of 1968, the Robert T. Stafford Disaster Relief and Emergency
Assistance Act, (PL 93-288, as amended), Ethics in Public Service (RCW 42.52),
Covenant Against Contingent Fees (48 CFR Section 52.203-5), Public Records Act (RCW
42.56), Prevailing Wages on Public Works (RCW 39.12), State Environmental Policy Act
(RCW 43.21C), Shoreline Management Act of 1971 (RCW 90.58), State Building Code
(RCW 19.27), Energy Related Building Standards (RCW 19.27A), Provisions in Buildings
for Aged and Handicapped Persons (RCW 70.92), and safety and health regulations.
In the event of noncompliance or refusal to comply with any applicable law, regulation,
executive order, OMB Circular or policy by the Subrecipient, its contractors or
subrecipients, the Department may rescind, cancel, or terminate the Agreement in whole
or in part in its sole discretion. The Subrecipient is responsible for all costs or liability
arising from its failure, and that of its contractors and subrecipients, to comply with
applicable laws, regulations, executive orders, OMB Circulars or policies.
A.10 CONTRACTING & PROCUREMENT
a. The Subrecipient shall use a competitive procurement process in the procurement
and award of any contracts with contractors or sub -contractors that are entered
into under the original contract award. The procurement process followed shall be
in accordance with 2 CFR Part 200.318 General procurement standards through
200.326 Contract Provisions.
As required by Appendix If to 2 CFR Part 200, all contracts entered into by the
Subrecipient under this Agreement must include the following provisions, as
applicable:
1) Contracts for more than the simplified acquisition threshold currently set at
$150,000, which is the inflation adjusted amount determined by the Civilian Agency
Acquisition Council and the Defense Acquisition Regulations Council (Councils) as
authorized by 41 U.S.C. 1908, must address administrative, contractual, or legal
remedies in instances where contractors violate or breach contract terms, and
provide for such sanctions and penalties as appropriate.
2) All contracts in excess of $10,000 must address termination for cause and for
convenience by the non -Federal entity including the manner by which it will be
effected and the basis for settlement.
3) Equal Employment Opportunity. Except as otherwise provided under 41 CFR
Part 60, all contracts that meet the definition of "federally assisted construction
contract" in 41 CFR Part 60-1.3 must include the equal opportunity clause provided
under 41 CFR 60-1.4(b), in accordance with Executive Order 11246, "Equal
Employment Opportunity" (30 FR 12319, 12935, 3 CFR Part, 1964-1965 Comp.,
p. 339), as amended by Executive Order 11375, "Amending Executive Order
11246 Relating to Equal Employment Opportunity," and implementing regulations
at 41 CFR part 60, "Office of Federal Contract Compliance Programs, Equal
Employment Opportunity, Department of Labor."
4) Davis -Bacon Act, as amended (40 U.S.C. 3141-3148). When required by
Federal program legislation, all prime construction contracts in excess of $2,000
DHS-FEMA-EMPG-FFY 16 Page 13 of 34 Jefferson, County of, E17-100
awarded by non -Federal entities must include a provision for compliance with the
Davis -Bacon Act (40 U.S.C. 3141-3144, and 3146-3148) as supplemented by
Department of Labor regulations (29 CFR Part 5, "Labor Standards Provisions
Applicable to Contracts Covering Federally Financed and Assisted Construction").
In accordance with the statute, contractors must be required to pay wages to
laborers and mechanics at a rate not less than the prevailing wages specked in a
wage determination made by the Secretary of Labor. In addition, contractors must
be required to pay wages not less than once a week. The non -Federal entity must
place a copy of the current prevailing wage determination issued by the
Department of Labor in each solicitation. The decision to award a contract or
subcontract must be conditioned upon the acceptance of the wage determination.
The non -Federal entity must report all suspected or reported violations to the
Federal awarding agency. The contracts must also include a provision for
compliance with the Copeland "Anti -Kickback" Act (40 U.S.C. 3145), as
supplemented by Department of Labor regulations (29 CFR Part 3, "Contractors
and Subcontractors on Public Building or Public Work Financed in Whole or in Part
by Loans or Grants from the United States"). The Act provides that each contractor
or subrecipient must be prohibited from inducing, by any means, any person
employed in the construction, completion, or repair of public work, to give up any
part of the compensation to which he or she is otherwise entitled. The non -Federal
entity must report all suspected or reported violations to the Federal awarding
agency.
5) Contract Work Hours and Safety Standards Act (40 U.S.C. 3701-3708). Where
applicable, all contracts awarded by the non -Federal entity in excess of $100,000
that involve the employment of mechanics or laborers must include a provision for
compliance with 40 U.S.C. 3702 and 3704, as supplemented by Department of
Labor regulations (29 CFR Part 5). Under 40 U.S.C. 3702 of the Act, each
contractor must be required to compute the wages of every mechanic and laborer
on the basis of a standard work week of 40 hours. Work in excess of the standard
work week is permissible provided that the worker is compensated at a rate of not
less than one and a half times the basic rate of pay for all hours worked in excess
of 40 hours in the work week. The requirements of 40 U.S.C. 3704 are applicable
to construction work and provide that no laborer or mechanic must be required to
work in surroundings or under working conditions which are unsanitary, hazardous
or dangerous. These requirements do not apply to the purchases of supplies or
materials or articles ordinarily available on the open market, or contracts for
transportation or transmission of intelligence.
6) Rights to Inventions Made Under a Contract or Agreement. If the Federal award
meets the definition of "funding agreement' under 37 CFR §401.2 (a) and the
recipient or subrecipient wishes to enter into a contract with a small business firm
or nonprofit organization regarding the substitution of parties, assignment or
performance of experimental, developmental, or research work under that "funding
agreement," the recipient or subrecipient must comply with the requirements of 37
CFR Part 401, "Rights to Inventions Made by Nonprofit Organizations and Small
Business Firms Under Government Grants, Contracts and Cooperative
Agreements," and any implementing regulations issued by the awarding agency.
7) Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control
Act (33 U.S.C. 1251-1387), as amended—Contracts and subgrants of amounts in
excess of $150,000 must contain a provision that requires the non -Federal award
to agree to comply with all applicable standards, orders or regulations issued
pursuant to the Clean Air Act (42 U.S.C. 7401-7671q) and the Federal Water
Pollution Control Act as amended (33 U.S.C. 1251-1387). Violations must be
reported to the Federal awarding agency and the Regional Office of the
Environmental Protection Agency (EPA).
DHS-FEMA-EMPG-FFY 16 Page 14 of 34 Jefferson, County of, E17-100
8) Debarment and Suspension (Executive Orders 12549 and 12689)—A contract
award (see 2 CFR 180.220) must not be made to parties listed on the government -
wide exclusions in the System for Award Management (SAM), in accordance with
the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR
part 1986 Comp., p. 189) and 12689 (3 CFR part 1989 Comp., p. 235), "Debarment
and Suspension." SAM Exclusions contains the names of parties debarred,
suspended, or otherwise excluded by agencies, as well as parties declared
ineligible under statutory or regulatory authority other than Executive Order 12549.
9) Byrd Anti -Lobbying Amendment (31 U.S.C. 1352)—Contractors that apply or
bid for an award exceeding $100,000 must file the required certification. Each tier
certifies to the tier above that it will not and has not used Federal appropriated
funds to pay any person or organization for influencing or attempting to influence
an officer or employee of any agency, a member of Congress, officer or employee
of Congress, or an employee of a member of Congress in connection with
obtaining any Federal contract, grant or any other award covered by 31 U.S.C.
1352. Each tier must also disclose any lobbying with non -Federal funds that takes
place in connection with obtaining any Federal award. Such disclosures are
forwarded from tier to tier up to the non -Federal award.
10) Procurement of recovered materials -- As required by 2 CFR 200.322, a non -
Federal entity that is a state agency or agency of a political subdivision of a state
and its contractors must comply with section 6002 of the Solid Waste Disposal Act,
as amended by the Resource Conservation and Recovery Act. The requirements
of Section 6002 include procuring only items designated in guidelines of the
Environmental Protection Agency (EPA) at 40 CFR part 247 that contain the
highest percentage of recovered materials practicable, consistent with maintaining
a satisfactory level of competition, where the purchase price of the item exceeds
$10,000 or the value of the quantity acquired during the preceding fiscal year
exceeded $10,000; procuring solid waste management services in a manner that
maximizes energy and resource recovery; and establishing an affirmative
procurement program for procurement of recovered materials identified in the EPA
guidelines.
11) Notice of awarding agency requirements and regulations pertaining to
reporting.
12) Federal awarding agency requirements and regulations pertaining to
copyrights and rights in data.
13) Access by the Department, the Subrecipient, the Federal awarding agency,
the Comptroller General of the United States, or any of their duly authorized
representatives to any books, documents, papers, and records of the contractor
which are directly pertinent to that specific contract for the purpose of making audit,
examination, excerpts, and transcriptions.
14) Retention of all required records for six years after the Subrecipient has made
final payments and all other pending matters are closed.
15) Mandatory standards and policies relating to energy efficiency which are
contained in the state energy conservation plan issued in compliance with the
Energy Policy and Conservation Act (Pub. L. 94-163, 89 Stat. 871).
b. The Department reserves the right to review the Subrecipient procurement plans
and documents, and require the Subrecipient to make changes to bring its plans
and documents into compliance with the requirements of 2 CFR Part 200.318
through 200.326. The Subrecipient must ensure that its procurement process
requires contractors and subcontractors to provide adequate documentation with
sufficient detail to support the costs of the project and to allow both the
Subrecipient and Department to make a determination on eligibility of project costs.
DNS-FEMA-EMPG-FFY 16 Page 15 of 34 Jefferson, County of, E17-100
C. All contracting agreements entered into pursuant to this Agreement shall
incorporate this Agreement by reference
A.11 DISCLOSURE
The use or disclosure by any party of any information concerning the Department for any
purpose not directly connected with the administration of the Department's or the
Subrecipient's responsibilities with respect to services provided under this Agreement is
prohibited except by prior written consent of the Department or as required to comply with
the state Public Records Act, other law or court order.
A.12 DISPUTES
Except as otherwise provided in this Agreement, when a bona fide dispute arises between
the parties and it cannot be resolved through discussion and negotiation, either party may
request a dispute resolution panel to resolve the dispute. A request for a dispute resolution
board shall be in writing, state the disputed issues, state the relative positions of the
parties, and be sent to all parties. The panel shall consist of a representative appointed
by the Department, a representative appointed by the Subrecipient and a third party
mutually agreed upon by both parties. The panel shall, by majority vote, resolve the
dispute. Each party shall bear the cost for its panel member and its attorney fees and
costs, and share equally the cost of the third panel member.
A.13 LEGAL RELATIONS
It is understood and agreed that this Agreement is solely for the benefit of the parties to
the Agreement and gives no right to any other party. No joint venture or partnership is
formed as a result of this Agreement.
To the extent allowed by law, the Subrecipient, its successors or assigns, will protect, save
and hold harmless the Department, the State of Washington, and the United States
Government and their authorized agents and employees, from all claims, actions, costs,
damages or expenses of any nature whatsoever by reason of the acts or omissions of the
Subrecipient, its sub -contractors, subrecipients, assigns, agents, contractors, consultants,
licensees, invitees, employees or any person whomsoever arising out of or in connection
with any acts or activities authorized by this Agreement.
To the extent allowed by law, the Subrecipient further agrees to defend the Department
and the State of Washington and their authorized agents and employees in any litigation;
including payment of any costs or attorneys' fees for any claims or action commenced
thereon arising out of or in connection with acts or activities authorized by this Agreement.
This obligation shall not include such claims, costs, damages or expenses which may be
caused by the sole negligence of the Department; provided, that if the claims or damages
are caused by or result from the concurrent negligence of (1) the Department, and (2) the
Subrecipient, its agents, or employees, this indemnity provision shall be valid and
enforceable only to the extent of the negligence of the Subrecipient, or Subrecipient's
agents or employees.
Insofar as the funding source, the Department of Homeland Security (DHS)/Federal
Emergency Management Agency (FEMA), is an agency of the Federal government, the
following shall apply:
44 CFR 206.9 Non -liability. The Federal government shall not be liable for any claim
based upon the exercise or performance of, or the failure to exercise or perform a
discretionary function or duty on the part of a federal agency or an employee of the Federal
government in carrying out the provisions of the Stafford Act.
A.14 LIMITATION OF AUTHORITY — AUTHORIZED SIGNATURE
The signatories to this Agreement represent that they have the authority to bind their
respective organizations to this Agreement. Only the Department's Authorized Signature
representative and the Authorized Signature representative of the Subrecipient or
Alternate for the Subrecipient, formally designated in writing, shall have the express,
implied, or apparent authority to alter, amend, modify, or waive any clause or condition of
this Agreement. Any alteration, amendment, modification, or waiver of any clause or
DHS-FEMA-EMPG-FFY 16 Page 16 of 34 Jefferson, County of, E17-100
condition of this Agreement is not effective or binding unless made in writing and signed
by both parties' Authorized Signature representatives.
Further, only the Authorized Signature representative or Alternate for the Subrecipient
shall have signature authority to sign reimbursement requests, time extension requests,
amendment and modification requests, requests for changes to projects or work plans,
and other requests, certifications and documents authorized by or required under this
Agreement.
A.15 LOSS OR REDUCTION OF FUNDING
In the event funding from state, federal, or other sources is withdrawn, reduced, or limited
in any way after the effective date of this Agreement and prior to normal completion or end
date, the Department may unilaterally reduce the scope of work and budget or unilaterally
terminate all or part of the Agreement as a "Termination for Cause" without providing the
Subrecipient an opportunity to cure. Alternatively, the parties may renegotiate the terms
of this Agreement under "Amendments and Modifications" to comply with new funding
limitations and conditions, although the Department has no obligation to do so.
A.16 NONASSIGNABILITY
Neither this Agreement, nor any claim arising under this Agreement, shall be transferred
or assigned by the Subrecipient.
A.17 NONDISCRIMINATION
The Subrecipient shall comply with all applicable federal and state non-discrimination
laws, regulations, and policies. No person shall, on the grounds of age, race, creed, color,
sex, sexual orientation, religion, national origin, marital status, honorably discharged
veteran or military status, or disability (physical, mental, or sensory) be denied the benefits
of, or otherwise be subjected to discrimination under any project, program, or activity,
funded, in whole or in part, under this Agreement.
A.18 NOTICES
The Subrecipient shall comply with all public notices or notices to individuals required by
applicable local, state and federal laws and regulations and shall maintain a record of this
compliance.
A.19 OCCUPATIONAL SAFETY/HEALTH ACT and WASHINGTON INDUSTRIAL SAFETY/
HEALTH ACT (OSHA/WISHA)
The Subrecipient represents and warrants that its work place does now or will meet all
applicable federal and state safety and health regulations that are in effect during the
Subrecipient's performance under this Agreement. To the extent allowed by law, the
Subrecipient further agrees to indemnify and hold harmless the Department and its
employees and agents from all liability, damages and costs of any nature, including but
not limited to, costs of suits and attorneys' fees assessed against the Department, as a
result of the failure of the Subrecipient to so comply.
A.20 OWNERSHIP OF PROJECT/CAPITAL FACILITIES
The Department makes no claim to any capital facilities or real property improved or
constructed with funds under this Agreement, and by this subaward of funds does not and
will not acquire any ownership interest or title to such property of the Subrecipient. The
Subrecipient shall assume all liabilities and responsibilities arising from the ownership and
operation of the project and agrees to indemnify and hold the Department, the state of
Washington and the United States government harmless from any and all causes of action
arising from the ownership and operation of the project.
A.21 POLITICAL ACTIVITY
No portion of the funds provided herein shall be used for any partisan political activity or
to further the election or defeat of any candidate for public office or influence the approval
or defeat of any ballot issue.
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A.22 PROHIBITION AGAINST PAYMENT OF BONUS OR COMMISSION
The assistance provided under this Agreement shall not be used in payment of any bonus
or commission for the purpose of obtaining approval of the application for such assistance
or any other approval or concurrence under this Agreement provided, however, that
reasonable fees or bona fide technical consultant, managerial, or other such services,
other than actual solicitation, are not hereby prohibited if otherwise eligible as project
costs.
A.23 PUBLICITY
The Subrecipient agrees to submit to the Department prior to issuance all advertising and
publicity matters relating to this Agreement wherein the Department's name is mentioned
or language used from which the connection of the Department's name may, in the
Department's judgment, be inferred or implied. The Subrecipient agrees not to publish or
use such advertising and publicity matters without the prior written consent of the
Department. The Subrecipient may copyright original work it develops in the course of or
under this Agreement; however, pursuant to 2 CFR Part 200.315, FEMA reserves a
royalty -free, nonexclusive, and irrevocable license to reproduce, publish or otherwise use,
and to authorize others to use the work for government purposes.
Publication resulting from work performed under this Agreement shall include an
acknowledgement of FEMA's financial support, by CFDA number, and a statement that
the publication does not constitute an endorsement by FEMA or reflect FEMA's views.
A.24 RECAPTURE PROVISION
In the event the Subrecipient fails to expend funds under this Agreement in accordance
with applicable federal, state, and local laws, regulations, and/or the provisions of the
Agreement, the Department reserves the right to recapture funds in an amount equivalent
to the extent of noncompliance. Such right of recapture shall exist for the life of the project
following Agreement termination. Repayment by the Subrecipient of funds under this
recapture provision shall occur within 30 days of demand. In the event the Department is
required to institute legal proceedings to enforce the recapture provision, the Department
shall be entitled to its costs and expenses thereof, including attorney fees from the
Subrecipient.
A.25 RECORDS
a. The Subrecipient agrees to maintain all books, records, documents, receipts, invoices
and all other electronic or written records necessary to sufficiently and properly reflect
the Subrecipient's contracts, subawards, grant administration, and payments,
including all direct and indirect charges, and expenditures in the performance of this
Agreement (the "records").
b. The Subrecipient's records related to this Agreement and the projects funded may be
inspected and audited by the Department or its designee, by the Office of the State
Auditor, DHS, FEMA or their designees, by the Comptroller General of the United
States or its designees, or by other state or federal officials authorized by law, for the
purposes of determining compliance by the Subrecipient with the terms of this
Agreement and to determine the appropriate level of funding to be paid under the
Agreement.
c. The records shall be made available by the Subrecipient for such inspection and audit,
together with suitable space for such purpose, at any and all times during the
Subrecipient's normal working day.
d. The Subrecipient shall retain and allow access to all records related to this Agreement
and the funded project(s) for a period of at least six (6) years following final payment
and closure of the grant under this Agreement. Despite the minimum federal retention
requirement of three (3) years, the more stringent State requirement of six (6) years
must be followed.
DHS-FEMA-EMPG-FFY 16 Page 18 of 34 Jefferson, County of, E17-100
A.26 RESPONSIBILITY FOR PROJECT/STATEMENT OF WORKMORK PLAN
While the Department undertakes to assist the Subrecipient with the project/statement of
work/work plan (project) by providing Federal award funds pursuant to this Agreement,
the project itself remains the sole responsibility of the Subrecipient. The Department
undertakes no responsibility to the Subrecipient, or to any third parry, other than as is
expressly set out in this Agreement.
The responsibility for the design, development, construction, implementation, operation
and maintenance of the project, as these phrases are applicable to this project, is solely
that of the Subrecipient, as is responsibility for any claim or suit of any nature by any third
party related in any way to the project.
Prior to the start of any construction activity, the Subrecipient shall ensure that all
applicable Federal, State, and local permits and clearances are obtained, including but
not limited to FEMA compliance with the National Environmental Policy Act, the National
Historic Preservation Act, the Endangered Species Act, and all other environmental laws,
regulations and executive orders.
The Subrecipient shall defend, at its own cost, any and all claims or suits at law or in
equity, which may be brought against the Subrecipient in connection with the project. The
Subrecipient shall not look to the Department, or to any state or federal agency, or to any
of their employees or agents, for any performance, assistance, or any payment or
indemnity, including but not limited to cost of defense and/or attorneys' fees, in connection
with any claim or lawsuit brought by any third party related to any design, development,
construction, implementation, operation and/or maintenance of a project.
A.27 SEVERABILITY
If any court of rightful jurisdiction holds any provision or condition under this Agreement or
its application to any person or circumstances invalid, this invalidity does not affect other
provisions, terms or conditions of the Agreement, which can be given effect without the
invalid provision. To this end, the terms and conditions of this Agreement are declared
severable.
A.28 SINGLE AUDIT ACT REQUIREMENTS (including all AMENDMENTS)
Non-federal entities, as subrecipients of a federal award, that expend $760,000 or more
in one fiscal year of federal funds from all sources, direct and indirect, are required to have
a single or a program -specific audit conducted in accordance with 2 CFR Part 200 Subpart
F. Non-federal entities that spend less than $750,000 a year in federal awards are exempt
from federal audit requirements for that year, except as noted in 2 CFR Part 200 Subpart
F. As defined in 2 CFR Part 200, the term "non-federal entity" means a State, local
government, Indian tribe, institution of higher education, or non-profit organization that
carries out a federal award as a recipient or subrecipient.
Subrecipients that are required to have an audit must ensure the audit is performed in
accordance with Generally Accepted Government Auditing Standards (GAGAS) as found
in the Government Auditing Standards (the Revised Yellow Book) developed by the United
States Comptroller General and the OMB Compliance Supplement. The Subrecipient has
the responsibility of notifying its auditor and requesting an audit in compliance with 2 CFR
Part 200 Subpart F, to include the Washington State Auditor's Office, a federal auditor, or
a public accountant performing work using GAGAS, as appropriate. Costs of the audit
may be an allowable grant expenditure as authorized by 2 CFR Part 200 Subpart F.
The Subrecipient shall maintain auditable records and accounts so as to facilitate the audit
requirement and shall ensure that any sub -contractors also maintain auditable records.
The Subrecipient is responsible for any audit exceptions incurred by its own organization
or that of its sub -contractors. Responses to any unresolved management findings and
disallowed or questioned costs shall be included with the audit report. The Subrecipient
must respond to Department requests for information or corrective action concerning audit
issues or findings within 30 days of the date of request. The Department reserves the
right to recover from the Subrecipient all disallowed costs resulting from the audit.
DHS-FEMA-EMPG-FFY 16 Page 19 of 34 Jefferson, County of, E17-100
After the single audit has been completed, and if it includes any audit findings, the
Subrecipient must send a full copy of the audit and its corrective action plan to the
Department at the following address no later than nine (9) months after the end of the
Subrecipient's fiscal year(s):
Contracts Office
Washington Military Department
Finance Division, Building #1 TA -20
Camp Murray, WA 98430-6032
If the Subrecipient claims it is exempt from the audit requirements of 2 CFR Part 200
Subpart F, the Subrecipient must send a letter identifying this Agreement and explaining
the criteria for exemption no later than nine (9) months after the end of the Subrecipient's
fiscal year(s) to the address listed above.
The Department retains the sole discretion to determine whether a valid claim for an
exemption from the audit requirements of this provision has been established.
The Subrecipient shall include the above audit requirements in any subawards.
Conducting a single or program -specific audit in compliance with 2 CFR Part 200 Subpart
F is a material requirement of this Agreement. In the absence of a valid claim of exemption
from the audit requirements of 2 CFR Part 200 Subpart F, the Subrecipient's failure to
comply with said audit requirements may result in one or more of the following actions in
the Department's sole discretion: a percentage of federal awards being withheld until the
audit is completed in accordance with 2 CFR Part 200 Subpart F; the withholding or
disallowing of overhead costs; the suspension of federal awards until the audit is
conducted and submitted; or termination of the federal award.
A.29 SUBRECIPIENT NOT EMPLOYEE
The parties intend that an independent contractor relationship will be created by this
Agreement. The Subrecipient, and/or employees or agents performing under this
Agreement are not employees or agents of the Department in any manner whatsoever.
The Subrecipient will not be presented as, nor claim to be, an officer or employee of the
Department by reason of this Agreement, nor will the Subrecipient make any claim,
demand, or application to or for any right or privilege applicable to an officer or employee
of the Department or of the State of Washington by reason of this Agreement, including,
but not limited to, Workmen's Compensation coverage, unemployment insurance benefits,
social security benefits, retirement membership or credit, or privilege or benefit which
would accrue to a civil service employee under Chapter 41.06 RCW.
It is understood that if the Subrecipient is another state department, state agency, state
university, state college, state community college, state board, or state commission, that
the officers and employees are employed by the state of Washington in their own right
and not by reason of this Agreement.
A.30 TAXES, FEES AND LICENSES
Unless otherwise provided in this Agreement, the Subrecipient shall be responsible for,
pay and maintain in current status all taxes, unemployment contributions, fees, licenses,
assessments, permit charges and expenses of any other kind for the Subrecipient or its
staff required by statute or regulation that are applicable to Agreement performance.
A.31 TERMINATION FOR CONVENIENCE
Notwithstanding any provisions of this Agreement, the Subrecipient may terminate this
Agreement by providing written notice of such termination to the Department Key
Personnel identified in the Agreement, specifying the effective date thereof, at least thirty
(30) days prior to such date.
Except as otherwise provided in this Agreement, the Department, in its sole discretion and
in the best interests of the State of Washington, may terminate this Agreement in whole
or in part by providing ten (10) calendar days written notice, beginning on the second day
after mailing to the Subrecipient. Upon notice of termination for convenience, the
Department reserves the right to suspend all or part of the Agreement, withhold further
DHS-FEMA-EMPG-FFY 16 Page 20 of 34 Jefferson, County of, E17-100
payments, or prohibit the Subrecipient from incurring additional obligations of funds. In
the event of termination, the Subrecipient shall be liable for all damages as authorized by
law. The rights and remedies of the Department provided for in this section shall not be
exclusive and are in addition to any other rights and remedies provided by law.
A.32 TERMINATION OR SUSPENSION FOR CAUSE
In the event the Department, in its sole discretion, determines the Subrecipient has failed
to fulfill in a timely and proper manner its obligations under this Agreement, is in an
unsound financial condition so as to endanger performance hereunder, is in violation of
any laws or regulations that render the Subrecipient unable to perform any aspect of the
Agreement, or has violated any of the covenants, agreements or stipulations of this
Agreement, the Department has the right to immediately suspend or terminate this
Agreement in whole or in part.
The Department may notify the Subrecipient in writing of the need to take corrective action
and provide a period of time in which to cure. The Department is not required to allow the
Subrecipient an opportunity to cure if it is not feasible as determined solely within the
Department's discretion. Any time allowed for cure shall not diminish or eliminate the
Subrecipient's liability for damages or otherwise affect any other remedies available to the
Department. If the Department allows the Subrecipient an opportunity to cure, the
Department shall notify the Subrecipient in writing of the need to take corrective action. If
the corrective action is not taken within ten (10) calendar days or as otherwise specified
by the Department, or if such corrective action is deemed by the Department to be
insufficient, the Agreement may be terminated in whole or in part.
The Department reserves the right to suspend all or part of the Agreement, withhold further
payments, or prohibit the Subrecipient from incurring additional obligations of funds during
investigation of the alleged compliance breach, pending corrective action by the
Subrecipient, if allowed, or pending a decision by the Department to terminate the
Agreement in whole or in part.
In the event of termination, the Subrecipient shall be liable for all damages as authorized
by law, including but not limited to, any cost difference between the original Agreement
and the replacement or cover Agreement and all administrative costs directly related to
the replacement Agreement, e.g., cost of administering the competitive solicitation
process, mailing, advertising and other associated staff time. The rights and remedies of
the Department provided for in this section shall not be exclusive and are in addition to
any other rights and remedies provided by law.
If it is determined that the Subrecipient: (1) was not in default or material breach, or (2)
failure to perform was outside of the Subrecipient's control, fault or negligence, the
termination shall be deemed to be a "Termination for Convenience".
A.33 TERMINATION PROCEDURES
In addition to the procedures set forth below, if the Department terminates this Agreement,
the Subrecipient shall follow any procedures specified in the termination notice. Upon
termination of this Agreement and in addition to any other rights provided in this
Agreement, the Department may require the Subrecipient to deliver to the Department any
property specifically produced or acquired for the performance of such part of this
Agreement as has been terminated.
If the termination is for convenience, the Department shall pay to the Subrecipient as an
agreed upon price, if separately stated, for properly authorized and completed work and
services rendered or goods delivered to and accepted by the Department prior to the
effective date of Agreement termination, the amount agreed upon by the Subrecipient and
the Department for (i) completed work and services and/or equipment or supplies provided
for which no separate price is stated, (ii) partially completed work and services and/or
equipment or supplies provided which are accepted by the Department, (iii) other work,
services and/or equipment or supplies which are accepted by the Department, and (iv) the
protection and preservation of property.
DHS-FEMA-EMPG-FFY 16 Page 21 of 34 Jefferson, County of, E17-100
Failure to agree with such amounts shall be a dispute within the meaning of the "Disputes"
clause of this Agreement. If the termination is for cause, the Department shall determine
the extent of the liability of the Department. The Department shall have no other obligation
to the Subrecipient for termination. The Department may withhold from any amounts due
the Subrecipient such sum as the Department determines to be necessary to protect the
Department against potential loss or liability.
The rights and remedies of the Department provided in this Agreement shall not be
exclusive and are in addition to any other rights and remedies provided by law.
After receipt of a notice of termination, and except as otherwise directed by the
Department in writing, the Subrecipient shall:
a. Stop work under the Agreement on the date, and to the extent specified, in the notice;
b. Place no further orders or contracts for materials, services, supplies, equipment and/or
facilities in relation to this Agreement except as may be necessary for completion of
such portion of the work under the Agreement as is not terminated;
c. Assign to the Department, in the manner, at the times, and to the extent directed by
the Department, all of the rights, title, and interest of the Subrecipient under the orders
and contracts so terminated, in which case the Department has the right, at its
discretion, to settle or pay any or all claims arising out of the termination of such orders
and contracts;
d. Settle all outstanding liabilities and all claims arising out of such termination of orders
and contracts, with the approval or ratification of the Department to the extent the
Department may require, which approval or ratification shall be final for all the
purposes of this clause;
e. Transfer title to the Department and deliver in the manner, at the times, and to the
extent directed by the Department any property which, if the Agreement had been
completed, would have been required to be furnished to the Department;
f. Complete performance of such part of the work as shall not have been terminated by
the Department in compliance with all contractual requirements; and
g. Take such action as may be necessary, or as the Department may require, for the
protection and preservation of the property related to this Agreement which is in the
possession of the Subrecipient and in which the Department has or may acquire an
interest.
A.34 UTILIZATION OF MINORITY AND WOMEN BUSINESS ENTERPRISES (MWBE)
The Subrecipient is encouraged to utilize business firms that are certified as minority-
owned and/or women -owned in carrying out the purposes of this Agreement. The
Subrecipient may set utilization standards, based upon local conditions or may utilize the
state of Washington MWBE goals, as identified in WAC 326-30-041.
A.35 VENUE
This Agreement shall be construed and enforced in accordance with, and the validity and
performance shall be governed by, the laws of the state of Washington. Venue of any suit
between the parties arising out of this Agreement shall be the Superior Court of Thurston
County, Washington. The Subrecipient, by execution of this Agreement acknowledges
the jurisdiction of the courts of the State of Washington.
A.36 WAIVERS
No conditions or provisions of this Agreement can be waived unless approved in advance
by the Department in writing. The Department's failure to insist upon strict performance
of any provision of the Agreement or to exercise any right based upon a breach thereof,
or the acceptance of any performance during such breach, shall not constitute a waiver of
any right under this Agreement.
DHS-FEMA-EMPG-FFY 16 Page 22 of 34 Jefferson, County of, E17-100
Exhibit C
16EMPG WORK PLAN
Emergency Managerrrent Organization County of Jefferson Department of Emergency Management (DEM)
The purpose of EMPG is to assist with the enhancement, sustainment and improvement of state, local, and tribal emergency management programs.
Activities conducted using EMPG funding should relate directly to the five elements of emergency management: prevention, protection, response,
recovery, and mitigation. Washington State does not require a specific number of activities to receive EMPG funding. However, there are required
capabilities that must be conducted in order to remain eligible for EMPG funding, including but not limited to the ability to communicate and warn,
educate the public, train and exercise, plan, and be NIMS compliant. The Work Plan delineates the Emergency Management Organization's emergency
management program planning and priority focus for this grant cycle (to include 16EMPG grant and local funds).
Program Area lit
Community Preparedness - Build community preparedness (THIRA Community Resilience) through organizing and facilitation of monthly meeting with
the Jefferson Co. Neighborhood Preparedness Workgroup (NPREP), community NPREP lectures, neighborhood trainings, sponsorship and participant in
the Annual All -Co. Emergency Preparedness Picnic, and development, printed and distribution of educational material for the medically fragile
WORK
laborate and advertise with N PREP team to
iver three (3) or more preparedness and
ponse treinings.
WHY THE WORK IS BEING DONE RESULT OF THE WORK
Existing organized neighborhoods require ongoing Trainings will engage neighborhood leaders in the
education and training ideas to keep individuals topics of emergency planning, response,
and neighborhoods motivated to stay prepared communication, and mitigation and will improve
for emergencies. individual, neighborhood and the whole
community's resilience. These neighborhoods will
be better able to manage and adapt through an
Initial disaster response to recovery.
Participate in All -County Picnic with educational
Jefferson County is geographically isolated with Discussions will promote Individual preparedness
booth to promote individual and neighborhood
potential for catastrophic disasters. At the AII- and neighborhood organization in cooperation
preparedness. DEM will educate through one -on-
County Picnic, DEM reaches over 900 individuals with county -wide NPREP workgroup.
one preparedness discussions and distribute print
in a one -day event each having various levels of
2 material the need for individual and neighborhood
individual preparedness with no or limited
preparedness, including Map Your Neighborhood
neighborhood organization. The 2015 All -County
program (MYN), Citizen Emergency Response
Picnic signed up 30 new neighborhoods; 2016
Team (CERT) and more.
numbers are pending.
Facilitate one or more citizen/neighborhood
In a disaster, first responders will not be able to Exercise(s) will provide one or more new
disaster simulation exercises to learn radio skills
meet the demand for services or provide neighborhoods with radio -training to become
and provide credible timely reporting of disaster
situational awareness to our vast county. Training creditable reporters in a disaster and EMO gains I
situational awareness.
citizens to observe and communicate within their critical time -sensitive situational awareness.
neighborhoods with family service radios (walkie-
3
talkies), collect and log key neighborhood
situational awareness, prioritize it, and use HAM
radios to report the information to the EMO,
provides EMO with credible, timely situational
awareness where first responders are unavailable.
Program Area #2
Interoperabiiity and Capability Surge Capacity - Implement the interlocal agreements with adjacent jurisdictions to provide for short term surge capacity
and sustainability of the EOC Incident Management Team In the event of depletion of organic emergency management team members. These
agreements provide for rapid action at activation levels that may not qualify for WAMAS implementation. They also provide the basis for interlocal
VVVKK rLANNItU WHY THE WORK IS BEING DONE RESULT OF THE WORK
- ----- - —
Use the Cascadia rising Exercise (CRX) After Action CRX demonstrated there are a limited number of Interoperability with adjacent jurisdictions will:
Report (AAR) as guidance for further development trained emergency management personnel in - Increase surge capacity
of Region 2 interoperability by identifying northwest Region 2. During an activation, the -Allow cross training opportunities
1 commonalities and developing procedures and ability to share personnel between Region 2 -Standardize procedures
training for mutual assistance, interlocal jurisdictions would augment the work - Effectively shared resources
force available for response.
DHS-FEMA-EMPG-FFY 16 Page 23 of 34 Jefferson, County of, E17-100
Program Area N3
Alert and Warning - Increase the number of existing text messaging system (TMS) users (subscribers). The Jefferson County TMS system augments the
alert and warning system. There is limited AM/FM broadcast capabilities, and the TMS makes use of tertiary technology (text messaging and emalls) to
reach a large portion of the population at risk.
WORK
WHY THE WORK IS
RESULT OF THE
Broaden the warning and alert capability to TMS currently reaches 15% of the population. Increase the number of opt in TMS users through
backfill for limitations in local AM/FM broadcast public education, outreach, and incentive
1 capabilities. Increase the number of opt in TMS programs. The target goal is 20% of the
users through public education, outreach, and population.
incentive programs.
Program Area A4 00010
Expand EOC Team Development - Continued development of the EOC Incident Management Team and the City Coordination Center Team. The
objective of team development is professional development, program enhancement, sustainability (cross training) and whole community Integration
(involving a wider base of the community as volunteer team members).
WORK PLANNED WHY THE WORK IS BEING DONE RESULT OF THE WORK
Pursue an aggressive follow-up to the CRX lessons CRX identified a need to develop and conduct Continual recruitment and trainings for
learned; focus on identified action Items; develop training to further enhance team depth or a comprehensive EOC team development will
1 and conduct training to support recommended "reserve" team establish team depth by identifying and training a
Improvements "reserve" team.
Reconfiguration of the existing Emergency The CRX AAR identified problems with space Efficient re -alignment of the EOC team space
2 Operations Center utilization and allocation in the EOC. usage will enhance EOC coordination
Upgrade alternate Emergency Operation Center Alternate EOC's configuration is not optimal for Improved EOC configuration will:
(EOC) sustained emergency operations 1. Align with the primary EOC layout for efficiency
2. Make better use of space by installing
3 additional phone lines and computer terminal
ports
3. Better match improvements determined in CRX
program Area Any
Full NIMS compliance - Based on CRX, modify and enhance plans and procedures for augmentation of local capabilities by outside (extra -regional)
resources. Amend methods of adding essential resources through standing agreements, mutual aid, contractual agreements, etc. Plan surge capacity.
Tie resource development to NIMS resource management requirements where possible.
WORK PLANNED WHY THE WORK IS BEING DONE RESULT OF THE WORK
Use lessons learned from CRX to restructure CRX demonstrated a need to improve our Changing from Jefferson County specific resource
emergency operations coordination policies and resource ordering systems. ordering system to ICS Form 213 RR will improve
1 procedures to align with NIMS methodology. NIMS compliance and resource acquisition
efficiency.
DHS-FEMA-EMPG-FFY 16 Page 24 of 34 Jefferson, County of, E17-100
Exhibit D
TIMELINE
IFFY 2016 Emergency Management Performance Grant Program
DATE
TASK
June 1, 2016
Grant Agreement Start Date
January 30, 2017
Submit reimbursement request
April 30, 2017
Submit reimbursement request
October 15, 2017
Submit final reimbursement request, additional reports, and/or
deliverables.
DHS-FEMA-EMPG-FFY 16 Page 25 of 34 Jefferson, County of, E17-100
Exhibit E
BUDGET
FFY 2016 Emergency Management Performance Grant Program
16EMPG GRANT AWARD AMOUNT $18,000
SOLUTION
Salaries & Benefits
AREA
CATEGORY
0
Salaries & Benefits
Overtime/Backfill
2
Consultants/Contractors
Z
Consultants/Contractors
SGoods
& Services
Travel/Per Diem
Award AMOUNT
Match AMOUNT
$ 103,54
S _
Z
Salaries & Benefits
$ $ _
0
Overtime/Backfill
$ _ $ _
Consultants/Contractors
$ _ $ _
QGoods
& Services
$ $
W
Travel/Per Diem
$
Subtotal
$ $ _
Salaries & Benefits
$ - $ _
H
Overtime/Backfill
$ - $ _
0
Consultants/Contractors
$ _ $ _
X
Goods & Services
$ _ $ _
W
Travel/Per Diem
$ _ $ _
Subtotal
$ - $
Salaries & Benefits
$ _ $ _
Z
Overtime/Backfill
$ - $
Z
Consultants/Contractors
$ _ $ _
Goods & Services
$ _ $ _
~
Travel/Per Diem
$ _ $
Subtotal
$ - $ _
Eciuipment
$ _ $ _
Cr
Subtotal
$ - $
Salaries & Benefits
$ - $ _
Overtime/Backfill
$ _ $
ad
Consultants/Contractors
$ - $
Goods & Services
$ $ _
Travel/Per Diem
$ $ _
Subtotal
$ $
Indirect
0.00%
$
Grant Agreement AMOUNT:
$ 1103,548
tf�7TOTAL
• The Subrecipient will provide a match of at least $18,000, 50% of the total project cost (localttribal budget plus EMPG
award), of non-federal origin.
• Cumulative transfers to budget categories in excess of 10% of the grant agreement amount will not be reimbursed
without prior written authorization from the Department.
Funding Source: U.S. Department of Homeland Security - PI# 763PT — EMPG
DHS-FEMA-EMPG-FFY 16 Page 26 of 34 Jefferson, County of, E17-100
ATTACHMENT #1
Award better
U.S. Department of Homeland Security
Washington, D.C. 20472
Bret Daugherty
Washington Military Department
Building 20
Camp Murray, WA 98430 - 5122
Re: Grant No.EMS-2016-EP-00002
Dear Bret Daugherty:
Congratulations, on behalf of the Department of Homeland Security, your application for financial assistance submitted under
the Fiscal Year (FY) 2016 Emergency Management Performance Grants has been approved in the amount of $7,254,374.00.
As a condition of this award, you are required to contribute a cost match in the amount of $7,254,374.00 of non -Federal funds,
or 50 percent of the total approved project costs of $14,508,748.00.
Before you request and receive any of the Federal funds awarded to you, you must establish acceptance of the award. By
accepting this award, you acknowledge that the terms of the following documents are incorporated into the terms of your
award:
• Agreement Articles (attached to this Award Letter)
• Obligating Document (attached to this Award Letter)
• FY 2016 Emergency Management Performance Grants Notice of Funding Opportunity.
Please make sure you read, understand, and maintain a copy of these documents in your official file for this award.
In order to establish acceptance of the award and its terms, please follow these instructions:
Step 1: Please log in to the ND Grants system at httpsl/portal.fema.gov.
Step 2: After logging in, you will see the Home page with a Pending Tasks menu. Click on the Pending Tasks menu, select the
Application sub -menu, and then click the link for "Award Offer Review" tasks. This link will navigate you to Award Packages
that are pending review.
Step 3: Click the Review Award Package icon (wrench) to review the Award Package and accept or decline the award. Please
save or print the Award Package for your records.
System for Award Management (SAM): Grant recipients are to keep all of their information up to date in SAM, in particular,
your organization's name, address, DUNS number, EIN and banking information. Please ensure that the DUNS number used
in SAM is the same one used to apply for all FEMA awards. Future payments will be contingent on the information provided
in the SAM; therefore, it is imperative that the information is correct. The System for Award Management is located at b=
www.sam aov.
If you have any questions or have updated your information in SAM, please let your Grants Management Specialist (GMS)
know as soon as possible. This will help use to make the necessary updates and avoid any interruptions in the payment
process.
CHRISTINE JONIENTZ TRISLER
DHS-FEMA-EMPG-FFY 16 Page 27 of 34 Jefferson, County of, E17-100
Agreement Articles
Thu Oct 01 00:00:00 GMT 2015
ATTACHMENT #1
U.S. Department of Homeland Security
Washington, D.C. 20472
AGREEMENT ARTICLES
Emergency Management Performance Grants
GRANTEE: Washington Military Department
PROGRAM: Emergency Management Performance
Grants
AGREEMENT NUMBER: EMS -2016 -EP -00002-S01
TABLE OF CONTENTS
Article I
Use of DHS Seal, Logo and Flags
Article II
USA Patriot Act of 2001
Article III
Universal Identifier and System of Award Management
(SAM)
Article IV
Reporting of Matters Related to Recipient Integrity and
Performance
Article V
Rehabilitation Act of 1973
Article VI
Traff oldng Victims Protection Act of 2000
Article VII
Terrorist Financing
Article VIII
SAFECOM
Article IX
Reporting Subawards and Executive Compensation
Article X
Procurement of Recovered Materials
Article XI
Patents and Intellectual Property Rights
Article XII
Notice of Funding Opportunity Requirements
Article XIII
Non -supplanting Requirement
Article XIV
Lobbying Prohibitions
Article XV
Limited English Proficiency (Civil Rights Act of 1964, Title VI)
Article XVI
Hotel and Motel Fire Safety Act of 1990
Article XVI I
Fly America Act of 1974
Article XVIII
Best Practices for Collection and Use of Personally
Identifiable Information (PII)
Article XIX
Americans with Disabilities Act of 1990
Article XX
Age Discrimination Act of 1975
DHS-FEMA-EMPG-FFY 16 Page 28 of 34 Jefferson, County of, E17-100
Article XXI
Article XXI I
Article XXII I
Article XXIV
Article XXV
Article XXVI
Article XXVII
Article XXVIII
Article XXIX
Article XXX
Article XXXI
Article XXXII
Article XXXI II
Article XXXIV
Article XXXV
Article XXXVI
Article XXXVI I
Article XXXVIII
Article 1- Use of DHS Seal, Logo and Flags
ATTACHMENT #1
Activities Conducted Abroad
Acknowledgment of Federal Funding from DHS
Federal Leadership on Reducing Text Messaging while
Driving
Federal Debt Status
False Claims Act and Program Fraud Civil Remedies
Energy Policy and Conservation Act
Education Amendments of 1972 (Equal Opportunity in
Education Act) - Title IX
Duplication of Benefits
Drug -Free Workplace Regulations
Debarment and Suspension
Copyright
Civil Rights Act of 1968
Civil Rights Act of 1964 - Title VI
DHS Speck Acknowledgements and Assurances
Assurances, Administrative Requirements, Cost Principles,
and Audit Requirements
Whistleblower Protection Act
National Environmental Policy Act
Nondiscrimination in Matters Pertaining to Faith -based
Organizations
All recipients must obtain permission from their financial assistance office, prior to using the DHS seal(s), logos, crests or
reproductions of flags or likenesses of DHS agency officials, including use of the United States Coast Guard seal, logo, crests
or reproductions of flags or likenesses of Coast Guard officials.
Article II - USA Patriot Act of 2001
All recipients must comply with requirements of the Uniting and StrenQtboiM America by Providina Ag;EQg ate Tools
ftuired to Intercept and Obstruct Terrorism Act (USA PATRIOT Act), which amends 18 U.S.C. sections175 175c
Article 111- Universal Identifier and System of Award Management (SAM)
All recipients are required to comply with the requirements set forth in the government -wide Award Term regarding the System
for Award Management and Universal Identifier Requirements located at 2 C.F.R. Part 25 Appendix A„ the full text of which is
incorporated here by reference in the terms and conditions of your award.
Article IV - Reporting of Matters Related to Recipient Integrity and Performance
If the total value of your currently active grants, cooperative agreements, and procurement contracts from all Federal
assistance office exceeds $10,000,000 for any period of time during the period of performance of this Federal award, you
must comply with the requirements set forth in the government -wide Award Term and Condition for Recipient Integrity and
Performance Matters located at 2_C.F.R. Part 200. Appendix XII. the full text of which is incorporated here by reference in the
terms and conditions of your award
Article V - Rehabilitation Act of 1973
DHS-FEMA-EMPG-FFY 16 Page 29 of 34 Jefferson, County of, E17-100
ATTACHMENT #1
All recipients must comply with the requirements of Section 504 of the Rehabilitation Act of 1973, 29 U. S.C, section 794 as
amended, which provides that no otherwise qualified handicapped individual in the United States will, solely by reason of the
handicap, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or
activity receiving Federal financial assistance.
Article VI - Traffiddng Victims Protection Act of 2000
All recipients must comply with the requirements of the government -wide award term which implements Section 106(8) of the
Trafficking Victims Protection Act of 2000, (fVPA) as amended (22 U.S.C. section 7104). The award term is located at 2 CFR
section 17515, the full text of which is incorporated here by reference in the terms and conditions of your award.
Article VII - Terrorist Financing
All recipients must comply with E.O. 13224 and U.S. law that prohibit transactions with, and the provisions of resources
and support to, individuals and organizations associated with terrorism. It is the legal responsibility of recipients to ensure
compliance with the Order and laws.
Article VIII - SAFECOM
All recipients who receive awards made under programs that provide emergency communication equipment and its related
activities must comply with the SAFECOM Guidance for Emergency Communication Grants, including provisions on technical
standards that ensure and enhance interoperable communications.
Article IX - Reporting Subawards and Executive Compensation
All recipients are required to comply with the requirements set forth in the government -wide Award Term on Reporting
Subawards and Executive Compensation located at 2 C. F.R. Part 170. Appendix A the full text of which is incorporated here
by reference in the terms and conditions of your award.
Article X - Procurement of Recovered Materials
All recipients must comply with Section 6002 of the Solid Waste DistxW Act, as amended by the Resource ConseryatiM and
Recovery Act. The requirements of Section 6002 include procuring only items designated in guidelines of the Environmental
Protection Agency (EPA) at 40 C.F.R. Part 247 that contain the highest percentage of recovered materials practicable,
consistent with maintaining a satisfactory level of competition.
Article XI - Patents and Intellectual Property Rights
Unless otherwise provided by law, recipients are subject to the Bayh-Dole Act. Pub, L. No 96-517 as amended, and codified
in 35 U.S.C. section 200 et seq. All recipients are subject to the specific requirements governing the development, reporting,
and disposition of rights to inventions and patents resulting from financial assistance awards located at 37 C.F. R. Part 401 and
the standard patent rights clause located at 37 C.F.R. section 401.14.
Article XII - Notice of Funding Opportunity Requirements
All of the instructions, guidance, limitations, and other conditions set forth in the Notice of Funding Opportunity (NOFO) for this
program are incorporated here by reference in the terms and conditions of your award. All recipients must comply with any
such requirements set forth in the program NOFO.
Article XIII - Non -supplanting Requirement
All recipients who receive awards made under programs that prohibit supplanting by law must ensure that Federal funds do
not replace (supplant) funds that have been budgeted for the same purpose through non -Federal sources.
Article XIV - Lobbying Prohibitions
All recipients must comply with 31 U.S.C. section 1352, which provides that none of the funds provided under an award may
be expended by the recipient to pay any person to influence, or attempt 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 any
Federal action concerning the award or renewal.
Article XV - Limited English Proficiency (Civil Rights Act of 1864, Title VI)
DHS-FEMA-EMPG-FFY 16 Page 30 of 34 Jefferson, County of, E17-100
ATTACHMENT #1
All recipients must comply with the Title Vl of the Civil Rights Act of 1964 (Title VI) prohibition against discrimination on
the basis of national origin, which requires that recipients of federal financial assistance take reasonable steps to provide
meaningful access to persons with limited English proficiency (LEP) to their programs and services. For additional assistance
and information regarding language access obligations, please refer to the DHS Recipient Guidance httns:f/www.dhs,gov/
o idance-published-help-department-suWglted-oroanizations provide meaningful accessIle imited and additional
resources on httpJlwww.leD-gov.
Article XVI - Hotel and Motel Fire Safety Act of 1890
In accordance with Section 6 of the Hotel and Motel Fire Safety Act of 1990, 15 U.S.C. section 2225a_ all recipients must
ensure that all conference, meeting, convention, or training space funded in whole or in part with Federal funds complies with
the fire prevention and control guidelines of the Federal Fire Prevention and Control Act of 1974, as amended, 15 U• S•C.
section 2225.
Article XVII - Fly America Act of 1874
All recipients must comply with Preference for U.S. Flag Air Carriers: (air carriers holding certificates under 49 U.S.C.
section 41 1Q2) for international air transportation of people and property to the extent that such service is available, in
accordance with the International Air Transportation Fair Compeff6ve Practices Act of 1974 (49 U.S.0 section 40118) and
the interpretative guidelines issued by the Comptroller General of the United States in the March 31, 1981, amendment to
Comptroller General Decision &138942.
Article XVIII - Best Practices for Collection and Use of Personally Identifiable Information (PII)
DHS defines personally identifiable information (PII) as any information that permits the identity of an individual to be directly
or indirectly inferred, including any information that is linked or linkable to that individual. All recipients who collect PII are
required to have a publically-available privacy policy that describes standards on the usage and maintenance of PII they
collect. Award recipients may also find as a useful resource the DHS Privacy Impact Assessments: Privacy Guidance and
Privacy template respectively.
Article XIX - Americans with Disabilitles Act of 1990
All recipients must comply with the requirements of Titles I, 11, and I II of the Americans with Disabilities Act, which prohibits
recipients from discriminating on the basis of disability in the operation of public entities, public and private transportation
systems, places of public accommodation, and certain testing entities. (42t 1 S C sections 12101 122131.
Article XX - Age Discrimination Act of 1875
All recipients must comply with the requirements of the Age Discrimination Act of 1975 CTitle 42 U.S. Code section 6101 et
1..J,which prohibits discrimination on the basis of age in any program or activity receiving Federal financial assistance
Article XXI - Activities Conducted Abroad
All recipients must ensure that project activities carried on outside the United States are coordinated as necessary with
appropriate government authorities and that appropriate licenses, permits, or approvals are obtained.
Article XXII - Acknowledgment of Federal Funding from DHS
All recipients must acknowledge their use of federal funding when issuing statements, press releases, requests for proposals,
bid invitations, and other documents describing projects or programs funded in whole or in part with Federal funds
Article XXIII - Federal Leadership on Reducing Text Messaging while Driving
All recipients are encouraged to adopt and enforce policies that ban text messaging while driving as described in E -Q,
13513including conducting initiatives described in Section 3(a) of the Order when on official Government business or when
performing any work for or on behalf of the federal government.
Article XXIV - Federal Debt Status
All recipients are required to be non -delinquent in their repayment of any Federal debt. Examples of relevant debt include
delinquent payroll and other taxes, audit disallowances, and benefit overpayments. See OMB Circular A-129.
Article XXV - False Claims Act and Program Fraud Civil Remedies
DHS-FEMA-EMPG-FFY 16 Page 31 of 34 Jefferson, County of, E17-100
ATTACHMENT #1
All recipients must comply with the requirements of 31 U.S C. section 3729 - 3733 which prohibits the submission of false or
fraudulent claims for payment to the Federal Government. See 31 U,S.C. section 3801-3812 which details the administrative
remedies for false claims and statements made.
Article XXVI - Energy Policy and Conservation Act
All recipients must comply with the requirements of 42 U.8,0. taction 6201 which contain policies relating to energy efficiency
that are defined in the state energy conservation plan issued in compliance with this Act.
Article XXVII - Education Amendments of 1972 (Equal Opportunity in Education Act) - Title IX
All recipients must comply with the requirements of Title IX of the Education Amendments of 1972 (20 U, S.C. section 1681
.), which provide that no person in the United States will, on the basis of sex, be excluded from participation in, be
denied the benefits of, or be subjected to discrimination under any educational program or activity receiving Federal financial
assistance. DHS implementing regulations are coded at 6 C.F.R. Part 17 and 44 C.F.R.Part 19
Article XXVIII - Duplication of Benefits
Any cost allocable to a particular Federal award provided for in 2 C.F.R. Part 200 Subgart E may not be charged to other
Federal awards to overcome fund deficiencies, to avoid restrictions imposed by Federal statutes, regulations, or terms and
conditions of the Federal awards, or for other reasons. However, this prohibition would not preclude a recipient form shifting
costs that are allowable under two or more Federal awards in accordance with existing Federal statutes, regulations, or the
terms and conditions of the Federal award.
Article XXIX - Drug -Free Workplace Regulations
All recipients must comply with the Drug -Free Workplace Act of 1988 (41 U.S.C. section 701 of M.), which requires all
organizations receiving grants from any Federal agency agree to maintain a drug-free workplace. DHS has adopted the
Act's implementing regulations at 2-C.F.R Part 3001.
Article XXX - Debarment and Suspension
All recipients are subject to the non -procurement debarment and suspension regulations implementing Executive Orders
12549 and 12689. and 2 C.F.R. Part 180. These regulations restrict awards, subawards, and contracts with certain parties that
are debarred, suspended, or otherwise excluded from or ineligible for participation in federal assistance programs or activities.
Article XXXI - Copyright
All recipients must affix the applicable copyright notices of 17 U.S.C. sections 401 or 402 and an acknowledgement of
Government sponsorship (including award number) to any work first produced under Federal financial assistance awards.
Article XXXII - Civil Rights Act of 1968
All recipients must comply with Title VIII of the Civil Rights Act of 1968 which prohibits recipients from discriminating in
the sale, rental, financing, and advertising of dwellings, or in the provision of services in connection therewith, on the basis
of race, color, national origin, religion, disability, familial status, and sex (42 U.S.G. section 3601 et seg.), as implemented
by the Department of Housing and Urban Development at 24 C.F.R. Part 100. The prohibition on disability discrimination
includes the requirement that new multifamily housing with four or more dwelling units i.e., the public and common use areas
and individual apartment units (all units in buildings with elevators and ground -floor units in buildings without elevators) be
designed and constructed with certain accessible features (See 24 C.F.R. section 100 201).
Article XXXIII - Civil Rights Act of 1964 - Title VI
All recipients must comply with the requirements of Title VI of the Civil Rights Act of 9964 (42 i tion 2000d et
which provides that no person in the United States will, on the grounds of race, color, or national origin, be excluded from
participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal
financial assistance. DHS implementing regulations for the Act are found at 6 C.F. R. Part 21 and 44 CFR Part 7.
Article XXXIV - DHS Specific Acknowledgements and Assurances
All recipients, sub -recipients, successors, transferees, and assignees must acknowledge and agree to comply with applicable
provisions governing DHS access to records, accounts, documents, information, facilities, and staff.
DHS-FEMA-EMPG-FFY 16 Page 32 of 34 Jefferson, County of, E17-100
ATTACHMENT #1
1. Recipients must cooperate with any compliance reviews or compliance investigations conducted by DHS
2. Recipients must give DHS access to, and the right to examine and copy, records, accounts, and other documents and
sources of information related to the award and permit access to facilities, personnel, and other individuals and information as
may be necessary, as required by DHS regulations and other applicable laws or program guidance.
3. Recipients must submit timely, complete, and accurate reports to the appropriate DHS officials and maintain appropriate
backup documentation to support the reports.
4. Recipients must comply with all other special reporting, data collection, and evaluation requirements, as prescribed by law
or detailed in program guidance.
5. If, during the past three years, the recipient has been accused of discrimination on the grounds of race, color, national
origin (including limited English proficiency), sex, age, disability, religion, or familial status, the recipient must provide a list
of all such proceedings, pending or completed, including outcome and copies of settlement agreements to the DHS financial
assistance office and the DHS Office of Civil Rights and Civil Liberties (CRCL) by a -mail at crcl hq dhs aov or by mail at U.S.
Department of Homeland Security Office for Civil Rights and Civil Liberties Building 410, Mail Stop #0190 Washington, D. C.
20528.
6. In the event any court or administrative agency makes a finding of discrimination on grounds of race, color, national origin
(including limited English proficiency), sex, age, disability, religion, or familial status against the recipient, or the recipient
settles a case or matter alleging such discrimination, recipients must forward a copy of the complaint and findings to the DHS
financial assistance office and the CRCL office by a -mail or mail at the addresses listed above.
The United States has the right to seek judicial enforcement of these obligations.
Article XXXV - Assurances, Administrative Requirements, Cost Principles, and Audit Requirements
DHS financial assistance recipients must complete either the OMB Standard Form 4248 Assurances - Non-Canstruction
Programs or OMB Standard Form 4240 Assurances - Construction Programs as applicable. Certain assurances in these
documents may not be applicable to your program, and the DHS financial assistance office may require applicants to certify
additional assurances. Applicants are required to fill out the assurances applicable to their program as instructed by the
awarding agency. Please contact the financial assistance office if you have any questions.
DHS financial assistance recipients are required to follow the applicable provisions of the Uniform Administrative
Requirements, Cost Principles, and Audit Requirements for Federal Awards located at 2 C.F.R. Part 200. and adopted by
DHS at 2_C.F.R. Part 3002.
Article XXXVI - Whistleblower Protection Act
All recipients must comply with the statutory requirements for whistleblower protections (if applicable) at 10 U,S,C section
2N2, 41 U.S.C. 4712. and 10 U.S.G. section 2324 41 U.S.C. sections 4304 andQ.
Article XXXVII - National Environmental Policy Act
All recipients must comply with the requirements of the National Environmental PolicyAct (NEPA) and the Council on
Environmental Quality (CEQ) Regulations for Implementing the Procedural Provisions of NEPA, which requires recipients to
use all practicable means within their authority, and consistent with other essential considerations of national policy, to create
and maintain conditions under which people and nature can exist in productive harmony and fulfill the social, economic, and
other needs of present and future generations of Americans.
Article XXXVIII - Nondiscrimination in Matters Pertaining to Faith -based Organizations
Faith -based organizations are, under 6 C.F.R. Part 19, afforded certain protections as it relates to eligibility to receive financial
assistance from DHS for social service programs, or to participate in social service programs administered or financed by
DHS. Organizations that receive financial assistance from DHS for a social service program or participate in DHS social
service programs have an obligation to comply with the equal treatment policies and requirements contained in 6 C.F.R. Part
19, which, among other provisions, prohibit recipient organizations from discriminating against beneficiaries on the basis
of religion or religious belief, a refusal to hold a religious belief, or a refusal to attend or participate in a religious practice;
and generally require recipients subject to the rule to provide certain protections, and notice of those protections, to their
beneficiaries. Recipients must also comply with any other policies and procedures regarding the participation of faith -based
organizations contained in applicable statutes, regulations, and guidance governing individual DHS programs.
DHS-FEMA-EMPG-FFY 16 Page 33 of 34 Jefferson, County of, E17-100
ATTACHMENT #1
Obligating Document for Award/Amen ment
1a. AGREEMENT NO.
EMS -2016 -EP -00002-S01
2. 3. RECIPIENT NO.
AMENDMEN1916001095G
4. TYPE OF 5. CONTROL NO.
NO.
ACTION FY2016R10EMPG
AWARD
6. RECIPIENT NAME AND
7. ISSUING FEMA OFFICE AND
8. PAYMENT OFFICE AND ADDRESS
ADDRESS
ADDRESS
Financial Services Branch
Washington Military
Grant Operations
500 C Street, S.W., Room 723
Department
245 Murray Lane - Building 410, SW
Washington DC, 20472
Building 20
Washington DC, 20528-7000
Camp Murray, WA, 98430 -
POC: 866-927-5646
5122
9. NAME OF RECIPIENT
PHONE NO. 10. NAME OF FEMA PROJECT COORDINATOR
PROJECT OFFICER
253-512-7121 Central Scheduling and Information Desk
Sierra Wardell
Phone: 800-368-6498
Email: Askcsid@dhs.gov
11. EFFECTIVE DATE OF
12. 13. ASSISTANCE ARRANGEMENT 14. PERFORMANCE PERIOD
THIS ACTION
METHOD Cost Reimbursement
10/01/2015
OF
Prom: To:
PAYMENT
10/01 /2015 09430/2017
PARS
Budget Period
10/01/2015 09430/2017
15. DESCRIPTION OF ACTION
a. (Indicate funding data for awards or financial changes)
PROGRAM CFDA NO.
NAME
ACRONYM
Emergency 97.042
Management
Performance
Grants
ACCOUNTING DATA PRIOR
(ACCS CODE) TOTAL
XXJCX -XXX XXXXXX- AWARD
XXXXX-XXXX XXXX X
AMOUNT CURRENT
AWARDED TOTAL
THIS AWARD
ACTION
+ OR (-)
2016 -EM Dl l l -R107- $0.00 $7,254,374.00 $7,254,374.00
-4101-D
TOTALS $0.00 $7,254,374.00 $7,254,374.00
b. To describe changes other than funding data or financial changes, attach schedule and check here.
N/A
CUMULATIVE NON-
FEDERAL COMMITMENT
See Totals
$7,254,374.00
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)
Emergency Management Performance Grants recipients are not required to sign and return 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)
Sierra Wardell, Preparedness Grants Section Program Manager
18. FEMA SIGNATORY OFFICIAL (Name and Title)
KIMBERLY PENFOLD ,
DATE
Wed Aug 24 15:24:50 GMT
2016
DATE
Wed Aug 1017:43:17 GMT
2016
DHS-FEMA-EMPG-FFY 16 Page 34 of 34 Jefferson, County of, E17-100
2 CFR Part 200 Subpart F Audit Certification Form
Audits of States, Local Governments, Indian Tribes, and Non -Profit Oraanizatinnc
Contact Information
Subrecipient Name (Agency, Local Government, or organization): Jefferson Co. Dept. of Emergency Management
Authorized Chief Financial Officer (central accounting office):
Address:
Email: Phone #:
Purpose: As a pass-through entity of federal grant funds, the Washington Military Department/Emergency Management Division (Department)
is required by 2 CFR Part 200 Subpart F to monitor activities of subrecipients to ensure federal awards are used for authorized purposes and
verify that subrecipients expending $750,000 or more in federal awards during their fiscal year have met the 2 CFR Part 200 Subpart F Audit
Requirements. Your entity is a subrecipient subject to such monitoring by MIUEMD because it is a non-federal entity that expends federal grant
funds received from the Department as a pass-through entity to carry out a federal program. 2 CFR Part 200 Subpart F should be consulted
when completing this form.
Directions: As required by 2 CFR Part 200 Subpart F, non-federal entities that expend $750,000 in federal awards in a fiscal year shall have
a single or program -specific audit conducted for that year. If your entity is not subject to these requirements, you must complete Section A of
this Form. If your entity is subject to these requirements, you must complete Section B of this form. When completed, you must sign, date,
and return this form with your grant agreement and every fiscal year thereafter until the grant agreement is dosed. Failure to return this
completed Audit Certification Form may result in delay of grant agreement processing, withholding of federal awards or disallowance of costs,
and suspension or termination of federal awards.
SECTION A: Entffles NOT su ect to the audit re-au—imments of 2 CFR Part 200 SubpartF
Our entity is not subject to the requirements of 2 CFR Part 200 Subpart F because (check all that apply):
❑ We did not expend $750,000 or more of total federal awards during the fiscal year.
❑ We are a for-profit agency.
❑ We are exempt for other reasons (describe):
However, by signing below, I agree that we are still subject to the audit requirements, laws and regulations governing the program(s) in
which we participate, that we are required to maintain records of federal funding and to provide access to such records by federal and state
agencies and their designees, and that WMD/EMD may request and be provided access to additional information and/or documentation to
ensure proper stewardship of federal funds.
SECTION B: Entities that ARE subject to the audit requirements of 1 CFR Part 200 Subpart F
(Complete the information below and check the appropriate box
❑ We completed our last 2 CFR Part 200 Subpart F Audit on [enter date] for Fiscal Year ending [enter date] . There
were no findings related to federal awards from WMD/EMD. No follow-up action is required by WMD/EMD as the pass-through entity.
A complete copy of the audit report, which includes exceptions, corrective action plan and management response, is
either provided electronically to contracts.office0mil.wa.uov or provide the state auditor report number:
❑ We completed our last 2 CFR Part 200 Subpart F Audit on [enter date] for Fiscal Year ending [enter date] . There
were findings related to federal awards.
A complete copy of the audit report, which includes exceptions, corrective action plan and management response, is either
provided electronically to contracts.office0mil.wa.aov or provide the state auditor report number:
❑ Our completed 2 CFR Part 200 Subpart F Audit will be available on [enter date] for Fiscal Year ending
_enter date]. We will provide electronic copy of the audit report to contracts.offlceRmil.wa.00v at that tirtrt�r
provide the state auditor report number: ... -**
F wo!
I hereby certify that I am an individual authorized by the above identified entity to complete thW*for*h: ,'Fur�ki@r, 114 at the
above information is true and correct and all relevant material findings contained in audit repoljistatelme be0 losed.
Additionally, I understand this Form is to be submitted every fiscal year for which this entrty.rs:a pign4 of federal award
funds from the Department until the grant agreement is closed.
Signature of Authorized Chief Financial Officer:
Print Name & Title: R.W.Hamiin, DEM Program Director
WMD Form 1009-13, 8/192013, Updated 9/92015
Washington Military Department Contract Number: E17-100
Debarment, Suspension, Ineligibility or Voluntary Exclusion Certification Form
Jefferson County Department of Emergency Management
ADDRESS
81 Elkins Road.
Port Hadlock, WA 98339
Applicable Procurement
or Solicitation #, if any:
Doing business as (DBA)
WA Uniform Business Federal Employer Tax
Identifier (UBI) I Identification #:
This certification is submitted as part of a request to
Instructions For Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion --Lower
Tier Covered Transactions
READ CAREFULLY BEFORE SIGNING THE CERTIFICATION. Federal regulations require contractors and bidders to sign and
abide by the terms of this certification, without modification, in order to participate in certain transactions directly or
Indirectly involving federal funds.
1. By signing and submitting this proposal, the prospective lower tier participant is providing the certification set out
below.
2. The certification in this clause is a material representation of fact upon which reliance was placed when this
transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an
erroneous certification, in addition to other remedies available to the Federal Government the department or agency
with which this transaction originated may pursue available remedies, including suspension and/or debarment.
3. The prospective lower tier participant shall provide immediate written notice to the department, institution or office to
which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was
erroneous when submitted or had become erroneous by reason of changed circumstances.
4. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person,
primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meaning
set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the
person to which this proposal is submitted for assistance in obtaining a copy of those regulations.
5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered
transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is
proposed for debarment under the applicable CFR, debarred, suspended, declared ineligible, or voluntarily excluded
from participation in this covered transaction, unless authorized by the department or agency with which this
transaction originated.
6. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled
"Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered
Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered
transactions.
7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered
transaction that it is not proposed for debarment under applicable CFR, debarred, suspended, ineligible, or voluntarily
excluded from covered transactions, unless it knows that the certification is erroneous. A participant may decide the
method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required
to, check the List of Parties Excluded from Federal Procurement and Non -procurement Programs.
8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to
render in good faith the certification required by this clause. The knowledge and information of a participant is not
required to exceed that which is normally possessed by a prudent person in the ordinary course of business activity.
9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction
knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under applicable
CFR, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other
remedies available to the Federal Government, the department or agency with which this transaction originated may
pursue available remedies, including suspension and/or debarment.
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion --Lower Tier
Covered Transactions
The prospective lower tier participant certifies, by submission of this proposal or contract, that neither it nor its
principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded
from participation in this transaction by any Federal department or agency. Where the prospective lower tier
participant is unable to certify to any of the statements in this certification, such prospective participant shall
attach an explanation to this form.
Bidder or Contractor Signature:
Print Name and Title: RX. Hamlin, Director, DEM Program Manager
Date:
Washington Military Department Contract Number: E17-100
FEDERAL DEBARMENT, SUSPENSION
INELIGIBILITY and VOLUNTARY EXCLUSION
(FREQUENTLY ASKED QUESTIONS)
What is "Debarment. Suspension Ineligibility, and Voluntary Exclusion"?
These terms refer to the status of a person or company that cannot contract with or receive grants from a federal agency.
In order to be debarred, suspended, ineligible, or voluntarily excluded, you must have:
• had a contract or grant with a federal agency, and
• gone through some process where the federal agency notified or attempted to notify you that you could not contract
with the federal agency.
• Generally, this process occurs where you, the contractor, are not qualified or are not adequately performing under a
contract, or have violated a regulation or law pertaining to the contract.
Why am I required to sign this certification?
You are requesting a contract or grant with the Washington Military Department. Federal law (Executive Order 12549)
requires Washington Military Department ensure that persons or companies that contract with Washington Military
Department are not prohibited from having federal contracts.
What is Executive Order 12549?
Executive Order 12549 refers to Federal Executive Order Number 12549. The executive order was signed by the
President and directed federal agencies to ensure that federal agencies, and any state or other agency receiving federal
funds were not contracting or awarding grants to persons, organizations, or companies who have been excluded from
participating in federal contracts or grants. Federal agencies have codified this requirement in their individual agency
Code of Federal Regulations (CFRs).
What is the purpose of this certification?
The purpose of the certification is for you to tell Washington Military Department in writing that you have not been
prohibited by federal agencies from entering into a federal contract.
What does the word "proposal" mean when referred to in this certification?
Proposal means a solicited or unsolicited bid, application, request, invitation to consider or similar communication from
you to Washington Military Department.
What or who is a "lower tier participant"?
Lower tier participants means a person or organization that submits a proposal, enters into contracts with, or receives a
grant from Washington Military Department, OR any subcontractor of a contract with Washington Military Department. If
you hire subcontractors, you should require them to sign a certification and keep it with your subcontract.
What is a covered transaction when referred to in this certification?
Covered Transaction means a contract, oral or written agreement, grant, or any other arrangement where you contract
with or receive money from Washington Military Department. Covered Transaction does not include mandatory
entitlements and individual benefits.
Sample Debarment, Suspension, Ineligibility, Voluntary Exclusion Contract Provision
Debarment Certification. The Contractor certifies that the Contractor is not presently debarred, suspended,
proposed for debarment, declared ineligible, or voluntarily excluded from participating in this Contract by any
Federal department or agency. If requested by Washington Military Department, the Contractor shall complete
a Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion form. Any such form
completed by the Contractor for this Contract shall be incorporated into this Contract by reference.
FFATA FORM
Subrecipient Agency: Jefferson County Department of Emergency Manaqement
Grant and Year: EMPG FFY 16
Completed
by:(Bob) R.W. gob Hamlin
Date Completed:
Is your grant agreement less than $25,000?
In your preceding fiscal year, did your
organization receive 80% or more of its annual
gross revenues from federal funding?
In your preceding fiscal year, did your
organization receive $25,000,000 or more in
federal funding?
Does the public have access to information about
the total compensation* of senior executives in
your organization?
Agreement Number: E17-100
DEM Program Director 360 385-9368
YES STOP, no further NO
analysis needed,GO to Step 2
n
GO to Step 6 I 1
YES NO STOP, no further
1:1
GO to STEP 3 analysis needed, GO to
7 Step 6
YES
NO STOPno further
1:1GO to STEP 4IZI analysis needed, GO to
Step 6,
YES STOP, no further NO
❑ analysis needed,❑ GO to STEP 5
GO to step 6
Executive #1
Name:
Total Compensation amount:
$
Executive #2
Name:
Total Compensation amount:
$
Executive #3
Name:
Total Compensation amount:
$
Executive #4
Name:
Total Compensation amount:
$
Executive #5 1
jA
Name:
Total Compensation amount:
$
If your organization does not meet these criteria, specifically identify below each critgri;4 t i met for your
organization: For Example: "Our organization received less than $25,000." 9
Signature: : Date
* Total compensation refers to:
• Salary and bonuses
• Awards of stock, stock options, and stock appreciation rights
• Other compensation including, but not limited to, severance and termination payments
• Life insurance value paid on behalf of the employee
Additional Resources:
hftp://www.whitehouse.gov/omb/open
http:/Avww.hrsa.gov/grants/ffata html
hftp://www.qi)Q-qovtfdsys/pkq/FR-2010-09-14/odf/2010-22705.pdf
hftp://www.grants.gov/
Page 1 of 3
FFATA PROVISIONS AND INSTRUCTIONS
For Compliance With The
Federal Funding Accountability and Transparency Act of 2006 (P.L. 109-282) (FFATA)
The Federal Funding Accountability and Transparency Act (FFATA) was signed on September
26, 2006. The FFATA legislation requires information on federal awards (federal financial
assistance and expenditures) be made available to the public via a single, searchable website.
Federal awards include grants, subgrants, loans, awards, cooperative agreements and other
forms of financial assistance as well as contracts, subcontracts, purchase orders, task orders,
and delivery orders. The legislation does not require inclusion of individual transactions below
$25,000 or credit card transactions before October 1, 2008. However, if an award is initially
below this amount yet later increased, the act is triggered. Due to this variability in compliance
Subrecipients are required by the Military Department to be familiar with the FFATA
requirements and complete this Worksheet for each contract for the State's submission in to
the FFATA portal.
ADDITIONAL PROVISIONS
This contract (subaward) is supported by federal funds, requiring compliance with the Federal
Funding Accountability and Transparency Act (FFATA or the Transparency Act) and Office
of Management and Budget Guidance (OMB). Public Law 109-282 as amended by section
6202(a) of Public Law 110-252 (see 31 U.S.C. 6101 note). By entering into this contract,
contractor agrees to provide all applicable reporting information to the Washington Military
Department (WMD) required by FFATA and OMB Guidance.
The FFATA requires the OMB to establish a publicly available online database
(USASpending.gov) containing information about entities that are awarded Federal grants,
loans, and contracts. As required by FFATA and OMB Guidance, certain information on the
first-tier subawards related to Federal contracts and grants, and the executive compensation of
awardees, must be made publicly available.
For new Federal grants beginning October 1, 2010, if the initial subaward is equal to or greater
than $25,000, reporting of the subaward and executive compensation information is required.
If the initial subaward is below $25,000 but subsequent grant modifications result in a total
subaward equal to or over $25,000, the subaward will be subject to the reporting requirements
as of the date the subaward exceeds $25,000. If the initial subaward equals or exceeds $25,000
but funding is subsequently de -obligated such that the total award amount falls below $25,000,
the subaward continues to be subject to the reporting requirements of the Transparency Act
and OMB Guidance.
As a Federal grant subawardee under this contract, your organization is required by FFATA,
OMB Guidance and this contract to provide the WMD, as the prime grant awardee, all
information required for FFATA compliant reporting by WMD. This includes all applicable
subawardee entity information required by FFATA and OMB Guidance, subawardee DUNS
number, and relevant executive compensation data, as applicable.
Page 2 of 3
Data about your organization will be provided to USASpending.gov by the WMD. System for
Award Management (SAM) is a government wide registration system for organizations that
do business with the Federal Government. SAM stores information about awardees including
financial account information for payment purposes and a link to D&B for maintaining current
DUNS information, www.sam.gov. WMD requires SAM registration and annual renewal by
your organization to minimize unnecessary data entry and re-entry required by both WMD and
your organization. It will also reduce the potential of inconsistent or inaccurate data entry.
Your organization must have a Data Universal Numbering System (DUNS) number obtained
from the firm Dun and Bradstreet (D&B) (www.dnb.com). A DUNS number provides a
method to verify data about your organization. D&B is responsible for maintaining unique
identifiers and organizational linkages on behalf of the Federal Government for organizations
receiving Federal assistance.
The WMD, as the prime awardee, is required by FFATA to report names and total
compensation of the five (5) most highly compensated officers of your organization (as the
subawardee) if:
Your organization (the subawardee), in the preceding fiscal year, received 80 percent or more
of its annual gross revenues from Federal awards and $25,000,000 or more in annual gross
revenues from Federal awards; and
The public does not have access to this information about the compensation of the senior
executives of your organization through periodic reports filed under section 13(a) or 15(d) of
the Securities and Exchange Act of 1934 (15 U.S.C. §§ 78m(a), 78o(d) or section 6104 of the
Internal Revenue Code of 1986.
"Total compensation" for purposes of this requirement generally means the cash and non-cash
value earned by the executive during the past fiscal year and includes salary and bonus; awards
of stock, stock options and stock appreciation rights; and other compensation such as severance
and termination payments, and value of life insurance paid on behalf of the employee, and as
otherwise provided by FFATA and applicable OMB guidance.
If (1) in the preceding fiscal year your organization received 80 percent or more of its annual
gross revenues from Federal awards and $25,000,000 or more in annual gross revenues from
Federal awards, and (2) the public does not have access to this information about the
compensation of the senior executives of your organization through periodic reports filed under
section 13(a) or 15(d) of the Securities and Exchange Act of 1934 (15 U.S.C. §§ 78m(a), 78o(d)
or section 6104 of the Internal Revenue Code of 1986, insert the names and total compensation
for the five most highly compensated officers of your organization in the table below.
Page 3 of 3
Form
WMV
Request for Taxpayer
applicable, you are also certifying that as a U.S. person, your allocable share of
Give Form to the
(Rev. December 2014)
Department
Identification Number and Certification
4. Certify that FATCA code(s) entered on this form (if any) indicating that you are
requester. Do not
of the Treasury
Internal Revenue Service
• Form 1099-S (proceeds from real estate transactions)
page 2 for further information.
send to the IRS.
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
N
2 Business name/disregarded entity name, if different from above
W
is
m
CL
3 Check appropriate box for federal tax classification; check only one of the following seven boxes:
4 Exemptions (codes apply only to
Q)
C
p p ❑ C Corporation ❑ S Corporation
El Individual/sole proprietor or p ❑ Trust/estate
p ❑ Partnership
ie -member LLC
certain entities, not individuals; see
instructions on page 3):
�. V
L
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) Do -`p
Exempt payee code (if any)
Note. For a single -member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for
Exemption from FATCA reporting
e c
the tax classification of the single -member owner.
code (if any)
r1p j
ElOther (see instructions) ►
(Aoplies to accounts maintained outside the U.S.)
5 Address (number, street, and apt. or suite no.)
Requester's name and
address (optional)
6 City, state, and ZIP code
m
rn
7 List account number(s) here (optional)
I aApdyer iueriUTlcaxion Numoer i i iN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number
backup withholding. For individuals, this is generally your social security number (SSN). However, fora— m _
resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a FM
TIN on page 3, or
Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for Employer identification number
guidelines on whose number to enter. r --T-1
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. 1 am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage
interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and
generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the
instructions on Daae 3.
Sign I Signature of
Here U.S. person ► Date Do -
General
General Instructions
Section references are to the Internal Revenue Code unless otherwise noted.
Future developments. Information about developments affecting Form W-9 (such
as legislation enacted after we release it) is at www.irs.gov/fw9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an information
return with the IRS must obtain your correct taxpayer identification number (TIN)
which may be your social security number (SSN), individual taxpayer identification
number (ITIN), adoption taxpayer identification number (ATIN), or employer
identification number (EIN), to report on an information return the amount paid to
you, or other amount reportable on an information return. Examples of information
returns include, but are not limited to, the following:
• Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T
(tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident alien), to
provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might be subject
to backup withholding. See What is backup withholding? on page 2.
By signing the filled -out form, you:
1. Certify that the TIN you are giving is correct (or you are wafting for a number
to be issued),
2. Certify that you are not subject to backup withholding, or
• Form 1099 -INT (interest earned or paid)
3. Claim exemption from backup withholding if you are a U.S. exempt payee. If
• Form 1099 -DIV (dividends, including those from stocks or mutual funds)
applicable, you are also certifying that as a U.S. person, your allocable share of
• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)
any partnership income from a U.S. trade or business is not subject to the
withholding tax on foreign partners' share of effectively connected income, and
• Form 1099-B (stock or mutual fund sales and certain other transactions by
4. Certify that FATCA code(s) entered on this form (if any) indicating that you are
brokers)
exempt from the FATCA reporting, is correct. See What is FATCA reporting? on
• Form 1099-S (proceeds from real estate transactions)
page 2 for further information.
• Form 1099-K (merchant card and third party network transactions)
Cat. No. 10231X Form W-9 (Rev. 12-2014)
Form W-9 (Rev. 12-2014)
Page 2
Note. If you are a U.S. person and a requester gives you a form other than Form
W-9 to request your TIN, you must use the requester's form if it is substantially
similar to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are considered a U.S.
person if you are:
• An individual who is a U.S. citizen or U.S. resident alien;
• A partnership, corporation, company, or association created or organized in the
United States or under the laws of the United States;
• An estate (other than a foreign estate); or
• A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or business in
the United States are generally required to pay a withholding tax under section
1446 on any foreign partners' share of effectively connected taxable income from
such business. Further, in certain cases where a Form W-9 has not been received,
the rules under section 1446 require a partnership to presume that a partner is a
foreign person, and pay the section 1446 withholding tax. Therefore, if you are a
U.S. person that is a partner in a partnership conducting a trade or business in the
United States, provide Form W-9 to the partnership to establish your U.S. status
and avoid section 1446 withholding on your share of partnership income.
In the cases below, the following person must give Form W-9 to the partnership
for purposes of establishing its U.S. status and avoiding withholding on its
allocable share of net income from the partnership conducting a trade or business
in the United States:
• In the case of a disregarded entity with a U.S. owner, the U.S. owner of the
disregarded entity and not the entity;
• In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally,
the U.S. grantor or other U.S. owner of the grantor trust and not the trust; and
• In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a
grantor trust) and not the beneficiaries of the trust.
Foreign person. If you are a foreign person or the U.S. branch of a foreign bank
that has elected to be treated as a U.S. person, do not use Form W-9. Instead, use
the appropriate Form W-8 or Form 8233 (see Publication 515, Withholding of Tax
on Nonresident Aliens and Foreign Entities).
Nonresident alien who becomes a resident alien. Generally, only a nonresident
alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on
certain types of income. However, most tax treaties contain a provision known as
a "saving clause." Exceptions specified in the saving clause may permit an
exemption from tax to continue for certain types of income even after the payee
has otherwise become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception contained in the
saving clause of a tax treaty to claim an exemption from U.S. tax on certain types
of income, you must attach a statement to Form W-9 that specifies the following
five items:
1. The treaty country. Generally, this must be the same treaty under which you
claimed exemption from tax as a nonresident alien.
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that contains the saving
clause and its exceptions.
4. The type and amount of income that qualifies for the exemption from tax.
5. Sufficient facts to justify the exemption from tax under the terms of the treaty
article.
Example. Article 20 of the U.S.-China income tax treaty allows an exemption
from tax for scholarship income received by a Chinese student temporarily present
in the United States. Under U.S. law, this student will become a resident alien for
tax purposes if his or her stay in the United States exceeds 5 calendar years.
However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30,
1984) allows the provisions of Article 20 to continue to apply even after the
Chinese student becomes a resident alien of the United States. A Chinese student
who qualifies for this exception (under paragraph 2 of the first protocol) and is
relying on this exception to claim an exemption from tax on his or her scholarship
or fellowship income would attach to Form W-9 a statement that includes the
information described above to support that exemption.
If you are a nonresident alien or a foreign entity, give the requester the
appropriate completed Form W-8 or Form 8233.
Backup Withholding
What is backup withholding? Persons making certain payments to you must
under certain conditions withhold and pay to the IRS 28% of such payments. This
is called "backup withholding." Payments that may be subject to backup
withholding include interest, tax-exempt interest, dividends, broker and barter
exchange transactions, rents, royalties, nonemployee pay, payments made in
settlement of payment card and third party network transactions, and certain
payments from fishing boat operators. Real estate transactions are not subject to
backup withholding.
You will not be subject to backup withholding on payments you receive if you
give the requester your correct TIN, make the proper certifications, and report all
your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding if:
1. You do not furnish your TIN to the requester,
2. You do not certify your TIN when required (see the Part II instructions on page
3 for details),
The IRS tells the requester that you furnished an incorrect TIN,
4. The IRS tells you that you are subject to backup withholding because you did
not report all your interest and dividends on your tax return (for reportable interest
and dividends only), or
5. You do not certify to the requester that you are not subject to backup
withholding under 4 above (for reportable interest and dividend accounts opened
after 1983 only).
Certain payees and payments are exempt from backup withholding. See Exempt
payee code on page 3 and the separate Instructions for the Requester of Form
W-9 for more information.
Also see Special rules for partnerships above.
What is FATCA reporting?
The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign
financial institution to report all United States account holders that are specified
United States persons. Certain payees are exempt from FATCA reporting. See
Exemption from FATCA reporting code on page 3 and the Instructions for the
Requester of Form W-9 for more information.
Updating Your Information
You must provide updated information to any person to whom you claimed to be
an exempt payee if you are no longer an exempt payee and anticipate receiving
reportable payments in the future from this person. For example, you may need to
provide updated information if you are a C corporation that elects to be an S
corporation, or if you no longer are tax exempt. In addition, you must furnish a new
Form W-9 if the name or TIN changes for the account; for example, if the grantor
of a grantor trust dies.
Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are
subject to a penalty of $50 for each such failure unless your failure is due to
reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. if you make a
false statement with no reasonable basis that results in no backup withholding,
you are subject to a $500 penalty,
Criminal penalty for falsifying information. Willfully falsifying certifications or
affirmations may subject you to criminal penalties including fines and/or
imprisonment.
Misuse of TINs. If the requester discloses or uses TINs in violation of federal law,
the requester may be subject to civil and criminal penalties.
Specific Instructions
Line 1
You must enter one of the following on this line; do not leave this line blank. The
name should match the name on your tax return.
If this Form W-9 is for a joint account, list first, and then circle, the name of the
person or entity whose number you entered in Part I of Form W-9.
a. Individual. Generally, enter the name shown on your tax return. If you have
changed your last name without informing the Social Security Administration (SSA)
of the name change, enter your first name, the last name as shown on your social
security card, and your new last name.
Note. [TIN applicant: Enter your individual name as it was entered on your Form
W-7 application, line 1a. This should also be the same as the name you entered on
the Form 1040/1040A/1040EZ you filed with your application.
b. Sole proprietor or single -member LLC. Enter your individual name as
shown on your 1040/1040A/1040EZ on line 1. You may enter your business, trade,
or "doing business as" (DBA) name on line 2.
c. Partnership, LLC that is not a single -member LLC, C Corporation, or S
Corporation. Enter the entity's name as shown on the entity's tax return on line 1
and any business, trade, or DBA name on line 2.
d. Other entities. Enter your name as shown on required U.S. federal tax
documents on line 1. This name should match the name shown on the charter or
other legal document creating the entity. You may enter any business, trade, or
DBA name on line 2.
e. Disregarded entity. For U.S. federal tax purposes, an entity that is
disregarded as an entity separate from its owner is treated as a "disregarded
entity." See Regulations section 301.7701-2(c)(2)(iii). Enter the owner's name on
line 1. The name of the entity entered on line 1 should never be a disregarded
entity. The name on line 1 should be the name shown on the income tax return on
which the income should be reported. For example, if a foreign LLC that is treated
as a disregarded entity for U.S. federal tax purposes has a single owner that is a
U.S. person, the U.S. owner's name is required to be provided on line 1. If the
direct owner of the entity is also a disregarded entity, enter the first owner that is
not disregarded for federal tax purposes. Enter the disregarded entity's name on
line 2, "Business name/disregarded entity name." If the owner of the disregarded
entity is a foreign person, the owner must complete an appropriate Form W-8
instead of a Form W-9. This is the case even if the foreign person has a U.S. TIN.
Form W-9 (Rev. 12-2014)
Line 2
If you have a business name, trade name, DBA name, or disregarded entity name,
you may enter it on line 2.
Line 3
Check the appropriate box in line 3 for the U.S. federal tax classification of the
person whose name is entered on line 1. Check only one box in line 3.
Limited Liability Company (LLC). If the name on line 1 is an LLC treated as a
partnership for U.S. federal tax purposes, check the "Limited Liability Company"
box and enter "P" in the space provided. If the LLC has filed Form 8832 or 2553 to
be taxed as a corporation, check the "Limited Liability Company" box and in the
space provided enter "C" for C corporation or "S" for S corporation. If it is a
single -member LLC that is a disregarded entity, do not check the "Limited Liability
Company" box; instead check the first box in line 3 "Individual/sole proprietor or
single -member LLC."
Line 4, Exemptions
If you are exempt from backup withholding and/or FATCA reporting, enter in the
appropriate space in line 4 any code(s) that may apply to you.
Exempt payee code.
• Generally, individuals (including sole proprietors) are not exempt from backup
withholding.
• Except as provided below, corporations are exempt from backup withholding
for certain payments, including interest and dividends.
• Corporations are not exempt from backup withholding for payments made in
settlement of payment card or third party network transactions.
• Corporations are not exempt from backup withholding with respect to attorneys'
fees or gross proceeds paid to attorneys, and corporations that provide medical or
health care services are not exempt with respect to payments reportable on Form
1099-MISC.
The following codes identify payees that are exempt from backup withholding.
Enter the appropriate code in the space in line 4.
1—An organization exempt from tax under section 501(a), any IRA, or a
custodial account under section 403(b)(7) if the account satisfies the requirements
of section 401(f)(2)
2—The United States or any of its agencies or instrumentalities
3—A state, the District of Columbia, a U.S. commonwealth or possession, or
any of their political subdivisions or instrumentalities
4—A foreign government or any of its political subdivisions, agencies, or
instrumentalities
5—A corporation
6—A dealer in securities or commodities required to register in the United
States, the District of Columbia, or a U.S. commonwealth or possession
7—A futures commission merchant registered with the Commodity Futures
Trading Commission
8—A real estate investment trust
9—An entity registered at all times during the tax year under the Investment
Company Act of 1940
10—A common trust fund operated by a bank under section 584(a)
11—A financial institution
12—A middleman known in the investment community as a nominee or
custodian
13—A trust exempt from tax under section 664 or described in section 4947
The following chart shows types of payments that may be exempt from backup
withholding. The chart applies to the exempt payees listed above, 1 through 13.
IF the payment is for ...
THEN the payment is exempt for ...
Interest and dividend payments
All exempt payees except
for 7
Broker transactions
Exempt payees 1 through 4 and 6
through 11 and all C corporations. S
corporations must not enter an exempt
payee code because they are exempt
only for sales of noncovered securities
acquired prior to 2012.
Barter exchange transactions and
Exempt payees 1 through 4
patronage dividends
Payments over $600 required to be
Generally, exempt payees
reported and direct sales over $5,000'
1 through 52
Payments made in settlement of
Exempt payees 1 through 4
payment card or third party network
transactions
I See Form 1099-MISC, Miscellaneous Income, and its instructions.
2However, the following payments made to a corporation and reportable on Form
1099-MISC are not exempt from backup withholding: medical and health care
payments, attorneys' fees, gross proceeds paid to an attorney reportable under
section 6045(f), and payments for services paid by a federal executive agency.
Exemption from FATCA reporting code. The following codes identify payees
that are exempt from reporting under FATCA. These codes apply to persons
submitting this form for accounts maintained outside of the United States by
certain foreign financial institutions. Therefore, H you are only submitting this form
for an account you hold in the United States, you may leave this field blank.
Consult with the person requesting this form if you are uncertain if the financial
institution is subject to these requirements. A requester may indicate that a code is
not required by providing you with a Form W-9 with "Not Applicable" (or any
similar indication) written or printed on the line for a FATCA exemption code.
A—An organization exempt from tax under section 501(a) or any individual
retirement plan as defined in section 7701(a)(37)
B—The United States or any of its agencies or instrumentalities
C—A state, the District of Columbia, a U.S. commonwealth or possession, or
any of their political subdivisions or instrumentalities
D—A corporation the stock of which is regularly traded on one or more
established securities markets, as described in Regulations section
1.1472-1(c)(1)0
E—A corporation that is a member of the same expanded affiliated group as a
corporation described in Regulations section 1.1472-1(c)(1)(1)
F—A dealer in securities, commodities, or derivative financial instruments
(including notional principal contracts, futures, forwards, and options) that is
registered as such under the laws of the United States or any state
G—A real estate investment trust
H—A regulated investment company as defined in section 851 or an entity
registered at all times during the tax year under the Investment Company Act of
1940
I—A common trust fund as defined in section 584(a)
J—A bank as defined in section 581
K—A broker
L—A trust exempt from tax under section 664 or described in section 4947(a)(1)
M—A tax exempt trust under a section 403(b) plan or section 457(g) plan
Note. You may wish to consult with the financial institution requesting this form to
determine whether the FATCA code and/or exempt payee code should be
completed.
Line 5
Enter your address (number, street, and apartment or suite number). This is where
the requester of this Form W-9 will mail your information returns.
Line 6
Enter your city, state, and ZIP code.
Part I. Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. If you are a resident alien and you do not
have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer
identification number (ITIN). Enter it in the social security number box. If you do not
have an ITIN, see How to get a TIN below.
If you are a sole proprietor and you have an EIN, you may enter either your SSN
or FIN. However, the IRS prefers that you use your SSN.
If you are a single -member LLC that is disregarded as an entity separate from its
owner (see Limited Liability Company (LLC) on this page), enter the owner's SSN
(or EIN, if the owner has one). Do not enter the disregarded entity's EIN. If the LLC
is classified as a corporation or partnership, enter the entity's EIN.
Note. See the chart on page 4 for further clarification of name and TIN
combinations.
How to get a TIN. If you do not have a TIN, apply for one immediately. To apply
for an SSN, get Form SS -5, Application for a Social Security Card, from your local
SSA office or get this form online at www.ssa.gov. You may also get this form by
calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer
Identification Number, to apply for an ITIN, or Form SS -4, Application for Employer
Identification Number, to apply for an EIN. You can apply for an EIN online by
accessing the IRS website at www.irs.gov/businesses and clicking on Employer
Identification Number (EIN) under Starting a Business. You can get Forms W-7 and
SS -4 from the IRS by visiting IRS.gov or by calling 1 -800 -TAX -FORM
(1-800-829-3676).
If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN
and write "Applied For" in the space for the TIN, sign and date the form, and give it
to the requester. For interest and dividend payments, and certain payments made
with respect to readily tradable instruments, generally you will have 60 days to get
a TIN and give it to the requester before you are subject to backup withholding on
payments. The 60 -day rule does not apply to other types of payments. You will be
subject to backup withholding on all such payments until you provide your TIN to
the requester.
Note. Entering "Applied For" means that you have already applied for a TIN or that
you intend to apply for one soon.
Caution: A disregarded U.S. entity that has a foreign owner must use the
appropriate Form W-8.
Form W-9 (Rev. 12-2014)
Page 4
Part II. Certification
To establish to the withholding agent that you are a U.S. person, or resident alien,
sign Form W-9. You may be requested to sign by the withholding agent even if
items 1, 4, or 5 below indicate otherwise.
For a joint account, only the person whose TIN is shown in Part I should sign
(when required). In the case of a disregarded entity, the person identified on line 1
must sign. Exempt payees, see Exempt payee code earlier.
Signature requirements. Complete the certification as indicated in items 1
through 5 below.
1. Interest, dividend, and barter exchange accounts opened before 1984
and broker accounts considered active during 1983. You must give your
correct TIN, but you do not have to sign the certification.
2. Interest, dividend, broker, and barter exchange accounts opened after
1983 and broker accounts considered inactive during 1983. You must sign the
certification or backup withholding will apply. If you are subject to backup
withholding and you are merely providing your correct TIN to the requester, you
must cross out item 2 in the certification before signing the form.
3. Real estate transactions. You must sign the certification. You may cross out
item 2 of the certification.
4. Other payments. You must give your correct TIN, but you do not have to sign
the certification unless you have been notified that you have previously given an
incorrect TIN. "Other payments" include payments made in the course of the
requester's trade or business for rents, royalties, goods (other than bills for
merchandise), medical and health care services (including payments to
corporations), payments to a nonemployee for services, payments made in
settlement of payment card and third party network transactions, payments to
certain fishing boat crew members and fishermen, and gross proceeds paid to
attorneys (including payments to corporations).
S. Mortgage interest paid by you, acquisition or abandonment of secured
property, cancellation of debt, qualified tuition program payments (under
section 529), IRA, Coverdell ESA, Archer MSA or HSA contributions or
distributions, and pension distributions. You must give your correct TIN, but you
do not have to sign the certification.
What Name and Number To Give the Requester
For this type of account:
Give name and SSN of:
1. Individual
The individual
2. Two or more individuals (joint
The actual owner of the account or,
account)
if combined funds, the first
individual on the account'
3. Custodian account of a minor
The minor'
(Uniform Gift to Minors Act)
4. a. The usual revocable savings
The grantor -trustee'
trust (grantor is also trustee)
b. So-called trust account that is
The actual owner'
not a legal or valid trust under
state law
5. Sole proprietorship or disregarded
The owner'
entity owned by an individual
6. Grantor trust filing under Optional
The grantor'
Form 1099 Filing Method 1 (see
Regulations section 1.671-4(b)(2)(i)
For this type of account
Give name and EIN of:
7. Disregarded entity not owned by an
The owner
individual
8. A valid trust, estate, or pension trust
Legal entity'
9. Corporation or LLC electing
The corporation
corporate status on Form 8832 or
Form 2553
10. Association, club, religious,
The organization
charitable, educational, or other tax-
exempt organization
11. Partnership or multi -member LLC
The partnership
12. A broker or registered nominee
The broker or nominee
13. Account with the Department of
The public entity
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
14. Grantor trust filing under the Form
The trust
1041 Filing Method or the Optional
Form 1099 Filing Method 2 (see
Regulations section 1.671-4(b)(2)(i)
List first and circle the name of the person whose number you furnish. If only one person on a
joint account has an SSN, that person's number must be furnished.
2 Circle the minor's name and furnish the minor's SSN.
3You must show your individual name and you may also enter your business or DBA name on
the "Business name/disregarded entity" name line. You may use either your SSN or EIN (f you
have one), but the IRS encourages you to use your SSN.
' List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the
personal representative or trustee unless the legal entity itself is not designated in the account
title.) Also see Special rules for partnerships on page 2.
*Note. Grantor also must provide a Form W-9 to trustee of trust.
Note. If no name is circled when more than one name is listed, the number will be
considered to be that of the first name listed.
Secure Your Tax Records from Identity Theft
Identity theft occurs when someone uses your personal information such as your
name, SSN, or other identifying information, without your permission, to commit
fraud or other crimes. An identity thief may use your SSN to get a job or may file a
tax return using your SSN to receive a refund.
To reduce your risk:
• Protect your SSN,
• Ensure your employer is protecting your SSN, and
• Be careful when choosing a tax preparer.
If your tax records are affected by identity theft and you receive a notice from
the IRS, respond right away to the name and phone number printed on the IRS
notice or letter.
If your tax records are not currently affected by identity theft but you think you
are at risk due to a lost or stolen purse or wallet, questionable credit card activity
or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit
Form 14039.
For more information, see Publication 4535, Identity Theft Prevention and Victim
Assistance.
Victims of identity theft who are experiencing economic harm or a system
problem, or are seeking help in resolving tax problems that have not been resolved
through normal channels, may be eligible for Taxpayer Advocate Service (TAS)
assistance. You can reach TAS by calling the TAS toll-free case intake line at
1-877-777-4778 orTTY/TDD 1-800-829-4059.
Protect yourself from suspicious smalls or phishing schemes. Phishing is the
creation and use of email and websites designed to mimic legitimate business
emails and websites. The most common act is sending an email to a user falsely
claiming to be an established legitimate enterprise in an attempt to scam the user
into surrendering private information that will be used for identity theft.
The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does
not request personal detailed information through email or ask taxpayers for the
PIN numbers, passwords, or similar secret access information for their credit card,
bank, or other financial accounts.
If you receive an unsolicited email claiming to be from the IRS, forward this
message to phishing0irs.gov. You may also report misuse of the IRS name, logo,
or other IRS property to the Treasury Inspector General for Tax Administration
(TIGTA) at 1-800-366-4484. You can forward suspicious emails to the Federal
Trade Commission at: spamQuce.gov or contact them at www.ftc.gov/idtheft or
1-877-IDTHEFT (1-877-438-4338).
Visit IRS.gov to learn more about identity theft and how to reduce your risk.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct
TIN to persons Including federal agencies) who are required to file information
returns with the IRS to report interest, dividends, or certain other income paid to
you; mortgage interest you paid; the acquisition or abandonment of secured
property; the cancellation of debt; or contributions you made to an IRA, Archer
MSA, or HSA. The person collecting this form uses the information on the form to
file information returns with the IRS, reporting the above information. Routine uses
of this information include giving it to the Department of Justice for civil and
criminal litigation and to cities, states, the District of Columbia, and U.S.
commonwealths and possessions for use in administering their laws. The
information also may be disclosed to other countries under a treaty, to federal and
state agencies to enforce civil and criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism. You must provide your TIN whether or
not you are required to file a tax return. Under section 3406, payers must generally
withhold a percentage of taxable interest, dividend, and certain other payments to
a payee who does not give a TIN to the payer. Certain penalties may also apply for
providing false or fraudulent information.