HomeMy WebLinkAbout122120_ca11Consent Agenda
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Willie Bence, Emergency Management Director
DATE:
SUBJECT: FEMA DR20-182 Grant Agreement Contract for Stafford Act Reimbursement
STATEMENT OF ISSUE:
During a presidentially declared disaster, the Federal Emergency Management Agency reimburses local
jurisdictions for certain costs associated with disaster response activities. As a result of COVID-19, federal
funds have been made available for response and mitigation activities protecting against the novel
coronavirus. Jefferson County is currently eligible for approximately $163,169.10 in reimbursements (with a
25% local match). This contract with the State EMD, acting on behalf of FEMA, will allow for
reimbursement of costs that have been pre -approved by FEMA.
ANALYSIS:
The Stafford Act reimbursements for response costs will go a long way towards mitigating the local
financial impact of responding to COVID19. The county will need to match 25% of the eligible costs, but
will look to do so with in -kind match in the form of volunteer hours and equipment.
RECOMMENDATION:
The BOCC approve FEMA/EMD DR20-182 grant contract to offset the county's cost of responding to
COVIDI9.
�_ C istrator Date
Washington State Military Department
PUBLIC ASSISTANCE GRANT AGREEMENT FACE SHEET
1. SUBRECIPIENT Name and Address:
2. Grant Agreement Amount:
3. Grant Number:
Jefferson County
To be determined, based upon
81 Elkins Rd
approved project worksheets
D20-182
Port Hadlock, WA 98339
4. SUBRECIPIENT, phone/email:
5. Grant Agreement Start Date:
6. Grant Agreement End Date:
360-316-6008/wbence@co.jefferson.wa.us
January 20, 2020
March 22, 2024
7. DEPARTMENT Program Manager, phone/email:
8. Data Universal Numbering System
9. UBI # (state revenue):
Gerard Urbas, (253) 512-7402
(DUNS): 876703406
Gary. u rbasmil.wa. ov
10. Funding Authority:
Washington State Military Depart ent the "DEPARTMENT"), and Federal Emergency Management A enc FEMA
11. Funding Source Agreement #:
12. Program Index #
13. Catalog of Federal Domestic Asst. (CFDA)
14. Federal EIN #:
FEMA-4481-DR-WA
704UC (Federal) / 702UE
# & Title: 97.036, Public Assistance
State / 704UD Admin
15. Total Federal Award Amount: N/A
16. Federal Award Date: N/A
17. Service Districts:
18. Service Area by County(ies):
19. Women/Minority-Owned, State
(BY LEGISLATIVE DISTRICT): 24 th
Jefferson County
Certified?: X N/A El NO
❑
(BY CONGRESSIONAL DISTRICT): _6
YES, OMWBE #
20. tract 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. Contractor Selection Process:
23. Contractor 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 X Non -Profit
❑ Filed w/OFM? ❑ Advertised? ❑ YES ONO
❑ VENDOR ❑ SUBRECIPIENT X OTHER
24. BRIEF DESCRIPTION:
Presidential Disaster Declaration # FEMA-4481-DR-WA COVID-19. To provide funds to the SUBRECIPIENT for the emergency
protective measures taken in response to the COVID-19 pandemic outbreak as approved by FEMA in project worksheets
describing eligible scopes of work and associated funding. The DEPARTMENT is the Recipient and Pass -through Entity of the
Presidential Disaster Declaration # FEMA-4481-DR-WA COVID-19, and FEMA State Agreement, which are incorporated by
reference, and makes 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, references and
attachments hereto and have executed this Agreement as of the date and year written below. This Agreement Face Sheet, Special Terms
and Conditions (Attachment 1), General Terms and Conditions (Attachment 2), Project Worksheet Sample (Attachment 3), Washington State
Public Assistance Applicant Manual dated March 22, 2020 (Attachment 4), 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.
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 5. Special Terms and Conditions
2. DHS Standard Terms and Conditions 6. General Terms and Conditions, and,
3. Presidential Declaration, FEMA State Agreement, 7. Other provisions of the contract incorporated by reference.
and other Documents
4. Statement of Work and/or Project Description as outlined in FEMA approved Project Worksheet s
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
Stacey McClain, Governor's Authorized Representative print or type name:
Washington State Military Department
APPROVED AS TO FORM:
SUBRECIPIENT's Attorney Date
Public Assistance Grant Agreement Page 1 of 21 Jefferson County, D20-182
Attachment 1
Washington State Military Department
SPECIAL TERMS AND CONDITIONS
ARTICLE I — KEY PERSONNEL
The individuals listed below shall be considered key personnel and point of contact. Any substitution by either
party must be submitted in writing.
SUBRECIPIENT MILITARY DEPARTMENT
Name
Wifie Bence
Name
Gerard Urbas
Title
Director - JeffCo DEM
Title
Deputy State Coordinating Officer
Public Assistance
E-Mail
wbence@co.jefferson.wa.us
E-Mail
Qary.urbas(a�mil.wa.gov
Phone
Phone
(253) 612-7402
ARTICLE II - ADMINISTRATIVE 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 FEMA applicable to the Presidential Declaration including, but not Limited to, all criteria, restrictions, and
requirements of the "FEMA State Agreement' published by FEMA and the federal regulations commonly
applicable to FEMA grants, all of which are incorporated herein by reference. The Presidential Declaration and
the FEMA State Agreement are incorporated in this Agreement by reference.
The SUBRECIPIENT shall comply with the Washington State Public Assistance Applicant Manual dated March
22, 2020 incorporated in this Agreement as Attachment 4. The DHS Standard Terms and Conditions are
incorporated by reference in this Agreement in Appendix F of the Washington State Public Assistance
Applicant Manual dated March 22, 2020.
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.
Federal funding is provided by FEMA and is administered by the DEPARTMENT. Under the authority of
Presidential Disaster Declaration number FEMA-4481-DR-WA, the DEPARTMENT is reimbursing the
SUBRECIPIENT for those approved eligible costs and activities necessary under the Public Assistance Grant
Program during the incident period beginning January 20, 2020 and continuing. Eligible costs and activities
will be identified in Project Worksheets approved by FEMA and a Project Worksheet Sample is incorporated as
Attachment 3. The DEPARTMENT is also providing Advance Payments to the SUBRECIPIENT where
provided by FEMA and required and allowed by law. Any interest earned on advance payments (except for
interest earned on advances of funds exempt under the Intergovernmental Cooperation Act (31 U.S.C. 6501 et
seq.) and the Indian Self -Determination Act (23 U.S.C. 450)) shall be promptly, but at least quarterly, remitted
to the DEPARTMENT to be paid to FEMA. The SUBRECIPIENT may keep interest amounts up to $100 per
year for administrative expenses.
A. STATE AND FEDERAL REQUIREMENTS FOR PUBLIC ASSISTANCE GRANTS:
The following requirements apply to all DHS/FEMA Presidential Disasters administered by the DEPARTMENT.
1. FUNDING
The DEPARTMENT will administer the Public Assistance (PA) Grant Program, provide Advance payments,
and reimburse approved eligible Public Assistance costs to the SUBRECIPIENT that are identified under the
auspices of Presidential Disaster Declaration Number FEMA-4481-DR-WA and authorized by and consistent
with the Stafford Act (P.L. 93-288, as amended) and applicable regulations.
Public Assistance Grant Agreement Page 2 of 21 Jefferson County, D20-182
It is understood that no final dollar figure is committed to at the time that this Agreement is executed, but that
financial commitments will be made by amendments to the project application as Project Worksheets are
completed in the field and projects are authorized by state and federal officials.
Pursuant to the FEMA-STATE AGREEMENT, FEMA will contribute not less than 75 percent of the eligible
costs for any eligible project and 100 percent of the federal PA Management Costs, up to 5 percent of the total
award amount for each Subrecipient, as provided for in subsection 3.E. of Article II of this Public Assistance
Agreement. The SUBRECIPIENT commits to providing the remaining 25 percent non-federal match to any
eligible project that has been identified under the Presidential Disaster Declaration number FEMA-4481-DR-
WA, subject to the following exceptions:
DEPARTMENT Match: The Washington State Legislature may authorize the DEPARTMENT to provide a
match to the SUBRECIPIENT's non-federal share of eligible projects. Provision of a match by the
DEPARTMENT, if authorized by the Washington State Legislature, shall not require amendment of this
Agreement. If DEPARTMENT match funds are committed to the non-federal share by the DEPARTMENT
pursuant to legislative authorization, the DEPARTMENT will formally notify the SUBRECIPIENT of the match in
writing which will include information identifying any related reduction in the SUBRECIPIENT's percentage
commitment.
Donated Resources: FEMA will credit the SUBRECIPIENT for the value of donated resources (non -cash
contributions of property or services) related to eligible Emergency Work to offset the non -Federal cost share
of its eligible Emergency Work project worksheets — categories A and B, and for the value of donated
resources related to eligible work on a Permanent Work project to offset the non -Federal cost share of that
specific Permanent Work project worksheet for which the resources were donated — categories C through G.
The Donated Resources are recognized by FEMA in a Project Worksheet. Donated Resources offset the non-
federal share of the eligible emergency work approved in Project Worksheets or specific permanent work
approved in Project Worksheets. For non -state agency SUBRECIPIENTS, the donated resource value will first
be applied to the SUBRECIPIENT's non-federal share, and, if a DEPARTMENT match is authorized, any
remaining donated resource value will be applied to the DEPARTMENT's share. The value of the Donated
Resources is calculated as described in FP 104-009-2 Public Assistance Program and Policy Guide (PAPPG)
and the Public Assistance Donated Resources Recovery Policy, and is capped at the non -Federal share of
approved eligible emergency work costs or capped at the non -Federal share of the specific approved eligible
permanent work costs, as applicable. The Federal share of the Donated Resources will not exceed the non-
federal share of eligible emergency work costs or of specific permanent work costs approved in Project
Worksheets. Any excess credit for eligible emergency work costs can be credited only to other eligible
emergency work costs, for the same SUBRECIPIENT in the same disaster. The value of excess donated
resources cannot be credited toward or transferred to another eligible SUBRECIPIENT, or toward other State
obligations. The DEPARTMENT does not match a FEMA donated resource credit.
The Project Worksheet, sample provided in Attachment 3, is required to be completed by FEMA or State
Project Specialists.
2. GRANT AGREEMENT PERIOD
a. Activities payable under this Agreement and to be performed by the SUBRECIPIENT under this
Agreement shall be those activities which occurred during or subsequent to the incident period
defined in the FEMA State Agreement, and shall terminate upon completion of the project(s)
approved by federal and state officials, including completion of close-out and audit. This period
shall be referred to as the "Grant Agreement Period."
b. The Grant Agreement Period shall only be extended by (1) written notification of FEMA approval of
the Grant Agreement Period followed up with a mutually agreed written amendment, or (2) written
notification from the DEPARTMENT to the SUBRECIPIENT issued by the DEPARTMENT to
address extensions of its underlying federal grant performance period or to provide additional time
for completion of the SUBRECIPIENT's project(s).
3. PAYMENTS
The DEPARTMENT, using funds granted for the purposes of the Presidential Disaster Declaration from
FEMA, shall issue payments to the SUBRECIPIENT in compliance with the Washington State Public
Assistance Applicant Manual dated March 22, 2020 (Attachment 4) procedures as follows:
Public Assistance Grant Agreement Page 3 of 21 Jefferson County, D20-182
a. Small Project Payments: Payments are made for all small projects to the SUBRECIPIENT upon
submission and approval of an A19-1A State of Washington Invoice Voucher to the DEPARTMENT,
after FEMA has approved funding through approval of Project Worksheets.
b. Progress Payments: Progress payment of funds for costs already incurred on large projects minus
10 percent retainage may be made to the SUBRECIPIENT upon submission by the
SUBRECIPIENT of an A19-1A State of Washington Invoice Voucher, a letter of request, and a
spreadsheet identifying the claimed costs supporting the payment request and approval by the
DEPARTMENT.
c. Improved Projects: Payments on improved projects (capped project) will be pro -rated based upon
the percentage of the project that is funded under this disaster grant to the overall project cost. This
percentage will be identified when the first payment on the improved project is made. Progress
payments will be made as outlined above in Section B.
d. Final Payment: Final Payment on a large project will be made following submission by the
SUBRECIPIENT of a certification of completion on the STATEMENT OF DOCUMENTATION /
FINAL INSPECTION REPORT form upon completion of project(s), completion of all final
inspections by the DEPARTMENT, and final approval by FEMA. Final payment on a large project
will include any retainage withheld during progress payments. Final payments may also be
conditional upon financial review, if determined necessary by the DEPARTMENT or FEMA.
Adjustments to the final payment may be made following any audits conducted by the Washington
State Auditor's Office, the United States Inspector General or other federal or state agency.
e. The SUBRECIPIENT is eligible to receive federal PA Management Costs up to 5 percent of the
total award amount for each Subrecipient at the time of its request. PA Management Costs
includes any of the following when associated with the PA portion of a major disaster or emergency:
Indirect costs, direct administrative costs, and other administrative expenses associated with a
specific project. Documentation is required to substantiate the eligibility of management activities
and associated costs in accordance with PA Management Costs Interim Policy — Standard
Operating Procedures.
f. All payment requests shall be made on an A19-1A form, State of Washington, Invoice Voucher.
Payments will be made by electronic fund transfer to the SUBRECIPIENT's account.
g. Federal funding shall not exceed the total federal contribution eligible for Public Assistance costs
under Presidential Disaster Declaration number FEMA-4481-DR-WA.
h. For state agencies, the DEPARTMENT will, through interagency reimbursement procedures,
transfer payment to the SUBRECIPIENT. Payment will be transferred by journal voucher to Agency
No. , Accounting Fund No.
i. Within the total Grant Agreement Amount, travel, sub -contracts, salaries, benefits, printing,
equipment, and other goods and services will be reimbursed on an actual cost basis unless
otherwise provided in this Agreement.
j. For travel costs, SUBRECIPIENTs 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.gsa.gov, and follow the most
restrictive.
k. If travel costs exceed set state or federal limits, travel costs shall not be reimbursed without written
approval by DEPARTMENT Key Personnel.
I. 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
local, state, or federal auditors.
m. 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.
Public Assistance Grant Agreement Page 4 of 21 Jefferson County, D20-182
n. No costs for purchases of equipment/supplies will be reimbursed until the related
equipment/supplies have been received by the SUBRECIPIENT, its subrecipient or contractor, or
any non-federal entity to which the SUBRECIPIENT makes a subaward, and is invoiced by the
vendor.
o. 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 the
reduction in non-federal resources occurred for reasons other than the receipt or expected receipt
of federal funds.
The DEPARTMENT shall provide Advance Payments as provided by FEMA and as required and
authorized by law.
4. CLOSEOUT
To initiate close-out, the SUBRECIPIENT is required to certify in writing, by Project Worksheet Number,
date completed and total amount expended on the project, completion of the small projects. To initiate
close-out of the large projects, the SUBRECIPIENT shall submit certification of completion on a
STATEMENT OF DOCUMENTATION/FINAL INSPECTION REPORT form to the DEPARTMENT.
The DEPARTMENT will then complete a site inspection and a financial review of documentation to
support the claimed costs. Certifications on small and large projects are due within sixty days following
the completion of the project or receipt of the approved Project Worksheet, whichever date is later.
If SUBRECIPIENT is claiming federal PA Management Costs: Indirect costs, direct administrative
costs, and other administrative expenses associated with a specific project must be supported by
documentation to substantiate the eligibility of management activities and associated costs that has
been prepared and assembled in accordance with PA Management Costs Interim Policy — Standard
Operating Procedures prior to close-out.
After all of the projects have been certified as complete and approved for closure by FEMA, the
DEPARTMENT will forward a final A19-1A State of Washington Invoice Voucher to the
SUBRECIPIENT for release of the remaining funds due to the subrecipient for eligible costs, including
any retainage previously withheld, and the allowance for federal indirect costs.
5. DOCUMENTATION / REPORTING REQUIREMENTS
For all Advance Payment, the SUBRECIPIENT shall provide documentation and receipts for all costs
related to the Advance Payment and provide such to the DEPARTMENT quarterly.
The SUBRECIPIENT is required to retain all documentation which adequately identifies the source and
application of Public Assistance funds, including the federal indirect cost reimbursement, for six years
following the closure of this disaster grant. For all funds received, source documentation includes
adequate accounting of actual costs and recoveries incurred.
The SUBRECIPIENT shall also 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 the FFATA Form located at
http://mil.wa.gov/emergency-management-division/grants/requiredgrantforms and return to the
DEPARTMENT; which is incorporated by reference and made a part of this Agreement.
Quarterly Reports: The SUBRECIPIENT is required to submit to the DEPARTMENT a quarterly report
indicating the status of all their large projects. The status shall identify the costs incurred to date, the
percentage of work completed, the anticipated completion date of the project and whether cost under
runs or over runs are expected. In addition, the SUBRECIPIENT should note in the comment field any
challenges or issues associated with the project. Failure to submit a complete quarterly report within 15
days following the end of the quarter will result in suspension of all payments to the SUBRECIPIENT
until a complete quarterly report is received by the DEPARTMENT. The quarterly report will serve as
the basis for any FEMA Office of Chief Financial Officer (OCFO) funds reduction.
Public Assistance Grant Agreement Page 5 of 21 Jefferson County, D20-182
6. TIME EXTENSIONS
A time extension request is required to be forwarded to the DEPARTMENT by the SUBRECIPIENT for
a project prior to the expiration of the approved completion date. If the project is approved and funded
after the statutory approval time period for completion, then a time extension request must be submitted
to the DEPARTMENT within fifteen days of receipt of the funding package.
In accordance with 44CFR206.204, the DEPARTMENT reserves the right, in its sole discretion, to
consider and approve a time extension request after expiration of the approved completion date and
within the DEPARTMENT's statutory extension authority. Requests for time extensions beyond the
DEPARTMENT's authority will be considered and approved by FEMA, at their sole discretion.
All determinations made regarding time extension requests will be based on a case by case evaluation
of specific factual circumstances.
A time extension request must be in writing and identify the Project Worksheet number, the reason the
project has not been completed within the prior approved completion period, the reason the time
extension request was not submitted prior to the statutory approval time period (if applicable), a current
status of the completion of the work, a detailed timeline for completion of the remaining elements, and
an anticipated completion date for the completion of the remaining work. Failure to submit a time
extension request in a timely manner may result in denial of the time extension request, and loss of
funding for the related project.
7. PROCUREMENT
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 A.11.
8. 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 2 CFR Part 200 Subpart F Audit Certification Form"
located at http://mil wa gov/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 eligibility and
consistency with Agreement work plan, budget, and federal requirements;
V. observation and documentation of Agreement related activities;
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
and in 2 CFR Part 200 Subpart F, for any non-federal entity to which the SUBRECIPIENT makes
a subaward as a pass -through entity under this Agreement.
e. Compliance will be monitored throughout the performance period to assess risk. Concerns will be
addressed through a Corrective Action Plan. If the SUBRECIPIENT fails to comply with federal or
state statutes or regulations, or the terms and conditions of this Agreement, the DEPARTMENT
may impose any additional subaward conditions as described in 2 CFR 200.207. If the
DEPARTMENT determines that noncompliance cannot be remedied by imposing additional
conditions, it may take one or more of the following actions:
Public Assistance Grant Agreement Page 6 of 21 Jefferson County, D20-182
i. Temporarily withhold cash payments pending correction of the deficiency by the
SUBRECIPIENT.
ii. Wholly or partially suspend or terminate the subaward to the SUBRECIPIENT.
iii. Initiate suspension or debarment proceedings under 2 CFR 180 or recommend such a
proceeding be initiated by the federal awarding agency.
iv. Withhold further federal awards for the project or program.
v. Take any other remedies that may be legally available.
f. The DEPARTMENT agrees to:
i. Provide technical assistance during all monitoring or evaluation activities. The
DEPARTMENT will coordinate and schedule the meetings necessary to conduct and
complete all monitoring and evaluation activities.
ii. Develop the SUBRECIPIENT's project worksheet(s) (PW) and supporting attachments with
FEMA and the SUBRECIPIENT's assistance based upon the costs determined to be eligible.
iii. Submit the SUBRECIPIENT's funding package to FEMA.
iv. Notify the SUBRECIPIENT when funding approval is received, issue payment per the
process described above see Article II, A.4 — Payments, and provide the SUBRECIPIENT
with a copy of the approved project worksheet.
v. Work with the SUBRECIPIENT to resolve any issues identified during the monitoring
process.
vi. Review and respond appropriately to the SUBRECIPIENT's requests for time extensions and
changes.
9. LIMITED ENGLISH PROFICIENCY (CIVIL RIGHTS ACT OF 1964 TITLE VI)
All subrecipients 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 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
hftp://www.lep.gov.
B. FEMA STATE AGREEMENT TERMS AND CONDITIONS
As a subrecipient of FEMA funding, the SUBRECIPIENT shall comply with all applicable DHS/FEMA
terms and conditions of the Presidential Declaration and the FEMA State Agreement, which are
incorporated in and made a part of this Agreement in Appendix F of the Washington State Public
Assistance Applicant Manual dated March 22, 2020 (Attachment 4).
Public Assistance Grant Agreement Page 7 of 21 Jefferson County, D20-182
Attachment 2
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 following 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. "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 pass -through entity making a subaward to a subrecipient under this
Agreement.
b. "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. "Monitoring Activities" means all administrative, construction, financial, or other
review activities that are conducted to ensure compliance with all state and federal laws, rules,
regulations, authorities and policies.
C. "Project" means those actions funded through the Public Assistance Program and described in
approved Project Worksheets. Projects may include one or more of the following: reimbursement of
costs for emergency response, debris removal and/or repair or restoration of damaged public facilities.
A project may be a small, large, improved, or alternate project.
d. "Investment Justification" means grant application investment justification submitted by the
SUBRECIPIENT describing the project for which federal funding is sought and provided under this
Agreement. Such grant application investment justification is hereby incorporated into this Agreement
by reference.
A.2 ADVANCE PAYMENTS
The DEPARTMENT shall make no payments in advance or in anticipation of goods or services to be
provided under this Agreement, except as required under 2 CFR 200.305 for federal grants.
SUBRECIPIENT shall not invoice the DEPARTMENT in advance of delivery and invoicing of such
goods or services, except as authorized under 2 CFR 200.305.
Pursuant to the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.0 §5121-
5207), Advance Payment process, FEMA will process a SUBRECIPIENT project worksheet which is
provided to the state of Washington for direct disbursement to SUBRECIPIENT.
Pursuant to these provisions and RCW 43.88.160(5), these grant funds are not subject to the advance
payments prohibition and -will be disbursed immediately to SUBRECIPIENT as grants authorized by law
with subsequent authentication and certification of expenditures.
A.3 AMENDMENTS AND MODIFICATIONS
The SUBRECIPIENT or the DEPARTMENT may request, in writing, an amendment or modification of
this Agreement. Modifications may be requested for Grant Agreement end date, budget or scope
change. 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 36.
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.
Public Assistance Grant Agreement Page 8 of 21 Jefferson County, D20-182
A.5
The DEPARTMENT relies upon the SUBRECIPIENT's application in making its determinations as to
eligibility for, selection for, and scope of funding grants. Any misrepresentation, error or inaccuracy in
any part of the application may be deemed a breach of this Agreement.
A.6 ASSURANCES
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. In
addition, as a SUBRECIPIENT of FEMA funding, the SUBRECIPEINT shall comply with all applicable
DHS terms and conditions as specified in Appendix F of the Washington State Public Assistance
Applicant Manual dated March 22, 2020 incorporated in this Agreement as Attachment 4.
A.7 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 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/requiredgrantforms. 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 sub -contractors or sub -recipients 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 sub -awards to
sub -recipients for any amount. With respect to covered transactions, the SUBRECIPIENT may comply
with this provision by obtaining a certification statement from the potential sub -contractor or sub -
recipient 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.govfTradesLicensing/PrevWage/AwardingAgencies/DebarredContractorsn.
A.8 CERTIFICATION REGARDING RESTRICTIONS ON LOBBYING
As required by 44 CFR Part 18, the SUBRECIPIENT hereby certifies that to the best of their 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.
Public Assistance Grant Agreement Page 9 of 21 Jefferson County, D20-182
A.9 COMPLIANCE WITH APPLICABLE STATUTES, RULES AND DEPARTMENT POLICIES
The SUBRECIPIENT and all its contractors 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, Equal Employment Opportunity, as amended by
Executive Order 11375 of October 13, 1967, as supplemented by Department of Labor regulations (41
CFR chapter 60); Copeland Anti -Kickback Act (18 U.S.C. 874) as supplemented in Department of
Labor regulations (29 CFR Part 3); Davis -Bacon Act (40 U.S.C. 276a to 276a-7) as supplemented by
Department of Labor regulations (29 CFR Part 5); Clean Air Act (42 U.S.C. 1857(h), section 508 of the
Clean Water Act (33 U.S.C. 1368), Executive Order 11738, Environmental Protection Agency
regulations (40 CFR part 15); Sections 103 and 107 of the Contract Work Hours and Safety Standards
Act (40 U.S.C. 327-330) as supplemented by Department of Labor regulations (29 CFR Part 5); Energy
Policy and Conservation Act (PL 94-163, 89 Stat. 871, 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),
Title 44 of the Federal Regulations, 2 CFR Part 3002, 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 43.21 C), 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.
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.
In the event of the SUBRECIPIENT's or its contractor's noncompliance or refusal to comply with any
applicable law, regulation, executive order, OMB Circular or policy, 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 to comply with
applicable laws, regulations, executive orders, OMB Circulars or policies.
A.10 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 such 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 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 subcontracts, a
provision prohibiting such interest pursuant to this provision.
A.11 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 II 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 $250,000, 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.
Public Assistance Grant Agreement Page 10 of 21 Jefferson County, D20-182
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 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 specified 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.
The procurement process followed shall be in accordance with 2 CFR Parts 200 and 3002, Uniform
Administrative Requirements for Grants and Cooperative Agreements to State and Local
Governments, Uniform Administrative Requirements for Grants and Other Agreements with Institutions
of Higher Education, Hospitals, and Other Nonprofit Organizations, as applicable to the SUB -
GRANTEE. All subcontracting agreements entered into pursuant to this Agreement shall incorporate
this Agreement by reference.
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.
Public Assistance Grant Agreement Page 11 of 21 Jefferson County, D20-182
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).
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 Federal 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).
16) Pursuant to Executive Order 13858 "Strengthening Buy -American Preferences for Infrastructure
Projects,' the DEPARTMENT encourages SUBRECIPIENTS to use, to the greatest extent practicable
and consistent with the law, iron and aluminum as well as steel, cement and other manufactured
products produced in the United States, in Public Assistance and Hazard Mitigation Grant Program
eligible public infrastructure repair and construction projects affecting surface transportation, ports,
water resources including sewer and drinking water and power. Such preference must be consistent
with the law, including cost and contracting requirements of 2 CFR Part 200.
Public Assistance Grant Agreement Page 12 of 21 Jefferson County, D20-182
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 2 CFR 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.
c. All sub -contracting agreements entered into pursuant to this Agreement shall incorporate this
Agreement by reference.
A.12 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.13 DISPUTES
Except as otherwise provided in this contract, 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.14 DUPLICATION OF BENEFITS
The SUBRECIPIENT agrees that the funds for which federal or state assistance is requested does not,
or will not, duplicate benefits or funds received for the same loss from any other source. The
SUBRECIPIENT will pursue, and require sub -recipients to pursue, full payment of eligible insurance
benefits for properties or any other losses covered in a project under this Agreement. The
SUBRECIPIENT will repay the DEPARTMENT any funds provided under this grant agreement that are
duplicated by other benefits, funds, or insurance proceeds. The SUBRECIPIENT will also seek
recovery against any party or parties whose negligence or other intentional or tortious conduct may
have caused or contributed to the expenditures for which these grants funds are provided. The
SUBRECIPIENT will repay the DEPARTMENT any funds recovered by settlement, judgment or other
court order in an action to recover funds provided by this grant. The SUBRECIPIENT shall notify the
DEPARTMENT as early as possible and work in conjunction with the DEPARTMENT and FEMA to
ensure appropriate apportionment of any duplicated or recovered payment.
A.15 HAZARDOUS SUBSTANCES
The SUBRECIPIENT shall inspect and investigate the proposed development/construction site for the -
presence of hazardous substances. The SUBRECIPIENT shall fully disclose to the DEPARTMENT the
results of its inspection and investigation and all other knowledge the SUBRECIPIENT has as to the
presence of any hazardous substances at the proposed development/construction project site. The
SUBRECIPIENT will be responsible for any associated clean-up costs. "Hazardous Substance" is
defined in RCW 70.105D.020 (10).
A.16 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,
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.
Public Assistance Grant Agreement Page 13 of 21 Jefferson County, D20-182
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.17 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 and the Authorized
Signature of the assigned SUBRECIPIENT Agent or Alternate for the SUBRECIPIENT Agent, 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 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 authority to sign reimbursement
requests, certification of project completion, time extension requests, amendment and modification
requests, requests for changes to project status, and other requests, certifications and documents
authorized by or required under this Agreement.
A.18 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 or
suspend 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.19 NONASSIGNABILITY
Neither this Agreement, nor any claim arising under this Agreement, shall be transferred or assigned by
the SUBRECIPIENT.
A.20 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.21 NOTICES
The SUBRECIPIENT shall comply with all public notices or notices to individuals required by applicable
local, state and federal laws and shall maintain a record of this compliance.
A.22 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,
Public Assistance Grant Agreement Page 14 of 21 Jefferson County, D20-182
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.23 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 grant 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 arising from the ownership and operation of the project
and agrees to hold the DEPARTMENT and 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.24 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.
A.25 PRIVACY
Personal information collected, used or acquired in connection with this agreement shall be used solely
for the purposes of this agreement. SUBRECIPIENT and its subcontractors agree not to release,
divulge, publish, transfer, sell or otherwise make known to unauthorized persons personal information
without the express written consent of the DEPARTMENT or as provided by law or court order.
SUBRECIPIENT agrees to implement physical, electronic and managerial safeguards to prevent
unauthorized access to personal information.
The DEPARTMENT reserves the right to monitor, audit, or investigate the use of personal information
collected, used or acquired by the SUBRECIPIENT through this contract. The monitoring, auditing or
investigating may include but is not limited to "salting" by the DEPARTMENT. Salting is the act of
placing a record containing unique but false information in a database that can be used later to identify
inappropriate disclosure of data contained in the database.
Any breach of this provision may result in termination of the contract and the demand for return of all
personal information. The SUBRECIPIENT agrees to indemnify and hold harmless the DEPARTMENT
for any damages related to the SUBRECIPIENT's unauthorized use, loss or disclosure of personal
information.
For purposes of this provision, personal information includes, but is not limited to, information
identifiable to an individual that relates to a natural person's health, finances, education, business, use
or receipt of governmental services, or other activities, names, addresses, telephone numbers, social
security numbers, driver license numbers, financial profiles, credit card numbers, financial identifiers
and other identifying numbers.
A.26 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.27 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.
The SUBRECIPIENT shall include language which acknowledges the funding contribution of the
DEPARTMENT and FEMA to this project in any release or other publication developed or modified for,
or referring to, the project.
Public Assistance Grant Agreement Page 15 of 21 Jefferson County, D20-182
Publication resulting from work performed under this Agreement shall include an acknowledgement of
the DEPARTMENT and 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.28 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.
A.29 RECORDS AND REPORTS
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) year must be followed.
A.30 RECOVERY OF FUNDS
Any person who intentionally causes a condition for which funds are provided under this Agreement
shall be liable for the costs incurred by the state and federal governments in responding to such
disaster. In addition to its own duty to recover duplicated funds or funds expended due to the
intentional or negligent actions of others. SUBRECIPIENT will cooperate in a reasonable manner with
the DEPARTMENT and the United States in efforts to recover expenditures under this Grant
Agreement.
A.31 RESPONSIBILITY FOR PROJECT/STATEMENT OF WORK/WORK PLAN
While the DEPARTMENT undertakes to assist the SUBRECIPIENT with the projectistatement of
work/work plan (project) by providing grant 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 party, 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 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
Public Assistance Grant Agreement Page 16 of 21 Jefferson County, D20-182
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.32 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.33 SINGLE AUDIT ACT REQUIREMENTS (including all AMENDMENTS)
Non-federal entities as subrecipients that expend $750,000 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 subrecipients or contractors also maintain auditable records.
The SUBRECIPIENT is responsible for any audit exceptions incurred by its own organization or that of
its subcontractors. 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.
Once the single audit has been completed and includes any audit findings, the SUBRECIPIENT must
send a full copy of the audit to the DEPARTMENT and its corrective action plan no later than nine (9)
months after the end of the SUBRECIPIENT's fiscal year(s) to:
Contracts Office
Washington Military Department
Finance Division, Building #1 TA-20
Camp Murray, WA 98430-5032
If Contractor 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:
Public Assistance Grant Agreement Page 17 of 21 Jefferson County, D20-182
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.34 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 or of the State of Washington 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.36 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.36 TERMINATION FOR CONVENIENCE
Notwithstanding any provisions of this Agreement, the SUBRECIPIENT may terminate this Agreement
by providing written notice of such termination to the DEPARTMENTs 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 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.37 TERMINATION OR SUSPENSION FOR CAUSE
In the event the DEPARMENT, 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
SUBGRANTEE 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
Public Assistance Grant Agreement Page 18 of 21 Jefferson County, D20-182
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.38 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 the 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, and 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.
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 sub -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
sub -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 sub-
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 DEPATMENT 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
Public Assistance Grant Agreement Page 19 of 21 Jefferson County, D20-182
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.39 UTILIZATION OF MINORITY AND WOMEN BUSINESS ENTERPRISES (MWBE)
The SUBRECIPIENT shall comply with 2 CFR §200.321 and will take all necessary affirmative steps to
assure that minority firms, women's business enterprises, and labor surplus area firms are used when
possible and will take all necessary affirmative steps to utilize business firms that are certified as
minority -owned and/or women -owned in carrying out the purposes of this Agreement. The following
steps are required by the subrecipient if any contracts with contractors or sub -contractors are entered
into under the original contract award:
a. Placing qualified small and minority businesses and women's business enterprises on
solicitation lists;
b. Assuring that small and minority businesses, and women's business enterprises are solicited
whenever they are potential sources;
C. Dividing total requirements, when economically feasible, into smaller tasks or quantities to
permit maximum participation by small and minority businesses, and women's business
enterprises;
d. Establishing delivery schedules, where the requirement permits, which encourage participation
by small and minority businesses, and women's business enterprises; and
e. Using the services and assistance, as appropriate, of such organizations as the Small Business
Administration and the Minority Business Development Agency of the Department of
Commerce.
The SUBRECIPIENT may also set utilization standards, based upon local conditions or may utilize the
State of Washington MWBE goals, as identified in. WAC 326-30-041.
A.40 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.41 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.
Public Assistance Grant Agreement Page 20 of 21 Jefferson County, D20-182
Attachment 3
PROJECT WORKSHEET SAMPLE
U.S. DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
PROJECT WORKSHEET
O.M.B. No. 1660-0017
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 90 minutes per response. Burden means the time, effort and financial
resources expended by persons to generate, maintain, disclose, or to provide information to us. You may send comments
regarding the accuracy of the burden estimate and or any aspect of the collection, including suggestions for reducing the burden
to: Information Collections Management, U. S. Department of Homeland Security, Federal Emergency Management Agency, 500
C Street, SW, Washington, DC 20472, Paperwork Reduction Project (OMB Control Number 1660-0017). You are not required to
respond to this collection of information unless a valid OMB number appears in the upper right comer of this form. NOTE: Do not
send your completed form to this address.
DISASTER PROJECT NO. PA ID NO. DATE CATEGORY
F _ R
DAMAGED FACILITY
WORK COMPLETE AS OF:
%
SUBRECIPIENT
COUNTY
LOCATION
LATITUDE
LONGITUDE
DAMAGE DESCRIPTION AND DIMENSIONS
SCOPE OF WORK
Does the Scope of Work change the pre -disaster conditions at the site? ❑ Yes ❑ No
Special Considerations issues included? ❑ Yes ❑ No Hazard Mitigation proposal included?❑ Yes ❑ No
Is there insurance coverage on this facility? ❑ Yes ❑ No
PROJECT COST
I
CODE
NARRATIVE
QUANTITYIUNIT
UNIT PRICE
COST
TOTAL COST
PREPARED BY
TITLE
SIGNATURE
SUBRECIPIENT REP.
TITLE
SIGNATURE
FEMA Form 90-91, FEB 06 REPLACES ALL PREVIOUS LUI I IUNS.
Public Assistance Grant Agreement Page 21 of 21 Jefferson County, D20-182
HOW TO COMPLETE THE SUPPLEMENTAL CONTRACTING DOCUMENTS
Event Information:
Disaster Number:
4481-DR-WA
Event Name:
CovID-19
Declaration Date:
March 22, 2020
Contract #:
D20-182
FIPS #:
031-99031-00
Step 1: Complete the following information to populate the forms.
1. Enter the date the forms will be submitted to EMD
Date forms will be submitted:
2. Enter jurisdiction/organization/subgrantee name and address.
Applicant Name:
Jefferson County
Business As:
—Doing
County:
Jefferson
Street Address:
81 Elkins Rd
Mailing Address:
81 Elkins Road
City:
Port Had lock State. A ZI 8339
Enter tax identification number (TIN or EIN), state revenue # (UBI) and DUNS #. The TIN and DUNS
are required.
Tax Identification Number:
91-6001322
State Business # UBI `
601-098-110
DUNS #:
876703406
If you do not know your organization's DUNS #, please contact your comptroller, accountant, or finance
department. They should be able to give it to you. Smaller jurisdictions (such as irrigation districts) may not
already have one, but you can call Dun & Bradstreet at 1-866-705- 5711 and indicate that you are a Federal
grant applicant. You can also call this number to see if you have a DUNS number. The number is assigned
immediately. The following information is requested:
• Legal Name
Headquarters name and address
• Doing business as (DBA) or other name by which organization is commonly known or recognized
• Physical Address, City, State and Zip Code
• Mailing Address(if separate from Headquarters and/or physical address)
• Telephone Number
• Contact Name and Title
• Number of Employees at physical location
Please note: The DUNS number has to match the name on the Federal grant application (Request for Public
Assistance)
4. Do you have an account already established with the State of Washington?
Do you have an account already established with the State and have you received funds from the state
within the p 2 years?
Yes and the account information is current — skip sections 5 and 6, continue to section 7.
Yes but I need to make changes to the account information — continue to section 5.
No — skip section 5, continue to section 6.
State Vendor M
5. What information needs to be changed?
❑ Name ❑Address ❑Contact Information []Email ❑Account Info ❑Additional Info
6. Complete this section if you do not have an open account with the State of Washington or any changes
need to be made. You may also need to complete this section if you have not received funds from the
State for 2 years. If all information is current, skip this section.
Contact Person:
Phone:
Fax:
Email:
Financial Institution:
Phone:
Routing Number:
Account Number:
Account Type:
Checking Savings
Authorized Representative:
Authorized Representative Title:
7. Type of Applicant.
Enter the letter corresponding to the type of applicant: I B
A - State F — Higher Educational Institution
B — County G — Indian Tribe
C - City H — Private NonProfit
D — School District I — Other (Specify)
E — Special Purpose District (includes Diking Districts, Fire Districts, Water Districts,
etc.
If l: Other, specify type of organization this is rare �o not fill this in
8. Enter congressional district numbers and legislative district numbers located within in your jurisdiction.
If you don't know them, check out http://app.leg.wa.govldistrictfnder/
Congressional District Numbers :
s
Legislative District Number(s):
124
9. Enter information regarding the primary contact. This is the person who will be our main day-to-day
contact and will be signing most documents. This person must be named in the designation letter or
resolution as the applicant agent. It is recommended that this person not be the authorizing authority
such as the mayor or superintendent.
Name:
Willie Bence
Title:
Director - DEM
Phone:
360-316-6008
Fax:
Email:
wbence@co.jefferson.wa.us
10. Enter information regarding the alternate agent. This person can also sign documents and must be
named in the designation letter or resolution as the alternate.
Name:
Philip Morley
Title:
County Administrator
Phone:
360-531-4343
Fax:
Email:
pmorley@co.jefferson.wa.us
11. If the highest elected official or head authorizing authority is to be the applicant agent or alternate, then
a resolution format must be used to designate the applicant agent and alternate. This section can be
skipped if the highest elected official or head authorizing authority is not to be the applicant agent or
alternate. This section can also be skipped if the jurisdiction has its own resolution format. Examples of
governing body are the County Board of Commissioners, City Council, and School Board.
Date of resolution: I Da Month: I I Year:
Governing Body: Jefferson County Board of County Commissioners
w
Name: Title:
Date certifying resolution:
12. Enter the name, title, and term of office for the highest elected official or highest authorizing authority.
This needs to be the person signing the designation letter or the person(s) signing the resolution. At
least one is required. This person cannot be the applicant agent or alternate in sections 9 and 10.
Name:
Greg Brotherton
Title:
Chair, BOCC
Name:
Title:
Name:
Title:
Name:
Title:
Name:
Title:
Name:
Title:
13. Enter the name and title of anyone authorized to sign contracts. Unless your jurisdiction has rules
stipulating otherwise, the applicant agent and alternate should be listed again in this section.
Name:
Greg Brotherton
I Title:
JChair, BOCC
Name:
Philip Morley
Title:
County Admin
Name:
Title:
14. Enter name, email, and phone of Chief Financial Officer.
Name:
Rose Ann Carroll
Email:
carrolla@co.jefferson.wa.us
Phone:
360-395-9118
15. The authorized Chief Financial Officer completes and signs page 15: FFATA / Audit Certification Form.
STEP 2: The forms are now populated with the information entered in Step 1. Review the forms for
accuracy. Complete the information on page 15.
STEP 3: Print page 6 if applicant agent or alternate is not highest authority.
STEP 4: Print page 7 if applicant agent or alternate is highest authority (or use your own resolution format).
STEP 5: Print pages 8 —15 and TWO copies of the contract/grant agreement. The grant agreement will
be a separate attachment.
STEP 6: Either highest official signs page 6: Designation Letter (if not applicant agent or alternate) or
governing body passes and signs Resolution. If resolution format is used, clerk of governing
body signs a copy of the Resolution.
STEP 7: Highest official and/or governing body signs in block 1 of page 9: Signature Authorization Form
STEP 8: Applicant agent signs block 2 of page 9: Signature Authorization Form, page 8: Disaster
Assistance Application, page 10: Debarment form, page 11: W-9, and page 14: FFATA Form
STEP 9: Alternate applicant agent signs block 2 of page 9: Signature Authorization form, and page 8:
Disaster Assistance Application
STEP 10: Someone who signed in block 2 of Signature Authorization form signs two copies of contract/grant
agreement.
STEP 11: If account has not already been established with State and no changes need to be made,
someone authorized to access account signs Pages 12 and 13: Direct Deposit
STEP 12: The authorized Chief Financial Officer completes and signs page 15: FFATA / Audit Certification
Form.
STEP 13: After all signatures are obtained on all forms, mail the following to:
Mr. Gerard Urbas
Washington Military Department
Emergency Management Division
Public Assistance Program
MS: TA-20, Building 20-B
Camp Murray, WA 98430-5122
❑ ❑ 2.originals of contract/grant agreement
❑ 1 original of designation letter or 1 certified copy of resolution
❑ 1 original signature authorization form
❑ 1 original disaster assistance application
❑ 1 original debarment form
❑1W9
❑ 1 direct deposit form
❑ 1 FFATA / Audit Certification form
Keep pages 1 through 5 and copies of pages 6 (or 7) and 8 through 15 for your file.
STEP 14: After the contract/grant agreement is executed by WA Military Department, one original contract
agreement and a copy of the disaster assistance application will be mailed to the applicant agent.
These should be kept for your file.
If you have questions, please contact your Program Delivery Manager or Program Assistant.
Mr. Gerard Urbas
Washington Military Department
Public Assistance Program
MS: TA-20 Building 20-B
Camp Murray, WA 98430-5122
Re: Designated Applicant Agent
Dear Mr. Urbas:
The purpose of this letter is to designate the Applicant Agent and Alternate authorized
representatives for
Disaster- 4481-DR-WA COVID-19
Applicant: Jefferson County
Applicant Agent: Willie Bence
Alternate Applicant: Philip Morlev
The purpose of this designation as the authorized representatives is to obtain
federal and/or State Emergency or Major Disaster Assistance funds.
These representatives are authorized to execute all contracts, certify completion of
projects, request payments, and prepare all required documentation for funding
requirements.
Sincerely,
Greg Brotherton
Chair, BOCC
Designation of Applicant's Agent
Resolution
Be it resolved by Jefferson County Board of County Commissioners of Jefferson County
(Governing Body)
Willie Bence Director - DEM
(Name of New Agent) (Title)
representative and Philip Morley
(Name of Alternate)
the alternate for and in behalf of Jefferson county
(Public Agency)
is hereby designated the authorized
County Administrator is designated
(Title)
(Public Agency Name)
agency established under the laws of the state of Washington.
a public
The purpose of this designation as the authorized representative is to obtain federal and/or state
emergency or disaster assistance funds. These representatives are authorized on behalf of the
Jefferson County Board of County Commissiorg to execute all contracts, certify completion of projects, request
payments, and prepare all required documentation for funding requirements.
Passed and approved this day of , 20
Chair, BOCC
(Signature) (Title)
(Signature)
(Signature)
(Title)
(Signature)
(Signature)
(Title) (Signature)
Certification
(Title)
(Title)
(Title)
I, , duly appointed and of Jefferson county
(Name) (Title) (Public Agency)
do hereby certify that the above is a true and correct copy of a resolution passed and approved by
the Jefferson County Board of Cour of Jefferson County on the day of 20
(Governing Body) (Public Agency)
Date:
(Official Position)
(Signature)
12/10/09
DISASTER ASSISTANCE APPLICATION DEM -131
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Legal Applicant Recipient:
Applicant's Name: Jefferson County
Street Address: 81 Elkins Rd
Mailing Address: 81 Elkins Road County: Jefferson
City: Port Hadlock
State: WA Zip Code: 98339
Applicant Agent:
Contact Information:
Name: Willie Bence
Phone: 360-316-6008
Title. Director - DEM
Fax:
E-mail: whence&o.jefferson.wa.us
Signature:
Date:
Alternate Applicant Agent:
Name: Philip Morley
Phone: 360-531-4343
Title: County Administrator
Fax:
E-mail: pmorley&o.jefferson.wa.us
Signature:
Date:
Type of applicant:
A - State
F - Higher Educational Institution
B - County
G - Indian Tribe
C - City
H - Private NonProfit
D - School District
I - Other (Specify) Do not fill this in
E - Special Purpose District
Enter Appropriate Letter B
Congressional District Number:
6
State Legislative District Number:
24
n.
r
NOTE: Shaded blocks for WA EMD use.
SIGNATURE AUTHORIZATION FORM
WASHINGTON STATE MILITARY DEPARTMENT
Camp Murray, Washington 98430-5122
Please read instructions on reverse side before completing this form.
NAME OF ORGANIZATION I DATE SUBMITTED
Jefferson County
PROJECT DESCRIPTION I CONTRACT NUMBER
Public Assistance Program, Disaster 4481-DR-WA I D20-182
1. AUTHORIZING AUTHORITY
SIGNATURE
PRINT OR TYPE NAME
TITLE/TERM OF OFFICE
Greg Brotherton
Chair, BOCC
2. OTHER INDIVIDUALS AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS
SIGNATURE
PRINT OR TYPE NAME
TITLE
Greg Brotherton
Chair, BOCC
Philip Morley
County Admin
SIGNAUTH — PA, Revised 11/09
Form
W'9
Request for Taxpayer
Give form to the
(Rev. November 2005)
Identification Number and Certification
requester. Do not
Department of the Treasury
send to the IRS.
Internal
Revenue Service
N
Name (as shown on your income tax return)
m
Jefferson County
m
a
Business name, if different from above
c
0
0 to
a 0
Individual/
❑
❑ Corporation ❑ Partnership ❑ Other ► _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
❑ Exempt from backup
u
Check appropriate box: Sole proprietor
withholding
rAddress
c
(number, street, and apt. or suite no.)
Requester's name and
address (optional)
a
81 Elkins Rd
u
City, state, and ZIP code
a
Port Hadlock
WA 98339
N
d
List account number(s) here (optional)
m
FMM Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid Social security number
backup withholding. For individuals, this is your social security number (SSN). However, for a 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 TIN on page 3. or
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose Employer identification number
number to enter. 91-6001322
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal
Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has
notified me that I am no longer subject to backup withholding, and
3. 1 am a U.S. person (including a U.S. resident alien).
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 page 4.)
Sign Signature of
Here U.S. person ► Date 0-
Purpose of Form
A person who is required to file an information return with the
IRS, must obtain your correct taxpayer identification number
(TIN) to report, for example, income paid to you, real estate
transactions, mortgage interest you paid; acquisition or .
abandonment of secured property, cancellation of debt, or
contributions you made to an IRA.
U.S. person. Use Form W-9 only if you are a U.S. person
(including a resident alien), to provide your correct TIN to the
person requesting it (the requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you are
waiting for a number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a
U.S. exempt payee.
In 3 above, if applicable, you are also certifying that as a
U.S. person, your allocable share of any partnership income
from a U.S. trade or business is not subject to the
withholding tax on foreign partners' share of effectively
connected income.
Note. If 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.
For federal tax purposes, you are considered a person if you
e An individual who is a citizen or resident of the United
States,
• A partnership, corporation, company, or association
created or organized in the United States or under the laws
of the United States, or
fa Any estate (other than a foreign estate) or trust. See
Regulations sections 301.7701-6(a) and 7(a) for additional
information.
Special rules for partnerships. Partnerships that conduct a
trade or business in the United States are generally required
to pay a withholding tax on any foreign partners' share of
income from such business. Further, in certain cases where a
Form W-9 has not been received, a partnership is required to
presume that a partner is a foreign person, and pay the
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 withholding on your
share of partnership income.
The person who gives 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 is in the following cases:
• The U.S. owner of a disregarded entity and not the entity,
are:
Cat. No.10231X Form W-9 (Rev.11-2005)
Washington Military Department Contract Number: D20-182
Debarment, Suspension, Ineligibility or Voluntary Exclusion Certification Form
NAME
Doing business as (DBA)
Jefferson County
ADDRESS
Applicable Procurement
WA Uniform Business
Federal Employer Tax
81 Elkins Rd
or Solicitation #, if any:
Identifier (UBI)
Identification #:
Port Hadlock
WA 98339
601-098-110
91-6001322
This certification is submitted as part of a request to contract.
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 terns 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 ir1 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: Date:
Print Name and Title: Willie Bence
Director - DEM
PLEASE STA7�
PRINT FORM
DO NOT U-"-
Office of Financial Management
STAPLEBetter information. Better decisions. Better government. Better Washington.
Statewide Payee Registration
Washinqton State
- The legal name on both forms must
match each other and the legal name
on file with the IRS.
- Please use dark blue or black ink when
signing, or if filling out the forms by hand.
- Please fill out this form (both pages) in its entirety,
even if some information has not changed.
- A 9-digit US taxpayer identification number
(either SSN or EIN) is required on both forms.
If you know your Statewide Vendor Number, enter it here:
i-STEP 1-:- Enter information about the payee . contact person
Jefferson County
Legal Name of Payee as it appears on federal tax forms (see W-9)
Business Name, if different from Legal Name above — e.g. Doing Business As (DBA) Name
81 Elkins Road
Mailing Address
Port Hadlock WA 98339
City, State and Zip Code
Email to receive Statewide Vendor Number and payment notifications
Type of Business (If Non Profit or Tax Exempt, please submit your determination letter)
STEP 2: Select Payment Option:
Page t of 2
91-6001322
SSN OR EIN
Contact Person
Contact Telephone Number
Contact Fax Number
STATE USE ONLY Agy#/Owner-InL/Systemlidentifier
❑ Direct Deposit to bank (recommended) or ❑ Check in US mail (terminates any previous banking information on file)
1. Ri. W keel
12I"1 A��wbeee Avme
In addition toprovidingyour banking information on this form, you may also attach a voided check. 'myMe'Anystaft S6 &
�ronrs oaaa e•
Financial. Institution Name - must be a US institution
Financial Institution Phone Number whit
This account is:
❑ Checking ❑ Savings
Routing Number —see example at right Account Number— see example at right VAIIderaulttoChecking k1rooption ischecked I�pyy00dA04 a 160130629
Account Type: ❑PPD (Personal) ❑ CCD (Corporate/Business) routing number account number
Will default to CCD if no option is checked (nine digits) (can vary in length;
Authorization for Direct Deposit:
I hereby authorize and request the Office of Financial Management (OFM) and the Office of the State Treasurer (OST) to initiate credit entries for
payee payments to the account indicated above, and the financial institution named above is authorized to credit such account. I agree to abide by
the National Automated Clearing House Association (NACHA) rules with regard to these entries. Pursuant to the NACHA rules, OFM and OST
may initiate a reversing entry to recall a duplicate or erroneous entry that they previously initiated. I understand that, if a reversal action is required,
OFM will notify this office of the error and the reason for the reversal. 'rhis authority will continue until such time OFM and OS"r have had a
reasonable opportunity to act upon written request to terminate or change the direct deposit service initiated herein.
Authorized Representative (Please Print)
(Not to be signed by your financial institution)
SIGNATURE of Authorized Representative
(No stamped or electronic signatures please)
Title
Date
Forms will not be accepted if they have whiteout,
have been crossed off or have been written over. Revised 11/15/18
Page 2 of 2
STEP 3: Complete and sign the Request for Taxpayer Identification Number (W-9)
Substitute Request for Taxpayer
Form W-9 Identification Number and Certification
1. Legal Name (as shown on your income tax return)
Jefferson County
2.13usiness Name, if different from Legal Name above — e.g. Doing Business As (DBA) Name
3-Check ONLY ONE box below (see
W-9 instructions for additional information)
❑ Individual/Sole Proprietor
❑ Corporation (Induding LLC-Ca,parstian, ❑ Non Profit Organization Q Local Government
(Including LLC-Sole Propnetar)
❑ volunteer
S-Corp and LLC S-Corp)
❑ Tax Exempt Organization ❑ State Government
❑ Partner$hlp (Indutling LLC-Partnership)
❑ Board/Committee Member
❑ Trust/Estate ❑ Federal Government
(Including Tribal)
4. For Corporation or Partnership ONLY, check one box below if applicable:
❑ Medical ❑ Attorney/Legal
5. Legal Address (number, street, and apt. or suite no.) For office use
81 Elkins Road The Legal Name, Address and TIN must be
filled in completely and the document
6. City, State, and ZIP code signed for the forms to be accepted.
Port Hadlock WA 98339
7. Taxpayer Identification Number (TIN) Social Security Number
Enter your EIN OR SSN in the appropriate box to the right (do NOT enter both)
For individuals, this is your social security number (SSN). OR
For other entities, it is your employer identification number (EIN). Employer Identification Number
NOTE: The EIN or SSN must match the Legal Name as reported to the IRS to avoid backup
withholding. For a resident alien, sole proprietor, or disregarded entity, or to find out how to get a 91-6001322
Taxpayer Identification Number, see the W8 Instructions.
NOTE: If the account is in more than one name, see the W9 Instructions for guidelines on whose
number to enter.
8. Certification
Under penalty of perjury, I certify that:
• 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
• I 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
• I am a U.S. person (including a U.S. resident alien).
SIGNATURE of U.S. PERSON
Date
No Stam ed or Electronic Si natures will be acce ted
STEP 4:- Submit
Please allow up to 7 business days for processing of this paperwork from the day we receive it.
If adding or changing direct deposit information, up to 10 additional business days may be
needed for your financial institution to verify your information.
For fastest service, PRINT, SIGN, FAX to: 360-664-3363
or mail to: Statewide Payee Registration, PO Box 41450, Olympia WA 98504-1450
If you have questions regarding these forms, please contact the agency you are working with.
CONTACT INFORMATION
Subrecipient Name (Agency, Local Government, or Organization): Jefferson County
Subrecipient Data Universal Numbering System (DUNS) / Unique Entity Identifier (UEI) Number: 876703406
Authorized Financial Representative (Name and Title):
Address: 81 Elkins Rd Port Hadlock WA 98339
Email: Phone Number:
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. All subrecipients must complete the Federal Funding
Accountability and Transparency Act (FFATA) related questions in Section C of this Form. Failure to return this
completed Form to contracts.office@mil.wa.gov 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: Entities NOT subject to the audit requirements of 2 CFR Port 200 Subpart F
(check all that apply)
❑ We did not expend $750,000 or more of total federal awards during the preceding fiscal year.
❑ We are a for -profit organization.
❑ 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 may request and be provided access to additional information and/or documentation to ensure
proper stewardship of federal funds. -
SECTION 8: Entities that ARE subject to the audit requirements of 2 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 [enter date]. There
were no findings related to federal awards or internal controls.
❑ We completed our last 2 CFR Part 200 Subpart F Audit on [enter date] for fiscal year [enter date] and
there were findings related to federal awards and/or internal controls.
❑ Our completed 2 CFR Part 200 Subpart F Audit will be available on [enter date] for fiscal year [enter date].
Provide a complete copy of the audit report electronically to contracts.office@mil.wa.gov or provide the
state audit number [enter number].
Updated 2/11/2020
Page 1 of 2
SECTION C: Fedeml Funding Accountability and Twnsparency Act (check the corresponding answer)
In your preceding fiscal year, did your organization receive 80% or more of its gross revenues from federal
funding? ❑ Yes ❑ No
In your preceding fiscal year, did your organization receive $25,000,000 or more in federal funding?
❑ Yes ❑ No
If you answered yes to the previous questions, WMD Contracts staff will request additional information to
comply with FFATA reporting.
I hereby certify that I am an individual authorized by the above identified entity (subrecipient) to complete
this form. Further, I certify that the above information is true and correct, and all material findings contained
in the audit report/statement have been disclosed. Additionally, I understand this form is to be submitted
every fiscal year for which this entity is a subrecipient of federal award funds from the Department until the
grant agreement is closed.
Signature of Authorized Financial Representative:
Page 2 of 2
Date:2/10/2020
DEPARTMENT OF HOMELAND SECURITY O.M.B. Control Number: 16W-0017
Federal Emergency Management Agency Expires: June 30, 2020
PROJECT WORKSHEET
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this data collection is estimated to average 1.30 hours per response. The burden estimate includes the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and submitting this form. This collection of information is not
required to obtain or retain benefits. You are not required to respond to this collection of information unless a valid OMB control number is displayed in the upper
right corner of this form. Send continents regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections
Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW., Washington, DC 20472, Paperwork Reduction
Project (1660-0017) NOTE: Do not send your completed form to this address.
DISASTER
PROJECT tt
PA ID fe
DATE
CATEGORY
FEMA- D20_ -DR- D20-182
See below
331-9W31-00
Ongoing
B
DAMAGED FACILITY
WORK COMPLETE AS OF
N/A
Unk 100 %
APPLICANT
COUNTY
Jefferson County
Jefferson
LOCATION
LATITUDE
LONGITUDE
Varies
DAMAGE DESCRIPTION AND DIMENSIONS
County -wide response to the novel coronavirus and protective actions.
SCOPE OF WORK
The Applicant took the following direct actions to address the immediate threat to public health and safety, in order to protect human fives; EOC/IMT operations,
procuren ent/fabricatiordstorage/protectiorVdishibution of disinfecting materials, hand sanitizer, personal protective equipment and temporary physical barriers,
disinfection/decontamination/deep cleaning of all municipal areas in facilities occupied by essential personnel employed in direct support of essential FEMA
Community Lifeline functions and emergency response activities to lessen/eliminate the threat of exposure to COVID-19.
Does the Scope of Work change the pre -disaster conditions at the site? ❑X YES NO
Special Considerations Issues included? QX YES NO Hazard Mitigation proposal included? ❑ YES ENO
Is there insurance coverage on this facility? ❑X YES NO
PROJECT COST
ITEM CODE NARRATIVE QUANTITY/UNIT UNIT PRICE COST
1
137974
Temporary Morgue Alterations
1
10,862.04
10,862.04
2
142601
Response act4des May 2020
1
41,186.08
41,186.08
3
143775
Public Health activities May 2020
1
56,546.66
56,546.66
4
137535
Sanitation of Courthouse and Jail
1
7794.48
7794.48
5
139990
Response Activities March 2020
1
15,562.65
15,562.65
6
141214
Response Activities April 2020
31,217.19
31,217.19
TOTAL COST
163,169.10
PREPARED BY
TITLE
SIGNA
Willie Bence
Director - DEM
r
APPLICANT REP.
TITLE
SIGNATURE
Philip Morley
County Administrator
FEMA FORM 009-0-91 PREVIOUS EDITION OBSOLETE