HomeMy WebLinkAbout22-Fire Department
CITY OF SAN BERNARDINO - REQUEST FOR COUNCIL ACTION
Dept:
Fire
Subject: Resolution ratifying submittal of a grant
application to the Federal Emergency
Management Agency (FEMA) in the amount of
$210,600 to purchase defibrillators.
ORIGINAL
From:
Larry R. Pitzer, Fire Chief
Date:
April 1, 2003
MCtC Meeting Date:
April 21, 2003
Synopsis of Previous Council Action:
04/01/03
Special Grants Committee Meeting-Item recommended for approval.
RECOMMENDATION:
Adopt resolution.
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Contact Person: Larry Pitzer, Fire Chief
Phone: (909) 384-5286
Supporting data attached: Staff Report, Resolution, and Application
Ward: Citywide
FUNDING REQUIREMENTS:
Amount:
$147,420.00
Source:
FEMA's Grant Funding Share
Amount:
$63.180.00
Source:
(Acct. No) To Be Determined-City's Cost Share
If the grant is awarded, the Fire Department will
submit a request to amend the General Fund in the amount of $63.180.00 to match the grant.
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Finance:
Council Notes:
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Agenda Item No. 1L
STAFF REPORT
SUBJECT
Resolution ratifying submittal of a grant application to the Federal Emergency Management
Agency (FEMA) in the amount of $210,600 to purchase defibrillators.
BACKGROUND
FEMA has announced the availability of grant funding for the Assistance to Firefighters Grant
Program (AFGP) for fiscal year 2003. This assistance will be awarded to local fire departments
on a competitive basis.
On April 1, 2003, the Fire Department attended a Special Grants Committee to request
authorization to submit the on-line grant application (see Attachment "A") prior to Council
approval. Deadline for the FEMA grant application was April 11, 2003; there were no
exceptions. The Grant Committee consented that the Fire Department proceed with the submittal
of the application. Grant awards begin in June and continue until all funds are awarded.
The purpose of AFGP is to award grants directly to fire departments to enhance their ability to
protect the health and safety of the public, as well as that of firefighting personnel, facing fire
and fire-related hazards. FEMA is the agency that will administer the grant application and
allocation process.
Fire departments can apply for eligible activities in one of four different programs:
1. Fire Operations and Firefighter Safety Program.
2. Fire Prevention Program.
3. Emergency Medical Services Program.
4. Firefighting Vehicle Acquisition Program.
The San Bernardino City Fire Department submitted an application for Emergency Medical
Services Program to replace all existing defibrillators.
Defibrillators are a critical piece of equipment for our paramedic program. They are used for a
patient that is in cardiac arrest to change the non-functioning heart to a normal heart rhythm.
Obviously, flawless operation of the defibrillators is of paramount importance. Industry norms
identify approximately a 7-year life-span for defibrillators.
Currently, we have thirteen defibrillators and monitors that have 7 years or more in service. They
have exceeded the warranty phase and six of our monitors are Hewlett Packard (HP). HP no
longer makes these types of monitors and will not extend the preventative maintenance warranty.
We are requesting funding to purchase thirteen defibrillators to replace all of the defibrillators.
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FINANCIAL IMPACT
We are requesting 13 defibrillators and the cost per unit is $16,200. The total amount needed to
purchase and replace all defibrillators is $210,600 (see Attachment "A" for budget detail);
FEMA will fund 70% and the City is required to match 30% of the cost. The Fire Department's
match, in the amount of $63,180.00, will need to be funded by the General Fund in fiscal year
2003/2004. Alternatively, we could lease purchase an amount of the equipment that would
satisfy our 30% match requirement; this would approximate $13,900 annually over a 5 year
period. There are no anticipated on-going costs for this grant.
If the Fire Department is awarded this grant, a staff report requesting a budget amendment to
appropriate the required funds will be brought back to the Mayor and Common Council for
approval.
RECOMMENDA nON
Adopt resolution.
2
RESOLUTION NO.
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RESOLUTION OF THE MAYOR A:'-ID COMMON COUNCIL OF THE CITY OF SAN
BERNARDINO RATIFYING SUBMITTAL OF A GRANT APPLICATION TO THE
FEDER"-L EMERGENCY MANAGEMENT AGENCY (FEMA) IN THE AMOt:NT OF
S2 I 0,600 TO Pl'RCHASE DEFIBRILLATORS.
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BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY OF
SA:\ BERNARDI]\O AS FOLLOWS:
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SECTION 1. The \layor and Common Council hereby ratii)' the Fire Chiefs submittal of
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an on-line grant application to FE!\1A in the amount of $21 0,600 for San Bernardino Cit\, Fire
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Department's Emergency Medical Ser\'ices Program. A copy of the on-line grant application is
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attached as Attachment "A", and incorporated herein by reference.
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RESOLl!TIO!'\' OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN
BERNARDINO R.\ TIFYING SUBMITTAL OF A GRAl'IT APPLICA TIOl'l TO THE
FEDERAL EI\1ERGE!'\'CY MAl'IAGEMENT AGENCY (FEMA) IN THE AMOl'iT OF
S210,600 TO I'l;RCHASE DEFIBRILLATORS.
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I HEREBY CERTIFY that the foregoing resolution was duly adopted hy the !\Iayor and
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Common Council of the City of San Bernardino at a
meeting thereoL held on
6
day of
.2003. by the following Yote. to wit:
the
7
8
Council Members
AYES
NAYS
ABSTAIl'I ABSEI'\T
9
ESTRADA
10
LONGVILLE
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McGl'\:-;IS
12
DERRY
13
SUAREZ
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ANDERSON
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McCAMMACK
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17
] 8
Rachel G. Clark. City Clerk
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The foregoing resolution is hereby approyed this
day of
.2003.
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Judith Valles. Mayor
City of San Bernardino
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Approyed as to form
and legal content:
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James F. Penman.
City Attorney
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. Print Application
Attachment "A"
Entire Application
Applicant Information
Page 1 of 12
Submitted on 1 0-APR-2003 by Norma Camarena
Based on information you have provided, your department serves a Suburban community.
Contact Information:
Day Phone: 909-384-5388
Evening Phone:
Cell Phone:
Email: camerena_no@ci.san-bernardino.ca.us
. Fire Department Name
. Type of Fire Department
If other, please enter the type of Fire Department
. Emolover Identification Number
Physical Address
. Headquarters' Physical Address 1
Headquarters' Physical Address 2
. C~y
. State
'Zip
Mailing Address is the same as the Physical Address
. Mailing Address 1
Mailing Address2
. City
. State
'Zip
Account information
. Type of bank account
. Bank routing number - a.Qigj! number on the bottom
left hand corner of your check
. Your account number
Additional Information
This fiscal year, are you receiving Federal funding
from any other grant program for the same purpose No
for which you are applying for this grant?
This fiscal year, are you receiving Federal funding
from any other grant program regardless of Yes
purpose?
, Is the applicant delinquent on anv federal debt? No
If yes, type explanation in space provided below
Contact Information
City of San Bemardino Fire Department
City
95-6000772
200 East Third Street
San Bernardino
California
92410 - 4889
200 East Third Street
San Bernardino
California
92410 - 4889
Checking
121000248
4159283308
. ?rint ApplicatIOn
, Title
Salutation
, First Name
Middle Initial
, Last Name
, Day Phone
'Evening Phone
Cell Phone
Fax
Email
, Title
Salutation
, First Name
Middle Initial
, Last Name
, Day Phone
'Evening Phone
Cell Phone
Fax
Email
Department Characteristics (I)
Page 2 of 12
Alternate Contact Information Number 1
Fire Chief
Pitzer
R
Larry
(909) 384-5286 Ex!.
(909) 384-5286 Ex!
(909) 384-5281
pitzer Ja@ci.san-bernardino.ca.us
Alternate Contact Information Number 2
EMS Coordinator
Mr.
Henry
Vasquez
(909) 384-5286 Ex!.
(909) 384-5286 Ex!
(909) 384-5281
vasquez~he @ci.san-bernardino.ca.us
, What percentage of your response area IS
protected by hydrants?
- How much of your Jurisdiction is zoned for
agriculture?
, How much of your Jurisdiction is zoned for
commercial or industrial?
, How many structures in your jurisdiction are more
than four stories tall?
. What is the permanent reSident population of your
PrlmilJY!l1U;t-respoose area.Qr Jurisdiction ~erve_d_?
. Are you a member of a Fire Department or
authOrized representative of a fire department?
, Are you a member of Federal Fire Department or
contracted by the Federal government and solely
responsible for suppression of fires on Federal
property?
, What kind of Department do you represent?
If you answered combination, above, what is the
%,
percentage of career firefighters in your department?
'What is the square mileage of your primary
response area?
Yes
No
All Paid/Career
63
93%
0%
4%
17
205942
______~L~_ ~__ll
IlAflA/"'IfV\')
.Prim Application
Pagc 3 of 12
. now many aCllve mellgmers_are In me
operations/EMS divIsion of your department?
. How many stations are In your department?
. Do you currently report to the National Fire Incident
Reporting System (NFIRS)?
If you answered yes, above, please enter your
FDIN?
142
12
Yes
36195
, What services does your department provide?
Structural Fire Suppression Fighting Wildfire Suppression
Basic Life Support Advanced Life Support
Hazmat Technical Level Hazmat Specialist Level
Rescue Technical Level
Airport Rescue Fire Fighting (ARFF)
Hazmat Operational Level
Rescue Operational Level
Depar~~ent Characteris!i.cs (II) _.________"
. What is the total number of fire related fatalities in 7
your Junsdlctlon over the last three years?
'What is the total number of fire related firefighter 12
Injuries in your jurisdiction over the last three years?
, In an average year, how many times does your
department receive mutual/automatic aid?
. In an average year, how many times does your
department provide mutual/automatic aid?
, What was your department's estimated average
operating budget over the last three years?
, What percentage of your annual operating budget
is dedicated to personnel costs(salary, overtime and 85 %
fnnge benefits)?
. What percentage of your annual operating budget is derived from:
Taxes? 100 %
95
57
19935051
G 'ants?
Donations?
Fund drives?
0%
o ~o
0%
'How many vehicles does your department have in each of the categories below? Enter numbers only and
enter 0 If you don't have any of the vehicles below
First Line Reserve
a. Engines (or pumpers): 11 5
b. Aerial Apparatus: 2 1
c. Tankers: 2 0
d. Rescue Vehicles: 3 0
e. Brush/Quick attack: 5 0
f. Other: 27 0
Provide in the space below the following information only if you are applying for a firefighting vehicle: List all
your vehicles by type (for example, engines/pumpers, brush, rescue, etc.). Then provide the year each was
manufactured. If the department has more than two of any type, provide the total number of vehicles in that
categony and the years the oldest and the newest were manufactured.
Q.epartrT1.ent Call Volume
---~._--_._--_.~--- ...-..-.....-----.. ---..-..--.--- _._~-_._-_._-~_._---------
11 AAll"/.....()f'\'}
.Print Application
Page 4 of 12
. How many responses per year by category? Enter whale numbers Gilly If you have no calls lor any 01 the ca:eg':Jnes enter
zero.
Structure Fires
Vehicle Fifes
Vegetation Fires
EMS
314
311
330
23571
15
119
557
592
1283
Rescue
Hazardous Condition/Materials Calls
Service Calls
Good Intent Calls/False Alarms
Other Calls and Incidents
Request Information
. 1. Select the program for which you are applying. Remember, you can apply for only one program this year.
Within a program you may apply for as many activities as are required.
It you modify your selection. you will lose data entered under the original activity
Program Name
Emergency Medical Services
. 2. Will this grant benefit more than one department?
No
3. If you answered Yes to Question 2 above, please specify how? (You can only enter 4000 characters)
Request Details
--_.__.,-_._-_._-_._-.._------~_._.._._"._-" .--------_._----_.._------
o
Total Cost Additional Funding
$0 $0
Activity
Wellness and Fitness Programs
Emergency Medical Services
(Training and Equipment)
Number of Entries
$ 210,600 $ 0
Emergency Medical Services-Equipment
'1. What equipment will be purchased with grant funds?
Defibrillators
If you answered other, above, piease specify
'2. Number of units
13
'3. Cost per unit
$ 1 6200
'4. What is the reason for this equipment purchase?
Upgrade service
'5. Will this equipment bring you into compliance with
State or Federal standards/regulations?
'6. Up to what level of patient care will this equipment
bring your department?
Yes
First Responder
"0""-"''''''('\''1
Print Application
Total Budget
Budget Oi)j~cj Class
a. Personnel
b. Fringe Benefits
c. Travel
d. Equipment
e. Supplies
f. Contractual
g. Construction
h. Other
I. Indirect Charges
Indirect Cost Details
Agency Indirect Cost Agreement with
Indirect Cost Rate
Agreement Summary
Federal and Applicant Share
Federal Share
Applicant Share
Federal Rate Sharing (%)
. Non-Federal 8esources (The combined Non.Federal Resources must equal the Applicant Share of S 63.180)
%
Page 5 of 12
$0
$0
50
$ 210,600
$0
$0
$0
$0
$0
5147,420
$ 63,180
70/30
$ 63180
$0
$0
$0
a. Applicant
b. State
c. Local
d. Other Sources
If you entered a value in Other Sources, Please identify the source of your cost share, i.e., fund reserves,
savings, fund-raisers, donations, etc.
Total Budget
Narrative Statement
$ 210,600
. Print Application
Page 6 of 12
Project Description
Please provide your narrative statement in the space provided below:
THE PROJECT THAT WE ARE REQUESTING TO BE FUNDED:
The San Bernardino City Fire Department (SBCFD) is requesting to replace our current defibrillators that are
in desperate need of replacement. We would like to begin replacing thern due to the following reasons we are
facing:
. Overall poor condition of current devices,
. Exceed the industry norms of years in service,
Newer defibrillators have updated specifications,
. Decrease probability of outdated defibrillator malfunction, and
Reduce the potential for liability on our current device.
The new defibrillators would allow SBCFD to be better equipped to provide the highest quality of care and
overall standardization of our department"s defibrillators. Also, we will be able to detect and treat cardiac
incidents faster, resulting in better patient care outcomes. Defibrillators are not only very essential as part of
the firefighter/paramedics overall assessment, but can be the difference between life and death of a patient.
SBCFD provides a first responder paramedic program that has thirteen (13) defibrillators; they have been In
service for more than seven (7) years. The defibrillators exceeded the warranty phase and six (6) of those
defibrillators are Hewlett Packard (HP). HP no longer rnakes these units; parts and repair for them is a real
problem. The remaining seven (7) Phys-control Life Pak 10's are several years older and are in very poor
condition.
HOW WE PLAN TO USE THE GRANT FUNDS FOR EACH MAJOR BUDGET ACTIVITY AS LISTED ON
THE BUDGET FORM
The following is a break down of how the funds will be allocated:
Personnel: $ 0 requested.
Fringe Benefits: $ 0 requested.
Travel: $ 0 requested.
Equipment: $ 210,600 requested.
SBCFD plans to replace all thirteen (13) defibrillators with new devices that have current technology. It is
paramount that heart attack victims be identified as quickly as possible in order to receive life-saving
treatment. Rapid identification by our firelighter/paramedic crews is the first logical step in this effort. These
devices cost approxirnately $16,000 per defibrillator, and each device includes the following:
EKG monitor (3-lead patient cables; 2 - preventive maintenance per year for 5 years)
Biphasic waveform defibrillator (2-rechargeable batteries)
Pulse Oximetry (Battery charging system)
Noninvasive Blood pressure (Warranty for 5 years)
Noninvasive Pacing (Carry case/cover)
Supplies: $ 0 requested.
Contractual: $ 0 requested
Construction: $ 0 requested
Other: $ 0 requested
Indirect Charges: $ 0 requested
WHY THIS PROGRAM WOULD BE BENEFICIAL TO OUR COMMUNITY AND/OR TO OUR
DEPARTMENT:
.Print Application
Page 7 of 12
SBCFD responds to approximately 24,000 EMS calls annually. Defibrillators will assist in enhancing the
following areas:
1. Increase the number of lives saved of those with cardiac incidents.
2. Improve the quality of life for survivors of cardiac incidents and their families.
3. Equip the fire department"s EMS providers with state-of-the-art defibrillators to enhance their patient
assessment and treatment.
The new state-of-the-art defibrillators have the technology to record and store patient data. This allows our
department to improve on the current Quality Assurance & Quality Improvement Program. This program
allows us to look at outcome based research and with this information we can recommend changes to our
current county protocols for the betterment of the patient outcome within our city.
These new defibrillators have latest technology that will give our firefighter/paramedics the ability to more
rapidly and accurately make assessments. This in-turn allows us to give the patient(s) within our community
the best treatment and improve diagnosis.
WHY THIS PROJECT CANNOT BE FUNDED SOLELY THROUGH LOCAL FUNDING:
Our City was home to Norton Air Force base that was closed in the early 1990s. At approximately the same
time, Santa Fe Railroad moved their regional offices out of the area and a Kaiser Steel Mill closed. The direct
impact of these three closures resulted in the loss of 23,000 high paying jobs in the area. Consequently, our
City has been in an economic recovery mode for a decade that has created budgetary shortages. As
example, SBCFD budget has not had an inflationary increase in Maintenance and Operation for well over a
decade. This has created a significant erosion of purchasing power to the point that no funds exist for
purchases such as defibrillators.
San Bernardino City is faced with significant budgetary shortfalls because of the catastrophic State budget
crisis (estimated at $34 billion shortfall) and mandated retirement system increased contributions. Best case
scenario for SBCFD"s share of cuts is $1.2 million and worst case $2.8 million for next fiscal year. Budget
shortfall predictions for fiscal year 2004-2005 are considerably worse than for 2003-2004. Clearly, SBCFD will
not have funding to purchase defibrillators for quite some time into the future.
ADDITIONAL RELEVANT INFORMATION THAT WE WOULD LIKE YOU TO CONSIDER WHEN
EVALUATING OUR APPLICATION:
The San Bernardino City Fire Department serves a resident population of 205,942 and covers a diverse
service area of 63 square miles. It is the largest city in the County and serves as the County seat. There are 3
major freeways and approximately 19 miles of wildland/urban intertace areas within the city.
SBCFD staffs eleven paramedic engines companies, two aerial trucks companies, and one aircraft rescue
fireflghting vehicle housed in twelve stations throughout the City. Also, under a unique partnership with the
San Manuel Band of Mission Indians we provide fire and emergency services to their tribal lands.
If you received a grant award in the 2002 process, does No
your current request relate to your 2002 award?
If you answered yes, above, which of the following apply?
This request enhances the 2002 award
This request continues the 2002 award
This request completes the 2002 award
Assurances and Certifications
FEMA Form 2o-16A
You must read and sign these assurances by providing your password and checking the box at the
bottom of this page.
.Print Application
Page 8 of 12
Note: Fields marked with an . are required.
Assurances Non-Construction Programs
Note: Certain of these assurances may not be applicable to your project or program. If you have any
questions, please contact the awarding agency. Further, certain Federal awarding agencies may require
applicants to certify to additional assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant I certify that the applicant:
1. Has the legal authority to apply for Federal assistance, and the institutional, managerial
and financial capability (including funds sufficient to pay the non-Federal share of project
costs) to ensure proper planning, management and completion of the project described in
this application.
2. Will give the awarding agency, the Comptroller General of the United States, and if
appropriate, the State, through any authorized representative, access to and the right to
examine all records, books, papers, or documents related to the award; and will establish
a proper accounting system in accordance with generally accepted accounting standards
or agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose
that constitutes or presents the appearance of personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of
approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. Section 4728-
4763) relating to prescnbed standards for merit systems for programs funded under one
of the nineteen statutes or regulations specified in Appendix A of OPM's Standards for a
Merit System of Personnel Administration) 5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statutes relating to nondiscrimination. These include but are
not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits
discrimination on the basis of race, color or national origin; (b) Title IX of the Education
Amendments of 1972, as amended (20 U.S.C. Sections 1681-1683, and 1685-1686),
which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act
of 1973, as amended (29 U.S.C. Section 794), which prohibits discrimination on the basis
01 handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. Sections
6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office
and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on
the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention,
Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or alcoholism; (g) Sections 523 and 527
of the Public Health Service Act of 1912 (42 U.s.C. 290-dd-3 and 290-ee-3), as amended,
relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the
Civil Rights Acts of 1968 (42 U.S.C. Section 3601 et seq.), as amended, relating to
nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination
provisions in the specific statute(s) under which application for Federal assistance is being
made; and U) the requirements of any other nondiscnmination statute(s) which may apply
to the application.
7. Will comply, or has already complied, with the requirements of Title II and III of the
Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L.
91-646) which provide for fair and equitable treatment of persons displaced or whose
property is acquired as a result of Federal or Federally assisted programs. These
requirements apply to all interest in real property acquired for project purposes regardless
of Federal participation in purchases.
8. Will comply with provisions of the Hatch Act (5 U.S.C. Sections 1501-1508 and 7324-
7328), which limit the political activities of employees whose principal employment
activities are funded in whole or in part with Federal funds.
9. Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.s.C. Sections
276a to 276a- 7), the Copeland Act (40 U.S.C. Section 276c and 18 U.S.C. Sections 874),
and the Contract Work Hours and Safety Standards Act (40 U.S.C. Sections 327-333),
regarding labor standards for federally assisted construction sub agreements.
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of
the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a
.Print Application
Page 9 of 12
special flood hazard area to participate in the program and to purchase flood insurance If
the total cost of Insurable construction and acquisition IS $10,000 or more.
11. Will comply with environmental standards which may be prescribed pursuant to the
following: (a) institution of environmental quality control measures under the National
EnVIronmental Policy Act of 1969 (PL 91-190) and Executive Order (EO) 11514; (b)
notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant
to EO 11990; (d) evaluation of flood hazards In floodplains in accordance with EO 11988;
(e) assurance of project consistency with the approved State management program
developed under the Coastal Zone Management Act of 1972 (16 U.S.C. Section 1451 et
seq.); (f) conformity of Federal actions to State (Clean Air) Implementation Plans under
Section 176(c) of the Clean Air Act of 1955, as amended (42 U.s.C. Section 7401 et seq.);
(g) protection of underground sources of drinking water under the Safe Drinking Water Act
of 1974, as amended, (P.L. 93-523); and (h) protection of endangered species under the
Endangered Species Act of 1973, as amended, (P.L. 93-205).
12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. Section 1271 et seq.)
related to protecting components or potential components of the national wild and scenic
rivers system.
13. Will assist the awarding agency in assuring compliance with Section 106 of the National
Historic Preservation Act of 1966, as amended (16 U.s.C. 470), EO 11593 (identification
and protection of historic properties), and the Archaeological and Historic Preservation Act
of 1974 (16 U.S.C. 469a-1 et seq.).
14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in
research, development, and related activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7
U.S.C. 2131 et seq.) pertaining to the care, handling, and treatment of warm blooded
animals held for research, teaching, or other activities supported by this award of
assistance.
16. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. Section 4801
et seq.) which prohibits the use of lead based paint in construction or rehabilitation of
residence structures,
17. Will cause to be pertormed the required financial and compliance audits in accordance
with the Single Audit Act of 1984.
18. Will comply with all applicable requirements of all other Federal laws, executive orders,
regulations and policies governing this program.
19. It will comply with the minimum wage and maximum hours provisions of the Federal Fair
Labor Standards Act (29 U.S.C. 201), as they apply to employees of institutions of higher
education, hospitals, and other non-profit organizations.
FEMA Form 20-16C
-- ---.----------------.----..----
You must read and sign these assurances by providing your password and checking the box at the
bottom of this page.
Note: Fields marked with an . are required.
Certifications Regarding Lobbying; Debarment, Suspension and Other Responsibilities Matters; and Drug-Free
Workplace Requirements.
- Print Application
Page 10 of 12
Applicants should refer to the regulations cited below to determine the certification to which they are required
to attest. Applicants should also review the instructions for certification included in the regulations before
completing thiS form. Signature on thiS form provides for compliance with certification reqUIrements under 44
CFR Part 18, "New Restrictions on Lobbying; and 28 CFR Part 17, "Government-wide Debarment and
suspension (Non-procurement) and Government-wide Requirements for Drug-Free Workplace (Grants)." The
certifications shall be treated as a material representation of fact upon which reliance will be placed when the
Federal Emergency Management Agency (FEMA) determines to award the covered transaction, grant, or
cooperative agreement.
1. LOBBYING
A. As required by the section 1352, Title 31 of the US Code, and implemented at 44 CFR Part 18 for persons
into a grant or cooperative agreement over $100,000, as defined at 44CFR Part 18, the applicant certifies
that:
(a) No federal appropriated funds have been paid or will be paid by or on behalf of the
undersigned to any person for influencing or atfempting to influence an officer or employee of
any agency, a Member of Congress, an officer or employee of congress, or an employee of a
Member of Congress in connection with the making of any federal grant, the entering into of any
cooperative agreement and extension, continuation, renewal amendment or modification of any
Federal Grant or cooperative agreement.
(b) If any other funds than Federal appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of congress, or an employee of a Member of
Congress In connection with this Federal grant or cooperative agreement, the undersigned shall
complete and submit Standard Form LLL, "Disclosure of Lobbying Activities", in accordance
with its instructions.
Standard Form LLL Disclosure of Lobbying Activities Attached (This form must be attached to
certification if non-appropriated funds are to be used to influence activities.)
(c) The undersigned shall require that the language of this certification be included in the award
documents for all the sub awards at all tiers (including sub grants, contracts under grants and
cooperative agreements and sub contract(s)) and that all sub recipients shall certity and
disclose accordingly.
2. Debarment, Suspension and Other Responsibility Matters (Direct Recipient)
As required by Executive Order 12549, Debarment and Suspension, and implemented at 44CFR Part 67, for
prospective participants in pnmary covered transactions, as defined at 44 CFR Part 17, Section 17.51 a-A, the
applicant certifies that it and its principals:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible,
sentenced to a denial of Federal benefits by a State or Federal court, or voluntarily excluded
from covered transactions by any Federal department or agency.
(b) Have not within a three-year period preceding this application been convicted of or had a
civilian judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain or perform a public (Federal, State, or local)
transaction or contract under a public transaction; Violation of Federal or State antitrust statutes
or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records,
making false statements, or receiving stolen property_
(c) Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1 )(b)
of this certification: and
(d) have not within a three-year period preceding this application had one or more public
transactions (Federal, State, or local) terminated for cause or default; and
B. Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach
an explanation to this application.
- Print Application
Page 11 of 12
3. Drug-Free Workplace (Grantees other than individuals)
As required by the Drug-Free Workplace Act of 1988, and implemented at 44CFR Part 17, Subpart F, for
grantees, as defined at 44 CFR part 17, Sections 17.615 and 17.620:
(A) The applicant certifies that it will continue to provide a drug-free workplace by:
(a) Publishing a statement notifying employees that the unlawful manufacture,
distribution, dispensing, possession, or use of a controlled substance is prohibited
in the grantee's workplace and specifying the actions that will be taken against
employees for violation of such prohibition;
(b) Establishing an on-going drug free awareness program to inform employees
about:
(1) The dangers of drug abuse in the workplace;
(2) The grantees policy of maintaining a drug-free workplace;
(3) Any available drug counseling, rehabilitation and employee
assistance programs; and
(4) The penalties that may be imposed upon employees for drug
abuse violations occurring in the workplace;
(c) Making it a requirement that each employee to be engaged in the performance
of the grant to be given a copy of the statement required by paragraph (a);
(d) Notifying the employee in the statement required by paragraph (a) that, as a
condition of employment under the grant, the employee will:
(1) Abide by the terms of the statement and
(2) Notify the employee in writing of his or her conviction for a
violation of a criminal drug statute occurring in the workplace no later
than five calendar days after such conviction.
(e) Notifying the agency, in writing within 10 calendar days after receiving notice
under subparagraph (d)(2) from an employee or otherwise receiving actual notice
of such conviction. Employers of convicted employees must provide notice,
including position title, to the applicable FEMA awarding office, i.e. regional office
or FEMA office.
(f) Taking one of the following actions, against such an employee, within 30
calendar days of receiving notice under subparagraph (d)(2), with respect to any
employee who is so convicted:
(1) Taking appropriate personnel action against such an employee,
up to and including termination, consistent with the requirements of
the Rehabilitation Act of 1973, as amended; or
(2) Requiring such employee to participate satisfactorily in a drug
abuse assistance or rehabilitation program approved for such
purposes by a Federal, State, or local health, law enforcement or
other appropriate agency.
(g) Making a good faith effort to continue to maintain a drug free workplace
through implementation of paragraphs (a), (b), (c), (d), (e), and (f).
(8) The grantee may insert in the space provided below the site(s) for fhe performance of work
done in connection with the specific grant:
Place of Performance
Street
City
State
Zip
Action
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- -Print Application Page 12 of 12
.::uu r;:.a::>l "ItIU ":'Ut"I:H ..;lCltIOCI"alUIlIU vO.IIV""", ",..,U-..OO::7
1201 West Ninth Street San Bernardino California 92411-2213
2121 North Medical Center Drive San Bernardino California 92411-1289
2641 North E Street San Bernardino California 92405 -3425
1640 Kendall Drive San Bernardino California 92407-2800
1920 De! Rosa Avenue San Bernardino CalifornIa 92404 -5641
282 W 40th Street San Bernardino California 92407-3706
3398 East Highland Avenue Highland California 92346-2106
502 South Arrowhead Avenue San Bernardino California 92346-2040
202 Meridian Avenue San Bernardino California 92410 -1330
450 Vanderbilt Way San Bernardino California 92408-3552
162 South Leland Norton Way San Bernardino California 92408-0120
If your place of performance is different from the physical address provided by you in the Applicant
Information, click on Add Place of Performance button above to ensure that the correct place of
performance has been specified. You can add multiple addresses by repeating this process multiple
times.
Section 17.630 of the regulations provide that a grantee that is a State may elect to make one certification in
each Federal fiscal year. A copy of which should be included with each application for FEMA funding. States
and State agencies may elect to use a Statewide certification.
Only complete if applying for a grant for more then $100,000 and have lobbying activities. See Form 20-16C for
lobbying activities definition.
Form SF-LLL
This form is not applicable
** FOR OFFICE USE ONLY - NOT A PUBLIC DOCUMENT **
RESOLUTION AGENDA ITEM TRACKING FORM
Meeting Date (Date Adopted): .1\- Z\-03 Item #
Vote: Ayes ).-~ Nays j?
Change to motion to amend original documents:
2003-'10
Absent I '1
22.. Resolution #
Abstain .~
Reso. # On Attachments:
Contract term:
Note on Resolution of Attachment stored separately: -=--
Direct City Clerk to (circle I): PUBLISH, POST, RECORD W/COUNTY By:
Date Sent to Mayor: "\ - Z 3-- 0 :<,
Date of Mayor's Signature: "1- ?'j-o"3
Date ofClerklCDC Signature: Ll-J 4--0-'"
Date
o/Letter Sent for Signature:
See Attached:
See Attached:
See Attached:
60 Day Reminder Letter Sent on 30th day:
90 Day Reminder Letter Sent on 45th day:
Request for Council Action & Staff Report Attached:
Updated Prior Resolutions (Other Than Below):
Updated CITY Personnel Folders (6413, 6429, 6433, 10584, 10585, 12634):
Updated CDC Personnel Folders (5557):
Updated Traffic Folders (3985, 8234, 655, 92-389):
Copies Distributed )1':
City Attorney .,/
Parks & Rec.
Code Compliance Dev. Services
Police Public Services Water
Notes:
NullNoid After: -
Reso. Log Updated:
Seal Impressed:
,/"
y
Date Returned: -----
Yes"""""-:::: No By
Yes No~ By
Yes No -.L- By
Yes No ,/ By
Yes No 7
-
EDA
Finance y/
htL6
MIS
Others:
BEFORE FILING, REVIEW FORM TO ENSURE ANY NOTATIONS MADE HERE ARE TRANSFERRED TO THE
YEARLY RESOLUTION CHRONOLOGICAL LOG FOR FUTURE REFERENCE (Contract Term, etc.)
Ready to File: iVY<
Date: '-(\"'1'1>\0;'
Revised 01/12/01