HomeMy WebLinkAbout19-Fire Department IN - RE UEST FOR COUNCIL ACTION
CITY OF SAN BERNARD O Q
From: Dennis Reichazdt, Acting Fire Chief Subject: Resolution authorizing the submittal of a grant
application to the Federal Emergency
Management Agency (FEMA) in the amount of
$105,728.
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Dept: Fire
Date: Mazch 1, 2002 MC/C Meeting Date: March 18, 2002
Synopsis of Previous Council Action:
RECOMMENDATION:
Adopt resolution.
Signature
Contact Person: Dennis Reichazdt, Acting Fire Chief Phone: 384-5286
Supporting data attached: Staff Report, Resolution, & Application Ward: Citywide
FUNDING REQUIREMENTS: Amount: $105,728.00
Source: FEMA's Grant Funding
Amount: $ 45,312.00
Source: (Acct No) To Be Determined
If the ¢rant is awarded, the Fire Depaztment
will submit a re uest [o amend the General Fund in the amount of 45 312.00 to match the rant.
Finance: / ~ ~
Council Notes:
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Agenda Item No. I 1
STAFF REPORT
SUBJECT
Resolution authorizing the submittal of a grant application to the Federal Emergency
Management Agency (FEMA) in the amount of $105,728.
BACKGROUND
The Federal Government has allocated federal funding that provides assistance to fire
departments in the United States, this is their second year providing funds to fire agencies. This
assistance will be awazded to local fire departments on a competitive basis. The purpose of the
funding is to protect the health and safety of the public and firefighting personnel against fire,
fire related hazards, and to provide assistance for fire prevention programs. 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
2. Fire Prevention
3. Emergency Medical Services
4. Firefighting Vehicles
The San Bernardino City Fire Department is requesting authorization to submit an application
(Attachment A) for fire operations and firefighter safety to develop and implement a Wellness
and Fitness Program. The deadline for the application to be submitted online is April 1, 2002.
Grant awazds begin in May and continue until all funds aze awazded.
The proposed program will follow the International Association of Fire Chiefs and Firefighters
Wellness and Fitness Program guidelines. We will utilize:the funds to purchase equipment for all
fire stations, physical and assessment examinations, and an immunization program. The exercise
equipment will be installed at designated areas within the fire stations; there will be no
renovation costs for the installation.
The Wellness and Fitness Program will be designed to improve the health and longevity of
firefighters and increase their productivity and performance. It is with this goal that we aze
requesting authorization to submit our request for funding to FEMA.
FINANCIAL IMPACT
The total amount to implement the Wellness & Fitness Program is $151,040 (see attached
Exhibit "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 $45,312.00, will need to be funded by
the General Fund in fiscal year 2002/2003. There aze 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.
RECOMMENDATION
Adopt resolution.
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1 RESOLUTION NO.
• 2
RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN
3 BERNARDINO AUTHORIZING THE SUBMITTAL OF A GRANT APPLICATION TO
4 THE FEDERAL EMERGENCY MANAGEMENT AGENCY (FEMA) IN THE AMOUNT
OF $105,728.
5 BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY OF
6 SAN BERNARDINO AS FOLLOWS:
7 SECTION 1. The Fire Chief or his designee is authorized to sign and submit a grant
8 application to FEMA in the amount of $105,728 for San Bernardino City Fire Department's
9 Wellness and Fitness Program. A copy of the grant application is attached as Attachment "A",
10 and incorporated herein by reference.
11
12
13
• 14
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25 ////
• 26 ////
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1 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN
BERNARDINO AUTHORIZING THE SUBMITTAL OF A GRANT APPLICATION TO
• 2 THE FEDERAL EMERGENCY MANAGEMENT AGENCY (FEMA) IN THE AMOUNT
OF $105,728.
3
4 I HEREBY CERTIFY that the foregoing resolution was duly adopted by the Mayor and Common
5 Council of the City of San Bernazdino at a meeting thereof, held on the
6 day of , 2002, by the following vote, to wit:
7
8 COUNCILMEMBERS AYES NAYS ABSTAIN ABSENT
9 ESTRADA
10 LIEN
11 MCGINNIS
12 DERRY
13 SUAREZ
• 14 ANDERSON
15 MCCAMMACK
16
17
18 Rachel Clazk, City Clerk
19
The foregoing resolution is hereby approved this day of , 2002.
20
21
Judith Valles, Mayor
22 City of San Bernardino
23 Approved as to
24 Form and legal content:
25 JAMES F. PENMAN,
• 26 City Attorney
27 _ n
By: //~
28
z
• ', Print Application Attachrrent "A.. Page 1 of 10
Entire Application
• Standard Form 424
Application Status: IN PROGRESS User: Norma Action Date: 3/1/2002
APPLICATION FOR 2. DATE SUBMITTED Applicant Identifier
FEDERAL ASSISTANCE
1.TyPE OF SUBMISSION 3. DATE RECEIVED BY STATE State Application Identifier
N/A
Non-Construction
4. DATE RECEIVED BY Fedeal Identifier
FEDERAL AGENCY
S.APPLICANT INFORMATION
Legal Name Organizational Unit
Ciry of San Bernardino Fire Department WA
Address Name and telephone number of the person to be contacted on
200 Fast Third Street San Bernardino matters involving this application
California 92410 4889 Norma Camarena 909.384-5388
6. EMPLOYER IDENTIFICATION NUMBER (EIN) 7. TYPE OF APPLICANT
95-6000772
8. TYPE OF APPLICATION 9. NAME OF FEDERAL AGENCY
New Federel Emergency Management Agency
10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE 11. DESCRIPTIVE TITLE OF APPLICANTS PROJECT
NUMBER 85.554 Fire Operations and Firefighter Safery
CFDA Assistance to Firefighters
• TITLE Grant Program
12. AREAS AFFECTED BY PROJECT (cities, counties, states, etc.)
13. PROPOSED PROJECT: 14. CONGRESSIONAL DISTRICTS OF:
Start Date: a. Applicant
End Date : b. Project
15. ESTIMATED FUNDING 16. IS APPLICATION SUBJECT TO REVIEW BY STATE
F~[ECUTIVE ORDER 12372 PROCESS?
a. Federal 105728 N/q
b. Applicant 45312
a State 0
d. Local 0
e. Other 0
f. Program Inwme 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL
DEBT?
g. TOTAL 1570a0 No
I
• i
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Altemate Contact Information Number 1
Title Fire Chief
• Salutation
First Name Larry
Middle Inftial R
Last Name Pitzer
Day Phone 909-384-5286
Evening Phone 909-384-5286
Cell Phone
Fax 909-384-5281
Email pitzer_IaC~ci.san-bemardino.ca
Alternate Contact Information Number 2
Title Battalion Chief
Salutation
First Name Jess
Middle Initial
Last Name Campos
Day Phone 909-384-5286
Day Phone 909-384-5286
Cell Phone
• Fax 909-384-5281
Email campos~e~ci.san-bernardino.ca
Are you a member of Fire Department or
authorized representative of a fire department? Yes
Are you a member of Federal Fire Department or
contracted by the Federal government and solely no
responsible for suppression of Tires on Federal
property?
What kind of Department are you from? All paid/career
If you answered combination, above, what is the
percentage of career firefighters in your department?
How would you characterize your a suburban community
response/jurisdiction area?
How many active firefighters are in the 143
operations/EMS division of your department?
What is the square mileage far your jurisdictions 59.3
coverage area?
• What is the permanent resident population of your 205942
primary/first-response area or jurisdiction served?
How many stations are in your jurisdiction? 11
If the population you protect is 50,000 or less, you
are required to provide aNon-Federal cost-share
equal to 10 percent of the total project cost. If the
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NuNumuun yuu Ni u~ew:~ ~a wei vu,uvu, yuu aro ycs
required to provide aNon-Federal cost-share equal
to 30 percent of the total project cost. Are you willing
• to comply with this requirement?
Do you currently report to the national fire incident yes
reporting system (NFIRS)?
If you answered yes, above, please enter your 36795
FDIN?
If you answered no, above, will you report 'rf you
receive this grant?
What services does your department provide? EMS (transportation) Fire Rescue (auto extrication,
etc.) EMS (non-transportation) Hazmat
• The total number of fire related fatalities in your
jurisdiction over the last three years?
• On average, how many runs per year does your
department make?
• How many times have you received
Mutual/Automatic Aid?
• How many time have you given Mutual/Automatic
Aid?
• What is the percentage of your annual operating 86 ,/°
budget that is dedicated to personnel costs?
• What percentage of your annual operating budget is derived from:
• Taxes? 100
Grants? 0
Donations? 0
Fund drives ? 0
Vehicle Profiles
• What is the age of your oldest First Line vehicle? 16 + years
• What is the age of your newest First Line vehicle? 0 - 5 years
• What is the highest mileage for your First Line Over 30,000
vehicles?
• What is the lowest mileage for your First Line 0 - 10,000
vehicles?
•How many vehicles do you have within your department by the category specified 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. Other: 5 0
• List all vehicles owned and/or operated by your department, including the year of manufacture and mileage
• of each vehicle:
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Department Call Volume
How many responses per year by category?
• Structure Fire 318
Vehicle Fires 2gg
Vegetation Fires 355
EMS and Rescue 18500
Hazardous Condition/Materials Calls 37
Service Calls g2
Good Intent Calls 132
False Alarms 254
Other Calls and incidents 0
Request Information
1. Activities of grant for which the funding has been applied via this FireFighting Equipment
application. Personnel Protective Equipment
Wellness and Fitness Programs
Training
2. Will this grant benefit more than one department? No
3. If you answered Yes to 03 above, please specify how?
Activity Number of Entries Total Cost Additional Funding
Firefighting Equipment 0 $ 0 $ 0 Personal Protective Equipment 0 $ 0 $ 0 Wellness and Fitness Programs 1 $
151040$OTraining0$0$0
Federal Rate Sharing (%) 70/30
Budget Object Class
a. Personnel $ 12,000
b. Fringe Benefits $ 0
c. Travel $ 0
d. Equipment $ 111,390
e. Supplies $ 2 500
f. Contractual $ 21,150
g. Construction $ 0
h. Other $ 4,000
i. Indirect Charges $ 0
Budget Source
Federal Share $ 105,728
Applicant Share $ 45,312
Total Budget $ 151,040
•
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Narratives
Please provide your narrative statement in the space provided below:
• THE PROJECT THAT WE ARE REQUESTING TO BE FUNDED: The City of San Bemardino Fire
Department has no existing wellness and fitness program, nor a complete immunization porogram. Our
request for funding will assist in implementing a complete wellness and fitness program that will offer both the
entry physical examination and immunization program for all our fire safety personnel. Partcipation in the
wellness and fitness program would be mandatory for all fire safety personnel, non punitive. The wellness and
fitness program is intended to decrease the risk of death and strengthen their mental and physical capabilities
to withstand the stresses and stratins of their job. Firefighters respond to emergency incidents that require
extreme physical output and often result in negative physiological and psychological outcomes. Such
situations, over time can and will effect the overall wellness and fitness of our firefighters and emergency
responders. An adequate wellness and fitness program could minimize or eliminate these negative effects.
To ensure that our firefighters are physically and emotionally healthy to work in their fire service position, we
are committed to develop and implement a wellness and fitness program. Our firefighters will have the
opportunity to benefit from medical fitness and physical fitness assessment. The program is designed to
improve the health and longevity of our firefighters, increase their productivity and pertormance and provide a
cost-effective service to the community. The City of San Bemardino Fire Department wellness and fitness
program will follow the standard guidelines according to the Fire Service Joint Labor Management
Wellness/Fitness Initiative that was developed between the International Association of Fire Chiefs and the
International Association of Firefighters. HOWE WE PLAN TO USE THE GRANT FUNDS FOR EACH
MAJOR BUDGET ACTIVITY AS LISTED ON THE BUDGET FORM: To ensure the most efficient use of any
funds, we developed a Wellness and Fitness Committee to determine what is essential for our fire
department to implement the program. The following expenditures will commence the program in order to
benefit the health and safety of our firefighters. Personnel: $12,000 requested. This amount is budgeted for
fitness tests and trainer consultants to instruct and recommend to our firefighters the proper usage of the
equipment purchased for their health and safety. Fringe Benefits: $ 0 requested. Travel: $0 requested.
Equipment: $103,370 requested. The City of San Bemardino Fire Department has 12 fire stations and 2
battalion chief headquarters which are staffed by career firefighters. The equipment we intend to purchase
• includes 12-lifefitness dual adjustable pulley, 12-lifefitness adjustable flat to incline bench with wheels, and
14-stairmaster stepmi117000PT with polar HR. Currently, no complete sets of equipment are located through
out our fire stations. Supplies: $2,500 requested. The cost of books and training aids will be paid for with
grant funds and will include a training log for each participant. Contractual: $21,150 requested. This cost is
associated with medical evaluation for each fire safety employee. This cost is projected at $150 per member.
The type of tests that the medical group will provide for each employee is physical evaluation, body
composition, laboratory test, audiometry, EKG, treadmill test, pulmonary function lung capacityfflow rate,
CBC, Lipid Test, and Chempanel. The physical and medical assessment will indicate where their weakness
and strengths are and what areas the firefighter needs to improve/concentrate. In addition, the medical
evaluation will assure that their overall health is not affecting their ability to perform. Construction: $0
requested. Other: $4,000 requested. Testing equipment needs to be purchased to evaluate all firefighters on
asemi-annual basis. The tests will determine oxygen uptake levels, strength, percent body fast, and flexibility.
WHY THIS PROGRAM WOULD BE BENEFICIAL TO OUR COMMUNITY AND/OR OUR DEPARTMENT:
Our department serves an area that demands a high level of fitness for on duty personnel. A program to
improve overall health and fitness would have a direct impact on the citizens of this community. The
community we serve will benefit by having firefighters responding to emergencies that are medically,
physically, and mentally in shape to perform their duties in a professional manner. These characteristics will
allow personnel to perform their physical tasks at a higher level with increased safety while maintaining their
mental alertness. Fire Department personnel will benefit by having access to a wellness and fitness program
that is positive, educational, and rehabilitating. Our program will strive to improve the overall wellness and
quality of life for our employees, maintaining a fit, healthy and capable firefighter throughout their career.
Another benefit for our City is a long-term financial saving. Injury and sick leave usage will be reduced;
thereby, controlling overtime costs and medical costs to the Ciry, worker's compensation claims and other
indirect costs associated with injuries on and off the job. Work related injuries absorb sufficient amount of
allocated payroll costs and reduce services in other areas. Improved pertormance and reduced accident
and/or injury related costs, will have a direct and noticeable impact on our community. Benefits of reduced
service costs and increase of employees morale will directly enhance the safety of the City's fire personnel
and citizens. WHY THIS PROJECT CANNOT BE FUNDED SOLELY THROUGH LOCAL FUNDING: The City
• of San Bernardino Fire Department currently has no firefighter wellness and fitness program. To establish an
overall wellness and fitness program requires $143,020 to accomplish the program beyond the initial phase.
This expense has not been attainable through traditional budgeting workshops. ADDITIONAL RELEVANT
INFORMATION THAT WE WOULD LIKE YOU TO CONSIDER WHEN EVALUATING OUR APPLICATION:
The City of San Bernardino Fire Department serves a resident population of over 205,942 and covers a
diverse service area of 59.3 square miles. In this service area there is approximately 19 miles of
wilrilanrihirhan intwrfar.P aroma a maim rail varri an intarnatinnal airnnrt a iail twn maim mall rmm~lwrwc anri
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three major interstate freeways. The City of San Bemardino Fire Department staffs eleven fire engine
companies, 1 aircraft rescue firefighting vehicle, and two aerial truck companies housed in twelve stations in
• the City. Also, under a unique partnership with the San Manuel Band of Mission Indians we provide fire and
emergency services to the San Manuel Indian Reservation. The City of San Bemardino Fire Department has
been actively attempting to implement a program but has been unable to secure adequate funding. Our
department has developed a program and its implementation is geared towards success with your support.
If you received a grant award in the 2001 process, does
your current request relate to your 2001 award?
Assurances Non-Construction Programs
Note: Certain of these assurances may not be applicable to your projector program. If you have questions,
please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to
certify to additional assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant I certify that the applicant:
1. Has the legal authority to apply for Federal assistance, and the institutional, managerial
and financial capability (including funds sufficient to pay the non-Federal share of project
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, axess 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 constitute 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 prescribed standards for merit systems for programs funded under one
of the nineteen statutes or regulations specified in Appendix A of OPM's Standards for a
Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statutes relating to nondiscrimination. These include but are
not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-3S2) 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 (20 U.S.C. Section- 794), which prohibits discrimination on the
basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C.
Sections 6101-106), 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) Comprehensive Alcohol Abuse and
Alcohol Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended,
relating nondiscrimination on the basis of alcohol abuse 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 Act 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 under which application for Federal assistance being
made; and Q) the requirements of any other nondiscrimination statute(s) which may apply
to application.
7. Will comply, or has already complied, with the requirements of Titles II and III of the
• Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L.
91-646) which provide fair and equitable treatment of persons displaced whose property is
acquired as a result of Federal federally assisted programs. These requirements apply to
all interests in real property acquired for project purposes regardless of Federal
participation in purchases.
8. Will comply with the provisions of the Hatch Act (5 U.S.C. Sections 1501-1508 and 7324-
7.'i9Rl which limit fhA nnlifical ar.Tivifioa of amnlnvaaa whnca nrinr•.inal pmnlnvmanf
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activities are funded in whole or in part with Federal funds.
9. Will comply, as applicable, with the provisions of Davis-Bacon Act (40 U.S.C. Section
• 276a to 276a-7), Copeland Act (40 U.S.C. Section 276c and 18 U.S.C. Sections 874), and
the Contract Work Haurs and Safe Standards Act (40 U.S.C. 327-333); regarding labor
standards for federally assisted construction subagreements.
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of
the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a
special flood hazard area to participate in the program and to purchase flood insurance if
the total cost of insurable construction and acquisition is $10,000 or more.
11. Will comply with environmental standards which may be prescribed pursuant to the
following: (a) institution of environmental quality control measures under the National
Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b)
notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant
to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with-EO 11988;
(e) assurance of project consistency with the approved State management program
developed under the Coastal Zone Management Act of 1972 (16 U.S.C. 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 source of drinking water under the Safe Drinking Water Act
of 1974, as amended, (PL 93-523); and (h) protection of endangered species under the
Endangered Special 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
protection of historic properties), and Archaeological and Historic Preservation Act of 1974
• (16 U.S.C. 469a-1 et seq.)
14. Will comply with P.L. 93-348 regarding 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 pertonned 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.
Signed by Norma on 2002-03-01 16:04:01.0
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 (Nonprocurement) 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
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' 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 attempting to influence an officer or employee of
any agency, a Member of Congress, an officer or employee of congress, or an employee of a
Member of Congress in connection with the making of any federal grant, the entering into of any
cooperative agreement and extension, continuation, renewal amendment or modification of any
Federal Grant or cooperative agreement.
(b) If any other funds than Federal appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of congress, or an employee of a Member of
Congress in connection wfth this Federal grant or cooperative agreement, the undersigned shall
complete and submit Standard Form LLL, "Disclosure of Lobbying Activities", in accordance
with its instructions.This form must be attached to certification if nonappropriated 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 subawards at all tiers (including subgrants, contracts under grants and
cooperative agreements and subcontract(s)) and that all subrecipients shall certify and disclose
accordingly.
2. Debarment, Suspension and Other Responsibility Matters (Direct Recipient)
As required by Executive Order 12549, Debarment and Suspension, and implemented at 44CFR Part 67, for
prospective participants in primary covered transactions, as defined at 44 CFR Part 17, Section 17.510-A, the
applicant certifies that it and its principals:
• (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible,
sentenced to a denial of Federal benefits by a State or Federal court, or voluntarily excluded
from covered transactions by any Federal department or agency.
(b) Have not within athree-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 athree-year period preceding this application had one or more public
transactions (Federal, State, or local) terminated for cause or default; and
B. Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach
an explanation to this application.
3. Drug-Free Workplace (Grantees other than individuals)
As required by the Drug-Free Workplace Act of 1988, and implemented at 44CFR Part 17, Subpart F, for
grantees, as defined at 44 CFR part 17, Sections 17.615 and 17.620:
• (A) The applicant certifies that it will continue to provide adrug-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 spec'rfying the actions that will be taken against
employees for violation of such prohibition;
(b) Establishino an on-aoinc drug free awareness oroaram to inform emplovees
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about: ~ v y ~ ~ r .
• (1) The dangers of drug abuse in the workplace;
(2) The grantees policy of maintaining adrug-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 occurting 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 the performance of work
done in connection with the specific grant:
Place of Performance
Street City State Zip
200 East Third Street San Bemardino Calfomia 92470.4869
1201 West Ninth Street San Beman7ino Califomia 92411 -2213
2121 North Medical Center Drive San Bemardino Califomia 92471 -1289
2641 North E Street San Bernardino Califomia 92405.3425
1640 Kendall Drive San Bernardino Calrfomia 92407.2800
7920 Del Rosa Avenue San Bernardino Califomia 92404 -5641
• 282 W 40th Street San Bemardino California 92407 -3706
3398 East Highland Avenue Highland Califomia 92346 -2106
202 Meridian Avenue San Bernardino Calrfomia 92470.7330
502 South Arrowhead Avenue San Bernardino Califomia 92346.2040
450 Vantlerbilt Way San Bernardino Calfomia 92408-3552
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Signed by Norma on 2002-03-01 18:04:01.0
• 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.
Disclosure of Lobbying Activities
t. Type of Federal Action 2. Status of Federal Action 3. Report Type
4. Name and Address of Reporting Entity: 5. If Reporting Entity in No.4 is a Subawardee, Enter Name and Address of
Prime:
6. Federal DepartmenUAgency 7. Federal Program Name/Description
8. Federal Action Number it Knowrr. 9. Award Amount ff known
t0a. Name and address of lobbying Registrant: tOb. Individuals Performing Services:
(if individual, last name, first name, MI) (including address if different from No.10a)
• Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of
lobbying activities is a material representation of fact upon which reliance was placed by the tier above when
this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This
information will be reported to the Congress semi-annually and will be available for public inspection. Any
person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and
not more than $100,000 for each such failure.
•
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Entire Application
Standard Form 424
• Application Status: IN PROGRESS User: Norma Action Date: 3/7/2002
APPLICATION FOR 2. DATE SUBMITTED Applicant Identifier
FEDERAL ASSISTANCE
1.TYPE OF SUBMISSION 3. DATE RECEIVED BY STATE State Applica0on Identifier
N!A
Non-Construction
4. DATE RECEIVED BY Federal Identfier
FEDERAL AGENCY
5.APPLICANT INFORMATION
Legal Name Organizational Und
City of San Bernardino Fire DeparUnent WA
Address Name and telephone number of the person to be contacted on
200 East Third Street San Bernardino maNers involving this application
California 92410 4889 Nonna Camarena 909-384-5388
6. EMPLOYER IDENTIFICATION NUMBER (EIN) 7. TYPE OF APPLICANT
95000772 City
8. TYPE OF APPLICATION 9. NAME OF FEDERAL AGENCY
New Federal Emergency Management Agency
t0. CATALOG OF FEDERAL DOMESTIC ASSISTANCE 11. DESCRIPTIVE TITLE OF APPLICANTS PROJECT
NUMBER 85.554 Fire Operations and Firefighter Satery
CFDA Assistance to Firefighters
TITLE Grant Program
- . 12. AREAS AFFECTED BY PROJECT (cities, counties, states, etc.)
•
13. PROPOSED PROJECT: 14. CONGRESSIONAL DISTRICTS OF:
Start Date: a. Applicant
End Date : b. Project
15. ESTIMATED FUNDING 16. IS APPLICATION SUBJECT TO REVIEW BY STATE
EXECUTIVE ORDER 12372 PROCESS?
a. Federal 105728 WA
b. Applicant 45312
a State 0
d. Local 0
e. Omer 0
f. Progrem Income 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL
151040 DEBT?
g. TOTAL No
• ~ I ~ II
03-1$-02
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Alternate Contact Information Number 1
Title Fire Chief
Salutation
• First Name Larry
Middle Initial R
Last Name Pitzer
Day Phone 909-384-5286
Evening Phone 909-384-5286
Cell Phone
Fax 909-384-5281
Email pitzer la~ci.san-bernardino.ca
Altemate Contact Information Number 2
Title Battalion Chief
Salutation
First Name Jess
Middle Initial
Last Name Campos
Day Phone 909-384-5286
Evening Phone 909-384-5286
Cell Phone
Fax 909-384-5281
• Email camposJe@ci.san-bernardino.ca
Are you a member of Fire Department or
authorized representative of a fire department? Yes
Are you a member of Federal Fire Department or
contracted by the Federal government and solely
responsible for suppression of fires on Federal no
property?
What kind of Department are you from? All paid/career
If you answered combination, above, what is the
percentage of career firefighters in your department?
How would you characterize your a suburban communi
response/jurisdiction area? ry
How many active firefighters are in the 141
operations/EMS division of your department?
What is the square mileage for your jurisdictions 59
coverage area? ~i
What is the permanent resident population of your 205942
primary/first-response area orjurisdiction served?
• How many stations are in yourjurisdiction? 12
If the population you protect is 50,000 or less, you
are required to provide aNon-Federal cost-share
equal to 10 percent of the total project cost. If the
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pupwauun yuu pw~eui is uve~ au,uvu, Yuu me yea
required to provide aNon-Federal cost-share equal
to 30 percent of the total project cost. Are you willing
to comply with this requirement?
• Do you currently report to the national fire incident yes
reporting system (NFIRS)?
If you answered yes, above, please enter your 36195
FDIN?
If you answered no, above, will you report if you
receive this grant?
What services does your department provide? EMS (transportation) Fire Rescue (auto exVication,
etc.) EMS (non-transportation) Hazmat
• The total number of fire related fatalities in your 6
jurisdiction over the last three years?
• On average, how many runs per year does your 23799
department make?
• How many times have you received ~
Mutual/Automatic Aid?
• How many time have you given Mutual/Automatic 29
Aid?
• What is the percentage of your annual operating 86
budget that is dedicated to personnel costs?
• What percentage of your annual operating budget is derived from:
Taxes? 100
• Grants? 0
Donations? 0
Fund drives ? 0
Vehicle Profiles
• What is the age of your oldest First Line vehicle? 16 + years
• What is the age of your newest First Line vehicle? 0 - 5 years
• What is the highest mileage for your First Line Over 30,000
vehicles?
• What is the lowest mileage for your First Line 0 -10,000
vehicles?
•How many vehicles do you have within your department by the category specified 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. Other: 5 0
• List all vehicles owned and/or operated by your department, including the year of manufacture and mileage i
of each vehicle:
'I
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. ~ Department Call Volume
How many responses per year by category?
Structure Fire 321
• Vehicle Fires 301
Vegetation Fires 355
EMS and Rescue 21890
Hazardous Condition/Materials Calls 187
Service Calls 496
Good Intent Calls 344
False Alarms 632
Other Calls and Incidents 1084
Request Information
1. Activities of grant for which the funding has been applied via this Personnel Protective Equipment
application. Wellness and Fitness Programs
Training
FireFighting Equipment
2. Will this grant benefit more than one department? No
3. If you answered Yes to 03 above, please specify how?
• ~ - Activity Number of Entries Total Cost Additional Funding
Firefighting Equipment 0 $ 0 $ 0 Personal Protective Equipment 0 $ 0 $ 0 Wellness and Fitness Programs 1 $
151040$OTraining0$0$0
Federal Rate Sharing (%) 70/30
Budget Object Class
a. Personnel $ 12,000
b. Fringe Benefits $ 0
c. Travel $ 0
d. Equipment $ 111,390
e. Supplies $ 2,500
f. Contractual $ 21,150
g. Construction $ 0
h. Other $ 4,000
i. Indirect Charges $ 0
Budget Source
Federal Share $ 105,728
Applicant Share $ 45,312
Total Budget $151,040
•
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Narratives
Please provide your narrative statement in the space provided below:
. THE PROJECT THAT WE ARE REQUESTING TO BE FUNDED: The City of San Bemardino Fire
Department has no existing wellness and fitness program, nor a complete immunization porogram. Our
request for funding will assist in implementing a complete wellness and fitness program that will offer both the
entry physical examination and immunization program for all our fire safety personnel. Partcipation in the
wellness and fitness program would be mandatory for all fire safety personnel, non punitive. The wellness and
fitness program is intended to decrease the risk of death and strengthen their mental and physical capabilities
to withstand the stresses and strains of their job. Firefighters respond to emergency incidents that require
extreme physical output and often result in negative physiological and psychological outcomes. Such
situations, over time can and will effect the overall wellness and fitness of our firefighters and emergency
responders. An adequate wellness and fitness program could minimize or eliminate these negative effects.
To ensure that our firefighters are physically and emotionally healthy to work in their fire service position, we
are committed to develop and implement a wellness and fitness program. Our firefighters will have the
opportunity to benefit from medical fitness and physical fitness assessment. The program is designed to
improve the health and longevity of our firefighters, increase their productivity and pertormance and provide a
cost-effective service to the community. The City of San Bernardino Fire Department wellness and fitness
program will follow the standard guidelines according to the Fire Service Joint Labor Management
Wellness/Fitness Initiative that was developed between the International Association of Fire Chiefs and the
International Association of Firefighters. HOW WE PLAN TO USE THE GRANT FUNDS FOR EACH MAJOR
BUDGET ACTIVITY AS LISTED ON THE BUDGET FORM: To ensure the most efficient use of any funds, we
developed a Wellness and Fitness Committee to determine what is essential for our fire department to
implement the program. The following expenditures will commence the program in order to benefit the health
and safety of our firefighters. Personnel: $12,000 requested. This amount is budgeted for fitness tests and
trainer consultants to instruct and recommend to our firefighters the proper usage of the equipment
purchased for their health and safety. Fringe Benefits: $ 0 requested. Travel: $0 requested. Equipment:
$113,390 requested. The City of San Bernardino Fire Department has 12 fire stations and 2 battalion chief
headquarters which are staffed by career firefighters. The equipment we intend to purchase includes 12-
lifefitness dual adjustable pulley, 12-lifefitness adjustable flat to incline bench with wheels, and 14-stairmaster
• stepmi117000PT with polar HR. Currently, no complete sets of equipment are located through out our fire
stations. Supplies: $2,500 requested. The cost of books and training aids will be paid for with grant funds and
will include a training log for each participant. Contractual: $21,150 requested. This cost is associated with
medical evaluation for each fire safety employee. This cost is projected at $150 per member. The type of
tests that the medical group will provide for each employee is physical evaluation, body composition,
laboratory test, audiometry, EKG, treadmill test, pulmonary function lung capacity/flow rate, CBC, Lipid Test,
and Chempanel. The physical and medical assessment will indicate where their weakness and strengths are
and what areas the firefighter needs to improve/concentrate. In addition, the medical evaluation will assure
that their overall health is not affecting their ability to perform. Construction: $0 requested. Other: $4,000
requested. Testing equipment needs to be purchased to evaluate all firefighters on asemi-annual basis. The
tests will determine oxygen uptake levels, strength, percent body fast, and flexibility. WHY THIS PROGRAM
WOULD BE BENEFICIAL TO OUR COMMUNITY AND/OR OUR DEPARTMENT: Our department serves an
area that demands a high level of fitness for on duty personnel. A program to improve overall health and
fitness would have a direct impact on the citizens of this community. The community we serve will benefit by
having firefighters responding to emergencies that are medically, physically, and mentally in shape to perform
their duties in a professional manner. These characteristics will allow personnel to perform their physical
tasks at a higher level with increased safety while maintaining their mental alertness. Fire Department
personnel will benefit by having access to a wellness and fitness program that is positive, educational, and
rehabilitating. Our program will strive to improve the overall wellness and quality of life for our employees,
maintaining a fit, healthy and capable firefighter throughout their career. Another benefit for our City is a long-
term financial saving. Injury and sick leave usage will be reduced; thereby, controlling overtime costs and
medical costs to the City, worker's compensation claims and other indirect costs associated with injuries on
and off the job. Work related injuries absorb sufficient amount of allocated payroll costs and reduce services
in other areas. Improved pertormance and reduced accident and/or injury related costs, will have a direct and
noticeable impact on our community. Benefits of reduced service costs and increase of employees morale will
directty enhance the safety of the City's fire personnel and citizens. WHY THIS PROJECT CANNOT BE
FUNDED SOLELY THROUGH LOCAL FUNDING: The City of San Bernardino Fire Department currently has
• no firefighter wellness and fitness program. To establish an overall wellness and fitness program requires
$1151,040 to accomplish the program beyond the initial phase. This expense has not been attainable through
traditional budgeting workshops. ADDITIONAL RELEVANT INFORMATION THAT WE WOULD LIKE YOU
TO CONSIDER WHEN EVALUATING OUR APPLICATION: The City of San Bernardino Fire Department
serves a resident population of over 205,942 and covers a diverse service area of 59.3 square miles. In this
service area there is approximately 19 miles of wildland/urban interface area, a major rail yard, an
intwrnatinnal aimnrt a fail iwn maim mall rmm~laYac and Thrwa maim intwr.¢Tatw fraawave Tha city of San
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Bernardino Fire Department staffs eleven fire engine companies, 1 aircraft rescue firefighting vehicle, and two
aerial truck companies housed in twelve stations in the City. Also, under a unique partnership with the San
Manuel Band of Mission Indians we provide fire and emergency services to the San Manuel Indian
• Reservation. The City of San Bemardino Fire Department has been actively attempting to implement a
program but has been unable to secure adequate funding. Our department has developed a program and its
implementation is geared towards success with your support.
If you received a grant award in the 2001 process, does
your current request relate to your 2001 award?
Assurances Non-Construction Programs
Note: Certain of these assurances may not be applicable to your project or program. If you have questions,
please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to
certify to additional assurances. If such is the case, you will be not'rfied.
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 constitute 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 prescribed standards for merit systems for programs funded under one
of the nineteen statutes or regulations specified in Appendix A of OPM's Standards for a
Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statutes relating to nondiscrimination. These include but are
not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-3S2) 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 (20 U.S.C. Section- 794), which prohibits discrimination on the
basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C.
Sections 6101-106), 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) Comprehensive Alcohol Abuse and
Alcohol Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended,
relating nondiscrimination on the basis of alcohol abuse 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 Act 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 under which application for Federal assistance being
made; and (j) the requirements of any other nondiscrimination statute(s) which may apply
to application.
7. Will comply, or has already complied, with the requirements of Titles II and III of the
Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L.
• 91-646) which provide fair and equitable treatment of persons displaced whose property is
acquired as a result of Federal federally assisted programs. These requirements apply to
all interests in real property acquired for project purposes regardless of Federal
participation in purchases.
8. Will comply with the provisions of the Hatch Act (5 U.S.C. Sections 1501-1508 and 7324-
7R9f21 which IimR Tha nnlitinal arlivifiwc of amnlnvoca whnco nrinrinal wmnlnvmonT
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activities are funded in whole or in part with Federal funds.
9. Will comply, as applicable, with the provisions of Davis-Bacon Act (40 U.S.C. Section
276a to 276a-7), Copeland Act (40 U.S.C. Section 276c and 18 U.S.C. Sections 874), and
• the Contract Work Hours and Safe Standards Act (40 U.S.C. 327-333); regarding labor
standards for federally assisted construction subagreements.
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of
the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a
special flood hazard area to participate in the program and to purchase flood insurance if
the total cost of insurable construction and acquisition is $10,000 or more.
11. Will comply with environmental standards which may be prescribed pursuant to the
following: (a) institution of environmental quality control measures under the National
Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b)
notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant
to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with-EO 11988;
(e) assurance of project consistency with the approved State management program
developed under the Coastal Zone Management Act of 1972 (16 U.S.C. 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 source of drinking water under the Safe Drinking Water Act
of 1974, as amended, (PL 93-523); and (h) protection of endangered species under the
Endangered Special 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
protection of historic properties), and Archaeological and Historic Preservation Act of 1974
(16 U.S.C. 469a-1 et seq.)
• 14. Will comply with P.L. 93-348 regarding 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 7966 (P.L. 89-544, as amended, 7
U.S.C. 2131 et seq.) pertaining to the care, handling and treatment of warm blooded
animals held for research, teaching, or other activities supported by this award of
assistance.
16. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. Section 4801
et seq.) which prohibits the use of lead based paint in construction or rehabilitation of
residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance
with the Single Audit Act of 1984.
18. Will comply with all applicable requirements of all other Federal laws, executive orders,
regulations and policies governing this program.
19. It will comply with the minimum wage and maximum hours provisions of the Federal fair
Labor Standards Act (29 U.S.C 201), as they apply to employees of institutions of higher
education, hospitals, and other non-profit organizations.
Signed by Norma on 2002-03-01 16:04:01.0
Applicants should refer to the regulations cited below to determine the certification to which they are required I~
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 (Nonprocurement) and Govemment-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
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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 attempting to influence an officer or employee of
any agency, a Member of Congress, an officer or employee of congress, or an employee of a
Member of Congress in connection with the making of any federal grant, the entering into of any
cooperative agreement and extension, continuation, renewal amendment or modification of any
Federal Grant or cooperative agreement.
(b) If any other funds than Federal appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of congress, or an employee of a Member of
Congress in connection with this Federal grant or cooperative agreement, the undersigned shall
~ complete and submit Standard Form LLL, "Disclosure of Lobbying Activities", in accordance
with its instructions.This form must be attached to certification if nonappropriatedfnnds 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 subawards at all tiers (including subgrants, contracts under grants and
cooperative agreements and subcontract(s)) and that all subrecipients shall certify and disclose
accordingly.
2. Debarment, Suspension and Other Responsibility Matters (Direct Recipient)
As required by Executive Order 12549, Debarment and Suspension, and implemented at 44CFR Part 67, for
prospective participants in primary covered transactions, as defined at 44 CFR Part 17, Section 17.510-A, the
applicant certifies that it and its principals:
• (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible,
sentenced to a denial of Federal benefits by a State or Federal court, or voluntarily excluded
from covered transactions by any Federal department or agency.
(b) Have not within athree-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 pertorm 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 athree-year period preceding this application had one or more public
transactions (Federal, State, or local) terminated for cause or default; and
B. Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach
an explanation to this application.
3. Drug-Free Workplace (Grantees other than individuals)
As required by the Drug-Free Workplace Act of 1988, and implemented at 44CFR Part 17, Subpart F, for
grantees, as defined at 44 CFR part 17, Sections 17.615 and 17.620:
(A) The applicant certifies that it will continue to provide adrug-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 betaken against
employees for violation of such prohibition;
(bl Establishinc an on-coino druc free awareness oroaram to inform emolovees
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Print Application Page 9 of 10
about: ~ V v v ~ V
(1) The dangers of drug abuse in the workplace;
• (2) The grantees policy of maintaining adrug-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 pertormance
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 the pertormance of work
done in connection with the specific grant:
Place of Pertormance
Street CRy State Zip
200 East Third Street San Bemardino Califomia 92410 -4889
1201 West Ninth SVeet San Bernardino CalNOmia 92411 4213
2121 North Medical Center Drive San Bernardino California 92411 -1289
2641 North E SVeet San Bernardino California 92405 -3425
1640 Kendall Drive San Bernardino California 92407 -2800
1920 Del Rosa Avenue San Bernardino California 92404 -5641
282 W 40th SVeet San Bernardino California 92407 -3706
• 3398 East Highland Avenue Highland Cal'rfomia 92346 -2106
202 Meddian Avenue San Bemardino Cal'rfomia 92410 -1330
502 South Arrowhead Avenue San Bemardino Cal'rfomia 92346 -2040
450 Vanderbilt Way San Bemardino Cal'rfomia 92408 -3552
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Signed by Norma on 2002-03-01 16:04:01.0
• 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.
Disclosure of Lobbying Activities
1. Type of Federal Action 2. Status of Federal Action 3. Report Type
4. Name and Address of Reporting Entity: 5. If Reporting Entity in No.41s a Subawardee, Enter Name end Address of
Prime:
6. Federal Department/Agency 7. Federal Program NameiDescdption
8. Federal Action Number if Known. 9. Award Amount if known
10a. Name and address of Lobbying Registrant: 10b. Individuals Performing Services:
(if individual, last name, first name, MI) (including address if differem from No.10a)
Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of
lobbying activities is a material representation of fact upon which reliance was placed by the tier above when
• this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This
information will be reported to the Congress semi-annually and will be available for public inspection. Any
person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and
not more than $100,000 for each such failure.
•
https://portal.fema. gov/firegrant/new/fire/print app.
j sp?print=true&app_number-
FOR OFFICE USE ONLY - NOT A PUBLIC DOCUMENT
RESOLUTION AGENDA ITEM TRACHING FORM
Meeting Date (Date Adopted): ~" (~"~ Item # ~ ~ Resolution # ~ 6b~ ' Q ~
Vote: Ayes I-~ Nays -~ Abstain ~' Absent ~T'
Change to motion to amend original documents:
Reso. # On Attachments: ~ Contract term: ~ NulWoid After: -
Note on Resolution of Attachment stored separately:
Direct City Clerk to (circle 1): PUBLISH, POST, RECORD W/COUNTY By: -
-( Reso. Lo U dated:
Date Sent to Ma or: ~ ~I ~ ` g P
Y
Date of Mayor's Signature: 3 ` 26-~0~ Seal Impressed:
Date of Clerk/CDC Signature: 3 $1-O a-
Dat emo/Letter Sent for Signature: See Attached: _ Date Returned:
60 Day Reminder Letter Sent on See Attached:
90 Day Reminder Letter Sent on 45th day: Attached:
Request for Council Action & Staff Report Attached: Yes ? No By
Updated Prior Resolutions (Other Than Below): Yes _ No f By
Updated CITY Personnel Folders (6413, 6429, 6433, ]0584, 10585, 12634): Yes _ No ~ By
Updated CDC Personnel Folders (5557): Yes _ No ~ By
Updated Trattic Folders (3985, 8234, 655, 92-389): Yes _ No ~ By
Copies Distributed to:
City Attorney ~ Code Compliance Dev. Services EDA Finance ? MIS
Parks & Rec. Police Public Services Water Others: F ~ Q E ~
Notes:
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: ~]-~ Date: (j
Revised 01/12/01