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Home My WebLink About2009-206 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 ~ RESOLUTION NO. 2009-206 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AUTHORIZING THE SUBMITTAL OF THE ASSISTANCE TO FIREFIGHTERS FIRE STATION CONSTRUCTION GRANT. BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AS FOLLOWS: SECTION I. The Mayor and Common Council hereby authorize the Fire Chief or his designee to submit the on-line grant application to the Department of Homeland Security for the 2009 Assistance to Firefighters Fire Station Construction Grant in the amount of $3,000,000. A copy of the grant application is attached as Attachment "A", and incorporated herein by reference. IIII IIII IIII IIII IIII IIII IIII IIII IIII IIII IIII IIII 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 2009-206 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AUTHORIZING THE SUBMITTAL OF THE ASSISTANCE TO FIREFIGHTERS FIRE STATION CONSTRUCTION GRANT. I HEREBY CERTIFY that the foregoing Resolution was duly adopted by the Mayor and Common Council of the City of San Bernardino at a joint regular meeting thereof, held on the 6th day of ,2009, by the following vote, to July wit: COUNCIL MEMBERS: AYES NAYS ABSTAIN ABSENT ESTRADA X BAXTER x X BRINKER SHORETT X KELLEY X X JOHNSON MCCAMMACK X G~ k. ~_ Rac~rk, City Clerk City of San Bernardino The foregoing Resolution is hereby approved this, ~~ay of Jul y ,2009, Approved as to form: JAMES F, PENMAN, City Attorney 2 Preparer Infonnation 2009-206 Page 1 of I' IILLachmenL .11. Overview 'Are you a member, or are you currently involved in the management, of the fire department applying for this grant with this application? Yes, I am a member/officer of this applicant If you are a grant writer or otherwise not affiliated with this applicant, please complete the information below. Fields marked with an . are required, If you are a member/officer of this applicant, please do not complete the information requested below, Preparer Information . Preparer's Name . Address 1 Address 2 . City . State . Zip quest. Enter 0 if there is no fee, 0 . Enter Grant-writing fee associated with the preparat' n of t Contact Information Page I of I 2009-206 Contact Information 'Title Prefix , First Name Middle Initial , Last Name , Business Phone Alternate Phone Number Mobile Phone/Pager Fax 'Email Alternate Contact Information Number 1 Fire Chief N/A Mike Conrad 909 384.5286 Ex!. Ex!. conrad_mi@sbcity.org 'Title Prefix , First Name Middie Initial , Last Name . Business Phone Alternate Phone Number Mobile Phone/Pager Fax 'Email Alternate Contact Information Number 2 Ballalion Chief N/A Paul Drasil 909 384.5286 Ex!. 909 384.5401 Ex!. drasil_pa@sbcity.org https://portal.fema,gov/firegrant/jsp/construction2009/ app lication! contact info.j sp ?vi ew=p... 6/24/2 009 Applicant Information Applicant Information Page I of I 2009-206 . Fire Department Name . Type of Jurisdiction Served If other, please enter the type of Jurisdiction . EmploY~Lldentification Number . What is your organization's DLJN$Numper? Headquarters or Main Station Physical Address . Physical Address 1 Physical Address 2 . City . State -Zip Mailing Address - Mailing Address 1 Mailing Address 2 . City . State 'Zip Account Information . Type of bank account - Bank routing number. 9 diqit number on the bottom left hand corner of your check 'Your account number Additional Information . For this fiscal year is your organization receiving Federal funding from any other grant program that may duplicate the purpose and/or scope of this grant request? . If awarded the FSC grant, will your organization expend more than $500,000 in Federal funds during your organization's fiscal year in which this FSC grant was awarded? - Is the applicant delinquenLon.<lOY,E~g~ElLd<:lpn If you answered yes to any of the additional questions above, please provide an explanation in the space provided below: xxxx City of San Bernardino Fire Department City 95-6000772 143532153 (call 1.866.705.5711 to get a DUNS number) 200 East Third Street San Bernardino California 92410.4889 Need.JJ~lpJOL_.z:JP+41. 200 East Third Street San Bernardino California 92410.4889 N~~d..h,\3,IP...fQl,zI.P.+4? Checking 121000248 4159283308 No Yes No https:llportal.fema.gov/firegrant/isp/construction2 0091 app licati onl applicant info. i sp ?prin t.., 6/24/2009 Fire Department Characteristics (Part I) Fire Department Characteristics (Part I) Page 1 of2 2009-206 . Are you a member of a Federal Fire Department or contracted by the Federal government and solely responsible for suppression of fires on Federal property? , . What kind of fire department do you represent? If you answered combination, above, what is the percentage of career members in your organization? If you answered volunteer or combination or paid on. call, how many of your volunteer Firefighters are paid members from another career department? . What type of community does your organization serve? . What is the square mileage of your first.due response area? . What percentage of your response area is protected by hydrants? . In what county/parish is your organization physically located? If you have more than one station, in what county/parish is your main station located? . Does your organization protect critical infrastructure of the state? . How much of your jurisdiction's land use is for agriculture, wild land, open space, or undeveloped properties? . What percentage of your jurisdiction's land use is for commercial, industrial, or institutional purposes? . What percentage of your jurisdiction's land is used for residential purposes? . How many occupied structures (commercial, industrial, residential, or institutional) in your jurisdiction are more than four stories tall? Do not include structures which are not regularly occupied such as silos, towers, steeples, €ltc, . What is the permanent residen1 population of your P.rim<lIyiEirt>I:Due,BesPonse...8rea ~o[jurisd iction served1 . How many active firefighters does your department have who perform firefighting duties? . How many fire stations does your department currently operate? . Do you currently report to the National Fire Incident Reporting System (NFIRS)? If you answered yes above, please enter your EDIN/FDID . What services does your organization provide? No All Paid/Career % Suburban 64 93 % San Bernardino County Yes 28 % 33 % 39 % 18 205942 148 12 Yes 36195 hltps:1 Iportal. fema, gOY I firegrant/i spl construction20091 app I icati onf.gen ques, i sp ?view=pri nt." 6/24/2009 Fire Department Characteristics (Part I) Page 2 of2 2009-206 Structural Fire Suppression Wildland Fire Suppression Airport Rescue Firefighting (ARFF) Medicai First Response Hazmat Operational Level Basic Life Support Advanced Life Support Rescue Operational Level Formal/Year-Round Fire Prevention Program https:llportal.fema.gov/firegrant/jsp/construction2009 1 application! gen _ q ues.j sp ?view=print.., 6/24/2009 Fire Department Characteristics (Part II) 2009-206 Fire Department Characteristics (Part II) Page 1 of2 . What is the total number of fire-related civilian fatalities in your jurisdiction over the last three years? . What is the total number of fire-related civilian injuries in your jurisdiction over the last three years? . What is the total number of line of duty member fatalities in your jurisdiction over the last three years? . What is the total number of line of duty member injuries in your jurisdiction over the last three years? . Over the last three years, what was your fire department's average operating budget? . What percentage of your TOTAL budget is dedicated to personnel costs (salary, overtime and fringe benefits)? . What percentage of your annual operating budget is derived from: Enter numbers only, percentages must sum up to 100% Taxes? Grants? Donations? Fund drives? Fee for Service? 2008 2007 2006 o o o 5 4 o o o 20 2 2 33323806 90 % 100 % 0% 0% 0% 0% Other? 0 % If you entered a value into Other field (other than 0), please explain . How many vehicles does your organization have in each of the types or class of vehicle listed below? You must include vehicles that are leased or on long-term loan as well as any vehicles that have been ordered or otherwise currently under contract for purchase or lease by your organization but not yet in your possession, Enter numbers only and enter 0 if you do not have any of the vehicles below, Type or Class of Vehicle Engines or Pumpers (pumping capacity of 750 gpm or greater and water capacity of 300 gallons or more): Pumper. PumperlTanker, Rescue/Pumper, Foam Pumper, CAFS Pumper. Quint (Aerial device of less than 76 feet), Type I Engine, Type II Engine, Type 11I111 Wildland/Urban Interface Tankers (pumping capacity of less than 750 gallons per minute (gpm) and water capacity of 1,000 gallons or more): Tanker, Tender, TankerfTender Aerial Apparatus: Aerial Ladder Truck, Telescoping. Articulating, Ladder Towers, Platform, Tiller Ladder Truck, Quint (Aerial device of 76 feet or greater) Brush/Quick attack (pumping capacity of less than 750 gpm): Brush Truck, Patrol Unit (Pick up wI Skid Unit), Quick Attack Unit, Mini-Pumper. Type lit Engine, Type IV Engine, Type V Engine, Type VI Engine. Type VII Engine Rescue Vehicles: Rescue Squad, Rescue (Light, Medium. Heavy), Technical Rescue Vehicle, Total Number of Total Number Riding Positions 23 93 o o 4 16 5 20 5 20 https:llporta!.fema.gov/firegrantljsp/conslruction2009/app I i cali on! org_ char.j sp ?vi ew=pri nt", 6/24/2009 Fire Department Characteristics (Part II) Page 2 of2 2009-206 Hazardous Materials Unit Other: EMS Chase Vehicle. Air/Ught Unit, Rehab Units, Bomb Unit, Technical Support (Command, Operational Support/Supply), Hose Tender, Salvage Truck, ARFF (Aircraft Rescue Firefighting), Command/Mobile Communications Vehicle. Other Vehicle 12 48 https:l/portaLfema.gov/liregrant/jsp/construction2009/appl i cati onl org_ char.j sp ?view=print... 6/24/2009 Fire Department Call Volume 2009-206 Page I of I Fire Department Call Volume < 2008 2007 2006 . How many responses per year by category? (Enter whole numbers only. If you have no calls for any of the categories, enter 0) Working Structural Fires 235 331 388 False Aiarms/Good Intent Calls 953 1587 1546 Vehicle Fires 242 278 255 Vegetation Fires 314 248 293 EMS-BLS Response Calls 0 673 1110 EMS-ALS Response Calls 25125 20252 19728 EMS-BLS Scheduled Transports 0 0 0 EMS-ALS Scheduled Transports 0 0 0 Vehicle Accidents w/o 2105 2024 2026 Extrication Vehicle Extrications 385 417 440 Other Rescue 38 46 40 Hazardous Condition/Materials 220 235 288 Calls Service Calls 417 361 40 Other Calls and Incidents 476 418 552 Total 30510 26870 26706 What is the total acreage of all 745 1322 346 vegetation fires? How many times does your organization receive 300 187 236 mutual/automatic aid? How many times does your organization provide mutual/automatic aid? (Please indicate the number of times 285 184 258 your department provides or receives mutual aid, Do not include first-due responses claimed above,) https:llportal.fema.gov/firegrant/jsp/construction2009/ app licati on/response.j sp ?view=print... 6/24/2009 Request Details 2009-206 Page 1 of1 Request Details The activities for program Fire Station Construction are listed in the table below, Activity Fire Station Construction Number of Entries Total Cost Total Applicant Share Total Federal Share o $0 $0 $0 Project Cost Applicant Share Federal Share Action No line items are currently specified for this activity, https://portal.fema.gov/fire,grant/isp/construction2009/ app I i cati on/req uestdetai I s/acti vi tyS u... 6/24/2009 Narrative Statement Page 1 of 1 2009-206 Narrative Statement Project Description . Please indicate which of these Target Capabilities your request outlined in this application will satisfy. Check all that apply: Project Description . Please provide your narrative statement in the space provided below. Include in your narrative, details regarding your fire station project as detailed above. https:llportal.fema.gov/firegrantljsp/construction2009/ app licationlnarrati ve.j sp ?view=print... 6/24/2009 Assurances and Certifications Page 1 of8 2009-206 Assurances and Certifications Form SF--424D You must read and sign these assurances. These documents contain the Federal requirements attached to all Federal grants including the right of the Federal government to review the grant activity, You should read over the documents to become aware of the requirements, The Assurances and Certifications must be read, signed, and submitted as a part of the application, Note: Fields marked with an . are required, Assurances for 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 assistance 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 project described in this application, 2. Will give the awarding agency, the Comptroller General of the United States and, if appropriate, the State, the right to examine all records, books, papers, or documents related to the assistance: and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives, 3, Will not dispose of, modify the use of, or change the terms of the real property title or other interest in the site and facilities without permission and instructions from the awarding agency. Will record the Federal awarding agency directives and will include a covenant in the title of real property acquired in whole or in part with Federal assistance funds to assure nondiscrimination during the useful life of the project. 4, Will comply with the requirements of the assistance awarding agency with regard to the drafting, review and approval of construction plans and specifications, 5, Will provide and maintain competent and adequate engineering supervision at the construction site to ensure that the complete work conforms with the approved plans and specifications and will furnish progressive reports and such other information as may be required by the assistance awarding agency or State, 6, Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency, 7. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational confiict of interest, or personal gain, 8, Will comply with the Intergovernmental Personnei Act of 1970 (42 U,S,C, ~~4728-4763) relating to prescribed standards of merit systems for programs funded under one of the 19 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). 9, Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. ~~4801 et seq.) which prohibits the use of lead-based pain in construction or rehabilitation of residence structures, 10, 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 https://portaLfema.gov/firegrantlj sp/construction2009/applicationlassurances _ forms_comb... 6/24/2009 Assurances and Certifications Page 2 of8 2009-206 Amendments of 1972, as amended (20 U,S,C, gg1681 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, g794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S,C, gg6101-6107), 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 (PL 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) gg523 and 527 of the Public Health Service Act of 1912 (42 U,S,C, gg290 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. gg3601 et seq,), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statue(s) under which application for Federal assistance is being made; and OJ the requirements of any other nondiscrimination statue(s) which may apply to the application. 11, 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 (PL 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal and federally-assisted programs, These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases, 12, Will comply with the provisions of the Hatch Act (5 U.S.C. gg1501-1508 and 7324-7328) which limit the political activities of employees whose principal employment ac1ivities are funded in whole or in part with Federal funds, 13. Will comply, as applicable, with the provisions of the Davis- Bacon Act (40 U,S,C. gg276a to 276a-7), the Copeland Act (40 U,S,C, g276c and 18 U,S,C, g874), and the Contract Work Hours and Safety Standards Act (40 U,S,C, gg327 - 333) regarding labor standards for federally-assisted construction subagreements. 14, Will comply with flood insurance purchase requirements of Section 1 02(a) of the Flood Disaster Protection Act of 1973 (PL 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, 15. 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, gg1451 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, gg7401 et seq,): (g) protection of underground sources 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 Species Act of 1973, as amended (P L 93-205), 16, Will comply with the Wild and Scenic Rivers Act of 1968 (16 U,S,C, gg1271 et seq,) related to protecting components or potential components of the national wild and scenic rivers system, 17. 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. g470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. gg469a-1 et seq). 18. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A-133, "Audits of States, Local Governments, and Non-Profit Organizations," 19, Will comply with all applicable requirements of all other Federal laws, executive orders, https://portal.ferna.gov/firegrant/jsp/construction2009/ app lication! ass urances _ forms_comb... 6/24/2009 Assurances and Certifications 2009-206 Page 3 of8 regulations, and policies governing this program, Signed by on h lIps:/ /portal. fema. gOY /firegrant/j sp/ constructi on2 009/ app lication! assurances_forms _comb... 6/24/2009 Assurances and Certifications Page 4 of8 2009-206 Form SF-424B You must read and sign these assurances. Certifications Regarding Lobbying, Debarment, Suspension and Other Responsibility Matters and Drug-Free Workplace Requirements, Note: Fields marked with an . are required, 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 44 CFR Part 17, "Government-wide Debarment and Suspension (Non-procurement) and Government-wide Requirements for Drug-Free Workplace (Grants)," The certifications shall be treated as a material representation of fact upon which reliance will be placed when the Department of Homeland Security (DHS) determines to award the covered transaction, grant, or cooperative agreement. 1. LOBBYING A As required by the section 1352, Title 31 of the US Code, and implemented at 44 CFR Part 18 for persons (entering) into a grant or cooperative agreement over $100,000, as defined at 44CFR Part 18, 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, (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 certify and disclose accordingly. 2. Debarment, Suspension and Other Responsibility Matters (Direct Recipient) A. As required by Executive Order 12549, Debarment and Suspension, and implemented at 44CFR Part 67, for prospective participants in primary covered transactions, as defined at 44 CFR Part 17, Section 17.510-A, the applicant certifies that it and its principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of Federal benefits by a State or Federal court, or voluntarily excluded from covered transactions by any Federal department or agency, (b) Have not within a three-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 https:llportal.fema.gov/firegrant/jsp/construction2009/app Ii cation! assurances _ fonn s _comb.., 6/24/2009 Assurances and Certifications Page 5 of8 2009-206 (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. 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 tille, to the applicable DHS awarding office, Le, regional office or DHS office. (f) Taking one of the following actions, against such an employee, within 30 calendar days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted: (1) Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement or other appropriate agency, (g) Making a good faith effort to continue to maintain a drug free workplace through implementation of paragraphs (a), (b), (c), (d), (e), and (f), hUps:llportal. fema. gOY lfi regrant/j spl construction20091 app lication! assurances forms comb... 6/24/2009 - - Assurances and Certifications Page 6 of8 2009-206 (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: Street City Place of Performance State Zip Action If your place of performance is different from the physical address provided by you In the Applicant Information, press Add Place of Performance button above to ensure that the correct place of performance has been specified, You can add multiple addresses by repeating this process multiple times, Section 17,630 of the regulations provide that a grantee that is a State may elect to make one certification in each Federal fiscal year, A copy of which should be included with each application for DHS funding, States and State agencies may elect to use a Statewide certification. Signed by on https://portal.fema.gov/firegrantljsp/construction2009/application/assurances _ forms_comb... 6/24/2009 Assurances and Certifications Page 7 of8 -2009-206 SF-LLL Complete only if applying for a grant for more then $100,000 and have lobbying activities using Non- Federal funds. If this lobbying form is not applicable, check "this form is not Applicable." Note: Fields marked with an ' are required, SF-LLL: Disclosure of Lobbying Activities 1, ' Iype of Federal Action 2, 'Status of Federal Action 3, 'ReporLlype This subsection is for Material Change only Year Quarter Date of last report: 4, ' Nameandjl,ddress_ofBeporting!:Olity: 'Reporting Entity Type Tier (if known) Congressional District, if known: "'Name 'Street 'City 'State 'Zip N_~~t:!__b_~Jp...fqLz:JP2.4.7_ 5, If Reporting Entity in NoA is a Subawardee, enter name and address of Prime: Name Street City State Zip t-l~~d heJpiQr ZIP+4? 6. ' c.e<:ler<lLDepartmeOtlAgency 7. ' Federal Program Name/Description 8. Federal Action Number if known: 9, A"'@cl AmOJifllJHnown:_$ 10a, Name and_<l.Q.clre~s of LobJ:>ylngBeg[sl@nl: (if individual, Last Name, First Name, MI) Name hUps:/ /porta1.fema,gov/firegrantlj sp/construction2009/application/assurances Jonns _comb... 6/24/2009 Assurances and Certifications Page 8 of8 2009-206 Street City State Zip 10b, Individuals Performing Services: (include address if different from No,1 Oa) (Last Name, First Name, MI) Name Stree1 City State Zip 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 disciosure 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 nolless than $10,000 and not more than $100,000 for each such failure. Signed by on h ttps:/ /portaL fema, gov /firegrant/i sp/ constructi on2 009/ app lication! assurances forms_comb", 6/24/2009