CONTRACT 3216 OtherSTATE OF CALIFORNIA
GOVERNOR'S OFFICE OF EMERGENCY SERVICES
ASSISTANCE AGREEMENT
1. ASSISTANCE NO. 2. RECIPIENT NO. 3. TYPE OF ACTION 4. PROJECT /BUDGET PERIOD
HMECA2033100 009 Subgrant Award October 1, 2002 to September 30, 2003
PCA/Index Codes
5. SEND PAYMENT REQUEST TO 6. PAYMENT METHOD 7, TOTAL PROJECT /BUDGET COST (Accounting Office Use Only)
OES Accounting Department via 5411
Regional Coordinators Reimbursement $10,000
8. RECIPIENT PROJECT MANAGER AND ADDRESS 9. OES REGIONAL COORDINATOR, ADDRESS, & PHONE #
Steve Tsumura, Environmental Safety Manager
City of El Segundo Fire Department
314 Main Street
El Segundo, CA 90245
10. PAYEE
City of El Segundo Fire Department
314 Main Street
El Segundo, CA 90245
11. ASSISTANCE PROGRAM (CDFA PROGRAM)
HMEP 20.703
FUNDS
13. Federal Share
14. Recipients Match Share
15. Total Project Cost
Region I
Sean Grady
4671 Liberty Ave.,
Los Alamitos, CA
90720 -5158
(562) 795 -2912
Region IV
Jerilyn Peterson
P.O. Box 419047
Rancho Cordova, CA
95741 -9047
(916) 845 -8480
Region II
Leonard Miller
1300 Clay Street,
Suite 400
Oakland, CA 94612
(510) 286 -6745
Roy Manning
2550 Mariposa Mall,
Room 181
Fresno, CA 93721
(559) 445 -5672
12. PROJECT TITLE
Shelter in Place – Educational Materials Update
16. IDES 5TA7 t YF(UJM, I t.UUF%
THIS ACTION Diana Cossairt (916) 845 -8778
17. OES FISCAL COORDINATOR
$8,000 Linda Fong (916) 845 -8302
AND
Region III
Nellie Lee Barber
645 Antelope Blvd. #13
Red Bluff, CA 96080
(530) 529 -0409
Sean Grady
4671 Liberty Ave.
Los Alamitos, CA
90720 -5158
(562) 795 -2912
18. STATUTORY AUTFIUKI I r
$2,000 Federal Hazardous Materials Transportation Law, 49 U.S.C. 5101 at seq.
$10,000 19. REGULATORY AUTHORITY
Title 49 CFR, Part 110
NOTE: This Agreement must be completed in triplicate and two originals returned to the Office of Emergency Services (OES), Hazardous Materials
Unit, P. 0. Box 419047, Rancho Cordova, CA 95741 -9047 within 3 weeks after receipt or within any extension of time as may be granted by OES.
Receipt of a written refusal or failure to return the properly executed document within the prescribed time, may result in the withdrawal of this offer by
OES. Any change to this document by the recipient, subsequent to it being signed by the OES Award Official, who materially alters the document,
shall void the Agreement.
The United States of America, acting by and through the United States Department of Transportation and the California Governor's Office of
Emergency Services hereby offers assistance to City of El Segundo Fire Department for 80% of all approved project costs incurred up to and not
exceeding $10,000. Recipients must contribute a minimum of 20% matching share to the total cost of the project. Recipients agree to provide the
OES Hazardous Materials Unit with quarterly project status reports and quarterly requests for payments that include costs incurred during the quarter.
Recipients agree to closely track all project work activities and associated costs. Recipients agree to submit to OES all supporting documentation that
substantiates all project costs, including the matching share. Recipients agree to provide written notification to the OES Hazardous Materials Unit of
any deviation from the project described in the project application. Recipients agree to refrain from implementing any deviations unless approved by
DES. Recipients agree to provide OES with information that depicts the outcome, results, or products of the project at the end or prior to the end of
the last quarter of the grant year. Recipients agree that failure to comply with any of these requirements may result in the withdrawal of this offer.
TYPE NAME AND TITLE TE
SIGNATURE OF AWARD OFFICIAL
Q K
NANCY J. KONTOS, Budget Officer /
� u .,��iYt T�v
This Agreem is subject to applicable United States Department of Transportation statutory provisions and assistance regulations. In accepting this
award or amendment and any payments made pursuant thereto, (1) the undersigned represents that s(he) is duly authorized to act on behalf of the
recipient organization, and (2) the recipient agrees (a) with the requirements of the "Offer and Acceptance" clause, (b) that the award is subject to the
applicable provisions of 49 CFR § 110 et seq., 49 CFR Part 18, and of the provisions of this agreement, including the Articles of Agreement, and (c)
that acceptance of any payments constitutes an agreement by the payee that the amounts, if any found by OES to have been overpaid, will be
refunded in full to OES.
TYPE NAME AND TI l Lt I —
Mary Strenn, City Manager 8/11/03