CONTRACT 5544 Grant Agreement Agreement No. 5544
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SUBA"tiN'UARD AGREEMENT
Subrecipient: The City of EI Segundo
Title: FY 2016 Urban Area Security Initiative (UASI) Grant Program
City Contract Number
Agreement No. 5544
TABLE OF CONTENTS
Section Section Title Pie
Number Number
I. GENERAL INFORMATION
§1.1 Federal Award Information.................................................................................. 1
§1.2 Subaward Information and Period of Performance ............................................. 1
§1.3 Parties and Notice...............................................................................................2
§1.4 Authorities...........................................................................................................2
II. SUBAWARD TERMS AND CONDITIONS
§2.1 Summary of Requirements.......................................... ....................,..,......4
§2.2 City Adminstrative Requirements.........— ........... ....... ............4
§2.3 DHS and CaIOES Requirements ..... ................................ 7
§2.4 Uniform Requirements for Federal Awards............ .... 12
III. STANDARD PROVISIONS
§3.1 Independent Party................ .......................................................................... 17
§3.2 Construction of Provisions and Title Herein ...................................................... 17
§3.3 Applicable Law, Interpretation and Enforcement............................................... 17
§3.4 Integrated Agreement ...-............... ...............,.................................. 17
§3.5 Excusable Delays..................................... ....... ..................,...............,........ 18
§3.6 Breach.................... ......................................... ............................................. 18
§3.7 Prohibition Against Assignment and Delegation.......... ......... ............... .... 18
§3.8 Indemnification.................................................................................................. 18
§3.9 Subcontractor Assurances................................................................................ 19
§3,10 Remedies for Noncompliance ........................................................................... 19
§3.11 Termination ......................................................................... ............ 19
§3.12 Amendments.....................................................................................................20
§3.13 Complete Agreement.................... ...................................................................20
SignaturePage..............................................................................................21
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Agreement No. 5544
EXHIBITS
Exhibit A DHS Standard Conditions and CalOES Assurances
Exhibit B Financial Management Forms Workbook
Exhibit C Modification Request and Reimbursement Request Forms
Exhibit D CaIOES Forms
Exhibit E Technology Standards
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Agreement No. 5544
AGREEMENT NUMBER C' 13 1-70F CITY CONTRACTS
BETWEEN
THE CITY OF LOS ANGELES
AND THE CITY OF EL SEGUNDO
THIS SUBAWARD AGREEMENT ("Agreement" or "Contract") is made and
entered into by and between the City of Los Angeles, a municipal corporation (the
"City"), and the City of EI Segundo, a municipal corporation (the "Subrecipient"). In
consideration of the mutual covenants set forth herein and the mutual benefits to be
derived therefrom, the City and Subrecipient (each a "Party" and collectively, the
"Parties") agree as follows:
I. GENERAL INFORMATION
§1.1 Federal Award Information
The "Federal award" (as such term is defined in the Code of Federal Regulations
("CFR"), 2 CFR §200.38, and used in this Agreement) is the Fiscal Year (FY)
2016 Urban Area Security Initiative Grant Program, FAIN #2016-DJ-BX-0246,
CFDA#16.738, Federal Award Date August 10, 2016.
The "Federal awarding agency" (as such term is defined in 2 CFR §200.36 and
used in this Agreement) is the United States Department of Homeland Security,
Federal Emergency Management Agency, Grants Program Directorate ("DHS").
The State of California, through its Governor's Office of Emergency Services
("CalOES"), acts as the "pass-through entity" (as such term is defined in 2 CFR
§200.74 and used in this Agreement) for the subaward of the Federal award to
the City for the benefit of the Los Angeles/Long Beach Urban Area ("LA/LBUA")
in the amount of$54,888,000.00.
The City, acting through its Mayor's Office of Public Safety ("Mayor's Office"),
acts as the pass-through entity for this subaward of the Federal award to
Subrecipient.
§1.2 Subaward Information and Period of Performance
Subrecipient hereby accepts the following subaward ("Subaward") of the Federal
award upon the terms and conditions set forth in this Agreement:
Subaward amount: $139,125.00
Subaward Period of Performance ("Term"): September 1, 2016
to May 31, 2019
Match Requirement: None
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The term of this Agreement shall be the "Term" as set forth in this Section 1.2.
§1.3 Parties and Notice
The Parties to this Agreement, and their respective representatives who are
authorized to administer this Agreement and to whom formal notices, demands
and communications shall be given are as follows: -
Party: City of Los Angeles
Authorized Representative: Jeff Gorell, Deputy Mayor
Authorized Department: Mayor's Office of Public Safety
Address, Phone, Fax, E-mail: 200 N. Spring Street, Room 303
Los Angeles, CA 90012
Phone: (213)978-0687
Email: jeff.gorell@lacity.org
Party: City of El Segundo
Authorized Representative: Carol Lynn Anderson, Sr. Management Analyst
Authorized Department: EI Segundo Fire Department
Address, Phone, Fax, E-mail: 314 Main Street
El Segundo, CA 90245
Phone: (310) 524-2278
Email:canderson@elsegundo.org
Formal notices, demands and communications to be given hereunder by either
Party shall be made in writing and may be effected by personal delivery or by
registered or certified mail, postage prepaid, return receipt requested and shall
be deemed communicated as of the date of mailing. If the name of the person
designated to receive the notices, demands or communications or the address of
such person is changed, written notice shall be given, in accordance with this
section, within five (5) business days of said change.
§1.4 Authorities
The Los Angeles City Council and the City's Mayor have accepted the Federal
awar an hive authorized the City to execute this Agreement (C.F. #16-0777,
Subrecipient warrants that it has obtained written authorization from its city
council, governing board, or authorized body to execute this Agreement and
accept and use the Subaward. Subrecipient further warrants that such. written
authorization specifies that Subrecipient and the city council, governing board or
authorized body agree:
a, To provide all matching funds required under the Subaward and that any
cash match will be appropriated as required.
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b. That any liability arising out of the performance of this Agreement shall be
the responsibility of Subrecipient and the city council, governing board or
authorized body.
C. That Subaward funds shall not be used to supplant expenditures
controlled by the city council, governing board or authorized body.
d. That the official executing this Agreement is, in fact, authorized to do so.
Subrecipient shall maintain this proof of authority on file and make it readily
available upon demand.
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II. SUBAWARD TERMS AND CONDITIONS
§2.1 Summary of Requirements
By executing this Agreement, Subrecipient hereby agrees that it shall comply
with all terms and conditions set forth in this Agreement, which includes all
guidance, regulations and requirements (collectively, "Requirements") of the
Federal awarding agency and CalOES that are applicable to a recipient and/or
subrecipient of a Federal award or grant. Such Requirements are set forth in the
following documents and incorporated herein by this reference: (1) Department
of Homeland Security FY 2016 Homeland Security Grant Program Notice of
Funding Opportunity ("DHS NOFO"), (2) FY 2016 DHS Standard Terms and
Conditions ("DHS Standard Conditions"), (3) FEMA Information Bulletins (113"),
(4) CalOES 2016 Homeland Security Grant Program California Supplement to
the Federal Notice of Funding Opportunity ("CalOES Supplement"), (5) CalOES
2016 Standard Assurances for All CalOES Federal Grant Programs ("CalOES
Assurances"), (6) CalOES Grant Management Memos ("GMM"), and (6) the cost
principles, uniform administrative requirements and audit requirements for federal
grant programs as housed in Title 2, Part 200 of the Code of Federal Regulations
("CFR") and in updates issued by the Office of Management and Budget ("OMB")
on httra:///'www.whitehouse.gov/or°nb/.
Subrecipient hereby certifies that it has the legal authority to execute this
Agreement, accept the Subaward given through this Agreement, and has the
institutional, managerial and financial capability to ensure proper planning,
management and completion of its projects being funded by the Subaward.
Subrecipient hereby acknowledges that it is responsible for reviewing and
adhering to all Requirements referenced above. For reference and without
limitations, certain of the Requirements are set forth in more detail in the sections
below.
§2.2 City Administrative Requirements
A. Subrecipient acknowledges and agrees that the City is acting as a "pass-
through entity" (as such term is defined in 2 CFR §200.74 and used in this
Agreement) for this Subaward and that the City shall have the rights and
obligations relating to this Subaward and its administration as set forth in
this Agreement and in 2 CFR Part 200.
B. Subrecipient and the City have previously completed a mutually approved
Financial Management Forms Workbook which was approved by CalOES
prior to the execution of this Agreement (the "Workbook") and which is
attached hereto as Exhibit B. The Workbook contains detailed listings of
items and projects and the amount of Subaward funds allocated for such
items and projects. Subrecipient shall use the Subaward funds strictly in
accordance with the Workbook, and any expenditures not so made shall
be deemed disallowed under this Subaward.
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The City shall provide Subrecipient with an electronic Workbook of
Subrecipient's projects. Any request by Subrecipient to modify the
Workbook must be made in writing and accompanied by a completed
Modification Request Form, attached hereto as Exhibit C, and a revised
Workbook showing such,modification and containing all supporting
documentation as required. Workbook modification requests must be
submitted to the City no often than once a month and prior to deadlines
set by the City. Requests submitted after any such.deadline will be
returned to Subrecipient and will not be accepted until the following
submission period. The City will notify Subrecipient in writing if Workbook
modification requests are inaccurate and/or incomplete. Inaccurate and/or
incomplete requests shall be returned to the Subrecipient for revision and
shall be accepted by the City when such requests are accurate and
complete. Subrecipient shall not expend any funds on modified Workbook
items until such modification is approved by the City and CalOES.
C, Subrecipient previously submitted to the City a Project Application in
connection with the Subaward, which included a Project Timeline ("Project
Timeline") setting forth details regarding the milestone and completion
dates for Subrecipient projects funded under the Subaward. Subrecipient
shall manage its Subaward funded projects in accordance with the Project
Timeline and provide, in a timely manner, any plans and reports requested
by the City regarding the status of such projects. In the event a Workbook
modification request requires a modification to the Project Timeline,
Subrecipient shall update the Project Timeline accordingly and submit it
along with its Workbook modification request for approval. Failure to meet
any milestones or deadlines as set forth in Subrecipient's Project Timeline
may result in the City reducing Subaward funds allocated to the
Subrecipient.
D. Subrecipient shall complete and deliver to the City all forms required by
CalOES in connection with the implementation of Subrecipient's projects
under the Subaward. Such forms, which are collectively attached hereto
as Exhibit D, include: (1) an aviation equipment request form, (2) a
watercraft equipment request form, (3) an Emergency Operations Center
request form, (4) an Environmental and Historical Preservation ("EHP")
request form, and (5) a sole source procurement request form.
Subrecipient acknowledges that all such forms must be completed,
delivered and approved by the City and CalOES prior to the purchase of
said equipment, implementation of the project, or the completion of a sole
source procurement, as the case may be. Approval of such requests and
forms shall be made by the City and CalOES in their respective sole
discretion. Failure to gain approval of such completed requests and forms
by the City and CalOES may disallow any costs incurred by Subrecipient
under this Subaward in connection with such equipment, project or
procurement.
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E. Subrecipient agrees that any equipment, product, service or activity
funded with this Subaward shall comply with any and all technological
and/or interoperability specifications and standards as may be approved
by the LA/LBUA region, and any such equipment, product, service or
activity not so compliant shall be not eligible for funding by this Subaward.
A list of technological standards currently approved by the LA/LBUA
region is attached as Exhibit E. Subrecipient shall further ensure that it
retains from its contractors, subcontractors, and vendors all rights related
to inventions, copyrightable materials, and data for which the Federal
awarding agency and CalOES has rights to, as more fully set forth in 2
CFR §315 Agreement and Section 2.3.P. of this Agreement.
F. Any "equipment" (as such term is defined in 2 CFR §200.33 and used in
this Agreement) acquired or obtained with Subaward funds: (1) Shall be
made available pursuant to applicable terms of the California Disaster and
Civil Defense Master Mutual Aid Agreement in consultation with
representatives of the various fire, emergency medical, hazardous
materials response services, and law enforcement agencies within the
jurisdiction of the LA/LBUA, and deployed with personnel trained in the
use of such equipment in a manner consistent with the California Law
Enforcement Mutual Aid Plan or the California Fire Services and Rescue
Mutual Aid Plan; (2) Shall be consistent with needs as identified in the
State Homeland Security Strategy and will be deployed in conformance
with that Strategy; and (3) Shall have an LA/LBUA identification decal
affixed to it, and, when practical, shall be affixed where it is readily visible
and prominently marked as follows: "Purchased with funds provided by
the U.S. Department of Homeland Security."
Subrecipient shall take a physical inventory of all equipment acquired or
obtained with Subaward funds and reconcile the results with equipment
records at least once every year.
G, This Subaward is not a "fixed amount award" as such term is defined in 2
CFR §200.45. Subrecipient agrees that disbursment of this Subaward to
Subrecipient shall be made on a reimbursement method. In the event
Subrecipient requests advance payment of Subaward funds, Subrecipient
shall comply with, and provide evidence to the City of compliance with, the
criteria and obligations related to the use of advance payments as set
forth in 2 CFR §200.305 as well as satisfying any other City and CaIOES
requirements for advance payments.
In requesting reimbursement from Subaward funds, Subrecipient shall
prepare, maintain and provide to the City a completed Reimbursement
Request Form (attached hereto as Exhibit C) along with invoices,
purchase orders, proof of delivery, proof of payment and payroll records,
timesheets, receipts and any other supporting documentation necessary
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to fully and accurately describe the expenditure of funds for which
reimbursement from the Subaward is requested (collectively, the
"Reimbursement Request"). All such supporting documentation for the
Reimbursement Request shall satisfy applicable Federal, State and City
audit and review standards and requirements. Such documentation shall
be prepared at the sole expense and responsibility of Subrecipient, and
the City and the Subaward will not reimburse the Subrecipient for any
costs incurred for such preparation. The City may request, in writing,
changes to the content and format of such documentation at any time, and
the City reserves the right to request additional supporting documentation
to substantiate costs incurred at any time. The City will notify Subrecipient
in writing if a Reimbursement Request is inaccurate and/or incomplete.
Inaccurate and/or incomplete Reimbursement Requests shall be returned
to Subrecipient for revision and shall be accepted by the City when
Reimbursement Requests are accurate and complete.
Reimbursment Requests must be submitted to the City on a monthly
basis. The City shall forward a Reimbursement Request to CalOES for
payment within thirty (30) days of receipt of such Reimbursement
Request, provided such request is deemed accurate and complete. The
City shall forward reimbursement payment on a Reimbursement Request
to Subrecipient within thirty (30) days of receipt of such reimbursement
payment from CalOES to the City.
Final Reimbursement Requests for this Subaward must be received by the
City no later than one hundred twenty (120) days prior to the end of the
Term to allow the City sufficient time to complete close-out activities for
this Subaward (the "Reimbursement Deadline"). Any Reimbursement
Request submitted after the Reimbursement Deadline shall be rejected
unless, prior to the the submission of such request, the Mayor's Office, in
its sole discretion, has approved in writing the submission of such request
after the Reimbursement Deadline. After the Reimbursement Deadline,
any unexpended Subaward funds may be re-directed to other needs
across the LA/LBUA region. The City will notify Subrecipient, in writing,
when unexpended Subaward funds may be re-directed.
H. Subrecipient acknowledges that the City makes no commitment to
disburse Subaward funds beyond the terms set forth herein and that
funding for all periods during the Subaward Term is subject to the
continuing availability to the City of federal funds for this Subaward from
CalOES and the Federal awarding agency. This Agreement may be
terminated immediately upon written notice to Subrecipient of such loss or
reduction of Subaward funds.
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Agreement No. 5544
§2.3 DHS and CalOES Reouirements
Subrecipient shall comply with all Requirements promulgated by DHS (which is
the Federal awarding agency for this Subaward) and CaIOES which are
applicable to this particular Subaward. These include, without limitation, (1) the
Requirements for recipients and subrecipients set forth in the DHS NOFO and
the DHS Standard Conditions, and (2) the Requirements for"Applicant" and
subrecipients set forth in the CalOES Supplement and the CalOES Assurances.
For reference, the DHS Standard Conditions and the CalOES Assurances are
both attached hereto as Exhibit A and incorporated herein. Some of these DHS
and CalOES Requirements are set forth below in this Section 2.3.
A. Subrecipient will not use Subaward funds to supplant (replace) funds that
have been budgeted for the same purpose through non-federal sources.
Upon request by the City, CalOES and/or the Federal awarding agency,
Subrecipient shall be required to demonstrate and document that a
reduction in non-Federal resources occurred for reasons other than the
receipt or expected receipt of Subaward funds. Subrecipient shall not
charge any costs allocable under this Subaward to any other Federal
award to overcome fund deficiencies, to avoid restrictions imposed by
Federal statutues, regulations, or terms and conditions of Federal awards,
or for other reasons. Subrecipient shall not be delinquent in the
repayment of any Federal debt. Subrecipient must request instruction
from the City and CalOES for proper disposition of any original or
replacement equipment acquired with Subaward funds.
B. Subrecipient shall comply with the requirement of 31 U.S.C. Section 3729-
3733, which sets forth that no subgrantee, recipient or subrecipient of
federal funds or payments shall submit a false claim for payment,
reimbursement or advance. Subrecipient agrees to be subject to the
administrative remedies as found in 38 U.S.C. Section 3801-3812 for
violations of this requirement.
C. Subrecipient shall comply with the provisions of DHS Specific
Acknowledgements and Assurances section set forth in the DHS Standard
Conditions and the Reporting Accusations and Findings of Discrimination
section of the CalOES Assurances.
D. Subrecipient shall comply with the provisions of the Lobbying and Political
Activities section set forth in the CalOES Assurances. In connection
thereto, Subrecipient hereby certifies that:
a. No Federal appropriated funds have been paid or will be paid, by or on
behalf of Subrecipient, to any person for influencing or attempting to
influence an officer or employee of an agency, a Member of Congress,
an officer or employee of Congress, or an employee of a Member of
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Congress in connection with the awarding of any Federal contract, the
making of any Federal grant, the making of any Federal loan, the
entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of any Federal
contract, grant, loan or cooperative agreement.
b. If any funds other than Federal appropriated funds have been paid or
will be paid to any person for influencing or attempting to influence an
officer or employee of any agency, a Member of Congress, an officer
or employee of Congress, or an employee of a Member of Congress in
connection with this Federal contract, grant, loan, or cooperative
agreement, Subrecipient shall complete and submit Standard
Form-LLL "Disclosure Form to Report Lobbying" in accordance with its
instructions.
c. Subrecipient shall require that the language of this certification be
included in the award documents for all subawards at all tiers
(including subcontracts, subgrants, and contracts under grants, loans,
and cooperative agreements) and that all subrecipients shall certify
and disclose accordingly.
E. As required by Executive Orders (EO) 12549 and 12689, and 2 CFR
§200.212 and codified in 2 CFR Part 180, Subrecipient shall provide
protection against waste, fraud and abuse by debarring or suspending
those persons deemed irresponsible in their dealings with the Federal
government. Subrecipient hereby certifies that it and its principals:
a. Are not presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from covered transactions
by any Federal department or agency;
b. Have not within a three-year period preceding this Agreement been
convicted of or had a civil judgment rendered against them for
commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing 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 governmental entity (Federal, State, or local) with commission of
any of the offenses enumerated in paragraph 2.3.G.c. above; and
d. Have not within a three-year period preceding this Agreement had one
or more public transactions (Federal, State, or local) terminated for
cause or default.
F. Subrecipient shall comply with the Drug-Free Workplace Act of 1988 (41
U.S.C. §701 et seq.) which is adopted at 2 CFR Part 3001. In connection
thereto, Subrecipient hereby certifies that it will or will continue to provide
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a drug-free workplace and a drug-free awareness program as outlined in
such Act.
G. Subrecipient shall comply with all Federal statutes relating to non-
discrimination, including, without limitation, those statutes and provisions
set forth in the Non-Discrimination and Equal Employment Opportunity
section of the CalOES Assurances.
Subrecipient hereby certifies that it will comply with the Americans with
Disabilities Act, 42 USC §12101 et seq., and its implementing regulations
(ADA), the Americans with Disabilities Act Amendments Act of 2008
(ADAAA), Pub. L. 110-325 and all subsequent amendments, Section 504
of the Rehabilitation Act of 1973 (Rehab. Act), as amended, 29 USC 794
and 24 CFR Parts 8 and 9, the Uniform Federal Accessibility Standards
(UFAS), 24 CFR, Part 40, and the Fair Housing Act, 42 U.S.C. 3601, et
seq.; 24 CFR Parts 100, 103, and 104 (FHA) and all implementing
regulations. Subrecipient will provide reasonable accommodations to
allow qualified individuals with disabilities to have access to and to
participate in its programs, services and activities in accordance with the
provisions of the ADA, the ADAAA, the Rehab Act, the UFAS and the FHA
and all subsequent amendments. Subrecipient will not discriminate
against persons with disabilities or against persons due to their
relationship to or association with a person with a disability. Any contract
entered into by Subrecipient (or any subcontract thereof), relating to this
Agreement, to the extent allowed hereunder, shall be subject to the
provisions of this paragraph.
H. Subrecipient shall comply with the provisions set forth in the
Environmental Standards section of the CalOES Assurances.
I. Subrecipient shall comply with the provisions set forth in the Reporting-
Accountability section of the CalOES Assurances, which relate to
compliance with the Federal Funding Accountability and Transparency Act
and statutory requirements for whistleblower protections.
J. Subrecipient shall comply with the provisions set forth in the Human
Trafficking section of the CalOES Assurances, which relate to compliance
with the Trafficking Victims Protection Act (TVPA) of 2000.
K. Subrecipient shall comply with the provisions set forth in the Labor
Standards section and Worker's Compensation section of the CalOES
Assurances, which relate to compliance with various Federal statutes
regarding labor standards and State worker's compensation requirements.
L. Subrecipient shall comply with the provisions set forth in the Property-
Related section of the CalOES Assurances and the provisions applicable
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to construction projects as set forth in the Certfications Applicable to
Federally-Funded Construction Projects section of the CaIOEs
Assurances.
M. Subrecipient acknowledges the applicability of the Freedom of Information
Act and the California Public Records Act to certain information as more
fully set forth in the Freedom of Information Act section of the CalOES
Assurances.
N. Subrecipient shall comply with the provisions set forth in the Best
Practices for Collection and Use of Personally Identifiable Information (PII)
section of the CalOES Assurances.
O. Subrecipient shall comply with the provisions set forth in the
Acknowledgement of Federal Funding from DHS and Use of DHS Seal,
Logo and Flags section of the CalOES Assurances, which relate to
requirements for acknowledging the use of federal funds and obtaining
approval for use of various DHS seals and logos.
P. Subrecipient shall affix applicable copyright notices as required under the
Copyright section of the CalOES Assurances and shall comply with and
be subject to the provisions set forth in the Patents and Intellectual
Property Rights section of the DHS Standard Conditions and the CalOES
Assurances.
Q. If the total value of Subrecipient's currently active grants, cooperative
agreements, and procurement contracts from all Federal assistance office
exceeds $10,000,000 for any period of time during the period of
performance of this Subaward, Subrecipient shall comply with the
provisions set forth in the Reporting of Matters Related to Recipient
Integrity and Performance section of the DHS Standard Conditions and
the CalOES Assurances.
R. Subrecipient shall comply with the SAFECOM Guidance for Emergency
Communication Grants when using Subaward funds in connection with
emergency communication equipment, including provisions on technical
standards that ensure and enhance interoperable communications.
S. Subrecipient shall establish safeguards to prohibit employees from using
their positions for a purpose that constitutes, or presents the appearance
of personal or organizational conflict of interest or personal gain.
Subrecipient shall comply with all Federal and State conflict of interest
laws and regulations.
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T. Subrecipient shall comply with California Vehicle Code sections 23123
and 23123.5, and the provisions set forth in the Use of Cellular Device
While Driving is Prohibited section of the CalOES Assurances.
U. Subrecipient must ensure that any project activities carried on outside the
United States are coordinated as necessary with appropriate government
authorities and that appropriate licenses, permits, or approvals are
obtained.
V, Subrecipient shall comply with the provisions set forth in the following
sections of the DHS Standard Conditions and the CalOES Assurances; (1)
Energy Policy and Conservation Act, (2) Hotel and Motel Fire Safety Act of
1990, (3) Terrorist Financing, (4) USA Patriot Act of 2001, (5) Fly America
Act of 1974, and (6) Whistleblower Protections and Whistleblower
Protection Act.
§2.4 Uniform Requirements for Federal Awards
Subrecipient acknowledges that this Subaward is a "Federal award" as such term
is defined in 2 CFR §200.38 and that Subrecipient's use of this Subaward is
subject to the uniform administrative requirements, cost principles, and audit
requirements for Federal awards which are codified in 2 CFR Part 200 (the
"Uniform Requirements"). Subrecipient agrees that it is considered a "non-
Federal entity" and a "subrecipient" as such terms are defined in 2 CFR §§200.69
and 200.93, respectively. Thus, Subrecipient hereby agrees to comply with, and
be subject to, all provisions, regulations and requirements applicable to a
"subrecipient" and a "non-Federal entity" as set forth in the Uniform
Requirements. Further, Subrecipient agrees that the City and CalOES are each
a "pass-through entity" as such term is defined in 2 CFR §200.74 and that each
of them shall have the rights and remedies of a "pass-through entity" in relation to
this Subaward and Subrecipient as set forth in the Uniform Requirements.
Without limitation, some of these Uniform Requirements are set forth below in
this Section 2.4.
A, Subrecipient shall disclose to the City any potential conflict of interest in
connection to this Subaward and its use in accordance with 2 CFR
§200.112.
K Subrecipient shall comply with the mandatory disclosure requirements for
violations of Federal criminal law involving fraud, bribery, or gratutity as
set forth in 2 CFR §200.113.
C. Subrecipient acknowledges that the City may impose additional specific
conditions to this Subaward in accordance with 2 CFR §200.207, and
Subrecipient shall comply with such conditions. Subrecipient shall also
submit any annual certifications and representations deemed required by
the City in accordance with 2 CFR §200.208.
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D. Financial Management and Internal Controls
Subrecipient shall comply with the requirements for a non-Federal entity
regarding financial management and the establishment of a financial
management system, all as more fully set forth in 2 CFR §200.302.
Further, Subrecipient shall comply with the requirements set forth in 2
CFR §200.303, which relate to certain obligations required of Subrecipient
to maintain internal controls over the use of this Subaward.
E. In the event this Subaward requires cost sharing or matching of funds
from Subrecipient, Subrecipient shall comply with the cost sharing and
matching requirements set forth in 2 CFR §200.306.
F. Subrecipient shall comply with the requirements relating to program
income as more fully set forth in 2 CFR §200.307.
G. Property Standards
When property (real, tangible or intangible) is, in whole or in part,
improved, developed, purchased or otherwise acquired with Subaward
funds, Subrecipient shall comply with the regulations set forth in 2 CFR
§§200.310 through 200.316 ("Property Regulations"). These Property
Regulations include, without limitation, provisions related to the following:
1. Requirements for insurance coverage for real property and
equipment.
2. Requirements for title, use, disposition and transfer of title of"real
property" (as defined in 2 CFR §200.85).
3. Regulations involving Federally-owned and exempt property.
4. Requirements for title, use, management (including recordkeeping,
inventory, control systems and maintenance procedures), and
disposition of"equipment" (as defined in 2 CFR §200.33).
5. Requirements for title, use and disposition of"supplies" (as defined
in 2 CFR §200.94).
6. Requirements for title, rights, use and disposition of"intangible
property" (as defined in 2 CFR §200.59). Such requirements
include, without limitation, (a) a reservation of rights by the Federal
awarding agency to a royalty-free, non-exclusive and irrevocable
right to use certain copyrighted work or work subject to copyright,
(b) the rights of the Federal government to data produced under the
Subaward, (c) the applicability of the Freedom of Information Act to
certain research data produced or acquired under the Subaward,
and (d) Subrecipient's compliance with applicable regulations
governing patents and inventions, including government wide
regulations codified at 37 CFR Part 401.
Subrecipient agrees that it shall hold in trust all real property, equipment
and intangible property acquired, developed or improved with Subaward
UASI 16 Subaward Agreement 13
Agreement No. 5544
funds in accordance with the provisions set forth in 2 CFR §200.316.
H. Procurement and Contracting Regulations
When procuring and/or contracting for property and/or services that are to
be paid or reimbursed by any amount of Subaward funds, Subrecipient
shall comply with all regulations applying to "non-Federal entities" as set
forth in 2 CFR §§200.318 through 200.326 (the "Procurement
Regulations"). These Procurement Regulations include, without limitation,
provisions requiring the following:
1. Documentation and use of procurement procedures in compliance
with Procurement Regulations.
2. Contracting oversight and maintenance of written standards of
conduct covering conflicts of interest.
3. Compliance with federal standards regarding procurement and
award of contracts, competition, and procurement methods.
4. Affirmative steps required to encourage contracting with small and
minority businesses, women's business enterprises, and labor
surplus area firms.
5. Compliance with Section 6002 of the Solid Waste Disposal Act in
the procurement of recovered materials.
6. Requirement to perform a cost or price analysis in connection with
procurements.
7. Bonding requirements.
8. Requirement to make procurement documentation available for
review by the City, CaIOES and the Federal awarding agency.
In addition, Subrecipent must include in all of its contracts paid or
reimbursed in whole or in part with Subaward funds the provisions set
forth in Appendix II to 2 CFR Part 200 (Contract Provisions for non-
Federal Entity Contracts under Federal Awards) as required by 2 CFR
§200.326.
L Financial and Performance Monitoring and Reporting
Subrecipient shall comply with the monitoring requirements for a non-
Federal entity as set forth in 2 CFR §200.328, which requires the
Subrecipient to oversee the operations of its activities supported by the
Grant and monitor such activities to assure compliance with applicable
Federal requirements and performance expectations are being achieved.
Further, Subrecipient shall comply with the financial and performance
reporting requirements for a non-Federal entity as set forth in 2 CFR
§§200.327 to 200.329 and any other reporting requirements that may be
promulgated by the Federal awarding agency, CalOES or the City in
accordance with such regulations. Such reporting requirements include,
UASI 16 Subaward Agreement 14
Agreement No. 5544
without limitation, the provision of any information required for the
assessment or evaluation of any activities funded by the Subaward and
the reporting of information related to real property in which the Federal
government retains an interest.
Subrecipient acknowledges that the City, as a "pass-through entity," may
make various findings, determinations, evaluations and reports regarding
Subrecipient and its use of Subaward funds, as set forth in 2 CFR
§§200.330 to 200.332. In accordance with such regulations, Subrecipient
shall comply with, and timely grant to the City and its auditors, any
monitoring requests, requests for on-site access to facilities, equipment
and personnel, and requests for any other information as may be
authorized under such regulations. Subrecipient shall also timely grant to
the City and its auditors access to Subrecipient's records and financial
statements as required under 2 CFR §200.331(a)(5). In addition,
Subrecipient shall comply with any conditions that may be placed upon
Subrecipient as part of the City's risk evaluation of Subrecipient under 2
CFR §200.331(b).
J. Record Retention and Access
Subrecipient shall comply with all records retention, maintenance, storage,
transmission, and collection requirements applicable to a non-Federal
entity as set forth in 2 CFR §§200.333 to 200.335. Such regulations
require, without limitation, that Subrecipient retain financial records,
supporting documents, statistical records, and all other records of
Subrecipient that are related and/or pertinent to Subrecipient's use of
Subaward funds in a manner and for a duration of time as prescribed in
such regulations and that Subrecipient collect, transmit and store
Subaward-related information in a manner as set forth in 2 CFR §200.335.
In accordance with the provisions set forth in 2 CFR §200.336,
Subrecipient hereby grants the Federal awarding agency, the Inspectors
General, the Comptroller General of the United States, CalOES, and the
City, or any of their authorized representatives, the right of access to any
documents, papers, or other records of Subrecipient which are pertinent to
the Subaward, in order to make audits, examinations, excerpts, and
transcripts. This right also includes timely and reasonable access to
Subrecipient's personnel for the purpose of interview and discussion
related to such documents. These access rights shall not be limited to
any required record retention period but last as long as the records are
retained, and access shall not otherwise be limited unless as specifically
permitted under 2 CFR §§200.336 to 200.337.
Subrecipient shall require any of its subrecipients, contractors,
successors, transferees and assignees to acknowledge and agree to
comply with the provisions of this Section.
UASI 16 Subaward Agreement 15
Agreement No. 5544
K. Cost Principles
Subrecipient shall comply with the cost principles for federal awards as set
forth in 2 CFR Part 200 Subpart E ("Cost Principles"). Subrecipient
acknowledges and agrees that any costs incurred by Subrecipient may
only be charged to or reimbursed by Subaward funds if it is incurred in
compliance with all Requirements for the Subaward and is also deemed
allowable and allocable under the Subaward in accordance with the
provisions set forth in the Cost Principles.
L, Audit Requirements
By virtue of using Subaward funds, Subrecipient acknowledges and
agrees that it is subject to the provisions set forth in 2 CFR Part 200
Subpart F ("Audit Requirements"). Subrecipient shall comply with all
provisions applicable to a non-Federal entity and an "auditee" (as defined
in 2 CFR §200.6) as set forth in such Audit Requirements, including the
requirement to conduct a single audit if applicable.
M. Closeout and Post Closeout
Subrecipient shall comply with the obligations applicable to a non-Federal
entity as it pertains to the closeout of this Subaward as set forth in 2 CFR
§200.343. Subrecipient acknowledges and agrees that it shall continue to
comply with the post closeout obligations set forth in 2 CFR §200.344 after
closeout of the Subaward and expiration of the Term of this Agreement.
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UASI 16 Subaward Agreement 16
Agreement No. 5544
III. STANDARD PROVISIONS
§3.1 Independent Partv
Subrecipient is acting hereunder as an independent party, and not as an agent or
employee of the City. No employee of Subrecipient is, or shall be, an employee
of the City by virtue of this Agreement, and Subrecipient shall so inform each
employee organization and each employee who is hired or retained under this
Agreement. Subrecipient shall not represent or otherwise hold out itself or any of
its directors, officers, partners, employees, or agents to be an agent or employee
of the City by virtue of this Agreement.
§3.2 Construction of Provisions and Titles Herein
All titles, subtitles, or headings in this Agreement have been inserted for
convenience and shall not be deemed to affect the meaning or construction of
any of the terms or provisions hereof. The language of this Agreement shall be
construed according to its fair meaning and not strictly for or against either party.
The word "Subrecipient" herein and in any amendments hereto includes the party
or parties identified in this Agreement. The singular shall include the plural. If
there is more than one Subrecipient as identified herein, unless expressly stated
otherwise, their obligations and liabilities hereunder shall be joint and several.
Use of the feminine, masculine, or neuter genders shall be deemed to include the
genders not used.
§3.3 AlMlicable Law, Interoretation and Enforcement
Each party's performance hereunder shall comply with all applicable laws of the
United States of America, the State of California, the County and City of Los
Angeles, including but not limited to, laws regarding health and safety, labor and
employment, wage and hours and licensing laws which affect employees. This
Agreement shall be enforced and interpreted under the laws of the State of
California without regard to conflict of law principles. Subrecipient shall comply
with new, amended, or revised laws, regulations, and/or procedures that apply to
the performance of this Agreement.
In any action arising out of this Agreement, Subrecipient consents to personal
jurisdiction, and agrees to bring all such actions, exclusively in state and federal
courts located in Los Angeles County, California.
If any part, term or provision of this Agreement shall be held void, illegal,
unenforceable, or in conflict with any law of a federal, state or local government
having jurisdiction over this Agreement, the validity of the remaining parts, terms
or provisions of this Agreement shall not be affected thereby.
§3.4 Integrated Agreement
This Agreement sets forth all of the rights and duties of the parties with respect to
the subject matter hereof, and replaces any and all previous agreements or
understandings, whether written or oral, relating thereto. This Agreement may be
amended only as provided for herein.
UASI 16 Subaward Agreement 17
Agreement No. 5544
§3.5 Excusable Delays
In the event that performance on the part of any party hereto shall be delayed or
suspended as a result of circumstances beyond the reasonable control and
without the fault and negligence of said party, none of the parties shall incur any
liability to the other parties as a result of such delay or suspension.
Circumstances deemed to be beyond the control of the parties hereunder shall
include, but not be limited to, acts of God or of the public enemy; insurrection;
acts of the Federal Government or any unit of State or Local Government in
either sovereign or contractual capacity; fires; floods; epidemics; quarantine
restrictions; strikes, freight embargoes or delays in transportation; to the extent
that they are not caused by the party's willful or negligent acts or omissions and
to the extent that they are beyond the party's reasonable control.
§3.6 Breach
Except for excusable delays as described in §3.5 herein, if any party fails to
perform, in whole or in part, any promise, covenant, or agreement set forth
herein, or should any representation made by it be untrue, any aggrieved party
may avail itself of all rights and remedies, at law or equity, in the courts of law.
Said rights and remedies are cumulative of those provided for herein except that
in no event shall any party recover more than once, suffer a penalty or forfeiture,
or be unjustly compensated.
§3.7 Prohibition Aoainst Assionment or Deleoation
Subrecipient may not, unless it has first obtained the written permission of the
City:
A. Assign or otherwise alienate any of its rights hereunder, including the right
to payment; or
B. Delegate, subcontract, or otherwise transfer any of its duties hereunder.
§3.8 Indemnification
Each of the parties to this Agreement is a public entity. In contemplation of the
provisions of Section 895.2 of the Government Code of the State of California
imposing certain tort liability jointly upon public entities, solely by reason of such
entities being parties to an Agreement as defined by Section 895 of said Code,
the parties hereto, as between themselves, pursuant to the authorization
contained in Sections 895.4 and 895.6 of said Code, will each assume the full
liability imposed upon it or upon any of its officers, agents, or employees by law,
for injury caused by a negligent or wrongful act or omission occurring in the
performance of this Agreement, to the same extent that such liability would be
imposed in the absence of Section 895.2 of said Code. To achieve the above-
stated purpose, each party indemnifies and holds harmless the other party solely
by virtue of said Section 895.2. The provision of Section 2778 of the California
Civil Code is made a part hereto as if fully set forth herein. Subrecipient certifies
that it has adequate self insured retention of funds to meet any obligation arising
from this Agreement.
UASI 16 Subaward Agreement 18
Agreement No. 5544
A. Pursuant to Government Code Sections 895.4 and 895.6, the parties shall
each assume the full liability imposed upon it, or any of its officers, agents
or employees, by law for injury caused by any negligent or wrongful act or
omission occurring in the performance of this Agreement.
B. Each party indemnifies and holds harmless the other party for any loss,
costs, or expenses that may be imposed upon such other party by virtue
of Government Code section 895.2, which imposes joint civil liability upon
public entities solely by reason of such entities being parties to an
agreement, as defined by Government Code section 895.
C. In the event of third-party loss caused by negligence, wrongful act or
omission by both Parties, each party shall bear financial responsibility in
proportion to its percentage of fault as may be mutually agreed or judicially
determined. The provisions of Civil Code Section 2778 regarding
interpretation of indemnity agreements are hereby incorporated
§3.9 Subcontractor Assurances
Subrecipient shall contractually obligate all of its contractors, subcontractors and
vendors funded by Subaward funds as may be required to ensure that
Subrecipient can comply with all of the Requirements and other provisions of this
Agreement.
§3.10 Remedies for Noncompliance
Subrecipient acknowledges and agrees that, in the event Subrecipient fails to
comply with the terms and conditions of this Agreement or with any
Requirements referenced in Section 2.1 above, the Federal awarding agency,
CalOES or the City shall have the right to take one or more of the actions set
forth in 2 CFR §200.338. Such actions may include, without limitation, the
withholding of cash payments, suspension and/or termination of the Subaward,
and the disallowing of certain costs incurred under the Subaward. Any costs
incurred by Subrecipient during a suspension or after termination of the
Subaward shall not be considered allowable under the Subaward unless allowed
under 2 CFR §200.342. Subrecipient shall be liable to the Federal awarding
agency, CalOES and the City for any Subaward funds the Federal awarding
agency or CalOES determines that Subrecipient used in violation of any
Requirements reference in Section 2.1 above, and Subrecipient shall indemnify
and hold harmless the City for any sums the Federal awarding agency or
CalOES determines Subrecipient used in violation of such Requirements.
Subrecipient shall be granted the opportunity to object to and challenge the
taking of any remedial action by the Federal awarding agency, CalOES or the
City in accordance with the provisions set forth in 2 CFR §200.341.
§3.11 Termination
Subrecipient acknowledges and agrees that the Subaward, and any obligation to
disburse to or reimburse Subrecipient in connection thereto, may be terminated
UASI 16 Subaward Agreement 19
Agreement No. 5544
in whole or in part by the Federal awarding agency, CaIOES or the City as set
forth in 2 CFR §200.339. Subrecipient shall have the right to terminate the
Subaward only as set forth in 2 CFR §200.339. In the event the Subaward is
terminated, all obligations and requirements of this Agreement and the Grant
shall survive and continue in full force and effect in connection with any portion of
the Subaward remaining prior to such termination, including, without limitation,
the closeout and post closeout requirements set forth in this Agreement.
§3.12 Amendments
Any change in the terms of this Agreement, including the performance period of
the Subaward and any increase or decrease in the amount of the Subaward,
which are agreed to by the City and Subrecipient shall be incorporated into this
Agreement by a written amendment properly executed and signed by the person
authorized to bind the parties thereto.
§3.13 Complete Aqreernent
This Agreement sets forth all of the rights and duties of the parties with respect to
the subject matter hereof, and replaces any and all previous agreements or
understandings, whether written or oral, relating thereto. This Agreement may be
amended only as provided for herein and neither verbal agreement nor
conversation with any officer or employee of either party shall affect or modify
any of the terms and conditions of this Agreement. This Agreement is executed
in two (2) duplicate originals, each of which is deemed to be an original. This
Agreement includes twenty-one (21) pages and five (5) Exhibits which constitute
the entire understanding and agreement of the parties.
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UASI 16 Subaward Agreement 20
Agreement No. 5544
IN WITNESS WHEREOF, the City and Subrecipient have caused this Subaward
Agreement to be executed by their duly authorized representatives.
APPROVED AS TO FORM: For: THE CITY OF LOS ANGELES
MICHAEL N. F City Attorney ERIC GARCETTI, Mayor
By._
By Eric Garcetti, Mayor
Deputy City Attorney
Mayor's Office of Public Safety
Date b 1,8
Date
ATTEST:
HOLLY L. WOLCOTT, City Clerk
gar""
By C� ,
Deputy City Clerk
vj
Date � V,
,� a�a9M
APPROVED AS TO FORM: For: The City of EI Segundo,
a municipal corporation
By . c. A
City ttorney By
4 g 16
Date - ° �
Date
ATTEST: ""
By [SEAL]
City Clerk
Date v ]Lt �
City Business License Number:
Internal Revenue Service ID Number: t
Council File/OARS File rnber• C . x'#16-61777 Date of Approval
City Contract Number:
UASI 16 Subaward Agreement 21
Agreement No. 5544
EXHIBIT A
Agreement No. 5544
The FY 2016 DNS Standard Terms and Conditions apply to all new Federall financial assistance awards funded in FY 2016. The terms
and conditions of DHS financial'assistance awards flow down to subrecipients, unless a particular award terml or condition specifically
indicates otherwise.
Assurances,Administrative Retmirernents,Cost Principles,and'Audit R0,Quirem9ntS,
DHS financial assistance recipients must complete either the OMB Standard Form 424B Assurances—Non-Construction
Programs, or OMB Standard Form 424D Assurances—Construction Programs as ao licable. Certain assurances in these
documents may not be applicable to your program, and the DHS financial)assistance office may require applicants to certify
additional assurances. Applicants are required to fill out the assurances applicable to their program as instructed by the
awarding agency. Please contact the financial'assistance office if you have any questions.
DHS financial assistance recipients are required to follow the applicable provisions of the Uniform Administrative Requirements,
Cost Principles, and Audit Requirements for Federal Awards located at 2 C.F.R. Part 200. and adopted by DHS at 2 C.F.R. Part
3002.
OHS ftec'ific Acknowledgements and Assurances
All recipients, sub-recipients,successors,transferees, and assignees must acknowledge and agree to comply with applicable
provisions governing DHS access to records, accounts,documents, information, facilities, and staff.
1. Recipients must cooperate with any compliance reviews or compliance investigations conducted by DHS.
2. Recipients must give DHS access to, and the right to examine and copy, records, accounts, and other documents and sources
of information related to the award and permit access to facilities, personnel, and other individuals and information as may be
necessary, as required by DHS regulations and other applicable laws or program guidance.
3. Recipients must submit timely, complete, and accurate reports to the appropriate DHS officials and maintain appropriate
backup documentation to support the reports.
4. Recipients must comply with all other special reporting, data collection, and evaluation requirements,as prescribed by law or
detailed in program guidance.
5. If, during the past three years,the recipient has been accused of discrimination on the grounds of race, color, national origin
(including limited English proficiency), sex, age, disability, religion, or familial status,the recipient must provide a list of all such
proceedings, pending or completed, including outcome and copies of settlement agreements to the DHS financial assistance
office and the DHS Office of Civil Rights and Civil Liberties(CRCL)by e-mail at prcl0ho.dhs,00v or by mail at U.S. Department
of Homeland Security Office for Civil Rights and Civil Liberties Building 410, Mail Stop#0190 Washington, D.C. 20528.
6. In the event any court or administrative agency makes a finding of discrimination on grounds of race,color, national origin
(including limited English proficiency), sex, age, disability, religion, or familial status against the recipient, or the recipient settles
a case or matter alleging such discrimination, recipients must forward a copy of the complaint and findings to the DHS financial
assistance office and the CRCL office by e-mail or mail at the addresses listed above.
The United States has the right to seek judicial enforcement of these obligations.
Acknowledgment of Federal Funding from DHS All recipients must acknowledge their use of federal funding when issuing
statements, press releases, requests for proposals, bid invitations, and other
documents describing projects or programs funded in whole or in part with
Federal funds.
Activities Conducted Abroad All recipients must ensure that project activities carried on outside the United
States are coordinated as necessary with appropriate government authorities
and that appropriate licenses, permits, or approvals are obtained.
Standard Terms&Conditions: Version 6.0 January 29, 2016
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Agreement No. 5544
m
Age Discrimination Act of 1975 All recipients must comply with,the requirements of the Age Discrimination Act
of 1975('Title 42 U.S. Code, 6 6101 et seaj,which prohibits discrimination on
the basis of age in any program or activity receiving Federal financial
assistance.
Americans with Disabilities Act of 1999 All recipients must comply with the requirements of Titles I, II, and III of
the Americans with Disabilities Act,which prohibits recipients from
discriminating on the basis of disability in the operation of public entities,
public and private transportation systems, places of public
accommodation, and certain testing entities. (42 U.S.C. 44_12.101–
12�13).
Best Practices for Collection and Use of DHS defines personally identifiable information(PII)as any information that
Personally Identifiable Information(PII) permits the identity of an individual to be directly or indirectly inferred,
including any information that is linked or linkable to that individual.All
recipients who collect PII are required to have a publically-available privacy
policy that describes standards on the usage and maintenance of PII they
collect. Award recipients may also find as a useful resource the DNS Privacy
Impact Assessments: Privacy Guidance and Privacv template respectively.
Civil Rights Act of 1964–Title VI All recipients must comply with the requirements of Title VI of the Civil Rights
Act of 1964(42 U•S•C. 2000d et sgLq),which provides that no person in the
United States will, on the grounds of race, color, or national origin, be
excluded from participation in, be denied the benefits of, or be subjected to
discrimination under any program or activity receiving Federal financial
assistance. DHS implementing regulations for the Act are found at 6 C.F. R..,
Part 21 and 44 C.F.R. Part 7.
Civil Rights Act of 1968 All recipients must comply with Title VIII of the Civri Riahts Act of 1968,which
prohibits recipients from discriminating in the sale, rental,financing, and
advertising of dwellings, or in the provision of services in connection therewith,
on the basis of race, color, national origin, religion, disability, familial status,
and sex(42 U,S.C. 3601 et sera.), as implemented by the Department of
Housing and Urban Development at 24 C.F.R. Part'11141. The prohibition on
disability discrimination includes the requirement that new multifamily housing
with four or more dwelling units—i.e.,the public and common use areas and
individual apartment units(all units in buildings with elevators and ground-floor
units in buildings without elevators)—be designed and constructed with certain
accessible features(See 24 C.F.R. 5 11117.'241).
Copyright All recipients must affix the applicable copyright notices of 17 U.S.C.."401 or
402 and an acknowledgement of Government sponsorship(including award
number)to any work first produced under Federal financial assistance awards.
Debarment and Suspension All recipients are subject to the non-procurement debarment and suspension
regulations implementing Executive Orders 12549 and 12689,and 2 C.RR,
Part 184. These regulations restrict awards, subawards, and contracts with
certain parties that are debarred,suspended, or otherwise excluded from or
ineligible for participation in federal assistance programs or activities.
Drug-Free Workplace Regulations All recipients must comply with the Drug-Free Workplace Act of 1988(41
U.S.C. �701 et seer.), which requires all organizations receiving grants from
any Federal agency agree to maintain a drug-free workplace. DHS has
adopted the Act's implementing regulations at 2 C.F.R Part 3001.
Duplication of Benefits Any cost allocable to a particular Federal award provided for in 2 C.F.R. Part
200, Subraa I F may not be charged to other Federal awards to overcome fund
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Agreement No. 5544
deficiencies,to avoid restrictions imposed by Federal statutes, regulations, or
terms and conditions of the Federal awards,or for other reasons. However,
this prohibition•would not preclude a recipient form shifting costs that are
allowable under two or more Federal awards in accordance with existing
Federal statutes, regulations, or the terms and conditions of the Federal'
award.
Education/amendments of 1972(Equal All recipients must comply with the requirements of Title IX of the Education
Opportunity in Education Act)—Title IX Amendments of 1972(2.0 U,S•C. 4 '1681 et sea), which provide that no
person in the United States will, on the basis of sex, be excluded from
participation in, be denied the benefits of, or be subjected to discrimination
under any educational program or activity receiving Federal financial
assistance. DHS implementing regulations are codified at 6 C.F.R. Part 17
and 44 C,F,R, Part 19
Energy Policy and Conservation Act All recipients must comply with the requirements of 42 U.S.C.�_ 6201 which
contain policies relating to energy efficiency that are defined in the state
energy conservation plan issued in compliance with this Act.
False Claims Act and Program Fraud Civil All recipients must comply with the requirements of 31 U.S.C. 3729-3733
Remedies which prohibits the submission of false or fraudulent claims for payment to the
Federal Government. See 31 U.S.C. 3801-3812 which details the
administrative remedies for false claims and statements made.
Federal Debt Status All recipients are required to be non-delinquent in their repayment of any
Federal debt. Examples of relevant debt include delinquent payroll and other
taxes, audit disallowances, and benefit overpayments. See OMB Circular A-
129.
Federal Leadership on Reducing Text Messaging All recipients are encouraged to adopt and enforce policies that ban text
while Driving messaging while driving as described in E.O. 13513. including conducting
initiatives described in Section 3(a)of the Order when on official Government
business or when performing any work for or on behalf of the federal
government.
Fly America Act of 1974 All recipients must comply with Preference for U.S. Flag Air Carriers: (air
carriers holding certificates under 49 U.S.C, � 41102)for international air
transportation of people and property to the extent that such service is
available, in accordance with the International Air Transportation Fair
Competitive Practices Act of 1974(49 U.S.C. 40118 and the interpretative
guidelines issued by the Comptroller General of the United States in the
March 31, 1981, amendment to Comptroller General Decision B-138942.
Hotel and Motel Fire Safety Act of 1990 In accordance with Section 6 of the Hotel and Motel Fire Safety Act of 1990„
15 U,S.C. 4 2225x,all recipients must ensure that all conference, meeting,
convention,or training space funded in whole or in part with Federal funds
complies with the fire prevention and control guidelines of the Federal Fire
Prevention and Control Act of 1974, as amended, 15 U.S.C.�2225.
Limited English Proficiency(Civil Rights Act of All recipients must comply with the Title VI of the Civil Rights Act of 1964(Title
19647 Title VI) VI)prohibition against discrimination on the basis of national origin,which
requires that recipients of federal financial assistance take reasonable steps to
provide meaningful access to persons with limited English proficiency(LEP)to
their programs and services. For additional assistance and information
regarding language access obligations, please refer to the DHS Recipient
Guidance h'ttosJ/www,dhs aovlauidance-oublished-help-deDartment-
su000rted-oroani ations-orovid'e-meaninotul-access-oeoole-limited and
additional resources on httoWwwwww.leo.00v.
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Agreement No. 5544
Lobbying Prohibitions All recipients must comply with 31 U.S,C, 13.52 which provides that none of
the funds provided under an award may be expended by the recipient to pay
any person to influence, or attempt 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 any Federal action
concerning the award or renewal.
Non-supplanting Requirement All recipients who receive awards made under programs that prohibit
supplanting by law must ensure that Federal funds do not replace(supplant)
funds that have been budgeted for the same purpose through non-Federal
sources.
Notice of Funding Opportunity Requirements All of the instructions, guidance, limitations,and other conditions set forth in
the Notice of Funding Opportunity(NOFO)for this program are incorporated
here by reference in the terms and conditions of your award. All recipients
must comply with any such requirements set forth in the program NOFO.
Patents and Intellectual Property Rights Unless otherwise provided by law, recipients are subject to the Il3avh-bole Act,
Pub. L. No. 96.517. as amended, and codified in 35 U.S.C.S 200 et seq. All
recipients are subject to the specific requirements governing the
development, reporting, and disposition of rights to inventions and patents
resulting from financial assistance awards located at 37 C.F.R, Part 401 and
the standard patent rights clause located at 37 C.F.R. §401.14.
Procurement of Recovered Materials All recipients must comply with Section 6002 of the SolidWaste Disoosal_Act
.
as amended by the Resource Conservation and Recovery Act The
requirements of Section 6002 include procuring only items designated in
guidelines of the Environmental'Protection Agency(EPA)at 40 C.F.R. Part
247 that contain the highest percentage of recovered materials practicable,
consistent with maintaining a satisfactory level of competition.
Reporting Subawards and Executive All recipients are required to comply with the requirements set forth in the
Compensation government-wide Award Term on Reporting Subawards and Executive
Compensation located at 2 C.F,R, Part 170. Aaaendix A,the full text of which
is incorporated here by reference in the terms and conditions of your award.
SAFECOM All recipients who receive awards made under programs that provide
emergency communication equipment and its related activities must comply
with the SAFECOM Guidance for Emergency Communication Grants,
including provisions on technical standards that ensure and enhance
interoperable communications.
Terrorist Financing All recipients must comply with E.O. 13224 and U.S. law that prohibit
transactions with, and the provisions of resources and support to, individuals
and organizations associated with terrorism. It is the legal responsibility of
recipients to ensure compliance with the Order and laws.
Trafficking Victims Protection Act of 2000 All recipients must comply with the requirements of the government-wide
award term which implements Section 106(g)of the Trafficking Victims
Protection Act of 2000, (TVPA)as amended(22 U.S.C.&7104), The award
term is located at 2 CFR& 175.15,the full text of which is incorporated here
by reference in the terms and conditions of your award.
Rehabilitation Act of 1973 All recipients must comply with the requirements of Section 504 of the
Rehabilitation Act of 1973, 29 U.S.C.�794, as amended, which provides that
no otherwise qualified handicapped individual in the United States will, solely
by reason of the handicap, be excluded from participation in, be denied the
benefits of, or be subjected to discrimination under any program or activity
receiving Federal financial assistance.
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A reement No. 5544
Reporting of Matters Related to Recipient Integrity If the total value of your currently active grants, cooperative agreements, and
and Performance procurement contracts from all Federal assistance office exceeds$10,000,000
for any period of time during the period of performance of this Federal award,
you must comply with the requirements set forth in the government-wide
Award Term and Condition for Recipient Integrity and Performance Matters
located at 2 C.F.R. Part 200,Appendix Xll,the full text of which is
incorporated here by reference in the terms and conditions of your award.
Universal Identifier and System of Award All recipients are required to comply with the requirements set forth in the
Management(SAM) government-wide Award Term regarding the System for Award Management
and Universal Identifier Requirements located at'2 C,F.R. Part 25.Appendix
P�the full text of which is incorporated here by reference in the terms and
conditions of your award.
USA Patriot Act of 2001 All recipients must comply with requirements of the U'ni"tino and Strenotheninq
America by Providing Awrooriate 'Fools Rerrriired to Intercept and Obstruct
Terrorism Act(USA PAT'RlOT Act'),which amends 18 U.S,C, 4� 175-1755,
Use of DHS Seal,Logo and Flags All recipients must obtain permission from their financial assistance office,
prior to using the DHS seal(s), logos, crests or reproductions of flags or
likenesses of DNS agency officials, including use of the United States Coast
Guard seal, logo, crests or reproductions of flags or likenesses of Coast
Guard officials.
Whistleblower Protection Act All recipients must comply with the statutory requirements for whistleblower
protections(if applicable)at 10 U.S.0 8 2400, 41 U.S.C„4712. and 10 U.S.C.
2324 41 U.S.C, 4504 and 4810,
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Agreement No. 5544
Cal OES,
OOVFRNOII'S OFFICE
OF FMERSENCY SERVICES
Standard Assurances
For All Cal OES Federal Grant Programs
As the duty authorized representative of the Applicant, 1 hereby certify that the Applicant has the
legal authority to apply for federal assistance and the institutional, managerial and financial capability
(including funds sufficient to pay any non-federal share of project cost) to ensure proper planning,
management and completion of the project described in this application, within prescribed timelines.
1 further acknowledge that the Applicant is responsible for reviewing and adhering to all
requirements within the:
(a) Applicable Federal Regulations (see below);
(b) Federal Program Notice of Funding Opportunity (NOFO);
(c) California Supplement to the NOFO; and
(d) Federal and State Grant Program Guidelines.
Federal Regulations
Government cost principles, uniform administrative requirements and audit requirements for federal
grant programs are set forth in Title 2, Part 200 of the Code of Federal Regulations (CFR) and updates
are issued by the Office of Management and Budget (OMB) and can be found at
h'ttp;//www.whitehouse.gov/omb/.
Significant.state and federal grant award requirements (some of which appear in the documents
listed above) are set forth below. The Applicant hereby agrees to comply with the following:
1s Proof of Authority
The Applicant will obtain written authorization from the city council, governing board or authorized
body in support of this project. This written authorization must specify that the Applicant and the city
council, governing board, or authorized body agree:
(a) To provide all matching funds required for the grant project and that any cash match will be
appropriated as required.
(b) Any liability arising out of the performance sof this agreement shall be the responsibility of the
Applicant and the city council, governing board or authorized body.
(c) Grant funds shall not be used to supplant expenditures controlled by the city council,
governing board or authorized body.
(d) The official executing this agreement is, in fact, authorized to do so.
This Proof of Authority must be maintained on file and readily available upon request.
t ,I
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2. Period of Performance,
The Applicant will initiate wore, after approval of the award and complete all work within the period of
performance specked in the grant.
3. Lobbying and Poli0cal Activities
As required by Section 1352, Title 31 of the US Code (US.C.), for persons entering into a
contract, grant, loan or cooperative agreement from an agency or requests or receives from an
agency a commitment providing for the United States .to insure or guarantee a loan, 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 an agency, a Member of Congress, an officer or employee of Congress, or an employee
of a Member of Congress in connection with the awarding of any Federal contract, the
making of any federal grant, the making of any federal loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or
modification of any federal contract, grant, loan, or cooperative agreement.
(b) If any funds other than federal appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with this federal contract; grant, loan, or cooperative agreement,the
undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report
Lobbying", in accordance with its instructions.
(c) The undersigned shall require that the language of this certification be included in the award
documents for all subawards at all tiers (including subcontracts, subgrants, and contracts
under grants, loans, and cooperative agreements) and that all subrecipients shall certify and
disclose accordingly.
The Applicant will also comply with provisions of the Hatch Act(5 U.S.C. §§1501-1508 and §§7324-
7328)
§73247328) which limit the political activities of employees whose principal employment activities are
funded in whole or in part with federal funds.
Finally, the Applicant agrees that federal funds will not be used, directly or indirectly, to support the
enactment, repeal, modification or adoption of any law, regulation or policy without the express
written approval from the California Governor's Office of emergency Services (Cal OES) or the
federal awarding agency.
4. Debaffn ent and Suspension
As required by Executive Orders 12549 and 12689, and 2 CFR §200.212 and codified in 2 CFR
Part 180, Debarment and Suspension, the Applicant will provide protection against waste, fraud,
and abuse by debarring or suspending those persons deemed Irresponsible in their dealings with
the federal government. The Applicant certifies that it and its principals:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transactions by any federal department or agency;
Homeland Security Grant Program-2016 Grant Assurances Page2 of I
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Agreement No. 5544
(b;) Have not within a three-year period preceding this application been convictedof or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (federal, state, or
local) transaction or contract under a public transaction; violation of federal or state antitrust
statutes or commission of embez7lement„ 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 governmental
entity (federal,*state, or local) With commission of any of the offenses enumerated in
paragraph (2)(b) of this certification; and
(d) Have not within a three-year period preceding this application had one or more public
transaction (federal, state, or local)terminated for cause or default.
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..
5. Non-Discrimination and Equal Employment Opportunity
The Applicant will comply with all federal statutes relating to non-discrimination. These include, but
are not limited to, the following:
(a) Title VI of the Civil Rights Act of 1964 (Public Law (P.L.) 88-352 and 42 U.S.C. §2000d et.
seq.) which prohibits discrimination on the basis of race, color, or national origin and
requires that recipients of federal financial assistance take reasonable steps to provide
meaningful access to persons with limited English proficiency (LEP) to their programs and
services;
(b) Title IX of theEducation Amendments of 1972, (20 U.S.C. §§1681-1683, and 1685-1686),
which prohibits discrimination on the basis of sex in any federally funded educational
program or activity;
(c) Section 504 of the Rehabilitation Act of 1973, (29 U.S.C. §794), which prohibits
discrimination against those with disabilities or access and functional needs;
(d) Americans with Disabilities Act (ADA) of 1990, which prohibits discrimination on the basis of
disability and requires buildings and structures be accessible to those with disabilities and
access and functional needs;(42 U.S.C. §§ 12101-12213.);
(e) Age Discrimination Act of 1975, (42 U.S.C. §§ 6,101-6107), which prohibits discrimination on
the basis of age;
(#) Public Health Service Act of 1912 (42 U.S.C. §§ 290), relating to confidentiality of patient
records regarding substance abuse treatment;
(g) Title Vlii of the Civil Rights Act of 1968 (42 U.S.C. §3601 et seq.), relating to
nondiscrimination in the sale, rental or financing of housing;
(h) Executive Order '11246, which prohibits federal contractors and federally assisted
construction contractors and subcontractors,who do over$14,000 in Government business
in one year from discriminating in employment decisions on the basis of race, color, religion,
sex, sexual orientation,gender identification, or national origin;
Homeland Security brant Program—2015 Grant A3Sura=5
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Agreement No. 5544
(i) Executive Order 11375, which bans discrimination on the basis of race, color, religion, sex,
sexual orientation, gender identification, or national origin in hiring and employment in both
the United States federal workforce and on the part of government contractors;
(j) California Public Contract Code§10295.3, which prohibits discrimination based on domestic
partnerships and those in same sex marriages;
(k) Any other nondiscrimination provisions in the specihc statute(s) under which application for
federal assistance is being made; and
(1) The requirements of any other nondiscrimination statutes)which may apply to the
application_
In addition to the items listed in (a) through (n), the Applicant will comply with California's Fair
Employment and Housing Act (FERIA). FEHA prohibits harassment and discrimination in
employment because of ancestry, race, color, religious creed (including religious dress and
i.groorning practices), sex (which includes pregnancy, childbirth, breastfeeding and medical
conditions related to pregnancy, childbirth, or breastfeeding), gender, gender identity, gender
expression, sexual orientation, marital status, national origin, ancestry, mental and physical
disability, genetic information, medical condition, age, pregnancy, denial of medical and family care
leave, or pregnancy disability leave (California Government Code §§ 12940, 12845, 12945.2),
military and veteran status, and/or retaliation for protesting illegal discrimination related to one of
these categories, or for reporting patient abuse in tax supported institutions.
6. Drug-Free Workplace
As required by the Drug-Free Workplace Act of 1988 (41 U.S.C, §701 et seq.), the Applicant
certifies that it will maintain a drug-free workplace and a drug-free awareness program as outlined
in the Act.
7, Environmental Standards
The Applicant will comply with state and federal environmental standards, which may .be prescribed
pursuant to the following, as applicable,
(a) California Environmental Quality Act (CEQA) (California Public Resources Code §§ 21000-
21177), to include coordination with the city or county planning agency;
(b) 10EQA Guidelines (California Code of Regulations, 'Title 14, Division 6, Chapter 3, §§ 15000-
15387);
(c) Federal Clear Water Act (CWA) (33 U.S.C. § 1251 et seq.), which establishes the basic
structure for regulating discharges of pollutants into the waters of the United States and
regulating quality standards for surface waters;
(d) Federal Clean Air Act of 1955 (42 U.S.C. § 7401) which regulates air emissions from
stationary and mobile sources;
(e) Institution of environmental quality control measures under the National Environmental
Policy Act of 1969 (P.L. 91-190) and Executive Order 12898 on the Environmental Justice
Act, and Executive Order 11514 on Environmental Quality;
(f) Notification of Environmental Protection Agency (EPA) v;olating facilities pursuant to
Executive Order 11738;
(g) Protection of wetlands pursuant to Executive Order 11990,
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Agreement No. 5544
(h) Evaluation of flood hazards in floodplains in accordance with Executive Order 11988;
(i) Assurance of project consistency with the approved State management program developed
under the Coastal Zone Management Act of 1972 (16 U.S.C. §1461 et seq.);
(�) Conformity of Federal actions to State (Clean Air) Implementation Plans under Section
176�c) of the Dean Air Act of'1955, as amended (42 U.S.C. §7401 et sepa):
(k) Executive Order 11738 instituted to assure that each federal agency empowered to enter
into contracts for the procurement of goods. materials, or services and each federal agency
empowered to exte�rrd federal assistance by way of grant, loan, or contract shall undertake
such procurement and -assistance activities in a manner that will result in effective
enforcement of the Clean Air Act and the Federal Water PollAion Control Act Executive
Order Executive Order 11990 which requires preservation of wetlands;
(1) The Safe Drinking Water Act of 1974, (P.L. 93-523);
(m)The Endangered Species Act of 1973, (P,L. 93-205);
(n) Wild and Scenic Rivers Act of 1968 (16 U.S.C. §1271 et seq.) related to protecting
components or potential components of the national wild and scenic rivers system.
The Applicant shall not be: 1) in violation of any order or resolution promulgated by the State Air
Resources Board or an air pollution district; 2) subject to a cease and desist order pursuant to §
13301 of the California Water Code for violation of waste discharge requirements or discharge
prohibitions; or 3) determined to be in violation of federal law relating to air or water pollution.
8. Audits
For subrecipients expending $750,000 or more in federal grant funds annually, the Applicant will
cause to be performed the required financial and compliance audits in accordance with the Single
Audit Act Amendments cf 1996 and Title 2 of the Code of Federal Regulations, Part 200, Subpart F
Audit Requirements.
9. Access to Records
In accordance with 2 CFR §200.336, the Applicant 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.
The Applicant will require any subrecipients, contractors, successors, transferees and assignees to
acknowiedge and agree to comply with this provision.
10.Conflict of Interest
The Applicant will establish safeguards to prohibit employees from using their positions for a
purpose that constitutes or presents the appearance of personal or organizational conflict of
interest, or personal gain.
11. Financial Management
False Clams fora„er tt The Applicant will comply with 31 U.S.0 §3729 which sets forth that no
subgrantee, recipierd or subrecipient shall submit a false claim for payment, reimbursement or
advance,
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Agreement No. 5544
12. Reporting-Accountability
The Applicant agrees to comply with applicable provisions of the Federal Funding Accountability
and Transparency Act (F'FATA) (P.L. 108-282),„ specifically (a) the reporting of subawards obligating
$25,000 or more in federal funds and (b) executive compensation data for first-tier subawards. This
includes the provisions of FFATA, which includes regUirernents for executive compensation, and
also requirements implementing the Act for the non-federal entity at 2 CFR part 25 Financial
Assistance Use of Universal We:ntifier and Central Contractor Registration and 2 CFR part 170
Reporting Subaward and Executive Compensation Information.
13.Whistleblower Protections
The Applicant also must comply with statutory requirements for whistleblower protections at 10
U.S.C. §2409,41 U.S.C. §4712, and 10 U.S.C. §2324, 41 U.S.C. §4304 and §4310.
14,Human Trafficking
The Applicant will comply with the requirements of Section 106(8) of the Traffickinq Victims
Protection Act of 2000, as amended (22 U.S.C, § 7104)which prohibits grant award recipients or a
subrecipient from: (1) engaging in trafficking in persons during the period of time that the award is in
effect: (2) procuring a commercial sex act during the period of time that the award is in effect: or (3)
using forced labor in the performance of the award or subawards under the award.
15. ;Labor Standards
The Applicant will comply with the following federal labor standards:
(a) Comply with the provisions of the Davis-Bacon Act (40 U.S.C. §§ 276a to 276a-7), as
applicable,and the Copeland Act (40 U.S.C. § 3145 and 18 U.S.C. § 874) and the Contract
Work Hours and Safetv Standards Act (40 U.S.C. §§ 327-333), regarding labor standards
for federally-assisted construction contracts or subcontracts.
(b) Comply with the Federal Fair Labor Standards Act (28 U.S.C. § 201 et al.) as they apply to
employees of institutes of higher learning (1HE), hospitals and other non-profit organizations.
16.Workers Compensation
The Applicant must comply with provisions which require every employer to be insured to protect
workers who may be injured on the job before commencing performance of the work of this
Agreement, as per the workers compensation laws set forth in California tabor Code §§ 3700 et
seq.
17.Property-Related
If applicable to the type of project funded by this federal award, the Applicant will:
(a) Comply with the requirements of Titles 11 and Ill of the Uniform Relocation Assistange and
Real Prooerty Acquisition Policies Act of '1870 (P1. 91-648) which -provide for fair and
equitable treatment of persons displaced or whose property is acquired as a result of
Federal or federally-assisted programs. These requirements apply to all interests in real
property acquired for project purposes regardless of Federal participation in purchase.
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(b) Corn,piy with flood insurance purchase requirements of Section 102(x) of the Flood Disaster
Protection Acct of 1973 (P.L. 93-234) which requires subrecipients 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.
(c) Assist the awarding agency in assuring compliance wktO Section 136 of the National Historic
Preservation Act of 1966, as amended (16 U.S.C. § 470), Executive Order 11593
(identification and protection of historic properties), and the Archaeological and Historic
Preservation Act of 1974 (16 U.S.C. §469a-1 et seq.).
(d) Comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. §4831 and 24 CFR
Part 35) which prohibits the use of lead-based paint in construction or rehabilitation of
residence structures.
16, Certifications Applicable Only to Federally-Funded Construction Projects
For all construction projects, the Applicant will:
(a) 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.
(b) Comply with the requirements of the awarding agency with regard to the drafting, review and
approval of construction plans and specifications.
(c) 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,
19. Use of Cellular Device While Driving is Prohibited
Applicants are required to comply with California Vehicle Code sections 23123 and 23123.5.These
laws prohibit driving a motor vehicle while using an electronic wireless communications device to
write, send, or read a text-based communication. Drivers are also prohibited from the use of a
wireless telephone without hands-free listening and talking, unless to make an emergency call to
911, law enforcement, or similar services.
20, Freedom of Information Act
The Applicant acknowledges that all information submitted in the course of applying for funding
under this program, or provided in the course of an entity's grant management activities that are
under Federal control, is subject to the Freedom of Information Act (FOIA), 5 U.S.C. § 552, and the
California Public Records Rights Act, California Government Code section 6250 et seq. The
Applicant should consider these laws and consult its own State and local laws and regulations
regarding the release of information when reporting sensitive matters in the grant application, needs
assessment, and strategic planning process.
homeland Security Grant Program—2015 Grant Assurances Page 7 of 11
Agreement No. 5544
HOMELAND SECURITY GRANT PROGRAM - PROGRAM SPECIFIC ASSURANCES�
CERTIFICATIONS
21. Reporting Accusations and Findings of Discrimination
If during the past three years the recipient has been accused of discrimination on any basis the
recipient must provide a list of all such proceedings, pending or completed, including outcome and
copies of settlement agreements to the DNS financial assistance office and the DHS Office of Civil
Rights and Civil Liberties (CRCL) by e-mail at crcl,t�"7a,hci,dhs.00v or by mail at U.S Department of
Homeland Security Office for Civil Rights and Civil Liberties Building 410, Mail Stop #0190
Washington, D.C. 20525.
In the event any court or administrative agency makes a finding of discrimination against the
recipient, or the recipient settles a case or matter alleging such discrimination„ recipients must
forNard a copy of the complaint and endings to the DHS Component financ,4 assistance office and
the CRCL office by e-mail or mail at the addresses listed above.
The United States has the right to seek judicial enforcement of these obligations.
22.Acknowledgment of Federal Funding from DHS
All recipients must acknowledge their use of federal funding when issuing statements, press
releases, requests for proposals, bid invitations, and other documents describing projects or
programs funded in whole or in part with federal funds.
23.Activities Conducted Abroad
All recipients roust ensure that project activities carried on outside the United States are
coordinated as necessary with appropriate government authorities and that appropriate licenses,
permits, or approvals are obtained.
24. Best Practices for Collection and Use of Personally Identifiable Information (P9t)
DHS defines personally identifiable information (PII) as any information that permits the identity of
an individual to be directly or indirectly inferred, including any information that is linked or linkable to
that individual. All recipients who collect Pit are required to have a publically-avallable privacy policy
that describes standards on the usage and maintenance of PH they collect. Award recipients may
also find as a useful resource the DHS Privacy Impact Assessments: Privacy Guidance and Privacy
template respectively.
25.Copyright
All recipients roust affix the apphcable copyright notices of 17 U.S.C. §§ 401 or 402 and an
acknowledgement of Government sponsorship (including award number) to any work first produced
under federal financial assistance awards.
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26. Energy Policy and Conservation Act
All recipients must comply with the requirements of 42 U.S.C. §6201 which contain policies relating
to energy efficiency that are defined in the state energy conservation plan issued in compliance with
this Act.
27. Federal Debt Status
All recipients are required to be non-delinquent in their repayment of any federal debt. Examples of
relevant debt include delinquent payroll and other taxes, audit disallowances, and benefit
overpayments. See OMB Circular A-129.
28. Fly America Act o€1974
All recipients must comply with Preference for U.S. Flag Air Carriers: (air carriers holding certificates
under 49 U.S.C. § 41102) for international air transportation of people and property to the extent
that such service is available, in accordance with the International Air Transportation Fair
Competitive Practices Act of 1974 (49 U.S.G. § 40118) and the interpretative guidelines issued by
the Comptroller General of the United States in the March 31, 1981, amendment to Comptroller
General Decision B-138942
29.Hotel and Motel Fire Safety Act of 1990
In accordance with Section 6 of the Hotel and Motel Fire Safety Act of 1990, all recipients must
ensure that all conference, meeting, convention, or training space funded in whole or in part with
federal funds complies with the fire prevention and control guidelines of the Federal Fire Prevention
and Control Act of 1974, as amended, 15 U.S.C. §2225a.
30. Non-supplanting Requirements
All Applicants who receive awards made under programs that prohibit supplanting by law must
ensure that federal funds do not replace (supplant) funds that have been budgeted for the same
purpose through non-federal sources.
32. Patents and Intellectual Property Rights
Unless otherwise provided by law, recipients are subject to the Bayh-Dole Act, Pub. L. No. 96-517,
as amended, and codified in 35 U.S.C. § 200 et seq. All recipients are subject to the speck
requirements governing the development, reporting, and disposition of rights to inventions and
patents resulting from financial assistance awards located at 37 C.F.R. Part 401 and the standard
patent rights clause located at 37 C.F.R. § 401.14.
33.SAFECOM
All Applicants who receive awards made under programs that provide emergency communication
equipment and its related activities must comply with the SAFECOM Guidance for Emergency
Communication Grants, including provisions on technical standards that ensure and enhance
interoperable communications.
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34.Terrorist Financing
All Applicants must comply with Executive Order 13224 and U.S. law that prohibit transactions with,
and the provisions of resources and support to, individuals and organizations associated with
terrorism. It is the legal responsibility of recipients to ensure compliance wth the Order and laws_
35, Reporting of Matters Related to Recipient Integrity and performance
if the total value of the Applicant's currently active grants, cooperative agreements, and
procurement contracts from all federal assistance office exceeds$10,000,000 for any period of time
during the period of performance of this federal award, the Applicant must comply with the
requirements set forth in the government-wide Award Term and Condition for Recipient Integrity
and 'Performance Matters located at 2 C.F.R. Part 200, Appendix XII, the full text of which is
incorporated here by reference in the terms and conditions of your award,
36.USA Patriot Act of 2001
All recipients must comply with requirements of the Uniting and Strengthening America by Providing
Appropriate Tools Required to Intercept and Obstruct Terrorism Act (USA PATRIOT Act), which
amends 18 U.S.C. §§ 175-175c.
IMPORTANT
The purpose of the assurance is to obtain federal and state financial assistance, including any and all
federal and state grants, loans, reimbursement, contracts, etc. The Applicant recognizes and agrees
that state financial assistance will be extended based on the representations made in this assurance.
This assurance is binding on the Applicant, its successors, transferees, assignees, etc. Failure to
comply with any of the above assurances may result in suspension, termination, or reduction of grant
'funds.
All appropriate documentation, as outlined above, must be maintained on file by the Applicant and
available for Cal OES or public scrutiny upon request. Failure to comply with these requirements may
result in suspension of payments under the grant or termination of the grant or both and the
subrecipient may be ineligible for award of any future grants if the Cal OES determines that any of the
following has occurred: (1) the recipient has made false certification, or (2) violates the certification by
failing to carry out the requirements as noted above.
All of the language contained within this document must be included in the award documents for all
subawards at all tiers, including contracts under grants and cooperative agreements and subcontracts.
All recipients are bound by the Department of Homeland Security Standard Terms and Conditions
2016, Version 8.0, hereby incorporated by reference, which can be found at:
https://www.dhs,gov/sites/default/files/publications/Fiscal%20YearQA20201 S%20DHS%20General%20T
erms%20and%20Conditio ns.pdf
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The undersigned represents that he/she is authorized to enter lento Cn�s agreemen, 'Or and or behalf of
the said Applicant,
Applicant: Los AY)Ojejr-N U*'I
J
Signature of Authorized Agent:
Printed Name ofAuthorized Agent.- -ealgi, I'S'6 I�Ioo
Tide: -bireclar d Inmik r' Rp,,asnee Date.- Yo/'I PC
Homeland Security Grant Program-2016 Grant Assurances PagEl 11 OVII
Agreement No. 5544
EXHIBIT C
Agreement No. 5544
I.AAS
fil�our Chu 4rlasubmirit��youfa
r Grant Spedaw, Include the project details:tot'each
ffected by the modiAcahom vaqqq,tf,For new line Vs befho�U*Alero tbOO ho ProfectLe, ntilt,andSub-Lim*columns in Me Modified,To'
soobo6 blank-your Grant Specfaifst,41 assign,therm You MUST include the reason,for ther modification request Your Grant SpWalist will advise T your
mw$k44a0,rawest requires',addiffoneff friformaton.Addilfanally,you MUST attach a qpMpieled fodgar($�Wth the proposed changes, Formulas are
etnboddedA'the Form tar automatically miculate:the$Change,andthe.Form is batanced when the Tales:highlighted yellowp to the'Modified From and
thei'Modiffed To'sedans ate equal. Modillcaffort requests ate submitted to CaIOES on,a monthly basfsJo be considered for Chat montlYs modification
raquei�l please eahrriff lb,y v*ilkojiiJfto&
REQUIREMENTS FOR SUBMISSION"
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LA-LB UASI Modification Form 2017 xlsx 1 of 1
Agreement No. 5544
Does your Modification Request require a change to your Project Timeline?
If Yes,please complete the Project Timeline below All:modificabon requests MUST allow for project completion within the grant performance penod
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Milestone Timeline Comments
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Additional notes on project timeline:
Agreement No. 5544
CITY OF LOS ANGELES
URBAN AREAS SECURITY INITIATIVE GRANT
Reimbursement Request Form
Return Reimbursement Requests to: Jurisdiction:
Grant Specialist
Mayor's Office of Public Safety Agency/Department:
200 N. Spring Street, Room 303
Los Angeles, CA 90012 Expenditure Period:
Prepared By:
0
UASI FY 14 ❑ Project Letter: E-Mail Address:
UASI FY 15 ❑ Master Item#:
UASI FY 16 ❑ Sub-Line#: Phone.-
....................
hone:.................... _._....._._...........................
I'
REIMBURSEMENT SUMMARY
DIRECTIONS: Please submit one Reimbursement Request Form for each UASI grant year, fiscal year, and type of
expenditure. Follow the Reimbursement Request Checklist to compile supporting documentation, and then complete the Typed
Resource Report and the associated Roster(s). Please remember that if the reimbursement includes personnel or
consultant fees,those rosters will also need to be completed.
Type of Expenditure Authorized Previously Current Cumulative Balance
Total Amount Requested Request Request
Total $ - $ $ - $ $
Please mark this box to indicate final request for reimbursement ❑
This reimbursement claim is in all respects true, correct, and all expenditures were made in accordande with applicable laws,
rules, regulations, and grant conditions and assurances. In addition, this claim is for costs incurred within the Grant
Performance Period. Also, all supporting documentation related to these expenditures will be retained in accordance with
grant guidelines.
Authorized Department Approval., Please Remit Payment To:
Print Name Agency
Title Address(Line 1)
Signature Date Address(Line 2-Optional)
E-Mail Phone City State Zip
Mayor's Office Use Only
Invoice Tracking:
Fiscal Year:
Cash Request:
Invoice#:
Document ID:
UASI Reimbursement Request Form-April 2015
Agreement No. 5544
LA/LB UASI
REQUIRED SUPPORTING DOCUMENTATION FOR
EQUIPMENT CLAIM REIMBURSEMENT
IMPORTANT" In addition to the completed, signed and dated Reimbursement Request Form, you must submit this Checklist with the
supporting documents. Reimbursement requests must be submitted as soon as expenses are incurred and paid, and the required:
supporting documents are available. Do NOT accumulate all claims and invoices to submit on the final due date. Failure to submit your'
claim with the required supporting documents could result in expenses not reimbursed and/or funds reallocated.
Please contact your Grant Specialist with any questions about iretaulred sunnortinol documentation
PROCUREMENT
❑ Comoet'itive/Foirmal Procurement:Submit copies of procurement documents, as applicable, including Council approval, RFP,bids
or bid recap/summary, and contract.
❑ Informal Procurement:Provide copies of informal procurement documents, as applicable. Informal procurements must comply with
your Jurisdiction's policies.
❑ Sole Source Purchase:
❑ State Sole Source(over$150,000):Provide a copy of the State approval. There are NO retroactive approvals.
❑ Jurisdiction Sole Source(under$150,000):Provide a copy of your Jurisdiction's Sole Source documentation and approval.
EQUIPMENT CLAIMS MUST INCLUDE THE FOLLOWING:
❑ Purchase Order
❑ Invoice:Must be stamped"PAID,"signed with authorized signature for payment, and dated.
❑ Proof of Delivery:,Packing slips should be included. If packing slips were not part of the equipment delivery(e.g. licenses),the P.O.
needs to be stamped"RECEIVED"with the date received, and signature.
❑ Proof of Past:Include proof of payment and proof the payment has CLEARED, Proof of payment must have reference to the
invoice,and amount paid must match the invoice amount. If multiple invoices are being paid with one check,the invoices must be
listed with corresponding amounts.
❑ Print Screen of Federal Debarment Listing.Review the Federal Debarment Listing and provide a screen shot showing that the
listing was queried PRIOR to purchase. Federal Debarment Listings can be found at https://www.sam.gov/portal/public/SAM/
❑ Grant-Funded Typed Resource Report:'Typed Resource Report'needs to be completed,typically by the project's SME.
❑ Etauioment Roster:Complete the attached'Equipment Roster.'Submit electronically to your Grant Specialist and to
HSPS.Compliance@lacity.org
❑ State Approvals:EHP Approval,Watercraft Approval,Aircraft Approval, EOC Approval, as applicable.All requests must obtain
State approval PRIOR to purchase. There are NO exceptions or retroactive approvals.
❑ Performance Bond:All equipment items over$250,000 or any vehicle,aircraft or watercraft MUST obtain a performance bond. A
copy of the performance bond must be submitted to your Grant Specialist as soon as it is obtained,with an additional copy provided
with the Reimbursement Request Form.
Completed By: Signature: Date:
UASI Reimbursement Request Form-April.2015
Agreement No. 5544
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UASI Reimbursement Request Form-Feb.2015
Agreement No. 5544
LA/LB UASI
REQUIRED SUPPORTING DOCUMENTATION FOR
TRAINING CLAIM REIMBURSEMENT
IMPORTANT" In addition to the completed, signed and datedReimbursement Request Form, you must submit this Checklist with the
;supporting documents. Reimbursement requests must be submitted as soon as expenses are incurred and paid, and the required
;supporting documents are available. Do NOT accumulate all claims and invoices to submit on the final due date. Failure to submit your
jclaim with the required supporting documents could result Iri expenses not reimbursed and/or funds reallocated.
Please contact v„,qur Grant Soecisiist with any ouestions about rqqMjLgW supporting documentation.
PROCUREMENT
❑ Competitive/Formal Procurement:Submit copies of procurement documents,as applicable,including Council approval, RFP,bids
or bid recap/summary, and contract.
❑ Informal Procurement.,Provide copies of informal procurement documents,as applicable. Informal procurements must comply
with your Jurisdiction's policies.
❑ Sole Source Purchase:
❑ State Sole Source(over$150,000):Provide a copy of the State approval. There are NO retroactive approvals.
❑ Jurisdiction Sole Source(under$150,000):Provide a copy of your Jurisdiction's Sole Source documentation and approval.
TRAINING PROJECTS INVOLVING A VENDOR MUST'INCLUDE THE FOLLOWING:
❑ Purchase Order Or Service Contract
❑ Invoice:Must be stamped"PAID,"signed with authorized signature for payment,and dated.
❑ Proof of Delivery:Submit copies of the Agenda AND submit Class Roster/Sign-in Sheets or Certificate of Completion with training
date.
❑ Proof'of Payment: Include proof of payment and proof the payment has CLEARED. Proof of payment must have reference to the
invoice,and amount paid must match the invoice amount. If multiple invoices are'being paid with one check,the invoices must be
listed with corresponding amounts.
❑ Print Screen of Federal Debarment Listing:,Review the Federal Debarment Listing and provide a screen shot showing that the
listing was queried PRIOR to purchase. Federal Debarment Listings can be found at https://www.sam.gov/portal/publictSAM)
❑ Grant-Funded Tvved Resource Reoort„:,`Typed Resource Report'needs to be completed,typically by the project's SME.
❑ Consultant Roster:Complete the attached`Consultant Roster.'
❑ estate Approvals:Copy of ODP Approved Tracking Number is required. Copy of EHP Approval, as applicable. All requests must
obtain State approval PRIOR to commencement of training. There are NO exceptions or retroactive approvals.
❑ Total No.of Grant-Funded Trainees: Total No.of Grant-Funded Instructors:
TRAINING PROJECTS FOR PERSONNEL TIME MUST INCLUDE THE FOLLOWING:
❑ Summary Sheet: Indicate employee(s),amount per employee(s), and total being claimed. This amount should tie the official
payroll register to the total amount being claimed on the Reimbursement Request Form.
❑ Official PavroNl Register:Indicate employee name you are seeking reimbursement for,salary,hourly rate,employee benefits,and
overtime rate if applicable. If seeking reimbursement for Employee Benefits, include documentation verifying EB rates.
❑ Timecards: Indicate the#of hours charged per day,and include employee signature&supervisor signature. If claiming for Backfill,
timecard needs to include the name of the person the employee was backfilling for/person who attended the training.
❑ Class Ros,terfSion-in Sheets or Certificate of Comoletion with Training Clane:If claiming for Backfill the Class Roster/Sign-in
Sheet or Certificate of Completion should be for the person who attended the training.
❑ Grant-Funded Typed Resource Report: 'Typed Resource Report'needs to be completed,typically by the project's SME.
❑ State Approvals:Copy of ODP Approved Tracking Number is required. Copy of EHP Approval,as applicable. International
trainings require State approval. All requests must obtain State approval PRIOR to commencement of training. There are NO
exceptions or retroactive approvals.
❑ Travel fit aoplicable):Itemized receipts and proof of payment are required for airfare,lodging, meals and/or training/conference
fees.Jurisdictions must follow their own travel policies and submit a copy of that travel policy. If no local policy exists,please see
www.gsa.gov for approved per diem rates.
❑ Total No.of Grant-Funded Trainees: Total No.of Grant-Funded Instructors:
Completed By: Signature: Date:
UASI Reimbursement Request Form-April.2015
Agreement No. 5544
LA/LB UASI
REQUIRED SUPPORTING DOCUMENTATION FOR
EXERCISE CLAIM REIMBURSEMENT
IMPORTANT" In addition to the completed, signed and dated Reimbursement Request Form, you must submit this Checklist with the
supportirrg documents. Reimbursement requests must be submitted as soon as expenses are incurred and paid, and the required
supporting documents are available. Do NOT accumulate all claims and invoices to submit on the final due date. Failure to submit your
claim with the required supporting documents could result In expenses not reimbursed and/or funds reallocated,
Please contact vop „P„ecialist with anv q„taestions about reoulre grtlno documentation.
PROCUREMENT
❑ Comaetitive/Formal Procurement:Submit copies of procurement documents, as applicable, including Council approval, RFP,bids
or bid recap/summary,and contract.
❑ Informal Procurement:Provide copies of informal procurement documents,as applicable. Informal procurements must comply
with your Jurisdiction's policies.
❑ Sole Source Purchase:
❑ State Sole Source(over$150,000):Provide a copy of the State approval. There are NO retroactive approvals.
❑ Jurisdiction Sole Source(under$150,000):Provide a copy of your Jurisdiction's Sole Source documentation and approval.
EXERCISE PROJECTS INVOLVING A VENDOR MUST INCLUDE THE.FOLLOWING:
❑ Purchase Order or Service Contract
❑ Invoice:Must be stamped"PAID,"signed with authorized signature for payment,and dated.
❑ Proof of Deliver,Submit copies of Sign-in Sheets AND submit After Action Report into HSEEP portal within 60 days of event.
Submit proof that the report was submitted,including date of submission.
❑ Proof of Payment:Include proof of payment and proof the payment has CLEARED. Proof of payment must have reference to the
invoice,and amount paid must match the invoice amount. If multiple invoices are being paid with one check,the invoices must be
listed with corresponding amounts.
❑ Print Screen of Federal Debarment Listina .,Review the Federal Debarment Listing and provide a screen shot showing that the
listing was queried PRIOR to purchase. Federal Debarment Listings can be found at https://www.sam.gov/portal/public/SAMI
❑ Consultant Roster:Complete the attached'Consultant Roster.'
❑ State Aoorovals:Copy of EHP Approval,as applicable. Please note that ANY exercise with an outside component,MUST get
EHP approval.All requests must obtain State approval PRIOR to date of exercise. There are NO exceptions or retroactive
❑ Exercise Date: Number of Exercise Participants,
EXERCISE PROJECTS FOR PERSONNEL TIME MUST INCLUDE THE FOLLOWING:
❑ Summary Sheet: Indicate employee(s),amount per employee(s),and total being claimed. This amount should tie the official
payroll register to the total amount being claimed on the Reimbursement Request Form.
❑
Official Pavroil Reaiist'er1 Indicate employee name you are seeking reimbursement for,salary, hourly rate,employee benefits,and
overtime rate if applicable. If seeking reimbursement for Employee Benefits,include documentation verifying EB rates.
❑ Timecairds: Indicate the#of hours charged per day, and include employee signature&supervisor signature. If claiming for Backfill,
timecard needs to include the name of the person the employee was backfilling for/person who attended the exercise.
❑ Sinn-in Sheets or Certificate of Comoletion with Exercise Date:If claiming for Backfill,the Sign-in Sheet or Certificate of
Completion should be for the person who attended the exercise.
❑ State Approvals:Copy of EHP Approval,as applicable. Please note that ANY exercise with an outside component,MUST get
EHP approval.All requests must obtain State approval PRIOR to date of exercise. NO exceptions or retroactive approvals.
❑ Travel 1if ap Iicable :Itemized receipts and proof of payment are required for airfare,lodging,meals and/or exercise fees.
Jurisdictions must follow their own travel policies and submit a copy of that travel policy. If no local policy exists,please see
www.gsa.gov for approved per diem rates.
❑ After Action Report:Submit After Action Report into HSEEP portal within 60 days of event. Submit proof that the report was
submitted,including date of submission.
❑ Exercise Date: Number of Exercise Particinants:
Completed By: Signature: Date:
UASI Reimbursement Request Form-April.2015
Agreement No. 5544
LA/LB UASI
REQUIRED SUPPORTING DOCUMENTATION FOR
PLANNING CLAIM REIMBURSEMENT
IMPORTANT°" In addition to the completed, signed and dated Reimbursement Request Form, you must submit this Checklist with the
supporting documents. Reimbursement requests must be submitted as soon as expenses are incurred and paid, and the required
supporting documents are available. Do NOT accumulate all claims and invoices to submit on the final due date. Failure to submit your
claim with the required supporting documents could result in expenses not reimbursed and/or funds reallocated.
Please contact your Grant Specialist with any questions about required su porting documentation
PROCUREMENT
❑ Competitive/Formal Procurement:Submit copies of procurement documents,as applicable, including Council approval, RFP,bids
or bid recap/summary,and contract.
i
❑ Informal Procurement: Provide copies of informal procurement documents, as applicable. Informal procurements must comply with
your Jurisdiction's policies.
❑ Sole Source Purchase:
❑ State Sole Source(over$150,000):Provide a copy of the State approval. There are NO retroactive approvals.
❑ Jurisdiction Sole Source(under$150,000):Provide a copy of your Jurisdiction's Sole Source documentation and approval.
PLANNING PROJECTS INVOLVING A VENDOR MUST INCLUDE THE FOLLOWING:
❑ Purchase Order or Service Contract
❑ Invoice:Must be stamped"PAID,"signed with authorized signature for payment, and dated.
❑ Proof of Dellverv:Submit a copy/copies of the deliverables as outlined in the Purchase Order or Service Contract.
❑ Proof of Pam Include proof of payment and proof the payment has CLEARED. Proof of payment must have reference to the
invoice,and amount paid must match the invoice amount. If multiple invoices are being paid with one check,the invoices must be
listed with corresponding amounts.
❑ Print Screen of Federal Debarment Listing:Review the Federal Debarment Listing and provide a screen shot showing that the
listing was queried PRIOR to purchase; Federal Debarment Listings can be found at https://www.sam.gov/portal/public/SAM/
❑ Consultant Roster:Complete the attached'Consultant Roster.'
PLANNING PROJECTS FOR PERSONNEL TIME MUST INCLUDE THE FOLLOWING:
[] Summary Sheet:Indicate employee(s),amount per employee(s), and total being claimed. This amount should tie the official payroll
register to the total amount being claimed on the Reimbursement Request Form.
❑, Official Payroll Register: Indicate employee name you are seeking reimbursement for,salary, hourly rate,employee benefits,and
overtime rate if applicable. If seeking reimbursement for Employee Benefits, include documentation verifying EB rates.
❑ Timecards:Indicate the#of hours charged per day,and include employee signature&supervisor signature. If claiming for Backfill,
timecard needs to include the name of the person the employee was backfilling for.
❑ Personnel.Roster:Complete the attached'Personnel Roster'
Cj Final Product:Submit a copy/copies of the Final Product as outlined in the workbook OR submit intermittent deliverables as
discussed with your Grant Specialist.
Completed By: Signature: Date:
UASI Reimbursement Request Form-April.2015
Agreement No. 5544
LA/LB UASI
REQUIRED SUPPORTING DOCUMENTATION FOR
ORGANIZATION CLAIM REIMBURSEMENT
IMPORTANT** In addition to the completed, signed and dated Reimbursement Request Form, you must submit this Checklist with the
supporting documents. Reimbursement requests must be submitted as soon as expenses are incurred and paid, and the required
supporting documents are available. Do NOT accumulate all claims and invoices to submit on the final due date. Failure to submit your
claim with the required supporting documents could result in expenses not reimbursed and/or funds reallocated.
Please contact Your Grant Soeciall'st with anv aues°ttons about required suraoortind documentation
PROCUREMENT
❑ ComDet'itive/'Formal Procurement:Submit copies of procurement documents,as applicable, including Council approval, RFP, bids
or bid recap/summary, and contract.
❑ Informal Procurement:Provide copies of informal procurement documents,as applicable. Informal procurements must comply with
your Jurisdiction's policies.
❑ Sole'Source'Purchase:
❑ State Sole Source(over$150,000):Provide a copy of the State approval. There are NO retroactive approvals.
❑ Jurisdiction Sole Source(under$150,000):Provide a copy of your Jurisdiction's Sole Source documentation and approval.
ORGANIZATION PROJECTS INVOLVING A VENDOR MUST INCLUDE THE FOLLOWING:
❑ Purchase Order or Service Contract
❑ Invoice:Must be stamped"PAID,"signed with authorized signature for payment,and dated.
❑ Proof of Delivery:Submit a copy/copies of the deliverables as outlined in the Purchase Order or Service Contract.
❑ Proof of Payment: Include proof of payment and proof the payment has CLEARED. Proof of payment must have reference to the
invoice,and amount paid must match the invoice amount. If multiple invoices are being paid with one check,the invoices must be
listed with corresponding amounts.
❑ Print Screen of Federal Debarment IListina:Review the Federal Debarment Listing and provide a screen shot showing that the
listing was queried PRIOR to purchase. Federal Debarment Listings can be found at https://www.sam.gov/portal/public/SAM/
❑ Consultant Roster:Complete the attached'Consultant Roster'
ORGANIZATION PROJECTS FOR PERSONNEL TIME MUST INCLUDE THE FOLLOWING:
❑ SummaU Sheet:Indicate employee(s), amount per employee(s), and total being claimed. This amount should tie the official payroll
❑ Official Pavroll ReWster: Indicate employee name you are seeking reimbursement for,salary, hourly rate,employee benefits,and
❑ Timecards:Indicate the#of hours charged per day,and include employee signature&supervisor signature. If claiming for Backfill,
❑ Personnel Roster:Complete the attached'Personnel Roster.'
Lj Federal Req! est:If requesting reimbursement for Overtime, include a copy of the Federal Request for Overtime. This applies
Completed By: Signature: Date:
UASI Reimbursement Request Form-April.2015
Agreement No. 5544
GranbFunded Typed Resource Report
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Agreement No. 5544
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UASI Reimbursement Request Form-Feb.2015
Agreement No. 5544
3 001-Ora ry OA
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UASI Reimbursement Request Form-Feb.2015
Agreement No. 5544
EXHIBIT D
Agreement No. 5544
CALIFORNIA GOVERNOR'S OFFICE OF EMERGENCY SERVICES
AVIATION FOMPMENT REOTTEST F01JhJ
Homeland Security Grant Program FY: Grant NUmber: Cal OES IDD:
Urban Area Security Initiative (UASI)FY: Grant Number:_ Cal OES ID#:
Project Amount: UASI: $_ SHSGP: $
City/County/Agency Name:
1. Indicate the type of equipment for this request
Aviation Equipment Aviation Related Equipment
2. Provide a description of the area that will be served by the requested equipment.
3. Please justify the need for the aviation equipment and how the requested platform best meets
that need as compared to other options. Include the cost, discipline, and funding source.
4. Please certify on signed letterhead that an existing aviation unit is operating and will continue
to operate independent of the requested funding. Describe the active, operating aviation unit
and certify that no expenses will be charged against the grant award for the general
operational costs of such aviation unit.
5. Identify the applicable goals and objectives in the State/Urban Area Homeland Security
Strategy that the requested aviation equipment addresses.
6. Explain how the requested aviation equipment fits into the State/Urban Area's integrated
operational plans.
7. Explain how this aviation equipment will support activities specifically related to terrorism
incident prevention and response efforts.
Cal OES Form AVI Rev 08-01-13
Agreement No. 5544
Cal OES Aviation Request Form
Page Two
8. Please describe how this aviation equipment will be used operationally and which response
assets will be deployed using the requested aircraft.
9. Please describe how this aviation equipment will be utilized on a regular,non-emergency
basis.
10. Please certify licensing, registration fees, insurance, and all ongoing operational expenses are
(a)the responsibility of the grantee or the local units of government and (b)are not allowable
under this grant.
Cal OES Form AVI Rev 08-01-13
Agreement No. 5544
!Lab nia Gov -;s Office of EmergetieX
WA"I'i+11 ,T Rig O4jr�Sj'
Subgrantee Name:
Homeland Security Grant Program FY Grant Number Cal OES ID#
Urban Area Security Initiative (UASI) FY Grant Number Cal OES ID#
Other Program FY Grant Number Cal OES ID#
Project Amount: UASI $ SHSP $
1. Indicate the type of equipment for this request(choose only one of the following).
Watercraft Watercraft- Related Equipment
2. Please provide a description of the area that will be served by the requested equipment.
Equipment&Description Cost AEL number
V
3. Please justify the need for the watercraft and how the requested platform best meets
that need as compared to other options. Include the cost, discipline, and funding source.
4. Please describe the active, operating waterway patrol unit and certify on signed
letterhead that no expenses will be charged against the grant award for the operation of
such unit.
5. Please identify the applicable goals and objectives in your State/Urban Area Homeland
Security Strategy that the requested watercraft addresses, and the waterway identified
as critical asset requiring state and/or local prevention and response capabilities.
6, Please explain how the requested watercraft fits into the State/Urban Area's integrated
operational plans and vulnerability assessment.
Cal CES WRF Revised 07/11/13
Agreement No. 5544
lilorHist (W tLagj' . Tice of Fnigtggncy Services.
REQUESTAATERCRAFT
T Please describe how this watercraft will be used operationally and which response
assets will be deployed using the requested watercraft.
8. Please describe how this watercraft will be utilized on a regular, non-emergency basis.
9. Please describe what types of terrorism incident response and prevention equipment
with which the requested watercraft will be outfitted. Include any specialized
navigational, communications, safety, and operational equipment necessary to enable
such watercraft to support the homeland security mission. Please certify on signed
letterhead that licensing, registration fees, insurance, and all ongoing operational
expenses are"the responsibility of the grantee or the local units of government and are
not allowable under this grant.
10. Attach letters of endorsement, if applicable.
Submitted by: Date:
(Name) (Signature)
Cal OES WRF Revised 07/11/13
Agreement No. 5544
!L:plifornia G9ovcr n ' of ErrrU;,90La&Lviccs
U$,T,Al31;,I iI/EN'HANCF, +,RCF�NC'Y OI L� S CENrI+.l dI"+"OCA REQUEST
Subgrantee Name:
Homeland Security Grant Program FY Grant Number Cal OES ID#
Urban Area Security Initiative (UASI)FY Grant Number Cal OES ID#
Other Program FY Grant Number Cal OES ID#
1. What type of EOC does your organization plan to establish/enhance?(Choose one of the
following)
Primary EOC AltemateBack-up/Duplicate EOC
2, Physical address of facility:
1 Describe how the establishment/enhancement of an EOC improves your organization's
ability to prevent,plan for, respond to, and recover from a terrorism event(on a separate
attachment).
4. Identify all other sources and uses of additional funds assisting the project in any way.
5. Identify anticipated homeland security grant costs to establish/enhance your
organization's EOC in the table below.
6.
Supplies/Equipment AEL# Cost II
Computers
Network Servers
Printers
Computer accessories(i.e. surge protectors,battery backups, etc.)
Computer maintenance contracts
Computer connections and cables (including fiber optic cabling) e
Fax machines
Lighting Systems
LCD projectors
Projection/plasma/flat screens/monitors/televisions
CGIS plotter and software e
Telephone systems
Software development
Commercial off-the-shelf(COTS) software
Installation of EOC items
Miscellaneous connections for EOC items
Standardized mapping software
Cal OES EOCRF Revised 08/1/13
Agreement No. 5544
N Standardized emergency management software
Installation of EOC items
Miscellaneous connections for EOC items
Leasing Costs (Indicate starting and ending dates of lease and
explain the circumstances under which the moving or leasing costs
will be incurred.)
A Other(must provide list/description of"other" items and costs)
TOTAL -EOC Supplies and Equipment
n
7. Explanation of"other" items:
8. Has your organization determined the costs are reasonable?
Submitted by: Date:
(Name) (Signature)
Agreement No. 5544
Grant Programs Directorate
Homeland
Security
OME Control#: 1660-0115
Expiration Date: 10/31/2013
FEMA Form:024-0-1
DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY(FEMA)
EN-VIROINl"M'I1ENTAL AND HISTORK.'PRESE'RVATI0N SC'REEN'ING FORM
Directions for completing this form: This form is designed to initiate and facilitate the environmental
and historic preservation(EHP)compliance review for your FEMA preparedness grant-funded projeci(s).
FEMA conducts its EHP compliance reviews in accordance with National Environmental Policy Act
(NEPA)and other EHP-related laws and executive orders. In order to initiate EHP review of your
project,you must complete all relevant sections of this form and submit it to the Grant Programs
Directorate(GPD)along with all other pertinent project information. Failure to provide requisite
information could result in delays in the release of grant funds. Be advised that completion of this form
does not complete the EHP review process. You will be notified by FEMA when your review is
complete and/or if FEMA needs additional information.
There is no need to complete and submit this form if the grant scope is limited to planning, management
and administration, classroom-based training, tabletop exercises and functional exercises, or purchase of
mobile and portable equipment where no installation is needed. Information Bulletin 345,Grant
Programs Directorate Programmatic Environmental Assessment, September 1,2010,provides details
on these activities.
This form should be completed electronically. The document is available in both Word and Adobe
Acrobat(pdf)formats at this website:
(iit,tp.//ww��,,fenia.goN/library/viewRecot°d.do?frotiiSearcli=fi-otiiseai-cli&id=X4802. The following website
has additional guidance and instructions on the EHP review process and the information required for the
EHPreview:han:llw",w,fema.Lov/elan/eh n/ch preview/index.shtm
Submit completed form through your grant administrator who will forward it to GPDEl 1'PInfo(i�d1mg w.
Please use the subject line:EHP Submission:Project Title, location, Grant Award Number(Example,
EHP Submission: Courthouse Camera Installation,Any Town,State,12345;2011-SS-Oxxxx).
,1„ ',,I
Paperwork Burden Disclosure Notice
Public reporting burdenfor thisform is estimated to average 8 hours perresponse. The burden estimate includes the time forrevietivinginstrnuctions,
searching existing data sources,gathering and maintaining the data needed,and completing and submitting the form. You are not required to
respond to this collection of information unless it displays a valid OMB control number. Send comments regarding the accuracy of the burden
estimate and any suggestions for reducing the burden to:Information Collections Management, Department of Homeland Security, Federal
Emergency Management Agency,500 C Street, Washington,DC,20472,Paperwork Reduction Project(1660-0115).
Agreement No. 5544
Environmental and Historic Preservation Screening Form—June 2012
SECTION A. PROJECT INFORMATION
DHS Grant Award Number:......
Grant Program:..________-
Grantee........................................
Grantee POC:.,..,,........_.....
Mailing address:.................
E-mail:.......
Sub grantee:................................
Subgrantee POC:................
Mailing address:..................
E-mail:......
Estimated cost of project: ..........
Project title:
Project location(physical address or latitude-longitude):
Project Description. Provide a complete project description. The project description should contain a summary of
what specific action is proposed,where it is proposed,how it will be implemented. Include a brief description of
the objectives the project is designed to accomplish(the purpose),and the reason the project is needed. Use
additional pages if necessary. If multiple sites are involved,provide the summary for each site:
SECTION B. PROJECT TYPE
Based on the proposed project activities,determine which project type applies below and complete the
corresponding sections that follow. For multi-component projects or those that may fit into multiple project types,
complete the sections that best apply and fully describe all major components in the project description. If the
project involves multiple sites,information for each site(such as age of structure,location,ground disturbance,etc.)
must be provided. Attach additional pages to this submission,if needed.
1. ❑ Purchase of equipment. Projects in this category involve the purchase of equipment that will require
installation on or in a building or structure. Complete other portions of Section B as needed. Complete
Section C.1.
2. ❑ Training and exercises. Projects in this category involve training exercises with any field-based
components,such as drills or full-scale exercises. Complete Section C.2.
3. ❑ Renovations/upgrades/modifications or physical security enhancements to existing structures.
Projects in this category involve renovations,upgrades,retrofits,and installation of equipment or systems
in or on a building or structure. Examples include,but are not limited to:interior building renovations;
electrical system upgrades;sprinkler systems;vehicle exhaust systems;closed circuit television(CCTV)
cameras;security fencing;access control for an area,building,or room;bollards;motion detection systems;
OMB Control#: 1660-0115
FEMA Form:024-0-1 2
Agreement No. 5544
Environmental and Historic Preservation Screening Form—June 2012
alarm systems;security door installation or upgrades;lighting;and audio-visual equipment(projectors,
smart boards,whiteboards,monitors,displays,and projector screens). Complete Section C.3.
4. ❑ Generator installation. Projects in this category involve installation of new or replacement generators,to
include the concrete pads,underground fuel and electric lines,and if necessary,a fuel storage tank.
Complete Section CA.
5. ❑ New construction/addition. Projects in this category involve new construction,addition to,or expansion
of a facility. These projects involve construction of a new building,or expansion of the footprint or profile
of a current structure. Complete Section C.5.
6. ❑ Communication towers,antennas,and related equipment. Projects in this category involve
construction of new or replacement communications towers,or installation of communications-related
equipment on a tower or building or in a communications shelter or building. Complete Section C.6.
7. ❑ Other. Projects that do not fit in any of the categories listed above. Complete Section C.7.
SECTION C. PROJECT TYPE DETAILS
Check the box that applies to the proposed project and complete the corresponding details.
1. ❑ Purchase of equipment.If the entire project is limited to purchase of
mobile/portable equipment and there is no installation needed, this form
does not need to be completed and submitted.
a. Specify the equipment,and the quantity of each:.....
b. Provide the Authorized Equipment List(AEL)number(s)(if known):......
c. Complete Section D.
2. ❑ Training and exercises. If the training is classroom and discussion-based
only, and is not field-based, this form does not need to be completed and
submitted.
a. Describe the scope of the proposed training or exercise(purpose,
materials,and type of a activities required): .............
b. Provide the location of the training(physical address or latitude-
longitude): ...... ........ .........
atitude-
longitude):...................................................
c. Would the training or exercise take place at an existing facility which has
established procedures for that particular proposed training or exercise,
and that conforms with existing land use designations? For further
information refer to Information Bulletin#345,
httr)://\vww,fenroa,Lyov/Ddf/i-,ovemarmetit/t,K'arit/builetins/iiifo345.odf:....................................... ❑Yes ❑No
• If Yes,provide the name of the facility and the facility point of
contact(name,telephone number,and email address):........_....._......
• If No,provide a narrative description of the area where the training
or exercise would occur (e.g.,exercise area within four points
defined by latitude/longitude coordinates):............................................
OMB Control#: 1660-0115
FEMA Form:024-0-1 3
Agreement No. 5544
Environmental and Historic Preservation Screening Form—June 2012
• Does the field-based training/exercise differ from previously
permitted training or exercises in any way,including,but not limited
to frequency,amount of facilities/land used,materials or equipment
used,number of participants,or type of activities?............................................................ ❑Yes ❑No
• If Yes,explain any differences between the proposed activity and
Those that were approved in the past,and the reason(s)for the change
inscope:...................................................................................................
• If No,provide reference to previous exercise(e.g.,FEMA grant
name,number,and date):..„„...„........................................................„..„„.„„.
a
d traiequipment eor structures nee to be installed to facilitate
training?y , , setlYAtl„,,......,..„„..„„„YY..„„„„„„„„„„ ❑yes ❑No
• If Yes,complete Section D
3. ❑ Renovations/upgrades/modifications,or physical security
enhancements to existing structures.
a. Complete Section D.
4. ❑ Generator installation.
a. Provide capacity of the generator(kW):.........
b. Identify the fuel to be used for the generator(diesel/propane/natural gas):..
c. Identify where the fuel for the generator would be stored(e.g.stand-alone
tank,above or below ground,or incorporated in generator):.„
d. Complete Section D.
5. ❑ New construction/addition.
a. Provide detailed project description(site acreage,new facility square
footage/number of stories,utilities,parking,stormwater features,etc):.......
b. Provide technical drawings or site plans of the proposed project:..................... ......... ❑Attached
c. Complete Section D.
6. ❑ Communication towers,antennas,and related equipment.
a. Provide the current net height(in feet above ground level)of the existing
tower or building(with current attached equipment):...,. „......................„..
b. Provide the height(in feet above ground level)of the existing tower or
building after adding/replacing equipment: „„...„„„„.„.......................................
Complete items 6.c through 6.q below ONLY if this project involves construction of a new or replacement
communications tower. Otherwise continue to Section D.
Information Bulletin 351,National Historic Preservation Act Section 106 Review Requirements for
Communications Facilities,January 4,2011 has additional guidance and information on EHP requirements for
communications towers. Available at:brrix_,d�/wAwy x4cm ov/'racif/gc,avernment°/trant/l)ulletinsy'info35"t1P—Cif
OMB Control#: 1660-0115
FEMA Form:024-0-1 4
Agreement No. 5544
Environmental and Historic Preservation Screening Form—June 2012
c. Provide the ground-level elevation(feet above mean sea level)of the site
of the proposed communications tower: ............ ...........
d. Provide the total height(in feet above ground level)of the proposed
communications tower or structure,including any antennas to be mounted:
• If greater than 199 feet above ground level,state why this is needed
to meet the requirements of the project: ..................................................
e. Would the tower be free-standing or require guy wires? ............................. ❑ Freestanding ❑ Guy wires
• If guy wires are required,state number of bands and the number of
wires per band:..............._......___...... ............ ..............
• Explain why a guyed tower is needed to meet the requirements of
thisproject:..............................................................................................
f. What kind of lighting would be installed,if any(e.g.,white strobe,red
strobe,or steady burning)?............................................................................
g. Provide a general description of terrain(e.g.,mountainous,rolling hills,
flatto undulating):.........-__.-..................... ...__... ...... ........__..............
h. Describe the frequency and seasonality of fog/low cloud cover:..................
i. Provide a list of habitat types and land use at and adjacent to the tower
site(within'/z mile),by acreage and percentage of total(e.g.,woodland
conifer forest,grassland,agriculture)water body,marsh:....,....__......____
j. Is there evidence of bird roosts or rookeries present within''/z mile of the
proposedsite?........................................................................................................................... ❑Yes ❑No
• Describe how presence/absence of bird roosts or rookeries was
determined:...... ................... ......... ......
k. Identify the distance to nearest wetland area(e.g.,forested swamp,
marsh,riparian,marine)and coastline if applicable:
1. Distance to nearest existing telecommunication tower:............
in. Have measures been incorporated for minimizing impacts to migratory
birds?........................................................................................................................................ ❑Yes ❑No
• If Yes,describe:.......................................................................................
n. Has a Federal Communications Commission(FCC)registration been
obtained for this tower?............................................................................................................ ❑Yes ❑No
• If Yes,provide Registration#: ...... .............. ........__
• If No,why? ........................ ......................................................
o. Has the FCC E106 process been completed?..__. ................................................................... ❑Yes ❑No
p. Has the FCC Tower Construction Notification System(TCNS)process
beencompleted?....................................................................................................................... ❑Yes ❑No
• If Yes,attach the environmental documentation submitted as part of
the registration process including use of the Tower Construction
OMB Control#: 1660-0115
FEMA Form:024-0-1 5
Agreement No. 5544
Environmental and Historic Preservation Screening Form—June 2012
Notification System(TCNS),if applicable. FRN#:.........................„..„,,.
q. Would any related equipment or structures need to be installed(e.g.,backup
generator and fuel source,communications shelter,fencing,or security
measures)?.,,..,,,,,,,,,,,,... ........................ ❑Yes ❑No
• If Yes,explain where and how each installation would be done. Provide
details about generator capacity(M),fuel source,fuel location and
tank volume,amount of fencing,and size of communication shelter:.....
r. Complete Section D.
7. ❑ Other. Complete this section if the proposed project does not fit any of
the categories above.
a. Provide a complete project description:.......................„„.....„,,,.„.......„„..„.„.....„
b. Complete Section D.
SECTION D. PROJECT DETAILS
Complete all of the information requested below.
1. ❑ Project installation
a. Explain how and where renovations/upgrades/modifications would take
place,or where equipment/systems will be installed:....„...„„,.,.„„.,...„,....„„.,„„„„
b. Would ground disturbance be required to complete the projector training?.__.................... ❑Yes ❑No
• If Yes,provide total extent(depth, length, and width)of each ground-
disturbing activity.Include both digging and trenching. For example,
light poles and fencing have unique ground-disturbing activities(e.g.,
six light poles,24”dia.x 4' deep;trenching 12”x 500'x 18”deep;
22 fence posts, 12”diameter x 3' deep,and 2 gate posts, 18”diameter
x3' deep):..... .......... ............. ............... ........... .....__......_.....___
• If Yes,describe the current disturbed condition of the area(e.g.,
parking lot,road right-of-way,commercial development);,,,,,,,,,,,,,,,„..,,.
c. Would the equipment use the existing infrastructure for electrical
distribution systems? ,...__...............„..................................................................................... ❑Yes ❑No
• If No,describe power source and detail its installation at the site:..........
2. ❑ Age of structure building at project site
a. Provide the year existing building(s)or structure(s)on/in/nearest to the
location involved in the proposed project was built:........ ............... ........
• If the building or structure involved is over 45 years old and
OMB Control#: 1660-0115
FEMA Form:024-0-1 6
Agreement No. 5544
Environmental and Historic Preservation Screening Form—June 2012
significant renovation,rehabilitation,or modification has occurred,
provide the year(s)modified and briefly describe the nature of
themodification(s):.....,.„„.„.,„..,.......„.„„....,......„„„..,,.„..........„..„..„....,„„..„.......
b. Are there any structures or buildings that are 50 years old or older in or
adjacent to the project area?. ...................... .....,.............................................„.. ❑Yes ❑No
If yes,provide the location of the structure(s),ground-level color
photographs of the sructure(s),and identify their location(s)on an
aerialmap: .„„,.....„„......„„„...„„.„„.„„„.„.„„„..............„.„.....„„,.,,..„..„..,,.„„„........,,...
c. Is the project site listed in the National Register of Historic Places
(National Register),or in/near a designated local or National Register
Historic District? The internet address for the National Register
is: hnn://nrhu.focus,nus,eov................................................................................................ ❑Yes ❑No
« If Yes, identify the name of the historic property,site and/or district
and the National Register document number:.„..„,.,„....„„„„„,„„„„„.,„„.......„.„,.
3. ❑ Site photographs,maps and drawings
a. Attach site photographs. Site photographs are required for all projects.
Use the following as a checklist for photographs of your project. Attach
photographs to this document or as accompanying documents in your
submission.
• Labeled,color,ground-level photographs of the project site:............................................. ❑Required
• 'Labeled,color photograph of each location where equipment would be
attached to a building or structure:...................................................................................... ❑Required
• Labeled,color aerial photograph of the project site:........................................................... ❑Required
• Labeled,color aerial photographs that show the extent of ground
disturbance(if applicable):.........„..„.„...........„.„..„.............„.„....,..„„..,........,............................ ❑Attached
• Labeled,color ground-level color photographs of the structure from
each exterior side of the building/structure(applicable only if
building/structure is more than 45 years old): .......__.... ........... ❑Attached
b. Are there technical drawings or site plans available? ................„.........,.......,.............,............ ❑Yes❑No
Ifyes,attach:.............„.,..„......,,....„..„..,.......„„...,„..,.„.„....„....,...„„..,.,...„......„,.„.„..„..„„....„........... ❑Attached
Appendix A has guidance on preparing photographs for EHP review
4. ❑ Environmental documentation
a. Is there any previously completed environmental documentation for this
project at this proposed project site(e.g.,Environmental Assessment,or
wetland delineation,or cultural/archaeological study)?.,.„..............................................„„.,..„„. ❑Yes❑No
• If Yes,attach documentation with this form: ...,............ „............... ❑Attached
b. Is there any previously completed agency coordination for this project
(e.g.,correspondence with the U.S.Fish and Wildlife Service,State
Historic Preservation Office,Tribal Historic Preservation Office)?...„.,,...,..„...,,,,..„..,..„..„.,..... ❑Yes❑No
• If Yes,attach documentation with this form:,...........„..,..„„...,,..,,„,...,„„„„.,„„„„„„.„„„,..„„.............. ❑Attached
OMB Control#: 1660-0115
FEMA Form:024-0-1 7
Agreement No. 5544
Environmental and Historic Preservation Screening Form—June 2012
c. Was a NEPA document was prepared for this project?........................................................... ❑Yes❑No
• If Yes,what was the decision? (Check one,and please attach):
❑ Finding of No Significant Impact(FONSI)from an Environmental Assessment(EA)or
❑ Record of Decision(ROD)from an Environmental Impact Statement(EIS).
Name of preparing agency:...
Date approved:......................
OMB Control#: 1660-0115
FEMA Form:024-0-1 8
Agreement No. 5544
Appendix A. Guidance for Supporting Photographs for EHP Grant Submissions
Photographs are a vital component of the EHP review process and add an additional level of
understanding about the nature and scope of the project. They also provide pre-project documentation of
site conditions. Please follow the guidance provided below when preparing photographs for your EHP
submission. The following pages provide examples of best practices used in earlier EHP submissions.
Minimum requirements for photographs.
1. Photographs should be in color.
2. Label all photographs with the name of facility,location(city/county,state)and physical location
(physical address or latitude-longitude).
3. Label the photographs to clearly illustrate relevant features of the project,such as location of installed
features(e.g.,cameras,fences,sirens,antennas,generators)and ground disturbance. See examples
below.
4. Identify ground disturbance. Adding graphics to a digital photograph is a means to illustrate the size,
scope and location of ground disturbing activities.
Best Practices
1. Provide photographs in a separate file.
2. Place no more than 2 pictures per page.
3. Compressing pictures files(such as with Microsoft Picture Manager)' or saving the file in pdf format
will reduce the size of the file and facilitate e-mail submissions.
4. Identify the photograph file with the project name so that it can be matched to the corresponding
FEMA EHP screening form.
5. Maximum file size for enclosures should not exceed 12 MB. If the total size of files for an EHP
submission exceeds 12 MB,send the submission in multiple e-mails.
6. If necessary,send additional photographs or data in supplemental e-mails. Please use the same e-mail
subject line with the additional label: 1 of x, 2 of x, . . .x of x.
Options for Creating Photographs
1. Obtain an aerial photo. There are multiple online sources for aerial photographs.
2. For the aerial photo,use the screen capture feature(Ctrl+Print Screen keys)and copy the image to
photo editing software,such as Paint,or PhotoShop.' Use that software to crop the image so the
photo has the content necessary.
3. Open PowerPoint,or other graphics-oriented software,and paste the aerial or ground-level
photograph on the canvas.
4. Use drawing tools,such as line drawing and shapes,to indicate the location of project features(for
example:fencing,lighting,sirens,antennas,cameras,generators).
5. Insert text to label the features and to label the photograph.
6. Use drawing tools to identify ground-disturbing activities(if applicable).
7. Save the file with the project name or grant number so that it can be appropriately matched to the
corresponding FEMA EHP screening form.Include this file with the EHP screening when submitting
the project.
OMB Control#: 1660-0115
FEMA Form:024-0-1 A-1
Agreement No. 5544
Appendix A.Supporting Photographs for ENP Grant Submissions
Example Photographs
Aerial Photographs. The
example in Figure l provides II+�r��taw� Town t�a , 123 Main Street,A,nytown,State
the name of the site physical W
ww Y,
address and proposed
location for installing new
equipment. This example of
a labeled aerial photograph
good context of the
Provides g w�I,dVd i ,
I
surrounding area. p�',uI
I„
0
y,
io r.
I
I V
Figure 1. Example of labeled,color aerial photograph.
Ground-level photographs. �pww,' f�.Fpan,tZiMain§trwet,9m}6v�a,sGaYz
The ground-level photograph
in Figure 2 supplements the
aerial photograph in Figure 1,
above. Combined,they
provide a clear understanding
of the scope of the project.
This photograph has the name
and address of the project site,
and uses graphics to illustrate
where equipment will be
installed.
I
Figure 2. Example of ground-level photograph showing proposed
attachment of new equipment
ONM Control#: 1660-0115
FEMA Form:024-0-1 A-2
Agreement No. 5544
Appendix A.Supporting Photographs for EHP Grant Submissions
Ground-level photograph Abc Tower Sde,Some County,State: 12'D 34'56-7"N,
with equipment close-up. 45067'89-12"W
Figure 3 includes a pasted
image of a CCTV camera that
would be placed at the project lu
site.Using desktop computer
software,such as PowerPoint,'
this can be accomplished by
inserting a graphic symbol New CCTV
(square,triangle,circle,star,
I
I� '4'111�1MI
Camera
etc.)where the equipment
would be installed. Thisb "
I
1m
example includes the name and
location of the site.The site
coordinates are in the degree-
minute-second format
Figure 3.Ground-level photograph with graphic showing
proposed equipment installation.
Ground-level photograph
SI r.emr� t ®n11It� Street
w,?uplVuuEmYsU eemlt amw eta, Starts
wit
avation
u .Thee ample areaclose-
up. Figure
4
P• P
shows the proposed location
for the concrete pad for a Trenchirig ft �V�I 1011IIIVIY oV�ul(INIup " @^'III�V1°IIYu NN II�ojiYl Y°14111 YhVIIiIIIIQYhI,IIIIhu,Iillm IAyIYtNUI
generator and the ground s
eneretarto �hN�lil����ryry^IIVIII�� IIINYrvi il�l�ll�^��llulililj li II1111111 Iu�II��YI'lulV�lw'i�'VIY ��I'�I�u YYY���IMIry I
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building's 111 YmIY uiufl^I IIY ^I pII,1 11��`wl III II p
disturbance h e4dn al ser.,ce `iryq; N 1,11°I I II'V(^I i41VIN N� V1�I��Yi dlVI�+RV;rolilHlIlYlll��II IIII�Y ^ ill i N 111111111�tilllll�9ullllll u
enerator to the bu ld building's un%Iain%6 yl`I, �w� j ��IIII �IPl�l�t' II "1NNN7111 uu
g bin Iuii�,vl Vm uu�nummu�ul�°Ii IIIVI��llllili��lt' � �iY lMu'1i1i�i11,Yii q�II���i......� � 11r... II rv�'tlM''�i1
N�I m1111'iill "INVI I 11 ma °,111 dl
information can be illustrated �x iosPe
electrical service. This lullllllllll 1 ,
iad
with either an aerial or „I1m d m1 1
ground-level photograph,or
both. This
ple has the
name and physice
al address of
the project site.
mn„'0
0„''.11
Figure 4.Ground-level photograph showing proposed ground
disturbance area.
OMB Control#: 1660-0115
FEMA Form: 024-0-1 A-3
Agreement No. 5544
Appendix A. Supporting Photographs for EHP Grant Submissions
Communications equipment f
a
photographs.The example in
Figure 5 supports a project
involving installation of
equipment on a tower. Key
elements are identifying where
equipment would be installed on
the tower, name of the site and its
location.This example provides "II
site coordinates in decimal y "I�ui�lkVl II I',IIN
" i t I ullluuuulpV I s m mN � " II"
format. �� IIINVIIII ll IIIIVyVII'pMi 1, I II
' � �IIIto W�NP i 1 p1yIV� AI � ill"" I IAA ILII,
lilol'Iu,IN� ov uti�N�IVIV a Vi i I Iglu, u� �Nrb 9� w u„x,
Figure 5.Ground-level pholograph slowing proposed
locations of new communications equipment on an existing
tower.
Interior equipment
photographs.The example m p,amara will be added
Figure � �I ! of II II �9lpluuu
J
6 shows the use of graphic in.the upper right
mJllllluu' �„
symbols to represent security corner and a proxlmiri/
door features planned for a building.
The same symbols are used in the o added access,�ctle5�w will YIl ntrof a "I1
other pictures where the same
equipment would be installed at r
other locations in/on the building
r
This example includes the name
of the facility and its physical I'I!
address.
IIN I�IIVIIII���II'�„
III'; � lulill
I4 � In @, Y�II�I°!!VIIIIIIIIIIIII'
. dli IppII� I ��II���IIp �IIIIIIII^ill
I �I�li'1111 ' p iN"^IeIV�IVmIIiIIIII���^��Id4lhpi�lll��w
IIIIIIIIIVIVIVIIIIIIIIIINUIIlillll,,11111 !I!,IY�i+ �l„quu ,IIIIIhIIIW"t���t��ull;,'i",.I,I,J„„„J,�II
°1I „Jll�rlli
Figure 6.Interior photograph showing proposed location of new
equipment.
Ground-level photographs of nearby historic structures and buildings. Consultation with the State
Historic Preservation Office(SHPO)may be required for projects involving structures that are more than
50 years old,or are on the National Register of Historic Places. In that event,it will be necessary to
provide a color,ground-level photograph of each side of the building/structure.
'Use of brand name does not constitute product endorsement,but is intended only to provide an example of the type of product
capable of providing an element of the EHP documentation.
®ME Control#: 1660-0115
FEMA Form:024-0-1 A-4
Agreement No. 5544
CALIFORNIA GOVERNOR'S OFFICE OF EMERGENCY SERVICES
Homeland Security Grant Program FY: Grant Number: CalOES ID#
Subgrantee name: Project:
REQUEST FOR SOI.,E SOURCE PROCUREMENT T AIJTJ-J(')RI7eATION
1. Project name: Project Budget: $
1 Describe the project'and/or activity that will be provided by the proposed sole source
vendor/contractor.
3, Describe your organization's standard procedures when sole source contracting is considered,
including the conditions under which a sole source contract is allowed, and any other applicable
criteria(i.e. approval requirements, monetary thresholds, etc.).
4. Indicate which of the following circumstances resulted in your organization's need to enter into a
sole source contract.
a. Item/service is only available from one source (Describe the process used to make that
determination. Please provide details.)
b. A public urgency or emergency will not permit a delay resulting from competitive
solicitation. According to the US Department of Homeland Security/FEMA, "Time
constraints will not be considered a factor if the subgrantee has not sought competitive
bids in a timely manner." (Describe the urgency or emergency. Please provide details)
C. After solicitation of a number of sources, competition was determined inadequate.
(Describe the solicitation process that determined competition was inadequate.Please
provide details, and attach any relevant supporting material,Request for Proposal, etc.)
5. Did your organization confirm that the contractor/vendor is not debarred or suspended?
6. Will your organization be able to complete all activities associated with the sole source contract
by the end of the grant performance period?
7. Has your organization determined the costs are reasonable?
8. Please attach a copy of the cost benefit analysis prepared for this procurement.
Submitted by Date:
(Name) (Signature)
Cal OES SSRF rev 811113
Agreement No. 5544
EXHIBIT
Agreement No. 5544
Technology Project Standards
1) Web-based software: system on browser technology instead of proprietary system
2) API or STK software integration tools-application is typically provided by the
manufacturer
3) Exchange protocols: 128 bid encryption
4) Dual authentication
1. Ability to go non-encryptic for both receivers and transmitters
2. 6.5 GHz Range
3. High-gain antennas
4. Moving Pictures Expert Group (M-PEG) current standards for decoding: M-PEG 4
3,90d6BI Classroorn
1. 2 Mbps minimum bandwidth
2. Code-X Specs- minimum of C40 (2 video outputs)
3. Camera Specs- 1080 dpi
4. Firewall settings:
5. IT personnel required for set-up/installation
4.LARCOPP
Asset Manager—Tracks personnel and equipment to shift or operational period based on availability
either on duty or on overtime. Tracks all working hours and prints out overtime slips in compliance with
FMAG reimbursement procedures.
Logs-Ability to create multiple logs for different ICS sections,divisions,or agencies for multiple
operational periods.
Mapping—Ability to plot personnel,equipment, missions for a variety of incidents,draw perimeters,fire
lines,fire progression,plume modeling etc.
Video Streamer-Ability to stream multiple videos streams from ANTARES cameras in to several
locations,(ECC's mobile command post trailers).
Message Center—Ability to have private encrypted chat rooms for operators to discuss operations, FAX
service to send and receive FAXs', Email groups ability to send and receive emails with attachments or
send attachments on email.
ICS Forms-Ability to create ICS forms and complete EAP's/IAP's
Downlink Receiver—Ability to receive both 4.9 and 6.5 GHz downlink video
Triage App—Ability to track patients at an MCI incident both by name and location.
Agreement No. 5544
Tri-Korder phones-Ability to have most of the above applications on a smart phone and also the ability
to use the Tri Korder phone as a GPS tracker to track personnel live on the mapping app
Re-Stat ability-to have situational awareness of all you deployed and waiting resources as well as
missions
Missions—creates and tracks missions both for a pre-planned and emerging events. Ability to insert
detailed instructions for personnel
Reports-Ability to print up multiple reports about personnel,missions,overtime costs.
All of these abilities are shared with all agencies participating in the LARCOPP program. There are
several servers throughout the region that give us the ability to share and view everyone's incidents and
information live. It also allows us to works together on a single incident allowing multiple agencies in a
unified command to have the same picture of the incident. All of this information is encrypted.
!License Plate Recoanitlon tL PR)
Fixed and Mobile License Plate Recognition system should contain the following components: (a)Fixed
License Plate Recognition Cameras including all necessary mounting hardware, (b)Capability to accept a
network connection capable of backhauling data to city network, (c)Hardware capable of creating VPN
between network connection identified in(b)and City/Agency network.
• System shall have the ability to capture license plates and compare them to a database detailed
by the purchasing agency;
System shall be able to perform this analysis in varied lighting and weather conditions at an
accuracy level deemed suitable by the purchasing agency;
• System shall have the ability to link or share data with other LPR systems;
• The LPR system shall have the ability to be deployed in both a mobile and fixed installation
based on standards set by the agency purchasing;
• The systems timekeeping shall automatically update when time changes occur(e.g., Daylight
savings time)and be consistent with correct calendar dates;
• Any system selected shall allow for the purchasing agency to be the sole owner of the data;
• Data shall be compatible with standard SQL format;
• System selected shall at a minimum have the ability for a unique user sign and audit/reporting
capability;
• Still imagery must be in a non-proprietary format;
• Each read shall retain the associated metadata the minimally includes:
o GPS location;
o Date;
o Time,
o Source(vehicle ID/fixed identifier);
o Alert reason;
Agreement No. 5544
• System must have the ability to retain all data captured-For a period set by the purchasing
agencies requirements;
• The system must be industrial/commercial grade. No prototype models will be considered;
• Loss of power to any hardware shall not result in the unit requiring reprogramming;
• Sudden loss of power shall not cause the loss of data;
• All wiring shall meet industry standards applicable to the wire applications and all systems must
be properly grounded using the same industry standards;
• The systems shall operate under extreme hot and cold weather conditions (20to 160 degrees
Fahrenheit);
• Camera system shall capture an image of the plate and overview of the vehicle;
• Mobile systems shall support a minimum of four cameras capable of capturing license plates;
• System shall comply with the purchasing agencies'lighting standards for fixed installations;
• Cameras must operate on a filtered, regulated and short-circuit-protected power source.
• The system will be protected from damage due to input of voltage, reverse polarity,and
electrical transients that may be encountered.
• Camera will need to possess sufficient internal memory such that during times of impaired
network connectivity data will not be lost.
• Ruggedized exterior for camera and networking equipment
• Vibration resistant
• Rugged mounts that provide stability to all equipment
• System Network connection should be capable of sustained 250kb/s speeds.
• Human intervention shall not be required to establish/maintain the connection
• Connection should be capable of automatic reconnection in the event of power-loss or
temporary issue with service provider.
• If a device is required at each network connection point,it shall be capable of encrypting data
being sent back to any Agency network.
u 1 d„i
• System selected shall include a comprehensive warranty and maintenance for the maximum
amount of time allowed by the grant guidelines;
h
• Any agency using UASI/SHSG Grant Funding shall agree to enter into a standard Memorandum
of Agreement to share data between LA-LB UASI law enforcement members (to be developed
and provided prior to final grant award);