Okaloosa County BOCC — October 15, 2013 — Okaloosa Hazard Analysis Contract 2013-2014 — reading text

Name: City of Niceville WATER WELL #5 Contact Type: Owner / Operator 4040140 99-A College Blvd OKALOOSA Email: regans@niceville.org NICEVILLE, FL 32578 24-hour Phone :850-729-4064 Name: City of Niceville WATER WELL #8 Contact Type: Owner / Operator 4040138 992 WS Rocky Bayou Rd OKALOOSA Email: regans@niceville.org NICEVILLE, FL 32578 24-hour Phone :850-729-4064 7  Attachment D FINANCIAL INVOICE FORM FOR HAZARDOUS MATERIALS HAZARDS ANALYSIS UPDATE _________________________________________________________________ RECIPIENT: Okaloosa County AGREEMENT# 14-CP-11-01-56-01-XXX AMOUNT AMOUNT APPROVED REQUESTED BY THE BY THE RECIPIENT DIVISION 1. First Payment (45% of contract amount) $ $ (50% Hazards Analyses completed/submitted) 2. Second Payment (45% of contract amount) $ $ (50% Hazards Analyses completed/submitted) 3. Final Payment(10% of contract amount) $ $ (approval, distribution & notification) TOTAL AMOUNT $ $ (To be completed by the Division) I certify that to the best of my knowledge and belief the billed costs are in accordance with the terms of the Agreement. ______________________________________________ _________ Signature of Authorized Official/Title Date TOTAL AMOUNT TO BE PAID AS OF THIS INVOICE $ (To be completed by the Division)  Attachment E Hazard Analysis Contract Checklist and CAMEOfm Guide Facility Information (CAMEOfm Facility Page) Facility Name {per Attachment C} ( Facility Page) Facility Physical Address (Facility Page) Latitude and Longitude in Decimal Degrees {ex. 30.197, -84.3621} (Map Data Tab on Facility Page) Facility 24-hour Emergency Phone Number (Facility Phones Tab on Facility Page) Facility Emergency Coordinator Name and Title Contact Tab on Facility Page) Transportation Route(s) {From County Line to the Facility} (Notes Tab on Facility Page) Evacuation Route(s) to exit the Vulnerable Zone (Notes Tab on Facility Page) Historical Accident Record {If none, please note} (Notes Tab on Facility Page) Facility Population {a minimum of one is required for unmanned facilities} (ID Codes Tab on facility Page) Hazard Identification (CAMEOfm Chemical in Inventory Page) (for each Extremely Hazardous Substance on site) Proper Chemical Name(s) (Chemical in Inventory Page{s}) Chemical Abstract Service (CAS) Number (Chemical in Inventory Page{s}) Physical State in Storage {ex. mixture, pure, liquid, gas} (Chemical in Inventory Page{s}, Physical State and Quantity Tab) Maximum Quantity On-site in Pounds (Chemical in Inventory Page{s}, Physical State and Quantity Tab) Amount in Largest Container or Interconnected Containers (Chemical in Inventory Page{s}, Physical State and Quantity Tab) Type and Design of Storage Container(s) {ex. cylinder, steel drum, carboy} (Chemical in Inventory Page{s}, Physical State and Quantity Tab) Nature of the Hazard {ex. acute, chronic, fire, pressure, etc.} Chemical in Inventory Page{s}, Physical State and Quantity Tab) Vulnerability Analysis (CAMEOfm Scenario Page) (for each Extremely Hazardous Substance on site) Enter maximum amount in largest container or interconnected containers in the Amount Released field (Scenario Description tab) Enter the concentration percentage in the Concentration field (Scenario Description tab) Enter Release Duration (10 minutes for gases, solids in solution or powders; no entry for liquids is required) (Scenario Description tab) Weather Information - Use the weather default settings or enter average wind speed (don’t enter a value in the Wind From field) and Urban or Forest is recommended in the Ground Roughness field. (Scenario Description tab) Risk Assessment - Rate the Risk, Consequences and Overall Risk of a release occurring {based upon release history & maintenance etc.} (Scenario Description tab) Extent of Vulnerable Zone {CAMEO automatically calculates Threat Zone Radius when Edit button and Estimate Threat Zone Radius buttons are used} (Scenario Description tab) Enter estimate of Total Exposed Population (Notes Tab on Scenario Page{s}) Enter Critical Facilities {name of critical facility(s) and max occupancy for each; if none, state No Critical Facilities} (Notes Tab on Scenario Page{s}) On-Site Visits (for each Facility and within the Contract Period) Site Visit Certification Form (Attached to Site Plan Tab on Facility Page) {file naming required format Facility NameSV} Site Plan (Attached to Site Plan Tab on Facility Page) {file name required format Facility NameSP} Sufficient Detail to Identify: Location of Major Building(s) Name and Location of Extremely Hazardous Substance(s) (if extremely hazardous materials are co-located, noting EHS is acceptable) Name and Location of Street(s) Identify Pertinent Access and Egress Points Note Additional Features Pertinent to Hazardous Materials and Medical Response All data shall be submitted electronically via CAMEOfm version 2.4 in a .zip file format.  Attachment F FLORIDA STATE EMERGENCY RESPONSE COMMISSION FOR HAZARDOUS MATERIALS HAZARDS ANALYSIS SITE VISIT CERTIFICATION FORM Facility Name (Please print) Street Address, City & Zip Code (Please print) _________________________ County (Please print) Name of Facility Representative (Please print) Facility Representative Signature Site Visit Date Site Visit Performed by (Please print) Signature Site Visit Date The individuals signing above certify that a hazards analysis site visit was conducted on the above date. Notes:________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________  Check if facility representative was informed about using E-Plan (https://erplan.net/eplan/login.htm) for EPCRA on-line filing  Attachment G Warranties and Representations Financial Management Recipient’s financial management system must include the following: (1) Accurate, current and complete disclosure of the financial results of this project or program (2) Records that identify the source and use of funds for all activities. These records shall contain information pertaining to grant awards, authorizations, obligations, unobligated balances, assets, outlays, income and interest. (3) Effective control over and accountability for all funds, property and other assets. Recipient shall safeguard all assets and assure that they are used solely for authorized purposes. (4) Comparison of expenditures with budget amounts for each Request For Payment. Whenever appropriate, financial information should be related to performance and unit cost data. (5) Written procedures to determine whether costs are allowed and reasonable under the provisions of the applicable OMB cost principles and the terms and conditions of this Agreement. (6) Cost accounting records that are supported by backup documentation. Competition All procurement transactions shall be done in a manner to provide open and free competition. The Recipient shall be alert to conflicts of interest as well as noncompetitive practices among contractors that may restrict or eliminate competition or otherwise restrain trade. In order to ensure excellent contractor performance and eliminate unfair competitive advantage, contractors that develop or draft specifications, requirements, statements of work, invitations for bids and/or requests for proposals shall be excluded from competing for such procurements. Awards shall be made to the bidder or offeror whose bid or offer is responsive to the solicitation and is most advantageous to the Recipient, considering the price, quality and other factors. Solicitations shall clearly set forth all requirements that the bidder or offeror must fulfill in order for the bid or offer to be evaluated by the Recipient. Any and all bids or offers may be rejected when it is in the Recipient's interest to do so. Codes of conduct. The Recipient shall maintain written standards of conduct governing the performance of its employees engaged in the award and administration of contracts. No employee, officer, or agent shall participate in the selection, award, or administration of a contract supported by public grant funds if a real or apparent conflict of interest would be involved. Such a conflict would arise when the employee, officer, or agent, any member of his or her immediate family, his or her partner, or an organization which employs or is about to employ any of the parties indicated, has a financial or other interest in the firm selected for an award. The officers, employees, and agents of the Recipient shall neither solicit nor accept gratuities, favors, or anything of monetary value from contractors or parties to subcontracts. The standards of conduct shall provide for disciplinary actions to be applied for violations of the standards by officers, employees, or agents of the Recipient. Business Hours The Recipient shall have its offices open for business, with the entrance door open to the public, and at least one employee on site, from 8:00 AM to 5:00 PM. Licensing and Permitting All subcontractors or employees hired by the Recipient shall have all current licenses and permits required for all of the particular work for which they are hired by the Recipient.  Attachment H Certification Regarding Debarment, Suspension, Ineligibility And Voluntary Exclusion Subcontractor Covered Transactions (1) The prospective subcontractor of the Recipient, ____________________________, certifies, by submission of this document, that neither it nor its