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Attachment “A”
Statement of Assurances
The Recipient hereby assures and certifies compliance with all Federal statutes, regulations, policies,
guidelines and requirements, including OMB Circulars No. A-21, A-110, A-122, A-128, A-87; E.O. 12372
and Uniform Administrative Requirements for Grants and Cooperative Agreements 28 CFR, Part 66,
Common rule, that govern the application, acceptance and use of Federal funds for this federally-assisted
project. Additionally, to the extent the following provisions apply to this Agreement, the Subgrantee assures
and certifies that:
1. It possesses legal authority to apply for the grant, and to finance and construct the proposed facilities;
that a resolution, motion or similar action has been duly adopted or passed as an official act of the sub-
grantee’s governing body, authorizing the filing of the application, including all understandings and
assurances contained therein, and directing and authorizing the person identified as the official
representative of the subgrantee to act in connection with the application and to provide such additional
information as may be required.
2. It will have sufficient funds available to meet the non-Federal share of the cost for construction projects.
Sufficient funds will be available when construction is completed to assure effective operation and
maintenance of the facility for the purpose constructed.
3. It will not enter into a construction contract(s) for the project or undertake other activities until the
conditions of the grant program(s) have been met.
4. It will provide and maintain competent and adequate architectural engineering supervision and inspection .
at the construction site to insure that the completed work conforms with the approved plans and
specifications; that it will furnish progress reports and such other information as the Federal grantor agency
may need.
5. It will cause work on the project to be commenced within a reasonable time after receipt of notification
from the approving Federal agency that funds have been approved and will see that work on the project will
be prosecuted to completion with reasonable diligence.
6. It will not dispose of or encumber its title or other interests in the site and facilities during the period of
Federal interest or while the Government holds bonds, whichever is the longer.
7. (To the best of his knowledge and belief) the disaster relief work described on each Federal Emergency
Management Agency (FEMA) Project Application for which Federal Financial assistance is requested is
eligible in accordance with the criteria contained in 44 Code of Federal Regulations, Part 206, and
applicable FEMA Handbooks.
8. The emergency or disaster relief work therein described for which Federal Assistance is requested
hereunder does not or will not duplicate benefits received for the same loss from another source.
9. It will (1) provide without cost to the United States and the Grantee all lands, easements and rights-of-
way necessary for accomplishments of the approved work; (2) hold and save the United States and the
Grantee free from damages due to the approved work or Federal funding.
10. This assurance is given in consideration of and for the purpose of obtaining any and all Federal grants,
ioans, reimbursements, advances, contracts, property, discounts of other Federal financial assistance
extended after the date hereof to the subgrantee by FEMA, that such Federal Financial assistance will be
extended in reliance on the representations and agreements made in this assurance and that the United
States and the Grantee shall have the right to seek judicial enforcement of this assurance. This assurance
is binding on the subgrantee, its successors, transferees, and assignees, and the person or persons whose
signatures appear on the reverse as authorized to sign this assurance on behalf of the subgrantee.
11. It will comply with requirements of the provisions of the Uniform Relocation Assistance and Real
Property Acquisitions Act of 1970 (P.L. 91-646) which provides for fair and equitable treatment of persons
displaced as a result of Federal and federally-assisted programs.
42. It will comply with provisions of Federal law which limit certain political activities of employees of a State
or local unit of government whose principal employment is in connection with an activity financed in whole
or in part by Federal grants. (6 USC 1501,et. seq.)
13. It will comply with the provisions of 18 USC 594, 598, 600-605 (further known as the Hatch Act)
which limits the political activities of employees.
14. It will establish safeguards to prohibit employees from using their positions for a purpose that is or gives
the appearance of being motivated by a desire for private gain for themselves or others, particularly those
with whom they have family, business, or other ties.
15. It will comply with the minimum wage and maximum hour’s provisions of the Federal Fair Labor
Standards Act.
16. It will comply with the Contract Work Hours and Safety Standards Act of 1962, 40 U.S.C. 327 et seq.,
requiring that mechanics and laborers (including watchmen and guards) employed on federally assisted
contracts be paid wages of not less than one and one-half times their basic wage rates for all hours worked
in excess of forty hours in a work week.
17. It will comply with the Federal Fair Labor Standards Act, 29 U.S.C. Section 201 et seq., requiring that
covered employees be paid at least the minimum prescribed wage, and also that they be paid one and one-
half times their basic wage rates for all hours worked in excess of the prescribed work-week.
18. It will comply with the Anti-Kickback Act of 1986, 41 U.S.C. Section 51 which outlaws and prescribes
penalties for "kickbacks" of wages in federally financed or assisted construction activities.
19. It will give the sponsoring agency or the Comptroller General, through any authorized representative,
access to and the right to examine all records, books, papers, or documents related to the grant.
20. It will comply with all requirements imposed by the Federal sponsoring agency concerning special
requirements of law, program requirements, and other administrative requirements.
21. It will ensure that the facilities under its ownership, lease or supervision which shall be utilized in the
accomplishment of the project are not listed on the Environmental Protection Agency's (EPA) list of
Violating Facilities and that it will notify the Federal grantor agency of the receipt of any communication from
the Director of the EPA Office of Federal Activities indicating that a facility to be used in the project is under
consideration for listing by the EPA.
22. It will comply with the flood insurance purchase requirements of Section 102(a) of the Flood Disaster
Protection Act of 1973, Public Law 93-234, 87 Stat. 975, approved December 31, 1976, Section 102(a)
requires, on and after March 2, 1975, the purchase of flood insurance in communities where such insurance
is available as a condition for the receipt of any Federal financial assistance for construction or acquisition
purposes for use in any area that has been identified by the Secretary of the Department of Housing and
Urban Development as an area having special flood hazards. The phrase "Federal financial assistance"
includes any form of loan, grant, guaranty, insurance payment, rebate, subsidy, disaster assistance loan or
grant, or any other form of direct or indirect Federal assistance.
23. It will comply with the insurance requirements of Section 314, PL 93-288, to obtain and maintain any
other insurance as may be reasonable, adequate, and necessary to protect against further loss to any
property which was replaced, restored, repaired, or constructed with this assistance.
24. It will assist the Federal grantor agency in its compliance with Section 106 of the National Historic
Preservation Act of 1966 as amended (16 USC 470), Executive Order 11593, and the Archeological and
Historical Preservation Act of 1966 (16 USC 569a-1 et seq.) by (a) consulting with the State Historic
Preservation Officer on the conduct of Investigations, as necessary, to identify properties listed in or eligible
for inclusion in the National Register of Historic Places that are subject to adverse effects (see 36 CFR Part
800.8) by the activity, and notifying the Federal grantor agency of the existence of any such properties and
by (b) complying with all requirements established by the Federal grantor agency to avoid or mitigate
adverse effects upon such properties.
25. It will comply with all appropriate environmental laws, including but not limited to:
a.) The Clean Air Act of 1955, as amended, 42 U.S.C. 7401-7642.
b.) The Clean Water Act of 1977, as amended, 42 U.S.C. 7419-7626.
c.) The Endangered Species Act of 1973, 16 U.S.C. 1531-1544.
d.) The Intergovernmental Personnel Act of 1970, 42 U.S.C. 4728-4763.
e.) Environmental standards which may be prescribed pursuant to the National Environmental
Policy Act of 1969, 42 U.S.C. 4321-4347.
f.) The Wild and Scenic Rivers Act of 1968, 16 U.S.C. 1271-1287, related to protecting
components or potential components of the national wild and scenic rivers system.
g.) The Fish and Wildlife Coordination Act of 1958; 16 U.S.C. 661-666.
h.) Environmental standards which may be prescribed pursuant to the Safe Drinking Water Act of
1974, 42 U.S.C. 300f-300j, regarding the protection of underground water sources.
i.) The provisions of the Coastal Barrier Resources Act (P.L. 97-348) dated October 19, 1982 (16
USC 3501 et seq.) which prohibits the expenditure of most new Federal funds within the units
of the Coastal Barrier Resources System.
26. It will comply with the following Executive Orders: EO 11514 (NEPA); EO 11738 (violating
facilities); EO 11988 (Floodplain Management); EO 11990 (Wetlands); and EO 12898 (Environmental
Justice).
27. It will comply, and assure the compliance of all its subgrantees and contractors, with the applicable
provisions of Title | of the Omnibus Crime Control and Safe Streets Act of 1968, as amended, the Juvenile
Justice and Delinquency Prevention Act, or the Victims of Crime Act, as appropriate; the provisions of the
current edition of the Office of Justice Programs Financial and Administrative Guide for Grants, M7100.1;
and all other applicable Federal laws, orders, circulars, or regulations.
28. It will comply with the provisions of 28 CFR applicable to grants and cooperative agreements including
Part 18, Administrative Review Procedure; Part 20, Criminal Justice Information Systems; Part 22,
Confidentiality of Identifiable Research and Statistical Information; Part 23, Criminal Intelligence Systems
Operating Policies; Part 30, Intergovernmental Review of Department of Justice Programs and Activities;
Part 42, Nondiscrimination/Equal Employment Opportunity Policies and Procedures; Part 61, Procedures
for Implementing the National Environmental Policy Act; Part 63, Floodplain Management and Wetland
Protection Procedures; and Federal laws or regulations applicable to Federal Assistance Programs.
29. It will comply with Lead-Based Paint Poison Prevention Act (42 U.S.C.: 4821 et seq.) which prohibits the
use of lead based paint in construction of rehabilitation or residential structures.
30. It will comply with the Energy Policy and Conservation Act (P.L. 94-163; 42 U.S.C. 6201-6422), and the
provisions of the State Energy Conservation Plan adopted pursuant thereto.
31. With respect to demolition activities, it will:
a.) Create and make available documentation sufficient to demonstrate that the Subgrantee and
its demolition contractor have sufficient manpower and equipment to comply with the
obligations as outlined in this Agreement.
b.) Return the property to its natural state as though no improvements had ever been contained
thereon.
c.) Furnish documentation of all qualified personnel, licenses and all equipment necessary to
inspect buildings located in Subgrantee's jurisdiction to detect the presence of asbestos and
lead in accordance with requiremenis of the U.S. Environmental Protection Agency, the
Florida Department of Environmental Protection and the county health department.
d.) Provide documentation of the inspection results for each structure to indicate: safety hazards
present; health hazards present; and/or hazardous materials present.
e.) Provide supervision over contractors or employees employed by Subgrantee to remove
asbestos and Jead from demolished or otherwise applicable structures.
f.) Leave the demolished site clean, level and free of debris.
g.) Notify the Grantee promptly of any unusual existing condition which hampers the contractors
work.
h.) Obtain ail required permits.
i.) Provide addresses and marked maps for each site where water wells and septic tanks are to
be closed along with the number of wells and septic tanks located on each site, and provide
documentation of such closures.
j.) Comply with mandatory standards and policies relating to energy efficiency which are
contained in the State energy conservation plan issued in compliance with the Energy Policy
and Conservation Act (Public Law 94-163).
k.) Comply with all applicable standards, orders, or requirements issued under Section 112 and
306 of the Clean Air Act (42 U.S.C. 1857 (h), Section 508 of the Clean Water Act (33 U.S.
1368), Executive Order 11738, and the U.S. Environmental Protection Agency regulations (40
CFR Part 15 and 61). This clause shall be added to any subcontracts.
1.) Provide documentation of public notices for demolition activities.
32. it will comply, and all its contractors will comply, with the non-discrimination requirements of the
Omnibus Crime Coniro! and Safe Streets Act of 1968, as amended, 42 USC 3789(d), or Victims of Crime
Act (as appropriate); Title VI of the Civil Rights Act of 1964, as amended; Section 504 of the Rehabilitation
Act of 1973, as amended; Subtitle A, Title ll of the Americans with Disabilities Act (ADA) (1990); Title IX of
the Education Amendments of 1972; the Age Discrimination Act of 1975; Department of Justice Non-
Discrimination Regulations, 28 CFR Part 42, Subparts C,D,E, and G; and Department of Justice regulations
on disability discrimination, 28 CFR Part 35 and Part 39.
33. It will require the facility to be designed to comply with the "American Standard Specifications for
Making Buildings and Facilities Accessible to, and Usable by the Physically Handicapped," Number A117.7-
1961, as modified (41 CFR 101-17-7031). The subgrantee will be responsible for conducting inspections to
insure compliance with these specifications by the contractor.
34. It agrees to comply with Section 311, P.L. 93-288 and with Title VI of the Civil Rights Act of 1964 (P.L.
83-352) and in accordance with Title VI of the Act, no person in the United Grantees shall, on the ground of
race, color, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise
subjected to discrimination under any program or activity for which the subgrantee receives Federal
financial assistance and will immediately take any measures necessary to effectuate this agreement. If any
real property or structure is provided or improved with the aid of Federal financial assistance extended to
the subgrantee, this assurance shall obligate the subgrantee, or in the case of any transfer of such property,
any transferee, for the period during which the real property or structure is used for a purpose for which the
Federal financial assistance is extended or for another purpose involving the provision of similar services or
benefits.
35. It agrees to comply with Executive Order 11246 as amended by Executive Orders 11375 and 12086,
and the regulations issued pursuant thereto, which provide that no person shall be discriminated against on
the basis of race, color, religion, sex or national origin in all phases of employment during the performance
of federal or federally assisted construction contracts; affirmative action to insure fair treatment in
employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff/termination,
rates of pay or other forms of compensation; and election for training and apprenticeship.
36. It will comply with Title IX of the Education Amendments of 1972, as amended (20 U.S.C.:
1681-1683 and 1685 - 1686) which prohibits discrimination on the basis of sex.
37. It will comply with the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment
and Rehabilitation Act of 1970, (42 U.S.C. 4521-45-94) relating to nondiscrimination on the basis
of alcohol abuse or alcoholism.
38. It will comply with 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. 290 dd-3
and 290 ee-3), as amended, relating to confidentiality of alcohol and drug abuse patient records.
39. In the event a Federal or State court or Federal or State administrative agency makes a finding of
discrimination after a due process hearing on the Grounds of race, color, religion, national origin, sex, or
disability against a recipient of funds, the recipient will forward a copy of the finding to the Office for Civil
Rights, Office of Justice Programs.
40. lt will provide an Equal Employment Opportunity Program if required to maintain one, where the
application is for $500,000 or more.
41. DRUG-FREE WORKPLACE (GRANTEES OTHER THAN INDIVIDUALS) As required by the Drug-Free
Workplace Act of 1988, and implemented at 28 CFR Part 67, Subpart F, for grantees, as defined at 28 CFR
Part 67 Sections 67.615 and 67.620.
Attachment “B”
Public Assistance Quarterly Report
Available for Each Subgrantee on www.FloridaPA.org
Guartery Report
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Attachment “C”
Certification Regarding
Debarment, Suspension, Ineligibility
and
Voluntary Exclusion
Subcontractor Covered Transactions:
1. The prospective subcontractor of the Subgrantee certifies, by submission of this document, that
neither it nor its principals is presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from participation in this transaction by any federal department
or agency.
2. Where the Subgrantee’s subcontractor is unable to certify to the above statement, the prospective
subcontractor shall attach an explanation to this form.
SUBCONTRACTOR:
Name of Company
Street Address
City, State, Zip
Federal Employer Identification Number (FEIN)
By:
Signature Date
Subgrantee’s Name
Grantee Agreement Number
Attachment “D”
DESIGNATION OF SUBGRANTEE’S AGENT
FEMA/GRANTEE PUBLIC ASSISTANCE PROGRAM
Florida Division of Emergency Management
Sub-Grantee
Okaloosa County
Primary Agent
Secondary Agent
Agent’s Name
Marcella B. Eubanks
Agent’s Name
Gary J. Standford
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Organization / Official Position
Contracts & Grants Manager
Organizatigh / Offcial Position ~
Finance Officer
Mailing Address
1804 Lewis Turner Blvd, Ste 206
Mailing Address
302 N Wilson Street, Ste 203
City, State, Zip
Fort Walton Beach, FL 32547-1285
City, State, Zip
Crestview, FL 32536-3474
Daytime Telephone
850-651-7200 ext 4381
Daytime Telephone
850-689-5000 ext 3411
Facsimile Number
850-609-5029
Facsimile Number
850-689-5882
E-mail Address
meubanks@clerkofcourts.cc
E-mail Address
gstanford@clerkofcourts.cc
The above Primary and Secondary Agents are hereby authorized to execute and file Application for Public
Assistance on behalf of the Sub-grantee for the purpose of obtaining certain Grantee and federal financial
assistance under the Robert T. Stafford Disaster Relief & Emergency Assistance Act, (Public Law 93-288 as
amended) or otherwise available. These agents are authorized to represent and act for the Sub-Grantee in all
dealings with the Grantee of Florida, Grantee for all matters pertaining to such disaster assistance required by
the agreements and assurances printed on page 2 hereof. Additional authorized contacts may be registered on
the Grantee’s PA Website (www.floridapa.org) for full or read only access by the above authorized Agents.
Chief Financial Officer
Sub-Grantee’s
Authority/Board/Commission
Name
Gary J. Stanford
Official’s Name
Charles K. Windes, Jr.
"Dag Sond
Signature
OrganizafiorY Official Position
Finance Officer
Organization / Official Position
Chairman Okaloosa County Board of County Commissioners
Mailing Address
302 N Wilson Street, Ste 203
Mailing Address
1804 Lewis Turner Blvd, Ste 206
City, State, Zip
Crestview, FL 32536-3474
City, State, Zip
Fort Walton Beach, FL 32547-1285
Daytime Telephone
850-689-5000 ext 3411
Daytime Telephone
850-651-7105
Facsimile Number
850-689-5882
Facsimile Number
850-609-5029
E-mail Address
gstanford@clerkofcourts.cc
E-mail Address
grants@clerkofcourts.cc
Sub-Grantee’s Grantee Cognizant Agency for Single Audit purposes::
Florida Division of Emergency Management
Sub-Grantee’s Fiscal Year (FY) Start
Month: October
Day: 1
Sub-Grantee's Federal Employer's Identification Number (EIN)
59 ~ 6000765
Sub-Grantee’s FIPS Number (If Known)
091- 99091 -00
Sub-Grantee Authority/Board/Commission Signature
Attachment “E”
JUSTIFICATION OF ADVANCE PAYMENT
RECIPIENT:
If you are requesting an advance, indicate same by checking the box below.
[ ] ADVANCE REQUESTED
Advance payment of $ is requested, Balance of
payments will be made on a reimbursement basis. These funds are
needed to pay staff, award benefits to clients, duplicate forms and
purchase start-up supplies and equipment. We would not be able to
operate the program without this advance.
If you are requesting an advance, complete the following chart and line item justification below.
ESTIMATED EXPENSES
BUDGET CATEGORY/LINE ITEMS 20___ -20___— Anticipated Expenditures for First Three Months of
(list applicable line items) Contract
For example
ADMINISTRATIVE COSTS
(Include Secondary Administration.)
For example
PROGRAM EXPENSES
TOTAL EXPENSES
LINE ITEM JUSTIFICATION (For each line item, provide a detailed justification explaining the need for the
cash advance. The justification must include supporting documentation that clearly shows the advance will be
expended within the first ninety (90) days of the contract term. Support documentation should include quotes
for purchases, delivery timelines, salary and expense projections, ete. to provide the Division reasonable and
necessary support that the advance will be expended within the first ninety (90) days of the contract term. Any
advance funds not expended within the first ninety (90) days of the contract term shall be returned to the
Division Cashier, 2555 Shumard Oak Boulevard, Tallahassee, Florida 32399, within thirty (30) days of receipt,
along with any interest earned on the advance)