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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
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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
tt ZZte A. EK | Rag 9). Mnf
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)
