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Fort Walton Beach Resolution — 2013 -03 FEMA--fire equipment — reading text
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2) Requiring such employee to participate satisfactorily in a drug abuse assistance or
rehabilitation program approved for such purposes by a Federal, State, or local health, law
enforcement or other appropriate agency.
g) Making a good faith effort to continue to maintain a drug free workplace through implementation of
paragraphs (a), ( b), ( c), ( d), ( e), and ( 1).
B) The grantee may insert in the space provided below the site( s) for the performance of work done in connection
with the specific grant:
Place of Performance
State Zip Action
Street City
If your place of performance is different from the physical address provided by you in the Applicant Information, press Add
Place of Performance button above to ensure that the correct place of performance has been specified. You can add
multiple addresses by repeating this process multiple times.
Section 17. 630 of the regulations provide that a grantee that is a State may elect to make one certification in each Federal
fiscal year. A copy of which should be included with each application for DHS funding. States and State agencies may elect
to use a Statewide certification.
https: / /eservices. fema. gov/ FemaFireGrant/ firegrmtljsp/ fire20l2lapplicationlprint_app.j sp ?print= true& app_ nu... 1/ 4/ 2013
Application Number: ENM- 2012 -FO -02509 Page 22 of 2,
Signed by Kenneth Perkins on 07/ 03/2012
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Page 23 of 24
Application Number: EMW- 2012 -FO -02509
FEMA Standard Form LLL
Only complete if applying for a grant for more than $100,000 and have lobbying activities. See Form 20 -16C for lobbying
activities definition.
This form is not applicable
https: / /eservices. fema. gov/ FemaFireGranUfiregrant/ jsp/ fue20l2lapplicationlprint_app.j sp ?print= true &app_ nu... 1/ 4/2013
Application Number: EMW- 2012 -FO -02509 Page 24 of 2
Submit Application
Application 100% complete, Submitted
Please click on any of the following links to visit a particular section of your application. Once all areas of your application
are complete, you may submit your application.
Application Area Status
Overview Complete
Contact Information Complete
Applicant Information Complete
Applicant Characteristics ( 1) Complete
Applicant Characteristics ( II) Complete
Department Call Volume Complete
Request Information Complete
Request Details Complete
Budget Complete
Narrative Statement Complete
Assurances and Certifications Complete
PLEASE READ THE FOLLOWING STATEMENTS BEFORE YOU SUBMIT.
YOU WILL NOT BE ALLOWED TO EDIT THIS APPLICATION ONCE IT HAS BEEN SUBMITTED. It you are not yet ready
to submit this application, save it, and log out until you feel that you have no more changes.
When you submit this application, you, as an authorized representative of the organization applying for this grant,
are certifying that the following statements are true:
To the best of my knowledge and belief, all data submitted in this application are true and correct.
This application has been duly authorized by the governing body of the applicant and the applicant will comply to the
Assurances and Certifications if assistance is awarded.
To sign your application, check the box below and enter your password in the space provided. To submit your application,
click the Submit Application button below to officially submit your application to FEMA.
Note: the primary contact will be responsible for signing and submitting the application. Fields marked with an' are
required.
I, Kenneth W Perkins, am hereby providing my signature for this application as of 05 -Jul -2012.
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