Entire Application

*Are you a member, or are you currently involved in the management, of the fire department applying for this grant with this application?
Yes, I am a member/officer of this applicant

If you are a grant writer or otherwise not affiliated with this applicant, please complete the information below.

Fields marked with an * are required.

If you are a member/officer of this applicant, please do not complete the information requested below.

Preparer Information
* Preparer's Name
* Address 1
Address 2
* City
* State
* Zip -   

* Enter Grant-writing fee associated with the preparation of this request. Enter 0 if there is no fee. 0



Contact Information

Alternate Contact Information Number 1
* Title Chairperson Vermillion Twp
Prefix N/A 
* First Name Robert  
Middle Initial  
* Last Name Bohn  
* Business Phone  Ext.
Alternate Phone Number  Ext.
Mobile Phone/Pager

Alternate Contact Information Number 2
* Title Fire Committe Lead
Prefix N/A 
* First Name James  
Middle Initial  
* Last Name Sathra  
* Business Phone  Ext.
Alternate Phone Number  Ext.
Mobile Phone/Pager


Applicant Information

Originally submitted on 07/10/2009 by Judy Sloan

Contact Information:

Application number is EMW-2009-FC-05794R

* Fire Department Name Vermillion Township
* Type of Jurisdiction Served
If other, please enter the type of Jurisdiction
* Employer Identification Number

* What is your organization’s DUNS Number?
(call 1-866-705-5711 to get a DUNS number)
Headquarters or Main Station Physical Address
* Physical Address 1 .  
Physical Address 2  
* City  
* State
* Zip    
Need help for ZIP+4?
Mailing Address
* Mailing Address 1  
Mailing Address 2  
* City  
* State
* Zip    
Need help for ZIP+4?
Account Information
* Type of bank account
* Bank routing number - number on the bottom left hand corner of your check
*Your account number    
Additional Information  
* For this fiscal year is your organization receiving Federal funding from any other grant program that may duplicate the purpose and/or scope of this grant request? No
* If awarded the FSC grant, will your organization expend more than $500,000 in Federal funds during your organization's fiscal year in which this FSC grant was awarded? No
* Is the applicant
If you answered yes to any of the additional questions above, please provide an explanation in the space provided below:     


Fire Department Characteristics (Part I)

* Are you a member of a Federal Fire Department or contracted by the Federal government and solely responsible for suppression of fires on Federal property?
* What kind of fire department do you represent?
All volunteer 

If you answered combination, above, what is the percentage of career members in your organization?
If you answered volunteer or combination or paid on-call, how many of your volunteer Firefighters are paid members from another career department?
* What type of community does your organization serve?

* What is the square mileage of your first-due response area?
* What percentage of your response area is protected by hydrants?
0 %
* In what county/parish is your organization physically located? If you have more than one station, in what county/parish is your main station located?
* Does your organization protect critical infrastructure of the state?

* How much of your jurisdiction's land use is for agriculture, wild land, open space, or undeveloped properties?
93 %
* What percentage of your jurisdiction's land use is for commercial, industrial, or institutional purposes?
1 %
* What percentage of your jurisdiction's land is used for residential purposes?
6 %
* How many occupied structures (commercial, industrial, residential, or institutional) in your jurisdiction are more than four stories tall? Do not include structures which are not regularly occupied such as silos, towers, steeples, etc.

* What is the permanent resident population of your

* How many active firefighters does your department have who perform firefighting duties?

* How many fire stations does your department currently operate?
* Do you currently report to the National Fire Incident Reporting System (NFIRS)?

If you answered yes above, please enter your

* What services does your organization provide?
Structural Fire Suppression Medical First Response Hazmat Operational Level
Wildland Fire Suppression
Hazmat Technical Level

Rescue Operational Level
Occasional Fire Prevention Program Formal/Year-Round Fire Prevention Program Rescue Technical Level


Fire Department Characteristics (Part II)

* What is the total number of fire-related civilian fatalities in your jurisdiction over the last three years?
0 0 0
* What is the total number of fire-related civilian injuries in your jurisdiction over the last three years?
0 0 0
* What is the total number of line of duty member fatalities in your jurisdiction over the last three years?
0 0 0
* What is the total number of line of duty member injuries in your jurisdiction over the last three years?
0 0 0
* Over the last three years, what was your fire department’s average operating budget?
* What percentage of your TOTAL budget is dedicated to personnel costs (salary, overtime and fringe benefits)?
    0 %
* What percentage of your annual operating budget is derived from:
Enter numbers only, percentages must sum up to 100%
    100 %
    0 %
    0 %
Fund drives?
    0 %
Fee for Service?
    0 %
    0 %
If you entered a value into Other field (other than 0), please explain

* How many vehicles does your organization have in each of the types or class of vehicle listed below? You must include vehicles that are leased or on long-term loan as well as any vehicles that have been ordered or otherwise currently under contract for purchase or lease by your organization but not yet in your possession. Enter numbers only and enter 0 if you do not have any of the vehicles below.
Type or Class of Vehicle    Total Number
Total Number of
Riding Positions
Engines or Pumpers (pumping capacity of 750 gpm or greater and water capacity of 300 gallons or more):
Pumper, Pumper/Tanker, Rescue/Pumper, Foam Pumper, CAFS Pumper, Quint (Aerial device of less than 76 feet), Type I Engine, Type II Engine, Type II/III Wildland/Urban Interface
    1     5
Tankers (pumping capacity of less than 750 gallons per minute (gpm) and water capacity of 1,000 gallons or more):
Tanker, Tender, Tanker/Tender
    1     2
Aerial Apparatus:
Aerial Ladder Truck, Telescoping, Articulating, Ladder Towers, Platform, Tiller Ladder Truck, Quint (Aerial device of 76 feet or greater)
    0     0
Brush/Quick attack (pumping capacity of less than 750 gpm):
Brush Truck, Patrol Unit (Pick up w/ Skid Unit), Quick Attack Unit, Mini-Pumper, Type III Engine, Type IV Engine, Type V Engine, Type VI Engine, Type VII Engine
    1     2
Rescue Vehicles:
Rescue Squad, Rescue (Light, Medium, Heavy), Technical Rescue Vehicle, Hazardous Materials Unit
    0     0
EMS Chase Vehicle, Air/Light Unit, Rehab Units, Bomb Unit, Technical Support (Command, Operational Support/Supply), Hose Tender, Salvage Truck, ARFF (Aircraft Rescue Firefighting), Command/Mobile Communications Vehicle, Other Vehicle
    0     0


Fire Department Call Volume


* How many responses per year by category? (Enter whole numbers only. If you have no calls for any of the categories, enter 0)
Working Structural Fires
1 0 5
False Alarms/Good Intent Calls
2 3 1
Vehicle Fires
2 2 4
Vegetation Fires
1 0 2
EMS-BLS Response Calls
14 15 19
EMS-ALS Response Calls
0 0 0
EMS-BLS Scheduled Transports
0 0 0
EMS-ALS Scheduled Transports
0 0 0
Vehicle Accidents w/o Extrication
0 0 0
Vehicle Extrications
4 3 9
Other Rescue
0 0 0
Hazardous Condition/Materials Calls
1 0 1
Service Calls
0 1 0
Other Calls and Incidents
0 2 0
25 26 41
What is the total acreage of all vegetation fires?
5 7 2
How many times does your organization receive mutual/automatic aid?
0 0 0
How many times does your organization provide mutual/automatic aid? (Please indicate the number of times your department provides or receives mutual aid. Do not include first-due responses claimed above.)
0 0 0


Request Details

The activities for program Fire Station Construction are listed in the table below.

Activity Number of Entries Total Cost Total Applicant Share Total Federal Share
Fire Station Construction 1 $ 1,146,600 $ 150,000 $ 996,600

Project Cost Applicant Share Federal Share Action
Adding a new fire station to meet changing service demands. $ 1,146,600 $ 150,000
$ 996,600
View Details View Project Budget

Fire Station Construction
*1. What is the purpose of your request?
Adding a new fire station to meet changing service demands.
*2. If your request is to replace or rehabilitate an unsafe or uninhabitable station, what is the reason for your request?
N/A (we're building an additional station)
2a. If you have health-code violations or orders to vacate your existing fire station, what is the date of that order and what are the conditions under which the order was issued?
Date: (mm/dd/yyyy)
* 3. If your request is to construct an additional fire station in order to better serve your community, did you conduct a formal survey to identify the location of your new fire station?
a. If yes, what percentage of your first-due response area can currently be protected within a five minute response time (from the time of dispatch), without the new station?
b. If yes, what percentage of your first-due response area will be protected within a five minute response time (from the time of dispatch) once the new station is operational?
* 4. Regardless of local building code requirements, will your new station or your modification project be designed and built according to the most recently approved requirements and codes developed by the International Code Council as well as NFPA standards that involve fire station construction including sprinkler systems (in accordance with NFPA 1, chapter 13) and fire alarms and vehicle exhaust extraction systems (in accordance with NFPA 1500, chapter 9)?
* 5. Will your project provide for sleeping quarters and other amenities to accommodate 24/7 occupancy?
*6a. Has your department obtained formal cost estimates for your project from a contractor, engineering firm, architectural firm, or some other industry source?
6b. If so, please provide the estimated cost obtained. If not please provide your best estimates for the cost necessary to complete your project.
6c. What is the source of the estimated cost (e.g., general construction contractor, engineering firm, construction cost estimate tables such as Marshall and Swift, R.S. Means, etc.)?
general construction contractor
* 6d. What is the total square footage of the modification to your facility or your new facility?
* 6e. There are no cost-share requirements under this program, but is your department willing to contribute to the cost of the project?
Yes - how much? $150,000
* 7. Do you own the land on which the construction will occur?
* 8. Is the land on which the construction will occur already zoned for the planned fire station?
* 9. The land on which you plan to build the new fire station:
Is a vacant lot which has never been disturbed (never been built on).

* 10. Has your department already obtained all the necessary local permits for your planned construction project?
* 11. Has your department already conducted an environmental assessment (EA) for your planned construction project?


If applicable, explain what work has been done on the EA:
* 12. If your project is for a renovation of an existing structure, have you already received clearances from the State Historic Preservation Office (SHPO) to proceed with the project?

N/A (we're building a new station).
* 13. Are utilities already at or adjacent to the land on which the construction will occur?
Yes, the utilities are readily available to the site.
* 14. Is your community a participant in the National Flood Insurance Program and in good standing (i.e. not sanctioned)?

* 15. What was the unemployment rate for your county or city in December 2008 (go to the website provided under the help button to the right)?
6.1  % 
* 16. What was the unemployment rate for your county or city in December 2007 (go to the website provided under the help button to the right)?
4.4  % 
* 17. What is the population of the county or city for which you have provided the unemployment statistics above?
*18. How long will it take to complete your fire station after the completion of the environmental assessment and receipt of Federal approval to begin work?
18  Months 
*19. How long has your department been ready to start the construction of your fire station (how long have you had your permits)?
*20. How much has your department spent on your project to date?
0  for design (architects) 
0  for permits 
500  other (explain)  
Informational sessions & publications
* 21. Is your department responsible for the provision of Emergency Medical Services in addition to fire suppression?

*22. What percentage of your active firefighters meets the training requirements under NFPA 1001?
0  % 
*23. Will the new fire station improve your department’s ability to affect mutual aid?

If yes, explain
Vermillion Township is central to seven other fire districts; it will provide mutual aid to all neighboring districts.


BUDGET INFORMATION - Construction Programs

Project Cost Estimate
Budget Class
Unit of
Cost ($)
Estimate ($)
Building construction
Construction Construction 6300 Square Foot 182 1146600
Total Cost Estimate $1146600
Applicant Share $150000 / 13.08%
Federal Share $996600 / 86.92%

Fire Station Construction
*1. Select an item from the drop-down menu.
Building construction
*2. Select a grant budget class for each item selected.
*3. Select a cost classification for each item selected.
*4. Select unit of Measure for the cost classification item selected in question 3.
Square Foot
*5. Provide Unit quantity
*6. Provide a unit cost.
*7. Budget Item Narrative.
To complete this section, refer to the requirements outlined in the help link located below right.



a. Personnel
$ 0
b. Fringe Benefits
$ 0
c. Travel
$ 0
d. Equipment
$ 0
e. Supplies
$ 0
f. Contractual
$ 0
g. Construction
$ 1,146,600
h. Other
$ 0
i. Indirect Charges
$ 0
Federal and Applicant Share
Federal Share
$ 996,600
Applicant Share
$ 150,000
Federal Rate Sharing (%)
* (The combined Non-Federal Resources must equal the Applicant Share of  $ 150,000)
    a. Applicant
  $ 0
    b. State
  $ 0
    c. Local
  $ 150,000
    d. Other Sources
  $ 0
If you entered a value in Other Sources other than zero (0), include your explanation below. You can use this space to provide information on the project, cost share match, or if you have an indirect cost agreement with a federal agency.

 Total Budget
$ 1,146,600


Narrative Statement

Project Description
* Please indicate which of these Target Capabilities your request outlined in this application will satisfy. Check all that apply:
Responder Safety and Health
Firefighting Operations/Support
Hazardous Materials Response
Search and Rescue
Emergency Medical Services
Project Description
* Please provide your narrative statement in the space provided below. Include in your narrative, details regarding your fire station project as detailed above.
Vermillion Township is a community in Dakota County, Minnesota, where life revolves around family, work and heritage.

Primarily agricultural, the township supports industries such as equestrian, landscaping, green houses, apple orchards, strawberry fields, plant nurseries, masonry, automotive, machine shops, photography, farm implements, boarding kennels, construction, excavation, gravel mining, road paving, teaching and daycare.

The Vermillion Township Board of Supervisors is renown for their fiscally conservative approach to all matters. Year after year, decade after decade they carefully guide the township through requests and concerns brought to them by residents while balancing the mandates of county and state government. The Board is staffed by long-time residents who take their elected position seriously; most retain their position anywhere from one to three decades. There is very little turnover in township government, which is a reflection of the stable community that produced them.
There have been two major bridge construction projects performed in the last ten years, and both were accomplished with a combination of county funding and township cost-sharing. The Board was also responsible for acquiring the extra land needed for increased right-of-way. The Board was able to complete both projects yet incur no debt to the township residents.

Project Description
Vermillion Township’s new fire facility is needed to improve response time of fire and rescue calls not only for this township, but also for the surrounding communities.
The township currently has no facility or equipment, but because of its central location to 6 other townships and 5 cities, it is essential to the mutual aid of the other fire districts.

Several factors have indicated a need for a new facility in the township, with response time improvement, shelter of residents in the after-math of a large scale natural
disaster (such as tornados, which commonly occur in the spring) and cost management being a priority. The facility would also be used as a holding location for
blankets and supplies to be distributed to those in need.

The new facility is estimated to cost 1.15 Million and is intended to have approximately 6300 square feet that would include four bays for vehicles (Engine, Tender, Brush/Quick Attack and utility vehicle). It would also have a kitchen, two gender-specific bathrooms, two gender-specific sleeping quarters for at least two fire fighters, meeting area, day room with open space for short term shelter of residents (misplaced from their homes in case of disaster such as tornado touchdown), eye wash station, bathroom with shower, separate decontamination shower and area, fire alarms, smoke detectors and a sprinkler system. Utilities already present in the area are electrical power. The main heating and cooling component of the facility is targeted to be a two-well geo-thermal system with backup heating by an LP gas furnace (with leased external tank), and a backup cooling provided by an electrical central air conditioner. The township has no central water or sewer system, so
wells and septic fields would be installed.

Project status: location analysis has been performed and verbal agreements are in place for land purchase, the facility has been researched and estimated, personnel are currently in training and familiarization, facility permit process is estimated to be 30-60 days with no zoning issues. Environmental assessment is pending. Funding is the key factor, and any significant delays are due solely to funding. Fire-fighting personnel are being sponsored by Randolph Hampton Fire District for Fire Fighter I training.

Financial Need
Financing is the key; this grant is needed for the project to become a reality. The township is very committed and pledge $150,000 (about 13%) in cost sharing. The cost sharing funds would be provided through taxes and community fund-raising events. Federal, County and State resources of funding have been and continue to be researched, but with no success. The current economic distress of the area severely limits funding. The unemployment statistics indicate an average of 8.1% unemployment for this area. Also, since this primarily an agricultural community, the average income of the residents has been negatively impacted by the increasingly unstable weather patterns; annual income of the residents is limited with little opportunity for improvement over the next decade.

Cost Benefit
The current fire service for the community is contracted through the city of Hastings. Until three years ago, the cost of this service was affordable. But, like health-care costs, the cost of this service has risen dramatically; in 2005 it was approximately $35,000. In 2008 it more than doubled to $72,000. Vermillion Township is a very fiscally conservative and responsible community; they need to have control of their fire service to improve and maximize protection while controlling cost.

For some areas of the township, the distance traveled from Hastings would be 15 to 18 miles, resulting in a 25 to 30 minute travel time to a fire or rescue operation. In these situation, this would most likely result in a salvage call, with total loss of property and danger to life. These delays would decrease significantly if the attending fire department was in a more central location within the township.

The annual operating cost of current fire service is funded by taxes. If Vermillion Township had their own fire department, it would also be eligible for funding through grants and community fund raising; this would decrease the tax burden to the residents significantly.

It is intended that the facility construction project would include new technologies such as geo-thermal heating/cooling, solar panels for battery charging of radio and other light electronics, energy conserving LED lighting, and a wind generator to supplement electricity. Vermillion Township is an ideal location for wind-generated electricity. These aspects coupled with the traditional constructions industries would provide much needed financial support for the area industries and businesses.

An analysis of geo-thermal heating has been performed using the Transcona Funeral Chapel in Winnipeg as a model. This business has an older 9000 sq ft. facility with minimal
insulation that was originally heated and cooled with multiple gas furnaces and electrical wall air conditioners. All furnaces and air conditioners have been removed and replaced by the geo-thermal heating system at a cost of approximately $100,000. Operating costs for the first year showed that the new system cost just one tenth of the old system. Vermillion Township would like to employ this technology in the new facility.

Statement of Effect
This project will benefit the community many ways in both the short term and long term. The response time for fire and rescue will be improved significantly for the immediate area and an enormous addition to the area’s mutual aid, which would serve an estimated 9000 people.

Another advantage of having a locally run department would be in the rescue of lost or injured individuals. Due to the size of the area and the proximity to the Vermillion River, it is essential that the disappearance of young children be investigated and a search mounted immediately by trained residents (people that are familiar with the area).

Vermillion Township has Minnesota State Highway 52 running through it. A large percentage of the calls would be for auto-accident attendance. Support would also be provided as needed to neighboring communities that include the Flint Hills oil refinery and the Prairie Island Nuclear Power Plant. The fire department would also lead the community in safety and fire prevention programs.


Assurances and Certifications

Form SF-424D

You must read and sign these assurances. These documents contain the Federal requirements attached to all Federal grants including the right of the Federal government to review the grant activity. You should read over the documents to become aware of the requirements. The Assurances and Certifications must be read, signed, and submitted as a part of the application.

Note: Fields marked with an * are required.

Assurances for Construction Programs
Note: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the Awarding Agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified.

As the duly authorized representative of the applicant I 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 the non-Federal share of project costs) to ensure proper planning, management and completion of project described in this application.
Will give the awarding agency, the Comptroller General of the United States and, if appropriate, the State, the right to examine all records, books, papers, or documents related to the assistance; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives.
Will 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.
Will comply with the requirements of the assistance awarding agency with regard to the drafting, review and approval of construction plans and specifications.
Will 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.
Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
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.
Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728-4763) relating to prescribed standards of merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).
Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.) which prohibits the use of lead-based pain in construction or rehabilitation of residence structures.
Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) 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; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29) U.S.C. 794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. 6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) 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; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statue(s) under which application for Federal assistance is being made; and (j) the requirements of any other nondiscrimination statue(s) which may apply to the application.
Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal and federally-assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases.
Will comply with the provisions of the Hatch Act (5 U.S.C. 1501-1508 and 7324-7328) which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds.
Will comply, as applicable, with the provisions of the Davis- Bacon Act (40 U.S.C. 276a to 276a-7), the Copeland Act (40 U.S.C. 276c and 18 U.S.C. 874), and the Contract Work Hours and Safety Standards Act (40 U.S.C. 327- 333) regarding labor standards for federally-assisted construction subagreements.
Will comply with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients 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.
Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91- 190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. 1451 et seq.); (f) conformity of Federal actions to State (Clean Air) implementation Plans under Section 176(c) of the Clean Air Act of 1955, as amended (42 U.S.C. 7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended (P.L. 93-523); and, (h) protection of endangered species under the Endangered Species Act of 1973, as amended (P.L. 93-205).
Will comply with the 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.
Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. 470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. 469a-1 et seq).
Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A-133, "Audits of States, Local Governments, and Non-Profit Organizations."
Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, and policies governing this program.


Signed by Judy Sloan on 07/10/2009


Form SF-424B

You must read and sign these assurances.

Certifications Regarding Lobbying, Debarment, Suspension and Other Responsibility Matters and Drug-Free Workplace Requirements.

Note: Fields marked with an * are required.

Applicants should refer to the regulations cited below to determine the certification to which they are required to attest. Applicants should also review the instructions for certification included in the regulations before completing this form. Signature on this form provides for compliance with certification requirements under 44 CFR Part 18, "New Restrictions on Lobbying; and 44 CFR Part 17, "Government-wide Debarment and Suspension (Non-procurement) and Government-wide Requirements for Drug-Free Workplace (Grants)." The certifications shall be treated as a material representation of fact upon which reliance will be placed when the Department of Homeland Security (DHS) determines to award the covered transaction, grant, or cooperative agreement.

A. As required by the section 1352, Title 31 of the US Code, and implemented at 44 CFR Part 18 for persons (entering) into a grant or cooperative agreement over $100,000, as defined at 44CFR Part 18, 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 any agency, a Member of Congress, an officer or employee of congress, or an employee of a Member of Congress in connection with the making of any Federal grant, the entering into of any cooperative agreement and extension, continuation, renewal amendment or modification of any Federal grant or cooperative agreement.

(b) If any other funds 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 grant or cooperative agreement, the undersigned shall complete and submit Standard Form LLL, "Disclosure of Lobbying Activities", in accordance with its instructions.

(c) The undersigned shall require that the language of this certification be included in the award documents for all the sub awards at all tiers (including sub grants, contracts under grants and cooperative agreements and sub contract(s)) and that all sub recipients shall certify and disclose accordingly.

2. Debarment, Suspension and Other Responsibility Matters (Direct Recipient)

A. As required by Executive Order 12549, Debarment and Suspension, and implemented at 44CFR Part 67, for prospective participants in primary covered transactions, as defined at 44 CFR Part 17, Section 17.510-A, the applicant certifies that it and its principals:

(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of Federal benefits by a State or Federal court, or voluntarily excluded from covered transactions by any Federal department or agency.

(b) Have not within a three-year period preceding this application been convicted of or had a civilian judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain or perform 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 government entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification: and

(d) Have not within a three-year period preceding this application had one or more public transactions (Federal, State, or local) terminated for cause or default; and

B. 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.

3. Drug-Free Workplace (Grantees other than individuals)

As required by the Drug-Free Workplace Act of 1988, and implemented at 44CFR Part 17, Subpart F, for grantees, as defined at 44 CFR part 17, Sections 17.615 and 17.620:

(A) The applicant certifies that it will continue to provide a drug-free workplace by:

(a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the grantee's workplace and specifying the actions that will be taken against employees for violation of such prohibition;
(b) Establishing an on-going drug free awareness program to inform employees about:

(1) The dangers of drug abuse in the workplace;
(2) The grantees policy of maintaining a drug-free workplace;
(3) Any available drug counseling, rehabilitation and employee assistance programs; and
(4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace;

(c) Making it a requirement that each employee to be engaged in the performance of the grant to be given a copy of the statement required by paragraph (a);
(d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will:

(1) Abide by the terms of the statement and
(2) Notify the employee in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five calendar days after such conviction.

(e) Notifying the agency, in writing within 10 calendar days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to the applicable DHS awarding office, i.e. regional office or DHS office.
(f) Taking one of the following actions, against such an employee, within 30 calendar days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted:

(1) Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or
(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 (f).

(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
Street City State Zip Action

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.

Signed by Judy Sloan on 07/10/2009


FEMA Standard Form LLL
Complete only if applying for a grant for more then $100,000 and have lobbying activities using Non-Federal funds.

If this lobbying form is not applicable, check "this form is not Applicable."

This form is not applicable