HomeMy WebLinkAbout20132855.tiffRESOLUTION
RE: APPROVE REQUEST FOR PUBLIC ASSISTANCE AND AUTHORIZE ELECTRONIC
SUBMITTAL - FEDERAL EMERGENCY MANAGEMENT AGENCY
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Request for Public Assistance from the
County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld
County, to the Federal Emergency Management Agency, with terms and conditions being as
stated in said request, and
WHEREAS, after review, the Board deems it advisable to approve said request, a copy of
which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Request for Public Assistance from the County of Weld, State of
Colorado, by and through the Board of County Commissioners of Weld County, to Federal
Emergency Management Agency be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said request.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 8th day of October, A.D., 2013.
BOARD OF COUNTY COMMISSIONERS
WELD CQUJsIT-Y COLORADO
ATTES
Weld County Clerk to the Board
Deputy
215-
k to the Board
County Attorney
Date of signaturccT 0 9 2013
rbara Kirkmeyr
loll
2013-2855
BC0045
DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
REQUEST FOR PUBLIC ASSISTANCE
O.M.B. NO. 1660.0017
Expires April 30, 2013
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 10 minutes. Burden means the time, effort and financial resources
expended by persons to generate, maintain, disclose, or to 'provide information to us. You may send comments regarding the
burden estimate or any aspect of the collection, including suggestions for reducing the burden to: Information Collections Management,
Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472,
Paperwork Reduction Project (OMB Control Number 1660-0017). You are not required to respond to this collection of information
unless it displays a valid OMB number. NOTE: Do not send your completed questionnaire to this address.
APPLICANT (Political subdivision or eligible applicant)
COUNTY (Location of Damages. If Iated in multiple counties, please indicate)
APPLICANT PHYSICAL LOCATION
DATE SUBMITTED
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DUNS NUMBER
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STREET ADDRESS
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CITY
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STREET ADDRESS
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COUNTY
STATE
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MAILING ADDRESS (If different from Physical Location)
ZIP CODE
POST OFFICE BOX
CITY
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STATE
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ZIP CODE
Primary Contact/Applicant's Authorized Agent
Alternate Contact
NAME
NAME
TITLE
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TITLE
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BUSINESS PHONE
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BUSINESS PHONE
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FAX NUMBER
FAX NUMBER
HOME PHONE (Optional)
HOME PHONE (Optional)
CELL PHONE
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CELL PHONE
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E-MAIL ADDRESS
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E-MAIL ADDRESS
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PAGER & PIN NUMBER
PAGER & PIN NUMBER
Did you participate in the Federal/State Preliminary Damage Assessment (PDA)? YES I-- NO
Private Non -Profit Organization? r YES r NO (�
If yes, which of the facilities identified below best describe your organization?
Title 44 CFR, part 206.221(e) defines an eligible private non-profit facility as: "... any private non-profit educational, utility, emergency, medical or custodial
care facility, including a facility for the aged or disabled, and other facility providing essential governmental type services to the general public, and such
facilities on Indian reservations." "Other essential governmental service facility means museums, zoos, community centers, libraries, homeless shelters,
senior citizen centers, rehabilitation facilities, shelter workshops and facilities which provide health and safety safety services of a governmental nature.
All such facilities must be open to the general public."
Private Non -Profit Organizations must attach copies of their Tax Exemption Certificate and Organization Charter or By -Laws. If your
organization is a school or educational facility, please attach information on accreditation or certification.
OFFICIAL USE ONLY: FEMA - -DR-
FIPS# DATE RECEIVED
FEMA Form 90-49 AUG 10 REPLACES ALL PREVIOUS EDITIONS
2013-2855
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