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Home My WebLink About20150305.tiff OEM — Office of Emergency Management AN. Jr 18aol Director: Roy Rudisill 1150 "O" Street • r _ PO Box 758 Greeley, CO 80632-0758 R u N T • Phone 970-304-6540 iX! + . f� Fax 970-336-7242 www.co.weld.co.us EMERGENCY MANAGEMENT Mrs. Marilyn Gaily State Hazard Mitigation Officer Colorado Department of Public Safety Division of Homeland Security and Emergency Management Office of Emergency Management 9195 E. Mineral Ave. Suite 200 Centennial, CO 80112-3556 Dear Mrs. Marilyn Gaily, As part of the Hazard Mitigation Grant Program process, a local funding match is required to be identified. This letter serves as Weld County commitment to meet the matching fund requirements for the Hazard Mitigation Program project Southwest Service Center Generator.The local matching fund requirement is$ 17,533.00 Matching funds will come from Weld County General funds, at this time we are counting on CDBG-DR funds for our match. It is understood that 12.5%of the non-federal share of the HMGP projects will be contributed by the State of Colorado. Your assistance is greatly appreciated. Sincerely,8^410 /,� Roy Rudisill - Director �� d f Seth— CC:OEM 62k)%44, 2015-0305 i as-.240r3 FM DO ® Colorado Division of Homeland Security Hazard Mitigation Application and Emergency Management Standby Generator THIS SECTION FOR STATE USE ONLY DISASTER:4145 FEMA Identification Number: Colorado Point of Contact: State Hazard Mitigation Office Date Applications Received: Colorado DHSEM 9195 East Mineral Avenue,Suite 200 Date State Approval: Centennial,Colorado 80112 Office: 720-852-6694 FEMA Application Submittal Date: Fax: 720-852-6750 Email: Sean.Settle@state.co.us NOTE:Application must be submitted in digital form. PROJECT OVERVIEW 1. Applicant Legal Name: Weld County Organizational Unit: Weld County Office of Emergency Management 2. Applicant Type: n Local Government n State Government nNative American Tribe Private Non-Profit(Attach copy of 501 c3) 3. Project Title: Southwest Services Center Generator 4. Proposed Project Total Cost: $ I4 Ct 2.59.co The Stale of Colorado Generator Handbook and the Hazard Mitigation Grant Program Scoring Sheet accompanies this application.Much of the Federal Share(75%) $ 105,194.00 information needed to complete this application,and particularly those areas marked with an asterisk, can be found in these documents. In State Match(12.5%): $ 17,s-.31, eo addition,e-mail and telephone technical assistance may be requested. Local Match(12.5%): $ 17,533.00 5. Enter the Benefit Cost benefits,cost,and ratio determined prior to application. Export the Benefit Cost file and provide in electronic format,along with all supporting documentation used to develop the ratio. If Benefit Cost Analysis was waived,place an"N/A"in the blanks,and provide explanation below for the exemption.Attach Documentation Benefit: $ n/a Cost: $ n/a Ratio: n/a • 6. Certifications: The undersigned assures fulfillment of all requirements of the Hazard Mitigation Grant Program as contained in the program guidelines and that all information contained herein is true and correct to the best of my knowledge. The governing body of the applicant has duly authorized the document,and hereby applies for the assistance documented in this application. Also,the applicant understands that the project may proceed ONLY AFTER FEMA APPROVAL is gained. Barbara Kirkmeyer Chairman Weld County Commissioners 970-336-7204 Type Name of Authorized Represen tive/Applicant Agent Title Telephone Number "`Lir- 02t C213/54 g Date Signed Atte any continuations or additional items to this page. Page 1 of 15 Hazard Mitigation Application Continued Colorado Division of Homeland Security and Emergency Management APPLICANT INFORMATION 1. Does your community have a current FEMA approved multi-hazard mitigation plan? n Yes n No Location of proposed project in mitigation plan strategies Page 5.3-5.4 Section/Part 5.1.1 2. Is the community a member of good standing with the National Flood Insurance Program? n Yes n No 3. Has the community adopted the IBC nationally recognized building code? n Yes n No 4. FIPS Code: 123 DUNS Number: 07575-7955 5. U.S. Congressional District: 4th Congressman Name: Mr Cory Gardner 6. State Senatorial District: 1 Senator Name: Senator Greg Brophy 7. State Legislative District: 50 Representative Name: Rep David Young 8. Primary Point of Contact: The Primary Point of Contact is the person responsible for coordinating the implementation of this proposal, if approval is granted. Ms. X Mr. Mrs. First Name: Roy Last Name: Rudisill Title: Director,Weld Co. OEM Organization: Weld County Street Address: 1150 O Street City: Greeley State: Co Zip Code: 80632 Telephone: 970-304-6540 Fax: Mobile: 970-381-0417 E-mail Address: rrudisill@weldgov.com 9. Alternate Point of Contact: The Alternate Point of Contact is the person that can address questions or concerns in the Primary Point of Contact's absence. X Ms. _ Mr. Mrs. First Name: Merrie Last Name: Leach Title: OEM Coordinator Organization: Weld County Street Address: 1150 O Street City: Greeley State: Co Zip Code: 80632 Telephone: 970-381-0417 Fax: Mobile: E-mail Address: mleach@weldgov.com 10. Application Prepared by: _ Ms. X Mr. Mrs. First Name: Aaron Last Name: Henderson Title: Hazard Mitigation Planner Organization: Arcadis US, Inc Street Address: 3522 Thomasville Rd City: Tallahassee State: Fl Zip Code: 32309 Telephone: 850-895-4708 Fax: Mobile: E-mail Address: aaron.henderson©arcadis-us.com 11. Authorized Applicant Agent: The Authorized Applicant Agent MUST be the chief executive officer, mayor, etc. This person must be able to sign contracts,authorize funding allocations or payments,etc. _ Ms. X Mr. Mrs. First Name: Douglas Last Name: Rademacher Title: Chairman,Weld Commissioner Organization: Weld County Street Address: 1150 O Street City: Greeley State: Co Zip Code: 80632 Telephone: 970-336-7204 Fax: Mobile: E-mail Address: drademacher@weldgov.com Attach any continuations or additional items to this page. Page 2 of 15 Hazard Mitigation Application Continued Colorado Division of Homeland Security and Emergency Management Generator Scoring Worksheet: (to be used in project ranking)Answer all questions Does the project reduce the needs for emergency services? Yes n No[n(0,5,or 10 pts.) Does the project reduce threats to multiple communities? Yes nNon(0 or 5 pts.) Does the project reduce death and injury vulnerability? Yes n Nor-1(0,5,or 10 pts.) Does the project reduce costs of future disaster damages? Yes nNo n(0,5,or 10 pts.) Does the applicant have an approved mitigation plan(existing or being added)? Yes 1--No n(10 or 0 pts.) Has the applicant previously submitted for mitgation funding? Yes El Non(0 or 5 pts.) Is the applicant willing to increase their local match of funding for their project? Yes nNo n(10 or 0 pts.) Has the applicant made a plan for future operation and maintenance costs(O&M)? YesnNon(0 or 5 pts.) Has the applicant successfully implemented previous mitigation grants? Yes nNo n(0 or 5pts.) Has the applicant submitted a complete proposal that does not lead to confusion? Yes nNo n(0,5,or 10 pts.) Attach any continuations or additional items to this page. Page 3 of 15 Hazard Mitigation Application Continued Colorado Division of Homeland Security and Emergency Management PROJECT DESCRIPTION 12. Site Address: (No PO or Route No.) 4209 Weld County Road 24 1/2 13. City, State,Zip Code: Longmont Co.80501 14. Tax Parcel ID: 131302400005 15. Property Tax ID: 131302400005 16. Latitude(in decimal form): 40.169468 17. Longitude(in decimal form): -104.975343 (Site information and latitude/longitude should be entered on Individual Generator Worksheets and not here if more than one generator/connection site is proposed.) 18. Flood Zone Designation: AE or A 1-30 A(no base flood elevation given) B or X(shaded) x C or X(un-shaded) 19. Panel Number of the FIRM used to determine the above: 08123 1890E 20. Date of FIRM: 5-31-13 21. Describe, in detail,the proposed project. Explain how the proposed project will solve the problem(s)and provide the level(s)of protection. Include a description of the desired outcome and methodology of the mitigation activity in terms of mitigation objectives to be achieved. Identify the critical components and describe the facility/location of the proposed project. See attached documentation 22. Is this a new or replacement generator or connection? n New PI Replacement 23. Is this a stand-alone or a portion of an existing structure? n Stand-Alone ri Existing Structure 24. Power Generation Worksheet- for emergency power generation only Instructions for Worksheet: • Prepare separate worksheet for each individual site requesting generator or connection systems. • In order to ensure timely processing of your application,please number and prioritize all sites. • Include certification of the emergency power generation capacity needed for structure. This certification should include the criteria used for determination,along with the calculated safety factor. A professional engineer,Power Company representative or the generator manufacturer's representative shall submit the certification(See Attached Data Sheet). Attach any continuations or additional items to this page. Page 4 of 15 Hazard Mitigation Application Continued Colorado Division of Homeland Security and Emergency Management Generator Data Worksheet: THIS IS WORKSHEET#1 OF 1 (Total Number of Worksheets) 1. Site Information: Southwest Weld County Service Center 2. Site Name: Weld SWS Building 3. Priority# 1 4. Street Address(including city, state,zip code,tax map&parcel, and county)or Physical/Legal Location: 4a. Latitude(in decimal form): 40.169468 4b. Longitude (in decimal form): -104.975343 5. Population Affected Provide the number of each type of structure(listed below)in the project area. Include all structures in project area. 0 residential properties 1 businesses/commercial properties public buildings 0 schools/hospitals/houses of worship n/a for 5%water and wastewater generator connection projects list the number of customer connections 6. How long was site without power? 7. Do you currently have back-up power for this site? no If so,what type? 8. Structure Information: 9. Date of Construction 10. Kilowatt/Hour Usage 11. Will the generator be mounted on the building? no 12. On the ground or in a separate housing? on a pad 13. Is generator elevated on a platform or in a flood-proofed location? Yes 14. Funding Sources(round figures to the nearest dollar). The maximum FEMA share for HMGP projects is 75%. The other 25%can be made up of State and Local funds as well as in-kind services. HMGP funds may be packaged with other Federal funds,but other Federal funds(except for Federal funds which lose their Federal identity at the State level)may not be used for the State or Local match. Estimated FEMA Share $105,194.00 75 %of Total Non-Federal Share Estimated Local Share $35,065.00 25 %of Total (Include In-Kind Values) State Match List Funding Sources $17,533.00 12.5 %of Total Estimated State Share List Funding Sources Local Match Estimated Other Agency Share $17,532.00 12.5 %of Total Identify Other Non-Federal Agency Other Non-FEMA Federal Funds $ Do Not Include In Total Identify Other Federal Agency Attach any continuations or additional items to this page. Page 5 of 15 Hazard Mitigation Application Continued Colorado Division of Homeland Security and Emergency Management 15. Generator Data: Manufacturer Name: Generac Automatic Stand-By generator Model Number: 32NF34 Date of Manufacture: A. Running Load(KW) 125 Kw B. Starting Load(KW) 125 Kw C. Is load being stepped in? D. Generator Specified(KW) 125 Kw E. Generator Voltage 480 V F. Maximum Power Output 200 amps G. Single or Three Phase Three H. Number of Poles 3 I. Type of Controls X Automatic Manual Remote Manual Voltage Control J. How Fast Can Controls Respond: X 0-19 Seconds 20 Seconds—3 Minutes Greater than 3 Minutes K. Type of Fuel X Gas Diesel Propane Steam Other Additional information/remarks: I certify that I have visited the project site,performed all necessary tests,and have verified that the attached calculated loads and generator specifications will meet all requirements of this proposed installation as described in the Project Application's description of work. Principal 1/5/15 Signature Title Date Ronald Boone RJ McNutt&Associates 970-330-3266 Print Name Organization Telephone Number NOTES: 1. The generator must be installed in accordance with all applicable local and national building and electrical codes. 2. Please attach available information on proposed equipment,load and sizing data,etc. 3. The Applicant should develop and implement a generator maintenance plan which includes periodically exercising the generator under load. Attach any continuations or additional items to this page. Page 6 of 15 Hazard Mitigation Application Continued Colorado Division of Homeland Security and Emergency Management SCOPE OF WORK / BUDGET 25. This section details all of the costs estimated for the project and is broken into three areas that cover(1)Materials;(2) Labor;and(3)Fees Paid. To assist in understanding what types of costs are eligible,we have provided a synopsis for you below from FEMA's 2013 Hazard Mitigation Assistance Unified Guidance, Part X,Appendix G. List all items and costs in line item fashion. Do not include contingency costs in the budget. 26. Materials Item Dimensions Quantity Cost per Unit Cost mtwr so Pmw.n.,mar.wsm 1 7413.10 $7413.10 27. Labor (Include equipment costs--please indicate all"soft" or in-kind matches) Description Hours Rate Cost Design,Engineering,Permits and install 5.5/22 272.73/204.55 $6000.00 28. Fees Paid Include any other costs associated with the project Description of Task Hours Rate Cost Project mamangement 7%total Project $938.92 Total Estimated Project Cost$ 29. LINE-ITEM BUDGET ***ATTACH EXCEL BUDGET HERE(may use the EXCEL worksheet provided by the Grantee) *** 1. TOTALS FROM SPREADSHEET: a.Total Materials $ 109,380.00 If CDBG-DR funds are included in this cost estimate, the value of general and/or professional labor wages b. Total Labor $ 24,200.00 must be tabulated in accordance with the Davis Bacon c. Total Fees Paid $ 6,679.00 Act of 1931. 2. Total Project Cost(a+b+c) $ 140,259.00 75% Federal Share $ 105,194.00 12.5% State Match $ 17,533.00 12.5%Local Match $ 17,533.00 NOTE:Round Federal Share to nearest dollar. 30. Non-Federal Funding Share(25%of Total Cost) List all sources and amounts utilized in the non-federal share including all in-kind services. In-Kind services may not exceed the 25% non-federal share. If any portion of the non-Federal share will come from non-applicant sources (donated services,private donation,etc.),attach letters of funding commitment for each non-applicant source. Commitment Source Name of Source Agency Type Funding Amount Letter Attached Weld County Weld County Commission Cash $ 17,533.00 Yes State of Colorado Division of HSEM $ 17,533.00 In-Kind Labor In-Kind Labor In-Kind $ n/a In-Kind Materials In-Kind Materials In-Kind $ n/a Source=State,Local,Private Non-Profit,Other Source Agency=Specific entity providing match Type Funding=Administration,Cash,Consulting Fees,Engineering Fees,Equipment Operation/Rental,Labor,Supplies,Other 31. Describe how you will manage the costs and schedule,and how you will ensure successful performance. See attached documentation Attach any continuations or additional items to this page. Page 7 of 15 Hazard Mitigation Application Continued Colorado Division of Homeland Security and Emergency Management 32. Enter any additional comments related to the proposed project's funding,if desired. See attached documentation Eligible Costs Notes: • HMGP funding of emergency stand-by power generators may be either classified as regular or initiative projects depending on whether or not a benefit cost radio(BCR) can be determined. If a BCR can be determined, the ratio must satisfy the requirements of cost-effectiveness (e.g. the minimum ratio must be 1.0 benefit or higher to 1.0 cost). If the applicant's proposal is determined not to be cost-effective after the results of a Benefit Cost Analysis is known, the same project may not be resubmitted as an initiative proposal. • HMGP funding for stand-alone connection systems may only be considered for approval under the 5%initiative grant. • Generators and/or connections may not be funded under the 1-IMGP for single family residential structures. Multi-family critical facility residential structures may be funded under the HMGP as either a regular or initiative project. Non-critical multi-family residential structures may only receive 5%initiative HMGP funding. • A separate HMGP emergency stand-by generator application is not requires if the applicant is including a generator or connection as part of a larger HMGP funded construction proposal. TIMELINE / MAINTENANCE 1. Timeline Insert the proposed work schedule as tasks to accomplish the overall goal of the proposed activity, i.e., appraisals, title search, closing, etc., and provide a description of the task's purpose. This timeline will be used as a measurement tool for progress in the project's implementation and is included in the required Quarterly Reports. Also, FEMA uses the timeline for determining the approved period of performance. It will be the basis used to justify delays or extensions,if necessary, and should be estimated carefully. The first and last entries are state requirements and have already been entered. I. Task I: Colorado State Contract Process Timeframe: 3 Months The State contract is the State's legal mechanism required to ensure funding or services to the applicant. The timeframe reflects up to a 3 month period. Task 2: Design&permitting beainning after award within 90 days Timeframe: 3 Months Task 3: procurement of eauipment/contractual services,within 60 days of contract Timeframe: 2 months Task 4:Vendor selection/contracting within 60 days after task 3 Timeframe: 2 months Task 5: Project implementation,within 8 months of state contract Timeframe: 3 months Task 6:Weather delays may add as much as 60 days Timeframe: 2 months Task 7: State/local inspections within 30 days of implementation Timeframe: 1 months Task 8: State Compliance Review and Closeout Timeframe: 3 Months Financial and project reconciliation with local,state,and federal concurrence. Total Timeframe(must not exceed 1,095 days,36 months,or 3 years) Timeframe: 19 Months SPECIAL NOTE:If CDBG-DR funds are included as part of this application,the timeframe may not exceed 730 days,24 months, or 2 years in accordance with HUD regulations. Time extensions will not be approved. Attach any continuations or additional items to this page. Page 8 of 15 Hazard Mitigation Application Continued Colorado Division of Homeland Security and Emergency Management 2. The start date for any proposed project begins upon FEMA approval. If a specific timeframe is needed, provide the timeframe and an explanation. N/a 3. An Operations and Maintenance(O&M)plan must be developed for each generator/connection project. For application purposes,there must be an assurance acknowledging that the generator and/or connection will be operated and maintained in a manner that will achieve the proposed hazard mitigation. The final plan must be submitted prior to project closeout,because FEMA will review the final O&M plan during project closeout. For the application,do you provide assurance that: A. The generator will be operated and maintained in a manner that will achieve the n Yes n No proposed hazard mitigation? B. The final O&M Plan will be provided prior to project closeout,for review by FEMA? [J Yes I-1 No C. Is a signed Maintenance Agreement attached to this application? n Yes .0 No 4. In addition to#3 above, the following questions are to give assurance on the project's maintenance over its useful life. Please answer each question and give a brief explanation. a. Who will be responsible for providing maintenance to the generator and/or connection(s)? Both the Weld Co.Office of Emergency Management and the Weld Co.Dept.of Buildings&Grounds will share responsibility for the meintonnn,.o and o..orrica nf thoca nnnorotnrc b. What is the cost of maintenance on an annual basis? $544.00/year Note: Cost of maintenance is considered an application prioritization weighting factor.Projects containing high maintenance costs have a greater risk of future failure due to deferred maintenance.Therefore,the responses provided above should be as complete and verifiable as possible in order to minimize the likelihood of ranking points reductions due to maintenance concerns. ALTERNATIVE ACTIONS List two feasible alternative projects to mitigate the hazard(s)in the project area. One alternative is the"No Action Alternative." 1. No Action Alternative Discuss the impacts on the project area if no action is taken. See attached documentation 2. Other Feasible Alternative Project Title: See attached documentation a. Project Description and Scope of Work Discuss a feasible alternative to the proposed project. This could be an entirely different mitigation method or a significant modification to the design of the current proposed project. Please include scope of work, engineering details(if applicable), estimated budget and the impacts of this alternative. Also,explain how the alternative project will solve the problem(s)and/or provide protection for the hazard(s). Attach any continuations or additional items to this page. Page 9 of 15 Hazard Mitigation Application Continued Colorado Division of Homeland Security and Emergency Management ENVIRONMENTAL/CONSULTATION REQUIREMENTS Regulations governing the Hazard Mitigation Grant Program(HMGP)state that any project must"be in conformance with 44 CFR part 9, Floodplain Management and Protection of Wetlands, and 44 CFR part 10, Environmental Considerations." To comply with this mandate, written coordination must occur with the state and Federal agencies listed below to provide documentation relative to its potential effect on the physical,biological and built environment. NOTE: In coordinating with the below listed agencies, please provide photographs of the project site and adjacent area/structures, a description of the project referencing structure/site addresses, site map,property map and USGS map with the property location marked Maps must be of sufficient scale and detail that show the project site and surrounding project area(area of potential effects). Attach copies of the correspondence sent and received from below agencies (letters, permits, etc.). A list of contacts, addresses, and phone numbers,as well as an example letter,are provided in the Applicant Handbook. State Historical Preservation Office Environmental Requirement: National Historic Preservation Act:Historical Structures and Archeological Resources Questions Addressed: Does your project affect or is it in close proximity to any buildings or structures of any kind? Does your project involve disturbance of ground? Colorado Division of Wildlife-T&E Species AND U.S.Department of the Interior(Fish and Wildlife Service) Environmental Requirement: Endangered Species Act and Fish and Wildlife Coordination Act Questions Addressed: Does your project remove vegetation? Is your project in or near any type of waterway or body of water?(within%d mile) Is the project not contained within existing structures,or may it result in changes or potential effects to the natural environment? Are there threatened or endangered species or their critical habitat present in the project area or within the county the project is located within? Will this activity require an Aquatic Resource Alteration Permit? Colorado Department of Public Health and Environment AND U.S.Army Corps of Engineers Environmental Requirement: Clean Water Act,Rivers and Harbors Act,and Executive Order 11990(Protection of Wetlands) Executive Order 11988(Floodplain Management) Questions Addressed: Will the project involve work near or in a waterway, dredging or disposal of dredged material, excavation,adding fill material or result in any modification to water bodies or wetlands designed as "waters of the U.S."as identified by the US Army Corps of Engineers or on the National Wetland Inventory? Will the project require a National Pollutant Discharge Elimination System(NPDES) permit from the U.S.Environmental Protection Agency? Will this activity require a Construction Storm-water Permit? Does the project alter a watercourse,water flood patterns,or a drainage way,regardless of its floodplain designation? Will the activity require a CLOMR(Conditional Letter of Map Revision)? U.S. Department of Agriculture(Natural Resources Conservation Services) Environmental Requirement: Farmland Protection Policy Act Questions Addressed: Will the project convert more than 5 acres of farmland outside community limits and require documentation from the USDA Natural Resource Conservation Service (Prime, Unique or other Important Farmlands)? U.S. Army Corps of Engineers AND Colorado Department of Transportation Regulatory Requirement: 44 CFR§80.13(b): Consultation regarding other ongoing Federal Activities Question Addressed: (1)The sub-applicant must demonstrate that is has consulted with USACE regarding the subject land's potential future use for the construction of a levee system. The subapplicant must also demonstrate that it has, and will, reject any future consideration of such use if it accepts FEMA assistance to convert the property to permanent open space. (2)The sub-applicant must demonstrate that it has coordinated with its State Department of Transportation to ensure that no future, planned modifications, improvements, or enhancements to Federal aid systems are under consideration that will affect the subject property. Attach any continuations or additional items to this page. Page 10 of 15 Hazard Mitigation Application Continued Colorado Division of Homeland Security and Emergency Management Additional Comments Enter any additional comments related to environmental concerns for the proposed project if desired. See additional Documentation Attach any continuations or additional items to this page. Page 11 of 15 Hazard Mitigation Application Continued Colorado Division of Homeland Security and Emergency Management ASSURANCES Construction Programs Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions,searching existing data sources,gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden,to the Office of Management and Budget, Paperwork Reduction Project(0348-0042),Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. 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: 1. Has the legal authority to apply for Federal assistance, one of the 19 statutes or regulations specified in and the institutional, managerial and financial capability Appendix A of OPM's Standards for a Merit System of including funds sufficient to pay the non-Federal share Personnel Administration(5 C.F.R. 900, Subpart F). of project costs to ensure proper planning, management and completion of the project described in this 9. Will comply with the Lead-Based Paint Poisoning application. Prevention Act(42 U.S.C. §§4801 et seq.)which prohibits the use of lead-based paint in construction or 2. Will give the awarding agency,the Comptroller General rehabilitation of residence structures. of the United States and,if appropriate,the State, 10. Will comply with all Federal statutes relating to non- through any authorized representative,access to and the right to examine all records, books, papers, or discrimination. These include but are not limited to:(a) documents related to the assistance; and will establish a Title VI of the Civil Rights Act of 1964(P.L. 88-352) which prohibits discrimination on the basis of race,color proper accounting system in accordance with generally accepted accounting standards or agency directives. or national origin; (b)Title IX of the Education Amendments of 1972,as amended (20 U.S.C.§§1681- 3. Will not dispose of,modify the use of,or change the 1683,and 1685-1686),which prohibits discrimination on terms of the real property title,or other interest in the the basis of Sex; (c)Section 504 of the Rehabilitation site and facilities without permission and instructions Act of 1973, as amended (29 U.S.C. §794),which from the awarding agency. Will record the Federal prohibits discrimination on the basis of handicaps; (d) interest in the title of real property in accordance with the Age Discrimination Act of 1975,as amended(42 awarding agency directives and will include a covenant U.S.C. §§6101-6107),which prohibits discrimination on in the title of real property acquired in whole or in part the basis of age; (e)the Drug Abuse Office and with Federal assistance funds to assure non- Treatment Act f 1972(P.L. 92-255),as amended, discrimination during the useful life of the project. relating to nondiscrimination on the basis of drug abuse; (f)the Comprehensive Alcohol Abuse and Alcoholism 4. Will comply with the requirements of the assistance Prevention,Treatment and Rehabilitation Act of 1970 awarding agency with regard to the drafting, review and (P.L.91-616), as amended, relating to nondiscrimination approval of construction plans and specifications. on the basis of alcohol abuse or alcoholism;(g)§§523 5. Will provide and maintain competent and adequate and 527 of the Public Health Service Act of 1912(42 engineering supervision at the construction site to U.S.C. §§290 dd-3 and 290 ee-3),as amended, relating ensure that the complete work conforms with the to confidentially of alcohol and drug abuse patient approved plans and specifications and will furnish records; (h)Title VIII of the Civil Rights Act of 1968(42 progress reports and such other information as may be U.S.C. §§3601 et seq.), as amended, relating to required by the assistance awarding agency or state. nondiscrimination in the sale, rental or financing of housing; (i)any other nondiscrimination provisions in the 6. Will initiate and complete the work within the applicable specific statute(s)under which application for Federal time frame after receipt of approval of the awarding assistance is being made; and(j)the requirements of agency. any other nondiscrimination statute(s)which may apply 7. Will establish safeguards to prohibit employees from to the application. using their positions for a purpose that constitutes or 11. Will comply,or has already complied,with the presents the appearance of personal or organizational requirements of Titles II and III of the Uniform conflict of interest,or personal gain. Relocation Assistance and Real Property Acquisition 8. Will comply with the Intergovernmental Personnel act of Policies Act of 1970(P.L. 91-646)which provide for fair 1970(42 U.S.C.§§4728-4763)relating to prescribed and equitable treatment of persons displaced or whose standards for merit systems for programs funded under property is acquired as a result of Federal and federal- Attach any continuations or additional items to this page. Page 12 of 15 • Hazard Mitigation Application Continued Colorado Division of Homeland Security and Emergency Management assisted programs. These requirements apply to all approved State management program developed under interests in real property acquired for project purposes the Coastal Zone Management Act of 1972(16 U.S.C. regardless of Federal participation in purchases. §§1451 et seq.);(f)conformity of Federal actions to State(Clean Air)Implementation Plans under Section 12. Will comply with the provisions of the Hatch Act(5 (c)o U.S.C. §§1501-1508 and 7324-7328)which limit the U.S.C. §f the 1 Clean t Air Act of 1955, n of underground nde (u2 political activities of employees whose principal U.S.C. §oof drinkingdri water seq.); r under er the protection Safe Drinking Water employment activities are funded in whole or in part with sources 7 ,asamended d (P .93-523);3- S a d,(h) hing Federal funds. Act of 1974, (PL. and, protection of endangered species under the 13. Will comply, as applicable, with the provisions of the Endangered Species Act of 1973,as amended (P.L. 93- Davis-Bacon Act(40 U.S.C.§§276a to 276a-7),the 205). Copeland Act(40 U.S.C.§276c and 18 U.S.C. §874), 16. Will comply with the Wild and Scenic Rivers Act of 1968 and the Contract Work Hours and Safety Standards Act (16 U.S.C. §§1271 et seq.)related to protecting (40 U.S.C.§§327-333)regarding labor standards for components or potential components of the national wild federally-assisted construction sub-agreements. and scenic rivers system. 14. Will comply with flood insurance purchase requirements 17. Will assist the awarding agency in assuring compliance of Section 102(a)of the Flood Disaster Protection Act of with Section 106 of the National Historic Preservation 1973(P.L. 93-234)which requires recipients in a special Act of 1966,as amended (16 U.S.C. §470), EO 11593 flood hazard area to participate in the program and to (identification and protection of historic properties),and purchase flood insurance if the total cost of insurable the Archaeological and Historic Preservation Act of construction and acquisition is$10,000 or more. 1974(16 U.S.C.§§469a-1 et seq.). 15. Will comply with environmental standards which may be 18. Will cause to be performed the required financial and prescribed pursuant to the following: (a)institution of compliance audits in accordance with the Single Audit environmental quality control measures under the Act Amendments of 1996 and OMB Circular No. A-133, National Environmental Policy Act of 1969(P.L.91-190) "Audits of States, Local Governments, and Non-Profit and Executive Order(EO) 11514; (b)notification of Organizations." violating facilities pursuant to EO 11738; (c)protection of wetlands pursuant to ED 11990; (d)evaluation of 19. Will comply with all applicable requirements of all other flood hazards in floodplains in accordance with EO Federal laws,executive orders, regulations,and policies 11988; (e)assurance of project consistency with the governing this program. i �y��,( d Commissioner Chairman Weld County B0CC SIG RE O AU"T—HO'R"I`Z-m ERTIFYING OFF IAL TITLE Weld County /—&6-020 is- APPLICANT ORGANIZATION DATE SUBMITTED SF424D(Rev.7-97)Back Attach any continuations or additional items to this page. Page 13 of 15 Hazard Mitigation Application Continued Colorado Division of Homeland Security and Emergency Management ASSURANCES CONTINUED Certifications Regarding Lobbying; Debarment,Suspension and Other Responsibility Matters;and Drug-Free Workplace Requirements 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 FEMA funding. States and State agencies may elect to use a Statewide certification. 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 28 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 Federal Emergency Management Agency(FEMA)determines to award the covered transaction,grant,or cooperative agreement. 1. LOBBYING 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 44 CFR 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 subgrants,contracts under grants and cooperative agreements,and subcontract(s))and that all subrecipients shall certify and disclose accordingly. 2. DEBARMENT,SUSPENSION AND OTHER RESPONSIBILITY MATTERS(DIRECT RECIPIENT) As required by Executive Order 12549, Debarment and Suspension,and implemented at 44 CFR 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 governmental entity(Federal, State, or locally)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 44 CFR Part 17, Subpart F,for grantees, as defined at 44 CFR part 17, Sections 17.615 and 17.623: (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; Attach any continuations or additional items to this page. Page 14 of 15 Hazard Mitigation Application Continued Colorado Division of Homeland Security and Emergency Management (2) The grantee's 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 FEMA awarding office, i.e. regional office or FEMA 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) Require 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 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 Code Southwest Weld County Services Building 4209 Weld County Rd 24.5 Longmont Co 80501 4UREoFAUTHORIlYiNIoFL Commissioner Chairman Weld County BOCC weld County /-O27-20/3 APPLICANT ORGANIZATION DATE SUBMITTED Attach any continuations or additional items to this page. Page 15 of 15 Hello