HomeMy WebLinkAboutIII (D) Acceptance and Authorization for Mayor and City Clerk to execute Disaster Relief Funding Agreement with the State of Florida Department of Community Affairs AGENDA 9-19-95
Item III D
Ocoee76 e re ta4 sce.et
125 N. Bluford Avenue — Ocoee, Florida 34761
•
RON STROSNIDER EMERGENCY 656-1313
Fire Chief BUSINESS 656-7796
DATE: September 14 , 1995
TO: The Honorable Mayor and Board of City Commissioners
FROM: Ron Strosnider , Fire Chief f/
RE: Disaster Relief Funding Agreement
Since Hurricane Erin , Administrative Services and I have met with
State and Federal Officials and worked on the monies associated
with disaster relief . The Federal Government through its Federal
Emergency Management Agency (FEMA) has guaranteed reimbursement of
75% of the eligible costs associated with the disaster , (August 1st
and August 2nd , 1995 ) and the debris removal activities , as
attached , (August 2 , 5 , 6 , 9- 12 , 14-19 , 21 , and 22 , 1995 ) while the
State will fund the remaining 25%. With a 100% refunding and an
additional 3% for administrative expense , the overtime cost and
miscellaneous operating expenses for Hurricane Erin should provide
the anticipated revenues in Fiscal Year 1996 of $30 , 000 . 00
The attached Disaster Relief Funding Agreement must be executed
before repayment may occur . This is a standard Federal Agreement
with clauses that accept the adherence to various Federal Acts .
Because of the required return the City Attorney will be reviewing
simuultaneous to the Commission ' s Review.
Staff recommends that the Mayor and Board of City Commissioners
approve the Agreement and authorize the Mayor and City Clerk to
execute .
RDS/sm
OIL
Co(60,4
DCA AGREEMENT NO. 96RM-6B-06-58-02-129
FEMA PROJECT APPLICATION NO. 095-51075
DISASTER RELIEF FUNDING AGREEMENT
This Agreement is between the State of Florida, Department of
Community Affairs (Grantee) and City of Ocoee
, (Subgrantee) . In support of the
Agreement, the parties state:
WTEREAS, Hurricane Erin and its remnants produced disastrous
weather conditions which had a devastating impact upon Central .
North Central and Northwestern Florida; and
WHEREAS, the severity of the damage loss resulted in the
declaration of an emergency by the Governor in Executive Order
numbers 95-282 and 95-283 ; and
WHEREAS, The President of the United States has concurred and
has declared an emergency for the counties of Escambia, Santa Rosa,
Okaloosa, Walton, Bay, Gulf, Calhoun, Washington, Holmes, Jackson,
Wakulla, Brevard, Indian River, Pasco, Pinellas, Hillsborough,
Hernando, Manatee, Franklin, Orange and St.Lucie; and
WHEREAS, the Federal Emergency Management Agency (FEMA) , as a
result of the Presidential Declaration, has made available federal
funds for disaster relief activities in FEMA-3116-EM-FL; and
WHEREAS, the FEMA-State Agreement, defined herein below,
governing the use of those funds requires the State to share in the
total costs eligible for federal assistance; and
WHEREAS, Sections 252 . 35 . 252 . 36, 252 . 37 , and 252 . 38 ,
Florida Statutes, authorize the relationship described herein.
p
NOW THEREFORE, the parties agree as follows:
1. DEFINITIONS: Unless otherwise indicated, the following
terms shall be defined as stated herein.
a. "Eligible emergency work and debris removal
activities" , as used in this Agreement, means those activities
authorized in the FEMA-State Agreement, as defined herein below,
and defined in Public Law 93-288 , as amended by Public Law 100-707
(hereinafter the "Stafford Act") ; and Title 44 CFR, Part 206.
b. "FEMA-State Agreement" shall mean that agreement
between FEMA and the State of Florida, dated August 9 . 1995 and all
modifications thereto. -
c. "Emergency Assistance" shall be defined as that
assistance authorized in Title V of the Stafford Act and 44 CFR 206
subpart C.
d. "Project" shall be defined as stated in 44 CFR
206.201 (i) .
e. "Large Project" and "Small Project" shall be defined
as indicated in 44 CFR 206. 203 (c) .
2 . APPLICABLE STATUTES, RULES and AGREEMENTS: The parties
agree to be bound by all terms of the FEMA-State Agreement and all
applicable state and federal statutes and regulations, including
but not limited to:
(a) 44 CFR parts 13 , 14 and 206;
(b) 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;
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(c) 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;
(d) Section 504 of the Rehabilitation Act of 1973 , as amended
(29 U.S.C. 794) which prohibits discrimination on the basis of
handicaps;
(e) the Age Discrimination Act of 1975, as amended (42 U. S.C.
6101-6107) which prohibits discrimination on the basis of age;
(f) the Drug Abuse Office and Treatment Act of 1972 (P.L. 91-
616) as amended, relating to nondiscrimination on the basis of drug
abuse;
(g) 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;
(h) 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;
(i) 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, and any other nondiscrimination
provisions in the specific statute(s) under which application for
federal assistance is being made;
(j) Davis-Bacon Act (40 U. S.C. 276a to 276A-7) , the Copeland
Act of 1973 (40 U.S.C. 276c and 18 U. S.C. 874) , the Contract Work
Hours and Safety Standards Act (40 U. S.C. 327-333) regarding labor
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standards for federally assisted construction subagreements;
(k) Section 106 of the National Historic Preservation Act of
1966, as amended (16 U.S.C. 470) , EO 11593 (identification and
preservation of historic properties) , and the Archaeological and
Historic Preservation Act of 1974 (16 U. S.C. 469a-1 et seq. ) ;
(1) Lead-Based Paint Poisoning Act (42 U.S.C. 4801) et seq. )
which prohibits the use of lead based paint in construction of
rehabilitation or residential structures;
(m) Titles II and III of the Uniform Relocation Assistance and
Real Property Acquisition Act of 1970 (P.L. 91-646) which provides
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. ) ; and
(n) Energy Policy and Conservation Act (P.L. 94-163) , and the
provisions of the state Energy Conservation Plan adopted pursuant
thereto.
3 . FUNDING and INSURANCE: The Grantee shall provide funds to
the Subgrantee for eligible emergency assistance activities for the
projects approved by the Grantee and the Federal Emergency
Management Agency (FEMA) , specifically described in the Damage
Survey Report(s) (DSR(s] ) . Allowable costs shall be determined in
accordance with 44 CFR 5206 and 44 CFR Part 13 , and FEMA
guidelines.
Subgrantee agrees, as a condition of receipt of funding
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pursuant to this Agreement, to obtain reasonably available,
adequate, and necessary insurance for the type or types of hazard
for which the major disaster was declared.
4. DUPLICATION OF BENEFITS PROHIBITION: In accordance with the
provisions of Section 312 of the Stafford Act, duplication of
benefits is prohibited. The Subgrantee shall notify the Grantee, as
soon as practicable, of the existence of any insurance coverage for
the damage identified on the DSR, and of any entitlement or
recovery to payments from another source for the projects described
in the DSR(s) . Eligible costs shall be reduced by the amount of
duplicate sources available. The Subgrantee shall be liable to the
Grantee to the extent that the Subgrantee receives duplicate
benefits from another source for the same purposes for which the
Subgrantee has received payment from the Grantee. The Subgrantee
shall immediately remit to the Grantee any duplication of benefits
payment received by the Subgrantee.
5. COMPLIANCE WITH ENVIRONMENTAL, PLANNING AND PERMITTING
LAWS: The Subgrantee shall be responsible for implementation and
completion of the approved projects described in the DSR(s) in a
manner satisfactory to the Grantee, and in accordance with
applicable federal, state, and local statutes, regulations, plans,
and policies. Any development permit issued by, or development
activity undertaken by, the Subgrantee, and any land use permitted
by or engaged in by the Subgrantee, shall be consistent with the
local comprehensive plan and land development regulations prepared
and adopted pursuant to Chapter 163 , Part II , Florida Statutes.
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Funds shall be expended for, and development activities and land
uses authorized for, only those uses which are permitted under the
comprehensive plan and land development regulations. The
Subgrantee shall be responsible for insuring that any development
permit issued and any development activity or land use undertaken
is, where applicable, also authorized by the Water Management
District, the Florida Department of Environmental Protection, the
Florida Department of Health and Rehabilitative Services, and any
local environmental or land use permitting authority, where
required.
In addition, Subgrantee shall comply with other federal and
state environmental regulations, including, but are not limited 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. ) ;
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(g) protection of underground sources of drinking water under
the Safe Drinking Water Act of 1974 , as amended, (P.L. 93-523) ;
(h) protection of endangered species under the Endangered
Species Act of 1973 , as amended, (P.L. 93-205) ; and
(i) 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.
Subgrantee further agrees to 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.
6. REQUIRED DOCUMENTATION; REVIEW/INSPECTION: The Subgrantee
shall create and maintain acceptable documentation of work
performed and costs incurred with respect to each project
identified in connection with a Damage Survey Report (DSR) .
Failure to create and maintain proper documentation will result in
the disallowance of Public Assistance funding, and require the
refund of funds previously reimbursed or advanced, including an
interest penalty. For all projects, the Subgrantee must submit:
(a) a Summary of Documentation (blank form attached as Exhibit A)
supported by all appropriate backup documentation (e.g. : invoices,
canceled checks, daily activity reports, payroll records,
timesheets, executed contracts, receipts, purchase orders, billing
statements, etc. ) ; and (b) the Project Listing. For all Projects,
the Subgrantee must submit a request for a final inspection. The
Grantee will inspect Projects on a random basis. The Grantee will
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schedule and perform the final inspections on Projects, and review
the Project Listing or inspect the project, to ensure that the work
was performed within the scope of work delineated on the DSR(s) .
Costs of any work not performed within the approved scope of work
shall not be eligible for funding.
7. COST SHARING: The disaster relief funds for eligible costs
indicated on the DSR(s) and described in this Agreement shall be
shared in accordance with the cost sharing provisions established
in the Stafford Act and the FEMA-State Agreement.
Administrative costs, if allowed, are in addition to and not part
of the DSR(s) eligible costs, may otherwise be eligible and involve
no required match, will be funded by FEMA.
8 . PAYMENT OF CLAIMS:
a. SMALL PROJECTS: The Grantee shall make payment to the
Subgrantee. of the Federal share of the eligible costs as soon as
practicable after execution of this Agreement and approval of a
DSR.
b. LARGE PROJECTS: The payments for Large Projects will
be on a cost reimbursement basis and subject to receipt of the
following: (1) a Request For Advance or Reimbursement Form (blank
form attached hereto as Exhibit B) ; (2) a Summary of Documentation
Form, listing the DSR #, identifying the audit ready documentation
that exists to support the payment request, identifying the dollar
amounts of each eligible cost, and identifying the Subgrantee' s own
internal reference number (voucher, warrant, purchase order, etc. ) ;
and (3) a letter providing a brief synopsis of the request, and
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certifying that the reported costs were incurred in the performance
of eligible work.
c. ADVANCES: This Subgrantee may, at the discretion of
the Grantee, be paid an advance of up to twenty-five percent (25%) ,
provided that the Subgrantee: (1) demonstrates and maintains the
willingness and ability to maintain procedures to minimize the time
elapsing between the transfer of funds and their disbursement; (2)
submits budget data on which the request is based; (3) submits a
justification statement explaining the necessity for and proposed
use of the funds, and specification of the amount requested; and
(4) submits a completed Request for Advance or Reimbursement Form.
After any advance, and in the event no advance is provided, all
payments shall be on a cost reimbursement basis. Subgrantees shall
promptly, but at least quarterly, remit interest earned on advances
(if any) to the Grantee for remittance to FEMA.
9 . FINAL PAYMENT: The final payment will be made only after
project completion, submission of all required documentation, final
inspection (Large Projects) , review of Project Listing and/or
inspection (Small Projects) , and a request for final reimbursement.
10 . RECORDS MAINTENANCE: The Subgrantee agrees to maintain
all records pertaining to the projects described in the DSR(s) and
the funds received under this Agreement until all issues relating
to the inspection and final audit have been completed, and any
action or resolution of outstanding issues have been completed. In
no event will such records be maintained for a period of less than
three (3) years from the date of the final payment under this
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Agreement. Access to those records must be provided at reasonable
times to the Comptroller General of the United States, the Grantee,
its employees and agents, and to FEMA, its employees and agents.
11. RECOVERY OF FUNDS: If the final inspection, audit, or
other review by FEMA, the State, or any other authorized entity
determines that payment made under this Agreement exceeds the
amount of actual eligible costs, the Subgrantee shall, within
forty-five (45) days of receipt of the determination notice, repay
the Grantee the amount determined to be in excess of the actual
costs.
12 . AUDIT: -
a. Subgrantees shall submit an Audit of Agreement
Compliance to the Grantee as provided herein. This audit will be
performed by an independent Certified Public Accountant or other
entity independent of the Subgrantee in accordance with the
standards of the Comptroller General as specified in the General
Accounting Office Standards for Audit of Governmental
Organizations, Programs, Activities and Functions, and generally
accepted auditing standards established by the American Institute
of Certified Public Accountants. The agreement number of this
grant must be identified with the audit submitted. Such audit
shall also comply with the requirements of Sections 11. 45 and
216.349, Florida Statutes and Chapter 10. 550, Rules of the Auditor
General, and, to the extent applicable, the Single Audit Act of
1984 , (31 U.S.C. 7501 through 7507) , and OMB Circulars A-128 and
A-133 .
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b. If the Subgrantee is a private non-profit
organization, it shall submit an organization-wide audit in
accordance with OMB Circular A-133 . An organization-wide audit
from a private non-profit organization will be due seven (7) months
after the termination of the organization' s fiscal year.
c. If the Subgrantee is a local government, it shall
submit an audit in accordance with OMB Circular A-128 , pursuant to
the Single Audit Act of 1984, Public Law 98-502 . The audit will be
submitted not later than seven (7) months after the end of the
local fiscal year, in accordance with the requirements of Section
11.45 (3) (a) , Florida Statutes.
d. The Grantee may require the Subgrantee to undertake
such further or additional audits as determined necessary or
appropriate including, but not limited to, past and current
organization-wide audits. Such audits may be necessary
to determine the adequacy, accuracy, and reliability of the
Subgrantee's internal controls, fiscal data, and management systems
established to safeguard the Subgrantee ' s assets and to ensure
compliance with this Agreement.
e. If this Agreement is closed out without an audit, the
Grantee reserves the right to recover any disallowed costs
identified in an audit after such close-out.
13 . NONCOMPLIANCE: If the Subgrantee violates any of the
conditions of disaster relief assistance under the Robert T.
Stafford Act of 1988 , Public Law 93-288 as amended by Public Law
100-707 , the FEMA-State Agreement, applicable state law or
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. j
applicable state or federal regulations, including those noted
herein, additional financial assistance for the project in which
the violation occurred will be withheld until such violation has
been corrected or the Grantee may take any other action that is
legally available.
14 . NONDISCRIMINATION/CONTRACTORS: The Subgrantee shall
maintain an active program of nondiscrimination in disaster
assistance as outlined in 44 CFR, Parts 7 and 16, and 44 CFR
Section 206. 11. The Subgrantee shall comply with federal
regulations concerning the General Services Administrative
Consolidated List of Debarred, Suspended _ and Ineligible
Contractors, as provided in 44 CFR Part 17 .
15. MODIFICATION: Either party may request modifications to
this Agreement, including work to be completed on the DSR(s) and
the time performance period. Such modifications MUST be proposed
in writing by either party and become effective only upon execution
by both parties.
16. TIME FOR PERFORMANCE: In accordance with 44 CFR 206.204,
and subject to any approved extension by the Governor' s Authorized
Representative (GAR) or the Federal Regional Director, the term of
an agreement for debris clearance or emergency work is six (6)
months from the date of the declaration of a major disaster or
emergency. Permanent work is not authorized. Time extensions may
be granted on an individual basis, in accordance with 44 CFR
206.204 . If any extension request is denied, the Subgrantee may be
reimbursed for eligible project costs incurred up to the latest
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approved completion date. Failure to complete the project will
result in the denial of funding for that project.
17. CONTRACTS WITH OTHERS: If a Subgrantee contracts with any
other entity (herein after "contractor") for performance of any of
the work required under this Agreement, the Subgrantee agrees to
include in the contract that the contractor is bound by the terms
and conditions of this Agreement with the Grantee, and to provide
the contractor with a copy of this Agreement. The Subgrantee
further agrees to include in the contract, unless prohibited by
law, that the contractor shall hold the Subgrantee and the Grantee
harmless against all claims of whatever nature arising out of the
performance of the work by the contractor under the contract. To
the extent that the Subgrantee has outstanding, uncompleted,
contracts for work for which reimbursement will be requested under
this Agreement,, Subgrantee agrees to use its best efforts to modify
said contracts in accordance with this paragraph.
18. TERMINATION: Either party may request termination of this
Agreement, in writing, delivered in person, or by certified mail,
to the party' s representative who executes this Agreement. Said
termination may be accomplished by mutual agreement of the parties,
effective thirty (30) days after an executed modification to effect
termination.
19. LIABILITY: The Subgrantee shall be solely responsible to
the parties with whom it shall interact in carrying the terms of
this Agreement. The Grantee assumes no liability whatsoever to
those third parties as a result of this Agreement. For purposes of
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this Agreement, Subgrantee agrees that it is neither an employee
nor an agent of the Grantee.
20. REPORTS: The Subgrantee shall provide quarterly progress
reports to the Grantee. The first report is due three (3) months
after the date of execution of this Agreement and quarterly
thereafter until the work has been completed and approved through
final inspection. All reports shall be provided using the attached
Quarterly Report Form. Interim inspections shall be scheduled by
the Subgrantee prior to the final inspection and may be requested
by the Grantee based on information supplied in the quarterly
reports. The Grantee may require additional reports as needed.
The Subgrantee shall, as soon as possible, provide any additional
reports requested by the Grantee. The Grantee contact will be the
state public assistance officer for all reports and requests for
reimbursement.
21. STANDARD CONDITIONS: The Subgrantee further agrees to be
bound by the following standard conditions:
a. The State of Florida's performance and obligation to
pay under this Agreement is contingent upon an annual appropriation
by the Legislature, or the provision of funding to the Grantee
pursuant to Section 252 . 37 , Florida Statutes.
b. If otherwise allowed under this Agreement, any
extension shall be in writing and shall be subject to the same
terms and conditions set forth in the initial Agreement. There
shall be only one extension of the Agreement unless the failure to
meet the criteria for completion is due to events bfeyond the
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control of the Subgrantee.
c. Bills for fees or other compensation for services or
expenses must be submitted in detail sufficient for a proper pre
and post audit thereof.
d. The Grantee may unilaterally cancel this Agreement
for refusal by the Subgrantee or its contractors to allow public
access to all documents, papers, letters or other material subject
to the provisions of Chapter 119, Florida Statutes, and made or
received by the Subgrantee or its subcontractor in conjunction with
this Agreement. It is expressly understood that substantial
evidence of the Subgrantee' s or their contractor ' s refusal to
comply with this provision shall constitute a breach of contract,
and constitute grounds for termination.
e. Pursuant to Section 216 . 347 , Florida Statutes, and
applicable federal law, the Subgrantee agrees that no funds from
this Agreement will be expended for the purpose of lobbying the
Legislature, state agency employees, Members of Congress, officers
or employees of Congress, or an employee of a Member of Congress in
connection with the awarding of this Agreement or any amendments or
modifications of this Agreement.
f. The Subgrantee certifies with respect to this
Agreement that it possesses the legal authority to receive the
funds.
g. The Subgrantee shall comply with any Statement of
Assurance incorporated herein and attached hereto. The Subgrantee
acknowledges that the responsibility for complying with the
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1
approved subgrant award rests with the recipient Subgrantee and
acknowledges that failure to do so constitutes grounds for the
recision or suspension of this subgrant and may influence future
subgrant awards.
22. TERM: This Agreement shall be effective upon execution and
terminate upon completion of, and final payment for, all approved
projects, subject to any modification in accordance with paragraph
15, above.
t
23 . NOTICE AND CONTACT: All notices under this Agreement shall
be in writing, delivered either by hand delivery or certified mail
to_ the representative and address below:
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m
FOR THE GRANTEE: FOR THE SUBGRANTEE:
Joseph F. Myers GAR S. Scott Vandergrift
State Public Assistance Mayor
FEMA Disaster Field Office City of Ocoee
2740 Centerview Drive 150 N. Lakeshore Dr.
Tallahassee, Florida 32399 Ocoee, FL 34761
24 . The Subgrantee hereby authorizes City Manager Ellis Shapiro
as its designated Agent, to execute Requests for
Reimbursement, necessary certifications, and other supplementary
documentation.
IN WITNESS HEREOF, the Grantee and Subgrantee have executed
. this Agreement;
FOR THE SUBGRANTEE: FOR THE GRANTEE:
STATE OF FLORIDA
City of Ocoee DEPARTMENT OF COMMUNITY AFFAIRS
By: By:
Mayor Governor' s Authorized Rep.
Title Title
9-19-95
Date Date
59-6019764
Subgrantee's Federal
Employer Identification No.
CATALOGUE OF FEDERAL DOMESTIC
ASSISTANCE NUMBER: 83 . 516 DISASTER ASSISTANCE
17 8/30
PAGE OF PAGES
FLORIDA DIVISION OF EMERGENCY MANAGEMENT
SUMMARY OF DOCUMENTATION IN SUPPORT OF AMOUNT
CLAIMED FOR ELIGIBLE DISASTER WORK
Applicant Disaster No. FEMA-. _ :DR-FL
DCA Agreement No. Project Application No. DSR No.
Applicant's Were= Delivery Due of DOCUMerfATTON Amatm
No.(Warms.Voucher. sada a Lia Doommatim(Appiiaa's psyroil.otate:o!Cant of appiicaa's Applicant' EIigtle
Cain a Scbed ' No.) performs= stock.applicant owed equipment sod nano of moire'or ton aetor)by Cosa
serving. category and lice ions it due approved project application and give a brit£
deaeription of Martieles a sevrrs.
THIS INFORMATION PAGE HAS BEEN
COMPLETED DUE TO PRIOR FEMA
MEETINGS.
TOTAL
•
DSR TOTAL •
rA separate form will be prepared for each DSR.
FLORIDA DEPARTMENT OF COMMUNITY AFFAIRS PAS G�
DIVISION OF EMERGENCY MANAGEMENT
REQUEST FOR REIMBURSEMENT FOR PUBLIC ASSISTANCE FUNDS
JBGRANTEE NAME: City of Ocoee 0 DECL. NO: 3116-EM-FL
DDRESS: 150 N. Lakeshore Drive PA ID NO: 095-51075
Ocoee, FL 34761-2216 • FEID NO:
OCA AGREEMENT NO: 96RM-68-06-58-02-129
FOR DCA's USE ONLY
• DSR PREVIOUS CURRENT APPROVED
AMOUNT PAYMENTS REQUEST FOR PAYMENT COMMENTS
{
DSRS 200589
CATEGORY A ~34,012.35 -0- 34,012.35 •
DSR 200590 •
CATEGORY B 17,452.62 -0- 17,452.62
DSR# •
CATEGORY —-
•
DSR:
CATEGORY
(71'� a
:: GORY
•
DSR#
CATEGORY
PAYMENT NO:____ TOTAL CURRENT REQUEST $ 51 ,464.97
certify that to the best of my knowledge and belief the above accounts are correct and that all disbursements were made
rt accordance with all conditions of the DCA Agreement and payment is due and has not been requested for these amcmts.
SUBGRANTEE SIGNATURE
NAME AND TITLE DATE
TO BE COMPLETED BY DEPARTMENT OF COMMUNITY AFFAIRS (DCA)
APPROVED DSR TOTAL $
•
ADMINISTRATIVE COST S
II GOVERNOR'S AUTHORIZED REPRESENTATIVE
IIS: 5% $
APPROVED FOR PAYMENT $
DATE
PA1001 110/011216
r
EXHIBIT C
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS,
AND COOPERATIVE AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and
belief, that:
1. 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 awarding of any federal contract, the making of any
federal grant, the making of a federal loan, the entering into
of'any cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any federal contract,
grant, loan, or cooperative agreement.
2 . If any funds other 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 contract, grant, loan, or cooperative agreement, the
undersigned shall complete and submit Standard Form-LLL,
"Disclosure Form to Report Lobbying" , in accordance with
instructions.
3 . The undersigned shall require that the language of this
certification be included in the award document for all
subawards at all tiers (including subcontracts, subgrants, and
contracts under grants, loans and cooperative agreements) and
that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which
reliance was placed when this transaction was made or entered into.
Submission of this certification is a prerequisite for making or
entering into this transaction imposed by Section 1352 , Title 31,
U.S. Code. Any person who fails to file the required certification
shall be subject to a civil penalty of not less than $10, 000 and
not more than $100, 000 for each such failure.
Applicant' s Agent Date
INSURED'S AUTHORIZATION TO RELEASE INFORMATION
City of Ocoee hereby authorizes our insurance company
(Subgrantee)
Hartford , to release directly to the Governor's Authorized
Representative, Department of Community Affairs any and all information needed to
complete processing of damage survey reports related to Hurricane Erin.
To assist in this process, the following data is provided:
1. Legal Name Referenced in the Policy: Ocoee, City of
150 N. Lakeshore Drive, Ocoee, FL 34761-2216
2. Policy Number: 21 CEN QN9592
3. Check off type of policy:
x All risks, blanket, or umbrella policy
Other. Explain
4. Property and locations insured(If numerous, attach photocopy of declarations page
and locations schedule included in policy): N/A
5. Adjuster: N/A /
Name Telephone Number
6. CLAIM NUMBER(s): N/A
•
Authorized Representative
of named insured Peggy Psaledakis
Signature Printed Name
Director of Personnel
& Employee Relations
Title Date
If you have more than one property insurance policy, complete a separate release form for
each policy.
City of Ocoee
Execution Page to Disaster Relief Funding Agreement
APPROVED:
ATTEST: CITY OF OCOEE, FLORIDA
Jean Grafton, City Clerk S. Scott Vandergrift, Mayor
(SEAL)
FOR USE AND RELIANCE ONLY BY APPROVED BY THE OCOEE CITY
THE CITY OF OCOEE, FLORIDA COMMISSION AT A MEETING
APPROVED AS TO FORM AND LEGALITY HELD ON , 1995
this day of , 1995 . UNDER AGENDA ITEM NO.
FOLEY & LARDNER
By:
City Attorney
C:\W P51\DOCSWADMIN\0030F 19/15/95118S0091 DPB:IaI(2)