Agreement with WA State Military Department for FEMA Emergency Management Performance Grant BEFORE THE BOARD OF COUNTY COMMISSIONERS
LEWIS COUNTY, WASHINGTON
IN THE MATTER OF: RESOLUTION NO. 19-362
ACCEPTANCE OF AGREEMENT BETWEEN LEWIS
COUNTY AND WASHINGTON STATE MILITARY
DEPARTMENT FOR FEMA EMERGENCY MANAGEMENT
PERFORMANCE GRANT AND AUTHORIZING
SIGNATURES THEREON
WHEREAS, the Board of County Commissioners (BOCC) has reviewed the Agreement
between Lewis County, Washington, and the Washington State Military Department for
FEMA Emergency Management Performance Grant (EMPG); and
WHEREAS, the contract amount of $43,680 has already been included in the budget;
and
WHEREAS, it appears to be in the best public interest to authorize the execution of
said agreement for Lewis County.
NOW THEREFORE BE IT RESOLVED that the BOCC hereby approves an agreement
between Lewis County and the Washington State Military Department, providing
$43,680 in EMPG funds, and delegates authority to Lewis County Commissioner Bobby
Jackson to sign the Agreement # E20-125 revised on behalf of Lewis County
DONE IN OPEN SESSION this 9th day of December, 2019.
APPROVED AS TO FORM. BOARD OF COUNTY COMMISSIONERS
Jonathan Meyer, Prosecuting Attorney LEWIS COUNTY, WASHINGTON
Amber Smith Robert C . Jackson
By. Amber Smith, Robert C Jackson, Chair
Deputy Prosecuting Attorney
ATTEST. •'.°�"-'-`-"qs•. Gary Stampe r
Qors ',c Cary Stamper, Vice Chair
s' 45 F;.
•
Rieva Lester Edna J . Fund
Rieva Lester, Edna J Fund, Commissioner
Clerk of the Lewis County Board of County
Commissioners
Washington State Military Department
EMERGENCY MANAGEMENT PERFORMANCE GRANT AGREEMENT FACE SHEET
1 Subrecipient Name and Address 2 Grant Agreement Amount 3 Grant Agreement Number
Lewis County $43,680 E20-125 Revised
Division of Emergency Management(DEM)
351 NW North Street
Chehalis,WA 98532-0509
4 Subreapient Contact, phone/email 5 Grant Agreement Start Date 6 Grant Agreement End Date
Steve Mansfield,360-740-3310 June 1, 2019 August 31,2020
steve mansfield@lewiscountywa.gov
7 Department Contact, phone/email 8 Data Universal Numbering System (DUNS) 9 UBI#(state revenue)
John Hollingsworth, 253-512-7044 079272555 214-000-323
john hollingsworth @mil wa gov
10 Funding Authonty
Washington State Military Department(the"DEPARTMENT")and the U S Department of Homeland Security(DHS)
11 Federal Funding Identification# 12 Federal Award Date 13 Assistance Listings#(formerly CFDA) &Title
EMS-2019-EP-00003-S01 08/05/2019 97 042(19EMPG)
14 Total Federal Amount# 15 Program Index#&OBJ/SUB-OBJ
$7,409,645 793PT NZ
16 Service Districts 17 Service Area by County(ies) 18 Women/Minority-Owned, State
(BY LEGISLATIVE DISTRICT) 19,20 Lewis Certified /1 N/A ❑ NO
(BY CONGRESSIONAL DISTRICT) 3 ❑ YES, OMWBE#
19 Agreement Classification 20 Contract Type(check all that apply)
❑ Personal Services ❑ Client Services El Public/Local Gov't ❑ Contract Z Grant ► Agreement
❑ Research/Development ❑ A/E Cl Other ❑ Intergovernmental (RCW 39 34) ❑ Interagency
21 Subreapient Selection Process 22 Subreapient Type(check all that apply)
® "To all who apply&qualify" ❑ Competitive Bidding ❑ Private Organization/Individual ❑ For-Profit
❑ Sole Source ❑ NE RCW ❑ N/A ® Public Organization/Jurisdiction ❑ Non-Profit
❑ Filed w/OFM? ❑ Advertised? ❑ YES ❑ NO ❑ CONTRACTOR ® SUBRECIPIENT ❑ OTHER
23 PURPOSE&DESCRIPTION
The purpose of the Fiscal Year(FY) 2019 Emergency Management Performance Grant(19EMPG) program is to provide U.S
Department of Homeland Security (DHS)/Federal Emergency Management Agency (FEMA) Federal award funds to states to
assist state, local, territorial, and tribal governments in preparing for all hazards through sustainment and enhancement of
those programs as described in the Work Plan.
The Department is the Recipient and Pass-through Entity of the 19EMPG OHS Award Letter for Grant No EMS-2019-EP-00003-
S01, which is incorporated in and attached hereto as Exhibit F and has made a subaward of Federal award funds to the
Subrecipient pursuant to this Agreement. The Subrecipient is accountable to the Department for use of Federal award funds
provided under this Agreement and the associated matching funds
IN WITNESS WHEREOF, the Department and Subrecipient acknowledge and accept the terms of this Agreement, including all referenced
Exhibits and Attachments which are hereby incorporated in and made a part hereof,and have executed this Agreement as of the date below
This Agreement Face Sheet, Special Terms & Conditions (Exhibit A), General Terms and Conditions (Exhibit B), Work Plan (Exhibit C),
Timeline(Exhibit D), Budget (Exhibit E), 19EMPG Award Letter EMS-2019-EP-00003-S01 (Exhibit F), and all other documents expressly
referenced and incorporated herein contain all the terms and conditions agreed upon by the parties and govern the rights and obligations of
the parties to this Agreement No other understandings, oral or otherwise, regarding the subject matter of this Agreement shall be deemed
to exist or to bind any of the parties hereto
In the event of an inconsistency in this Agreement, unless otherwise provided herein, the inconsistency shall be resolved by giving
precedence in the following order
1. Applicable Federal and State Statutes and Regulations 4 • Terms and Conditions
2. DHS/FEMA Award and program documents Genera Terms and Conditions, 'd,
3. Work Plan,Timeline,and Budget 6 Other ,rovisions of the Agr ent incorporated by reference
WHEREAS,the parties hereto have executed this Agreemen n the day and ear last sp-afied b
FOR THE DEPARTMENT e S R" /1/1"-Th• �
Signature Date Sign. Date ` j
Regan Anne Hesse, Chief Financial Officer Bobby Jackson, Chair
Washington State Military Department Lewis County Board of Commissioners
BOILERPLATE APPROVED AS TO FORM
Brian E Buchholz 6/27/2019 APPROVED AS TO FORM(if applicable)
Sr Assistant Attorney General Applicant's Legal Review Date
DHS-FEMA-EMPG-FY 19 Page 1 of 36 Lewis County DEM, E20-125 Revised
Exhibit A
SPECIAL TERMS AND CONDITIONS
ARTICLE I. KEY PERSONNEL
The individuals listed below shall be considered key personnel for point of contact under this Agreement. Any
substitution of key personnel by either party shall be made by written notification to the current key personnel
SUBRECIPIENT DEPARTMENT
Name Steve Mansfield Name John Hollingsworth
Title Director Title Program Coordinator
E-Mail steve.mansfield @lewiscountywa.gov E-Mail john.hollingsworth @mil.wa.gov
Phone 360-740-3310 Phone 253-512-7044
Name Jill Kangas Name Tirzah Kincheloe
Title Planner Title Program Manager
E-Mail jill.kangas @Iewiscountywa gov E-Mail _ tirzah.kincheloe @mil.wa.gov
Phone 360-740-1153 Phone 253-512-7456
Name Andy Caldwell Name
Title Planner Title
E-Mail Andy.Caldwell @Iewiscountywa gov E-Mail
Phone 360-740-1147 Phone
ARTICLE II. ADMINISTRATIVE AND/OR FINANCIAL REQUIREMENTS
The Subrecipient shall comply with all applicable state and federal laws, rules, regulations, requirements and
program guidance identified or referenced in this Agreement and the informational documents published by
DHS/FEMA applicable to the 19EMPG Program, including, but not limited to, all criteria, restrictions, and
requirements of The Department of Homeland Security (DHS) Notice of Funding Opportunity (NOFO) Fiscal
Year 2019 Emergency Management Performance Grant (EMPG) document, the FEMA Preparedness Grants
Manual document, the DHS Award Letter for Grant No. EMS-2019-EP-00003-S01, and the federal regulations
commonly applicable to DHS/FEMA grants, all of which are incorporated herein by reference The DHS Award
Letter is incorporated in this Agreement as Exhibit F
The Subrecipient acknowledges that since this Agreement involves federal award funding, the period of
performance described herein may begin prior to the availability of appropriated federal funds The Subrecipient
agrees that it will not hold the Department, the state of Washington, or the United States liable for any damages,
claim for reimbursement, or any type of payment whatsoever for services performed under this Agreement prior
to distribution of appropriated federal funds, or if federal funds are not appropriated or in a particular amount
A. STATE AND FEDERAL REQUIREMENTS FOR DHS/FEMA PREPAREDNESS GRANTS:
The following requirements apply to all DHS/FEMA Preparedness Grants administered by the
Department
1. SUBAWARDS & CONTRACTS BY SUBRECIPIENT
a. The Subrecipient must make a case-by-case determination whether each agreement it
makes for the disbursement of 19EMPG funds received under this Agreement casts the
party receiving the funds in the role of a Subrecipient or contractor in accordance with 2
CFR 200 330
b If the Subrecipient becomes a pass-through entity by making a subaward to a non-federal
entity as its Subrecipient
The Subrecipient must comply with all federal laws and regulations applicable to
pass-through entities of 19EMPG funds, including, but not limited to, those
contained in 2 CFR 200
ii. The Subrecipient shall require its subrecipient(s) to comply with all applicable
state and federal laws, rules, regulations, requirements, and program guidance
identified or referenced in this Agreement and the informational documents
published by DHS/FEMA applicable to the 19EMPG Program, including, but not
DHS-FEMA-EMPG-FY 19 Page 2 of 36 Lewis County DEM, E20-125 Revised
limited to, all criteria, restrictions, and requirements of The Department of
Homeland Security (DHS) Notice of Funding Opportunity (NOFO) Fiscal Year
2019 Emergency Management Performance Grant (EMPG) document, the DHS
Award Letter for Grant No EMS-2019-EP-00003-S01 in Exhibit F, and the
federal regulations commonly applicable to DHS/FEMA grants
iii. The Subrecipient shall be responsible to the Department for ensuring that all
19EMPG federal award funds provided to its subrecipients, and associated
matching funds, are used in accordance with applicable federal and state
statutes and regulations, and the terms and conditions of the federal award set
forth in Exhibit F of this Agreement.
2. BUDGET, REIMBURSEMENT, AND TIMELINE
a. Within the total Grant Agreement Amount, travel, subcontracts, salaries, benefits, printing,
equipment, and other goods and services or other budget categories will be reimbursed
on an actual cost basis upon completion unless otherwise provided in this Agreement.
b. The maximum amount of all reimbursement requests permitted to be submitted under this
Agreement, including the final reimbursement request, is limited to and shall not exceed
the total Grant Agreement Amount
c If the Subrecipient chooses to include indirect costs within the Budget (Exhibit E), an
indirect cost rate agreement negotiated between the federal cognizant agency and the
Subrecipient establishing approved indirect cost rate(s) as described in 2 CFR 200 414
and Appendix VII to 2 CFR 200 must be submitted to the Department Key Personnel
However, under 2 CFR 200 414(f), if the Subrecipient has never received a negotiated
indirect cost rate agreement establishing federally negotiated rate(s), the Subrecipient
may negotiate a rate with the Department or charge a de minimis rate of 10% of modified
total direct costs The Subrecipient's actual indirect cost rate may vary from the approved
rate but must not exceed the approved negotiated indirect cost rate percentage for the
time period of the expenditures. If a Subrecipient chooses to charge the 10% de minimis
rate, but did not charge indirect costs to previous subawards, a request for approval to
charge indirect costs must be submitted to the Department Key Personnel for approval
with an e.explanation for the change.
9
d For travel costs, the Subrecipient shall comply with 2 CFR 200 474 and should consult
their internal policies, state rates set pursuant to RCW 43 03 050 and RCW 43.03.060 as
now existing or amended, and federal maximum rates set forth at http.//www.gsa.gov, and
follow the most restrictive If travel costs exceed set state or federal limits, travel costs
shall not be reimbursed without written approval by Department Key Personnel
e Reimbursement requests will include a properly completed State A-19 Invoice Form and
Reimbursement Spreadsheet (in the format provided by the Department) detailing the
expenditures for which reimbursement is sought Reimbursement requests must be
submitted to Reimbursements @mil wa qov no later than the due dates listed within the
Timeline (Exhibit D)
Reimbursement request totals should be commensurate to the time spent processing by
the Subrecipient and the Department
f Receipts and/or backup documentation for any approved items that are authorized under
this Agreement must be maintained by the Subrecipient consistent with record retention
requirements of this Agreement and be made available upon request by the Department
and auditors
g. The Subrecipient should request prior written approval from Department Key Personnel
to waive the due date in the Timeline (Exhibit D) and, once approved, submit those costs
on the next scheduled reimbursement due date contained in the Timeline Waiving or
missing deadlines serves as an indicator for assessing an agency's level of risk of
noncompliance with the regulations, requirements, and the terms and conditions of the
agreement and may increase required monitoring activities Any request for a waiver or
extension of a due date in the Timeline (Exhibit D) will be treated as a request for
DHS-FEMA-EMPG-FY 19 Page 3 of 36 Lewis County DEM, E20-125 Revised
Amendment of the Agreement. This request must be submitted to the Department Key
Personnel sufficiently in advance of the due date to provide adequate time for Department
review and consideration and may be granted or denied within the Department's sole
discretion
h All work under this Agreement must end on or before the Grant Agreement End Date, and
the final reimbursement request must be submitted to the Department within 45 days after
the Grant Agreement End Date, except as otherwise authorized by written amendment of
this Agreement and issued by the Department
No costs for purchases of equipment/supplies will be reimbursed until the related
equipment/supplies have been received by the Subrecipient, its contractor, or any non-
' federal entity to which the Subrecipient makes a subaward and is invoiced by the vendor
1. Failure to submit timely, accurate, and complete reports and reimbursement requests as
required by this Agreement(including, but not limited to, those reports in the Timeline)will
prohibit the Subrecipient from being reimbursed until such reports and reimbursement
requests are submitted and the Department has had reasonable time to conduct its review
k Final reimbursement requests will not be approved for payment until the Subrecipient is
current with all reporting requirements contained in this Agreement
A written amendment will be required if the Subrecipient expects cumulative transfers to
budget categories, as identified in the Budget (Exhibit E), to exceed 10% of the Grant
Agreement Amount. Any changes to budget category totals not in compliance with this
paragraph will not be reimbursed without approval from the Department
m Subrecipients shall only use federal award funds under this Agreement to supplement
existing funds and will not use them to replace(supplant) non-federal funds that have been
budgeted for the same purpose. The Subrecipient may be required to demonstrate and
document that a reduction in non-federal resources occurred for reasons other than the
receipt or expected receipt of federal funds
3 REPORTING
a With each reimbursement request, the Subrecipient shall report how the expenditures, for
which reimbursement is sought, relate to the Work Plan (Exhibit C) activities in the format
provided by the Department
b With the final reimbursement request, the Subrecipient shall submit to the Department Key
Personnel a final report describing all completed activities under this Agreement
c. In conjunction with the final report,the Subrecipient shall submit a separate report detailing
how the EMPG Training requirements were met for all personnel funded by federal or
matching funds under this Agreement
d The Subrecipient shall comply with the Federal Funding Accountability and Transparency
Act(FFATA) and related OMB Guidance consistent with Public Law 109-282 as amended
by section 6202(a) of Public Law 110-252 (see 31 U.S.C. 6101 note) and complete and
return to the Department the FFATA Form located at http.//mil wa gov/emergency-
manaqement-division/qrants/requiredgrantforms, which is incorporated by reference and
made a part of this Agreement
e. The Subrecipient shall participate in the State's Stakeholder Preparedness Review(SPR)
as well as the State's Threat and Hazard Identification and Risk Assessment(THIRA), as
needed
4. EQUIPMENT AND SUPPLY MANAGEMENT
a The Subrecipient and any non-federal entity to which the Subrecipient makes a subaward
shall comply with 2 CFR 200.318 — 200.326 when procuring any equipment or supplies
under this Agreement, 2 CFR 200 313 for management of equipment, and 2 CFR 200 314
for management of supplies, to include, but not limited to
Upon successful completion of the terms of this Agreement, all equipment and
supplies purchased through this Agreement will be owned by the Subrecipient,
DHS-FEMA-EMPG-FY 19 Page 4 of 36 Lewis County DEM, E20-125 Revised
or a recognized non-federal entity to which the Subrecipient has made a
subaward, for which a contract, Subrecipient grant agreement, or other means
of legal transfer of ownership is in place
ii. All equipment, and supplies as applicable, purchased under this Agreement will
be recorded and maintained in the Subrecipient's inventory system
iii Inventory system records shall include
A description of the property
B manufacturer's serial number, model number, or other identification
number
C. funding source for the equipment, including the Federal Award
Identification Number (FAIN)
D Assistance Listings Number(formerly CFDA Number)
E who holds the title
F acquisition date
G cost of the equipment and the percentage of federal participation in the cost
H. location, use, and condition of the equipment at the date the information
was reported
I disposition data including the date of disposal and sale price of the
property
iv The Subrecipient shall take a physical inventory of the equipment, and supplies
as applicable, and reconcile the results with the property records at least once
every two years Any differences between quantities determined by the physical
inspection and those shown in the records shall be investigated by the
Subrecipient to determine the cause of the difference The Subrecipient shall, in
connection with the inventory, verify the existence, current utilization, and
continued need for the equipment
v The Subrecipient shall be responsible for any and all operational and
maintenance expenses and for the safe operation of their equipment and supplies
including all questions of liability The Subrecipient shall develop appropriate
maintenance schedules and procedures to ensure the equipment, and supplies
as applicable, are well maintained and kept in good operating condition
vi. The Subrecipient shall develop a control system to ensure adequate safeguards
to prevent loss, damage, and theft of the property. Any loss, damage, or theft
shall be investigated, and a report generated and sent to the Department
vii The Subrecipient must obtain and maintain all necessary certifications and
licenses for the equipment
viii. If the Subrecipient is authorized or required to sell the property, proper sales
procedures must be established and followed to ensure the highest possible
return For disposition, if upon termination or at the Grant Agreement End Date,
when original or replacement supplies or equipment acquired under a federal
award are no longer needed for the original project or program or for other
activities currently or previously supported by a federal awarding agency, the
Subrecipient must comply with the following procedures
A For Supplies If there is a residual inventory of unused supplies exceeding
$5,000 in total aggregate value upon termination or completion of the
project or program and the supplies are not needed for any other federal
award, the Subrecipient must retain the supplies for use on other activities
or sell them, but must, in either case, compensate the federal government
DHS-FEMA-EMPG-FY 19 Page 5 of 36 Lewis County DEM, E20-125 Revised
for its share The amount of compensation must be computed in the same
manner as for equipment
B. For Equipment
1) Items with a current per-unit fair-market value of $5,000 or less may
be retained, sold, or otherwise disposed of with no further obligation
to the federal awarding agency
2) Items with a current per-unit fair-market value in excess of $5,000
may be retained or sold The Subrecipient shall compensate the
federal awarding agency in accordance with the requirements of 2
CFR 200 313 (e) (2)
ix Records for equipment shall be retained by the Subrecipient for a period of six
years from the date of the disposition, replacement, or transfer. If any litigation,
claim, or audit is started before the expiration of the six-year period, the records
shall be retained by the Subrecipient until all litigation, claims, or audit findings
involving the records have been resolved
b The Subrecipient shall comply with the Department's Purchase Review Process, which is
incorporated by reference and made part of this Agreement. No reimbursement will be
provided unless the appropriate approval has been received
c Allowable categories for the EMPG Program are listed on the Authorized Equipment List
(AEL) located on the FEMA website at http //www fema qov/authorized-equipment-list It
is important that the Subrecipient and any non-federal entity to which the Subrecipient
makes a subaward regard the AEL as an authorized purchasing list identifying items
allowed under the specific grant program and includes items that may not be categorized
as equipment according to the federal, state, local, and tribal definitions of equipment
The Subrecipient is solely responsible for ensuring and documenting purchased items
under this Agreement are authorized as allowed items by the AEL at time of purchase
If the item is not identified on the AEL as allowable under EMPG, the Subrecipient must
contact the Department Key Personnel for assistance in seeking FEMA approval prior to
acquisition
d Unless expressly provided otherwise, all equipment must meet all mandatory regulatory
and/or DHS/FEMA adopted standards to be eligible for purchase using federal award
funds
e The Subrecipient must pass on equipment and supply management requirements that
meet or exceed the requirements outlined above to any non-federal entity to which the
Subrecipient makes a subaward under this Agreement
5. ENVIRONMENTAL AND HISTORICAL PRESERVATION
a The Subrecipient shall ensure full compliance with the DHS/FEMA Environmental
Planning and Historic Preservation (EHP) program EHP program information can be
found at https//www fema qov/media-library/assets/documents/85376 all of which are
incorporated in and made a part of this Agreement.
b. Projects that have historical impacts or the potential to impact the environment, including,
but not limited to, construction of communication towers, modification or renovation of
existing buildings, structures and facilities; or new construction including replacement of
facilities, must participate in the DHS/FEMA EHP review process prior to initiation
Modification of existing buildings, including minimally invasive improvements such as
attaching monitors to interior walls, and training or exercises occurring outside in areas
not considered previously disturbed, also require a DHS/FEMA EHP review before project
initiation
c The EHP review process involves the submission of a detailed project description that
includes the entire scope of work, including any alternatives that may be under
consideration, along with supporting documentation so FEMA may determine whether the
DHS-FEMA-EMPG-FY 19 Page 6 of 36 Lewis County DEM, E20-125 Revised
proposed project has the potential to impact environmental resources and/or historic
properties
d The Subrecipient agrees that to receive any federal preparedness funding, all EHP
compliance requirements outlined in applicable guidance must be met The EHP review
process must be completed and approval received by the Subrecipient before any
work is started for which reimbursement will be later requested. Expenditures for projects
started before completion of the EHP review process and receipt of approval by the
Subrecipient will not be reimbursed
6 PROCUREMENT
a The Subrecipient shall comply with all procurement requirements of 2 CFR Part 200.318
through 200 326 and as specified in the General Terms and Conditions, Exhibit B, A.10.
b For all sole source contracts expected to exceed $250,000, the Subrecipient must submit
to the Department for pre-procurement review and approval the procurement documents,
such as requests for proposals, invitations for bids and independent cost estimates. This
requirement must be passed on to any non-federal entity to which the Subrecipient makes
a subaward, at which point the Subrecipient will be responsible for reviewing and
approving sole source justifications of any non-federal entity to which the Subrecipient
makes a subaward
7. SUBRECIPIENT MONITORING
a The Department will monitor the activities of the Subrecipient from award to closeout The
goal of the Department's monitoring activities will be to ensure that agencies receiving
federal pass-through funds are in compliance with this Agreement, federal and state audit
requirements, federal grant guidance, and applicable federal and state financial
regulations, as well as 2 CFR Part 200 Subpart F
b To document compliance with 2 CFR Part 200 Subpart F requirements, the Subrecipient
shall complete and return to the Department the "2 CFR Part 200 Subpart F Audit
Certification Form" located at http//mil wa qov/emergency-management-
division/qrants/requiredgrantforms with the signed Agreement and each fiscal year
thereafter until the Agreement is closed, which is incorporated by reference and made a
part of this Agreement
c Monitoring activities may include, but are not limited to
Review of financial and performance reports
ii Monitoring and documenting the completion of Agreement deliverables
iii Documentation of phone calls, meetings (e.g. agendas, sign-in sheets, meeting
minutes), e-mails and correspondence
iv. Review of reimbursement requests and supporting documentation to ensure
allowability and consistency with Agreement work plan, budget, and federal
requirements
v Observation and documentation of Agreement related activities, such as
exercises, training, funded events, and equipment demonstrations
vi On-site visits to review equipment records and inventories, to verify source
documentation for reimbursement requests and performance reports, and to verify
completion of deliverables.
d. The Subrecipient is required to meet or exceed the monitoring activities, as outlined
above, for any non-federal entity to which the Subrecipient makes a subaward as a pass-
through entity under this Agreement
e Compliance will be monitored throughout the performance period to assess risk.
Concerns will be addressed through a Corrective Action Plan.
DHS-FEMA-EMPG-FY 19 Page 7 of 36 Lewis County DEM, E20-125 Revised
8. LIMITED ENGLISH PROFIENCY (CIVIL RIGHTS ACT OF 1964 TITLE VI)
a The Subrecipient must comply with the Title VI of the Civil Rights Act of 1964 (Title VI)
prohibition against discrimination on the basis of national origin, which requires that
Subrecipients of federal financial assistance take reasonable steps to provide meaningful
access to persons with limited English proficiency (LEP) to their programs and services.
Providing meaningful access for persons with LEP may entail providing language
assistance services, including oral interpretation and written translation Executive Order
13166, Improving Access to Services for Persons with Limited English Proficiency(August
11, 2000), requires federal agencies to issue guidance to recipients, assisting such
organizations and entities in understanding their language access obligations DHS
published the required recipient guidance in April 2011, DHS Guidance to Federal
Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin
Discrimination Affecting Limited English Proficient Persons, 76 Fed. Reg. 21755-21768,
(April 18, 2011) The Guidance provides helpful information such as how a recipient can
determine the extent of its obligation to provide language services, selecting language
services, and elements of an effective plan on language assistance for LEP persons. For
additional assistance and information regarding language access obligations, please refer
to the DHS Recipient Guidance at https//www dhs qov/guidance-published-help-
department-supported-organizations-provide-meaningful-access-people-limited and
additional resources on http//www lep goy
9. NIMS COMPLIANCE
a The National Incident Management System (NIMS) identifies concepts and principles that
answer how to manage emergencies from preparedness to recovery regardless of their
cause, size, location, or complexity NIMS provides a consistent, nationwide approach
and vocabulary for multiple agencies or jurisdictions to work together to build, sustain, and
deliver the core capabilities needed to achieve a secure and resilient nation.
b Consistent implementation of NIMS provides a solid foundation across jurisdictions and
disciplines to ensure effective and integrated preparedness, planning, and response.
NIMS empowers the components of the National Preparedness System, a requirement of
Presidential Policy Directive 8, to guide activities within the public and private sector and
describes the planning, organizational activities, equipping, training and exercising
needed to build and sustain the core capabilities in support of the National Preparedness
Goal
c In order to receive FY 2019 federal preparedness funding, to include EMPG, the
Subrecipient will ensure all NIMS objectives have been initiated and/or are in progress
toward completion. NIMS Implementation Objectives are located at
https//www fema qov/media-library/assets/documents/130743
B. EMPG PROGRAM SPECIFIC REQUIREMENTS
1 The Department receives EMPG Program funding from DHS/FEMA, which is provided to assist
state, local, and tribal governments to enhance and sustain all-hazards emergency management
capabilities as authorized by Robert T Stafford Disaster Relief and Emergency Assistance Act,
as amended (42 U.S.C. §§ 5121 et seq.) and Section 662 of the Post Katrina Emergency
Management Act (6 U S C § 762)
2 A portion of the 19EMPG is passed through to local jurisdictions and tribes with emergency
management programs to supplement their local/tribal operating budgets to help sustain and
enhance emergency management capabilities pursuant to Washington Administrative Code
(WAC) 118-09
3 The Subrecipient shall use the EMPG funds authorized under this Agreement only to perform
tasks as described in the Work Plan of the Subrecipient's application for funding, as approved by
the Department and incorporated into this Agreement
4 Funding may not be used to replace or supplant existing local or tribal government funding of
emergency management programs.
DHS-FEMA-EMPG-FY 19 Page 8 of 36 Lewis County DEM, E20-125 Revised
5. The Subrecipient shall provide a fifty percent match of non-federal origin The Federal share
applied toward the EMPG budget shall not exceed fifty percent of the total budget as submitted
in the application and approved in Budget, Exhibit E To meet matching requirements, the
Subrecipient's cash matching contributions must be considered reasonable, allowable, allocable,
and necessary under the grant program and must comply with all Federal requirements and
regulations, including, but not limited to, 2 CFR Part 200 An appropriate mechanism must be in
place to capture, track, and document matching funds In the final report, the Subrecipient shall
identify how the match was met and documented.
6 All personnel funded in any part through federal award or matching funds under this Agreement
shall.
a Complete and record proof of completion for the NIMS training requirements outlined in
the NIMS Training Program located at
https //www.fema qov/pdf/emergency/nims/nims training program pdf (to include ICS-
100, ICS-200, IS-700, and IS-800 for most personnel) The Subrecipient will report
training course completion by individual personnel along with the final report, and
b Complete either (1) the FEMA Professional Development Series IS-120, IS-230, IS-235,
IS-240, IS-241, IS-242, and IS-244, or (2) the National Emergency Management Basic
Academy The Subrecipient will report training course completion by individual personnel
along with the final report
C DHS TERMS AND CONDITIONS
As a Subrecipient of 19EMPG program funding, the Subrecipient shall comply with all applicable DHS
terms and conditions of the 19EMPG Award Letter and its incorporated documents for DHS Grant No
EMS-2019-EP-00003-S01, which are incorporated and made a part of this Agreement as Exhibit F
DHS-FEMA-EMPG-FY 19 Page 9 of 36 Lewis County DEM, E20-125 Revised
Exhibit B
Washington State Military Department
GENERAL TERMS AND CONDITIONS
Department of Homeland Security (DHS)/
Federal Emergency Management Agency (FEMA)
Grants
A 1 DEFINITIONS
As used throughout this Agreement, the terms will have the same meaning as defined in 2 CFR 200
9 9 9
Subpart A (which is incorporated herein by reference), except as otherwise set forth below
a "Agreement" means this Grant Agreement
b "Department" means the Washington State Military Department, as a state agency, any division,
section, office, unit or other entity of the Department, or any of the officers or other officials lawfully
representing that Department. The Department is a recipient of a federal award directly from a
federal awarding agency and is the pass-through entity making a subaward to a Subrecipient
under this Agreement
c. "Subrecipient" when capitalized is primarily used throughout this Agreement in reference to the
non-federal entity identified on the Face Sheet of this Agreement that has received a subaward
from the Department However, the definition of "Subrecipient" is the same as in 2 CFR 200 93
for all other purposes
d "Monitoring Activities" means all administrative, financial, or other review activities that are
conducted to ensure compliance with all state and federal laws, rules, regulations, authorities and
policies.
e "Investment" means the grant application submitted by the Subrecipient describing the project(s)
for which federal funding is sought and provided under this this Agreement. Such grant
application is hereby incorporated into this Agreement by reference
A.2 ADVANCE PAYMENTS PROHIBITED
The Department shall make no payments in advance or in anticipation of goods or services to be provided
under this Agreement Subrecipient shall not invoice the Department in advance of delivery and invoicing
of such goods or services.
A.3 AMENDMENTS AND MODIFICATIONS
The Subrecipient or the Department may request, in writing, an amendment or modification of this
Agreement However, such amendment or modification shall not be binding, take effect or be
incorporated herein until made in writing and signed by the authorized representatives of the Department
and the Subrecipient. No other understandings or agreements, written or oral, shall be binding on the
parties
A 4 AMERICANS WITH DISABILITIES ACT (ADA) OF 1990, PUBLIC LAW 101-336, 42 U.S.C. 12101 ET
SEQ. AND ITS IMPLEMENTING REGULATIONS ALSO REFERRED TO AS THE "ADA" 28 CFR Part
35.
The Subrecipient must comply with the ADA, which provides comprehensive civil rights protection to
individuals with disabilities in the areas of employment, public accommodations, state and local
government services, and telecommunication.
A5 ASSURANCES
The Department and Subrecipient agree that all activity pursuant to this Agreement will be in accordance
with all the applicable current federal, state and local laws, rules and regulations
A 6 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, OR INELIGIBILITY
As federal funds are a basis for this Agreement, the Subrecipient certifies that the Subrecipient is not
presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participating in this Agreement by any federal department or agency
The Subrecipient shall complete, sign, and return a Certification Regarding Debarment, Suspension,
Ineligibility, and Voluntary Exclusion form located at http//mil.wa.qov/emergency-management-
division/qrants/requiredgrantforms Any such form completed by the Subrecipient for this Agreement
shall be incorporated into this Agreement by reference
DHS-FEMA-EMPG-FY 19 Page 10 of 36 Lewis County DEM, E20-125 Revised
Further, the Subrecipient agrees to comply with all applicable federal regulations concerning the federal
debarment and suspension system, including 2 CFR Part 180 The Subrecipient certifies that it will
ensure that potential contractors or Subrecipients or any of their principals are not debarred, suspended,
proposed for debarment, declared ineligible, or voluntarily excluded from participation in "covered
transactions" by any federal department or agency "Covered transactions" include procurement
contracts for goods or services awarded under a non-procurement transaction (e g grant or cooperative
agreement) that are expected to equal or exceed $25,000, and subawards to Subrecipients for any
amount With respect to covered transactions, the Subrecipient may comply with this provision by
obtaining a certification statement from the potential contractor or Subrecipient or by checking the System
for Award Management(https//sam gov/SAM/) maintained by the federal government The Subrecipient
also agrees not to enter into any arrangements or contracts with any party on the Washington State
Department of Labor and Industries' "Debarred Contractor List"
(https.//secure.lni.wa.qov/debarandstrike/ContractorDebarList aspx) The Subrecipient also agrees not
to enter into any agreements or contracts for the purchase of goods and services with any party on the
Department of Enterprise Services' Debarred Vendor List
(http//www des wa qov/services/ContractingPurchasinq/Business/Pages/Vendor-Debarment aspx)
A 7 CERTIFICATION REGARDING RESTRICTIONS ON LOBBYING
As required by 44 CFR Part 18, the Subrecipient hereby certifies that to the best of its knowledge and
belief (1) no federally appropriated funds have been paid or will be paid by or on behalf of the
Subrecipient to any person for influencing or attempting to influence an officer or employee of an 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
any 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)
that 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
Agreement, grant, loan, or cooperative agreement, the Subrecipient will complete and submit Standard
Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions, (3) and that, as
applicable, the Subrecipient will require that the language of this certification be included in the award
documents 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 and is a prerequisite for making or entering into this transaction imposed by section
1352, title 31, U.S. Code
A.8 COMPLIANCE WITH APPLICABLE STATUTES, RULES AND DEPARTMENT POLICIES
The Subrecipient and all its contractors and subrecipients shall comply with, and the Department is not
responsible for determining compliance with, any and all applicable federal, state, and local laws,
regulations, executive orders, OMB Circulars, and/or policies This obligation includes, but is not limited
to. nondiscrimination laws and/or policies, Energy Policy and Conservation Act(PL 94-163, as amended),
the Americans with Disabilities Act (ADA), Age Discrimination Act of 1975, Title VI of the Civil Rights Act
of 1964, Civil Rights Act of 1968, the Robert T Stafford Disaster Relief and Emergency Assistance Act,
(PL 93-288, as amended), Ethics in Public Service (RCW 42 52), Covenant Against Contingent Fees (48
CFR Section 52 203-5), Public Records Act (RCW 42.56), Prevailing Wages on Public Works (RCW
39 12), State Environmental Policy Act(RCW 43 21C), Shoreline Management Act of 1971 (RCW 90 58),
State Building Code (RCW 19 27), Energy Related Building Standards (RCW 19 27A), Provisions in
Buildings for Aged and Handicapped Persons (RCW 70 92), and safety and health regulations.
In the event of noncompliance or refusal to comply with any applicable law, regulation, executive order,
OMB Circular or policy by the Subrecipient, its contractors or subrecipients,the Department may rescind,
cancel, or terminate the Agreement in whole or in part in its sole discretion. The Subrecipient is
responsible for all costs or liability arising from its failure, and that of its contractors and subrecipients, to
comply with applicable laws, regulations, executive orders, OMB Circulars or policies
A.9 CONFLICT OF INTEREST
No officer or employee of the Department, no member, officer, or employee of the Subrecipient or its
designees or agents, no member of the governing body of the jurisdiction in which the project is
DHS-FEMA-EMPG-FY 19 Page 11 of 36 Lewis County DEM, E20-125 Revised
undertaken or located, and no other official of the Subrecipient who exercises any functions or
responsibilities with respect to the project during his or her tenure, shall have any personal or pecuniary
gain or interest, direct or indirect, in any contract, subcontract, or the proceeds thereof, for work to be
performed in connection with the project assisted under this Agreement.
The Subrecipient shall incorporate, or cause to incorporate, in all such contracts or subawards, a
provision prohibiting such interest pursuant to this provision
A 10 CONTRACTING & PROCUREMENT
a The Subrecipient shall use a competitive procurement process in the procurement and award of
any contracts with contractors or subcontractors that are entered into under the original
agreement award. The procurement process followed shall be in accordance with 2 CFR Part
200 318 General procurement standards through 200 326 Contract provisions
As required by Appendix II to 2 CFR Part 200, all contracts entered into by the Subrecipient under
this Agreement must include the following provisions, as applicable.
1) Contracts for more than the simplified acquisition threshold currently set at $250,000, which
is the inflation adjusted amount determined by the Civilian Agency Acquisition Council and
the Defense Acquisition Regulations Council (Councils) as authorized by 41 U S C 1908,
must address administrative, contractual, or legal remedies in instances where contractors
violate or breach contract terms, and provide for such sanctions and penalties as appropriate
2) All contracts in excess of$10,000 must address termination for cause and for convenience
by the non-federal entity including the manner by which it will be affected and the basis for
settlement
3) Equal Employment Opportunity Except as otherwise provided under 41 CFR Part 60, all
contracts that meet the definition of"federally assisted construction contract" in 41 CFR Part
60-1 3 must include the equal opportunity clause provided under 41 CFR 60-1 4(b), in
accordance with Executive Order 11246, "Equal Employment Opportunity" (30 FR 12319,
12935, 3 CFR Part, 1964-1965 Comp., p. 339), as amended by Executive Order 11375,
"Amending Executive Order 11246 Relating to Equal Employment Opportunity," and
implementing regulations at 41 CFR part 60, "Office of Federal Contract Compliance
Programs, Equal Employment Opportunity, Department of Labor."
4) Davis-Bacon Act, as amended (40 U.S.C. 3141-3148). When required by Federal program
legislation, all prime construction contracts in excess of $2,000 awarded by non-federal
entities must include a provision for compliance with the Davis-Bacon Act (40 U S C 3141-
3144, and 3146-3148) as supplemented by Department of Labor regulations (29 CFR Part
5, "Labor Standards Provisions Applicable to Contracts Covering Federally Financed and
Assisted Construction") In accordance with the statute, contractors must be required to pay
wages to laborers and mechanics at a rate not less than the prevailing wages specified in a
wage determination made by the Secretary of Labor. In addition, contractors must be
required to pay wages not less than once a week The non-federal entity must place a copy
of the current prevailing wage determination issued by the Department of Labor in each
solicitation. The decision to award a contract or subcontract must be conditioned upon the
acceptance of the wage determination The non-federal entity must report all suspected or
reported violations to the federal awarding agency The contracts must also include a
provision for compliance with the Copeland "Anti-Kickback" Act (40 U S C 3145), as
supplemented by Department of Labor regulations (29 CFR Part 3, "Contractors and
Subcontractors on Public Building or Public Work Financed in Whole or in Part by Loans or
Grants from the United States") The Act provides that each contractor or Subrecipient must
be prohibited from inducing, by any means, any person employed in the construction,
completion, or repair of public work, to give up any part of the compensation to which he or
she is otherwise entitled. The non-federal entity must report all suspected or reported
violations to the federal awarding agency
5) Contract Work Hours and Safety Standards Act (40 U S.C. 3701-3708). Where applicable,
all contracts awarded by the non-federal entity in excess of $100,000 that involve the
employment of mechanics or laborers must include a provision for compliance with 40 U S C
3702 and 3704, as supplemented by Department of Labor regulations(29 CFR Part 5) Under
40 U.S.C. 3702 of the Act, each contractor must be required to compute the wages of every
DHS-FEMA-EMPG-FY 19 Page 12 of 36 Lewis County DEM, E20-125 Revised
mechanic and laborer on the basis of a standard work week of 40 hours Work in excess of
the standard work week is permissible provided that the worker is compensated at a rate of
not less than one and a half times the basic rate of pay for all hours worked in excess of 40
hours in the work week. The requirements of 40 U S C 3704 are applicable to construction
work and provide that no laborer or mechanic must be required to work in surroundings or
under working conditions which are unsanitary, hazardous or dangerous. These
requirements do not apply to the purchases of supplies or materials or articles ordinarily
available on the open market, or contracts for transportation or transmission of intelligence
6) Rights to Inventions Made Under a Contract or Agreement If the federal award meets the
definition of"funding agreement" under 37 CFR §401.2 (a) and the recipient or Subrecipient
wishes to enter into a contract with a small business firm or nonprofit organization regarding
the substitution of parties, assignment or performance of experimental, developmental, or
research work under that "funding agreement," the recipient or Subrecipient must comply
with the requirements of 37 CFR Part 401, "Rights to Inventions Made by Nonprofit
Organizations and Small Business Firms Under Government Grants, Contracts and
Cooperative Agreements,"and any implementing regulations issued by the awarding agency
7) Clean Air Act (42 U S C 7401-7671q ) and the Federal Water Pollution Control Act (33
U S C 1251-1387), as amended—Contracts and subgrants of amounts in excess of
$150,000 must contain a provision that requires the non-federal award to agree to comply
with all applicable standards, orders or regulations issued pursuant to the Clean Air Act (42
U S.0 7401-7671q) and the Federal Water Pollution Control Act as amended (33 U.S C
1251-1387) Violations must be reported to the federal awarding agency and the Regional
Office of the Environmental Protection Agency (EPA)
8) Debarment and Suspension (Executive Orders 12549 and 12689)—A contract award (see 2
CFR 180.220) must not be made to parties listed on the government-wide exclusions in the
System for Award Management(SAM), in accordance with the OMB guidelines at 2 CFR 180
that implement Executive Orders 12549 (3 CFR part 1986 Comp , p 189) and 12689 (3 CFR
part 1989 Comp., p 235), "Debarment and Suspension " SAM Exclusions contains the
names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties
declared ineligible under statutory or regulatory authority other than Executive Order 12549
9) Byrd Anti-Lobbying Amendment(31 U.S.C. 1352)—Contractors that apply or bid for an award
exceeding $100,000 must file the required certification Each tier certifies to the tier above
that it will not and has not used federal appropriated funds to pay any person or organization
for influencing or attempting to influence an officer or employee of any agency, a member of
Congress, officer or employee of Congress, or an employee of a member of Congress in
connection with obtaining any federal contract, grant or any other award covered by 31
U S C 1352 Each tier must also disclose any lobbying with non-federal funds that takes
place in connection with obtaining any federal award Such disclosures are forwarded from
tier to tier up to the non-federal award
10) Procurement of recovered materials -- As required by 2 CFR 200.322, a non-federal entity
that is a state agency or agency of a political subdivision of a state and its contractors must
comply with section 6002 of the Solid Waste Disposal Act, as amended by the Resource
Conservation and Recovery Act. The requirements of Section 6002 include procuring only
items designated in guidelines of the Environmental Protection Agency (EPA)at 40 CFR part
247 that contain the highest percentage of recovered materials practicable, consistent with
maintaining a satisfactory level of competition,where the purchase price of the item exceeds
$10,000 or the value of the quantity acquired during the preceding fiscal year exceeded
$10,000, procuring solid waste management services in a manner that maximizes energy
and resource recovery, and establishing an affirmative procurement program for
procurement of recovered materials identified in the EPA guidelines
11) Notice of awarding agency requirements and regulations pertaining to reporting.
12) Federal awarding agency requirements and regulations pertaining to copyrights and rights in
data.
13) Access by the Department, the Subrecipient, the federal awarding agency, the Comptroller
General of the United States, or any of their duly authorized representatives to any books,
DHS-FEMA-EMPG-FY 19 Page 13 of 36 Lewis County DEM, E20-125 Revised
documents, papers, and records of the contractor which are directly pertinent to that specific
contract for the purpose of making audit, examination, excerpts, and transcriptions
14) Retention of all required records for six years after the Subrecipient has made final payments
and all other pending matters are closed.
15) Mandatory standards and policies relating to energy efficiency which are contained in the
state energy conservation plan issued in compliance with the Energy Policy and
Conservation Act (Pub L 94-163, 89 Stat 871)
b The Department reserves the right to review the Subrecipient's procurement plans and
documents and require the Subrecipient to make changes to bring its plans and documents into
compliance with the requirements of 2 CFR Part 200.318 through 200.326. The Subrecipient
must ensure that its procurement process requires contractors and subcontractors to provide
adequate documentation with sufficient detail to support the costs of the project and to allow both
the Subrecipient and Department to make a determination on eligibility of project costs.
c. All contracting agreements entered into pursuant to this Agreement shall incorporate this
Agreement by reference
A 11 DISCLOSURE
The use or disclosure by any party of any information concerning the Department for any purpose not
directly connected with the administration of the Department's or the Subrecipient's responsibilities with
respect to services provided under this Agreement is prohibited except by prior written consent of the
Department or as required to comply with the state Public Records Act, other law or court order
A 12 DISPUTES
Except as otherwise provided in this Agreement, when a bona fide dispute arises between the parties
and it cannot be resolved through discussion and negotiation, either party may request a dispute
resolution panel to resolve the dispute A request for a dispute resolution board shall be in writing, state
the disputed issues, state the relative positions of the parties, and be sent to all parties The panel shall
consist of a representative appointed by the Department, a representative appointed by the Subrecipient
and a third party mutually agreed upon by both parties. The panel shall, by majority vote, resolve the
dispute Each party shall bear the cost for its panel member and its attorney fees and costs and share
equally the cost of the third panel member
A 13 LEGAL RELATIONS
It is understood and agreed that this Agreement is solely for the benefit of the parties to the Agreement
and gives no right to any other party No joint venture or partnership is formed as a result of this
Agreement
To the extent allowed by law, the Subrecipient, its successors or assigns, will protect, save and hold
harmless the Department, the state of Washington, and the United States Government and their
authorized agents and employees, from all claims, actions, costs, damages or expenses of any nature
whatsoever by reason of the acts or omissions of the Subrecipient, its subcontractors, subrecipients,
assigns, agents, contractors, consultants, licensees, invitees, employees or any person whomsoever
arising out of or in connection with any acts or activities authorized by this Agreement
To the extent allowed by law, the Subrecipient further agrees to defend the Department and the state of
Washington and their authorized agents and employees in any litigation, including payment of any costs
or attorneys' fees for any claims or action commenced thereon arising out of or in connection with acts
or activities authorized by this Agreement
This obligation shall not include such claims, costs, damages or expenses which may be caused by the
sole negligence of the Department, provided, that if the claims or damages are caused by or result from
the concurrent negligence of(1) the Department, and (2) the Subrecipient, its agents, or employees, this
indemnity provision shall be valid and enforceable only to the extent of the negligence of the Subrecipient,
or the Subrecipient's agents or employees
Insofar as the funding source, the Department of Homeland Security (DHS)/Federal Emergency
Management Agency (FEMA), is an agency of the Federal government, the following shall apply
44 CFR 206 9 Non-liability The Federal government shall not be liable for any claim based upon the
exercise or performance of, or the failure to exercise or perform a discretionary function or duty on the
DHS-FEMA-EMPG-FY 19 Page 14 of 36 Lewis County DEM, E20-125 Revised
part of a federal agency or an employee.of the Federal government in carrying out the provisions of the
Stafford Act
A 14 LIMITATION OF AUTHORITY—AUTHORIZED SIGNATURE
The signatories to this Agreement represent that they have the authority to bind their respective
organizations to this Agreement Only the Department's Authorized Signature representative and the
Authorized Signature representative of the Subrecipient or Alternate for the Subrecipient, formally
designated in writing, shall have the express, implied, or apparent authority to alter, amend, modify, or
waive any clause or condition of this Agreement Any alteration, amendment, modification, or waiver of
any clause or condition of this Agreement is not effective or binding unless made in writing and signed
by both parties'Authorized Signature representatives
Further, only the Authorized Signature representative or Alternate for the Subrecipient shall have
signature authority to sign reimbursement requests, time extension requests, amendment and
modification requests, requests for changes to projects or work plans, and other requests, certifications
and documents authorized by or required under this Agreement
A 15 LOSS OR REDUCTION OF FUNDING
In the event funding from state, federal, or other sources is withdrawn, reduced, or limited in any way
after the effective date of this Agreement and prior to normal completion or end date, the Department
may unilaterally reduce the work plan and budget or unilaterally terminate all or part of the Agreement as
a "Termination for Cause" without providing the Subrecipient an opportunity to cure. Alternatively, the
parties may renegotiate the terms of this Agreement under "Amendments and Modifications" to comply
with new funding limitations and conditions, although the Department has no obligation to do so
A.16 NONASSIGNABILITY
Neither this Agreement, nor any claim arising under this Agreement, shall be transferred or assigned by
the Subrecipient
A 17 NONDISCRIMINATION
The Subrecipient shall comply with all applicable federal and state non-discrimination laws, regulations,
and policies No person shall, on the grounds of age, race, creed, color, sex, sexual orientation, religion,
national origin, marital status, honorably discharged veteran or military status, or disability (physical,
mental, or sensory) be denied the benefits of, or otherwise be subjected to discrimination under any
project, program, or activity, funded, in whole or in part, under this Agreement
A 18 NOTICES
The Subrecipient shall comply with all public notices or notices to individuals required by applicable local,
state and federal laws and regulations and shall maintain a record of this compliance
A.19 OCCUPATIONAL SAFETY/HEALTH ACT and WASHINGTON INDUSTRIAL SAFETY/HEALTH ACT
(OSHA/WISHA)
The Subrecipient represents and warrants that its work place does now or will meet all applicable federal
and state safety and health regulations that are in effect during the Subrecipient's performance under this
Agreement. To the extent allowed by law,the Subrecipient further agrees to indemnify and hold harmless
the Department and its employees and agents from all liability, damages and costs of any nature,
including, but not limited to, costs of suits and attorneys' fees assessed against the Department, as a
result of the failure of the Subrecipient to so comply
A 20 OWNERSHIP OF PROJECT/CAPITAL FACILITIES
The Department makes no claim to any capital facilities or real property improved or constructed with
funds under this Agreement, and by this subaward of funds does not and will not acquire any ownership
interest or title to such property of the Subrecipient The Subrecipient shall assume all liabilities and
responsibilities arising from the ownership and operation of the project and agrees to indemnify and hold
the Department, the state of Washington, and the United States government harmless from any and all
causes of action arising from the ownership and operation of the project
A 21 POLITICAL ACTIVITY
No portion of the funds provided herein shall be used for any partisan political activity or to further the
election or defeat of any candidate for public office or influence the approval or defeat of any ballot issue
A 22 PROHIBITION AGAINST PAYMENT OF BONUS OR COMMISSION
DHS-FEMA-EMPG-FY 19 Page 15 of 36 Lewis County DEM, E20-125 Revised
The assistance provided under this Agreement shall not be used in payment of any bonus or commission
for the purpose of obtaining approval of the application for such assistance or any other approval or
concurrence under this Agreement provided, however, that reasonable fees or bona fide technical
consultant, managerial, or other such services, other than actual solicitation, are not hereby prohibited if
otherwise eligible as project costs
A.23 PUBLICITY
The Subrecipient agrees to submit to the Department prior to issuance all advertising and publicity
matters relating to this Agreement wherein the Department's name is mentioned, or language used from
which the connection of the Department's name may, in the Department's judgment, be inferred or
implied. The Subrecipient agrees not to publish or use such advertising and publicity matters without the
prior written consent of the Department The Subrecipient may copyright original work it develops in the
course of or under this Agreement, however, pursuant to 2 CFR Part 200 315, FEMA reserves a royalty-
free, nonexclusive, and irrevocable license to reproduce, publish or otherwise use, and to authorize
others to use the work for government purposes
Publication resulting from work performed under this Agreement shall include an acknowledgement of
FEMA's financial support, by the Assistance Listings Number(formerly CFDA Number), and a statement
that the publication does not constitute an endorsement by FEMA or reflect FEMA's views
A 24 RECAPTURE PROVISION
In the event the Subrecipient fails to expend funds under this Agreement in accordance with applicable
federal, state, and local laws, regulations, and/or the provisions of the Agreement, the Department
reserves the right to recapture funds in an amount equivalent to the extent of noncompliance Such right
of recapture shall exist for the life of the project following Agreement termination Repayment by the
Subrecipient of funds under this recapture provision shall occur within 30 days of demand. In the event
the Department is required to institute legal proceedings to enforce the recapture provision, the
Department shall be entitled to its costs and expenses thereof, including attorney fees from the
Subrecipient
A.25 RECORDS
a The Subrecipient agrees to maintain all books, records, documents, receipts, invoices and all
other electronic or written records necessary to sufficiently and properly reflect the Subrecipient's
contracts, subawards, grant administration, and payments, including all direct and indirect
charges, and expenditures in the performance of this Agreement (the "records").
b The Subrecipient's records related to this Agreement and the projects funded may be inspected
and audited by the Department or its designee, by the Office of the State Auditor, DHS, FEMA or
their designees, by the Comptroller General of the United States or its designees, or by other
state or federal officials authorized by law, for the purposes of determining compliance by the
Subrecipient with the terms of this Agreement and to determine the appropriate level of funding
to be paid under the Agreement
c The records shall be made available by the Subrecipient for such inspection and audit, together
with suitable space for such purpose, at any and all times during the Subrecipient's normal
working day.
d The Subrecipient shall retain and allow access to all records related to this Agreement and the
funded project(s) for a period of at least six (6) years following final payment and closure of the
grant under this Agreement Despite the minimum federal retention requirement of three (3)
years, the more stringent State requirement of six (6) years must be followed
A 26 RESPONSIBILITY FOR PROJECT/STATEMENT OF WORK/WORK PLAN
While the Department undertakes to assist the Subrecipient with the project/statement of work/work plan
(project) by providing federal award funds pursuant to this Agreement, the project itself remains the sole
responsibility of the Subrecipient. The Department undertakes no responsibility to the Subrecipient, or
to any third party, other than as is expressly set out in this Agreement
The responsibility for the design, development, construction, implementation, operation and maintenance
of the project, as these phrases are applicable to this project, is solely that of the Subrecipient, as is
responsibility for any claim or suit of any nature by any third party related in any way to the project
Prior to the start of any construction activity, the Subrecipient shall ensure that all applicable federal,
state, and local permits and clearances are obtained, including, but not limited to, FEMA compliance with
DHS-FEMA-EMPG-FY 19 Page 16 of 36 Lewis County DEM, E20-125 Revised
the National Environmental Policy Act, the National Historic Preservation Act, the Endangered Species
Act, and all other environmental laws, regulations, and executive orders
The Subrecipient shall defend, at its own cost, any and all claims or suits at law or in equity, which may
be brought against the Subrecipient in connection with the project The Subrecipient shall not look to the
Department, or to any state or federal agency, or to any of their employees or agents, for any
performance, assistance, or any payment or indemnity, including, but not limited to, cost of defense
and/or attorneys' fees, in connection with any claim or lawsuit brought by any third party related to any
design, development, construction, implementation, operation and/or maintenance of a project
A 27 SEVERABILITY
If any court of rightful jurisdiction holds any provision or condition under this Agreement or its application
to any person or circumstances invalid, this invalidity does not affect other provisions, terms or conditions
of the Agreement, which can be given effect without the invalid provision. To this end, the terms and
conditions of this Agreement are declared severable.
A 28 SINGLE AUDIT ACT REQUIREMENTS (including all AMENDMENTS)
The Subrecipient shall comply with and include the following audit requirements in any subawards
Non-federal entities, as Subrecipients of a federal award, that expend $750,000 or more in one fiscal
year of federal funds from all sources, direct and indirect, are required to have a single or a program-
specific audit conducted in accordance with 2 CFR Part 200 Subpart F Non-federal entities that spend
less than $750,000 a year in federal awards are exempt from federal audit requirements for that year,
except as noted in 2 CFR Part 200 Subpart F As defined in 2 CFR Part 200,the term"non-federal entity"
means a state, local government, Indian tribe, institution of higher education, or nonprofit organization
that carries out a federal award as a recipient or subrecipient
Subrecipients that are required to have an audit must ensure the audit is performed in accordance with
Generally Accepted Government Auditing Standards (GAGAS) as found in the Government Auditing
Standards (the Revised Yellow Book)developed by the United States Comptroller General and the OMB
Compliance Supplement The Subrecipient has the responsibility of notifying its auditor and requesting
an audit in compliance with 2 CFR Part 200 Subpart F, to include the Washington State Auditor's Office,
a federal auditor, or a public accountant performing work using GAGAS, as appropriate Costs of the
audit may be an allowable grant expenditure as authorized by 2 CFR Part 200 425
The Subrecipient shall maintain auditable records and accounts so as to facilitate the audit requirement
and shall ensure that any subcontractors also maintain auditable records The Subrecipient is
responsible for any audit exceptions incurred by its own organization or that of its
subcontractors. Responses to any unresolved management findings and disallowed or questioned costs
shall be included with the audit report The Subrecipient must respond to Department requests for
information or corrective action concerning audit issues or findings within 30 days of the date of
request The Department reserves the right to recover from the Subrecipient all disallowed costs
resulting from the audit.
After the single audit has been completed, and if it includes any audit findings, the Subrecipient must
send a full copy of the audit and its Corrective Action Plan to the Department at the following address no
later than nine (9) months after the end of the Subrecipient's fiscal year(s).
Contracts Office
Washington Military Department
Finance Division, Building #1 TA-20
Camp Murray, WA 98430-5032
The Subrecipient must send a completed "2 CFR Part 200 Subpart F Audit Certification Form"
(https//www mil wa qov/emergency-manaqement-division/grants/requiredgrantforms)to the Department
at the address listed above before this Agreement is executed and timely submit annual updates to the
Department every year thereafter, and if the Subrecipient is claiming it is exempt from the audit
requirements of 2 CFR Part 200 Subpart F include an explanation of the criteria for exemption
The Department retains the sole discretion to determine whether a valid claim for an exemption from the
audit requirements of this provision has been established.
Conducting a single or program-specific audit in compliance with 2 CFR Part 200 Subpart F is a material
requirement of this Agreement In the absence of a valid claim of exemption from the audit requirements
DHS-FEMA-EMPG-FY 19 Page 17 of 36 Lewis County DEM, E20-125 Revised
of 2 CFR Part 200 Subpart F, the Subrecipient's failure to comply with said audit requirements may result
in one or more of the following actions in the Department's sole discretion a percentage of federal awards
being withheld until the audit is completed in accordance with 2 CFR Part 200 Subpart F, the withholding
or disallowing of overhead costs, the suspension of federal awards until the audit is conducted and
submitted; or termination of the federal award
A.29 SUBRECIPIENT NOT EMPLOYEE
The parties intend that an independent contractor relationship will be created by this Agreement The
Subrecipient, and/or employees or agents performing under this Agreement are not employees or agents
of the Department in any manner whatsoever The Subrecipient will not be presented as, nor claim to
be, an officer or employee of the Department by reason of this Agreement, nor will the Subrecipient make
any claim, demand, or application to or for any right or privilege applicable to an officer or employee of
the Department or of the state of Washington by reason of this Agreement, including, but not limited to,
Workmen's Compensation coverage, unemployment insurance benefits, social security benefits,
retirement membership or credit, or privilege or benefit which would accrue to a civil service employee
under Chapter 41 06 RCW
It is understood that if the Subrecipient is another state department, state agency, state university, state
college, state community college, state board, or state commission, that the officers and employees are
employed by the state of Washington in their own right and not by reason of this Agreement.
A.30 TAXES, FEES AND LICENSES
Unless otherwise provided in this Agreement, the Subrecipient shall be responsible for, pay and maintain
in current status all taxes, unemployment contributions, fees, licenses, assessments, permit charges and
expenses of any other kind for the Subrecipient or its staff required by statute or regulation that are
applicable to Agreement performance
A 31 TERMINATION FOR CONVENIENCE
Notwithstanding any provisions of this Agreement, the Subrecipient may terminate this Agreement by
providing written notice of such termination to the Department Key Personnel identified in the Agreement,
specifying the effective date thereof, at least thirty (30) days prior to such date
Except as otherwise provided in this Agreement, the Department, in its sole discretion and in the best
interests of the state of Washington, may terminate this Agreement in whole or in part by providing ten
(10) calendar days written notice, beginning on the second day after mailing to the Subrecipient Upon
notice of termination for convenience, the Department reserves the right to suspend all or part of the
Agreement, withhold further payments, or prohibit the Subrecipient from incurring additional obligations
of funds In the event of termination, the Subrecipient shall be liable for all damages as authorized by
law The rights and remedies of the Department provided for in this section shall not be exclusive and
are in addition to any other rights and remedies provided by law
A.32 TERMINATION OR SUSPENSION FOR CAUSE
In the event the Department, in its sole discretion, determines the Subrecipient has failed to fulfill in a
timely and proper manner its obligations under this Agreement, is in an unsound financial condition so
as to endanger performance hereunder, is in violation of any laws or regulations that render the
Subrecipient unable to perform any aspect of the Agreement, or has violated any of the covenants,
agreements or stipulations of this Agreement, the Department has the right to immediately suspend or
terminate this Agreement in whole or in part
The Department may notify the Subrecipient in writing of the need to take corrective action and provide
a period of time in which to cure The Department is not required to allow the Subrecipient an opportunity
to cure if it is not feasible as determined solely within the Department's discretion Any time allowed for
cure shall not diminish or eliminate the Subrecipient's liability for damages or otherwise affect any other
remedies available to the Department If the Department allows the Subrecipient an opportunity to cure,
the Department shall notify the Subrecipient in writing of the need to take corrective action If the
corrective action is not taken within ten (10) calendar days or as otherwise specified by the Department,
or if such corrective action is deemed by the Department to be insufficient, the Agreement may be
terminated in whole or in part.
The Department reserves the right to suspend all or part of the Agreement, withhold further payments,
or prohibit the Subrecipient from incurring additional obligations of funds during investigation of the
DHS-FEMA-EMPG-FY 19 Page 18 of 36 Lewis County DEM, E20-125 Revised
alleged compliance breach, pending corrective action by the Subrecipient, if allowed, or pending a
decision by the Department to terminate the Agreement in whole or in part
In the event of termination,the Subrecipient shall be liable for all damages as authorized by law, including,
but not limited to, any cost difference between the original Agreement and the replacement or cover
Agreement and all administrative costs directly related to the replacement Agreement, e.g., cost of
administering the competitive solicitation process, mailing, advertising and other associated staff time
The rights and remedies of the Department provided for in this section shall not be exclusive and are in
addition to any other rights and remedies provided by law
If it is determined that the Subrecipient (1)was not in default or material breach, or(2)failure to perform
was outside of the Subrecipient's control, fault or negligence, the termination shall be deemed to be a
"Termination for Convenience".
A 33 TERMINATION PROCEDURES
In addition to the procedures set forth below, if the Department terminates this Agreement, the
Subrecipient shall follow any procedures specified in the termination notice. Upon termination of this
Agreement and in addition to any other rights provided in this Agreement, the Department may require
the Subrecipient to deliver to the Department any property specifically produced or acquired for the
performance of such part of this Agreement as has been terminated.
If the termination is for convenience, the Department shall pay to the Subrecipient as an agreed upon
price, if separately stated, for properly authorized and completed work and services rendered or goods
delivered to and accepted by the Department prior to the effective date of Agreement termination, the
amount agreed upon by the Subrecipient and the Department for(i) completed work and services and/or
equipment or supplies provided for which no separate price is stated, (ii) partially completed work and
services and/or equipment or supplies provided which are accepted by the Department, (iii) other work,
services and/or equipment or supplies which are accepted by the Department, and (iv)the protection and
preservation of property
Failure to agree with such amounts shall be a dispute within the meaning of the "Disputes" clause of this
Agreement. If the termination is for cause, the Department shall determine the extent of the liability of
the Department The Department shall have no other obligation to the Subrecipient for termination The
Department may withhold from any amounts due the Subrecipient such sum as the Department
determines to be necessary to protect the Department against potential loss or liability
The rights and remedies of the Department provided in this Agreement shall not be exclusive and are in
addition to any other rights and remedies provided by law
After receipt of a notice of termination, and except as otherwise directed by the Department in writing,
the Subrecipient shall
a. Stop work under the Agreement on the date, and to the extent specified, in the notice,
b Place no further orders or contracts for materials, services, supplies, equipment and/or facilities
in relation to this Agreement except as may be necessary for completion of such portion of the
work under the Agreement as is not terminated,
c Assign to the Department, in the manner, at the times, and to the extent directed by the
Department, all of the rights, title, and interest of the Subrecipient under the orders and contracts
so terminated, in which case the Department has the right, at its discretion, to settle or pay any
or all claims arising out of the termination of such orders and contracts,
d Settle all outstanding liabilities and all claims arising out of such termination of orders and
contracts, with the approval or ratification of the Department to the extent the Department may
require, which approval or ratification shall be final for all the purposes of this clause,
e Transfer title to the Department and deliver in the manner, at the times, and to the extent directed
by the Department any property which, if the Agreement had been completed, would have been
required to be furnished to the Department,
f Complete performance of such part of the work as shall not have been terminated by the
Department in compliance with all contractual requirements, and
g Take such action as may be necessary, or as the Department may require, for the protection and
preservation of the property related to this Agreement which is in the possession of the
Subrecipient and in which the Department has or may acquire an interest
DHS-FEMA-EMPG-FY 19 Page 19 of 36 Lewis County DEM, E20-125 Revised
A 34 UTILIZATION OF MINORITY AND WOMEN BUSINESS ENTERPRISES (MWBE)
The Subrecipient is encouraged to utilize business firms that are certified as minority-owned and/or
women-owned in carrying out the purposes of this Agreement The Subrecipient may set utilization
standards, based upon local conditions or may utilize the state of Washington MWBE goals, as identified
in WAC 326-30-041
A 35 VENUE
This Agreement shall be construed and enforced in accordance with, and the validity and performance
shall be governed by, the laws of the state of Washington Venue of any suit between the parties arising
out of this Agreement shall be the Superior Court of Thurston County, Washington The Subrecipient,
by execution of this Agreement, acknowledges the jurisdiction of the courts of the state of Washington
A.36 WAIVERS
No conditions or provisions of this Agreement can be waived unless approved in advance by the
Department in writing The Department's failure to insist upon strict performance of any provision of the
Agreement or to exercise any right based upon a breach thereof, or the acceptance of any performance
during such breach, shall not constitute a waiver of any right under this Agreement
DHS-FEMA-EMPG-FY 19 Page 20 of 36 Lewis County DEM, E20-125 Revised
Exhibit C
•
WORK PLAN
FY 2019 Emergency Management Performance Grant
Emergency Management Organization Lewis County
The purpose of EMPG is to assist with the enhancement,sustainment and improvement of state,local,and tribal emergency management
programs Activities conducted using EMPG funding should relate directly to the five elements of emergency management. prevention,
protection,response,recovery,and mitigation Washington State does not require a specific number of activities to receive EMPG funding
However,there are required capabilities that must be sustained in order to remain eligible for EMPG funding,including but not limited to
the ability to communicate and warn,educate the public,train and exercise,plan,and be NIMS compliant.The Work Plan delineates the
Emergency Management Organization's emergency management program planning and priority focus for this grant cycle(to include
19EMPG grant and local funds)
Program Area-Sustainment
IT maintenance and support of computers purchased with EMPG funds in the 2011-14 grant periods
Program Area#1
Planning
WORK PLANNED WHY THE WORK IS BEING DONE RESULT OF THE WORK
1 Continue work with Mass Casualty Incident(MCI) Federal government has adopted SALT triage, Plans will be updated and training coordinators
committee and plan to implement Sort,Assess, therefore,Lewis County needs to work with the will be set up to provide the necessary training to
Lifesaving Interventions,Treatment/Transport committee to update the plans and develop an responders.
(SALT)triage in compliance with Federal implementation plan for training.
standards.
2 Update HIVA with incidents from the 2019 year Required to annually update HIVA with annual HIVA will be updated and posted to the web so
incidents. citizens can determine their risks.
3 Formulate draft Flood Response Plan to-record Many long-term members of the response team Formalized flood response process will be in place
benchmarks for actions. have been,or will be,retiring.It is essential to to provide new personnel with background
record benchmarks for new staff ,knowledge of this area of response
4 Coordinate responder/partner meetings,including Regular meetings with agencies allow partners to Current partners will have the opportunity to work
training opportunities as applicable meet and share best practices.The focus will be together with new responders in a relaxed
on bringing in new partners from cities,fire,law, atmosphere to share experiences and best
and NGOs and revising plans to reflect new practices and facilitate ongoing learning,making it
federal/EMS standards.Staff will be able to travel easier to work together,especially during
throughout the county to meet more rural emergency incidents.Staff will be able to work
partners who may not be able to come to the one-on-one with those in rural areas.
DEM office
5 Coordinate Multi-Agency Coordination Center Currently there is no formal name on display in Continue to add informational signs and storage
(MACC)supplies and storage cabinets the MACC It is important to distinguish it from the cabinets for the MACC,which will be easily
EOC in another building.Storage cabinets are distinguishable from the EOC
necessary to organize supplies for easy access and
inventories.
Program Area#2
Communications
WORK PLANNED WHY THE WORK IS BEING DONE RESULT OF THE WORK
I Enhance the Lewis County Alert program by It is the responsibility of EM to be able to notify Currently there are 4,000 cell users in the
increasing the number of persons in the program citizens(countywide)in an emergency The alert -program The new cell efforts are expected to at
with cell phones who do not have landlines, and warning program allows notification directly least double coverage to cell phone users
includes citizen self sign-ups and periodic testing. to citizens by several means.There is a gap in the
coverage of citizens with cell phones that have
not signed up for the program
2 Conduct annual tests of the Lewis County alert Tests are needed to ensure new citizen sign-ins Notification preferences have been properly
system,coordinating activities with Tacoma have been added properly and to ensure that activated and citizens are ready to receive actual
Power's annual Dam Siren Testing program and previously registered citizens remain active and alerts when emergencies occur
State Shakeout drills receive notices
DHS-FEMA-EMPG-FY 19 Page 21 of 36 Lewis County DEM, E20-125 Revised
3 Conduct Ham Radio meetings,training,and Ham radio tests and training are needed to ensure Equipment and staff will be tested and issues will
network tests. equipment and staff will perform as expected be identified and corrected Operators will
during emergency incidents become familiar with the processes and
equipment in a relaxed atmosphere that will lead
to confidence during emergency incidents.
4 Continue work on the Communications Plan with New federal mandates for creating and The Regional LEP plan will provide the specifics
partner agencies,Region 3,and the public distributing a Limited English Proficiency(LEP) that Lewis County will need to fill in to draft the
Plan and a Communications Plan have created a local plan,so that the county is able to
gap for Lewis County Joining with Region 3 HLS communicate effectively with individuals,
partners for the LEP portion will reduce costs and including those with LEP
share the workload
5 Purchase subscription for archiving social media Changes in how citizens access information Purchasing the archive subscription will allow staff
content. requires DEM to enter the arena of social media to develop a Facebook and Twitter presence to
(Facebook,Twitter,etc)to expand our network communicate with users of these programs and
WA State guidelines(RCW 40.14)require archiving allow archiving of the information
of social media
Program Area#3
Public Outreach
WORK PLANNED WHY THE WORK IS BEING DONE RESULT OF THE WORK
I Conduct and facilitate public outreach to the There is an increased need for updated Citizens will be advised of the new threats and be
citizens and responders of Lewis County Develop preparedness messages with the new vulnerability educated in how to prepare themselves,resulting
and distribute handouts for preparedness to wildland fire and evacuation preparedness in a more resilient community
messages and programmatic activities.Also Water conservation is also a new idea to the area
purchase insignia clothing for new employees. The Drought Committee has identified these gaps
Purchase promotional preparedness items to be and approved materials and messages to be
distributed to the public distributed to the public Wearing of EM insignia
clothing will identify staff professionals during
events.
2 Prepare four Grab'n'Go bags for demonstrations These four bags will be filled with supplies to give The bags will be available to take on preparedness
The four different kits will cover family,individual, people an idea what they might want to put in presentations to demonstrate how easy it is to put
automobile,and pet preparedness. their backpack kits and how to store them.Having together a kit to encourage those that haven't yet
a pack to demonstrate has proven to help the started to do so.
public get started once they see how easy it is.
3 Purchase portable canopy,folding table,and The unpredictable weather conditions in the area The canopy and table will make DEM immediately
chairs with DEM logo to be deployed at have been identified as a problem for when recognizable and easy to find in a crowd Also,it
community events and preparedness fairs. participating at local outdoor activities The 10x10 will protect the preparedness materials and staff
canopy setup will protect materials from the from inclement weather conditions
weather and also make it immediately
recognizable that DEM is participating in events
and make it easy for the public to identify it at the
preparedness fair
4 Purchase portable projectors The two projectors DEM has no longer work DEM staff will be able to continue to provide
These projectors are vital to the outreach program preparedness outreach to rural areas that do not
as DEM provides a large amount of public have their own equipment
presentations at small venues that do not have
projection equipment
5 Purchase two portable monitors for presentations A large percentage of Lewis County is rural The monitors will expand opportunities for
without classroom resources,therefore,it is preparedness instructions at local
important for DEM staff to have portable preparedness/health fairs and meetings.
equipment they can bring for meetings and
classes
DHS-FEMA-EMPG-FY 19 Page 22 of 36 Lewis County DEM, E20-125 Revised
Program Area#4
Training and Professional Development
WORK PLANNED WHY THE WORK IS BEING DONE RESULT OF THE WORK
1 Attend/participate in Partners in Emergency The PIEP Conference will provide employees a Staff will have increased awareness and
Preparedness(PIEP)Conference variety of training opportunities,as well as lessons knowledge of current EM trends and network with
learned and networking opportunities other agencies that can provide some program
support The concentrated training offered will
accelerate the learning curve,especially for new
staff
2 Attend/participate in the Tribal/Local Emergency The local budget does not include funds for travel Attendees will be brought up-to-date on current
Planning Committee(LEPC)Conference Attendance will allow collaboration on best LEPC requirements Networking will increase
practices and opportunities to receive HazMat awareness and provide for better partnerships
information and network opportunities with state-
wide partners
3 Support staff development and training(PDS, Training requirements are prescribed by law and Staff members will be in compliance with the ICS
Advanced Professional Series,and ICS classes). grant guidelines(EMPG) New staff need to be and DEM training necessary to perform the duties
trained to these requirements.Once they meet of their positions in order to provide technical
minimum requirements,it is desirable to expand assistance to the smaller agencies that don't have
their knowledge by attending additional classes as experts on staff
needs arise
4 Coordinate rental facilities to provide enough Adequate public meeting space for large groups Responders will be able to gather together to ask
space to bring together large groups for the (30-150)has to be rented in Lewis County Also, questions,conduct and attend training,and meet
annual Flood meeting,tabletops,and other most agencies don't have an opportunity to other discipline personnel to share information
education gatherings interact with other disciplines unless EM provides before emergencies occur
that opportunity
5 Purchase a portable Smart TV for use in a shared This gap has been identified due to the fact the The mobile TV will be used for staff training in a
training room Director's office is also in the MACC space and shared training room that can be used when the
often there are confidential meetings taking place primary MACC room is otherwise occupied
when training has been scheduled
DHS-FEMA-EMPG-FY 19 Page 23 of 36 Lewis County DEM, E20-125 Revised
Exhibit D
TIMELINE
FY 2019 Emergency Management Performance Grant
DATE TASK
June 1, 2019 Grant Agreement Start Date
January 31, 2020 Submit reimbursement request
April 30, 2020 Submit reimbursement request
August 31, 2020 Grant Agreement End Date
October 15, 2020 Submit final reimbursement request, final report, training
requirement report, and/or other deliverables
DHS-FEMA-EMPG-FY 19 Page 24 of 36 Lewis County DEM, E20-125 Revised
Exhibit E
BUDGET
FY 2019 Emergency Management Performance Grant
19EMPG AWARD $ 43,680.00
SOLUTION
AREA BUDGET CATEGORY EMPG AMOUNT MATCH AMOUNT
Salaries & Benefits $ - $ 43,680
W Overtime/Backfill $ - $
-
Z
Z Consultants/Contractors $ - $ -
gGoods &Services $ 5,301 $ -
a Travel/Per Diem $ - $ -
Subtotal $ 5,301 $ 43,680
ZSalaries &Benefits $ - $ -
p Overtime/Backfill $ - $ -
g Consultants/Contractors $ - $ -
Z Goods &Services $ 33,174 $
a -
oC Travel/Per Diem $ 5,205 $ -
0 Subtotal $ 38,379 $ -
Salaries &Benefits $ - $ -
N
0 Overtime/Backfi I I $ - $ -
Consultants/Contractors $ - $ -
X Goods &Services $ - $ -
W Travel/Per Diem $ - $ -
Subtotal $ - $ -
Salaries &Benefits $ - $ -
Zti
Overme/Ba ckfi I I $ - $ -
Z Consultants/Contractors $ - $ -
Q Goods &Services $ - $ -
I— Travel/Per Diem $ - $ -
Subtotal $ - $ -
a
n Equipment $ - $ -
LS $ - $
"' Subtotal
Salaries & Benefits $ - $ -
Ovehtime/Backfill $ - $ -
0 Consultants/Contractors $ - $ -
2 Goods &Services $ - $ -
Travel/Per Diem $ - $ -
Subtotal $ - $ -
Indirect $ - $ -
Indirect Cost Rate on file 0%
TOTAL Grant Agreement AMOUNT: $ 43,680 I $ 43,680
• The Subrecipient will provide a match of$43,680 of non-federal origin, 50% of the total project cost(local
budget plus EMPG award).
• Cumulative transfers to budget categories in excess of 10% of the Grant Agreement Amount will not be
reimbursed without prior written authorization from the Department
Funding Source U S Department of Homeland Security- Pl# 793PT— EMPG
DHS-FEMA-EMPG-FY 19 Page 25 of 36 Lewis County DEM, E20-125 Revised
i
Exhibit F
19EMPG Award Letter
EMS-2019-EP-00003-S01
Award Letter
U S Department of Homeland Security
��..A�\t.4, Washington, D C.20472
�c4ND SEGJ
U
Tirzah Kincheloe
Washington Military Department
Building 20
Camp Murray, WA 98430-5122
Re: Grant No.EMS-2019-EP-00003
Dear Tirzah Kincheloe
Congratulations,on behalf of the Department of Homeland Security,your application for financial assistance submitted under
the Fiscal Year(FY)2019 Emergency Management Performance Grants has been approved in the amount of$7,409,645 00
As a condition of this award,you are required to contribute a cost match in the amount of$7,409,645 00 of non-Federal funds,
or 50 percent of the total approved project costs of$14,819,290.00
Before you request and receive any of the Federal funds awarded to you,you must establish acceptance of the award By
accepting this award, you acknowledge that the terms of the following documents are incorporated into the terms of your
award
• Agreement Articles(attached to this Award Letter)
• Obligating Document(attached to this Award Letter)
• FY 2019 Emergency Management Performance Grants Notice of Funding Opportunity
• FEMA Preparedness Grants Manual
Please make sure you read,understand, and maintain a copy of these documents in your official file for this award
In order to establish acceptance of the award and its terms, please follow these instructions
Step 1 Please log in to the ND Grants system at https://portal fema gov
Step 2 After logging in,you will see the Home page with a Pending Tasks menu Click on the Pending Tasks menu,select the
Application sub-menu, and then click the link for"Award Offer Review"tasks This link will navigate you to Award Packages
that are pending review
Step 3.Click the Review Award Package icon(wrench)to review the Award Package and accept or decline the award Please
save or print the Award Package for your records
System for Award Management(SAM) Grant recipients are to keep all of their information up to date in SAM, in particular,
your organization's name,address, DUNS number, EIN and banking information Please ensure that the DUNS number used
in SAM is the same one used to apply for all FEMA awards Future payments will be contingent on the information provided
in the SAM,therefore, it is imperative that the information is correct.The System for Award Management is located at http I/
www.sam.gov
If you have any questions or have updated your information in SAM, please let your Grants Management Specialist(GMS)
know as soon as possible This will help us to make the necessary updates and avoid any interruptions in the payment
process
DHS-FEMA-EMPG-FY 19 Page 26 of 36 Lewis County DEM, E20-125 Revised
•
KIMBERLY ERIN PENFOLD Assistance Officer
DHS-FEMA-EMPG-FY 19 Page 27 of 36 Lewis County DEM, E20-125 Revised
Agreement Articles
Mon Oct 01 00 00 00 GMT 2018
U S Department of Homeland Security
i4ART,y Washington, D C 20472
4 +r
� 1
44,4�ND StiG'
AGREEMENT ARTICLES
Emergency Management Performance Grants
GRANTEE. Washington Military Department
PROGRAM: Emergency Management Performance
Grants
AGREEMENT NUMBER: EMS-2019-EP-00003-S01
TABLE OF CONTENTS
Article I Assurances,Administrative Requirements,Cost Principles,
Representation and Certifications
Article II Acknowledgement of Federal Funding from DHS
Article Ill DHS Specific Acknowledgements and Assurances
Article IV Activities Conducted Abroad
Article V Age Discrimination Act of 1975
Article VI Americans with Disabilities Act of 1990
Article VII Best Practices for Collection and Use of Personally
Identifiable Information(PII)
Article VIII Civil Rights Act of 1964-Title VI
Article IX Civil Rights Act of 1968
Article X Copyright
Article XI Debarment and Suspension
Article XII Drug-Free Workplace Regulations
Article XIII Duplication of Benefits
DHS-FEMA-EMPG-FY 19 Page 28 of 36 Lewis County DEM, E20-125 Revised
Article XIV Education Amendments of 1972(Equal Opportunity in
Education Act)-Title IX
Article XV Energy Policy and Conservation Act
Article XVI False Claims Act and Program Fraud Civil Remedies
Article XVII Federal Debt Status
Article XVIII Federal Leadership on Reducing Text Messaging while
Driving
Article XIX Fly America Act of 1974
Article XX Hotel and Motel Fire Safety Act of 1990
Article XXI Limited English Proficiency(Civil Rights Act of 1964,Title VI)
Article XXII Lobbying Prohibitions
Article XXIII National Environmental Policy Act
Article XXIV Nondiscrimination in Matters Pertaining to Faith-Based
Organizations
Article XXV Non-Supplanting Requirement
Article XXVI Notice of Funding Opportunity Requirements
Article XXVII Patents and Intellectual Property Rights
Article XXVIII Procurement of Recovered Materials
Article XXIX Rehabilitation Act of 1973
Article XXX Reporting of Matters Related to Recipient Integrity and
Performance
Article XXXI Reporting Subawards and Executive Compensation
Article XXXII SAFECOM
Article XXXIII Terrorist Financing
Article)(XXIV Trafficking Victims Protection Act of 2000
Article XXXV Universal Identifier and System for Award Management
Article XXXVI USA Patriot Act of 2001
DHS-FEMA-EMPG-FY 19 Page 29 of 36 Lewis County DEM, E20-125 Revised
9 Y
•
Article XXXVII Use of DHS Seal, Logo and Flags
Article XXXVIII Whistleblower Protection Act
Article XXXIX Environmental Planning and Historic Preservation
Article XL Acceptance of Post Award Changes
Article XLI Disposition of Equipment Acquired Under the Federal Award
Article XLII Prior Approval for Modification of Approved Budget
Article I-Assurances,Administrative Requirements,Cost Principles,Representation and Certifications
DHS financial assistance recipients must complete either the Office of Management and Budget(OMB)Standard Form 424B
Assurances-Non-Construction Programs,or OMB Standard Form 424D Assurances-Construction Programs,as applicable.
Certain assurances in these documents may not be applicable to your program,and the DHS financial assistance office(DHS
FAO)may require applicants to certify additional assurances Applicants are required to fill out the assurances applicable to
their program as instructed by the awarding agency Please contact the DHS FAO if you have any questions.
DHS financial assistance recipients are required to follow the applicable provisions of the Uniform Administrative
Requirements, Cost Principles, and Audit Requirements for Federal Awards located at Title 2,Code of Federal Regulations
(C F R)Part 200,and adopted by DHS at 2 C F R Part 3002
Article II-Acknowledgement of Federal Funding from OHS
Recipients must acknowledge their use of federal funding when issuing statements, press releases, requests for proposal, bid
invitations,and other documents describing projects or programs funded in whole or in part with federal funds
Article III-DHS Specific Acknowledgements and Assurances
All recipients,subrecipients,successors,transferees,and assignees must acknowledge and agree to comply with applicable
provisions governing DHS access to records,accounts,documents, information,facilities,and staff
1 Recipients must cooperate with any compliance reviews or compliance investigations conducted by DHS
2 Recipients must give DHS access to, and the right to examine and copy, records,accounts,and other documents and
sources of information related to the federal financial assistance award and permit access to facilities,personnel, and other
individuals and information as may be necessary,as required by DHS regulations and other applicable laws or program
guidance
3 Recipients must submit timely,complete, and accurate reports to the appropriate DHS officials and maintain appropriate
backup documentation to support the reports
4 Recipients must comply with all other special reporting,data collection,and evaluation requirements, as prescribed by law
or detailed in program guidance
5 Recipients of federal financial assistance from OHS must complete the DHS Civil Rights Evaluation Tool within thirty(30)
days of receipt of the Notice of Award or,for State Administering Agencies,thirty(30)days from receipt of the DHS Civil
Rights Evaluation Tool from DHS or its awarding component agency Recipients are required to provide this information once
every two(2)years, not every time an award is made After the initial submission for the first award under which this term
applies, recipients are only required to submit updates every two years, not every time a grant is awarded Recipients should
submit the completed tool, including supporting materials, to CivilRightsEvaluation @hq.dhs.gov.This tool clarifies the civil
rights obligations and related reporting requirements contained in the DHS Standard Terms and Conditions Subrecipients are
not required to complete and submit this tool to OHS The evaluation tool can be found at https://www.dhs.gov/publication/dhs-
civil-rig hts-evaluation-tool.
Article IV-Activities Conducted Abroad
DHS-FEMA-EMPG-FY 19 Page 30 of 36 Lewis County DEM, E20-125 Revised
Recipients must ensure that project activities carried on outside the United States are coordinated as necessary with
appropriate government authorities and that appropriate licenses, permits,or approvals are obtained
Article V-Age Discrimination Act of 1975
Recipients must comply with the requirements of the Age Discrimination Act of 1975, Pub. L. No. 94-135(1975)(codified as
amended at Title 42, U S Code, section 6101 et seq),which prohibits discrimination on the basis of age in any program or
activity receiving federal financial assistance
Article VI-Americans with Disabilities Act of 1990
Recipients must comply with the requirements of Titles I, II, and III of the Americans with Disabilities Act, Pub L No 101-336
i on(1990)(codified as amended at 42 U S C sections 12101-12213),which prohibits recipients from discriminating in at g o the b asis
of disability in the operation of public entities, public and private transportation systems, places of public accommodation,and
certain testing entities
Article VII-Best Practices for Collection and Use of Personally Identifiable Information(PII)
Recipients who collect PII are required to have a publicly available privacy policy that describes standards on the usage and
maintenance of the PII they collect DHS defines personally identifiable information(PII)as any information that permits the
identity of an individual to be directly or indirectly inferred, including any information that is linked or linkable to that individual
Recipients may also find the DHS Privacy Impact Assessments Privacy Guidance and Privacy Template as useful resources
respectively
Article VIII-Civil Rights Act of 1964-Title VI
Recipients must comply with the requirements of Title VI of the Civil Rights Act of 1964(codified as amended at 42 U S C
section 2000d et seq),which provides that no person in the United States will,on the grounds of race, color,or national origin,
be excluded from participation in, be denied the benefits of,or be subjected to discrimination under any program or activity
receiving federal financial assistance OHS implementing regulations for the Act are found at 6 C F R Part 21 and 44 C F R
Part 7
Article IX-Civil Rights Act of 1968
Recipients must comply with Title VIII of the Civil Rights Act of 1968, Pub L No 90-284,as amended through Pub L 113-4,
which prohibits recipients from discriminating in the sale, rental,financing, and advertising of dwellings, or in the provision of
services in connection therewith,on the basis of race, color,national origin, religion,disability,familial status,and sex(see
42 U S C section 3601 et seq),as implemented by the U.S. Department of Housing and Urban Development at 24 C F R
Part 100 The prohibition on disability discrimination includes the requirement that new multifamily housing with four or more
dwelling units-i.e,the public and common use areas and individual apartment units(all units in buildings with elevators and
ground-floor units in buildings without elevators)-be designed and constructed with certain accessible features (See 24
C F R Part 100, Subpart D.)
Article X-Copyright
Recipients must affix the applicable copyright notices of 17 U S C sections 401 or 402 and an acknowledgement of U S
Government sponsorship(including the award number)to any work first produced under federal financial assistance awards
Article XI-Debarment and Suspension
Recipients are subject to the non-procurement debarment and suspension regulations implementing Executive Orders(E O)
12549 and 12689,which are at 2 C.F.R.Part 180 as adopted by DHS at 2 C F R Part 3000 These regulations restrict
federal financial assistance awards,subawards,and contracts with certain parties that are debarred,suspended,or otherwise
excluded from or ineligible for participation in federal assistance programs or activities
Article XII-Drug-Free Workplace Regulations
Recipients must comply with drug-free workplace requirements in Subpart B(or Subpart C, if the recipient is an individual)of 2
C F R Part 3001,which adopts the Government-wide implementation(2 C F R Part 182)of sec 5152-5158 of the Drug-Free
Workplace Act of 1988(41 U S C sections 8101-8106)
Article XIII-Duplication of Benefits
DHS-FEMA-EMPG-FY 19 Page 31 of 36 Lewis County DEM, E20-125 Revised
Any cost allocable to a particular federal financial assistance award provided for in 2 C F R Part 200, Subpart E may not
be charged to other federal financial assistance awards to overcome fund deficiencies,to avoid restrictions imposed by
federal statutes,regulations, or federal financial assistance award terms and conditions,or for other reasons However,these
prohibitions would not preclude recipients from shifting costs that are allowable under two or more awards in accordance with
existing federal statutes, regulations,or the federal financial assistance award terms and conditions
Article XIV-Education Amendments of 1972(Equal Opportunity in Education Act)-Title IX
Recipients must comply with the requirements of Title IX of the Education Amendments of 1972, Pub. L No. 92-318(1972)
(codified as amended at 20 U S C section 1681 et seq),which provide that no person in the United States will,on the basis
of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any educational
program or activity receiving federal financial assistance DHS implementing regulations are codified at 6 C F R Part 17 and
44CFR Part 19
Article XV-Energy Policy and Conservation Act
Recipients must comply with the requirements of the Energy Policy and Conservation Act, Pub L No 94-163(1975)(codified
as amended at 42 U S C section 6201 et seq),which contain policies relating to energy efficiency that are defined in the state
energy conservation plan issued in compliance with this Act
Article XVI-False Claims Act and Program Fraud Civil Remedies
Recipients must comply with the requirements of the False Claims Act, 31 U S C sections 3729-3733,which prohibits the
submission of false or fraudulent claims for payment to the federal government.(See 31 U S C sections 3801-3812,which
details the administrative remedies for false claims and statements made)
Article XVII-Federal Debt Status
All recipients are required to be non-delinquent in their repayment of any federal debt Examples of relevant debt include
delinquent payroll and other taxes,audit disallowances,and benefit overpayments (See OMB Circular A-129)
Article XVIII-Federal Leadership on Reducing Text Messaging while Driving
Recipients are encouraged to adopt and enforce policies that ban text messaging while driving as described in E O. 13513,
including conducting initiatives described in Section 3(a)of the Order when on official government business or when
performing any work for or on behalf of the federal government
Article XIX-Fly America Act of 1974
Recipients must comply with Preference for U S Flag Air Carriers(air carriers holding certificates under 49 U S C
section 41102)for international air transportation of people and property to the extent that such service is available,in
accordance with the International Air Transportation Fair Competitive Practices Act of 1974,49 U S C section 40118,and
the interpretative guidelines issued by the Comptroller General of the United States in the March 31, 1981,amendment to
Comptroller General Decision B-138942
Article XX-Hotel and Motel Fire Safety Act of 1990
In accordance with Section 6 of the Hotel and Motel Fire Safety Act of 1990, 15 U S C section 2225a, recipients must ensure
that all conference, meeting, convention,or training space funded in whole or in part with federal funds complies with the fire
prevention and control guidelines of the Federal Fire Prevention and Control Act of 1974, codified as amended at 15 U S C
section 2225
Article XXI-Limited English Proficiency(Civil Rights Act of 1964,Title VI)
Recipients must comply with the Title VI of the Civil Rights Act of 1964(42 U S C section 2000d et seq.)prohibition against
discrimination on the basis of national origin,which requires that recipients of federal financial assistance take reasonable
steps to provide meaningful access to persons with limited English proficiency(LEP)to their programs and services For
additional assistance and information regarding language access obligations, please refer to the DHS Recipient Guidance
https//www dhs gov/guidance-published-help-department-supported-organizations-provide-meaningful-access-people-limited
and additional resources on http//www lep gov
DHS-FEMA-EMPG-FY 19 Page 32 of 36 Lewis County DEM, E20-125 Revised
Article XXII-Lobbying Prohibitions
Recipients must comply with 31 U S C section 1352,which provides that none of the funds provided under a federal financial
assistance award may be expended by the recipient to pay any person to influence,or attempt 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 any federal action related to a federal award or contract, including any extension,continuation,
renewal, amendment, or modification
Article XXIII-National Environmental Policy Act
Recipients must comply with the requirements of the National Environmental Policy Act of 1969, Pub L No 91-190(1970)
(codified as amended at 42 U S C section 4321 et seq)(NEPA)and the Council on Environmental Quality(CEQ)Regulations
for Implementing the Procedural Provisions of NEPA,which requires recipients to use all practicable means within their
authority,and consistent with other essential considerations of national policy, to create and maintain conditions under which
people and nature can exist in productive harmony and fulfill the social,economic,and other needs of present and future
generations of Americans
Article XXIV-Nondiscrimination in Matters Pertaining to Faith-Based Organizations
It is DHS policy to ensure the equal treatment of faith-based organizations in social service programs administered or
supported by DHS or its component agencies,enabling those organizations to participate in providing important social
services to beneficiaries Recipients must comply with the equal treatment policies and requirements contained in 6 C F R
Part 19 and other applicable statues, regulations,and guidance governing the participations of faith-based organizations in
individual OHS programs
Article XXV-Non-Supplanting Requirement
Recipients receiving federal financial assistance awards made under programs that prohibit supplanting by law must ensure
that federal funds do not replace(supplant)funds that have been budgeted for the same purpose through non-federal
sources
Article XXVI-Notice of Funding Opportunity Requirements
All of the instructions, guidance, limitations, and other conditions set forth in the Notice of Funding Opportunity(NOFO)for
this program are incorporated here by reference in the award terms and conditions All recipients must comply with any such
requirements set forth in the program NOFO
Article XXVII -Patents and Intellectual Property Rights
Unless otherwise provided by law, recipients are subject to the Bayh-Dole Act, 35 U S C section 200 et seq Recipients are
subject to the specific requirements governing the development, reporting, and disposition of rights to inventions and patents
resulting from federal financial assistance awards located at 37 C F R Part 401 and the standard patent rights clause located
at 37 C F R section 401 14
Article XXVIII-Procurement of Recovered Materials
States, political subdivisions of states, and their contractors must comply with Section 6002 of the Solid Waste Disposal Act,
Pub L No 89-272(1965)(codified as amended by the Resource Conservation and Recovery Act,42 U S C section 6962
The requirements of Section 6002 include procuring only items designated in guidelines of the Environmental Protection
Agency(EPA)at 40 C F R Part 247 that contain the highest percentage of recovered materials practicable,consistent with
maintaining a satisfactory level of competition
Article XXIX-Rehabilitation Act of 1973
Recipients must comply with the requirements of Section 504 of the Rehabilitation Act of 1973, Pub L No 93-112(1973)
(codified as amended at 29 U S C section 794),which provides that no otherwise qualified handicapped individuals in
the United States will, solely by reason of the handicap, be excluded from participation in,be denied the benefits of,or be
subjected to discrimination under any program or activity receiving federal financial assistance
Article XXX-Reporting of Matters Related to Recipient Integrity and Performance
DHS-FEMA-EMPG-FY 19 Page 33 of 36 Lewis County DEM, E20-125 Revised
If the total value of any currently active grants,cooperative agreements,and procurement contracts from all Federal awarding
agencies exceeds$10,000,000 for any period of time during the period of performance of this Federal award,then the
recipients must comply with the requirements set forth in the government-wide Award Term and Condition for Recipient
Integrity and Performance Matters located at 2 C F R Part 200,Appendix XII,the full text of which is incorporated h ere by
reference in the award terms and conditions
Article XXXI-Reporting Subawards and Executive Compensation
Recipients are required to comply with the requirements set forth in the government-wide award term on Reporting Subawards
and Executive Compensation located at 2 C F R Part 170,Appendix A,the full text of which is incorporated here by reference
in the award terms and conditions
Article XXXII-SAFECOM
Recipients receiving federal financial assistance awards made under programs that provide emergency communication
equipment and its related activities must comply with the SAFECOM Guidance for Emergency Communication Grants,
including provisions on technical standards that ensure and enhance interoperable communications
Article XXXIII-Terrorist Financing
Recipients must comply with E 0 13224 and U S laws that prohibit transactions with, and the provisions of resources and
support to, individuals and organizations associated with terrorism Recipients are legally responsible to ensure compliance
with the Order and laws
Article XXXIV-Trafficking Victims Protection Act of 2000
Recipients must comply with the requirements of the government-wide financial assistance award term which implements
Section 106(g)of the Trafficking Victims Protection Act of 2000(TVPA), codified as amended at 22 U S C Section 7104 The
award term is located at 2 C F R Section 175 15,the full text of which is incorporated here by reference
Article XXXV-Universal Identifier and System for Award Management
Recipients are required to comply with the requirements set forth in the government-wide financial assistance award term
regarding the System for Award Management and Universal Identifier Requirements located at 2 C F R Part 25,Appendix A,
the full text of which is incorporated here by reference
Article XXXVI-USA Patriot Act of 2001
Recipients must comply with requirements of Section 817 of the Uniting and Strengthening America by Providing Appropriate
Tools Required to Intercept and Obstruct Terrorism Act of 2001(USA PATRIOT Act),which amends 18 U S C sections
175-175c
Article XXXVII-Use of DHS Seal,Logo and Flags
Recipients must obtain permission from their DHS FAO prior to using the DHS seal(s), logos,crests or reproductions of flags
or likenesses of DHS agency officials, including use of the United States Coast Guard seal,logo,crests or reproductions of
flags or likenesses of Coast Guard officials
Article XXXVIII-Whistleblower Protection Act
Recipients must comply with the statutory requirements for whistleblower protections(if applicable)at 10 U.S C section 2409,
41 U S C.section 4712,and 10 U.S.C.section 2324,41 U.S.0 sections 4304 and 4310
Article XXXIX-Environmental Planning and Historic Preservation
DHS/FEMA funded activities that may require an EHP review are subject to FEMA's Environmental Planning and Historic
Preservation(EHP)review process This review does not address all federal, state,and local requirements Acceptance of
federal funding requires recipient to comply with all federal,state, and local laws Failure to obtain all appropriate federal,
state,and local environmental permits and clearances may jeopardize federal funding
DHS/FEMA is required to consider the potential impacts to natural and cultural resources of all projects funded by DHS/
FEMA grant funds,through its EHP Review process, as mandated by the National Environmental Policy Act, National Historic
Preservation Act of 1966, as amended, National Flood Insurance Program regulations,and, any other applicable laws and
DHS-FEMA-EMPG-FY 19 Page 34 of 36 Lewis County DEM, E20-125 Revised
Executive Orders To access the FEMA's EHP screening form and instructions,go to the DHS/FEMA website at https.//
www.fema.gov/media-library/assets/documents/90195 In order to initiate EHP review of your project(s),you must complete
all relevant sections of this form and submit it to the Grant Programs Directorate(GPD)along with all other pertinent project
information. Failure to provide requisite information could result in delays in the release of grant funds
If ground disturbing activities occur during construction,applicant will monitor ground disturbance,and if any potential
archeological resources are discovered,applicant will immediately cease work in that area and notify the pass-through entity,
if applicable,and DHS/FEMA
Article XL-Acceptance of Post Award Changes
In the event FEMA determines that changes are necessary to the award document after an award has been made, including
changes to period of performance or terms and conditions, recipients will be notified of the changes in writing Once
notification has been made,any subsequent request for funds will indicate recipient acceptance of the changes to the award
Please call the FEMA/GMD Call Center at(866)927-5646 or via e-mail to ASK-GMD @dhs gov if you have any questions
Article XLI-Disposition of Equipment Acquired Under the Federal Award
When original or replacement equipment acquired under this award by the recipient or its sub-recipients is no longer needed
for the original project or program or for other activities currently or previously supported by DHS/FEMA,you must request
instructions from DHS/FEMA to make proper disposition of the equipment pursuant to 2 C.F.R. Section 200.313.
Article XLII-Prior Approval for Modification of Approved Budget
Before making any change to the DHS/FEMA approved budget for this award,you must request prior written approval from
DHS/FEMA where required by 2 C F R Section 200 308 DHS/FEMA is also utilizing its discretion to impose an additional
restriction under 2 C.F R Section 200 308(e)regarding the transfer of funds among direct cost categories, programs,
functions, or activities Therefore,for awards with an approved budget where the Federal share is greater than the simplified
acquisition threshold(currently$250,000),you may not transfer funds among direct cost categories, programs,functions,
or activities without prior written approval from DHS/FEMA where the cumulative amount of such transfers exceeds or is
expected to exceed ten percent(10%)of the total budget DHS/FEMA last approved You must report any deviations from
your DHS/FEMA approved budget in the first Federal Financial Report(SF-425)you submit following any budget deviation,
regardless of whether the budget deviation requires prior written approval
BUDGET COST CATEGORIES
Personnel $4,057,037 00
Fringe Benefits $1,489,217 00
Travel $19,383 00
Equipment $0 00
Supplies $15,597 00
Contractual $8,805,562 00
Construction $0 00
Indirect Charges $432,494 00
Other $0 00
DHS-FEMA-EMPG-FY 19 Page 35 of 36 Lewis County DEM, E20-125 Revised
•
Obligating Document for Award/Amendment
Ia.AGRFFMENT NO. 2.AMFNDMFNT NO 3 4 TYPF OF ACTION 5 CONTROL NO
EMS-2019-EP-00003-S01 *** RECIPIENT AWARD FY2019R1OEMPG
NO
916001095G
6 RECIPIENT NAME AND 7 ISSUING FEMA OFFICE AND 8 PAYMENT OFFICE AND ADDRESS
ADDRESS ADDRESS FEMA Hmance Center
Washington Military FEMA-GPD 430 Market Street
Department 400 C Street,SW,3rd floor Winchester,VA 22603
Building 20 Washington,DC 20472-3645
Camp Murray,WA,98430- POC.866-927-5646
5122
9 NAME OF RECIPIENT PHONE NO 10 NAME OF FEMA PROJECT COORDINATOR
PROJECT OFFICER 2535127456 Central Scheduling and Information Desk
Tirzah Kincheloe Phone 800-368-6498
Fmail Askcsid @dhs gov
11 EFFECTIVE DATE OF 12 13 ASSISTANCE ARRANGEMENT 14 PERFORMANCE PERIOD
THIS ACTION METHOD Cost Reimbursement
10/01/2018 OE From: To:
PAYMENT
09/30/2021
PAYS Budget Period
10/01/2018 09/30/2021
1 5 DESCRIPTION OF ACTION
a.(Indicate funding data for awards or financial changes)
PROGRAM CFDA NO ACCOUNTING DATA PRIOR AMOUNT CURRENT CUMULATIVE NON-
NAME (ACCS CODE) TOTAL AWARDED TOTAL FEDERAL COMMITMENT
ACRONYM XXXX-XXX-XX XXX- AWARD THIS AWARD
XXXXX-XXXX-XXXX-X ACTION
+OR(-)
Emergency 97 042 2019 FA-Gn01-R107--4120-D $0.00 $7,409,645.00 $7,409,645 00 See Totals
Management
Performance
Grants
50.00 57,409,645.00 57,409.645.00 57,409,645.00
b To describe changes other than funding data or financial changes,attach schedule and check here.
N/A
16 a FOR NON-DISASTER PROGRAMS.RECIPIENT IS REQUIRED TO SIGN AND RETURN THREE(3)COPIES OF THIS
DOCUMENT TO FEMA(See Block 7 for address)
Emergency Management Performance Grants recipients are not required to sign and return copies of this document However,recipients
should print and keep a copy of this document for their records
16b FOR DISASTER PROGRAMS.RECIPIENT IS NOT REQUIRED TO SIGN
This assistance is subject to terms and conditions attached to this award notice or by incorporated reference in program legislation cited
above
17 RECIPIENT SIGNATORY OFFICIAL(Name and Fitle) DATE
TtrLah Kincheloe,Mrs Tue Aug 06 23 35 35 GMT
2019
18 FEMA SIGNATORY OFFICIAL(Name and Title) DATF
Mon Aug 05 17 05 05 GMT
- .� 2019
KIMBERLY ERIN PENFOLD,Assistance Officer
DHS-FEMA-EMPG-FY 19 Page 36 of 36 Lewis County DEM, E20-125 Revised
2 CFR Part 200 Subpart F Audit Certification Form
Audits of States, Local Governments, Indian Tribes, and Non-Profit Organizations
Contact Information
Subrecipient Name(Agency,Local Government,or Organization) LEWIS COUNTY
Authorized Chief Financial Officer(central accounting office) Suzette Smith, Chief Accountant
Address PO Box 29, Chehalis, WA 98532
Email' suzette smith @lewiscountywa gov Phone#* 360-740-1339
Purpose. As a pass-through entity of federal grant funds,the Washington Military Department/Emergency Management Division(Department)
is required by 2 CFR Part 200 Subpart F to monitor activities of subrecipients to ensure federal awards are used for authorized purposes and
verify that subrecipients expending $750,000 or more in federal awards during their fiscal year have met the 2 CFR Part 200 Subpart F Audit
Requirements Your entity is a subrecipient subject to such monitoring by MIL/EMD because it is a non-federal entity that expends federal grant
funds received from the Department as a pass-through entity to carry out a federal program 2 CFR Part 200 Subpart F should be consulted
when completing this form.
Directions. As required by 2 CFR Part 200 Subpart F, non-federal entities that expend$750,000 in federal awards in a fiscal year shall have
a single or program-specific audit conducted for that year If your entity is not subject to these requirements,you must complete Section A of
this Form If your entity is subject to these requirements, you must complete Section B of this form When completed, you must sign, date,
and return this form with your grant agreement and every fiscal year thereafter until the grant agreement is closed Failure to return this
completed Audit Certification Form may result in delay of grant agreement processing,withholding of federal awards or disallowance of costs,
and suspension or termination of federal awards
SECTION A Entities NOT subject to the audit requirements of 2 CFR Part 200 Subpart F
Our entity is not subject to the requirements of 2 CFR Part 200 Subpart F because(check all that apply)
El We did not expend$750,000 or more of total federal awards during the fiscal year
El We are a for-profit agency
El We are exempt for other reasons(describe)
However, by signing below, I agree that we are still subject to the audit requirements, laws and regulations governing the program(s)in
which we participate,that we are required to maintain records of federal funding and to provide access to such records by federal and state
agencies and their designees,and that WMD/EMD may request and be provided access to additional information and/or documentation to
ensure proper stewardship of federal funds
SECTION B. Entities that ARE subject to the audit requirements of 2 CFR Part 200 Subpart F
(Complete the information below and check the appropriate box) -
V We completed our last 2 CFR Part 200 Subpart F Audit on[enter date]diJa7/Ik for Fiscal Year ending[enter date]jaiwa There
were no findings related to federal awards from WMD/EMD No follow-up action is required by WMD/EMD as the pass-through entity
A complete copy of the audit report,which includes exceptions,corrective action plan and management response, is
either provided electronically to contracts.officeamil.wa.gov or provide the state auditor report number
/vacg J)L/
El We completed our last 2 CFR Part 200 Subpart F Audit on[enter date] for Fiscal Year ending[enter date] There
were findings related to federal awards
A complete copy of the audit report,which includes exceptions,corrective action plan and management response, is either
provided electronically to contracts officemil wa gov or provide the state auditor report number.
El Our completed 2 CFR Part 200 Subpart F Audit will be available on [enter date]for Fiscal Year ending
[enter date] We will provide electronic copy of the audit report to contracts officeCilmil wa gov at that time or
provide the state auditor report number
Our- GA). ,'101 S R E-po-fs has r\c bee-h 421 led y&L
I hereby certify that I am an individual authorized by the above identified entity to complete this form Further, I certify that the
above information is true and correct and all relevant material findings contained in audit report/statement have been disclosed
Additionally, I understand this Form is to be submitted every fiscal year for which this entity is a subrecipient of federal award
funds from the Department until the grant agreement is closed
Signature of Authorized Chief Financial Officer;��iI)zb i Date. ////9/97b/�
Print Name &Title Suzette Smith,Chief Accountant
WMD Form 1009 13,8/19/2013,Updated 9/9/2015
Washington Military Department Contract Number
Debarment, Suspension, Ineligibility or Voluntary Exclusion Certification Form
NAME Doing business as(DBA)
Lewis, County of
ADDRESS Applicable Procurement WA Uniform Business Federal Employer Tax
351 NW North Street or Solicitation#,if any Identifier(UBI) Identification#
Chehalis, WA 98532 214-000-323 91-6001351
This certification is submitted as part of a request to contract.
Instructions For Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion--Lower
Tier Covered Transactions
READ CAREFULLY BEFORE SIGNING THE CERTIFICATION Federal regulations require contractors and bidders to sign and
abide by the terms of this certification, without modification, in order to participate in certain transactions directly or
indirectly involving federal funds.
1 By signing and submitting this proposal, the prospective lower tier participant is providing the certification set out
below
2 The certification in this clause is a material representation of fact upon which reliance was placed when this
transaction was entered into If it is later determined that the prospective lower tier participant knowingly rendered an
erroneous certification, in addition to other remedies available to the Federal Government the department or agency
with which this transaction originated may pursue available remedies, including suspension and/or debarment
3 The prospective lower tier participant shall provide immediate written notice to the department, institution or office to
which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was
erroneous when submitted or had become erroneous by reason of changed circumstances
4 The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person,
primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meaning
set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the
person to which this proposal is submitted for assistance in obtaining a copy of those regulations
5 The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered
transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is
proposed for debarment under the applicable CFR, debarred, suspended, declared ineligible, or voluntarily excluded
from participation in this covered transaction, unless authorized by the department or agency with which this
transaction originated
6 The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled
"Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered
Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered
transactions
7 A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered
transaction that it is not proposed for debarment under applicable CFR, debarred, suspended, ineligible, or voluntarily
excluded from covered transactions, unless it knows that the certification is erroneous A participant may decide the
method and frequency by which it determines the eligibility of its principals Each participant may, but is not required
to, check the List of Parties Excluded from Federal Procurement and Non-procurement Programs
8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to
render in good faith the certification required by this clause The knowledge and information of a participant is not
required to exceed that which is normally possessed by a prudent person in the ordinary course of business activity
9 Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction
knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under applicable
CFR, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other
remedies available to the Federal Government, the department or agency with which this transaction originated may
pursue available remedies, including suspension and/or debarment
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion--Lower Tier
Covered Transactions
The prospective lower tier participant certifies, by submission of this proposal or contract, that neither it nor its
principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded
from participation in this transaction by any Federal department or agency Where the prospective lower tier
participant is unable to certify to any of the statements in this certification, such prospective participant shall
attach an explanation to this form
Bidder or Contractor Signature. p( Date. 1)-►y-I G1
Print Name and Title Andy Cald , Deputy Director
Washington Military Department Contract Number
•
FEDERAL DEBARMENT, SUSPENSION
INELIGIBILITY and VOLUNTARY EXCLUSION
(FREQUENTLY ASKED QUESTIONS)
What is "Debarment, Suspension, Ineligibility, and Voluntary Exclusion"?
These terms refer to the status of a person or company that cannot contract with or receive grants from a federal agency
In order to be debarred, suspended, ineligible, or voluntarily excluded, you must have
• had a contract or grant with a federal agency, and
• gone through some process where the federal agency notified or attempted to notify you that you could not contract
with the federal agency
• Generally, this process occurs where you, the contractor, are not qualified or are not adequately performing under a
contract, or have violated a regulation or law pertaining to the contract
Why am I required to sign this certification?
You are requesting a contract or grant with the Washington Military Department. Federal law (Executive Order 12549)
requires Washington Military Department ensure that persons or companies that contract with Washington Military
Department are not prohibited from having federal contracts
What is Executive Order 12549?
Executive Order 12549 refers to Federal Executive Order Number 12549. The executive order was signed by the
President and directed federal agencies to ensure that federal agencies, and any state or other agency receiving federal
funds were not contracting or awarding grants to persons, organizations, or companies who have been excluded from
participating in federal contracts or grants. Federal agencies have codified this requirement in their individual agency
Code of Federal Regulations(CFRs)
What is the purpose of this certification?
The purpose of the certification is for you to tell Washington Military Department in writing that you have not been
prohibited by federal agencies from entering into a federal contract
What does the word "proposal" mean when referred to in this certification?
Proposal means a solicited or unsolicited bid, application, request, invitation to consider or similar communication from
you to Washington Military Department
What or who is a "lower tier participant"?
Lower tier participants means a person or organization that submits a proposal, enters into contracts with, or receives a
grant from Washington Military Department, OR any subcontractor of a contract with Washington Military Department If
you hire subcontractors, you should require them to sign a certification and keep it with your subcontract
What is a covered transaction when referred to in this certification?
Covered Transaction means a contract, oral or written agreement, grant, or any other arrangement where you contract
with or receive money from Washington Military Department Covered Transaction does not include mandatory
entitlements and individual benefits
Sample Debarment, Suspension, Ineligibility, Voluntary Exclusion Contract Provision
Debarment Certification. The Contractor certifies that the Contractor is not presently debarred, suspended,
proposed for debarment, declared ineligible, or voluntarily excluded from participating in this Contract by any
Federal department or agency If requested by Washington Military Department, the Contractor shall complete
a Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion form Any such form
completed by the Contractor for this Contract shall be incorporated into this Contract by reference
FFATA FORM
Subrecipient Agency Lewis, County of
Grant and Year 2019-20 Agreement Number E20-125
Completed Andy Caldwell Deputy Director 360-740-1157
by
Name Title Telephone
Date Completed
YES STOP, no further NO
Is your grant agreement less than $25,000? analysis needed, / GO to Step 2
GO to Step 6
In your preceding fiscal year, did your YES NO STOP, no further
organization receive 80% or more of its annual GO to STEP 3 1 analysis needed, GO to
gross revenues from federal funding? Step 6
STEP
In your preceding fiscal year, did your YES NO STOP, no further
organization receive $25,000,000 or more in GO to STEP 4 analysis needed, GO to
federal funding? Step 6
STEP 4
Does the public have access to information about YES STOP, no further NO
the total compensation*of senior executives in analysis needed, GO to STEP 5
your organization's GO to step 6
STEP 5
Executive#1 Name
Total Compensation amount: $
Name
Executive#2
Total Compensation amount. $
Executive#3 Name
Total Compensation amount $
Name
Executive#4 Total Compensation amount $
Executive#5 Name
Total Compensation amount $
STEP 6
If your organization does not meet these criteria, specifically identify below each criteria that is not met for your
organization For Example "Our organization received less than $25,000 "
Signature: Date 1) - -15
*Total compensation refers to
• Salary and bonuses
• Awards of stock, stock options, and stock appreciation rights
• Other compensation including, but not limited to, severance and termination payments
• Life insurance value paid on behalf of the employee
Additional Resources
http.//www.whitehouse.gov/omb/open
http//www hrsa qov/grants/ffata html
http//www qpo qov/fdsys/pkq/FR-2010-09-14/pdf/2010-22705.pdf
http.//www.grants.gov/
Page 1 of 3
FFATA PROVISIONS AND INSTRUCTIONS
For Compliance With The
Federal Funding Accountability and Transparency Act of 2006(P.L. 109-282)(FFATA)
The Federal Funding Accountability and Transparency Act (FFATA) was signed on September
26, 2006. The FFATA legislation requires information on federal awards (federal financial
assistance and expenditures) be made available to the public via a single, searchable website.
Federal awards mclude grants, subgrants, loans, awards, cooperative agreements and other forms
of financial assistance as well as contracts, subcontracts, purchase orders, task orders, and
delivery orders The legislation does not require inclusion of individual transactions below
$25,000 or credit card transactions before October 1, 2008. However, if an award is initially
below this amount yet later increased, the act is triggered. Due to this variability in compliance
Subrecipients are required by the Military Department to be familiar with the FFATA
requirements and complete this Worksheet for each contract for the State's submission m to the
FFATA portal
ADDITIONAL PROVISIONS
A This contract (subaward) is supported by federal funds, requiring compliance with the
Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act)
and Office of Management and Budget Guidance (OMB). Public Law 109-282 as amended
by section 6202(a) of Public Law 110-252 (see 31 U.S.C. 6101 note). By entering into this
contract, contractor agrees to provide all applicable reporting mformation to the Washington
Military Department(WMD)required by FFATA and OMB Guidance
B The FFATA requires the OMB to establish a publicly available online database
(USASpendmg gov) containing information about entities that are awarded Federal grants,
loans, and contracts As required by FFATA and OMB Guidance, certain information on the
first-tier subawards related to Federal contracts and grants, and the executive compensation
of awardees,must be made publicly available.
C For new Federal grants beginning October 1, 2010, if the initial subaward is equal to or
greater than $25,000, reporting of the subaward and executive compensation information is
required. If the initial subaward is below $25,000 but subsequent grant modifications result
m a total subaward equal to or over $25,000, the subaward will be subject to the reporting
requirements as of the date the subaward exceeds $25,000 If the initial subaward equals or
exceeds $25,000 but fundmg is subsequently de-obligated such that the total award amount
falls below $25,000, the subaward continues to be subject to the reporting requirements of
the Transparency Act and OMB Guidance
D As a Federal grant subawardee under this contract, your organization is required by FFATA,
OMB Guidance and this contract to provide the WMD, as the prime grant awardee, all
information required for FFATA compliant reporting by WMD This includes all applicable
subawardee entity information required by FFATA and OMB Guidance, subawardee DUNS
number, and relevant executive compensation data, as applicable
1. Data about your organization will be provided to USASpendmg gov by the WMD
System for Award Management (SAM) is a government wide registration system for
organizations that do business with the Federal Government SAM stores information
about awardees including financial account information for payment purposes and a link
to D&B for maintaining current DUNS information, www sam gov WMD requires SAM
registration and annual renewal by your organization to minimize unnecessary data entry
Page 1 of 2
and re-entry required by both WMD and your orgamzation It will also reduce the
potential of inconsistent or inaccurate data entry.
2 Your organization must have a Data Universal Numbering System (DUNS) number
obtained from the firm Dun and Bradstreet (D&B) (www.dnb.com). A DUNS number
provides a method to verify data about your organization. D&B is responsible for
maintaining unique identifiers and organizational linkages on behalf of the Federal
Government for organizations receiving Federal assistance.
E The WMD, as the prime awardee, is required by FFATA to report names and total
compensation of the five (5) most highly compensated officers of your organization (as the
subawardee)if.
1. Your orgamzation (the subawardee), in the preceding fiscal year, received 80 percent or
more of its annual gross revenues from Federal awards and $25,000,000 or more in
annual gross revenues from Federal awards, and
2. The public does not have access to this information about the compensation of the senior
executives of your organization through periodic reports filed under section 13(a) or
15(d) of the Securities and Exchange Act of 1934 (15 U S C §§ 78m(a), 78o(d) or
section 6104 of the Internal Revenue Code of 1986
"Total compensation" for purposes of this requirement generally means the cash and non-
cash value earned by the executive during the past fiscal year and includes salary and bonus,
awards of stock, stock options and stock appreciation rights, and other compensation such as
severance and termination payments, and value of life insurance paid on behalf of the
employee, and as otherwise provided by FFATA and applicable OMB guidance
F. If(1) m the preceding fiscal year your orgamzation received 80 percent or more of its annual
gross revenues from Federal awards and $25,000,000 or more in annual gross revenues from
Federal awards, and (2) the public does not have access to this information about the
compensation of the senior executives of your organization through periodic reports filed
under section 13(a) or 15(d) of the Securities and Exchange Act of 1934 (15 U.S.C. §§
78m(a), 78o(d) or section 6104 of the Internal Revenue Code of 1986, insert the names and
total compensation for the five most highly compensated officers of your organization as
identified in Step 5 of the FFATA Form
Page 2 of 2
SIGNATURE AUTHORIZATION FORM
WASHINGTON STATE MILITARY DEPARTMENT
Camp Murray, Washington 98430-5122
Please read instructions on reverse side before completing this form
NAME OF ORGANIZATION 1 DATE SUBMITTED
Lewis County 12-09-19
PROJECT DESCRIPTION CONTRACT NUMBER
2019-20 EMPG Grant E20-125
1. AUTHORIZING AUTHORITY
SIGNATU PRINT OR TYPE NAME TITLE/TERM OF OFFICE
C, Robert C. "Bobby" Jackson BOCC Chair
i
/ /d
2. AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS
/
SIGNATU' • PRINT OR TYPE NAME TITLE
/ Robert C. "Bobby" Jackson BOCC Chair
' /
Ol Steve Mansfield DES Director
P. Andy Caldwell DEM Deputy Director
3 AUTHORIZED TO SIGN REQUESTS FOR REIMBURSEMENT
SIGNATURE PRINT OR TYPE NAME TITLE
!- _ a
Andy Caldwell DEM Deputy Director
If Jill Kangas DEM Planner
\\NAC-11VOL1\HOME\KARENB\ \WP\SIGNAUTH Revised 3/03
•
INSTRUCTIONS FOR SIGNATURE AUTHORIZATION FORM
This form identifies the persons who have the authority to sign contracts, amendments,
and requests for reimbursement It is required for the management of your contract with
the Military Department (MD) Please complete all sections. One copy with original
signatures is to be sent to MD with the signed contract, and the other should be kept with
your copy of the contract.
When a request for reimbursement is received, the signature is checked to verify that it
matches the signature on file. The payment can be delayed if the request is
presented without the proper signature. It is important that the signatures in MD's files
are current Changes in staffing or responsibilities will require a new signature
authorization form
1 Authorizing Authority. Generally, the person(s) signing in this box heads
the governing body of the organization, such as the board chair or mayor In
some cases, the chief executive officer may have been delegated this
authority.
2 Authorized to Sign Contracts/Contract Amendments. The person(s) with
this authority should sign in this space Usually, it is the county
commissioner, mayor, executive director, city clerk, etc.
3 Authorized to Sign Requests for Reimbursement. Often the executive
director, city clerk, treasurer, or administrative assistant have this authority.
It is advisable to have more than one person authorized to sign
reimbursement requests. This will help prevent delays in processing a
request if one person is temporarily unavailable.
If you have any questions regarding this form or to request new forms, please call your
MD Program Manager.
• It
Form W-9 Request for Taxpayer Give Form to the
(Rev December2014) Identification Number and Certification requester.Do not
Department of the Treasury send to the IRS.
Internal Revenue Service
1 Name(as shown on your income tax return) Name is required on this line do not leave this line blank
Lewis, County of
a 2 Business name/disregarded entity name,if different from above
rn Lewis County Division of Emergency Management
m
D- 3 Check appropriate box for federal tax classification,check only one of the following seven boxes 4 Exemptions(codes apply only to
certain entities,not individuals,see
° ❑Individual/sole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑Trust/estate instructions on page 3)
single-member LLC Exempt payee code(if any)
° ❑Limited liability company Enter the tax classification(C=C corporation,S=S corporation,P=partnership)►
° Exemption from FATCA reporting
p 2 Note For a single-member LLC that is disregarded,do not check LLC,check the appropriate box in the line above for
y the tax classification of the single-member owner code(if any)
i c
a V 0 Other(see instructions)■ (Applies to accounts maintained outside the U S.)
!E 5 Address(number street and apt or suite no.) Requester's name and address(optional)
U
2,..) 351 NW North Street
6 City state and ZIP code
co Chehalis,WA 98532
7 List account number(s)here(optional)
Part I Taxpayer Identification Number(TIN)
Enter your TIN in the appropriate box The TIN provided must match the name given on line 1 to avoid I Social security number
backup withholding For individuals,this is generally your social security number(SSN) However,for a
resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3 For other - -
entities,it is your employer identification number(EIN) If you do not have a number,see How to get a
TIN on page 3 or
Note If the account is in more than one name,see the instructions for line 1 and the chart on page 4 for Employer identification number
guidelines on whose number to enter
9 1 - 6 0 0 1 3 5 1
Part II Certification
Under penalties of perjury,I certify that
1 The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me),and
2 I am not subject to backup withholding because (a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue
Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am
no longer subject to backup withholding;and
3 I am a U S citizen or other U S person(defined below),and
4 The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct
Certification instructions You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and dividends on your tax return For real estate transactions,item 2 does not apply For mortgage
interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and
generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN See the
instructions on page 3
Sign Signature of
Here U.S.person■ Date■ - )Gj -
General Instructions •Form 1098(home mortgage interest) 1098-E(student loan interest) 1098-T
(tuition)
Section references are to the Internal Revenue Code unless otherwise noted •Form 1099-C(canceled debt)
Future developments Information about developments affecting Form W-9(such •Form 1099-A(acquisition or abandonment of secured property)
as legislation enacted after we release it)is at www irs.gov/fw9
Use Form W-9 only if you are a U S person(including a resident alien) to
Purpose of Form provide your correct TIN
An individual or entity(Form W-9 requester)who is required to file an information If you do not return Form W-9 to the requester with a TIN,you might be subject
return with the IRS must obtain your correct taxpayer identification number(TIN) to backup withholding See What is backup withholding?on page 2
which may be your social security number(SSN) individual taxpayer identification By signing the filled-out form,you
number(ITIN),adoption taxpayer identification number(ATIN),or employer 1 Certify that the TIN you are giving is correct(or you are waiting for a number
identification number(EIN),to report on an information return the amount paid to to be issued),
you or other amount reportable on an information return Examples of information
returns include,but are not limited to,the following 2 Certify that you are not subject to backup withholding,or
•Form 1099-INT(interest earned or paid) 3 Claim exemption from backup withholding if you are a U S exempt payee If
•Form 1099-DIV(dividends including those from stocks or mutual funds) applicable,you are also certifying that as a U.S person,your allocable share of
any partnership income from a U.S trade or business is not subject to the
•Form 1099-MISC(various types of income,prizes,awards,or gross proceeds) withholding tax on foreign partners share of effectively connected income and
•Form 1099-B(stock or mutual fund sales and certain other transactions by 4 Certify that FATCA code(s)entered on this form(if any)indicating that you are
brokers) exempt from the FATCA reporting,is correct See What is FATCA reporting?on
•Form 1099-S(proceeds from real estate transactions) page 2 for further information
•Form 1099-K(merchant card and third party network transactions)
Cat No 10231X Form W-9(Rev 12-2014)
•Form W-9(Rev 12-2014) Page 2
Note If you are a U.S person and a requester gives you a form other than Form 3 The IRS tells the requester that you furnished an incorrect TIN,
W-9 to request your TIN you must use the requester's form if it is substantially 4 The IRS tells you that you are subject to backup withholding because you did
similar to this Form W-9 not report all your interest and dividends on your tax return(for reportable interest
Definition of a U.S.person.For federal tax purposes,you are considered a U S and dividends only),or
you are
person if y 5 You do not certify to the requester that you are not subject to backup
•An individual who is a U.S citizen or U S resident alien, withholding under 4 above(for reportable interest and dividend accounts opened
•A partnership,corporation,company,or association created or organized in the after 1983 only)
United States or under the laws of the United States Certain payees and payments are exempt from backup withholding See Exempt
•An estate(other than a foreign estate) or payee code on page 3 and the separate Instructions for the Requester of Form
W-9 for more information
•A domestic trust(as defined in Regulations section 301 7701-7) Also see Special rules for partnerships above
Special rules for partnerships Partnerships that conduct a trade or business in
the United States are generally required to pay a withholding tax under section What is FATCA reporting?
1446 on any foreign partners share of effectively connected taxable income from
such business Further in certain cases where a Form W-9 has not been received The Foreign Account Tax Compliance Act(FATCA)requires a participating foreign
the rules under section 1446 require a partnership to presume that a partner is a financial institution to report all United States account holders that are specified
foreign person,and pay the section 1446 withholding tax Therefore,if you are a United States persons Certain payees are exempt from FATCA reporting See
U.S person that is a partner in a partnership conducting a trade or business in the Exemption from FATCA reporting code on page 3 and the Instructions for the
United States,provide Form W-9 to the partnership to establish your U.S status Requester of Form W-9 for more information
and avoid section 1446 withholding on your share of partnership income
In the cases below the following person must give Form W-9 to the partnership Updating Your Information
for purposes of establishing its U S status and avoiding withholding on its You must provide updated information to any person to whom you claimed to be
allocable share of net income from the partnership conducting a trade or business an exempt payee if you are no longer an exempt payee and anticipate receiving
in the United States reportable payments in the future from this person For example,you may need to
•In the case of a disregarded entity with a U S owner the U S owner of the provide updated information if you are a C corporation that elects to be an S
disregarded entity and not the entity corporation,or if you no longer are tax exempt In addition,you must furnish a new
Form W-9 if the name or TIN changes for the account,for example,if the grantor
•In the case of a grantor trust with a U.S grantor or other U S owner,generally, of a grantor trust dies
the U.S grantor or other U S owner of the grantor trust and not the trust,and
•In the case of a U.S trust(other than a grantor trust),the U S trust(other than a Penalties
grantor trust)and not the beneficiaries of the trust Failure to furnish TIN.If you fail to furnish your correct TIN to a requester you are
Foreign person.If you are a foreign person or the U S branch of a foreign bank subject to a penalty of$50 for each such failure unless your failure is due to
that has elected to be treated as a U.S person,do not use Form W-9 Instead,use reasonable cause and not to willful neglect
the appropriate Form W-8 or Form 8233(see Publication 515,Withholding of Tax Civil penalty for false information with respect to withholding If you make a
on Nonresident Aliens and Foreign Entities) false statement with no reasonable basis that results in no backup withholding
Nonresident alien who becomes a resident alien.Generally,only a nonresident you are subject to a$500 penalty
alien individual may use the terms of a tax treaty to reduce or eliminate U S tax on Criminal penalty for falsifying Information.Willfully falsifying certifications or
certain types of income However most tax treaties contain a provision known as affirmations may subject you to criminal penalties including fines and/or
a"saving clause"Exceptions specified in the saving clause may permit an imprisonment
exemption from tax to continue for certain types of income even after the payee
has otherwise become a U S resident alien for tax purposes Misuse of TINs.If the requester discloses or uses TINs in violation of federal law,
If you are a U S resident alien who is relying on an exception contained in the the requester may be subject to civil and criminal penalties
saving clause of a tax treaty to claim an exemption from U.S tax on certain types
of income,you must attach a statement to Form W-9 that specifies the following Specific Instructions
five items
1 The treaty country Generally,this must be the same treaty under which you Line 1
claimed exemption from tax as a nonresident alien You must enter one of the following on this line do not leave this line blank The
2 The treaty article addressing the income name should match the name on your tax return
3 The article number(or location)in the tax treaty that contains the saving If this Form W-9 is for a joint account,list first,and then circle,the name of the
clause and its exceptions person or entity whose number you entered in Part I of Form W-9
4 The type and amount of income that qualifies for the exemption from tax a Individual Generally,enter the name shown on your tax return If you have
changed your last name without informing the Social Security Administration(SSA)
5 Sufficient facts to justify the exemption from tax under the terms of the treaty of the name change enter your first name the last name as shown on your social
article security card and your new last name
Example.Article 20 of the U S.-China income tax treaty allows an exemption Note ITIN applicant:Enter your individual name as it was entered on your Form
from tax for scholarship income received by a Chinese student temporarily present W-7 application,line 1 a This should also be the same as the name you entered on
in the United States Under U S law,this student will become a resident alien for the Form 1040/1040A11040EZ you filed with your application
tax purposes if his or her stay in the United States exceeds 5 calendar years
However paragraph 2 of the first Protocol to the U.S.-China treaty(dated April 30, b Sole proprietor or single-member LLC.Enter your individual name as
1984)allows the provisions of Article 20 to continue to apply even after the shown on your 1040/1040A11040EZ on line 1 You may enter your business,trade,
Chinese student becomes a resident alien of the United States A Chinese student or"doing business as"(DBA)name on line 2
who qualifies for this exception(under paragraph 2 of the first protocol)and is c Partnership,LLC that is not a single-member LLC,C Corporation,or S
relying on this exception to claim an exemption from tax on his or her scholarship Corporation Enter the entity's name as shown on the entity's tax return on line 1
or fellowship income would attach to Form W-9 a statement that includes the and any business,trade,or DBA name on line 2
information described above to support that exemption d Other entities.Enter your name as shown on required U.S federal tax
If you are a nonresident alien or a foreign entity give the requester the documents on line 1 This name should match the name shown on the charter or
appropriate completed Form W-8 or Form 8233 other legal document creating the entity You may enter any business trade or
DBA name on line 2
Backup Withholding e Disregarded entity For U.S federal tax purposes,an entity that is
What is backup withholding?Persons making certain payments to you must disregarded as an entity separate from its owner is treated as a"disregarded
under certain conditions withhold and pay to the IRS 28%of such payments This entity" See Regulations section 301 7701-2(c)(2)(iii).Enter the owner's name on
is called"backup withholding" Payments that may be subject to backup line 1 The name of the entity entered on line 1 should never be a disregarded
withholding include interest,tax-exempt interest,dividends,broker and barter entity The name on line 1 should be the name shown on the income tax return on
exchange transactions,rents,royalties,nonemployee pay,payments made in which the income should be reported For example,if a foreign LLC that is treated
settlement of payment card and third party network transactions,and certain as a disregarded entity for U S federal tax purposes has a single owner that is a
payments from fishing boat operators Real estate transactions are not subject to U.S person,the U.S owner's name is required to be provided on line 1 If the
backup withholding direct owner of the entity is also a disregarded entity,enter the first owner that is
You will not be subject to backup withholding on payments you receive if you not disregarded for federal tax purposes Enter the disregarded entity's name on
give the requester be your correct TIN,make the proper n payments u and report all line 2 "Business name/disregarded entity name."If the owner of the disregarded
your taxable interest and dividends on your tax return entity is a foreign person,the owner must complete an appropriate Form W-8
instead of a Form W-9 This is the case even if the foreign person has a U S TIN
Payments you receive will be subject to backup withholding if-
1 You do not furnish your TIN to the requester
2 You do not certify your TIN when required(see the Part II instructions on page
3 for details),
Form W-9(Rev 12-2014) • Page 3
Line 2 'However,the following payments made to a corporation and reportable on Form
If you have a business name,trade name,DBA name,or disregarded entity name 1099-MISC are not exempt from backup withholding medical and health care
you may enter it on line 2 payments,attorneys'fees,gross proceeds paid to an attorney reportable under
section 6045(f) and payments for services paid by a federal executive agency
Line 3 Exemption from FATCA reporting code.The following codes identify payees
Check the appropriate box in line 3 for the U.S federal tax classification of the that are exempt from reporting under FATCA These codes apply to persons
person whose name is entered on line 1 Check only one box in line 3 submitting this form for accounts maintained outside of the United States by
Limited Liability Company(LLC) If the name on line 1 is an LLC treated as a certain foreign financial institutions Therefore,if you are only submitting this form
partnership for U S federal tax purposes,check the"Limited Liability Company" for s account you person hold r tue United States,you may lunce tain if th blank
box and enter"P"in the space provided If the LLC has filed Form 8832 or 2553 to insnsuit with sue tthese requesting this form it you are may indicate if the a financial
be taxed as a corporation,check the"Limited Liability Company"box and in the institution id by providing to you witFrm A with"Not may lic ble"(or aa ny
code is
space provided enter"C"for C corporation or"S"for S corporation If it is a not required indication)ti pro rit eg you with a Form line or a"Not Applicable" code
any
single-member LLC that is a disregarded entity,do not check the"Limited Liability similar indication)written or printed on the line for a FATCA exemption code
Company"box,instead check the first box in line 3"IndividuaVsole proprietor or A—An organization exempt from tax under section 501(a)or any individual
single-member LLC" retirement plan as defined in section 7701(a)(37)
Line 4,Exemptions B—The United States or any of its agencies or instrumentalities
If you are exempt from backup withholding and/or FATCA reporting,enter in the C—A state,the District of Columbia a U S commonwealth or possession,or
any of their
appropriate space in line 4 any code(s)that may apply to you political subdivisions or instrumentalities
Exempt payee code D—A corporation the stock of which is regularly traded on one or more
established securities markets,as described in Regulations section
• Generally,individuals(including sole proprietors)are not exempt from backup 1 1472-1(c)(1)(i)
withholding E—A corporation that is a member of the same expanded affiliated group as a
• Except as provided below,corporations are exempt from backup withholding corporation described in Regulations section 1 1472-1(c)(1)(i)
for certain payments,including interest and dividends F—A dealer in securities,commodities,or derivative financial instruments
• Corporations are not exempt from backup withholding for payments made in (including notional principal contracts,futures,forwards,and options)that is
settlement of payment card or third party network transactions registered as such under the laws of the United States or any state
• Corporations are not exempt from backup withholding with respect to attorneys' G—A real estate investment trust
fees or gross proceeds paid to attorneys,and corporations that provide medical or H—A regulated investment company as defined in section 851 or an entity
health care services are not exempt with respect to payments reportable on Form registered at all times during the tax year under the Investment Company Act of
1099-MISC 1940
The following codes identify payees that are exempt from backup withholding I—A common trust fund as defined in section 584(a)
Enter the appropriate code in the space in line 4
1—An organization exempt from tax under section 501(a),any IRA,or a —A bank as defined in section 581
custodial account under section 403(b)(7)if the account satisfies the requirements K—A broker
of section 401(f)(2) L—A trust exempt from tax under section 664 or described in section 4947(a)(1)
2—The United States or any of its agencies or instrumentalities M—A tax exempt trust under a section 403(b)plan or section 457(g)plan
3—A state,the District of Columbia a U S commonwealth or possession,or Note You may wish to consult with the financial institution requesting this form to
any of their political subdivisions or instrumentalities determine whether the FATCA code and/or exempt payee code should be
4—A foreign government or any of its political subdivisions,agencies,or completed
instrumentalities
Line 5
5—A corporation
6—A dealer m securities or commodities required to register in the United Enter your address(number street,and apartment or suite number) This is where
States the District of Columbia,or a U.S commonwealth or possession the requester of this Form W-9 will mail your information returns
7—A futures commission merchant registered with the Commodity Futures Line 6
Trading Commission Enter your city,state,and ZIP code
8—A real estate investment trust
9—An entity registered at all times during the tax year under the Investment Part I Taxpayer Identification Number(TIN)
Company Act of 1940 Enter your TIN in the appropriate box.If you are a resident alien and you do not
10—A common trust fund operated by a bank under section 584(a) have and are not eligible to get an SSN,your TIN is your IRS individual taxpayer
11—A financial institution identification number(ITIN) Enter it in the social security number box If you do not
have an ITIN see How to get a TIN below
12—A middleman known in the investment community as a nominee or If you are a sole proprietor and you have an EIN,you may enter either your SSN
custodian or EIN However,the IRS prefers that you use your SSN
13—A trust exempt from tax under section 664 or described in section 4947 If you are a single-member LLC that is disregarded as an entity separate from its
The following chart shows types of payments that may be exempt from backup owner(see Limited Liability Company(LLC)on this page) enter the owner's SSN
withholding The chart applies to the exempt payees listed above,1 through 13 (or EIN,if the owner has one) Do not enter the disregarded entity's EIN If the LLC
is classified as a corporation or partnership,enter the entity's EIN
IF the payment is for THEN the payment is exempt for... Note See the chart on page 4 for further clarification of name and TIN
combinations
Interest and dividend payments All exempt payees except How to get a TIN.If you do not have a TIN apply for one immediately To apply
for 7 for an SSN,get Form SS-5,Application for a Social Security Card,from your local
SSA office or get this form online at www ssa.gov You may also get this form by
Broker transactions Exempt payees 1 through 4 and 6 calling 1-800-772-1213 Use Form W-7 Application for IRS Individual Taxpayer
through 11 and all C corporations S Identification Number to apply for an ITIN,or Form SS-4,Application for Employer
corporations must not enter an exempt Identification Number,to apply for an EIN You can apply for an EIN online by
payee code because they are exempt accessing the IRS website at www irs.gov/businesses and clicking on Employer
only for sales of noncovered securities Identification Number(EIN)under Starting a Business You can get Forms W-7 and
acquired prior to 2012 SS-4 from the IRS by visiting IRS.gov or by calling 1-800-TAX-FORM
(1-800-829-3676)
Barter exchange transactions and Exempt payees 1 through 4 If you are asked to complete Form W-9 but do not have a TIN apply for a TIN
patronage dividends and write"Applied For"in the space for the TIN,sign and date the form,and give it
to the requester For interest and dividend payments,and certain payments made
Payments over$600 required to be Generally,exempt payees
z with respect to readily tradable instruments,generally you will have 60 days to get
reported and direct sales over$5,0001 1 through 5 a TIN and give it to the requester before you are subject to backup withholding on
payments The 60-day rule does not apply to other types of payments You will be
Payments made in settlement of Exempt payees 1 through 4 subject to backup withholding on all such payments until you provide your TIN to
payment card or third party network the requester
transactions Note Entering"Applied For"means that you have already applied for a TIN or that
I See Form 1099-MISC,Miscellaneous Income,and its instructions you intend to apply for one soon.
Caution A disregarded U.S entity that has a foreign owner must use the
appropriate Form W-8
at AO, -
Form W-9(Rev 12-2014) Page 4
Part II. Certification 'You must show your individual name and you may also enter your business or DBA name on
the"Business name/disregarded entity"name line You may use either your SSN or EIN(if you
To establish to the withholding agent that you are a U S person or resident alien, have one),but the IRS encourages you to use your SSN
sign Form W-9 You may be requested to sign by the withholding agent even if
items 1 4 or 5 below indicate otherwise List first and circle the name of the trust,estate,or pension trust(Do not furnish the TIN of the
personal representative or trustee unless the legal entity itself is not designated in the account
For a joint account only the person whose TIN is shown in Part I should sign title.)Also see Special rules for partnerships on page 2
(when required) In the case of a disregarded entity,the person identified on line 1 *Note Grantor also must provide a Form W 9 to trustee of trust.
must sign Exempt payees,see Exempt payee code earlier Note.If no name is circled when more than one name is listed the number will be
Signature requirements Complete the certification as indicated in items 1 considered to be that of the first name listed
through 5 below Secure Your Tax Records from Identity Theft
1.Interest,dividend,and barter exchange accounts opened before 1984
and broker accounts considered active during 1983.You must give your Identity theft occurs when someone uses your personal information such as your
correct TIN,but you do not have to sign the certification name,SSN,or other identifying information,without your permission,to commit
2.Interest,dividend,broker,and barter exchange accounts opened after fraud or other crimes An identity thief may use your SSN to get a job or may file a
1983 and broker accounts considered inactive during 1983.You must sign the tax return using your SSN to receive a refund
certification or backup withholding will apply If you are subject to backup To reduce your risk
withholding and you are merely providing your correct TIN to the requester you •Protect your SSN,
must cross out item 2 in the certification before signing the form
3.Real estate transactions You must sign the certification You may cross out •Ensure your employer is protecting your SSN,and
item 2 of the certification •Be careful when choosing a tax preparer
4.Other payments.You must give your correct TIN,but you do not have to sign If your tax records are affected by identity theft and you receive a notice from
the certification unless you have been notified that you have previously given an the IRS respond right away to the name and phone number pnnted on the IRS
incorrect TIN "Other payments"include payments made in the course of the notice or letter
requester's trade or business for rents,royalties,goods(other than bills for If your tax records are not currently affected by identity theft but you think you
merchandise),medical and health care services(including payments to are at risk due to a lost or stolen purse or wallet,questionable credit card activity
corporations),payments to a nonemployee for services,payments made in or credit report,contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit
settlement of payment card and third party network transactions payments to Form 14039
certain fishing boat crew members and fishermen,and gross proceeds paid to For more information see Publication 4535 Identity Theft Prevention and Victim
attorneys(including payments to corporations) Assistance
5.Mortgage interest paid by you,acquisition or abandonment of secured Victims of identity theft who are experiencing economic harm or a system
property,cancellation of debt,qualified tuition program payments(under problem,or are seeking help in resolving tax problems that have not been resolved
section 529),IRA,Coverdell ESA,Archer MSA or HSA contributions or through normal channels may be eligible for Taxpayer Advocate Service(TAS)
pension distributions,and pension distributions.You must give your correct TIN but you assistance You can reach TAS by calling the TAS toll-free case intake line at
do not have to sign the certification 1-877-777-4778 or TTY/TDD 1-800-829-4059
What Name and Number To Give the Requester Protect yourself from suspicious emails or phishing schemes. Phishing is the
creation and use of email and websites designed to mimic legitimate business
For this type of account: Give name and SSN of emails and websites The most common act is sending an email to a user falsely
1 Individual The individual claiming to be an established legitimate enterprise in an attempt to scam the user
into surrendering private information that will be used for identity theft
2 Two or more individuals Qoint The actual owner of the account or, The IRS does not initiate contacts with taxpayers via emails Also,the IRS does
account) if combined funds,the first not request personal detailed information through email or ask taxpayers for the
individual on the account' PIN numbers,passwords,or similar secret access information for their credit card,
3 Custodian account of a minor The minor' bank,or other financial accounts
(Uniform Gift to Minors Act) If you receive an unsolicited email claiming to be from the IRS forward this
4 a The usual revocable savings The grantor-trustee' message to phishing@irs.gov You may also report misuse of the IRS name,logo,
trust(grantor is also trustee) or other IRS property to the Treasury Inspector General for Tax Administration
b So-called trust account that is The actual owner' (TIGTA)at 1-800-366-4484 You can forward suspicious emails to the Federal
not a legal or valid trust under Trade Commission at spamOuce.gov or contact them at www ftc.gov/idtheft or
state law 1-877-IDTHEFT(1-877-438-4338)
5 Sole proprietorship or disregarded The owner' Visit IRS.gov to learn more about identity theft and how to reduce your risk
entity owned by an individual
6 Grantor trust filing under Optional The grantor* Privacy Act Notice
Form 1099 Filing Method 1(see
Regulations section 1 671-4(b)(2)(i) Section 6109 of the Internal Revenue Code requires you to provide your correct
(A)) TIN to persons(including federal agencies)who are required to file information
returns with the IRS to report interest,dividends,or certain other income paid to
For this type of account Give name and EIN of you,mortgage interest you paid,the acquisition or abandonment of secured
7 Disregarded entity not owned by an The owner property,the cancellation of debt or contributions you made to an IRA Archer
individual MSA,or HSA The person collecting this form uses the information on the form to
8 A valid trust,estate,or pension trust Legal entity' file information returns with the IRS,reporting the above information Routine uses
of this information include giving it to the Department of Justice for civil and
9 Corporation or LLC electing The corporation criminal litigation and to cities,states,the District of Columbia,and U S
corporate status on Form 8832 or commonwealths and possessions for use in administering their laws The
Form 2553 information also may be disclosed to other countries under a treaty,to federal and
10 Association,club,religious, The organization state agencies to enforce civil and criminal laws,or to federal law enforcement and
charitable,educational,or other tax- intelligence agencies to combat terrorism You must provide your TIN whether or
exempt organization not you are required to file a tax return Under section 3406,payers must generally
11 Partnership or multi-member LLC The partnership withhold a percentage of taxable interest,dividend,and certain other payments to
a payee who does not give a TIN to the payer Certain penalties may also apply for
12 A broker or registered nominee The broker or nominee providing false or fraudulent information
13 Account with the Department of The public entity
Agriculture in the name of a public
entity(such as a state or local
government,school district,or
prison)that receives agricultural
program payments
14 Grantor trust filing under the Form The trust
1041 Filing Method or the Optional
Form 1099 Filing Method 2(see
Regulations section 1 671-4(b)(2)(i)
(B))
List first and circle the name of the person whose number you furnish If only one person on a
joint account has an SSN,that person's number must be furnished
'Circle the minor's name and furnish the minor's SSN
BOCC AGENDA ITEM SUMMARY
Resolution: 19-362 BOCC Meeting Date: Dec. 9, 2019
Suggested Wording for Agenda Item: Agenda Type: Deliberation
Acceptance of Agreement between Lewis County and Washington State Military Department for
FEMA Emergency Management Performance Grant and authorizing signatures thereon.
Contact: Andy Caldwell Phone: 360-740-1157
Department: DES - Emergency Management (Dept of Emergency Services)
Description:
The US Department of Homeland Security, through the Washington State Military Department
provides FEMA Emergency Management Performance Grant (EMPG) funds to local jurisdictions and
tribes with emergency management programs. The intent of this grant is to support the local
emergency management operating budget by providing funds for the program enhancements that
are outside the regular budget.
Lewis County Emergency Management applies annually for the EMPG Grant and will receive
$43,680.00. for this grant cycle The contract period will run from June 1, 2019 to August 31, 2020
This money will be utilized for a number of projects, equipment, training, Everbridge Resident
Connection, preparedness and educational materials for the county's first responders and
members of our community.
Approvals: Publication Requirements:
Publications:
User Status None
Additional Copies
None