Acceptance of agreement with WA State Military Dept for the 2021-22 EMPG-ARPA BEFORE THE BOARD OF COUNTY COMMISSIONERS
LEWIS COUNTY, WASHINGTON
IN THE MATTER OF: RESOLUTION NO. 22-015
ACCEPTANCE OF AGREEMENT BETWEEN LEWIS
COUNTY AND WASHINGTON STATE MILITARY
DEPARTMENT FOR THE 2021 - 22 EMERGENCY
MANAGEMENT PERFORMANCE GRANT,
AMERICAN RESCUE PLAN ACT (EMPG-ARPA)
WHEREAS, the Lewis County Board of County Commissioners (BOCC) has
reviewed the agreement between Lewis County and the Washington State Military
Department for the 2021-22 Emergency Management Performance Grant,
American Rescue Plan Act (EMPG-ARPA) grant; and
WHEREAS, the contract amount of $14,901 was not included in the budget; and
WHEREAS, it appears to be 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 $14,901 in Emergency Management Performance Grant, American
Rescue Plan Act (EMPG-ARPA); and the BOCC delegates authority to Lewis County
Commissioner Lindsey R. Pollock, DVM, to sign Agreement #E22-235 on behalf of
Lewis County.
DONE IN OPEN SESSION this 18th day of January, 2022.
Page 1 of 2 Res. 22-015
APPROVED AS TO FORM: BOARD OF COUNTY COMMISSIONERS
Jonathan Meyer, Prosecuting Attorney LEWIS COUNTY, WASHINGTON
Amber Smith Lindsey R. Pollock, DVM
By: Amber Smith, Lindsey R. Pollock, DVM, Chair
Deputy Prosecuting Attorney
ATTEST: •s�°""'''wgsy., Sean D. Swope
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Sean D. Swope, Vice Chair
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Rieva Lester •.SyN . F. Lee Grose
Rieva Lester, • F. Lee Grose, Commissioner
Clerk of the Lewis County Board of
County Commissioners
Page 2 of 2 Res. 22-015
Washington Military Department Contract Number:
Debarment, Suspension, Ineligibility or Voluntary Exclusion Certification Form
NAME Doing business as(DBA)
Lewis County N/A
ADDRESS Applicable Procurement WA Uniform Business Federal Employer Tax
2025 NE Kresky Ave, Chehalis, WA 98532 or Solicitation#,if any: Identifier(UBI) Identification#:
212-002-978 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. Date: OV°Y/26z-Z—
Print Name and Title: Zrf MCr-e at. ""� pj, caber
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.
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 DATE SUBMITTED
Lewis County Public Works, Division of Emergency Management 12/30/2021
PROJECT DESCRIPTION CONTRACT NUMBER
Emergency Management Performance Grant - American Rescue E22-235
Plan Act Agreement
1. AUTHORIZING AUTHORITY
SIGNATURE PRINT OR TYPE NAME TITLE/TERM OF OFFICE
/ A z f i/� Lindsey R. Pollock, DVM Chair, Commissioner
/(.4..— �) Sean Swope Commissioner
I �t�
Josh Metcalf PW/DEM
2. AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS
SIGNATURE PRINT OR TYPE NAME TITLE
Lindsey R. Pollock, DVM Commissioner
Josh Metcalf PW/DEM Director
3. AUTHORIZED TO SIGN REQUESTS FOR REIMBURSEMENT
SIGNATURE PRINT OR TYPE NAME TITLE
Josh Metcalf PW/DEM Director
Tina Hemphill Deputy -
\\NAC-1\VOL1\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.
Washington State Military Department
EMERGENCY MANAGEMENT PERFORMANCE GRANT AMERICAN RESCUE PLAN ACT AGREEMENT FACE SHEET
1. Subrecipient Name and Address: 2. Grant Agreement Amount: 3. Grant Agreement Number:
County of Lewis $14,901 E22-235
Division of Emergency Management(DEM)
351 NW North Street
Chehalis,WA 98532-0509
4. Subrecipient Contact, phone/email: 5. Grant Agreement Start Date: 6. Grant Agreement End Date:
Ross McDowell, 360-740-1157 June 1, 2021 December31, 2022
ross.mcdowel I@lewiscountywa.gov,
DEM@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 Authority:
Washington State Military Department(the"DEPARTMENT")and the U.S. Department of Homeland Security (DHS)
11. Federal Award ID#(FAIN): 12. Federal Award Date: 13. Assistance Listings#(formerly CFDA)&Title:
EMS-2021-EP-00008-501 08/30/2021 97.042(21 EMPG-ARPA
14. Total Federal Amount: 15. Program Index#&OBJ/SUB-OBJ: 16. EIN:
$2,136,034 713PA NZ 91-6001351
17. Service Districts: 18. Service Area by County(ies): 19. Women/Minority-Owned, State
(BY LEGISLATIVE DISTRICT): 19,20 Lewis Certified: ® N/A ❑ NO
(BY CONGRESSIONAL DISTRICT): 3 ❑ YES, OMWBE#
20. Agreement Classification: 21. Contract Type(check all that apply):
❑ Personal Services ❑ Client Services ® Public/Local Gov't ❑ Contract ® Grant ® Agreement
❑ Research/Development ❑ NE ❑ Other E Intergovernmental(RCW 39.34) ❑ Interagency
22. Subrecipient Selection Process: 23. Subrecipient 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
24. PURPOSE& DESCRIPTION:
The purpose of the Fiscal Year (FY) 2021 Emergency Management Performance Grant American Rescue Plan Act(21 EMPG-
ARPA) 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 21 EMPG-ARPA DHS Award Letter for Grant No. EMS-2021-EP-
00008-S01,which is incorporated in and attached hereto as Attachment C 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
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(Attachment A); General Terms and Conditions(Attachment B);21 EMPG-ARPA Award
Letter EMS-2021-EP-00008-S01 (Attachment C);Work Plan (Attachment D); Timeline(Attachment E); Budget(Attachment 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. Special Terms and Conditions
2. DHS/FEMA Award and program documents 5. General Terms and Conditions,and,
3. Work Plan,Timeline,and Budget 6. Other provisions of the Agreement incorporated by reference
WHEREAS, the parties hereto have executed this Agreement on the day and year last specified below.
FOR THE DEPARTMENT: FOR THE SUBRECIPIENT:
Signature Date Si natur Date
Regan Anne Hesse, Chief Financial Officer Lindsey Pollock, Chair
Washington State Military Department Lewis County Board of Commissioners
BOILERPLATE APPROVED AS TO FORM: APPROVED AS TO FORM (if applicable):
Dawn C. Cortez [August 10, 2021]
Assistant Attorney General Subrecipient's Legal Review Date
DHS-FEMA-EMPG-ARPA-FY21 Page 1 of 34 Lewis County DEM, E22-235
Attachment 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 Ross McDowell Name John Hollingsworth
Title Deputy Director Title Program Coordinator
Email ross.mcdowell@lewiscountywa.gov Email john.hollingsworth@mil.wa.gov
DEM@lewiscountywa.gov
Phone 360-740-1157 Phone 253-512-7044
Name Josh Metcalf Name Tirzah Kincheloe
Title Director Title Program Manager
Email josh.metcalf@lewiscountywa.gov Email tirzah.kincheloe@mil.wa.gov
Phone 360-740-2762 Phone 253-512-7456
Name Erika Katt Name Courtney Bemus
Title Planner Title Program Assistant
Email erika.katt@lewiscountywa.gov Email courtney.bemus@mil.wa.gov
Phone 360-740-1153 Phone 253-316-6438
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 21 EMPG-ARPA 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 (FY) 2021 Emergency Management Performance Grant (EMPG) document, the FEMA Preparedness
Grants Manual document (the Manual), the DHS Award Letter for Grant No. EMS-2021-EP-00008-S01, and the
federal regulations commonly applicable to DHS/FEMA grants, all of which are incorporated herein by reference.
The OHS Award Letter is incorporated in this Agreement as Attachment C.
The Subrecipient acknowledges that since this Agreement involves federal award funding, the performance
period 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 21EMPG-ARPA funds received under this Agreement
casts the party receiving the funds in the role of a subrecipient or contractor in accordance
with 2 CFR 200.331.
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 21EMPG-ARPA 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 21EMPG-ARPA Program, including,
DHS-FEMA-EMPG-ARPA-FY21 Page 2 of 34 Lewis County DEM, E22-235
BOCC AGENDA ITEM SUMMARY
Resolution: BOCC Meeting Date: Jan. 18, 2022
Suggested Wording for Agenda Item: Agenda Type: Deliberation
Acceptance of agreement between Lewis County and Washington State Military Department for the
2021 - 22 Emergency Management Performance Grant, American Rescue Plan Act (EMPG-ARPA)
and authorizing signatures thereon
Contact: Erika Katt Phone: 3607401153
Department: DES - Emergency Management (Dept. of Emergency Services)
Description:
The U.S. Department of Homeland Security, through the Washington State Military Department
provides FEMA Emergency management Performance Grant American Rescue Plan Act (EMPG-
ARPA) funds to local jurisdictions and tribes with emergency management activities in preparing
for all hazards through enhancement, sustainment and improvement programs.
The grant contract number is E22-235 in the amount of $14,901. The grant agreement ends
December 31, 2022.
Our grant application is to continuation of the upgrade of interoperable communications within the
county to provide emergency radio coverage during critical events. Equipment is being planned on
being purchased to assist with this, such as antenna, maintenance items, power panels, etc.
Approvals: Publication Requirements:
Publications:
User Status
Josh Metcalf Pending
PA's Office Pending
Additional Copies: Cover Letter To: