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BUSINESS OF THE CITY COUNCIL
YAKIMA, WASHINGTON
AGENDA STATEMENT
Item No. 6.D.
For Meeting of: January 10, 2017
ITEM TITLE: Resolution authorizing the Fire Chief, who serves as the City's
Emergency Manager, to enter into a grant agreement with
Washington State Military Department and the U.S. Department of
Homeland Security to provide funds to enhance the City of
Yakima Emergency Management Program
SUBMITTED BY: Bob Stewart, Fire Chief
SUMMARY EXPLANATION:
The purpose of the Emergency Management Performance Grant (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. There are
also required capabilities that must be conducted 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 National Incident Management System (NI MS) compliant.
Specifically, we intend to use the EMPG award for training, exercises, emergency notifications
and EOC readiness. Our training plans include: EOC City Staff; Mass Care Services; and
Disaster Rapid Needs Assessment and Recovery. Our exercise plans include: Hazardous
Materials Incidents—fixed and transportation; Continuity of Government and Operations for City
Staff; Yakima Air Terminal FAA required. Our Emergency Notification focus will be on initial
emergency notifications to city staff; high risk population centers; and hospitals. Our EOC
Readiness plan includes: Equipment, Training and Consultative Services; Equipment acquisition
for multiple EOC Command sites, i.e. Fire Station 91; Public Works; and Police.
Due to an error on the part of the State of Washington, the final 2016 reimbursement request of
$42,295 has been added to the 2017 awarded grant.
ITEM BUDGETED: NA
STRATEGIC PRIORITY: Public Safety
APPROVED FOR City Manager
SUBMITTAL:
STAFF RECOMMENDATION:
Adopt resolution.
BOARD/COMMITTEE RECOMMENDATION:
ATTACHMENTS:
Description Upload Date Type
D kosolluUon for If MPG f 17143 12119/2016 ResoDuion
D ( rarfl Agroorneril F. 17143 121.19/2016 1C;oril rad
D Aqreenent AV Well mon ts 12119/2016 Backup Maker
RESOLUTION NO. R-2017-
A RESOLUTION authorizing the Fire Chief, who serves as the City's Emergency
Manager, to enter into a grant agreement with Washington State
Military Department and the U.S. Department of Homeland
Security to provide funds to enhance the City of
Yakima Emergency Management Program
WHEREAS, in January 2015, the City of Yakima's Comprehensive Emergency
Management Plan was approved by the Washington State Emergency Management
Division; and,
WHEREAS, the Washington State Military Department and the U.S. Department
of Homeland Security awards funds to local jurisdictions with Emergency Management
Programs to assist in preparing for all hazards through sustainment and enhancement of
those programs; and,
WHEREAS, in June 2016, application was made to, and approved by the
Washington State Military Department and the U.S. Department of Homeland Security
for Emergency Management Preparedness Grant (EMPG); therefore,
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF YAKIMA:
That the City Council of the City of Yakima authorizes the Fire Chief to enter into
Grant Agreement Number E17-143 with Washington State Military Department and U.S.
Department of Homeland Security.
ADOPTED BY THE CITY COUNCIL this 10th day of January, 2017.
ATTEST: Kathy Coffey, Mayor
Sonya Claar Tee, City Clerk
Washington State Military Department
HOMELAND SECURITY GRANT AGREEMENT FACE SHEET
1,, Subrecipient Name and Address: 2, Grant Agreement Amount: 3. Grant Agreement Number:
Yakima,City of $95,744 E17-143
401 North Front Street
Yakima,WA 98901-2321
4. Subrecipient Contact, phone/email: 5. Grant Agreement Start Date: 6. Grant Agreement End Date:
Bob Stewart,(509)575-6060 June 1,2016 August 31,2017
bob.stewa • akimawa.•ov
7. Department Contact, phone/email: 8. Data Universal Numbering System (DUNS): 9. UBI#(state revenue):
Zoie Choate,(253)512-7461
zoie.choate(a mil.wa.gov 078212651 391-005-272
10. Funding Authority:
Washington State Military Department(the"DEPARTMENT")and the U.S. Department of Homeland Security(DHS)
11. Federal Funding Identification #: 12. Federal Award Date: 13. Catalog of Federal Domestic Assistance(CFDA)#&Title:
EMS-2016-EP-00002-S01 08/10/2016 97.042(16EMPG)
14. Total Federal Amount #: 15. Program Index#&OBJ/SUB-OBJ: 16. TIN:
$7,254,374 763PT NZ 91-6001293
17. Service Districts: 18, Service Area by County(ies): 19. Women/Minority-Owned, State
(BY LEGISLATIVE DISTRICT): 13 Yakima Certified?: X N/A 0 NO
(BY CONGRESSIONAL DISTRICT): 4 0 YES, OMWBE#
20. Agreement Classification 21. Contract Type(check all that apply):
❑ Personal Services 0 Client Services X Public/Local Gov't 0 Contract X Grant X Agreement
❑ Research/Development 0 A/E 0 Other 0 Intergovernmental (RCW 39.34) 0 Interagency
22. Subrecipient Selection Process: 23. Subrecipient Type(check all that apply)
X "To all who apply&qualify" 0 Competitive Bidding 0 Private Organization/Individual 0 For-Profit
❑ Sole Source 0 A/E RCW 0 N/A X Public Organization/Jurisdiction 0 Non-Profit
❑ Filed w/OFM? ❑ Advertised? 0 YES ONO 0 CONTRACTOR X SUBRECIPIENT 0 OTHER
24. PURPOSE&DESCRIPTION:
The purpose of the FY 2016 Emergency Management Performance Grant(16EMPG) is to provide U.S. Department of Homeland
Security (DHS)/Federal Emergency Management Agency (FEMA) Federal award funds to local jurisdictions and tribes with
emergency management programs to assist 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 16EMPG Award EMS-2016-EP-00002-S01,which is incorporated in
and attached hereto as Attachment#1, 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); and all other documents, exhibits and attachments 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 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 Signature Date
Richard A.Woodruff, Contracts Officer Bob Stewart, Chief
Washington State Military Department Yakima Fire Department
BOILERPLATE APPROVED AS TO FORM: APPROVED AS TO FORM(if applicable):
Signature on File(9/6/2016)
Brian E. Buchholz,Assistant AttorneyGeneral
Applicant's Legal Review Date
Form 05/12/2015 MLL
DHS-FEMA-EMPG-FFY 16 Page 1 of 33 Yakima, City of, E17-143
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 MILITARY DEPARTMENT
Name Bob Stewart Name Zoie Choate
Title Chief,Yakima Fire Department Title Program Coordinator
E-Mail bob.stewartavakimawa.gov E-Mail zoie.choate(a mil.wa.gov
Phone 509-575-6060 Phone 253-512-7451
Name Charles Erwin Name Sierra Wardell
Title Emergency Management Specialist Title Section Supervisor
E-Mail charles.erwinavakimawa.gov E-Mail sierra.wardell@mil.wa.gov
Phone 509-576-6732 Phone 253-512-7121
Name Name Dalton Gamboa
Title Title Program Assistant
E-Mail E-Mail dalton.gamboa@mil.wa.gov
Phone Phone 253-512-7044
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 16EMPG 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 2016 Emergency Management Performance Grant (EMPG)" document, the DHS Award Letter for Grant
No. EMS-2016-EP-00002-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
Attachment#1.
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 16EMPG 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:
i. The Subrecipient must comply with all federal laws and regulations applicable to
pass-through entities of 16EMPG funds, including but not limited to those contained
in 2 CFR 200.
ii. The Subrecipient shall require its subrecipient to comply with all applicable state
and federal laws, rules, regulations, requirements and program guidance identified
DHS-FEMA-EMPG-FFY 16 Page 2 of 33 Yakima, City of, E17-143
or referenced in this Agreement and the informational documents published by
DHS/FEMA applicable to the 16EMPG 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 2016 Emergency
Management Performance Grant (EMPG)" document, the DHS Award Letter for
Grant No. EMS-2016-EP-00002-S01 in Attachment#1, and the federal regulations
commonly applicable to DHS/FEMA grants.
The Subrecipient shall be responsible to the Department for ensuring that all
16EMPG federal award funds provided to its subrecipient are used in accordance
with applicable federal and state statutes and regulations, and the terms and
conditions of the federal award set forth in Attachment#1 of this Agreement.
2., REIMBURSEMENT&BUDGET REQUIREMENTS
a. Within the total Grant Agreement Amount, travel, sub-contracts, salaries, benefits,
printing, equipment, and other goods and services or other budget categories will be
reimbursed on an actual cost basis 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 for indirect
costs 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.
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 indirect cost rate percentage identified in the Budget(Exhibit
E). 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 explanation for the
change.
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 ReimbursementsAmil.wa.gov no later than the due dates listed within the
Timeline (Exhibit D), but not more frequently than monthly.
Reimbursement request totals should be commensurate to the time spent processing by
the Subrecipient and the Department. If the reimbursement request isn't substantial
enough, the Subrecipient should request prior written approval from Department Key
Personnel to waive the due date in the Timeline(Exhibit D) and instead submit those costs
on the next scheduled reimbursement due date contained in the Timeline.
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.
DHS-FEMA-EMPG-FFY 16 Page 3 of 33 Yakima, City of, E17-143
g. Any request for extension of a due date in the Timeline (Exhibit D) will be treated as a
request for Amendment of the Agreement and 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 can 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.
j. Failure to timely submit 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 complete 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 REQUIREMENTS
a. With each reimbursement request, the Subrecipient shall report how the expenditures, for
which reimbursement is sought, relate to the Work Plan activities in the format provided
by the Department.
b. In conjunction with the next annual grant cycle application process, the Subrecipient shall
submit to the Department Key Personnel a final report describing all completed activities
under this Agreement. If a Subrecipient will not be applying for grant funding during the
next annual grant cycle application process, the Subrecipient will submit a final report with
its final reimbursement request to the Department detailing progress on all activities listed
in the Work Plan.
c. In conjunction with the final report,the Subrecipient shall submit a separate report detailing
how the EMPG Exercise and 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-
management-division/grants/requiredgrantforms, which is incorporated by reference and
made a part of this Agreement.
e. The Subrecipient shall participate in the State's annual capabilities assessment for the
State Preparedness Report.
DHS-FEMA-EMPG-FFY 16 Page 4 of 33 Yakima, City of, E17-143
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:
i. Upon successful completion of the terms of this Agreement, all equipment and
supplies purchased through this Agreement will be owned by the Subrecipient, 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; the
manufacturer's serial number, model number, or other identification number; the
funding source for the equipment, including the Federal Award Identification
Number (FAIN); Catalog of Federal Domestic Assistance (CFDA) number; who
holds the title; the acquisition date; the cost of the equipment and the percentage
of Federal participation in the cost; the location, use and condition of the equipment
at the date the information was reported; and 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.
ix. If upon termination or at the Grant Agreement End Date, there is a residual
inventory of unused supplies exceeding $5,000 in total aggregate value which will
not be needed for any other Federal award, or when original or replacement
equipment is no longer needed for the original project or program or for other
activities currently or previously supported by a Federal agency or award, the
Subrecipient must comply with the following procedures:
A. Supplies: The Subrecipient may retain the supplies for use on other non-
Federal related activities or sell them, but must compensate the Federal
sponsoring agency for its share.
B. Equipment: The Subrecipient must dispose of equipment as follows:
DHS-FEMA-EMPG-FFY 16 Page 5 of 33 Yakima, City of, E17-143
i. Items of equipment with a current per-unit fair market value of less than
$5,000 may be retained, sold, or otherwise disposed of by the
Subrecipient with no further obligation to the awarding agency.
ii. Items of equipment with a current per-unit fair market value of more than
$5,000 may be retained or sold and the Subrecipient shall compensate
the Federal-sponsoring agency for its share.
x. 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 equipment categories for the EMPG Program are listed on the Authorized
Equipment List (AEL) located on the FEMA website at htt'://: . ,fema.kov/authorized-
equipment-list. It is important 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. Equipment purchased with DHS federal award funds is to be marked with "Purchased
with funds provided by the U.S. Department of Homeland Security" when practicable.
f. As a subrecipient of federal funds, 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 becomes a pass through entity by making a
subaward of federal award funds under this Agreement.
5. ENVIRONMENTAL AND HISTORICAL PRESERVATION
The Subrecipient shall ensure full compliance with the DHS/FEMA Environmental Planning and
Historic Preservation (EHP) Program. EHP program information can be found at
htt+s://" .fema.eov/office-environmental-elanning-and-historic-preservation; FP 108-023-1
Environmental Planning and Historic Preservation Policy Guidance at
http://www.fema.qaWmedia-librarWassets/documents/85376; and FP 108.24.4 Environmental
Planning and Historical Preservation Policy at https://www.fema.gov/media-
Iibrary/assets/documents/101537, all of which are incorporated in and made a part of this
Agreement.
a. 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 walls, and training or exercises occurring outside in areas not
DHS-FEMA-EMPG-FFY 16 Page 6 of 33 Yakima, City of, E17-143
considered previously disturbed, also require a DHS/FEMA EHP review before project
initiation.
b. The EHP review process involves the submission of a detailed project description that
explains the goals and objectives of the proposed project along with supporting
documentation so FEMA may determine whether the proposed project has the potential
to impact environmental resources and/or historic properties.
c. 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 $150,000, 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.gov/emergencv-management-
division/grants/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:
i. review of financial and performance reports
ii. monitoring and documenting the completion of Agreement deliverables
iii. documentation of phone calls, meetings, 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.
DHS-FEMA-EMPG-FFY 16 Page 7 of 33 Yakima, City of, E17-143
e. Compliancy will be monitored throughout the performance period to assess risk.
Concerns will be addressed through a Corrective Action Plan.
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 OHS Recipient Guidance at https:// .dhs. ov/g, lc -published-help-
department-supported-organizations-provide-meaningfukaccess-people limited and
additional resources on littp://www.leplov.
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(PPD)-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. The Subrecipient agrees that in order to receive Federal Fiscal Year 2016 federal
preparedness funding, to include EMPG, NIMS compliance requirements for 2016 must
be met.
B. EMPG PROGRAM SPECIFIC REQUIREMENTS
1. The Department receives EMPG Program funding from the DHS/FEMA, which is provided to
assist state, local, and tribal governments 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 16EMPG grant was identified by the state to be 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 under 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
DHS-FEMA-EMPG-FFY 16 Page 8 of 33 Yakima, City of, E17-143
the Department and incorporated into this Agreement. Funding may not be used to replace or
supplant existing local or tribal government funding of emergency management programs.
4, The Subrecipient shall provide a fifty percent match of $95,744 of non-federal origin. To meet
matching requirements, the Subrecipient 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.
5. Exercises that are implemented with EMPG Program funds under this Agreement must meet the
requirements of the 16EMPG Program.
6. All personnel funded in any part through federal award or matching funds under this Agreement
shall:
a. participate in no less than three exercises in a 12-month period. The Subrecipient will report
exercise participation along with the final report.
b. complete the following training requirements and record proof of completion: NIMS Training
ICS 100, ICS 200, IS 700, and IS 800 and the FEMA Professional Development Series IS
120, IS 230, IS 235, IS 240, IS 241, IS 242, and IS 244. The Subrecipient will report training
course completion by individual personnel along with the final report.
C. DHS TERMS AND CONDITIONS
As a subrecipient of 16EMPG Program funding, the Subrecipient shall comply with all applicable DHS
terms and conditions of the 16EMPG Award Letter and its incorporated documents for DHS Grant No.
EMS-2016-EP-00002-S01, which are incorporated and made a part of this Agreement as Attachment#1.
DHS-FEMA-EMPG-FFY 16 Page 9 of 33 Yakima, City of, E17-143
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
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.
f. "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.
A.5 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.gov/emergency-management-
DHS-FEMA-EMPG-FFY 16 Page 10 of 33 Yakima, City of, E17-143
division/ rants/reguirgdgrantform . Any such form completed by the Subrecipient for this Agreement
shall be incorporated into this Agreement by reference.
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 (http://www.sam.hov) 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"
(http://www.Ini.wa.gov/TradesLicensing/PrevWage/AwardingAgencies/DebarredContractors/). 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
('bttg:// .des.we.ggv/services/ContrctingPurghasing/Business/Ra«esendor-Debarment. s.x).
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 sub-contracts, sub-grants, and contracts under grants,
loans, and cooperative agreements) and that all sub-recipients 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 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
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.9 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,
DHS-FEMA-EMPG-FFY 16 Page 11 of 33 Yakima, City of, E17-143
(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.10 CONTRACTING & PROCUREMENT
a. The Subrecipient shall use a competitive procurement process in the procurement and award of
any contracts with contractors or sub-contractors that are entered into under the original contract
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 $150,000, 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 effected 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.
DHS-FEMA-EMPG-FFY 16 Page 12 of 33 Yakima, City of, E17-143
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 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.C. 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
DHS-FEMA-EMPG-FFY 16 Page 13 of 33 Yakima, City of, E17-143
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,
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 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 sub-contractors, 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.
DHS-FEMA-EMPG-FFY 16 Page 14 of 33 Yakima, City of, E17-143
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 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
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 scope of work 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.
DHS-FEMA-EMPG-FFY 16 Page 15 of 33 Yakima, City of, E17-143
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
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 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
DHS-FEMA-EMPG-FFY 16 Page 16 of 33 Yakima, City of, E17-143
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 WORKNVORK 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
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)
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 non-profit 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 Subpart F.
The Subrecipient shall maintain auditable records and accounts so as to facilitate the audit requirement
and shall ensure that any sub-contractors also maintain auditable records. The Subrecipient is
responsible for any audit exceptions incurred by its own organization or that of its sub-
contractors. 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):
DHS-FEMA-EMPG-FFY 16 Page 17 of 33 Yakima, City of, E17-143
Contracts Office
Washington Military Department
Finance Division, Building #1 TA-20
Camp Murray, WA 98430-5032
If the Subrecipient claims it is exempt from the audit requirements of 2 CFR Part 200 Subpart F, the
Subrecipient must send a letter identifying this Agreement and explaining the criteria for exemption no
later than nine (9) months after the end of the Subrecipient's fiscal year(s) to the address listed above.
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.
The Subrecipient shall include the above audit requirements in any subawards.
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
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,
DHS-FEMA-EMPG-FFY 16 Page 18 of 33 Yakima, City of, E17-143
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
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;
DHS-FEMA-EMPG-FFY 16 Page 19 of 33 Yakima, City of, E17-143
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.
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-FFY 16 Page 20 of 33 Yakima,City of, E17-143
Exhibit C
16EMPG WORK PLAN
i- dv YenVVl IM(4T v '/a/ nVr'FxvFi rr V r V'ni Vuv;K Y XINv;)YN O((WWJ 'N+11MN+W'W.VAWW'WWNK t'nWV!ww'rrt 11WV !'FF ff'f ukfur PW OfKrtY'Nlif 1lVOVIV Y r lhVV'N N NVVVVtivr WxdW rm o.evn.Nry miwxim nvr✓fr irm VL //1 ..,lid r WFVw✓,u',:r<r/if'.
Emergency Management Organization City of Yakima
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 conducted 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 16EMPG grant and local funds).
Program Area#1
Planning
WORK PLANNED WHY THE WORK IS BEING DONE RESULT OF THE WORK
Develop and produce Financial,Administrative The current CEMP does not include Finance& Have a comprehensive set of procedures
and Cost Recovery procedures to be utilized in the Administration(F&A)procedures.F&A procedures addressing F&A topics and cost recovery which
EOC. Outputs include desk reference books,job are in place but need to be updated and further will assist in the response and recovery phases of
tasks/checklists,etc. Incorporate current developed. Additionally,cast recovery process a disaster.
1(documents into revised processes. Process isn't as detailed as is needed. Support the
developed will be will be published in the 2017 National Preparedness Goal as defined under
CEMP. Common Core Capabilities--Planning and
Operational Coordination.
Develop enhanced evacuation plans and There is a very limited basic framework in place Have a completed and functional plan ensuring
procedures primarily for special populations,e.g., for evacuation of special populations during a special populations are taken care of during and
American Disabilities Act definition, Limited catastrophic event.The plan needs to be after a catastrophic event.
English Proficiency,Access and Functional Needs improved to include planning for transport,
populations.This will include plans for: housing,and communication with the City's
2 alert/warnings,crisis communications,pre- special population.
positioning of equipment for areas impacted by
Imass evacuation,sheltering,and re-entry. The
(work will involve sessions with other departments
'and private sector entities.
2015'THII'tA Review—conduct all hazards To identify planning gaps and ensure consistency. Planning shortfalls identified.
emergency management planning update to the
1 city's 2015 T"HIRA, Conduct study session
rworksh'ops.
Resource Management Plan--develop/enhance Current process isn't automated or consistent City will have a consistent methodology for
logistics and resource management plans; across the City. This will support the National resource management and procedures which can
develop/enhance volunteer and/or donations Preparedness Goal as defined under Common be used during a disaster.
management plan. City will utilize a Core Capabilities--Planning and Operational
4
contractor/consultant to develop materials and Coordination.
conduct study sessions with stakeholders.
Recovery Planning--develop long term recovery Short term recovery is fairly well outlined, More An enhanced city disaster recovery plan which
plans and preparedness program. City will utilize work is needed for long term recovery plans. To encompasses 21 city agencies and addresses
contractor/consultant to develop materials and ensure consistency with the principles and specific issues that impact citizens and city staff
5 conduct study sessions. guidance in the National Disaster Recovery after an emergency event.
Framework that will provide the foundation for
recovery programs and whole-community
partnerships.
DHS-FEMA-EMPG-FFY 16 Page 21 of 33 Yakima, City of, E17-143
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Program Area#2
I Training
WORK PLANNED WHY THE WORK IS BEING DONE RESULT OF THE WORK
•Review 2016 THIRA for low ratings in training. The 2015 THIRA results included low capability Training shortfalls identified and multi-agency
•Conduct Training and Exercise Workshop ratings in Training across the core capabilities and training program developed.City departments'
(TEPW);incorporate capability gaps discovered in as such,Training is one of the top priorities for the training activities aligned to a current,Multi-year
Abe THIRA review, City, TEP. A community oriented approach to
-Develop a Multi-year Training and Exercise Plan emergency management that emphasizes
(TEP). engagement at the community level,strengthens
I.Conduct or facilitate training included in TEP. best practices,and provides a path toward
-Purchase of field guides,audio-visuals,and other building a sustainable city has been established.
training resources to support all hazards training. City responders have enhanced ability to protect
•Integrate FEMA-approved emergency citizens,residents,visitors,and assets against the
management training. greatest threats and hazards.
•Continue to build NIMS compliance for the City's
response personnel.
-Continue ongoing training program for
elected/appointed officials,department heads,
emergency management response personnel,and
the private sector.
Program Area#3
Exercises
WORK PLANNED WHY THE WORK IS BEING DONE .. .. ..oa_ ...�.. _RE,ESULT OF OFT..
..�,e THE WORK
Conduct Access and Functional Needs Functional To identify and be educated on gaps in meeting The City's Access and Functional Needs protocols
Exercise(FE)--conduct pre-exercise training; the needs of special populations during a disaster. validated before an emergency or disaster. The
purchase exercise expendables. Demonstrate the City's Center Management city can provide timely,accurate,and actionable
1 System(Emergency Operations Center)activation. information for its residents utilizing Everbridge
Support the National Preparedness Goal as and Avaya emergency notification capabilities.
defined under Common Core Capability-
Operational Coordination.
)
If Conduct City of Yakima Air Terminal Airport The FAA requires for certification.Sequence of Yakima Air Terminal will remain compliant with
Emergency Plan Functional Exercise(FE) exercises will include follow-up to shortfalls FAA rules
identified in the AAR from September 2015 full
2 scale exercise. Supports the National
Preparedness Goal as defined under Common
Core Capabilities-Operational Coordination.
Conduct Flood(FE)--conduct pre-exercise training; The exercise will inform what is needed for The city provides timely,accurate,and actionable
purchase exercise expendables. support to the area and will test the City's information for its residents utilizing Everbridge
notification and warning to residents regarding and Avaya emergency notification capabilities.
Severe Winter Storm(FE)--conduct pre-exercise flooding and/or severe winter storm. Supports The City's transportation plan,snow removal plan,
3 training;purchase exercise expendables. the National Preparedness Goal as defined under and public information and warning procedures
Common Core Capabilities-Operational validated.
IA part of the exercises will be the distribution of Coordination. This work continues from the last
(preparedness information to targeted funding cycle.
areas/populations.
DHS-FEMA-EMPG-FFY 16 Page 22 of 33 Yakima, City of, E17-143
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i.'N@6V If Pv ✓,�p91Vf(fiNl{dAf�VkFoodJWVFVln eu�tY uny�@INANXIAffVAMli VikYPkBlil@IdrPPNfI!hI11Yl�YPi( o i
Program Area#4
EOC Upgrades
WORK PLANNED ... WHY THE WORK IS BEING DONE ,., RESULT OF
THE WORK
EOC Renovation--Renovate an existing area, EOC is functional but needs major improvements A sustainable working EOC environment,backup
formerly used as the city's 911 Center,to to establish a working EOC environment. Support communications not compromised. EOC
accommodate a Joint Information Center and the National Preparedness Goal as defined under connected to the city's two department
Emergency Operations Center. Install carpeting Prevention/Protection Core Capabilities- operations centers,i.e.,Yakima Fire Department
i and work stations. Intelligence and Information Sharing and Common and Public Works.
1 Core Capability-Operational Coordination.
Acquire necessary equipment and supplies to
establish and maintain an emergency operations
center,e.g.,general office supplies,computer
monitors,projector display,portable podium,etc.
p rrvr�,r�,�,dmrn �r aiiicaa roan�ur�urwrac,�mnr�rswi sr riiwµpima s row-'i au a mrrr,i i r a veiimr «rrrrrp.:r amus/!'m r ��� er rx�+�' r ren r,r✓�;,ur�er��nr�xnrrr - riia✓� r ✓✓✓ii,✓:arir rrr i 'rr a:
Program Area#5
Public Outreach
WORK PLANNED WHY THE WORK IS BEING DONE RESULT OF THE WORK
I Crisis,Communications,Public Education and To develop a framework to meet the challenges of A written framework for the implementation of
Information: Crisis Communications,Public Education and Crisis Communications,Public Education and
Acquire informational materials Information as they apply to the city's diverse Information for the City's diverse demographics,
-Conduct community meetings and attend public demographics,e.g.,Hispanic population;elderly; e,g.,Hispanic population;elderly;special needs.
gatherings, Include mass communication special needs. Support the National Enroll additional points of contact into the City's
,outreach..information. Preparedness Goal as defined under Mitigation existing Everbridge mass notification capability.
1 Provide outreach to the Limited English Core Capabilities-Community Resilience. This
(proficiency,Hispanic,elderly,and access and effort is ongoing from funding cycle.
functional needs populations.
Major costs-publications,printing and expansion
of the city's mass notification system. '
�dU�lrJult�iV�l�i47r1�iU�,Ud�)plla�UZi7t0AVu7rr101'r1u9r7�M1r�/�r/rl�ipr,��2,"nl�lrrrrNu,N�ur4di�ua7J�/CydrJrt(,1,��,711,r'�AtO�lfosnailbir7�utl,�l�rir'n��+�lnum��irr�!wIWW,rr�7➢ll,�d¢/�i�i����pDi,rrrrr�nm,��l�1Jl�r��flP"til�llGl�lrmpm qr �rrrl+„k0i�lar'�rfl�i//l��l/��/ .ti�ft�r�;mrr�iJ,kPyJlly�farlY/a lA.+ful
Program Area#6
Public Notification and Warning
,Brow°°, „ „,� �� ,, „o,. w„ Hee.o,.„ _ .,,, - ,„„v w „„ , ,„„, .„ — „®,,.
WORK PLANNED WHY THE WORK IS BEING DONE RESULT OF THE WORK
Implement an early notification system to The city has never addressed a mass notification Warnings delivered from the City through the
jenhance warning to the City population. system. Applicable ADA requirements indicate system will reach 50%of the targeted
-Target outreach to specials needs populations that local jurisdictions shall have the capability to populations.
Encourage opt-in participation via cell phone or warn ADA populations.The city has developed
1 'lana#line.. over 100 sites around the city to address special
-,Drill quarterly on new capability population needs. This program area includes the
completion of work from the 15EMPG work plan,,
Public Information and Warning--Install a public City Hall does not have a reliable alert/notification City Hall employees and visitors will be able to
address system for emergency notification which capability for employees and visitors.This will receive prompt notification of a hazard,imminent
will be incorporated into the city's telephone address the National Preparedness Goal as or occurring,take immediate action as stated in
P system. defined under Common Core Capabilities-Public their COG plan and provide emergency assistance
Information and Warning. to the public.
DHS-FEMA-EMPG-FFY 16 Page 23 of 33 Yakima, City of, E17-143
Exhibit D
TIMELINE
FFY 2016 Emergency Management Performance Grant Program
__.WWWWW_WWW_._
DATE TASK
June 1, 2016 Grant Agreement Start Date
January 30, 2017 Submit reimbursement request
April 30, 2017 Submit reimbursement request
August 31, 2017 Grant Agreement End Date
October 15, 2017 Submit final reimbursement request, additional reports, and/or
deliverables.
DHS-FEMA-EMPG-FFY 16 Page 24 of 33 Yakima, City of, E17-143
I
I
Exhibit E
BUDGET
FFY 2016 Emergency Management Performance Grant Program
16EMPG GRANT AWARD AMOUNTF$ 95,744,
SOLUTION
AREA CATEGORY Award AMOUNT Match AMOUNT
u11WUW!WU11WllUWUdluul1UUUW'!N!•N11111IJ11�111».. NNI WI'1!Vl�. 11 1111111 11 111111111
Salaries&Benefits $ - mi $ 94,244
Z Overtime/Backfill $ li $
E Consultants/Contractors $ 15,000 $ -
g Goods&Services $ 9,000 1 $
it
a Travel/Per Diem $ - $
Subtotal $ 24,000 $ 94,244
z Salaries&Benefits $ $ -
Q� Overtime/Backfill -
N Consultants/Contractors $ i $ -
Q Goods &Services $ 50,244 $
cc Travel/Per Diem $ 10,000 $
ii
Subtotal $ 60,244 10 $ ,
Salaries&Benefits $ - ! $
w Overtime/Backfill $ - $
in
o0C Consultants/Contractors $ - $
LAI X Goods &Services $ 800 $
W
Travel/Per Diem $ - ' $
1,500
Subtotal $ 800 $ 1,500
Salaries&Benefits $ - $ -
w Overtime./Backfill $ - $ -
E Consultants/Contractors $ $
a Goods&Services $ 1,700 $
~ Travel/Per Diem $ - $ -
Subtotal $ 1,700 $ .
3 �Ecpuipment $ 9,000 I $ .�
5 Subtotal $ 9,000 $ -
Salaries&Benefits $ -• $
Overtime/Backfill $ - l $
0 Consultants/Contractors $ $
2 Goods&Services $ $
Travel/Per Diem $ - $ -
Subtotal $ $
Indirect 0% $ w $
TOTAL Grant Agreement AMOUNT: $ 95,744 $ 95,744
• The Subrecipient will provide a match of$95,744, 50% of the total project cost (local/tribal budget plus EMPG award),
of non-federal origin.
• 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#763PT—EMPG
DHS-FEMA-EMPG-FFY 16 Page 25 of 33 Yakima, City of, E17-143
Attachment#1
16EMPG Award Document
EMS-2016-EP-00002-S01
U.S. Department of Homeland Security
Washington, D.C. 20472
Bret Daugherty
Washington Military Department
Building 20
Camp Murray, WA 98430-5122
Re:Grant No.EMS-2016-EP-00002
Dear Bret Daugherty:
Congratulations, on behalf of the Department of Homeland Security,your application for financial assistance submitted under
the Fiscal Year(FY)2016 Emergency Management Performance Grants has been approved in the amount of$7,254,374.00.
As a condition of this award,you are required to contribute a cost match in the amount of$7,254,374.00 of non-Federal funds,
or 50 percent of the total approved project costs of$14,508,748.00.
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 2016 Emergency Management Performance Grants Notice of Funding Opportunity,
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://
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 use to make the necessary updates and avoid any interruptions in the payment
process,
CHRISTINE JONIENTZ TRISLER
DHS-FEMA-EMPG-FFY 16 Page 26 of 33 Yakima, City of, E17-143
Aloomtrit A tt o
Thu A t 01 Qt 00.00yMT 201 a
U.S. Department of Homeland Security
Washington, D.C. 20472
AGREEMENT ARTICLES
Emergency Management Performance Grants
GRANTEE: Washington Military Department
PROGRAM: Emergency Management Performance
Grants
AGREEMENT NUMBER: EMS-2016-EP-00002-S01
TABLE OF CONTENTS
Article I Use of DHS Seal, Logo and Flags
Article II USA Patriot Act of 2001
Article III Universal Identifier and System of Award Management
(SAM)
Article IV Reporting of Matters Related to Recipient Integrity and
Performance
Article V Rehabilitation Act of 1973
Article VI Trafficking Victims Protection Act of 2000
Article VII Terrorist Financing
Article VIII SAFECOM
Article IX Reporting Subawards and Executive Compensation
Article X Procurement of Recovered Materials
Article XI Patents and Intellectual Property Rights
Article XII Notice of Funding Opportunity Requirements
Article XIII Non-supplanting Requirement
Article XIV Lobbying Prohibitions
Article XV Limited English Proficiency (Civil Rights Act of 1964,Title VI)
Article XVI Hotel and Motel Fire Safety Act of 1990
Article XVII Fly America Act of 1974
Article XVIII Best Practices for Collection and Use of Personally
Identifiable Information(PII)
Article XIX Americans with Disabilities Act of 1990
Article XX Age Discrimination Act of 1975
DHS-FEMA-EMPG-FFY 16 Page 27 of 33 Yakima, City of, E17-143
Article XXI Activities Conducted Abroad
Article XXI I Acknowledgment of Federal Funding from DHS
Article XXIII Federal Leadership on Reducing Text Messaging while
Driving
Article XXIV Federal Debt Status
Article)(XV False Claims Act and Program Fraud Civil Remedies
Article XXVI Energy Policy and Conservation Act
Article XXVII Education Amendments of 1972(Equal Opportunity in
Education Act)-Title IX
Article XXVIII Duplication of Benefits
Article XXIX Drug-Free Workplace Regulations
Article XXX Debarment and Suspension
Article XXXI Copyright
Article XXXII Civil Rights Act of 1968
Article XXXIII Civil Rights Act of 1964-Title VI
Article)(XXIV DHS Specific Acknowledgements and Assurances
Article XXXV Assurances, Administrative Requirements,Cost Principles,
and Audit Requirements
Article XXXVI Whistleblower Protection Act
Article XXXVII National Environmental Policy Act
Article XXXVIII Nondiscrimination in Matters Pertaining to Faith-based
Organizations
Article I-Use of DHS Seal,Logo and Flags
All recipients must obtain permission from their financial assistance office, 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 II-USA Patriot Act of 2001
All recipients must comply with requirements of the (Mitt rtt s . .Sf1;111' rAn; - "«',r earsonate Toots
A V j ( 01.0.62 t and Obstruct T trot r Act(USA PATRIOT Act),which amends 18 U.S.C. sections175 175c
Article III-Universal Identifier and System of Award Management(SAM)
All recipients are required to comply with the requirements set forth in the government-wide 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 in the terms and conditions of your award.
Article IV-Reporting of Matters Related to Recipient Integrity and Performance
If the total value of your currently active grants, cooperative agreements, and procurement contracts from all Federal
assistance office exceeds$10,000,000 for any period of time during the period of performance of this Federal award, you
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 here by reference in the
terms and conditions of your award..
Article V-Rehabilitation Act of 1973
DHS-FEMA-EMPG-FFY 16 Page 28 of 33 Yakima, City of, E17-143
All recipients must comply with the requirements of Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. section 794, as
amended,which provides that no otherwise qualified handicapped individual 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 VI-Trafficking Victims Protection Act of 2000
All recipients must comply with the requirements of the government-wide award term which implements Section 106(g)of the
Trafficking Victims Protection Act of 2000, (TVPA)as amended(22 U.S.C. section 7104). The award term is located at 2 CFR
.6WilQ11 11515,the full text of which is incorporated here by reference in the terms and conditions of your award.
Article VII-Terrorist Financing
All recipients must comply with E.Q. 13224 and U.S. law that prohibit transactions with,and the provisions of resources
and support to, individuals and organizations associated with terrorism. It is the legal responsibility of recipients to ensure
compliance with the Order and laws.
Article VIII-SAFECOM
All recipients who receive 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 IX-Reporting Subawards and Executive Compensation
All recipients are required to comply with the requirements set forth in the government-wide Award Term on Reporting
Subawards and Executive Compensation located at Q , Pert 17a, 10 70', 4 the full text of which is incorporated here
by reference in the terms and conditions of your award.
Article X-Procurement of Recovered Materials
All recipients must comply with Section 6002 of the.aof t..W t .Qv po iA t, as amended by the Resource Conservation and
, ecyeryAct. 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 XI-Patents and Intellectual Property Rights
Unless otherwise provided by law, recipients are subject to the Bayh-Dale Act. Pub. L. No. 96-517, as amended, and codified
in 35 U.S.C. section 200 et seq. All recipients are subject to the specific requirements governing the development, reporting,
and disposition of rights to inventions and patents resulting from 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 XII-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 terms and conditions of your award. All recipients must comply with any
such requirements set forth in the program NOFO.
Article XIII-Non-supplanting Requirement
All recipients who receive 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 XIV-Lobbying Prohibitions
All recipients must comply with 31 U.S.C,section 1352,which provides that none of the funds provided under an 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 concerning the award or renewal.
Article XV-Limited English Proficiency(Civil Rights Act of 1964,Title VI)
DHS-FEMA-EMPG-FFY 16 Page 29 of 33 Yakima,City of, E17-143
All recipients 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 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/
L dar , 1;1,F- iG U, r -S,w.r a 7_1-+ titi:,p ti a,.It iv' ;-m7 r r cif. _ �~a r , .'.• ,s',and additional
resources on http://www.lep.gov.
Article XVI-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,all 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,as amended, 15 U.S,C.
section 2225.
Article XVII-Fly America Act of 1974
All recipients must comply with Preference for U.S. Flag Air Carriers:(air carriers holding certificates under 49 U.S.G.
,section 4110.E 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..0 S 0... _actcon_4011, )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 XVIII-Best Practices for Collection and Use of Personally Identifiable Information(PII)
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. All recipients who collect PII are
required to have a publically-available privacy policy that describes standards on the usage and maintenance of PII they
collect. Award recipients may also find as a useful resource the DHS Privacy Impact Assessments: Privacy Guidance and
Privacy ternpiat „respectively.
Article XIX-Americans with Disabilities Act of 1990
All recipients must comply with the requirements of Titles I, II,and III of the Americans with Disabilities Act,which prohibits
recipients from discriminating on the basis of disability in the operation of public entities, public and private transportation
systems, places of public accommodation, and certain testing entities. KZk). e tion 121.91 12213),
Article XX-Age Discrimination Act of 1975
All recipients must comply with the requirements of the Age Discrimination Act of 1975(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 XXI-Activities Conducted Abroad
All 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 XXII-Acknowledgment of Federal Funding from DHS
All recipients must acknowledge their use of federal funding when issuing statements, press releases, requests for proposals,
bid invitations, and other documents describing projects or programs funded in whole or in part with Federal funds
Article XXIII-Federal Leadership on Reducing Text Messaging while Driving
All 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 XXIV-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 XXV-False Claims Act and Program Fraud Civil Remedies
DHS-FEMA-EMPG-FFY 16 Page 30 of 33 Yakima, City of, E17-143
All recipients must comply with the requirements of 31 U.S.C.section 3729-3733 which prohibits the submission of false or
fraudulent claims for payment to the Federal Government.See 31 U.S.C. section 3801-3812 which details the administrative
remedies for false claims and statements made.
Article XXVI-Energy Policy and Conservation Act
All recipients must comply with the requirements of 42 U.S.C.section 6201 which contain policies relating to energy efficiency
that are defined in the state energy conservation plan issued in compliance with this Act.
Article XXVII-Education Amendments of 1972(Equal Opportunity in Education Act)-Title IX
All recipients must comply with the requirements of Title IX of the Education Amendments of 1972(20 U.S.C. section 1681
etmg.),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 44_,Q,,E,R,
Article XXVIII-Duplication of Benefits
Any cost allocable to a particular Federal award provided for in L.R. Part 200.Sur may not be charged to other
Federal awards to overcome fund deficiencies,to avoid restrictions imposed by Federal statutes, regulations, or terms and
conditions of the Federal awards, or for other reasons. However, this prohibition would not preclude a recipient form shifting
costs that are allowable under two or more Federal awards in accordance with existing Federal statutes, regulations, or the
terms and conditions of the Federal award.
Article XXIX-Drug-Free Workplace Regulations
All recipients must comply with the Drug-Free Workplace Act of 1988(41 U.S.C. section 701 et sem',,),which requires all
organizations receiving grants from any Federal agency agree to maintain a drug-free workplace. DHS has adopted the
Act's implementing regulations at 2 F RP rt_ Q.0j,
Article XXX-Debarment and Suspension
All recipients are subject to the non-procurement debarment and suspension regulations implementing Executive Orders
12642 and 12689. and 2 C.F.R. Part 180.These regulations restrict 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 XXXI-Copyright
All recipients must affix the applicable copyright notices of 17 U,,S'..C, rw. 4'2 r and an acknowledgement of
Government sponsorship(including award number)to any work first produced under Federal financial assistance awards.
Article XXXII-Civil Rights Act of 1968
All recipients must comply with Title VIII of the Civil Rights Act of 1968,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(42 U.S.C. section 3601 et seq.), as implemented
by the 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. section 100.201).
Article XXXIII-Civil Rights Act of 1964-Title VI
All recipients must comply with the requirements of Title VI of the Civil Rights Act of 1964(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. DHS implementing regulations for the Act are found at 6 C.F. R.. Part 21 and 44 C.F.R. Part 7.
Article XXXIV-DHS Specific Acknowledgements and Assurances
All recipients, sub-recipients, successors, transferees, and assignees must acknowledge and agree to comply with applicable
provisions governing DHS access to records, accounts, documents, information, facilities, and staff.
DHS-FEMA-EMPG-FFY 16 Page 31 of 33 Yakima, City of, E17-143
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 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. If, during the past three years, the recipient has been accused of discrimination on the grounds of race, color, national
origin(including limited English proficiency), sex, age, disability, religion, or familial status,the recipient must provide a list
of all such proceedings, pending or completed, including outcome and copies of settlement agreements to the DHS financial
assistance office and the OHS Office of CM,Rjghta and Cid i t .ertie (CRCL)by e-mail at orcatacitia,goy or by mail at U.S.
Department of Homeland Security Office for Civil Rights and Civil Liberties Building 410, Mail Stop#0190 Washington, D.C.
20528,
6. In the event any court or administrative agency makes a finding of discrimination on grounds of race, color, national origin
(including limited English proficiency), sex,age, disability, religion,or familial status against the recipient, or the recipient
settles a case or matter alleging such discrimination, recipients must forward a copy of the complaint and findings to the DHS
financial assistance office and the CRCL office by e-mail or mail at the addresses listed above.
The United States has the right to seek judicial enforcement of these obligations,
Article XXXV-Assurances,Administrative Requirements,Cost Principles,and Audit Requirements
OHS financial assistance recipients must complete either the CM, idl' F;l ill 424.5 ,, fgp, , 0 Cel strt,LCtiol:t
Programs or OMB Standard Form 4240 Assurances-Construction Programa as applicable. Certain assurances in these
documents may not be applicable to your program,and the DHS financial assistance office 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 financial assistance office if you have any questions,
OHS 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 2 C.F.R. Part 200, and adopted by
DHS at 2 C.F.R. Part 3002.
Article XXXVI-Whistleblower Protection Act
All recipients must comply with the statutory requirements for whistleblower protections(if applicable)at 10 U.S.0 section
2409, 41 U.S.C. 4712, and 10 U.S.C. section 2324 41 U.S.C. sections 4304 and 4310.
Article XXXVII-National Environmental Policy Act
All recipients must comply with the requirements of the t(oriej Ernvironj titgj„Bogy w, t JNEEN 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 XXXVIII-Nondiscrimination in Matters Pertaining to Faith-based Organizations
Faith-based organizations are, under 6 C.F.R. Part 19, afforded certain protections as it relates to eligibility to receive financial
assistance from DHS for social service programs, or to participate in social service programs administered or financed by
DHS. Organizations that receive financial assistance from DHS for a social service program or participate in OHS social
service programs have an obligation to comply with the equal treatment policies and requirements contained in 6 C,F.R. Part
19,which, among other provisions, prohibit recipient organizations from discriminating against beneficiaries on the basis
of religion or religious belief, a refusal to hold a religious belief, or a refusal to attend or participate in a religious practice;
and generally require recipients subject to the rule to provide certain protections, and notice of those protections,to their
beneficiaries. Recipients must also comply with any other policies and procedures regarding the participation of faith-based
organizations contained in applicable statutes, regulations,and guidance governing individual OHS programs.
DHS-FEMA-EMPG-FFY 16 Page 32 of 33 Yakima, City of, E17-143
Obligating Do .1 eat fA,io l�lk 4 ��
nt
1a.AGREEMENT NO. 2. 3. RECIPIENT NO. 4. TYPE OF 5.CONTROL NO.
EMS-2016-EP-00002-S01 AMEND MEN1916001095G ACTION FY2016R1OEMPG
NO. AWARD
6 RECIPIENT NAME AND 7.ISSUING FEMA OFFICE AND 8..PAYMENT OFFICE AND ADDRESS
ADDRESS ADDRESS Financial Services Branch
Washington Military Grant Operations 500 C Street,S.W.,Room 723
Department 245 Murray Lane-Building 410,SW Washington DC,20472
Building 20 Washington DC,20528-7000
Camp Murray,WA,98430- POC: 866-927-5646
5122
9.NAME OF RECIPIENT PHONE NO. 10 NAME OF FEMA PROJECT COORDINATOR
PROJECT OFFICER 253-512-7121 Central Scheduling and Information Desk
Sierra Wardell Phone:800-368-6498
Email:Askcsid@dhs.gov
11 EFFECTIVE DATE OF 12. 13 ASSISTANCE ARRANGEMENT 14 PERFORMANCE PERIOD
THIS ACTION METHOD Cost Reimbursement From: To:
10/01/2015 OF
PAYMENT 10/01/2015 09/30/2017
PARS Budget Period
10/01/2015 09/30/2017
15 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-XXXXXX- AWARD THIS AWARD
XXXXX-XXXX-XXXX-X ACTION
+OR(-)
Emergency 97.042 2016-EM-D111-R107- $0.00 $7,254,374.00 $7,254,374.00 See Totals
Management -4101-D
Performance
Grants
TOTALS $0.00 $7,254,374.00 $7,254,374.00 $7,254,374.00
b.To describe changes other than fundingdata or financial changes, schedule c here.attach 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 Title) DATE
Sierra Wardell,Preparedness Grants Section Program Manager Wed Aug 24 15:24:50 GMT
2016
18.FNMA SIGNATORY OFFICIAL(Name and Title) DATE
KIMBERLY PENFOLD, Wed Aug 10 17:43:17 GMT
2016
DHS-FEMA-EMPG-FFY 16 Page 33 of 33 Yakima, City of, E17-143
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):
Authorized Chief Financial Officer(central accounting office):
Address:
Email; Phone#:
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):
❑ We did not expend$750,000 or more of total federal awards during the fiscal year,
❑ We are a for-profit agency.
0 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)
❑ We completed our last 2 CFR Part 200 Subpart F Audit on[enter date] for Fiscal Year ending[enter date] 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.officetamil.wa.gov or provide the state auditor report number:
❑ 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.officeamil.wa.dov or provide the state auditor report number:
❑ 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.officeamil.wa.gov at that time or
provide the state auditor report number:
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 o ut orize Chief Inancia Officer: Date:
Print Name &Title:
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)
ADDRESS Applicable Procurement WA Uniform Business Federal Employer Tax
or Solicitation#,if any: Identifier(UBI) Identification#:
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:
Print Name and Title:
Washington Military Department Contract Number:
FEDERAL DEBARMENT, SUSPENSION
INELIGIBILITY and VOLUNTARY EXCLUSION
(FREQUENTLY ASKED QUESTIONS)
What is"Debarment Sus«ension Irteli•ibilR and Volunta 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 skin 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:
Grant and Year: Agreement Number:
Completed
by:
Name Title Tele r hone
Date Completed:
YES STOP, no further NO
Is your grant agreement less than $25,000? analysis needed, GO to Step 2
GO toStep6
1111 11111111111111111110111111/1011111011/112Wiliall11111111111511111211111111111111111111.
In your preceding fiscal year, did your YES NO STOP, no further
organization receive 80% or more of its annual GO to STEP 3 analysis needed, GO to
gross revenues from federal funding? Step 6
riraimmansinanounemmintionatimaioranwastamossminostamarnammarmist
In your preceding fiscal year, did your YES NO I STOP, no further
organization receive$25,000,000 or more in GO to STEP 4 111111 analysis needed, GO to
federal funding? Step 6
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? GO to step 6
Name:
Executive#1 _.
Total Compensation amount: $
Executive#2 Name:
Total Compensation amount: $
Name:
Executive#3 Total Compensation amount: $
Name:
Executive#4
I Total Compensation amount: $
Name:
Executive#5 Total Compensation amount: $
VIII f ui' I
f1 ,
If your organization does not meet these criteria, specifically identify below each criteria that is not met for your
organization: For Example: "Our oraanization received less than $25.000."
Signature: Date:
*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.gov/crants/ffata.html
http://www.n oo,q ov/fdsys/pkg/FR-2010-09-14/pd f/2010-2270 5.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 include 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 in 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 information 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
(USASpending.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
in 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 funding 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 USASpending.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 organization. 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 organization (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) in the preceding fiscal year your organization 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 DATE SUBMITTED
PROJECT DESCRIPTION CONTRACT NUMBER
1. AUTHORIZING AUTHORITY
SIGNATURE I PRINT OR TYPE NAME TITLE/TERM OF OFFICE
2. AUTHORIZED TO SIGN CONTRACTS/CONTRACT AMENDMENTS
SIGNATURE PRINT OR TYPE NAME TITLE
3. AUTHORIZED TO SIGN REQUESTS FOR REIMBURSEMENT
SIGNATURE PRINT OR TYPE NAME TITLE
MAC-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 copyof the contract.t.
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.
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
I 1 Name(as shown on your income tax return).Name is required on this line;do not leave this line btank.
Business
2 ...... .......-._._._-_..-..-.-.. �-....----._-.._...-�.
narne/disreggarded entity name,if different from above
m
rn
as
a 3 Check appropriate box for federal tax classification;check only one of the following seven boxes: 14 Exemptions(codes apply only to
❑Individual/sole proprietor or ❑ C Corporation ❑ S Corporation 111Partnership ❑Trust/estate
certain entities,not individuals;see
instructions on page 3):
a C single-member LLC Exempt payee code(if any)
❑Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)►
p ` Note.For a single-member LLC that is disregarded,do not check LLC;check the appropriate box in the line above for Exemption from FATCA reporting
c w the tax classification of the single-member owner. code(if any)
Other(see instructions)N. (Applies to accounts maintained outside the US.)
E 5 Address(number,street,and apt.or suite no.) Reguester"s name and address(optional)
a I
5)
0.
6 City,state,and ZIP code
a)
to
7 List account number(s)here(optional)
Part I Taxpayer Identification Number IN
Enter your TIN in thppropriate box.The TIN provided must match the name given on line 1 to avoid 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 L_�. ...
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.
IGZEL 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 P.
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
person if you are: 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 1040/1040N1040EZ 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 1040/1040N1040EZ 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 ora 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 your correct TIN,make the proper certifications,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 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
thisform
Limited Liability Company(LLC).If the name on line 1 is an LLC treated as a certain foreign account you hold itthetU nit Therefore,if you are only submittingd
partnership for U.S.federal tax purposes,check the"Limited Liability Company" for sn you inrequestinghe United States,ifyyouu may leave thisaif theh blank.
box and enter"P"in the space provided.If the LLC has filed Form 8832 or 2553 to Consult with the person these requirements.
qitme form irate indi if a anciol
be taxed as a corporation,check the"Limited Liability Company"box and in the notirequir id suot to rwith a Form A with"NotNr may indicate(tor a code is
not required byprovidingyou with a Form W-9 with Applicable"(or any
q
space provided enter"C"for C corporation or"S"for S corporation.If it is a similar indication)written or printed on the line for a FATCA exemption code.
single-member LLC that is a disregarded entity,do not check the"Limited Liability
Company"box;instead check the first box in line 3"Individual/sole 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 political subdivisions or instrumentalities
appropriate space in line 4 any code(s)that may apply to you,
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 J—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
Enter your address(number,street,and apartment or suite number).This is where
6—A dealer in securities or commodities required to register in the United
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
Payments over to the requester.For interest and dividend payments,and certain payments made
$600 required to be Generally,exempt payees with respect to readily tradable instruments,generally you will have 60 days to get
reported and directsales over$5,000 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
1 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.
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
To establish to the withholding agent that you are a U.S.person,or resident alien, the"Business name/disregarded entity"name line,You may use either your SSN or EIN(if you
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 a
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 printed 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)
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
claiming to be an established legitimate enterprise in an attempt to scam the user
1.Individual I The individual into surrendering private information that will be used for identity theft.
2.Two or more individuals(joint The actual owner of the account or, The IRS does not initiate contacts with taxpayers via emails.Also,the IRS does
account) I 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:spam@uce.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,
2 Circle the minor's name and furnish the minor's SSN.