FLOOD MITIGATION ASSISTANCE PROJECT AGREEMENT
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FLOOD MITIGATION ASSISTANCE PROJECT AGREEMENT
THIS FLOOD MITIGATION ASSISTANCE PROJECT AGREEMENT, (the
"Agreement") is entered into by and between the City of Clearwater, Florida (hereinafter
referred to as the "City"), and Mark Smith and Charlene Smith, the property owners at 701
Bay Espalande, Clearwater, Florida 33767, (hereinafter referred to as the "Recipient").
WHEREAS, the United States Congress, through an appropriation to the Federal
Emergency Management Agency (FEMA), has made available to the City, Flood
Mitigation Assistance (FMA) funds for flood mitigation projects; and
WHEREAS, the goals of the FMA program include assisting States and
communities in implementing flood mitigation projects to reduce the risk of flood damage
to National Flood Insurance Program insurable structures; and
WHEREAS, the City, on behalf of the Recipient, has applied for and has had
approved, FMA program funds (herein "Program Funds"); and
WHEREAS, the Recipient represents that they possess the requisite skills,
knowledge, financial capability and experience to perform the flood mitigation Project and
other activities as provided herein; now therefore;
FOR and in consideration of the mutual promises and covenants made and agreed
to be kept herein, the City and the Recipient do mutually agree as follows:
(1) SCOPE OF WORK REPRESENTATION AND WARRANTIES
The Recipient shall fully perform the flood mitigation Project attached hereto as
Attachment A (herein the "Project"), in accordance with the approved scope(s) of work
indicated .therein, the allocation of funds indicated therein, and the terms and conditions of
this Agreement. Recipient shall not deviate from the approved Project and the terms and
conditions of this Agreement. Recipient shall comply with any and all applicable codes
and standards in performing work funded under this Agreement, including but not limited
to those noted in Attachments B, C and D. Recipient represents and warrants that the
structure proposed for assistance from this Agreement is currently covered by a flood
insurance policy, and shall remain so insured as a condition of receipt of this assistance.
Recipient further represents and warrants that the scope of work for structures receiving
assistance under this Agreement is categorically excluded from National Environmental
Policy Act (NEPA) requirements according to 44 CFR part 10. Recipient represents and
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warrants that the proposed Project described in Attachment A is/are cost effective, i.e.
costs no more than the anticipated net present value of the reduction in both direct
damages. and subsequent negative impacts to the area if future floods were to occur.
Recipient agrees to use design and construction methods and materials that are
approved, codified, recognized, fall under standard or acceptable level of practice, or
otherwise are determined to be generally acceptable by the design and construction
industry.
In performing the Scope of Work Recipient agrees to ensure performance of all
activities described in the Attachment A, to the satisfaction of the City.
(2) FUNDING
This is a cost-reimbursement Agreement. The Recipient shall be reimbursed for
FMA eligible costs incurred in the satisfactory performance of work required to complete
the Project. The City shall provide FMA funds to Recipient for reimbursement of up to
$62.546.00 or seventy-five percent (75%) in allowable costs, whichever is less, which
Recipient will match from non-federal sources with $20.848.00 or twenty-five percent
(25%) of allowable costs, whichever is less, for payment of expenditures and costs
incurred in performing the Project identified in Attachment A. Cash match from non-
federal sources may include: (1) Recipient's cash funds provided to contractors and
consultants to carry out approved mitigation activities; and (2) cash funds provided by any
non-federal source. Allowable costs shall be determined in accordance with OMB
Circular A-87, 44 Code of Federal Regulations CFR) Part 78,44 CFR Part 13, and other
applicable Flood Mitigation Assistance Program guidance. The reimbursement payment
shall be provided subsequent to: (1) satisfactory completion of the Project; (2) submittal of
required receipts for labor and materials to complete work as described in Attachment A;
and (3) receipt of payment by the City of Clearwater of Program Funds sufficient to fund
all reimbursement projects in which the City is participating from the State of Florida,
Department of Community Affairs. If, for any reason, the City does not receive sufficient
funds from such federal or State sources to fund the reimbursement contemplated herein,
in whole, or in part, the City shall be obligated to the Recipient only for the Recipient's pro
rata share of allowable funds.
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The final payment of funds will be made only after Project completion, including
passing of all state and local inspections, submission of all required documentation, and a
request for final payment. Payment and retention of all funding under this Agreement is
subject to a final review by FEMA and/or the City to confirm eligible and ineligible
expenses. In the event that this final review identifies payments for ineligible expenses,
the Recipient shall be determined in non-compliance with this Agreement and funds shall
be repaid or recaptured.
In recognition that Recipient will have and receive full value and benefit from the
Project, Recipient waives any claim whatsoever to Project Funds not received by the City
from other funding sources for any reason including failure of the City to comply with
program requirements, non-appropriation or any other reason irrespective of the City's
fault or negligence.
The amount of funding available for FMA activities is limited by the National Flood
Insurance Reform Act, 42 USC 4104c. The funding provided under this Agreement shall
be considered in evaluating eligibility for future FMA funding awards.
Funds may be recaptured from Recipient by the City or the Federal Emergency
Management Agency (FEMA) in the event of non-compliance with the terms and
conditions of this Agreement. Recipient consents and agrees that in the event of a final
determination of non-compliance, Recipient shall immediately remit repayment of the
ineligible expenses to the City. In the alternative, any other funds due and payable to
Recipient from either FEMA or the City may be retained by the City or FEMA for purposes
of recapture. Recapture may result from any non-compliance, including but not limited
to: (1) failure to provide any required matching funds; (2) failure to complete the Project
within the required time-frames; or failure to complete the Project in accordance with
applicable provisions of this Agreement, FEMA regulations, or other applicable law or
guidance. Any Recipient who has had funds recaptured under FMA shall be ineligible for
future funding for a period of five (5) years from the date the funds were withdrawn.
The Coastal Barrier Resources Act (COBRA) significantly limits the
availability of Federal assistance in areas designated within the Coastal Barrier Resource
System. Recipient represents and warrants that no funds from this Agreement will be
utilized for activities in a COBRA designated unit.
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INCORPORATION OF LAW. RULES. REGULATIONS AND POLICIES
Both the Recipient and the City shall be governed by applicable State and Federal
laws, rules, regulations and agreements, including but not limited to those identified
Attachments B, C, and D.
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PERIOD OF AGREEMENT 1 ;
This Agreement shall begin oni~/?:~and shall end
,
September 12, 2001, unless terminated earlier in accordance with the provisions of
paragraphs (7) or (11) of this Agreement and unless extended pursuant to the City's Flood
And Mitigation Assistance Project Agreement with the Florida Department of Community
Affairs, Contract No. OO-FM-J 1-08-62-15-011.
(5) MODIFICATION OF CONTACT
Either party may request modification of the provIsions of this Agreement.
Changes, which are mutually agreed upon, shall be valid only when reduced to writing,
duly signed by each of the parties hereto, and attached to the original of this Agreement.
(6) RECORD KEEPING, PROCUREMENT AND PROPERTY MANAGEMENT
(a) All- original records pertinent to this Agreement shall be retained by the Recipient for
three years following the date of termination of this Agreement or of submission of
the final close-out report by the City, whichever is later, with the following exception:
If any litigation, claim or audit is started before the expiration of the three-
year period, the records will be maintained until all litigation, claims or audit
findings involving the records have been resolved.
(b) All records, including supporting documentation of all program costs, shall be
sufficient to determine compliance with the requirements and objectives of the
Budget and Scope of Work - Attachment A - and all other applicable laws and
regulations. Recipient agrees to implement and maintain a record keeping and
financial management system sufficient to meet Federal Emergency Management
Agency (FEMA) and State of Florida financial reporting requirements and to
document that FMA funds have been used in accordance with applicable law,
The Recipient, its employees or agents, including all subcontractors or consultants
to be paid from funds provided under this Agreement, shall allow access to its
(4)
(c)
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(3)
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records at reasonable times to the City, its employees, and agents. "Reasonable"
shall be construed according to the circumstances but ordinarily shall mean during
normal hours of 8:00 a.m. to 5:00 p.m., local time, on Monday through Friday.
"Agents" shall include, but not be limited to, auditors retained by the City.
(d) Recipient shall comply with all terms and conditions established in 44 CFR 13.36,
and pertinent state and local laws regarding the procurement of services,
equipment and supplies. Recipient shall also comply with the standards governing
property management established in 44 CFR Part 13.
(7) REPORTS
(a) The Recipient shall provide monthly Project progress reports to the City. The City
may require additional reports as needed. The Recipient shall, as soon as
possible, provide any additional reports requested by the City.
(b) If all required reports and copies are not sent to the City or are not completed in a
manner acceptable to the City, the City may withhold further payments until they
are completed or may take such other action as set forth in paragraph (11). The
City may terminate the Agreement with Recipient if reports are not received within
thirty (30) days after written notice by the City. "Acceptable to the City" means that
the work product was completed in accordance with generally accepted principles
and is consistent with the Scope of Work, Attachment A.
(c) Upon reasonable notice, the Recipient shall provide such additional Project updates
or information as may be required by the City.
(8) MONITORING
The Recipient shall constantly monitor its performance under this Agreement to
ensure that time schedules are being met, the Scope of Work is being accomplished within
specified time periods, and other performance goals are being achieved. Such review
shall be made for each function, or activity set forth in Attachment A to this Agreement,
and the terms and conditions of the Agreement. The City may perform on-site or other
types of Project monitoring as it deems necessary. Should activities or deliverables be
found to be insufficient in meeting the stated terms of this contract, the City may request
explanations, amendments or further specifications to the submitted report to which
Recipient shall promptly respond.
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(9) LIABILITY
Recipient agrees to be fully responsible for its own negligent acts or omissions or
tortious acts. Nothing herein shall be construed as consent by the City or a state agency
or subdivision of the State of Florida to be sued by third parties in any matter arising out of
any contract.
Recipient represents and warrants that hazardous and toxic materials, if present at
any locations where the Project will be performed, are at levels within regulatory limits and
do not trigger action required by Federal, State or local laws or regulations. Recipient
further represents and warrants that household hazardous waste meeting the definition set
forth in 40 CFR shall be handled in a manner which meets all Federal, State and local
laws and regulations. Recipient further represents and warrants that the presence of any
condition(s) or material(s) on site, which is subject to Federal, State or local laws and
regulations (including but not limited to: above ground or underground storage tanks or
vessels, asbestos, pollutants, irritants, pesticides, contaminants, petroleum products,
waste, chemicals and septic tanks), shall be handled and disposed of in accordance with
the pertinent requirements.
(10) GENERAL INDEMNIFICATION
The Recipient agrees to and will at all time indemnify, save and hold harmless the
City from all liability, and claims, demands, damages and costs of every kind and nature,
including attorneys' fees at trial or appellate levels, and all court costs arising out of injury
to or death of persons, and damage to any and property, including loss of use thereof,
resulting from or in any manner arising out of or in connection with the Project, or resulting
from or in any manner arising out of its relationship with the City, excepting only liability
resulting from the sole negligence of the City. The Recipient shall, upon request from the
City, defend and satisfy any and all suits arising from its use of the premises.
(11) DEFAULT: REMEDIES: TERMINATION
(a) If any of the following events occur ("Events of Default"), all obligations on the part
of the City to make any further payment of funds hereunder shall, if the City so
elects, terminate, and the City may at its option exercise any of its remedies set
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forth herein, but the City may make any payments or parts of payments after the
happening of any Events of Default without thereby waiving the right to exercise
such remedies, and without becoming liable to make any further payment:
1. If any warranty or representation made by the Recipient in this Agreement or
any previous Agreement with the City shall at any time be false or
misleading in any respect, or if the Recipient shall fail to keep, observe or
perform any of the terms or covenants contained in this Agreement or any
previous agreement with the City and has not cured such in timely fashion,
or is unable or unwilling to meet its obligations thereunder;
2. If Project funds from mortgage lenders or other sources are not received
because of defaults in the mortgages, construction loan agreements or other
loan documents used for Recipient's funding of the Project;
3. If any Reports required by this Agreement have not been submitted to the
City or have been submitted with incorrect, incomplete or insufficient
information;
4. If the Recipient has failed to perform and complete in timely fashion any of
the Project work required under the Budget and Scope of Work attached
hereto as Attachment A;
5. If the necessary funds are not available to fund this Agreement as a result of
action by the City, Legislature, the State of Florida Office of the Comptroller
or the Office of Management and Budgeting.
(b) Upon the happening of an Event of Default, then the City may, at its option, upon
written notice to the Recipient and upon the Recipient's failure to timely cure,
exercise anyone or more of the following remedies, either concurrently or
consecutively, and the pursuit of anyone of the following remedies shall not
preclude the City from pursuing any other remedies contained herein or otherwise
provided at law or in equity:
1. Terminate this Agreement, provided that the Recipient is given at least
fifteen (15) days prior written notice of such termination. The notice shall be
effective when placed in the United States mail, first class mail, postage
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prepaid, by registered or certified mail-return receipt requested, to the
address set forth in paragraph (12) herein;
2. Commence an appropriate legal or equitable action to enforce performance
of this Agreement;
3. Withhold or suspend payment of all or any part of a request for payment;
4. Exercise any corrective or remedial actions, to include but not be limited to,
requesting additional information from the Recipient to determine the
reasons for or the extent of non-compliance or lack of performance, issuing
a written warning to advise that more serious measures may be taken if the
situation is not corrected, advising the Recipient to suspend, discontinue or
refrain from incurring costs for any activities in question or requiring the
Recipient to reimburse the City for the amount of costs incurred for any
items determined to be ineligible; and
5. Exercise any other rights or remedies which may be otherwise available
under law.
(c) The City may terminate this Agreement for cause upon such written notice as is
reasonable under the circumstances. Cause shall include, but not be limited to,
misrepresentation in this grant application; misuse of funds; fraud; lack of
compliance with applicable rules, laws and regulations; failure to perform in a timely
manner; and refusal by the Recipient to permit public access to any document,
paper, letter, or other material forming part of the Project documents.
(d) The Recipient shall return funds to the City if found in non-compliance with laws,
rules, regulations governing the use of the funds or this Agreement.
(e) This Agreement may be terminated by the written mutual consent of the parties.
(f) Notwithstanding the above, the Recipient shall not be relieved of liability to the City
by virtue of any breach of Agreement by the Recipient. The City may withhold any
payments to the Recipient, from this or any other agreement between Recipient
and the City, for purpose of set-off until such time as the exact amount of damages
due the City from the Recipient is determined.
(12) NOTICE AND CONTACT
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(a) All notices provided under or pursuant to this Agreement shall be in writing, either
by hand delivery, or first class, certified mail, return receipt requested, to the
representative identified below and said notification attached to the original of this
Agreement.
(b) The name and address of the City contact for this Agreement is:
Mr. Kevin Garriott, Building Official
City of Clearwater
100 South Myrtle Avenue
Clearwater, Florida 33756-5520
Telephone: (727) 562-4567
Fax: (727) 562-4576
(c) The name and address of the Representative of the Recipient responsible for the
administration of this Agreement is:
Mark Smith and Charlene Smith
701 Bay Espanade
Clearwater, Florida 33767
(d) In the event that different representatives are designated by either party after
execution of this Agreement, notice of the name, title and address of the new
representative will be rendered as provided in (12)(a) above.
(13) OTHER PROVISIONS
(a) The validity of this Agreement is subject to the truth and accuracy of all the
information, representations, and materials submitted or provided by the Recipient,
in the Application, in any subsequent submission or response to City request, or in
any submission or response to fulfill the requirements of this Agreement, and such
information, representations, and materials are incorporated by reference. The lack
of accuracy thereof or any material changes shall, at the option of the City and with
thi~y (30) days written notice to the Recipient, cause the termination of this
Agreement and the release of the City from all its obligations to the Recipient.
(b) This Agreement shall be construed under the laws of the State of Florida, and
venue for any actions arising out of this Agreement shall lie in Pinellas County. If
any provision hereof is in conflict with any applicable statute or rule, or is otherwise
unenforceable, then such provision shall be deemed null and void to the extent of
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such conflict and shall be deemed severable, but shall not invalidate any other
provision of this Agreement.
(c) No waiver by the City of any right or remedy granted hereunder or failure to insist
on strict performance by the Recipient shall affect or extend or act as a waiver of
any other right or remedy of the City hereunder, or affect the subsequent exercise
of the same right or remedy by the City for any further or subsequent default by the
Recipient. Any power or approval or disapproval granted to the City under the
terms of this Agreement shall survive the terms and life of this Agreement as a
whole.
(d) The Agreement may be executed in any number of counterparts, anyone of which
may be taken as an original.
(14) FINANCIAL REQUIREMENTS
(a) The Recipient agrees to maintain receipts and other documents in order to account
for the receipt and expenditure of funds under this Agreement.
(b) These records shall be available at all reasonable times for inspection, review, or
audit by state personnel and other personnel duly authorized by the City.
"Reasonable" shall be construed according to circumstances, but ordinarily shall
mean normal business hours of 8:00 a.m. to 5:00 p.m., local time, Monday through
Friday.
(c) The Recipient shall also provide the City with the records, reports or financial
statements upon request for the purposes of auditing and monitoring the funds
awarded under this Agreement.
(d) The Recipient shall retain all financial records, supporting documents, statistical
records, and any other documents pertinent to this contract for a period of three
years after the date of submission of the final expenditures report. However, if
litigation or an audit has been initiated prior to the expiration of the three-year
period, the records shall be retained until the litigation or audit findings have been
resolved.
(15) SUBCONTRACTS
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(a) If the Recipient subcontracts any or all of the work required under this Agreement,
the Recipient agrees to include in the subcontract that the subcontractor is bound
by the terms and conditions of this Agreement with the City.
(b) The Recipient agrees to include in the subcontract that the subcontractor shall hold
the City and Recipient harmless against all claims of whatever nature arising out of
the subcontractor's performance of work under this Agreement.
(c) Contractual arrangements shall in no way relieve the Recipient of its responsibilities
to ensure that all funds issued pursuant to this Agreement be administered In
accordance with all state and federal requirements.
(16) TERMS AND CONDITIONS
The Agreement contains all the terms and conditions agreed upon by the parties.
(17) ATTACHMENTS
(a) AU attachments to this Agreement are incorporated as if set out fully herein.
(b) In the event of any inconsistencies or conflict between the language of this
Agreement and the attachments hereto, the language of such attachments shall be
controlling, but only to the extent of such conflict or inconsistency.
(c) This Agreement has the following attachments:
Attachment A Approved Project Scope of Work
Attachment B Program Statutes and Regulations
Attachment C Lobbying Prohibition/Certification
Attachment D Statement of Assurances
Attachment E Request for Advance or Reimbursement
(18) STANDARD CONDITIONS
The Recipient agrees to be bound by the following standard conditions:
(a) The State of Florida's performance and obligation to pay under this Agreement is
contingent upon an annual appropriation by the Legislature, and subject to any
modification in accordance with Chapter 216 and Section 252.37, FS or the Florida
Constitution.
(b) If otherwise allowed under this Agreement, extensions of an Agreement for
contractual services shall be in writing for periods not to exceed three (3) months
per extension and shall be subject to the same terms and conditions set forth in the
initial Agreement. Any extension of this Agreement is conditioned upon the
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willingness of the State and federal agencies to extend their agreements with the
City to accommodate an extension of this Agreement.
(c) All bills for fees or other compensation for services or expenses shall be submitted
in detail sufficient for a proper pre-audit and post-audit thereof.
(19) STATE LOBBYING PROHIBITION
No funds or other resources received from the City in connection with this
Agreemeflt may be used directly or indirectly to influence legislation or any other official
action by the Florida Legislature or the City. Refer to Attachment C for additional terms
and provisions relating to lobbying. Recipient shall execute and return Attachment C with
this Agreement.
(20) LEGAL AUTHORIZATION
The Recipient certifies with respect to this Agreement that it possesses the legal
authority to receive the funds to be provided under this Agreement. The Recipient also
certifies that the undersigned possesses the authority to legally execute and bind
Recipient to the terms of this Agreement and that the undersigned are all persons having
legal or equitable title to the property on which the Project is being accomplished.
(21) ASSURANCES
The Recipient shall comply with the Statement of Assurances incorporated as
Attachment D. Failure of the Recipient to comply with the program statutes, Executive
Orders, ~greements and regulations in Attachments Band D of this Agreement shall be
cause for the immediate suspension of payments or the immediate termination of this
Agreement.
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IN, WITNESS WHEREOF, the parties hereto have caused this Agreement to be
executed by their undersigned officials as duly authorized.
RECIPIENT:
By: 1?U ~,
Map\'( SmithV
Date: /I-;J. , - 0 D
WITNESS:
BY:'~W~~
Name: IE/3EUfi 1/. t. rn ;:JJ.he
Date: 1/.1 z q/ 00
Countersigned:
Approved as to form:
Leslie K. Dougall ides
Assistant City Attorney
~
RECIPIENT:
By: Q/W,j it~~ ~
Charlene Smith
Date: Ii IZq / On
f f
WITNESS:
By: f~ ZY:{!.~
Name: &-.6EtU.-~ iI.(1. tnl1l1~
Date: iI/ 2Q/OO
CITY OF CLEARWATER, FLORIDA
By: t1J~~t,j~ 7r
William B. Horne, II
Interim City Manager
Attest:
c~ Z. ~-.~.c.~
Cynthia E. GOudeau
City Clerk .
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ATTACHMENT A
BUDGET AND SCOPE OF WORK
Property Owner:
Mark and Charlene Smith
Property Address:
701 Bay Esplanade Way
Clearwater, Florida 33767
Recipient shall require the property Owner to perform tasks associated with the demolition of a
substantially damaged structure and the construction of a new residential structure, as further
described in the Recipient's Flood Mitigation Assistance (FMA) Program application. That
application is hereby incorporated by reference. The Department of Community Affairs (DCA)
shall reimburse eligible costs for this project up to $62,546.00.
I.
Funding Summary
Federal Share: $ 62,546.00
Local Share: $ 20,848.00
Project Cost: $ 83,394.00
(75%)
(25%)
II. Eligible Expenditures
The following categories of expenditures are generally considered eligible for
reimbursement under the FMA. Only reasonable eligible expenses may be reimbursed. The
Recipient shall provide the Department with a detailed listing of project expenditures, and
classify them according to the listed categories, as part of any request for payment. Any
expenditures that do not clearly fall under the specified categories shall be submitted to the
Department for review and determination of funding eligibility under the FMA.
Preliminary cost estimates for this project have been provided to the Department, and
those costs that are eligible have been incorporated into the categories below.
The amounts set forth below are estimates, and the Recipient may allow the Property
Owner to exceed the estimates and be reimbursed for 75% of expenditures in a category,
provided that the total reimbursement shall not exceed $62,546.00.
A-I
A.
B.
C.
D.
E.
F.
G.
Planning
Permitting
Site Preparation
Elevation
Electrical System
Landscape and
Driveway Repairs
Temporary Living
TOTAL
Attachment A (continued)
Budget and Scope of Work
FEDERAL (75%) NON-FEDERAL (25%)
$ 1,125.00
$ 375.00
$ 1,650.00
$ 55,521.00
$ 1,125.00
$ 2,000.00
$ 375.00
$ 125.00
$ 550.00
$ 18,506.00
$ 375.00
$ 667.00
$ 750.00
$ 62,546.00
$ 250.00
$ 20,848.00
A-2
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ATTACHMENT B
PROGRAM STATUTES AND REGULATIONS
This Agreement and the Flood Mitigation A3sistance Program (FMAP) are governed by the
following statutes and regulations:
(1) The National Flood Insurance Act of 1968, as amended by the National Flood
Insurance Reform Act of 1994; 42 use 4101, et seq;
(2) 44 CFR parts 7,9, 10, 13, 14, 17, 18,25,60, 78, 220, and 221, FEMA policy
memoranda and guidance documents;
(3) State of Florida Cooperative Agreement provisions for the Flood Mitigation
Assistance Program;
(4) The Performance Partnership Agreement (PPA) between the State of Florida and the
United States;
(5) All applicable laws and regulations delineated in Attachment E of this agreement.
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B-1
ATTACHMENT C
LOBBYING PROHIBITION
The undersigned certifies, to the best of his or her knowledge and belief, that:
(a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence either directly or
indirectly an officer or employee of any state or federal agency, a member of the
Florida Legislature, 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.
(b) lfany funds other than Federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an employee
of a Member of Congress in connection with this Federal contract, grant, loan, or
cooperative agreement, the undersigned shall complete and submit Standard Form-
LLL. "Disclosure Form to Report Lobbying," in accordance with its instructions.
(c) . The undersigned shall require that the language of this certification be included in the
award documents for all sub awards at all tiers (including subcontracts, sub grants, and
contracts under grants, loans, and cooperative agreements) and that all subrecipients
shall certify and disclose accordingly.
This certification is a material representative of fact upon which reliance was placed when
this transaction was made orentered into. Submission of this certification is a prerequisite for
making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any
persons who fails to file the required certification shall be subject to a civil penalty of not less
than $10,000 and not more than $100,000 for each such failure.
RECIPIENT
BY:
S'Zl~i.1-tvJ...'H1!.t-tLv:. . fL-
WllIlam B. Horne, II,Interim City Manager
Type Name and Title
ATTEST:
(/\ . \ \ (' id C-1
. ~-u ,J i \ .i.
\ . l__~Y\," ~\AtL { /..,h.-j.-c.~"-.~~~,--
CYl1tr ia E. Goudeau
City', ,berk
Approved as to fo~:
1 . /
'-;;,,/ Y Y -:.;/,j:?~: /; <;:i
;j(r' {'~-\/"-L,~ ~ . y\ {:2!I~lL::.-, ,,"-<_JZ--.f:,.
Leslie K. Dougall-~~es J
Assistant City Attorney
ATTACHMENT D
STATEMENT OF ASSURANCES
The Recipient hereby assures and certifies that:
(a) It possesses legal authority to enter into this agreement, and to execute the proposed
program.
(b) Its governing body has duly adopted or passed as an official act a resolution, motion
or similar action authorizing the application for and receipt of FMA funds, including
all understandings and assurances contained therein, and directing and authorizing the
Recipient's chief executive officer to act in connection with the application and to
provide such additional information as may be required.
(c) No member of or delegate to the Congress of the United States, and no Resident
Commissioner, shall be admitted to any share or part of this agreement or to any
benefit to arise from the same. No member, officer, or employee of the Recipient, or
its designees or agents, no member of the governing body of the locality in which the
program is situated, and no other public official of such locality or localities who
exercises any functions or responsibilities with respect to the program during his
tenure or for one year thereafter, shall have any interest direct or indirect, in any
contract or subcontract, or the proceeds thereof, for work to be performed in
connection with the program assisted under this agreement. The Recipient shall
incorporate or cause to be incorporated, in all such contracts or subcontracts a
provision prohibiting such interest pursuant to the purposes stated above.
(d) It has complied with all the requirements of the State of Florida Intergovernmental
Coordination and Review (IC & R) process, and that either:
(1) Any comments and recommendations made by or through clearinghouses are
attached and have been considered prior to submission of the application; or
(2) The required procedures have been followed and no comments or
recommendations have been received prior to submission of the application.
(e) It will comply with the Single Audit Act of 1994, as amended. Additionally, the
Recipient shall comply with the following requirements related to audits and financial
management pursuant.to the Single Audit Act of 1994, as amended:
D-l
(1) The Department shall review the Recipient's performance periodically to
determine whether the Recipient has substantially completed its program as
described in the approved Application and this Agreement. Training and
technical assistance shall be provided by the Department, within limits of staff
time and budget, upon written request by the Recipient and/or upon a
determination by the Department of Recipient need.
(2) The Recipient shall allow the Department to carry out monitoring, evaluation,
and technical assistance and shall assure the cooperation of its employees and
subcontractors during such activities.
(3) In the event that the Department suspends funding pursuant to the provisions
of this Agreement, said suspension shall take effect as of the receipt of the
notice of said suspension by the Recipient. Any requests for payment for
which the Department has not yet disbursed payment shall be subject to said
suspenSIOn.
(4) If one has been submitted, then Recipient's application for funds to the State
for funding consideration under the FMA Program is made a part of this
contract by reference.
(5) Submission of inaccurate ~nformation by the Recipient in monitoring report
responses; audit or audit finding responses; quarterly, closeout, program
income, or other reports; or Requests for Funds that result in subsequent
official Department action based on that inaccurate information (such as the
granting of administrative or final closeout status, releasing funds, or clearing
findings) may, at the option of the Department, subject the Recipient to
revocation of the official Department action(s) predicated on that report or
submission, (e.g., revocation of closeout status, audit clearance, monitoring
report clearance, etc.).
(f) If applicable, the Recipient shall provide the Department with a signed Public Entity
Crime Statement, Form PUR 7068; pursuant to the requirements of Section
287. 133(3)(a) FS, and enclose it with the Agreement documents. Ifsubcontractors
will receive payment from this contract, it is the Recipient's responsibility to ensure
that a copy of the form is executed by each for whom it is applicable, and is included
with the Agreement documents.
(g) Recipient will comply with:
(1) Title VI of the Civil Rights Act of 1964 (P.L. 88-352), as amended, and the
regulations issued pursuant thereto, which provide that no person in the
D-2
(3)
(4)
"
.. -i
(5)
(6)
United States shall on the grounds of race, color, or national origin, be
excluded from participation in, be denied the benefits of, or be otherwise
subjected to discrimination under any program or activity for which the
Recipient receives Federal financial assistance and will immediately take any
measures necessary to effectuate this assurance. If any real property or
structure thereon is provided or improved with the aid of Federal financial
assistance extended to the Recipient, this assurance shall obligate the
Recipient, or in the case of any transfer of such property, any transferee, for
the period during which the real property or structure is used for a purpose for
which the Federal financial assistance is extended, or for another purpose
involving the provision of similar services or benefits;
(2)
Title VIII of the Civil Rights Act of 1968 (Pub. L. 90-284), as amended,
administering all programs and activities relating to housing and community
development in a manner to affirmatively further fair housing; and will take
action to affirmatively further fair housing in the sale or rental of housing, the
financing of housing, and the provision of brokerage services;
E.O. 12259, Leadership and Coordination of Fair Housing in Federal
Programs, requiring that programs and activities relating to housing and urban
development be administered in a manner affirmatively to further the goals of
Title VIII of the Civil Rights Act of 1968;
Section 109 of the Housing and Community Development Act of 1974, as
amended, and the regulations issued pursuant thereto (24 CFR Section
570.601), which provides that no person in the United States shall, on the
grounds of race, color, national origin, or sex, be excluded from participation
in, be denied the benefits of, or be subjected to discrimination under, any
program or activity funded in whole or in part with funds provided under the
Act;
Any prohibition against discrimination on the basis of age under the Age
Discrimination Act of 1975, as amended (42 U.S.C.: 6101-6107) which
prohibits discrimination on the basis of age or with respect to otherwise
qualified handicapped individuals as provided in Section 504 of the
Rehabilitation Ac t of 1973 and implementing regulations
Executive Order 11063 on equal opportunity in housing and
nondiscrimination in the sale or rental of housing built with Federal
assistance; and
D-3
(7) Executive Order 11246 as amended by Executive Orders 11375 and 12086,
and the regulations issued pursuant thereto, which provide that no person shall
be discriminated against on the basis of race, color, religion, sex or national
origin in all phases of employment during the performance of federal or
federally assisted construction contracts; affirmative action to insure fair
treatment in employment, upgrading, demotion, or transfer; recruitment or
recruitment advertising; layoff or termination, rates of payor other forms of
compensation; and election for training and apprenticeship.
(k) It will comply with Section 3 of the Housing and Urban Development Act of 1968, as
amended, requiring that to the greatest extent feasible opportunities for training and
employment be given to lower-income persons residing within the unit of local
government in which the project is located; and that contracts for work in connection
with the project be awarded to eligible business concerns which are located in, or
owned in substantial part by, persons residing within the unit of local government.
(1) It will comply with Title II (Uniform Relocation Assistance) of the Uniform
Relocation Assistance and Real Property Acquisition Policies Act of 1970 and
implementing regulations.
(m) The Recipient agrees to comply with the Americans With Disabilities Act (Public
Law 101-336,42 U.S.C. Section 12101 et seq.), as amended, if applicable, which
prohibits discrimination by public and private entities on the basis of disability in the
areas of employment, public accommodations, transportation, State and local
government services, and in telecommunications.
(n) It will establish safeguards to prohibit employees from using positions for a purpose
that is or gives the appearance of being motivated by a desire ror private gain for
themselves or others, particularly those with whom they have family, business, or
other ties pursuantto Section 112.313 and Section 112.3135, FS.
(0) It will comply with the Anti-kickback (Copeland) Act of 1934, 18 U.S.C. Section 874
and 40 U.S.C. Section 276a, as amended, which outlaws and prescribes penalties for
"kickbacks" of wages in federally financed or assisted construction activities.
(P) It will comply with the provisions of the Hatch Act (5 USC part 73, subpart III, as
amended), which limits the political activity of employees.
(q) It will give the State, FEMA and the Comptroller General, through any authorized
representatives, access to and the right to examine all public records.
D-4
(r) It will insure that the facilities under its ownership, lease or supervision which shall
be utilized in the accomplislunent of the program are not listed on the Environmental
Protection Agency's (EPA) list of Violating Facilities and that it will notify the State
of the receipt of any communication from the Director of the EPA Office of Federal
Activities indicating that a facility to be used in the project is under consideration for
listing by the EP A.
(s) It will comply with the flood insurance purchase requirements of Section 102(a) of
the Flood Disaster Protection Act of 1973. P.L. 93-234, as amended. Section 103(a)
required, on and after March 2, 1974, the purchase of flood insurance in communities
where such insurance is available as a condition for the receipt of any Federal
financial assistance for construction or acquisition purposes for use in any area, that
has b€en identified by the Secretary of the Department of Housing and Urban
Development as an area having special flood hazards. The phrase "Federal financial
assistance" includes any form of loan, grant, guaranty, insurance payment, rebate,
subsidy, disaster assistance loan or grant, or any other form of direct or indirect
Federal assistance.
(t) It will require every building or facility (other than a privately owned residential
structure) designed, constructed, ur altered with funds provided under this Part to
comply with the "Uniform Federal Accessibility Standards," (UF AS) which is
Appendix A to 41 CFR Section 101-19.6 for general type buildings and Appendix A
to 24 CFR Part 40 for residential structures. The Recipient will be responsible for
conducting inspections to ensure compliance with these specifications by the
contractor.
(u) It will, in connection with its performance of environmental assessments under the
National Environmental Policy Act of 1969, comply with Section 106 ofthe National
Historic Preservation Act of 1966 (16 V.S.C. 470), Executive Order 11593,24 CFR
Part 800, and the Preservation of Archaeological and Historical DataAct of 1966 (16
U.S.C. 469a-1, et seq.) by:
(1) Consulting with the State Historic Preservation Officer to identify properties
listed in or eligible for inclusion in the National Register of Historic Places
that are subject to adverse effects (see 36 CFR Section 800.8) by the proposed
activity; and
(2) Complying with all requirements established by the State to avoid or mitigate
adverse effects upon such properties.
D-5
(v) It will comply with:
(1) The National Environmental Policy Act of 1969 (42 V.S.C. Section 4321 et
seq.) and 24 CFR Part 58;
(2) Executive Order 11988, Floodplain Management;
(3) Executive Order 11990, Protection of Wetlands;
(4) The Endangered Species Act of 1973, as amended (16 V.S.C. Section 1531 et
seq.);
(5) The Fish and Wildlife Coordination Act of 1958, as amended, (16 D.S.C.
Section 661 et seq.);
(6) The Wild and Scenic Rivers Act of 1968, as amended, (16 V.S.C. Section
1271 et seq.);
(7) The Safe Drinking Water Act of 1974, as amended, (42 V.S.C. Section 300f et
seq.);
(8) The Clean Air Act of 1970, as amended (42 V.S.C. Section 7401 et seq.);
(9) The Federal Water Pollution Control Act of 1972, as amended, (33 V.S.C.
Section 1251 et seq.);
(10) The Clean Water Act of 1977 (public Law 95-217), as amended;
(11) The Solid Waste Disposal Act, as amended by the Resource Conservation and
Recovery Act of 1975 (42 V.S.C. Section 6901 et seq.);
(12) Coastal Zone Management Act of 1972, P.L. 92-583, as amended;
(13) Architectural Barriers Act of 1968,42 V.S.C. 415, as amended;
(14) Executive Order 11296, relating to evaluation of flood hazards;
(15) Executive Order 11288, relating to the prevention, control and abatement of
water pollution; ,
(16) Reservoir Salvage Act;
(17) Farmland Protection Policy Act of 1981; and
D-6
(18) Coastal Barrier Resources Act of 1982, as amended.
(w) It will abide by the provisions of Section 116.111, FS, pertaining to nepotism in its
performance under this agreement.
(x) The Recipient will include the pruvisions outlined in Section 287.055 and 287.057,
FS, when negotiating contracts for services.
(y) It will comply with Title IX of the Education Amendments of 1972, as amended (20
V.S.C.: 1681-1683 and 1685-1686) which prohibits discrimination on the basis of
sex;
(z) It will comply with the Drug Abuse Office and Treatment Act of 1972 (P.L. 91-616)
as amended, relating to nondiscrimination on the basis of drug abuse;
(aa) It will comply with the Comprehensive Alcohol Abuse and Alcoholism Prevention,
Treatment and Rehabilitation Act of 1970, relating to nondiscrimination on the basis
of alcohol abuse or alcoholism.
(bb) It will comply with 523 and 527 of the Public Health Service Act of 1912 (42 V.S.C.
290 dd-3and 290 ee-3, as amended, relating to confidentiality of alcohol and drug
abuse patient records;
(cc) It will comply with Lead-Based Paint Poisoning Act (42 V.S.C.: 4801) et seq.) which
prohibits the use of lead based pamt in construction of rehabilitation or residential
structures;
(dd) It will comply with the Energy Policy and Conservation Act (P.L. 94-163), and the
provisions of the state Energy Conservation Plan adopted pursuant thereto.
(ee) Recipient shall ensure, as a condition of assistance under this Agreement, that the
following information is supplied to FEMA and the Department for each structure
assisted:
(1) Repetitive loss documentation, indicating number and amount of claims,
payments, and dates of each.
(2) Date structure was initially constructed.
(3) Structure's lowest floor elevation.
(4) Applicable flood zone where structure is located.
D-7
(5) Base flood elevation.
(6) Appraised value of structure.
(7) Contractor estimates for work. Recipient shall attempt to separate eligible
from any obviously ineligible costs.
(8) Square footage estimates of structure before and after proposed retrofit.
(9) Estimates of damage for any substantially damaged structures. Proposed
elevation height for any substantially damaged structure.
:)
.... ;''1"
D-8
Attachment E
FLORIDA DEPARTMENT OF COMMUNITY AFFAIRS
DIVISION OF EMERGENCY MANAGEMENT
Request for Advance or Reimbursement of
Flood Mitigation Assistance Program Funds
SUB GRANTEE NAME: City of Clearwater
ADDRESS: 100 South Myrtle Avenue
CITY, STATE. ZIP CODE: Clearwater. Florida 33756-5520
PAYMENT No:_
FMA No: FMA-PJ-04FL-1998031 DCA Agreement No: 00FM-Jl-08-62-15-011
PROJECT TYPE: Elevation/Retrofit
Total Contract Amount: $62.546.00
POINT OF CONTACT NAME :Mr. Kevin Garriott
POINT OF CONTACT PHONE No. : (727) 562-4567
FAX NO.:(727) 562-4576
HOMEOWNER: Mark and Charlene Smith
HOMEOWNER ADDRESS: 701 Bay Esplanade Wav
CITY STATE ZIP CODE' Clearwater Florida 33767
, , .
Project FEMA Non-Federal Previous Current Balance of
Amount 75% Match Payments Request Remaining
100% 25% Funds
TOTAL CURRENT REQUEST $
I certifY that to the best of my knowledge and belief the above accounts are correct, and that all disbursements were made in accordance
with all conditions of the DCA agreement and payment is due and has not been previously requested for these amounts.
SUB GRANTEE SIGNATURE
NAME AND TITLE
DATE
TO BE COMPLETED BY DEPARTMENT OF COMMUNITY AFFAIRS
APPROVED PROJECT TOTAL $
ADMINISTRA TIVE COST $
GOVERNOR'S AUTHORIZED REPRESENTATIVE
APPROVED FOR PAYMENT $
DATE
E-I
FLORIDA T ARTMENT OF COMMUNITY A1~IRS
DIVISlvN OF EMERGENCY MANAGEMEi11'
SUMMARY OF DOCUMENTATION IN SUPPORT OF AMOUNT
CLAIMED FOR ELIGIBLE DISASTER WORK THE
HAZARD MITIGATION GRANT PROGRAM
Applicant City of Clearwater
Disaster No. FMA-1998
DCA Agreement No OOFM-JI-08-62-15-011
FEMA Tracking # FMA-PJ-04FL-1998031
Applican(s Reference No, Date of delivery of DOCUMENTATION Applicant's
(W arran~ Voucher. Claim articles, completion of List Documentation (Applicant's payroll. material out of applican(s stock, Eligible Costs
Check, or Schedule No,) work or penonnance applicant owned equipment and name of vendor or contractor) by category and line 100%
services. item in the approved project application and give a brief description of the articles
or services.
^'
'.
TOTAL
E-2
Attachment F
FLORIDA DEPARTMENT OF COMMUNITY AFFAIRS
DIVISION OF EMERGENCY MANAGEMENT
PROJECT }lROGRESS FORM
SUB GRANTEE: City of Clearwater
Project Number#:FMA-PJ-04FL-1998031
PROJECT LOCATION: ElevationlRetrofit
DCA ID #: OOFM-JI-08-62-15-011
DISASTER NUMBER: FEMA-DR-FMA-1998-FL
QUARTER ENDING:
Percentage of Work Completed (may be confirmed by state inspectors):
Project Pro.;eeding on Schedule: [ ] Yes [] No
%
Describe milestones achieved during this quarter:
Provide a schedule for the remainder of work to project completion:
Describe problems or circumstances affecting completion date, milestones, scope of work, and cost:
Cost Status:
[] Cost Unchanged
[] Under Budget
[ ] Over Budget
Additional CommentslElaboration:
NOTE: Department of Community Affairs (DCA) staff may perform interim inspections and/or audits at any time. Events
may occur between quarterly reports which have significa/lt impact upon your project(s), such as anticipated overruns, changes
in scope of work, etc. Please contact DCA as soon as these conditions become known, otherwise you may be found non-
compliant with your subgrant award.
Name and Phone Number of Person Completing This Form
F-l
------,-..... "--
. f~DERAL EMERGENCY MANAGEMEN :ENCY
OUTLA.Y REPORT AND REQUEST FOR 1.,V1BURSEMENT
. FOR CONSTRUCTION PROGRAMS
PAGE
OF
O. M.a. No. 3067-0206
Expires June 30, 1998
2. BASIS OF REQUEST
o CASH' 0 ACCRUAL
5. PARTIAL PAYMENT REQUEST
NO.
3. FEDERAL SPONSORING AGENCY AND ORGANlZA TIONAL ELEMENT
WHICH THIS REPORT IS SUBMITTED
I iGES
1. TYPE OF REQUEST
o FINAL 0 PARTIAL
4. FEDERAL GRANT OR OTHER
IDENTIFYING NO. ASSIGNED
BYFEMA
6. EMPLOYER IDENTIFICATION
NUMBER
7. RECIPIENT ACCOUNT OR
OTHER IDENTIFYING NUMBER
8. PERIOD COVERED BY THis REPORT
FROM (Month, day, year) TO (Month, day, year)
9. NAME (Recipient Organi~ation)
10. PAYEE (Where checks should be sent if different than item 9)
ADDRESS (City, State Bnd Zp Code)
ADDRESS (City, State Bnd Zip. Code)
11.
CLAS S IFICA TION
STATUS OF FUNDS
PROGRAMS-FUNCTION S-ACTlVITIES
(a) (b)
TOTAL
J. Administra/ive e nse
s
s
s
J. Prelimina ex nse
:ii!ii!!iiii!iiiiii!;i!i!i!ii;;iiiii!iIiiii!iii!!~i!iiiii!!i!!iiii!i!iiiiiii'iii!!!ii!iiiii!,jiiiiiiii!iiti!i!i!!i;'ii!i!iiii!i!i!iiiiiiiii!iiiiii!i!ii.!iii!ii!ifii!:!i!i!iiiiiiiiiiiiiU!i!iiiiiiiiiiii!iii!iIiiIiliii!i!iiiiiiiiiii:i::ii!!iii!ii!i!iiiiiiiii!iiiii!i!iiil!@,ii!
:. Land, s!ruc/ures, riah/-of-wa
. Olher architec/ural enaineerinq fees
Hon fees
. land develo menl
:iii~!ii~;;!~i!ii~:ii~;;!~!;ii!i!!!!;~)~i!iiiiimiiiiii~iiiii!!F,!!ii!!iiiii:ii;!:i!]!!iii:i!i!!:i!i;'!ii!;i~i:ii~!:~;;!;!i!!ii!!iiiF,:ii!i;!!i:t;;i:;;;!it!i!B\itmi;iiilliii!!!;iiiiiii;i!!f,~i!l:!iii*:!ir~;!!:i!:ii[i!i!:ii!iii!:~~~i
. RelocaHon expense
Relocation a en/s to individuals and businesses
Demolition and removal
Construction and
rovement cost
E uipment
. Miscellane<>us cost
Tolal cumulative to date sum of lines a thru m)
Deductions for ro ram income
Net cumulative to date line n minus line 0
Federal share 10 datE!'
~ eha bilitation grants (100% reimbursement
fotal Federal share sum or lines q and r
~mounl requested for reimbursement
%
%
c;.:
I certify that 10 the besl of my knoy,1edge and ~Iier the billed
ts or disbursements are in accordance y,ith the terms cr L'1e
eel and that the reimbu~ment represents the Federal share
y,hich has net been previously requested and that an
,edion has be-en p€rformed and all work is in accordance 'y',i'u'1
:erms of the award.
a.
RECIPIENT
SiGNATURE OF AUTHOR~EO CCRTIFYING
OFFiCIAL
DA TE REpr.,AU S:.F~ITr=D
TYPED OR PRIN'TEO NAME ,10,.-;0 TITLE
Tl:.LEP~,,: (Ale.J c::x::e, l">Yf":"\:;"':-"
..-.j~~J
b,
Representative
certifying to line
11 v,
TYPED OF PR'I'.'TED NAME ^ND TrTLE
TELEPHONE (Ate> c::06<, num,""
or.d .x'-'""'~J
e.. Form 20-17, JUL 95
,::lub!"c :mpzrt,ing burden for this form is' nated to average 17.2 hours per re' '5e. The burden estimate
lclud'es the time for reviewing instructio, searching existing data sources, gatr. ,g and maintaining the data
eeded, and completing, reviewing, and submitting the form. 'Send comments regarding the accuracy of the
urden estimate and any suggestions fot reducing the burden' to: Information Collections Management, Federal
mergency Management Agency, 500 C Street, SW, Washington, DC 20472. R
INSTRUCTIONS
Mark the appropriate box.
Mark the appropriate box.
Enter the name of the FEMA Regional Office which awarded the grant/cooperative agreement to your.organization.
Enter the number assigned by FEMA. This number can be foun~ in item 1 of the Obligating Document for
Award/Amendment, FEMA Form 76-1 OA.
This item will not be used to report in the EOC program'.
Enter the number assigned by the Internal Revenue Service. This number should be the same number reported in item 6
of the applicant's Application for Federal Assistance, SF 424.
This space is reserved for an account number or other identifying number assigned by the recipient.
Enter the beginning and ending dates of the quarter you are reporting on. .
Enter the name and address of the organization receiving the grant. This information should be the same
information as shown in item 5 of FEMA Form 76-1 OA.
Enter where checks should be sent if different than item 9.
Enter amount expended for such items as travel, legal fees, rental of vehicles and any other administrative
expenses. Include the amount of interest expense when authorized by program legislation.
Enter the amounts pertaining to the work of locating and designing, making surveys and maps, sinking test holes,
and all other work required prior to actual construction.
Enter all amounts directly associated with the acquisition of land, existing structures, and related
right-of-way {this includes purchase, lease, and/or easements/.
Enter basic fees for services of architectural engineers relating to construction {this includes start-up seNices .and
preparation of project performance work plan}. .
1 e. . Enter amounts for other architectural engineering services, such as surveys..tests, soil borings, etc. Do ~ot include any
amounts shown on line 11 d.
Enter construction monitoring, engineering inspection, and audit fees of construction and related programs.
Enter all amounts asso,ciated with the development of land where the primary purpose of the grant is land improvement.
Enter the dollar amounts used to provide relocation advisory assistance and net costs of replacement housing.
Enter the amount of relocation payments made by the recipient to displaced persons, farms, business concerns, and
nonprofit organizations
Enter gross salaries and wages of employees of the recipient and payments to third party contractors directly engaged
in performing demolition or removal of structures from developed land. , ,
Enter those amounts associated with the actual construction of, addition to, or restoration of a facility. Also, include
the amounts for project improvements such as sewers, streets, landscaping and lighting.
Enter amounts for all equipment, both fixed and movable, exclusive of equipment used for construction.
Enter the amounts for all items not specifically mentioned above.
Enter the total cumulative amount to date which should be the sum of lines 11 a through 11 m.
Enter the total amount of program income applied to the grant or contract agreement except income on line j. Identify
on a separate sheet of paper the sources and types of the income.
Enter the net cumulative amount to date which should be the amount shown on line 11 n minus the amount on Iinell o.
Enter the Federal share of the amount shown on line 11 p.
Enter the amount of rehabilitation grant payments made to individu~ls when program legislation provides 100 percent
payment by the Federal agency.
Enter the total amount of Federal share.
Enter the total amount of Federal payments previously requested, if this form is used for requesting reimbursement.
Enter the total amount being requested for reimbursement. This amount should be the difference between the amounts
shown on lines 11 q and 11 t. If different, explain on a separate sheet.
Enter the actual percentage of project already constructed.
The purpose of this item is to verify that the costs or disbursements are in accordance with the terms of the project.
To be completed by the recipient official who is responsible for preparation and submission of the outlay report.
To be completed by the official representative who is certifying to the percent of project completion as provided for in
the terms of the grant or cooperative agreement.
:fer to Outlays Module, Part III, for detailed instructions.
O.
1 a.
1 b.
1 c.
1 d.
11.
1 g.
1 h.
1 i.
, j.
1 k.
11.
1m.
1 n.
10.
, p.
1 q.
, r.
1 s.
H.
I u.
Iv.
,
~a.
~b.