CATEGORICAL EXCLUSION - NORTHEAST WRF CLARIFIERS 1 THROUGH 4 REHABILITATIONCategorical Exclusion Checklist - for all Project Types
Pro ect Name C tyy Clearw ter, Northea t WRF
CaYiiers 1 trough 4 Reha zlitation
Grant Number
Categorical Exclusions (CEs) are identified categories of actions which do not individually,
cumulatively overtime, or in conjunction with other Federal, State, local or private actions have a
significant effect on the quality of the human environment. For a project to be eligible for a CE,
it generally relates to an existing infrastructure system which is either (1) an existing sewer
collection network and treatment system; (2) a system to collect, treat, store and distribute
drinking water; or (3) a stormwater system (including a combined sewer overflow system) and
is in accord with determination procedures adopted by EPA [40 CFR 6.204].
Table 1. Special Congressional Earmarks for Reimbursement of Costs of
Already Completed Projects
>>>PreliminaryEvaluationccc If the earmark is not for the reimbursement of a completed
project, proceed to Table 2.
Under 40 CFR 6.204(a)(1)(v), actions for the award of grants authorized by Congress under EPA's
annual Appropriations Act may qualify for a CE if they are solely for the reimbursement of costs
associated with a project completed prior to the enacted appropriation date. The project must also be
in compliance with EPA guidelines covering the year of the appropriation in order to be funded.
Indicate the date of the appropriation. 2010
Indicate the date of project completion. 2012
Is the completion date after the Appropriation date? Yes
No x
If the answer is Yes, go to Table 2, the project does not qualify for a CE under this special
provision, but may otherwise qualify. If the answer is No, proceed to Table 4.
Table 2. Replacement of Existing Onsite Systems in Unsewered Communities
>>>PreliminaryEvaluation<<< If the project does not consist of actions in unsewered
communities involving the replacement of existing onsite systems, proceed to Table 3.
Under 40 CFR 6.204(a)(1)(iii), actions in unsewered communities involving the replacement of
onsite systems with new onsite systems may qualify for a CE.
Will the project result in substantial increases in the volume of discharge or Yes
loadings of pollutants from existing sources, or relocate an existing discharge? No x
10/25/07 EPA Region 4
If the answer is Yes, the project does not qualify for a CE, STOP. If the answer is No, go to
Table 4.
Table 3. General Categories of Projects That Qualify for a CE
Under 40 CFR 6.204(a)(1)(ii), minor actions relating to an existing infrastructure system (a sewer
collection network and treatment system; a system to collect, treat, store and distribute drinking
water; or a stormwater or combined sewer system) may qualify for a CE. Answer 1 to 3.
1. Is the project for minor upgrade or minor expansion of system capacity? Yes
This includes, but is not limited to: minor extensions of sanitary sewers or force No x
mains or drinking water extensions within approximately '/z mile of the existing
system to primarily serve existing development; stormwater detention pond and
retention pond cleaning and dredging or minor storage increase or culvert
upgrades.
2. Is the project for rehabilitation of existing facilities? Yes x
This includes, but is not limited to: infiltration and inflow corrections in the No
existing wastewater collection system or equipment rehabilitation at the existing
wastewater plant, pumping, or storage facilities; drinking water system equipment
replacement or modifications at an existing water plant, or pumping and storage
facilities; stormwater culvert rehabilitation and repair, rip-rap renewal or other
flow dissipation structure rehabilitation, or storm sewer to grass swale
conversions.
3. Is the project for new minor ancillary facilities adjacent to or on the same Yes
property as existing facilities? No x
This includes, but is not limited to: new wastewater facilities and equipment for
sludge handling, odor control, screening, flow equalization, disinfection, or
laboratory facilities; new drinking water facilities such as alum sludge handling,
filtration, flow equalization, chemical storage, chlorination, or laboratory facilities;
innovative facilities at stormwater control locations, such as sedimentation basins,
infiltration trenches, detention pond to retention pond retrofits, or oil and grit
separators.
If the answer to all of the above is No, then the project does not qualify for a CE. STOP.
If any answer is Yes, proceed to the next section: Excluding Factors.
Excluding Factors
(1) Project will involve new or relocated discharges to surface or ground water Yes
No x
(2) Project will result in substantial increases in the volume of discharge or the Yes
loadings of pollutant to the receiving water No x
(3) Project will provide capacity to serve a population 30 percent greater than the Yes
existing population No x
(4) Project will be in conflict with state or other regional growth plan or strategy Yes
No x
(5) Project will directly or indirectly relate to upgrading or extending infrastructure Yes
systems primarily for the purposes of future development No x
10/25/07 EPA Region 4
If any answer (1-5) is Yes, then project does not qualify for a CE. STOP.
If all answers (1-5) are No, go to Table 4.
Table 4. Extraordinary Circumstances That Disallow a CE
(1) The action is known or expected to have a significant effect on the quality of Yes
the human environment, either individually or cumulatively over time. No x
(2) The action is known or expected to have disproportionately high and adverse Yes
human health or environmental effects on any community, including minority No x
communities, low-income communities, or federally-recognized Indian tribal
communities.
(3) The action is known or expected to significantly affect federally listed Yes
threatened or endangered species or their critical habitat. No x
(4) The action is known or expected to significantly affect national natural Yes
landmarks or any property with nationally significant historic, architectural, No x
prehistoric, archeological, or cultural value, including but not limited to, property
listed on or eligible for the National Register of Historic Places.
(5) The action is known or expected to significantly affect environmentally Yes
important natural resource areas such as wetlands, floodplains, significant No x
agricultural lands, aquifer recharge zones, coastal zones, barrier islands, wild and
scenic rivers, and significant fish or wildlife habitat.
(G) The action is known or expected to cause significant adverse air quality effects. Yes
No x
(7) The action is known or expected to have a significant effect on the pattern and Yes
type of land use or growth and distribution of population including altering the No x
character of existing residential area, or be inconsistent with state of local
government, or federally-recognized Indian tribe approved land use plans or federal
land management plans.
(8) The proposed action is known or expected to cause significant public Yes
controversy about a potential environmental impact of the proposed action. No x
(9) The proposed action is known or expected to be associated with providing Yes
financial assistance through an interagency agreement for a project that is known or No x
expected to have potentially significant environmental impacts.
(10) The proposed action is known or expected to conflict with federal, state, or Yes
local government, or federally-recognized Indian tribe environmental resource- No x
protection, or land-use laws or regulations.
If all of the answers (1-10) are No, then the project is eligible for a CE.
If any of the answers to the questions in Table 4 is Yes, then a CE can not be granted.
10/25/07 EPA Region 4
Current as of. October 28, 2010
Dear APPLICANT:
This application package for EPA Special Appropriations Projects
(SPAPs) Grants can be used for either construction or non-
construction projects. You may want to check the following web site
for the most up-to-date SF424 forms:
Application Forms and Attachments
If you have questions about the assistance program for which
you are applying or need help in completing your application, please
contact the Grants Management Office at 404/562-8400 or one of
the following Grants Specialists at 404/562-xxxx:
AL: Sherry Miles - 8396
FL: Shantel Shelmon - 9817
GA: Sharonita Johnson - 831
KY: Laura Fowler - 8427
MS: Marsha Humphries - 9766
NC: Kenny Richardson - 9021
SC: William Lundy - 8417
TN: Dionne Bounds - 8374
Applications should be submitted at least sixty (60) days prior
to the expected date of award. Your completed original application
and one copy should be mailed to:
GRANTS MANAGEMENT OFFICE
ENVIRONMENTAL PROTECTION AGENCY
ATLANTA FEDERAL CENTER
61 FORSYTH STREET
ATLANTA, GA 30303-8960
APPLICATION KIT CONTENTS
ATTACHMENTS
1. Application Submittal Checklist
2. Application Forms:
SF 424 - Amlication for Federal Assistance
SF 424A - Budget Information, Non-constructio Not Included - Appi
F 424B - Assurances, Non-construction is for Construction
SF 424C - u ge ons ruction
SF 424D - Assurances, Construction
Key Contacts Form
3. Supplemental General Instructions
4. Lobbying Certification and Disclosure Forms (SF LLL)
5. Pre-award Compliance Review Report (EPA Form 4700-4)
6. Regulations and OMB Circulars
Note: EPA Grantee Forms such as EPA Form 4700-4 are available at:
htti)://www.epa.gov/ogd/forms/forms.htm
ATTACHMENT 1
APPLICATION SUBMITTAL
CHECKLIST
APPLICATION PACKAGE SUBMITTAL CHECKLIST
x SF 424, 424A & S (Non-construction), 424C & D (Construction), and Key Contacts
Form
N/A Clearinghouse comments, if applicable and available.
x Anti-Lobbying Recipient Certification must be completed and returned if you are
requesting $100,000 or more in Federal funds. Please retain the "Disclosure of
Lobbying Activities" form for your use in reporting Lobbying activities during the
project period of the assistance award.
N/A Current indirect cost rate negotiation agreement, if applicable.
x Compliance Report - EPA Forth 47004
x WORKPLAN - Prepared in accordance with the instructions at
http://www.el2a_goy/region4/water/gtas/workbookdocs/workplan elements031705.2df
MAIL THE ORIGINAL AND ONE COPY OF YOUR COMPLETED
APPLICATION TO:
GRANTS MANAGEMENT OFFICE
ENVIRONMENTAL PROTECTION AGENCY
ATLANTA FEDERAL CENTER
61 FORSYTH ST, SW
ATLANTA, GA 30303-8960
ATTACHMENT 2
APPLICATION FORMS
SF 424
424A & SF424B (Non-Construction Not Irncluded -cAppI
- .. is fo Constrution
SF 424C & SF424D (Construction
KEY CONTACTS FORM
OMB Number: 4040-0004
Expiration Date: 01/31/2009
Application for Federal Assistance SF-424 Version 02
* 1. Type of Submission-
? Preapplication
?? Application
? Changed/Corrected Application * 2. Type of Application:
Q New
? Continuation
? Revision ` If Revision, select appropriate letter(s):
`Other(Specify)
* 3. Date Received- 4. Applicant Identifier:
Completed by Grants.gov upon submission.
5a. Federal Entity Identifier: ` 5b. Federal Award Identifier:
State Use Only:
6. Date Received by State. 7. State Application Identifier:
8. APPLICANT INFORMATION:
` a. Legal Name: City of Clearwater, FL
* b. Employer/Taxpayer Identification Number (EINITIN): * c. Organizational DUNS.
59-6000-289 07-0830-7303
d. Address:
• Streets: 1650 N. Arcturas Avenue
Street2: Bldg. C
* City Clearwater
County: Pinellas
• state: Florida
Province:
• Country. USA
• Zip / Postal Code: 33765-1945
e. Organizational Unit:
Department Name. Division Name:
Public Utilities
f. Name and contact Information of person to be contacted on matters involving this application:
Prefix: Ms. ` First Name: L.
Middle Name: Tracy
* Last Name: Mercer
Suffix:
Title: Director of Public Utilities
Organizational Affiliation:
City of Clearwater
* Telephone Number: 727 562-4962 Fax Number: (727) 562-4963
* Email: tracy.mercer@myclearwater.com
OMB Number: 4040-0004
Expiration Date: 01/31/2009
Application for Federal Assistance SF-424 Version 02
9. Type of Applicant 1: Select Applicant Type:
C - City or Township Government
Type of Applicant 2: Select Applicant Type:
Type of Applicant 3: Select Applicant Type:
" Other (specify):
I
' 10. Name of Federal Agency:
USEPA
11. Catalog of Federal Domestic Assistance Number:
66.202
CFDA Title:
Congressionally Mandated Projects
• 12. Funding Opportunity Number:
" Title:
13. Competition Identification Number:
Title:
14, Areas Affected by Project (Cities, Counties, States, etc.):
City of Clearwater, Pinellas County, FL
* 15. Descriptive Title of Applicant's Project.
City of Clearwater, Northeast WRF Clarifiers 1 through 4 Rehabilitation
Attach supporting documents as specified in agency instructions.
OMB Number: 4040-0004
Expiration Date: 01/3112009
Application for Federal Assistance SF-424 Version 02
16. Congressional Districts Of:
a. Applicant FL-009 a FL01o * b. Program/Project FL-009 & Fo10
Attach an additional list of Program/Project Congressional Districts if needed.
7,771
17. Proposed Project:
" a. Start Date: June 2011 ` b. End Date: June 2012
18. Estimated Funding (a):
a. Federal $485,000.00
• b. Applicant $1,318,000.00
• c. State
• d. Local
• e. Other
" f. Program Income
• g. TOTAL $1,803,000.00
* 19. Is Application Subject to Review By State Under Executive Order 12372 Process?
Q a. This application was made available to the State under the Executive Order 12372 Process for review on .
b. Program is subject to E.O. 12372 but has not been selected by the State for review,
c. Program is not covered by E.O. 12372.
* 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes", provide explanation.)
? Yes 0 No _ _:2'c'iai ,_u
21. *By signing this application, I certify (1) to the statements contained in the list of certifications" and (2) that the statements
hereln are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to
comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims
may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001)
?? "I AGREE
The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency
specific instructions.
Authorized Representative:
Prefix: Mr. *First Name: William
Middle Name: B.
* Last Name: Horne
Suffix II
" Title: City Manager
* Telephone Number: (727) 562-4040 Fax Number: (727) 562-4052
* Email: william.horne@myclearwater.com
FS gnature of Authorized Representative' ?-??' Date Signed: tar G t
Authorized for Local Reproduction
Standard Form 424 (Revised 10/2005)
Prescribed by OMB Circular A-102
OMB Number: 4040-0004
Expiration Date: 07/31/2006
Application for Federal Assistance SF-424 Version 02
* Applicant Federal Debt Delinquency Explanation
The following field should contain an explanation if the Applicant organization is delinquent on any Federal Debt. Maximum number of
characters that can be entered is 4,000. Try and avoid extra spaces and carriage returns to maximize the availability of space.
INSTRUCTIONS FOR THE SF-424
Public reporting burden for this collection of information is estimated to average 60 minutes per response, including time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the
burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget,
Paperwork Reduction Project (0348-0043), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED
BY THE SPONSORING AGENCY.
This is a standard form (including the continuation sheet) required for use as a cover sheet for submission of preapplications and applications and
related information under discretionary programs. Some of the items are required and some are optional at the discretion of the applicant or the Federal
agency (agency). Required items are identified with an asterisk on the form and are specified in the instructions below. In addition to the instructions
provided below, applicants must consult agency instructions to determine specific requirements.
Item Ent : Item Ent :
1. Type of Submission: (Required): Select one type of submission in 10. Name Of Federal Agency: (Required) Enter the name of the
accordance with agency instructions. Federal agency from which assistance is being requested with
• Preapplication this application-
• Application
• Changed/Corrected Application - If requested by the agency, check 11. Catalog Of Federal Domestic Assistance Number/Title;
if this submission is to change or correct a previously submitted Enter the Catalog of Federal Domestic Assistance number and
application. Unless requested by the agency, applicants may not title of the program under which assistance is requested, as
use this to submit changes after the closing date. found in the program announcement, if applicable.
2. Type of Application: (Required) Select one type of application in 12. Funding Opportunity Number/Title: (Required) Enter the
accordance with agency Instructions. Funding Opportunity Number and title of the opportunity under
• New - An application that is being submitted to an agency for the which assistance is requested, as found in the program
first time. announcement.
• Continuation - An extension for an additional funding/budget period 11 Competition Identification Number/Title: Enter the
for a project with a projected completion date. This can include Competition Identification Number and title of the competition
renewals. under which assistance is requested, if applicable.
• Revision - Any change in the Federal Government's financial
obligation or contingent liability from an existing obligation. If a
revision
enter the appropriate letter(s). More than one may be
,
selected. If "Other" is selected, please specify in text box provided. 14. Areas Affected By Project: List the areas or entities using
A. Increase Award B. Decrease Award the categories (e.g., cities, counties, states, etc.) specified in
C. Increase Duration D. Decrease Duration agency instructions. Use the continuation sheet to enter
E. Other (specify) additional areas, if needed,
3. Date Received: Leave this field blank. This date will be assigned by the 15. Descriptive Title of Applicant's Project: (Required) Enter a
Federal agency. brief descriptive title of the project. If appropriate, attach a
map showing project location (e.g., construction or real
4. Applicant Identifier: Enter the entity identifier assigned by the Federal property projects). For preapplications, attach a summary
agency, if any, or applicant's control number, if applicable. description of the project.
5a Federal Entity Identifier: Enter the number assigned to your 16. Congressional Districts Of: (Required) 16a. Enter the
organization by the Federal Agency, if any. applicant's Congressional District, and 16b. Enter all District(s)
5b. Federal Award Identifier: For new applications leave blank. For a affected by the program or project. Enter in the format: 2
continuation or revision to an existing award, enter the previously characters State Abbreviation - 3 characters District Number,
assigned Federal award identifier number. If a changed/corrected e.g., CA-005 for California 5"' district, CA-012 for California 12'h
application, enter the Federal Identifier in accordance with agency district, NC-103 for North Carolina's 103'' district.
instructions. If all congressional districts in a state are affected, enter
6, Date Received by State: Leave this field blank. This date will be °all" for the district number, e.g., MD-all for all
assigned b the State, if applicable. congressional districts in Maryland.
7. State Application Identifier: Leave this field blank. This identifier will If nationwide, i.e. all districts within all states are affected,
be assigned by the State, if applicable. enter US-all.
• If the program/project is outside the US
enter 00-000
8. Applicant Information: Enter the following in accordance with agency ,
.
instructions:
a. Legal Name: (Required): Enter the legal name of applicant that will 17. Proposed Project Start and End Dates: (Required) Enter the
undertake the assistance activity. This is the name that the organization proposed start date and end date of the project.
has registered with the Central Contractor Registry. Information on
registering with CCR may be obtained b visiting the Grants. ov website.
b. Employer/Taxpayer Number (EIN/TIN): (Required): Enter the
Employer or Taxpayer Identification Number (EIN or TIN) as assigned by 18. Estimated Funding: (Required) Enter the amount requested
the Internal Revenue Service. If your organization is not in the US, enter or to be contributed during the first funding/budget period by
44-4444444. each contributor- Value of in-kind contributions should be
c. Organizational DUNS: (Required) Enter the organization's DUNS or included on appropriate lines, as applicable. If the action will
DUNS+4 number received from Dun and Bradstreet. Information on result in a dollar change to an existing award, indicate only the
obtaining a DUNS number may be obtained by visiting the Grants.gov amount of the change. For decreases, enclose the amounts in
website. parentheses.
d. Address: Enter the complete address as follows: Street address (Line
1 required), City (Required), County, State (Required, if country is US), 19. Is Application Subject to Review by State Under Executive
Province, Country (Required), Zip/Postal Code (Required, if country is Order 12372 Process? Applicants should contact the State
US), Sin
le Point of Cont
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12372 to determine whether the application is subject to the
unit (and department or division, if applicable) that will undertake the
assistance activity, if applicable. State intergovernmental review process. Select the
f. Name and contact information of person to be contacted on appropriate box. If "a." is selected, enter the date the
matters involving this application: Enter the name (First and last name application was submitted to the State
required), organizational affiliation (if affiliated with an organization other
than the applicant organization), telephone number (Required), fax 20. Is the Applicant Delinquent on any Federal Debt?
number, and email address (Required) of the person to contact on (Required) Select the appropriate box. This question applies to
matters related to this application. the applicant organization, not the person who signs as the
authorized representative. Categories of debt include
delinquent audit disallowances, loans and taxes.
If es, include an explanation on the continuation sheet.
9. Type of Applicant: (Required) 21. Authorized Representative: (Required) To be signed and
Select up to three applicant type(s) in accordance with agency dated by the authorized representative of the applicant
instructions. organization. Enter the name (First and last name required)
A. State Government M. Nonprofit with 501 C3 IRS title (Required), telephone number (Required), fax number,
B. County Government Status (Other than Institution and email address (Required) of the person authorized to sign
C. City or Township Government of Higher Education) for the applicant.
D. Special District Government N. Nonprofit without 501 C3 IRS A copy of the governing body's authorization for you to sign
E. Regional Organization Status (Other than Institution this application as the official representative must be on file in
F. U.S. Territory or Possession of Higher Education) the applicant's office. (Certain Federal agencies may require
G. Independent School District O. Private Institution of Higher that this authorization be submitted as part of the application.)
H. Public/State Controlled Education
Institution of Higher Education P. Individual
I. Indian/Native American Tribal Q. For-Profit Organization
Government (Federally (Other than Small Business)
Recognized) R. Small Business
J. Indian/Native American Tribal S. Hispanic-serving Institution
Government (Other than T. Historically Black Colleges
Federally Recognized) and Universities (HBCUs)
K. Indian/Native American U. Tribally Controlled Colleges
Tribally Designated and Universities (TCCUs)
Organization V. Alaska Native and Native
L. Public/Indian Housing Hawaiian Serving Institutions
Authority W. Non-domestic (non-US)
Entity
X. Other (specify)
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INSTRUCTIONS FOR THE SF-424C
Public reporting burden for this collection of information is estimated to average 180 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0041), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
This sheet is to be used for the following types of applications: (1) "New" (means a new [previously unfunded] assistance award); (2)
"Continuation" (means funding in a succeeding budget period which stemmed from a prior agreement to fund); and (3) "Revised" (means
any changes in the Federal Government's financial obligations or contingent liability from an existing obligation). If there is no change in
the award amount, there is no need to complete this form. Certain Federal agencies may require only an explanatory letter to effect minor
(no cost) changes. If you have questions, please contact the Federal agency.
Column a. - If this is an application for a "New" project, enter
the total estimated cost of each of the items listed on lines 1
through 16 (as applicable) under "COST CLASSIFICATION."
If this application entails a change to an existing award, enter
the eligible amounts approved under the previous award for
the items under "COST CLASSIFICATION."
Column b. - If this is an application for a "New" project, enter
that portion of the cost of each item in Column a. which is not
allowable for Federal assistance. Contact the Federal agency
for assistance in determining the allowability of specific costs.
If this application entails a change to an existing award, enter
the adjustment [+ or (-)] to the previously approved costs
(from column a.) reflected in this application.
Column. - This is the net of lines 1 through 16 in columns "a."
and "b."
Line 1 - Enter estimated amounts needed to cover
administrative expenses. Do not include costs which are
related to the normal functions of government. Allowable
legal costs are generally only those associated with the
purchases of land which is allowable for Federal participation
and certain services in support of construction of the project.
Line 4 - Enter estimated basic engineering fees related to
construction (this includes start-up services and preparation of
project performance work plan).
Line 5 - Enter estimated engineering costs, such as surveys, tests,
soil borings, etc.
Line 6 - Enter estimated engineering inspection costs.
Line 7 - Enter estimated costs of site preparation and restoration
which are not included in the basic construction contract.
Line 9 - Enter estimated cost of the construction contract
Line 10 - Enter estimated cost of office, shop, laboratory, safety
equipment, etc. to be used at the facility, if such costs are not
included in the construction contract.
Line 11 - Enter estimated miscellaneous costs.
Line 12 - Total of items 1 through 11.
Line 13 - Enter estimated contingency costs. (Consult the Federal
agency for the percentage of the estimated construction cost to
use.)
Line 14 - Enter the total of lines 12 and 13.
Line 15 - Enter estimated program income to be earned during the
grant period, e.g., salvaged materials, etc.
Line 16 - Subtract line 15 from line 14.
Line 2 - Enter estimated site and right(s)-of-way acquisition
costs (this includes purchase, lease, and/or easements).
Line 3 - Enter estimated costs related to relocation advisory
assistance, replacement housing, relocation payments to
displaced persons and businesses, etc.
Line 17 - This block is for the computation of the Federal share.
Multiply the total allowable project costs from line 16, column "c."
by the Federal percentage share (this may be up to 100 percent;
consult Federal agency for Federal percentage share) and enter
the product on line 17.
SF-424C (Rev. 7-97) Back
ASSURANCES - CONSTRUCTION PROGRAMS
OMB Approval No. 0348-0042
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewi
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection
information, Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions
reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0042), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the
Awarding Agency. Further, certain Federal assistance awarding agencies may require applicants to certify to additional
assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant, I certify that the applicant:
Has the legal authority to apply for Federal assistance, 8. Will comply with the Intergovernmental Personnel Act
and the institutional, managerial and financial capability of 1970 (42 U.S.C. §§4728-4763) relating to prescribed
(including funds sufficient to pay the non-Federal share standards for merit systems for programs funded
of project costs) to ensure proper planning, under one of the 19 statutes or regulations specified in
management and completion of the project described in Appendix A of OPM's Standards for a Merit System of
this application. Personnel Administration (5 C.F.R. 900, Subpart F).
2, Will give the awarding agency, the Comptroller General
of the United States and, if appropriate, the State,
through any authorized representative, access to and
the right to examine all records, books, papers, or
documents related to the assistance; and will establish
a proper accounting system in accordance with
generally accepted accounting standards or agency
directives.
3. Will not dispose of, modify the use of, or change the
terms of the real property title, or other interest in the
site and facilities without permission and instructions
from the awarding agency. Will record the Federal
interest in the title of real property in accordance with
awarding agency directives and will include a covenant
in the title of real property aquired in whole or in part
with Federal assistance funds to assure non-
discrimination during the useful life of the project.
4. Will comply with the requirements of the assistance
awarding agency with regard to the drafting, review and
approval of construction plans and specifications.
5. Will provide and maintain competent and adequate
engineering supervision at the construction site to
ensure that the complete work conforms with the
approved plans and specifications and will furnish
progress reports and such other information as may be
required by the assistance awarding agency or State.
6. Will initiate and complete the work within the applicable
time frame after receipt of approval of the awarding
agency.
7. Will establish safeguards to prohibit employees from
using their positions for a purpose that constitutes or
presents the appearance of personal or organizational
conflict of interest, or personal gain.
9. Will comply with the Lead-Based Paint Poisoning
Prevention Act (42 U.S.G. §§4801 at seq.) which
prohibits the use of lead-based paint in construction or
rehabilitation of residence structures.
10. Will comply with all Federal statutes relating to non-
discrimination. These include but are not limited to: (a)
Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race,
color or national origin; (b) Title IX of the Education
Amendments of 1972, as amended (20 U.S.C. §§1681
1683, and 1685-1686), which prohibits discrimination
on the basis of sex; (c) Section 504 of the
Rehabilitation Act of 1973, as amended (29 U.S.C.
§794), which prohibits discrimination on the basis of
handicaps; (d) the Age Discrimination Act of 1975, as
amended (42 U.S.C. §§6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse
Office and Treatment Act of 1972 (P.L. 92-255), as
amended, relating to nondiscrimination on the basis of
drug abuse; (f) the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) §§523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee
3), as amended, relating to confidentiality of alcohol
and drug abuse patient records; (h) Title VIII of the
Civil Rights Act of 1968 (42 U.S.G. §§3601 at seq.), as
amended, relating to nondiscrimination in the sale,
rental or financing of housing; (i) any other
nondiscrimination provisions in the specific statute(s)
under which application for Federal assistance is being
made; and, (j) the requirements of any other
nondiscrimination statute(s) which may apply to the
application.
Standard Form 424D (Rev. 7-97)
Previous Edition Usable Authorized for Local Reproduction Prescribed by OMB Circular A-102
11. Will comply, or has already complied, with the
requirements of Titles II and III of the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of
1970 (P.L. 91-646) which provide for fair and equitable
treatment of persons displaced or whose property is
acquired as a result of Federal and federally-assisted
programs. These requirements apply to all interests in real
property acquired for project purposes regardless of
Federal participation in purchases.
12. Will comply with the provisions of the Hatch Act (5 U.S.C.
§§1501-1508 and 7324-7328) which limit the political
activities of employees whose principal employment
activities are funded in whole or in part with Federal funds.
13. Will comply, as applicable, with the provisions of the Davis-
Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act
(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract
Work Hours and Safety Standards Act (40 U.S.C. §§327- 16.
333) regarding labor standards for federally-assisted
construction subagreements.
National Environmental Policy Act of 1969 (P.L. 91-
190) and Executive Order (EO) 11514; (b) notification
of violating facilities pursuant to EO 11738; (c)
protection of wetlands pursuant to EO 11990; (d)
evaluation of flood hazards in floodplains in accordance
with EO 11988; (e) assurance of project consistency
with the approved State management program
developed under the Coastal Zone Management Act of
1972 (16 U.S.C. §§1451 et seq.); (f) conformity of
Federal actions to State (Clean Air) Implementation
Plans under Section 176(c) of the Clean Air Act of
1955, as amended (42 U.S.C. §§7401 et seq.); (g)
protection of underground sources of drinking water
under the Safe Drinking Water Act of 1974, as
amended (P.L. 93-523); and, (h) protection of
endangered species under the Endangered Species Act
of 1973, as amended (P.L. 93-205).
Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. §§1271 et seq.) related to protecting
components or potential components of the national
wild and scenic rivers system.
14. Will comply with flood insurance purchase requirements of
Section 102(a) of the Flood Disaster Protection Act of 1973 17. Will assist the awarding agency in assuring compliance
(P.L. 93-234) which requires recipients in a special flood with Section 106 of the National Historic Preservation
hazard area to participate in the program and to purchase Act of 1966, as amended (16 U.S.C. §470), EO 11593
flood insurance if the total cost of insurable construction (identification and protection of historic properties), and
and acquisition is $10,000 or more. the Archaeological and Historic Preservation Act of
1974 (16 U.S.C. §§469a-1 et seq.).
15. Will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of 18. Will cause to be performed the required financial and
environmental quality control measures under the compliance audits in accordance with the Single Audit
Act Amendments of 1996 and OMB Circular No. A-133,
"Audits of States, Local Governments, and Non-Profit
Organizations."
19. Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations, and policies
governing this program.
SIGNATURE OF AUTH RIZED CERTIFYING OFFICIAL TITLE
. 6 City Manager
APPLICANT ORGANIZATION DATE SUBMITTED
City of Clearwater
March 15, 2011
SF-424D (Rev. 7-97) Back
KEY CONTACTS
AGENCY/ORGANIZATION DIRECTOR
(Individual authorized to sign the assistance agreement application and award acceptance.)
NAME: Mr. William B. Horne, 11
TITLE: City Manager
ADDRESS: City of Clearwater
PO Sox 4748
Clearwater, FL 33758-4748
TELEPHONE: (727) 562-4040 EMAIL william.horne@myclearwater.com
PROGRAMIPROJECT DIRECTOR
(Technical program director or person responsible for the project as a contact person in Block #S of the
application.)
NAME: L. Tracy Mercer
TITLE: Public Utilities Director
ADDRESS: 1650 N. Arcturas Avenue
Bldg C
Clearwater, FL 33765
TELEPHONE: (727) 562-4962 EMAIL tracy.mercer@myclearwater.com
FINANCE DIRECTOR
(Individual responsible for maintaining the accounting and financial management system supporting
expenditures, preparing the financial reports, etc.)
NAME: Jay Ravins
TITLE: Finance Director
ADDRESS: City of Clearwater
PO Box 4748
Clearwater, FL 33758-4748
TELEPHONE: (727) 562-4538 EMAIL jay.ravins@myclearwater.com
ATTACHMENT 3
SUPPLEMENTAL GENERAL INSTRUCTIONS
Note: Please refer to the instructions on the SF-424 form. Those items not discussed below
are considered self explanatory or adequately covered by the form instructions.
FACE SHEET - SF 424
ITEM
7. If a non-profit organization, please indicate your IRS classification. 501(c)(4)
organizations which lobby are not eligible for Federal financial assistance.
9. Please insert the name, if applicable, of the EPA person(s) from whom you
have received pre-application assistance. This ensures your application will
go to the appropriate EPA program office for review.
10. Insert the Catalogue of Federal Domestic Assistance number and title if
known. See enclosed list of catalog numbers and titles.
11. A BRIEF description of the project or program. A detailed description is
included in the workplan or project narrative.
13. The proposed project period should reflect the amount of time that will be
required to complete the ENTIRE scope of work.
14.a. Enter Congressional district numbers where office is located.
14.b. Enter district(s) affected by the program/project. If every district in State,
enter "Statewide."
16. The Intergovernmental Review process is necessary and can delay funding of
your application until completed. You should start this process as early as
possible but not later than 60 days prior to anticipated award. Contact your
State Clearinghouse to determine if an application review is required. You
must submit to EPA either a written statement that a review of the application
is not required or the Clearinghouse must provide EPA with comments on the
application. This review process may take as long as 60 days. See enclosed
list of State Points of Contact or alternate instructions. Tribes are encouraged
to comply with the process, but it is not mandatory.
18. The application must be signed by the person or entity who has authority to
commit the applicant to performance and compliance with the assurances
stated in SF 424D and to execute the assistance agreement on behalf of the
applicant.
GRANT PROGRAMS ADMINISTERED BY EPA
The Catalog of Federal Domestic Assistance (CFDA) is a government-wide compendium of
Federal programs, projects, services, and activities which provide assistance or benefits to the
American public. The CFDA contains financial and nonfinancial assistance programs
administered by departments and establishments of the Federal government.
For a listing of the CFDA and the assistance programs administered by EPA as contained in the
CFDA, please refer to the following web site:
http://www.epa.g_ov/ogd/grants/cfda.htm
Below is a listing of the grant programs administered by EPA as listed in the catalog:
66.001 Air Pollution Control Program Support
66.009 Air Information Center
66.032 State Indoor Radon Grants
66.033 Ozone Transport
66.202 Congressionally Mandated Projects
66.418 Construction Grants for Wastewater Treatment Works
66.419 Water Pollution Control: State and Interstate Program Support
66.432 State Public Water System Supervision
66.433 State Underground Water Source Protection
66.454 Water Quality Management Planning
66.456 National Estuary Program
66.458 Capitalization Grants for State Revolving Funds
66.460 Nonpoint Source Implementation Grants
66.461 Wetlands Grants
66.463 Water Quality Cooperative Agreements
66.466 Chesapeake Bay Program
66.467 Wastewater Operator Training Grant Program (Technical
Assistance)
66.468 Capitalization Grants for Drinking Water State Revolving Fund
66.469 Great Lakes Program
66.500 Environmental Protection: Consolidated Research
66.508 Senior Environmental Employment Program
66.600 Environmental Protection Consolidated Grants: Program
Support
66.604 Environmental Justice Grants to Small Community Groups
66.605 Performance Partnership Grants
66.606 Surveys, Studies, Investigations and Special Purpose Grants
66.607 Training and Fellowships for the Environmental Protection
Agency
66.608 One Stop Reporting
66.609 Children's Health Protection
66.700 Consolidated Pesticide Enforcement Cooperative Agreements
66.701 Toxic Substances Compliance Monitoring Cooperative
Agreements
66.707 TSCA Title IV State Lead Grants: Certification of Lead-Based
Paint Professionals
66.708 Pollution Prevention Grants Program
66.710 Environmental Justice Community/University Partnership
Grants Program
66.711 Environmental Justice through Pollution Prevention Grants
66.713 State and Tribal Environmental Justice
66.714 Pesticide Environmental Stewardship: Regional Grants
66.801 Hazardous Waste Management State Program Support
66.802 Superfund State Site: Specific Cooperative Agreements
66.804 State and Tribal Underground Storage Tanks Program
66.805 Leaking Underground Storage Tank Trust Fund Program
66.806 Superfund Technical Assistance Grants for Citizen Groups at
Priority Sites
66.807 Superfund Innovative Technology Evaluation Program
66.808 Solid Waste Management Assistance
66.809 Superfund State Core Program Cooperative Agreements
66.810 CEPP Technical Assistance Grants Program
66.811 Brownfield Pilots Cooperative Agreements
66.926 Indian Environmental General Assistance Program
66.930 U.S.-Mexico Border Grants Program
66.950 Environmental Education and Training Program
66.951 Environmental Education Grants
INTERGOVERNMENTAL REVIEW PROCESS
STATE POINTS OF CONTACT
(Refer to Attachment 2 for Application Form SF424.)
ALABAMA
BACKGROUND:
Executive Order 12372 and EPA's implementing regulations - 40 CFR Part 29, 40 CFR 30.12(c),
and 40 CFR 31.11 - require that all interested state, areawide, regional, and local agencies be
given the opportunity to review and to comment on proposed Federal assistance within their
area(s) of jurisdiction or influence. The regulations also provide for implementation of the
requirements of Section 204 of the Demonstration Cities and Metropolitan Development Act of
1966, as amended, which apply to all Federal assistance.
EPA cannot award assistance until all interested parties (e.g., State agencies, Planning and
Economic Development agencies) have been given the opportunity to review the proposed
project and all concerns of these agencies about the proposed project have been satisfactorily
disposed of by the applicant.
A copy of your application should be submitted to the appropriate agency (or agencies)
listed below for comment at least 60 days before sending your application to EPA. It is not
necessary to send an application to all Development Districts and agencies listed but only to
those agencies responsible for the area(s) affected or that may be affected by your proposed
project. Please include with your application to EPA a copy of all comments received and, if
required, an explanation of action taken to accommodate any concerns of the designated
agencies.
PROCEDURES:
Applicants for projects in Alabama having state-wide impact should submit a copy of their
applications to the CENTRAL ALABAMA REGIONAL PLANNING AND DEVELOPMENT
COMMISSION (REGION 9) on the list below. They are serving as the State Intergovernmental
Review Clearinghouse for these projects. For projects having local impact, applications should
be sent to the appropriate Regional Development Commission listed below.
REGION 1
NORTHWEST ALABAMA COUNCIL OF LOCAL GOVERNMENTS
Mr. Keith Jones, Executive Director
P.O. Box 2603
103 Student Drive
Muscle Shoals,AL 35662 256/389-0500 FAX 256/389-0599
REGION 2
WEST ALABAMA REGIONAL COMMISSIION
Mr. Robert B. Lake, Executive Director
4200 Highway 69 North, Suite 1
Northport, AL 35473 205/333-2990 FAX 205/333-2713
REGION 3
BIRMINGHAM REGIONAL PLANNING COMMISSION
Mr. Charles Ball, Executive Director
2112 Eleventh Avenue, South
Magnolia Office Park, Suite 220
Birmingham, AL 36256 205/251-8139 FAX 205/328-3304
REGION 4
EAST ALABAMA REGIONAL PLANNING AND DEVELOPMENT COMMISSION
Mr. Bill Curtis, Executive Director
P.O. Box 2186
1130 Quintard Avenue, Suite 300
Anniston, AL 36202 256/237-6741 FAX 256/237-6763
REGION 5
SOUTH CENTRAL ALABAMA DEVELOPMENT COMMISSION
Tyson Howard, Executive Director
5900 Carmichael Place
Montgomery, AL 36117 334/244-6903 FAX 334-270-0038
REGION 6
ALABAMA-TOMBIGBEE REGIONAL COMMISSION
Mr. John C. Riggs, Executive Director
107 Broad Street
Camden, AL 36726 334/682-4234 FAX 334/682-4205
REGION 7
SOUTHEAST ALABAMA REGIONAL PLANNING & DEVELOPMENT COMMISSION
Mr. Thomas B. Solomon, Executive Director
P.O. Box 1406
462 North Oates Street
Dothan, AL 36302 334/794-4093 FAX 334/794-3288
REGION 8
SOUTH ALABAMA REGIONAL PLANNING COMMISSION
Mr. Russ Wimberly, Executive Director
P.O. Box 1665
651 Church Street
Mobile, AL 36633 251/433-6541 FAX 334/433-6009
REGION 9
CENTRAL ALABAMA REGIONAL PLANNING & DEVELOPMENT COMMISSION
Mr. Bob Grasser, Executive Director
125 Washington Avenue, 3`d Floor
Montgomery, AL 36104 334/262-4300 FAX 334/262-6976
REGION 10
LEE-RUSSELL COUNCIL OF GOVERNMENTS
Ms. Suzanne G. Burnette, Executive Director
2207 Gateway Drive
Opelika, AL 36801 334/749-5264 FAX 334/749-6582
REGION 11
NORTH CENTRAL ALABAMA REGIONAL COUNCIL OF GOVERNMENTS
Mr. C. Ronald Matthews, Executive Director
216 Jackson Street, SE
F.O. Box C
Decatur, AL 35602 205/355-4515 FAX 205/351-1380
REGION 12
TOP OF ALABAMA REGIONAL COUNCIL OF GOVERNMENTS
Mr. Bob Culver, Executive Director
115 Washington Street, SE
Huntsville, AL 35801 256/533-3330 FAX 256/533-3442
Fl<,nR TD A
Ms. Lauren P. Milligan
Florida State Clearinghouse
Florida Department of Environmental Protection
3900 Commonwealth Blvd, Mail Station 47
Tallahassee, FL 32399-3000 850/245-2161 FAX 850/245-2190
GEORGIA
Ms. Barbara Jackson, Administrator
Georgia State Clearinghouse
Office of Planning and Budget
270 Washington Street, SW
Atlanta, GA 30334 404/656-3855
KENTUCKY
Ms. Lee Nalley, Manager
Kentucky State Clearinghouse
Department of Local Governments
1024 Capital Center Drive, Suite 340
Frankfort, KY 40601 502/573-2382 FAX 502/573-1519
MISSISSIPPI
Central MS PDD
F. Clarke Holmes
Chief Executive Officer
PO Box 4935
Jackson, MS 39296-4935
Tel: (601) 981-1511
Fax: (601) 981-1515
cholmes@cmpdd.org
East Central PDD
Bill Richardson
Executive Director
PO Box 499
Newton, MS 39345
Tel: (601) 683-2007
Fax: (601) 683-7873
mail@ecpdd.org
Golden Triangle PDD
Rupert "Rudy" Johnson
Executive Director
PO Box 828
Starkville, MS 39760-0828
Tel: (662) 324-7860
Fax: (662) 324-7328
rjohnson@gtpdd.com
North Central PDD
Steve Russell
Executive Director
711 South Applegate
Winona, MS 38967
(662) 283-2675
(662) 283-5875 - fax
srussell@ncpdd.org
North Delta PDD
Glenn Brown
Executive Director
PO Box 1488
Batesville, MS 38606
Tel: (662) 561- 4100
Fax: (662) 561- 4112
batesville@ndpdd.com
Northeast MS PDD
Sharon Gardner
Executive Director
PO Box 600
Booneville, MS 38829
Tel: (662) 728-6248
Fax: (662) 728-2417
sgardner@nempdd.com
South Delta PDD
William B. "Billy"Haney, Jr.
Executive Director
PO Box 1776
Greenville, MS 38702
Tel: (662) 378-3831
Fax: (662) 378-3834
sdpdd@bellsouth.net
Southern MS PDD
Leslie Newcomb
Executive Director
9229 Highway 49
Gulfport, MS 39503
Tel: (228) 868-2311
Fax: (228) 868-7094
les@sdpdd.com
Southwest MS PDD
Wirt L. Peterson
Executive Director
100 South Wall Street
Natchez, MS 39120
Tel: (601) 446-6044
Fax: (601) 446-6071
wpetersonl@bellsouth.net
Three Rivers PDD
Vernon R. "Randy" Kelley
Executive Director
PO Box 609
Pontotoc, MS 38863
Tel: (662) 489-2415
Fax: (662) 489-6815
vrkgtrpdd.com
NORTH CAROLINA
Since the State of North Carolina currently has no Single Point of Contact for
Intergovernmental Review, a copy of your application should be submitted to the
appropriate agency(ies) listed below for comment at least 60 days before sending your
application to EPA. It is not necessary to send an application to all Development Districts
and agencies listed but should be sent only to those agencies responsible for the area(s)
affected or that may be affected by your proposed project. Please include with your
application to EPA a copy of all comments received and, if required, an explanation of
action taken to accommodate any concerns of the designated agencies.
PROCEDURES:
Applicants should also send a copy to the appropriate North Carolina Regional Council
listed below:
SOUTHWESTERN COMMISSION
Mr. Bill Gibson
125 Bonnie Lane
Sylva, NC 28779 828/586-1962 FAX 828/586-1968
LAND OF SKY REGIONAL COG
Mr. Joe McKinney
25 Heritage Drive
Asheville, NC 28806
828/251-6622 FAX 828/251-6353
ISOTHERMAL PLANNING AND DEVELOPMENT COMMISSION
Mr. Jim Edwards
P.O. Box 841
Rutherford, NC 28139 828/287-2281 FAX 828/287-2735
HIGH COUNTRY COG
Mr. Rick Herdon
P.O. Box 1820
Boone, NC 28607
WESTERN PIEDMONT COG
Mr. Douglas Taylor
P.O. Box 9026
Hickory, NC 28603
CENTRALINA COG
Mr. A.R. Sharp
P.O. Box 35008
Charlotte, NC 28235
TRIANGLE J COG
Mr. Dee Freeman
P.O. Box 12276
Research Triangle Park, NC 27709
KERR-TAR REGIONAL COG
Mr. Timothy Baynes
P.O. Box 709
Henderson, NC 27536
UPPER COASTAL PLAIN COG
Mr. Greg Godard
P.O. Drawer 2748
Rocky Mount, NC 27802
MID-CAROLINA COG
Mr. James Caldwell
P.O. Drawer 1510
Fayetteville, NC 28302
828/265-5434 FAX 828/265-5439
828/322-9191 FAX 828/322-5991
704/372-2416 FAX704/347-4710
919/558-9395 FAX 919/549-9390
252/436-2040 FAX 252/436-2055
252/446-0411 FAX 252/446-5651
910/323-4191 FAX 910/323-9330
LUMBER RIVER COG
Mr. James Perry
4721 Fayetteville Road
Lumberton, NC 28358
CAPE FEAR COG
Mr. Chris May
1480 Harbour Drive
Wilmington, NC 28401
EASTERN CAROLINA COG
Mr. Larry Moolenaar
P.O. Box 1717
New Bern, NC 28563
910/618-5533 FAX 910/618-5576
910/395-4553 FAX 910/395-2684
252/638-3185 FAX 252/638-3187
PIEDMONT TRIAD COG
Mr. Randall Billings
Willington Building, Suite 201
2216 W. Meadowview Road, Suite 201
Greensboro, NC 27407-3480 336/294-4950 FAX 336/632-0457
NORTHWEST PIEDMONT COG
Mr. Matthew Dolge
400 West Fourth Street, Suite 400
Winston Salem, NC 27101 336/761-2111 FAX 336/761-2112
MID-EAST COMMISSION
Mr. Tim Ware
P.O. Box 1787
Washington, NC 27889 252/946-8043 FAX 252/946-5489
ALBEMARLE COMMISSION
Mr. Adrian Cox
P.O. Box 646
Hertford, NC 27944 252/426-5753 FAX 252/426-8482
SOUTH CAROLINA
SC Clearinghouse
Budget and Control Board
Office of State Budget
1201 Main Street, Suite 950
Columbia, SC 29201 803/734-0494 FAX 803/734-0645
TENNESSEE
BACKGROUND:
Executive Order 12372 and EPA's implementing regulations - 40 CFR Part 29, 40 CFR 30.12(c),
and 40 CFR 31.11 - require that all interested state, area wide, regional, and local agencies be
given the opportunity to review and to comment on proposed Federal assistance within their
area(s) of jurisdiction or influence. The regulations also provide for implementation of the
requirements of Section 204 of the Demonstration Cities and Metropolitan Development Act of
1966, as amended, which apply to all Federal assistance.
EPA cannot award assistance until all interested parties (e.g., State agencies, Planning and
Economic Development agencies) have been given the opportunity to review the proposed
project and all concerns of these agencies about the proposed project have been satisfactorily
disposed of by the applicant.
Since the State of Tennessee currently has no Single Point of Contact for Intergovernmental
Review, a copy of your application should be submitted to the appropriate agency(ies) listed
below for comment at least 60 days before sending your application to EPA. It is not necessary
to send an application to all Development Districts and agencies listed but should be sent only to
those agencies responsible for the area(s) affected or that may be affected by your proposed
project. Please include with your application to EPA a copy of all comments received and, if
required, an explanation of action taken to accommodate any concerns of the designated
agencies.
PROCEDURES:
Therefore, applicants for projects in Tennessee should submit a copy of their applications to each
of the appropriate State Agency Grant Review Contacts.
Mr. Tim Roach
Department of Economic and Community Development
Local Planning Division
6th Floor, Rachel Jackson Building
Nashville, TN 37243 615/741-2211
Mr. Paul E. Davis, Director
Department of Environment and Conservation
Division of Water Pollution Control
401 Church Street
5t' Floor, L & C Tower
Nashville, TN 37243 615/532-0625
Ms. Nancy Sartor
Department of Transportation
6th Floor, James K. Polk Building
Nashville, TN 37243 615/532-3183
Mr. Richard G. Tune, Officer
Tennessee Historical Commission
2941 Lebanon Road
Nashville, TN 37243-0442 615/332-1550
Mr. Robert Todd
Tennessee Wildlife Resources Agency
P.O. Box 40747
Nashville, TN 37204 615/781-6572
Applicants should also send a copy to the appropriate Tennessee Development District listed
below:
NORTHWEST TENNESSEE
Mr. John Bucy, Executive Director
124 Weldon Drive
Martin, TN 38237 731/587-4213
GREATER NASHVILLE REGIONAL COUNCIL
Mr. Sam Edwards, Executive Director
501 Union Street, 6`h Floor
Nashville, TN 37219-1705 615/862-8828
UPPER CUMBERLAND
Ms. Wendy Askins, Executive Director
1225 South Willow Ave.
Cookeville, TN 38506 931/432-4111
FIRST TENNESSEE
Ms. Susan Roberts Reid, Executive Director
207 North Boone Street, Suite 800
Johnson City, TN 37604 423/928-0224
MEMPHIS AREA ASSOCIATION OF GOVERNMENTS
Mr. John Sicola, Executive Director
1420 Union Ave., Suite 410
Memphis, TN 38104 901/729-2871
SOUTHWEST TENNESSEE
Mr. Joe Barker, Executive Director
Williamsburg Office Park
27 Conrad Drive, Suite 150
Jackson, TN 38305 731/668-7112
SOUTH CENTRAL TENNESSEE
Mr. Jerry Mansfield,. Executive Director
815 South Main
P.O. Box 1346
Columbia, TN 38402 931/381-2040
SOUTHEAST TENNESSEE
Ms. Beth Jones, Executive Director
25 Cherokee Boulevard
P.O. Box 4757
Chattanooga, TN 37405 423/266-5781
EAST TENNESSEE
Mr. Terry Bobrowski, Executive Director
5616 Kingston Pike
P.O. Box 19806
Knoxville, TN 37939 865/584-8553
ATTACHMENT 4
LOBBYING CERTIFICATION
The attached Anti-Lobbying Recipient Certification must
be completed and returned if you are requesting $100,000
or more in federal funds.
Please use the Disclosure of Lobbying Activities form (SF-LLL)
for reporting Lobbying activities to the EPA
pursuant to 31 U.S.C. 1352.
CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants,
Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or
employee of 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) If any funds other than Federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with this Federal contract, grant, loan, or cooperative
agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure
Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the
award documents for all subawards at all tiers (including subcontracts, subgrants, and
contracts under grants, loans, and cooperative agreements) and that all subrecipients shall
certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when
this transaction was made or entered into. Submission of this certification is a prerequisite
for making or entering into this transaction imposed by section 1352, title 31, U.S. Code.
Any person who fails to file the required certification shall be subject to a civil penalty of
not less than $10,000 and not more than $100,000 for each such failure.
Rosemarie Call, CNC, City Clerk
TYPED NAME & TITLE OF AUTHORIZED REPRESENTATIVE
3?i??rl
/C•Qd[h(R.ln. 041Q,
SIGNATURE OF AUTHORIZED REPRESENTATIVE DATE
I am unable to certify to the above statements. My explanation is attached.
DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB
Complete this form to disclose lobbying activities pursuant to 31 U.S.C, 1352 0348-0046
I.Rap ravarsa fnr nuhlir hurden disclosure.l
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
b? a. contract na, bid/offer/application KI a. initial filing
b. grant LL JJb. initial award b. material change
c. cooperative agreement c. post-award For Material Change Only:
d. loan year quarter
e. loan guarantee date of last report
f. loan insurance
4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is a Subawardee, Enter Name
0 Prime ? Subawardee and Address of Prime:
Tier , if known :
city of Clearwater Northeast WRF
3290 SR 580
Safety Harbor, FL 34695
Congressional District, if known : 09 Congressional District, if known :
6. Federal Department/Agency: 7. Federal Program Name/Description:
US Environmental Protection Agency EPA STAG Water & Wastewater Infrastructure Project
CFDA Number, if applicable:
8. Federal Action Number, if known: 9. Award Amount, if known:
$ 485,000.00
10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address if
(if individual, last name, first name, M/): different from No. 10a)
(last name, first name, Ml):
Alcalde & Fay Alcalde, Hector and McBeth, Danielle L.
2111 Wilson Boulevard, 8th Floor
Arlington, VA 22201
11, Information requested through this form is authorized by title 31 U.S.C. section
of fact
tio
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i
t
l
t
i Signature: ?'??
s a ma
er
a
represen
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1352. This disclosure of lobbying activi
ies
upon which reliance was placed by the tier above when this transaction was made Rosemarie Call, CMC
Print Name:
or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This
Information will be available for public inspection. Any person who fails to file the City Clerk
000 and
uired disclosure shall be subject to a civil penalty of not less than 510
re Title:
,
q
not more than $100,000 for each such failure.
Telephone No.: (727) 562-4091 Date:
Federal 'Use Only: Authorized for Local Reproduction
Standard Form LLL (Rev. 7-97)
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal
action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreementto make
payment to any lobbying entity 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 employeeof a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing and material
change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a followup report caused by a material change to the information previously reported, enter
the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal
action.
4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification
of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee
of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.
5. If the organization filing the report in item 4 checks 'Subawardee,'then enter the full name, address, city, Slate and zip code of the prime Federal
recipient. Include Congressional District, if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For
example, Department of Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance
(CFDA) number for grants, cooperative agreements, loans, and loan commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number;
Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number
assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001."
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan
commitment for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting
entity identified in item 4 to influence the covered Federal action.
(b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a). Enter Last Name, First Name, and
Middle Initial (MI).
11. The certifying official shall sign and date the form, print his/her name, title, and telephone number-
According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB Control
Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information is
estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the Office of Managementand Budget, Paperwork Reduction Project (0348-0046), Washington,
DC 20503.
ATTACHMENT 5
PRE-AWARD COMPLIANCE REPORT -
EPA FORM 4700-4
This report must be completed and submitted with your application.
Guidelines for the pre-award compliance review of this form are
provided on the pages following the form.
PRE-AWARD COMPLIANCE REPORT -
EPA FORM 4700-4
TITLE VI, CIVIL RIGHTS ACT OF 1964
As required by 40 CFR Part 7, all applicants must include a completed EPA Form 4700-
4, Pre-award Compliance Review Report, with any/all requests for federal financial assistance.
Grant applications will not be processed if this form is not submitted State applicants may
submit the form annually with the other required yearly certifications.
All applicants must complete roman numerals I through V. Sections VI through IX must
be completed if applicable to the assisted program. If any of the information in Sections VI
through IX is not relevant to the project or program for which assistance is requested, please
enter "NA" for "Not Applicable." Loan recipients under EPA funded grantee revolving loan
programs shall also complete and submit the form to the state agency authorizing the loan.
Applicants for the Hardship Grants Program for Rural Communities shall also complete and
submit the form to the appropriate State agency.
Any questions relating to these requirements should be directed to the Regional Equal
Employment Opportunity (EEO) Officer:
Rhonda Bailey (Region 4 EEO Officer) at (404) 562-9442.
FORM Approved By OMB: No. 2030-0020 Expires 04-30-2012
Preaward Compliance Review Report for
All Applicants and Recipients Requesting EPA Financial Assistance
Note: Read instructions on other side before completing form.
I. Applicant/Recipient (Name, Address, State, Zip Code). City of Clearwater, 1650 N. Arcturas Avenue, Clearwater, FL DUNS No
33765 07-0830-7301
II. Is the applicant currently receiving EPA assistance? Yes
III. List all civil rights lawsuits and administrative complaints pending against the applicant/recipient that allege discrimination based on race,
color, national origin, sex, age, or disability. (Do not include employment complaints not covered by 40 C.F.R. Parts 5 and 7. See
instructions on reverse side.) Angel Berlingeri (#511-2010-02159), Michael L. Faulkner (#511-2008-01548), Dwayne C. Vaughan
(#511-2008-01620) & Monica Iuarbe (#511-2010-00455)
IV. List all civil rights lawsuits and administrative complaints decided against the applicant/recipient within the last year that allege
discrimination based on race, color, national origin, sex, age, or disability and enclose a copy of all decisions. Please describe all corrective
action taken. (Do not include employment complaints not covered by 40 C.F.R. Parts 5 and 7. See instructions on reverse side.) We have
no lawsuits or administrative com laints that have decided against us in the last year.
V. List all civil rights compliance reviews of the applicant/recipient conducted by any agency within the last two years and enclose a copy of the
review and any decisions, orders, or agreements based on the review. Please describe any corrective action taken. (40 C.F.R. § 7.80(c)(3))
None
VI. Is the applicant requesting EPA assistance for new construction? If no, proceed to VII; if yes, answer (a) and/or (b) below.
? Yes X No
a. If the grant is for new construction, will all new facilities or alterations to existing facilities be designed and constructed to be readily accessible
to and usable by persons with disabilities? If yes, proceed to VII; if no, proceed to VI(b). ? Yes ? No
b. If the grant is for new construction and the new facilities or alterations to existing facilities will not be readily accessible to and usable by
persons with disabilities, explain how a regulatory exception (40 C.F.R. § 7.70 applies. ? Yes ? No
Vll,* Does the applicant/recipient provide initial and continuing notice that it does not discriminate on the basis of race, color, national origin, sex, age,
or disability in its programs or activities? (40 C.F.R. § 5.140 and § 7.95) X Yes ? No
a. Do the methods of notice accommodate those with impaired vision or hearing? X Yes ? No
b. Is the notice posted in a prominent place in the applicant's offices or facilities or, for education programs and activities, in appropriate
periodicals and other written communications? X Yes ? No
c. Does the notice identify a designated civil rights coordinator? X Yes ? No
VIII.* Does the applicant/recipient maintain demographic data on the race, color, national origin, sex, age, or handicap of the population it serves? (40
C.F.R. § 7.85(a Yes
IX.* Does the applicant/recipient have a policy/procedure for providing access to services for persons with limited English proficiency? (40 C.F.R.
Part 7, E.O. 13166 Yes
X. * If the applicant/recipient is an education program or activity, or has 15 or more employees, has it designated an employee to coordinate its
compliance with 40 C.F.R. Parts 5 and 7? Provide the name, title, position, mailing address, e-mail address, fax number, and telephone number of
the designated coordinator. Cynthia Davis-Gryce, Equity Services Manager, P.O. Box 4748, Clearwater, FL 33758,
Cynthia. davi s-r ce m clearwater.com, 727-562-4059, 727-562-4072
XI* If the applicant/recipient is an education program or activity, or has 15 or more employees, has it adopted grievance procedures that assure the
prompt and fair resolution of complaints that allege a violation of 40 C.F.R. Parts 5 and 7? Provide a legal citation or Internet address for, or a copy
of, the procedures, Yes
For the Applicant/Recipient I certify that the statements I have made on this form and all attachments thereto are true, accurate and complete. I
acknowledge that any knowingly false or misleading statement maybe punishable by fine or imprisonment or both under applicable law. 1 assure that I
will full comply with all applicable civil rights statutes and EPA regulations.
A. Si ature of Authorized Official B. Title of Authorized Official C. Date
Ci Mana er
For the U.S. Environmental Protection Agency I have reviewed the information provided by the applicant/reeipient and hereby certify that the
applicant/recipient has submitted all preaward compliance information required by 40 C.F.R. Parts 5 and 7; that based on the information submitted, this
application satisfies the preaward provisions of 40 C.F.R. Parts 5 and 7; and that the applicant has given assurance that it will fully comply with all
applicable civil rights statutes and EPA regulations.
A. Signature of Authorized EPA Official B. Title of Authorized EPA Official C. Date
See ** note on reverse side.
EPA Form 4700-4 (Rev. 04/2009). Previous editions are obsolete.
r
ADMINISTRATIVE POLICY & PROCEDURE MANUAL
SECTION: Personnel POLICY NO.: 3201.2
ADMINISTERING DEPARTMENT (S): Equity Services
SUBJECT: Equal Employment Opportunity Policies
Purpose:
To foster and maintain a healthy working environment in which equal employment
opportunities for all people can thrive, while truly appreciating the value of diversity in
thought, being, and expression within our working relationships. These policies support
required compliance with federal, state, and local employment laws.
Policy:
It is the policy of the City of Clearwater that no person shall be unlawfully discriminated
against with regard to recruitment, selection, appointment, training, promotion,
retention, discipline or other aspects of employment because of any consideration of
race, color, religion, national origin, age, disability, marital status, or gender (including
conditions of pregnancy and sexual harassment), or genetic or family medical history
information as defined by the Genetic Information Nondiscrimination Act. The
importance of permitting equal opportunity protest is affirmed, and the City of
Clearwater will not tolerate any illegal acts of retaliation against any employee who
exercises his/her rights under these policies.
Definitions:
Applicable definitions are contained within the body of these policies.
Administrative Repeal:
The provisions contained herein shall supersede and replace all prior policies and procedures
regarding this subject.
/s/ William B. Horne II 12/17/2010
William B. Horne II, City Manager Date
Effective Date: April 6, 2000
Amended or Reissue Date: 12/17/2010
Reference(s): Federal, State, & Local Equal Employment Opportunity laws
Page 1 of 4
CY,?M
ADMINISTRATIVE POLICY & PROCEDURE MANUAL
Administering Department: Legal Policy Committee
Procedure: See Attached.
Equal Employment Opportunity Policies
City of Clearwater, Florida
Any employment issue concerning situations of perceived unequal treatment based upon
alleged consideration of race, color, religion, national origin, age, disability, marital status,
gender (including conditions of pregnancy and sexual harassment), or genetic or family medical
history information must immediately be referred to the Equity Services Division for technical
assistance. Other em to ee concerns ertainin to treatment or circumstances not related to an
classification listed above should be referred to the Human Resources De artment for review under
citywide values and standards.
It is the intent of these 12olicies to ensure the continuous well being of our work laces b :
• Removing all non-job-related barriers to the employment, placement, and promotion of
minorities, women, and the differently-able.
• Attaining and maintaining a workforce composition that proportionately represents the make-
up of the community as reflected in the local Metropolitan Statistical Area data compiled
from the most current federal census information.
• Ensuring that under-represented and under-utilized classes within our organization are
provided the opportunity to earn promotion and placement into all levels of supervision and
management, as well as desired positions of responsibility.
• Recruiting and employing qualified multi-lingual persons in all categories as needed to
provide adequate services to the citizenry.
The City Manager and all administrative management personnel are committed to equal
employment opportunity and will adhere to all equal employment opportunity laws and policies
to ensure the equitable treatment of all employees. The City Manager shall be accountable for
the development, implementation, and administration of the City of Clearwater equal
employment opportunity obligations and objectives.
The Equity Services Manager shall assist the City Manager in interpreting the policies and processes
necessary for compliance with local, state and federal equal employment opportunity laws.
Additionally, the Equity Services Manager shall provide equal employment opportunity investigative
services and training to City of Clearwater personnel in order to maintain equal employment
opportunity objectives. The Equity Services Manager shall be responsible for responding to equal
employment opportunity inquiries made by properly authorized regulatory agencies.
Page 2 of 4
Ny
ADMINISTRATIVE POLICY & PROCEDURE MANUAL
Discriminatory Conduct Policy:
All City of Clearwater personnel are required to maintain the values of equal employment
opportunity and appreciating diversity within our organization. As a part of this commitment,
employees shall not at any time during working hours or while in any circumstance that
could impact upon employment rights engage in or be subjected to offensive verbal, visual,
or physical misconduct which has the effect of denigrating or abusing people because of a
consideration of race, color, religion, national origin, age, disability, marital status, gender,
(including conditions of pregnancy and sexual harassment), or genetic or family medical
history information as defined by the Genetic Information Nondiscrimination Act.
It is imperative that the City of Clearwater assumes leadership in this important area. All
managers and supervisors are required to ensure that the spirit of this policy is fully
implemented and vigorously enforced. The City considers misconduct that contravenes the
intent of these equal employment opportunity policies to be among the most serious
violations of City policy that an employee can commit, and deserving of serious disciplinary
action, up to and including termination of employment. The City Manager, or appointed
designee shall enforce these policies to the extent necessary to preserve the proper values
of our organization.
• Should any incidents of discriminatory abuse or harassment by the public towards any City
employee occur while on working assignments, the City authorizes its employees to
immediately return to administrative offices to report the incident to supervision. Public
safety employees will follow departmental procedures. The City will advise the offender of its
policy to protect its employees against abuse.
Hostile Environment Policy:
The City of Clearwater will not tolerate hostile, offensive or intimidating conduct that is
repeated, unwanted, unwelcome and impedes the ability of employees to perform job duties;
or is so severe, persistent, and pervasive that it alters the terms and conditions of
employment so as to create an abusive working environment because of any consideration
of race, color, religion, national origin, disability, age, marital status, gender, (including
conditions of pregnancy and sexual harassment), or genetic or family medical history
information as defined by the Genetic Information Nondiscrimination Act.
Sexually hostile environment claims shall be defined as, but not limited to: 1) unwanted
physical contact; 2) unwelcome sexually explicit language, innuendo, or gestures; 3)
uninvited or unwanted sexual advances; 4) the intrusion into the workplace of unwanted
sexually explicit materials or images that could be characterized as being offensive or
demeaning from the perspective of sex or gender; and 5) gender-based differences in
treatment that are hostile and intimidating.
• Hostile environment claims may be caused by non-employees; such as vendors, citizens,
and other third parties. This type of misconduct will not be tolerated.
Page 3 of 4
I.•
ADMINISTRATIVE POLICY & PROCEDURE MANUAL
F
Sexual Harassment Prohibitions:
Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct
of a sexual nature constitute illegal sexual harassment when; 1) submission to such conduct is
made either explicitly or implicitly a term or condition of an individual's continued employment;
2) submission to, or rejection of such conduct by an individual is used for the basis for
employment decisions affecting such individual; or 3) such conduct has the purpose or effect of
unreasonably interfering with an individual's work performance or creating an intimidating,
hostile, or offensive working environment. The City of Clearwater prohibits unlawful sexual
harassment.
Complaint Obligations:
• Any employee who feels or believes he/she may have been the victim of misconduct as
described in these policies is obliged to report the alleged misconduct to supervision. Every
effort should be made to resolve the issue at the lowest level of problem resolution.
• Employees may express their equal employment opportunity concerns directly to the Equity
Services Manager, who serves as the City of Clearwater Equal Employment Opportunity
Officer.
• Supervisors and managers must immediately report the receipt of equal opportunity
concerns received from employees to the Equity Services Division to ensure the appropriate
technical assistance in responding to the concern.
• Swift, remedial corrective activity should be undertaken to diminish the potential for
escalating the problem until a thorough review of the issues can be completed.
• Upon notification of the equal employment opportunity concern, the Equity Services Division
will investigate the matter, or guide a preliminary review.
• Equal employment opportunity complaints submitted by public safety employees who have
specialized rights will be reviewed in a collaborative style by the affected department and
the Equity Services Division to ensure the preservation of the specialized rights.
• Retaliation against any employee for having utilized his/her rights under these policies is
strictly prohibited.
Nothing within these policies shall be construed to create any limitation upon the rights of
employees to additionally address an employment equity concern through any legally
appropriate means available.
Findings and compliance recommendations resulting from Equity Services Division internal
reviews of equal employment opportunity concerns will be forwarded to the City Manager, or
designee for appropriate action. Should evidence of reasonable reliability confirm any violations
of these policies or equal opportunity law, the violator would be subject to discipline, up to and
including termination of employment. The City of Clearwater will take whatever actions are
necessary to preserve its values for equal employment opportunity and appreciating diversity
within our organization.
Page 4 of 4
Instructions for EPA FORM 4700-4 (Rev. 03/2008)
General
Recipients of Federal financial assistance from the U.S.
Environmental Protection Agency must comply with the following
statutes and regulations.
Title VI of the Civil Ri hts Acts of 1964 provides that no person in
the United States shall, 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. The Act goes on to explain
that the statute shall not be construed to authorize action with respect
to any employment practice of any employer, employment agency, or
labor organization (except where the primary objective of the Federal
financial assistance is to provide employment).
Section 13 of the 1972 Amendments to the Federal Water Pollution
Control Act provides that no person in the United States shall on the
ground of sex, be excluded from participation in, be denied the
benefits of, or be subjected to discrimination under the Federal Water
Pollution Control Act, as amended. Employment discrimination on
the basis of sex is prohibited in all such programs or activities.
Section 504 of the Rehabilitation Act of 1973 provides that no
otherwise qualified individual with a disability in the United States
shall solely by reason of disability be excluded from participation in,
be denied the benefits of, or be subjected to discrimination under any
program or activity receiving Federal financial assistance.
Employment discrimination on the basis of disability is prohibited in
all such programs or activities.
The Age Discrimination Act of 1975 provides that no person on the
basis of age shall be excluded from participation under any program
or activity receiving Federal financial assistance. Employment
discrimination is not covered. Age discrimination in employment is
prohibited by the Age Discrimination in Employment Act
administered by the Equal Employment Opportunity Commission.
Title IX of the Education Amendments of 1972 provides that no
person in the United States on the basis of sex shall be excluded from
participation in, be denied the benefits of, or be subjected to
discrimination under any education program or activity receiving
Federal financial assistance. Employment discrimination on the basis
of sex is prohibited in all such education programs or activities.
Note: an education program or activity is not limited to only those
conducted by a formal institution.
40 C.F.R. Part 5 implements Title IX of the Education Amendments
of 1972.
40 C.F.R. Part 7 implements Title V1 of the Civil Rights Act of 1964,
Section 13 of the 1972 Amendments to the Federal Water Pollution
Control Act, and Section 504 of The Rehabilitation Act of 1973.
The Executive Order 13166 (E.O. 13166) entitled; "Improving
Access to Services for Persons with Limited English Proficiency"
requires Federal agencies work to ensure that recipients of Federal
financial assistance provide meaningful access to their LEP
applicants and beneficiaries.
Items
"Applicant" means any entity that files an application or unsolicited
proposal or otherwise requests EPA assistance. 40 C.F.R. §§ 5.105,
7.25.
"Recipient" means any entity, other than applicant, which will actually
receive EPA assistance. 40 C.F.R. §§ 5.105, 7.25.
"Civil rights lawsuits and administrative complaints" means any
lawsuit or administrative complaint alleging discrimination on the
basis of race, color, national origin, sex, age, or disability pending or
decided against the applicant and/or entity which actually benefits
from the grant, but excluding employment complaints not covered by
40 C.F.R. Parts 5 and 7. For example, if a city is the named applicant
but the grant will actually benefit the Department of Sewage, civil
rights lawsuits involving both the city and the Department of Sewage
should be listed.
"Civil rights compliance review" means any review assessing the
applicant's and/or recipient's compliance with laws prohibiting
discrimination on the basis of race, color, national origin, sex, age, or
disability.
Submit this form with the original and required copies of applications,
requests for extensions, requests for increase of funds, etc. Updates of
information are all that are required after the initial application
submission.
If any item is not relevant to the project for which assistance is
requested, write "NA" for "Not Applicable."
In the event applicant is uncertain about how to answer any questions,
EPA program officials should be contacted for clarification.
* Questions VII - XI are for informational use only and will not affect
an applicant's grant status. However, applicants should answer all
questions on this form. (40 C.F.R. Parts 5 and 7).
** Note: Signature appears in the Approval Section of the EPA
Comprehensive Administrative Review For Grants/Cooperative
Agreements & Continuation/Supplemental Awards form.
Approval indicates, in the reviewer's opinion, questions I - VI of Form
4700-4 comply with the preaward administrative requirements for EPA
assistance.
"Burden Disclosure Statement"
EPA estimates public reporting burden for the preparation of this form
to average 30 minutes per response. This estimate includes the time
for reviewing instructions, gathering and maintaining the data needed
and completing and reviewing the form. Send comments regarding the
burden estimate, including suggestions for reducing this burden, to
U.S. EPA, Attn: Collection Strategies Division (MC 2822T), Office of
Information Collection, 1200 Pennsylvania Ave., NW, Washington,
D.C. 20460; and to the Office of Information and Regulatory AtTairs,
Office of Management and Budget, Washington, D.C. 20503.
The information on this form is required to enable the U.S.
Environmental Protection Agency to determine whether applicants and
prospective recipients are developing projects, programs and activities
on a nondiscriminatory basis as required by the above statutes and
regulations.
Guidelines for Preaward Compliance Review of EPA Form 4700-4
EPA Form 4700-4 must be completed by all applicants of EPA assistance. Questions I through VI
of Form 4700-4 pertain to the preaward compliance requirements in EPA's nondiscrimination regulations
found at 40 C.F.R. Parts 5 and 7. The EPA Grants Management Office should review questions I - VI for
administrative compliance with the preaward requirements found in EPA's nondiscrimination regulations.
Blocks I through VI should be reviewed as follows:
1. Block I:
The applicant's name and mailing address must match the information provided in the grants
application package. The DUNS number must be correct.
2. Block II:
The applicant must state "yes" or "no" in this block.
3. Blocks III - V:
If the answer to Blocks III, IV and V is "Not Applicable (N/A)" or "None," then the GMO
Reviewer should proceed to Block VI.
If the answer to Blocks 111, IV or V is "Yes" or left blank, the Reviewer should immediately scan
the Form and send it via e-mail to the appropriate Equal Employment Opportunity (EEO) Officer
and OCR Official requesting further review. The e-mail should describe the item requiring a
more detailed examination.
The EEO Officer will make a determination of the applicant's compliance within 30 calendar
days of the request from the GMO Reviewer. The EEO Officer will send the determination to the
GMO Reviewer via e-mail.
4. Block VI:
If the requested EPA assistance does not pertain _to the construction or alteration of a facility, then
this question does not apply. The applicant has now fulfilled their preaward compliance
obligations. The GMO Reviewer should:
a. Check the Preaward Compliance note in Question 1 I of the Comprehensive
Administrative Review for Grants/Cooperative Agreements &
Continuation/Supplemental Awards form,
b. Scan Form 4700-4 and e-mail it to the appropriate EEO Officer and OCR Official,
c. Place the Form 4700-4 back into the grants application package.
The review of Form 4700-4 pre-award information is now complete.
If the requested EPA assistance will be used to construct a new facility or alter an existing
facili , and the answer to Block VI(a) is "Yes," the applicant has fulfilled their preaward
compliance obligations. The GMO Reviewer should follow steps a through c above.
Guidelines for Preaward Compliance Review of EPA Form 4700-4 (cont.)
If the requested EPA assistance will be used to construct a new facility or alter an existing
facility, and the answer to Block VI(a) or VI(b) is "No", the GMO Reviewer should immediately
scan the Form and send it via e-mail to the appropriate EEO Officer and OCR Official requesting
further review. The e-mail should describe the item requiring a more detailed examination.
The EEO Officer will make a determination of the applicant's compliance within 30 calendar
days of the request from the GMO Reviewer. The EEO Officer will send the determination to the
GMO Reviewer via e-mail.
Once the review of Questions I - VI is complete, the applicant has met their preaward compliance
requirement for EPA assistance. The Regional EEO Officer in conjunction with OCR
Headquarters will review Blocks VII through XI of Form 4700-4, which pertains to post-award
compliance. Blocks VII through XI of Form 4700-4 do not affect an applicant's grant status.
If there are questions with respect to Form 4700-4 or this process, please call your Regional EEO
Officer or the External Compliance Program in OCR at 202-343-9894.
WORKPLAN
Name of Applicant and Project Title
City of Clearwater
Northeast WRF Clarifiers 1 through 4 Rehabilitation
Project Objectives and Need
The City's objective for this project is to continue to provide for the overall health and welfare
of the Community and specifically to reduce or remove organic matter, solids, nutrients,
disease-causing organism, and other pollutants from raw wastewater. The project
contributes towards the achievement of the EPA goal of Safe and Clean Water. The goal is
to ensure that all Americans have drinking water that is clean and safe to drink, and that the
nation's aquatic ecosystems and their ecological components are healthy and sustainable.
This project directly affects an Aquatic Preserve as described in the next section.
The project is required in order for the treatment plant to continue to produce effluent that
meets established water quality and reliability criteria for these types of processes.
Environmental Results or Benefits of Project
The Northeast Water Reclamation Facility operates under a permit (FL0128937 (Major)
issued under the provisions of Chapter 403, Florida Statutes (F.S.), and applicable rules of
the Florida Administrative Code (F.A.C.). The permit constitutes authorization to discharge to
waters of the state under the National Pollutant Discharge Elimination System and to the
City's public access master reclaimed water system.
The waters of the state in this case is Tampa Bay, which is classified as "Outstanding Florida
Waters" (OFW) and is identified as an Aquatic Preserve. Discharges to OFWs are mandated
to meet advanced waste treatment criteria on a continuing basis including high level
disinfection and acute and chronic toxicity requirements. The equipment being replaced
under this project is paramount to this end. If the clarification and pumping equipment fail,
the overall treatment process also fails jeopardizing effluent water quality discharging to the
OFW.
In addition to water quality discharging to the OFW, F.A.C. reuse regulations contain strict
guidelines regarding the quality of water supplied to public access reuse systems. Failure of
the clarifier equipment will jeopardize the quality of the water supplied to the public for
beneficial reuse, which can be a human health hazard.
F.A.C rules also require that key unit process equipment and components be redundant for
reliability concerns. The clarifiers and pumping equipment being replaced under this project
is subject to Class I Reliability Requirements as outlined in EPA publication 430-99-74-001.
As such, it is mandatory that these four clarifiers and their associated return activated sludge
(RAS) and waste activated sludge (WAS) pumping systems remain fully functional and
reliable in order for the plant to meet regulatory requirements.
Categorical Exclusion
The City requests that this project be considered for a Categorical Exclusion (CATEX) with
respect to the environmental analysis applied by EPA. The City has completed the
appropriate form and included it with the application package. The project meets the CATEX
criteria designated on the form and Section 2.0 of the EPA Publication 315-K-08-001
Environmental Review Guide For Special Appropriations Grants.
Project Description and Activities
The City was notified in a July 2010 letter from EPA Region 4, that they were designated as a
recipient of an appropriation that was listed in the FY 2010 Interior and Environment
Appropriations Bill (PL 111-88). The appropriation is a Special Appropriations Act Project
(SAAP) grant identified in the State and Tribal Assistance Grants (STAG) account for the FY
2010. The grant is in the U.S Environmental Protection Agency (EPA) section of the Bill and
is identified in line item 63 of the Region 4 Section as "The City of Clearwater For Wastewater
Treatment Facility Improvements".
The earmark amount is for $500,000. A three percent set-aside is applied by statutory
authority making the final grant amount $485,000.
The City would like to apply this grant to the rehabilitation of four secondary clarifiers and
associated return and waste activated sludge pumping facilities at the Northeast Water
Reclamation Facility. A report summarizing the condition of these clarifiers, addressing
equipment and structural concerns, and outlining rehabilitation recommendations was
completed in September 2010. The report also provided a preliminary cost estimate of
$1,803,000 to rehabilitate all four clarifiers and the associated pumping equipment.
EPA policy is that grant applicants will be expected to pay for at least 45 percent of the
project costs unless there is specific language in the Explanatory Statement or Appropriations
Act that specifies a different matching requirement or a waiver to the matching requirement is
approved. Furthermore, in those situations where the description in the Joint Explanatory
Statement explicitly defines the scope of work of the project, the Federal share will be limited
to 55 percent of the estimated cost for completing the scope of work described unless a
waiver is approved. This project meets the EPA criteria without a waiver as the grant amount
is approximately twenty seven percent of the estimated cost for this project
The project is described as `The City of Clearwater For Wastewater Treatment Facility
Improvements" in the EPA funding document. The work is identified in the Contract
Documents as construction associated with rehabilitating clarifiers 1 thru 4 and associated
facilities at the Northeast Water Reclamation Facility.
Clarifiers 1 thru 4 have been in service since 1978 and were modified in the early 1990s. The
1990 modifications did not address most of the internal structural steel, internal piping, drives,
weirs, scum baffles, and walkway bridges. The concrete structures for each clarifier are in
good condition and will be re-used. All of the mechanical equipment will be replaced using
the current designs. The new equipment will be fitted directly to the existing structure and
piping providing seamless integration into the overall treatment process at the plant.
Specific items and identified tasks for the rehabilitation are listed below. Performing the work
identified below is expected to add 15 to 20 years of life expectancy to the existing unit.
• Replace all rotating and mechanical equipment in Clarifiers 1 thru 4 including the
center columns, the rotating mechanism, the drives, the walkway bridges, the scum
beaches, the scum baffles, the weirs, and the associated hardware and
subcomponents of these items.
• Replace the scum pipe wall penetration on clarifier 1 thru 4 from the scum trough to
the first pipe joint outside the clarifier wall. Replace the link seals for these wall
penetrations.
• Replace two RAS pumps, motors, pump bases, and VFDs.
• Replace two RAS pump check valves.
• Replace two RAS pump suction plug valves.
• Replace two RAS pump discharge butterfly valves.
• Replace two WAS pumps and pump bases.
• Replace two WAS VFDs
• Replace the motor control center (MCC).
• Add current trip devices to the clarifier drive motor starters. Integrate the trip devices
into the plant telemetry system.
• Replace the seals in four telescopic valves.
• Cut in and add one WAS flow meter to the WAS piping.
• Replace 1 WAS plug valve.
• Replace pipe supports in the pump house and paint RAS and WAS piping.
• Repair five sets of stairs.
• Replace one ultrasonic RAS well level detector. Integrate that detector into the RAS
pump control logic.
• Integrate all clarifier, RAS, and WAS motor and instrumentation equipment into the
plant telemetry system.
• Relocate four existing ultrasonic sludge blanket level detector probes from the existing
walkway bridges to the new walkway bridges.
Clarifiers No. 1 and No. 2 will be rehabilitated first. Clarifiers No. 3 and No. 4 will remain in
service while No. 1 and No. 2 are being rehabilitated. Clarifiers No. 1 and No. 2 will remain in
service while No. 3 and No. 4 are being rehabilitated. At least one RAS pump and one WAS
pump must remain in service at all times. It may be possible for all clarifier equipment to be
temporarily shut down during equipment changouts and changeover periods for no more than
2-hours upon approval by the Engineer.
Land Acquisition
There will be no land acquisition as part of this project. The project is located at an existing
City owned Wastewater Treatment Facility.
Pre-Award Costs
The City will not request pre-award costs. The clarifier evaluation report has already been
completed and reviewed by the City. Contract drawings and specifications are at the 90%
complete level for this project.
Geographic Location
See Figure 1 for the location of the project.
The clarifiers are located at:
City of Clearwater Northeast Water Reclamation Facility
3290 SR 580
Clearwater, FL 33755
EPA Registry ID 110010043032
Project Schedule
The City anticipates a project schedule as listed:
Completion of Contract Documents April 2011
Advertise Project for Bid May 2011
Award Construction Contract July 2011
Construction Start Date August 2011
Construction Completion Date February 2012
Final Report and Grant Close Out March 2012
Project Budget
The estimated construction cost for the project is $1,803,000. The EPA grant request is for
$485,000. There are no land acquisition costs. The City will fund the difference from its
Capital Improvement Budget.
Reporting Requirements
The City will submit monthly construction reports after construction begins. These requests
will include reimbursements requests and supporting invoices as needed.
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ATTACHMENT 6
REGULATIONS
AND
OMB CIRCULARS
REGULATIONS
AND
OMB CIRCULARS
The general grant regulations and OMB Circulars listed below apply to all EPA
Special Appropriations Projects (SPAPs) grants. (NOTE: General Administrative
Regulations and Cost Principles apply by type of organization, e.g. State Agency,
non-profit, etc.) Compliance is a recipient responsibility; accordingly,
applicants/recipients should read and follow these documents. EPA will provide
assistance, if needed, in interpretation and compliance with these documents.
Contact your EPA Project Officer for details.
The various parts of 40 CFR may be accessed electronically at the following
Internet address:
http://www.access.gpo.gov/nara/cfr/waisidx 00/40cfrvl 00.html
OMB Circulars are available online at:
http://www.whitehouse.gov/omb/circulars/index.html
Hard copies are available upon request. Contact a Grants Specialist for further
information.
GENERAL GRANT REGULATIONS:
40 CFR -
PART 7 - NON-DISCRIMINATION IN PROGRAMS RECEIVING
FEDERAL ASSISTANCE FROM EPA (1990)
PART 29 - INTERGOVERNMENTAL REVIEW OF EPA PROGRAMS
AND ACTIVITIES
PART 30 - GRANTS AND AGREEMENTS WITH INSTITUTIONS OF
HIGHER EDUCATION, HOSPITALS, AND OTHER NON-
PROFIT ORGANIZATIONS (1996)
40 CFR -
PART 31 - UNIFORM ADMINISTRATIVE REQUIREMENTS FOR
GRANTS AND COOPERATIVE AGREEMENTS TO STATE
AND LOCAL GOVERNMENTS (1995)
PART 32 - GOVERNMENT-WIDE DEBARMENT AND SUSPENSION
(NON-PROCUREMENT) AND GOVERNMENT-WIDE
REQUIREMENTS FOR DRUG-FREE WORKPLACE;
CLEAN AIR ACT AND CLEAN WATER ACT
INELIGIBILITY OF FACILITIES IN PERFORMANCE OF
FEDERAL CONTRACTS, GRANTS, AND LOANS (1996)
PART 34 - NEW RESTRICTION ON LOBBYING (1995)
OMB CIRCULARS
A-21 - COST PRINCIPLES FOR EDUCATIONAL INSTITUTIONS
A-87 - COST PRINCIPLES FOR STATE, LOCAL AND TRIBAL
GOVERNMENTS
A-122 - COST PRINCIPLES FOR NON-PROFIT ORGANIZATIONS
A-133 - AUDIT REQUIREMENTS - ALL APPLICANTS