APPLICATION FOR FEDERAL FINANCIAL ASSISTANCE SUBAWARDWILTON SIMPSON
COMMISSIONER
Florida Department of Agriculture and Consumer Services
Division of Administration;
APPLICATION FOR FEDERAL FINANCIAL ASSISTANCE SUBAWARD
2 CFR 200
Instructions for Application Packet
*Each field of the application must be completed.
*If a field does not apply, indicate N/A in the field.
1. Federal Financial Assistance Funding Opportunity Number - Record the number shown on the Notice of Funding
2. Amount of funds requested for this project - List the total amount of funds required to complete the scope of work.
3. Subrecipient Legal Name - Record the legal name of applicant that will undertake the scope of work. The name
must match the name listed in SAM.
4. Subrecipient FEIN - Record the employer or taxpayer identification number as assigned by the Internal Revenue
Service.
5. Subrecipient Registered in SAM - All applicants must be registered in the System of Award Management (SAM) to
obtain federal financial assistance. Individuals are not required to register in SAM.
6. Street Address - Record the street address as recognized by the U.S. Postal Service. Do not record a P.O. Box.
7. City - Record the city.
8. State - Record the state.
9. Zip Code plus 4 - Record the nine -digit U.S. Postal Code.
10. Mailing address (if different from above) - Record a different mailing address.
11. Phone Number - Record a 10 -digit (xxx-xxx-xxxx) daytime phone number.
12. Fax Number - Record a 10 -digit (xxx-xxx-)xxx) fax number.
13. Is the subrecipient delinquent on any federal debt? Record yes or no. The question applies to the applicant.
Categories of federal debt include, but are not limited to, delinquent loans, tax, and audit disallowances. If yes,
provide an explanation.
14. Cost Sharing (Match) if applicable - Record the value of cost share to be provided.
15. Congressional District - Record the applicant's congressional district.
16. Name and contact information for matters involving this application.
17. Subrecipient Type - Circle the type of subrecipient.
18. Descriptive title of Subrecipient Project - Record a brief descriptive title of the project.
19. Funding Period - Enter the dates, within the award period, as to when the project will begin and finish.
20. Location of Proposed Program/Project - Record the physical address of where the scope of work will be completed.
21. Total # of full-time employees - Record the number of full-time employees. A full-time employee works 40 hours per
week.
22. Total # of part-time employees - Record the number of part-time employees. A part-time employee works less than
40 hours per week.
23. Is your organization a 501(c)(3) tax exempt organization? Record yes or no.
24. Has your organization previously received federal financial assistance from FDACS? Record yes or no. Please
answer yes if the funding has been received within the last three years.
25. The application must be signed and dated by an authorized representative of the applicant organization.
Opportunity.
Florida Department of Agriculture and Consumer Services
Division of Administration
APPLICATION FOR FEDERAL FINANCIAL ASSISTANCE SUBAWARD
2 CFR 200
1. Federal Financial Assistance Funding Opportunity Number:
23 -DG -11083112-500
2. Amount of funds requested for this
project: $44,117.62
3. Subrecipient Legal Name: CITY OF CLEARWATER
4. Subrecipient FEIN:
59-6000289
6. Subrecipient Registered in SAM: Yes
7. Street Address: 100 SOUTH MYRTLE AVE
8. City: CLEARWATER
9: State: FLORIDA
10. Zip Code plus 4: 33756-5520
11. Mailing Address (if different from above):
12. Phone Number: (727) 562-4800
13. Fax Number: (727) 562-4825
14. Is the subrecipient delinquent on any federal
debt? NO
15. Cost Sharing (Match):
N/A
16. Congressional District: 13th
17. Name and contact information of person to be contacted on matters involving this application:
Name: NATHAN PANDY i
Phone Number: 727-444-8306 Email: Nathan.pandy@myclearwater.com
18. Subrecipient Type: (Check One) Indian Tribal Government Individual Local Government X
Institution of Higher Education Non -Profit Organization State Government Other
19. Descriptive Title of Subrecipient Project: City Parks Canopy Replenishment
20. Funding Period
Start Date: JANUARY 05, 2026
End Date: SEPTEMBER 30, 2026
21. Location of Proposed Program/Project:
DEL ORO PARK - 401 MCMULLEN BOOTH ROAD, CLEARWATER FL 33759; FOREST RUN PARK - 3450 LANDMARK
DRIVE, CLEARWATER FL 33761; WOODGATE PARK — 2495 COUNTRYSIDE BLVD, CLEARWATER FL 33763; CLIFF
STEPHENS PARK — 901 FAIRWOOD AVE, CLEARWATER FL 33759; COOPERS BAYOU — 709 N. BAYSHORE BLVD,
CLEARWATER 33759; WOOD VALLEY PARK — 2816 PARK TRAIL LANE, CLEARWATER, FL 33759; McMULLEN TENNIS —
1000 EDENVILLE AVE, CLEARWATER FL 33764; COACHMAN PARK — 300 CLEVELAND ST, CLEARWATER FL 33756.
22. Total # of full-time employees: 44
23. Total # of part-time employees: 0
24. Is your organization a 501(c)(3) tax exempt organization? NO
25. Has your organization previously received federal financial assistance; from FDACS? NO
I
26. By signing this application, I certify that the statements herein are true, complete, and accurate to the best of my
knowledge. I have also provided the required attachments and assurances. I agree to comply with all terms and
conditions if I accept an award.
Authorized Representative Name: JENNIFER POIRRIER
Title: CITY MANAGER
Phone Number: 727-444-7171
Email Address: jennifer.poirrier@myclearwater.com
Signature of Authorized Representative:
Date Signed:
I 14,0I°
FDACS-02032 Rev. 02/23
Page 1 of 33
Florida Department of Agriculture and Consumer Services
Division of Administration
KEY CONTACT INFORMATION
2 CFR 200
Instructions for Application Packet - Key Contact Form
*Each field of the key contact form must be completed.
*If a field does not apply, indicate N/A in the field.
1. Federal Financial Assistance Funding Opportunity Number - Recoi d the number shown on the Notice of
Funding Opportunity.
2. Subrecipient FEIN - Record the employer or taxpayer identification number as assigned by the Internal
Revenue Service.
3. Subrecipient Legal Name - Record the legal name of applicant that will undertake the scope of work. The name
must match the name listed in SAM.
4. Contact Project Role: Authorized Representative - Record requested information.
5. Contact Project Role: Grant Manager - Record requested information.
6. Contact Project Role: Fiscal Contact - Record requested information.
7. Contact Project Role: Principal Investigator - Record requested information.
FDACS-02032 Rev. 02/23
Page 2 of 33
Florida Department of Agriculture and Consumer Services
Division of Administration
KEY CONTACT FORM
2 CFR 200
Federal Financial Assistance Funding Opportunity Number: 23 -DG -11083112-500
Subrecipient FEIN:
59-6000289
Subrecipient Legal Name: CITY OF CLEARWATER
Contact Project Role: Authorized Representative
Name: JENNIFER POIRRIER
Title: CITY MANAGER
Phone Number: 727-444-
7171
Fax Number: 727-562-
4052
Street Address: ONE CLEARWATER TOWER, 6TH FLOOR, 600 CLEVELAND ST.
City: CLEARWATER
State: FL
Zip Code plus 4: 33755-
47448
Mailing Address (If different from above):
Contact Project Role: Grant Manager
Name: NATHAN PANDY
Title: MANAGEMENT ANALYST
Phone Number: 727-444-
8306
Fax Number:
Street Address: 100 SOUTH MYRTLE AVENUE
City: CLEARWATER
State: FL
Zip Code plus 4: 33756-5520
Mailing Address (If different from above):
Contact Project Role: Fiscal Contact
Name: NICOLE HERNANDEZ
Title: ACCOUNTANT II
Phone Number: 727-444-
8311 ,
Fax Number: 727-562-
4825
Street Address: 100 SOUTH MYRTLE AVENUE
City: CLEARWATER
State: FL
Zip Code plus 4: 33756-5520
Mailing Address (If different from above):
Contact Project Role: Principal Investigator
Name: ALEXIS WELLS
Title: PARKS SENIOR DIVISION MANAGER
Phone Number: 727-224-7587
Fax Number: 727-562-
4826
Street Address: 507 VINE AVENUE
City: CLEARWATER
State: FL
Zip Code plus 4:
33755-4446
Mailing Address (If different from above):
FDACS-02032 Rev. 02/23
Page 3 of 33
Florida Department of Agriculture and Consumer Services
Division of Administration
PROJECT NARRATIVE
2 CFR 200
Instructions for Application Packet - Project Narrative
*If a field does not apply, indicate N/A in the field.
1. Federal Financial Assistance Funding Opportunity Number - Record the number shown on the Notice of
Funding Opportunity.
2. Amount of funds requested for this project - List the total amount of funds required to complete the scope of
work.
3. Subrecipient Legal Name - Record the legal name of applicant that will undertake the scope of work. The name
must match the name listed in SAM. Please note section XII Public Records in the Notice of Federal Financial
Assistance Funding Opportunity before including any proprietary or confidential information.
4. The header section of each page of the project narrative must have the funding opportunity number,
subrecipient federal identification number and subrecipient legal name.
5. The project narrative must not exceed (insert #) 8 %" by 11" single. sided pages. Additional pages beyond the
page limitation will not be considered.
6. The project narrative must include, but is not limited to:
• A statement of need for the federal financial assistance and how the project will address the need.
• A description of the expected project outcomes. The measurable objectives and specific targets of the
expected project outcomes should be specified.
• A plan of action to achieve the projected outcomes and how the plan of action will be accomplished.
• A timeline of activities or implementation schedule.
• Collaboration details, if any.
• Information on key personnel including their background and experience with the project objectives. An
indication of the amount of effort the key personnel will provide to the project.
• Precise location of the project or the area to be served/benefited by the project.
• A statement of whether this project relates to any other project, current or anticipated.
FDACS-02032 Rev. 02/23
Page 4 of 33
Florida Department of Agriculture and Consumer Services
Division of Administration
PROJECT NARRATIVE
2 CFR 200
1. Federal Financial Assistance Funding Opportunity Number:
23 -DG -11083112-500
2. Amount of funds requested for this project:
$75,000.00
3. Subrecipient Legal Name: CITY OF CLEARWATER
Please note section XII Public Records in the Notice of Federal Financial Assistance Funding Opportunity before
including any proprietary or confidential information.
Project Narrative: Rebuilding Clearwater's Urban Canopy: A Commitment to
The City of Clearwater is seeking funding support from the FDACS!
cover lost to recent storms and disease. As a proud Tree City USA
remains deeply committed to preserving and enhancing its urban forest.
Nestled just west of Tampa and bordered by the Gulf, Clearwater is
population of just over 117,000. Our residents are actively engaged
the stewardship of our public spaces. The Parks & Recreation Department
about our practices, and we've found that providing thoughtful,;
understanding and support.
Over recent years, numerous hurricanes, including Hurricane lanj
the loss of 601 canopy trees. Compounding this loss, the persistent
claimed 58 palms of various species over the past year. These setbacks
ecological health and aesthetic value of our green spaces.
To address this, we are proposing the replanting and long-term
naturalized species that are resilient and well-suited to our environment.
Landscape Division of the Parks & Recreation Department, which
eight Certified Arborists and nineteen Certified Horticulture Professionals—with
soon. These figures exclude our dedicated Urban Forestry Division,
capacity to manage tree health in-house.
We are also proud to note that one of our Certified Arborists holds a
from the Florida Chapter of the International Society of Arboriculture.
are pruned appropriately throughout their development, preventing
trimming.
By replenishing our tree canopy, we not only restore the natural beauty
our residents that their voices are heard and valued. This project
environmental stewardship, community engagement, and the legacy
Community and Resilience
Division of Administration to restore tree
community for over 40 years, Clearwater
a vibrant, mid-sized municipality with a
in civic life and take a keen interest in
frequently receives questions
educational responses fosters greater
have devastated our parks, resulting in
spread of Lethal Yellowing disease
have significantly impacted the
care of 93 trees, focusing on native and
This initiative will be led by the
boasts a highly qualified team including
additional experts joining
whose expertise further strengthens our
Prescription Pruning Qualification (PPQ)
This specialized training ensures trees
damage from improper or excessive
of our parks but also demonstrate to
reflects our enduring commitment to
of Clearwater's green spaces.
FDACS-02032 Rev. 02/23
Page 5 of 33
Florida Department of Agriculture and Consumer Services
Division of Administration
SCOPE OF WORK
2 CFR 200
Instructions for Application Packet - Scope of Work
*If a field does not apply, indicate N/A in the field.
1. Federal Financial Assistance Funding Opportunity Number - Record the number shown on the Notice of
Funding Opportunity.
2. Subrecipient FEIN - Record the employer or taxpayer identification number as assigned by the Internal
Revenue Service.
3. Subrecipient Legal Name - Record the legal name of applicant that will undertake the scope of work. The name
must match the name listed in SAM. Please note section XII Public Records in the Notice of Federal
Financial Assistance Funding Opportunity before including any proprietary or confidential information.
4. The header section of each page of the scope of work must have the funding opportunity number, subrecipient
federal identification number and subrecipient legal name.
5. The scope of work must not exceed (3) 8'/2" by 11" single sided pages. Additional pages beyond the page
limitation will not be considered.
6. The scope of work must include, but is not limited to:
• Describe in detail the activity or work to be conducted. Include project location information.
• Describe specific project objectives, tasks, and deliverables and related timelines for each. Include who will
perform the tasks.
• Objectives and tasks should relate to the project narrative.
• Discuss how the scope of work is feasible and can be completed within the award period.
• Provide quantifiable, measurable and verifiable units of deliverables.
• Deliverables must be directly related to the scope of work.
FDACS-02032 Rev. 02/23
Page 6 of 33
Florida Department of Agriculture and Consumer Services
Division of Administration
SCOPE OF WORK
2 CFR 200
1. Federal Financial Assistance Funding Opportunity Number:
23 -DG -11083112-500
2. Subrecipient FEIN: 59-6000289
3. Subrecipient Legal Name: CITY OF CLEARWATER f
Please note section XII Public Records in the Notice of Federal Financial Assistance Funding Opportunity before
including any proprietary or confidential information.
Performance Measures
Deliverable
Tasks
Task Description
Indicator
Costs per Unit
Outcome Measures
1
Site Assessment
Identify the parks where the
trees and palms will be
planted
Parks are
selected to
maximize the
benefits of an
expanded
tree canopy
$0
List of parks for tree planting
2
Location Selection
Optimal planting sites for
replacements
Sites that
provide the
best growing
conditions for
trees selected
$0
Paint and stake the locations
for species. Optimal tree
planting sites identified for 80
trees.
3
Selection
Select the best species for
each site
Optimal
species
selected for
each site
$0
Use plant pallets and storm
resistant species to make
choices. Tree species
selected for 8 planting sites.
4
Finance
Prepare and issue formal bid
Obtain
required
number of
quotes
$0
Follow purchasing protocol,
obtain required number of
quotes
5
Material (tree) Acquisition
Inspect and receive
replacements
An inventory
of trees that
meet Florida
Grades &
Standards
criteria
$600/tree
Trees must meet Florida
Grades & Standards criteria
6
Utility Clearance
Notify 811 to mark areas for
safety
Avoid
disturbance of
utility lines
$0
All utilities report that 80 tree
planting sites are clear and
safe for digging
7
Installation
Installation of the
replacements
A healthy
tree canopy is
established
$0
Number of trees planted
8
Structural Support
Staking of trees for stability
Trees are
stable and
secured to
promote root
growth
$15.04/tree
Number of trees staked for
stability
9
Establishment Care
Create a watering schedule
(water bags)
Ensure trees
are watered
consistently
$24.99/water bag
Number of trees included in
watering schedule
10
Ongoing Maintenance
Create a maintenance
schedule
Ensure trees
are properly
maintained
$0
Trees established and show
growth. Finalized
maintenance schedule for 80
new trees
Describe in detail the activity or work to be conducted.
FDACS-02032 Rev. 02/23
Page 7 of 33
Scope of Work
This project seeks funding to initiate the replacement of trees lost to recent hurricanes and palms affected by
Lethal Yellowing (LY) disease. While we recognize that available funds may not cover the full restoration of
every tree and palm, they will provide a critical foundation for rebuilding our community's canopy cover.
Our restoration plan includes the following steps:
1. Site Assessment: Identify specific parks where tree and palm losses occurred.
2. Location Selection: Determine optimal planting sites for replacements. Palms lost to LY will not be
replanted in the same location to mitigate the risk of residual soil -borne pathogens.
3. Species Selection: Research and select plant species best suited to each site, considering water
requirements, growth rate, mature height, and soil compatibility.
4. Procurement Process: In accordance with City policies, prepare and issue a formal bid for the
purchase of materials.
5. Material Acquisition: Upon completion of the bid process and issuance of a purchase order, acquire
materials from approved vendors. All trees will be inspected to ensure compliance with Florida Grades
and Standards prior to acceptance.
6. Utility Clearance: Conduct utility locates before installation to prevent damage to underground
infrastructure.
7. Installation: Plant trees and palms following Florida Nursery Growers and Landscape Association
(FNGLA) guidelines to promote long-term health and viability.
8. Structural Support: Stake trees and palms as needed based on species-specific requirements during
the early growth phase.
9. Establishment Care: Implement a structured watering schedule during the establishment period to
support healthy growth.
10.Ongoing Maintenance: Monitor and maintain each plant over the next several years to ensure
successful establishment and canopy regeneration.
FDACS-02032 Rev. 02/23
Page8of33
Florida Department of Agriculture and Consumer Services
Division of Administration
SCOPE OF WORK
2 CFR 200
1. Federal Financial Assistance Funding Opportunity Number:
23 -DG -11083112-500
2. Subrecipient FEIN: 59-6000289
3. Subrecipient Legal Name: CITY OF CLEARWATER
Please note section XII Public Records in the Notice of Federal Financial Assistance Funding Opportunity before
including any proprietary or confidential information.
Describe in detail the activity or work to be conducted.
Project Leadership and Installation Plan
The installation phase of this project will be led by Senior Division
Manager Nathan Brigman and their direct reports. Together, they
select appropriate species for replacement. As the project progresses,
will be engaged to provide expertise and oversight.
Procurement and Quality Assurance:
Mr. Wells will oversee the procurement process, working closely with
Once the purchase order is issued, trees and palms will be ordered
Mr. Wells, Mr. Brigman, and other Certified Arborists will inspect the
Florida Grades and Standards.
Installation Logistics:
The City is fully equipped with the necessary tools and machinery for
is trained in proper handling and planting techniques. The selected
containers, allowing safe handling by teams of two to three individuals.
To streamline the process:
• One crew will pre -dig planting holes.
• A second crew will follow with installation, ensuring efficient
Staking materials will be purchased to provide structural support
without irrigation, a city -operated water truck will maintain a scheduled
establishment.
Timeline and Output:
Assuming full workdays without weather delays, the designated installation
of approximately 93 trees within twenty (20) working days. Each
watering to ensure stability and promote healthy growth.
Manager Alexis Wells, with support from
will identify optimal planting locations and
additional Certified Arborists (CAs)
the Division Controller and their team.
from approved vendors. Upon delivery,
shipment to ensure all materials meet
tree and palm installation, and our staff
trees and palms will be in 30 -35 -gallon
workflow and minimal disruption.
during the acclimation period. In areas
watering routine to support healthy
team will complete the planting
installation will include staking and initial
FDACS-02032 Rev. 02/23
Page 9 of 33
Florida Department of Agriculture and Consumer Services
Division of Administration
BUDGET PLAN NARRATIVE
2 CFR 200
Instructions for Application Packet - Budget Plan Narrative
*If a field does not apply, indicate N/A in the field.
1. Federal Financial Assistance Funding Opportunity Number - Record the number shown on the Notice of
Funding Opportunity.
2. Subrecipient FEIN - Record the employer or taxpayer identification number as assigned by the Internal
Revenue Service.
3. Subrecipient Legal Name - Record the legal name of applicant that will undertake the scope of work. The name
must match the name listed in SAM. Please note section XII Public Records in the Notice of Federal
Financial Assistance Funding Opportunity before including any proprietary or confidential information.
4. The header section of each page of the budget plan narrative must have the funding opportunity number,
subrecipient federal identification number and subrecipient legal name.
5. The budget plan narrative must not exceed (insert #) 8 %/z" by 11" single sided pages. Additional pages beyond
the page limitation will not be considered.
6. Describe line items for each applicable budget category shown on the budget plan. Provide sufficient detail to
clearly indicate the estimated funding amounts for each project task contained in the scope of work.
7. Project costs will be evaluated for reasonableness and necessity. Any travel costs must be in compliance with
the State of Florida travel rules.
8. Indirect costs are at the rate approved by the applicant's cognizant agency. A copy of the approved rate must
be attached to the application. If the applicant has never received a negotiated indirect cost, provide a
statement indicating the applicant is electing to charge a de minimis rate of 10% of modified total direct costs.
FDACS-02032 Rev. 02/23
Page 10 of 33
Florida Department of Agriculture and Consumer Services
Division of Administration
BUDGET PLAN NARRATIVE
2 CFR 200
1. Federal Financial Assistance Funding Opportunity Number:
23 -DG -11083112-500
2. Subrecipient FEIN: 59-6000289
3. Subrecipient Legal Name: CITY OF CLEARWATER
I
I
Direct Costs
Personnel Costs
$0
Example
$0
Example
$0
Fringe Benefits
$0
Travel (if authorized)
$0
Equipment (if authorized)
N/A
Supplies
Six-foot Metal "T" Stakes —186 at $5.59 = $1,039.74
Tree Tie Webbing (Green) - 4 at $89.85 = $359.40
Watering Bags — 65 at $24.99 = $1,624.35
Shade Trees — 93 at $600.00 = $55,800.00
Est. Total - $58,823.49
Contractual (if authorized)
$0
Other Expenses
$0
Indirect Costs
Indirect Charges
$0
1
FDACS-02032 Rev. 02/23
Page 11 of 33
Florida Department of Agriculture and Consumer Services
Division of Administration
BUDGET PLAN
2 CFR 200
Instructions for Application Packet - Budget Plan
*If a field does not apply, indicate N/A in the field.
1. Federal Financial Assistance Funding Opportunity Number - Record the number shown on the Notice of
Funding Opportunity.
2. Subrecipient FEIN - Record the employer or taxpayer identification number as assigned by the Internal
Revenue Service.
3. Subrecipient Legal Name - Record the legal name of applicant that will undertake the scope of work. The name
must match the name listed in SAM.
The header section of the budget plan must have the funding opportunity number, subrecipient federal identification
number and subrecipient legal name.
The applicant shall submit a budget plan for its projected costs to implement the scope of work submitted with the
application. The budget plan shall provide the estimated costs by category in order to carry out the scope of work.
FDACS-02032 Rev. 02/23
Page 12 of 33
Florida Department of Agriculture and Consumer Services
Division of Administration
BUDGET PLAN
2 CFR 200
1. Federal Financial Assistance Funding Opportunity
Number: 23 -DG -11083112-500
2. Subrecipient FEIN: 59-6000289
3. Subrecipient Legal Name: CITY OF CLEARWATER
Category
1st Quarter
Quarter
3rd Quarter
Quarter
Total Estimated Budget
Personnel
$0
$0
$0
$0
$0
Fringe Benefits
$0
$0
$0
$0
$0
Travel (if
authorized)
$0
$0
$0
$0
$0
Equipment (if
authorized
$0
$0
$0
$0
$0
Supplies
$58,823.49
$0
$0
$0
$58.823.49
Contractual (if
authorized)
$0
$0
$0
$0
$0
Other
Expenses
$0
$0
$0
$0
$0
Total Direct
Charges
$58,823.49
$0
$0
$0
$58,823.49
Indirect
Charges
$0
$0
$0
$0
$0
Total Amount
$58,823.49
$0
$0
$0
$58,823.49
FDACS-02032 Rev. 02/23
Page 13 of 33
Florida Department of Agriculture and Consumer Services
Division of Administration
KEY PERSON / STAFF
2 CFR 200
Instructions for Application Packet - Key Person / Staff
*If a field does not apply, indicate N/A in the field.
1. Federal Financial Assistance Funding Opportunity Number - Record the number shown on the Notice of
Funding Opportunity.
2. Subrecipient FEIN - Record the employer or taxpayer identification number as assigned by the Internal
Revenue Service.
3. Subrecipient Legal Name - Record the legal name of applicant that will undertake the scope of work. The name
must match the name listed in SAM.
The header section of the key person/staff must have the funding opportunity number, subrecipient federal
identification number and subrecipient legal name.
Each application must include descriptions of key personnel and their qualifications to meet the requirements of the
notice of funding opportunity. An individual form will be completed for each key person/staff member. Include an
estimate of the number or hours or percentage of time devoted to the project.
Key personnel are individuals who contribute in a substantive and meaningful way to the execution or development
of the project. Reimbursement of salary costs are not required for an individual to be considered key personnel.
Consultants or contract employees may be included if they meet the definition.
FDACS-02032 Rev. 02/23
Page 14 of 33
Florida Department of Agriculture and Consumer Services
Division of Administration
KEY PERSON / STAFF
2 CFR 200
An individual form must be completed for each key person/staff member.
hours or percentage of time devoted to the project.
Include an estimate of the number of
1. Federal Financial Assistance Funding Opportunity Number:
23 -DG -11083112-500
2. Subrecipient
FEIN: 59-6000289
3. Subrecipient Legal Name: CITY OF CLEARWATER
Person Name: ALEXIS WELLS
Title: Parks Senior Division
Manager
Hours or % of time devoted to the
project: 100%
Phone Number: 727-224-7587
Email Address: Alexis.Wells@MyClearwater.com
Qualifications:
List of qualifications includes the following:
• Certified Arborist — FL5356A since 2005
• TRAQ — Tree Risk Assessment Qualification from ISA
• PPQ — Prescription Pruning Qualification — Florida Chapter ISA
• Florida Certified Horticulture Professional — H-05853 since 2005
• 22 years in the landscape industry
• Landscape Inspector Association of Florida — 2016-0188
• Abrams Academy Graduate 2012
• NC State Parks Maintenance Management School 2008
• Associate's Degree in Science — (Crime Scene Technology) — St.
Petersburg College 2016
FDACS-02032 Rev. 02/23
Page 15 of 33
Florida Department of Agriculture and Consumer Services
Division of Administration
KEY PERSON / STAFF
2 CFR 200
An individual form must be completed for each key person/staff member. Include an estimate of the number of
hours or percentage of time devoted to the project.
1. Federal Financial Assistance Funding Opportunity Number:
23 -DG -11083112-500
2. Subrecipient FEIN: 59-6000289
3. Subrecipient Legal Name: CITY OF CLEARWATER
Person Name: MATTHEW ANDERSON
Title: PARKS & RECREATION
ASSISTANT DIRECTOR
Hours or % of time devoted to the
project: 5%
Phone Number: 727-580-0436
Email Address: Matthew.Anderson@MyClearwater.com
Qualifications:
List of qualifications includes the following:
• ISA Certified Arborist Cert# FL6152A
• FNGLA Certified Horticulture Professional Cert# H08439
• FDACS Limited Lawn and Ornamental Holder Cert# LL265744
• Pinellas County Landscape BMP Cert# 1921
• Stormwater Management Inspector Cert#27320
• AS in Forest Management Lake City Community College
• BS Environmental Policy University of South Florida
Florida Department of Agriculture and Consumer Services
FDACS-02032 Rev. 02/23
Page 16 of 33
Division of Administration
KEY PERSON / STAFF
2 CFR 200
An individual form must be completed for each key person/staff member.
hours or percentage of time devoted to the project.
Include an estimate of the number of
1. Federal Financial Assistance Funding Opportunity Number:
23 -DG -11083112-500
2. Subrecipient
FEIN: 59-6000289
3. Subrecipient Legal Name: CITY OF CLEARWATER
Person Name: PAUL MACK
Title: PARKS SENIOR
DIVISION MANAGER
Hours or % of time devoted to the
project: 90%
Phone Number: 727-224-7107
Email Address: Paul.Mack@MyClearwater.com
Qualifications:
List of qualifications includes the following:
• Associate's in Arts Honors St. Petersburg College
• Certified in Leadership Management, St. Petersburg College
• Florida Certified Horticulture Professional cert# H05331
• 25 years in the green industry. Multiple landscape projects throughout career with the City of Clearwater,
with complete renovations of irrigation systems. I
I
FDACS-02032 Rev. 02/23
Page 17 of 33
Florida Department of Agriculture and Consumer Services
Division of Administration
KEY PERSON / STAFF
2 CFR 200
An individual form must be completed for each key person/staff member. Include an estimate of the number of
hours or percentage of time devoted to the project.
1. Federal Financial Assistance Funding Opportunity Number:
23 -DG -11083112-500
2. Subrecipient FEIN: 59-6000289
3. Subrecipient Legal Name: CITY OF CLEARWATER
Person Name: NATHAN BRIGMAN
Title: LANDSCAPE MANAGER
Hours or % of time devoted to the
project: 80%
Phone Number: 727-463-9857
Email Address: nathan.brigman@myclearwater.com
Qualifications:
List of qualifications includes the following: i
• Bachelor of Science Auburn University, with Major in Ornamental Horticulture, emphasis in Landscape
design. Class of May 2002
• ISA Certified Arborist since 2007. Cert # FL -5516A
• FDACS, Limited Lawn and Ornamental Holder Cert # LL265774 since 2006
• Florida Certified Horticulture Professional cert # 97240 Since 06/02/2006
• 25 years in the landscape industry as a nursery production manager and landscape maintenance manager.
• Irrigation and chemical spray applicator supervisor for 11 years.
FDACS-02032 Rev. 02/23
Page 18 of 33
Florida Department of Agriculture and Consumer Services
Division of Administration
KEY PERSON / STAFF
2 CFR 200
An individual form must be completed for each key person/staff member. Include an estimate of the number of
hours or percentage of time devoted to the project.
1. Federal Financial Assistance Funding Opportunity Number:
23 -DG -11083112-500
2. Subrecipient FEIN: 59-6000289
3. Subrecipient Legal Name: CITY OF CLEARWATER
Person Name: CRAIG WILSON
Title: PARKS SENIOR
DIVISION MANAGER
Hours or % of time devoted to the
project: 10%
Phone Number: 727-444-8584
Email Address: craig.wilson@myclearwater.com
Qualifications:
List of qualifications includes the following:
• Associate's in Arts (Business Management/Economics) — St. Petersburg
• ISA Certified Arborist — FL 5657A since 2007
• ISA Tree Risk Assessment Qualification (TRAQ) since 2016
• ISA Prescription Pruning Qualification: Prescribing Arborist Manual
• Municipal Arborist (2014-2023)
• Abrahams - Jones Academy for Leadership Excellence Graduate
• Green Industries Best Management Practices Certified (GI -BMP)
• Environmental Hero Award (2022)
• 30+ years in the landscape and arboriculture industry
College
& Workbook (content contributor)
(2018)
FDACS-02032 Rev. 02/23
Page 19 of 33
Florida Department of Agriculture and Consumer Services
Division of Administration
KEY PERSON / STAFF
2 CFR 200
An individual form must be completed for each key person/staff member. Include an estimate of the number of
hours or percentage of time devoted to the project.
1. Federal Financial Assistance Funding Opportunity Number:
23 -DG -11083112-500
2. Subrecipient FEIN: 59-6000289
3. Subrecipient Legal Name: CITY OF CLEARWATER
Person Name: JOEL SILCOX
Title: SUPERVISOR 2
Hours or % of time devoted to the
project: 80%
Phone Number: 727-479-8949
Email Address: Joel.Silcox@Myclearwater.com
Qualifications:
List of qualifications includes the following:
• Bachelor of Arts in Environmental Science and Policy from Florida
• Best Management Practices Florida Green Industries: Certification
• Limited Lawn and Ornamental Holder: Certification # LL339307
• FNGLA Certified Horticulture Professional: Certification # H9357296
• ISA Certified Arborist: Certification # FL -10136A
State University, Class of 2019.
# GV918281-1
1
FDACS-02032 Rev. 02/23
Page 20 of 33
Florida Department of Agriculture and Consumer Services
Division of Administration
KEY PERSON / STAFF
2 CFR 200
An individual form must be completed for each key person/staff member. Include an estimate of the number of
hours or percentage of time devoted to the project.
1. Federal Financial Assistance Funding Opportunity Number:
23 -DG -11083112-500
2. Subrecipient FEIN: 59-6000289
3. Subrecipient Legal Name: CITY OF CLEARWATER
Person Name: ROBERT HICKMAN
Title: LANDSCAPE MANAGER
Hours or of time devoted to the
%
project: 80%
Phone Number: 727-580-8106
Email Address: Robert.hickman@myclearwater.com
Qualifications:
List of qualifications includes the following:
• Member of the Ohio Green Industry Association 2003-2023
• NALP — Landscape Certified Industry Technician 2008
• Pavelock Certification
• Aquascape Certification
• Rainbird Certification
• BA Southern Ohio TC in Business Management and MultimediaProduction. Class of 2000
• FNGLA certification 2025
• 27 years in the Landscaping Industry with 20 years at the largest nursery in Ohio and third largest in the
Midwest as lead foreman and operations manager in the commercial landscape division.
FDACS-02032 Rev. 02/23
Page 21 of 33
Florida Dep
rtment of Agriculture and Consumer Services
Division of Administration;
KEY PERSON / STAFF
2 CFR 200
An individual form must be completed
hours or percentage of time devoted to
for each key person/staff member. Include an estimate of the number of
the project.
1. Federal Financial Assistance Funding
23 -DG -11083112-500
Opportunity Number:
2. Subrecipient
FEIN: 59-6000289
3. Subrecipient Legal Name: CITY OF
CLEARWATER
Person Name: JOSEPH TAYLOR
Title: SUPERVISOR 2
Hours or % of time devoted to the
project: 80%
Phone Number: 727-463-8391
Email Address: joe.taylor@myclearwater.com
Qualifications:
List of qualifications includes the following:
• Associate's Degree in Science
• Limited Lawn and Ornamental
, • FNGLA Certified Horticulture
• FNGLA Certified Landscape T
• ISA Certified Arborist: Certific
Landscaping Technology St Petersburg College Class of 2005
older: Certification # LL203178
rofessional:
chnician
tion # FL -6643-A
FDACS-02032 Rev. 02/23
Page 22 of 33
Florida Dep
rtment of Agriculture and Consumer Services
Division of Administration
PERFORMANCE SITE / LOCATIONS
2 CFR 200
Instructions fo Application Packet - Performance Site / Locations
*If a fi-Id does not apply, indicate N/A in the field.
1. Federal Financial Assistance F nding Opportunity Number - Record the number shown on the Notice of
Funding Opportunity.
2. Subrecipient FEIN - Record th- employer or taxpayer identification number as assigned by the Internal
Revenue Service.
3. Subrecipient Legal Name - Re•ord the legal name of applicant that will undertake the scope of work. The
name must match the name listed in SAM.
Each application must include a lisp of site(s)/locations(s) where the work will be performed.
The reimbursement of facilities cos will only be allowable for site(s)/location(s) listed on the form. The allocation
of facilities cost must be based up• n the square footage used by the project activities.
FDACS-02032 Rev. 02/23
Page 23 of 33
Florida Department of Agriculture and Consumer Services
Division of Administration
ERFORMANCE SITE /LOC
TIONS
IONS
2 CFR 200
1. Federal Financial Assistance Funding
23 -DG -11083112-500
Opportunity Number:
2. Subrecipient FEIN: 59-6000289
3. Subrecipient Legal Name: CITY OF CLEARWATER
I am submitting an application as an individual,
government, academia, or other type of organization.
and not on behalf of a company, state, local, or tribal
Check Box
Project/Performance
Site Primary Location
Street Address: 100 SOUTH MYRTLE AVENUE
City: CLEARWATER
State: FL
Zip Code plus 4: 33756-4039
Mailing Address (If different from above):
Phone Number: 727-
562-4800
Fax Number:
562-4825
727-
County:
PINELLAS
Project/Performance Site Congressional District:
13th
Project/Performance
Site Location 1 — DEL ORO PARK
Street Address: 401 MCMULLEN BOO—H
ROAD
City: CLEARWATER
State: FL '
Zip Code plus 4: 33759-3416
Mailing Address (If different from above):
Phone Number: N/A
Fax Number:
N/A
County:
PINELLAS
Project/Performance Site Congressional District:
13th,
Project/Performance
Site Location 2 — FOREST RUN PARK
Street Address: 3450 LANDMARK BOULEVARD
City: CLEARWATER
State: FL
Zip Code plus 4: 33761
Mailing Address (If different from above):
Phone Number: N/A
Fax Number:
N/A
County:
PINELLAS
Project/Performance Site Congressional District:
1301
Project/Performance
Site Location 3 - WOODGATE PARK
Street Address: 2495 COUNTRYSIDE BOULEVARD
City: CLEARWATER
State: FL
Zip Code plus 4: 33763
Mailing Address (If different from above):
FDACS-02032 Rev. 02/23
Page 24 of 33
Phone Number: N/A
Fax Number: N/A
County:
PINELLAS
Project/Performance Site Congressional District:
Project/Per`ormance Site Location 4 — CLIFF' STEPHENS PARK
Street Address: 901 FAIRWOOD AVENUE
City: CLEARWATER
State: FL I
Zip Code plus 4: 33759
Mailing Address (If different from above):
Phone Number: N/A
Fax Number: N/A
County:
PINELLAS
Project/Performance Site Congressional District:
13th
Project/ • erformance Site Location 5 — COACHMAN PARK
Street Address: 300 CLEVELAND STR ET
City: CLEARWATER
State: FL
Zip Code plus 4: 33755-4001
Mailing Address (If different from abo e):
Phone Number: N/A
Fax Number: N/A
County:
PINELLAS
Project/Performance Site Congressional District:
13th'
Project/Performance Site Location 6 — MCMULLEN TENNIS COMPLEX
Street Address: 1000 EDENVILLE AVENUE
City: CLEARWATER
State: FL
Zip Code plus 4: 33764-5062
Mailing Address (If different from above):
Phone Number: N/A
Fax Number: N/A
County:
PINELLAS
Project/Performance Site Congressional District:
13th
Project/Performance Site Location 7 — COOPER'S BAYOU PARK
Street Address: 709 BAYSHORE BOULEVARD
City: CLEARWATER
State: FL
Zip Code plus 4: 33759
Mailing Address (If different from above):
Phone Number: N/A
Fax Number: N/A
County:
PINELLAS
Project/Performance Site Congressional District:
13th
FDACS-02032 Rev. 02/23
Page 25 of 33
FDACS-02032 Rev. 02/23
Page 26 of 33
Project/Performance Site Location 8 — WOOD VALLEY PARK
Street Address: 2816 PARK TRAIL LANE
City: CLEARWATER
State: FL
Zip Code plus 4: 33759-2737
Mailing Address (If different from above):
Phone Number: (727)
669-1919
Fax Number: N/A
County:
PINELLAS
Project/Performance Site Congressional District:
13th
Project/Performance Site Location 9
Street Address: N/A
City: N/A
State: N/A
Zip Code plus 4: N/A
Mailing Address (If different from above): N/A
1
Phone Number: N/A
Fax Number: N/A
County: N/A
Project/Performance Site Congressional District:
N/A
Project/Performance Site Location 10
Street Address: N/A
City: N/A
State: N/A
Zip Code plus 4: N/A
Mailing Address (If different from above): N/A
Phone Number: N/A
Fax Number: N/A
County: N/A
Project/Performance Site Congressional District:
N/A
Project/Performance Site Location 11
Street Address: N/A
City: N/A
State: N/A
Zip Code plus 4: N/A
Mailing Address (If different from above): N/A
Phone Number: N/A
Fax Number: N/A
County: N/A
Project/Performance Site Congressional District:
N/A
FDACS-02032 Rev. 02/23
Page 26 of 33
Florida Department of Agriculture and Consumer Services
Division of Administration.
FEDERAL ASSURANCE FOR FEDERAL FINANCIAL
ASSISTANCE SUBRECIPIENT'AWARD
2 CFR 200
Federal Financial Assistance Funding Opportunity Number: 23 -DG -11083112-500
Subrecipient Legal Name: CITY OF CLEARWATER
Subrecipient FEIN: 59-6000289
As the duly authorized representative of the Subrecipient, I certify that to the extent applicable, the Subrecipient:
1. Has the legal authority to apply for federal assistance and the institutional, managerial and financial capability (including
funds sufficient to pay the non-federal share of project costs) to ensure proper planning, management and completion of the
project described in this application.
2. Will give the Recipient, 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 subrecipient
award; and will establish a proper accounting system in accordance with generally accepted accounting principles or
Recipient directives.
3. 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.
4. Will initiate and complete the work within the applicable time frames after receipt of approval of the Recipient.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §§4728-4763) relating to prescribed standards
for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's
Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal statutes relating to nondiscrimination. 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.C. §§3601 et 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.
7. Will comply, or has already complied, with the requirements of Titles 11 and 111 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 or federally -assisted programs. These requirements apply to
all interests in real property acquired for project purposes regardless of Federal participation in purchases.
8. Will comply, as applicable, with 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.
9. 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. §§327-333),
regarding labor standards for federally -assisted construction subagreements:
FDACS-02032 Rev. 02/23
Page 27 of 33
10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection
Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to
purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more.
11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of
environmental quality control measures under the 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).
12. 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.
13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of
1966, as amended (16 U.S.C. §470), EO 11593 (identification and protection of historic properties), and the Archaeological
and Historic Preservation Act of 1974 (16 U.S.C. §§469a-1 et seq.).
14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related
activities supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et seq.)
pertaining to the care, handling, and treatment of warm-blooded animals held for research, teaching, or other activities
supported by this award of assistance.
16. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. §§4801 et seq.) which prohibits the use of
lead-based paint in construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act
Amendments of 1996 and 2 CFR, Part 200 Uniform Administrative Requirements, Costs Principles and Audit Requirements
for Federal Awards, Subpart F Audit Requirements.
18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, and policies
governing this program.
19. Will comply with the requirements of Section 106(g) of the Trafficking Victims Protection Act (TVPA) of 2000, as amended
(22 U.S.C. 7104) which prohibits grant award recipients or a subrecipient from (1) Engaging in severe forms of trafficking in
persons during the period of time that the award is in effect, (2) Procuring a commercial sex act during the period of time that
the award is in effect or, (3) Using forced labor in the performance of the award or subawards under the award.
20. Will comply with and enforce the requirements for a drug-free workplace as mandated in 2 CFR Part 421, "Requirements
for Drug-Free Workplace".
21. Will comply with 2 CFR 417, Subpart C to ensure that any vendor or subcontractor that carries out the provisions of this
agreement are not debarred or suspended.
22. Will comply with the Executive Order 13513 entitled "Federal Leadership ;on Reducing Text Messaging While Driving" by
prohibiting employees, contractors, and subcontractors from texting while driving on official business and or in federally
owned, rented or leased vehicles or privately owned vehicles when on official government business or when performing any
work for or on behalf of or in cooperation with the federal government.
Authorized Representative Name: JENNIFER POIRRIER
Title: CITY MANAGER
Signature o1thorize eprelentative:
7
Date Signed:
atruicAl acit,2-0a)(e
Appli atr7in Organization: CITY OF CLEARWATER
FDACS-02032 Rev. 02/23
Page 28 of 33
Florida Department of Agriculture and Consumer Services
Division of Administration
CERTIFICATION REGARDING LOBBYING
2 CFR 200
Federal Financial Assistance Funding Opportunity Number: 23 -DG -11083112-500
Subrecipient Legal Name: CITY OF CLEARWATER
Subrecipient FEIN: 59-6000289
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 of Lobbying Activities" 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.
4. 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 or not less
than $10,000 and not more than $100,000 for each such failure.
Authorized Representative Name: JENNIFER POIRRIER
Title: CITY MANAGER
1
Signature of uthorized Representative:
Date Signed:
cva th"1/ tQ
Application Organization: CITY OF CLEARWATER
FDACS-02032 Rev. 02/23
Page 29 of 33
Florida Department of Agriculture and Consumer Services
Division of Administration
CERTIFICATION REGARDING DEBARMENTS, SUSPENSION,
INELIGIBILITY AND VOLUNTARY EXCLUSION - LOWER TIER
FEDERALLY FUNDED TRANSACTIONS
2 CFR 200
Federal Financial Assistance Funding Opportunity Number: 23 -DG -11083112-500
Subrecipient Legal Name: CITY OF CLEARWATER
Subrecipient FEIN: 59-6000289
This certification is pursuant to Executive Order 12549, Debarment and Suspension
1880.
and implemented at 2 CFR parts 180 and
Instructions for Certification
1. By signing and submitting this proposal, the prospective lower tier participant is providing the certifications set out below.
2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was
entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification. In
addition to other remedies available to the federal government, the department or agency with which this transaction originated
may pursue available remedies, including suspension and/or debarment.
3. The prospective lower tier participant shall provide immediate written notice to the person to whom this proposal is submitted
if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has become
erroneous by reason of changed circumstances.
4. The terms "covered transaction", "debarred", "suspended", "ineligible", "lower tier covered transaction", "participant", "person",
"primary covered transaction", "principal", "proposal", and "voluntarily excluded",, as used in this clause, have the meanings set
out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which
this proposal is submitted for assistance in obtaining a copy of those regulations.
5. The prospective lower tier participant agrees by submitting this form that, should the proposed covered transaction be entered
into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared
ineligible, or voluntarily excluded from participation in this covered transaction , unless authorized by the department or agency
with which this transaction originated.
6. The prospective lower tier participant further agrees by submitting this form that it will include this clause titled "Certification
Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions," without
modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.
7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered
transaction that is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that
the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its
principals. Each participant may, but is not required to, check the Nonprocurement List.
8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in
good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that
which is normally possessed by a prudent person in the ordinary course of business dealings.
FDACS-02032 Rev. 02/23
Page 30 of 33
9. Except for transactions authorized under paragraph 5 of these instructions, if
enters into a lower tier covered transaction with a person who is suspended, debarred,
participating in this transactions, in addition to other remedies available to the Federal
with which this transaction originated may pursue available remedies, including
a participant in a covered transaction knowingly
ineligible, or voluntarily excluded from
Government, the department or agency
suspension and/or debarment.
Certification
1. The prospective lower tier participant certifies to the best of its knowledge and belief, that it and its principals;
a. Are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from
covered transactions by any Federal department or agency.
b. Have not within a three-year period preceding this proposal been convicted
them for commission of fraud or a criminal offense in connection with obtaining,
(Federal, State, or local) transaction or contract under a public transaction; violation
commission of embezzlement theft, forgery, bribery, falsification or destruction
receiving stolen property;
of or had a civil judgment rendered against
attempting to obtain, or performing a public
of Federal or State antitrust statues or
or records, making false statements, or
c. Are not presently indicted for or otherwise criminally or civilly charged by a
with commission of any of the offenses enumerated in paragraph (1)(b) of this
governmental entity (Federal, State or local)
certification; and
d. Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal,
State, or local) terminated for cause or default.
2. Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such
prospective lower tier participant shall attach an explanation to this proposal.
Authorized Representative Name: JENNIFER POIRRIER
Title: CITY MANAGER
Signature of Authorized Representative:
Date Signed:
\JG 1 voti all 1 21) a
Application Orga - ation: CITY OF CLEARWATER
FDACS-02032 Rev. 02/23
Page 31 of 33
Florida Department of Agriculture and Consumer Services
Division of Administration
CERTIFICATION STATEMENT
2 CFR 200
Federal Financial Assistance Funding Opportunity Number: 23 -DG -11083112-500
Subrecipient Legal Name: CITY OF CLEARWATER
Subrecipient FEIN: 59-6000289
i
By signing this page, the undersigned certifies that:
A. This application is in all respects fair and submitted in good faith, without collusion or fraud;
I
B. If selected through this application process, the subrecipient will work in good faith and in partnership with the Florida
Department of Agriculture and Consumer Services to manage its subrecipient agreement in a timely and accurate manner;
C. Any funds awarded as a result of this application process will not be used to supplant or replace any state or local funds;
D. Any funds awarded as a result of this application process will not be used as matching funds to apply for or receive other
federal funds;
E. No federal funds will be used as match for funds awarded as a result of this application process.
F. The undersigned has full authority to bind the applicant.
Authorized Representative Name: JENNIFER POIRRIER
Title: CITY MANAGER
Signatureof Autho ized�Representative:
Date Signed:
App ication Organization: CITY OF CLEARWATER
FDACS-02032 Rev. 02/23
Page 32 of 33