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Mr. Gary Gorman
Columbia Heights
555 Mill Street NE
Columbia Heights, Minnesota 55421-3883
Re: Grant No.EMW-2005-FG-14397
Dear Mr. Gorman:
U.S. Department of Homeland Security
Office for Domestic Preparedness
Washington, D.C. 20531
Page 2 of 8
Congratulations, on behalf of Office of State and Local Government Coordination and Preparedness, in
collaboration with the U.S. Fire Administration at the Federal Emergency Management Agency. Your grant
application submitted under the FY 2005 Assistance to Firefighters Grant has been approved. The approved
project costs amount to $55,225.00. The Federal share is $52,463.00 of the approved amount and your share of
the costs is $2,762.00.
As part of your award package, you will find Grant Agreement Articles. Please make sure you read and
understand the Articles as they outline the terms and conditions of your Grant award. Maintain a copy of these
documents for your official file. You establish acceptance of the Grant and Grant Agreement Articles when
you request and receive any of the Federal Grant funds awarded to you.
The first step in requesting your grant funds is to confirm your correct Direct Deposit Information. Please go on-
line to the AFG eGrants system at www.firegrantsupport.com and if you have not done so, complete and
submit your SF 1199A, Direct Deposit Sign-up Form. Please forward the original, completed SF 1199A, Direct
Deposit Sign-up Form, signed by your organization and the banking institution to the address below:
Department of Homeland Security
Emergency Preparedness and Response Directorate (FEMA)
Grants Management Branch
500 C Street, SW, Room 334
Washington, DC 20472
Attn: Assistance to Firefighters Grant Program
After your SF 1199A is reviewed and you receive an email indicating the form is approved, you will be able to
request payments online. Remember, you should basically request funds when you have an immediate cash
need (i.e. you have a bill in-hand that is due within 30 days). If you have any questions or concerns regarding
the process to request your grant funds, please call 1-877-510-6762.
Sincerely,
~'~
Matt A.Mayer
Acting Executive Director
Office of State and Local Government
Coardination and Preparedness
1983
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Panel Review
Agreement Articles
U.S. Department of Homeland Security
Washington, D.C. 20531
Page 4 of 8
AGREEMENT ARTICLES
ASSISTANCE TO FIREFIGHTERS GRANT PROGRAM -Operations and Safety program
GRANTEE: Columbia Heights
PROGRAM: Operations and Safety
AGREEMENT NUMBER: EMV1/-2805-FG-14397
AMENDMENT NUMBER:
TABLE OF CONTENTS
Article I Project Description
Article II Grantee Concurrence
Article III Period of Performance
Article IV Amount Awarded
Article V Requests for Advances or Reimbursements
Article VI Budget Changes
Article VII Financial Reporting
Article VIII Performance Reports
Article IX DHS Officials
Article X Other Terms and Conditions
Article XI General Provisions
Article Xli Audit Requirements
Article I -Project Description
The grantee shall perform the work described in the approved grant application's Program Narrative. That
narrative is made a part of these grant agreement articles by reference. The purpose of the Assistance to
Firefighters Program is to protect the health and safety of the public and firefighting personnel against fire and
fire-related hazards. After careful consideration, DHS has determined that the grantee's project, as detailed in
submitted project narrative and budget information, submitted as part of the grantee's application (and
considered part of this agreement by reference), was consistent with the program's purpose and worthy of
award. As such, any material deviation from the approved program narrative must have prior written approval.
Article II -Grantee Concurrence
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By requesting and receiving Federal grant funds provided by this grant program, the grantee accepts and agrees
to abide by the terms and conditions of the grant as set forth in this document and the documents identified
below. All documents submitted as part of the application are made a part of this agreement by reference.
Article 111 -Period of Performance
The period of performance shall be from 18-AUG-05 to 17-AUG-06.
The grant funds are available to the grantee for obligation only during the period of performance of the grant
award. The grantee is not authorized to incur new obligations after the expiration date unless the grantee has
requested, and DHS has approved, a new expiration date. The grantee has 90 days after period of performance
to incur costs associated with closeout or to pay for obligations incurred during period of performance. Award
expenditures are for the purposes detailed in the approved grant application only. The grantee cannot transfer
funds or assets purchased with grant funds to other agencies or departments without prior written approval from
DHS.
Art{cle IV -Amount Awarded
The amount of the award is detailed on the Obligating Document for Award attached to these articles. Following
are the budgeted estimates for object classes for this grant (including Federal share plus grantee match):
Personnel $0.00
Fringe Benefits $0.00
Travel $0.00
Equipment $55,225.00
Supplies $0.00
Contractual $0.00
Construction $0.00
Other $0.00
Indirect Charges $0.00
Total $55,225.00
Article V -Requests for Advances or Reimbursements
Grant payments under the Assistance to Firefighters Grant Program are made on an advance or reimbursable
basis for immediate cash needs. When the grantee needs grant funds and has obtained a user account, the
grantee fills out the on-line Request for Advance or Reimbursement. If the grantee has not obtained a user
account, an account may be obtained by calling the help desk at 1-866-274-0960.
Article VI -Budget Changes
Generally, changes in the budget-line items are permitted, as long as the original program narrative is
accomplished. The only exception to this provision is for grants where the Federal share is in excess of
$100,000.00. In grants where the Federal share exceeds $100,000.00, the budgeted line items can be changed,
but if the cumulative changes exceed ten (10) percent of the total budget, Changes must be pre-approved.
Article V{1 -Financial Reporting
The Request for Advance or Reimbursement mentioned above, will also be used for interim financial reporting
purposes. At the end of the performance period, or upon completion of the grantee's program narrative, the
grantee must complete, on-line, a final financial report that is required to close out the grant. The Financial
Status Report, is due within 90 days after the end of the performance period.
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Article VIII -Performance Reports
Page 6 of 8
The grantee must submit asemi-annual and a final performance report to DHS. The final performance report
should provide a short narrative on what the grantee accomplished with the grant funds and any benefits derived
there from. The semi-annual report is due six months after the award date.
Article IX -DHS Officials
Program Officer: Tom Harrington, Deputy Chief of the Grants Program Office, is the Program Officer for this
grant program. The Program Ofi'ICer is responsible for the technical monitoring of the stages of work and
technical performance of the activities described in the approved grant application.
Grants Assistance Officer: Christine Torres, is the Assistance Officer for this grant program. The Assistance
Officer is the Federal official responsible for negotiating, administering, and executing all grant business matters.
Grants Management Branch POC: Ramon Bush is the point of contact for this grant award and shall be
contacted for all financial and administrative grant business matters. If you have any questions regarding your
grant please call 202-646-4001.
Article X -Other Terms and Conditions
Pre-award costs directly applicable to the awarded grant are allowable if approved in writing by the DHS
Program Office.
Article XI -General Provisions
The following are hereby incorporated into this agreement by reference:
44 CFR, Emergency Management and Assistance
Part 7 Nondiscrimination in Federally-Assisted Programs
Part 13 Uniform administrative requirements for grants and cooperative
agreements to state and local governments
Government-wide Debarment and Suspension (Non-procurement)
Part 17 and Government-wide Requirements for Drug-free Workplace
(Grants)
Part 18 New Restrictions on Lobbying
31 CFR 205.6 Funding Techniques
OMB Circular A-21 Cost Principles for Educational Institutions
OMB Circular A-87 Cost Principles for State/local Governments, Indian tribes
OMB Circular A-122 Cost Principles for Non-Profit Organizations
OMB Circular A- Uniform Administrative Requirements for Grants and Agreements With State and Local
102 Governments Assistance to Firefighters Grant Application and Assurances contained therein.
OMB Circular A- Uniform Administrative Requirements for Grants and Agreements With institutions of Higher
110 Education, Hospitals, and Other Nonprofit Organizatians Assistance to Firefighters Grant
Application and Assurances contained therein.
Article XII-Audit Requirements
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All grantees must follow the audit requirements of OMB Circular A-133, Audits of States, Local Governments,
and Non-Profit Organizations, The main requirement of this OMB Circular is that grantees that expend
$500,000.00 or more in Federal funds (from all Federal sources) must have a single audit performed in
accordance with the circular.
As a condition of receiving funding under this grant program, you must agree to maintain grant files and
supporting documentation for three years upon the official closeout of your grant. You must also agree to make
your grant files, books, and records available for an audit by DNS, the General Accounting Office (GAO), or their
duly authorized representatives to assess the accomplishments of the grant program or to ensure compliance
with any requirement of the grant program.
Additional Requirements if applicable
This grant award was reduced by $13,025. The approved amount for cascade fill station is $40,000 not $48,000.
The approved amount for racks is $11,725 @ 35 not the $16,750 @ 50 indicated in the initial application. The
reduction has already been made in the grant award and in the application as agreed by the applicant, Gary
Gorman via email 8/3/05. The total project cost was reduced from $68,250 to $55,225. The federal share was
reduced from $64,838 to $52,463. The applicant's match was reduced from $3412 to $2762.
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Panel Review
FEDERAL EMERGENCY MANAGEMENT AGENCY
OBLIGATING DOCUMENT FOR AWARDIAMENDMENT
1a. AGREEMENT NO. 2. AMENDMENT 3. RECIPIENT NO. 4. TYPE OF
EMW-2005-FG-14397 NO. 41-6005096 ACTION
0 AWARD
6. RECIPIENT NAME AND
ADDRESS
Columbia Heights
555 Mill Street NE
Columbia Heights
Minnesota, 55421-3883
9. NAME QF RECIPIENT
PROJECT OFFICER
Gary Gorman
11. EFFECTIVE DATE OF
THIS ACTION
18-AUG-05
Page 8 of 8
5. CONTROL NO.
W397597N
7. ISSUING OFFICE AND ADDRESS 8. PAYMENT OFFICE AND ADDRESS
ODP/Financial and Grants Management ODP/Financial Services Branch
Division 500 C Street, S.W., Room 723
500 C Street, S.W., Room 350 Washington DC, 20472
Washington DC, 20472
POC: Ramon Bush 202-646-4001
PHONE NO. 10. NAME OF PROJECT COORDINATOR PHONE NO.
763-706-3652 Tom Harrington 1-866-274-0960
12. METHOD OF 13. ASSISTANCE ARRANGEMENT
PAYMENT Cost Sharing
SF-270
15. DESCRIPTION OF ACTION
a. (Indicate funding data for awards or frnanciaf changes)
PROGRAM NAME CFDA NO. ACCOUNTING DATA PRIOR AMOUNT
ACRONYM (ARCS CODE) TOTAL AWARDED THIS
XXXX-XXX-XXXXXX-XXXXX- AWARD ACTION
XXXX-XXXX-X + OR (-)
AFG 97.044 2005-62-0501RE-63000000- $0.00 $52,463.00
4101-R
14. PERFORMANCE PERIOD
From:18-AUG- To:17-AUG-06
05
Budget Period
From:01-OCT- To:30-SEP-06
04
CURRENT CUMMULATIVE
TOTAL AWARD NON-
FEDERAL
COMMITMENT
$52,463.00
TOTALS $0.00 $52,463.00 $52,463.00
$2,762.00
$2,762.00
b, To describe changes other than funding data or financial changes, attach schedule and check here.
N/A
16 a. FOR NON-DISASTER PROGRAMS: RECIPIENT IS REQUIRED TO SIGN AND RETURN THREE (3} COPIES OF THIS DOCUMENT
TO FEMA (See Block 7 for address)
Assistance to Firefighters Grant recipients are not required to sign and return copies of this document. However, recipients should print and
keep a copy of this document for their records.
16b. FOR DISASTER PROGRAMS: RECIPIENT IS NOT REQUIRED 70 SIGN
This assistance is subject to terms and conditions attached to this award notice or by incorporated reference in program legislation cited
above.
17. RECIPIENT SIGNATORY OFFICIAL (Name and Title} DATE
N/A N/A
18. FEMA SIGNATORY OFFICIAL (Name and Title} DATE
Sheila Parker Darby 10-AUG-05
Go Back
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Gary Gorman -Final Closeout Letter For EMW-2005-FG-14397
From: <earl.davis@associates.dhs.gov>
To: <gary.gorman@ci.columbia-heights.mn.us>
Date: 11/10/2006 2:03:45 AM
Subject: Final Closeout Letter Far EMW-2005-FG-14397
Columbia Heights
Gary Gorman
555 Mill St. NE,
Columbia Heights, Minnesota 55421
Dear Mr. Gorman:
This is to inform you that we have reviewed your final reports and other documents pertaining to your
FY2005 Grant Award No. EMW-2005-FG-14397 and found that you have fulfilled all performance,
financial, and administrative requirements.
We have officially closed out this agreement in accordance with the general closeout principles and
guidance provided in 44 CFR 13.50. It is understood that Columbia Heights will maintain all
equipment/supplies purchased through the Assistance to Firefighter grant for the entire life cycle of the
equipment/supplies. It is understood that your Fire Department will report to the National Fire Incident
Reporting System for one year and you will maintain all your grant records for three years after the date
of this letter.
If you have any questions regarding this closeout, please call 1-877-510-6762.
Sincerely,
Page 1 ,
__.._
Grants Management Branch
Assistance to Firefighters Grant Program
Department of Homeland Security/FEMA
Application Number: EMS-2005-FG-14397
Entire Application
Overview
Page 1 of 22
Are you a member, or are you currently involved in the management, of the fire department
or non-affiliated EMS organization applying for this grant with this application?
Yes, I am amember/officer of this applicant
If you answered No, please complete the information below and press the Save and Continue button. If you
answered Yes, please do not complete the information requested below and press the Save and Continue
button.
Note: If you answered No to fhe above question, the fields marled with an ~ are required.
Preparer information
Preparer's Name
t Address 1
Address 2
city
State
Zip
• Is there agrant-writing fee associated with the
preparation of this request?
If you answered yes above, what is the fee? $
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Application Number: EMW-2005-FG-14397
Contact Information
Page 2 of 22
Alternate Contact Information Number 1
• Title Fire Chief
Prefix Mr.
First Name Gary
Middle Initial C
Last Name Gorman
Business Phone 763-706-3650 Ext.
°Home Phone 763-586-0839 Ext.
Mobile PhonelPager 512-790-1929
Fax 763-706-3551
Email gary.gorman@ci.columbia-heights.mn.us
Alternate Contact Information Number 2
Title Captain
Prefix Mr.
First Name Matthew
Middle Initial D
• Last Name Field
Business Phone 763-706-3650 Ext.
-Home Phone 763-571-9697 Ext.
Mobile Phone/Pager 612-640-7052
Fax 763-706-3651
°Email matt.field@ci.columbia-heights.mn.us
Application Number: EMW-200-FG-14397
Applicant Information
Page 3 of 22
EMW-2005-FG-14397
Originally submitted on 04/08/2005 by Gary Gorman (Userid: charliethompson)
Contact Information:
Address: 555 Mill St. NE,
City: Columbia Heights
State: Minnesota
Zip: 55421
Day Phone: 763-706-3652
Evening Phone: 763-586-0839
Cell Phone: 612-790-1929
Email: gary.garman@ci.columbia-heights.mn.us
Application number is EMW-2005-FG-14397
* Organization Name Columbia Heights
• Type of Applicant Fire Department
* Type of Jurisdiction Served City
If other, please enter the type of Jurisdiction
* _E_mployer Identification Number 41-600506.
• Does your organization have a DUNS_Number? Yes
If yes, please enter the DUNS_Number 556467579
Headquarters Physical Address
* Physical Address 1 555 Mill Street NE
Physical Address 2
* City Columbia Heights
* State Minnesota
55421 - 3883
* Zip
Need help_for ZI,P+4?
Mailing Address
* Mailing Address 1 555 Mill Street NE
Mailing Address 2
* City Columbia Heights
* State Minnesota
55421 - 3883
* Zlp Need help for ZIP+4?
Account !nformation
* Type of bank account Checking
* Hank routing number - 9 digit number on the bottom 091000132
felt hand corner of your check
*Your account number 5390034
Additional Information
* For this fiscal year (Federal} is yourjurisdiction
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Application Number: EIv1W-2005-FG-14397
receiving Federal funding from any other grant
program that may duplicate the purpose and/or scope No
of this grant request?
If awarded this grant, will your jurisdiction expend
greater than $300,000 in Federal share funds during No
the Federal fsca! year in which the grant was
awarded?
• !s the applicant delinquent on_any_federal_debt? No
(f you answered yes to any of the additional questions
above, please provide an explanation in the space
provided below:
Page 4 of 22
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Application. Number: EMW-2005-FG-14397
Department Characteristics (Part Ij
Page 3 of 22
• Are you a member of a Federal Fire Department or
contracted by the Federal government and solely No
responsible for suppression of fires on Federal
property?
What kind of organization do you represent? Combination
If you answered combination, above, what is the 22 %
percentage of career members in your organization?
• What type of community does your organization
serve? Urban
What is the square mileage of your primary response 3.4
area?
k What percentage of your response area is protected 100
by hydrants?
In what county/parish is your organization physically
located? If you have more than one station, in what Anoka
county/parish is your main station located?
• Does your organization protect critical infrastructure Yes
of the state?
How much of your jurisdiction's land use is for
agriculture, wild land, open space, or undeveloped 0
properties?
What percentage of your jurisdiction's land use is for 14 %
commercial, industrial, or institutional purposes?
• What percentage of your jurisdiction's land is used 86 %
for residential purposes?
How many commercial, industrial, residential, or
institutional structures in your jurisdiction are more 13
than four stories tall?
* What is the permanent resident population of your
Pnma_ry/First Due Resp®nse Area ar jurisdiction 18698
served?
How many active firefighters does the department 33
have who perform firefighting duties?
How many personnel provide only EMS service 0
delivery?
How many stations are in your organization? 1
Do you currently report to the National Fire Incident Yes
Reporting System (NFIRS}?
If you answered yes above, please enter your 02105
FD(_N/1=DID
What services does your organization provide?
Structural Fire Suppression Medical First Response Hazmat ®perational Level
Basic Life Support
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Application Number: EMW-2005-FG-14397
Page 6 of 22
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ApplicatianNumber: EMW-2005-FG-14397
Department Characteristics (Part II)
Page 7 of 22
• What is the total number of fire-related civilian fatalities in your 0
jurisdiction over the last three years?
What is the total number of fire-related civilian injuries in your ~
jurisdiction over the last three years?
What is the total number of line of duty member fatalities in your 0
jurisdiction over the last three years?
What is the total number of line of duty member injuries in your 25
jurisdiction over the last three years?
In an average year, how many times does your organization 24
receive mutual/automatic aid?
• In an average year, how many times does your organization 53
provide mutual/automatic aid?
What was your organization's estimated average annual 879000
operating budget over the last three years?
What percentage of your annual operating budget is dedicated to 88
personnel costs (salary, overtime and fringe benefits)?
What percentage of your annual operating budget is derived from:
Enter numbers only, percentages must sum up to 100%
Taxes? 100
Grants? 0
Donations? 0
Fund drives? 0
Other? 0
If you entered a value into Other field (other than 0), please explain
•How many vehicles does your organization have in each of the categories below? Enter numbers only and
enter 0 if you do not have any of the vehicles below
Total Number
Engines (or pumpers):
Pumper, Pumper/Tanker, Rescue/Pumper, Foam Pumper, CAFS Pumper, Quint
(Aerial device of less than 76 feet}, Fire Boats (more than 13 feet long}, Type I, 3
Type II, Type III Engine, Tanker, Tender, Foam Tankerlrender (greater than 1,200
gallon tank capacity}
Aerial Apparatus:
Aerial Ladder Truck, Telescoping, Articulating, Ladder Towers, Platform, Tiller 1
Ladder Truck, Quint (Aerial device of 76 feet or greater)
Brush/Quick attack
Brush Truck, Patrol Unit (Pick up w/Skid Unit), Quick Attack Unit, Mini-Pumper, 0
Type IV Engine
Rescue Vehicles:
Rescue Squad, Rescue (Light, Medium, Heavy), Technical Rescue Vehicle, 2
Hazardous Materials Unit
Other:
EMS Chase Vehicle, Air/Light Unit, Rehab Units, Bomb Unit, Technical Support
(Command, Operational Support/Supply}, Hose Tender, Selvage Truck, ARFF ~
(Aircraft Rescue Firefighfing}, Command/Mobile Communications Vehicle, tither
Vehicle
Provide in the space below the following information only if you are applying for a vehicle:
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Application Number: EN1W-2005-FG-14397
Page 8 of 22
If you have 15 emergency response vehicles or less, list all vehicles providing the type, the age, the pump
capacity (GPM} if applicable, and the carrying capacity (gallons} if applicable.
If you have more than 15 emergency response vehicles, provide us with the oldest, newest, and the average
age of the vehicles per type or class of vehicle.
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Application Number: EMW-2005-FG-14397
Department Call Volume
Page 9 of 22
HOW many responses per year by Category? (Enter whole numbers only: if you have no calls for any of the categories, enter 0)
Structural Fires 27
Vehicle Fires 6
Vegetation Fires 16
EMS Response Call 1645
Rescue 9
Hazardous Condition/Materials Calls 52
Service Calls 46
Good Intent Calls/False Alarms 77
Other Calls and Incidents 258
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Application Number: EMW-2005-FG-14397
Request Information
Page 10 of 22
1. Select a program for which you are applying. Remember, you can only apply for one program this year. You
can apply for as many activities within a program as you need.
(If you modify your selection, you will lose data entered under the original activity.)
Program Name
Operations and Safety
2. Will this grant benefit more than one organization?
Yes
If you answered Yes to Question 2 above, please explain.
The Columbia Heights Fire Department (CHFD)is a member of the North Suburban Regional Mutual Aid
Association. This is an organization of 34 fire departments, spread across 5 counties, that shares resources and
equipment. The CHFD has an automatic mutual aid agreement with our two neighbors Fridley and St. Anthony
which, depending upon the call type, dispatches their equipment at the same time as ours. The CHFD also
provides fire and EMS coverage for the City of Hilltop. Anoka County has created specialized teams made up of
members of individual fire departments. These teams include a Chemical Assessment Team (CAT), a Fire
Investigation Team (FIT), and a Specialized Rescue Team (SRT). All of the equipment obtained through this
grant would be available for use by these departments and teams as part of the mutual aid agreement under
which these specialized teams operate.
Request Details
The activities for program Operations and Safety are listed in the table below.
Activity Number of Entries Total Cost Additional Funding
Equipment 3 $ 68,250 $ 0
Modify Facilities 0 $ 0 $ 0
Personal Protective Equipment 0 $ 0 $ 0
Training 0 $ 0 $ 0
Wellness and Fitness Programs 0 $ 0 $ 0
Equipment
Equipment Details
*1. What equipment will your organization purchase with this grant? Compressors/Cascade/Fill Station (Fixed)
Please provide further description of the item selected above or if
you selected Other above, please specify.
*2. Number of units
*3. Cast per unit
*4. Generally the equipment purchased under this grant program:
A stationary air compressor system which
includes a containment filling station and
four 6000 psi cascade bottles. In addition,
three 6000 psi cascade bottles and a
single containment fill station for our
mobile Rescue /Air truck. The system will
have the ability to fill our new high
pressure SCBA air bottles at both the
station and at the scene.
1 (whole number only)
$ 48000 (whole dollar amounts only)
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Application Number: EMW-2005-FG-14397
Will replace old, obsolete, or substandard equipment currently owned by this organization
If you selected "replacing equipment" (from Q4) above, please
specify the age of equipment in years.
*5. Generally the equipment purchased under this grant program:
Will bring the organization into statutory compliance. Please explain
how this equipment will bring the organization into statutory
compliance in the space provided to the right.
Over 5 Years
Page I 1 of 22
The current compressor/cascade system
is 13 years old and was purchased for
use with our o!d !ow pressure SCBA
equipment. The CHFD made an
emergency purchase of new high
pressure SCBA in 2004. The current
compressor/cascade system does not
have the capactity to fll! the SCBA air
bottles up to the needed pressure to meet
the 30 minute requirements of OSHA
29CFR1910.156 and NIOSH under
42CFR part 84.
*6. Does this equipment provide a health and safety benefit to the Yes
members of your organization? If yes, please fully explain in the
narrative section.
*7. Will the item requested benefit other organizations or otherwise
be available for use by other organizations?
If you answered Yes in the question above, please explain:
Equipment
Equipment Details
*1. What equipment will your organization purchase with this grant?
Please provide further description of the item selected above or if
you selected Other above, please specify.
*2. Number of units
*3. Cost per unit
`4. Generally the equipment purchased under this grant program:
Yes
The cascade system requested far our
mobile Rescue/Air truck would be
available to other communities through
our 34 member mutual aid group, auto
aid communities and the specialized
county teams.
Other Basic Equipment (explain}
Gear racks for everyday storage our
protective firefighting clothing.
50 (whole number only)
$ 335 (whole dollar amounts only)
Wfl replace ofd, obsolete, ar substandard equipment currently owned by this organization
If you selected "replacing equipment" (from Q4) above, please Over 5 Years
specify the age of equipment in years.
*5. Generally the equipment purchased under this grant program:
Will bring the organization into statutory compliance. Please explain The current gear racks are 27 years oid
how this equipment will bring the organization into statutory and are constructed of plywood. They do
compliance in the space provided to the right. not meet proper care and maitenance
requirements based on OSHA CFR
1910.132, 1910.156 and 1910.1030. This
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Application Number: EMW-2005-FG-14397
*6. Does this equipment provide a health and safety benefit to the
members of your organization? If yes, please fully explain in the
narrative section.
°7. Will the item requested benefit other organizations or otherwise
be available for use by other organizations?
If you answered Yes in the question above, please explain:
Equipment
Equipment Details
*1. What equipment will your organization purchase with this grant?
Page 12 of 22
grant will allow for the purchase of racks
that will meet these requirements.
Yes
Yes
In 2002 the CHFD purchased a
commercial washing machine to assist us
in meeting the cleaning requirements of
our gear. This washer is available, and
has been used, by other communities.
Our grant request would allow for gear
rack space for the proper drying of the
gear from these neighboring
communities.
Portable/Mobile Generator
Please provide further description of the item selected above or if Portable gas generator with mobile lights
you selected Other above, please specify: and cords.
~`2. Nurnber of units 1 (whole number only)
*3. COSt per Unit $ 3500 (whole dollar amounts only)
*4. Generally the equipment purchased under this grant program:
Will expand the capabilities of the organization into a new mission area
!f you selected "replacing equipment" (from Q4} above, please
specify the age of equipment in years.
~`5. Generally the equipment purchased under this grant program:
Has no statutory basis
*6. Does this equipment provide a health and safety benefit to the
members of your organization? If yes, please fully explain in the
narrative section.
*7. Will the item requested benefit other organizations or otherwise
be available for use by other organizations?
If you answered Yes in the question above, please explain:
Select Age
Yes
Yes
Budget cuts at the state level have forced
the MN State Fire Marshals office the
state to no longer conduct fire
investigations anises it involves a death
or high dollar loss. The Anoka County fire
departments created afire/arson
investigation tearn(F!T} made up of
firefighters, police officers, and county
investigators. County fire departments
provide their recourses and equipment if
a FIT member from their department is
called. This equipment would be available
Application Number: EMW-2005-FG-14397
Budget
Budget_Object_Class
a. Personnel
b. Fringe Benefits
c. Travel
d. Equipment
e. Supplies
f. Contractual
g. Construction
h. Other
Page 13 of 22
for use by the Countywide team.
$0
$0
$0
$ 68,250
$0
$0
$0
$0
i. Indirect Charges $ 0
Federal and Applicant Share
Federal Share $ 64,838
Applicant Share $ 3,412
Federal Rate Sharing (%) 95/5
* NOn-Federal ReSOUrCe$ (The combined Non-Federal Resources must equal the Applicant Share of $ 3,412)
a. Applicant $ 3,412
b. State $ 0
c. Local $ 0
d. Other Sources $ 0
If you entered a value in Other Sources, include your explanation below. You can use this space to provide
information on the project, cost share match, or if you have a indirect cost agreement with a federa l agency.
Total Budget $ 68,250
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Applxcatian Number: EMW-2005-FG-14397
Narrative Statement
Page 14 of 22
Project Description
* Please provide your narrative statement in the space provided below. Include in your Werra#ive, details
regarding (1) your project's description and budget, (2) your organization's financial need, (3) the benefit to be
derived from the cost of your project, and (4) how the activities requested in your application will help your
organization's daily operations and how this grant will protect life and properly.
The City of Columbia Heights Fire Department (CHFD) is proposing to replace several outdated and non-
compliant pieces of equipment as well as expand its capabilities for response with the award of this grant. The
grant propose! that follows is broken down into three areas, an air cascade system, a turnout gear storage
system and a portable generator, lights and cords.
The CHFD is a combination department, which employs one fulltime Fire Chief, one fulltime Assistant Fire Chief,
three fulltime Fire Captains, three fulltime Firefighters and up to 30 Paid-on-Call Firefighters. The City of
Columbia Heights is a first-ring suburb of Minneapolis with a population of 18,698. The CHFD also provides fire
and EMS coverage for the City of Hilltop, a small community of approximately 700 residents surrounded on all
sides by Columbia Heights. The City of Columbia Heights is predominately a community of elderly residents
(approximately 28% of the residents are 58 years and older) with a size of 3.4 square miles that met its growth
potential many years ago. Opportunities for redevelopment in the city are few, but some are currently in process.
The CHFD responded to 1,653 emergency medical calls and 483 fire and hazardous material related calls in
2004 amounting to 9.7% of all emergency calls in Anoka County. Columbia Heights makes up less then 1 % of
the county in area and has 6% of the county's population. Median household income in Columbia Heights is
over $17,000 less then the countywide median household income. Columbia Heights also has a 2% higher
number of population below the poverty level than the county as a whole. To meet its budgetary needs in the
past, the City of Columbia Heights has relied heavily on State aid, a program that, over the past three years, has
been cut dramatically. In 2003, and again in 2004, the Governor of Minnesota proposed and implemented a
reduced budget for the State, which included a severe reduction to many cities' Local Government Aid (LGA)
and Market Value Homestead Credit (MVHC) monies. The City of Columbia Heights was hit drastically by this
budget decrease and had a $700,000 reduction in aid in 2003 and $1.4 million reduction in aid in 2004. Every
department in the city was forced to make major budget cuts due to the reductions. In 2004, the CHFD had to
make a 4.5% reduction in a budget that had already been reduced by the previous cut in 2003 of 5%. The 2005
fire department budget is a "stay-the-line" budget from 2004 and with the additional State aid reductions, a 2%
increase in contract wages and a shortage of one full-time firefighting position, the fire department is in financial
dire straits.
The first portion of the request seeks the opportunity to replace our current inadequate compressor/cascade fill
station with a new stationary compressor/ cascade system that will include containment fill stations as per NFPA
requirements. The current compressor and cascade system is 13 years old and has the capacity to fill only low-
pressure self contained breathing apparatus (SGBA) bottles. In 2003 and 2004 a significant amount of rust
particles were found in the system, which according to the service company, may contribute to future damage to
the compressor and SGBA failures. In the fall of 2004 we made an emergency purchase for new high pressure
SCBA equipment. The SCBA equipment was purchased two years earlier than planned due to five SCBA
failures on the fireground and during training over the course of a year and a half. The current compressor does
not have the capacity to fill the new high-pressure SCBA air bottles to the recommended level to allow for 30
minutes of use per OSHA 29CFR1910.156 and NIOSH 42 CFR part 84. This does not allow our line firefighters
the amount of air needed to conduct normal operations in an IDLH atmosphere and to bring them out safely. In
2004 a 1990 heavy rescue vehicle of ours was refurbished. The refurbishment reworked an existing low-
pressure cascade system for space to carry three cascade bottles and a single fill containment vessel. Our
request includes three high-pressure cascade bottles and a containment vessel for this vehicle to replace the
current low-pressure system. This will allow us to completely fill SCBA bottles on an incident scene. The CHFD
has an automatic aid agreement with the neighboring communities of Fridley and St. Anthony. St. Anthony
purchased new high pressure SCBA in 2002 and we jointly purchased our new SCBA with the City of Fridley.
The rescue truck and its cascade system will be used in both of these neighboring communities as well as being
a likely available resource to the 31 other neighboring communities that are part of the North Suburban Regional
Mutual Aid agreement. The CHFD has already made several necessary upgrades to our contingent of air rescue
tools and air bags to make them compatible with the new high-pressure bottles. The station
compressor/cascade system, along with the rescue vehicle cascade system we are requesting, would be the
final pieces of equipment to complete our canversian to high-pressure SCBA air bottles.
The second portion of the request seeks the opportunity to purchase replacement turnout gear racks that allow
far the proper care and maintenance of our turn out gear based on OSHA and NFPA regulations, and the
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Application Number: EMW-2005-FG-14397
Page 15 of 22
manufacturers' requirements. The single Columbia Heights fire station was built in late 1942 and was added
onto in the 1960's and most recently 1978. Temporary turnout gear racks were installed lining the walls adjacent
to the emergency vehicles during the 1978 remodel. These "temporary" plywood gear racks became permanent
and are currently still in use 27 years later. The use of plywood is a concern due to the potential of the wood to
absorb carcinogens and bioodborne pathogens. We feel that these wood racks are truly a health and safety
issue for the fallowing reasons:
1. The space between the vehicles and the turnout gear racks is approximately 24 inches. This space does not
provide a safe area for firefighters to get dressed in while vehicles are exiting for response. Exhaust extraction
hoses, which also occupy this 24-inch area, spring back into this space when released from the exhaust pipe.
The danger to firefighters of being struck by these hoses while getting dressed in this space is extremely high.
2. The bases of fhe wood racks sit on the apparatus floor and have ongoing rotting and mold issues due to the
continuously wet floors.
3. The spacing of the gear on the racks is inadequate. Currently we have 11 sets of gear in 15 feet of rack. Sets
of turnout gear touch each other, promoting the cross contamination of carcinogens and bioodborne pathogens
(since this gear is used many times on EMS calls). In 2002 a commercial washing machine was purchased to
assist in meeting cleaning requirements for our turnout gear.
4. The wall-mounted turnout gear racks are at the front of the station where they come in contact with direct
sunlight. The turnout gear manufacturers recommend that gear not be stored in direct sunlight.
5. When not in use, bunker pants are stared folded down around the boots and turnout coats are hung on a
hook. Firefighter gloves and helmets are laid on a shelf. Staring turnout gear in this fashion does not allow the
proper ventilation for its complete drying which has the potential to cause burns to firefighters if wet gear is worn
into a structure fire.
The new racks will be installed in the rear of the fire station, away from direct sunlight and away from moving
vehicles, which will allow our firefighters the space and safety needed while they get dressed to respond to
emergencies. Modern turnout gear racks have engineered into them the necessary elements for proper spacing,
ventilation and drying. This will assist in eliminating any possible cross contamination of bioodborne pathogens
and carcinogens.
The third and last portion of the grant request addresses an interest in purchasing a portable gas generator
along with cords and lights to expand our fire/arson investigation capabilities. The Minnesota State Fire
Marshals office has seen severe budget cuts over the last three years and has stopped conducting fire scene
investigations unless a death or major dollar loss is involved. In response, fire departments in Anoka County
started a Fire Investigation Team (FIT). This team is comprised of trained firefighter investigators, police officers,
and members of the county sheriffs and investigative departments. When a community in the county requests
the FIT team, members of this team respond to the fire/arson scene and conduct a fire investigation.
Investigation duties include fire cause and origin, interviews, drawings, and photographs. The team assembles
all information and a final written report is submitted to the fire department having jurisdiction. Individual
departments, besides providing trained personnel, also provide equipment for the team's usage. To this end, the
CHFD is requesting a portable gas generator, lights, and cords for use on fire/arson investigation scenes. The
CHFD has already purchased an assortment of small tools, equipment, and a digital camera to equip a vehicle
that wiN be ready to respond for invesfrgations at all times. The portable generator, light and cords that are
requested will be the last pieces of equipment needed to ready this vehicle for response. The equipment
purchased will also be shared with communities spanning five counties through the Anoka County Chemical
Assessment Team, an automatic mutual aid agreement, and our 34-member North Suburban Mutual Aid
association.
The monies proposed by this grant will go toward bringing several pieces of equipment up-to-date and compliant
with several federal and state regulations and standards. This proposal will also expand our capacity to serve
the public with the purchase of equipment to be used during fire/arson investigations and will equip our
department with the necessary tools which will empower us to continue to provide a fast, professional and
courteous level of service to our community as a whole.
* Please describe any grants that you currently have with DHS including the AFG, for example, 2002 AFG grant
for vehicle or 2003 ODP grant for exercises. (Enter "N/A" if Not Applicable)
In 2003 AFG funded the Columbia Heights Fire Department with a grant for a vehicle.
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Application Number: EMW-2005-FG-14397
Page 16 of 22
Assurances and Certifications
Form 20-16A
You must read and sign these assurances by providing your password and checking the box at the
bottom of this page.
Note: Fields marked with an * are required.
Assurances Non-Construction Programs
Note: Certain of these assurances may not be applicable to your projector program. If you have any questions,
please contact the awarding agency. Further, certain Federal 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:
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 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 award; and will establish a
proper accounting system in accordance with generally accepted accounting standards or
agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that
constitutes or presents the appearance of personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval
of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. Section 4728-4763)
relating to prescribed standards for merit systems for programs funded under one of the
nineteen 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. WII comply with all Federa! 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. Sections 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. Section 794), which prohibits discrimination on the basis of
handicaps; (d} the Age Discrimination Act of 1975, as amended (42 U.S.C. Sections 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} Sections 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 Vlll of the Civil Rights Acts
of 1968 (42 U.S.C. Section 3601 et seq.), as amended, relating to nondiscrimination in the
sale, rents( 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 statutes} which may apply to the application.
7. Will comply, or has already complied, with the requirements of Title li and III of the Uniform
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Application Number. EMW-2005-FG-14397
Page 17 of 22
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 interest in real property acquired for project purposes regardless of Federal participation in
purchases.
8. Will comply with provisions of the Hatch Act (5 U.S.C. Sections 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. WII comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C. Sections
276a to 276a- 7), the Copeland Act (40 U.S.C. Section 276c and 18 U.S.C. Sections 874),
and the Contract Work Hours and Safety Standards Act (40 U.S.C. Sections 327-333),
regarding labor standards for Federally assisted construction sub agreements.
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 flood plains 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. Section 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. Section 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. V1rll comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. Section 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. Wiil 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. Section 4801 et
seq.} which prohibits the use of lead based paint in construction or rehabilitation of residence
structures.
17. WII cause to be performed the required financial and compliance audits in accordance with
the Single Audit Act of 1984.
18. Will comply with all applicable requirements of all other Federal laws, executive orders,
regulations and policies governing this program.
19. It will comply with the minimum wage and maximum hours provisions of the Federal Fair
Labor Standards Act (29 U.S.C. 201), as they apply to employees of institutions of higher
education, hospitals, and other non-profit organizations.
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Appiication Number: EMW-2005-FG-14397
Signed by Gary Gorman on 04/04/2005
Page 18 of 22
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Application Number: EMW-2005-FG-14397
Page 19 of 22
Farm 20-16C
You must read and sign these assurances by providing your password and checking the box at the
bottom of this page.
Nate: Fields marked with an * are required.
Certifications Regarding Lobbying, Debarment, Suspension and Other Responsibility Matters and Drug-Free
Workplace Requirements.
Applicants should refer to the regulations cited below to determine the certification to which they are required to
attest. Applicants should also review the instructions for certification included in the regulations before
completing this form. Signature on this form provides for compliance with certification requirements under 44
CFR Part 18, "New Restrictions on Lobbying; and 28 CFR Part 17, "Government-wide Debarment and
Suspension (Non-procurement} and Government-wide Requirements for Drug-Free Workplace (Grants).'" The
certifications shall be treated as a material representation of fact upon which reliance will be placed when the
Department of Homeland Security {DHS} determines to award the covered transaction, grant, or cooperative
agreement.
1. Lobbying
A. As required by the section 1352, Title 31 of the US Code, and implemented at 44 CFR Part 18 for persons
(entering) into a grant or cooperative agreement over $100,000, as defined at 44CFR Part 18, the applicant
certifies that:
(a) No Federal appropriated funds have been paid or will be paid by or on behalf of the
undersigned to any person for influencing or attempting to influence 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 the making of any Federal grant, the entering into of any
cooperative agreement and extension, continuation, renewal amendment or modification of any
Federal grant or cooperative agreement.
(b) If any other funds 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 grant or cooperative agreement, the undersigned shall complete and
submit Standard Form LLL, "Disclosure of Lobbying Activities", in accordance with its instructions.
(c) The undersigned shall require that the language of this certification be included in the award
documents for all the sub awards at all tiers (including sub grants, contracts under grants and
cooperative agreements and sub contract(s)) and that all sub recipients shall certify and disclose
accordingly.
2. Debarment, Suspension and Other Responsibility Matters (Direct Recipient)
A. As required by Executive Order 12549, Debarment and Suspension, and implemented at 44CFR Part 67, for
prospective participants in primary covered transactions, as defined at 44 CFR Part 17, Section 17.510-A, the
applicant certifies that it and its principals:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced
to a denial of Federal benefits by a State or Federal court, or voluntarily excluded from covered
transactions by any Federal department or agency.
(b} Have not within athree-year period preceding this application been convicted of or had a
civilian judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain ar perform a public (Federal, State, or focal)
transaction or contract under a public transaction; violation of Federal or State antitrust statutes or
commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making
false statements, or receiving stolen property.
(c} Are not presently indicted far or otherwise criminally or civilly charged by a government entity
(Federal, State, ar local} with commission of any of the offenses enumerated in paragraph (1 }(b) of
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Application Number: EMW-2005-FG-14397 Page 20 of 22
this certification: and
(d) Have not within athree-year period preceding this application had one or more public
transactions (Federal, State, or focal) terminated for cause or default; and
B. Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach an
explanation to this application.
3. Drug-Free Workplace (Grantees other than individuals)
As required by the Drug-Free Workplace Act of 1988, and implemented at 44CFR Part 17, Subpart F, for
grantees, as defined at 44 CFR part 17, Sections 17.615 and 17.620:
(A) The applicant certifies that it will continue to provide adrug-free workplace by:
(a) Publishing a statement notifying employees that the unlawful manufacture,
distribution, dispensing, possession, or use of a controlled substance is prohibited in
the grantee's workplace and specifying the actions that will be taken against
employees for violation of such prohibition;
(b) Establishing an on-going drug free awareness program to inform employees
about:
(1 }The dangers of drug abuse in the workplace;
(2) The grantees policy of maintaining adrug-free workplace;
(3} Any available drug counseling, rehabilitation and employee
assistance programs; and
(4) The penalties that may be imposed upon employees for drug abuse
violations occurring in the workplace;
(c) Making it a requirement that each employee to be engaged in the performance of
the grant to be given a copy of the statement required by paragraph (a);
(d) Notifying the employee in the statement required by paragraph (a) that, as a
condition of employment under the grant, the employee will:
(1) Abide by the terms of the statement and
(2) Notify the employee in writing of his or her conviction for a violation
of a criminal drug statute occurring in the workplace no later than five
calendar days after such conviction.
(e) Notifying the agency, in writing within 10 calendar days after receiving notice
under subparagraph (d)(2) from an employee or otherwise receiving actual notice of
such conviction. Employers of convicted employees must provide notice, including
position title, to the applicable DHS awarding office, i.e. regional office or DHS office.
(f} Taking one of the following actions, against such an employee, within 30 calendar
days of receiving notice under subparagraph (d)(2), with respect to any employee
who is so convicted:
(1) Taking appropriate personnel action against such an employee, up
to and including termination, consistent with the requirements of the
Rehabilitation Act of 1973, as amended; or
(2) Requiring such employee to participate satisfactorily in a drug abuse
assistance or rehabilitation program approved for such purposes by a
Federal, State, or local health, law enforcement or other appropriate
agency.
(g) Making a good faith effort to continue to maintain a drug free workplace through
implementation of paragraphs (a), (b), (c), (d), (e), and (f).
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Application Number: EMW-?005-FG-14397
Page 21 of 22
(8} The grantee may insert in the space provided below the site(s) for the performance of work
done in connection with the specific grant:
Place of Performance
Street City State Zip Action
If your place of performance is different from the physical address provided by you in the Applicant Information,
press Add Place of Performance button above to ensure that the correct place of performance has been
specified. You can add multiple addresses by repeating this process multiple times.
Section 17.630 of the regulations provide that a grantee that is a State may elect to make one certification in each
Federal fiscal year. A copy of which should be included with each application for DHS funding. States and State
agencies may elect to use a Statewide certification.
Signed by Gary Gorman on 04/04/2005
https://portal.fema. gov/firegrant/j sp/fire2005/application/print_app.j sp?print=true&app_nu... 7/29/2005
Application Number: EMW-2005-FG-14397
FEMA Standard Farm LLL
Page 22 of 22
Only complete if applying for a grant for more than $100,000 and have lobbying activities. See Form 20-16C for
lobbying activities definition.
This form is not applicable
https://portal.fema.gov/firegrant/~ sp/fire2005/application/print_app.j sp?print=true&app_nu... 7/29/2005