HomeMy WebLinkAboutWashington State Military Department - Interlocal Agreement Washington State Military Department
PUBLIC ASSISTANCE GRANT AGREEMENT FACE SHEET
1. SUBRECIPIENT Name and Address: 2, Grant Agreement Amount: 3 Grant Number:
Mason County To be determined, based upon
100 W Public Works Drive approved project worksheets D22-283
Shelton,WA 98584
4. SUBRECIPIENT, phone/email: 5. Grant Agreement Start Date: 6. Grant Agreement End Date:
Ijtaylor@masoncountywa.gov December 26, 2021 March 29, 2026
7. DEPARTMENT Program Manager, phone/email: 8. Unique Entity Identifier(UEI) : 9. UBI#(state revenue):
Gerard Urbas,(253)512-7402 A + h v p ,!F 4 ao
Gary.urbas0_mil.wa.gov fv 1,Iv �( o� f1
10. Funding Authority:
Washington State Military Department(the"DEPARTMENT"), and Federal Emergency Management Agent (FEMA)
11. Funding Source Agreement#: 12. Program Index# 13. Catalog of Federal Domestic Asst. (CFDA) 14. Federal EIN#:
FEMA-4650-DR-WA 724zc (Federal)1722ZE #&Title: 97.036, Public Assistance
State 1724ZD Admin
15.Total Federal Award Amount: NIA 16. Federal Award Date: NIA
17, Service Districts: 18. Service Area by County(ies): 19. Women/Minority-Owned, State
(BY LEGISLATIVE DISTRICT): th Certified?: X NIA El NO
(BY CONGRESSIONAL DISTRICT): th MaSOn ❑ YES, OMWBE#
20. Contract Classification: 21, Contract Type(check all that apply):
❑ Personal Services ❑ Client Services X Public/Local Gov't ❑ Contract X Grant X Agreement
❑ Research/Development ❑ AIE ❑ Other ❑ Intergovernmental (RCW 39.34) ❑ Interagency
22. Contractor Selection Process: 23. Contractor Type(check all that apply)
X "To all who apply&qualify" ❑ Competitive Bidding ❑ Private Organization/individual ❑ For-Profit
❑ Sole Source ❑ AIE RCW ❑ NIA X Public Organ izationhlurisdiction X Non-Profit
❑ Filed w10FM? ❑ Advertised? ❑ YFS []NO ❑ VENDOR X SUBRECIPIENT ❑ OTHER
24. BRIEF DESCRIPTION:
Presidential Disaster Declaration # FEMA-4650-DR-WA Severe Winter Storms, Snowstorms, Straight-fine Winds, Flooding, Landslides, and
Mudslides. To provide funds to the SUBRECIPIENT for emergency work and the repair or replacement of disaster-damaged facilities.as approved
by FEMA in project worksheets describing eligible scopes of work and associated funding. The DEPARTMENT is the Recipient and Pass-through
Entity of the Presidential Disaster Declaration#FEMA-4650-DR-WA Severe Winter Storms,Snowstorms,Straight-line Winds, Flooding, Landslides,
and Mudslides, and FEMA State Agreement, which are incorporated by reference, and makes a subaward of Federal award funds to the
SUBRECIPIENT pursuant to this Agreement. The SUBRECIPIENT is accountable to the DEPARTMENT for use of Federal award funds provided
under this Agreement and the associated matching funds.
IN WITNESS WHERFOF,the DEPARTMENT and SUBRECIPIENT acknowledge and accept the terms of this Agreement,references and attachments hereto
and have executed this Agreement as of the date and year written below. This Agreement Face Sheet,Special Terms and Conditions(Attachment 1),General
Terms and Conditions (Attachment 2), Project Worksheet Sample (Attachment 3), Washington State Public Assistance Applicant Manual dated March 29,
2022 (Attachment 4), and all other documents, exhibits and attachments expressly referenced and incorporated herein contain all the terms and conditions
agreed upon by the parties and govern the rights and obligations of the parties to this Agreement. No other understandings, oral or otherwise, regarding the
subject matter of this Agreement shall be deemed to exist or to bind any of the parties.
In the event of an inconsistency in this Agreement, unless otherwise provided herein, the inconsistency shall be resolved by giving
precedence in the following order:
1. Applicable Federal and State Statutes and Regulations 5. Special Terms and Conditions
2. DHS Standard Terms and Conditions 6. General Terms and Conditions,and,
3. Presidential Declaration, FEMA State Agreement, 7. Other provisions of the contract incorporated by reference.
and other Documents
4. Statement of Work and/or Project Description as outlined in FEMA approved Project Worksheet(s)
WHEREAS, the pantie hereto have executed this Agreement on the day and year last specified below.
FOR THE DE T: FOR TIC 5 RECIPIENT:
Signature Date Signature Date
J
Stacey McClain, Governor's Authorized Representative print or type name: vr,J .S;H U T T y
Washington State Military Department
APPROVED AS TO FORM: ED AS TO FOR
Dierk Meierbachtol (signature on file) 6/9/2022 �j Z
Assistant Attorney General 7 �(SUB T's Attorney Date
Public Assistance Grant Agreement Page 1 of 24 Mason County, D22-283
Attachment 1
Washington State Military Department
SPECIAL TERMS AND CONDITIONS
ARTICLE I — KEY PERSONNEL
The individuals listed below shall be considered key personnel and point of contact. Any substitution by either
party must be submitted in writing.
SUBRECIPIENT MILITARY DEPARTMENT
Name John Taylor Name Gerard Urbas
Emergency Manager Deputy State Coordinating Officer
Title Title Public Assistance
E-Mail JTaylorp_masoncountywa.gov E-Mail gary.urbasOmil.wa.gov
Phone (360) 427-9670 ext 806 Phone (253) 512-7402
ARTICLE II -ADMINISTRATIVE REQUIREMENTS
The SUBRECIPIENT shall comply with all applicable state and federal laws, rules, regulations, requirements
and program guidance identified or referenced in this Agreement and the informational documents published
by FEMA applicable to the Presidential Declaration including, but not limited to, all criteria, restrictions, and
requirements of the "FEMA State Agreement" published by FEMA and the federal regulations commonly
applicable to FEMA grants, all of which are incorporated herein by reference. The Presidential Declaration and
the FEMA State Agreement are incorporated in this Agreement by reference.
The SUBRECIPIENT shall comply with the Washington State Public Assistance Applicant Manual dated March
29, 2022 incorporated in this Agreement as Attachment 4. The DHS Standard Terms and Conditions are
incorporated by reference in this Agreement in Appendix F of the Washington State Public Assistance
Applicant Manual dated March 29, 2022.
The SUBRECIPIENT acknowledges that since this Agreement involves federal award funding, the period of
performance described herein may begin prior to the availability of appropriated federal funds, The
SUBRECIPIENT agrees that it will not hold the DEPARTMENT, the State of Washington, or the United States
liable for any damages, claim for reimbursement, or any type of payment whatsoever for services performed
under this Agreement prior to distribution of appropriated federal funds, or if federal funds are not appropriated
or in a particular amount.
Federal funding is provided by FEMA and is administered by the DEPARTMENT. Under the authority of
Presidential Disaster Declaration number FEMA-4650-DR-WA, the DEPARTMENT is reimbursing the
SUBRECIPIENT for those approved eligible costs and activities necessary under the Public Assistance Grant
Program during the incident period beginning December 26, 2021 to January 15, 2022. Eligible costs and
activities will be identified in Project Worksheets approved by FEMA and a Project Worksheet Sample is
incorporated as Attachment 3. The DEPARTMENT is also providing Advance Payments to the
SUBRECIPIENT where provided by FEMA and required and allowed by law. Any interest earned on advance
payments (except for interest earned on advances of funds exempt under the Intergovernmental Cooperation
Act (31 U.S.C, 6501 et seq.) and the Indian Self-Determination Act (23 U.S.C. 450)) shall be promptly, but at
least quarterly, remitted to the DEPARTMENT to be paid to FEMA. The subrecipient may keep interest
amounts up to $100 per year for administrative expenses.
STATE AND FEDERAL REQUIREMENTS FOR PUBLIC ASSISTANCE GRANTS:
The following requirements apply to all DHSIFEMA Presidential Disasters administered by the DEPARTMENT:
1. FUNDING
The DEPARTMENT will administer the Public Assistance (PA) Grant Program, provide Advance
payments, and reimburse approved eligible Public Assistance costs to the SUBRECIPIENT that are
identified under the auspices of Presidential Disaster Declaration Number FEMA-4650-DR-WA and
Public Assistance Grant Agreement Page 2 of 24 Mason County, D22-283
authorized by and consistent with the Stafford Act (P,L. 93-288, as amended) and applicable
regulations.
It is understood that no final dollar figure is committed to at the time that this Agreement is executed,
but that financial commitments will be made by amendments to the project application as Project
Worksheets are completed in the field and projects are authorized by state and federal officials,
Pursuant to the FEMA-STATE AGREEMENT, FEMA will contribute not less than 90 percent of the
eligible costs for any eligible project and 100 percent of the federal PA Management Costs, up to 5
percent of the total award amount for each Subrecipient, as provided for in subsection 3.E. of Article II
of this Public Assistance Agreement. The SUBRECIPIENT commits to providing the remaining 10
percent non-federal match to any eligible project that has been identified under the Presidential
Disaster Declaration number FEMA-4650--DR-WA, subject to the following exceptions:
DEPARTMENT Match: The Washington State Legislature may authorize the DEPARTMENT to
provide a match to the SUBRECIPIENT's non-federal share of eligible projects. Provision of a match
by the DEPARTMENT, if authorized by the Washington State Legislature, shall not require amendment
of this Agreement. if DEPARTMENT match funds are committed to the non-federal share by the
DEPARTMENT pursuant to legislative authorization, the DEPARTMENT will formally notify the
SUBRECIPIENT of the match in writing which will include information identifying any related reduction
in the SUBRECIPIENT's percentage commitment.
Donated Resources: FEMA will credit the SUBRECIPIENT for the value of donated resources (non-
cash contributions of property or services) related to eligible Emergency Work to offset the non-Federal
cost share of its eligible Emergency Work project worksheets — categories A and B, and for the value of
donated resources related to eligible work on a Permanent Work project to offset the non-Federal cost
share of that specific Permanent Work project worksheet for which the resources were donated —
categories C through G. The Donated Resources are recognized by FEMA in a Project Worksheet.
Donated Resources offset the non-federal share of the eligible emergency work approved in Project
Worksheets or specific permanent work approved in Project Worksheets. For non-state agency
SUBRECIPIENTS, the donated resource value will first be applied to the SUBRECIPIENT's non-federal
share, and, if a DEPARTMENT match is authorized, any remaining donated resource value will be
applied to the DEPARTMENT's share. The value of the Donated Resources is calculated as described
in Public Assistance Program and Policy Guide VA (PAPPG), and is capped at the non-Federal share
of approved eligible emergency work costs or capped at the non-Federal share of the specific approved
eligible permanent work costs, as applicable. The Federal share of the Donated Resources will not
exceed the non-federal share of eligible emergency work costs or of specific permanent work costs
approved in Project Worksheets. Any excess credit for eligible emergency work costs can be credited
only to other eligible emergency work costs, for the same SUBRECIPIENT in the same disaster. The
value of excess donated resources cannot be credited toward or transferred to another eligible
SUBRECIPIENT, or toward other State obligations, The DEPARTMENT does not match a FEMA
donated resource credit.
The Project Worksheet, sample provided in Attachment 3, is required to be completed by FEMA or
State Project Specialists.
2. GRANT AGREEMENT PERIOD
a. Activities payable under this Agreement and to be performed by the SUBRECIPIENT under this
Agreement shall be those activities which occurred during or subsequent to the incident period
defined in the FEMA State Agreement and shall terminate upon completion of the project(s)
approved by federal and state officials, including completion of close-out and audit. This period
shall be referred to as the "Grant Agreement Period."
b. The Grant Agreement Period shall only be extended by (1) written notification of FEMA approval of
the Grant Agreement Period followed up with a mutually agreed written amendment, or (2) written
notification from the DEPARTMENT to the SUBRECIPIENT issued by the DEPARTMENT to
address extensions of its underlying federal grant performance period or to provide additional time
for completion of the SUBRECIPIENT's project(s).
Public Assistance Grant Agreement Page 3 of 24 Mason County, D22-283
3. PAYMENTS
The DEPARTMENT, using funds granted for the purposes of the Presidential Disaster Declaration from
FEMA, shall issue payments to the SUBRECIPIENT in compliance with the Washington State Public
Assistance Applicant Manual dated March 29, 2022 (Attachment 4) procedures as follows:
a. Small Project Payments: Payments are made for all small projects to the SUBRECIPIENT upon
submission and approval of an A19-IA State of Washington Invoice Voucher to the DEPARTMENT,
after FEMA has approved funding through approval of Project Worksheets.
b. Progress Payments: Progress payment of funds for costs already incurred on large projects minus
10 percent retainage may be made to the SUBRECIPIENT upon submission by the
SUBRECIPIENT of an A19-1A State of Washington Invoice Voucher, a letter of request, and a
spreadsheet identifying the claimed costs supporting the payment request and approval by the
DEPARTMENT.
c. Improved Projects: Payments on improved projects (capped project) will be pro-rated based upon
the percentage of the project that is funded under this disaster grant to the overall project cost. This
percentage will be identified when the first payment on the improved project is made. Progress
payments will be made as outlined above in Section B.
d. Final Payment: Final Payment on a large project will be made following submission by the
SUBRECIPIENT of a certification of completion on the STATEMENT OF DOCUMENTATION 1
FINAL INSPECTION REPORT form upon completion of project(s), completion of all final
inspections by the DEPARTMENT, and final approval by FEMA. Final payment on a large project
will include any retainage withheld during progress payments. Final payments may also be
conditional upon financial review, if determined necessary by the DEPARTMENT or FEMA.
Adjustments to the final payment may be made following any audits conducted by the Washington
State Auditor's Office, the United States Inspector General or other federal or state agency.
e. The SUBRECIPIENT is eligible to receive federal PA Management Costs up to 5 percent of the
total award amount obligated for each Subrecipient at the time of its request. PA Management
Costs includes any of the following when associated with the PA portion of a major disaster or
emergency: Indirect costs, direct administrative costs, and other administrative expenses
associated with a specific project. Documentation is required to substantiate the eligibility of
management activities and associated costs in accordance with PA Management Costs Interim
Policy— Standard Operating Procedures.
f. All payment requests shall be made on an A19-IA form, State of Washington, Invoice Voucher.
Payments will be made by electronic fund transfer to the SUBRECIPIENT's account.
g. Federal funding shall not exceed the total federal contribution eligible for Public Assistance costs
under Presidential Disaster Declaration number FEMA-4650-DR-WA.
h, For state agencies, the DEPARTMENT will, through interagency reimbursement procedures,
transfer payment to the SUBRECIPIENT. Payment will be transferred by journal voucher to Agency
No. , Accounting Fund No.
i. Within the total Grant Agreement Amount, travel, sub-contracts, salaries, benefits, printing,
equipment, and other goods and services will be reimbursed on an actual cost basis unless
otherwise provided in this Agreement.
j, For travel costs, SUBRECIPIENTs shall comply with 2 CFR 200.474 and should consult their
internal policies, state rates set pursuant to RCW 43.03.050 and RCW 43.03.060 as now existing or
amended, and federal maximum rates set forth at http://www,gsa.gov, and follow the most
restrictive.
k. If travel costs exceed set state or federal limits, travel costs shall not be reimbursed without written
approval by DEPARTMENT Key Personnel.
I. Receipts and/or backup documentation for any approved items that are authorized under this
Agreement must be maintained by the SUBRECIPIENT consistent with record retention
Public Assistance Grant Agreement Page 4 of 24 Mason County, D22-283
requirements of this Agreement, and be made available upon request by the DEPARTMENT, and
local, state, or federal auditors.
m. All work under this Agreement must end on or before the Grant Agreement End Date, and the final
reimbursement request must be submitted to the DEPARTMENT within 45 days after the Grant
Agreement End Date, except as otherwise authorized by written amendment of this Agreement and
issued by the DEPARTMENT.
n. No costs for purchases of equipment/supplies will be reimbursed until the related
equipment/supplies have been received by the SUBRECIPIENT, its subrecipient or contractor, or
any non-federal entity to which the SUBRECIPIENT makes a subaward, and is invoiced by the
vendor.
o. SUBRECIPIENTs shall only use federal award funds under this Agreement to supplement existing
funds, and will not use them to replace (supplant) non-federal funds that have been budgeted for
the same purpose. The SUBRECIPIENT may be required to demonstrate and document that the
reduction in non-federal resources occurred for reasons other than the receipt or expected receipt
of federal funds.
The DEPARTMENT shall provide Advance Payments as provided by FEMA and as required and
authorized by law.
4. CLOSEOUT
To initiate close-out, the SUBRECIPIENT is required to certify in writing, by Project Worksheet Number,
date completed and total amount expended on the project, completion of the small projects. To initiate
close-out of the large projects, the SUBRECIPIENT shall submit certification of completion on a
STATEMENT OF DOCUMENTATION/FINAL INSPECTION REPORT form to the DEPARTMENT.
The DEPARTMENT will then complete a site inspection and a financial review of documentation to
support the claimed costs. Certifications on small and large projects are due within sixty days following
the completion of the project or receipt of the approved Project Worksheet, whichever date is later.
If SUBRECIPIENT is claiming federal PA Management Costs: indirect costs, direct administrative
costs, and other administrative expenses associated with a specific project must be supported by
documentation to substantiate the eligibility of management activities and associated costs that has
been prepared and assembled in accordance with PA Management Costs Interim Policy — Standard
Operating Procedures prior to close-out.
After all of the projects have been certified as complete and approved for closure by FEMA, the
DEPARTMENT will forward a final A19-1A State of Washington Invoice Voucher to the
SUBRECIPIENT for release of the remaining funds due to the subrecipient for eligible costs, including
any retainage previously withheld, and the allowance for federal indirect costs.
5. DOCUMENTATION 1 REPORTING REQUIREMENTS
For all Advance Payment, the SUBRECIPIENT shall provide documentation and receipts for all costs
related to the Advance Payment and provide such to the DEPARTMENT quarterly.
The SUBRECIPIENT is required to retain all documentation which adequately identifies the source and
application of Public Assistance funds, including the federal indirect cost reimbursement, for six years
following the closure of this disaster grant. For all funds received, source documentation includes
adequate accounting of actual costs and recoveries incurred.
The SUBRECIPIENT shall also comply with the Federal Funding Accountability and Transparency Act
(FFATA) and related OMB Guidance consistent with Public Law 109-282 as amended by section
6202(a) of Public Law 110-252 (see 31 U.S.C. 6101 note) and complete the FFATA Form located at
http://mil.wa..qov/emergency-management-division/grants/reguiredgrantforms and return to the
DEPARTMENT; which is incorporated by reference and made a part of this Agreement.
Quarterly Reports: The SUBRECIPIENT is required to submit to the DEPARTMENT a quarterly report
indicating the status of all their large projects. The status shall identify the costs incurred to date, the
Public Assistance Grant Agreement Page 5 of 24 Mason County, D22-283
percentage of work completed, the anticipated completion date of the project and whether cost under
runs or over runs are expected. In addition, the SUBRECIPIENT should note in the comment field any
challenges or issues associated with the project. Failure to submit a complete quarterly report within 15
days following the end of the quarter will result in suspension of all payments to the SUBRECIPIENT
until a complete quarterly report is received by the DEPARTMENT. The quarterly report will serve as
the basis for any FEMA Office of Chief Financial Officer(OCFO) funds reduction.
6. TIME EXTENSIONS
A time extension request is required to be forwarded to the DEPARTMENT by the SUBRECIPIENT for
a project prior to the expiration of the approved completion date. If the project is approved and funded
after the statutory approval time period for completion, then a time extension request must be submitted
to the DEPARTMENT within fifteen days of receipt of the funding package.
In accordance with 44 CFR 206.204, the DEPARTMENT reserves the right, in its sole discretion, to
consider and approve a time extension request after expiration of the approved completion date and
within the DEPARTMENT's statutory extension authority. Requests for time extensions beyond the
DEPARTMENT's authority will be considered and approved by FEMA, at their sole discretion.
All determinations made regarding time extension requests will be based on a case by case evaluation
of specific factual circumstances.
A time extension request must be in writing and identify the Project Worksheet number, the reason the
project has not been completed within the prior approved completion period, the reason the time
extension request was not submitted prior to the statutory approval time period (if applicable), a current
status of the completion of the work, a detailed timeline for completion of the remaining elements, and
an anticipated completion date for the completion of the remaining work. Failure to submit a time
extension request in a timely manner may result in denial of the time extension request, and loss of
funding for the related project.
7. PROCUREMENT
The SUBRECIPIENT shall comply with all procurement requirements of 2 CFR Part 200.318 through
200.326 and as specified in the General Terms and Conditions, Exhibit A.11.
8. SUBRECIPIENT MONITORING:
a. The DEPARTMENT will monitor the activities of the SUBRECIPIENT from award to closeout. The
goal of the DEPARTMENT's monitoring activities will be to ensure that agencies receiving federal
pass-through funds are in compliance with this Agreement, federal and state audit requirements,
federal grant guidance, and applicable federal and state financial regulations, as well as 2 CFR
Part 200 Subpart F.
b. To document compliance with 2 CFR Part 200 Subpart F requirements, the SUBRECIPIENT shall
complete and return to the DEPARTMENT 2 CFR Part 200 Subpart F Audit Certification Form
located at htt ://mii.wa. ov/emer enc -many ement-division/ rants/re uired rantforms with the
signed Agreement and each fiscal year thereafter until the Agreement is closed, which is
incorporated by reference and made a part of this Agreement.
C. Monitoring activities may include, but are not limited to:
1. review of financial and performance reports;
ii. monitoring and documenting the completion of Agreement deliverables;
iii. documentation of phone calls, meetings, e-mails, and correspondence;
iv. review of reimbursement requests and supporting documentation to ensure eligibility
and consistency with Agreement work plan, budget, and federal requirements;
v. observation and documentation of Agreement related activities;
vi. on-site visits to review equipment records and inventories, to verify source
documentation for reimbursement requests and performance reports, and to verify
completion of deliverables.
Public Assistance Grant Agreement Page 6 of 24 Mason County, D22-283
d. The SUBRECIPIENT is required to meet or exceed the monitoring activities, as outlined above
and in 2 CFR Part 200 Subpart F, for any non-federal entity to which the SUBRECIPIENT makes
a subaward as a pass-through entity under this Agreement.
C. Compliance will be monitored throughout the performance period to assess risk. Concerns will be
addressed through a Corrective Action Plan. If the SUBRECIPIENT fails to comply with federal or
state statutes or regulations, or the terms and conditions of this Agreement, the DEPARTMENT
may impose any additional subaward conditions as described in 2 CFR 200.208. If the
DEPARTMENT determines that noncompliance cannot be remedied by imposing additional
conditions, it may take one or more of the following actions:
i. Temporarily withhold cash payments pending correction of the deficiency by the
SUBRECIPIENT.
ii. Wholly or partially suspend or terminate the subaward to the SUBRECIPIENT.
iii. Initiate suspension or debarment proceedings under 2 CFR 180 or recommend such
a proceeding be initiated by the federal awarding agency.
iv. Withhold further federal awards for the project or program.
v. Take any other remedies that may be legally available.
f. The DEPARTMENT agrees to:
i. Provide technical assistance during all monitoring or evaluation activities. The
DEPARTMENT will coordinate and schedule the meetings necessary to conduct and
complete all monitoring and evaluation activities.
ii. Develop the SUBRECIPIENT's project worksheets) (PW) and supporting attachments with
FEMA and the SUBRECIPIENT's assistance based upon the costs determined to beeligible.
iii. Submit the SUBRECIPIENT's funding package to FEMA.
iv. Notify the SUBRECIPIENT when funding approval is received, issue payment per the
process described above see Article II, A.4 -- Payments, and provide the SUBRECIPIENT
with a copy of the approved project worksheet.
v. Work with the SUBRECIPIENT to resolve any issues identified during the monitoring
process.
vi. Review and respond appropriately to the SUBRECIPIENT's requests for time extensions and
changes.
i. LIMITED ENGLISH PROFICIENCY (CIVIL RIGHTS ACT OF 1964 TITLE VI)
All subrecipients must comply with the Title VI of the Civil Rights Act of 1964 (Title VI) prohibition
against discrimination on the basis of national origin, which requires that subrecipients of federal
financial assistance take reasonable steps to provide meaningful access to persons with limited English
proficiency (LEP) to their programs and services. Providing meaningful access for persons with LEP
may entail providing language assistance services, including oral interpretation and written translation.
Executive Order 13166, Improving Access to Services for Persons with Limited English Proficiency
(August 11, 2000), requires federal agencies to issue guidance to recipients, assisting such
organizations and entities in understanding their language access obligations. DHS published the
required recipient guidance in April 2011, DHS Guidance to Federal Financial Assistance Recipients
Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient
Persons, 76 Fed. Reg, 21755-21768, (April 18, 2011). The Guidance provides helpful information such
as how a recipient can determine the extent of its obligation to provide language services; selecting
language services; and elements of an effective plan on language assistance for LEP persons. For
additional assistance and information regarding language access obligations, please refer to the DHS
Recipient Guidance at htt s://www.dhs.gov/guidance-published-help-department-supported-
organizations-provide-meaningful-access-people-limited and additional resources on
http://www.lep.gov.
A. FEMA STATE AGREEMENT TERMS AND CONDITIONS
As a subrecipient of FEMA funding, the SUBRECIPIENT shall comply with all applicable DHS/FEMA
terms and conditions of the Presidential Declaration and the FEMA State Agreement, which are
Public Assistance Grant Agreement Page 7 of 24 Mason County, D22-283
incorporated in and made a part of this Agreement in Appendix F of the Washington State Public
Assistance Applicant Manual dated March 29, 2022 (Attachment 4).
Public Assistance Grant Agreement Page 8 of 24 Mason Courity, D22-283
Attachment 2
Washington State Military Department
GENERAL TERMS AND CONDITIONS
Department of Homeland Security(DHS)1
Federal Emergency Management Agency (FEMA)
Grants
A.1 DEFINITION
As used throughout this Agreement, the following terms will have the same meaning as defined in 2 CFR 200
Subpart A (which is incorporated herein by reference), except as otherwise set forth below:
a. "DEPARTMENT' means the Washington State Military Department, as a state agency, any division,
section, office, unit or other entity of the DEPARTMENT, or any of the officers or other officials
lawfully representing that DEPARTMENT. The DEPARTMENT is a recipient of a federal award
directly from a federal awarding agency and is pass-through entity making a subaward to a
subrecipient under this Agreement.
b. "SUBRECIPIENT" when capitalized is primarily used throughout this Agreement in reference to the
non-federal entity identified on the Face Sheet of this Agreement that has received a subaward from
the DEPARTMENT. However, the definition of "subrecipient" is the same as in 2 CFR 200.93 for all
other purposes. "Monitoring Activities" means all administrative, construction, financial, or other
review activities that are conducted to ensure compliance with all state and federal laws, rules,
regulations, authorities and policies.
c. "Project' means those actions funded through the Public Assistance Program and described in
approved Project Worksheets. Projects may include one or more of the following: reimbursement of
costs for emergency response, debris removal and/or repair or restoration of damaged public
facilities. A project may be a small, large, improved, or alternate project.
d. "Investment Justification" means grant application investment justification submitted by the
SUBRECIPIENT describing the project for which federal funding is sought and provided under this
Agreement. Such grant application investment justification is hereby incorporated into this
Agreement by reference.
A.2 ADVANCE PAYMENTS
The DEPARTMENT shall make no payments in advance or in anticipation of goods or services to be
provided under this Agreement, except as required under 2 CFR 200.305 for federal grants.
SUBRECIPIENT shall not invoice the DEPARTMENT in advance of delivery and invoicing of such
goods or services, except as authorized under 2 CFR 200.305.
Pursuant to the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.0 §5121-
5207), Advance Payment process, FEMA may process a SUBRECIPIENT project worksheet which is
provided to the state of Washington for direct disbursement to SUBRECIPIENT.
Pursuant to these provisions and RCW 43.88,160(5), these grant funds are not subject to the advance
payments prohibition and will be disbursed immediately to SUBRECIPIENT as grants authorized by law
with subsequent authentication and certification of expenditures.
A.3 AMENDMENTS AND MODIFICATIONS
The SUBRECIPIENT or the DEPARTMENT may request, in writing, an amendment or modification of
this Agreement. Modifications may be requested for Grant Agreement end date, budget or scope
change. However, such amendment or modification shall not be binding, take effect or be incorporated
herein until made in writing and signed by the authorized representatives of the DEPARTMENT and the
SUBRECIPIENT. No other understandings or agreements, written or oral, shall be binding on the
parties,
A.4 AMERICANS WITH DISABILITIES ACT (ADA) OF 1990, PUBLIC LAW 101-336. 42 U.S.C. 12101 ET
SEQ.LAND ITS IMPLEMENTING REGULATIONS ALSO REFERRED TO AS THE "ADA" 28 CFR,
f art 35.
The SUBRECIPIENT must comply with the ADA, which provides comprehensive civil rights protection
to individuals with disabilities in the areas of employment, public accommodations, state and local
Public Assistance Grant Agreement Page 9 of 24 Mason County, D22-283
government services, and telecommunication.
A.5 APPLICATION REPRESENTATION-MISREPRESENTATION INACCURACY AND BREACH
The DEPARTMENT relies upon the SUBRECIPIENT's application in making its determinations as to
eligibility for, selection for, and scope of funding grants. Any misrepresentation, error or inaccuracy in
any part of the application may be deemed a breach of this Agreement.
A.6 ASSURANCES
DEPARTMENT and SUBRECIPIENT agree that all activity pursuant to this Agreement will be in
accordance with all the applicable current federal, state and local laws, rules and regulations. In
addition, as a SUBRECIPIENT of FEMA funding, the SUBRECIPEINT shall comply with all applicable
DHS terms and conditions as specified in Appendix F of the Washington State Public Assistance
Applicant Manual dated March 29, 2022 incorporated in this Agreement as Attachment 4.
A.7 CERTIFICATION REGARDING DEBARMENT SUSPENSION OR INELIGIBILITY
As federal funds are a basis for this Agreement, the SUBRECIPIENT certifies that the SUBRECIPIENT
is not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily
excluded from participating in this Agreement by any federal department or agency.
The SUBRECIPIENT shall complete, sign, and return a Certification Regarding Debarment,
Suspension, Ineligibility, and Voluntary Exclusion form located at httl?://rnil-wa.gov/emergengy-
ma na ement-division) rants/req u i redg rantforms. Any such form completed by the SUBRECIPIENT for
this Agreement shall be incorporated into this Agreement by reference.
Further, the SUBRECIPIENT agrees to comply with all applicable federal regulations concerning the
federal debarment and suspension system, including 2 CFR Part 180. The SUBRECIPIENT certifies
that it will ensure that potential sub-contractors or sub-recipients or any of their principals are not
debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participation in "covered transactions" by any federal department or agency. "Covered transactions"
include procurement contracts for goods or services awarded under a non-procurement transaction
(e.g. grant or cooperative agreement)that are expected to equal or exceed $25,000, and sub-awards to
sub-recipients for any amount. With respect to covered transactions, the SUBRECIPIENT may comply
with this provision by obtaining a certification statement from the potential sub-contractor or sub-
recipient or by checking the System for Award Management (http://www.sam.gov) maintained by the
federal government. The SUBRECIPIENT also agrees not to enter into any arrangements or contracts
with any party on the Washington State Department of Labor and Industries' "Debarred Contractor List"
(hftps://secure.ini.wa.govidebarandstrike/ContractorDebarList.aSI2
A.8 CERTIFICATION REGARDING RESTRICTIONS ON LOBBYING
As required by 44 CFR Part 18, the SUBRECIPIENT hereby certifies that to the best of their knowledge
and belief: (1) no federally appropriated funds have been paid or will be paid by or on behalf of the
SUBRECIPIENT to any person for influencing or attempting to influence an officer or employee of an
agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with the awarding of any federal contract, the making of any federal grant, the
making of any federal loan, the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative
agreement; (2) that if any funds other than federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection
with this Agreement, grant, loan, or cooperative agreement, the SUBRECIPIENT will complete and
submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions;
(3) and that, as applicable, the SUBRECIPIENT will require that the language of this certification be
included in the award documents for all subawards at all tiers (including sub-contracts, sub-grants, and
contracts under grants, loans, and cooperative agreements) and that all sub-recipients shall certify and
disclose accordingly.
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This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into, and is a prerequisite for making or entering into this transaction
Imposed by 31 U.S.C. 1352.
A.9 COMPLIANCE WITH APPLICABLE STATUTES RULES AND DEPARTMENT POLICIES
The SUBRECIPIENT and all its contractors shall comply with, and the DEPARTMENT is not
responsible for determining compliance with, any and all applicable federal, state, and local laws,
regulations, executive orders, OMB Circulars, and/or policies. This obligation includes, but is not
limited to: nondiscrimination laws and/or policies, Equal Employment Opportunity, as amended by
Executive Order 11375 of October 13, 1967, as supplemented by Department of Labor regulations (41
CFR chapter 60); Copeland Anti-Kickback Act (18 U.S.C. 874) as supplemented in Department of
Labor regulations (29 CFR Part 3); Davis-Bacon Act (40 U.S.C. 276a to 276a-7) as supplemented by
Department of Labor regulations (29 CFR Part 5); Clean Air Act (42 U.S.C. 1857(h), section 508 of the
Clean Water Act (33 U.S.C. 1368), Executive Order 11738, Environmental Protection Agency
regulations (40 CFR part 15); Sections 103 and 107 of the Contract Work Hours and Safety Standards
Act (40 U.S.C. 327-330) as supplemented by Department of Labor regulations (29 CFR Part 5); Energy
Policy and Conservation Act (PL 94-163, 89 Stat. 871, as amended), the Americans with Disabilities
Act (ADA), Age Discrimination Act of 1975, Title VI of the Civil Rights Act of 1964, Civil rights Act of
1968, the Robert T. Stafford Disaster Relief and Emergency Assistance Act, (PL 93-288, as amended),
Title 44 of the Federal Regulations, 2 CFR Part 3002, Ethics in Public Service (RCW 42.52), Covenant
Against Contingent Fees (48 CFR Section 52.203-5), Public Records Act (RCW 42.56), Prevailing
Wages on Public Works (RCW 39.12), State Environmental Policy Act (RCW 43.21 C), Shoreline
Management Act of 1971 (RCW 90.58), State Building Code (RCW 19.27), Energy Related Building
Standards (RCW 19.27A), Provisions in Buildings for Aged and Handicapped Persons (RCW 70.92),
and safety and health regulations.
DEPARTMENT and SUBRECIPIENT agree that all activity pursuant to this Agreement will be in
accordance with all the applicable current federal, state and local laws, rules and regulations.
In the event of the SUBRECIPIENT's or its contractor's noncompliance or refusal to comply with any
applicable law, regulation, executive order, OMB Circular or policy, the DEPARTMENT may rescind,
cancel, or terminate the Agreement in whole or in part in its sole discretion.
The SUBRECIPIENT is responsible for all costs or liability arising from its failure to comply with
applicable laws, regulations, executive orders, OMB Circulars or policies.
A.10 CONFLICT OF INTEREST
No officer or employee of the DEPARTMENT; no member, officer, or employee of the SUBRECIPIENT
or its designees or agents; no member of the governing body of the jurisdiction in which the project is
undertaken or located; and no other official of such the SUBRECIPIENT who exercises any functions or
responsibilities with respect to the project during his or her tenure, shall have any personal or pecuniary
gain or interest, direct or indirect, in any contract, subcontract, or the proceeds thereof, for work to be
performed in connection with the project assisted under this Agreement.
The SUBRECIPIENT shall incorporate, or cause to incorporate, in all such contracts or subcontracts, a
provision prohibiting such interest pursuant to this provision.
A.11 CONTRACTING & PROCUREMENT
a. The SUBRECIPIENT shall use a competitive procurement process in the procurement and award of
any contracts with contractors or sub-contractors that are entered into under the original contract
award. The procurement process followed shall be in accordance with 2 CFR Part 200.318 General
procurement standards through 200.326 Contract Provisions.
As required by Appendix II to 2 CFR Part 200, all contracts entered into by the SUBRECIPIENT under
this Agreement must include the following provisions, as applicable:
1. Contracts for more than the simplified acquisition threshold, which is the inflation adjusted amount
determined by the Civilian Agency Acquisition Council and the Defense Acquisition Regulations
Council (Councils) as authorized by 41 U.S.C. 1908, must address administrative, contractual, or
Public Assistance Grant Agreement Page 11 of 24 Mason County, D22-283
legal remedies in instances where contractors violate or breach contract terms, and provide for
such sanctions and penalties as appropriate.
2. All contracts in excess of$10,000 must address termination for cause and for convenience by the
non-Federal entity including the manner by which it will be effected and the basis forsettlement.
3. Equal Employment Opportunity. Except as otherwise provided under 41 CFR Part 60, all
contracts that meet the definition of"federally assisted construction contract" in 41 CFR Part60-
1.3 must include the equal opportunity clause provided under 41 CFR 60-1.4(b), in accordance
with Executive Order 11246, "Equal Employment Opportunity" (30 FR 12319, 12935, 3 CFR Part,
1964-1965 Comp., p. 339), as amended by Executive Order 11375, "Amending Executive Order
11246 Relating to Equal Employment Opportunity," and implementing regulations at 41 CFR part
60, "Office of Federal Contract Compliance Programs, Equal Employment Opportunity,
Department of Labor."
4. Davis-Bacon Act, as amended (40 U.S.C. 3141-3148). When required by Federal program
legislation, all prime construction contracts in excess of$2,000 awarded by non-Federal entities
must include a provision for compliance with the Davis-Bacon Act (40 U.S.C. 3141-3144, and_
3146-3148) as supplemented by Department of Labor regulations (29 CFR Part 5, "Labor
Standards Provisions Applicable to Contracts Covering Federally Financed and Assisted
Construction"). In accordance with the statute, contractors must be required to pay wages to
laborers and mechanics at a rate not less than the prevailing wages specified in a wage
determination made by the Secretary of Labor. In addition, contractors must be required to pay
wages not less than once a week. The non-Federal entity must place a copy of the current
prevailing wage determination issued by the Department of Labor in each solicitation. The
decision to award a contract or subcontract must be conditioned upon the acceptance of the wage
determination. The non-Federal entity must report all suspected or reported violations to the
Federal awarding agency. The contracts must also include a provision for compliance with the
Copeland "Anti-Kickback"Act 40 U.S.C. 3145), as supplemented by Department of Labor
regulations (29 CFR Part 3, "Contractors and Subcontractors on Public Building or Public Work
Financed in Whole or in Part by Loans or Grants from the United States"). The Act provides that
each contractor or subrecipient must be prohibited from inducing, by any means, any person
employed in the construction, completion, or repair of public work, to give up any part of the
compensation to which he or she is otherwise entitled. The non-Federal entity must report all
suspected or reported violations to the Federal awarding agency.
5. Contract Work Hours and Safety Standards Act(40 U.S.C. 3701-3708). Where applicable, all
contracts awarded by the non-Federal entity in excess of$100,000 that involve the employment of
mechanics or laborers must include a provision for compliance with 40 U.S.C. 3702 and 3704, as
supplemented by Department of Labor regulations (29 CFR Part 5). Under 40 U.S.C. 3702 of the
Act, each contractor must be required to compute the wages of every mechanic and laborer on
the basis of a standard work week of 40 hours. Work in excess of the standard work week is
permissible provided that the worker is compensated at a rate of not less than one and a half
times the basic rate of pay for all hours worked in excess of 40 hours in the work week. The
requirements of 40 U.S.C. 3704 are applicable to construction work and provide that no laborer or
mechanic must be required to work in surroundings or under working conditions which are
unsanitary, hazardous or dangerous. These requirements do not apply to the purchases of
supplies or materials or articles ordinarily available on the open market, or contracts for
transportation or transmission of intelligence.
6. Rights to Inventions Made Under a Contract or Agreement. If the Federal award meets the
definition of"funding agreement" under 37 CFR §401.2 a and the recipient or subrecipient
wishes to enter into a contract with a small business firm or nonprofit organization regarding the
substitution of parties, assignment or performance of experimental, developmental, or research
work under that "funding agreement,"the recipient or subrecipient must comply with the
requirements of 37 CFR Part 401, "Rights to Inventions Made by Nonprofit Organizations and
Small Business Firms Under Government Grants, Contracts and Cooperative Agreements," and
any implementing regulations issued by the awarding agency.
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7. Clean Air Act (42 U.S.C. 7401-7671g.) and the Federal Water Pollution Control Act (33 U.S.C.
1251-1387), as amended - Contracts and subgrants of amounts in excess of$150,000 must
contain a provision that requires the non-Federal award to agree to comply with all applicable
standards, orders or regulations issued pursuant to the Clean Air Act(42 U.S.C. 7401-7671 ) and
the Federal Water Pollution Control Act as amended (33 U.S.C. 1251-1387). Violations must be
reported to the Federal awarding agency and the Regional Office of the Environmental Protection
Agency (EPA).
8. Debarment and Suspension (Executive Orders 12549 and 12689) -A contract award (see 2 CFR
180.220) must not be made to parties listed on the governmentwide exclusions in the System for
Award Management (SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement
Executive Orders 12549 (3 CFR part 1986 Comp., p. 189) and 12689 (3 CFR part 1989 Comp., p.
235), "Debarment and Suspension." SAM Exclusions contains the names of parties debarred,
suspended, or otherwise excluded by agencies, as well as parties declared ineligible under
statutory or regulatory authority other than Executive Order 12549.
9. Byrd Anti-Lobbying Amendment(31 U.S.C. 1352) - Contractors that apply or bid for an award
exceeding $100,000 must file the required certification. Each tier certifies to the tier above that it
will not and has not used Federal appropriated funds to pay any person or organization for
influencing or attempting to influence an officer or employee of any agency, a member of
Congress, officer or employee of Congress, or an employee of a member of Congress in
connection with obtaining any Federal contract, grant or any other award covered by 31 U.S.C.
1352. Each tier must also disclose any lobbying with non-Federal funds that takes place in
connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier up
to the non-Federal award.
10. Procurement of recovered materials --As required by 2 CFR 200.322, a non-Federal entity that is
a state agency or agency of a political subdivision of a state and its contractors must comply with
section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and
Recovery Act. The requirements of Section 6002 include procuring only items designated in
guidelines of the Environmental Protection Agency (EPA) at 40 CFR part 247 that contain the
highest percentage of recovered materials practicable, consistent with maintaining a satisfactory
level of competition, where the purchase price of the item exceeds $10,000 or the value of the
quantity acquired during the preceding fiscal year exceeded $10,000; procuring solid waste
management services in a manner that maximizes energy and resource recovery; and
establishing an affirmative procurement program for procurement of recovered materials identified
in the EPA guidelines.
11. Notice of Federal awarding agency requirements and regulations pertaining to reporting.
12. Federal awarding agency requirements and regulations pertaining to copyrights and rights in data.
13. Access by the DEPARTMENT, the SUBRECIPIENT, the Federal awarding agency, the
Comptroller General of the United States, or any of their duly authorized representatives to any
books, documents, papers, and records of the contractor which are directly pertinent to that
specific contract for the purpose of making audit, examination, excerpts, and transcriptions.
14. Retention of all required records for six years after the SUBRECIPIENT has made final payments
and all other pending matters are closed.
15, Mandatory standards and policies relating to energy efficiency which are contained in the state
energy conservation plan issued in compliance with the Energy Policy and Conservation Act(Pub.
L. 94-163, 89 Stat, 871).
16. Pursuant to Executive Order 13858 "Strengthening Buy-American Preferences for Infrastructure
Projects," the DEPARTMENT encourages SUBRECIPIENTS to use, to the greatest extent
practicable and consistent with the law, iron and aluminum as well as steel, cement and other
manufactured products produced in the United States, in Public Assistance and Hazard Mitigation
Grant Program eligible public infrastructure repair and construction projects affecting surface
transportation, ports, water resources including sewer and drinking water and power. Such
Public Assistance Grant Agreement Page 13 of 24 Mason County, D22-283
preference must be consistent with the law, including cost and contracting requirements of 2 CFR
Part 200.
17. The DEPARTMENT reserves the right to review the SUBRECIPIENT procurement plans and
documents, and require the SUBRECIPIENT to make changes to bring its plans and documents
into compliance with the requirements of 2 CFR Part 200.318 through 2 CFR 200.326. The
SUBRECIPIENT must ensure that its procurement process requires contractors and
subcontractors to provide adequate documentation with sufficient detail to support the costs of the
project and to allow both the SUBRECIPIENT and DEPARTMENT to make a determination on
eligibility of project costs.
18. All sub-contracting agreements entered into pursuant to this Agreement shall incorporate this
Agreement by reference.
A.12 DISCLOSURE
The use or disclosure by any party of any information concerning the DEPARTMENT for any purpose
not directly connected with the administration of the DEPARTMENT's or the SUBRECIPIENT's
responsibilities with respect to services provided under this Agreement is prohibited except by prior
written consent of the DEPARTMENT or as required to comply with the state Public Records Act, other
law, or court order.
A.13 DISPUTES
Except as otherwise provided in this contract, when a bona fide dispute arises between the parties and
it cannot be resolved through discussion and negotiation, either party may request a dispute resolution
panel to resolve the dispute. A request for a dispute resolution board shall be in writing, state the
disputed issues, state the relative positions of the parties, and be sent to all parties. The panel shall
consist of a representative appointed by the DEPARTMENT, a representative appointed by the
SUBRECIPIENT and a third party mutually agreed upon by both parties. The panel shall, by majority
vote, resolve the dispute. Each party shall bear the cost for its panel member and its attorney fees and
costs, and share equally the cost of the third panel member.
A.14 DUPLICATION OF BENEFITS
The SUBRECIPIENT agrees that the funds for which federal or state assistance is requested does not,
or will not, duplicate benefits or funds received for the same loss from any other source. The
SUBRECIPIENT will pursue, and require sub-recipients to pursue, full payment of eligible insurance
benefits for properties or any other losses covered in a project under this Agreement. The
SUBRECIPIENT will repay the DEPARTMENT any funds provided under this grant agreement that are
duplicated by other benefits, funds, or insurance proceeds. The SUBRECIPIENT will also seek
recovery against any party or parties whose negligence or other intentional or tortious conduct may
have caused or contributed to the expenditures for which these grants funds are provided. The
SUBRECIPIENT will repay the DEPARTMENT any funds recovered by settlement, judgment or other
court order in an action to recover funds provided by this grant. The SUBRECIPIENT shall notify the
DEPARTMENT as early as possible and work in conjunction with the DEPARTMENT and FEMA to
ensure appropriate apportionment of any duplicated or recovered payment.
A.15 HAZARDOUS SUBSTANCES
The SUBRECIPIENT shall inspect and investigate the proposed development/construction site for the
presence of hazardous substances. The SUBRECIPIENT shall fully disclose to the DEPARTMENT the
results of its inspection and investigation and all other knowledge the SUBRECIPIENT has as to the
presence of any hazardous substances at the proposed development/construction project site. The
SUBRECIPIENT will be responsible for any associated clean-up costs. "Hazardous Substance" is
defined in RCW 70A.305.020.
A.16 LEGAL RELATIONS
It is understood and agreed that this Agreement is solely for the benefit of the parties to the Agreement
and gives no right to any other party. No joint venture or partnership is formed as a result of this
Agreement.
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To the extent allowed by law, the SUBRECIPIENT, its successors or assigns, will protect, save and
hold harmless the DEPARTMENT, the State of Washington, and the United States Government and
their authorized agents and employees, from all claims, actions, costs, damages or expenses of any
nature whatsoever by reason of the acts or omissions of the SUBRECIPIENT, its sub-contractors,
assigns, agents, contractors, consultants, licensees, invitees, employees or any person whomsoever
arising out of or in connection with any acts or activities authorized by this Agreement.
To the extent allowed by law, the SUBRECIPIENT further agrees to defend the DEPARTMENT and the
State of Washington and their authorized agents and employees in any litigation; including payment of
any costs or attorneys'fees for any claims or action commenced thereon arising out of or in connection
with acts or activities authorized by this Agreement.
This obligation shall not include such claims, costs, damages or expenses which may be caused by the
sole negligence of the DEPARTMENT; provided, that if the claims or damages are caused by or result
from the concurrent negligence of (1) the DEPARTMENT, and (2) the SUBRECIPIENT, its agents, or
employees, this indemnity provision shall be valid and enforceable only to the extent of the negligence
of the SUBRECIPIENT, or SUBRECIPIENT's agents or employees.
Insofar as the funding source, the DEPARTMENT of Homeland Security (DHS)IFederal Emergency
Management Agency(FEMA), is an agency of the federal government, the following shall apply:
44 CFR 206.9 Non-liability. The federal government shall not be liable for any claim based upon the
exercise or performance of, or the failure to exercise or perform a discretionary function or duty on the
part of a federal agency or an employee of the Federal government in carrying out the provisions of the
Stafford Act.
A.17 LIMITATION OF AUTHORITY—AUTHORIZED SIGNATURE
The signatories to this Agreement represent that they have the authority to bind their respective
organizations to this Agreement. Only the DEPARTMENT's Authorized Signature and the Authorized
Signature of the assigned SUBRECIPIENT Agent or Alternate for the SUBRECIPIENT Agent, formally
designated in writing, shall have the express, implied, or apparent authority to alter, amend, modify, or
waive any clause or condition of this Agreement. Any alteration, amendment, modification, or waiver of
any clause or condition of this Agreement is not effective or binding unless made in writing and signed
by both parties Authorized Signature representatives. Further, only the Authorized Signature
representative or Alternate for the SUBRECIPIENT shall have authority to sign reimbursement
requests, certification of project completion, time extension requests, amendment and modification
requests, requests for changes to project status, and other requests, certifications and documents
authorized by or required under this Agreement.
A.18 LOSS OR REDUCTION OF FUNDING
In the event funding from state, federal, or other sources is withdrawn, reduced, or limited in any way
after the effective date of this Agreement and prior to normal completion or end date, the
DEPARTMENT may unilaterally reduce the scope of work and budget or unilaterally terminate or
suspend all or part of the Agreement as a "Termination for Cause" without providing the
SUBRECIPIENT an opportunity to cure. Alternatively, the parties may renegotiate the terms of this
Agreement under "Amendments and Modifications" to comply with new funding limitations and
conditions, although the DEPARTMENT has no obligation to do so.
A.19 NONASSIGNABILITY
Neither this Agreement, nor any claim arising under this Agreement, shall be transferred or assigned by
the SUBRECIPIENT.
A.20 NONDISCRIMINATION
The SUBRECIPIENT shall comply with all applicable federal and state non-discrimination laws,
regulations, and policies. No person shall, on the grounds of age, race, creed, color, sex, sexual
orientation, religion, national origin, marital status, honorably discharged veteran or military status, or
disability (physical, mental, or sensory) be denied the benefits of, or otherwise be subjected to
discrimination under any project, program, or activity, funded, in whole or in part, under this Agreement.
Public Assistance Grant Agreement Page 15 of 24 Mason County, D22-283
A.21 NOTICES
The SUBRECIPIENT shall comply with all public notices or notices to individuals required by applicable
local, state and federal laws and shall maintain a record of this compliance.
A.22 OCCUPATIONAL SAFETY/HEALTH ACT and WASHINGTON INDUSTRIAL SAFETY/
HEALTH ACT(OSHAIWISHA)
The SUBRECIPIENT represents and warrants that its workplace does now or will meet all applicable
federal and state safety and health regulations that are in effect during the SUBRECIPIENT's
performance under this Agreement. To the extent allowed by law, the SUBRECIPIENT further agrees
to indemnify and hold harmless the DEPARTMENT and Its employees and agents from all liability,
damages and costs of any nature, including but not limited to, costs of suits and attorneys' fees
assessed against the DEPARTMENT, as a result of the failure of the SUBRECIPIENT to so comply.
A.23 OWNERSHIP OF PROJECTICAPITAL FACILITIES
The DEPARTMENT makes no claim to any capital facilities or real property improved or constructed
with funds under this Agreement, and by this grant of funds does not and will not acquire any ownership
interest or title to such property of the SUBRECIPIENT. The SUBRECIPIENT shall assume all
liabilities arising from the ownership and operation of the project and agrees to hold the DEPARTMENT
and the State of Washington and the United States government harmless from any and all causes of
action arising from the ownership and operation of the project.
A.24 POLITICAL ACTIVITY
No portion of the funds provided herein shall be used for any partisan political activity or to further the
election or defeat of any candidate for public office or influence the approval or defeat of any ballot
issue.
A.25 PRIVACY
Personal information collected, used or acquired in connection with this agreement shall be used solely
for the purposes of this agreement. SUBRECIPIENT and its subcontractors agree not to release,
divulge, publish, transfer, sell or otherwise make known to unauthorized persons personal information
without the express written consent of the DEPARTMENT or as provided by law or court order.
SUBRECIPIENT agrees to implement physical, electronic and managerial safeguards to prevent
unauthorized access to personal information.
The DEPARTMENT reserves the right to monitor, audit, or investigate the use of personal information
collected, used or acquired by the SUBRECIPIENT through this contract. The monitoring, auditing or
investigating may include but is not limited to "salting" by the DEPARTMENT. Salting is the act of
placing a record containing unique but false information in a database that can be used later to identify
inappropriate disclosure of data contained in the database.
Any breach of this provision may result in termination of the contract and the demand for return of all
personal information. The SUBRECIPIENT agrees to indemnify and hold harmless the DEPARTMENT
for any damages related to the SUBRECIPIENT's unauthorized use, loss or disclosure of personal
information.
For purposes of this provision, personal information includes, but is not limited to, information
identifiable to an individual that relates to a natural person's health, finances, education, business, use
or receipt of governmental services, or other activities, names, addresses, telephone numbers, social
security numbers, driver license numbers, financial profiles, credit card numbers, financial identifiers
and other identifying numbers.
A.26 PROHIBITION AGAINST PAYMENT OF BONUS_OR COMMISSION
The assistance provided under this Agreement shall not be used in payment of any bonus or
commission for the purpose of obtaining approval of the application for such assistance or any other
approval or concurrence under this Agreement provided; however, that reasonable fees or bona fide
technical consultant, managerial, or other such services, other than actual solicitation, are not hereby
prohibited if otherwise eligible as project costs.
A.27 PUBLICITY
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The SUBRECIPIENT agrees to submit to the DEPARTMENT prior to issuance all advertising and
publicity matters relating to this Agreement wherein the DEPARTMENT's name is mentioned or
language used from which the connection of the DEPARTMENT's name may, in the DEPARTMENT's
judgment, be inferred or implied. The SUBRECIPIENT agrees not to publish or use such advertising
and publicity matters without the prior written consent of the DEPARTMENT. The SUBRECIPIENT may
copyright original work it develops in the course of or under this Agreement; however, pursuant to 2
CFR Part 200.315, FEMA reserves a royalty-free, nonexclusive, and irrevocable license to reproduce,
publish or otherwise use, and to authorize others to use the work for government purposes.
The SUBRECIPIENT shall include language which acknowledges the funding contribution of the
DEPARTMENT and FEMA to this project in any release or other publication developed or modified for,
or referring to, the project.
Publication resulting from work performed under this Agreement shall include an acknowledgement of
the DEPARTMENT and FEMA's financial support, by CFDA number, and a statement that the
publication does not constitute an endorsement by FEMA or reflect FEMA's views.
A.28 RECAPTURE PROVISION
In the event the SUBRECIPIENT fails to expend funds under this Agreement in accordance with
applicable federal, state, and local laws, regulations, and/or the provisions of the Agreement, the
DEPARTMENT reserves the right to recapture funds in an amount equivalent to the extent of
noncompliance. Such right of recapture shall exist for the life of the project following Agreement
termination. Repayment by the SUBRECIPIENT of funds under this recapture provision shall occur
within 30 days of demand. In the event the DEPARTMENT is required to institute legal proceedings to
enforce the recapture provision, the DEPARTMENT shall be entitled to its costs and expenses thereof,
including attorney fees.
A.29 RECORDS AND REPORT
a. The SUBRECIPIENT agrees to maintain all books, records, documents, receipts, invoices and all
other electronic or written records necessary to sufficiently and properly reflect the
SUBRECIPIENT's contracts, subawards, grant administration, and payments, including all direct
and indirect charges, and expenditures in the performance of this Agreement (the"records").
b. The SUBRECIPIENT's records related to this Agreement and the projects funded may be inspected
and audited by the DEPARTMENT or its designee, by the Office of the State Auditor, DHS, FEMA
or their designees, by the Comptroller General of the United States or its designees, or by other
state or federal officials authorized by law, for the purposes of determining compliance by the
SUBRECIPIENT with the terms of this Agreement and to determine the appropriate level of funding
to be paid under the Agreement.
c. The records shall be made available by the SUBRECIPIENT for such inspection and audit, together
with suitable space for such purpose, at any and all times during the SUBRECIPIENT's normal
working day.
d. The SUBRECIPIENT shall retain and allow access to all records related to this Agreement and the
funded project(s) for a period of at least six (6) years following final payment and closure of the
grant under this Agreement. Despite the minimum federal retention requirement of three (3) years,
the more stringent State requirement of six (6) year must be followed.
A.30 RECOVERY OF FUNDS
Any person who intentionally causes a condition for which funds are provided under this Agreement
shall be liable for the costs incurred by the state and federal governments in responding to such
disaster. In addition to its own duty to recover duplicated funds or funds expended due to the
intentional or negligent actions of others. SUBRECIPIENT will cooperate in a reasonable manner with
the DEPARTMENT and the United States in efforts to recover expenditures under this Grant
Agreement.
A.31 RESPONSIBILITY FOR PROJECT/STATEMENT OF WORK/WORK PLAN
While the DEPARTMENT undertakes to assist the SUBRECIPIENT with the project/statement of
work/work plan (project) by providing grant funds pursuant to this Agreement, the project itself remains
Public Assistance Grant Agreement Page 17 of 24 Mason County, D22-283
the sole responsibility of the SUBRECIPIENT. The DEPARTMENT undertakes no responsibility to the
SUBRECIPIENT, or to any third party, other than as is expressly set out in this Agreement.
The responsibility for the design, development, construction, implementation, operation and
maintenance of the project, as these phrases are applicable to this project, is solely that of the
SUBRECIPIENT, as is responsibility for any claim or suit of any nature by any third party related in any
way to the project.
Prior to the start of any construction activity, the SUBRECIPIENT shall ensure that all applicable
Federal, State, and local permits and clearances are obtained, including but not limited to FEMA
compliance with the National Environmental Policy Act, the National Historic Preservation Act, the
Endangered Species Act, and all other environmental laws and executive orders.
The SUBRECIPIENT shall defend, at its own cost, any and all claims or suits at law or in equity, which
may be brought against the SUBRECIPIENT in connection with the project. The SUBRECIPIENT shall
not look to the DEPARTMENT, or to any state or federal agency, or to any of their employees or
agents, for any performance, assistance, or any payment or indemnity, including but not limited to cost
of defense and/or attorneys' fees, in connection with any claim or lawsuit brought by any third party
related to any design, development, construction, implementation, operation and/or maintenance of a
project.
A.32 SEVERABILITY
If any court of rightful jurisdiction holds any provision or condition under this Agreement or its
application to any person or circumstances invalid, this invalidity does not affect other provisions, terms
or conditions of the Agreement, which can be given effect without the invalid provision. To this end, the
terms and conditions of this Agreement are declared severable.
A.33 SINGLE AUDIT ACT REQUIREMENTS (including all AMENDMENTS)
Non-federal entities as subrecipients that expend $750,000 or more in one fiscal year of federal funds
from all sources, direct and indirect, are required to have a single or a program-specific audit conducted
in accordance with 2 CFR Part 200 Subpart F. Non-federal entities that spend less than $750,000 a
year in federal awards are exempt from federal audit requirements for that year, except as noted in 2
CFR Part 200 Subpart F. As defined in 2 CFR Part 200, the term "non-federal entity" means a State,
local government, Indian Tribe, institution of higher education, or non-profit organization that carries out
a federal award as a recipient or subrecipient.
SUBRECIPIENTs that are required to have an audit must ensure the audit is performed in accordance
with Generally Accepted Government Auditing Standards (GALAS) as found in the Government
Auditing Standards (the Revised Yellow Book) developed by the United States Comptroller General
and the OMB Compliance Supplement. The SUBRECIPIENT has the responsibility of notifying its
auditor and requesting an audit in compliance with 2 CFR Part 200 Subpart F, to include the
Washington State Auditor's Office, a federal auditor, or a public accountant performing work using
GALAS, as appropriate. Costs of the audit may be an allowable grant expenditure as authorized by 2
CFR Part 200 Subpart F.
The SUBRECIPIENT shall maintain auditable records and accounts so as to facilitate the audit
requirement and shall ensure that any subrecipients or contractors also maintain auditable records.
The SUBRECIPIENT is responsible for any audit exceptions incurred by its own organization or that of
its subcontractors. Responses to any unresolved management findings and disallowed or questioned
costs shall be included with the audit report.
The SUBRECIPIENT must respond to DEPARTMENT requests for information or corrective action
concerning audit issues or findings within 30 days of the date of request. The DEPARTMENT reserves
the right to recover from the SUBRECIPIENT all disallowed costs resulting from the audit.
Once the single audit has been completed and Includes and audit findings, the SUBRECIPIENT must
send a full copy of the audit to the DEPARTMENT and its corrective action plan no later than nine (9)
months after the end of the SUB RECIPIENT's fiscal year(s) to:
Public Assistance Grant Agreement Page 18 of 24 Mason County, a22-283
Contracts.Office mil.wa. ov
Subject: Subrecipient Name, Single Audit and Corrective Action Plan
OR
Contracts Office
Washington Military Department
Finance Division, Building #1 TA-20
Camp Murray, WA 98430-5032
If Contractor claims it is exempt from the audit requirements of 2 CFR Part 200 Subpart F, the
SUBRECIPIENT must send a letter identifying this Agreement and explaining the criteria for exemption
no later than nine (9) months after the end of the SUBRECIPIENT's fiscal year(s) to the address listed
above.
The DEPARTMENT retains the sole discretion to determine whether a valid claim for an exemption
from the audit requirements of this provision has been established.
The SUBRECIPIENT shall include the above audit requirements in any subawards.
Conducting a single or program-specific audit in compliance with 2 CFR Part 200 Subpart F is a
material requirement of this Agreement. In the absence of a valid claim of exemption from the audit
requirements of 2 CFR Part 200 Subpart F, the SUBRECIPIENT's failure to comply with said audit
requirements may result in one or more of the following actions in the DEPARTMENT's sole discretion:
a percentage of federal awards being withheld until the audit is completed in accordance with 2 CFR
Part 200 Subpart F; the withholding or disallowing of overhead costs; the suspension of federal awards
until the audit is conducted and submitted; or termination of the federal award.
A.34 SUBRECIPIENT NOT EMPLOYEE
The parties intend that an independent contractor relationship will be created by this Agreement. The
SUBRECIPIENT, and/or employees or agents performing under this Agreement are not employees or
agents of the DEPARTMENT in any manner whatsoever. The SUBRECIPIENT will not be presented
as nor claim to be an officer or employee of the DEPARTMENT or of the State of Washington by
reason of this Agreement, nor will the SUBRECI PI ENT make any claim, demand, or application to or for
any right or privilege applicable to an officer or employee of the DEPARTMENT or of the State of
Washington by reason of this Agreement, including, but not limited to, Workmen's Compensation
coverage, unemployment insurance benefits, social security benefits, retirement membership or credit,
or privilege or benefit which would accrue to a civil service employee under Chapter 41.06 RCW.
It is understood that if the SUBRECIPIENT is another state department, state agency, state university,
state college, state community college, state board, or state commission, that the officers and
employees are employed by the State of Washington in their own right and not by reason of this
Agreement.
A.35 TAXES, FEES AND LICENSES
Unless otherwise provided in this Agreement, the SUBRECIPIENT shall be responsible for, pay and
maintain in current status all taxes, unemployment contributions, fees, licenses, assessments, permit
charges and expenses of any other kind for the SUBRECIPIENT or its staff required by statute or
regulation that are applicable to Agreement performance.
A.36 TERMINATION FOR CONVENIENCE,
Notwithstanding any provisions of this Agreement, the SUBRECIPIENT may terminate this Agreement
by providing written notice of such termination to the DEPARTMENTs Key Personnel identified in the
Agreement, specifying the effective date thereof, at least thirty (30) days prior to such date.
Except as otherwise provided in this Agreement, the DEPARTMENT, in its sole discretion and in the
best interests of the State of Washington, may terminate this Agreement in whole or in part by providing
ten (10) calendar days written notice, beginning on the second day after mailing to the
Public Assistance Grant Agreement Page 19 of 24 Mason County, D22-283
SUBRECIPIENT. Upon notice of termination for convenience, the DEPARTMENT reserves the right to
suspend all or part of the Agreement, withhold further payments, or prohibit the SUBRECIPIENT from
incurring additional obligations of funds. In the event of termination, the SUBRECIPIENT shall be liable
for all damages as authorized by law. The rights and remedies of the DEPARTMENT provided for in
this section shall not be exclusive and are in addition to any other rights and remedies provided by law.
A.37 TERMINATION OR SUSPENSION FOR CAUSE
In the event the DEPARMENT, in its sole discretion, determines the SUBRECIPIENT has failed to fulfill
in a timely and proper manner its obligations under this Agreement, is in an unsound financial condition
so as to endanger performance hereunder, is in violation of any laws or regulations that render the
SUBRECIPIENT unable to perform any aspect of the Agreement, or has violated any of the covenants,
agreements or stipulations of this Agreement, the DEPARTMENT has the right to immediately suspend
or terminate this Agreement in whole or in part.
The DEPARTMENT may notify the SUBRECIPIENT in writing of the need to take corrective action and
provide a period of time in which to cure. The DEPARTMENT is not required to allow the
SUBRECIPIENT an opportunity to cure if it is not feasible as determined solely within the
DEPARTMENT's discretion. Any time allowed for cure shall not diminish or eliminate the
SUBRECIPIENT's liability for damages or otherwise affect any other remedies available to the
DEPARTMENT. If the DEPARTMENT allows the SUBRECIPIENT an opportunity to cure, the
DEPARTMENT shall notify the SUBRECIPIENT in writing of the need to take corrective action. If the
corrective action is not taken within ten (10) calendar days or as otherwise specified by the
DEPARTMENT, or if such corrective action is deemed by the DEPARTMENT to be insufficient, the
Agreement may be terminated in whole or in part.
The DEPARTMENT reserves the right to suspend all or part of the Agreement, withhold further
payments, or prohibit the SUBRECIPIENT from incurring additional obligations of funds during
investigation of the alleged compliance breach, pending corrective action by the SUBRECIPIENT, if
allowed, or pending a decision by the DEPARTMENT to terminate the Agreement in whole or in part.
In the event of termination, the SUBRECIPIENT shall be liable for all damages as authorized by law,
including but not limited to, any cost difference between the original Agreement and the replacement or
cover Agreement and all administrative costs directly related to the replacement Agreement, e.g., cost
of administering the competitive solicitation process, mailing, advertising and other associated staff
time. The rights and remedies of the DEPARTMENT provided for in this section shall not be exclusive
and are in addition to any other rights and remedies provided by law.
If it is determined that the SUBRECIPIENT: (1) was not in default or material breach, or (2) failure to
perform was outside of the SUBRECIPIENT's control, fault or negligence, the termination shall be
deemed to be a "Termination for Convenience".
A.38 TERMINATION PROCEDURES
In addition to the procedures set forth below, if the DEPARTMENT terminates this Agreement, the
SUBRECIPIENT shall follow any procedures specified in the termination notice. Upon termination of
this Agreement and in addition to any other rights provided in this Agreement, the DEPARTMENT may
require the SUBRECIPIENT to deliver to the DEPARTMENT any property specifically produced or
acquired for the performance of such part of this Agreement as has been terminated.
If the termination is for convenience, the DEPARTMENT shall pay to the SUBRECIPIENT the agreed
upon price, if separately stated, for properly authorized and completed work and services rendered or
goods delivered to and accepted by the DEPARTMENT prior to the effective date of Agreement
termination, and the amount agreed upon by the SUBRECIPIENT and the DEPARTMENT for (i)
completed work and services and/or equipment or supplies provided for which no separate price is
stated, (ii) partially completed work and services and/or equipment or supplies provided which are
accepted by the DEPARTMENT, (iii) other work, services and/or equipment or supplies which are
accepted by the DEPARTMENT, and (iv) the protection and preservation of property.
Failure to agree with such amounts shall be a dispute within the meaning of the "Disputes" clause of
this Agreement. If the termination is for cause, the DEPARTMENT shall determine the extent of the
Public Assistance Grant Agreement Page 20 of 24 Mason County, D22-283
liability of the DEPARTMENT. The DEPARTMENT shall have no other obligation to the
SUBRECIPIENT for termination. The DEPARTMENT may withhold from any amounts due the
SUBRECIPIENT such sum as the DEPARTMENT determines to be necessary to protect the
DEPARTMENT against potential loss or liability.
The rights and remedies of the DEPARTMENT provided in this Agreement shall not be exclusive and
are in addition to any other rights and remedies provided by law.
After receipt of a notice of termination, and except as otherwise directed by the DEPARTMENT in
writing, the SUBRECIPIENT shall:
a. Stop work under the Agreement on the date, and to the extent specified, in the notice;
b. Place no further orders or sub-contracts for materials, services, supplies, equipment and/or
facilities in relation to this Agreement except as may be necessary for completion of such
portion of the work under the Agreement as is not terminated;
C. Assign to the DEPARTMENT, in the manner, at the times, and to the extent directed by the
DEPARTMENT, all of the rights, title, and interest of the SUBRECIPIENT under the orders and
sub-contracts so terminated, in which case the DEPARTMENT has the right, at its discretion, to
settle or pay any or all claims arising out of the termination of such orders and contracts;
d. Settle all outstanding liabilities and all claims arising out of such termination of orders and sub-
contracts, with the approval or ratification of the DEPARTMENT to the extent the
DEPARTMENT may require, which approval or ratification shall be final for all the purposes of
this clause;
e. Transfer title to the DEPARTMENT and deliver in the manner, at the times, and to the extent
directed by the DEPATMENT any property which, if the Agreement had been completed, would
have been required to be furnished to the DEPARTMENT;
f. Complete performance of such part of the work as shall not have been terminated by the
DEPARTMENT in compliance with all contractual requirements; and
g. Take such action as may be necessary, or as the DEPARTMENT may require, for the protection
and preservation of the property related to this Agreement which is in the possession of the
SUBRECIPIENT and in which the DEPARTMENT has or may acquire an interest.
A.39 UTILIZATION OF MINORITY AND WOMEN BUSINESS ENTERPRISES(MWBE)
The SUBRECIPIENT shall comply with 2 CFR §200.321 and will take all necessary affirmative steps to
assure that minority firms, women's business enterprises, and labor surplus area firms are used when
possible and will take all necessary affirmative steps to utilize business firms that are certified as
minority-owned and/or women-owned in carrying out the purposes of this Agreement. The following
steps are required by the subrecipient if any contracts with contractors or sub-contractors are entered
into under the original contract award:
a. Placing qualified small and minority businesses and women's business enterprises on
solicitation lists;
b. Assuring that small and minority businesses, and women's business enterprises are solicited
whenever they are potential sources;
C. Dividing total requirements, when economically feasible, into smaller tasks or quantities to
permit maximum participation by small and minority businesses, and women's business
enterprises;
d. Establishing delivery schedules, where the requirement permits, which encourage participation
by small and minority businesses, and women's business enterprises; and
e. Using the services and assistance, as appropriate, of such organizations as the Small Business
Administration and the Minority Business Development Agency of the Department of
Commerce.
The SUBRECIPIENT may also set utilization standards, based upon local conditions or may utilize the
State of Washington MWBE goals, as identified in. WAC 326-30-041.
A.40 VENUE
Public Assistance Grant Agreement Page 21 of 24 Mason County, D22-283
This Agreement shall be construed and enforced in accordance with, and the validity and performance
shall be governed by the laws of the State of Washington. Venue of any suit between the parties
arising out of this Agreement shall be the Superior Court of Thurston County, Washington. The
SUBRECIPIENT, by execution of this Agreement acknowledges the jurisdiction of the courts of the
State of Washington.
A.41 WAIVERS
No conditions or provisions of this Agreement can be waived unless approved in advance by the
DEPARTMENT in writing. The DEPARTMENT's failure to insist upon strict performance of any
provision of the Agreement or to exercise any right based upon a breach thereof, or the acceptance of
any performance during such breach, shall not constitute a waiver of any right under this Agreement.
Public Assistance Grant Agreement Page 22 of 24 Mason County, D22-283
Attachment 3
PROJECT WORKSHEET SAMPLE
U.S.DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY d.M.B. No, 1660-0017
PROJECT WORKSHEET
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this form is estimated to average 90 minutes per response. Burden means the time, effort and financial
resources expended by persons to generate, maintain, disclose, or to provide information to us. You may send comments
regarding the accuracy of the burden estimate and or any aspect of the collection, including suggestions for reducing the burden
to: Information Coliections Management, U. S. Department of Homeland Security, Federal Emergency Management Agency, 500
C Street, SW, Washington, DC 20472, Paperwork Reduction Project(OMB Control Number 1660-0017). You are not required to
respond to this collection of information unless a valid OMB number appears in the upper right corner of this form. NOTE: Do not
send your completed form to this address.
DISASTER PROJECT NO. PA ID NO. DATE CATEGORY
F - R
DAMAGED FACILITY WORK COMPLETE AS OF:
SUBRECIPIENT COUNTY
LOCATION LATITUDE LONGITUDE
DAMAGE DESCRIPTION AND DIMENSIONS
SCOPE OF WORK
Does the Scope of Work change the pre-disaster conditions atthe site? ❑ Yes ❑ No
Special Considerations issues included? ❑ Yes ❑ No Hazard Mitigation proposal included?❑ Yes ❑ No
Is there insurance coverage on this facility? ❑ Yes ❑ No
PROJECT COST
CODE NARRATIVE QUANTITY/UNIT UNIT PRICE COST
T
1
I
1
1
1
1
1
TOTAL COST
PREPARED BY TITLE SIGNATURE
SUBRECIPIENT REP, TITLE SIGNATURE
Public Assistance Grant Agreement Page 23 of 24 Masan County, D22-283
FEMA Form 90-91,FEB 06 REPLACES ALL PREVIOUS EDITIONS.
Public Assistance Grant Agreement Page 24 of 24 Mason County, D22-283