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KANSAS EMERGENCY MANAGEMENT  HAZARD MITIGATION GRANT PROGRAM  REQUIRED DATA

 

 

Kansas Division of Emergency Management

              Hazard Mitigation Grant Program 
 

Project Application 

Safe Room Construction

(Tornado Shelter) 

Applicant:  

Project Location:

(street, city, county, and state) 

Project Title (descriptive):   

Estimated Project Cost (total):  
 
 
 

                                                                 Rev 8/2011

THIS SECTION FOR STATE USE ONLY 

FEMA--DR-KS 

☒ Standard HMGP or

☐ HMGP 5% Initiative  

☒ Initial Submission or

☐ Re-Submission

  

  

☐ Completeness Checklist

☐ State Mitigation Plan

☐ Eligible Applicant

Project Type(s)

☐ Wind Retrofit

☒ Tornado 
 
 
 
 
 
 
 
 

Community NFIP Status:

☐ Participating Community

ID#  

☐ CRS Participant

☐ In Good Standing

☐ Sanctioned 
 
 
 
 
 

State Application ID:                                                                                                                                                                                                                

Date Received:                                                                                  

State Reviewer:                                                                                                  
 
 

 

 

This application is for design/construction of safe rooms using Hazard Mitigation Grant Program (HMGP) funds.  Please complete ALL sections and provide the documents requested.  If you require additional assistance with this application, please contact the Kansas Emergency Management Mitigation Division 785-274-1973.

 

    Applicant Information

  1. Applicant (Organization):     
  1. Applicant Type: 

    State or Local Government  Recognized Indian Tribe  Private Non-Profit

  1. County / Counties:      
  2. State Legislative district(s):     Congressional District(s):  
  3. Tax I.D. Number:      FIPS Code (if known):  
  4. DUNS#: 
  1. Point of Contact or Authorized Agent for the Grant 
 

    Ms.   Mr.  Mrs.  First Name:      Last Name:

      Title:

    Street Address:

      City: State:  Zip Code:

    Telephone: () - Fax: () -

    Email Address (if available):  

  1. Application Prepared by:
 

        Ms.  Mr.  Mrs.  First Name:   Last Name:

    Title: Telephone: () - Fax: () - 

  1. Chief Executive, (an individual with legal signatory authority for the respective applicant, e.g. City/County manager, Chairperson of the County Commission, Mayor, etc.)
 

    Ms. Mr. Mrs. First Name:   Last Name:

    Title:

    Street Address:

      City: State:  Zip Code:

    Telephone: () - Fax: () -

    Email Address (if available):  

    CERTIFICATION: 1) By signing this document you declare to the best of your knowledge the data in this application are true and correct, the governing body has duly authorized the document and hereby applies for assistance in this application, and 2) the individual identified in block 7 above will act as the applicant��s agent in the performance of this grant.

 

 

    Signature: _______________________________  Date:

 
 

     

  1. Shelter Building Information:  (Please provide the following information)
 

    Building Name:   

    Street Address:   

      Occupancy: (indicate approximate occupancy of building during each hour)

    12 AM - 1 AM

    1 AM - 2 AM

    2 AM – 3 AM

    3 AM - 4 AM

    4 AM – 5 AM

    5 AM – 6 AM

    6 AM – 7 AM

    7 AM – 8 AM

    8 AM - 9 AM

    9 AM – 10 AM

    10 AM – 11 AM

    11 AM - 12 PM

    12 PM - 1 PM 1 PM - 2 PM 2 PM - 3 PM 3 PM - 4 PM
    4 PM - 5 PM 5 PM - 6 PM 6 PM - 7 PM 7 PM - 8 PM 8 PM - 9 PM 9 PM - 10 PM 10 PM - 11 PM 11 PM - 12 AM
 

What was the above based on: (i.e. student population, design occupancy rate, etc.)   

Building Information 

      Buildings Longest Width, include Shelter Area:   Buildings Longest Length include Shelter Area:   

      Total Square Feet:     Number of Stories:   

      First Floor Elevation:    Construction Date of Current Building:   

Include Sketch of Current Building  

      Square Footage of proposed Shelter Area:   

      Shelter Construction Type:   

      Describe preliminary plans for shelter (include sketch):   

      Est. Completion Date for Design (mo/yr):   Est. Completion Date for Construction (mo/yr):   

      Est. Design Cost:  $  Est. Shelter Cost:  $ 

      Latitude of Shelter:   Longitude of Shelter:   (decimal format) 

      Point where coordinates were taken:    (front door, center of driveway or road, etc.) 

Design MUST be approved by FEMA prior to construction. 

      Est. Annual Shelter Maintenance Cost:  $ 

      In What Flood Zone is the Building Located:  Include a copy of the Flood Insurance Rate Map. 

      Base Flood Elevation (100 yr):  (if applicable) 

      500 Year Flood Elevation:    (if applicable)   

First floor elevation of the shelter MUST be at or above the 500 year flood elevation. 

Additional Notes:   

 

  1. Scope of Work (SOW)(Describe in detail the proposed project)
 

The proposed project is to design and construct a safe room (tornado shelter) in accordance with the criteria set forth in FEMA 361, Design and Construction Guidance for Community Shelters, ICC 500, and the National Storm Shelter Association (NSSA).  SOW may include design, site work, necessary construction cost to comply with FEMA 361, testing, and inspection.  Design plans for the shelter area will be forwarded to FEMA Region VII for review and approval prior to start of construction.  Recommended changes identified during the FEMA review will be addressed and updated as necessary.  Windows and/or doors and associated hardware will comply with FEMA 361.  Construction will be in compliance with all local planning, zoning, building and other applicable codes. 

Additional Scope of Work: (Describe which room/s will be hardened, proposed construction method, how the cost was estimated, and any other information available that describes the project.) 
 
 

NOTE:  This program only provides for those costs that are consistent with the FEMA approved performance criteria (FEMA 361, ICC 500, and NSSA) of the safe room area as follows; 

    1. Design and inspection activities,
    2. Site preparation and building foundation materials and construction,
    3. Structural systems capable of resisting the designed wind loads (250 mph) including roof decking and roof components,
    4. Protective envelope components such as;
    • Walls, ceiling/roof components and doors, and
    • Other retrofit hardening activities consistent with the above performance criteria
    1. Functional components such as;
    • Permanent electrical lighting meeting minimum code, ventilation, toilets and hand washing facilities and signage
    1. Safe room operations and maintenance plan. 

Project components not directly related to the safe room performance criteria are NOT eligible. 

A draft Safe Room Operations Plan must be submitted with the application.  (plan requirements can be found in FEMA 361, Chap 9; available online @ fema.gov) 

 

Scope of Work - Project Location 

    City or County Map with Project Site and Photographs (check the box to indicated the attached maps)

     

        ☐ Attach a copy of a city or county scale map (large enough to show the entire project area) with the project site and structures marked on the map. 

        ☐ USGS 1:24,000 topo map with project site marked on the map
         

        ☐ Attach overview photographs (2 copies each) for each project site.  The photographs should be representative of the project area, including any relevant streams, creeks, rivers, etc. and drainage areas which affect the project site or will be affected by the project.   

        ☐ Attach Flood Insurance Rate Maps (FIRM) and Flood Insurance Study (FIS) as appropriate.  Identify the site location on the maps. 

Attach 2 copies of each site photograph here 

Clearly label the back of each photo

or

email digital photos to: 

jacob.s.gray@us.army.mil  

(If applicable)

 
 
 
 
 
 
 
 
 

Additional Notes:

 

Scope of Work – Budget

 

In this section, provide the details of all costs of the project.  As this information is used for the Benefit-Cost Analysis, reasonable cost estimates are essential.  As project administrative costs are calculated on a sliding scale, do not include this in the budget 

Supplanting: Have local funds been budgeted for the Shelter Area?  ☐ No,  ☐ Yes (if yes explain)  

Do not include contingency costs in the budget
 
 

The A&E should refer to the ��Budget Information for Tornado Shelter Projects�� for estimating eligible expenses.

 

Categories     Quantity  Total Budget  

 

Engineering & Design  

Construction  

Inspection  

Other: (explain)  

Other: (explain)        

Other: (explain)        

Other: (explain)         

                                                Total:   

Funding Sources (round figures to the nearest dollar) the maximum FEMA share for HMGP projects is 75%.  The other 25% can be made up of Local funds as well as in-kind services.  HMGP funds may be packaged with other Federal funds, but other Federal funds (except for Federal funds which lose their Federal identity at the State level i.e. such as CDBG, ARS, HOME) may not be used for the State or Local match. 


Estimated FEMA Share $   % of Total
 

Non-Federal Share


Estimated Local Share $   % of Total

      (Include In-Kind Value) 

Other Federal (Non-FEMA) Share


  $0

(Identify Federal Agency)   

List other Federal Funding Sources:   

Source of Local Funds:   

Additional Notes:     

 

Budget Narrative: Engineering & Design used for the additional cost of engineering and design of the shelter area to ensure compliance with FEMA 361.  Construction – associated cost for material, labor, hardware, doors, electrical, etc., to build the shelter envelope in accordance with FEMA 361, ICC 500, & NSSA.  Inspection – for additional inspection costs of the shelter area to ensure the designed construction complies with FEMA 361, ICC 500, & NSSA.  

If you included additional budget items above, please explain: 

 

Scope of Work - Performance

 

  Project Milestones: (List the major milestones in this project) 

Milestone Number of Days to Complete 

[e.g. Design of shelter area 60 days] 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Additional Notes:

 

  1. Alternative Actions (This application cannot be reviewed if this section is incomplete)
 

List two feasible alternative projects to mitigate the hazards faced in the project area.  One alternative is the "No Action Alternative" (section A).

 

    1. No Action Alternative

    Discuss the impacts on the project area if no action is taken and the estimated losses
     
     

    1. Other Feasible Alternative  

    Discuss a feasible alternative to the proposed project.  This could be an entirely different mitigation method or a significant modification to the design of the current proposed project.  Please include scope of work, engineering details (if applicable), estimated budget and the impacts of this alternative

      1. Other Feasible Project Description and Scope of Work

      Describe, in detail, the alternative project and estimated cost. Also, explain how the alternative project will solve the problem(s) / provide protection from the hazard(s). 
       
       

        1. Other Feasible Project Location

          ☐   Attach a map or diagram showing the alternative site in relation to the proposed project site.

        ☐   Photographs (2 copies) of alternate site. 

    Attach 2 copies of each photograph here 

    Clearly label the back of each photo.

    or

    email digital photos to: 

    jacob.s.gray@us.army.mil  

    (If applicable)

     

      1. Reason for rejecting the ��No Action�� alternative and ��Other Feasible�� alternative. 
         
         
         
         
         
         
         
         
     

       

     

    Enviornmental Documentation

    • If the project involves five or more acres of land – provide a National Pollutant Discharge Elimination System (NPDES) permit from the U.S. Environmental Protection Agency
    • If the project is located outside of town/city limits - provide documentation from the USDA National Resource Conservation Service (Prime, Unique or other Important Farmlands)
    • If the project will affect any low-income or minority groups in the project area – provide applicable Environmental Justice information (census, economics, housing and employment)
     
     
     
     
     
     
     
     
     

      Please address all these standard environmental issues as it pertains to the project 

      For each issue, determine the status by identifying and entering the number of the most appropriate response. 

    1. -  Not in the project area.
    2. -  In the project area with no effect
    3. -  Presence in area undetermined
    4. -  In project area – effect unknown
    5. -  Adverse effect

                # of

    Standard issues are:             Response     Agency Contacted 

    • Aquatic/Terrestrial Biotic Resources    
    • Designated Floodplain/Floodway    
    • Hazardous Materials      
    • Historic Structures      
    • Hydrology/Hydraulics      
    • Land Use/development Patterns    
    • Local Economy/Community Services    
    • Low Income or Minority Population    
    • Prime Farmland      
    • Slopes and Soils      
    • Special Status Natural Areas     
    • Threatened/Endangered Species    
    • Water Quality      
    • Wetlands       
 
 

      Additional Notes:  
 

FEMA can provide additional environmental technical assistance.  Your State Hazard Mitigation Officer can provide FEMA Environmental points of contact. 

Additional Documentation and/or Site Visits May Be Required For Final Environmental Review

 

Maintenance Agreement 

Only applicants whose proposed project involves the retrofit or modification of existing public property or whose proposed project would result in the public ownership or management of property, structures, or facilities, should sign the following agreement prior to submitting their application to FEMA.   

NOTE: those applicants whose project only involves the retrofitting, elevation, or other modification to private property where the ownership will remain private after project completion DO NOT have to complete this form.) 
 

The (name of school/facility) located within the (school district/city) in County, State of Kansas, hereby agrees that if it receives any Federal aid as a result of the attached project application, it will accept responsibility, at its own expense if necessary, for the routine maintenance of any real property, structures, or facilities acquired or constructed as a result of such Federal aid Routine maintenance shall include, but not be limited to, such responsibilities as maintaining supply kits in shelter and shelter identification signs as well as updating shelter operations plan. 
 

The purpose of this agreement is to make clear the Sub-grantee��s maintenance responsibilities following project award and to show the Sub-grantee��s acceptance of these responsibilities.  It does not replace, supercede, or add to any other maintenance responsibilities imposed by Federal, State and Local laws or regulations and which are in force on the date of project award.  
 
 

Signed by (printed or typed name of signing official) the duly authorized

 (title) of (name of applicant),

this (day) of (month), (year). 

 

 

Signature: ____________________________________________ 

 

 

OMB Approval No. 0348-0040

ASSURANCES — CONSTRUCTION PROGRAMS 

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  Send comments regarding the burden of estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, D.C. 20503. 

    Note: Certain of these assurances may not be applicable to your project or program. If you have questions, 
    please contact the Awarding Agency. Further, certain federal assistance awarding agencies may require 
    applicants to certify to additional assurances. If such is the case, you will be notified. 

    As the duly authorized representative of the applicant I certify that the applicant:

      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  
      assistance; and will establish a proper accounting  
      system in accordance with generally accepted  
      accounting standards or agency directives.

      3.  Will not dispose of, modify the use of, or change 
      the terms of the real property title, or other 
      interest in the site and facilities without 
      permission and instructions from the awarding 
      agency.  Will record the Federal interest in the 
      title of real property in accordance with awarding 
      agency directives and will include a covenant in 
      the title of real property acquired in whole on in 
      part with Federal assistance funds to assure 
      nondiscrimination during the useful life of the 
      project.

      4. Will comply with the requirements of the  
      assistance awarding agency with regard to the  
      drafting, review and approval of construction  
      plans and specifications.

      5. Will provide and maintain competent and  
      adequate engineering supervision at the  
      construction site to ensure that the complete work conforms with the approved plans and specifica- 
      tions and will furnish progress reports and such  
      other information as may be required buy the  
      assistance awarding agency or State.

      6. Will initiate and complete the work within the 
      applicable time frame after receipt of approval of 
      the awarding agency.

      7. Will establish safeguards to prohibit employees 
      from using their positions for a purpose that 
      constitutes or presents the appearance of personal  
      or organizational conflict of interest, or personal 
      gain.

      8.  Will comply with the Intergovernmental  
      Personnel Act of 1970 (42 U.S.C. ��� 4728-4763)  
      relating to prescribed standards for merit systems  
      for programs funded under one of the 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).

      9.  Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. ��� 4801 et seq.) which prohibits the use of lead based paint in  
      construction or rehabilitation of residence  
      structures.

      10. Will comply with all Federal statutes relating to  
      nondiscrimination. These include but are not  
      limited to: (a) Title VI of the Civil Rights Act of  
      1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b)  
      Title IX of the Education Amendments of 1972, as amended (20 U.S.C. ��� 1681-1683, and 1685- 
      1686), which prohibits discrimination on the basis  
      of sex; (c) Section 504 of the Rehabilitation Act of  
      1973, as amended (29 U.S.C. �� 794), which prohibit discrimination on the basis of handicaps; (d) the  
      Age Discrimination Act of 1975, as amended (42  
      U.S.C. ��� 6101-6107), which prohibits discrimi- 
      nation on the basis of age; (e) the Drug Abuse  
      Office and Treatment Act of 1972 (P.L. 92-2S5), 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 nondiscrimi- 
      nation on the basis of alcohol abuse or alcoholism;  
      (g) ��� 523 and 527 of the Public Health Service  
      Act of 1912 (42 U.S.C. 290 dd-3 and 290 ee-3), as amended, relating to confidentiality of alcohol and  
      drug abuse patient records; (h) Title VIII of the  
      Civil Rights Act of 1968 (42 U.S.C. �� 3601 et seq.),  
      as amended, relating to non-discrimination in the  
      sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific  
      statute(s) under which application for Federal  
      assistance is being made; and (j) the requirements  
      of any other nondiscrimination statute(s) which  
      may apply to the application.

      11.  Will comply, or has already complied, with the requirements of Titles II and 111 of the Uniform

     

      Relocation Assistance and Real Property  
      Acquisition Policies Act of 1970 (P.L. 91-646)  
      which provide for fair and equitable treatment  
      of persons displaced or whose property is  
      acquired as a result of Federal or federally  
      assisted programs. These requirements apply to  
      all interests in real property acquired for project  
      purposes regardless of Federal participation in  
      purchases.

      12.  Will comply with the provisions of the Hatch Act  
      (5 U.S.C. ��� 1501-1508 and 7324-7328) which  
      limit the political activities of employees whose  
      principal employment activities are funded in  
      whole or in part with Federal funds.

      13.  Will comply, as applicable, with the provisions of  
      the Davis-Bacon Act (40 U.S.C. ��� 276a to 276a 
      7), the Copeland Act (40 U.S.C. �� 276c and 18  
      U.S.C. ��� 874), and the Contract Work Hours and  
      Safety Standards Act (40 U.S.C. ��� 327-333)  
      regarding labor standards for federally assisted  
      construction sub-agreements.

      14. Will comply with flood insurance purchase  
      requirements of Section 102(a) of the Flood  
      Disaster Protection Act of 1973 (P.L. 93234)  
      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.

    SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE  
     
     
     
    APPLICANT ORGANIZATION  
     
     
     
    DATE SUBMITTED  
     
     
     

      15.  Will comply with environmental standards  
      which may be prescribed pursuant to the  
      following: (a) institution of environmental  
      quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190)  
      and Executive Order (EO) 11514; (b)  notification 

      of violating facilities pursuant to EO 11738; (c)  
      protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in  
      accordance with EO 11988; (e) assurance of  
      project consistency with the approved State  
      management program developed under the  
      Coastal Zone Management Act of 1972 (16 U.S.C.  
      ��� 1451 et seq.); (f) conformity of Federal actions  
      to State (Clear Air) Implementation Plans under  
      Section 176(c) of the Clear Air Act of 1955, as  
      amended (42 U.S.C. �� 7401 et seq.); (g) protection  
      of underground sources of drinking water under  
      the Safe Drinking Water Act of 1974, as  
      amended, (P.L. 93-523); and (h) protection of  
      endangered species under the Endangered  
      Species Act of 1973, as amended, (P.L. 93-205).

      16.  Will comply with the Wild and Scenic Rivers Act  
      of 1968 (16 U.S.C. ��� 1271 et seq.) related to  
      protecting components or potential components  
      of the national wild and scenic rivers system.

      17.  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  
      preservation of historic properties), and the  
      Archaeological and Historic Preservation Act of  
      1974 (16 U.S.C. 469a-1 et seq.).

      18.  Will cause to be performed the required financial 
      and compliance audits in accordance with the 
      Single Audit Act of 1984.

      19. Will comply with all applicable requirements of 
      all other Federal laws, Executive Orders, 
      regulations and policies governing this program.

     
     

     
     
    APPLICATION FOR

    FEDERAL ASSISTANCE

      Version 7/03
    2.  DATE SUBMITTED Applicant Identifier
    1.  TYPE OF SUBMISSION:

    Application

     

    Construction

    Non-construction

     
    Pre-application  

    Construction

    Non-Construction

    3.  DATE RECEIVED BY STATE State Application Identifier
    4.  DATE RECEIVED BY FEDERAL AGENCY Federal Identifier
    1. APPLICANT INFORMATION
    Legal Name:  Organizational Unit:
    Department: 
    Organizational DUNS:  Division:
    Address: Name  and telephone number of person to be contacted on matters involving this application (give area code)
    Street:            
    Prefix:  First Name: 
    City:   Middle Name: 
    County: Last Name: 
    State: Zip Code: Suffix: 
    Country: Email: 
    1. EMPLOYER IDENTIFICATION NUMBER (EIN):
    Phone Number (give area code)  
    FAX Number (give area code)  
          -                
     
    1. TYPE OF APPLICATION:
                                 New                   Continuation              Revision

    If Revision, enter appropriate letter(s) in box(es)

    (See back of form for description of letters.)

    1. TYPE OF APPLICANT:  (See back of form for Application Types)
     
          

    Other (specify) 

                   
     
    Other (specify) 
    1. NAME OF FEDERAL AGENCY:
    Federal Emergency Management Agency
    1. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:
    1. DESCRIPTIVE TITLE OF APPLICANTS PROJECT:
     
    Design and construct a safe room area IAW FEMA 361
      9 7 - 0 3 9  
     

    TITLE (Name of Program) Hazard Mitigation Grant Program (HMGP)

    1. AREAS AFFECTED BY PROJECT (Cities, Countries, States, etc.)
     
    1. PROPOSED PROJECT
    1. CONGRESSIONAL DISTRICTS OF:

    Start Date

    Ending Date

    a.  Applicant b.  Project
    1. ESTIMATED FUNDING:
    1. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER  12372 PROCESS?
    a.  Federal  
    $
    .00     

    a.   YES.  ☐  THIS PREAPPLICATION/APPLICATION WAS MADE

                    AVAILABLE TO THE STATE  EXECUTIVE ORDER 12372  PROCESS FOR REVIEW ON

       

                       DATE: 

     

    b.   NO.   ☒  PROGRAM IS NOT COVERED BY E.O. 12372

     

                    ☐  OR PROGRAM HAS NOT BEEN SELECTED BY STATE         FOR REVIEW

    b.  Applicant  
    $
    .00
    c.  State  
    $
    .00
    d.  Local  
    $
    .00
    e.  Other  
    $
    .00
    f.  Program Income  
    $
    .00
    1. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
    g.  TOTAL  
    $
    .00      

             Yes   If ��Yes,�� attach an explanation.           No

    1.   TO THE BEST OF MY KNOWLEDGE AND BELIEF ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT.  THE DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES.
    a. Authorized Representative
    Prefix  First Name  Middle Name 
    Last Name  Suffix 
    b.  Title  c.  Telephone Number (give area code) 
    Email:  Fax Number (give area code) 
    d.  Signature of Authorized Representative e.  Date Signed
    Previous Editions Usable

    Authorized for Local Reproduction

    Standard Form 424 (Rev 9-2003)

    Prescribed by OMB Circular A-102

     

    THIS SECTION FOR STATE USE ONLY

     

          Eligibility in accordance with 44 CFR 206.434

     

      44 CFR 206.434 (c)(1).  Project is in conformance with State and Local Mitigation Plans.

     
     

      44 CFR 206.434 (c)(2).  Project has a beneficial impact on the designated disaster area, whether or not located in the designated area.

     
     

      44 CFR 206.434 (c)(3).  Project is in conformance with 44 CFR Part 9, Floodplain Management and protection of wetlands.

     
     

      44 CFR 206.434 (c)(3).  Project is in conformance with 44 CFR Part 10, Environmental Considerations.

     
     

      44 CFR 206.434 (c)(4).  Project solves a problem independently or constitutes a functional part of a solution where there is assurance that the project as a whole will be completed.  Projects that only analyze hazards or problems are not eligible.

     
     

      44 CFR 206.434 (c)(5).  Project is cost effective.

     
     

      44 CFR 206.434 (c)(5)(i-v). Project substantially reduces the risk of future damage, hardship, loss, or suffering resulting from a major disaster.  The grantee must demonstrate this by documenting that the project;

     

        (i) Addresses a problem that has been repetitive, (or)

     
     

        (ii) Addresses a problem that poses a significant risk to public health and safety if left unsolved.

     
     

        (iii) Will not cost more than the anticipated value of the reduction in both damages and subsequent negative impacts to the area if future disasters were to occur (computed on net present value)

     
     

        (iv) Is the most practical, effective, and environmentally sound alternative from a range of options.

     
     

        (v) Contributes, to the extent practicable, to a long-term solution to the problem.

         

     

        (vi) Considers long-term changes to the area and entities it protects.

     
     

        (vii) Has manageable future maintenance and modification requirements.

     

     

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