HomeMy WebLinkAboutContract 48594 CITY SECRETARY,'' %�__;«
MITIGATION GRANT PROJECT APPLICATION
TEXAS HAZARD MITIGATION GRANT PROGRAM
Mail Application to: State Hazard Mitigation Officer Phone:(512)424-2429
Division of Emergency Management FAX: (512)424-5959
Texas Department of Public Safety
P.0.Box 4087
Austin,Texas 78773-0226
SUB-APPLICANT COUNTY.Tarrant DUNS CODE.147336965
NAME OFSUB APPLICANT:(CITY,AGENCY,ETC.) FIPS CODE.48439
City of Fort Worth
POINT-OF—CONTACT
Jennifer Dyke
SUB-APPLICANTADDRESS: /STREET.CITY. ZIP) PHONE:817-392-2714
200 Texas Street, Fort Worth, TX 76102 MOBILE:682-404-7234
PROJECT LOCATION ADDRESS: FAX:817-392-2433
2203-2221 Western Ave, 2212-2309 Carleton Ave, Fort
Worth, TX 76107 E-MAIL:Jennifer.Dyke@FortWorthTexas.gov
ESTIMATED TOTAL PROJECT cosh$6,636,700 PRE-AWARD COST:$25,000.00
Costs directly related to preparing the sub-application such as BCA(Beneift Cost
FEMA FUNDING(75%J:$4,977,525
Analysis)development,the gathering of environmental data,and project design
meetings,must be a seperate line item included in the total project cost breakdown and
LOCAL MATCH(25%):$1,659,175 identified as pre-award costs to be eligible for uses as non-federal costshare. If the
project does not receive federal approval and grant funds are not awarded then you will
SOURCE OF LOCAL FUNDING: Stormwater Utility not receive reimbursement for pre-award costs.
DESCRIPTION OF PROJECT I SCOPE OF WORK:
Voluntary acquisition and demolition of 13 homes along Western and Carleton Avenues in Fort Worth.
Construction of multi-use surface detention and park-like green space.
Signature: 20. Title:Assistant City 21. Date:
(A — Manager
T"is SwwN FOR STATE Ilan ONLY
RECOMMENDED ❑ DISASTER DECLARATION NUMBER:
NOT RECOMMENDED ❑ PROJECT CODE:
INELIGIBLE ❑ DATE RECEIVED:
STATE HAZARD MITIGATION OFFICER'S SIGNATURE: TX APPLICATION #:
FEMA APPLICATION #:
LAT/LONG:
COMMENTS:
DATE:
OFFICIAL RECORD
Texas Division of Emergency Management
Texas Hrv1GP-State Application CITY SECRETARY
Form#:-1-DEM-609;Revision Date:1.3.2012
FT.WORTH,TX
Application for Federal Assistance SF-424
Hazard Mitigation Grant OMB Number 4040-004
1. Type of Submission: ■ Construction Non Construction
2. Date Submitted: Application Identifier: - State Use)
3. Date Received by the State: (State Use) State Application Identifier: (State Use)
4. Date Received by Federal Agency: Federal Identifier
5. Applicant Information:
Legal Name: City of Fort Worth
Address: ''zoo T.-s(l City. 'Fonwonn State: Tx Zip: TBtoz
Organizational Unit: T.nPW8u0nWdPbA0W0dc3o0vaft"t Department and Division: ,StormwaterManagement Division
FIPS Code: 40439 DUNS Code: ;,147336965
Primary contact on matters involving this application:
First Name: Jenn;rer Last Name: Email '
Email: Jennifer.Dyke@FortWorthTexas.gov
Phone: Fax:
817-392-2714 817-392-2433
6. Employer Identification Number/Tax Identification Number(EIN/TIN): 75-6040528
7. Type of Applicant: (See instructionsfor Application Types) G'
8. Type of Application: _ New - Continuation _ Revision(enter appropriate revision letter)
9. Name of Federal Agency: FEMA/DHS
10. Catalog of Federal Domestic Assistance Number: 97-039
Title(Name of Program): Hazard Mitigation Grant Program
11. Descriptive title of the applicants protect: Arlington Heights Voluntary Acquisitions and Detention
12. Areas Affected by Project
Cities: Fort Worth
Counties: Tarrant
13. Proposed Start Date: Upon Approval Ending Date: 24 Months from Approval
14. Congressional Districts of: Applicant: JX12 Project Location: 7x12
15. Estimated Funding:
Federal: 'Z�4,y11,5to
Applicant:sisss,ns Funding Source: If match is CDBG funds,this triggers Davis-Bacon on the whole project.
Total: :$6,636,700 Stormwater Utility Typically,HMGP is exempt from Davis Bacon.
16. Is the Application Subject to Review by State Executive Order 12372 Process? (Intergovernmental Review of Federal Programs)
YES—This pre-application was made available to the State Executive Order 12372 process for review on date:
NO ■1 Program is not covered by E.O.12372
Or Program has not been selected by State for Review
17. Is the Applicant Delinquent on any Federal Debt?
Yes—attach an explanation -No
18. *By signing this application,I certify(1)to the statements contained in the list of certifications**and(2)that the statements herein are true,
complete and accurate to the best of my knowledge. I also provide the required assurances**and agree to comply with any resulting terms if
I accept an award. I am aware any false,fictitious,or fraudulent statements or claims may subject me to criminal, civil or administrative
penalties. (U.S.Code,Title 218,Section 1001) M', **1 AGREE
Authorized Representative:Jesus J. Chapa Title: !Assistant City Manager Phone: ;817-392-5804
Signature �'t�—��L/U! Date:_ 21�21:2
TDEM-618(Rev 1/14)
Instructions for the SF-424
Public reporting burden for this collection of information is estimated to average 45 minutes per response,including time for reviewing instructions,searching
existing data sources,gathering and maintaining the data needed,and completing and reviewing the collection of information. Send comments regarding the
burden estimate or any other aspect of this collection of information,including suggestions for reducing this burden,to the Office of Management and Budget,
Paperwork Reduction Project(0348-0043),Washington,DC 20503
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING
AGENCY
This is a standard form used by applicants as a required face sheet for pre-applications and applications submitted for Federal assistance. It will be used by Federal
agencies to obtain applicant certification that States which have established a review and comment procedure in response to Executive Order 12372 and have selected
the program to be included in their process,have been given an opportunity to review the applicant's submission.
Item Entry Item Entry
1. Select Type 11. Enter a brief descriptive title of the project. If more than one
program is involved, you should append an explanation on a
separate sheet. If appropriate (e.g., construction or real property
projects), attach a map showing project location. For pre-
applications, use a separate sheet to provide a summary
description of this project.
2. Date application submitted to Federal agency (or State if 12. List only the largest political entities affected (e.g.,State,counties,
applicable)and applicant's control number(if applicable). cities).
3. State use only(if applicable) 13. Prefilled—should be upon approval and end 24 months.
4. Enter Date Received by Federal Agency 14. List the applicant's Congressional District and any District(s)
Federal identifier number: If this application is a continuation affected by the program or project.
or revision to an existing award, enter the present Federal
Identifier number. For a new project,leave blank.
5. Enter legal name of applicant, name of primary organizational 15. Amount requested or to be contributed during the first
unit(including division,if applicable),which will undertake the funding/budget period by each contributor. Value of in kind
assistance activity, enter the organization's DUNS number contributions should be included on appropriate lines as applicable.
(received from Dun and Bradstreet), enter the complete If the action will result in a dollar change to an existing award,
address of the applicant (including country), and name, indicate only the amount of the change. For decreases,enclose the
telephone number,e-mail and fax of the person to contact on amounts in parentheses. If both basic and supplemental amounts
matters related to this application. are included,show breakdown on an attached sheet. For multiple
program funding, use totals and show breakdown using same
categories as item 15.
6. Enter Employer Identification Number(EIN)as assigned by the 16. Applicants should contact the State Single Point of contact (SPOC)
Internal Revenue Service. for Federal Executive Order 12372 to determine whether the
application is subject to the State intergovernmental review
process.
7. Select the appropriate letter in the space provided 17. This question applies to the applicant organization, not the person
A. State I. State Controlled Institution who signs as the authorized representative. Categories of debt
of Higher Learning include delinquent audit disallowances,loans,and taxes
B. County J. Private Industry
C. Municipal K. Indian Tribe
D. Township L. Individual
E. Interstate M. Profit Organization
F. Intermunicipal N. Other(Specify)
G. Special District 0. Not for Profit Organization
H. Independent School
District
8. Select from the following list: 18. To be signed by the authorized representative of the applicant. A
New=New assistant Award copy of the governing body's authorization for you to sign this
Continuation = Extension for an additional funding/budget application as official representative must be on file in the
period for a project with a projected completion date. applicant's office. (Certain Federal agencies may require that this
Revision = Change in the Federal Government's financial authorization be submitted as part of the application.)
obligation.
If a revision enter the appropriate letter
A. Increase Award C. Increase Duration
B. Decrease Award D. Decrease Duration
9. Prefilled. Name of Federal agency from which assistance is
being requested with this application.
10. Prefilled with proper code. Use the Catalog of Federal
Domestic Assistance number and title of the program under
which assistance is requested.
TDEM-618(Rev 1/14)
State of TexasAssurances
Hazard Mitigation Grant
In addition to federal requirements, state law requires a number of assurances from applicants for federal
pass-through or other state-appropriated funds. An attempt has been made below to list major state and
federal assurances. Generally, not all of these'assurances will be required for any one grant. However, it is
the,applicant's responsibility to ensure that all assurances required by the awarding agency are submitted.
The legal instrument for awarding state funds must be consistent with the
standards prescribed herein; however, these standard conditions or assurances
may be incorporated into contracts or grant agreements by reference rather than
by being reproduced in their entirety.
1) A subgrantee must comply with Texas Government Code, Chapter 573, Vernon's 994, by ensuring that no officer,
employee, or member of the applicant's governing body or of the applicant's contractor shall vote or confirm the
employment of any person related within the second degree of affinity or the third degree of consanguinity to any
member of the governing body or to any other officer or employee authorized to employ or supervise such person.
This prohibition shall not prohibit the employment of a person, who shall have been continuously employed for a
period of two years, or such other period stipulated by local law, prior to the election or appointment of the officer,
employee,or governing body member related to such person in the prohibited degree.
2) A subgrantee must insure that all information collected, assembled or maintained by the applicant relative to a project
will be available to the public during normal business hours in compliance with Texas Government Code,Chapter 552,
Vernon's 1994, unless otherwise expressly prohibited by law.
3) A subgrantee must comply with Texas Government Code, Chapter 551, Vernon's 1994, which requires all regular,
special or called meeting of governmental bodies to be open to the public, except as otherwise provided by law or
specifically permitted in the Texas Constitution.
4) A subgrantee must comply with Section 231.006,Texas Family Code, which prohibits payments to a person who is in
arrears on child support payments.
5) No health and human services agency or public safety or law enforcement agency may contract with or issue a license,
certificate or permit to the owner, operator or administrator of a facility if the license, permit or certificate has been
revoked by another health and human services agency or public safety or law enforcement agency.
6) A subgrantee that is a law enforcement agency regulated by Texas Government Code; Chapter 415, must be in
compliance with all rules adopted by the Texas Commission on Law Enforcement Officer Standards and Education
pursuant to Chapter 415, Texas Government Code or must provide the grantor agency with a certification from the
Texas Commission on Law Enforcement Officer Standards and Education that the agency is in the process of achieving
compliance with such rules.
7) When incorporated into a grant award or contract, standard assurances contained in the application package become
terms or conditions for receipt of grant funds. Administering state agencies and local subrecipients shall maintain an
appropriate contract administration system to insure that all terms, conditions, and specifications are met. (See
Uniform Grant Management Standards,Part III,subpart C .36 for additional guidance on contract provisions.)
8) A subgrantee must comply with the Texas Family Code, Section 261.101 which requires reporting of all suspected
cases of child abuse to local law enforcement authorities and to the Texas Department of Child Protective and
Regulatory Services. Subgrantees shall also ensure that all program personnel are properly trained and aware of this
requirement.
9) Intentionally omitted; This State Assurance corresponds with OMB Approved No. 0348-0042 Federal Assurance
number(10)
10) Intentionally omitted; This State Assurance corresponds with OMB Approved No. 0348-0042 Federal Assurance
number(13)
11) Intentionally omitted; This State Assurance corresponds with OMB Approved No. 0348-0042 Federal Assurance
number(11)
TDEM-618(Rev 1/14)
12) Intentionally omitted; This State Assurance corresponds with OMB Approved No. 0348-0042 Federal Assurance
number(12)
13) Subgrantees will comply with the minimum wage and maximum hour's provisions of the Federal Fair Labor Standards
Act and the Intergovernmental Personnel Act of 1970,as applicable.
14) Subgrantees will insure that the facilities under its ownership, lease or supervision which shall be utilized in the
accomplishment of the project are not listed on the Environmental Protections Agency's (EPA) list of Violating
Facilities and that it will notify the Federal grantor agency of the receipt of any communication from the Director of
the EPA Office of Federal Activities indicating that a facility to be used in the project is under consideration for listing
by the EPA.(EO 11738).
15) Subgrantees will comply with the flood insurance purchase requirements of 102(a) of the Flood Disaster Protection
Act of 1973, Public Law 93-234. Section 102 (a) requires the purchase of flood insurance in communities where such
insurance is available as a condition for the receipt of any Federal financial assistance for construction or acquisition
proposed for use in any area that has been identified by the Secretary of the Department of Housing and Urban
Development as an area having special flood hazards.
16) Intentionally omitted; This State Assurance corresponds with OMB Approved No. 0348-0042 Federal Assurances
number(15).
17) Intentionally omitted; This State Assurance corresponds with OMB Approved No. 0348-0042 Federal Assurance
number(16).
18) Intentionally omitted; This State Assurance corresponds with OMB Approved No. 0348-0042 Federal Assurance
number(17).
19) Intentionally omitted; This State Assurance corresponds with OMB Approved No. 0348-0042 Federal Assurance
number(11).
20) Intentionally omitted; This State Assurance corresponds with OMB Approved No. 0348-0042 Federal Assurance
number(9).
21) Subgrantees will comply with Public Law 103277, also known as the Pro-Children Act of 1994 (Act), which prohibits
smoking within any portion of any indoor facility used for the provision of services for children as defined by the Act.
22) Subgrantees will comply with all federal tax laws and are solely responsible for filing all required state and federal tax
forms.
23) Subgrantees will comply with all applicable requirements of all other federal and state laws, executive orders,
regulations and policies governing this program.
24) The applicant must certify that they are not debarred or suspended or otherwise excluded from or ineligible for
participation in federal assistance programs.
25) Subgrantees must adopt and implement applicable provisions of the model HIV/AIDS work place guidelines of the
Texas Department of Health as required by the Texas Health and Safety Code,Ann.,Sec.85.001,et seq.
Authorized Representative:Jesus J. ChapaTitle: Assistant City Manager Phone: 817-392-5804
laA Signature —Date:��'?��
TDEM-618(Rev 1/14)
Match Certification
City of Fort Worth certifies we have the ability to meet the 25%or more cost share of this project.
Duplication of Program Statement
City of Fort Worth certifies there has not been, nor will there be, a duplication of benefits for
this project.
Maintenance Agreement
Is there a Maintenance Agreement needed for this facility? Yes VNo
If yes,include a copy of the Maintenance Agreement with this application.
Environmental Justice Statement
EO 12898 compliance requirements:
1. Are there concentrations of low income or minority populations in or near the HMGP project?
No.
2. Will the HMGP project result in a disproportionately high and adverse effect on low income or
minority populations?
No.
3. What action(s)will be taken to insure achievement of environmental justice for low income and
minority populations?
No action.
Authorized Representative:Jesus J. ChapaTitle:Assistant City Manager Phone:817-392-5804
Signature -Pt..,�i �3 /--- Date:
TDEM-618(Rev 1/14)
Summary Sheet for Assurances and Certifications
U.S. DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 1660-0025
SUMMARY SHEET FOR ASSURANCES AND CERTIFICATIONS
For FY -ol/ov2017 I CA FOR (Name of Recipient) City of Fort Worth
This summary sheet includes Assurances and Certifications that must be read,signed and submitted as a part of the
Application for Federal Assistance.
The applicant must check each item that they are certifying to:
Part I ❑ FEMA Form 20-16A,Assurances-NonConstruction Programs
Part II 0 FEMA Form 20-16B,Assurances-Construction Programs
Part III ❑ FEMA Form 20-16 C, Certification Regarding Lobbying; Debarment, Suspension and Other Responsibility
Matters; and Drug-Free Workplace Requirements
Part IV ❑ SF LLL, Disclosure of Lobbying Activities (If applicable)
As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with identified
attached assurances and certifications.
Jesus J.Chapa Assistant City Manager
Typed Name of Authorized Representative Title
Signature of Authorized Representative Date Signed
NOTE:
By signing the certification regarding debarment, suspension, and other responsibility matters for primary covered
transaction, the applicant agrees that, should the proposed covered transaction be entered into, it shall not knowingly
enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily
excluded from participation in this covered transaction, unless authorized by FEMA entering into this transaction.
The applicant further agrees by submitting this application that it will include the clause titled "Certification Regarding
Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered Transaction," provided by the FEMA
Regional Office entering into this covered transaction, without modification, in all lower tier covered transactions and in all
solicitations for lower tier covered transactions. (Refer to 44 CFR Part 17.)
Paperwork Burden Disclosure Notice
Public reporting burden for this form is estimated to average 1.7 hours per response. The burden estimate includes the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing, reviewing, and maintaining the data needed, and completing and submitting the form. Send comments
regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections
Management, U.S. Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW,
Washington DC 20472. You are not required to complete this form unless a valid OMB control number is displayed in the
upper corner on this form.
Please do not send your completed form to the above address.
FEMA orm 20-16
At;.C
OFFICIAL RE `!L
CITY SECRETARY *
FTe WO TH TX S� aty J yser,( ity Secretary
TDEM-618(Rev 1/14)
Federal Assurances for Non-Construction Programs Zo-16a
U.S DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.No.1660-0025
ASS URANCES-NONCONSTRUCTION PROGRAMS Expires July 31,2007
Paperwork Burden Disclosure Notice
Public reporting burden for this form is estimated to average 1.7 hours per response.The burden estimate includes the time for reviewing instructions,searching
existing data sources,gathering and maintaining the data needed,and completing,reviewing,and maintaining the data needed,and completing and submitting the
form.Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to:Information Collections Management,U.S.
Department of Homeland Security,Federal Emergency Management Agency,500 C Street,SW,Washington DC 20472.You are not required to complete this form unless
a valid OMB control number is displayed in the upper corner on this form.
Please do not send your completed form to the above address.
NOTE: Certain of these assurances may not be applicable to your project or program.If you have any questions,please contact the awarding agency.Further,certain
Federal awarding agencies may require applicants to certify to additional assurances.If such is the case,you will be notified.
As the duly authorized representative of the applicant,I certify that the applicant:
1.Has the legal authority to apply for Federal assistance,and the institutional, 9.Will comply,as applicable,with the provisions of the Davis-Bacon Act
managerial and financial capability(including funds sufficient to pay the non- (40 U.S.C.Sections 276a to 276a-7)the Copeland Act(40 U.S.C.Section
Federal share of project costs)to ensure proper planning,management and 276c and 18 U.S.C.Sections 874),and the Contract Work Hours and
completion of the project described in this application. Safety Standards Act(40 U.S.C.Sections 327-333),regarding labor standards for
federally assisted construction subagreements.
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 10.Will comply,if applicable with flood insurance purchase requirements
right to examine all records,books,papers,or documents related to the award; of Section 102a of the Flood Disaster Protection Act of 1973(P.L.93-234)
and will establish a proper accounting system in accordance with generally which requires recipients in a special flood hazard area to participate in the
accepted accounting standards or agency directives. program and to purchase flood insurance if the total cost of insurable
construction and acquisition is$10,000 or more.
3.Will establish safeguards to prohibit employees from using their positions for a
purpose that constitutes or presents the appearance of personal gain. 11.Will comply with environmental standards which may be prescribed
pursuant to the following:(a)institution of environmental quality control
4.Will initiate and complete the work within the applicable time frame after measures under the National Environmental Policy Act of 1969(P.L.
receipt of approval of the awarding agency. 91-190)and Executive Order(EO)11514;(b)notification of violating
facilities pursuant to EO 11738;(c)protection of wetlands pursuant to EO
5.Will comply with the Intergovernmental Personnel Act of 1970(42 U.S.C.Section 11990;(d)evaluation of flood hazards in floodplains in accordance with EO
4727-4763)relating to prescribed standards for merit systems for programs funded 11988;(e)assurance of project consistency with the approved State
under one of the nineteen statues or regulations specified in Appendix A of OPM's management program developed under the Coastal Zone Management
Standards for Merit System of Personnel Administration(5 C.F.R.900,Subpart F). Act of 1972(16)U.S.C.Sections 1451 et seq.);(f)conformity of Federal
actions to State(Clear Air)Implementation Plans under Section 176(c)of
6.Will comply with all Federal statues relating to nondiscrimination.These include the Clear Air Act of 1955,as amended(42 U.S.C.Section et seq.);(g)
but are not limited to:(a)Title VI of the Civil Rights Act of 1964(P.L.88-352)which protection underground sources of drinking water under Safe Drinking
prohibits discrimination on the basis of race,color,or Water Act of 1974,as amended,(P.L.93-523);and(h)protection of endangered
national origin;(b)Title IV of the Education Amendments of 1972,as amended(20 species under the Endangered Species Act of 1973,as amended,(P.L.93-205).
U.S.C.Sections 1681-1683,and 1685-1686),which prohibits discrimination on the
basis of sex;(c)Section 504 of the Rehabilitation Act of 1973,as amended(29 12.Will comply with the wild and Scenic Rivers Act of 1968(16 U.S.C.
U.S.C.Section 794),which prohibits discrimination on the basis of handicaps;(d) Sections 1271 et seq.)related to protecting components of the national wild and
the Age Discrimination Act of 1975,as amended(42 U.S.C.Sections 6101-6107), scenic rivers systems.
which prohibits discrimination on the basis of age;(e)the Drug Abuse Office and
Treatment Act of 1972(P.L.92-255),as amended,relating to nondiscrimination on 13.Will assist the awarding agency In assuring compliance with Section
the basis of drug abuse;(f)the Comprehensive 106 of the National Historic Preservation Act of 1966,as amended(16
Alcohol Abuse and Alcoholism Prevention,Treatment and Rehabilitation U.S.C.470),EO 11593(identification and protection of historic properties),and
Act of 1970,)P.L.91-616),as amended,relating to nondiscrimination on the Archaeological and Historic Preservation Act of 1974(16 U.S.C.
the basis of alcohol abuse or alcoholism;(g)Sections 523 and 527 of the 469a-et seq.).
Public Health Service Act of 1912,(42 U.S.C.290-dd-3 and 290 ee-3),as 14.Will comply with P.I.93-348 regarding the protection of human subjects
amended,relating to confidentiality of alcohol and drug abuse patient involved in research,development,and related activities supported by this award
records;(h)Title VIII of the Civil Rights Acts of 1968(42 U.S.C.Section of assistance.
3601 et.seq.),as amended,relating to nondiscrimination in the sale,rental or
financing of housing;(i)any other nondiscrimination provision in the specific 15.Will comply with the Laboratory Animal Welfare Act of 1966(P.L.
statue(s)under which application for Federal assistance is being made;and(j)the 89-544,as amended,7 U.S.C.2131 et seq.)pertaining to the care,handling,and
requirements of any other nondiscrimination statue(s)which may apply to the treatment of warm blooded animals held for research,teaching,or other
application. activities supported by this award of assistance.
7.Will comply,or has already complied,with the requirements of Title II 16.Will comply with the Lead-Based Paint Poising Prevention Act(42
and III of the Uniformed Relocation Assistance and Real Property U.S.C.Sections 4801 et seq.)which prohibits the use of lead based paint in
Acquisition Policies Act of 1970(P.L.91-646)which provides for fair and construction or rehabilitation of residence structures.
equitable treatment of persons displaced or whose property is acquired as 17.Will cause to be performed the required financial and compliance audits in
a result of Federal or Federally assisted programs.These requirements accordance with the Single Audit Act of 1984.
apply to all interest in real property acquired for project purposes regardless of 18 Will comply with all applicable requirements of all other Federal laws,
Federal participation in purchase. executive orders,regulations and policies governing this program.
8.Will comply with provisions of Hatch Act(5 U.S.C.Sections 1501-1508 19.It will comply with the minimum wage and maximum hours provisions
and 7324-7328)which limit the political activities of employees whose principle of the Federal Fair Labor Standards Act(29 U.S.C.201),as they apply to
employment activities are funded in whole or in part with Federal funds. employees of institutions of higher education,hospitals,and other non-profit
organizations.
TDEM-618(Rev 1/14)
Assurances for Construction Programs 20-16B''
U.S DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.No.1660-0025
ASSURANCES-NONCONSTRUCTION PROGRAMS Expires July 31,2007
Paperwork Burden Disclosure Notice
Public reporting burden for this form is estimated to average 1.7 hours per response.The burden estimate includes the time for reviewing instructions, searching
existing data sources,gathering and maintaining the data needed,and completing,reviewing,and maintaining the data needed,and completing and submitting the
form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, U.S.
Department of Homeland Security,Federal Emergency Management Agency,500 C Street,SW,Washington DC 20472.You are not required to complete this form unless
a valid OMB control number is displayed in the upper corner on this form. Please do not send your completed form to the above address.
NOTE: Certain of these assurances may not be applicable to your project or program.If you have any questions,please contact the awarding agency.Further,certain
Federal awarding agencies may require applicants to certify to additional assurances.If such is the case,you will be notified.
As the duly authorized representative of the applicant,I certify that the applicant:; City of Fort Worth
1. Has the legal authority to apply for Federal assistance, and the institutional, ee-3),as amended,relating to confidentiality of alcohol and drug abuse patient
managerial and financial capability (including funds sufficient to pay the non- records;(h)Title VIII of the Civil Rights Act of 1968(42 U.S.C.Sections et seq.),as
Federal Share of project cost) to ensure proper planning, management, and amended,relating to non-discrimination in the sale,rental or financing of
completion of the project described in this application. housing;(i)and other non-discrimination provisions in the specific statutes(s)
under which application for Federal assistance is being made,and(j)the
2.Will give the awarding agency,the comptroller General of the United States,and requirements on any other non-discrimination Statues(s)which may apply to the
if appropriate,the States,through any authorized representative,access to and the application.
right to examine all records,books,papers,or documents related to the assistance;
and will establish a paper accounting system in accordance with generally accepted 11.Will comply,or has already complied,with the requirements of Title II and III
accounting standards or agency directives. of the Uniform Relocation Assistance and Real Property Acquisition policies Act of
1970(P.L.91-646)which provides for fair and equitable treatment of persons
3.Will not dispose of,modify the use of,or change the terms of the real property displaced or whose property is acquired as a result of Federal and Federally
title,or other interest in the site and facilities without permission and instructions assisted programs.These requirements apply to all interest in real property
from the awarding agency. Will record the Federal interest in the title of real acquired for project purpose regardless of Federal participation in purchases.
property in accordance with awarding agency directives and will include a covenant
in the title of real property acquired in whole or in part with Federal assistance 12.Will comply with the provisions of the Hatch Act(5 U.S.C.Sections 1501-1508
funds to assure nondiscrimination during the useful life of the project. and 7324-7328)which limit the political activities of employment activities are
funded in whole or impart with Federal funds.
4. Will comply with the requirements of the assistance awarding agency with
regard to the drafting, review and approval of construction plans and 13.Will comply,as applicable,with the provisions of the Davis-Bacon Act(40
specifications. U.S.C.Sections 27a to 276a-7),the Copeland Act(40 U.S.C.Section 276c and 18
U.S.C.Section 874),the Contract Work Hours and Safety Standards Act(40
5.Will provide and maintain competent and adequate engineering supervision at U.S.C.Sections 327-333)regarding labor standards for Federally assisted
the construction site to ensure that the complete work conforms with the construction subagreements.
approved plans and specifications and will furnish progress reports and such other
information as may be required by the assistance awarding agency or state. 14.Will comply with the flood insurance purchase requirements of Section 102(a)
of the Flood Disaster Protection Act of 1973(P.L.93-234)which requires
6. Will initiate and complete the work within the applicable time frame after recipients in a special flood hazard area to participate in the program and to
receipt of approval of the awarding agency. purchase flood insurance in the total cost of insurable construction and
acquisition is$10,000 or more.
7.Will establish safeguards to prohibit employees from using their positions for a
purpose that constitutes or presents the appearance of personal or organizational 15.Will comply with environmental standards which may be prescribed pursuant
conflict to interest,or personal gain. 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
8.Will comply with Intergovernmental Personnel Act of 1970(42 U.S.C.Sections (E.O.)11514;(b)notification of violating facilities pursuant
4728-4763)relating to prescribed standards for merit systems for programs funded to EO 11738;(c)protection of wetlands pursuant to EO 11990;(d)evaluation of
under one of the nineteen statues or regulations specified in Appendix A of OPM's flood hazards in floodplains in accordance with EO 11988;(e)assurance of project
standards for a Merit System of Personnel Administration(5 C.F.R.900-subpart F). consistency with the approved State management programs developed under the
Coastal Zone Management Act of 1973(16 U.S.C.Sections 1451 et seq.);(f)
9. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. conformity of Federal actions to State(Clean Air)Implementations Plans under
Sections 4801-et seq.)which prohibits the use of lead based paint in construction Section 176(c)of the Clean Air Act of 1955,as amended(42 U.S.C.Section 7401et
or rehabilitation of residence structures. seq.);(g)protection of underground sources of drinking water under the Safe
Drinking Water Act of 1974,as amended,(P.L.93-523);(H)Protection of
10. Will comply with all Federal statues relating to non-discrimination. These Endangered species Act of 1973,as amended,(P.L.93-205).
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 16.Will comply with the Wild and Scenic Rivers Act of 1968(16 U.S.C.Sections
IX of the Education Amendments of 1972,as amended (20 U.S.C.Sections 1681- 1271 et seq.)related to protecting components or potential components of the
1683,and 1685-1686)which prohibits discrimination on the basis of sex,(c)Section national wild and scenic rivers system.
504 of the Rehabilitation Act of 1973,as amended(29 U.S.C.Sections 794)which
prohibits discrimination on the basis of;(d)the Age Discrimination Act of 1975,as 17.Will assist the awarding agency in assuring compliance with Section 106 of the
amended(42 U.S.C.Sections 6101-61-7)which prohibits discrimination on the basis National Historic Preservation Act of 1966,as amended(16 U.S.C.470),EO 11593
of age;(e)the Drug Abuse Office Treatment Act of 1972(P.L.93-255),as amended, (identification and preservation of historic properties),and the Archaeological
relating to non-discrimination on the bases of abuse; (f) the Comprehensive and Historic Preservation Act of 1974(16 U.S.C.46s-1 et seq.).
Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of
1970 (P.L. 91-616), as amended, relating to nondiscrimination on the bases of
alcohol abuse or alcoholism;(g)Sections 523 and 527 of the Public Health Service
Act of 1912(42 U.S.C.290 dd-3 and 290
TDEM-618(Rev 1/14)
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.
20. It will comply with the minimum wage and maximum hours provisions of the
Federal Fair Labor Standards Act (29 U.S.C. 201), as they apply to employees of
institutions of higher education,hospitals,and other non-profit organizations.
21.It will obtain approval by the appropriate Federal agencies of the final working
drawings and specifications before the project is advertised or placed on the
market for bidding;that it will construct the project,or cause it to be constructed,
to final completion in accordance with the application and approved plans and
specifications;that it will submit to the appropriate Federal
agency for prior approval changes that alter the cost of the project,use of space,or
functional layout; that it will not enter into a construction contract(s) for the
project or undertake other activities until the conditions of the construction grant
program(s)have been met.
22. It will operate and maintain the facility in accordance with the minimum
standards as may be required or prescribed by the applicable Federal,State,and
local agencies for the maintenance and operation of such facilities.
23.It will require the facility to be designed to comply with the"American
Standard Specifications for Making Buildings and Facilities Accessible to,and Usable
by, the Physically Handicapped,' Number A117-1961, as modified (41CFR 101-
17.703). The applicant will be responsible for conducting inspections to ensure
compliance with these specifications by the contractor.
24.If any real property or structure thereon is provided or improved with the aid of
Federal financial assistance extended to the applicant,this assurance shall obligate
the applicant,or in the case of any transfer of such property,any transferee,for
the period during which the real property or structure is used for a purpose for
which the Federal financial assistance is extended or for another purpose involving
the provision of similar services or benefits.
25. In making subgrants with nonprofit institutions under this Comprehensive
Cooperative Agreement,it agrees that such grants will be subject to OMB Circular
A-122, "Cost Principles for Non-profit Organization" including but not limited to,
the"Lobbying Revision"published in vol 49,Federal Register,pages 18260 through
18277(April 27,1984).
20-16B Page Two
TDEM-618(Rev 1/14)
Certificate Regarding Lobbying, Debarment, Suspension and Other
Responsibility Matters; and Drug-Free Workplace Requirements 20.160
U.S DEPARTMENT OF HOMELAND SECURITY O.M.B.No.1660-0025
FEDERAL EMERGENCY MANAGEMENT AGENCY Expires July 31,2007
Paperwork Burden Disclosure Notice
Public reporting burden for this form is estimated to average 1.7 hours per response.The burden estimate includes the time for reviewing instructions, searching
existing data sources,gathering and maintaining the data needed,and completing,reviewing,and maintaining the data needed,and completing and submitting the
form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, U.S.
Department of Homeland Security,Federal Emergency Management Agency,500 C Street,SW,Washington DC 20472.You are not required to complete this form unless
a valid OMB control number is displayed in the upper corner on this form. Please do not send your completed form to the above address.
Applicants should refer to the regulations cited below to determine the certification to which they are required to attest.Applicants should also review the instructions
for certification included in the regulations before completing this form.Signature of this form provides for compliance with certification requirements under 44 CFR
Part 18,"New Restrictions on Lobbying"and 28 CFR Part 17,"Government-wide Debarment and Suspension(Nonprocurement)and Government-wide Requirements for
Drug-Free Workplace(Grants),."The certifications shall be treated as a material representation of fact upon which reliance will be placed when the Federal Emergency
Management Agency(FEMA)determines to award the transaction,grant,or cooperative agreement.
LOBBYING (d)Have not within a three-year period preceding this application had one or
more public transactions(Federal,State,or local)terminated for cause of default;
As required by section 1352,Title 31 of the U.S.Code,and implemented at 44 CFR and
Part 18,for persons entering into a grant or cooperating agreement over$100,000,
as defined at 44 CFR Part 18,the applicant certifies that: B. Where the applicant is unable to certify to any of the statements in this
(a)No Federal appropriated funds have been paid or will be paid,by or on behalf of certification,he or she shall attach an explanation to this application
the undersigned,to any person for influencing or attempting to influence an officer 3.DRUG-FREE WORKPLACE(GRANTEE OTHER THAN INDIVIDUALS)
or employee of any agency, a Member of Congress, an officer or employee of
Congress,or an employee of a Member of Congress in connection with the making As required by the Drug-Free Workplace Act of 1988,and implemented at 44 CFR
of any Federal grant, the entering into of any cooperative agreement, and the Part 17,Subpart F,for grantees,as defined at 44 CFR Part 17.615 and 17.620-
extension,continuation,renewal,amendment,or modification of any Federal grant
A.The applicant certifies that it will continue to provide a drug-free workplace by;
or cooperative agreement.
(b)If any other funds than Federal appropriated funds have been paid or will be (a)Publishing a statement notifying employees that the unlawful manufacture,
paid to any other person for influencing or attempting to influence an officer or distributions
employee of any agency, a member of Congress, an officer or an employee of (b)Establishing an on-going drug free awareness program to inform employees
Congress,or employee of a member of Congress in connection with this Federal about-
Grant or cooperative agreement,the undersigned shall complete and submit Stand
Form-LLL,"Disclosure of lobbying Activities,"in accordance with its instructions The dangers of drug abuse in the workplace;
The grantee's policy of maintaining a drug-free workplace;
(c)The undersigned shall require that the language of this certification be included Any available drug counseling,rehabilitation,and employee assistance programs;
in the award documents for all subawards at all tiers (including subgrants, and the penalties that may be imposed upon employees for drug abuse violations
contracts under grants and cooperative agreements,and subcontracts)and that all occurring in the workplace;
subrecipients shall certify and disclose accordingly.
(c) Making it a requirement that each employee to be engaged in the
Standard Form-LLL"Disclosure of Lobbying Activities"attached performance of the grant to be given a copy of the statement required by
(This form must be attached to certification if nonappropriated funds are to paragraph(a);
be used to influence activities.)
(d)Notifying the employee in the statement required by paragraph a that,
2. DEBARMENT,SUSPENSION, AND OTHER RESPONSIBILITY MATTERS (DIRECT as a condition of employment under the grant,the employee will-
RECIPIENT)
Abide by the term of the statement;and
As required by Executive Order 12549, Debarment and Suspension, and Notify the employee in writing of his or her conviction for a violation of a criminal
implemented at 44 CFR Part 67,for prospective participants in primary covered drug statute occurring ion the workplace no later than five calendar days after
transactions,as defined at 44 CFR Part 17,Section 17.510-A. such convections;
The applicant certifies that it and its principals:
(e)Notifying the agency,in writing,with 10 calendar days after receiving notice
(a) Are not presently debarred, suspended, proposed for debarment, declared under subparagraph(d)(2)from an employee or otherwise receiving actual notice
ineligible,sentenced to a denial of Federal benefits by a State or Federal court,or of such conviction. Employers of convicted employees must provide notice,
voluntarily excluded from covered transactions by any Federal department or including position, title, to the applicable FEMA awarding office, i.e., regional
agency; office or FEMA office.
(b)Have not within a three-year period preceding this application been convicted
of a or had a civilian judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining,attempting to obtain,or perform a
public a public (Federal ,State, or local) transaction or contract under a public Place of Performance(Street address,City,County,State,Zip code)
transaction; violation of Federal or State antitrust statutes or commission of 200 Texas Street Fort Worth TX 76102
embezzlement, theft, forgery, bribery, falsification or destruction of records, > >
making false statements,or receiving stolen property;
(c)Are not presently indicted for otherwise criminally or civilly charged by a
governmental entity(Federal,State,or local)with commission of any of the
offenses enumerated in paragraph(1)(b)of this certification;and Check ;;j If there are workplaces on file that are not identified here.
(d)Taking one of the following actions,within 30 calendar days of receiving notice Section 17.630 of the regulations provide that a grantee that is a State may elect
under subparagraph(d)(2),with respect to any employee who is to make one certification in each Federal fiscal year.A copy of which should be
convicted- included with each application for FEMA funding.States and State agencies may
elect to use a state wide certification.
Taking appropriate personnel action against such an employee,up to and including
TDEM-618(Rev 1/14)
termination,consistent with the requirements of the Rehabilitation act of 1973,as
amended;or
Requiring such an employee to participate satisfactorily in a drug abuse assistance
or rehabilitation program approved for such purposes by a Federal,State,or local
health,law enforcement,or other appropriate agency;
(e) Making a good faith effort to continue to maintain a drug free workplace
through implementation of paragraphs(a),(b),(c),(d),(e)and(f).
B.The grantee may insert in the space provided below the site(s)for the
performance of work done in connection with the specific grant:
Form 20-16C Page Two
TDEM-618(Rev 1/14)
FORTWORTH
Attachment B
25%Or More Match Certification
This is to certify that the City of Fort Worth is liable and has ready access to the funding for 25%or more of the
attached acquisition and detention project.The City Council authorized the application for a grant in an amount
up to 5,025,00 dollars with a cash and in-kind service match in an amount up to 1,675,000 dollars for a total
project cost up to 6,700,000 dollars.The Mayor and Council (M&C) Review approved on 12/13/2016 is attached.
Authorized agent:
Jesus J. Chapa
Assistant City Manager
DATE
TRANSPORTATION PUBLIC WORKS DEPARTMENT
THE CITY OF FORT WORTH*200 TEXAS STREET*TPW/STORMWATER*FORT WORTH,TEXAS 76102
FORTWORTH
Attachment D
Environmental Justice Statement
In compliance with Executive Order 12898:
1. There are not concentrations of low income or minority populations in or near the HMGP project.
2. The HMGP project will not result in a disproportionately high and adverse effect on low income or
minority populations.
3. Given statements 1 and 2 above, no action will be taken.
Authorized agent:
Jesus J. Chapa
Assistant City Manager
DATE
TRANSPORTATION PUBLIC WORKS DEPARTMENT
THE CITY OF FORT WORTH*200 TEXAS STREET*TPW/STORMWATER*FORT WORTH,TEXAS 76102
FORTWORTH
Attachment J
Maintenance Agreement
The City of Fort Worth will be responsible for the maintenance of the surface detention pond as well as the two
vacant lots at 2305 and 2309 Carleton Avenue. Maintenance is estimated to cost$24,530 per year. Maintenance
items include mowing, care for trees and shrubs, and repairs to the detention structure to maintain functionality,
as necessary.
Authorized agent:
Jesus Jam. CChapa
Assistant City Manager
DATE
TRANSPORTATION PUBLIC WORKS DEPARTMENT
THE CITY OF FORT WORTH*200 TEXAS STREET*TPW/STORMWATER*FORT WORTH,TEXAS 76102
Flood Plain Manager Form (if the project is located in floodplain/floodway)
Sub-Applicant city of Fort worth
Fill in the Disaster number below for the appropriate program
HIVIGP Disaster Number DR-4272
Certified Flood Plain Manager Clair Davis
Organization city of Fort worm
Official Position Floodplain Administrator
Mailing Address 200 Texas Street
City, State, Zip Fort Worth,TX 76102
Daytime Number (817)392-5981
Cell Number
Fax Number
Email Clair,Davis@fortworthtexas,gov
CFM Certification Number 0136-99N
Make a statement about the project's location in relationship to the
Floodplain Manager's floodplainlway and describe the effects of the project to the
Assessment floodplainlway.Attach additional information if needed.
Per FIRM panel 48439CO285K,the project location is designated as Zone X outside the 0.2% annual chance
floodplain. The project is not located within the FEMA regulatory floodplain or floodway and would not impact
the FEMA regulatory floodplain or floodway.
The designated Floodplain Manager is authorized by the below Certifying Official to represent and act for this organization
in all dealings with the State of Texas matters pertaining to floodplain issues for this grant.
Signature Date:
TDEM-618(Rev 1/14)
F'O .TWOTH
Attachment A
Floodplain Manager's Assessment
Per FIRM panel 48439CO285K, the project location is designated as Zone X outside the 0.2% annual chance
floodplain. The project is not located within the FEMA regulatory floodplain or floodway and would not impact the
FEMA regulatory floodplain or floodway.
Authorized agent:
Clair C. Davis, P.E., CFM
Floodplain Administrator
DATE
TRANSPORTATION PUBLIC WORKS DEPARTMENT
THE CITY OF FORT WORTH*200 TEXAS STREET*TPW/STORMWATER*FORT WORTH,TEXAS 76102
City of Fort Worth, Texas
Mayor and Council Communication
COUNCIL ACTION: Approved on 12113/2016
DATE: Tuesday, December 13, 2016 REFERENCE NO.: C-28056
LOG NAME: 20SWM AH FEMA GRANT APPLICATION
SUBJECT:
Authorize Application for a Grant from the Federal Emergency Management Agency's Hazard Mitigation
Grant Program in an Amount Up to $5,025,000.00 for the Voluntary Acquisition of Flood Prone Properties
in the Arlington Heights Neighborhood with a Cash and In-Kind Services Match in an Amount Up to
$1,675,000.00 for a Total Project Cost Up to $6,700,000.00 (COUNCIL DISTRICT 7)
RECOMMENDATION:
It is recommended that the City Council authorize the application for a Property Acquisition Grant from the
Federal Emergency Management Agency's Hazard Mitigation Grant Program in an amount up to
$5,025,000.00 with a cash and in-kind service match in an amount up to $1,675,000 for a total project cost
up to $6,700,000.00.
DISCUSSION:
This Mayor and Council Communication recommends that the City submit a grant application to the
Federal Emergency Management Agency (FEMA) as a part of their Hazard Mitigation Grant Program
(HMGP) for the voluntary acquisition of up to 14 highly flood prone residential properties in the Arlington
Heights Neighborhood. Due to repeated flood damage, the property owners of each of the residences
being considered for inclusion in the application have approached the City asking that their property be
considered for buy out.
The application deadline for this grant is January 20, 2017. Prior to submission of the grant application,
Staff will finalize evaluation of the properties to verify that the flood mitigation benefits of acquiring each
property justifies the acquisition. Additionally Staff will be working with the volunteering property owners to
confirm their agreement to participate in the grant application. Based on that effort the grant application
will be prepared and submitted for the appropriate properties, up to 14 residences.
Any properties ultimately acquired through this effort will be converted into well-maintained green space.
The lots will also be graded in such a way as to provide as much detention and additional flood protection
as is possible for adjacent residences. If contiguous lots are assembled, the potential to convert the lots
into park-like amenities will be explored with the community and implemented to the maximum extent
possible.
Any eligible in-kind services that are identified will be used to reduce the amount of the City's cash match.
Additionally, any indirect costs allowable by the HMGP will be a part of the total project cost submitted for
grant funding. The City's cash match will be provided from funds in the Stormwater Utility Fiscal Year 2017
and Fiscal Year 2018 CIP budgets.
Depending on the number of lots acquired and re-purposed, the annual cost to the City to maintain the
green space could be up to $100,000.00.
Logname: 20SWM AH FEMA GRANT APPLICATION Page I of 2
This program serves COUNCIL DISTRICT 7
This M&C does not request approval of a contract with a business entity.
FISCAL INFORMATION/CERTIFICATION:
This Director of Finance certifies that upon award, a Mayor and Council Communication will be presented
for consideration which establishes and approves the City's match and appropriations for this grant. This
is a reimbursement grant.
FUND IDENTIFIERS (FIDs):
TO
Fund Department ccoun Project Program ctivity Budget Reference # moun
ID ID Year Chartfield 2
FROM
Fund Department ccountl Project Program ctivity Budget Reference # moun
ID ID Year Chartfield 2
CERTIFICATIONS:
Submitted for City Manager's Office by: Jay Chapa (5804)
Originating Department Head: Douglas Wiersig (7801)
Additional Information Contact: Greg Simmons (7862)
ATTACHMENTS
No attachments found.
Logname: 20SWM AH FEMA GRANT APPLICATION Page 2 of 2