1996-005 Disaster Relief Funding Agreementr
RESOLUTION NO. 5-96
A RESOLUTION OF THE VILLAGE COUNCIL OF NORTH PALM BEACH,
FLORIDA, ACCEPTING THE "DISASTER RELIEF FUNDING AGREEMENT" BETWEEN
THE VILLAGE AND THE FLORIDA DEPARTMENT OF COMMUNITY AFFAIRS.
BE IT RESOLVED BY THE VILLAGE COUNCIL OF NORTH PALM BEACH,
FLORIDA:
Section 1. The "Disaster Relief Funding Agreement", a copy of which is attached to
this Resolution, is hereby accepted by the Village of North Palm Beach, Florida, in accordance
with its terms. The Village Mayor is hereby directed to execute said contract on behalf of the
Village Council.
Section 2. This Resolution shall take effect immediately upon passage.
' PASSED AND ADOPTED TH[S 11TH DAY OF JANUARY , 1996.
_~1~~. ~
Mayor
ATTEST:
C~
Village Clerk
1
DCA AGREEMENT NO. 96-RM-7A-10-60-02-018 _
' FEMA PROJECT APPLICATION NO. 099-49600
DISASTER RELIEF FUNDING AGREEMENT
This Agreement is between the State of Florida, Department of
Community Affairs (Grantee) and y;llane of North Palm Beach __
~ Palm Reach COLnty ,
(Subgrantee). In support of the Agreement, the parties state:
WHEREAS, extensive flooding beginning October 13, 1995, produced
disastrous weather conditions which had a devastating impact upon
' Central and Southeast Florida; and
WHEREAS, the severity of the damage loss resulted in the
declaration of a disaster emergency by the Governor in Executive
Order number 95-387; and
WHEREAS, the President of the United States has concurred and
has declared a major disaster emergency for the counties of
Martin, St. Lucie and Palm Beach in FEMA-1074-DR-FL; and
WHEREAS, the Federal Emergency Management Agency (FEMA), as a
result of the Presidential Declaration, has made available federal
funds for limited disaster relief activities in FEMA-1074-DR-FL; and
WHEREAS, the FEMA-State Agreement, defined herein below,
governing the use of those funds requires the State to share in the
total costs eligible for federal assistance; and
WHEREAS, Sections 252.35. 252.36, 252.37, and 252.38,
Florida Statutes, authorize the relationship described herein. NOW
THEREFORE, the parties agree as follows:
1. DEFINITIONS: unless otherwise indicated, the following terms
shall be defined as stated herein.
a. "Eligible disaster relief activities", as used in this
Agreement, means those activities authorized in the FEMA-State
Agreement, as defined herein below; Public Law 93-288, as amended by
Public Law 100-707 (hereinafter the "Stafford Act"); and Title 44
CFR, Part 206.
b. "Large Project" and "Small Project" shall be defined as
' indicated in 44 CFR 206.203(c).
c. "FEMA-State Agreement" shall mean that agreement between
FEMA and the State of Florida, dated November 2 1995, for the
Presidential Major Disaster Declaration FEMA-1074-DR-FL, and all
modifications thereto.
d. "Permanent Work" shall be defined as stated in 44 CFR
206.201(g).
e. "Predisaster design" shall be defined as stated in 44
CFR 206.201(h).
f. "Project" shall be defined as stated in 44 CFR
206.201(1).
' 2. APPLICABLE STATUTES, RULES and AGREEMENTS: The parties agree
2
to be bound by all terms of the FEMA-State Agreement and all
applicable state and federal statutes and regulations, including but
not limited to:
(a) 44 CFR parts 7, 9, 10, 13, 14 and 206 and other applicable
FEMA regulations and policies;
(b) Title VI of the Civil Rights Act of 1964 (P.L. BB-352) which
prohibits discrimination on the basis of race, color or national
origin;
(c) 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;
' (d) Section 504 of the Rehabilitation Act of 1973, as amended
(29 U.S.C.794) which prohibits discrimination on the basis of
handicaps;
(e) the Age Discrimination Act of 1975, as amended (42
U.S.C.6101-6107) which prohibits discrimination on the basis of age;
(f) the Drug Abuse Office and Treatment Act of 1972 (P.L. 91-
616) as amended, relating to nondiscrimination on the basis of drug
abuse;
(g) the Comprehensive Alcohol Abuse and Alcoholism Prevention,
Treatment and Rehabilitation Act of 1970 (P.L. 91-616) as amended,
relating to nondiscrimination on the basis of alcohol abuse or
' alcoholism;
3
(h) 523 and 527 of the Public Health Service Act of 1912 (4?.
U.S.C. 290 dd-3 and 290 ee-3), as amended, relating to
confidentiality of alcohol and drug abuse patient records;
(i) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. 3601
et seq.), as amended, relating to nondiscrimination in the sale,
rental or financing of housing, and any other nondiscrimination
provisions in the specific statute(s) under which application for
federal assistance is being made;•
(j) Davis-Bacon Act (40 U.S.C. 276a to 276A-7), the Copeland Act
of 1973 (40 U.S.C. 276c and 18 U.S.C. 874), the Contract Work Hours
and Safety Standards Act (40 U.S.C. 327-333) regarding labor
standards for federally assisted construction subagreements;
(k) 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.);
(1) Lead-Based Paint Poisoning Act (42 U.S.C.'4801) et seq.)
which prohibits the use of lead based paint in construction of
rehabilitation or residential structures;
(m) Titles II and III of the Uniform Relocation Assistance and
Real Property Acquisition Act of 1970 (P.L. 91-646) which provides
for fair and equitable treatment of persons displaced or whose
property is acquired as a result of federal and federally assisted
4
programs. (These requirements apply to all interests in real
property acquired for project purposes regardless of federal
participation in purchases.); and
(n) Energy Policy and Conservation Act (P.L. 94-163), and the
provisions of the state Energy Conservation Plan adopted pursuant
thereto.
3. FUNDING and INSURANCE: The Grantee shall provide funds to the
Subgrantee for eligible disaster relief activities for the projects
approved by the Grantee and the Federal Emergency Management Agency
(FEMA), specifically described in the Damage Survey Report(s)
(DSR[s]). Allowable costs shall be determined in accordance with 44
CFR §206, 44 CFR Part 13, and pertinent FEMA guidance documents.
Subgrantee agrees, as a condition of receipt of funding pursuant
to this Agreement, to obtain reasonably available, adequate, and
necessary insurance for the type or types of hazard for which the
major disaster was declared for any and all projects receiving
funding. Proof of said insurance shall be made available to the
Grantee as a condition of receipt of funding under this Agreement.
4. DUPLICATION OF BENEFITS PROHIBITION: In accordance with the
provisions of Section 312 of the Stafford Act, duplication of
benefits is prohibited. The Subgrantee shall notify the Grantee, as
soon as practicable, of the existence of any insurance coverage for
the damage identified on the DSR, and of any entitlement or recovery
5
to payments from another source for the projects described in the
nSR(s). Eligible costs shall be reduced by the amount of duplicate
sources available. The Subgrantee shall be liable to the Grantee to
the extent that the Subgrantee receives duplicate benefits from
another source for the same purposes for which the Subgrantee has
received payment from the Grantee. The Subgrantee shall immediately
remit to the Grantee any duplication of benefits payment received by
the Subgrantee.
5. COMPLIANCE WITH ENVIRONMENTAL, PLANNING AND PERMITTING LAWS:
The Subgrantee shall be responsible for implementation and completion
of the approved projects described in the DSR(s) in a manner
satisfactory to the Grantee, and in accordance with applicable
federal, state, and local statutes, regulations, plans, and policies.
Any development permit issued by, or development activity undertaken
by, the Subgrantee, and any land use permitted by or engaged in by
the Subgrantee, shall be consistent with the local comprehensive plan
and land development regulations prepared and adopted pursuant to
Chapter 163, Part II, Florida Statutes. Funds shall be expended for,
and development activities and land uses authorized for, only those
uses which are permitted under the comprehensive plan and land
development regulations. The Subgrantee shall be responsible for
ensuring that any development permit issued and any development
activity or land use undertaken is, where applicable, also authorized
6
by the pertinent Water Management District, the Florida Department of
Environmental Protection, the Florida Department of Health and
'
Rehabilitative Services, and any local environmental or land use
permitting authority, where required.
In addition, Subgrantee shall comply with other federal and
state environmental regulations, including, but are not limited to,
the following:
(a) institution of environmental quality control measures under
the National Environmental Policy Act of 1969 (P.O. 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 i.n accordance
with EO 11988;
(e) assurance of project consistency with the approved state
management program developed under the Coastal Zone Management Act of
1972 (16 U.S.C. 1451 et seq.);
(f) conformity of federal actions to State (Clean Air)
Implementation Plans under Section 176(c) of the Clean Air Act of
1955, as amended (42 U.S.C. 7401 et seq.);
(g) protection of underground sources of drinking water under
the Safe Drinking water Act of 1974, as amended, (P.L. 93-523);
(h) protection of endangered species under the Endangered
7
Species Act of 1.973, as amended, (P.O. 93-205); and
(i) 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.
Subgrantee further agrees to provide and maintain competent and
adequate engineering supervision at the construction site to ensure
that the complete work conforms with the approved plans and
specifications.
6. REQUIRED DOCUMENTATION; REVIEW/INSPECTION: The Subgrantee
shall create and maintain acceptable documentation of work performed
and costs incurred with respect to each project identified in
' connection with a Damage Survey Report (DSR). Failure to create and
maintain proper documentation will result in the disallowance of
Public Assistance funding, and require the refund of funds previously
reimbursed or advanced, including an interest penalty. For all
projects, the Subgrantee must submit: (a) a Summary of Documentation
(blank form attached as Exhibit A) supported by all appropriate
backup documentation (e.g.:invoices, canceled checks, daily activity
reports, payroll records, time sheets, executed contracts, receipts,
purchase orders, billing statements, etc.); and (b) the Project
Listing. For all Large Projects, the Subgrantee must submit a
request for a final inspection. The Grantee will inspect Small
' Projects on a random basis. The Grantee will schedule and perform
8
I~
l___J
the final inspections on Large Projects, and review the Project
Listing for Small Projects or inspect the project, to ensure that the
work was performed within the scope of work delineated on the DSR(s).
Costs of any work not performed within the approved scope of work
shall not be eligible for funding.
7. COST SHARING: The disaster relief funds for eligible costs
1
indicated on the DSR(s) and described in this Agreement shall be
shared in accordance with the cost sharing provisions established in
the Stafford Act and the FEMA-State Agreement. Administrative
costs which according to the schedule are in addition to and not part
of the DSR(s) eligible costs, and are otherwise eligible and involve
no required match, will be funded by FEMA.
8. PAYMENT OF CLAIMS:
a. SMALL PROJECTS: The Grantee shall make payment to the
Subgrantee of the Federal share of the eligible costs as soon as
practicable after execution of this Agreement.
b. LARGE PROJECTS: The payments for Large Projects will be
1
on a cost reimbursement basis and subject to receipt of the
following: (1) a Request For Advance or Reimbursement Form (blank
form attached hereto as Exhibit B); (2) a Summary of Documentation
Form, listing t-he DSR #, identifying the audit ready documentation
that exists to support the payment request, identifying the dollar
amounts of each eligible cost, and identifying the Subgrantee's own
9
internal reference number (voucher, warrant, purchase order, etc.);
and (3) a letter providing a brief synopsis of the request, and
certifying that the reported costs were incurred in the performance
of eligible work.
c. ADVANCES: This Subgrantee may be paid an advance of up
to w n y- ~v percent (~%), provided that the Subgrantee: (1)
demonstrates and maintains the willingness and ability to maintain
procedures to minimize the time elapsing between the transfer of
funds and their disbursement; (2) submits budget data on which the
request is based; (3) submits a justification statement explaining
the necessity for and proposed use of the funds, and specification of
the amount requested; and (4) submits a completed Request for Advance
or Reimbursement Form. After any advance, and in the event no
advance is provided, all payments shall be on a cost reimbursement
basis. Subgrantees shall promptly, but at least quarterly, remit
interest earned on advances (if any)to the Grantee for remittance to
FEMA.
d. IMPROVED PROJECTS: If the Subgrantee desires to make
improvements, but still restore the predisaster function of the
damaged facility in accordance with 44 CFR 206.203, the Subgrantee
must obtain approval from the Grantee.
e. ALTERNATE PROJECTS: In any case in which the Subgrantee
determines that the public welfare would not be best served by
10
restoring a damaged public facility, or function of that facility,
the Subgrantee may request that the Grantee and FEMA approve an
alternate project in accordance with 44 CFR 206.203.
f. The Grantee may, in its sole discretion, withhold a
percentage, up to 10% of each DSR, of any funds authorized by FEMA in
order to protect against subsequent adverse determinations by FEMA
regarding previously authorized or disbursed grant funds.
9. FINAL PAYMENT: The final payment will be made only after
project completion, submission of all required documentation, final
inspection (Large Projects), review of Project Listing and/or
inspection (Small Projects), and a request for final reimbursement.
' 10. RECORDS MAINTENANCE: The Subgrantee agrees to maintain all
records pertaining to the projects described in the DSR (s) and the
funds received under this Agreement until all issues relating to the
inspection and final audit have been completed, and any action or
resolution of outstanding issues have been completed. In no event
will such records be mainL-ained for a period of less than three (3)
years from the date of the final payment under this Agreement.
Access to those records must be provided at reasonable times to the
Comptroller General of the United States, the Grantee, its employees
and agents, and to FEMA, its employees and agents.
11. RECOVERY OF FUNDS: If the final inspection, audit, or other
review by FEMA, the State, or any other authorized entity determines
11
that= payment made under this Agreement exceeds the amount of actual
t eligible costs, the Subgrantee shall, within forty-five (45) days of
receipt of the determination notice, repay the Grantee the amount
determined to be in excess of the actual costs.
12. AUDIT:
a. Subgrantees shall submit an Audit of Agreement
Compliance to the Grantee as provided herein. This audit will be
performed by an independent Certified Public Accountant or other
entity independent of the Subgrantee in accordance with the standards
of the Comptroller General as specified in the General Accounting
Office Standards for Audit of Governmental Organizations, Programs,
' Activities and Functions, and generally accepted auditing standards
established by the American Institute of Certified Public
Accountants. Th~greement number of this grant must be identified
with the audit submitted. Such audit shall also comply with the
requirements of Sections 11.45 and 216.349, Florida Statutes and
Chapter 10.550, Rules of the Auditor General, and, to the extent
applicable, the Single Audit Act of 1984, 31 USC 7501 through 7507,
and OMB Circulars A-128 and A-133.
b. If the Subgrantee is a private non-profit organization,
it shall submit an organization-wide audit in accordance with OMB
Circular A-133. An organization-wide audit from a private non-profit
organization will be due seven (7) months after the termination of
12
the organization's fiscal year.
' c. If the Subgrantee is a local government, it shall
submit an audit in accordance with OMB Circular A-128, pursuant to
the Single Audit Act of 1964, Public Law 98-502. The audit will be
submitted not later than seven (7) months after the end of the local
fiscal year, in accordance with the requirements of Section 11.45
(3)(a), Florida Statutes.
d. The Grantee may require the Subgrantee to undertake
such further or additional audits ae determined necessary or
appropriate including, but not limited to, past and current
organization-wide audits. Such audits may be necessary
' to determine the adequacy, accuracy, and reliability of the
Subgrantee's internal controls, fiscal data, and management systems
established to safeguard the Subgrantee's assets and to ensure
compliance with this Agreement.
e. If this Agreement is closed out without an audit, the
Grantee reserves the right to recover any disallowed costs identified
in an audit after such close-out.
13. NONCOMPLIANCE: If the Subgrantee violates any of the
conditions of disaster relief assistance under the Robert T. Stafford
Act of 1988, Public Law 93-288 ae amended by Public Law 100-707, the
FEMA-State Agreement, applicable state law or applicable state or
' federal regulations, including those noted herein, additional
13
financial assistance for the project in which the violation occurred
will be withheld until such violation has 'been corrected or the
Grantee may take any other action that is legally available.
14. NONDISCRIMINATION/CONTRACTORS: The Subgrantee shall
maintain an active program of nondiscrimination in disaster
assistance as outlined in 44 CFR, Parts 7 and 16, and 44 CFR Section
206.11. The Subgrantee shall comply with federal regulations
concerning the General Services Administrative Consolidated List of
Debarred, Suspended and Ineligible Contractors, as provided in 44 CFR
Part 17.
15. MODIFICATION: Either party may request modifications to
' this Agreement, including work to be completed on the DSR(s) and
the time performance period. Such modifications MUST be proposed in
writing by either party and become effective only upon execution by
both parties.
16. TIME FOR PERFORMANCE: In accordance with 44 CFR 206.204,
and subject to any approved extension by the Governor s Authorized
Representative (GAR) or the Federal Regional Director, the term of
an agreement for debris clearance or emergency work is six (6) months
from the date of the declaration of a major disaster or emergency.
Permanent work must be completed within eighteen (18) months of the
date of the declaration of a major disaster or emergency. Time
' extensions may be granted on an individual basis, in accordance with
14
44 CFR 206.204. If any extension request is denied, the Subgrantee
may be reimbursed for eligible project costs incurred up to the
latest approved completion date. Failure to complete the projecL-
will result in the denial of funding for that- project.
17. CONTRACTS WITH OTHERS: If a Subgrantee contracts with any
other entity (herein after "contractor") for performance of any of
the work required under this Agreement, the Subgrantee agrees to
include in the contract that the contractor is bound by the terms and
conditions of this Agreement with the Grantee, and to provide the
contractor with a copy of this Agreement. The Subgrantee further
agrees to include in the contract that the contractor shall hold the
' Subgrantee and the Grantee harmless against all claims of whatever
nature arising out of the performance of the work by the contractor
under the contract. To the extent that the Subgrantee has
outstanding, uncompleted, contracts for work for which reimbursement
will be requested under this Agreement, Subgrantee agrees to use its
best efforts to modify said contracts in accordance with this
paragraph.
18. TERMINATION: Either party may request termination of this
Agreement, in writing, delivered in person, or by certified mail, to
the party's representative who executes this Agreement. Said
termination may be accomplished by mutual agreement of the parties,
' effective thirty (30) days after an executed modification to effect
15
termination.
19. HOLD HARMLESS: The Subgrantee shall be solely responsible
to the parties with whom it shall interact in carrying the terms of
this Agreement. The Grantee assumes no liability whatsoever to third
parties as a result of this Agreement. For purposes of this
Agreement, Subgrantee agrees that it is neither an employee nor an
agent of the Grantee. Subgrantee agrees to be fully responsible for
its negligent acts or omissions or tortious acts, and the acts of its
agents, which result in claims or suits. of any kind against the
Grantee or the State of Florida. The Subgrantee agrees to be liable
for any and all damages proximately caused by said acts or omissions.
Nothing herein is intended t.o serve as a waiver of sovereign immunity
by the Subgrantee, Grantee, or the State of Florida. .Nothing herein
shall be construed as a consent by the State of Florida, its agencies
or subdivisions, to be sued by third parties in any matter arising
out of the performance of this Agreement. Except where prohibited by
law, the Subgrantee agrees to indemnify the State of Florida and hold
it harmless against any and all claims, suits, liabilities and
damages, of whatever nature, arising out of the performance of
activities funded or contemplated under this Agreement.
20. REPORTS: The Subgrantee shall provide quarterly progress
reports to the Grantee. The first report is due three (3) months
' after the date of execution of this Agreement and quarterly
16
thereafter until the work has been completed and approved through
final inspection. All reports shall be provided using the attached
Quarterly Report Form. Interim inspections shall be scheduled by the
Subgrantee prior to the final inspection and may be requested by the
Grantee based on information supplied in the quarterly reports. The
Grantee may require additional reports as needed. The Subgrantee
shall, as soon as possible, provide any additional reports requested
by the Grantee. The Grantee contact will be the state public
assistance officer for all reports and requests for reimbursement.
21. STANDARD CONDITIONS: The Subgrantee further agrees to be
bound by the following standard conditions:
a. The State of Florida's performance and obligation to
pay under this Agreement is contingent upon an annual appropriation
by the Legislature, or the provision of funding to the Grantee
pursuant to Section 252.37, Florida Statutes.
b. If otherwise allowed under this Agreement, any
extension shall be in writing and shall be subject to the same terms
and conditions set forth in the initial Agreement. There shall be
only one extension of the Agreement unless the failure to meet the
criteria for completion is due to events beyond the control of the
Subgrantee.
c. Bills for fees or other compensation for services or
expenses must be submitted in detail sufficient for a proper pre and
17
post audit thereof.
d. The Grantee may unilaterally cancel this Agreement for
refusal by the Subgrantee or its contractors to allow public access
to all documents, papers, letters or other material subject to the
provisions of Chapter 119, Florida Statutes, and made or received by
the Subgrantee or its subcontractor in conjunction with this
Agreement. It is expressly understood that substantial evidence of
the Subgrantee's or their contractor's refusal to comply with this
provision shall constitute a breach of contract, and constitute
grounds for termination.
e. Pursuant to Section 216.347, Florida Statutes, and
applicable federal law, the Subgrantee agrees that no funds from this
' Agreement will be expended for the purpose of lobbying the
Legislature, state agency employees, Members of Congress, officers or
employees of Congress, or an employee of a Member of Congress iTi
connection with the awarding of this Agreement or any amendments or
modifications of this Agreement
f. The Subgrantee certifies with respect to this Agreement
that it possesses the legal authority to receive the funds.
g. The Subgrantee shall comply with any Statement of
Assurance attached hereto, which shall be incorporated herein. The
Subgrantee acknowledges that the responsibility for complying with
the approved subgrant award rests with the recipient Subgrantee and
18
acknowledges that failure to do so constitutes grounds for the
recision or suspension of this subgrant and may influence future
subgrant awards.
22. TERM: This Agreement shall be effective upon execution and
terminate upon completion of, and final payment for, all approved
projects, subject to any modification in accordance with paragraph
15, above.
23. NOTICE AND CONTACT: All notices under this Agreement shall
be in writing, delivered either by hand delivery or certified mail to
the representative and address below:
i~
19
FOR THE GRANTEE:
Joseph F. Myers GAR
State Public Assistance
FENA Disaster Field Office
2740 Centerview Drive
Tallahassee, Florida 32399
24. The Subgrantee hereby authorizes Tom Hogarth _
as its designated Agent, to execute Requests for
Reimbursement, necessary certifications, and other supplementary
documentation.
IN WITNESS HEREOF, the Grantee and Subgrantee have executed this
1
1
Agreement;
FOR THE SUBGRANTEE:
Villa a of N//or//th Palm Beach
v~
gy; Tom Valente
Mayor
Title
January 12. 1996
Date
59-6017984
Subgrantee's Federal
Employer Identification No.
FOR THE SUBGRANTEE:
Tom Hogarth
Director of Public Services
Village of North Palm Beach
501 U. S. Highway One
North Palm Beach, Fl 33408
Date
CATALOGUE OF FEDERAL DOMESTIC
ASSISTANCE NUMBER: 83.516 DISASTER ASSISTANCE
FOR THE GRANTEE:
STATE OF FLORIDA
DEPARTMENT OF COMMUNITY AFFAIRS
By:
Governor's Authorized Rep
Title
20
ftOitlp,~
^. ~
~p ,.
+,~ ~ e
f~r OE COMM~H`~
SURGRANTF.E
nDDRrss:
NO: FIiMA-1074-DR-FL
PAl'MEN1' No:_ DCA Agreement No: 96-RM-7A-
DSR PREVIOUS CURRENT DCA Use Only
AMOUNT PAYMENT REQUEST
Approved Comments
llSRd
CATEGORY
llSlZt/-
CATEGORY_
DSRN_
CATEGORY-
DSRt/
CATEGORY-
DSIZN
CATEGORY_
TOTAL CURRENT REQUEST $
1 certify that tho the best of my knowledge and belief the above accounts are correct and that all disbursements were made in accordance with
all conditions o(the UCA agreement and payment is due and has not been previously requested for these amounts.
SURGRANTEESIGNATURE
rvnmc nrvu rur.c
TO BE COMPLBTED RY DEPARTMENT OP COMMUNITY AFFAIRS
1
AI'PROVEU DSR AMOUNT $
ADMINISTRATIVE COST $ GOVERNOR'S AUTHORIZED REPRESENTATIV F.
Al'1'ROVIiU FOIL PAYMENT $
DATE
FLORIDA DEPARTMENT OF COMMUNITY AFFAIRS
DIVISION OF EMERGENCY MANAGEMENT
Request for Advance or Reimbursement for
Public Assistance Funds
PAGE _I_OF _ PAGES
FLORIDA DIVISION OF EMERGENCY MANAGEMENT
SUMMARY OF DOCUMF,NTATION IN SUPPORT OF AMOUNT
CLAIMED FOR ELIGIBLE DISASTER WORK
Applicant
DCA Agreement
No. 96-RM-7A-_
1
1
Disaster No. FEMA-1074-DR-FL
Project Application No. DSR No.
Applicnni s Rckrence No.
(Warrant, Voucher, Claim
or Schedule No.) DAivcry Dam of
ulitles Or
pcrfamlance services. DOCUMF.NI'ATION
List DOCUIOtOlaIl00 (Applicant'[payroll, nmerial out of appliunh stork,
applium owned equipnwnt and rume of veMor or rontn<mr) by ulagory and
lint i¢m in the approved projen applicalbn and give a brill desniprion of the Ama:nb
Applkani Eligible
Cosu
ar11CIC5 Of KNKCS.
TOTAL
DSR.
TOTAL
A scparatr form will be prepared ror cacti llSR.
[J
u
II
w
0
0
N ~
U
y a
~ N
C b
O
N
ti
N
N
N
U
y
a.+
cv - O
vi "
~ a
A v H
a
o v
~ U
al y
~ N
U
~.J ~
^
O O
• G
~
u •~ ,
,
F~
a o
s w v
~~
•'' N td
rP. ,~
O v v
C A
'
W t. ~
4.
N N
.h b
W "-~
v
~ o d
~
,
[.
N
N
17
a "~
p
w ~
00
"
~ oa;
U P ~
N ~ ~
O
Q
N
~ .
~
{
!
F
0
" rx
v
~!
~ ~
b
G ~ ~ ~• ~~
> `" " o
~
°' a
v ~ °'
° v
U
~
~
C p G
one >,y
.n ,y u ~ :%
~ Q P,
~-i
V~
~~
V~
II')
N
d
a
x
0
.-~-~
N
G
v
~ u
A
F
v
v
c
~~
~
.~
v
O (f u
5~ ~"+
M N
.-fir .may.
a
~ N_
v
G ~ v
~~ 4:
o
7
O
~ a
T
1,. n
a
.v E
u
w
y u •C
a on
U T ~'
G j
~ N
u'9 x
O .C
M ~ U
(+ N .C
'O ~ •0 5
v _ ~~ n
a~ ~ o G~
a
T
U
q ~ I I ~ q
4 v
rv u
~ 'o^ a'
v '° ,,
~ 00 ~ u
~C T ~ ~ ~N
~O tCV N O ,p
W O C 4
v O ua
O
v u u 0 O U N'
O. ~-+
F ~ .~ u
O ~I ~ ~ ~
l,~ > R. g p ~
U
S a~ W a '~ W
~ Q u u b^ ~ v
~d cd U v ti ~
' ~ x .% a -
> v 3 gv ~
v ~ u o a o ro
0
u, ~ _ O c oo ,5 „ v
Q `-' `-' U u C u v b
w
g d ~ u ~ ~ ~
> n'
y C ~ ~ a ;g ~
aJ u '~ u
~ b ~ ~ ~ ~ ~ o
~ N U
O c~~n `-' U '-' c ~ o ~ ~
N S ~ .~
v M C u
X.v ~ o F
~ ~ ~ u V tui0 h~ g U v C
~ ~v{' ~ 7 Q
V£l h *. X. ~ u Q ~" P. Q cni w
'd y ~~ a o E ~',
«. G _ Oq N N ~ .'~'
r. tad .. rTJ
= •O ~ iN7 •~ .~ U U y..
~ 'd y q W H ."..".
..
~ ~ ~ ~ W
cv m ~ '~' U'7 O . r ~ .~
1
_,
..
0
W
0
0
V
N
V
~ 3
~ ~
u
. w
`~ p
u ~
O
v ry
a ~3
o.
n B
~ o
u '~'
7 C
r vb
U O
O
R
1
IN4l>RED'S AUTHORIZATION TO RELEASE INFORMATION
hereby authorizes our insurance contpany(ies) to
Nan:e of Applicant
release directly to the Governor's Authorized Representative, Department of Community
Affairs of the State of Florida, any and all information needed to process damage survey
reports related to a federally-declared disaster. Date of Loss:
To assist ir: this process, tl:e following data is provided:
I. Legal Nanee Referenced in the Policy:
2. Wir:dstonr:lnsurer:
3. Policy Nunrbcr:_
4. CLAIM NUMBER(S):
5. Adjus•tcr:
Namc
6. Flood insurer:
Narne and Address
Telephone number
A'ante and address
7. National Flood baurance Policy Number:
8. CLAIM NUMBER(S):
9. N. F.I. P. Adjuster: ( )
Nante
Authorized Representative
of Named Insured
Signature
Title
Telephone number
Printed Nante
Date
Updated October 17, 1995 .. Printed: December 8, 1995
Form nppruved
OMB No. 02G-R-0058
FEDERAL EMERGENCY MANAGEMENT AGENCY
DISASTER RESPONSE AND RECOVERY
INSURANCE COMMITMENT
(Supplement to Project Application)
APi'LIC.ANT
Name
Type of Major Disaster
Project Application No.
-
Address DSR Item No.
City
State
1'clepltonc No. County
Zip Date of Inspection
Federallnspector
Federal Agency
Location of Damaged Property
Description of Damage
Estimated Cosl of Eligible Work
Appraised Value of Property $
Life of Insured Property
Years Life of Restorative Work Years
~,c
Eatcnt-Buildings
-Conlcnls
Dcducliblc ($ or %)
Policy Number-
company REQUIRED 1N E~'PIiC"I'
$
$
E17ective Datc
Address
AI'I'LICANT'S COMMITMENT
The Applicant hereby assures the Governor's Authorized Representative end the FEMA Regional Director that it (will obtain) has ob-
tained) and will maintain the required insurance for years as a condition for obtaining Federal disaster assistance under
1'I. 93-288
APPLICANT'S AUTHORI7-.ED REPRESENT-ATIVE
Signature DATE
1'itlc
ATE REVIEW
, DATE
ITiMA RIiVIEW UA-fB
I~I[~1n form 90-4d (3/80) GI'O 87i G~!S
REQUEST FOR IMPROVED OR ALTERNATE PROJECT
( PREPARE A SEPARATE REQUEST FOR EACH PROJECT )
APPLICANT PROJECT NUMBER
' DAMAGE CATEGORY ITEM NUMBER
DESCRIPTION of the higher grade facility constructed or more permanent repair
to be accomplished or description of the proposed Alternate or Improved
Project ( Dimensions and type of materials, etc. )
ESTIMATED COST of the above SOURCE OF THE FUNDING over FEMA Grant
~90RK TO BE PERFORMED BY:~ (Check one)
( ] a. Contract l ] b. Own employees ( 1 c. CombSnaCion of a, and b.
and equipment
ESTIMATED DATE the work will be completed
' AMOUNT OF APPROVED ESTIMATED COST DATE
APPLICANT'S AUTHORIZED REPRESENTATIVE
APPROVAL of this request is based on above information. Any changed
conditions should immediately be brought to the attention of the Governors
Authorized Representative.
AMOUNT RECOMMENDED DATE
GOVERNOR'S AUTHORIZEll REPRESENTATIVE
AMOUNT APPROVED DATE
DIRECTOR, FEMA REGION (only for aiternate proiecte>