HomeMy WebLinkAboutCWPP Grant App - Fuel Mitigation WorkDESCHUTES COUNTY DOCUMENT SUMMARY
(NOTE: This form is required to be submitted with ALL contracts and other agreements, regardless of whether the document is to be
on a Board agenda or can be signed by the County Administrator or Department Director. If the document is to be on a Board
agenda, the Agenda Request Form is also required, If this form is not included with the document, the document will be returned to
the Department Please submit documents to the Board Secretary for tracking purposes, and not directly to Legal Counsel, the
County Administrator or the Commissioners, In addition to submitting this form with your documents, please submit this form
electronically to the Board Secretary,)
Please complete all sections above the Official Review line,
Date: 17/22/141 Department: !Administration (Forestry)1
Contractor/Supplier/Consultant Name: [[SDA Forest ServICe]
Contractor Contact: IDennis Fiorel Contractor Phone #: 1503-S0Sj
163341
Type of Document: Grant
Goods and/or Services: This is a National Fire Plan Community Assistance Grant to
provide funds for fuel reduction in communities in the La Pine, Upper Deschutes and
Sunriver CWPP areas.
Background & History: This grant continues our hazardous fuel mitigation work that
has been ongoing throughout the county.
Annual Value or Total Payment: 1$175,300.00
Insurance Certificate Received (check box)
Insurance Expiration Date: 1 1
Check all that apply:
D RFP, Solicitation or Bid Process
D Informal quotes «$150K)
D Exempt from RFP, Solicitation or Bid Process (specify -see DCC §2.37)
Funding Source: (Included in current budget? Yes [;g] No
If No, has budget amendment been submitted? [;g] Yes D No
Is this a Grant Agreement providing revenue to the County? [;g] Yes D No
Special conditions attached to this grant:
Deadlines for reporting to the grantor: Annual reports until grant expires or is closed.
7/22/2014
If a new FTE will be hired with grant funds, confirm that Personnel has been notified that
it is a grant-funded position so that this will be noted in the offer letter: 0 Yes ~No
Contact information for the person responsible for grant compliance:
Name : Ed Keith
Phone #: 1541-322-71171
Departmental Contact and Title: Ed Keith, County Forester
Phone #: 541-322-7117
Department Director Approval: ___________
Signature Date
Distribution of Document: Return to Ed Keith, Ed will obtain final signatures from
the USFS
Official Review:
County Signature Required (check One)~BOCC 0 Department Director (if <$25K)
o Administrator (if >$25K but <$150K; if >$150K, BOCC Order No. _____
Legal Review ~(YG Date 7(1--3!ry
Document Number 2014-410
7/22 /2014
OMS 0596-0217
Expiration Date: 2128 /2014
Rev. (2-14)
FEDERAL FINANCIAL ASSISTANCE
AWARD OF DOMESTIC GRANT 2014-DG-11062752-733
Between The
DESCHUTES COUNTY
And The
USDA, FOREST SERVICE
STATE AND PRIVATE FORESTRY,
ALASKA AND PACIFIC NORTHWEST REGIONS
Project Title: Southern Deschutes Fuels Project
Upon execution of this document, an award to Deschutes County, hereinafter referred to as
"Recipient," in the amount of $175,300, is made under Cooperative Forestry Assistance Act of
1978, Public Law 95-313, 16 U.S.C.21O I et. Seq., as amended. Recipient accepts this award for
the purpose described in the application narrative. Your application for Federal financial
assistance, dated June 12,2014, and the attached U.S. Forest Service provisions, 'U.S. Forest
Service Award Provisions,' are incorporated into this letter and made a part of this award.
This is an award of Federal fmancial assistance and is subject to 7 CFR 3016 (A-I02) Uniform
Administrative Requirements, 2 CFR 225 Cost Principles, and OMB Circular A-133 as
implemented by USDA regulation 7 CFR 3052. All Federal and Recipient matching/cost-share
contributions are subject to all relevant OMB Circulars and Code of Federal Regulations.
The OMB Circulars are available on the internet at
http://www .whitehouse.gov/omb/grants default!. Electronic copies of the CFRs can be obtained
at the following internet site: http://www.gpoaccess.gov/cfrlindex.html. If you are unable to
retrieve these regulations electronically, please contact your Grants and Agreements Office at
(503) 808-2350.
Effective October 1,2010, recipients are required to report information on subaward and
executive total compensation, as required by the Federal Funding Accountability and
Transparency Act of 2006 (pub. L. 109-282), as amended by section 6202 of Public Law
110-252, hereinafter referred to as "the Transparency Act." See the award terms in
Attachment B: 2 CFR Part 170.
The following administrative provisions apply to this award:
A. LEGAL AUTHORITY. Recipient shall have the legal authority to enter into this
award, and the institutional, managerial, and financial capability to ensure proper
planning, management, and completion of the project, which includes funds sufficient
to pay the non-Federal share of project costs, when applicable.
B. PRINCIP AL CONTACTS. Individuals listed below are authorized to act in their
respective areas for matters related to this award.
""
Caring for the Land and Serving People Printed on Recycled Paper \.1
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OMB 0596·0217
Expiration Date: 2/28/2014
Rev. (2-14)
Principal Cooperator Contacts :
Cooperator Administrative Contact Cooperator Program Contact
Ed KeithIEd Keith
61150 SE 27th Street i 61150 SE 27 th Street
Bend, OR 97702Bend, OR 97702
Telephone: (541) 322-7117 Telephone: (541) 322-7117
Email: ed.keith@deschutes.org Email: ed.keith@deschutes.org
Principal U.S. Forest Service Contacts:
U.S. Forest Service Program Manager U.S. Forest Service Administrative I
Contact Contact I ~----------~~--~~---=~~~----------4 Deborah Flowers
Program Manager
Dennis Fiore
Grants Management Specialist
1220 SW 3rt! Ave, 16th Floor 1220 SW 3rt! Ave.
Portland, OR 97204 . City, State, Zip: Portland, OR 97204
. Telephone: (503) 808-6334 \ Telephone: (503) 808-2350
i Email: dfior blm. ov Email: deborahflowersfs.fed.usI,
I c. SYSTEM FOR AWARD MANAGEMENT REGISTRATION REQUIREMENT
(SAM). Recipient shall maintain current infonnation in the System for Award
Management (SAM) until receipt of final payment. This requires review and update to
the infonnation at least annually after the initial registration, and more frequently if
required by changes in infonnation or agreement tenn(s). For purposes of this
agreement, System for Award Management (SAM) means the Federal repository into
which an entity must provide infonnation required for the conduct of business as a
Cooperative. Additional infonnation about registration procedures may be found at the
SAl\1 Internet site at www.sam.gov.
D. INDIRECT CQST RATES. Indirect cost rates must be fonnalized in a written
agreement between the cognizant agency and Recipient and have an effective period
applicable to the tenn of this award.
(1) If Recipient does not have a previously established indirect cost rate with a
Federal agency, Recipient shall submit its initial indirect cost proposal to its
cognizant audit agency no later than 3 months after the effective date of the award.
Recipient will be reimbursed for indirect costs at the tentative rate reflected in the
budget until the rate is fonnalized in a negotiated indirect cost rate agreement
(NICRA) at which time, reimbursements for prior indirect costs may be subject to
adjustment.
(2) As new NICRAs are agreed to between Recipient and their cognizant audit
agency, the revised provisional or final rate(s) are automatically incorporated into this
award, as appropriate, and must specify (1) the agreed upon rates, (2) the bases to
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which the rates apply, (3) the fiscal year for which the rates apply, and (4) the items
treated as direct costs. The award obligation will not increase as a result of indirect
cost rate increases. Updates to NICRAs will not affect the total funds available for
this award unless documented in a formally executed modification.
(3) If the NICRA is for a provisional rate, Recipient shall be reimbursed at the
established provisional rate(s), subject to appropriate adjustment when the final
rate(s) for the fiscal year are established.
(4) Failure to provide a revised provisional or final NICRA could result in disallowed
costs and repayment to the U.S. Forest Service.
E. REIMBURSABLE PAYMENTS -FINA.NCIAL ASSISTANCE. See provision "II! in
the attachment, 'U.S. Forest Service Award Provisions.'
F. PROGRAMMATIC CHANGES. Recipient shall obtain prior approval for any change
to the scope or objectives of the approved project, key personnel, or transfer of
substantive programmatic work to another party.
G. MODIFICATIONS. Modifications within the scope of this award/agreement must be
made by mutual consent of the parties, by the issuance of a written modification signed
and dated by all properly authorized, signatory officials, prior to any changes being
performed. Requests for modification should be made, in writing, at least 45 days prior
to implementation of the requested change. The U.S. Forest Service is not obligated to
fund any changes not properly approved in advance.
H. COMMENCEMENTIEXPIRATION DATE. This award is executed as of the date of
the last signature and is effective through December 31. 2016 at which time it will
expire. The expiration date is the final date for completion of all work activities under
this agreement.
I. AlJTHORIZED REPRESENTATIVES. By signature below, each party certifies that
the individuals listed in this document as representatives of the individual parties are
authorized to act in their respective areas for matters related to this award/agreement. In
witness whereof the parties hereto have executed this agreement as of the last date
written below.
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OMB 0596"()21?
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ALAN UNGER, County Commissioner Date
Deschutes County
TAMMY BM'EY, County Commissioner Date
Deschutes County
TONY DEBONE, County Commissioner Date
Deschutes County
BORYS TKACZ, Acting Director Date
U.S. Forest Service, State and Private Forestry
Alaska and Pacific Northwest Regions
f this agreement have been reviewed and approved for
U.S. Forest Service Grants Management Specialist
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Expiration Date: 2/28/2014
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ATTACHMENT A: U.S. FOREST SERVICE AWARD PROVISIONS
A. FOREST SERVICE LIABILITY TO THE RECIPIENT. The United States shall not be
liable to Recipient for any costs, damages, claims, liabilities, and judgments that arise
in connection with the performance of work under this award, including damage to any
property owned by Recipient or any third party.
B. NOTICES. Any notice given by the U.S. Forest Service or Recipient will be sufficient
only if in writing and delivered in person, mailed, or transmitted electronically by e
mail or fax, as follows:
To the U.S. Forest Service Program Manager. at the address specified in the grant.
To Recipient,at the address shown in the grant/agreement or such other address
designated within the grant/agreement.
Notices will be effective when delivered in accordance with this provision, or on the
effective date of the notice, whichever is later.
C. SUBRECIPIENT NOTIFICATION Recipient shall notify Subrecipients under this
award that they are subject to the terms and conditions herein, except with respect to
Recipient's OMB Uniform Administrative Requirements and Cost Principles. In the
case of Subrecipient Uniform Administrative Requirements and Cost Principles,
Subrecipients shall be notified that they are subject to the following:
j ··:s~~'·············••.. ··;;";~p~~~'..•. '.
Administrative Re uirements Cost PriDci es
2CFR215 2 CFR230
State & Federa1laws, regulations 2 CFR225
7CFR3016 2CFR 225
State & Federal laws, re ations 2CFR225
2CFR215 2CFR220
2 CFR215 48 CFR31.2
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D. MEMBERS OF CONGRESS. Pursuant to 41 U.S.C. 22, no member of, or delegate to,
Congress shall be admitted to any share or part of this agreement, or benefits that may
arise therefrom, either directly or indirectly.
E. TRAFFICKING IN PERSONS.
1. Provisions applicable to a Recipient that is a private entity.
a. You as the Recipient, your employees, Sub recipients under this award, and
Subrecipients' employees may not:
(1) Engage in severe forms of trafficking in persons during the period of time
that the award is in effect;
(2) Procure a commercial sex act during the period of time that the award is in
effect; or
(3) Use forced labor in the performance ofthe award or subawards under the
award.
h. We as the Federal awarding agency may unilaterally terminate this award,
without penalty, if you or a Subrecipient that is a private entity:
(1) Is determined to have violated a prohibition in paragraph a.l of this award
term; or
(2) Has an employee who is determined by the agency official authorized to
terminate the award to have violated a proln"bition in paragraph a.I oftrus
award term through conduct that is either:
i. Associated with performance under this award; or
11. Imputed to you or the subrecipient using the standards and due
process for imputing the conduct of an individual to an organization
that are provided in 2 CFR part 180, BOMB Guidelines to Agencies
on Government wide Debarment and Suspension
(Nonprocurement),".
2. Provision applicable to a Recipient other than a private entity. We as the Federal
awarding agency may unilaterally terminate this award, without penalty, if a
subrecipient that is a private entity:
a. Is determined to have violated an applicable prohibition in paragraph a.1 ofthis
award term; or
b. Has an employee who is determined by the agency official authorized to
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terminate the award to have violated an applicable prohibition in paragraph a.l
of this award term through conduct that is either
(I) Associated with performance under this award; or
(2) Imputed to the subrecipient using the standards and due process for
imputing the conduct of an individual to an organization that are provided
in 2 CFR part 180, "OMB Guidelines to Agencies on Govemmentwide
Debannent and Suspension (Nonprocurement),"
3. Provisions applicable to any recipient.
a. You must inform us immediately of any information you receive from any
source alleging a violation of a prohibition in paragraph a.1 of this award term.
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b. Our right to terminate unilaterally that is described in paragraph a.2 or b of this
section:
(1) Implements section 106(g) of the Trafficking Victims Protection Act of
I 2000 (TVPA), as amended (22 U.S.C. 7104(g», and
(2) Is in addition to all other remedies for noncompliance that are available to
us under this award. i
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c. You must include the requirements of paragraph a.1 of this award term in any
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sub award you make to a private entity.
4. Definitions. For purposes of this award term: I a. "Employee" means either:
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I (1) An individual employed by you or a subrecipient who is engaged in the
performance of the project or program under this award; or
(2) Another person engaged in the performance of the project or program I
under this award and not compensated by you including, but not limited to,
a volunteer or individual whose services are contributed by a third party as
an in-kind contribution toward cost sharing or matching requirements.
I b. "Forced labor" means labor obtained by any of the following methods: the
recruitment, harboring, transportation, provision, or obtaining of a person for
labor or services, through the use of force, fraud, or coercion for the purpose ofI subjection to involuntary servitude, peonage, debt bondage, or slavery.
c. "Private entity":
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(1) Means any entity other than a State, local government, Indian tribe, or
foreign public entity, as those terms are defined in 2 CFR 175.25.
(2) Includes:
i. A nonprofit organization, including any nonprofit institution of
higher education, hospital, or tribal organization other than one
included in the definition of Indian tribe at 2 CFR 175.25(b).
11. A for-profit organization.
d. "Severe forms of trafficking in persons," "commercial sex act," and
"coercion" have the meanings given at section 103 of the TVPA, as amended
(22 U.S.C. 7102).
F. DRUG-FREE WORKPLACE.
1. Recipient agree(s) that it will publish a drug-free workplace statement and provide
a copy to each employee who will be engaged in the performance of any
I project/program that receives federal funding. The statement must
1 a. Tell the employees that the unlawful manufacture, distribution, dispensing,
I possession, or use of a controlled substance is prohibited in its workplace;
b. Specify the actions Recipient will take against employees for violating that
prohibition; and
c. Let each employee know that, as a condition of employment under any award,
the employee:
(1) Shall abide by the terms of the statement, and
(2) Shall notify Recipient in writing if they are convicted for a violation of a
criminal drug statute occurring in the workplace, and shall do so no more
than 5 calendar days after the conviction.
2. Recipient agree(s) that it will establish an ongoing drug-free awareness program to
inform employees about
a. The dangers of drug abuse in the workplace;
b. The established policy of maintaining a drug-free workplace;
c. Any available drug counseling, rehabilitation and employee assistance
programs; and
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d. The penalties that you may impose upon them for drug abuse violations
occurring in the workplace.
3. Without the Program Manager's expressed written approval, the policy statement
and program must be in place as soon as possible, no later than the 30 days after
the effective date of this instrument, or the completion date of this award,
whichever occurs first.
4. Recipient agrees to immediately notify the Program Manager if an employee is
convicted of a drug violation in the workplace. The notification must be in
writing, identify the employee's position title, the award number of each award on
which the employee worked. The notification must be sent to the Program
Manager within 10 calendar days after Recipient learns of the conviction.
5. Within 30 calendar days ofleaming about an employee's conviction, Recipient
must either
a. Take appropriate personnel action against the employee, up to and including
termination, consistent with the requirements of the Rehabilitation Act of 1973
(29 USC 794), as amended, or
b. Require the employee to participate satisfactorily in a drug abuse assistance or
rehabilitation program approved for these purposes by a Federal, State or local
health, law enforcement, or other appropriate agency.
G. ELIGIBLE WORKERS. Recipient shall ensure that all employees complete the 1-9
form to certify that they are eligible for lawful employment under the Immigration and
Nationality Act (8 USC 1324a). Recipient shall comply with regulations regarding
certification and retention of the completed forms. These requirements also apply to
any contract or supplemental instruments awarded under this award.
H. FINANCIAL STATUS REPORTING. A Federal Financial Report, form SF-425{and
Federal Financial Report Attachment, SF-425A, if required for reporting multiple
awards), must be submitted annually. These reports are due 90 days after the reporting
period ending December 31. The final SF-425 (and SF-425A, if applicable) must be
submitted either with the final payment request or no later than 90 days from the
expiration date of the award. These forms may be found at
www.whitehouse.gov/omb/grants forms.
I. REIMBURSABLE PAYMENTS -FINA..l\JCIAL ASSISTANCE. Reimbursable
payments are approved under this award. Only costs for those project activities
approved in (1) the initial award, or (2) modifications thereto, are allowable. Requests
for payment must be submitted on Standard Form 270 (SF-270), Request for Advance
or Reimbursement or 271 (SF-271), Request for Reimbursement Construction, and
must be submitted no more than monthly. In order to approve a Request for Advance
Payment or Reimbursement, the Forest Service shall review such requests to ensure
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advances or payments for reimbursement are in compliance and otherwise consistent
with OMB, USDA, and Forest Service regulations.
The Program Manager reserves the right to request additional information prior to
approving a payment.
I Send a copy to:
~
LuAnn Grover
Cooperative Fire
! POSTAL: Albuquerque Service Center 1 E-mail: 19rover@fs.fed.us
Payments -Grants & Agreements 1, Cc: spf-reports@fs.fed.us
101B Sun Ave NE
I Albuquerque, NM 87109 I
1. AWARD CLOSEOUT. Within 90 days after expiration or notice of termination the
parties shall close out the award/agreement.
Any unobligated balance of cash advanced to Recipient must be immediately refunded
to the U.S. Forest Service. including any interest earned in accordance with 7CFR
3016.2112CFR 215.22.
Within a maximum of90 days following the date of expiration or termination of this
grant. all financial performance and related reports required by the terms of the
agreement must be submitted to the U.S. Forest Service by Recipient.
If this agreement is closed out without audit. the U.S. Forest Service reserves the right
to disallow and recover an appropriate amount after fully considering any
recommended disallowances resulting from an audit which may be conducted later.
K. PROGRAM PERFORMANCE REPORTS. The parties to this agreement shall monitor
the performance ofthe grant activities to ensure that performance goals are being
achieved.
Performance reports shall contain information on the following:
- A comparison of actual accomplishments to the goals established for the period.
Where the output of the project can be readily expressed in numbers, a computation of
the cost per unit of output, if applicable,
-Reason(s) for delay if established goals were not met.
-Additional pertinent information,
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Recipient shall submit annual performance reports. These reports are due 90 days after
the reporting period ending December 31.
The final performance report shall be submitted either with Recipient's final payment
request, or separately, but not later than 90 days from the expiration date of the grant.
L. NOTIFICATION. Recipient shall immediately notify the U.S. Forest Service of
developments that have a significant impact on the activities supported under this
award. Also, notification must be given in case of problems, delays or adverse
conditions that materially impair the ability to meet the objectives ofthe award. This
notification must include a statement ofthe action taken or contemplated, and any
assistance needed to resolve the situation.
M. CHANGES IN KEY POSITIONS AATI PERSONNEL. Any revision to key positions
and personnel identified in the application for this award require prior, written approval
from the Forest Service Program Manager. All technical positions are considered Key
Personnel by the Forest Service. Failure on the part of Recipient to obtain prior, written
approval when required may result in the disallowance of costs.
N. FREEDOM OF INFORMATION ACT (FOIA). Public access to award or agreement
records must not be limited, except when such records must be kept confidential and
would have been exempted from disclosure pursuant to Freedom of Information
regulations (5 U.S.C. 552). Requests for research data are subject to 2 CFR 215.36.
Public access to culturally sensitive data and information of Federally·recognized
Tribes may also be explicitly limited by P.L. 110-234, Title Vllr Subtitle B §8106
(2009 Fann Bill).
o. TEXT MESSAGING WHILE DRIVING. In accordance with Executive Order (EO)
13513, "Federal Leadership on Reducing Text Messaging While Driving," any and all
text messaging by Federal employees is banned: a) while driving a Government owned
vehicle (GOV) or driving a privately owned vehicle (POV) while on official
Government business; or b) using any electronic equipment supplied by the
Government when driving any vehicle at any time. All Cooperatives, their Employees,
Volunteers, and Contractors are encouraged to adopt and enforce policies that ban text
messaging when driving company owned, leased or rented vehicles, POVs or GOVs
when driving while on official Government business or when performing any work for
or on behalf of the Government.
P. FUNDING EOUIPMENI. Federal funding under this award is not available for
reimbursement of Recipient's purchase of equipment Equipment is defined as having
a fair market value of $5,000 or more per unit and a useful life of over one year.
Supplies are those items that are not equipment.
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Q. U.S. FOREST SERVICE ACKNOWLEDGED IN PUBLICATIONS,
AUDIOVISUALS, AND ELECTRONIC MEDIA. Recipient shall acknowledge U.S.
Forest Service support in any publications, audiovisuals, and electronic media
developed as a result of this award.
R. NONDISCRIMINATION STATEMENT -PRINTED, ELECTRONIC. OR
AUDIOVISUAL MATERIAL. Recipient shall include the following statement, in full,
in any printed, audiovisual material, or electronic media for pubJic distribution
developed or printed with any Federal funding.
In accordance with Federal law and U.S. Department ofAgriculture policy, this
institution is prohibitedfrom discriminating on the basis ofrace, color, national
origin, sex, age, or disabUity. (Not all prohibited bases apply to all programs.)
To me a complaint of discrimination, write USDA, Director, Office of Civil
Rights, Room 326·W, Whitten Building, 1400 Independence Avenue, SW,
Washington, DC 20250.9410 or call (202) 720-5964 (voice and TDD). USDA is
an equal opportunity provider and employer.
If the material is too small to permit the full statement to be included, the material must,
at minimum, include the following statement, in print size no smaller than the text:
"This institution is an equal opportunity provider. "
S. TERMINATION BY MUTUAL AGREEMENT. This award may be terminated, in
whole or part, as follows:
-When the U.S. Forest Service and Recipient agree upon the termination conditions,
including the effective date and, in the case of partial termination, the portion to be
terminated.
-By 30 days written notification by Recipient to the U.S. Forest Service setting forth
the reasons for tennination, effective date, and in the case of partial termination, the
portion to be terminated.
If, in the case of a partial termination, the U.S. Forest Service determines that the
remaining portion of the award will not accomplish the purposes for which the award
was made, the U.S. Forest Service may terminate the award in its entirety.
upon termination of an award, Recipient shall not incur any new obligations for the
tenninated portion ofthe award after the effective date, and shall cancel as many
outstanding obligations as possible. The U.S. Forest Service shall allow full credit to
Recipient for the United States Federal share of the non-cancelable obligations properly
incurred by Recipient up to the effective date of the termination. Excess funds shall be
refunded within 60 days after the effective date of tennination.
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T. DISPUTES.
1. Any dispute under this award shall be decided by the Signatory Official .. The
Signatory Official. shall furnish Recipient a written copy of the decision.
2. Decisions of the Signatory Official. shall be final unless, within 30 days of receipt
of the decision of the Signatory Official., Recipient appea1(s) the decision to the
U.S. Forest Service's Director, Acquisition Management (AQM). Any appeal made
under this provision shall be in writing and addressed to the Director, AQM,
USDA, Forest Service, Washington, DC 20024. A copy ofthe appeal shall be
concurrently furnished to the Signatory Official..
3. In order to facilitate review on the record by the Director, AQM, Recipient shall be
given an opportunity to submit written evidence in support of its appeal. No hearing
will be provided.
4. A decision under this provision by the Director, AQM is final
5. The final decision by the Director, AQM does not preclude Recipient from pursuing
remedies available under the law.
U. DEBARMENT AND SUSPENSION. Recipient shall immediately infonn the U.S.
Forest Service if they or any of their principals are presently excluded, debarred, or
suspended from entering into covered transactions with the federal government
according to the terms of2 CFR Part 180. Additionally, should Recipient or any of
their principals receive a transmittal letter or other official federal notice of debannent
or suspension, then they shall notify the U.S. Forest Service without undue delay. This
applies whether the exclusion, debannent, or suspension is voluntary or involuntary.
v. SYSTEM FOR AWARD MANAGEMENT REGISTRATION A.N'D UNIVERSAL
IDENTIFIER REQUIREMENTS
1. Requirementfor System for Award Management Registration (SAM -formerly
Central Contractor Registration or CCR):
Recipient shall maintain the currency of infonnation in the SAM until submission
of the final financial report required under this award or receipt of the final
payment, whichever is later. This requires that a review and update of the
infonnation at least annually after the initial registration, and more frequently if
required by changes in information or another award tenn.
2. Requirement for Data Universal Numbering System (DUNS) Numbers:
If authorized to make subawards under this award:
a. Recipient must notify potential Subrecipients that no entity (see definition
in paragraph C of this award tenn) may receive a subaward unless the
entity has provided its DUNS number to you.
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b. Recipient may not make a subaward to an entity unless the entity has
provided its DUNS number.
3. Definitions:
For purposes of this award term:
a. System/or Award Management Registration (SAM) means the Federal
repository into which an entity must provide information required for the
conduct of business as a Recipient. Additional information about
registration procedures may be found at the SAM Internet site (currently at
https://www.sam.gov).
b. Data Universal Numbering System (DUNS) number means the nine-digit
number established and assigned by Dun and Bradstreet, Inc. (D&B) to
uniquely identify business entities. A DUNS number may be obtained
from D&B by telephone (currently 866-705-5711) or the Internet
(currently at http://fedgov.dnb.com/webfOrm).
c. Entity. as it is used in this award term, means all of the following, as
defined at 2 CFR part 25, subpart C:
i. A Governmental organization, which is a State, local
government, or Indian Tribe;
ii. A foreign public entity;
iii. A domestic or foreign nonprofit organization;
iv. A domestic or foreign for-profit organization; and
v. A Federal agency, but only as a subrecipient under an award or
subaward to a non-Federal entity.
4. Subaward:
a. This term means a legal agreement to provide support for the performance
of any portion of the substantive project or program covered by this award
and that are subsequently awarded to an eligible Subrecipient.
b. The term does not include procurement of property and services needed to
carry out the project or program (for further explanation, see Sec. 11.210 of
the attachment to OMB Circular A-133, "Audits of States, Local
Governments, and Non-Profit Organizations").
c. A subaward may be provided through any legal agreement, including an
agreement that may be considered a contract.
5. Subrecipient:
a. Receives a sub award under this award;
b. Is accountable to the recipient for the use of the Federal funds provided by
the subaward.
[END OF PROVISION]
Page 14 ofl7
OMB 0596-0217
Expiration Date: 2/28/2014
Rev. (2-14)
ATTACHMENT B: 2 CFR PART 170
Appendix A to Part 170-Award Term
L Reporting Subawards and Executive Compensation.
a. Reporting offirst-tier subawards.
1. Applicability. Unless you are exempt as provided in paragraph d. of this award
term, you must report each action that obligates $25,000 or more in Federal
funds that does not include Recovery funds (as defined in section 1512(a)(2) of
the American Recovery and Reinvestment Act of 2009, Pub. L. 111-5) for a
subaward to an entity (see definitions in paragraph e. of this award term).
2. Where and when to report.
i. You must report each obligating action described in paragraph a.l. of this
award term to http://wwwfsrs.gov.
n. For subaward information, report no later than the end of the month
following the month in which the obligation was made. (For example, if
the obligation was made on November 7, 2010, the obligation must be
reported by no later than December 31, 2010.)
3. What to report. You must report the information about each obligating action that
the submission instructions posted at http://wwwfsrs.gov specify.
b. Reporting Total Compensation ofRecipient Executives.
1. Applicability and what to report. You must report total compensation for each of
your five most highly compensated executives for the preceding completed fiscal
year, if.
i. the total Federal funding authorized to date under this award is $25,000 or
more;
ii. in the preceding fiscal year, you received
(A) 80 percent or more of your annual gross revenues from Federal
procurement contracts (and subcontracts) and Federal financial
assistance subject to the Transparency Act, as defined at 2 CFR
170.320 (and subawards); and
(B) $25,000,000 or more in annual gross revenues from Federal
procurement contracts (and subcontracts) and Federal financial
assistance subject to the Transparency Act, as defmed at 2 CFR
170.320 (and subawards); and
iii. The public does not have access to information about the compensation of
the executives through periodic reports filed under section 13(a) or 15(d)
ofthe Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 780(d)) or
section 6104 ofthe Internal Revenue Code of 1986. (To determine if the
public has access to the compensation information, see the U.S. Security
and Exchange Commission total compensation filings at
http://www.sec.gov/answers/execomp.htm.)
2. Where and when to report. You must report executive total compensation
described in paragraph b.l. of this award term:
1. As part of your registration profile at http://www.sam.gov.
ii. By the end of the month following the month in which this award is made,
and annually thereafter.
Page 15 of 17
OMB 059'6"{)217
Expiration Date: 212812014
Rev. (2-14)
c. Reporting ofTotal Compensation ofSub recipient Executives.
1. Applicability and what to report. Unless you are exempt as provided in paragraph
d. of this award term, for each first-tier subrecipient under this award, you shall
report the names and total compensation of each of the subrecipient's five most
highly compensated executives for the subrecipient's preceding completed fiscal
year, if-
i. in the subrecipient's preceding fiscal year, the sUbrecipient received
(A) 80 percent or more of its annual gross revenues from Federal
procurement contracts (and subcontracts) and Federal financial
assistance subject to the Transparency Act, as defmed at 2 CFR
170.320 (and subawards); and
(B) $25,000,000 or more in annual gross revenues from Federal
procurement contracts (and subcontracts), and Federal financial
assistance subject to the Transparency Act (and subawards); and
ii. The public does not have access to information about the compensation of
the executives through periodic reports filed under section 13(a) or 15(d)
of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 780(d» or
section 6104 of the Internal Revenue Code of 1986. (To determine if the
public has access to the compensation information, see the U.S. Security
and Exchange Commission total compensation filings at
http://www.sec.govlanswerslexecomp.htm.)
2. Where and when to report. You must report subrecipient executive total
compensation described in paragraph c.l. of this award term:
i. To the recipient.
ii. By the end of the month following the month during which you make the
subaward. For example, if a subaward is obligated on any date during the
month of October of a given year (i.e., between October 1 and 31), you
must report any required compensation information of the subrecipient by
November 30 of that year.
d. Exemptions If, in the previous tax year, you had gross income, from all sources,
under $300,000, you are exempt from the requirements to report:
1. Subawards, and
2. The total compensation of the five most highly compensated executives of any
subrecipient.
e. Definitions. For purposes of this award term:
1. Entity means all of the following, as defined in 2 CFR part 25:
1. A Governmental organization, which is a State, local government, or
Indian tribe;
Ii. A foreign public entity;
iii. A domestic or foreign nonprofit organization;
iv. A domestic or foreign for-profit organization;
v. A Federal agency, but only as a subrecipient under an award or subaward
to a non-Federal entity.
2. Executive means officers, managing partners, or any other employees in
management positions.
3. Subaward:
Page 16 of 17
OMB 0596-0217
Expiration Date: 2128/2014
Rev. (2-14)
i. This term means a legal agreement to provide support for the performance
of any portion of the substantive project or program for which you
received this award and that you as the recipient award to an eligible
subrecipient.
it The term does not include your procurement of property and services
needed to carry out the project or program (for further explanation, see
Sec.H.2lO of the attachment to OMB Circular A-I33, "Audits of States,
Local Governments, and Non-Profit Organizations").
iii. A subaward may be provided through any legal agreement, including an
agreement that you or a subrecipient considers a contract.
4. Subrecipient means an entity that:
i. Receives a subaward from you (the recipient) under this award~ and
ii. Is accountable to you for the use of the Federal funds provided by the
subaward.
5. Total compensation means the cash and noncash dollar value earned by the
executive during the recipient's or subrecipient's preceding fiscal year and
includes the following (for more information see 17 CFR 229.402( c)(2»:
i. Salary and bonus.
ii. Awards ofstock, stock options, and stock appreciation rights. Use the
dollar amount recognized for financial statement reporting purposes with
respect to the fiscal year in accordance with the Statement of Financial
Accounting Standards No. 123 (Revised 2004) (FAS I23R), Shared Based
Payments.
iii. Earnings for services under non-equity incentive plans. This does not
include group life, health, hospitalization or medical reimbursement plans
that do not discriminate in favor of executives, and are available generally
to all salaried employees.
iv. Change in pension value. This is the change in present value of defined
benefit and actuarial pension plans.
v. Above-market earnings on deferred compensation which is not tax
qualified. vi. Other compensation, if the aggregate value of all such other
compensation (e.g. severance, termination payments, value oflife
insurance paid on behalf of the employee, perquisites or property) for the
executive exceeds $10,000.
END OF ATTACHMENT B: 2 CFR PART 170
Page 17 of 17
OMS Number: 4040-0004
f:xpiralion Dlll1!: 01/3112009
Application for Federal Assistance SF-424 Version 02
*1. Type of Submission: !"2 Type of Appiicalion • If Revision, select appropriate letter(s)
0 Preapp!ication ~ New
I8l Application 0 Continuation 'Other (Specify)
o Changed/Corrected Application o Revision
3. Date Received: 4. Applicant Identifier:
Sa, Federal Entity Identifier: *Sb. Federal Award Identifier:
USDA Forest Service 1"I-j)(j-JJ()6~'I5~-7..33
State Use Only:
6. Date Received by Slate: 17. State Application Identifier:
8. APPLICANT INFORMATION:
*B. Legal Name: Deschutes County
*b. Employerrraxpayer Identification Number (EINfTlN): ·c. Organizational DUNS:
93-60002292 030805147
d.Address:
'Street 1: 61150 SE27'h Street
Street 2:
'City: B~ng
County: Deschutes
'State: Oregon
Province:
~Country: US8
'Zip' Postal Code 97702
e. Organizational Unit:
Department Name: Division Name:
Forestry
f. Name and contact information of person to be contacted on matters involving this application:
Prefix: "First Name: Ed
Middle Name:
*Last Name: Keith
Suffix:
Tille: County Forester
Organizalional Affiliation:
Deschutes County
'Telephone Number: 541·322·7117 Fax Number: 541-3SS-2719
"Email: ed.keith@deschutes.org
\ l
~\¥
OM8 Number: 4040·0004
Expiration Date: ()1I31!200Q
Application for Federal Assistance SF-424
*9. Type of Applicant 1; Select Applicant Type:
B.County Government
Type of Applicant 2: Select Applicant Type:
Type of Applican! 3: Select Applicant Type:
·Other (Specify)
"10 Name of Federal Agency:
USDI Bureau of Land Management
11. Catalog of Federal Domestic Assistance Number:
I~· ~6 t.j
CFDA Title: i; ~tlt'lP2ltl it firtfJ
-12 Funding Opportunity Number:
"Title:
13. Competition Identification Number:
Title:
14, Areas Affected by Project (Cities, Counties, States, etc.):
Deschutes County, Oregon; Bend, Oregon
*15. Descriptive Title of Applicant's Project:
Southern Deschutes Fuels
Version 02
~
OMB Number: 4040-0004
EXflil'llhOn Date: OIt:W2009
ApplicatIon for Federal Assistance SF-424 Version 02
1S. Congressional Districts Of:
*8. Applicant 2 ·b. ProgramlPraject: 2
17. Proposed Project:
"s. Start Date: 9/15/14 "b. End Date: 12!31'16
18. Estimated Funding ($):
"a. Federal 175,300
"b. Applicant
*c. State
"d. Local
"e. Other
"f. Program Income
"2. TOTAL $175,300
*19. Is Application Subject to Review By State Under Executive Order 12312 Process?
o a. This application was made available to the State under the Executive Order 12372 Process for review on __•
o b. Program is subject to E.O. 12372 but has not been selected by the State for review.
o c. Program is not covered by E. O. 12372
"20, Is the Applicant Delinquent On Any Federal Debt? (If "Yes", provide explanation.)
DYes t8l No
21. '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 H and agree to comply
with any resulting terms if I accept an award. ! am aware that any false, fictitious, or fraudulent statements or claims may subject
me to criminal, civil, or administrative penalties. (U. S. Code, Title 218, Section 1001)
jg ·"1 AGREE
." The list of certifications and assurances, Of an internet site where you may obtain this list. is contained in the announcement or
agency specific instructions
Authorl2ed Representative:
Prefix: "First Name Ed
Middle Name:
"Last Name: Keitt)
Suffix:
*Title: County Forester
*Telephone Number: 541-322·7117 IFax Number: 541-388·2719
• Emaii: ed.keith@deschutes.org \ A
"Signature of Authorized Representative: lsI Ed Keith fA iOf]I +Date Signed: 6/12/13 ~
Authorized for Local Reproduction Standard Form 424 (Revised ~~~
Prescribed by OMS Circular A-I. ~
OMB Number: 4(J4{)-0004
Expiralmn Date 01131/2009
A.pplication for Federal Assistance SF-424 Version 02
*Applicant Federal Debt Delinquency Explanation
The following should contain an explanation if the Applicant organization is delinquent of any Federal Debt
I
I
!
j
J Grant Narrative
I Southern Deschutes Fuels Community Assistance Grant I
Summary of Project
This project will treat areas ihe highest rated areas within the La Pine, Upper Deschutes and
Suru-iver CWPPs. This project will use treatment approaches including thinning, brush mowing,
chipping and biomass removal to accompiish the goals as outlined in the CWPP including
creating defensible space around structures and treating fuels Stich that they will produce flame
lengths of 4 feet or less, moving areas from condition class 2 and 3 back to condition class I. By
accompiising the goals of this project risks to loss of Iitt: and properly damage will be
minimized, and firefighter safety will be increased. Funds will be used to pay contractors to
conduct the work and for project administration and oversight.
Methodolo~
Deschutes County and Project Wildftre will begin the project by providing fire prevention and
defensible space education and outreach to subdivisions and commun.ities within the project area.
Project Wildftre will also coordinate outreach with the local fire department, ODF and the US
Forest Service as well as other partners in order to provide a coordinated message between all
organizations conducting fire prevention education and outreach in the area. Following an
education and outreach campaign Deschutes County and Project Wildfire wili prioritize work
areas. identify timelines for work in coo;>eration with the participating landovvners and identify
and hire contractors to periorm the work.
Specific treatment areas wi!! be prioritized by:
1) Conditions of fuel: i\reas that are densely stocked or have mature brush or other ladder fuels
nearest or intermixed with developed areas will be given the highest priority.
2) Neighborhood participation: Contiguous parcels and neighborhoods that are willing to
participate as a group therefore creating larger adjacent treatment areas will be favored over
individual isolated treatment areas.
Objectives
This project will treat approximately 500 acres. Costs per footprint acre are estimated at $350.
SpeciJic contractual activities include:
-Thinning & chipping: Dense stands of trees with the potential to create ember showers or
crown fires will be thinned and the sla<;h treated with chipping. We plan to treat 50 acres with
these treatment methods.
-Mowing: Areas thick with bitterbrush or other ladder fuels will be mowed or masticated
reducing fuel heights to 4 inches or less. We plan to treat 200 acres with mowing or mastication.
-Biomass removal: In areas directly adjacent to homes the homeowner wili create defensible
space following guidelines provided by Project Wildfire and Deschutes County. Once
homeowners complete the work they will place the slash and other debris along roadsides or
other designated areas. Contractors will be utilized to collect the dehris and remove it from the
neighborhoods. With residents completing the portion of work around their homes they gain the
education needed to maintain the treatment into the future. We plan to treat and remove biomass
from 250 acres of defensible space around homes.
Kev Personnel
Ed Keith, Deschutes County Forester, ed.keith(a)deschutes.org 541-322-7117
Alison Green, Project Wildfire Program Director, 541-322-7129
Timeline
The project timeline is included as a separate attachment
Project Budget
The project budget is included as a separate attachment.
Project Timeline
List tasks and time frames relative only to the scope of this grant, consultants or organization responsible for carrying
out each task. Potentia! obstacles should be addressed.
Tasks Time Frame Responsible Party
----------~::__--__:::__-__:::___:__--__i
Outreach to community and !September 2014 Deschutes County. Project f
I cooperators, plan treatment areas : , Wildfire
:-'-=o-n-g-Oi:-n-g-f:-u-el:-s-tr-e-a-tm-e-n-t------t--I-=-s-ep-t-em-,-:-'b-er-_":-.,O":-1c-4----:O-cto ber 20 161 D~schutes County, Proj,ct
!!
;
I {'ldfii '" 1 Ire, contractors,
! community members and
•cooperators,
Reporting results
,
: As required, quarterly,
; annually. end of project
Deschutes County
i
! i
:
I
i
*
I
r
~
I Expanded Project Budget
II Cost Cau~gory Federal ,. I'
!ill. Description f. .a;gency {FS) ~,I Applicant Partner 1 '\' Partner 2 Total. I'
A) Personnei Iposjtion'rate~11mel I,' Deschutes County Forester 6.00000 I I 6,000.00 IIIIt Project Wildfire Coordinator ! 5,000,00 1 ! I 5.000.00 .
II§F,:!::=~;~;~=~~~!OI$ll·---1:':~~-----......:.L.--~J.____.___:.~----c:~~:-1
-, IfI ' . .
I
Ir-------------~~~"·-'....-..·..·-..··....~..~-..··....·..·..·".."...... ·......+......" ..."......-..............!-.-.... ".....-.. -.~...;..~~...-....~,,-,,_·.._·..·11
I!F) Contractual eg, cost/acres
il Fuels Contractors
\
Subtotal 2.300.00 i . -I -! 2,300.00I~..",..---------===:.f ..··......'''''''·'''·''·''·''''''''''.'··'''~''''''·'''·'',,,.._._..... -,,,.,,,--_._-.......,,,,....."'...,.....,...,,.................,,............................"..',...,,,.... I
C) Travel
'#people·l#trips 'perdiemfmileage
)
162.000,00 I: i 162.00~
H,'_________..:::S:;;:.lJb:=;t:;;:.o:.:ta~f!·,·.._...._ ......•·..:···-1 ....·..,_..··•....·..·..:·"..·,1,...."....·..........·,·..·,:...·~l·......·....·...---..:··...,..r-·-......·....~~·'--
'H) Other (specify} detail ! i I Ii·
I 1 I ..
II~ Pro g.:ram Income (using ,I
~ve Alternative) ;
[1 J EqUIpment IS single unit values of S5J)OO or greater WIth a useful hfe of more than 1 year. PJe-ase nemrze equtPn:tentJcosts.
[2j Program Income is the gross revenue generated by a grant or cooperative agreement supported activity during the
life of the grant Program income can be earned from fees charged for conference or workshop attendance, from rental
fees earned from renting out real property or eqUipment acquired with grant or cooperative agreement funds, or from
the sale of commodities or items developed under the grant or cooperative agreement. The use of Program Inco:\.
d,riog lhe '''ieel ""ood may <eq"', prlo< ap.,oya' by Ih, grar.llog agen",. ~
-----
4
·_~.___._____ ...... _...""....... _____.._._. __.__~ ~_BI:!Q~_ET.!~F~:C~~~~~~~~~:l:~~~~O!~~~~9I!!!lS ___ .. _________ OMS ,~PI,I.~_~~~~:_~:~~~~~
___'_-....I~ . --.. ~...-~.. -,..--.,.-.... -.,--------~......-''"'--'',--..-.--~~.-~"'-, ' .. -----~------.......----.,,,... ,,'w•• ,_' •.•.•• '~-.......-----
GranL Program Catalog o f Federal New or Revised BudgetEstimated Unobligated Funds Function Domestic Assistance
or Activity Number
Non-FederalFederal F:~;;~~k_N~:-~~~_ $ To",$ -[t·.. · {d}
$I.Community Assistanc 15.228
------f---~---·~----I-··,.··
0.002.
•...._._-------_...... 1-.................. ·-~·---__+-·I
0.00
--------......". ..-·,,-'..·i---·....··
3.
0.00
5. Totals l~:"~~= ~·.~[~~=-·-~~0.~J~.......=-~-~75.30~·~~t~·-..·'-·---0.00 1$ 175,300.00
'---SECTION B .. BUDGET CATEGORIES .1------__...""•..•.. "--...--.------"----~"..--,,.. -....,,. ·T-..---···-·--. -.... ~----.. -..... --.-,-. ._--_._-"".
Total.....____GRANT PROGRAM, fUNCTION OR ACTIV!!!6. Object Class Categories
.ML.._ _ .-____!$.~J. ·1~L---.---".-... $ a. Personnel 11,000.00
.. ,-...-......--.-j.,,--~----,........ ..
..-t-..._--.------t----
b. Fringe Benefits 2.300.00 2,300.00
,....'_..._'*-----~""-." ..,..-......
0_00C. Travel
------..-,---+---,-.-...--.~ " ..... ""',1,, .. --. "._.
d. Equipment 0.00
._---_.__.._.•._j-....,,, ... ,,-----, --.... _ ..."..
e. Supplios 0.00
I
f. Contractual 162,000.00 162,000.00
g. Construction 0.00
----............ -.. --•.-----------1------_.._-..-._..---1
h_ Other 0.00
i. Total Direct Charges (sum of 6a-6h) 0.00 I 0.00 175,300.00175,300.001_._.___~-~~
j. Indirect Charges 0.00
$ $k. TOTALS (sum of 6i and 6)) $
175,300.00 I 0.00 0.00 1$ 0.00 1$ 175,300.00
...--....-•.~.. --~--,
0.00
7. Program Income Standard Form 42~A (Rev. 7.97)
Previous Erlltlon Usable Prescritmrl by OMS Circular A-1 02
SECTiON C • NON-FEDERAL RESOURCES
(a) Grant Program (b) Applicant (c) State (d) Other Sources (e) TOTALS
8. Deschutes County $ 0.00 $ $ $ 0.00
9. 0.00
10. 0.00
11. 0.00
12. TOTAL (sum oflines 8-11) $ 0.00 $ 0.00 $ 0.00 $ 0.00
SeCTION D • FORECASTED CASH NEEDS
Total for 1st Year 1st Quartar 2nd Quarter 3rd Quartar 4th Quarter
13. Federal $ 175,300.00 $ 43,825.00 $ 43,825.00 $ 43,825.00 $ 43,825.00
14. Non-Federal 0.00 0.00 0.00 0.00 0.00
15. TOTAL (sum oflines 13 and 14) $ 175,300.00 $ 43,825.00 $ 43,825.00 $ 43,825.00 $ 43,825.00
SECtiON E -BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT .
(a) Grant Program FUTURE FUNDING PERIODS (Years)
(b) First (c) Second (d) Third (e) Fourth
•
16.Deschutes County $ $ $ $ i
17. i
18.
19.
20. TOTAL (sum of/ines 16-19) $ 0.00 $ 0.00 $ 0.00 $ 0.00
SECTION F • OTHER BUDGET INFORMAtiON
21. Direct Charges: 122. Indirect Charges:
23. Remarks:
Authorized for local Reproduction Standard Form 424A (Rev. 7-97) Page 2
OMS Aporoval No. 0348-0040
ASSURANCES· NON·CONSTRUCTION PROGRAMS
•Public reporting burden for this collection of information is estimated to average 15 minutes per response, Including lime for reviewing I
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 infomlation, Including suggesbons for
reducing this burden, to the Office of Management and Budget Paperwork Reduction Project (0348-0040), 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.
NOTE: Certain of these assurances may not be applicable to your project or program If you have questions, plaase contact the
awarding agency. Further, certain Federal awaroing agenc;ss may require applicants 10 certify to additional assurances. If such
is the case, you will be notified, '
As the duly authorized representative of the applicant, I ce·1ify that the appiicant·
1. Has the legal authority to apply for Federal assfstance
and the institutional, managerial and financial capabiltty
(fncluding funds sufficient to pay the non-Federal share
of project COSI) 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 Slate,
tnrough any authonzed representative, access to and
tne right to examine a\l records, books, papers, or
documents related to the award; and will establish a
praDer accounting system in accordance with generally
accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from
using their positions for a purpQse Ihat constitutes or
presents the appearance of personal or organizational
conflict of interest, or personai gain.
4, Will !nitiate and complete the work within the applicable
time frame after receipt of approval of the awarding
agency,
5, Will comply with the Intergovernmental Personnel Act of
1970 (42 U.S,C, §§4728-4763) relating to prescribed
standards for merit systems for programs funded under
one of the 19 statutes or regulations specified in
Appendix A of OPM's Standards for a Merit System of
Personnel Administration (5 C,F.R. 900, SUbpart F).
6. Will comply with all Federal statutes relating to
nondiscrimination, These include but are noi 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 nationai origin; (b) Title IX of the Education
Amendments of 1972, all amended (20 U.S.C, §§1661
1683, and 1685-1686), which prohibits discrimination on
the basis 01 sex; (e) Section 504 of the Rehabilitation
PraviOUIi Edltiol1 Usable
Act of 1973, as amended (29 U,S.C, §794). which
prohibits discrimination on the basis of handicaps: (d)
the Age DiSCrimination Act of 1975, as amended (42
U .S.C. §§61 01·61 07), which prohibits discrimination
on the basfs of age; (e) the Drug Abuse Office and
Trea~ment Act of 1972 (P.L 92-255), as al1lenaed,
relating to nondiscrimination on the basis of drug
sbus.a; (f) the Comorehensive Aicohol Abuse and
Alcoholism Prevention, Treatment and Rehabl!itation
Act of 1970 (P.L. 91·616), as amended, relatfng to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) §§523 and 527 of the Puoiic Health
Service Act of 1912 (42 U,S.C, §§290 dd-3 and 290 ee
3), as amenced, relating to confidentiality of alcohol
and drug abuse patient records; {hj Title VIII of the
Civil Rights Act of 1968 (42 U,S,C. §§3601 at seq,), as
amended, relatJng to nondiscrimination in the sale,
remal or financing of housing; (I) any ciher
nondiscrimination provisions in the speCific statute(s)
under which application for Federal assistance is being
made; and, fj) the requirements of any other
nondiscrimination statute(s) which may apply to tfJe
application.
7 Will comply, or has already complied, with the
requirements of Titles II and III 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
wtlDse property is acquired as a result of Federal or
federally-assisted orograms. These reqUirements apply
to all interests in real property acquired for project
purposes regardless of Federal participation in
purchases.
8. Will comply, as applicable, with 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.
Standard Form 4248 (Rev. 7-97)
Authorized for Local Reproduction P'rescribed by OMS Circular A-1 02
June 30, 2014
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL ITITlE
I County Forester
IAPPLICANT ORGANIZAT!ON D,.!l,TE SUBMIITED
!Deschutes County
9, 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. §27ec and 18 U.S.C, §874), and the Contract
Wort Hours and Safety Stanoards Act (40 U.S.C. §§327
333), regarding labor standards for federally-assisted
constructior1 st.bagreements
10. Will comply, if appl:cable, with flood InSlJrance purchase
requirements of Section 102(a) of the Flood Disaster
Protection Act of '1973 (PL 93-234) which requires
recipients in a special flood hazard area to participate in the
program and to purchase ftood Insurance if the total cost of
insurable construction and acquishion IS $10.000 or more.
11 , Will comply with environmental standards which may be
prescribed pursuant to the following: (a j 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 ',1738: (e) protection of wetlands
pursuan! to EO 11990; (d) evaluation of flood hazards in
floodplains in accordance with EO 11988; (e) assurance of
project consistency with tne approved State management
program developed under the Coastal Zone Manaaement
Act of 1972 (16 U.S.C. §§1451 et seq.); (f) eonfo..;oity of
Federai 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 Wa~er Ac! of 1974. as amended (P.L. 93-523);
and, (h) protection of endangered species under the
Endangered Species Ac1 of 1973, as amended (P.L 93
205).
12. Wit! 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.
13 Will assist the awarding agency In assuring compliance
with Section 106 of the Nat:onal Historic Preservation
Act of 1965. as amended (16 U.S.C. §470). EO 11593
(identification and orotection of historic properties). and
the Arehaeclcgical and Historic Preservation Act of
1974 (16 U.S,C, §§469a.1 et seq.),
14, Will comply with P,L, 93-348 regarding the protection 0'
human subjects involved in research, development, and
related activities supported by this award of assistance,
15, Will comply with rhe Laboratory Animal Weljare Act of
1966 (P.L. 89-544, as amended. 7 U,S.C, §§2131 et
seq,) pertaining to the care, handling, and treatment of
warm blooded animals held for research. teaching, or
other activities supported by this award of assislance,
16. Will comply with the Lead-Based Paint Poisoning
Prevention Act (42 U.S.C. §§4801 at seq.) which
prohibits the use of lead-based paint in constructiol'1 or
rehabilitation of residence structures,
17, Will cause to be performed ihe required financial and
compliance audits in accordance with the Single Audit
Act Amenoments of 1996 and OMS Circular No, A·133,
"Audits of Slales, Local Govemments, and Non"Profit
Organizations. '
18. Will comply with all applicable requirements of all other
Federal laws, executive orders, regulations. and policies
governing this program.
I
u.s. DEPARTMENT OF AGRICULTURE
Certification Regarding Debarment, Suspension~ and Other
Responsibility Matters -Primary Covered Transactions
This certificaliorl is required by ,he regulatio!1s impiementtng Execlltive O:'der 12549, Dei:JarlTlcn! am: Suspension, 7
CfR Part 3017, Section 30i 7.510, Participants' respon.-.ibilities The reguhnions were published as Pari IV of the
.Iunuruy 30, 1989 ~rnl Register (p<lgcs 4722-4733). Copie:; uf ;hc regulations may be obtained by contacting the
Departmcn l of Agriculture agency offering [he propo~ed covered transactiol1.
(BEFORE COMPLETING CERTIFICATIO", READ INSTRUCTIONS ON REVERSE)
(I) The prospective primary participant certifies La the best or its knowledge and belief, that it and its principals:
(<1) are not presently debarred. suspended. proposed for debarment, declared ineligible, or
voluntarily excluded from covered transactions by any Federal department or agency;
(b) have not within ;l rhree-year period preceding this proposal been convicred of or had a
civif judgement rendered against Ihem for commission of fraud or a criminal offense in
connection with oblaining. 3,ltemplmg lU obrain, or performing a publit! (Federal. State or
local) transaction or contract under a public [ransacLion; violation of Federal or State
llntitfU.·>! statutes or commission of embezzlemenl, :heft forgery, bribery, falSification or
destruction of records, making false statcmems, or rc<.:civing stulen property;
(c) are not presently indIcted for or othclWisc criminally Qr civilly chnrged by a governmental
entity (Federal, State or local) with commissioli of any of the offenses enumerated in
panagraph (I)(b) orthis cerritication; and
(d) have not within ti three-year penod preceuing tillS application/proposal had ont Of more
publi:.: transactions (Federal. Stale or lo\:al) terminated !'or canse or default.
(2) Where the prospccuve primary pr,rtlcipant is unable to certify to any (If the statel1lents in tlllS celtitication.
such prospective participant shail,mach an explanation to this proposal.
Deschutes County Southem Deschutes Fueis
Ed Keith, County Forester
~,ame(;)j IiUt! Tltic{t!) of Authrui2cD Rcprc3entallV\!(s)
1~7~~
OMS APPROVAL NO. 0991·0002
U.S. DEPARTMENT OF AGRICULTURE
CERTIFICATION REGARDING
DRUG-FREE WORKPLACE REQUIREMENTS (GRANTS)
ALTERNATIVE ,. FOR GRANTEES OTHER THAN INDIVIDUALS
This ce-rfufcati~.,Tsreq"ul~ed"by the'regulations impleme~nting'Se'cHons'~51'5"1':5-1'60:"c)'fThe~6rug-~F~ree ~\iorkpl"ace"Act"of 1988
(Pub. L. 100-690, Title V, Subtitle 0: 41 U.S.C. 701 et seq.): 7 CFR Part 3017, Subpart F, Section 3017.600, Purpose. The
January 31, 1989, regulations were amended and published as Part II of the MAY 25, 1990, Federal Register (pages 21681
21691). Copies of the regulations may be obtained by contacting the Department of Agriculture agency offering the grant.
(BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON REVERSE)
Alternative I
A. The grantee certifies that it will or will continue to provide a drug-free workplace by:
(a) Publishing a statement notifying employeeslhat the unlawful manufacture, distribution, dispensing. possession, or
use of a controlled substance is prohibited in the grantee's workplace and specifying the actions that will be taken
against employees for Violation of such prohibition;
(b) Establishing an ongoing drug-free awareness program to inform employees aboui-·
(1) The dangers of drug abuse in the workpiace;
(2) The grantee's policy of maintaining a drug-free workplace;
(3) Any available drug counseling. rehabilitation, and employee assistance programs: and
(4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace;
(c) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the
statement required by paragraph (a):
(d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the
grant, the employee will
(1) Abide by the terms of the statement; and
(2) Notify the employer in writing of his or her' conviction for a violation or a criminal drug statute occurring in
the workplace no later than five calendar days after such conviction:
(e) Notify the agency in writing. within 10 calef1dar d.ays after receiving notice under subparagraph (d)(2) from an
employee or otherwise receiving actual notice of such conviction, Employers of convicted employees must provide
notice, including position. title, to every grant officer on whose grant aciivity the convicted employee was working.
unless the Federal agency has designated a central pOint for the receipt of such notices. Notice shall include the
identification number(s) of each affected grant;
(1) Taking appropriate personnel action against such an employee, up to and including termmation, consistent
with the requirements of the Rehabilitation Act of 1973, as amended; or
(2) Requiring such employee to partiCipate satisfactorily in a drug abuse assistance or rehabilitation program
approved for such purposes by a Federal, State, or local health, law enforcement. or other appropriate
agency;
(g) Making 8 good faith effort to continue to maintain a drug-free workplace through implementation of
paragraphs (a), (b), (c). (d), (e) and (0.
1-1
Form AD-1049 (REV 5/90)
Microsoft Word 20DO
B The grantee may Insert in the space Drovlded below the sile(5) for the performance of work done in connection with tho specific grant:
Place of Performance (Street address, city, county, State, zip code)
61, SO SE 27th SL, Bane, OR 97702
----:-I"""I..----~~'.. --_ .... , ...........~ ....-.---..--...
Check 1...1 if there are workplaces on file that are not
DesChutes CounlY Souttlem Desc.hutes Fuels
OrganizaUon Award Number or Project Name
Ed Keith, County Forester
06/30/2014
Date
Instructions for Certification
By Signing and submining this form, lhe grantee is providing tl1e certiftcauon set out on pages 1 and 2,
2, The certification set out on pages 1 and 2 is a material representation of fact upon which reliance is placed when the agency awards the grant. If it 1s
later determined that the gramee knOWingly rendered a faise certificati()(1, or otherwise violates the requirements of the Drug-Free Workplace Act, the
agency. In addition to any other remedies available 10 Ihe Feda,dl Govemment, may take action authorized under the Drug-Free Workpiace Act
3. Workplaces under grants. fOl' grantees other than individuals, need no! be identitied on the certification. ~f know they may be identified in the grant
appiicalion. If the grantee (ioes nOl identify the workplaces at the lime ct appllcabon, or upor, award. if there is no apPlication, the grantee must keep
the identiry oi!he workplace(s) or; file 111 its ofrce and make the Information available fO!' Federal inspection. Failure to Ide"ltlfy all known workplaces
constilutes a violation of the grantee's 6!Ug-free workplace reQuiremenlS.
~. Workplace identifications must include the acival address of buildings (or parts of building~l or othe, sites where W<lr\< under the grant laKes place.
Categorical desCtipllons !'flay be used (e,g., ali vehicles ot a mass transit authOrity or State highway department while in operahon. Slate employees in
each loca; unemployment office, performers in CO'1cert halls or racio studios).
5. If the workplace Identified to the agency c'langes during the performance of the grant. the gran lee shail inform the agency cf ttle change(s), if \(
previOUSly identltied 1!'Ie 'AIOrkpla::.es In queslion [see paragrapi1 three).
6. De.finitions of terri's in the Nonprocurement Suspension ar-a Debarment common I1.lla am! Drug·=re!! Wor~plaoe common rule apply to this certification.
Grantees' atlention !s callell, in partlciJlar, 10 :he following definitions from Ihese relies:
•. Controlled substance" means a controlled substance in ScheduiEs ' tl1rough V of the Controlled Substances A<:t (21 U .S,C. !! 12) and as further
defined by regulation (21 CFR 1308.11 through 1308,15):
"Conviction" means a finding o!guilt (including a plea .:)1 nolo ~ontendere) or imposition of sen!ence, or both, by any judicial body charged wi!h the
responsibility:o determine violations of the Federal or Stale criminal drug statutes:
"Criminal drug statute" means iii Federa; or non-Federal criminal statL!e involving the manufacture, distribution, disoer.slng, use, or possession of a~y
controlled substance;
.. ::mployee" means the employee of a grantee directly engaged in L'>e performance of work \i.oder a gran\, inclt;ding: (i) all "direct charge" employees:
(ii) aU "indirect Charge" employees unless their impacl or involv9r.-.enl '5 insigmficant to the oertormance of tI1e grant; ana, (iiil temporary personnel
and consultants who are direcn" engaged In the performance of work under t'le grant lilnd who are on the grantee's payroll. This definition does nol
InclUde workers net on the payroll of the grantee (a,9., volunteers, eV1.ln if sved to meel a matching raquireme ....:: consultantS or ,ndependent contractors
noi on the grantee's payroll; or employees of subrecipients or 5ubco....tractors in covered workplaces).
1-2
U.S. DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
CERTIFICATION FOR FEDERAL ASSISTANCE
Certification Regarding Lobbying
Certification for Contmcts_ Grants. Loans. and Cooperatlve Agreement~
Applies to recipients of awards exceeding $! 00,000.
This certification is required by Section 1352, title 31, U.S, Coae, entitled "Limitation on use of
appropriated funds to influence certain Federal contracting and financial transactions."
The undersigned certifies, to the best of bis or her Imowledge and belief, that:
( 1) No Federal appropriated fun(ls have been paid or will be paid, by or on behalf of the
undersigned. to any person for influt:ncing or attempting to iniluence an officer or employee of any agency,
a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with the awarding of any Federal contract, the making of any Federal grant the making of any
Federal loan, the entering into of any cooperative agreement, and the extension. cominuation, renewal.
anleodment, or modification of any Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person
for influencing or attempting to influence an officer or employee Gf any agency, a Member of Congress, an
ot1'icer or employee of Congress, or an employee of a Member of Congress in connection with this Federal
contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard
Fonn-LLL, "Disclosure Form to Report Lobbying," in accordance with its instnlctlons.
(3) The undersigned shall require that the language of this certification be included in the award
documents for all subawards at all tiers (including subcontracts. sub grants, and contracts ullder grants,
loans, and cooperative agreements) and that all subrccipients shall certify accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction
was made or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction imposed by Section \352, title 31, U,S, Code, Any person who fails to file the required
certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each
such failure.
As the authorized certifying official, I hereby certify that the above specified certifications are true,
I
/I t"'7 ;; / .Signature & Date: U I }' f/~,j-, J
.-!~ ltv7«-f ,v (p I 1 (:1 i ,
Typed Name & Title: Ed Keith, Deschutes Count)' Forester
Applicant/Recipient Name: Deschutes County
----.~"-.-------,----------------
BLM Agreement No.'
(if modification) ~
NOTE: This certification must be cOlnllieted upon initial award if the rotal amount exceeds $100,000.00 llnd~~
with ..,h ,.h""•••, m.dir~"... wh" .ddit;..., ' ..d ••" ,w",d,d. r~