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DESIGNATION OF APPLICANTS AGENT'
RESOLUTION
BE IT RESOLVED BYl&i
THE BOARD OF SUPERVISORS OF
(Governing Body)
FREDERICK COUNTY, VA
(Public Entity)
THAT
GARY A OUBRUELER
DIRECTOR
(Name of Incumbent)
(Official Position)
Is hereby authorized to execute for and in behalf of
Frederick County Virginia '" . . .
, . a public entity established under the laws of the State of Vlrgmla,
this application and to file it in the appropriate State Office for the purpose of obtaining certain Federal fmancial assistance
under the OJP, National Domestic Preparedness Office Grant Program(s), administered by the Commonwealth of Virginia.
Frederick County, VA
That, a public entity established under the laws of the
Commonwealth of Virginia, hereby authorizes its agent to provide to the Commonwealth and to the Office of Justice
Programs (OJP) for all matters pertaining to such Federal financial assistance any and all information pertaining to these
Grants as may be requested.
Passed and approved this
13th
day of
August
,20
03
Richard C. Shickle, Chairman, Board of Supervisors
~
~
_ (Name and Tilc)
~ _ ~c...,^,'\I'Y'v<+n
\
(Name and Tile)
(Name and Tile)
CERTIFICATION
~ohn R. Riley, ~r.
County Administrator
I,
, duly appointed and
of
(name)
Frederick County, Virginia
(enticy)
(Title)
, do hereby certify that the above is a true and correct copy ofa
Resolution passed and approved by the
Board of Supervisors of
(Governing Body)
Frederick County, VA
(Public Enticy)
On the
13th
Day of
August 20 03
County Administrator ~~-
(Official Position) C/ I' N.(5i~a~e)
Date:
August 14, 2003
Board of Supervisors Resolution No.: 007-03
VDEM - OlP GRANT DM. REV 2.1111812002
COUNTY OF FREDERICK, VIRGINIA
FIRE AND RESCUE DEPARTMENT
107 North Kent Street
Winchester, VA 22601
Gary A. DuBrueler
Director
MEMORANDUM
Dennis D. Linaburg
....~~ Fire Marshal
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TO:
Board of Supervisors
Gary A. DuBrueler, Director ~
l<~ire and Rescue Department
FRO]VI~
St3BJECT:
2003 Office of Domestic Preparedness
Equipment Program Grant
D4.r',,;,y".
~-.&-lJ.J"
July 23, 2003
'l'he Virginia Department of Emergency Management has announced the allocation of the Base
2003 Office of Domestic Preparedness Equipment Progranl Grant. This grant program is
designed to allow local governments in Virginia to purchase equipment allowing them to
enhance their ability to respond to terrorist acts involving weapons of mass destru:::tlOn.
lherefore, F:ederick County, Virginia has been allocated a total of $57.267 under this grant
Each jurisdiction must complete application and required federal documents for the gr&,t 1:1
,'ii'de, to receive funding. The application contains a Designation of Applicants Agent for ~he
grant process through which the grants must flow. Attached is a Designation of Applicam~
Agent Resolution that requires the approval of the Board of Supervisors to appoint myself. G<::f','
A. DuBrueler. as the Designated Agent for Frederick County, Virginia. This resolution signed
by .he Chairman of the Board of Supervisors is required. Upon receipt of the grant &pplj("<ltiml
dnd tl1(~ ~igned Resolution. VDEM will transfer the total amount to the County of fi.,Jlerick. It is
,he responsibility of the jurisdiction to detennine what eql'ipment will be purchased ,lnJ to
ensure that only eligible equipment is procured.
If you have any questions or concerns in regard to the gral1l application or lile ;i!t1lched
resolution. please do not hesitate to contact me.
GAD:j!c
4.Hachment: as stated
Cc.: 2003 Office of Domestic Preparedness
Equipment Program Grant
(. U f'--i .-\-0 C n"(,y 0\ ,J \--';J1ky-
1). \I OnlG\ca1- ~ \ \'-1 \ 0~ liP
Director (540) 665-5618
.
Fire Marshal (540) 665-6350
.
Fax (540) 678-4739
VIRGINIA DEPARTMENT OF EMERGENCY MANAGEMENT
DOMESTIC PREPAREDNESS PROGRAM
GRANT APPLICATION'
Virginia Department of Emergency Management
10501 Trade Court
Richmond. VA 23236
804-897-6500
Grant Funding Year 19990 2000 0 20010 2002 0 2003 0
JURISDICTION/AGENCY
Frederick County, Virginia
ADDRESS
107 North Kent Street
Winchester, Virginia 22601
TELEPHONE # 540_865-5683 I FAX # I (54n) S57-0370
JURISDICTION EIN# 54-F;nn1;::>qn
DESIGNATED AGENT NAME
Mr. Gary A. DuBrueler, Director
ADDRESS
107 North Kent Street, Suite 106
Winchester, Virginia 22601
TELEPHONE # 540-665-5618 I FAX # I 540-678-4739
GRANT IS TO BE USED FOR: I POLICE Kl I FIRE I!SJ I HAZMAT ~ I EM. MED E;J
GRANT IS FOR MUL TI-]URISDICTIONAL USE: I YES 0 IN00
IF YES FILL OUT ATTACHHENT A FOR EACH IURISDICTION PARTICIPATING IN PROPOSAL
OJP GRANT APPLICATION. REV 1,11/18/2002
Equipment Coordination Certification
I certify that:
Use of these funds to meet immediate equipment replacement needs and address critical
ongoing equipment needs will be coordinated with other ongoing Federal disaster
recovery initiatives related to the September 11,2001, terrorist attack on the World Trade
Center and with the State's domestic preparedness strategy.
Designated Agent of
Frederick County, Virginia
Locality
Gary A. Du8rueler
Name
Director
Title
LEVEL OF TRAINING AND EQUIPMENT
PURCHASE AND USE
I certify that:
Use ofthese grant funds to purchase any of the equipment authorized by this grant is
done so with the express knowledge that there are levels of "training certification" that
may be required by Federal and State laws, rules and regulations to use such equipment.
To allow response personnel to have and use this equipment is done so by this
Jurisdiction having been informed of these restrictions and in no way is the
Commonwealth of Virginia and the Department of Domestic Preparedness, DOJ
responsible for any consequence of this use.
For any equipment that this Jurisdiction may purchase under this grant and it is
determined that our personnel require additional training and/or "certification" this
training and lor "certification' will be obtained prior to use of the equipment at issue.
Designated Agent of
Frederick County, Virginia
Locality
Gary A. DuBrueler
Name
Director
Title
VDEM - OlP GRANT LEVEL OF TRAINING. REV I, 11/18/2002
APPLICATION FOR
OMB Appro I N
va o.
FEDERAL ASSISTANCE 2. OATE SUSMITTeo Applicant Identifier
AUqust 14. 2003
t. TYPE OF SUell'SSION: 3. OATE RECEIVED SY STATE State Application Identifier
Applic.,ion P".ppljcalion
0 Construction o Construction
.. DATE RECEIVED SY FEOERAL AG ENCY Federal Identifier
~ Non~Cotlstruct;on 0 Non.Construction
S. AP'P'L1CANT INFORMATION
Legal Name: Organizational Unit
Frederick Count v Virainia . Fire and Rescue
Addre... (gNe city. county. stalll, and zip cod,,): Name and telephone number or rhe person ta be contacted on matters involv
107 North Kent Street this appllcaUon (I}i"" a~a code)
Winchester, Virginia 22601 Gary A. DuBrueler, Director
(540) 665-5618
5. EMPLOYER IDENTIFICATION NUlotBEA (EIN): 7. TYPE OF A.PPLICANT: (_nt., .lPPlOpri.t. '_ft., in btu) U
~ - r 6 ToTo I 1 2 I 910 1 A. State H. Independenl School OisL
B. County I. Slale Controlled Institution 01 Higher Lean
t. TYPE OF APPliCATION: C. Municipal J. Private University
O. Township K Indian Tribe
0 New 0 Continuation 0 Revision E. Inlerstale L Individual
0 0 F. IntermunicipaJ M. Prolit Organization
II AlMsion. enler appropriatelener(s) In box(es): G. Special Oisl1icI N. Other (Specify):
A. Increase Award B. Decrease Award C. Increase Duration
O. Decrease Duralion Other (specify): 9. NAME OF FEDERAL AGENCY:
I.. CATALOG OF FED ERAL OOMEsnc I I I. I I 11, oeSCRIPTlvE TITLE OF APPlICANT'S PROJECT:
ASSISTANCE NUIoISER:
TlTt.E:
12. AREAS AFFECTED BY PROJECT (citi.$. countiu. sr~tu. .t~.J:
13. PROPOS EO PROJECT: U. CONGRESSIONAL DISTRICTS OF:
Slatl Date Ending Oa,e a. Applicant b. Project
;
;
'$. Esnlol.TEO FUNDING: 11. IS APPLICATION SUSJECT TO REVIEw SY SUTE EXECUTIVE ORDER '2312 PROCESS7
... Federal S .00 a. YES. THIS PREAPPUCATlONlAPPLICATlON WAS MADE AVAILABLE TO THE
STATE EXECUTIVE ORDER 12372 PROCESS FOR AEVIEW ON:
b. Applican. S .00 DATE
c. Stale S .00
b NO. D PROGRAM IS NOT COVERED BY E.O. 12372
d. Local S .00 D
OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW
e. Other S .00
I. Program Income S .00 '7. IS THE APPLICANT DELINOUENT ON ANY FEDERAL OEBT7
DYes lt "Yes: attach an explanaUon. 0 No
g. TOTAl. $ .00
II. TO THE SEST O~ liT KNOWLEOGE AND SELIEF: ALL DATA IN THIS APPLICATlON/PREAPPLICATiON ARE TRUE AND CORRECT. THE DOCUIIENT HAS SEEN DULY
... Typed Name 01 Authorized Represenlalive
A. DuBrueler
AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COIIPLY W'TH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED
Co Telephone number
b. TiOe
Director
540-
e. Dale Signed
IAUtIlonZed~~
8/14/03
Standard Form 424 (R
'. -"'--__......JO.-:_.
Disclosure of Lobbying Activities
Approvod by OMS 0341
Complete this form 10 disclose lobbying activities pursuanlto 31 U.5.C. 1352
(5<1. "versa sida lor Instructions.)
Public Roportlng Burdon lor this ooll8c~on 01 InformaUon Is eslimalBd 10 avltage 30 minutos p.r I'8sponse..lnducl1ng ll'l8 Ume lor re'<lewln I
..arching exlsung dala sources. gathering and maintaining Il'la cfala n..decf. and oompl.~ng and revlawlng ~ Cl)llecUon o/ln/onna~on S~dnsl1u
regilding Ihis burden Il$limalB 01 any olhar aspect or !hIs collection a/lnformatlon.lncludlng sugges~Dns lor reclJcng lhls burel.n 10 Ille O~~. 0/ ~orr
and Budget. Paperwor1< Reduction ProjecI (0348-0045). Washington. O.C. 20503. . . a.
t. Type a/ Federal ActIon: 2. Statu. ar Fedo,.1 AcUan: 3. Report Type:
O a. contract D a. bid/ofter/application D .. InltJalfillng
b. gram b. initial award b. material change
c. cooperative agreement c. post-award For Matorlal a..nge Only:
d. loan yaar quartst
e. loan guarantee
I. loan Insurance da18 01 last "'port
4. Nome end Acfdrus or Roporllng EnUty: I 5. II Reporlln; Entity In No. 41. Sub.ward.., enter Nanll and Acfdrol
o Prime D 5ubawardn Tier . if known: I Prime:
1
I
!
i
,
Co ngresslonal 0 Is trlcl. i/known:
6. Fodo."IOoputmenIlAgency:
Congruslonal Olstrict. il known:
7. Federa: Program NamelDucnpUon:
CFDA Num~r. if applicable:
a. F~eraJ AcUon Number, if !<nown:
9. Awerd Amount, it known:
S
10L Namo end Address of Lobbying Roglslrant
Qf indivicfuaJ. last name. first name, MI):
b. Individuals Perlarmlng SIMoes (indudlng add",... if cilferant !rom No.1
(Iasr name. ~rst name. MIl:
NONE DONE
". In/ormaUon requested through this form is authorized by 5ec.319. i
Pub.L 101-121. 103 SIal 750, asamendedbysec.10;Pub.L 104. ! Slgnalur.:
65. Stal. 700 (31 U.5.C. 1352). This disclosure 01 lobbying actiVitillS I
is a material representation 01 lact upon which reRance was placed !
by the above when this transactfon was made or entered into. This ! Prlnl Name:
disclosure Is required pursUanll031 U.5.C. 1352. This In/ormation i
will be reported 10 the Congress semiannually and will be available "
lor public Inspection. Any person who tails to /1Ie the required T1tIo:
disclosure shall be subject to a civil penalty 0/ not less than $10.000 :
and not more than $100.000 lor llach such /ailure. i
Gary A. DuBrueler
Director
540-665-5618 Dal.: 8-14-03
Authorlzod lor Local R.producU<
Slandanl Fonn.LLL (1/9
U.S. Department of Justice
Office of Justice Programs
Office of the Comptroller
CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND
OTHER RESPONSIBILITY MATTERS; AND DRUG-FREE WORKPLACE REQUIREMENTS
Applicants should refer to the rezulations cited below to determine the certification to which they arc required to attest. Applicants should als
review the inslructions for certification included in the regulations before completing this form. Signature of this form provides for complianc
with certification requirements under 28 CFR Part 69, "New Restrictions on Lobbying" and 28 CFR Part 67, "Government-wIde Debarment
and Suspension (Nonpro-curement) and Government-wide Requirements for Drug- Free Workplace (Grants)." The certifications shall be
treated as a material representation of fact upon which reliance will be placed when the Department of Justice determines to award the covere
transaction, grant, or cooperative agreement.
I. LOBBYI1~G
As required by Section 1352, Title 31 of the U.S. Code, and
implemented at 28 CFR Part 69, for persons entering into a
grant or cooperative agreement over S I 00,000, as defined at
28 CFR Part 69, the applicant certifies that:
(a) No Federal appropriated funds have been paid or will be
paid. by or on behalf of the undersigned. to any person for in-
fluencing or attempting to influence an officer or employee of any
agency, a Member ofCongrcss, an officer or employee of
Congress, or an employee of a Member of Congress in con-
nection with the making of any Federal gran~ the entering into
of any cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any Federal grant or
cooperative agreement;
(b) If any funds other than Federal appropriated funds have been
paid or will be paid to any person for influencing or at-
tempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or
an employee ofa Member of Congress in connection with this
Federal grant or cooperatilQ: agreement, the undersigned shall
complete and submit Standard Form - LLL, "Disclosure of
Lobbying Activities," in accordance with its instructions;
(c) The undersigned shall require that the language of this cer-
tification be included in the;award documents for all sub awards
at all tiers (including sub grants, contracts under grants and
cooperative agreements, and subcontracts) and that all sub-
recipients shall certify and disclose accordingly.
1. DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY l'rtA TIERS
(DIRECT RECIPIENT)
As required by Executive Order 12549, Debarment and
Suspension, 3lId implemented at 28 CFR Part 67, for prospec-
tive participants in primary covered transactions, as defined at 28
CFR Part 67, Section 67.510-
A. The applic3llt certifies that it and its principals:
(a) Arc not presently debarred, suspended, proposed for debar-
ment, declared ineligible, sentenced to a denial of Federal
benefits by a State or Federal court, or voluntarily excluded
from covered transactions by any Federal department or agency;
(b) Have not within a three-year period preceding this application
been convicted of or had a civil judgment rendered against them
for commission of fraud or a criminal otTense in connec-
public (Federal, State, or local) transaction or contract under a
public transaction; violation of Federal or State antitrust statutes
or commission of embezzlement,. theft, for&:ery, .
bribery, falsification or destruction of records, making false:
statements, or receiving stolen property;
(c) Are not presently indicted for or otherwise: criminally or
civilly charged by a governmental entity (Federal, State, or
local) with commission of any of the offenses enumerated in
paragraph (IXb) of this certification; and.
(d) Have not within a three-year period pr~ceding this application
had one or more public transactions (Federal, State, or
local) terminated for cause or default; and
B. Where the applicant is unable to certify to any ofthl:'
statements in this certification, he or she shall attach an
explanation to this application.
3. DRUG-FREE WORKPLACE
(GRANTEES OTHER THAN INDIVIDUALS)
As required by the Drug-Free Workplace Act of 198.8. and
implemented at 28 CFR Part 67, Subpart F, for grantees. as
defined at 28 CFR Part 67 Sections 67.615 and 67.620-
A. The applicant certifies that it will or will continue to provide
a drug-free workplace by:
(a) Publishing a statement notifying employees that the
unlawful manufacture, distribution, dispensing, possession, or
use oCa controlled substance is prohibited in the grantee's
workplace and specifying the actions that will be l<1ken against
employees for violation of such prohibition;
(b) Establishing an on-going drug-free awareness program to
inform employees about-
(I) The dangers of drug abuse in the workplace;
(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,
C I) Abide by the terms ofthe statement; and
(2) Notify !he employer in writing of his or heT conviction for a
violation of a criminal drug statute occurring in the workplace
no later than five calendar days after such conviction;
(e) Notifying the agcncy, in writing, within 10 c:alendar days
after rcceiving 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: Department of Justice, Office of
Justice prozrams, ATIN: Control Desk, 810 l' Street, N.W..
Washington, D.C. 20531. Notice shall include the identification
number(s) of each affected grant;
(f) Takine one of the following actions, within 30 calendar days
of rcceivinz notice under subparagn,ph (d)(2), with respect to
any employec who is so convicted-
(I) Taking appropriate personnel action against such an
employee, up to and including termination, consistent wi!h the
requirements of the Rehabilitation Act of 1973, as amended; or
(2) Requiring such employee to participate Satisfactorily in a
drug abllSe assistance or rehabilitation program approved for
such purposes by a Federal, State. Dr local health, law
enforcement. or other appropriate agency;
Cg) Making a good faith effort to continue to maintain a drug-
free workplace through implementation of paragraphs (a), (b),
(c), (d), (e), and (f).
B. The grantee may insert in the space provided below the
site(s) for the performance of work done in connection with !he
specific grant:
Place of Performance (Street address, city, county, state, zip
code)
.
Check _if there are workplaces on file that arc not identified
here.
Section 67, 630 of the regulations provides that a grantc:c that
is a State may elect to make one certification in each Federal
flSc:al year. A copy of which should be included with each ap-
plication for Department of Justice funding. States and State
agencies may elect to USc OJP Form 4061n.
Check _if the State has elected to complete OJP Fonn 4061n.
DRUG.FREE WORKPLACE
(GRANTEES WHO ARE INDIVIDUALS)
As required by the Drug-Free Workplace Act of 1988, and
implemented at 28 CFR Part 67, Subpart F, for grantees, as
defined at 28 CFR Part 67; Sections 67.61S and 67.620--
A. As a condition of the grant, I certify that I will not engage
in the unlawful manufaeturc, distribution, dispensing, posses-
sion. or use of a controlled substance in conducting any
activity with the grant; and .
B. If convicted of a criminal drug offense resulting from a
violation occurring during the conduct of any grant activ'ity,1
will report the conviction, in writing, within 10 calendar dlys
of the conviction, to: Department of Justice. Office of Justice
As the duly authorized representative of the applicant, I hereby cenify that the applicant will comply with the above.certifications.
I. Grantee Name and Address: County of Frederick, VA
107 North Kent Street
Winchester, VA 22601
2003 Office of Domestic Preparedness Equipment Program Grant
2. Application Number and/or Project Name
M~. Garv A. DuBrueler, Di~ector
4. Typed Name and Title of Authorized Representative
~/~~
5. Signature
OW FORo". ..061:6 KCPt.ACE$ OJP FOL'tS ~":. .aOb111 AND AD6-\S4 WH1Cll A1\E. OBSOLETE.
Tax 10 #54-6001?90
3. G<1ll\tee IRSNendor Number
8/14/03
6. Date
-u S. CicwernmClllt Pri,tIIinl OfTicc 1996 . .&0$..0.. 7f.4CO 1.&