HomeMy WebLinkAboutContract 2025-088A2025-088A
THIS SECTION FOR STATE USE ONLY
FEMA-11,-DR-FL ❑ Standard HMGP ❑ 5% Initiative Application ❑ Application Complete
❑ Initial Submission or ❑ Re- Submission
Support Documents Eligible Applicant
❑ Conforms w/ State 409 Plan ® State or Local Government
❑ In Declared Area ❑ Private Non -Profit (Tax ID Received)
❑ Statewide ❑ Recognized Indian Tribe or Tribal Organization
Community NFIP Status: (Check all that apply) LMS Ranking:
❑ Participating Community ID#: County: Lake
❑ In Good Standing ❑ Non -Participating ❑ CRS
State Application ID: 142094
Project Type(s)
❑ Wind
❑ Flood
® Other: Generator
This application is for all Federal Emergency Management Agency (FEMA Region IV) Hazard Mitigation Grant Program (HMGP)
proposals. Complete ALL sections and provide the documents requested. If you require technical assistance, contact the Florida
Division of Emergency Management at DEM—HazardMitigationGrantProgram@em.myflorida.com.
Section I — Applicant
A. Applicant Instruction: Complete all sections that correspond with the type of proposed project
Application Sections I-iV.
All Applicants must complete these sections
Environmental Review:
All Applicants must complete these sections
Maintenance Agreement:
Any Applications involving public property, public ownership, or management
of property
Flood Control — Drainage
Acquisition, Elevation, Dry Flood Proofing, Drainage improvements, Flood
Improvement Worksheet:
Control Measures, Floodplain and Stream Restoration, and Flood Diversion
— one worksheet per structure
Generator Worksheet:
Permanent, portable generators, and permanent emergency standby pumps
Tornado Safe Room Worksheet:
New Safe Room, Retrofit of existing structure, Community Safe Room,
Residential Safe Room
Hurricane Safe Room Worksheet:
New Safe Room, Retrofit of existing structure
Wind Retrofit Worksheet:
Wind Retrofit projects only — one worksheet per structure
Wildfire Worksheet:
Defensible Space, Hazardous Fuels Reduction, Ignition Resistant
Construction, other
Drought Worksheet:
Aquifers, other
Utility Mitigation Worksheet
Upgrades to sewer systems, upgrading electrical components for a utility,
undergrounding electrical systems, etc.
Request for Public Assistance
FEMA Form 90-49 (Request for Public Assistance): All applicants must
Form:
complete, if applicable.
Acquisition Forms:
If project type is Acquisition, these forms must be completed.
(Only one of the two Notice of Voluntary Interest forms is necessary.)
Model Statement of Assurances for Property Acquisition Projects
Declaration and Release
Notice of Voluntary Interest (Town Hall Version)
Notice of Voluntary interest (Single Site Version)
Statement of Voluntary Participation
FEMA Model Deed Restriction Language
Application Completeness
All applicants are recommended to complete this checklist and utilize the
Guidance / Checklist:
guidance for completing the application.
1
27P-22- 007 F A C FDEM Form No HMGP Application (01-2020) (Eff 01-2020)
B. Applicant Information:
FEMA-4673-DR-FL DISASTER NAME: Ian
Title of Project: Station 3 Generator
1. Applicant (Organization): City of Clermont Fire Department
2. Applicant Type: ® State or Local Government ❑ Native American Tribe ❑ Private Non -Profit ❑ Special District
3. County: Lake
4. State Legislative Senate District(s): 32; State Legislative House District(s): 22 ;
Congressional House District(s): FL15
5. Federal Tax I.D. Number: 59-6000290
6. Data Universal Numbering System (DUNS): 619250710
7. Federal Information Processing Standards (FIPS) Code`: 069-12925-0 (*if your FIPS code is not known, see
guidance)
8. National Flood Insurance Program (NFIP) Community Identification Number: 120133
(this number can be obtained from the FIRM map for your area)
9. Point of Contact: (Applicant staff serving as the coordinator of project)
®Ms. ❑Mr. First Name: Rick Last Name: Casler
Title: Assistant Chief Administration
Address: 439 W. HWY 50
City: Clermont
Telephone: 352 241-2217
10. Application Prepared by:
®Ms. ❑Mr. First Name: Kathy
Title: Assistant Chief Administration
Address: 439 W. HWY 50
City: Clermont
Telephone: 352-241-2213
State: FI Zip Code: 34711
Email: rcasler@clermontfl.org
Last Name: Johnston
State: FI Zip Code: 34711
Email: kjohnston@clermontfl.org
Organization: City of Clermont, Florida
11. Authorized Applicant Agent (proof of authorization authority required)
❑Ms. ®Mr. First Name: Tim Last Name: Murry
Title: _
Address: _
City:
Telephone:
Signature:
Date:
685 W. Montrose Street
Clermont
352-241-7358
State: FI Zip Code: 34711
Email: tmurry@clermontfl.org
12. Local Mitigation Strategy (LMS) Compliance
a. All proposed projects must be included in the county's Local Mitigation Strategy (LMS) Project List, and on file
with FDEM's Mitigation Bureau Planning Unit. Does your jurisdiction have a current FEMA Approved
Mitigation Plan and this project is listed? ® Yes ❑ No
b. Attached is a letter of endorsement for this project from the county's LMS Coordinator. ® Yes ❑ No
Ensure the LMS endorsement letter contains both the Total Estimated Projects Cost (Section IV. D.), along
with the Estimated Federal Share (Section IV. 1.1.) allocated to this project.
c. The LMS project list and endorsement letter both have an estimated cost column and Federal Share amount
that is within $500.00 between the two. ® Yes ❑ No
13. Has this project been submitted under a previous disaster event? ® No
2
27P-22-.007 F.A.0 FDEM Form No. HMGP Application (01-2020) (Eff. 01-2020)
❑ Yes, provide the disaster number and project number (as applicable):
27P-22- 007 F A C FDEM Form No HMGP Application (01-2020) (Eff 01-2020)
Section II — Project Description
A. Hazards to be Mitigated / Level of Protection
1. Select the type of hazards the proposed project will mitigate:
❑ Flood ® Wind ❑ Storm surge ❑ Wildfire ❑ Other (list):
2. Identify the type of proposed project:
❑ Elevation and retrofitting of residential or non-residential structure
❑ Acquisition and Relocation ❑ Acquisition and Demolition
❑ Wind retrofit ❑ Drainage project that reduces localized flooding
® Generator ❑ Other (explain)
3. List the total number of persons that will be protected by the proposed project (include immediate population
affected by the project only):
45000
4. List how many acres of "Total Impacted Area" is to be protected by the proposed project (include immediate area
affected by the project only):
2
5. Fill in the level of protection and the magnitude of event the proposed project will mitigate. (e.g. 23 structures
protected against the 100-year storm event (1 % chance)
1 structure(s) protected against the 100 -year storm event (10, 25, 50, 100, or 500 year storm event)
1 structure(s) protected against 160 mile per hour (mph) winds
Check all item(s) the project may impact
❑
Wetlands
❑ Water Quality
❑
Previously Undisturbed Soil
❑
Floodplain
❑ Coastal Zone
❑
Toxic or Hazardous Substances
❑
Historic Resources
❑ Fisheries
❑
Threatened & Endangered Species
❑
Vegetation Removal
❑ Public Controversy
®
Potential for Cumulative Impacts
®
Health & Safety
❑ Other
7. Engineered projects: If your project has been already designed and engineering information is available, attach
to your application ALL calculations, H&H study and design plans (e.g. Drainage Improvement, Erosion Control,
or other special project types). ® No ❑ Yes If so, see Attachment #(s)
B. Project Description, Scope of Work, and Protection Provided (Must be Completed in Detail)
Describe, in detail, the existing problem, the proposed project, and the scope of work. Explain how the proposed
project will solve the problem(s) and provide the level(s) of protection described in Part A. Also, if available, attach a
vendor's estimate and/or a contractor's bid for the scope of work. Ensure that each proposed project is mitigation
and not maintenance.
1. Describe the existing problems:
The existing Generator was manufactured in 2007 and put into sevice at station 3 in 2009. The generator is 16 years
old and insuficient for current emergency power needs. The generator has become unreliable and failed to start
when power was lost during a hurricane in 2022.
2. Describe the type(s) of protection that the proposed project will provide:
Generator will allow normal operations of critical emergency services during an extended period of interrupted utility
service.
3. Scope of Work (describe in detail what you are planning to do):
The proposed project includes the installation of a new generator and enclosure capable of providing full power to
fire station three for at least 72 hours post event.
4. Describe any other on -going or proposed projects in the area that may impact, positively or negatively, the
proposed HMGP Project:
NIA
4
27P-22- 007 F A C FDEM Form No Hh1GP Application (01-2020) (Eff. 01-2020)
Section III —Project Location (Fully describe the location of the proposed project)
A. Site
Describe the physical location of this project, including street numbers (or neighborhoods) and project site zip
code(s). Provide precise longitude and latitude coordinates for the site utilizing a hand-held global positioning
system (GPS) unit or the equivalent:
Site Location: Clermont Fire Station 103
Address(es): 2155 Legends Way, Clermont, Florida
GPS coordinates (decimal degree format): 28.548133,-81.715577
Project Zip Code(s): 34711
2. Titleholder: City of Clermont
3. Is the project site seaward of the Coastal Construction Control Line (CCCL)? ❑ Yes ® No
4. Provide the number of each structure type (listed below) in the project area that will be affected by the project.
Include all structures in project area.
❑ Residential property:
❑ Businesses/commercial property:
❑ Other:
® Public buildings: 1
❑ Schools/hospitals/houses of worship: _
B. Flood Insurance Rate Map (FIRM) Showing Project Site
1.0
Attach one (1) copy of the FIRM map, a copy of the panel information from the FIRM, and, if available,
the Floodway Map. FIRM maps are required for this application (if published for your area). Also,
all attached maps must have the project site and structures clearly marked on the map. FIRMS
are typically available from your local floodplain administrator who may be located in a planning, zoning,
or engineering office. Maps can also be ordered from the Map Service Center at 1-800-358-9616. For
more information about FIRMs, contact your local agencies or visit the FIRM site on the FEMA Web -
page at https:Hmsc.fema.gov/portal.
2. Using the FIRM, determine the flood zone(s) of the project site (Check all zones in the project area)
(See FIRM legend for flood zone explanations) (A Zone must be identified)
❑
VE or V 1-30 ® AE or A 1-30
❑
AO or AH ❑ A no base flood elevationgiven)
❑
B or X shaded ❑ C or X unshaded
❑
Floodwa ❑
❑
Coastal Barrier Resource Act (CBRA) Zone (Federal regulations strictly limit Federal funding for projects
in this Zone; coordinate with your state agency before submitting an application for a CBRA Zone project).
3. ❑
If the FIRM Map for your area is not published, attach a copy of the Flood Hazard Boundary Map
FHBM for your area, with the project site and structures clearly marked on the map.
4. ❑
Attach a copy of a Model Acknowledgement of Conditions for Mitigation in Special Flood Hazard Area
C. Maps with Project Site and Photographs
1.0 Attach a copy of a city or county scale map (large enough to show the entire project area) with the project
site and structures marked on the map.
2. ® Attach a USGS 1:24,000 TOPO map with project site clearly marked on the map.
3. ❑ For acquisition or elevation projects, include copy of Parcel Map (Tax Map, Property Identification Map,
etc.) showing each property to be acquired or elevated. Include the Tax ID numbers for each parcel, and
Parcel information — including year built and foundation.
4. ® Attach photographs (at a minimum 4 photographs) for each project site per application. The photographs
should be representative of the project area, including any relevant streams, creeks, rivers, etc. and
drainage areas that affect the project site or will be affected by the project, and labeled. For each structure,
include the following angles: front, back and both sides.
6
27P-22-.007 F_A.0 FDEM Form No. HMGP Application (01-2020) (Eff. 01-2020)
Section IV — BudgeVCosts
In order to assist applicants with filling out the following Budget section, we have provided the following instructions for
your convenience. For this section, we ask that you provide details of all the estimated costs of the project, as it is used
for the benefit -costs analysis as well as for the feasibility and effectiveness review.
For the cost sections relating to Materials, Labor, and Fees, it is important to note,
• Lump sums without supporting documentation showing a breakdown of those costs are not acceptable. For
those items that will not fit in the spaces provided, attach the appropriate documentation to your application.
• Identify your match sources in sections B and I.
• Sub -Total cells will auto sum the costs in their respective columns.
• Do not factor management costs into parts A-C. If management costs are being requested, see part G.
• Contingency Costs need to be justified and reported as a separate line item in part E of this section. From left to
right in that part, enter the desired percentage (maximum 5% of Material/Labor), the amount the percentage is to
be applied to, and the resulting amount. PLEASE NOTE- These cells will not auto -calculate across the row, but
the final cell will be calculated into the Final Project Cost below it. Take care that everything is calculated
correctly.
• Pre -Award Costs: costs must be identified as a separate line item, AND a completed HMGP Pre -Award Cost
Request Form MUST be submitted with this application, detailing the items/cost and requested start date.
• Mark all In -kind (donated) services with ("); In-house (employee) services with ("'), per each line item.
• All funding sources (In -kind, In-house, Global Match, and Other Agencies) must be identified (below) AND
identified on the Funding Sources - Section IV I.
For project management costs, in compliance with Disaster Relief and Recovery Act of 2018 (DRRA) and the subsequent
FEMA Interim Policy #104-11-1, the Florida Division of Emergency Management has included a section for applicants to
request, or refuse, project management funds that are available to them. Under this new policy, HMGP projects awarded
under disasters declared on or after August 1, 2017, are eligible for project management costs up to 5 percent of their
total project costs.
Applicants choosing to apply for this funding must detail the specific administrative costs in Part G of this section. These
costs must be eligible administrative costs, conforming to the requirements set in 2 CFR Part 200 Subpart E. Applicants
must ensure that their administrative costs are reasonable, allowable, allocable, and necessary for the performance of the
federal award.
The State will allot these management costs on a project -by -project basis per the amount requested by the sub -recipient,
up to 5 percent of the total project cost. A sub -recipient may request less than this, but no higher. These management
costs will be considered a separate pool of funding, and WILL NOT affect a project's benefit -cost analysis.
Management costs will be reimbursed per reimbursement request, and no more than 5 percent of any given
reimbursement request amount. All management costs reimbursements will be contingent upon adequate documentation
from the sub -recipient.
Management costs will be reimbursed at 100 percent of the amount of management costs requested, so far as they are
adequately documented and are no more than 5 percent of the request. Any unused management costs at closeout
following the final payment will be de -obligated. If the final total project cost results in an under -run, management costs
will be reduced accordingly.
Applicants must make the determination to request or refuse management costs at the time of formal application
submittal. The State will accept the initial determination from the applicant. There will be no recourse from the State for
applicants wishing to change their initial determination after the application has been formally submitted.
27P-22- 007 F A C FDEM Form No. HMGP Application (01-2020) (Eff 01-2020)
A. Materials
B.
C.
A
Labor Include equipment costs. Indicate all "soft" or in -kind matches (**).
Fees Paid Include any other costs associated with the project.
Total Estimated Project Cost $111,970.00
E. Contingency Costs (maximum 5% of Material/Labor) 5.00% 5,599 $5,599.00-
F. Final Project Cost $117,569.00
Note: To be eligible for HMGP Pre -Award costs — the costs must be identified as a separate line item in the estimate above, AND a
completed HMGP Pre -Award Cost Request Form MUST be submitted with this application, detailing the items/cost requesting.
Mark all In -kind (donated) services with (**); In-house (employee) services with (***), per each line item.
8
27P-22-.007 F.A_C FDEM Form No. HMGP Application (01-2020) (Eff. 01-2020)
All funding sources (In -kind, In-house, Global Match, and Other Agencies) must be identified (above) AND identified on the Funding
Sources - Section IV I.
G. Project Management Costs
Based on the amount of total project cost being requested in Part D (above), your project is eligible for up to an
additional 5% of that amount for project management costs. Indicate below whether or not you would like to request
these funds and follow the directions for your selected choice.
Total Estimated Management Costs Available (5% of Total Project Costs) $5,878.45
Note: This number will be generated automatically after Part I is completed
❑ YES, I would like to requests these funds (Fill out the itemized table below, then continue to Part 1)*
® NO, I do not wish to request these funds. (continue to Part 1)*
Description Hours Rate Cost
H. Total Estimated Management Costs Requested $0.00
*Note: By selecting either "yes" or "no" the applicant is acknowledging that they understand what is being offered to them
as it is described in this application.
9
27P-22- 007 F A.0 FDEM Form No HMGP Application (01-2020) (Eff 01-2020)
Funding Sources (round figures to the nearest dollar)
The maximum FEMA share for HMGP projects is 75% The other 25% can be made up of State and Local funds as well
as in -kind services. HMGP funds may be packaged with other Federal funds, but other Federal funds (except for Federal
funds that lose their Federal identity at the State level, such as CDBG, and certain tribal funds) may not be used for the Non -
Federal share of the costs.
1. Estimated Federal Share
2. Non -Federal Shares
3. Estimated Local Shares
4.
5.
6.
7. Other Agency Share
(identify Non -Federal Agency and availability date)
A
E
$88,178.75
$29,390.25
75 % of Total (Maximum 75%)
25 % of Total (ash)
% of Total (In -Kind")
• of Total (In -House""")
% of Total (Global Match—')
% of Total
Total Funding sources from above $117,569.00 100.00% Total (Equals 100%)
❑**Identify proposed eligible activities directly related to project to be considered for In -Kind services in Section IV.C. Fees
❑***Identify proposed eligible activities directly related to project to be considered for In -House services in Section N.C. Fees
❑****Separate project applications must be submitted for each Global Match project.
Global Match Project Number and Title:
Total Estimated I Requested
Management Costs
Available
$5,878.45 5% of Total (Max Allowed)
J. Project Milestones/Schedule of Work
List the major milestones in this project by providing an estimated time -line for the critical activities not to exceed a period of 3
years (36-months) of performance. (e._q. Contractinq, Desipnin_q, En_-aineerinq, Permittinq, Inspections, closeout, etc.)
Milestone(s)
Number of Months to
Complete
State and local contracting
2
Construction lan/te finical specifications
5
Bidding/Local Procurement
4
Permitting
4
Construction/installation
15
Local ins ctions/Com liance
2
State final inspection
2
Closeout compliance
2
Total
36 Months
10
27P-22-.007 F.A.0 FDEM Form No. HMGP Application (01-2020) (Eff. 01-2020)
Section V. Environmental Review and Historic Preservation Compliance
(NOTE: This application cannot be processed if this section is not completed.)
Because the HMGP is a federally funded program, all projects are required to undergo an environmental and historic
preservation review as part of the grant application process. Moreover, all projects must comply with the National
Environmental Policy Act (NEPA) and associated Federal, State, Tribal, and Local statutes to obtain funding. NO WORK
can be done prior to the NEPA review process. If work is done on your proposed project before the NEPA review
is completed, it will NOT be eligible for Federal funding.
A. The following information is required for the Environmental and Historic Preservation review:
All projects must have adequate documentation to determine if the proposed project complies with NEPA and
associated statutes. The State Environmental Staff provide comprehensive NEPA technical assistance for Applicants,
with their consent, to complete the NEPA review. The type and quantity of NEPA documents required to make this
determination varies depending upon the project's size, location, and complexity. However, at a minimum, provide the
applicable documentation from this section to facilitate the NEPA compliance process.
1. ® Detailed project description, scope of work, and budget/costs (Section II and Section IV of this application).
2. ® Project area maps (Section III, part B & C of this application).
3. ® Project area/structure photographs (Section III, part C of this application).
4. ® Preliminary project plans.
5. ® Project alternatives description and impacts (Section V of the application).
6. ® Complete the applicable project worksheets.
Documentation showing dates of construction are required for all structures.
7. ® Environmental Justice — Provide any applicable information or documentation regarding low income or
minority populations in the project area. See Section V.B of this application for details.
8. ® Provide any applicable information or documentation referenced on the Information and Documentation
Requirements by Project Type below.
B. Executive Order 12898; Environmental Justice for Low Income and Minority Population:
1. Are there low income or minority populations in the project area or adjacent to the project area?
® No ❑ Yes; describe any disproportionate and adverse effects to these populations:
2. ❑ To help evaluate the impact of the project, explain below or attach any other information that describes the
population, or portion of the population, that would be either disproportionately or adversely affected. Include specific
efforts to address the adverse impacts in your proposal narrative and budget.
N/A
11
271P-22-.007 F.A.0 FDEM Form No HMGP Application (01-2020) (Eff. 01-2020)
C. Tribal Consultation (Information Required)
Section 106 of the National Historic Preservation Act (NHPA) requires federal agencies to take into account the effect
of their undertakings on historic properties. The NHPA requires that agencies must complete this process prior to the
expenditure of any Federal funds on the undertaking. A Tribal Consultation is required for any project disturbing ground
or moving soil, including but not limited to: drainage projects; demolition; construction; elevation; communication towers;
tree removal; utility improvements.
1. Describe the current and future use of the project location. A land use map may be provided in lieu of a written
description.
N/A
2. Provide information on any known site work or historic uses for project location.
N/A
❑ Attach a copy of a city or county scale map (large enough to show the entire project area) with the horizontal
limits (feet) and vertical depths (square feet) of all anticipated ground disturbance of 3 inches or more.
D. Alternative Actions (information Required)
The NEPA process requires that at least two alternative actions be considered that address the same problem/issue
as the proposed project. In this section, list two feasible alternative projects to mitigate the hazards faced in the
project area. One alternative is the "No Action Alternative".
1. No Action Alternative
Discuss the impacts on the project area if no action is taken.
If this project is not funded and a disaster occurs with an interruption of electrical utility services to the fire station,
our ability to provide critical services or manage an effective response would be hampered. Services could
potentially have to be shifted to adjacent stations with active utilities resulting in reduced coverage.
2. Other Feasible Alternative
Describe a feasible alternative project that would be the next best solution if the primary alternative is not
accomplished. This could be an entirely different mitigation method or a significant modification to the design of
the current proposed project. Include a Scope of Work, engineering details (if applicable), estimated budget and
the impacts of this alternative. Complete all of parts a-e (below).
a. Project Description for the Alternative
Describe, in detail, the alternative project, and explain how the alternative project will solve the problem(s)
and/or provide protection from the hazard(s). Also, provide pros and cons for this alternative and a reason for
why it was not selected.
An alternative to the propsed project would be to contract with a private company for a 3-phase generator to be
delivered to the station and set up in times of disaster to provide the station with power. This would cause a
delay in citizens receiving emergency ais and cause a disruption to critcal services.
b. Project Location of the Alternative (describe briefly, if different from proposed project)
The location would be the same as the proposed project.
❑ Attach a map or diagram showing the alternative site in relation to the proposed project site (if different
from proposed project)
c. Scope of Work for Alternative Project
To place a portable, 3-phase generator in the same location to provide electrical services to Fire Station 103.
The cost would be approximately $2200 per week in rental fees, and does not include cost of delivery, set up
fuel or cables. Costs in section E include fuel costs for 1 month at 2023 fuel prices. The cost of installation of a
3 phase elecrical adaptor or switch would need to be installed at an estimated cost of $27,500.00.
12
27P-22- 007 F.A.0 FDEM Form No HMGP Application (01-2020) (Eff. 01-2020)
d. Impacts of Alternative Project
Discuss the impact of this alternative on the project area. Include comments on these issues as appropriate:
Environmental Justice, Endangered Species, Wetlands, Hydrology (Upstream and Downstream Surface
Water Impacts), Floodplain/Floodway, Historic Preservation and Hazardous Materials.
Theft damage and other potential issues may arise from having a portable generator at the station. Inflated
rental rates and generator availablity during a disaster are also concerns. Working with an outdise vendor, the
city cannot guarantee equipment and/or fuel availability during the disaster.
e. Estimated Budget/Costs for Alternative Project
In this section, provide details of all the estimated costs of the alternative project (round figures to the
nearest dollar). A lump sum budget is acceptable.
Materials:
$19,500.00
Labor:
$8,000.00
Fees:
$8,800.00
Total Estimated Project Cost:
$36,300.00
13
27P-22- 007 FA C FDEM Form No. HMGP Application (01-2020) (Eff_ 01-2020)
HMGP ENVIRONMENTAL REVIEW
Information and Documentation Requirements by Project Type
Retrofits to Existing Facilities/Structures
Elevations
Acquisitions with Demolition
✓ Dates of Construction
✓ Ground disturbance map for projects with 3 inches or more of ground disturbance
✓ Structure photographs
Drainage Improvements
✓ Engineering plans/drawings
✓ Permit or Exemption letter to address any modifications to water bodies and
wetlands
o Department of Environmental Protection
o Water Management District
o U.S. Army Corps of Engineers
✓ Ground disturbance map for projects with 3 inches or more of ground disturbance.
✓ Concurrence from U.S. Fish and Wildlife addressing any impacts to wildlife, particularly
endangered and threatened species and their habitats.
✓ If the project is in a coastal area, attach a letter from the National Marine Fisheries
Service addressing impacts to marine resources.
✓ Concurrence from Natural Resource Conservation Service if project is located outside
city limits and may impact prime or unique farmland.
✓ Concurrence from your Local Floodplain Manager — if project is located in a floodplain.
Note: This is a general guideline for most projects. However, there will be exceptions.
Consult with state environmental staff on project types not listed.
14
Section VI — Maintenance Agreement
All applicants whose proposed project involves the retrofit or modification of existing public property
or whose proposed project would result in the public ownership or management of property,
structures, or facilities, must first sign the following agreement prior to submitting the application to
FEMA.
(NOTE: Not applicable to projects solely related to residential or private property.)
The _____ Cit,, __of Clermont State of Florida, hereby
agrees that if it receives any Federal aid as a result of the attached project application, it will accept
responsibility, at its own expense if necessary, for the routine maintenance of any real property,
structures, or facilities acquired or constructed as a result of such Federal aid. Routine maintenance
shall include, but not be limited to, such responsibilities as keeping vacant land clear of debris, garbage,
and vermin; keeping stream channels, culverts, and storm drains clear of obstructions and debris; and
keeping detention ponds free of debris, trees, and woody growth.
The purpose of this agreement is to make clear the Sub -recipient's maintenance responsibilities
following project award and to show the Sub -recipient's acceptance of these responsibilities. It does
not replace, supersede, or add to any other maintenance responsibilities imposed by Federal law or
regulation and which are in force on the date of project award.
Signed by Tim Murry the duly authorized representative
(printed or typed name of signing official)
Mayor
(title)
This `L) (day) of �' - i (month), (year).
Signature' ---
*Note: The above signature must be by an individual with legal signing authority for the respective
local government or county (e.g., the Chairperson, Board of County Commissioners or the County
Manager, etc.)
15
Section VI — Maintenance Agreement
All applicants whose proposed project involves the retrofit or modification of existing public property
or whose proposed project would result in the public ownership or management of property,
structures, or facilities, must first sign the following agreement prior to submitting the application to
FEMA.
(NOTE: Not applicable to projects solely related to residential or private property.)
The City of Clermont , State of Florida, hereby
agrees that if it receives any Federal aid as a result of the attached project application, it will accept
responsibility, at its own expense if necessary, for the routine maintenance of any real property,
structures, or facilities acquired or constructed as a result of such Federal aid. Routine maintenance
shall include, but not be limited to, such responsibilities as keeping vacant land clear of debris, garbage,
and vermin; keeping stream channels, culverts, and storm drains clear of obstructions and debris; and
keeping detention ponds free of debris, trees, and woody growth.
The purpose of this agreement is to make clear the Sub -recipient's maintenance responsibilities
following project award and to show the Sub -recipient's acceptance of these responsibilities. It does
not replace, supersede, or add to any other maintenance responsibilities imposed by Federal law or
regulation and which are in force on the date of project award.
Signed by Tim Murry the duly authorized representative
(printed or typed name of signing official)
Mayor
(title)
This (day) of (month), (year).
Signature*
*Note: The above signature must be by an individual with legal signing authority for the respective
local government or county (e.g., the Chairperson, Board of County Commissioners or the County
Manager, etc.)
15
HMGP Application Completeness Guidance/Checklist
This guidance/checklist contains an explanation, example and/or reference for information requested in the application.
Use this list to assure your application is complete and includes the required information for HMGP projects. The appropriate
documentation must also be attached. It is important to note that this list is similar to the form that will be used during the
application sufficiency review by the HMGP staff.
Project Title: Generator and enlosure for Fire Station 103
Applicant: City of Clermont
Application Explanation of Information Required ✓
Information
Section
B. Applicant Information
FEMA_-DR-FL
Type in the four digit number FEMA assigned to the disaster that this application is
being submitted under. (Example: 4337, 4283
DISASTER NAME
Type in the Disaster name. (Example: Hurricane Irma, Tropical Storm Fay)
Title of Project
The project title should include: 1) Name of Applicant, 2) Name of Project, 3) Type of
Project. (Example: City of Tallahassee, City Hall Building, Wind Retrofit)
1. Applicant
Name of organization applying. Must be an eligible applicant.
2. Applicant Type
State or local government, recognized Native American tribe, or private non-profit
organization. If private non-profit, attach documentation showing legal status as a
501(C). (Example: IRS letter, Tax Exempt Certificate)
3. County
Indicate county in which the project is located.
4. State Legislative
Specify the appropriate State Senate, House and Congressional District code for the
and
project site. For multiple sites, list codes for each site.
Congressional
http://www.myfloridahouse.gov/sections/representatives/myrepresentative.aspx
District(s)
5. Federal Tax I.D.
List the Federal Employer's Identification Number (FEIN), also known as Federal Tax
Number
Identification number, 9-digit code. May be obtained from your finance/accounting
department.
6. DUNS Number
Include Data Universal Numbering System (DUNS) number in appropriate location
on application. Typically, this number can be obtain through your finance
department. If not, use the link below to look up your entity. If none, exists you can
use the same link to request one.
hftps://www.dnb.com/duns-number.html
7. FIPS Code
List the Federal Information Processing Standards (FIPS) Code. May be obtained
from your finance/accounting/grants department. If none, submit FEMA Form 90-49.
See state website under the relevant disaster
htt s://floddadisaster.or /dem/miti ation/hazard-miti ation- rant- ro ram/
8. NFIP ID Number
List the National Flood Insurance Program (NFIP) number. You must be a
participating NFIP member to be eligible for HMGP funding. Make sure that the
number is the same as the panel number on the FIRM provided with the application.
9. Point of Contact
Provide all pertinent information for the point of contact. This person serves as the
coordinator of the project. If this information changes once the application is
submitted, please contact the HMGP staff immediately.
10. Application
Provide the preparer information. May be different from the point of contact (line 9)
Prepared By
and/or the applicant's agent line 11).
11. Authorized
An authorized agent must sign the application.
Applicant Agent
An authorized agent is the chief elected official of a local government who has signature
authority, so for a county it would be the Chairman of the Board of County Commissioners and
for a municipality it would be the Mayor (the exact title sometimes varies). Any local
government may delegate this authority to a subordinate official (like a City or County
Manager) by resolution of the governing body (the Board of County Commissioners or Board
of City Commissioners). If a local government delegates signature authority, a copy of the
resolution by the governing body authorizing the signature authority for the individual signing
must beprovided."
16
For Private Non -Profit: A member of its Board of Directors or whoever has authority
to authorize funding for such a project. If this task is delegated down, a copy of a
resolution confirming this must be provided.
12. LMS Compliance
a) LMS Project List:
All proposed projects must be included in the county's Local Mitigation Strategy
(LMS) Project List and must be on file with FDEM's Mitigation Bureau Planning
Unit.
b) LMS Endorsement Letter:
All proposed projects must include an endorsement letter from the county's Local
Mitigation Strategy Coordinator. You may use 1 letter as long as it includes every
proposed project.
c) Estimated Costs & Application Costs:
The LMS Project List must include an Estimated Cost column and each HMGP
project application must be within $500.00 of that Project List's estimated cost.
Also ensure that the Federal Cost Share indicated on the LMS Coordinator's
Endorsement Letter exactly matches the Federal Cost Share indicated within the
application. Ensure the LMS endorsement letter contains both the Total
Estimated Projects Cost (Section IV. D.), along with the Estimated Federal Share
(Section IV. 1.1.) allocated to this project.
A letter of endorsement for the project and its priority number from the Local
Mitigation Strategy Project List must be included. Refer to Sample LMS Letter.
Applications without a letter of endorsement will not be processed. (44 CFR 201.6
Local Mitigation Plans
13. Previous
If the project has been previously submitted under another disaster, provide the
Submittal
disaster number, the project number, and the titre of the project.
Section 11 - Project DescriAtion
A. Hazards to be Mitigated/Level of Protection
1. Type of Hazards
Type of Hazards the Proposed Project will Mitigate: Identify the hazard(s) that the
proposed project will mitigate. More than one hazard may be selected.
2. Identify the Type
Identify the Type of Proposed Project: Describe the mitigation project being
of Project
proposed. (Example: drainage, wind retrofit, generator etc.)
3. Number of
Explain how many people will be protected by or benefit from the proposed project.
Persons
(Example: A drainage project improving a residential area of 23 homes, with an
Protected
average household of 2 people = 46 people)
4. Total Impacted
Explain how many acres will be impacted from the proposed project:
Area
Drainage/Berm/Pond/Culverts/Flood hazard projects: combination of the area to be
protected and ground disturbance must not exceed 25 acres.
5. Level of
Specify the level of protection and magnitude of the event the proposed project will
Protection
mitigate. Attach support documentation that verifies the stated level of protection.
(Example: In a wind retrofit project, it will be the design wind speed to comply with
the Florida Building Code requirements. In a drainage project, it will be the
implemented design level, e.g. a 25-year FDOT design standard for culvert.)
6. Project Impact
Identify all the items the project may impact or are within the project area.
7. Engineered
Include available engineering calculations, studies, and designs for the proposed
Projects (e.g.
project showing results from applied Recurrence Interval scenarios before and after
Drainage)
mitigation. (Number of structures, building replacement value, depth of the water,
structural damages, content damages, displacement, road closures, etc.
B. Project Description, Scope of Work, and Protection Provided (Must be Completed in Detail)
1. Existing Problem
Describe the existing problem, location, source of the hazard, and the history and
1171
extent of the damage. Include newspaper articles, insurance documentation,
photographs, etc. If this project is eligible for PA (406) mitigation activities, describe
the 406 activities.
2. Type of Protection
Determine how the funding will solve the existing problem and provide protection.
3. Scope of Work:
What the Project Proposes to Do: Determine the work to be done. The scope of
work must meet eligibility based on HMGP regulations and guidance. Explain how
the proposed problem will be solved. NOTE: The proposed project must be a
17
mitigation action, not maintenance.) Does the proposed project solve a problem
independently or constitute a functional part of a solution where there is assurance
that the project as a whole will be completed (44 CFR 206.434[c][4])? Does the
proposed project address a problem that has been repetitive or that poses a
significant risk to public health and safety if left unresolved (44 CFR 206.434[c](5]CJ)?
Projects that merely identify or analyze hazards or problems are not eligible.
4. On -Going or
Determine if other projects, zoning changes, etc. are planned (particularly in the
Proposed
same watershed if flooding is being addressed) that may negatively or positively
Projects in the
impact the proposed project. If there is a drainage project or downstream issue
Area
elsewhere, it may eliminate the current flooding issue, erasing the need for the
proposed project. Response applies to drainage and acquisition projects. N/A is
appropriate in wind retrofit shutter projects only. If this project is also being
considered under the Public Assistance Program (406), describe in detail the 406
mitigation activities and/or services. Do not include project costs associated with this
HMGP application.
Section 111 - Project Location
A. Site
1. Physical Location
List the physical location of the project site(s) including the street number(s), zip
code(s) and GPS coordinates (latitude/longitude, in decimal degrees). The physical
address must correspond with the address locations specified on maps submitted
with the application.
2. Titleholder
Provide the titleholder's name.
3. Project Seaward
Determine if the project site is located seaward of the Coastal Construction Control
of the CCCL?
Line. hftps:/Moddadep.gov/water/coastal-construction-control-line
4. Number and
Specify the number and type of properties affected by the project.
1171
Types of
(Example: Drainage project that affects 100 homes, 15 businesses and 2 schools.)
Structures
What does the project protect? Should have a number next to the box that is
Affected
I checked. See Section II, Item A.5 — detail of these totals
B. Flood Insurance Rate Map (FIRM) Showing Project Site
1. Copies of FIRM
Attach a copy (or copies) of the FIRM and clearly identify the project site. The FIRM
Panel number must be included. To obtain a FIRM map, go to
hftps:Hmsc.fema.gov/portal. See instructions on How to make a FIRMette.
2. Flood Zone
Specify the flood zone(s) of the project site(s). If project is located in a Special
1171
Determination
Flood Hazard Area. Amount of coverage must be equal to or greater than the
amount of Federal mitigation funding obligated to the project.
3. Flood Hazard
Not required if a copy of the FIRM is attached.
Boundary Map
FHBM
4. Model
The Model Acknowledgement of Conditions for Mitigation in Special Flood Hazard
Acknowledgement
Area form is required for those structures receiving federal funds that will also remain
of Conditions
in the special flood hazard area by the close of the project. This form is required at
form
application. It can be found on FEMA's website at hftps://www.fema.gov/media-
library/assets/documents/1 5677
D. C. Maps with Project Site and Photographs
1. City/County Map
The project site and staging location (if applicable) should be clearly marked on a
with Project Site
legible City/County map. The map should be large enough to show the project site.
More than one map may be required.
2. USGS TOPO with
The project site should be clearly marked on a legible USGS 1:24,000 TOPO map.
Project Site
To obtain a TOPO map, go to hdps://ngmdb.usgs.gov/topoview/
3. Parcel/Tax Map
A Parcel, Tax or Property Identification map is required only for acquisition and
elevation projects. The location of the structure must be clearly identified.
4. Site Photographs
At least four photographs are required that clearly identify the project site. The
photos must be representative of the project area, including any relevant streams,
creeks, rivers, etc., and drainage areas that affect the project site or will be affected
by the project. The front, back and both side angles are required for each structure.
For acquisition and elevation projects, a photo taken away from the structure (in front
toward the street, and in back toward backyard) to show the area along with
18
photographs of specific elements of the structure affected by the project (windows for
shutters or window replacements) should also be provided. Label photographs
appropriately. In addition, CDs may be submitted.
Section IV - BudQeUCosts
Make sure all calculations are correct. Provide a breakdown of materials, labor and fees for the proposed project. Support
documentation must be attached, i.e. vendor's quote, professional estimate (from engineer, architect, local building official,
etc.). The proposed budget line items should represent allowable costs associated with the scope of work. Contingency
Cost should be included as a line item in the budget section, and justified — Maximum allowed is 5%, and is required to
complete this section; it will be used for the Benefit -Cost Analysis (BCA). Costs should be accurate, complete and
reasonable compared to industry standards. Make sure the total cost is correct on the entire application.
A. Materials
List materials and their associated costs. Provide breakdown.
B. Labor
Provide a breakdown of description, hours, rate, and cost or lump sum labor cost.
Can use in -kind contribution as part of the 25% match. (Attach support
documentation for in -kind, in-house to detail wages and salaries charged for any
contribution. No overtime wages can be used to satisfy match contributions).
C. Fees Paid
Provide a breakdown of associated fees i.e., consultants, studies, engineering,
permits, and project management. Maintenance is not an allowable cost under
HMGP. Pre -award costs may be requested See Pre -award Costs guidance).
D. Total Estimated
This number includes all project costs without contingency costs included. Make sure
Project Cost
all calculations are correct.
E. Contingency Cost
Per FEMA's HMA Guidance (Section VI Part D.3.4), a contingency cost is, "an
allowance in the total cost estimate to cover situations that cannot be fully defined at
the time the cost estimate is prepared but that will likely result in additional eligible
costs. Allowances for major project scope changes, unforeseen risks, or
extraordinary events may not be included as contingency costs."
The applicant may request up to 5% of material/labor costs. As with other line items,
the applicant must justify these contingency costs based on the nature of the project
at application.
If an applicant wants to include contingency costs, they will need to enter the
percentage that they require as well as what amount they want that percentage to be
applied to. Type the resulting calculation in the final cell on the right. These cells will
NOT auto -calculate. Be sure that they are calculated correctly.
F. Final Project Cost
This number includes any contingency costs that were requested. The final BCA will
use this number in its final calculation.
G. Project
After reading the guidance provided on pg. 5, select either YES or NO to indicate
Management
your need for management costs for this project.
Costs
If YES, provide a breakdown of description, hours, rate and costs for requested
management costs.
If NO, continue to Part I.
H. Total Estimated
This will auto complete based on what is entered into the cost cells above. Your
Management
request must not exceed 5 percent of the total project cost available for this project.
Costs Requested
I. Funding Sources (round figures to the nearest dollar)
The proposed sources of non-federal matching funds must meet eligibility requirements. (Except as provided by
Federal statute, a cost -sharing or matching requirement may not be met by costs bome by another Federal grant.) 2
CFR Part 200.306.
1. Estimated Federal
The estimated Federal share is generally 75%. If the Federal share is not 75%,
Share
assure actual amount is entered. It could be 50.1234% or 35.1234%, etc. of the total
dollar amount of project depending on county LMS allocation and priority. This figure
cannot exceed 75%.
2. Non -Federal Share
May include all 3 sources, i.e. cash, in -kind and global match, as long as the total is a
minimum of 25%. Match cannot be derived from a federal agency except Federal
funds that lose their federal identity (e.g., CDBG funding and certain tribal funding).
3. Cash
Cash- Local funding will be utilized for the non-federal share. Enter amount of cash
and percentage of total that amount represents.
4. Total In -Kind
May use materials, personnel, equipment, and supplies owned, controlled and
operated from within governing jurisdiction as an in -kind match. Third party in -kind
contributions would be volunteer services, employee services from other
19
organizations furnished free of charge, donated supplies, and loaned equipment or
space. The value placed on these resources must be at a fair market value and must
be documented. If in -kind is claimed from outside the applicant jurisdiction, it must be
cash only. ** Identify proposed eligible activities in Section IV B. and C. as a
separate line with In -kind written as a part of the description.
5. Total In-house
Sub -Recipient employees, equipment, etc. — internal services (must utilize the
Personnel Activity Report or the Equipment Activity Report for the Request for
Reimbursement
6. Total Project
Project (global) match must 1) meet all the eligibility requirements of HMGP; and 2)
(Global) Match
begin after FEMA's approval of the match project. A separate HMGP application
must be submitted for global match projects. Indicate which project(s) will be
matched. The global match is not required to be an identical project. Projects
submitted as global match for another project must meet the same period of
performance time constraints as the HMGP.
7. Other Agency
Identify Non -Federal Agency and availability date; provide the documentation from
Share
the agency. (e.g., CDBG funding, and certain tribal funding)
8. Total Funding
Total must represent (100%) of the total estimated project cost. Ensure that
percentages match corresponding cost -shares and the total matches the Budget (in
Section IV. F. - Total Estimated Project Cost).
9.
Your requested amount must be equal to or less than 5 percent of the total project
cost
J. Project Milestones/Schedule of Work
1. Milestones Identify the major milestones in the proposed project and provide an estimated time -
(Schedule) line (e.g. Designing, Engineering — 3 months, Permitting — 6 months, Procurement —
30 days, Installation — 6 months, Contracting — 1 month, Delays, Project
Implementation, Inspections, Closeout, etc.) for the critical activities not to exceed a
period of 3 years (36-months) for performance. Milestones should not be grouped
together but listed individually. Allot for the appropriate amount of time for final
ins ection and closeout about 3 months).
Section V - Environmental Review & Historic Preservation Compliance
No work can begin prior to the completion of the environmental (NEPA) review. In order for the Environmental staff to
conduct the NEPA review, all sections listed below must be completed.
1. Description, SOW
Detailed Project Description, Scope of Work & Budget/Costs.
& Budget
Complete Sections II & IV of the application.
2. Area Maps
Project area Maps - Attach a copy of the maps and clearly mark the project site, and
place the specific project structure(s) on map(s). Complete Section III, part B & C of
the application.
3. Project
Complete Section III part C of the application.
Area/Structure
Photographs
4. Preliminary Project
For shutters see the scope of work and for drainage & elevation see engineering
Plans
drawings.
5. Project
Complete Section V part D. of this application.
Alternatives
6. Project
Dates of construction are required for all structures. See worksheets.
Worksheets
7. Environmental
See Section V.B for applicable information.
Justice
Documentation
8. Information/
Provide any of the required documentation as listed at the end of Section V in the
Documentation
Information and Documentation Requirements by Project Type that may have already
Requirements by
been obtained.
Project Type
B. Executive Order 12398 Environmental Justice for Low Income and Minority Population
1. Disproportionate Determine if there are populations in either the project zip code or city that are
Effects I characterized as having a minority background or living below the poverty level. If ves.
20
complete the rest of Section V, part B. Describe any disproportionate effects that these
populations would experience if the project were completed.
2. Population
Describe the population affected by this project and the portion of the population
Affected
adversely impacted. Attach any documentation and list the attachments here.
C. Information required for Tribal Consultation
Documentation for I For all projects with any ground disturbing activities of 3 inches or more, complete
Tribal Consultation I Section V part C.
D. Alternative Actions
1. No Action
Discuss the impacts on the project area if no action is taken.
Alternative
2. Other Feasible
This is a FEMA and FDEM requirement for any Application Review. A narrative
Alternative Action
discussion of at least three project alternatives (from No Action to the most effective,
practical solution) and their impacts, both beneficial and detrimental is required. It is
expected that the jurisdiction has completed sufficient analysis to determine the
proposed project can be constructed as submitted and it supports the goals and
objectives of the FEMA approved hazard mitigation plan. Has the proposed project
been determined to be the most practical, effective and environmentally sound
alternative after consideration of a range of options? 44 CFR 206.434 c 5 iii
a. Project
It is very important and a requirement that an Alternative project is submitted.
Description
NEPA requires that at least three alternatives must be presented to mitigate the
problem. In addition to the proposed action and no action, one other feasible
alternative must be provided.
Describe the surrounding environment. Include information regarding both natural
b. Project Location of
the Alternative
(i.e., fish, wildlife, streams, soils, plant life) and built (i.e., public services, utilities,
land/shoreline use, population density) environments.
Describe how the alternative project will solve the problem and provide protection
c. Scope of Work —
Alternative Project
from the hazard. Provide enough detail to describe the project for the evaluation
panel to decide the best course of action for the state. Include any appropriate
diagrams, sketch maps, amount of materials and equipment, dimensions of project,
amount of time required to complete, etc.
d. Impacts of the
Alternative Project
Total cost is required.
e. Estimated
Budget/Costs for
the Alternative
Project
Detailed line items are not required. Just enter a total amount.
Materials, Labor,
and Fees Paid
Total Estimated
Total cost is required. Vendor quote is not required. A lump sum budget may be
Project Costs
submitted as justification to why this alternative was not chosen.
Section VI — Maintenance A reement
Maintenance Complete, sign and date the maintenance agreement. The maintenance agreement
Agreement must be signed by an individual with signature authority, preferably the authorized
agent.
Other Required Documentation
Go to www.floridadisaster.orq/dem/mitigation/hazard-mitigation-grant-program/ for additional documents
1. Maps
All maps must be included with the application.
2. FFATA Form
During contracting with the state, complete, sign and date the FFATA Project File
Form. Instructions are provided for your convenience in the document provided. This
is not required at the time of application submittal.
3. SFHA
Required for all projects in the Special Flood Hazard Area. Read and sign the SFHA
Acknowledgement
Acknowledgement of Conditions document. This form must be notarized, signed by
of Conditions
the local jurisdiction and the property owner.
4. Pre -award Cost
If pre -award costs are being requested with your project, be sure to identify all pre -
Form
award costs in the application budget per instructions. The pre -award cost form must
be completed and submitted with your application.
21
5. Request for Public
Applicable if no FIPS number is assigned to applicant/recipient.
❑
Assistance Form
6. Model Statement
For Acquisition projects only.
of Assurances for
Property
Acquisition
Projects
7. Declaration and
For Acquisition projects only. Must be signed by all persons whose names are on the
Release
property deed.
8. Notice of
For Acquisition projects only. Two forms are available for your convenience. Use the
Voluntary Interest
form that is most appropriate to your situation. Must be signed by all persons whose
names are on the property deed.
9. Statement of
For Acquisition projects only. Must be signed by all persons whose names are on the
❑
Voluntary
property deed.
Participation for
Acquisition of
Property for
Purpose of Open
_Space
10. Worksheets
The appropriate worksheet(s) must be completed and submitted with the application.
❑
a. Flood Control — Drainage Improvement
b. Generator
c. Tornado Safe Room
d. Hurricane Safe Room
e. Wind Retrofit
f. Wildfire
g. Drought
*Submit 1 original (signed) and 1 full copy of the entire application and backup documentation.
Include a full copy of the submittal and all documentation on CD or thumb drive.
22
Attachment Index
Use the following template to list any supporting documentation that is included on the CD or flashdrive.
Clearly and concisely label each attachment on this form to correspond with the file name on the CD or
flashdrive. In the first column list which section and item (from the HMGP application) the attachment refers to.
Example: Section 2, Item 1. If any required documentation is not included on the CD or flashdrive, the
application will be considered incomplete and will not be considered for possible funding.
[Section # & Item Attached Document Name
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
23