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HomeMy WebLinkAbout2025-161Agreement Number: T0428 STATE -FUNDED GRANT AGREEMENT THIS AGREEMENT is entered into by the State of Florida, Division of Emergency Management, with headquarters in Tallahassee, Florida (hereinafter referred to as "FDEM"), and Indian River County , (hereinafter referred to as the "Recipient"). THIS AGREEMENT IS ENTERED INTO BASED ON THE FOLLOWING REPRESENTATIONS: A. The Recipient represents that it is fully qualified and eligible to receive these grant funds to provide the services identified herein; and B. FDEM has received these grant funds from the State of Florida, and has the authority to subgrant these funds to the Recipient upon the Terms and Conditions below; and C. FDEM has statutory authority to disburse the funds under this Agreement. THEREFORE, FDEM and the Recipient agree to the following: (1) LAWS. RULES, REGULATIONS, AND POLICIES a. As required by section 215.971(1), Florida Statutes, this Agreement includes: A provision specifying a Scope of Work that clearly establishes the tasks that the Recipient is required to perform. A provision dividing the Agreement into quantifiable units of deliverables that must be received and accepted in writing by FDEM before payment. Each deliverable must be directly related to the Scope of Work and specify the required minimum level of service to be performed and the criteria for evaluating the successful completion of each deliverable. iii. A provision specifying the financial consequences that apply if the Recipient fails to perform the minimum level of service required by the Agreement. iv. A provision specifying that the Recipient may expend funds only for allowable costs resulting from obligations incurred during the specified agreement period. A provision specifying that any balance of unobligated funds which has been advanced or paid must be refunded to FDEM. vi. A provision specifying that any funds paid in excess of the amount to which the Recipient is entitled under the Terms and Conditions of the Agreement must be refunded to FDEM. b. In addition to the foregoing, the Recipient and FDEM shall be governed by all applicable State and Federal laws, rules and regulations, including those identified in Attachment B. Any express reference in this Agreement to a statute, rule, or regulation in no way implies that no other statute, rule, or regulation applies. (2) CONTACT a. In accordance with section 215.971(2), Florida Statutes, FDEM's Grant Manager shall be responsible for enforcing performance of this Agreement's Terms and Conditions and shall serve as FDEM's liaison with the Recipient. As part of his/her duties, the Grant Manager for FDEM shall: i. Monitor and document Recipient performance; and, ii. Review and document all deliverables for which the Recipient requests payment. b. FDEM's Grant Manager for this Agreement is: Marvin Kalms 2555 Shumard Oak Boulevard Tallahassee, FL 32399-2100 Work Phone: 448-215-9582 Email: Marvin. Kalms(o)em.myflorida.com c. The name and address of the representative of the Recipient responsible for the administration of this Agreement is: David Johnson Name: 4225 43rd Avenue Address: Vero Beach, FL 32967 City, State, Zip: Work Phone: (772) 226-3900 Email: djohnson@indianriver.gov d. In the event that different representatives or addresses are designated by either party after execution of this Agreement, notice of the name, title and address of the new representative will be provided to the other party. (3) TERMS AND CONDITIONS This Agreement contains all the Terms and Conditions agreed upon by the parties. (4) EXECUTION This Agreement may be executed in any number of counterparts, any one of which may be taken as an original. (5) MODIFICATION Either party may request modification of the provisions of this Agreement. Changes which are agreed upon shall be valid only when in writing, signed by each of the parties, and attached to the original of this Agreement. 2 (6) SCOPE OF WORK The Recipient shall perform the work in accordance with the Budget and Scope of Work, Attachment A of this Agreement. (7) PERIOD OF AGREEMENT This Agreement shall begin July 1, 2025 and shall end on June 30, 2026, unless terminated earlier in accordance with the provisions of Paragraph (16) TERMINATION. In accordance with section 215.971(1)(d), Florida Statutes, the Recipient may expend funds authorized by this Agreement "only for allowable costs resulting from obligations incurred during" the period of agreement. (8) FUNDING a. This is a Fixed Price Agreement, subject to the availability of funds. b. The State of Florida's performance and obligation to pay under this Agreement is contingent upon an annual appropriation by the Florida Legislature, and subject to any modification in accordance with either Chapter 216, Florida Statutes, or the Florida Constitution. c. FDEM will pay the Recipient only for the successful completion of each deliverable. The maximum payment amount for each deliverable is outlined in Attachment A of this Agreement ("Budget"). The maximum payment amount for the entirety of this Agreement is $ 1,953.73 d. FDEM will review any request for payment by comparing the documentation provided by the Recipient against a performance measure, outlined in Attachment A, which clearly delineates: i. The required minimum acceptable level of service to be performed; and, ii. The criteria for evaluating the successful completion of each deliverable. e. FDEM's Grant Manager, as required by section 215.971(2)(c), Florida Statutes, shall reconcile and verify all funds received against all funds expended during the period of agreement and produce a Final Reconciliation Report. The Final Reconciliation Report must identify any funds paid in excess of the expenditures incurred by the Recipient. f. For the purposes of this Agreement, the term "improper payment" means or includes: i. Any payment that should not have been made or that was made in an incorrect amount (including overpayments and underpayments) under statutory, contractual, administrative, or other legally applicable requirements; and, ii. Any payment to an ineligible party, any payment for an ineligible good or service, any duplicate payment, any payment for a good or service not received (except for such payments where authorized by law), any payment that does not account for credit for applicable discounts, and any payment where insufficient or lack of documentation prevents a reviewer from discerning whether a payment was proper. g. As required by the Reference Guide for State Expenditures, reimbursement for travel must be in accordance with section 112.061, Florida Statutes, which includes submission of the claim on the approved State travel voucher. (9) RECORDS a. As a condition of receiving State financial assistance, and as required by sections 20.055(6)(c) and 215.97(5)(b), Florida Statutes, FDEM, the Chief Inspector General of the State of Florida, the Florida Auditor General, or any of their authorized representatives, shall enjoy the right of access to any documents, financial statements, papers, or other records of the Recipient which are pertinent to this Agreement, in order to make audits, examinations, excerpts, and transcripts. The right of access also includes timely and reasonable access to the Recipient's personnel for the purpose of interview and discussion related to such documents. For the purposes of this section, the term "Recipient" includes employees or agents, including all subcontractors or consultants to be paid from funds provided under this Agreement. b. The Recipient shall maintain all records related to this Agreement for the period of time specified in the appropriate retention schedule published by the Florida Department of State. Information regarding retention schedules can be obtained at: http://dos.myfforida.com/library-archives/records- ma nape me nt/gen era►-records-sched u les/. c. Florida's Government in the Sunshine Law (Section 286.011, Florida Statutes) provides the citizens of Florida with a right of access to governmental proceedings and mandates three (3) basic requirements: (1) all meetings of public boards or commissions must be open to the public; (2) reasonable notice of such meetings must be given; and, (3) minutes of the meetings must be taken and promptly recorded. The mere receipt of public funds by a private entity, standing alone, is insufficient to bring that entity within the ambit of the open government requirements. However, the Government in the Sunshine Law applies to private entities that provide services to governmental agencies and that act on behalf of those agencies in the agencies' performance of their public duties. If a public agency delegates the performance of its public purpose to a private entity, then, to the extent that private entity is performing that public purpose, the Government in the Sunshine Law applies. For example, if a volunteer fire department provides firefighting services to a governmental entity and uses facilities and equipment purchased with public funds, then the Government in the Sunshine Law applies to the board of directors for that volunteer fire department. Thus, to the extent that the Government in the Sunshine Law applies to the Recipient based upon the funds provided under this Agreement, the meetings of the Recipient's governing board or the meetings of any subcommittee making recommendations to the governing board may be subject to open government requirements. These meetings shall be publicly noticed, open to the public, and the minutes of all the meetings shall be public records, available to the public in accordance with chapter 119, Florida Statutes. d. Florida's Public Records Law provides a right of access to the records of the State and local governments as well as to private entities acting on their behalf. Unless specifically exempted from disclosure by the Legislature, all materials made or received by a governmental agency (or a private entity acting on behalf of such an agency) in conjunction with official business which are used to perpetuate, communicate, or formalize knowledge qualify as public records subject to public inspection. The mere receipt of public funds by a private entity, standing alone, is insufficient to bring that entity within the ambit of the public record requirements. However, when a public entity delegates a public function to a private entity, the records generated by the private entity's performance of that duty become public records. Thus, the nature and scope of the services provided by a private entity determine whether that entity is acting on behalf of a public agency and is therefore subject to the requirements of Florida's Public Records Law. e. The Recipient shall maintain all records for the Recipient and for all subcontractors or consultants to be paid from funds provided under this Agreement, including documentation of all program costs, in a form sufficient to determine compliance with the requirements and objectives of the Budget and Scope of Work, Attachment A, and all other applicable laws and regulations. f. IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT: (850) 815-4156, Records@em.myflorida.com, or 2555 Shumard Oak Boulevard, Tallahassee, FL 32399. (10) AUDITS a. In accounting for the receipt and expenditure of funds under this Agreement, the Recipient shall follow Generally Accepted Accounting Principles ("GAAP"). As defined by 2 C.F.R. §200.49, GAAP "has the meaning specified in accounting standards issued by the Government Accounting Standards Board (GASB) and the Financial Accounting Standards Board (FASB)." b. When conducting an audit of the Recipient's performance under this Agreement, FDEM shall use Generally Accepted Government Auditing Standards ("GAGAS"). As defined by 2 C.F.R. §200.50, GAGAS, "also known as the Yellow Book, means generally accepted government auditing standards issued by the Comptroller General of the United States, which are applicable to financial au7dits." c. If an audit shows that all or any portion of the funds disbursed were not spent in accordance with the conditions of this Agreement, the Recipient shall be held liable for reimbursement to FDEM of all funds not spent in accordance with these applicable regulations and Agreement provisions within thirty (30) days after FDEM has notified the Recipient of such non-compliance. d. The Recipient shall have all audits completed by an independent auditor, which is defined in section 215.97(2)(i), Florida Statutes, as "an independent certified public accountant licensed under chapter 473." The independent auditor shall state that the audit complied with the applicable provisions noted above. The audits must be received by FDEM no later than nine (9) months from the end of the Recipient's fiscal year. e. The Recipient shall send copies of reporting packages required under this paragraph directly to each of the following: i. Division of Emergency Management DEMSingle Audit cbem.myflorida.com OR Office of the Inspector General 2555 Shumard Oak Boulevard Tallahassee, Florida 32399-2100 5 ii. The Auditor General Room 401, Claude Pepper Building 111 West Madison Street Tallahassee, Florida 32399-1450 (11) REPORTS The Recipient shall provide FDEM with a Close -Out Report in accordance with Attachment A. This Report shall include the current status and progress by the Recipient and all Sub -Recipients and subcontractors in completing the work described in the Scope of Work, in addition to any other information requested by FDEM. b. The Close -Out Report is due thirty (30) days after termination of this Agreement or thirty (30) days after completion of the activities contained in this Agreement, whichever occurs first. c. If all required deliverables, reports, and copies are not sent to FDEM or are not completed in a manner acceptable to FDEM, FDEM may withhold further payments until they are completed or may take other action as stated in Paragraph (15) REMEDIES. "Acceptable to FDEM" means that the work product was completed in accordance with the Budget and Scope of Work. d. The Recipient shall provide additional program updates or information that may be required by FDEM. e. The Recipient shall provide additional reports and information identified in Attachment A. (12) MONITORING a. The Recipient shall monitor its performance under this Agreement, as well as that of its subcontractors and/or consultants who are paid from funds provided under this Agreement, to ensure that time schedules are being met, the Schedule of Deliverables and Scope of Work are being accomplished within the specified time periods, and other performance goals are being achieved. A review shall be done for each function or activity in Attachment A to this Agreement and reported in the Close -Out Report. b. In addition to reviews of audits conducted in accordance with Paragraph (10) AUDITS above, monitoring procedures may include, but not be limited to, on-site visits by FDEM staff, limited scope audits, or other procedures. The Recipient agrees to comply and cooperate with any monitoring procedures/processes deemed appropriate by FDEM. In the event FDEM determines that a limited scope audit of the Recipient is appropriate, the Recipient agrees to comply with any additional instructions provided by FDEM to the Recipient regarding such audit. The Recipient further agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the Florida Chief Financial Officer or Auditor General. In addition, FDEM will monitor the performance and financial management by the Recipient throughout the period of the agreement to ensure timely completion of all tasks. (13) LIABILITY a. Unless Recipient is a State agency or subdivision, as defined in section 768.28, Florida Statutes, the Recipient is solely responsible to parties it deals with in carrying out the terms of this Agreement and shall hold FDEM harmless against all claims of whatever nature by third parties arising from the work performed under this Agreement. For purposes of this Agreement, Recipient agrees that it is not an employee or agent of FDEM but is an independent contractor. b. Any Recipient which is a State agency or subdivision, as defined in section 768.28, Florida Statutes, agrees to be fully responsible for its negligent or tortious acts or omissions which result in claims or suits against FDEM, and agrees to be liable for any damages proximately caused by the acts or omissions to the extent set forth in section 768.28, Florida Statutes. Nothing herein is intended to serve as a waiver of sovereign immunity by any party to which sovereign immunity applies. Nothing herein shall be construed as consent by a State agency or subdivision of the State of Florida to be sued by third parties in any matter arising out of this Agreement. (14) DEFAULT If any of the following events occur ("Events of Default"), all obligations on the part of FDEM to make further payment of funds shall, if FDEM elects, terminate and FDEM has the option to exercise any of its remedies set forth in Paragraph (15) REMEDIES. However, FDEM may make payments or partial payments after any Events of Default without waiving the right to exercise such remedies, and without becoming liable to make any further payment: a. If any warranty or representation made by the Recipient in this Agreement or any previous agreement with FDEM is or becomes false or misleading in any respect, or if the Recipient fails to keep or perform any of the obligations, terms or covenants in this Agreement or any previous agreement with FDEM and has not cured them in timely fashion, or is unable or unwilling to meet its obligations under this Agreement; b. If material adverse changes occur in the financial condition of the Recipient at any time during the period of agreement, and the Recipient fails to cure this adverse change within thirty (30) days from the date written notice is sent by FDEM. c. If any reports required by this Agreement have not been submitted to FDEM or have been submitted with incorrect, incomplete or insufficient information. d. If the Recipient has failed to perform and complete on time any of its obligations under this Agreement. (15) REMEDIES If an Event of Default occurs, then FDEM shall, after thirty (30) days written notice to the Recipient and upon the Recipient's failure to cure within those thirty (30) days, exercise any one or more of the following remedies, either concurrently or consecutively: a. Terminate this Agreement, provided that the Recipient is given at least thirty (30) days prior written notice of the termination. The notice shall be effective when placed in the United States, first class mail, postage prepaid, by Registered Mail TM or Certified Mail®, Return Receipt Requested, to the address in Paragraph (2) CONTACT herein. b. Begin an appropriate legal or equitable action to enforce performance of this Agreement. c. Withhold or suspend payment of all or any part of a request for payment. d. Require that the Recipient refund to FDEM any monies used for ineligible purposes under the laws, rules and regulations governing the use of these funds. e. Exercise any corrective or remedial actions, to include but not be limited to: i. request additional information from the Recipient to determine the reasons for or the extent of non-compliance or lack of performance, ii. issue a written warning to advise that more serious measures may be taken if the situation is not corrected, iii. advise the Recipient to suspend, discontinue or refrain from incurring costs for any activities in question or iv. require the Recipient to reimburse FDEM for the amount of costs incurred for any items determined to be ineligible. f. Exercise any other rights or remedies which may be available under law. Pursuing any of the above remedies will not stop FDEM from pursuing any other remedies in this Agreement or provided at law or in equity. If FDEM waives any right or remedy in this Agreement or fails to insist on strict performance by the Recipient, it will not affect, extend or waive any other right or remedy of FDEM, or affect the later exercise of the same right or remedy by FDEM for any other default by the Recipient. (16) TERMINATION a. FDEM may terminate this Agreement for cause after thirty (30) days written notice. Cause can include misuse of funds, fraud, lack of compliance with applicable rules, laws and regulations, failure to perform on time, and refusal by the Recipient to permit public access to any document, paper, letter, or other material subject to disclosure under chapter 119, Florida Statutes, as amended. b. FDEM may terminate this Agreement for convenience or when it determines, in its sole discretion, that continuing the Agreement would not produce beneficial results in line with the further expenditure of funds, by providing the Recipient with thirty (30) days prior written notice. c. The parties may agree to terminate this Agreement for their mutual convenience through a written amendment of this Agreement. The amendment will state the effective date of termination and the procedures for proper closeout of this Agreement. d. In the event this Agreement is terminated, the Recipient will not incur new obligations for the terminated portion of this Agreement after the Recipient has received the Notification of Termination. The Recipient will cancel as many outstanding obligations as possible. Costs incurred after receipt of the termination notice will be disallowed. The Recipient shall not be relieved of liability to FDEM because of any breach of this Agreement by the Recipient. FDEM may, to the extent authorized by law, withhold payments to the Recipient for the purpose of set-off until the exact amount of damages due FDEM from the Recipient is determined. (17) SUBCONTRACTS If the Recipient subcontracts any of the work required under this Agreement, a copy of the unsigned subcontract must be forwarded to FDEM for review and approval before it is executed by the Recipient. The Recipient agrees to include in the subcontract that (i) the subcontractor is bound by the terms of this Agreement, (ii) the subcontractor is bound by all applicable State and Federal laws and regulations, and (iii) the subcontractor shall hold FDEM and Recipient harmless against all claims of whatever nature arising out of the subcontractor's performance of work under this Agreement, to the extent allowed and required by law. The Recipient shall document in the Close -Out Report the subcontractor's progress and completion of its tasks and work performance under this Agreement. For each subcontract, the Recipient shall provide a written statement to FDEM as to whether that subcontractor is a minority business enterprise, as defined in section 288.703, Florida Statutes. (18) ATTACHMENTS a. All Attachments to this Agreement are incorporated as if set out fully. b. In the event of any inconsistencies or conflict between the language of this Agreement and the Attachments, the language of the Attachments shall control, but only to the extent of the conflict or inconsistency. c. This Agreement has the following Attachments: Exhibit 1 - Funding Sources Attachment A — Budget and Scope of Work Attachment B — Program Statutes and Regulations Attachment C — Statement of Assurances Attachment D — Justification of Advance Payment Attachment E — Warranties and Representations Attachment F — Certification Regarding Debarment Attachment G — Financial Invoice Form Attachment H — 302 Facility List Attachment I — Close -Out Reporting Form Attachment J — Hazards Analysis Guidance and Information Attachment K — Hazard Analysis Site Visit (SV) Certification Form Attachment L — Statement of Determination (SOD) Form Attachment M — HA Deliverable Review and Comment Form (19) PAYMENTS a. Any advance payment under this Agreement is subject to section 216.181(16), Florida Statutes. All advances are required to be held in an interest-bearing account. If an advance payment is requested, the budget data on which the request is based, and a justification statement shall be included in this Agreement as Attachment D. Attachment D will specify the amount of advance payment needed and provide an explanation of the necessity for and proposed use of these funds. No advance shall be accepted for processing if a reimbursement has been paid prior to the submittal of a request for advanced payment. After the initial advance, if any, payment shall be made on a fixed price basis as needed. b. Invoices shall be submitted in accordance with Attachment G and shall include the supporting documentation for the project or services. The Final Invoice shall be submitted within sixty (60) days after the expiration date of the Agreement. An explanation of any circumstances prohibiting the submittal of timely invoices per deliverable due date shall be submitted to FDEM Grant Manager as referenced in Paragraph (11) REPORTS of this Agreement. c. If the necessary funds are not available to fund this Agreement as a result of action by the State Chief Financial Officer or under Paragraph 8 of this Agreement, all obligations on the part of FDEM to make any further payment of funds shall terminate, and the Recipient shall submit its Close -Out Report within thirty (30) days of receiving notice from FDEM. (20) REPAYMENTS All refunds or repayments due to FDEM under this Agreement are to be made payable to the order of "Florida Division of Emergency Management," and mailed directly to the following address: Florida Division of Emergency Management Cashier 2555 Shumard Oak Boulevard Tallahassee FL 32399-2100 In accordance with section 215.34(2), Florida Statutes, if a check or other draft is returned to FDEM for collection, Recipient shall pay FDEM a service fee of $15.00 or 5% of the face amount of the returned check or draft, whichever is greater. (21) MANDATED CONDITIONS a. The validity of this Agreement is subject to the truth and accuracy of all the information, representations, and materials submitted or provided by the Recipient in this Agreement, in any later submission or response to a FDEM request, or in any submission or response to fulfill the requirements of this Agreement. All of said information, representations, and materials is incorporated by reference. The inaccuracy of the submissions or any material changes shall, at the option of FDEM and with thirty (30) days written notice to the Recipient, cause the termination of this Agreement and the release of FDEM from all its obligations to the Recipient. b. This Agreement shall be construed under the laws of the State of Florida, and venue for any actions arising out of this Agreement shall be in the Circuit Court of Leon County. If any provision of this Agreement is in conflict with any applicable Statute or rule, or is unenforceable, then the provision shall be null and void to the extent of the conflict, and shall be severable, but shall not invalidate any other provision of this Agreement. c. Any power of approval or disapproval granted to FDEM under the terms of this Agreement shall survive the term of this Agreement. d. This Agreement may be executed in any number of counterparts, any one of which may be taken as an original. 01 e. The Recipient agrees to comply with the Americans with Disabilities Act (Public Law 101-336, 42 U.S.C. Section 12101 et sea.), which prohibits discrimination by public and private entities on the basis of disability in employment, public accommodations, transportation, State and local government services, and telecommunications. f. Those who have been placed on the convicted vendor list following a conviction for a public entity crime or on the discriminatory vendor list may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to a public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with a public entity, and may not transact business with any public entity in excess of $25,000.00 for a period of thirty-six (36) months from the date of being placed on the convicted vendor list or on the discriminatory vendor list. g. Any Recipient which is not a local government or State agency, and which receives funds under this Agreement from the State government, certifies, to the best of its knowledge and belief, that it and its principals: i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by a Federal, State, or local department or agency. ii. Have not, within a five (5) year period preceding this Agreement been convicted of or had a civil judgment rendered against it for fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under public transaction; violation of Federal or State Antitrust Statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any offenses enumerated in Paragraph (21)(g)(ii) of this certification; and iv. Have not within a five (5) year period preceding this Agreement had one or more public transactions (Federal, State or local) terminated for cause or default. If the Recipient is unable to certify to any of the statements in this certification, then the Recipient shall attach an explanation to this Agreement. In addition, the Recipient shall send to FDEM (by email or by facsimile transmission) the completed "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion" (Attachment F) for each intended subcontractor that Recipient plans to fund under this Agreement. The Form must be received by FDEM before the Recipient enters into a contract with any subcontractor. h. The State of Florida's performance and obligation to pay under this Agreement is contingent upon an annual appropriation by the Florida Legislature, and subject to any modification in accordance with chapter 216, Florida Statutes, or the Florida Constitution. i. All bills for fees or other compensation for services or expenses shall be submitted in detail sufficient for a proper pre -audit and post -audit thereof. is j. Any bills for travel expenses shall be submitted in accordance with section 112.061, Florida Statutes. k. FDEM reserves the right to unilaterally cancel this Agreement if the Recipient refuses to allow public access to all documents, papers, letters, or other material subject to the provisions of chapter 119, Florida Statutes, which the Recipient created or received under this Agreement. If the Recipient is allowed to temporarily invest any advances of funds under this Agreement, any interest income shall either be returned to FDEM or be applied against FDEM's obligation to pay the contract amount. m. The State of Florida will not intentionally award publicly funded contracts to any contractor who knowingly employs unauthorized alien workers, constituting a violation of the employment provisions contained in 8 U.S.C. Section 1324(a)(1)(A)(iv) [Section 274A(e) of the Immigration and Nationality Act ("INA")]. FDEM shall consider the employment by any contractor of unauthorized aliens a violation of Section 1324(a)(1)(A)(iv) of the INA. Such violation by the Recipient of the employment provisions contained in Section 1324(a)(1)(A)(iv) of the INA shall be grounds for unilateral cancellation of this Agreement by FDEM. n. The Recipient is subject to Florida's Government in the Sunshine Law (Section 286.011, Florida Statutes) with respect to the meetings of the Recipient's governing board or the meetings of any subcommittee making recommendations to the governing board. All meetings shall be publicly noticed, open to the public, and the minutes of all meetings shall be public records, available to the public in accordance with chapter 119, Florida Statutes. o. All expenditures of State financial assistance shall be in compliance with laws, rules and regulations applicable to expenditures of State funds, including but not limited to, the Reference Guide for State Expenditures. p. This Agreement may be charged only with allowable costs resulting from obligations incurred during the period of agreement. q. Any balances of unobligated cash that have been advanced or paid that are not authorized to be retained for direct program costs in a subsequent period must be refunded to the State. r. Section 287.05805, Florida Statutes, requires that any State funds provided for the purchase of or improvements to real property are contingent upon the contractor or political subdivision granting to the State a security interest in the property at least to the amount of State funds provided for at least five (5) years from the date of purchase or the completion of the improvements or as further required by law. s. FDEM may, at its option, terminate the Contract if the Contractor is found to have submitted a false certification as provided under section 287.135(5), Florida Statutes, or been placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or been engaged in business operations in Cuba or Syria, or to have been placed on the Scrutinized Companies that Boycott Israel List or is engaged in a boycott of Israel. t. If applicable, pursuant to Section 255.0993, Florida Statutes, the Recipient shall ensure that any iron or steel product, as defined in section 255.0993(1)(b), Florida Statutes, that is permanently incorporated in the deliverable(s) resulting from this project, must be produced in the United States. WA (22) LOBBYING PROHIBITION a. Section 216.347, Florida Statutes, prohibits "any disbursement of grants and aids appropriations pursuant to a contract or grant to any person or organization unless the terms of the grant or contract prohibit the expenditure of funds for the purpose of lobbying the Legislature, the Judicial Branch, or a State agency." b. No funds or other resources received from FDEM under this Agreement may be used directly or indirectly to influence Legislation or any other official action by the Florida Legislature or any State agency. (23) COPYRIGHT, PATENT AND TRADEMARK EXCEPT AS PROVIDED BELOW, ANY AND ALL PATENT RIGHTS ACCRUING UNDER OR IN CONNECTION WITH THE PERFORMANCE OF THIS AGREEMENT ARE HEREBY RESERVED TO THE STATE OF FLORIDA. ANY AND ALL COPYRIGHTS ACCRUING UNDER OR IN CONNECTION WITH THE PERFORMANCE OF THIS AGREEMENT ARE HEREBY TRANSFERRED BY THE RECIPIENT TO THE STATE OF FLORIDA. a. If the Recipient has a pre-existing patent or copyright, the Recipient shall retain all rights and entitlements to that pre-existing patent or copyright unless this Agreement provides otherwise. b. If any discovery or invention is developed in the course of or as a result of work or services performed under this Agreement, or in any way connected with it, the Recipient shall refer the discovery or invention to FDEM for a determination whether the State of Florida will seek patent protection in its name. Any patent rights accruing under or in connection with the performance of this Agreement are reserved to the State of Florida. If any books, manuals, films, or other copyrightable material are produced, the Recipient shall notify FDEM. Any copyrights accruing under or in connection with the performance under this Agreement are transferred by the Recipient to the State of Florida. c. Within thirty (30) days of execution of this Agreement, the Recipient shall disclose all intellectual properties relating to the performance of this Agreement that he or she knows or should know could give rise to a patent or copyright. The Recipient shall retain all rights and entitlements to any pre-existing intellectual property that is disclosed. Failure to disclose will indicate that no such property exists. FDEM shall then, under Paragraph (b), have the right to all patents and copyrights that accrue during performance of this Agreement. d. If the Recipient qualifies as a State University under Florida law, then, pursuant to section 1004.23, Florida Statutes, any invention conceived exclusively by the employees of the Recipient shall become the sole property of the Recipient. In the case of joint inventions, that is inventions made jointly by one or more employees of both parties hereto, each party shall have an equal, undivided interest in and to such joint inventions. FDEM shall retain a perpetual, irrevocable, fully paid, nonexclusive license, for its use and the use of its contractors of any resulting patented, copyrighted or trademarked work products, developed solely by the Recipient, under this Agreement, for Florida government purposes. 13 (24) LEGAL AUTHORIZATION The Recipient certifies that it has the legal authority to receive the funds under this Agreement and that its governing body has authorized the execution and acceptance of this Agreement. The Recipient also certifies that the undersigned person has the authority to legally execute and bind Recipient to the terms of this Agreement. (25) ASSURANCES The Recipient shall comply with any Statement of Assurances incorporated as Attachment C. 14 IN WITNESS WHEREOF, the parties hereto have executed this Agreement. •tiO��jTY C0dfj *-,,. RECIPIENT:: * , sX0 Signature: ' F •.oF:�' Name and title: Joseph E. Flescher - Chairman �• • APPROVED AS TO FORM ANDJ,EGA4- SUFFICIENCY ASSISTA Include a copy of the Delegation of Authority for the Signatory, if applicable. STATE OF FLORIDA DIVISION OF EMERGENCY MANAGEMENT Signature: A. HICKS Y ATTORNEY Okttest: Ryan L. Butler, Clerk of Circuit Court and Comptroller Name and Title: Kevin Guthrie as Executive Director, or Ian Guidicelli as Authorized Designee Date: 15 Deputy Clerk EXHIBIT —1 STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS AGREEMENT CONSIST OF THE FOLLOWING: SUBJECT TO SECTION 215.97, FLORIDA STATUTES: State Project - State awarding agency: Florida Division of Emergency Management Catalog of State Financial Assistance Title: Emergency Management Projects Catalog of State Financial Assistance Number: 31.067 Award Amount: $1,953.73 COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS AGREEMENT ARE AS FOLLOWS: 1. I Florida Emergency Planning and Community Right -To -Know Act (Chapter 252, Part II, Florida Statutes) 2. CAMEO Data Manager Hazardous Analysis (HA) updates for critical planning data required under Emergency Planning and Community Right -to -Know Act (EPCRA) 3. U.S. Environmental Protection Agency's Technical Guidance for Hazards Analysis https://www.epa.gov/epera/technical-quidance-hazardous-analysis-emergency-planning-extremely- h aza rd o u s -s u b s to n ce s 4. E -Plan - Emergency Response Information System Tier II electronic Reporting online hftps://tier2.erplan.netionlinefilinci/filingLogin.htm NOTE: 2 C.F.R. Part 200, and section 215.97(5)(a), Florida Statutes, require that the information about State Projects included in Exhibit 1 be provided to the Recipient. 16 Attachment A Budget and Scope of Work Budget 1. First Payment (40% of Contract Amount) $781.49 2. Second Payment (40% of Contract Amount) $781.49 3. Final Payment (20% of Contract Amount) $390.75 TOTAL AMOUNT $1,953.73 On October 17, 1986, Congress enacted the Emergency Planning and Community Right -to -Know Act (EPCRA). At the State level, the Florida Division of Emergency Management (FDEM) serves as the lead agency responsible for oversight and coordination of the local planning efforts required by EPCRA. Chaired by the Executive Director of the Florida Division of Emergency Management, the State Emergency Response Commission for Hazardous Materials (SERC) serves as a technical advisor and information clearinghouse for State and Federal hazardous materials (HazMat) programs. Additionally, the SERC conducts quarterly public meetings in varying locations throughout the State. Currently, SERC membership consists of Governor appointed individuals who represent the interests of State and local government, emergency services, industry. and the environment. A portion of EPCRA is the requirement to perform Hazards Analyses (HA) of chemical facilities with Extremely Hazardous Substances (EHS). FDEM has provided the HA Grant Program to ensure this requirement is met by providing assistance to grant recipients. This requirement falls on the Local Emergency Planning Committees (LEPCs) which were created by EPCRA, however in addition to LEPCs, FDEM offers the grant to Florida Counties who wish to perform their own HAs due to Florida's Home Rule status. The Grant Recipient will provide completed and approved HA data to local LEPCs and first responders to enhance information flow and enhance the safety of responders to an emergency which includes a facility with EHS chemicals. The Recipient shall conduct Hazards Analyses (HA) on-site visits for 50% of the facilities listed in Attachment H which have reported to the SERC the presence of those specific Extremely Hazardous Substances (EHSs) designated by the U.S. Environmental Protection Agency in quantities above the Threshold Planning Quantity (TPQ). The data collected under this Agreement will be used to comply with the planning requirements of the Superfund Amendments and Reauthorization Act of 1986, Title III, "Emergency Planning and Community Right - To -Know Act of 1986" and the Florida Emergency Planning and Community Right -To -Know Act, Florida Statutes, chapter 252, Part II. 17 A. The Recipient shall submit a list of facilities within the geographical boundaries of the County or Counties listed on Attachment H that are suspected of not reporting to the State Emergency Response Commission (SERC) the presence of Extremely Hazardous Substances (EHSs) in quantities above the Threshold Planning Quantity (TPQ), as designated by the U. S. Environmental Protection Agency. B. The completed Hazards Analysis (HA) shall comply with the guidance documents listed below, unless otherwise stated by FDEM's HA Grant Manager. The primary guidance document is the Attachment J Hazards Analysis Guidance and Information. Other guidance documents are the HA How- To Guidance Document created by the SERC's HA Working Group, CAMEO Data Manager Help Files, and the U.S. Environmental Protection Agency's "Technical Guidance for Hazards Analysis" at; https://www.epa.gov/epera/technical-quidance-hazardous-analysis-emergency-planning-extremely hazardous-substances. C. Consult the Tier II Report in E -Plan prior to any on-site visits. Compare the E -Plan Tier II Report with information in CAMEO Data Manger files. Discuss any discrepancies with Facility Representatives during the on-site visit. D. Conduct an on-site visit at each Attachment H facility to ensure accuracy of the Hazards Analysis. Each applicable facility's Hazards Analysis (HA) information shall be entered using the new CAMEO Data Manager. CAMEO Data Manager software can be download from the U.S. Environmental Protection Agency's website at https://www.epa.gov/cameo/cameo-data-manager-software. E. Undiscovered Facilities — if the subrecipient discovers a facility not currently listed on the Attachment H that they expect may have EHS in quantities above the THQ, they should communicate with FDEM's HA Grant Manager to add the facility to Attachment H and determine replacing a current facility from Attachment H with the newly discovered facility. The subrecipient can determine which facility to conduct the Site Visit. F. Battery Facilities — If a facility on Attachment H only has EHS in the form of batteries, the subrecipient may either A) complete the Site Visit and notate that this facility only has EHS in the form of batteries or B) replacement the facility on Attachment H with another facility for a Site Visit. G. Deliverables — See Deliverables. All Deliverables shall be submitted through FDEM's Salesforce portal, DEMES. H. Financial Activities — See Deliverables. All financial activity requests (invoices) shall be submitted through FDEM's Salesforce portal, DEMES. 18 Subject to the funding limitations of this Agreement, FDEM shall reimburse the Recipient for successful completion of the deliverable task(s) required by this Agreement. Deliverable Requirement Financial Due Date Price Consequences • Provide completed CAMEO Data Manager files for 25% of facilities listed in Attachment H, Attachment G Financial Subject to the Invoice Form, Attachment K Forms, and Financial Attachment L Forms (when applicable) to November 30, 40% of Consequences DEMES Deliverable object and submit for 2025 Contract section of 1 approval. Amount Attachment A, • FDEM's Grant Manager can use Attachment M Budget and HA Deliverable Review and Comment Form to Scope of Work. provide feedback if a deliverable needs correction • Provide completed CAMEO Data Manager files for 25% of facilities listed in Subject to the Attachment H, Attachment G Financial Financial Invoice Form, Attachment K Forms, and 40% of Consequences Attachment L Forms (when applicable) to March 31, 2026 Contract section of DEMES Deliverable object and submit for Amount Attachment A, 2 approval. Budget and • FDEM's Grant Manager can use Attachment M Scope of Work. HA Deliverable Review and Comment Form to provide feedback if a deliverable needs correction • Provide completed Hazards Analysis (HA) (CAMEO Data Manager zip file) to the Local Emergency Planning Committee (LEPC) (if Subject to the applicable) and provide FDEM with Financial 3 notification of transmittal. 20% of Consequences • Notify first responders and Attachment H facilities May 31, 2026 Contract section of of the availability of HA information and provide Amount Attachment A, the FDEM Grant Manager with the notification of Budget and transmittal. Scope of Work. • Upload the final "approved' CAMEO Data Manager zip file into DEMES. Use naming convention (County name, Final HA, Year). • Upload completed Attachment I Close -Out 30 days Report Form to DEMES. following contract completion 19 Deliverables shall be submitted to FDEM's DEMES platform on the Deliverable object. The deliverable shall include all required forms and supporting documents sufficient to verify the accuracy of deliverable completion. FDEM's Grant Manager can use Attachment M via the DEMES Deliverables object to provide review and comments of the deliverable submission while deliverable is undergoing review. Following review and approval of the deliverable by FDEM's assigned Grant Manager, the Recipient shall submit an invoice request on FDEM's DEMES Platform on the Financial Activity object. In the Financial Activity, the Recipient shall attach their approved deliverable in the "Deliverable" field, and the completed Attachment G — Financial Invoice Form. Note that to receive payment, all Financial Activities must be submitted and approved by FDEM by the end of the first September following the end of the period of performance. Instructions for utilizing DEMES will be provided as a DEMES External User Guide Failure to successfully complete each of the required tasks, as demonstrated by the failure to satisfy the applicable deliverables, shall result in one of the following penalties. • A 20% reduction of the overall amount authorized by this Agreement and/or • Payment will be reduced by $110.00 per facility with incorrect or incomplete CAMEO Data Manager files. Failure to submit deliverables by their due date shall result in the following penalty: There will be a 30 -day grace period to turn in deliverables after their due date. Following this 30 -day grace period, the deliverable payment amounts due to the Recipient will be reduced by 25%. Subsequent 25% reductions will take effect thirty (30) days after the previous reduction. If, because of circumstances beyond the Recipient's control, the Recipient is unable to successfully perform a task and/or complete a deliverable required by this Agreement, then the Recipient shall notify FDEM immediately. If FDEM agrees that the inability to perform was directly due to circumstances beyond the control of the Recipient, then FDEM will consider waiving the imposition of a financial consequence. 20 Attachment B Program Statutes and Regulations 1. Emergency Planning and Community Right -to -Know Act (EPCRA), Title III of the Superfund Amendments Reauthorization Act of 1986, 42 U.S.C. s. 1101, et seq. (SARA Title III). 2. Florida Emergency Planning and Community Right -to -Know Act, chapter 252, Part II, Florida Statutes. 21 Attachment C Statement of Assurances The Recipient hereby assures and certifies compliance with all Federal Statutes, and State of Florida laws, regulations, policies, guidelines and requirements, and Uniform Administrative Requirements for Grants and Cooperative Agreements 28 CFR, Part 66, Common Rule that govern the application, acceptance and use of State funds for this State -funded Agreement. The Applicant assures and certifies that: 1. It will comply with provisions of Federal law which limit certain political activities of employees of a State or local unit of government whose principal employment is in connection with an activity financed in whole or in part by Federal grants. (5 USC 1501,et. seq.) 2. It will comply with the minimum wage and maximum hour's provisions of the Federal Fair Labor Standards Act. 3. It will establish safeguards to prohibit employees from using their positions for a purpose that is or gives the appearance of being motivated by a desire for private gain for themselves or others, particularly those with whom they have family, business, or other ties. 4. It will give the sponsoring agency or the Comptroller General, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the grant. 5. It will ensure that the facilities under its ownership, lease, or supervision which shall be utilized in the accomplishment of the deliverables are not listed on the Environmental Protection Agency's (EPA) list of Violating Facilities and that it will notify FDEM of the receipt of any communication from the Director of the EPA Office of Federal Activities indicating that a facility to be used in the project is under consideration for listing by the EPA. 6. In the event a Federal or State court or Federal or State administrative agency makes a finding of discrimination after a due process hearing on the grounds of race, color, religion, national origin, sex, or disability against a Recipient of funds, the Recipient will forward a copy of the finding to the Office for Civil Rights, Office of Justice Programs. 7. It will provide an Equal Employment Opportunity Program if required to maintain one, where the application is for $500,000 or more. 8. DRUG-FREE WORKPLACE (GRANTEES OTHER THAN 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 67.615 and 67.620. 22 Attachment D JUSTIFICATION OF ADVANCE PAYMENT SUB -RECIPIENT: If you are requesting an advance, indicate same by checking the box below. ❑ ADVANCE REQUESTED Advance payment of $ is requested. Balance of payments will be made on a reimbursement basis. These funds are needed to pay staff, award benefits to clients, duplicate forms and purchase start-up supplies and equipment. We would not be able to operate the program without this advance. If you are requesting an advance, complete the following chart and line item justification below. ESTIMATED EXPENSES BUDGET CATEGORY (List Applicable Cost Category) 2024-2025 Anticipated Budget Category Expenditures for Advance Payment Request TOTAL ANTICIPATED EXPENSES: $0.00 BUDGET CATEGORY & COST JUSTIFICATION: For each Budget Category and cost, provide a detailed justification explaining the need for the cash advance. The justification must include supporting documentation that clearly shows the advance will be expended within the first ninety (90) days of the Agreement's Performance Period. Support documentation should include anticipated training, POIs, planning project expenses, and administrative costs (as applicable) to provide the Division with reasonable and necessary justification for the advance request. Any advance funds not expended within the first ninety (90) days of the Agreement's execution shall be returned to the Division Cashier, 2555 Shumard Oak Boulevard, Tallahassee, Florida 32399, within thirty (30) days after the ninety (90) day timeframe expires, along with any interest earned on the advance. 23 Attachment E Warranties and Representations Financial Management Recipient's financial management system must include the following: (1) Accurate, current, and complete disclosure of the financial results of this project or program. (2) Records that identify the source and use of funds for all activities. These records shall contain information pertaining to grant awards, authorizations, obligations, unobligated balances, assets, outlays, income and interest. (3) Effective control over and accountability for all funds, property and other assets. Recipient shall safeguard all assets and assure that they are used solely for authorized purposes. (4) Comparison of expenditures with budget amounts for each Request for Payment. Whenever appropriate, financial information should be related to performance and unit cost data. (5) Written procedures to determine whether costs are allowable and reasonable under the provisions of the applicable OMB cost principles and the Terms and Conditions of this Agreement. (6) Cost accounting records that are supported by backup documentation. Competition All procurement transactions shall be done in a manner to provide open and free competition. The Recipient shall be alert to conflicts of interest as well as noncompetitive practices among contractors that may restrict or eliminate competition or otherwise restrain trade. In order to ensure excellent contractor performance and eliminate unfair competitive advantage, contractors that develop or draft specifications, requirements, statements of work, invitations for bids and/or requests for proposals shall be excluded from competing for such procurements. Awards shall be made to the bidder or offeror whose bid or offer is responsive to the solicitation and is most advantageous to the Recipient, considering the price, quality and other factors. Solicitations shall clearly set forth all requirements that the bidder or offeror must fulfill for the bid or offer to be evaluated by the Recipient. Any and all bids or offers may be rejected when it is in the Recipient's interest to do so. Codes of Conduct The Recipient shall maintain written standards of conduct governing the performance of its employees engaged in the award and administration of contracts. No employee, officer, or agent shall participate in the selection, award, or administration of a contract supported by public grant funds if a real or apparent 24 conflict of interest would be involved. Such a conflict would arise when the employee, officer, or agent, any member of his or her immediate family, his or her partner, or an organization which employs or is about to employ any of the parties indicated, has a financial or other interest in the firm selected for an award. The officers, employees, and agents of the Recipient shall neither solicit nor accept gratuities, favors, or anything of monetary value from contractors or parties to subcontracts. The standards of conduct shall provide for disciplinary actions to be applied for violations of the standards by officers, employees, or agents of the Recipient. Licensing and Permitting All subcontractors or employees hired by the Recipient shall have all current licenses and permits required for all work for which they are hired by the Recipient. 25 Attachment F Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion suocontractor Covered Transactions (1) The prospective Subcontractor, , of the Recipient certifies, by submission of this document, that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. (2) Where the Recipient's Subcontractor is unable to certify to the above statement, the prospective Subcontractor shall attach an explanation to this Form. SUBCONTRACTOR: Recipient's Signature Recipient's Printed Name Name and Title FDEM Agreement Number Street Address Project Number (if applicable) City, State, Zip Date 26 Attachment G Financial Invoice Form 2025-2026 Hazard Analysis Grant Agreement Recipient: Grant Agreement#: Deliverable & Invoice Amounts # Minimum Performance Requirements Budget amount Amount requested by Sub - per Deliverable Recipient No later than December 1, 2025, provide completed CAMEO Data Manager files for 25% 40% of HA 1 of facilities listed in Attachment H. Agreement $2.00 Hazards Analysis submissions are reviewed and Amount must be approved before invoice is submitted. No later than April 1, 2026, provide completed CAMEO Data Manager files for 25% of 40% of HA 2 facilities listed in Attachment H. Agreement $1.00 Hazards Analysis submissions are reviewed and Amount must be approved before invoice is submitted. No later than June 1, 2026, provide a copy of the "approved" CAMEO Data Manager file to the LEPC, 20% of HA 3 notify first responders and Attachment H facilities of Agreement $1.00 the availability of HA information, and provide FDEM Amount with the notifications of transmittals. Total Requested: $0.00 I certify to the best of my knowledge and belief the billed costs are in accordance with the Terms and Conditions of the Hazards Analysis Agreement. Printed Name and Title Recipient Signature Date 27 RA Attachment I Financial Invoice Form 616/2022 Attachment H SECTION 302 HA FACILITY LIST This is your Counties' entire Section 302 Extremely Hazardous Substances (EHSs) List obtained from E -Plan. Select 50% of the highest risk facilities to inspect this grant year. If you become aware or know of a chemical facility near a school, large residential apartment complex, or other high-risk areas, put that facility on your list to inspect. Try to select facilities that pose a greater risk based upon the chemicals present, the chemicals' amounts, previous releases, etc. This year's Section 302 EHS HA data was extracted from E -Plan in May 2025. If you know of facilities that you believe still have chemicals on-site from recent site visits or from other historical data you have on file that should be reporting, but are not on this list: • Contact the facility directly and ask them to report if possible. • Contact FDEM staff listed below so that the facility can be added to FDEM's Potential Non - Filer List. • Wendy. Reynolds(a)_em.myflorida.com • Robert.Dietrich@em.myflorida.com • Remember: Complete only 50% of your entire Section 302 EHS List this grant year. • Choose 25% of the Section 302 EHS facilities on this list for Deliverable 1 • Choose 25% of the Section 302 EHS facilities on this list for Deliverable 2 PLEASE REFER TO THE FACILITIES ATTACHMENT LIST SENT VIA EMAIL WHICH SERVES AS THE BASIS FOR THIS ATTACHMENT. 28 Attachment I Close -Out Report Form 2025-2026 Hazard Analysis Grant Agreement This form should be completed and submitted to FDEM no later than thirty (30) days after termination date of the Agreement. SUB -RECIPIENT: Grant Agreement #: For Each Deliverable, Enter the Award Amount from Attachment A - Budget and Scope of Work Cost Category HA Agreement Deliverable Amounts Date or Quarter Completed Total Amount Paid Per Deliverable Deliverable 1 $2.00 Deliverable 2 $1.00 Deliverable 3 $1.00 Total Paid for Completed Deliverables: $ 0.00 HA Agreement Amount: $ 4.00 Amount Previously Paid: $ 0.00 Unused Balance: By signing this report, l certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the expenditures, disbursements, and cash receipts are for the purposes and objectives set forth in the Terms and Conditions of the State -Funded Hazards Analysis Agreement. l am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil, or administrative penalties for fraud, false statements, false claims, or otherwise as proscribed by law. Recipient Printed Name & Title Recipient Signature Date Signed FDEM Grant Manager Signature Date Signed 29 ILA Attachment M Close -Out Report Form 6/6/2022 Attachment J 2025-2026 Hazard Analysis Checklist (All HA's must include the following items at minimum.) Facility Field Information Facility Name {per current facility list } Department field is where the SERC number goes. (Do not add the SERC acronym just the number) Enter the current Tier II report year Facility Physical Address Latitude and Longitude in Decimal Degrees {ex. 30.197, -84.36211 Facility Phone Number Facility Emergency Coordinator Name, Title, and 24-hour Emergency Phone Number Transportation Route(s) {From County Line to the Facility} Evacuation Route(s) to exit the Vulnerable Zone Historical Accident Record {If none, please note} Facility Maximum Occupancy (a minimum of one is required for unmanned facilities) Facility Page (ID and Regs ) (Mark correct 112(r) and Section 302 check boxes, max occupancy, facility manned or unmanned) Hazard Identification (Chemical in Inventory Field Section) (for each Extremely Hazardous Substance on site) Update Chemical in Inventory section for each Extremely Hazardous Substance Present over the TPQ Enter Chemical Abstract Service (CAS) Number and Proper Chemical Name Type/Design, Pressure, and Temperature of Container(s) cylinder, battery, ambient etc. (Chemical in Inventory Location field) Physical State in Storage {ex. mixture, pure, liquid, gas) (Chemical in Inventory Physical State and Quantity field) Enter max daily, average daily amount in lbs. (Chemical in Inventory Physical State and Quantity field) EjEnter storage location amounts and locations. Max daily chemical amount should equal the sum of all storage locations. Enter amount in Largest Container or Interconnected Containers {this is the amount to be used in the scenario release} Lji Nature of the Hazard - Physical and Health check boxes {ex. acute, chronic, fire, pressure, etc.) (Chemical in Inventory field) Vulnerability Analysis (Scenario Fields accessible from each individual EHS Chemical) Enter maximum amount in largest container or interconnected containers in the Amount Released field (Scenario ) (This amount must be the same as the Chemical in Inventory field Maximum amount in largest container amount) Enter the concentration percentage in the Concentration field (Scenario Description field) Enter Release Duration (10 minutes for gases, solids in solution or powders; no entry for liquids is required) (Scenario Description field) Determine the natural Physical State of each chemical (If you don't know it's often specified in Cameo Chemicals add on module) and enter it into the Scenario Physical description field.) 0 Weather Information - Use the weather default settings or enter average wind speed (do not enter a value in the Wind from field) Urban or Forest is recommended in the Ground Roughness field. (Scenario Description field.) Risk Assessment - Rate the Risk, Consequences and Overall Risk of a release occurring {based upon release history etc.} (Scenario Description field) Extent of Vulnerable Zone {CAMEO automatically calculates Threat Zone Radius when Edit button and Estimate Threat Zone Radius buttons are used} (Scenario Description field) Enter estimate of Total Exposed Population (Notes area in Scenario) Enter Critical Facilities (name of critical facility(s) and max occupancy for each; if none, state No Critical Facilities) (Notes area in Scenario) On -Site Visits, Statements of Determination, and Site Plans (For each Facility within Agreement Period of Performance.) Site Visit Certification Form (Upload to attachment section on main Facility Field.)(file name must contain at minimum the SERC number, SV and date. Statement of Determination (SOD) if applicable (Upload to Attachment Section on main Facility Field) {file name must contain at minimum SERC number and proper acronym SOD and date. Site Plan (SP) (Upload to Attachment Section on on main Facility Field.) {file name must contain at minimum the SERC acronym SP — if SERC number and date. (additional info encouraged but not required.} Sufficient Detail to Identify: North Arrow Location of Major Buildings Name and Location of Extremely Hazardous Substance(s) (if Extremely Hazardous Substances are co -located, noting EHS is acceptable) Name and Location of Street(s) ) (list the street the facility is on and at a minimum one cross street) Identify Pertinent Access and Egress Points and other features pertinent to Emergency Response 30 Attachment K Hazards Analysis Site Visit (SV) Certification Form 2025-2026 Hazards Analysis Grant FACILITY NAME STREET ADDRESS, CITY & ZIP CODE COUNTY NAME OF FACILITY REPRESENTATIVE SERC ID # FACILITY REPRESENTATIVE SIGNATURE DATE SIGNED SITE VISIT PERFORMED BY SITE VISIT DATE The Individuals signing above certify that a Hazards Analysis Site Visit was conducted on the date listed above. NOTES Check if facility representative was informed about using E -Plan for EPCRA Tier II on-line filing. (https://erplan.net/eplan/login.htm) 31 2021-22 AA A91-hwent X lIkArds Anahsis Site Vish (S►) Cenifcmlon Pone 0/2612021 ❑Exempt from Reporting for Filing Year *Due to chemicals being under threshold for the filing year Attachment L Statement of Determination (Check Only One) ❑Deregister Facility *Facility closed and all chemicals removed *Facility open and all chemicals removed *Chemicals permanently reduce to below threshold Facility/Chemical Status Change *Facility Sold *One or more chemicals removed, other substances remain above threshold Facility Name: Street: City: Zip: LEPC:County: :1 SERC ID or Access ID: SECTIONS 302-303 Extremely Hazardous Substances (EHSs) WERE present only in amounts less than established Threshold Planning Quantities (TPQs) as of this date: NO EHSs were present on-site during the current filing year. ALL EHSs were removed as of this date: SECTIONS 311-312 Hazardous Substances (HSs)/EHSs WERE present only in amounts below established Threshold Planning Quantities (TPQs) as ofthis date: NO Hazardous Substances (HSs)/EHSs WERE present on-site during the current filing ear. List the date ALL HS& EHSs were removed: STATUS CHANGE Closed Facility: ❑YES❑NO Chemicals Removed: El YES []No Chemicals Permanently Below TPQ: ❑YESQNO Date Effective: Further Explanation (ex: facility sold with date, name and CAS Number of chemical removed/reduced chemical, etc.): Certification: (Read and sign after completing all sections) I certify under penalty of law that I have personally examined and am familiar with the information submitted on this page, and that based on my inquiry of those individuals responsible for obtaining the information, I believe that the submitted information is true, accurate and complete. Name and Official Title of Owner / Operator OR Owner / Operator's Authorized Representative Signature HMP -13-00 32 Date Signed Form Updated 41"025 Attachment M HA Deliverable Review and Comment Form 25-26 HA Grant Agreement LEPC/COUNTY NAME: GRANT # CONTACT'S NAME: PHONE # FDEM GRANT MANAGER: Marvin Kalms PHONE # 448-215-9582 # SERC NOF E # FACILITY 1 2 3 4 S 6 7 8 9 *Site visit (SV) DELIVERABLE I *SV SOD LEPC/COUNTY DATE DATE � COMMENTS Approved: Rejected: FDEM REVIEW COMMENTS DATE APPROVED Attachment M HA Deliverable Review and Comment Form 25-26 HA Grant Agreement # SERC NAE E *SV SOD '� LEPC/COUNTY FDEM REVIEW & # APPROVED FACILITY DATE DATE COMMENTS COMMENTS 10 ❑ 11 12 ❑ 13 ❑ 14 ❑ 1-5 El 16 16 - ❑ 17 ❑ 18 ❑ 19 ❑ 20 ❑ 21 * site Visit (s;%