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Home My WebLink About2016-397-E Emergency Svc - NC Emergency Management - Application for Annual Emergency Mgmt. Performance Grant DocuSign Envelope ID:7AC7CCCD-2FEA-4C09-B2A3-FA4F14F912CE NORTH CAROLINA LOCAL GOVERNMENT APPLICATION FOR FFY 2017 EMPG FUNDING INSTRUCTIONS FOR COMPLETING EM FORM 66 1.1 EM Agency Name - Type or print the official legal title of your Emergency Management (EM) agency. 1.2 Street Address, City, Zip Code+4 - Type or print the street address, city, and nine digit zip code. 1.3 EIN/Tax ID Number- Type or print the unique nine digit identification number for your county's agency. NOTE: Your financial personnel should be able to provide you with this number. 1.4 D-U-N-S Number- Type or print the unique nine digit identification number for your county's agency. NOTE: Your financial personnel should be able to provide you with this number. 1.5 Zip Code+4 — Enter your nine digit zip code for your county government agency mailing address, e.g., 281230465. 1.6 SAM Registered — Each applicant must be registered in the Federal System for Award Management (SAM) annually in order to be eligible to receive EMPG monies. The URL is https://www.sam.gov/. Expiration Date — What is the expiration date for your SAM account? 1.7 EM Program Manager- Type or print the name of the county EM Program Manager. NOTE: Must be the same title on the Position Description and Organization Chart. 1.8 Finance Manager - Type or print the name of the county Financial Manager. NOTE: Must be the same title on the Position Description and Organization Chart. 1.9 Time (%) - EM Director will type or print the percentage of time the director devotes to Emergency Management program activities (e.g. 50%, 60%, 90%, etc.). 1.10 Current Salary - Type or print the current annual salary for EM Director. (Round to the nearest dollar). 1.11 Date of Employment in Current Position — Enter the start date of your position as Local Emergency Management Program Manager, e.g. 02/04/2014. EM Application Form 66 (Rev.7/16) Page 1 DocuSign Envelope ID:7AC7CCCD-2FEA-4C09-B2A3-FA4F14F912CE 1.12 Personnel Data Table — Complete the specific questions that deal with EM program staff. For the Cost Share or In-Kind Match question, explain how the county will match the federal award grant monies. In FFY 2017, EMPG has a 50% County and 50% Federal cost share cash- or in- kind match requirement. Federal funds cannot be matched with other Federal funds. The data requested will assist in documenting the extent to which EMPG Program funding contributes to enhancing or sustaining emergency management capacity in terms of personnel support at the local level. All EMPG Program funds (Federal and match) allocated towards Local emergency management personnel? Enter the dollar amount for all EMPG Program funds (Fed & match) allocated for State emergency management personnel. All EMPG Program funds (Fed & match) allocated towards Non-Local emergency management personnel? Enter the dollar amount for all EMPG Program funds (Fed & match) allocated towards Non-State emergency management personnel. Total Number of Local Emergency Management full-time equivalent (FTE) personnel (including those supported and not supported by the EMPG Program). Enter the Total Number of State Emergency Management full-time equivalent (FTE) personnel (including those supported and not supported by the EMPG Program). Number of Local emergency management full-time equivalent (FTE) personnel supported by the EMPG Program? Enter the number of State emergency management full-time equivalent (FTE) personnel supported by the EMPG Program. Total Number of Local emergency management personnel funded (fully or partially) by the EMPG Program. Enter the total Number of State and local emergency management personnel funded (fully or partially) by the EMPG Program. Cost Share or In-Kind Match explanation in detail? Enter in information as to how the county will match the local EMPG share. Describe if funds will come from a general fund, EMPG local funds, etc. EM Application Form 66 (Rev.7/16) Page 2 DocuSign Envelope ID:7AC7CCCD-2FEA-4C09-B2A3-FA4F14F912CE NORTH CAROLINA LOCAL GOVERNMENT APPLICATION FOR FFY 2017 EMPG FUNDING Grant Period: October 1, 2016—September 30, 2018 1.1 EM Agency Name Orange County Emergency Services 1.2 Street Address, City 510 Meadowlands Drive, Hillsborough,NC 27278 1.3 EIN/Tax ID Number 1.4 DUNS 9 Digit Number 069420961 1.5 Zip Code+4 2 7 2 7 8 8 1 8 1 1.6 SAM Registered? (Yes, No) Yes Expiration Date 22-Nov-2016 LOCAL EMERGENCY MANAGEMENT PROGRAM For 1.7 indicate actual percentage of time Emergency Management 1.9* 1.10 1.11 director devotes to work on only EM activities. Please do not include work time for EMS, 911, Fire Marshal,Safety activities, Time % Current ( ) Date of Employment etc. (e.g. 50%,75%, Salary in Current Position 1.7 EM Program Manager (Print/Type in Name Below) 100%) W. Kirby Saunders 100 $57,000 06/30/2014 Email: ksaunders @orangecountync.gov 1.8 County Finance Manager (Print/Type in Name Below) Gary Donaldson Email: gdonaldson@orangecountync.gov 1.12 Personnel Data: Complete for personnel supported with FFY 2017 EMPG Program funds a. All EMPG Program funds (Federal and match) allocated towards Local emergency management personnel? $ 137,556 b. All EMPG Program funds (Federal and match) allocated towards Non-Local emergency management $0 personnel? c. Total Number of Local emergency management full-time equivalent(FTE) personnel (including those 3 supported and not supported by the EMPG Program)? d. Number of Local emergency management full-time equivalent (FTE)personnel supported(fully or partially)by 0 the EMPG Program? e. Number of Local emergency management personnel supported(fully or partially) by the EMPG Program? 0 £ Cost Share or In-Kind Match explanation in detail? The county's match is the salaries of EM personnel *Area Coordinator must verify the percentage of time devoted to Emergency Management activities. EM Application Form 66 (Rev.7/16) Page 3 DocuSign Envelope ID:7AC7CCCD-2FEA-4C09-B2A3-FA4F14F912CE I DO HEREBY CERTIFY THAT THE EM PROGRAM MANAGER POSITION* IS NOT VACANT OR IS CURRENTLY BEING FILLED BY AN ACTING COUNTY EMPLOYEE. �DocuSigned by: 6� saw 7/22/2016 Local EM Program Manager Signature 01HD23CFB93428... Area Coordinator Signature Branch Manager Signature Date: * AS PART OF THE GRANT APPLICATION DELIVERABLES, A CURRENT POSITION DESCRIPTION AND ORGANIZATION CHART THAT MEETS U.S. DEPARTMENT OF HOMELAND SECURITY PROGRAM AND STATE REQUIREMENTS IS ESSENTIAL. EM Application Form 66 (Rev.7/16) Page 4 DocuSign Envelope ID:7AC7CCCD-2FEA-4C09-B2A3-FA4F14F912CE INSTRUCTIONS FOR COMPLETING EM FORM 66A (STATE/LOCAL FFY 2017 EMPG AGREEMENT) It is important that the Finance Officer and the local Chief Executive Officer have information and knowledge of the local EM program and the financial status of the local EM Agency. By coordinating the program emphasis with your county officials, the State's "Comprehensive Emergency Management Criteria" and the state and federal required activities, your partnership agreement should serve as a master plan for the year's activities. The State/Local FFY 2017 EMPG Agreement requires the signature of the Local Emergency Management Program Manager, the Local Finance Officer, and the Local Chief Executive Officer (the last may be the same individual). Your Area Coordinator will monitor your FFY 2017 EMPG progress throughout the grant period. REPORTING EMPG deliverables to include Universal and Optional activities must be uploaded into WebEOC so that your agency's performance in the completion of scheduled activities throughout the year can be tracked and approved. North Carolina Emergency Management does recognize that circumstances may prevent the accomplishment of a scheduled activity. However, for full eligible Federal funding in FFY 2017, all Universal activities must be completed and uploaded into WebEOC. All requests for revisions (rescheduling or substitution of an equivalent activity) must be justified in writing to the Director of North Carolina Emergency Management through the appropriate Branch Manager. EMPG Application Form(Rev. 7/16) Page 5 DocuSign Envelope ID:7AC7CCCD-2FEA-4C09-B2A3-FA4F14F912CE STATE/LOCAL FFY 2017 EMPG AGREEMENT AGENCY: Orange County Emergency Services This is to certify that the above named agency agrees to successfully complete the activities below in full partnership with North Carolina Emergency Management and the U.S. Department of Homeland Security. The appropriate Branch Manager and/or Area Coordinator will review the progress of this agreement quarterly with the local Emergency Management Director. This report will also be the basis for continued funding during this fiscal year. All Emergency Management activity deliverables must be completed before the agreement period ends September 30, 2017. To receive credit for any deliverables you complete, an electronic copy for each deliverable must be uploaded into WebEOC by the deadline above and approved by State personnel. Certify completion of the following activities for EMPG Universal activities no later than September 30, 2017 unless otherwise noted below: 2017.01 Update the NIMS reporting tool by November 15, 2016; 2017.02 Review/Update County Emergency Operation/Response plan; 2017.03 Participate in a minimum 24 hours EM training; 2017.04 Conduct or participate in three exercises per year; 2017.05 Complete all NIMS training requirements as outlined in NIMS Five-Year Plan; 2017.07 Attend Statewide EM Conference 2017.09 Update Statewide Mutual Aid Agreement Authorized Agent Page 2017.52 Update County Profile NOTE: As listed above to be eligible to receive FFY 2017 EMPG funding, applicants must meet NIMS compliance requirements. The NIMS is the required means to report FY 2017 NIMS compliance for FFY 2017 funds. FFY 2017 Compliance Requirements • NIMS Training: IS 100; IS 200; IS 700; and IS 800; • FEMA Professional Development Series: IS 120, IS 230a. b.; IS 235a. b.; IS 240a; IS 241a; IS 242a; and IS 244a EMPG Program funds used for training should support the nationwide implementation of NIMS. Grantees are encouraged to place emphasis on the core competencies as defined in the NIMS Training Program. The NIMS Training Program can be found at http://www.fema.gov/pdf/emergency/nims/nims training program.pdf. The NIMS Guideline for Credentialing of Personnel provides guidance on the national credentialing standards. The NIMS Guidelines for Credentialing can be found at http://www.fema.gov/pdf/emergency/nims/nims cred guidelines report.pdf. The Federal Funding Accountability and Transparency Act (FFATA) necessitates a system to allow prime grant award and sub-award recipients to report monies received from federal funds. The FFATA Subaward Reporting System — FSRS.gov— is the system that allows grant award and contract award recipients to electronically report their sub-award monies. Each prime and sub-award recipients must be registered and renewed annually in the System for Award Management (SAM) to continue to be eligible for EMPG monies. EMPG Application Form(Rev. 7/16) Page 6 DocuSign Envelope ID:7AC7CCCD-2FEA-4C09-B2A3-FA4F14F912CE This Agreement will become effective upon execution of all parties to the Agreement. The date of execution shall be the date of the last signature. EXECUTED THIS THE DAY OF , 201_ W. Kirby Saunders (Print) Name of Local EM Program Manager DocuSigned by: 66ti SakwultrS 7/22/2016 ' i ttire3t f Local EM Program Manager Date DocuSigned by: botAAA lt, ticumwt,V'Stui 7/22/2016 • erfev Local Chief Executive Officer Date EMPG Application Form(Rev. 7/16) Page 7