FEMA City Rep for Disaster ReliMEMORANDUM
July 10, 2002
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Designation of City Representative for FEMA Assistance
Finance Director Ken TeKippe recommends that I be designated as the City of
Dubuque's authorized representative for signing and filing documents with the Iowa
Emergency Management Division (IEMD) for the purpose of obtaining Federal/State
financial assistance under the Disaster Relief Act (PL 93-288, as amended) or
otherwise available from the President's Disaster Relief Fund and the Code of Iowa,
Chapter 29C. This request is due to the sever storms and flooding that began on
June 3, 2002. Ken TeKippe will also serve as a designated representative who may
provide information in these matters.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
Michael C. Van Milligen
MCVM/jh
Attachment
cc: Barry Lindahl, Corporation Counsel
Cindy Steinhauser, Assistant City Manager
Ken TeKippe, Finance Director
CITY OF DUBUQUE, IOWA
MEMORANDUM
TO: Michael C. Van Milligen, City Manager
FROM: Ken TeKippe, Finance Director
SUBJECT: Designation of City Representative for FEMA Assistance
DATE: July 10, 2002
INTRODUCTION
The purpose of this memorandum is to submit a resolution designating you as the City
of Dubuque's authorized representative for signing and filing documents with the Iowa
Emergency Management Division (IEMD) for the purpose of obtaining Federal/State
financial assistance under the Disaster Relief Act (PL 93-288, as amended) or
otherwise available from the President's Disaster Relief Fund and the Code of Iowa,
Chapter 29C. This request is due to the severe storms and flooding that began on June
3, 2002. I will also serve as designated representative who may provide information in
these matters.
A resolution approving this designation is required in order for the City to begin
receiving FEMA/State disaster assistance.
DISCUSSION
The City is required to submit the attached forms and a copy of a resolution passed by
City Council designating the City's authorized representative before disaster funds will
be released for public assistance. This process and recommended course of action are
similar to that followed last year after the Mississippi flooding July of 2001 and three
years ago after the catastrophic rain event in May of 1999.
ACTION STEP
The action step is for City Council to adopt the attached resolution designating you as
the City of Dubuque's authorized representative.
cc: Barry Lindahl, Corporation Counsel
Pauline Joyce, Administrative Services Manager
Attachments
KT/jg
RESOLUTION NO. 361-02
RESOLUTION DESIGNATING THE CITY MANAGER AS THE CITY OF DUBUQUE'S
AUTHORIZED REPRESENTATIVE FOR SIGNING AND FILING DOCUMENTS TO
OBTAIN FEDERAL/STATE FINANCE ASSISSTANCE UNDER THE DISASTER
RELIEF ACT
Whereas, the City of Dubuque received a Presidential Declaration as a disaster
area as the result of severe storms and floOding beginning June 3, 2002; and,
Whereas, the State of Iowa requires the City of Dubuque to designate a
representative for purpose of obtaining Federal/State finance assistance under the
Disaster Relief Act (PL 93-288, as amended) or otherwise available from the President's
Disaster Relief Fund and the Code of Iowa, Chapter 29C.
NOW THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY
OF DUBUQUE, IOWA:
Section 1. That the City Manager is hereby designated to be the City of
Dubuque's Authorized Representative for the purpose of obtaining Federal/State
finance assistance under the Disaster Relief Act or otherwise available from the
President's Disaster Relief Fund and iowa Code Chapter 29C. The Finance Director is
authorized and directed to provide information in these matters.
Passed, approved and adopted this 15th day of July, 2002.
Terrance M. Duggan, Mayor
Attest:
Jeanne F. Schneider
City Clerk
IOWA EMERGENCY MANAGEMENT DIVISION
PUBLIC ASSISTANCE PROGRAM
CRITICAL DOCUMENTS
Included in this bundle are the 8 forms referred to as "Critical Documents". They consist of the
following:
1. Designation of Applicant's Auth(~rized Representative
2. State of Iowa Application for Federal/State Assistance
3. Hold Harmless Agreement
4. Certification Regarding Lobbying
5. Assurances - Construction Programs (2 pages)
6. Certification Regarding Drug-Free Workplace Requirements
7. Pdvate Non-Profit Organization Certification
(if the Private Non-Profit Organization Certification form does not apply to your
agency/organization, please simply draw an X, or write N/A, over the text, and include it
with the submittal of the rest of the documents)
8. Substitute W 9 / Vendor Update Form
Iowa Emergency Management Division recommends that each Public Assistance aRplicant
designate an authorized representative as soon as possible. The individual so designated
should then complete and sign each of the documents listed above, make a copy for your
records, and send a copy to:
Public Assistance Program Administrator
Iowa Emergency Management Division
Hoover State Office Building - Level A
Des Moines, IA 50319-0113
In accordance with the State of Iowa Public Assistance Administrative Plan, and the FEMA -
State Agreement, NO FUNDING PAYMENTS CAN BE REQUESTED FOR AN APPLICANT
UNTIL ALL OF THESE COMPLETED AND SIGNED DOCUMENTS ARE ON FILE WITH
IOWA EMEGENCY MANAGEMENT DIVISION.
STATE OF IOWA
DESIGNATION OF APPLICANT'S AUTHORIZED REPRESENTATIVE
The person named below is the Authorized Representative for
City of Dubuque
(Applicant Name)
Printed Name: Michael C. Van Milligen , Signature:
Title: City Manager Organization: City of Dubuque, Iowa
Address: 50 West 13th Street
City[ Dubuque
Business Phone #:(563) 589-4110
Cellular Phone #: NA
State: Iowa Zip: 52001
Fax#:(563) 589-4149 Home phone #: (563) 556-7388
E-Mail Address: ctyragr@cityofdubuque, or#
Person named above can sign and file documents with Iowa Emergency management Division (EMD) for the
purpose of obtaining Federal/State financial assistance under the Disaster Relief Act (PL 93-288, as amended) or
otherwise available from the President's Disaster Relief Fund and the code of Iowa, Chapter 29C. Resubmit a
new designation when your authorized representative changes.
Others that may provide information in these mattem are:
Chief Financial Officer:
Name: Ken TeKippe
Organization: City of Dubuque, Iowa
, Title:
Finance Director
Address: 50 West 13th Street
City: Dubuque
Business Phone #:(563) 589-4133
Cellular Phone #: NA
State: Iowa Zip: 52001
Fax #:(563) 589-0890 Home phone #: (563) 588-4027
E-Mail Address: ktekippeOcityofdubuque.org
CERTIFICATION
Jeanne Schneider
The City of Dubuque
(Entity Name)
, duly appointed City Clerk of
(Official Position)
, do hereby certify that the above is tree and correct copy
@fa resolmionpassedandapprovedby
onthe 15th day of July ,
(Date) (M~)
Jeanne F. Schneider
The Dubuque City Council
(OovemingBody)
2002
(Signature)
(Printed Name)
(563) 589-4120
(Area Code/Telephone Number)
STATE OF IOWA APPLICATION ]?OR FEDERAL/STATE ASSISTANCE
1. Date Submitted:
2. FEMA DR- 1420
3. Applicant Legal Name:
4. Address (Street):
July 15, 2002
-IA
City of Dubuque, Iowa
50 West 13th Street
6.
7.
8.
Address (City, Zip Code, County): Dubuque, Iowa 52001
Contact Person: Michael C. Van Milligen
Area Code/Phone: 563-589-4110
Organization Type: (check one)
[] State Agency
[] County
[] city
[] Township
[] Special District
[] Private Non-Profit
Facsimile: 563-589-4149
Federal Tax ID Number:
42-600459
Fiscal year (FY) start date: Month:
July Day: 1
To the best of my knowledge and belief, I certify that the information on this application is true and that
our application will comply with project administration requirements.
Michael C. Van Milligen
Typed NameofAu~or~ed Repmsenmtive
563-589-4110
AreaCode/Telephone
S~n~e
City Manager
Title
563-589-4149
Facsimile Number (if any)
July 15, 2002
Date Signed
HOLD HARMLESS AGREEMENT
Pursuant to Sections 403 and 407 of the Robert T. Stafford Disaster Relief And
Emergency Assistance Act, P.L. 93-288 as amended, 42 U.S.C. 5170(b) and 5173, the
applicant agrees to indemnify, hold harmless, and defend the United States of America
and the State of Iowa, as well as their agents and employees, for any claims arising from
the removal of debris or wreckage for this disaster. The applicant agrees that debris
removal from public and private property will not occur until the landowner provides an
unconditional authorization for the.removal of debris.
Michael C. Van Milligen
Typed Name of Authorized Representative
563-589-4110
Area Code/Telephone
Signature
City Manager
T~le
563-589-4149
Facsimile Number
July 15, 2002
Date Signed
CERTIFICATION REGARDING LOBBYING
This certification is required by the regulations implementing the New Restrictions on Lobbying, 44 CFR
Part 18. The undersigned certifies, to the best &his or her knowledge and belief, that:
No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned,
to any person for influencing or attempting to influence an officer or employee of an agency, a
Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with the awarding of any Federal contract, the making of any Federal
grant, the making of any Federal loan, the entering into of any cooperative agreement, and the
extension, continuation, renewal, amendment, or modification of any Federal contract, grant,
loan, or cooperative agreement.
If any funds other than Federal appropriated funds have been paid or will be paid to any person
for influencing or attempting to influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with this Federal contract, grant loan, or cooperative agreement, the undersigned shall
complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance
with its instructions.
The undersigned shall require that the language of this certification be included in the award
documents for all sub-awards at all tiers (including sub-contracts, sub-grants, and contracts under
grants, loans, and cooperative agreements) and that all sub-recipients shall certify and disclose
accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction
was made or entered into. Submission of this certification is a prerequisite for making or entering into
this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required
certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for
each failure.
Michael C', Van Milligen, City Manager
Name and Title of Authorized Representative
July 15, 2002
Signature "
Date
ASSURANCES - CONSTRUCTION PROGRAMS
NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, I
' please contact the Awarding Agency. In addition, certain Federal assistance awarding agencies mayI
require applicants to certify to additional assurances not included in this document. You will be
instmcted by the awarding agency if additional assurances are required.
As the duly authorized representative of the applicant, I certify that the applicant:
1. Has the legal authority to apply for Federal assistance, and the institutional, managerial, and financial
capability (including funds sufficient to pay the non-Federal share of project costs) to ensure proper planning,
management, and completion of the project described in this application.
2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate the State,
through any authorized representative, access to and the right to examine all records, books, papers, or
documents related to the assistance; and will establish a proper accounting system in accordance with
generally accepted accounting standards, or agency directives.
3. Will not dispose of, modify the use of, or change the terms of the real property title, or other interest in the
site and facilities without permission and instructions from the awarding agency. Will record the Federal
interest in the title of real property in accordance with awarding agency directives, and will include a
covenant in the title of real property acquired in whole or part with Federal assistance funds to assure non-
discrimination during the useful life of the project.
4. Will comply with the requirements of the assistance awarding agency with regard to the drafting, review and
approval of construction plans, and specification.
5. Will provide and maintain competent, adequate engineering supervision at the construction site to ensure that
the complete work conforms with the approved plans and specifications, and will furnish progress reports and
other information as required by the assistance awarding agency, or State.
6. Will initiate and complete the work within the applicable time frame after receipt of approval &the awarding
agency.
7. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes, or
presents, the appearance of personal or organizational conflict of interest or personal gain.
8. Will comply with the Intergovernment Personnel Act of 1970 (42 U.S.C. §§ 4728-4783) relating to
prescribed standards for merit systems for programs funded under one of the nineteen statutes, or regulations
specified in Appendix A or OPM's Standards for a Merit System of Personal Administration (5 C.F.R. 900,
Subpart F).
9. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. §§ 4801 et seq.) which prohibits
the use ora lead based paint in construction or rehabilitation of residence structures.
10. Will comply with all Federal statutes relating to non-discrimination. These include, but are not limited to:
a. Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis &race,
color, or national origin
b. Title IX of the Federation Amendments of 1972, as amended (20 U.S.C. §§ 1681-1683, and 1685-1686)
which prohibits discrimination on the basis of sex
c. Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. § 794) which prohibits
discrimination on the basis of handicaps
d. the Age Discrimination Act of 1975, as amended (42 U.S.C. §§ 6101-6107) which prohibits
discrimination on the basis of age
e. the Drug Abuse Office and Treatment Act of 1972 (P.L. 93-255), as amended, relating to non-
discrimination on the basis of drug abuse
f. the Comprehensive Alcohol Abuse and Alcoholism Prevention Treatment and Rehabilitation Act of 1970
(P.L. 91-616), as amended, relating to confidentiality of alcohol and drug abuse patient records
Page 1 of 2
11.
12.
17.
18.
g. Title VIII of the Civil Rights Act of 1968 (42 U.S.C. 9 3601 et seq.), as amended, relating to non-
discrimination in the sale, rental, or financing of housing
h. any other non-discrimination previsions in the specific statute(s) under which application for Federal
assistance is being made
i. the requirements on any other non-discrimination statute(s) which may apply to the application.
Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646), which provides fair and
equitable treatment of persons displaced, or whose property is acquired as a result of Federal and Federally
assisted programs. These requirements apply to all interests in real property purposes regardless of Federal
participation in purchases.
Will comply with the provisions of the Hatch Act (5 U.S.C. §§ 1501-1508 and 7324-7328), which limit the
political activities of employees whose principle employment activities are funded in whole, or in part, with
Federal funds.
13. Will comply with the flood insurance purchase requirements of Section 102 (a) of the Flood Disaster
Protection Act of 1973 (P.L. 93-234), which requires recipients in a special flood hazard area to participate in
the program, and to purchase flood insurance if the total cost of insurable construction and acquisition is
$5,000 or more.
14. Will comply with the environmental standards which may be prescribed pursuant to the following:
a. institution of environmental quality control measures under the National Environmental Policy Act of
1969 (P.L. 91-190) and Executive Order (EO) 11514
b. Environmental Policy Act of 1969 (P.L. 91-190) and EO 11514
c. notification of violating facilities pursuant to EO 11990
d. evaluation of flood hazards in flood plains in accordance with EO 11988
e. assurance of project consistency with the approved State management program developed under the
Coastal Zone Management Act of 1972 (16 U.S.C. 99 1451 et seq.)
f. conformity of Federal actions to State (Clean Air) Implementation Plans under Section 1764 (c) of the
Clean Air Act of 1955, as amended (42 U.S.C. 9 7401 et seq.)
g. protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as
amended, (P.L. 93-523)
h. protection of endangered specie~ under the Endangered Species Act of 1973, as amended, (P.L. 93-205).
15. Will comply with the Wild Scenic Rivers Act of 1968 (16 U.S.C. 99 1271 et seq.) related to protecting
components of potential components of the national wild and scenic rivers system.
16. Will assist the awarding agency in assuring compliance with Section 108 of the National Historic
Preservation Act of 1966, as amended (16 U.S.C. 470), EO 11593 (identification and preservation of historic
properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.).
Will cause to be performed the required financial and compliance audits in accordance with the Single Audit
Act of 1984.
Will comply with all applicable requirements of all other Federal laws, Executive Orders, regulations, and
policies governing this program.
Signature of Authorized Certifying Official
The City of Dubuque, Iowa
Application Organization
City Manager
TRIe
July 15, 2002
Date SubmiRed
Page 2 of 2
CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS
This certification is required by the regulations implementing the Drag-Free Workplace Act of 1988, 44 CFR, Part 17, Subpart F. The
regulations, published in the May 25, 1990 Federal Register, require certification by sub-granteas, prior to award, that they will maintain a
drug-free workplace. The certification set out below is a material representation of fact upon which reliance will be placed when the
agency determines to award the grant. False certification or violation of the certification shall be grounds for suspension of payments,
suspension or termination of grants, or government wide suspension or debarment. (See 44 CFR Part 17, Subpart C, 17.300, and Subpart
D, 17.400.)
A. The sub-grantee certifies that it will or will continue to provide a dmg-frec workplace by:
(a)
Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a
controlled substance is prohibited in the grantee's workplace and specifying the actions that will be taken against employees for
violation of such prohibition.
(b)
Establishing an ongoing drug-frec awareness program to inform employees about-
(l) The dangem of dmg abuse in tbe workplace;
(2) The grantee's policy of maintaining a drug-free workplace;
(3) Any available drag counseling, rehabilitation, and employec assistence programs; and
(4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace;
(c) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement
required by paragraph (a):
(d)
Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the
employee will-
(l) Abide by the terms of the statement; and
(2) Notify the employer in writing of his or her conviction for a violation ora criminal drug statute occurring in the workplace
no later than five calendar days al~er such conviction;
(e) Notifying the agency in writing within ten calendar days at,er receiving notice under subparagraph (d)(2) from an employee or
otherwise receiving actual notice of such conviction.
Employers of convicted employees must provide notice, including position title, to every grant officer or other designee on whose grant
activity the convicted employee was working unless the Federal agency has designated a central point for the receipt of such notices.
Notice shall include the identification number(s) of each affected grant;
(0 Taking one of the following actions, within 30 calendar days of reeciving notice under subparagraph (d)(2), with respect to any
employee who is so convicted-
(l) Taking appropriate personnel action against such an employee, up to and including termination, consistent with the
requirements of the Rehabilitation Act of 1973, as amended; or
(2) Requiting such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such
purposes by a Federal, State, or local health, law enforcement or other appropriate agency.
(g) Making a good faith effort to continue to maintain a drug-frec workplace through implementation of paragruphs (a), (b), (c), (d),
(e) and (0.
B. The sub-grantee may insert in the space provided below the site(s) for the performance of work done in connection with this grant:
Place(s) of Performance:
50 West 13th Street
Street Address
Dubuque Iowa 52001
C~t'y
City of-Dubuque, Iowa
State Zip Code
Organization Name
1420
Disaster Number
Michael C. Van Milligen, City Manager
Name and ~fle of Authorized Representative
July 15, 2002
Signstu~ Date
PRIVATE NON-PROFIT ORGANIZATION CERTIFICATION
This is to certify that:
meets the requirements outlined in
Section 406 (a)(2) of P.L. 93-288 as amended by P.L. 100-707 and is seeking Federal Disaster Assistance
under P.L. 93-288 as amended by P.L. 100-707, as a private non-profit organization.
The above Named organization has been granted tax exemption by the Internal Revenue Service (IRS) under
Section 501 (c) or (e) of the Internal Revenue Code of 1934, as amended, or it is a non-revenue producing
organization or entity and is a nonprofit one organized or doing business under State law.
Note: Please attach a current copy of the IRS ruling letter or opinion from the State.
3. The above named organization has the necessary permits and licenses to repair, restore, reconstruct, or replace
the facility in accordance with the project application; and to maintain and operate the facility thereafter.
4. The above named organization will conform with all applicable codes, specifications, and standards during
the performance of restorative work.
The above named organization owns the damaged facility, and in the case of real property, has, or will have, a
title or fee simple, or such other estate or interest in the site, including necessary easements and rights-of-way,
sufficient to assure (for a reasonable time period) undisturbed use and possession for the purpose of the
conslruction and operation of the facility.
The facility will conti, nue to be operated in such a manner as to maintain either tax exempt status granted
under the Internal Revenue Code or the non-profit status under the State law during the normal anticipated
Useful life of the restored facility, or the useful life of the restorative work, whichever is less.
7~
The above named organization will maintain adequate and separate accounting and fiscal records to account
for all funds provided from any source to pay the project costs and allow pert audit of such records and
accounts at any reasonable time. Record keeping will also be utilized to insure that claims for Federal
reimbursement do not duplicate funding provided from any other some.
o
The above named organization will provide and maintain competent and adequate architectural or engineering
supervision and inspection at the construction site to insure that the completed work conforms with the
appropriate plans and specifications.
9. Adequate financial support will be available for maintenance and operation when completed.
10. Insurance required by P.L. 93-288, as amended by P.L. 100-707, and Federal Disaster Assistance Regulations
will be obtained and maintained.
July 15, 2002
Signature of Private Non-Profit Organization's Date
Authorized Official
SUBSTITUTE W 9 I VENDOR UPDATE FORM
(Please print or type except for signature)
CPK~5933
In order for the state of Iowa to pay you the amount that is due to you and to comply with the IRS regulations on reporting
t~.se payments, we are requesting the following information. Failure to provide this information will result in
withholding of payment.
BOX A BOX B
Are you/your business: YES NO
Individual [I]
or Sole Proprietorship iCI
If the answer to both was no, please complete Box B. '
If you answered yes to either item, please provide .
Your Social Security number:
AND
Complete the Name and Address below:
Last Name:
First Name:
MI
Doing Business As:
~ddress:
~ddress:
~ity: St: Zip:
Is your business:
Corporation [C]
Partnership [P]
Estate or Trust [E]
Public Service Corp [U]
Government [G]
Other [O]
Please explain
Please provide us with your
Federal Employer !dentification number:
42 6004596
AND
Complete the Name and Address below:
Firm:
City of Dubuque, Iowa
Doing Business As:
Address:
50 West 13th Street
Address:
YES
x
NO
City: St: Zip:
Dubuque IA 52001-4864
CERTIFICATION MUST BE SIGNED BY VENDOR
Certification - Under penalties of perjury, I certify that:
(1) The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
(2) I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal
Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has
notified me that I am no longer subject to backup withholding.
Signature: Date:
i FOR OFFICE USE ONLY (.Refer to Procedure 270.450 for more details) ]
L
J
From:
Dept.
Contact
Added For Purchasing
[] Yes [] No
[] Add
[] Change
(Include vendor code and
changes only)
[] Delete
Reason: