SAMPLE

[FEMA-STATE AGREEMENT]{.underline}

On ////////, 2001, the President declared that a major disaster exists
in the State of //////. This declaration was based on damage resulting
from////////////, on ///////, 2001. This is the FEMA-State Agreement for
this major disaster, designated FEMA-////-DR, under the Robert T.
Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. §§
5121-5206 (the Stafford Act), in accordance with 44 CFR § 206.44.

1\. No Federal assistance under the Stafford Act shall be approved
unless the damage or hardship to be alleviated resulted from the major
disaster that took place on /////, 2001; except that reasonable expenses
that were incurred in anticipation of and immediately preceding such
event may be eligible.

2\. Federal assistance under the Stafford Act and this Agreement shall
be limited to the following areas of the State and such additional areas
as may be subsequently designated by the Regional Director, FEMA Region
//, (\"the Regional Director\"):

> //////////////////////////////
>
> All counties in the State of /////// are eligible to apply for
> assistance under the Hazard Mitigation Grant Program.

3\. Any Federal funds provided under the Stafford Act for Public
Assistance will be limited to 75 percent of total eligible costs in the
designated area.

4\. The Governor has indicated his intent to implement the Individual
and Family Grant Program and has agreed that the State will pay its 25
percent share of all grants to individuals and families. ***(IA
PARAGRAPH)***

5\. Funds are available on a 75 percent Federal cost share basis for
hazard mitigation measures that could substantially reduce the risk of
future damage, hardship, loss or suffering in any area within the State.
Total Federal contributions shall not exceed 15 percent of the estimated
aggregate amount of grants to be made (less any associated
administrative costs) under this Act for this disaster.

6\. Pursuant to 44 CFR § 206.208 if direct Federal Assistance is
requested by the State, the Governor certifies that the State will; 1)
provide without cost to the United States all lands, easements, and
rights-of-ways necessary to accomplish the approved work; 2) hold and
save the United States free from damages due to the requested work, and
shall indemnify the Federal Government against any claims arising from
such work; 3) provide reimbursement to FEMA for the nonfederal share of
the cost of such work; and 4) assist the performing Federal Agency in
all support and local jurisdictional matters. ***(PA PARAGRAPH)***

7\. Pursuant to Sections 403 and 407 of the Stafford Act, 42 U.S.C. §§
5170(b) & 5173, the State agrees to indemnify and hold harmless the
United States of America for any claims arising from the removal of
debris or wreckage for this disaster. The State agrees that debris
removal from public and private property will not occur until the
landowner signs an unconditional authorization for the removal of
debris. ***(PA PARAGRAPH)***

8\. Attached and also made a part of this Agreement are:

Exhibit A, List of State officials authorized to execute certifications
and otherwise to act on behalf of the State,

Exhibit B, General Conditions, and

Exhibit C, Disaster Grant Agreement Articles

9\. This Agreement may be amended at any time by written approval of
both parties.

Agreed:

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\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Governor Regional Director

Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

EXHIBIT A

STATE CERTIFICATION OFFICERS

1\. The Governor hereby certifies that
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is the Governor\'s
Authorized Representative empowered to execute on behalf of the State
all necessary documents for disaster assistance, including approval of
subgrants and certification of claims for Public Assistance.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
is the Alternate Governor\'s Authorized Representative and is similarly
empowered. Their specimen signatures follow:

GAR Alternate GAR

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\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

2\. The Governor\'s Authorized Representative, named above, is
responsible for State performance of hazard mitigation activities under
this Agreement and, further,
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is
designated the State Hazard Mitigation Coordinator for the purposes of
such hazard mitigation activities.

3\. The Governor hereby certifies that
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ and
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ are the State
Coordinating Officer (SCO) and Alternate State Coordinating Officer,
respectively, who will act in cooperation with the Federal Coordinating
Officer under this declared major disaster.

4\. The Governor hereby certifies that
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is the
representative of the State authorized to receive donations or loans of
surplus property on behalf of the State and to execute certification,
agreements, and other necessary documents with regard thereto.

5\. The Governor hereby certifies that
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is the official of
the State authorized to execute compliance reports, carry out compliance
reviews, and distribute informational material as required by FEMA to
ensure that all recipients of Federal disaster assistance are in full
compliance with FEMA nondiscrimination regulations (located at 44 CFR
Part 7).

6\. The Governor hereby certifies that
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is the official of
the State who will execute compliance reports, carry out compliance
reviews, and distribute information material as required by FEMA to
ensure that all recipients of Federal disaster assistance are in
compliance with the General Services Administration List of Parties
Excluded from Federal Procurement and Nonprocurement Programs.

EXHIBIT B

GENERAL CONDITIONS

FEMA and the State agree to take measures to deliver assistance to
individuals, families, and governments as expeditiously as possible,
consistent with Federal laws and regulations. To that end, the following
terms and conditions apply:

1\. Federal assistance will be made available, within the limits of
funds available from Congressional appropriations for such purposes, in
accordance with the Stafford Act, Executive Orders 12148 and 12673, and
applicable regulations found in Title 44 of the Code of Federal
Regulations (CFR), and applicable policy and guidance.

2\. If necessary because of limited funds, FEMA will give first priority
to assistance for individuals and families, emergency work for
protection of public health and safety, and administrative costs for
managing the disaster program. Public assistance recovery claims, hazard
mitigation, and fire suppression assistance will be paid when, and if,
funds become available and will be provided on a first come, first serve
basis.

3\. Pursuant to the regulations, the State agrees to be the grantee for
all grant assistance provided under the Stafford Act. The State agrees
to comply with the requirements of laws and regulations found in the
Stafford Act and 44 CFR. The State hereby waives any consultation
process under Executive Order 12372 and 44 CFR Part 4, for grants,
loans, or other financial assistance under the Stafford Act for this
major disaster.

4\. Within his authorities, the Governor shall ensure, through the State
agency responsible for regulation of the insurance industry, that
insurance companies make full payment of eligible insurance benefits to
disaster victims and other recipients of Federal disaster assistance.
The State also shall take all responsible steps to ensure that disaster
victims are aware of procedures for filing insurance claims, and are
informed of any State procedures instituted for assisting insured
disaster victims. Further, the State shall take all actions necessary
and reasonable to ensure that all recipients of Federal disaster
assistance are aware of their responsibility to repay government
assistance that is duplicated by insurance proceeds.

5\. The State agrees, on its behalf and on behalf of its political
subdivisions and other recipients of Federal disaster assistance, to
cooperate with the Federal Government in seeking recovery of funds that
are expended in alleviating the damages and suffering caused by this
major disaster against any party or parties whose intentional acts or
omissions caused or contributed to the damage or hardship for which
Federal assistance is provided pursuant to the Presidential declaration
of this major disaster.

EXHIBIT C

DISASTER GRANT AGREEMENT ARTICLES

**[ARTICLE I]{.underline}.** The United States of America through the
Director, Federal Emergency Management Agency (FEMA) (hereinafter
referred to as \"the Grantor\") or his/her delegate, agrees to grant to
the State Government, through its designated agency named above
(hereinafter referred to as \"the Grantee\") funds in the amount
specified on the obligating document, to support the Grant Program
authorized under the Robert T. Stafford Disaster Relief and Emergency
Assistance Act, 42 U.S.C. §§ 5121-5204 (the Stafford Act), and activated
in the FEMA-State Agreement for FEMA-////-DR. The Grantee agrees to
abide by the grant terms and conditions as set forth in this document,
to comply with all provisions of the State Administrative Plan for each
disaster grant, and all conditions contained in the FEMA-State
Agreement.

**[ARTICLE II]{.underline}.** This agreement takes effect at the time
the FEMA-State Agreement is executed and remains in effect until the
grant program has been closed by FEMA. Refer to obligating documents for
funding information.

**[ARTICLE III]{.underline}.** As stated in Exhibit B paragraph 3, the
Grantee agrees to comply with all applicable laws and regulations. In
particular, the following laws, regulations, and OMB circulars govern
standard grant management practices and are incorporated into this
Agreement by reference. Due to the nature of grant administration
following a Presidential declaration of a disaster or emergency, some
variance from standard practice may be warranted upon determination by
FEMA.

**The Robert T. Stafford Disaster Relief and Emergency Assistance Act,**
**42 U.S.C. §§ 5121-5204 (the Stafford Act).**

**Title 44 of the Code of Federal Regulations (CFR)**

44 CFR Part 13 Uniform administrative requirements for grants and
cooperative agreements to state and local governments

44 CFR Part 14 Administration of grants: Audits of State and local
governments

> 44 CFR Part 17 Governmentwide debarment and suspension
> (nonprocurement) and governmentwide requirements for drug-free
> workplace (grants)

44 CFR Part 18 New restrictions on lobbying

44 CFR SUBCHAPTER B - Insurance and Hazard Mitigation

44 CFR SUBCHAPTER C - Fire Prevention and Control

44 CFR SUBCHAPTER D - Disaster Assistance

44 CFR Part 7 Nondiscrimination in Federally Assisted Programs

**OMB Circular A-110** Uniform Administrative Requirements for Grants
and Agreements with institutions of Higher Education, Hospitals, and
Other Non-Profit Organizations

**OMB Circular A-102** Uniform Administrative Requirements for Grants
and Cooperative Agreements with State and Local Governments

**OMB Circular A-87** Cost Principles for State and Local Governments

**OMB Circular A-21** Cost Principles for Educational Institutions

**OMB Circular A-122** Cost Principles for Nonprofit Organizations

**OMB Circular A-133** Audits of States, Local Governments, and
Non-Profit Organizations

Assurances submitted with the SF 424, Application for Federal
Assistance.

**31 CFR 205.6** Funding techniques

**[ARTICLE IV]{.underline}.** The specific terms and conditions of this
agreement are as follows:

1.  No transfer of funds to agencies other than those identified in the
    approved grant agreement shall be made without prior approval of
    FEMA. Grantee shall be paid using the HHS Smartlink System, provided
    Grantee maintains and complies with procedures for minimizing the
    time between transfer of funds from the US Treasury and disbursement
    by the Grantee and Subgrantees. The Grantee commits itself to: 1)
    initiating cash drawdowns only when actually needed for its
    disbursement; 2) timely financial reporting per FEMA requirements,
    using the SF269 or equivalent report; and 3) imposing the same
    standards of timing and amount upon any secondary recipient.

2.  Grantee shall follow cost-sharing requirements per 44 CFR § 13.24.

3\. The Grantee shall transfer to FEMA the appropriate share, based on
the Federal support percentage, of any refund, rebate, credit or other
amounts arising from the performance of this agreement, along with
accrued interest, if any. The Grantee shall take necessary action to
effect prompt collection of all monies due or which may become due and
to cooperate with FEMA in any claim or suit in connection with amounts
due.

4\. Prior to the start of any construction activity, the Grantee shall
ensure that all applicable Federal, State, and local permits and
clearances are obtained including FEMA compliance with National
Environmental Policy Act, the National Historic Preservation Act, the
Endangered Species Act, and all other environmental laws.

5.  The Grantee is free to copyright any original work developed in the
    course of or under the agreement. FEMA reserves a royalty-free,
    nonexclusive and irrevocable right to reproduce, publish or
    otherwise use, and to authorize others to use the work for
    Government purposes. Any publication resulting from work performed
    under this agreement shall include an acknowledgement of FEMA
    financial support and a statement that the publication does not
    necessarily reflect FEMA\'s views.

6.  The Grantee shall submit financial status reports (SF269 or
    equivalent) to the FEMA regional office 30 days after the end of the
    first federal quarter following the initial grant award. (This
    initial report may be waived by the Disaster Recovery Manager). The
    Grantee shall submit quarterly financial status reports thereafter
    until the grant ends. Reports are due on January 30, April 30, July
    30, and October 30. The Disaster Recovery Manager or the Regional
    Director may suspend drawdowns if quarterly reports are not
    submitted on a timely basis.

7.  Per 44 CFR § 13.50, when FEMA and the State have completed the
    agreed upon grant activities, the State shall submit a final
    financial status report (SF269 or equivalent), any required
    performance reports, a request to close the program, and any other
    required forms and certifications within 90 days of completion of
    grant activities. FEMA will evaluate Grantee reports, perform the
    necessary financial reconciliation, make any necessary adjustments,
    and closeout the grant.

8.  The grant shall be completed within the time period prescribed in
    FEMA regulations and on the obligating documents. Written request
    for an extension will include information and documentation to
    support the amendment and a schedule for completion. No subsequent
    grant agreements, monetary increase amendments, or time extension
    amendments will be approved unless all overdue final financial or
    performance reports have been submitted by the Grantee to the
    appropriate Regional Office. Exceptions to this policy can be
    approved only by the FEMA Regional Director or Disaster Recovery
    Manager.

9.  The certifications signed by the State on the FEMA-State Agreement
    relating to maintenance of a Drug-Free workplace (44 CFR Part 17,
    Subpart F) and New Restrictions on Lobbying (44 CFR Part 18) apply
    to this grant agreement and are incorporated by reference.

> CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS

This certification is required by the regulations implementing the
Drug-Free Workplace Act of 1988, 44 CFR Part 17, Subpart F. The
regulations require certification by grantees, 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 governmentwide
suspension or debarment. (See 44 CFR Part 17, Subpart C and Subpart D.)

A. **The grantee certifies that it will or will continue to provide a
drug-free workplace by:**

\(a\) Publishing a statement notifying employees that the unlawful
manufacture, distribution, dispensing, possession, or use 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-free awareness program to inform
employees about\--

\(1\) The dangers of drug abuse in the workplace;

\(2\) The grantee\'s policy of maintaining a drug-free workplace;

\(3\) Any available drug counseling, rehabilitation, and employee
assistance programs; and

\(4\) The penalties that may be imposed upon employees for drug abuse
violations occurring in the workplace;

\(c\) Making it a requirement that each employee to be engaged in the
performance of the grant be given a copy of the statement required by
paragraph (a);

\(d\) Notifying the employee in the statement required by paragraph (a)
that, as a condition of employment under the grant, the employee will\--

\(1\) Abide by the terms of the statement; and

\(2\) Notify the employer in writing of his or her conviction for a
violation of a criminal drug statute occurring in the workplace no later
than five calendar days after such conviction;

\(e\) Notifying the agency in writing within ten calendar days after
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;

\(f\) Taking one of the following actions, within 30 calendar days of
receiving notice under subparagraph (d)(2), with respect to any employee
who is so convicted\--

\(1\) Taking appropriate personnel action against such an employee, up
to and including termination, consistent with the requirements of the
Rehabilitation Act of 1973, 29 U.S.C. § 701 [et seq]{.underline}.; or

\(2\) Requiring 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-free
workplace through implementation of paragraphs (a), (b), (c), (d), (e)
and (f).

B. The grantee may insert in the space provided below the site(s) for
the performance of work done in connection with this grant:

**Place(s) of Performance**: (Street address, city, county, state, zip
code)

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\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_[FEMA-////-DR\_\_\_\_]{.underline}\_\_\_\_\_\_

Organization Name Disaster Number

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Name and Title of Authorized Representative

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature Date

CERTIFICATION FOR CONTRACTS, GRANTS, LOANS,

AND COOPERATIVE AGREEMENTS

This certification is required by the regulations implementing the New
Restrictions on Lobbying, 44 CFR Part 18. The undersigned certifies, to
the best of his or her knowledge and belief, that:

1\. 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.

2\. 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.

3\. The undersigned shall require that the language of this
certification be included in the award documents for all subawards at
all tiers (including subcontracts, subgrants, and contracts under
grants, loans, and cooperative agreements) and that all subrecipients
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 31 U.S.C. § 1352. 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
such failure.

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Name and Title of Authorized Representative

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
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Signature Date