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Emergency Management Performance Grant
EMPG Application
Step
1
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Welcome to the EMPG Online Application
The application is a multi-step process and all applicable steps
MUST
be completed in order for your grant application to be considered. If you have questions throughout the application process, please contact the Homeland Security & Emergency Management EMPG Program Coordinator.
By checking the box below, I certify that I have read and understand the NH EMPG Program Guidance and certify the project has not been started and will not begin prior to official notification of a grant award.
*
The NH EMPG Program Grant Guidance is available
here
I Understand and Agree
ATTACHMENTS UPDATE:
In an effort to make our application process easier to use, we have implemented a new option for sending attachments/files. Applicants can upload the file directly into the application. However, if the file is large (>2MB), applicants have the option to email the files to the EMPG Program. If you select the email option, you will receive an email with instructions on where and how to send your attachments after you've submitted your application.
Community/SAU/Agency Name:
*
Community/SAU/Agency Unique Entity ID (UEI)
*
Is your Unique Entity ID (UEI) Active on SAM.gov?
*
Yes
No
Please upload a screenshot of the active status on SAM.gov
*
Accepted file types: pdf, jpg, gif, xslx, doc, docx, ppt, pptx, xsl, Max. file size: 1 GB.
You must have a valid Unique Entity ID (UEI) registered on sam.gov to continue. Please visit
sam.gov
to register or update Unique Entity ID (UEI) information
Address:
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Primary Contact Name
*
Please Note:
The Primary Contact represents the community/SAU/agency that will become the subrecipient (fiscal agent) of this grant.
First
Last
Title:
*
Address
*
Same as previous
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Email:
*
Enter Email
Confirm Email
Secondary Contact Name
*
First
Last
Title
*
Address
*
Same as previous
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Email:
*
Enter Email
Confirm Email
Fiscal/Financial Agent Name
*
First
Last
Fiscal/Financial Agent Title
*
Phone
*
Email
*
Enter Email
Confirm Email
Notifications: Who should receive notifications about the EMPG Application?
*
Notifications include automated emails concerning this application. This will likely be your Field Representative or the Primary Contact.
Enter Email
Confirm Email
I. SUMMARY INFORMATION
A) Projects
*
Please select the number of projects:
1
2
3
4
Project 1 Title
*
Project 1 Type
*
1. Generators for a primary EOC or primary Shelter, sewer and water facilities, critical communications (towers with communications equipment)
2. LEOP
3. COOP Plan
4. Primary EOC Equipment
5. Active Threat (train-the-trainer) Training
6. Other (Please describe project in detail in section II "Project Narrative")
I am:
*
a Police Department Representative authorized to apply for grants on behalf of the police department.
a School/SAU Representative authorized to apply for grants on behalf of the SAU/School.
a town/city/community Representative authorized to apply for gratns on behalf of the town/city/community.
I am applying for this grant on behalf of:
*
the Police Department
the school/SAU
I am authorized to apply for this grant on behalf of the organization(s) I selected above.
*
Yes
No
If you are applying for a community to update their Local Emergency Operations Plan (LEOP), please complete the
LEOP Contractor Selection Form
.
Please note that this form will open in another page. Once it has been submitted, you must return to this page and continue with the application.
Project 1 Milestones
*
Please identify important milestones that will indicate progress on your proposed project. Please use days, months, etc. instead of using dates under the timeframe. Please click on the (+) symbol below to add additional milestones, as appropriate. Projects should not extend beyond a 24 month period.
Milestone
Approximate Timeframe
LEOP Milestones
Here is a list of typical milestones for LEOP Projects. If you wish to add more information, please do so below.
Milestone
Approximate Timeframe
100% Cost of Project 1
*
Please enter the total cost of the project(s) including match and the amount of the grant. For your convenience, you may utilize the following spreadsheet to assist in match calculation:
soft-match accrual form
or use this spreadsheet as a guide for calculating combination of cash and soft match:
Soft/In-Kind Cash Matching Tool
.
If staff time is going to be utilized for in-kind match, the expected staff member(s), the number of hours, and their rate of pay [or the volunteer rate] must be detailed.
The maximum grant amount allowed is $100,000 federal share for
ALL
projects in this application ($200,000 100% cost of project) without providing a request for a waiver.
Project 2 Title
Project 2 Type
1. Generators for a primary EOC or primary Shelter, sewer and water facilities, critical communications (towers with communications equipment)
2. LEOP
3. COOP Plan
4. Primary EOC Equipment
5. Active Threat (train-the-trainer)
6. Other (Please describe project in detail in section II "Project Narrative")
I am:
*
a Police Department Representative authorized to apply for grants on behalf of the police department.
a School/SAU Representative authorized to apply for grants on behalf of the SAU/School.
a town/city/community Representative authorized to apply for gratns on behalf of the town/city/community.
I am applying for this grant on behalf of:
*
the Police Department
the school/SAU
I am authorized to apply for this grant on behalf of the organization(s) I selected above.
*
Yes
No
100% Cost of Project 2
The maximum grant amount allowed is $100,000 federal share for
ALL
projects in this application ($200,000 100% cost of project) without providing a request for a waiver.
Project 2 Milestones
Please identify important milestones that will indicate progress on your proposed project. Please use days, months, etc. instead of using dates under the timeframe. Please click on the (+) symbol below to add additional milestones, as appropriate.
Explanation
Approximate Timeframe
Project 3 Title
Project 3 Type
1. Generators for a primary EOC or primary Shelter, sewer and water facilities, critical communications (towers with communications equipment)
2. LEOP
3. COOP Plan
4. Primary EOC Equipment
5. Active Threat (train-the-trainer)
6. Other (Please describe project in detail in section II "Project Narrative")
I am:
*
a Police Department Representative authorized to apply for grants on behalf of the police department.
a School/SAU Representative authorized to apply for grants on behalf of the SAU/School.
a town/city/community Representative authorized to apply for gratns on behalf of the town/city/community.
I am applying for this grant on behalf of:
*
the Police Department
the school/SAU
I am authorized to apply for this grant on behalf of the organization(s) I selected above.
*
Yes
No
100% Cost of Project 3
The maximum grant amount allowed is $100,000 federal share for
ALL
projects in this application ($200,000 100% cost of project) without providing a request for a waiver.
Project 3 Milestones
Please identify important milestones that will indicate progress on your proposed project. Please use days, months, etc. instead of using dates under the timeframe. Please click on the (+) symbol below to add additional milestones, as appropriate.
Explanation
Approximate Timeframe
Project 4 Title
Project 4 Type
1. Generators for a primary EOC or primary Shelter, sewer and water facilities, critical communications (towers with communications equipment)
2. LEOP
3. COOP Plan
4. Primary EOC Equipment
5. Active Threat (train-the-trainer)
6. Other (Please describe project in detail in section II "Project Narrative")
I am:
*
a Police Department Representative authorized to apply for grants on behalf of the police department.
a School/SAU Representative authorized to apply for grants on behalf of the SAU/School.
a town/city/community Representative authorized to apply for gratns on behalf of the town/city/community.
I am applying for this grant on behalf of:
*
the Police Department
the school/SAU
I am authorized to apply for this grant on behalf of the organization(s) I selected above.
*
Yes
No
100% Cost of Project 4
The maximum grant amount allowed is $100,000 federal share for
ALL
projects in this application ($200,000 100% cost of project) without providing a request for a waiver.
Project 4 Milestones
Please identify important milestones that will indicate progress on your proposed project. Please use days, months, etc. instead of using dates under the timeframe. Please click on the (+) symbol below to add additional milestones, as appropriate.
Explanation
Approximate Timeframe
Total Cost of Projects (100%)
*
Please enter the total cost of the project(s) including match and the amount of the grant. For your convenience, you may utilize the following spreadsheet to assist in match calculation:
soft-match accrual form
or use this spreadsheet as a guide for calculating combination of cash and soft match:
Soft/In-Kind Cash Matching Tool
.
If staff time is going to be utilized for in-kind match, the expected staff member(s), the number of hours, and their rate of pay [or the volunteer rate] must be detailed.
B) Project Address/Location Description (If applicable)
*
If this is for Emergency School Notification Software for a school/SAU, please list all the school names and corresponding addresses.
Number of schools you are applying for:
*
Multiple schools may share a single campus and one school may include multiple buildings. Contact your Vendor Rep to clarify this answer.
Please enter a number from
1
to
24
.
Approximate Number of School Devices
*
Approximately how many school devices will have the software installed?
Number of Police Devices
*
How many police devices will the software be installed in?
Latitude
Decimal Degrees Preferred
Longitude
Decimal Degrees Preferred
II. PROJECT DESCRIPTION / SCOPE OF WORK
A) Project Narrative
*
Please include a detailed narrative of each project identified in Section I. Include a breakdown of all expenses - attach other documents as needed.
Please be sure to include:
•How the project supports and aligns with the National Preparedness Goal (NPG): A secure and resilient nation with the capabilities required across
the whole community to prevent, protect against, mitigate, respond to and recover from the threats and hazards that pose the greatest risk.
•How the project enhances emergency management capabilities based on the threats and hazards that are most relevant now and in the future.
•How the project will be used specifically for emergency management vs everyday use.
•How the project is technically feasible, i.e. the ability to execute and accomplish the project is possible, realistic and will close the gap(s).
•How the matching funds directly correlate to the project, can be verified through records, is a reasonable cost (ordinary or typical for this project type), is
an allowable matching cost (necessary and reasonable for this project) and necessary to accomplish the overall project goal.
•Clearly defined and well-planned milestones which show the project can be completed within the performance period for the grant.
•How the cost of this project is reasonable for the project type.
•Why the project is a high priority/immediate need for the subrecipient.
•The longevity/expected useful life of the project.
•How this project aligns with NH's identified priority projects: Plan development/update for LEOPs and COOP; Primary EOC equipment; Backup
power for PRIMARY EOCs and shelters; Active Threat Training (train-the-trainer); School Emergency Notification Systems; Backup power to water treatment facilities or critical communication systems.
•How, if applicable, the project supports local citizen preparedness campaigns to help residents become aware of how to prepare for and respond to an emergency.
Please note that regardless of the eligibility of an item, items requested or intended for everyday use will NOT be eligible under the EMPG Program.
A) Project Narrative LEOP
The purpose of this project is for the community to update or create a Local Emergency Operations Plan (LEOP). This LEOP will be developed in an open manner involving community stakeholders, federal and state organizations whose mission it is to respond to emergencies. This project will remain consistent with the policies of the community and will serve as an accurate reflection of the community's values and will be implemented into the community's planning initiatives.
If you'd like to include any additional information not listed above, please compete the paragraph below.
Subrecipient Procurement Policy
Max. file size: 1 GB.
By checking the box below, I agree that I have followed all applicable federal, state, and local procurement policies:
*
See the EMPG Grant Guidance for more information regarding procurement by non-federal entities.
I Understand and Agree
Check to send via email instead of uploading:
Project Quotes/Proposals
B) Attach project quotes/proposals (maximum 25MB per file):
Drop files here or
Select files
Accepted file types: pdf, jpg, gif, xslx, doc, docx, ppt, pptx, xsl, Max. file size: 1 GB.
Please describe how the quote(s)/vendor(s) were determined based upon your procurement policies:
*
C) Attach curriculum for Active Threat Training (Train-the-Trainer) (maximum 25MB per file):
*
• Curriculum shall include instructor led class to educate and train participants on proactive response to violent intruder events based on the Federal “Run/Avoid, Hide/Deny, Fight/Defend” recommendation, utilizing a combination of education and practical training.
• Curriculum shall be research based and comply with national standard of care recommendations that meet or exceed Department of Homeland Security (DHS), Federal Bureau of Investigation (FBI), Department of Justice (DOJ), and NFPA 3000.
• Training should include Pre-K through 12th Grade Curriculum with an alerting component in addition to federally recommended “Run/Avoid, Hide/Deny, Fight/Defend”.
• Training modules should be specific to administration, bus drivers, coaches, custodial staff food service, support staff, Pre-K, and students with disabilities.
• Instructor Certification train-the-trainer training in options-based active threat response preparedness.
Drop files here or
Select files
Accepted file types: pdf, jpg, gif, xslx, doc, docx, ppt, pptx, xsl, Max. file size: 1 GB.
D) Current number of Faculty and Staff (maximum 25MB per file):
*
Faculty and staff to include, but not limited to: administration, bus drivers, coaches, custodial staff, food service, nurses, and School Resource Officers (SROs).
Accepted file types: pdf, jpg, gif, xslx, doc, docx, ppt, pptx, xsl, Max. file size: 1 GB.
III. MATCH SUMMARY
PLEASE REMEMBER THAT FEDERAL FUNDS CANNOT BE MATCHED WITH OTHER FEDERAL FUNDS.
1) EMPG Funds Request - Federal Share of 50%
*
1) EMPG Funds Request - Federal Share of 50%
*
2) Local Share of 50%
*
Cost-share (match) for this project will be contributed and recorded by (name of community/agency):
*
3) For each project, please describe below how the community/agency will use either in-kind match or cash match for the Local Share of 50%. If using a combination of cash & in-kind match, please include or attach a detailed explanation of match. Include the value and details of any in-kind contributions to the project(s).
*
For your convenience, you may utilize the following spreadsheet to assist in match calculation:
soft-match accrual form
or use this spreadsheet as a guide for calculating combination of cash and soft match:
Soft/In-Kind Cash Matching Tool
.
If staff time is going to be utilized for in-kind match, the expected staff member(s), the number of hours, and their rate of pay [or the volunteer rate] must be detailed.
LEOP Match Information
*
Please choose from the options below to indicate the match that will be used for this project(s).
In-Kind - match will be met through meetings and homework
Other
LEOP Match Explanation
*
Please describe in detail the match that will be used for this project(s).
Detailed attachment(s):
Drop files here or
Select files
Accepted file types: pdf, jpg, gif, xslx, doc, docx, ppt, pptx, xsl, Max. file size: 25 MB.
IV. PROJECT ELIGIBILITY CHECKLIST
Please complete the following checklist. Your replies should provide sufficient information for State reviewers to determine whether the application meets each of these criteria.
Does the community/SAU/agency meet the following requirements?
Has National Incident Management System (NIMS) compliance survey been submitted to HSEM within the past year?
*
Yes
No
Unknown
Please enter the date of NIMS Compliance Survey Submittal
MM slash DD slash YYYY
NIMS Compliance Survey
Visit the following link to complete the NIMS Compliance Survey and enter the date of submittal below.
NIMS Compliance Survey Link
MM slash DD slash YYYY
Please contact the HSEM EMPG Program Coordinator for compliance information.
*
I Understand
Does the community have a Local Emergency Operations Plan (LEOP) in Emergency Support Function (ESF) format?
*
Yes
No
Unknown
Month & Year of LEOP:
*
Please explain:
*
Is the community's Hazard Mitigation Plan FEMA-approved and not expired?
*
Yes
No
Date of FEMA Approval
*
MM slash DD slash YYYY
Please explain:
*
Does the project enhance the community's/SAU's/agency's Emergency Management capabilities?
*
Yes
No
Does the project relate directly to all-hazards Emergency Management: Response, Recovery, Mitigation, Preparedness, and Protection?
*
Yes
No
V. DHS AUTHORIZED EQUIPMENT LIST (AEL) - EQUIPMENT PURCHASES
For INVENTORY purposes, New Hampshire defines equipment as fixed assets with an original purchase price of $250 or more and a life expectancy of one year or more.
Subrecipients are required to be prudent in the acquisition and management of property obtained with Federal funds. An effective system for property management must exist to ensure adequate safeguards to prevent loss, damage, or theft of the property. An applicant must describe its property management system. If the applicant does not employ an adequate property management system some project costs may not be approved.
1) Are you requesting funding for any equipment?
*
Yes
No
2) Does your community/agency have an adequate property management system in place?
*
Yes
No
Please describe your property management system:
*
3) If purchasing equipment, please go to the DHS AUTHORIZED EQUIPMENT LIST (AEL) to verify the item(s) is an allowable purchase under the EMPG Program. Ensure that EMPG is listed under FEMA Related Grant Programs on the page. If so, copy and paste link(s) below:
*
FEMA AEL:
Click Here
If you do not have the AEL numbers, please contact the HSEM EMPG Program Coordinator.
If you have any questions concerning the eligibility of equipment not specifically addressed on the AEL or need assistance navigating the AEL, you should contact your the HSEM EMPG Program Coordinator for clarification.
Please continue to the next section of the application
VI. ENVIRONMENTAL AND HISTORIC PRESERVATION (EHP) COMPLIANCE - EQUIPMENT PURCHASES
If the project involves installation of equipment that may cause any type of ground disturbance (i.e. generator) or will be installed in or on a structure (i.e. repeater on a tower, projector mounted to the ceiling of an EOC) an Environmental and Historic Preservation (EHP) Review is required for your application to be considered. This does not include mobile or portable equipment.
Does your project require an EHP Review?
*
Yes
No
Please download and complete the following EHP Screening Form. You will be asked to upload the completed screening form below. If you have any questions on the EHP process, please contact your HSEM Field Representative
EHP Screening Form EMPG
For assistance on preparing photos for the EHP review, please click on the following link:
EHP Guidance for Supporting Photographs
Check to send via email instead of uploading:
EHP Screening Form
Aerial Photo
Interior Photos
Exterior Ground Level Photos
Additional Photos/Documentation
Please upload a completed EHP Screening Form, Aerial Photo, interior and exterior ground level photos as applicable, and additional photos/documentation below (maximum 25MB per file).
All submitted photos
MUST
be in color.
EHP Screening Form
Accepted file types: pdf, jpg, gif, xslx, doc, docx, ppt, pptx, xsl, Max. file size: 225 MB.
Aerial Photo
Accepted file types: pdf, jpg, gif, xslx, doc, docx, ppt, pptx, xsl, Max. file size: 1 GB.
Exterior Ground Level Photos
Accepted file types: pdf, jpg, gif, xslx, doc, docx, ppt, pptx, xsl, Max. file size: 1 GB.
Interior Photos As Applicable
Drop files here or
Select files
Accepted file types: pdf, jpg, gif, xslx, doc, docx, ppt, pptx, xsl, Max. file size: 1 GB.
Additional Photos/Documentation
Drop files here or
Select files
Accepted file types: pdf, jpg, gif, xslx, doc, docx, ppt, pptx, xsl, Max. file size: 1 GB.
VII. COMMUNICATIONS EQUIPMENT PURCHASES
Applicants that plan to use EMPG funds to support emergency communications activities shall comply with the current year's SAFECOM Guidance for Emergency Communication Grants, including provisions on technical standards that ensure and enhance interoperable communications. This guidance provides recommendations to applicants seeking funding for interoperable emergency communications projects, including allowable costs, items to consider when funding emergency communications projects, grants management best practices for emergency communications grants, and information on standards that ensure greater interoperability. The guidance is intended to ensure that Federally-funded investments are compatible with and support national goals and objectives for improving interoperability nationwide. Emergency communications activities include the purchase of interoperable communications equipment and technologies such as voice-over-internet protocol bridging or gateway devices. NOTE: Any questions on whether the project complies with the SAFECOM guidance, please contact the State's Interoperability Coordinator, 603-223-8003.
1) Are you requesting Interoperable Communications Equipment
*
Yes
No
2) In addition to following the steps in Section V for equipment purchases, I certify that this project complies with the current year's SAFECOM Grant Guidance.
*
This guidance document can be found at:
http://www.safecomprogram.gov/library/lists/library/DispForm.aspx?ID=334
I Agree
VIII. COMPLIANCE CONDITIONS
Agreement to the following conditions is required for consideration of the grant application. Failure to fulfill any of these conditions may jeopardize receipt of federal funds, pursuant to 2 CFR 200.338/Remedies for Noncompliance and §200.207/Specific Conditions.
1) By checking the box below, I certify that I agree to comply with all federal, state, and local laws, regulations, codes, standards, ordinances, etc.
*
I Understand and Agree to abide by all applicable laws and standards as they apply to the projects contained within this application.
2) By checking the box below, I certify that I understand that applicants for the EMPG program assure that matching funds and resources are available to supplement the requested EMPG grant at 50% of the total project costs.
*
I Understand and Agree to the 50% local match requirements.
3) By checking the box below, I certify that I have checked the Federal Excluded Parties List and none of the vendors, contractors, or sub-contractors being used for the proposed project(s) were listed.
*
To confirm that none of the vendors, contractors, or sub-contractors being used for the proposed project(s) are on the Federal Excluded Parties List complete the following steps:1) Visit
https://www.sam.gov/portal/SAM/##11
2) Click on "Search Records" 3) In the "Quick Search" field type in the name of the vendor.4) Complete for each vendor.
I Understand and Agree that I have checked the Federal Excluded Parties List
4) Davis Bacon Act Compliance
*
EMPG Program grantees using funds for construction projects (i.e., construction of a communications tower) must comply with the Davis-Bacon Act (40 U.S.C. §§ 3141 et seq.). Grant recipients must ensure that their contractors or subcontractors for construction projects pay workers employed directly at the work-site no less than the prevailing wages and fringe benefits paid on projects of a similar character. Additional information, including Department of Labor (DOL) wage determinations, is available from the following website:
http://www.dol.gov/whd/govcontracts/dbra.htm
.
By selecting "Yes" the applicant agrees that they shall comply with the Davis-Bacon Act as applicable.
Yes
N/A
5) By checking the box below, I certify that I have reviewed and I understand the remaining Grant Compliance Requirements as outlined in the EMPG Program Guidance.
*
I Understand and Agree to the EMPG Program Grant Compliance Requirements
Audit Upload:
*
Please submit a copy of your community/agency's most recent audit report here:
Audit Information Submission Form
or if your audit file is larger than 2MB please email it to the
NH EMPG Program
I understand if my community/agency's audit is not submitted that the application will not be considered complete and will not be processed.
I Understand and Agree
IX. Reimbursement of Funds
In order to be reimbursed, costs that are associated with the approved project, including match, must be necessary, allowable, allocable, and reasonable. Reimbursement requests for federal funds must be matched using hard (cash) or in-kind match (as approved in your application) and must be documented at the time of the reimbursement request.
If your application is approved for funding, are there any local budget/fiscal constraints that could be affected by the timing of the award of this grant (e.g. the end of the local fiscal year)?
*
Yes
No
If yes, please explain:
Select your method of payment:
*
1) Reimbursement
DURING
progression of project(s)
2) Reimbursement
AFTER
completion of project(s)
Reimbursement DURING progression of project(s)
*
The Subrecipient may submit bills/invoices from the project to the EMPG Program Coordinator during the progression of the project. Complete reimbursement requests will be processed and paid in approximately 30 days after receipt. All requests for reimbursement must include a letter of request on community/agency letterhead, copies of invoices, and documentation of match. All funds provided
must
be expended within 30 days of receipt and proof of payment provided to HSEM within 45 days of receipt. The Subrecipient will continue this process until they have drawn down the 50% federal funds with proper documentation of 50% local match.
I Understand and Agree
Reimbursement AFTER completion of project(s)
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The Subrecipient will submit all paid bills/invoices from the project(s) to the EMPG Program Coordinator when all of the project(s) have been completed. The complete reimbursement request will be processed and paid in approximately 30 days after receipt. All requests for reimbursement must include a letter of request on community/agency letterhead, copies of invoices, proof of payment (such as cancelled checks, accounting statements, etc.), and documentation of match.
I Understand and Agree
X. Assurances
Please note that the Assurances and Disclosures can be opened using browsers such as Firefox and Internet Explorer. Note that Microsoft Edge is a browser that will cause errors when used to open these forms.
Check to send via email instead of uploading:
Assurances
Disclosures
Disclosures
*
Please download the following two files, sign, and upload below:
Lobby Disclosure Form
and
Assurances
Drop files here or
Select files
Accepted file types: pdf, jpg, gif, xslx, doc, docx, ppt, pptx, xsl, Max. file size: 1 GB.
Is this a construction or non-construction project?
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Non-Construction
Construction
Construction Assurance
*
Please download the following file, sign, and upload below:
Construction Assurances
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Max. file size: 1 GB.
Non-Construction Assurance
*
Please download the following file, sign, and upload below:
Non-Construction Assurances
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Max. file size: 1 GB.
XI. CERTIFICATION PAGE
PLEASE NOTE: Applications that do not contain all of the requested information, including any necessary attachments, will be followed up on by the entity's assigned HSEM Field Representative. Priority will be given to applications that are all-inclusive.
The requesting community/SAU/agency understands that the grant will be on a first-come, first-served basis and is prioritized as outlined in the grant guidance document. Subrecipients will be required to fund any subsequent costs after the grant expires. The subrecipient’s share may be in the form of cash or in-kind/soft match. Upon official notification of this grant award the community/agency may incur costs against the grant award and submit requests for reimbursement to the NH Homeland Security & Emergency Management (NHHSEM). Any projects and/or purchases made against the Federal award share prior to receiving official notification of the grant award will NOT be eligible for reimbursement and will risk ability to receive future grant funds. Payment will be made on actual costs only. Costs that exceed the amount of this grant will not be reimbursed. The community/agency further understands that it shall complete all activities, including installation, prior to the grant's expiration date. Invoices for said activities must also be dated on or before the grant's expiration date. Subrecipients will have thirty (30) days from the grant's expiration date to submit requests for reimbursement and fulfill all reporting requirements.
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I Understand
I certify that I am authorized to submit this grant application on behalf of the aforementioned community/SAU/agency.
*
I agree
I DO NOT agree
Statement of Acknowledgement
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By writing my full name below (as an electronic signature), selecting today's date and clicking the submit button, I am attesting that the information I provided in this application is true and accurate to the best of my ability. I also acknowledge that failure to provide accurate and/or misleading information may be grounds for application disqualification. Lastly, I certify that I understand that this application
DOES NOT
constitute a grant award. Initiation of the proposed project(s) identified in this application will NOT begin until official notification of award has been formally received from the HSEM EMPG Program Staff.
Certification Date
*
MM slash DD slash YYYY