Grant Security Camera for Water treatment plantFIAWROM
TO: Allen Schoemaker, Director of Public Works
F Phil Green, Assistant City Administrator
DATE: August 13, 2012
® Security Camera Quotes for Water Treatment Plant Facility
Al,
Attached are the following quotes we have received for security camera installation at the Blair.
Water Treatment Plant facility. This plan would provide five (5) cameras which would cover the
entrances to the Water Plant and Waste Water Plant (both provide access to the entire facility)
and the areas around the Water Intake Structure.
SEi $26,376.00
Five (5) cameras and video server. Server has` 6 TB of data storage,
capable of recording 7+ days of video, and is expandable, enabling
the addition of additional cameras in the future.
Lutz Technology $7906.75
Network components to connect the video server to the Internet
(secure password access) to all law enforcement to monitor the
site.
Al1Com Global Services, Inc. $10,000.00
Wireless components to connect the video cameras to the video
server.
Grand Total of All Equipment and Installation . $43 9 444.75
Prom ls,-'
71 M-ff
Nebraska Dep. of • Human Service'
Public Water System Water Security Subg'
2. Mayor /Board Chairperson /Owner
Name/Title: James Realp-h Ma or
Phone:
402 - 426 -4191 Email
(valid phone number and e-mail address required)
3. Contact Person for Further Information on Application
Name/Title: Allen Schoemaker, Director (of Public Works
Phone: 402- 426 -4191 Email: ars @ci.blair.ne.us
(valid phone number and e-mail address required)
4. Identify the security /emergency response improvements that will be addressed by this public
water system security grant for each facility (well, storage, etc.) and include estimated cost
for each facility. Please make this an itemized list with the individual cost associated with
each item (i.e., locks, $$$; cameras, $$$, etc.). [Attach additional page(g) if needed.]
Blair proposes to install security cameras at the City's water treatment plant
intake and water treatment plant. The cameras will provide a video feed to
employees to allow them to monitor all outside activities to assist them in
providing a first line defense for the city ® s water treatment facilities.
The system will consist of cameras, hardware and software as outlined in the
attached documents. We have included a map showing the proposed locations
for teh cameras. This system's cost is $43,444.75 and is expandable as
funding becomes available.
Allen Sc hoemaker... 402 - 426 - 426 ;= 1
PWS Representative NamelTitie (Please Print) Phone
8/10/2Q —
Signature Date
Fax or Mail Completed Application to:
Kristin Luebbe, Water System Security Coordinator
Nebraska Department of Health and Human Services
Division of Public Health
P.O. Box 95026
Lincoln, NE 68509 -5026
Fax: 4021471 -6436
2
Section Federal Award Information • •,
Use this page only if the subgrant is being funded by multiple sources (multiple federal grants or
a combination of federal and state funds)
Federal Award Identifier Number (FAIN)
Federal Awarding Agency Name
Award Date
CFDA Program Number
Subgrant Amount From This
Award: L_
Federal Award Identifier Number (FAIN)
Federal Awarding Agency Name
CFDA Program Number
Award Date
Subgrant Amount From This
Award: $ -_
Federal Award Identifier Number (FAIN)
Federal Awarding Agency Name
CFDA Program Number
Amount funded from Federal Grants $10,000.00
Amount funded from State General Funds $
Amount funded from State Cash Funds $
Amount funded from Federal Cash Funds $10,000.00
Award Date
Subgrant Amount From This
Award: $
Total amount funded from all sources $10,000.00
Subgrant
Rev. 10/2011
total of grants in Section A
fed sources other than grants
should equal total of subgrant
14
action tp — uiTicerUOMPUF15dL1U11
1. In your business or organization's previous fiscal year, did your business
organization (including parent organization, all branches, and all affiliates
worldwide) receive 80% or more of your annual gross revenues in U.S. federal
contracts, subcontracts, loans, grants, subgrants, and /or cooperative agreements
AND $25,000,000 or more in annual gross revenues from U.S. federal contracts,
subcontracts, loans, grants, subgrants, and /or cooperative agreements?
❑ Yes — answer Question 2
® No — not required to provide officer compensation
2. Does the public have access to information about the compensation of the senior
executives in your business or organization (including parent organization, all
branches, and all affiliates worldwide) through periodic reports filed under section
13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d))
or section 6104 of the Internal Revenue Code of 1986?
❑ Yes — not required to provide officer compensation
❑ No — provide the names and total compensation of the five most highly
compensated officers of the entity below
1.
$
Name
Compensation
2.
$
Name
Compensation
3.
$
Name
Compensation
4.
$
Name
Compensation
5.
$
Name
Compensation
Subgrant 13
Rev. 10/2011
Attachment 2
• - ' -•• • •
Federal Award Identifier Number (FAIN) FS997805
Federal Awarding Agency Name U.S. Environmental Protection Agency
Award Date 9/10/2009
CFDA Program Number 66.648
Subgrant Amount From This
Award: $10,000.00
*See instructions if the subgrant is funded from more than one funding source
. l - - r - - -
Subrecipient DUNS 067087887
Subrecipient Name City of Blair
Subrecipient Address: Street 216 S 16 Street
City Blair
State NE
Country USA
Zip Code + 4 68008 -1674
Congressional District 1
Amount of Subgrant $10,000.00 Subgrant Date 3/7/2013
Subrecipient Principal City Blair
State NE
Place of Performance:
Country USA
Zip Code + 4 68008 -1674
Congressional District 1
Subgrant Number 17051 -Y3 (Will be completed by Support Services)
Subgrant Project Description Public Water System Security Grant
Subgrant 12
Rev. 10/2011
including commodities in our current fiscal year. Therefore, we are subject to the single
audit requirements of Circular A -133.
We will engage a licensed Certified Public Accountant to conduct and prepare the audit
of our organization's financial statements and components of the single audit pertaining
to those financial statements. We acknowledge the audit must be completed no later
than nine months after the end of our current fiscal year.
We further acknowledge, that a single audit performed in accordance with Circular A -133
must be submitted to the Federal Audit Clearinghouse. The reporting package, as
evidence the audit was completed must contain:
® financial statements,
a schedule of Expenditure of Federal Awards,
0 a Summary Schedule of Prior Audit Findings (if applicable),
® a corrective action plan (if applicable) and
the auditor's report(s) which includes an opinion upon financial statements and
Schedule of Expenditures of Federal Awards, a report of internal control, a report of
compliance and a Schedule of Findings and Questioned Costs.
We further acknowledge the auditor and this contractor or subrecipient must complete
and submit with the reporting package a Data Collection Form for Reporting on Audits of
States, Local Governments and Non - Profit Organizations (SF -SAC).
We further acknowledge a copy of the contractor's financial statements, auditor's report
and SF -SAC must be submitted, at the time these documents are submitted to the
Federal-Audit Clearinghouse, to:
Nebraska Department of Health and Human Services
Financial Services
Grants and Cost Management
P.O. Box 95026
Lincoln, NE 68509 -5026
The foregoing submissions must be made within the earlier of 30 days after receipt of the
auditor's report(s), or nine months after the end of the audit period.
Subgrant 11
Rev. 10/2011
Attachment 1
Subrecipients and certain contractors receiving funds from the Nebraska Department of Health
and Human Services are required to complete this document. Reference to the Office of
Management and Budget Circular A -133, Audits of States, Local Governments and Non - Profit
Organizations, in this document is "Circular A -133 ".
Grant Name Capitalization Grants for Drinking Water State Revolving Funds
Grant # FS99780 CFDA* # 66.468
*(Catalog of Federal Domestic Assistance)
Contractor's Name City of Blair
Address: 218 S 16 Street
City: Blair State: NE Zip Code: 68008 -1674
Federal Tax Identification Number (FTI) 476006106
Contractor's Fiscal Year ®C ��� 1 , 20 12 to Dk_m r 3 , 20 I3
All written communications from the Certified Public Accountant (CPA) engaged under #1 or #2
below, given to the contractor related to Statement of Auditing Standards (SAS) 112
Communicating Internal Control related Matters Identified in an Audit and SAS 114 The
Auditor's Communication with Those Charged With Governance and any additional reports
issued by the auditor as a result of this engagement must be provided to the DHHS immediately
upon receipt, unless the Subrecipient or contractor has directed the CPA to provide the copy
directly to the DHHS and has verified this has occurred.
Check either 1 or 2
1. r As the subrecipient or contractor named above, we expect to expend less than $500,000
from all Federal Financial Assistance sources, not just the grant named above, and
including commodities in our current fiscal year. Therefore, we are not subject to the
audit requirements of Circular A -133.
We are, however, responsible for engaging a licensed Certified Public Accountant (CPA)
to conduct an audit of our organization's financial statements if we have total federal
expenditures over $100,000. We acknowledge the audit must be completed no later
than nine months after the end of our organization's current fiscal year. A copy of the
report must be submitted to DHHS address as shown below within the earlier of 30 days
after receipt of the auditor's report(s), or nine months after the end of the audit period.
2. _ As the subrecipient or contractor named above, we expect to expend $500,000 or more
from all Federal Financial Assistance sources, not just the grant named above, and
Subgrant 10
Rev. 10/2011
HH. SMOKE FREE. Public Law 103 -227, also known as the Pro - Children Act of 1994 (Act),
requires that smoking not be permitted in any portion of any indoor facility owned or leased
or contracted for by an entity and used routinely or regularly for the provision of health, day
care, early childhood development services, education or library services to children under
the age of 18, if the services are funded by Federal programs either directly or through State
or local governments, by Federal grant, contract, loan, or loan guarantee. The law also
applies to children's services that are provided in indoor facilities that are constructed,
operated, or maintained with such federal funds. The law does not apply to children's
services provided in private residences; portions of facilities used for inpatient drug or
alcohol treatment; service providers whose sole source of applicable Federal funds in
Medicare or Medicaid; or facilities where WIC coupons are redeemed. Failure to comply
with the provisions of the law may result in the imposition of a civil monetary penalty of up to
$1000 for each violation and /or the imposition of an administrative compliance order on the
responsible entity. By signing, the Subrecipient certifies that the Subrecipient will comply
with the requirements of the Act and will not allow smoking within any portion of any indoor
facility used for the provision of services for children as defined by the Act.
II. SUBRECIPIENTS OR SUBCONTRACTORS. The Subrecipient shall not subgrant or
subcontract any portion of this award without prior written consent of DHHS. The
Subrecipient shall ensure that all subcontractors and subrecipients comply with all
requirements of this subgrant and applicable federal, state, county and municipal laws,
ordinances, rules and regulations.
JJ. TIME IS OF THE ESSENCE. Time is of the essence in this subgrant. The acceptance of late
performance with or without objection or reservation by DHHS shall not waive any rights of
DHHS nor constitute a waiver of the requirement of timely performance of any obligations on
the part of the Subrecipient remaining.
NOTICES. Notices shall be in writing and shall be effective upon receipt. Written notices,
including all reports and other written communications required by this subgrant shall be sent to
the following addresses:
FOR DHHS:
Kristin Luebbe
NE Department of Health & Human Services
PO Box 95026
Lincoln, NE 68509 -5026
402/471 -1007
effl- --
James Realph
City of Blair
218S 16 Street
Blair, NE 68008 -1674
402/4264191
IN WITNESS THEREOF, the parties have duly executed this subgrant hereto, and each party
acknowledges the receipt of a duly executed copy of this subgrant with original signatures.
FOR DHHS:
Mary Sue Semerena
Environmental Health Unit Administrator
Subgrant
Rev. 10/2011
DATE:
9
designated by the United States Department of Homeland Security or other federal agency
authorized to verify the work eligibility status of a newly hired employee.
If the Subrecipient is an individual or sole proprietorship, the following applies:
1. The Subrecipient must complete the United States Citizenship Attestation Form,
available on the Department of Administrative Services website at www.das.state.ne.us
2. If the Subrecipient indicates on such attestation form that he or she is a qualified alien,
the Subrecipient agrees to provide the U.S. Citizenship and Immigration Services
documentation required to verify the Subrecipient's lawful presence in the United States
using the Systematic Alien Verification for Entitlements (SAVE) Program.
3. The Subrecipient understands and agrees that lawful presence in the United States is
required and the Subrecipient may be disqualified or the subgrant terminated if such
lawful presence cannot be verified as required by NEB. REV. STAT. § 4 -108.
BB. PUBLICATIONS. Subrecipient agrees that all publications that result from work under this
subgrant will acknowledge that the project was supported by "Grant No. XXXX" under a
subgrant from "Federal Agency" and DHHS.
CC. PROGRAMMATIC CHANGES. The Subrecipient shall request in writing to DHHS for
approval of programmatic changes. DHHS shall approve or disapprove in whole or in part in
writing within thirty (30) days of receipt of such request.
DD. PROMPT PAYMENT Payment shall be made in conjunction with the State of Nebraska
Prompt Payment Act, NEB. REV. STAT. §§ 81 -2401 through 81 -2408. Unless otherwise
provided herein, payment shall be made by electronic means.
Automated Clearinq House (ACH) Enrollment Form Requirements for P ayment.
The Subrecipient shall complete and sign the State of Nebraska ACH Enrollment Form and
obtain the necessary information and signatures from their financial institution. The
completed form must be submitted before payments to the Subrecipient can be made.
Download ACH Form:
http://www.das,state.ne.us/accounting/nis/address book info.htm
EE. PUBLIC COUNSEL In the event Subrecipient provides health and human services to
individuals on behalf of DHHS under the terms of this award, Subrecipient shall submit to
the jurisdiction of the Public Counsel under NEB. REV. STAT. §§ 81 -8,240 through 81 -8,254
with respect to the provision of services under this subgrant. This clause shall not apply to
subgrants between DHHS and long -term care facilities subject to the jurisdiction of the state
long -term care ombudsman pursuant to the Long -Term Care Ombudsman Act.
FF. RESEARCH The Subrecipient shall not engage in research utilizing the information
obtained through the performance of this subgrant without the express written consent of
DHHS. The term "research" shall mean the investigation, analysis, or review of information,
other than aggregate statistical information, which is used for purposes unconnected with
this subgrant.
GG. SEVERABILITY If any term or condition of this subgrant is declared by a court of
competent jurisdiction to be illegal or in conflict with any law, the validity of the remaining
terms and conditions shall not be affected, and the rights and obligations of the parties shall
be construed and enforced as if this subgrant did not contain the particular provision held to
be invalid.
Subgrant 8
Rev. 10/2011
W. INTEGRATION This written subgrant represents the entire agreement between the parties,
and any prior or contemporaneous representations, promises, or statements by the parties,
that are,,not incorporated herein, shall not serve to vary or contradict the terms set forth in
this subgrant.
X. LOBBYING
1. Subrecipient certifies that no Federal appropriated funds shall be paid, by or on behalf of
the Subrecipient, 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 award for: (a) the
awarding of any Federal agreement; (b) the making of any Federal grant; (c) the entering
into of any cooperative agreement; and (d) the extension, continuation, renewal,
amendment, or modification of any Federal agreement, 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 subgrant, the Subrecipient shall complete
and submit Federal Standard Form -LLL, "Disclosure Form to Report Lobbying," in
accordance with its instructions.
Y. NEBRASKA NONRESIDENT INCOME TAX WITHHOLDING. Subrecipient acknowledges
that Nebraska law requires DHHS to withhold Nebraska income tax if payments for personal
services are made in excess of six hundred dollars ($600) to any Subrecipient who is not
domiciled in Nebraska or has not maintained a permanent place of business or residence in
Nebraska for a period of at least six months. This provision applies to: individuals; to a
corporation, if 80% or more of the voting stock of the corporation is held by the shareholders
who are performing personal services, and to a partnership or limited liability company, if
80% or more of the capital interest or profits interest of the partnership or limited liability
company is held by the partners or members who are performing personal services.
The parties agree, when applicable, to properly complete the Nebraska Department of
Revenue Nebraska Withholding Certificate for Nonresident Individuals Form W -4NA or its
successor. The form is available at:
http://www.revenue.ne.gov/tax/current/f w- 4na.pdf or
http: / /www.revenue.ne.gov /tax /current /fill -in /f w- 4na.pdf
Z. NEBRASKA TECHNOLOGY ACCESS STANDARDS The Subrecipient shall review the
Nebraska Technology Access Standards, found at
http: / /www.nitc.ne.gov/ standards /accessibility /tacfinal.html and ensure that products and /or
services provided under the subgrant comply with the applicable standards. In the event
such standards change during the Subrecipient's performance, the State may create an
amendment to the subgrant to request that Subrecipient comply with the changed standard
at a cost mutually acceptable to the parties.
AA. NEW EMPLOYEE WORK ELIGIBILITY STATUS The Subrecipient shall use a federal
immigration verification system to determine the work eligibility status of new employees
physically performing services within the State of Nebraska. A federal immigration
verification system means the electronic verification of the work authorization program
authorized by the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, 8
U.S.C. § 1324a, known as the E- Verify Program, or an equivalent federal program
Subgrant 7
Rev. 10/2011
Subrecipient Reporting Requirements. DHHS reserves the right to extend the due date
for any report and may waive, in writing, any report it considers to be unnecessary.
4. DHHS shall make any necessary adjustments upward or downward in the federal share
of costs.
5. The Subrecipient shall assist and cooperate in the orderly transition and transfer of
subgrant activities and operations with the objective of preventing disruption of services.
6. Close -out of this subgrant shall not affect the retention period for, or state or federal
rights of access to, Subrecipient records, or Subrecipient's responsibilities regarding
property or with respect to any program income for which Subrecipient is still
accountable under this subgrant. If no final audit is conducted prior to close -out, DHHS
reserves the right to disallow and recover an appropriate amount after fully considering
any recommended disallowances resulting from an audit which may be conducted at a
later time.
S. GOVERN! NG LAW The award shall be governed in all respects by the laws and statutes of
the State of Nebraska. Any legal proceedings against DHHS or the State of Nebraska
regarding this award shall be brought in Nebraska administrative or judicial forums as
defined by Nebraska State law. The Subrecipient shall comply with all Nebraska statutory
and regulatory law.
T. HOLD HARMLESS
1. The Subrecipient shall defend, indemnify, hold, and save harmless the State of
Nebraska and its employees, volunteers, agents, and its elected and appointed officials
( "the indemnified parties ") from and against any and all claims, liens, demands,
damages, liability, actions, causes of action, losses, judgments, costs, and expenses of
every nature, including investigation costs and expenses, settlement costs, and attorney
fees and expenses ( "the claims "), sustained or asserted against the State of Nebraska,
arising out of, resulting from, or attributable to the willful misconduct, negligence, error,
or omission of the Subrecipient, its employees, consultants, representatives, and agents,
except to the extent such Subrecipient's liability is attenuated by any action of the State
of Nebraska which directly and proximately contributed to the claims.
2. DHHS's liability is limited to the extent provided by the Nebraska Tort Claims Act, the
Nebraska Contract Claims Act, the Nebraska Miscellaneous Claims Act, and any other
applicable provisions of law. DHHS does not assume liability for the action of its
Subrecipients.
U. INDEPENDENT ENTITY The Subrecipient is an Independent Entity and neither it nor any
of its employees shall, for any purpose, be deemed employees of DHHS. The Subrecipient
shall employ and direct such personnel, as it requires, to perform its obligations under this
subgrant, exercise full authority over its personnel, and comply with all workers'
compensation, employer's liability and other federal, state, county, and municipal laws,
ordinances, rules and regulations required of an employer providing services as
contemplated by this subgrant.
V. REIMBURSEMENT REQUEST. Requests for payments submitted by the Subrecipient shall
contain sufficient detail to support payment. Any terms and conditions included in the
Subrecipient's request shall be deemed to be solely for the convenience of the parties.
Subgrant 6
Rev. 10/2011
procedures to be followed by the Subrecipient in discharging its obligations under this
subgrant shall be deemed incorporated by reference and made a part of this subgrant with
the same force and effect as if set forth in full text, herein.
M. DRUG -FREE WORKPLACE Subrecipient agrees, in accordance with 41 USC §701 et al.,
to maintain a drug -free workplace by: (1) publishing a drug -free workplace statement; (2)
establishing a drug -free awareness program; (3) taking actions concerning employees who
are convicted of violating drug statutes in the workplace; and (4) in accordance with 2 CFR
§180.230, identify all workplaces under its federal awards.
N. FEDERAL FINANCIAL ASSISTANCE The Subrecipient shall comply with all applicable
provisions of 45 C.F.R. §§ 87.1 -87.2. The Subrecipient certifies that it shall not use direct
federal financial assistance to engage in inherently religious activities, such as worship,
religious instruction, and /or proselytization.
O. FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT REPORTING. The
Subrecipient shall complete the Subrecipient Reporting Worksheet, Attachment 2, sections
B and C. The Subrecipient certifies the information is complete, true and accurate.
P. FORCE MAJEURE Neither party shall be liable for any costs or damages resulting from its
inability to perform any of its obligations under this subgrant due to a natural disaster, or
other similar event outside the control and not the fault of the affected party ( "Force Majeure
Event "). A Force Majeure Event shall not constitute a breach of this subgrant. The party so
affected shall immediately give notice to the other party of the Force Majeure Event. Upon
such notice, all obligations of the affected party under this subgrant which are reasonably
related to the Force Majeure Event shall be suspended, and the affected party shall do
everything reasonably necessary to resume performance as soon as possible. Labor
disputes with the impacted party's own employees will not be considered a Force Majeure
Event and will not suspend performance requirements under this subgrant.
Q. FUNDING AVAILABILITY DHHS may terminate the subgrant, in whole or in part, in the
event funding is no longer available. Should funds not be appropriated, DHHS may
terminate the award with respect to those payments for the fiscal years for which such funds
are not appropriated. DHHS shall give the Subrecipient written notice thirty (30) days prior to
the effective date of any termination. The Subrecipient shall be entitled to receive just and
equitable compensation for any authorized work which has been satisfactorily completed as
of the termination date. In no event, shall the Subrecipient be paid for a loss of anticipated
profit.
R. GRANT CLOSE -OUT. Upon completion or notice of termination of this grant, the following
procedures shall apply for close -out of the subgrant:
1. The Subrecipient will not incur new obligations after the termination or completion of the
subgrant, and shall cancel as many outstanding obligations as possible. DHHS shall
give full credit to Subrecipient for the federal share of non - cancelable obligations
properly incurred by Subrecipient prior to termination, and costs incurred on, or prior to,
the termination or completion date.
2. Subrecipient shall immediately return to DHHS any unobligated balance of cash
advanced or shall manage such balance in accordance with DHHS instructions.
3. Within a maximum of 90 days following the date of expiration or completion,
Subrecipient shall submit all financial, performance, and related reports required by the
Subgrant 5
Rev. 10/2011
DHHS may, at its discretion, obtain any services required to complete this subgrant and hold
the Subrecipient liable for any excess cost caused by Subrecipient's default. This provision
shall not preclude the pursuit of other remedies for breach of subgrant as allowed by law.
G. CONFIDENTIALITY Any and all confidential or proprietary information gathered in the
performance of this subgrant, either independently or through DHHS, shall be held in the
strictest confidence and shall be released to no one other than DHHS without the prior
written authorization of DHHS, provided that contrary subgrant provisions set forth herein
shall be deemed to be authorized exceptions to this general confidentiality provision. As
required by United States Department of Health and Human Services (hereinafter "HHS ")
appropriations acts, all HHS recipients and DHHS Subrecipients must acknowledge Federal
and DHHS funding when issuing statements, press releases, requests for proposals, bid
invitations, and other documents describing projects or programs funded in whole or in part
with Federal and DHHS funds. Recipients are required to state: (1) the percentage and
dollar amounts of the total program or project costs financed with Federal and DHHS funds;
and (2) the percentage and dollar amount of the total costs financed by nongovernmental
sources. T his provision shall survive termination of this subgrant.
H. CONFLICTS OF INTEREST In the performance of this subgrant, the Subrecipient shall
avoid all conflicts of interest and all appearances of conflicts of interest. The Subrecipient
shall immediately notify DHHS of any such instances encountered, so that other
arrangements can be made to complete the work.
COST PRINCIPLES AND AUDIT REQUIREMENTS. The Subrecipient shall follow the
applicable cost principles set forth in OMB Circular A -87 for State, Local and Indian Tribe
Governments; A -21 for Colleges and Universities; or A -122 for Non - Profit Organizations.
Federal audit requirements are dependent on the total amount of federal funds expended by
the Subrecipient, set in the table below and Attachment 1, Audit Requirement Certification.
Audits must be prepared and issued by an independent certified public accountant licensed
to practice. A copy of the annual audit is to be made electronically available or sent to:
Nebraska Department of Health and Human Services, Financial Services, P.O. Box 95026,
Lincoln, NE 68509 -5026.
J. DATA OWNERSHIP AND COPYRIGHT. Except as otherwise provided in the Federal
Notice of Award, DHHS shall own the rights in data resulting from this project or program.
The Subrecipient may copyright any of the copyrightable material and may patent any of the
patentable products produced in conjunction with the performance required under this
subgrant without written consent from DHHS. DHHS and any federal granting authority
hereby reserve a royalty -free, nonexclusive, and irrevocable right to reproduce, publish, or
otherwise use, and to authorize others to use the copyrightable material for federal or state
government purposes. This provision shall survive termination of this subgrant.
K. DEBARMENT SUSPENSION OR DECLARED INELIGIBLE. The Subrecipient certifies that
neither it nor its principals are presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from participation in this transaction by any
federal department or agency.
L. DOCUMENTS INCORPORATED BY REFERENCE All references in this subgrant to laws,
rules, regulations, guidelines, directives, and attachments which set forth standards and
Subgrant 4
Rev. 10/2011
Amount of annual federal expenditure
Audit Type
$100, 000 to $499,999
Financial Statement Audit
500, 000 or more in federal expenditure
A -133 audit
J. DATA OWNERSHIP AND COPYRIGHT. Except as otherwise provided in the Federal
Notice of Award, DHHS shall own the rights in data resulting from this project or program.
The Subrecipient may copyright any of the copyrightable material and may patent any of the
patentable products produced in conjunction with the performance required under this
subgrant without written consent from DHHS. DHHS and any federal granting authority
hereby reserve a royalty -free, nonexclusive, and irrevocable right to reproduce, publish, or
otherwise use, and to authorize others to use the copyrightable material for federal or state
government purposes. This provision shall survive termination of this subgrant.
K. DEBARMENT SUSPENSION OR DECLARED INELIGIBLE. The Subrecipient certifies that
neither it nor its principals are presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from participation in this transaction by any
federal department or agency.
L. DOCUMENTS INCORPORATED BY REFERENCE All references in this subgrant to laws,
rules, regulations, guidelines, directives, and attachments which set forth standards and
Subgrant 4
Rev. 10/2011
The Auditor's Communication with Those Charged With Governance, The Subrecipient
agrees to provide DHHS with a copy of all such written communications immediately
upon receipt or instruct any auditor it employs to deliver copies of such written
communications to DHHS at the same time copies are delivered to the Subrecipient, in
which case the Subrecipient agrees to verify that DHHS has received a copy.
3. The subrecipient shall immediately commence follow -up action on findings arising from
audits or other forms of review. Follow -up action includes responding to those
conducting such examinations with clear, complete views concerning the accuracy and
appropriateness of the findings. If the finding is accepted, corrective action, such as
repaying disallowed costs, making financial adjustments, or taking other actions should
proceed and be completed as rapidly as possible. If the subrecipient disagrees, it should
provide an explanation and specific reasons that demonstrate that the finding is not
valid.
4. In addition to, and in no way in limitation of any obligation in this subgrant, the
Subrecipient shall be liable for audit exceptions, and shall return to DHHS all payments
made under this subgrant for which an exception has been taken or which has been
disallowed because of such an exception, upon demand from DHHS.
B. AMENDMENT This subgrant may be modified only by written amendment executed by
both parties. No alteration or variation of the terms and conditions of this subgrant shall be
valid unless made in writing and signed by the parties.
C. ANTI - DISCRIMINATION The Subrecipient shall comply with all applicable local, state and
federal statutes and regulations regarding civil rights and equal opportunity employment,
including Title VI of the Civil Rights Act of 1964; the Rehabilitation Act of 1973, Public Law
93 -112; the Americans with Disabilities Act of 1990, Public Law 101 -336; and the Nebraska
Fair Employment Practice Act, NEB. REV. STAT. §§ 48 -1101 to 48 -1125. Violation of said
statutes and regulations will constitute a material breach of this subgrant. The Subrecipient
shall insert this provision into all subgrants and subcontracts.
D. ASSIGNMENT The Subrecipient shall not assign or transfer any interest, rights, or duties
under this subgrant to any person, firm, or corporation without prior written consent of
DHHS. In the absence of such written consent, any assignment or attempt to assign shall
constitute a breach of this subgrant.
E. ASSURANCE If DHHS, in good faith, has reason to believe that the Subrecipient does not
intend to, is unable to, has refused to, or discontinues performing material obligations under
this subgrant, DHHS may demand in writing that the Subrecipient give a written assurance
of intent to perform. Failure by the Subrecipient to provide written assurance within the
number of days specified in the demand may, at DHHS's option, be the basis for terminating
this subgrant.
F. BREACH OF SUBGRANT DHHS may immediately terminate this subgrant and agreement,
in whole or in part, if the Subrecipient fails to perform its obligations under the subgrant in a
timely and proper manner. DHHS may withhold payments and provide a written notice of
default to the Subrecipient, allow the Subrecipient to correct a failure or breach of subgrant
within a period of thirty (30) days or longer at DHHS's discretion considering the gravity and
nature of the default. Said notice shall be delivered by Certified Mail, Return Receipt
Requested or in person with proof of delivery. Allowing the Subrecipient time to correct a
failure or breach of this subgrant does not waive DHHS's right to immediately terminate the
subgrant for the same or different subgrant breach which may occur at a different time.
Subgrant 3
Rev. 10/2011
C. BUDGET CHANGES. The Subrecipient is permitted to reassign funds from one line item to
another line item within the approved budget. If funds are reassigned between line items,
prior approval from DHHS is required for cumulative budget transfer requests for allowable
costs, allocable to the subgrant exceeding five percent (5 %) of the current total approved
budget. Budget revision requests shall be submitted in writing to DHHS. DHHS will provide
written notification of approval or disapproval of the request within thirty (30) days of its
receipt.
III. STATEMENT OF WORK
A. The Subrecipient shall:
1. Notify Kristin Luebbe at 402/471 -1007 or kristin.luebbepnebraska.gov that the
material /equipment in the application, Attachment 3, has been installed and is ready
for an inspection.
2. Provide a copy of the billing invoice(s) and a copy of the cancelled check(s) (front and
back) or a copy of the bank statement showing the check has cleared the bank for the
materials, equipment and installation.
3. Have a current public water system Emergency Response Plan that has been
approved by the DHHS.
4. Have a designated water system operator successfully obtain certification for
completed courses on Incident Command and the National Incident Management
Systems (Courses ICS 100, 200 and 700) and provide copies of the certification to the
DHHS.
5. Provide a 10% match of Subrecipient's funds to improve the protection of the public
water system.
B. DHHS shall:
1. Inspect the installation of the materials /equipment before payment can be issued.
IV. GENERAL TERMS AND ASSURANCES
A. ACCESS TO RECORDS AND AUDIT RESPONSIBILITIES.
1. All Subrecipient books, records, and documents regardless of physical form, including
data maintained in computer files or on magnetic, optical or other media, relating to work
performed or monies received under this subgrant shall be subject to audit at any
reasonable time upon the provision of reasonable notice by DHHS. Subrecipient shall
maintain all records for three (3) years from the date of final payment, except records
that fall under the provisions of the Health Insurance Portability and Accountability Act
(HIPAA) shall be maintained for six (6) full years from the date of final payment. In
addition to the foregoing retention periods, all records shall be maintained until all issues
related to an audit, litigation or other action are resolved to the satisfaction of DHHS. The
Subrecipient shall maintain its accounting records in accordance with generally accepted
accounting principles. DHHS reserves and hereby exercises the right to require the
Subrecipient to submit required financial reports on the accrual basis of accounting. If
the Subrecipient's records are not normally kept on the accrual basis, the Subrecipient is
not required to convert its accounting system but shall develop and submit in a timely
manner such accrual information through an analysis of the documentation on hand
(such as accounts payable).
2. The Subrecipient shall provide DHHS any and all written communications received by
the Subrecipient from an auditor related to Subrecipient's internal control over financial
reporting requirements and communication with those charged with governance
including those in compliance with or related to Statement of Auditing Standards (SAS)
112 Communicating Internal Control related Matters Identified in an Audit and SAS 114
Subgrant 2
Rev. 10/2011
17051 -Y3
.
DIVISION THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
OF '-,
OFFICE OF AND •
"TIM
This subgrant is entered into by and between the Nebraska Department of Health and Human
Services, DIVISION OF PUBLIC HEALTH OFFICE OF DRINKING WATER AND
ENVIRONMENTAL HEALTH (hereinafter "DHHS "), and CITY OF BLAIR, NEBRASKA
(hereinafter "Subrecipient ").
CFDA Title & #: Capitalization Grants for Federal Agency: U.S. EPA
Drinking Water State
Revolving Funds /66.468
Award Name: Drinking Water State Federal Award Identifier # FS997805
Revolving Fund
Issue Date: 9/10/2009 This award is not for research and
Award Date: 3/7/2013 does not include ARRA funds.
PURPOSE The purpose of this subgrant is: to provide funds to community and non - transient
non - community public water systems serving a population of 10,000 or less for improving the
protection of public water systems.
A. TERM This award is in effect from March 7, 2013 the effective date through June 30, 2013,
the completion date.
B. TERMINATION This subgrant may be terminated at any time upon mutual written consent
or by either party for any reason upon submission of written notice to the other party at least
Thirty (30) days prior to the effective date of termination. DHHS may also terminate this
subgrant in accord with the provisions designated "FUNDING AVAILABILITY" and "BREACH
OF SUBGRANT." In the event either party terminates this subgrant, the Subrecipient shall
provide to DHHS all work in progress, work completed, and materials provided by DHHS in
connection with this subgrant immediately.
A. TOTAL SUBGRANT DHHS shall pay the Subrecipient a total amount, not to exceed
$10,000.00 (ten thousand dollars and no cents) for the activities specified herein.
B. PAYMENT STRUCTURE Payment shall be structured as follows:
1. A single payment will be paid to the Subrecipient upon receipt of items referenced in
Item III.A.
Subgrant
Rev. 10/2011