HomeMy WebLinkAboutResolution 2014-124 Execute Subgrantee Agreement with the AZ Department of Homeland SecurityMARANA RESOLUTION NO, 2014 -124
RELATING TO THE POLICE DEPARTMENT; APPROVING AND AUTHORIZING THE
TOWN MANAGER TO EXECUTE A SUBGRANTEE AGREEMENT WITH THE ARIZONA
DEPARTMENT OF HOMELAND SECURITY FOR PURPOSES OF RECEIVING FUNDS
UNDER THE 2014 OPERATION STONEGARDEN GRANT PROGRAM.
WHEREAS the Town of Marana recognizes its duty to protect its citizens concerning matters
involving Homeland and Border Security; and
WHEREAS the Marana Police Department is working with the Arizona Department of
Homeland Security, United States Border Patrol, and other coi ununity agencies as a regional partner
in the operation Stonegarden Program; and
WHEREAS the Arizona Department of Homeland Security has awarded grant funding to the
Town for the provision of overtime pay for services provided in coordination with the operation
Stonegarden Program; and
WHEREAS the Town Council finds that it is in the best interests of the community to enter
into a Subgrantee Agreement with the Arizona Department of Homeland Security to be eligible to
receive funds related to the operation Stonegarden Program.
NOW, THEREFORE, BE IT RESOLVED BY THE MAYOR AND COUNCIL OF THE
TOWN OF MARANA, ARIZONA, AS FOLLOWS:
SECTION 1. Subgrantee Agreement 14- AZDOHS- OPSG- 140419 -01 between the Arizona
Department of Homeland Security and the Town of Marana, attached to and incorporated by this ref
erence in this resolution as Exhibit A, is hereby approved and the Town Manager is hereby author-
ized to execute it for and on behalf of the Town of Marana.
SECTION 2. The Town's Manager and staff are hereby directed and authorized to under-
take all other and further tasks required or beneficial to carry out the terms, obligations, and objec-
tives of the Subgrantee Agreement.
_1..
Marana Resolution No. 2014124
PASSED AND ADOPTED BY THE MAYOR AND COUNCIL OF THE TOWN OF
MARANA, ARIZONA, this 16"' da of December, 2014.
Ma Ed Hoy. a
FWAN 0 0
7 cel C ronson, Town Clerk
APPROVED AS TO FORM:
9
Cassiff/Town Attorp4�
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-2-
Marana Resolution No. 2014124
SUBGRANTEE AGREEMENT
Operation Stonegarden Grant Program — Overtime
14-AZDOHS-OPSG- 140419 -01
Enter Subgrantee Agreement Number above (e.g., 140xxx -xx)
Between
The Arizona Department of Homeland Security
And
Town of Marana
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Enter the Name of the Subrecipient Agency Above
WHEREAS, A.R.S. § 41 -4254 charges the Arizona Department of Homeland Security (AZDOHS) with
the responsibility of administering funds.
THEREFORE, it is agreed that the AZDOHS shall provide funding to the
Town of Na rana
Enter the Name of the Subrecipient Agency Above
(subrecipient) for services under the terms of this Grant Agreement.
PURPOSE OF AGREEMENT
The purpose of this Agreement is to specify the responsibilities and procedures for the
subrecipient's role in administering homeland security grant funds.
II. TERM OF AGREEMENT TERMINATION AND AMENDMENTS
This Agreement shall become effective on December 1, 2014 and shall terminate on December
31, 2015. The obligations of the Subrecipient as described herein will survive termination of this
agreement.
1111. DESCRIPTION OF SERVICES
The Subrecipient shall provide the services for the State of Arizona, Arizona Department of
Homeland Security as approved in the grant application titled "OPSG overtime" and funded at
$ 165,3 (as may have been modified by the award letter).
Enter Funded Amount Above
IV. MANNER OF FINANCING
The AZDOHS shall:
a) Provide up to $1s5,377,0o to the subrecipient for services provided under
Paragraph III . Cne�unded�moun Tove
b) Payment made by the AZDOHS to the subrecipient shall be on a reimbursement basis only
and is conditioned upon receipt of proof of payment and applicable, accurate and complete
reimbursement documents, as deemed necessary by the AZDOHS, to be submitted by the
subrecipient. A listing of acceptable documentation can be found at www.azdohL.g
Payments will be contingent upon receipt of all reporting requirements of the subrecipient
under this Agreement.
V. FISCAL RESPONSBILITY
It is understood and agreed that the total amount of the funds used under this Agreement shall be
used only for the project as described in the application. Any modification to quantity or scope of
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Exhibit "A"
work must be preapproved in writing by the AZDOHS. Therefore, should the project not be
completed, the subrecipient shall reimburse said funds directly to the AZDOHS immediately. If
the project is completed at a lower cost than the original budget called for, the amount reimbursed
to the subrecipient shall be for only the amount of dollars actually spent by the subrecipient in
accordance with the approved application. For any funds received under this Agreement for
which expenditure is disallowed by an audit exemption or otherwise by the AZDOHS, the State,
or Federal government, the subrecipient shall reimburse said funds directly to the AZDOHS
immediately.
VI. FINANCIAL AUDITIPROGRAMATIC MONITORING
The subrecipient agrees to terms specified in A.R.S. § 35 -214 and § 35 -215.
a) In addition, in compliance with the Federal Single Audit Act (31 U.S.C. par. 7501 -- 7507), as
amended by the Single Audit Act Amendments of 1996 (P.L. 104 to 156), the subrecipient
must have an annual audit conducted in accordance with OMB Circular #A -'133 ( "Audits of
States, Local Governments, and Non - profit Organizations ") if the subrecipient expends more
than $500,000 from Federal awards. If the subrecipient has expended more than $500,000 in
Federal dollars, a copy of the subrecipient's audit report for the previous fiscal year and
subsequent years within the period of performance is due annually to AZDOHS within nine (9)
months of the subrecipients fiscal year end.
b) Subrecipients will be monitored periodically by the AZDOHS staff, both programmatically and
financially, to ensure that the project goals, objectives, performance requirements, timelines,
milestone completion, budgets, and other related program criteria are being met. Monitoring
will be accomplished through a combination of office -based reviews and on -site monitoring
visits. Monitoring can involve aspects of the work involved under this contract including but
not limited to the review and analysis of the financial, programmatic, equipment, performance,
and administrative issues relative to each program and will identify areas where technical
assistance and other support may be needed.
VII. APPLICABLE FEDERAL REGULATIONS
The subrecipient must comply with the Funding Opportunity Announcement (FOA), Office of
Management and Budget (OMB) Circulars, Code of Federal Regulations (CFR) and other Federal
guidance including but not limited to:
a} 44 CFR Chapter 1, Federal Emergency Management Agency, Department of Homeland
Security at www. o. ov /fds sI k ICFR -2007 title44 - vo11 1content defa#. html
b) 2 CFR 225 Cost Principles for State, Local & Indian Tribal Governments (A -87 OMB Circular),
at www. o. ovffds sI k ICFR- 2007- title2- vol 11con ten tdetail.html.
Cost Principles: 2 CFR Part 225, State and Local Governments; 2 CFR Part 220, Educational
Institutions; 2 CFR Part 230, Non - Profit Organizations; Federal Acquisition Regulation Sub-
part 31.2, Contracts with Commercial Organ izations.OMB Circular A -133, Audits of States,
Local Governments, and Non - Profit Organizations, at
www. whitehouse. ovlsites ldefaultlfileslomblassetsla l33la 133 revised 2 df.
c) 44 CFR Part 13, Uniform Administrative Requirements for Grants and Cooperative
Agreements to State and Local Governments (formerly OMB Circular A -102), at origin
www. o. ov /fds s/ k /CFR- 2010- title44 -vo11/ df /CFR- 2010- title44 -vo11 -part 13, df. . U.S.
Department of Homeland Security Authorized Equipment List (AEL), at
www.11is. dhs. gov/ knowledoebase /authorizedequigmentlist
d) 2 CFR Part 215, Uniformed Administrative Requirements for Grants and Agreements with
Institutions of Higher Education, Hospitals and Other Non - Profit Organizations.
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e) 28 CFR applicable to grants and cooperative agreements, including Part 18, Office of Justice
Programs Hearing and Appeal Procedure; Part 20, Criminal Justice Information Systems; Part
22, Confidentiality of Identifiable Research and Statistical Information; Part 23, Criminal
Intelligence Systems Operating Policies; Part 42, Non - discrimination; Equal Employment
Opportunities; Policies and Procedures; Part 61, Procedures for Implementing the National
Environmental Policy Act; Part 63, Floodplain Management and Wetland Protection
Procedures; and Part 66, Uniform Administrative Requirements for Grants and Co- operative
Agreements to State and local Government. This CFR can be found at
htt .Ilwww. a. QZlfds sI k /CFR - 2001- titie28- volllcontent- detail. html.
fl Where applicable and with prior written approval from AZDOHS /DHS /FEMA, program
subgrantees using funds for construction projects must comply with the Davis -Bacon Act
(40 U.S.C. 3141 et seq.). Subrecipients 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 htt : / /www.dol. ov /com nce11aws/bomo-dbra.htm.
Included within the above mentioned guidance documents are provisions for the following:
National Incident Management System (NIMS)
The subrecipient agrees to remain in compliance with National Incident Management System
(NIMS) implementation initiatives as outlined in the applicable Funding Opportunity
Announcement (FOA).
Environmental Planning and Historic Preservation
The subrecipient shall comply with all applicable Federal, State, and Local environmental and
historic preservation (EHP) requirements and shall provide any information requested by FEMA
to ensure compliance with applicable laws including: National Environmental Policy Act, National
Historic Preservation Act, Endangered Species Act, and Executive Orders on Floodplains
(11988), Wetlands (11994) and Environmental Justice (12898).Subrecipient shall not undertake
any project having the potential to impact EHP resources without the Prior approval of
AZDOHSIFEMA including but not limited to communications towers, physical security
enhancements, new construction, and modifications to buildings that are 50 years old or greater.
Subrecipient must comply with all conditions placed on the project as the result of the EHP
review. Any change to the approved project scope of work will require re- evaluation for
compliance with these EHP requirements. if ground disturbing activities occur during project
implementation, the subrecipient must ensure monitoring of ground disturbance and if any
potential archeological resources are discovered, the subrecipient will immediately cease
construction in that area and notify FEMA and the appropriate State Historic Preservation Office.
Procurement and construction activities shall not be initiated prior to the full environmental and
historic preservation review and approval.
Cons ultantslTrainerslTrain1ng Providers
Billings for consultants/trainers/training providers must include at a minimum: a description of
services; dates of services; number of hours for services performed; rate charged for services;
and, the total cost of services performed. Consultant/trainer/training provider costs must be
within the prevailing rates; must be obtained under consistent treatment with the procurement
policies of the subrecipient and 44 CFR Chapter 1, Part 13; and shall not exceed the maximum of
$450 per day per consultant/trainer/training provider unless prior written approval is granted by
the AZDOHS. In addition to the per day $450 maximum amount, the consultant/trainer/training
provider may be reimbursed reasonable travel, lodging, and per diem not to exceed the state
rate. Itemized receipts are required for lodging and travel reimbursements. The subrecipient will
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not be reimbursed costs other than travel, lodging, and per diem on travel days for
consultants/trainers/training providers.
Contractors/Subcontractors
The subrecipient may enter into written subcontract(s) for performance of certain of its functions
under the contract in accordance with terms established in the OMB Circulars, Code of Federal
Regulations, DHS Guidance /FOA, and DHS Program Guidance. The subrecipient agrees and
understands that no subcontract that the subrecipient enters into with respect to performance
under this Agreement shall in any way relieve the subrecipient of any responsibilities for
performance of its duties. The subrecipient shall give the AZDOHS immediate notice in writing by
certified mail of any action or suit filed and prompt notice of any claim made against the
subrecipient by any subcontractor or vendor which in the opinion of the subrecipient may result in
litigation related in any way to the Agreement with the AZDOHS.
Personnel and Travel Costs
All grant funds expended for personnel, travel, lodging, and per diem must be consistent with the
subrecipient's policies and procedures; and the State of Arizona Accounting Manual (SAAM);
must be applied uniformly to both federally financed and other activities of the agency; and will be
reimbursed at the most restrictive allowability and rate. At no time will the subrecipient's
reimbursement(s) exceed the State rate established by the Arizona Department of Administration,
General Accounting Office Travel Policies: www.gao.az.gov.
Procurement
The subrecipient shall comply with all internal agency procurement rules/policies and must also
comply with Federal procurement rules/policies as outlined in section VII and all procurement
must comply with Arizona State procurement code and rules. The Federal intent is that all
Homeland Security Funds are awarded competitively. The subrecipient shall not enter into a
Noncompetitive (Sole or Single Source) procurement agreement, unless prior written approval is
granted by the AZDOHS. The Noncompetitive Procurement Request Form and instructions are
located on the AZDOHS website, vvwvv. azdohs. coIgrantsl
Training and Exercise
The subrecipient agrees that any grant funds used for training and exercise must be in
compliance with the applicable FOA. All training must be approved through the ADEM /AZDOHS
training request process prior to execution of training contract(s). All exercises must utilize the
FEMA Homeland Security Exercise and Evaluation Program (HSEEP) Toolkit for exercise design,
development and scheduling. Subrecipient agrees to:
a) Submit the HSEEP Toolkit Exercise Summary to AZDOHS with all Exercise Reimbursement
Requests.
b) Post all exercises, documentation and After Action Reports /Improvement Plans via the HSEEP
Toolkit.
c) Within 50 days of completion of an exercise, or as prescribed by the most recent HSEEP guidance,
the exercise host subrecipient is required to upload the AAR /I P into the HSEEP Toolkit and email the
AARII P to the local County Emergency Manager, the FEMA Region IX Exercise POC,
HSEEPad,hs,.go „y , the AZDOHS Strategic Planner, and the Arizona Department of Emergency
Management (ADEM) Exercise Officer.
Nonsupplanting Agreement
The subrecipient shall not use funds to supplant State or Local funds or other resources that
would otherwise have been made available for this program /project. Further, if a position created
by a grant is filled from within, the vacancy created by this action must be filled within thirty (30)
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days. If the vacancy is not filled within thirty (30) days, the subrecipient must stop charging the
grant for the new position. Upon filling the vacancy, the subrecipient may resume charging for
the grant position.
E- Verify
Compliance requirements for A.R.S. § 41- 4401 — immigration laws and E- Verify requirement.
a) The subrecipient warrants compliance with all Federal immigration laws and regulations
relating to employees and warrants its compliance with Section A.R.S. § 23 -214, Subsection
A. (That subsection reads: "After December 31, 2007, every employer, after hiring an
employee, shall verify the employment eligibility of the employee through the E- Verify
program).
b) A breach of a warranty regarding compliance with immigration laws and regulations shall be
deemed a material breach of the contract and the subrecipient may be subject to penalties up
to and including termination of the Agreement.
c) The AZDOHS retains the legal right to inspect the papers of any employee who works on the
Agreement to ensure that the subrecipient is complying with the warranty under paragraph (a)
above.
Property Control
Effective control and accountability must be maintained for all property. The subrecipient must
adequately safeguard all such property and must assure that it is used for authorized purposes as
described in the FOA, grant application, and Code of Federal Regulations (44 CFR 13.32 ). The
subrecipient shall exercise caution in the use, maintenance, protection and preservation of such
property.
a) Equipment shall be used by the subrecipient in the program or project for which it was
acquired as long as needed, whether or not the program or project continues to be supported
by federal grant funds. Theft, destruction, or loss of property shall be reported to the
AZDOHS immediately.
b) Nonexpendable Property and Capital Assets:
1. Nonexpendable Property is property which has a continuing use, is not consumed in use,
is of a durable nature with an expected service life of one or more years, has an
acquisition cost of $300 (Three Hundred Dollars) or more, and does not become a fixture
or lose its identity as a component of other equipment or systems.
2. A Capital Asset is any personal or real property, or figure that has an acquisition cost of
$5,000 (Five Thousand Dollars) or more per unit and a useful life of more than one year.
c) A Property Control Form (if applicable) shall be maintained for the entire scope of the
program or project for which property was acquired through the end of its useful life and /or
disposition. All Nonexpendable Property and Capital Assets must be included on the Property
Control Form. The subrecipient shall provide AZDOHS a copy of the Property Control Form
with the final quarterly programmatic report. A Property Control Form can be located at
www.azdohs. ov /Grants /. The subrecipient agrees to be subject to equipment monitoring and
auditing by state or federal authorized representatives to verify information.
d) A physical inventory of the Nonexpendable Property and Capital Assets must be taken and
the results reconciled with the Property Control Form at least once every two years.
1. A control system must be developed to ensure adequate safeguards to prevent loss,
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damage, or theft of the property. Any loss, damage, or theft shall be investigated and reported
to AZDOHS.
2. Adequate maintenance procedures must be developed to keep the property in good
condition.
e) When Nonexpendable Property and/or Capital Assets are no longer in operational use by the
subgrantee, an updated Property Control Form must be submitted to AZDOHS immediately.
The disposition of equipment shall be in compliance with the AZDOHS Disposition Guidance.
If the subgrantee is requesting disposition of Capital Assets for reasons other than theft,
destruction, or loss, the subgrantee must submit an Equipment Disposition Request Form and
receive approval prior to the disposition. The Equipment Disposition Request Form can be
found at www. azdohs. ov1Granfsl.
Allowable Costs
The allowability of costs incurred under this agreement shall be determined in accordance with
the general principles of allowability and standards for selected cost items as set forth in the
applicable OMB Circulars, Code of Federal Regulations, authorized equipment lists and guidance
documents referenced above.
a) The subrecipient agrees that grant funds are not to be expended for any indirect costs that
may be incurred by the subrecipient for administering these funds.
b) The subrecipeint agrees that grant funds are not to be expended for any Management and
Administrative (M &A) costs that may be incurred by the subrecipient for administering these
funds unless explicitly applied for and approved in writing by the AZDOHS and shall be in
compliance with the applicable FOA.
Vlll. DEBARMENT CERTIFICATION
The subrecipient agrees to comply with the Federal Debarment and Suspension regulations as
outlined in the "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary
Exclusion — Lower Tier Covered Transactions."
Ix. FUNDS MANAGEMENT
The subrecipient must maintain funds received under this Agreement in separate ledger accounts
and cannot mix these funds with other sources. The subrecipient must manage funds according
to applicable Federal regulations for administrative requirements, costs principles, and audits.
The subrecipient must maintain adequate business systems to comply with Federal requirements.
The business systems that must be maintained are:
• Financial Management
• Procurement
• Personnel
• Property
• Travel
A system is adequate if it is 1) written; 2) consistently followed -- it applies in all similar
circumstances; and 3) consistently applied — it applies to all sources of funds.
X. REPORTING REQUIREMENTS
Regular reports by the subrecipient shall include:
a) Programmatic Reports
The subrecipient shall provide quarterly programmatic reports to the AZDOHS within fifteen
(15) working days of the last day of the quarter in which services are provided. The
subrecipient shall use the form provided by the AZDOHS to submit quarterly programmatic
reports. The report shall contain such information as deemed necessary by the AZDOHS.
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The subrecipient shall use the Quarterly Programmatic Report form, which is posted at
www. azdohs. pov1Granfsl If the scope of the project has been fully completed and
implemented, and there will be no further updates, then the quarterly programmatic report for
the quarter in which the project was completed will be sufficient as the final report. The report
should be marked as final and should be inclusive of all necessary and pertinent information
regarding the project as deemed necessary by the AZDOHS. Quarterly programmatic reports
shall be submitted to the AZDOHS until the entire scope of the project is completed
b) Quarterly Programmatic Reports are due:
January 15 (period October 1— December 31)
April 15 (period January 1 —March 31)
July 15 (period April 1 —June 30)
October 15 (period July 1 — September 30)
c) Final Quarterly Report:
The final quarterly report is due no more than fifteen (15) days after the end of the
performance period. The Property Control Form and Grant Funded Typed Resource Report
are due with the final quarterly report (if applicable).
d) Property Control Form — if applicable:
The subrecipient shall provide AZDOHS a copy of the Property Control Form with the final
quarterly report.
a. In case of equipment disposition:
The Property Control Form shall be updated and a copy provided to AZDOHS no
more than forty -five (45) calendar days after equipment disposition, if applicable. The
disposition of equipment must be in compliance with the AZDOHS Disposition
Guidance.
e) The Grant Funded Typed Resource Report — if applicable:
The subrecipient shall email the AZDOHS Strategic Planner a copy of the Grant Funded
Typed Resource Report with the final quarterly report. The Grant Funded Typed Resource
Report and instructions are located at www.azdohs.gov /Grants /.
fl Financial Reimbursements
The subrecipient shall provide as frequently as monthly but not less than quarterly
requests for reimbursement. Reimbursements requests are only required when expenses
have been incurred. Reimbursements shall be submitted with the Reimbursement Form
provided by the AZDOHS staff. The subrecipient shall submit a final reimbursement for
expenses received and invoiced prior to the end of the termination of this Agreement no more
than forty -five (45) calendar days after the end of the Agreement. Requests for
reimbursement received later than the forty -five (45) days after the Agreement termination will
not be paid. The final reimbursement request as submitted shall be marked FINAL.
The AZDOHS requires that all requests for reimbursement are submitted via U.S. mail (United
States Postal Service), FedEx, UPS, etc... or in person. Reimbursements submitted via fax or
by any electronic means will not be accepted.
The AZDOHS reserves the right to request and/or require any supporting documentation it
feels necessary in order to process reimbursements.
All reports shall be submitted to the contact person as described in Paragraph XL, NOTICES, of
this Agreement.
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Xl. ASSIGNMENT AND DELEGATION
The subrecipient may not assign any rights hereunder without the express, prior written consent
of both parties.
MI. AMENDMENTS
Any change in this Agreement including but not limited to the Description of Services and budget
described herein, whether by modification or supplementation, must be accomplished by a formal
Agreement amendment signed and approved by and between the duly authorized representative
of the subrecipient and the AZDOHS. The AZDOHS shall have the right to immediately amend
this Agreement so that it complies with any new legislation, laws, ordinances, or rules affecting
this Agreement.
Any such amendment shall specify: 1) an effective date; 2) any increases or decreases in the
amount of the subrecipient's compensation if applicable; 3) be titled as an "Amendment," and 4) be
signed by the parties identified in the preceding sentence. The subrecipient expressly and explicitly
understands and agrees that no other method of communication, including any other document,
correspondence, act, or oral communication by or from any person, shall be used or construed as
an amendment or modification or supplementation to this Agreement.
XIII. US DEPARTMENT of HOMELAND SECURITY AGREEMENT ARTICLES
..............................
Article A — Acceptance of Post Award Changes
In the event FEMA determines that changes are necessary to the award document after an award
has been made, including changes to period of performance or terms and conditions, recipients
will be notified of the changes in writing. Once notification has been made, any subsequent
request for funds will indicate recipient acceptance of the changes to the award.
Article B - compliance with Funding opportunity Announcement
The recipient agrees that all allocations and use of funds under this grant will be in accordance
with the applicable FOA.
Article C - DHS Specific Acknowledgements and Assurances
All recipients of financial assistance must acknowledge and agree and require any sub -
recipients, contractors, successors, transferees, and assignees acknowledge and agree to
comply with applicable provisions governing DHS access to records, accounts, documents,
information, facilities, and staff.
1. Recipients must cooperate with any compliance review or complaint investigation conducted
by DHS.
2. Recipients must give DHS access to and the right to examine and copy records, accounts,
and other documents and sources of information related to the grant and permit access to
facilities, personnel, and other individuals and information as may be necessary, as required
by DHS regulations and other applicable laws or program guidance.
3. Recipients must submit timely, complete, and accurate reports to the appropriate DHS
officials and maintain appropriate backup documentation to support the reports.
4. Recipients must comply with all other special reporting, data collection, and evaluation
requirements, as prescribed by law or detailed in program guidance.
5. If, during the past three years, the recipient has been accused of discrimination on the
grounds of race, color, national origin (including limited English proficiency), sex, age,
disability, religion, or familial status, the recipient must provide a list of all such proceedings,
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pending or completed, including outcome and copies of settlement agreements to the DHS
awarding office and the DHS office of Civil Rights and Civil Liberties.
6. In the event any court or administrative agency makes a finding of discrimination on grounds
of race, color, national origin (including limited English proficiency), sex, age, disability,
religion, or familial status against the recipient, or the recipient settles a case or matter
alleging such discrimination, recipients must forward a copy of the complaint and findings to
the DHS Component and/or awarding office.
The United States has the right to seek judicial enforcement of these obligations.
Article D - Use of DHS Seal, Logo and Flags
All recipients must obtain DHS's approval prior to using the DHS seals), logos, crests or
reproductions of flags or likenesses of DHS agency officials, including use of the United States
Coast Guard seal, logo, crests or reproductions of flags or likenesses of Coast Guard officials.
Article E - USA Patriot Act of 2001
All recipients must comply with the requirements of the Uniting and Strengthening America by
Providing Appropriate Tools Required to Intercept and Obstruct Terrorism Act (USA PATRIOT
Act), which amends 18 U.S.C. §§ 175 -175c. Among other things, the USA PATRIOT Act
prescribes criminal penalties for possession of any biological agent, toxin, or delivery system of a
type or in a quantity that is not reasonably justified by a prophylactic, protective, bona fide
research, or other peaceful purpose.
Article F -Trafficking Victims Protection Act of 2000
All recipients of financial assistance will comply with the requirements of the government -wide
award term which implements Section 106(g) of the Trafficking Victims Protection Act (TVPA) of
2000, as amended (22 U.S.C. § 7104), located at 2 CFR Part 175. This is implemented in
accordance with OMB Interim Final Guidance, Federal Register, Volume 72, No. 218, November
13, 2007.
In accordance with the statutory requirement, in each agency award under which funding is
provided to a private entity, Section 106(g) of the TVPA, as amended, requires the agency to
include a condition that authorizes the agency to terminate the award, without penalty, if the
recipient or a subrecipient
1. Engages in severe forms of trafficking in persons during the period of time that the
award is in effect;
2. Procures a commercial sex act during the period of time that the award is in effect;
or
3. Uses forced labor in the performance of the award or subawards under the award.
Full text of the award term is provided at 2 CFR § 175.15.
Article G - Non - supplanting Requirement
All recipients must ensure that Federal funds do not replace (supplant) funds that have been
budgeted for the same purpose through non- Federal sources. Applicants or award recipients may
be required to demonstrate and document that a reduction in non- Federal resources occurred for
reasons other than the receipt of expected receipt of Federal funds.
Article H w Lobbying Prohibitions
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All recipients must comply with 31 U.S.C. § 1352, which provides that none of the funds provided
under an award may be expended by the recipient to pay any person to influence, or attempt 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 any Federal action
concerning the award or renewal.
Article I - Hotel and Motel Fire Safety Act of 1990
In accordance with Section 6 of the Hotel and Motel Fire Safety Act of 1990, 15 U.S.C. §2225(x),
all recipients must ensure that all conference, meeting, convention, or training space funded in
whole or in part with Federal funds complies with the fire prevention and control guidelines of the
Federal Fire Prevention and Control Act of 1974, 15 U.S.C. §2225.
Article J - Fly America Act of 1974
All recipients must comply with Preference for U.S. Flag Air Carriers: Travel supported by U.S.
Government funds requirement, which states preference for the use of U.S. flag air carriers (air
carriers holding certificates under 49 U.S.C. §41102) for international air transportation of people
and property to the extent that such service is available, in accordance with the International Air
Transportation Fair Competitive Practices Act of 1974 (49 U.S.C. § 40118) and the interpretative
guidelines issued by the Comptroller General of the United States in the March 31, 1981,
amendment to Comptroller General Decision 13138942.
Article K - Federal Debt Status
All recipients are required to be non - delinquent in their repayment of any Federal debt. Examples
of relevant debt include delinquent payroll and other taxes, audit disallowances, and benefit
overpayments. See OMB Circular A -129 and form SF-424, item number 17 for additional
information and guidance.
Article L - False Claims Act and Program Fraud Civil Remedies
All recipients must comply with the requirements of 31 U.S.C. § 3729 which set forth that no
recipient of federal payments shall submit a false claim for payment. See also 38 U.S.C. § 3801-
3812 which details the administrative remedies for false claims and statements made.
Article M - Duplication of Benefits
State, Local and Tribal recipients must comply with 2 CFR Part §225, Appendix A, paragraph
(C)(3)(c), which provides that any cost allocable to a particular Federal award or cost objective
under the principles provided for in this authority may not be charged to other Federal awards to
overcome fund deficiencies.
Article N - Drug -Free Workplace Regulations
All recipients must comply with the Drug -Free Workplace Act of 1988 (412 U.S.C. § 701 et seq.),
which requires that all organizations receiving grants from any Federal agency agree to maintain
a drug -free workplace. These regulations are codified at 2 CFR 3001.
Article o - Debarment and Suspension
All recipients must comply with Executive orders 12549 and 12689, which provide protection
against waste, fraud, and abuse by debarring or suspending those persons deemed irresponsible
in their dealings with the Federal government.
Article P w Copyright
All recipients must affix the applicable copyright notices of 17 U.S.C. § 401 or 402 and an
acknowledgement of Government sponsorship (including award number) to any work first
produced under Federal financial assistance awards, unless the work includes any information
that is otherwise controlled by the Government (e.g., classified information or other information
subject to national security or export control laws or regulations).
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Article Q - Best Practices for Collection and Use of Personally Identifiable Information (PII)
All award recipients who collect PII are required to have a publicly- available privacy policy that
describes what PII they collect, how they use the PII, whether they share PII with third parties,
and how individuals may have their PIl corrected where appropriate. Award recipients may also
find as a useful resource the DHS Privacy Impact Assessments guidance and template located
at:
h . W. - 11www.dhs.govlxlihra Iassets/ rivac I tivacy pia g uidance Lu e2010. df
and
htt ./Iwww. dhs. ovlxlihra /assets/ rivacyZprivacv pia tear late. df, respectively.
Article R - Activities Conducted Abroad
All recipients must ensure that project activities carried on outside the United States are
coordinated as necessary with appropriate government authorities and that appropriate licenses,
permits, or approvals are obtained.
Article S w Acknowledgement of Federal Funding from DHS
All recipients must acknowledge their use of federal 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 funds.
Article T - Assurances, Administrative Requirements and Cost Principles
Recipients of DHS federal financial assistance must complete OMB Standard Form 424B
Assurances — Non - Construction Programs. Certain assurances in this form may not be applicable
to your project or program, and the awarding agency may require applicants to certify to
additional assurances. Please contact the program awarding office if you have any questions.
The administrative requirements that apply to DHS award recipients originate from two sources:
Office of Management and Budget (OMB) Circular A -102, Uniform Administrative
Requirements for Grants and Cooperative Agreements to State and Local Governments
(also known as the "A -102 Common Rule "). These A -102 requirements are also located
within DHS regulations at Title 44, Code of Federal Regulations (CFR) Part 13.
OMB Circular A --110, Uniform Administrative Requirements for Grants and Agreements
with Institutions of Higher Education, Hospitals, and Other Non - Profit Organizations,
relocated to 2 CFR Part 215.
The cost principles that apply to DHS award recipients through a grant or cooperative agreement
originate from one of the following sources:
OMB Circular A-21, Cost Principles for Educational Institutions, relocated to 2 CFR Part
220.
• OMB Circular A-87, Cost Principles for State, Local, and Indian Tribal Governments,
relocated to 2 CFR Part 225.
OMB Circular A-122, Cost Principles for Non - Profit organizations, relocated to 2 CFR Part
230.
The audit requirements for State, Local and Tribal recipients of DHS awards originate from:
OMB Circular A --133, Audits of States, Local Governments and Non -- Profit Organizations.
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Article U - Age Discrimination Act of 1975
All recipients must comply with the requirements of the Age Discrimination Act of 1975 (42 U.S.C.
§ 6101 et seq.), which prohibits discrimination on the basis of age in any program or activity
receiving Federal financial assistance.
Article V - Americans with Disabilities Act of 1990
All recipients must comply with the requirements of Titles I, 11, and III of the Americans with
Disabilities Act, which prohibits recipients from discriminating on the basis of disability in the
operation of public entities, public and private transportation systems, places of public
accommodation, and certain testing entities (42 U.S.C. §§ 12101- 12213 ).
Article W - Title V1 of the Civil Rights Act of 1954
All recipients must comply with the requirements of Title VI of the Civil Rights Act of 1964 (42
U.S.C. § 2000d et seq. ), codified at 6 CFR Part 21 and 44 CFR Part 7, which provides that no
person in the United States will, on the grounds of race, color, or national origin, be excluded from
participation in, be denied the benefits of, or be subjected to discrimination under any program or
activity receiving Federal financial assistance.
Article X - Civil Rights Act of 1958
All recipients must comply with Title VIII of the Civil Rights Act of 1968, which prohibits recipients
from discriminating in the sale, rental, financing, and advertising of dwellings, or in the provision
of services in connection therewith, on the basis of race, color, national origin, religion, disability,
familial status, and sex (42 U.S.C. § 3601 et seq. ), as implemented by the Department of Housing
and Urban Development at 24 CFR Part 100. The prohibition on disability discrimination includes
the requirement that new multifamily housing with four or more dwelling units i.e., the public and
common use areas and individual apartment units (all units in buildings with elevators and
ground -floor units in buildings without elevators) be designed and constructed with certain
accessible features (see 24 CFR § 100.201).
Article Y - Limited English Proficiency (Civil Rights Act of 1964, Title VI)
All recipients must comply with the Title VI of the Civil Rights Act of 1964 (Title VI) prohibition
against discrimination on the basis of national origin, which requires that recipients of federal
financial assistance take reasonable steps to provide meaningful access to persons with limited
English proficiency (LEP) to their programs and services. Providing meaningful access for
persons with LEP may entail providing language assistance services, including oral interpretation
and written translation. In order to facilitate compliance with Title VI, recipients are encouraged to
consider the need for language services for LEP persons served or encountered in developing
program budgets. Executive Order 13166, Improving Access to Services for Persons with Limited
English Proficiency (August 11, 2000 ), requires federal agencies to issue guidance to recipients,
assisting such organizations and entities in understanding their language access obligations.
DHS published the required recipient guidance in April 2011 DHS Guidance to Federal Financial
Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination
Affecting Limited English Proficient Persons, 76 Fed. Reg. 21755. 21768,
(April 18, 2011). The Guidance provides helpful information such as how a recipient can
determine the extent of its obligation to provide language services; selecting language services;
and elements of an effective plan on language assistance for LEP persons. For additional
assistance and information regarding language access obligations, please refer to the DHS
Recipient Guidance hff s. / /www. dhs. o Z uidancew ublished hel -de arfinent su orfed
or anizafions- rovide- meanie fulaccess eo �imifed and additional resources on
hffo:llvwvw. lei). aov.
Article Z - SAFECOM
Recipients who receive awards made under programs that provide emergency communication
equipment and its related activities must comply with the SAFECOM Guidance for Emergency
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Communication Grants, including provisions on technical standards that ensure and enhance
interoperable communications.
Article AA - Title IX of the Education Amendments of 1975 (Equal Opportunity in Education
Act)
All recipients must comply with the requirements of Title 1X of the Education Amendments of 1972
(20 U.S.G. § 1681 et seq.), which provides that no person in the United States will, on the basis of
sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination
under any educational program or activity receiving Federal financial assistance.
These regulations are codified at 6 CFR Part 17 and 44 CFR Part 19.
Article AB - Rehabilitation Act of 1973
All recipients of must comply with the requirements of Section 504 of the Rehabilitation Act of
1973 29 U.S.C. § 794, as amended, which provides that no otherwise qualified handicapped
individual in the United States will, solely by reason of the handicap, be excluded from
participation in, be denied the benefits of, or be subjected to discrimination under any program or
activity receiving Federal financial assistance. These requirements pertain to the provision of
benefits or services as well as to employment.
XIV. OFFSHORE PERFORMANCE OF WORK PROHIBITED
Due to security and identity protection concerns, all services under this Agreement shall be
performed within the borders of the United States. All storage and processing of information shall
be performed within the borders of the United States. This provision applies to work performed
by subcontractors at all tiers.
Xv. AGREEMENT RENEWAL
This Agreement shall not bind nor purport to bind the AZDOHS for any contractual commitment in
excess of the original Agreement period.
XVI. RIGHT TO ASSURANCE
If the AZDOHS in good faith has reason to believe that the subrecipient does not intend to, or is
unable to perform or continue performing under this Agreement, the AZDOHS may demand in
writing that the subrecipient give a written assurance of intent to perform. If the subrecipient fails
to provide written assurance within the number of days specified in the demand, the AZDOHS at
its option may terminate this Agreement.
XVIL CANCELLATION FOR CONFLICT OF INTEREST
The AZDOHS may, by written notice to the subrecipient, immediately cancel this Agreement
without penalty or further obligation pursuant to A.R.S. § 38 -511 if any person significantly
involved in initiating, negotiating, securing, drafting, or creating the Agreement on behalf of the
State or its subdivisions (unit of Local Government) is an employee or agent of any other party in
any capacity or a consultant to any other party to the Agreement with respect to the subject
matter of the Agreement. Such cancellation shall be effective when the parties to the Agreement
receive written notice from the AZDOHS, unless the notice specifies a later time.
XVIII. THIRD PARTY ANTITRUST VIOLATIONS
The subrecipient assigns the State of Arizona any claim for overcharges resulting from antitrust
violations to the extent that such violations concern materials or services supplied by third parties
to subrecipient toward fulfillment of this Agreement.
XIX. AVAILABILITY OF FUNDS
Every payment obligation of the AZDOHS under this Agreement is conditioned upon the
availability of funds appropriated or allocated for the payment of such obligations. If the funds are
not allocated and available for the continuance of this Agreement, the AZDOHS may terminate
this Agreement at the end of the period for which funds are available. No liability shall accrue to
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the AzDOHS in the event this provision is exercised, and the AZDOHS shall not be obligated or
liable for any future payments or for any damages as a result of termination under this paragraph,
including purchases and/or contracts entered into by the subrecipient in the execution of this
Agreement.
XX. FORCE MAJEURE
If either party hereto is delayed or prevented from the performance of any act required in this
Agreement by reason of acts of God, strikes, lockouts, labor disputes, civil disorder, or other
causes without fault and beyond the control of the party obligated, performance of such act will be
excused for the period of the delay.
XXI. PARTIAL INVALIDITY
Any term or provision of this Agreement that is hereafter declared contrary to any current or future
law, order, regulation, or rule, or which is otherwise invalid, shall be deemed stricken from this
Agreement without impairing the validity of the remainder of this Agreement.
XXII. ARBITRATION
In the event of any dispute arising under this Agreement, written notice of the dispute must be
provided to the other party within thirty (30) days of the events giving the rise to the dispute. The
subrecipient agrees to terms specified in A.R.S. § 12 -1518.
XXIII. GOVERNING LAW AND CONTRACT INTERPRETATION
a) This Agreement shall be governed and interpreted in accordance with the laws of the State of
Arizona.
b) This Agreement is intended by the parties as a final and complete expression of their
agreement. No course of prior dealings between the parties and no usage of the trade shall
supplement or explain any terms in this document.
c) Either party's failure to insist on strict performance of any term or condition of the Agreement
shall not be deemed a waiver of that term or condition even if the party accepting or
acquiescing in the nonconforming performance knows of the nature of the performance and
fails to object.
XXIV. ENTIRE AGREEMENT
This Agreement and its Exhibits constitute the entire Agreement between the parties hereto
pertaining to the subject matter hereof and may not be changed or added to except by a writing
signed by all parties hereto in conformity with Paragraph XII, AMENDMENTS. The subrecipient
agrees to comply with any such amendment within ten (10) business days of receipt of a fully
executed amendment. All prior and contemporaneous agreements, representations, and
understandings of the parties, oral, written, pertaining to the subject matter hereof, are hereby
superseded or merged herein.
XXV. RESTRICTIONS ON LOBBYING
The subrecipient shall not use funds made available to it under this Agreement to pay for,
influence, or seek to influence any officer or employee of a State or Federal government.
XXVI. LICENSING
The subrecipient, unless otherwise exempted by law, shall obtain and maintain all licenses,
permits, and authority necessary to perform those acts it is obligated to perform under this
Agreement.
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XXVII. NON - DISCRIMINATION
The subrecipient shall comply with all State and Federal equal opportunity and non -- discrimination
requirements and conditions of employment, including the Americans with Disabilities Act, in
accordance with A.R.S. title 41, Chapter 9, Article 4 and Executive Order2OO9 -09.
XXVIII. SECTARIAN REQUESTS
Funds disbursed pursuant to this Agreement may not be expended for any sectarian purpose or
activity, including sectarian worship or instruction in violation of the United States or Arizona
Constitutions.
XXIX. SEVERABILITY
The provisions of this Agreement are severable. Any term or condition deemed illegal or invalid
shall not affect any other term or condition of the Agreement.
XXX. ADVERTISING AND PROMOTION OF AGREEMENT
The subrecipient shall not advertise or publish information for commercial benefit concerning this
Agreement without the written approval of the AZDOHS.
XXXI. OWNERSHIP OF INFORMATION, PRINTED AND PUBLISHED. M ATERIAL
The AZDOHS reserves the right to review and approve any publications funded or partially
funded through this Agreement. All publications funded or partially funded through this
Agreement shall recognize the AZDOHS and the U.S. Department of Homeland Security. The
U.S. Department of Homeland Security and the AZDOHS shall have full and complete rights to
reproduce, duplicate, disclose, perform, and otherwise use all materials prepared under this
Agreement.
The subrecipient agrees that any report, printed matter, or publication (written, visual, or sound,
but excluding press releases, newsletters, and issue analyses) issued by the subrecipient
describing programs or projects funded in whole or in part with Federal funds shall contain the
following statement:
"This document was prepared under a grant from U.S. Department of
Homeland Security. Points of view or opinions expressed in this document are
those of the authors and do not necessarily represent the official position or
policies of the U.S. Department of Homeland Security."
The subrecipient also agrees that one copy of any such publication, report, printed matter, or
publication shall be submitted to the AZDOHS to be placed on file and distributed as appropriate
to other potential subrecipients or interested parties. The AZDOHS may waive the requirement
for submission of any specific publication upon submission of a request providing justification
from the subrecipient.
The AZDOHS and the subrecipient recognize that research resulting from this Agreement has the
potential to become public information. However, prior to the termination of this Agreement, the
subrecipient agrees that no research -based data resulting from this Agreement shall be published
or otherwise distributed in any form without express written permission from the AZDOHS and
possibly the U.S. Department of Homeland Security. It is also agreed that any report or printed
matter completed as a part of this agreement is a work for hire and shall not be copyrighted by
the subrecipient.
XXXIL CLOSED - CAPTIONING OF PUBLIC SERVICE ANNOUNCEMENTS
Any television public service announcement that is produced or funded in whole or in part by the
subrecipient shall include closed captioning of the verbal content of such announcement.
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XXXI I I. INDEMNIFICATION
Each party (as "Indemnitor ") agrees to defend, indemnify, and hold harmless the other party (as
"lndemnitee ") from and against any and all claims, losses, liability, costs, or expenses (including
reasonable attorney's fees) (hereinafter collectively referred to as "Claims ") arising out of bodily
injury of any person (including death) or property damage, but only to the extent that such claims
which result in vicarious /derivative liability to the Indemnitee are caused by the act, omission,
negligence, misconduct, or other fault of the Indemnitor, its officers, officials, agents, employees,
or volunteers. The State of Arizona, (State Agency) is self - insured per A. R.S. 41 -021.
In addition, should subrecipient utilize a contractor(s) and subcontractor(s) the indemnification
clause between subrecipient and contractor(s) and subcontractor(s) shall include the following:
Contractor shall defend, indemnify, and hold harmless the (insert name of other governmental
entity) and the State of Arizona, and any jurisdiction or agency issuing any permits for any work
arising out of this agreement, and its departments, agencies, boards, commissions, universities,
officers, officials, agents, and employees (hereinafter referred to as "lndemnitee') from and
against any and all claims, actions, liabilities, damages, losses, or expenses ( including court
costs, attorneys' fees, and costs of claim processing, investigation and litigation) (hereinafter
referred to as "Claims) for bodily injury or personal injury (including death), or loss or damage to
tangible or intangible property caused, or alleged to be caused, in whole or in part, by the
negligent or willful acts or omissions of the contractor or any of the directors, officers, agents, or
employees or subcontractors of such contractor. This indemnity includes any claim or amount
arising out of or recovered under the Workers' Compensation Law or arising out of the failure of
such contractor to conform to any federal, state or local law, statute, ordinance, rule, regulation or
court decree. It is the specific intention of the parties that the lndemnitee shall, in all instances,
except for Claims arising solely from the negligent or willful acts or omissions of the lndemnitee,
be indemnified by such contractor from and against any and all claims. It is agreed that such
contractor will be responsible for primary loss investigation, defense acrd judgment costs where
this indemnification is applicable. Additionally on all applicable insurance policies, contractor and
its subcontractors shall name the State of Arizona, and its departments, agencies, boards,
commissions, universities, officers, officials, agents, and employees as an additional insured and
also include a waiver of subrogation in favor of the State.
XXXiV. TERMINATION
........................................................
a) All parties reserve the right to terminate the Agreement in whole or in part due to the failure of
the subrecipient or the grantor to comply with any term or condition of the Agreement, to
acquire and maintain all required insurance policies, bonds, licenses, and permits or to make
satisfactory progress in performing the Agreement. The staff of either party shall provide a
written thirty (30) day advance notice of the termination and the reasons for it.
b) If the subrecipient chooses to terminate the contract before the grant deliverables have been
met then the AZDOHS reserves the right to collect all reimbursements distributed to the
subrecipient.
c) The AZDOHS may, upon termination of this Agreement, procure, on terms and in the manner
that it deems appropriate, materials or services to replace those under this Agreement. The
subrecipient shall be liable to the AZDOHS for any excess costs incurred by the AZDOHS in
procuring materials or services in substitution for those due from the subrecipient.
XXXV. CONTINUATION OF PERFORMANCE THROUGH TERMINATION
The subrecipient shall continue to perform, in accordance with the requirements of the
Agreement, up to the date of termination, as directed in the termination notice.
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XXXVI. PARAGRAPH HEADINGS
The paragraph headings in this Agreement are for convenience of reference only and do not
define, limit, enlarge, or otherwise affect the scope, construction, or interpretation of this
Agreement or any of its provisions.
XXXVII. COUNTERPARTS
This Agreement may be executed in any number of counterparts, copies, or duplicate originals.
Each such counterpart, copy, or duplicate original shall be deemed an original, and collectively
they shall constitute one agreement.
XXXVIII. AUTHORITY To EXECUTE THIS AGREEMENT
Each individual executing this Agreement on behalf of the subrecipient represents and warrants
that he or she is duly authorized to execute this Agreement.
XXXIX. SPECIAL CONDITIONS
a) The subrecipient must comply with the most recent version of the Administrative
Requirements, Cost Principles, and Audit requirements
b) The subrecipient acknowledges that the U.S. Department of Homeland Security and the
AZDOHS reserve a royalty -free, non - exclusive, and irrevocable license to reproduce, publish,
or otherwise use, and authorize others to use, for Federal government purposes: (a) the
copyright in any work developed under an award or sub - award; and (2) any rights of copyright
to which a subrecipient purchases ownership with Federal support. The subrecipient shall
consult with the AZDOHS regarding the allocation of any patent rights that arise from, or are
purchased with, this funding.
c) The subrecipient agrees that, when practicable, any equipment purchased with grant funding
shall be prominently marked as follows: "Purchased with funds provided by the U.S.
Department of Homeland Security."
d) The subrecipient agrees to cooperate with any assessments, state /national evaluation efforts,
or information or data collection requests, including, but not limited to, the provision of any
information required for the assessment or evaluation of any activities within this agreement.
e) The subrecipient is prohibited from transferring funds between programs (State Homeland
Security Program, Urban Area Security Initiative, Citizen Corps Program, operation
Stonegarden, and Metropolitan Medical Response System).
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XL. NOTICES
An and all notices, re demands, or communications b either part to this A
pursuant to or in connection with this A shall be in writin be delivered in person, or
shall be sent to the respective parties at the followin addresses:
Arizona Department of Homeland Securit
1700 West Washin Street, Suite 210
Phoenix, AZ 85007
The subrecipient shall address all pro and reimbursement notices relative to this
A to the appropriate AZDOHS staff; contact information at www.azdoh
The AZDOHS shall address all notices relative to this A to:
Director of Communit Development & Nei Services, Lisa Shafer
Enter Title, First & Last Name above
Town of Marana
Enter A Name above
11555 W. Civic Center Drive
Enter Street Address
Marana, AZ 85653
Enter Cit State, ZIP
XLI. IN WITNESS WHEREOF
The parties hereto a to execute this A
FOR AND BEHALF OF THE
Town of Marana
Enter A Name above
FOR AND BEHALF OF THE
Arizona Department of Homeland Securit
Authorized SF above
Gilbert Davidson, Town Mana
Print Name & Title above
12/16/2014
Enter Date above
Gilbert M. Orrantia
Director
Date
( Please be sure to complete and mail two ori documents to the Arizona Department of Homeland Securit
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