HomeMy WebLinkAboutSummary SheetFEDERAL- EMERGENCY MANAGEMENT AGENCY
SUMMARY SHEET FOR ASSURANCES AND CERTIFICATIONS
O.M.B. No. 3067-0206
Expires February 28, 2007
FOR
FY FY2007
CA FOR (Name of Applicant)
SOUTH FLORIDA URBAN SEARCH AND RESCUE
This summary sheet includes Assurances and Certifications that must be read, signed, and submitted as a part of the
Application for Federal Assistance.
An applicant must check each item that they are certifying to:
Part I X FEMA Form 20-16A, Assurances-Nonconstruction Programs
Part II ❑X FEMA Form 20-16B, Assurances -Construction Programs
Part III FEMA Form 20-16C, Certifications Regarding Lobbying;
Debarment, Suspension, and Other Responsibility
Matters; and Drug -Free Workplace Requirements
Part IV El SF LLL, Disclosure of Lobbying Activities (If applicable)
As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the identified
attached assurances and certifications.
Deputy Chief Maurice Kemp TASK FORCE LEADER
Typed Name of Authorized Representative Title
Signature of Authorized Representative
1/15/2007
Date Signed
NOTE: By signing the certification regarding debarment, suspension, and other responsibility matters for primary covered
transaction, the applicant agrees that, should the proposed covered transaction be entered into, it shall not knowingly enter
into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded
from participation in this covered transaction, unless authorized by FEMA entering into this transaction.
The applicant further agrees by submitting this application that it will include the clause titled "Certification
Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transaction," provided by
the FEMA Regional Office entering into this covered transaction, without modification, in all lower tier covered transactions
and in all solicitations for lower tier covered transactions. (Refer to 44 CFR Part 17.)
Paperwork Burden Disclosure Notice
"Public reporting burden for this form Is estimated to average 1.7 hours per response. Burden means the time, effort and
financial resources expended by persons to generate, maintain, retain, disclose, or to provide Information to us. You may
send comments regarding the burden estimate or any aspect of the form, including suggestions for reducing the burden
to: information Collections Management, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472,
Paperwork Reduction Project (3067-0206). You are not required to respond to this collection of information unless a valid
OMB control number appears in the upper right corner of this form. Please do not send your completed form to the above
address.
FEMA Form 20-16, FEB 01