Sacramento County Office of Emergency Services

2016 SHSGP Application

(Limit 1 Application Form, Per Project)

Applicant / Agency Name
Address
City and Zip
Contacts / Primary Project Contact: / Desk #
Email: / Cell #
Secondary
Project Contact: / Desk #
Email: / Cell #
Financial/Admin
Contact: / Desk#
Email: / Cell #
Authorized Signatory / Name:
Title:
Address:
Phone:
Project Request
by Category / Training / $ / Equipment / $
Planning / $ / Exercise / $
TOTAL PROJECT REQUEST / $
Additional Documentation:
Please provide the additional documentation within 30 days of submitting the SHSGP application. / Does this project require an EHP? / Yes ☐
No ☐
Does this project require a Performance Bond? / Yes ☐
No ☐
Does this project require Sole Source? / Yes ☐
No ☐
Goals- Identify the goal that will be addressed by this project / Identify the goal that will be addressed by this project:
Check all boxes that apply
1. Strengthen Communications Capabilities
2. Strengthen Information Sharing, Collaboration Capabilities and Law Enforcement
Investigations.
3. Strengthen Medical and Public Health Preparedness
4. Enhance Protection of Critical Infrastructure & Key Resources
5. Citizen Preparedness and Participation
6. Enhance Agriculture, Food Systems and Animal Health Preparedness
7. Enhance Catastrophic Incident Planning, Response and Recovery
8. Homeland Security Exercise, Evaluation and Training Programs
Subrecipient
Risk Assessment
Questions / 1.  Has your agency been suspended or debarred by any Federal Agency?
2.  Does your agency have experience managing Federal funds?
If so, how many years?
Less than 5 ☐ Less than 10 ☐ Less than 15 ☐
3.  Does your agency have experience administering SHSGP grants?
If so, how many years?
Less than 5 ☐ Less than 10 ☐ Less than 15 ☐
4.  Did your agency meet the Single Audit threshold of $750,000?
When was the last Single Audit completed?
Click here to enter a date.
5.  Do you anticipate your project to be subcontracted out?
If so, how many subcontracts will you have?
6.  Does your agency have personnel that are new administering
SHSGP grants?
7.  How many years of experience do your personnel have in administering SHSGP grants?
Less than 5 ☐ Less than 10 ☐ Less than 15 ☐
8.  Does your agency have a new financial system?
If so, when was it implemented? / Yes ☐ No ☐
Yes ☐ No ☐
Yes ☐ No ☐
Yes ☐ No ☐
Yes ☐ No ☐
Yes ☐ No ☐
Yes ☐ No ☐
Yes ☐ No ☐
Project Narrative and Budget- Provide a detailed description of your project, explaining the need for this project and how the need was determined / Use this space to describe your project. All funding from this grant must be used within the borders of Sacramento County.
1.  Describe your project, goals and needs.
2.  Is this a regional project or agency specific? If regional – what agencies will participate or be positively affected? How will this project benefit the region?
3.  If a multi-agency project – which agency will take the lead?
4.  If this project funds equipment, describe the jurisdiction’s maintenance and sustainability plans for the item(s).
5.  If training is involved, how many persons will be trained and to what level? How will this training improve the general readiness of our Operational Area?
6.  Explain the basis for all costs?
7.  Has a cost analysis been performed?
8.  Are all of the costs reasonable, necessary and allowable as defined in 2CFR 200 Subpart E?
9.  If longer term funding is needed, does your agency have a funding plan beyond the termination date of the grant?
10.  When will this project be completed? Please provide a detailed timeline. Use December as a start time.
Please answer all questions fully and accurately.
Project Timeline/ Milestones / Applications must include information that supports the benchmarks of the project deliverables. Information required in this section must include anticipated dates of project initiation, significant deliverables completed, timely draws of funds and project closure.
(Additional rows may be added as necessary. Please use December as a start time.)
Task/Action / Date/Timeframe to Complete / Result of Action
Project Budget / Planning
Full or Part Time Staff
Contractors or Consultants
Conferences or Meetings
Materials or Supplies
Travel (based on per diem)
Planning Subtotal
Equipment
Equipment Item / AEL Code / Quantity / Unit Cost / Total cost
Equipment Subtotal
Training
Class Title per Catalog / Catalog From Which Class is Listed / Course Catalog Number /
Length of Class / # of Students
Full or Part Time Staff
Contractors or Consultants
Overtime
Backfill
Travel (based on per diem)
Materials and Supplies
Training Subtotal
Exercise
Full or Part Time Staff
Contractors or Consultants
Overtime
Backfill
Travel (based on per diem)
Materials or Supplies
Exercise Subtotal
Total Project Request

4

Application #