HomeMy WebLinkAboutPalm Desert_FY23 EMPG Initial Application_Approved SignaturesCALIFORNIA GOVERNOR'S OFFICE OF EMERGENCY SERVICES (Cal OES)
FIPS #VS#Subaward #2023-0006
92260-2524
92260-2524
(Zip+4)
July 1, 2023 ############
%
Item
Number
Grant
Year
Fund
Source A. State B. Federal C. Total D. Cash Match E. In-Kind Match F. Total Match G. Total Cost
8.2023 EMPG $13,683 $13,683 $13,683 $13,683 $27,366
9.
10.
11.
12.
Total Project Cost $13,683 $13,683 $13,683 $13,683 $27,366
Name:Title:
City:Zip Code+4:92260-2524
Signature:Date:
(Date)(Date)
(FOR Cal OES USE ONLY)
I hereby certify upon my personal knowledge that budgeted funds are available for the period and purposes of this expenditure stated above.
(Cal OES Fiscal Officer)(Cal OES Director or Designee)
15. Official Authorized to Sign for Subrecipient:
16. Federal Employer ID Number:
14. CA Public Records Act - Grant applications are subject to the California Public Records Act, Government Code section 7920 et seq. Do not put any personally
identifiable information or private information on this application. If you believe that any of the information you are putting on this application is exempt from the
Public Records Act, please attach a statement that indicates what portions of the application and the basis for the exemption. Your statement that the
information is not subject to the Public Records Act will not guarantee that the information will not be disclosed.
5. Disaster/Program Title:6. Performance /
Budget Period:to
N/A (if applicable):
- This Grant Subaward consists of this title page, the application for the grant, which is attached and made a part hereof, the
Assurances/Certifications, and any attached Special Conditions. I hereby certify I am vested with the authority to enter into this Grant Subaward, and have the
approval of the City/County Financial Officer, City Manager, County Administrator, Governing Board Chair, or other Approving Body. The Subrecipient certifies
that all funds received pursuant to this agreement will be spent exclusively on the purposes specified in the Grant Subaward. The Subrecipient accepts this Grant
Subaward and agrees to administer the grant project in accordance with the Grant Subaward as well as all applicable state and federal laws, audit
requirements, federal program guidelines, and Cal OES policy and program guidance. The Subrecipient further agrees that the allocation of funds may be
3. Implementing Agency Address:
4. Location of Project:
1. Subrecipient:
2. Implementing Agency:
(Cal OES Use Only)
Cal OES #
CALIFORNIA GOVERNOR'S OFFICE OF EMERGENCY SERVICESGRANT SUBAWARD FACE SHEET
1 of 2 Grant Subaward Face Sheet Cal OES 2-101 (Revised 05/2023)
CALIFORNIA GOVERNOR'S OFFICE OF EMERGENCY SERVICES (Cal OES)
ALN:
through
Beginning Performance Period Date Ending Performance Period Date
AUTHORIZED AGENT
EMPG 97.042
Supporting Information for Application, Modification, or Request for Federal Funds
This claim is for costs incurred within the grant performance period.
This request is for a/an:Initial Application July 1, 2023 December 31, 2024
Request #Amount This Request
Under Penalty of Perjury, I certify that:
grant conditions and assurances.
Statement of Certification - Authorized Agent
receipts are for the purposes and objectives set forth in the terms and conditions of the Federal award. I am aware that any false, fictitious, or fraudulent information, or the
Title 31, Sections 3729–3730 and 3801–3812).
Todd Hileman 73-510 Fred Waring Dr.
Printed Name of Authorized Agent Payment Address
City Manager Palm Desert, CA 92260-2524
Signature of Authorized Agent Date
Title of Authorized Agent City, ZIP
2 of 2 AA Approval