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FEDERAL EMERQr:NCY stANAtiEM~NTAGENCY O.,M.B. No. 3067-0206 SUMMARY SHEET FOR ASSURANCES AND CER1'IFICATION3 Farpins February 28, 2004 FOR CA FOR {Name ofAppflcantj I FY 20WS Orange County Department of Emergency Management summary sheet indndes Assuxnnces and Certifical3ons that must be head, signed, and submitted as a part of the ication for Federal Assistance. a applicant must check each item that they axe certit~iisg to: Part I a TElYIA Foxm 20.16A, Assonances Nonconstrudion Programs part II ~ I'E1KA Form 20•lbl3, Assru ances-Construction Programs Part III 1:=i FEMA Form 24360, Certlffcationa Regarding I.abbyiag; Debarment, Suspension, and Other Responsibility Matters; and Drug~Ftee Workplace Regnirements Part 1V D SF LLL, Disclosure of Labbyixxg Activities (If applicable) the duly authorized representative of the applicant, I hereby certify that the applicant wilt comply with the identi5ed ached assurances and certft"ications. John M Link, Jr.. County Manager _~ Typed Name of Authorized Representative --~ _~~~~_.....~,~_.,•_-.~ Tftle ~~~_•~•-_ ._._ ~~ ~ S tare of Authorized resentative ~ __.. ..~ ~O/ Date Signed ~~ p OTE: By signing the cer tiiicaflou regarding debarment, saspeasion, and other i~espoxrsibillty matters for primary covered ansacrion, the applicant agrees that, should the proposed covered transaction be entered into, it shall not lmowiagiy Dater its any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, ar voluntarily ezduded ~om participatieu in this covered transaction, unless authorized by FEMA entering into this transaction The applicant fur ther agrees by submitting this appfleafion that it wrll include the douse titled "Certification ;aiding Debarment, Saspeasioa, Ineligibility and Vahxntary Egchxalon-Lower Tier Covered Transaction," provided by Fi:MA Regional Office entering into this covered transaction, without modiQcatlon, in ati lower tier eoveired transactions l in all solicitations for lower tier covei+ed tr ansaettons. (Refet to 44 CFR Part 17.) Paperwork Burden Disclosure Notioe blic reporting burden far this form is estimated to average 1.T hour's per response. Burden means the time, effort and racial resources expended by parsons to generate, maintain, retain, disclose, or to provide itrformation to us. You may d comments regarding the burden estimate or any aspect of the form, including suggestions for reducing the burden tntormation Coihsctions Management, Federal 8mergency Management AgQncy, S00 C Street, StIV, Washington,l3C 30472, ~erwark Reduction Project {3067-0206). You are not required to respond to this collection of information unless a valid B control number appear in the upper right corner of this form. isiease do not send your compioted form to the above FEMA Form 20.18, FEB 0'i