HomeMy Public PortalAboutHMGP paperwork.pdfFEMA Hazard Mitigation Grant F
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Document Package
The Hazard Mitigation Grant Program (HK4GF)makesavaibWefeder |fundstnSta1e,Lmca|andThba|Gavemments
tmtake critical mitigation measures toreduce the risk ofloss oflife and property from future disasters isnot lost
during the reconstruction process following a disaster. The City mfTybee island is pursuing a competitive application
for Structure Elevations ufeligible homes through HK4GP. Structure elevation projects must betechnically feasible,
cost effective, and complaint with environmental and historic preservation regulations, among other eligibility
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o Completely fill out enclosed paperwork inthe Documentation Package.
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Compile necessary documentation, listed in the Application Package Checklist.
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Return the completed Documentation Package tothe Planning & Zoning Department —4O3 Butler Avenue
or by email at 1ybpeHMGP@Rmail.co�11.
SCHEDULE
* Homeowner Workshop: Wednesday, January loth 2018
* Documentation Package Deadfine: Wednesday, January 17t', 2018
:' Request for information (RFI) Deadline: Wednesday, January 24 1h 2018
0 Please turn in your Application Package even if you miss the RFI deadline.
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The City of Tybee Island will review all submitted Documentation Packages for eligibility and project prioritization
in accordance with FEMA, State of Georgia, and City of Tybee funding guidelines.
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Once eligibility isestablished, a construction professional will he visiting structures toevaluate technical
feasibility, complete an Elevation Certificate (if necessary), estimate project costs, take photographs and develop
ascope ofwork.
o TheOtyoflVbeeb|andvviUbedeue|npinBtheHK8GPprogrampre-app|ica1iununNFebmary1*,v/henthe
application is turned over to the State for further review. You will be notified when the final application is turned
imtoFEMA.
Please address any questions that you may have to
Please fill out the enclosed paperwork and attach all required documentation. Please ensure all information
included is accurate and complete for your application to be considered during this cycle. Once completed,
this package can either be submitted in person to the Planning & Zoning Department at 403 Butler Avenue
or online as a PDF to
Documentation Packages are due by Wednesday, January 17", 2018. You may receive a Request for
Information (RFI) to provide additional documentation or clarification following submittal. All elements of
the RFI must be completed by January 2411, 2018,
Re,qviied Pcipe�rwork Included in Pac,*%nge
Notice of Voluntary Interest
I Acknowledgement of Conditions
I Privacy Act Release
L: Duplication of Benefits
Declaration and Release
Voluntary Participation Form
Right of Entry Form
Addfflanal Docurnentaflon
11 Any documentation related to prior flood events (pictures, information on nature of damage, proof of loss, etc.)
I I Policy Declaration or other proof of NFIP flood insurance, if available
E Repetitive Loss or Severe Repetitive Loss Number, if applicable
I ' Elevation Certificate, if available
*PFea,5e note that the vvorkshop does riot serve as a contractual agreernent and there «s no
guairantee that your property v0H i')e rn'ltlgaled through thIs process. howewer, all
horneowne:fs who are int efested in participating must proOde necessary docL.mlentafion foI
elli:llfly reviews,
Acknowledgement of Conditions
or Mitigation of Property in a Special Flood Hazard Area
Wittir, FEMA Grant Funds
Street Address
City State Zip Code
Subject Property Address
Deed Dated Recorded
Tax Map Block .._T_ Parcel
Base Flood Elevation at the site is feet (N VD)
Map Panel Number Effective Date
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Program, as authorized by 42 U,S.C. §5170C / Pre -Disaster Mitigation Program, as authorized
42 U.&C§5133 / Flood Mitigation Assistance Program, as authorized by 42 U,S.C, §4104C t
Property Owner accepts the following conditions: I
That the Property Owner has insured all structures that will not be demolished or
relocated out of the SFHA for the above-mentioned property to an amount at least
equal to the project cost or to the maximum limit of coverage made available with
respect to the particular property, whichever is less, through the National Flood
Insurance Program (NFIP), as authorized by 42 US.C. §4001 et seq., as long as the
Property Owner holds title to the property as required by 42 U.&C. §4012a.
t. That the Property Owner will maintain all structures on the above-mentioned property
in accordance with the flood plain management criteria set forth in Title 44 of the Code -
of Federal Regulations (CFR) Part 60.3, The Official Code of Georgia Annotated.
O.C.G.A. Section 8-2-20(9)(B), and any local ordinance standards as long as the
Property Owner holds title to the property, These criteria include, but are not limited
to, the following measures:
iEnclosed areas below the Base Flood Elevation will only be used f
parking of vehicles, limited storage, or access to the building;
ii. All interior walls and floors below the Base Flood Elevation will
unfinished or constructed of flood resistant materials;
jiiNo mechanical, electrical, or plumbing devices will be installed belo
the Base Flood Elevation; and
iv. All enclosed areas below Base Flood Elevation must be equipped wi
vents permitting the automatic entry and exit of flood water. I
For a complete, detailed list of these criteria, see the Official Code of Georgia
Annotated. O.C.G.A. Section 8-2-20(9)(B) and any local ordinance standards.
3The above conditions are binding for the life of the property. To provide notice to
subsequent purchasers of these conditions, the Property Owner agrees to legally
record with the county or appropriate jurisdiction's land records a notice that includes
the name of the current property owner (including book/page reference to record of
current title, if readily available), a legal description of the property, and the following
notice of flood insurance requirements:
"This property has received Federal hazard mitigation assistance. Federal law
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the life of the property regardless of transfer of ownership of such property.
Pursuant to 42 U.S.C. §5154a. failure to maintain flood insurance on this property
may prohibit the owner from receiving Federal disaster assistance with respect to
this property in the event of a flood disaster. The Property Owner is also required
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4, Failure to abide by the above conditions may prohibit the Property Owner and/or any
subsequent purchasers from receiving Federal disaster assistance with respect to this
property in the event of any future flood disasters. If the above conditions are not met,
FEMA may recoup the amount of the grant award with respect to the subject property,
and the Property Owner may be liable to repay such amounts.
This Agreement shall be binding upon the respective parties' heirs, successors, personal
representatives, and assignees,
HOMEOWNER/PROPERTY OWNER SIGNS HERE:
Name of Property Owner. -
STATE OF GEORGIA
COUNTY OF
The foregoing instrument was acknowledged before me this _ day of by
who is (F ) personally known to me or (D) has produced as identification.
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I[We, the undersigned, hereby grant my/our permission for the City of Tybee Island to publish,
through public notice, the location of my real property which is being considered for an elevation
project by the City of Tybee Island,
This information will be used to notify the public that FEMA and the State are considering a
gation action that may include my property under Section 404 (HMGP) of the Stafford Act,
as amended, the Flood Mitigation Assistance Program, the Pre -Disaster Mitigation (PDM)
Program, and/or HUD programs,
Further, I/we hereby grant FEMA and the State of Georgia permission to disclose flood
insurance coverage and claim information, and information about disaster assistance payments
received by melus, to officials of the City of Tybee Island for the purpose of aiding in their
planning and decision-making regarding mitigation or assistance actions affecting my property.
This information will be used for this purpose only and will not be made public.
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Print Owner's Name
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Flood Insurance Policy Number:
Insurance Agent's Phone Number:
Insurance Provider/Company:
Insurance Company's 5 -digit Company Code:
The Federal Emergency Management Agency (FEMA) has adopted a policy that
prohibits duplication of benefits in the Hazard Mitigation Assistance Program that
includes Hazard Mitigation Grant Program (HMGP) grants. The policy was developed
in response to federal regulations that dictate the use of the primary funds used to
gate property. FEMA provides the following specific instructions in the Hazard
gation Assistance Program Guidelines for gation projects.
In the administration of HMGP grants, FEMA and the grantee should avoid any
duplication of benefits with other forms of assistance. FEMA's policy on
duplication of benefits for individuals and families is mandated by Section 312 of
the Stafford Act and is set forth in 44 CFR 206.191. This Section of the FEMA
regulations delineates a delivery sequence establishing the order in which the
disaster relief agencies and organizations provide assistance to individuals and
families. Programs listed later in the sequence are responsible for ensuring that
they do not duplicate assistance which should be provided by a program listed
earlier on the list (the program with primary responsibility).
In the case of flood -damaged property programs (Section 1362, Section 404,
etc.), they are not listed in the delivery sequence, and therefore are positioned
after the eight listed programs. This means that all eight programs listed in the
sequence at 44 CFR 206.191 (d) are "primary programs" in relation to mitiis
�ikrant programs. The Hazard Mitigation Grant Program is required to ensure th
it does not duplicate assistance which should be provided by any of the eight
,#;rimary assistance programs.
Receipt of or pending receipt of the following benefit amounts must be disclosed to the
State of Georgia
1 - SBA Loans - A property owner who has an SBA loan on the property being acquired
will either be required to repay the loan to SBA, or roll it over to a new property at
clOsing. Yes 0 No El
2. Flood insurance for Structure Repairs - That portion of a flood insurance payment
that
repairs to the property being acquired will be deducted from the purchase price of the
property being acquired. If flood insurance funds have been reinvested into repairs to
the property, this amount will not be deducted, Proof of reinvestment can be supplied
through receipts for materials and/or labor, or through on-site verification. Amount
reinvested is $
3. Increased Cost of Compliance -The NFIP Increased Cost of Compliance (]CC) claim
payment from a flood event may be used to contribute to the non -Federal cost -share
requirements so long as the claim is made within the timelines allowed by the NFIP.
ICC payments can only be used for costs that are eligible for [CC benefits; for example,
ICC cannot pay for property acquisition, but can pay for structure demolition or
relocation. In addition, Federal funds cannot be provided where ICC funds are available,
if the ICC payment exceeds the required non -Federal share, the Federal funding award
will be reduced to the difference between the cost of the activity and the ICC payment.
Have you received ]CC payments? _
If so, how much ICC funds have you received?
Do you plan on receiving ]CC payment?
If so, how much ICC funds do you plan on receiving?
4. FEMA Individual Family Grant and Emergency Minimal Repair Grant (EMR) - That
portion of an IFG grant that a property owner has received or is eligible to receive
intended to cover structural repairs to the property being acquired will be deducted from
the purchase price of the property. Additionally, grants received from FEMA as part of
Temporary Housing Assistance Program to quickly repair or restore, owner -occupied
primary residences to habitable and safe condition will be deducted from the purchase
price of the property. If the funds have been reinvested into repairs to the property, this
amount will not be deducted. Proof of reinvestment can be supplied through receipts
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for materials and/or labor, or through on-site verification. Amount received:
5. FEMA Disaster Housing - FEMA Disaster Housing money received by the property
owner will not be deducted if the property owner has used the grant for housing related
expenses. These can include: transient accommodations while an existing home is
being elevated or relocated; combining it with other funds to make more substantial
home repairs; minor home repairs made to make a home more livable prior to a buyout
Offer; down payments toward the purchase of a new home; moving expenses; closing
costs,, insurance; and deposits. Amount received: _
I hereby certify that the SBA Loans, Flood Insurance for Structure Repairs, FEMA
Individual and Family Grant, Emergency Minimal Repair Grant (EMR) and FEMA
Disaster Housing benefits defined above have been accurately reported and that the
not used for the purposes identified above have been fully disclosed.
DEPARTMENT OF HOMELAND SECURITY
O.M.B. No. 1660-0002
Federal Emergency Management Agency Expires 113112018
DECLARATION AND RELEA CC:
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this data collection is estimated to averaoe 2 minutes Qer resnotse. The Wurien estitt.2te ifrImepq flip.
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PRIVACY ACT STATEMENT
AUTHORITY: The Robert T. Stafford Disaster Relief and Emergency Assistance Art as amended, 42 U.S.C. § 5121 -5207 and Reorganization Plan No. 3 of
1978; 4 U.S.C. §§ 2904 and 2906: 4 C.F.R. § 206.2(a)(27): the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (Pub. L. 104-193) and
Executive Order 13411. DHS asks for your SSN pursuant to the Debt Collection Improvement Act of 1996, 31 U.S.C. § 3325(d) and § 7701(c) (1).
PRINCIPAL PURPOSE(S): This information is being collected for the primary purpose of determining eligibility and administering financial assistance under a
Presidentially -declared disaster. Additionally, information may be reviewed within FEMA for quality assurance purposes and used to assess FEIVIA's customer
service to disaster assistance applicants,
ROUTINE USE(S), The information on this form may be shared outside of FEMA as generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act of 1974, as
amended. This includes sharing this information with state, tribal, local, and voluntary organizations to enable you to receive additional disaster assistance and as
necessary and authorized by other routine uses published in DHS/FEMA-008 Disaster Recovery Assistance Files System of Records, 78 Fed. Reg. 25,282 (April
30, 2013), and upon written request, by agreement, or as required by law.
DISCLOSURE: The disclosure of information on this form is voluntary; however, failure to provide the information requested may delay or prevent the individual
from receiving disaster assistance,
DECLARATION AND RELEASE
In order to be eligible to receive FEMA Disaster Assistance, a member of the household must be a citizen, non -citizen national or qualified alien
of the United States, Please read the form carefully, sign the sheet and return it to the Inspector, and show him/her a current form of
photo identification. Please feel free to consult with an attorney or other immigration expert if you have any questions.
I hereby declare, under penalty of perjury that (check one):
E] i am a citizen or non -citizen national of the United States.
[] I am a qualified alien of the United States.
Fi I am the parent or guardian of a minor child who resides with me and who is a citizen, non -citizen national or qualified
alien of the United States. Print full name and age of minor child:
BY my signature I certify that:
Only one application has been submitted for my household.
All information I have provided regarding my application for FEMA disaster assistance is true and correct to the best of my
knowledge.
I will return any disaster aid money I received from FEMA or the State if I receive insurance or other money for the same loss, or if I
do not use FEMA disaster aid money for the purpose for which it was intended.
I understand that, if i intentionally make false statements or conceal any information in an attempt to obtain disaster aid, it is a
violation of federal and State laws, which carry severe criminal and civil penalties, including a fine up to $250,000, imprisonment, or
both (18 U.S.C. §§ 287, 1001, and 0571).
I understand that the information provided regarding my application for FEMA disaster assistance may be subject to sharing within
the Department of Homeland Security (DHS) including, but not limited to, the Bureau of immigration and Customs Enforcement.
I authorize FEMA to verify all information given by me about my property/place of residence, income, employment and dependents in,
order to determine my eligibility for disaster assistance; and
I authorize all custodians of records of my insurance, employer, any public or private entity, bank financial or credit data service to
release information to FEMA and/or the State upon request,
NAME (prier) SIGNATURE DATE OF BIRTH DATE SIGNED
INSPECTOR ID # FEMA APPLICATION # DISASTER #
ADDRESS OF DAMAGED PROPERTY CITY STATE ZIP CODE
FEMA FORM 009-0-3 REPLACES ALL PREVIOUS EDITIONS
:M. M. *1 $
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M�N K *at - �-- 4i,��Vgia�nn- Signing this
form does not commit you or the community to any action.
PROPERTY OWNER:
CO-OWNER(S):
Property Address:
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PROPE Y INFORMATION- At time of Flood Body of water causing Flooding:
For each of the following categories, please circle the features that apply.
ETk—UCTQ—RE —USE-
STRUCTURE TYPE:
FOUNDATION TYPE:
BUILDING TYP
Owner Occupied -Primary
Single Family
Basement Y N outside Entrance Y N
Wood
Owner Occupied- Secondary
2-4 Family
Finished Y N Partial Y N
Masonry (Brick)
Rental
Multi (5+)
Crawl Space Y N
Stone
Vacant Lot
Manufactured
Elevated on piers/columns/posts/piles
Cement
Other (Explain)
VacantLand
Slab on Grade
Other
Other (Explain) Vacant Land
Other (Explain)
original Date of Construction :
Total Living Area in Sq Ft. (All floors) Number of Stories above ground:—
Heated and Cooled Sq Ft.: Non -living area Sq Ft.: _
Is the Property contaminated with hazardous waste (lead-based paint, asbestos, etc,)? —Yes — No
Do you have an Elevation Certificate? Y N Is the structure an historic property? —Yes — No
INS!�RANCE INFORMATION — Please provide the following information.
Do you currently have Flood Insurance? Y N Insurance Company:
Rwww''.�
Please Provide Past flood claim information below. Provide details of historical losses on the next page.
Date: Claim Amount: $ Date: — Claim Amount: $
Date: Claim Amount: $ Date: Claim Amount: $
By submitting this form, I affirm the following:
0 That the statements on this form are true and complete to the best of my knowledge;
• That Ilwe own the property located at
• That the modification of this property under a FEMA Hazard Mitigation Assistance Program is voluntary in nature, that
am under NO obligation to participate, and that I may drop out of the application process at any time;
• That I currently intend to participate;
• That I understand my submittal of this form and associated documentation only indicates my willingness to participat
in the program and does not guarantee that my property will be mitigated through the program or by the community*
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• If approved for a grant, I understand that I may be required to pay a match amount of up to 15% of the total p erct co
to mitigate my home. I affirm that I have the resources to meet the cost -share and cost -reimbursement requirements. I
NAME: DATE: SIGNATURE:
WITNESS: DATE: SIGNATURE:
Voluntary Participation • ELEVATION
FEMA Hazard Mitigation Grant PrograHMGP)
HISTORICAL LOSS INFORMATION: Please attach any photos or historical loss documentation that may be helpful.
I affirm that, to the best of my knowledge, the following information is true and complete.
NAME: - DATE: SIGNATURE:
FIRST FLOOD EVENT Date and Name (if known) of Event:
Source of Flooding (Body of Water): Back up documentation attached? —Yes — No
Please list the back up documentation source. Depth of flooding:
Duration of flooding- Damages (_ Estimated _ Known): $
Displaced from home: _Yes No How long? Types of Damages:
Notes:
SECOND FLOOD EVENT Date and Name (if known) of Event:
Source of Flooding (Body of Water): Backup documentation attached? Yes No
Please list the back up documentation source: Depth of flooding:
Duration of flooding: _ Damages (® Estimated _ Known): $
Displaced from home: _Yes No How long? Types of Damages:
Notes:
THIRD FLOOD EVENT Date and Name (if known) of Event;
Source of Flooding (Body of 9Nater}: — Baek up documentatlon attached? s— No
Please list the back up documentation source: Depth of flooding:
Duration Of flooding: Damages (_ Estimated ® Known)- $
Displaced from home: — Yes No How long? Types of Damages:
Notes:
Voluntary Consent to Enter Property
Our records indicate that you have elected to apply for the Federal Emergency Management Agency's
Hazard Mitigation Grant Program. As part of the application development process, a qualified
professional must develop a rough cost estimate and assess the structure to ensunethat implementing
the elevation project istechnically feasible.
The purpose of this document is to obtain homeowner consent for Contracted staff to enter the
property located at for the purposes stated herein.
The City of Tybee has selected a team of contractors to provide technical assistance and support for the
grant application development process. The purpose for this site visit is to take exterior structure and
property photographs as well as necessary measurements to perform a feasibility study and gather
information for cost -estimating and scoping purposes. it is not necessary at this time to enter the home.
If signed and returned, staff may be assessing properties as early as the week of January 22 d 2018.
You will be notified via e-mail and/or the phone number you provided with additional details.
Print Name Date
Witness Signature
Print Name Date