FIPS # VS# Subaward #
2a. SAM UEI#:
(City) (Zip+4)
(Zip+4)
(Start Date) (End Date)
%
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. 9.
10. 11.
12. Total Project Cost
Name: Title:
City: Zip Code+4:
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) to
13. Certification - 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 contingent on the enactment of the State Budget.
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.
15. Official Authorized to Sign for Subrecipient:
Payment Mailing Address:
16.Federal Employer ID Number:
7. Indirect Cost Rate (please circle): N/A 10% de minimis Federally Approved ICR (if applicable):
3. Implementing Agency Address:
(Street)
4. Location of Project:
(City) (County)
5. Disaster/Program Title: 6. Performance/
Budget Period:
2. Implementing Agency:
The California Governor's Office of Emergency Services (Cal OES) hereby makes a Grant Subaward of funds to the following:
1. Subrecipient: 1a. SAM UEI#:
(Cal OES Use Only)
Cal OES #
CALIFORNIA GOVERNOR'S OFFICE OF EMERGENCY SERVICES
GRANT SUBAWARD FACE SHEET
Grant Subaward Face Sheet Cal OES 2-101
071-13210-00 071-13210 DR4683-AP00984
Chino, City of
Prepare CA Match
2021 GF $50,000.00 $50,000.00
2024 HMGP $160,000.00 $160,000.00
$50,000.00 $160,000.00 $210,000.00 $0.00 $0.00 $0.00 $210,000.00 11/21/2023 02/20/2026
Chino, City of
RGVNGHJR3NV5
RGVNGHJR3NV5
13220 Central Avenue Chino 91710-4127
Chino San Bernardino 91710-4127
City ManagerDr. Linda Reich
13220 Central Avenue Chino 91710-4127
95-0930239
2/21/2024
Blank1. Subrecipient
1Bla.a n Fkederal SAM ID Number
(Subrecipient)
Blank2. Implementing Agency
2Bla.a n Fkederal SAM ID Number
(Implementing Agency)
Blank3. Implementing Agency
Address
Blank4. Location of Project
Blank5. Disaster/Program Title
Blank6. Performance/
Budget Period
Blank7. Indirect Cost Rate
Blank8A. - 12G. Fund Allocations
and Total Project Cost
Blank13. Certification Paragraph
Blank14. CA Public Records Act
BlankThe Subrecipient is the unit of government or community based organization (CBO) that will have legal responsibility for these grant funds (e.g. County of Alameda, City of Fresno or Women’s Place of Merced). Enter the legal name of the Subrecipient that is registered with the Internal Revenue Service (IRS). PLEASE NOTE: that all CBOs must be registered, active, and current with the IRS, Department of Justice (DOJ), and Secretary of State (SOS) websites. Failure to be current will result in funds being withheld from Cal OES.
BlankEnter the subrecipient's twelve digit Unique Entity ID number provided by the federal System of Award Management (SAM) database. This requirement applies to federally funded grants only. This registration must be current and active in SAM for the duration of your Award.
EBlnatnerk the complete name of the agency responsible for the day-to-day operation of the grant (e.g.
Sheriff, Police Department, or Department of Public Works). If the Implementing Agency is the same as the Subrecipient, enter the same title again.
BlankEnter the Implementing Agency's twelve digit Unique Entity ID number provided by the federal System of Award Management (SAM) database. This applies to federally funded grants only. This registration must be current and active in SAM for the duration of your Award.
EBlnatnerk the address of the Implementing Agency. Provide the complete nine digit zip code (Zip+4).
EBlnatnerkthe City and County/Operational Area where the project is located. Provide the complete nine digit zip code (Zip+4).
BlankEnter the name of the Disaster or Program providing the funds for this Grant Subaward. A disaster may be referred by the federal declaration number. Program titles should be complete without the use of acronyms.
BlankEnter beginning and ending dates of the performance and expenditure period for the Grant Subaward. (mm/dd/yyyy)
IBnladinckate whether you are using the 10% de Minimis rate based on Modified Total Direct Costs (MTDC) or your current cognizant agency approved indirect cost rate agreement. A copy of the approved ICR Negotiating Agreement must be enclosed with your application. Indicate N/A if you will not be claiming indirect costs under the award.
Indirect costs may or may not be allowable under all Federal fund sources .
BlankFor each fund source used in the program, select the correct grant year and acronym from the drop down lists, the amount of state or federal funds requested, the amount of cash and/or in-kind match contributed and the resulting totals. Please do not enter both state and federal on the same line. The Total project cost row should correspond to the total project cost specified in the budget.
BPlleanakse review the Certification Paragraph.
BPlleanakse review, and if applicable, provide the necessary documentation.
Blank Blank15. Official Authorized to sign
for the Subrecipient
Provi
Blank16. Federal Employer ID
Number
Blank
de the name and title of the person who is the Official Authorized to enter into the Grant Subaward for the Subrecipient, listed on #1 of the Grant Subaward Face Sheet (Cal OES 2-101). Enter the Payment Mailing Address where grant reimbursements will be mailed and provide the complete nine digit zip code (Zip+4).
BlankEnter the nine digit Federal Employer Identification Number (no hyphen) for the Implementing Agency.
Blank
Grant Subaward Face Sheet Instructions
Cal OES Section: The top portion of the form contains blocks for four (4) important numbers. Please do not fill in these blocks. These numbers will be entered by Cal OES. Please print the Grant Subaward Face Sheet in portrait format.
Provide the signature of the authorized official. The use of white out or tape is prohibited and will invalidate the signature on the Grant Subaward Face Sheet.
Grant Subaward Face Sheet Cal OES 2-101