Open to Eligible Jurisdictions Only

************************************* OPEN TO ELIGIBLE JURISDICTIONS ONLY ***************************** State Fiscal Year 2018 Local Emergency Planning Committees Baseline Grant Application

Applications DUE by 11:59 p.m., Friday, May 26, 2017

Contact Division of Homeland Security and Emergency Management (DHS&EM), Program Support Grants Unit for application details at [email protected] (907) 428-7000 or Toll free 800-478-2337 State Fiscal Year 2018 Baseline Grant Application for LOCAL EMERGENCY PLANNING COMMITTEES (LEPCs)

In order to be eligible for funding in State Fiscal Year 2018, the Alaska Division of Homeland Security and Emergency Management (DHS&EM) must receive applications by 11:59 p.m., Friday, May 26, 2017. Completed, signed applications may be mailed, faxed, or emailed. State of Alaska Department of Military and Veterans Affairs Division of Homeland Security and Emergency Management PO Box 5750 JBER, Alaska 99505–5750

Phone: (907) 428–7000 Toll Free: (800) 478–2337 Fax: (907) 428–7009 Email: [email protected] Application Instructions: The application contains a section to provide the Local Emergency Planning Committee (LEPC) contact information, hazardous/extremely hazardous substance information, and an evaluation of previous baseline performance.

An LEPC must also create an anticipated baseline budget in the application. Space is provided to estimate LEPC Management, Outreach, and Preparedness expenses. The total budget must be equal to the projected State Emergency Response Commission (SERC) Finance Committee Baseline Funding shown in Table A.

Expenses under the Outreach and Preparedness categories must be associated with an activity. A narrative description of the activity is required.

The application must be signed by an authorized local jurisdiction and LEPC representative.

A current LEPC Signatory Authority Form and Membership Roster must be completed and returned with the Application. These documents can be found on the DHS&EM Grants website.

The following table reflects the baseline funding level for all current LEPCs, and may change from year to year depending on the availability of funds and decisions by the SERC Finance Committee. The baseline funding level for each LEPC was determined by the following:

 Number of Tier II reporting facilities  Number of extremely hazardous substances (EHS) in the Local Emergency Planning District (LEPD)  Hazmat transportation issues  Population at risk from an EHS release within the LEPD (excluding work-site population)  Population at risk from all-hazards  Funds available for award  Previous year’s performance

SERC BASELINE FUNDING LEVELS FOR ACTIVE LEPCs Table A – SERC Finance Committee Baseline Funding Levels Funding Funding LEPC LEPC Level Level Anchorage 5 Nome 2 Fairbanks North Star (FNSB) 4 Southern SE (Craig) 4 Kenai 5 Valdez 3 Ketchikan (KGB) 4 Denali 2 Juneau 4 Petersburg 3 Aleutians Pribilof Island 2 Wrangell 3 Northern SE (Skagway) 3 Delta Greely 3 Sitka 3 North Slope Borough 3 MatSu 5 Copper River 3 Kodiak Island Borough 4 Bristol Bay 2 Northwest Arctic Bor. (NWAB) 1 *SERC Finance committee will meet to establish SFY18 LEPC funding amounts in June 2017. LOCAL EMERGENCY PLANNING COMMITTEE State Fiscal Year 2018 LEPC Funding Application

General Information LEPC Name Address Click here to enter address. City Click here to enter city. State Click here to enter state. Zip Click here to enter zip. LEPC Project Manager Click here to enter text. Phone Number Click here to enter phone number. Fax Number Click here to enter fax number. Email Address Click here to enter email address. Membership Current LEPC membership list is attached. YES☐ NO☐ (**Please use the standard LEPC Membership Roster form located at: http://ready.alaska.gov/Grants/LEPC ) Hazardous/ Extremely Hazardous Substances Information Total number of facilities in LEPD reporting one or more Hazardous Substances Click here to enter text. Date of last review of number of Hazardous Substances reporting facilities Click here to enter a date. Total number of facilities in LEPD reporting one or more Extremely Hazardous Click here to enter text. Substances Date of last review of number of EHS reporting facilities Click here to enter a date. Estimated volume of hazardous substances and EHS transported through LEPD Click here to enter text. Date of last review of estimated volume of hazardous substances or of EHS Click here to enter a date. transported in LEPD Performance of Baseline Requirements in Previous Year Has LEPC membership been maintained? YES☐ NO☐ Have rules or bylaws been established and maintained to: YES☐ NO☐  Provide for public notification of LEPC meetings and activities?  Conduct meetings to discuss Emergency Operations Plan with the public?  Provide for public distribution of the Emergency Operations Plan? Have procedures for receiving and processing requests from the public for YES☐ NO☐ Material Safety Data Sheets (MSDS) and Tier II information been established and maintained? Has the LEPC evaluated the need for resources to develop, implement, and YES☐ NO☐ exercise the EOP? Did your LEPC act as an advisory committee to the political subdivisions within YES☐ NO☐ the LEPD? Did your LEPC attend the scheduled LEPCA workshops and/or SERC meetings? YES☐ NO☐ Did your LEPC submit timely quarterly reports to DHS&EM in accordance with YES☐ NO☐ Grant Award documents? Did your LEPC maintain a current list of all facilities within the LEPD which are YES☐ NO☐ required to complete a Tier II report? For any “No” answers, please explain below Click here to provide further details. Projected baseline allocation for this LEPC Choose a baseline allocation (See Table A) *this is a drop down field. If you cannot access the drop down feature please contact DHS&EM for a list of drop down options. LEPC MANAGEMENT Please describe the LEPC Management expenses. Not all expenses may be applicable to the management of the LEPC. **All Contractual Services will require DHS&EM pre-approval** Support Services Budgeted Cost Personnel Services $Click here to enter amount. Contractual Services $Click here to enter amount. TOTAL Support Services $Click here to enter amount. Support Services, Non–Contractual Budgeted Cost Meeting Rental Costs $Click here to enter amount. Utilities (Prorated for LEPC meeting room/office only) $Click here to enter amount. Office Supplies $Click here to enter amount. Postal Services $Click here to enter amount. Printing/Copying $Click here to enter amount. Telephone (Land/Mobile Dedicated to LEPC Only) $Click here to enter amount. Travel $Click here to enter amount. Click here to provide further details. Per Diem $Click here to enter amount. Click here to provide further details. Lodging $Click here to enter amount. Click here to provide further details. Equipment $Click here to enter amount. Click here to provide further details. Other $Click here to enter amount. Click here to provide further details. TOTAL Support Services, Non–Contractual $Click here to enter amount. TOTAL for LEPC MANAGEMENT $Click here to enter amount. OUTREACH Please describe the outreach activities and costs associated with each activity. Not all outreach activity boxes need to be completed. Additional activity boxes may be added if needed. Outreach Activity Description Outreach Activity Description Outreach Activity Costs Budgeted Cost Supplies $Click here to enter amount. Click here to provide further details. Promotional Item $Click here to enter amount. Click here to provide further details. Other (describe) $Click here to enter amount. Click here to provide further details. TOTAL for Outreach Activity $ Click here to enter amount. Outreach Activity Description Outreach Activity Description Outreach Activity Costs Budgeted Cost Supplies $Click here to enter amount. Click here to provide further details. Promotional Item $Click here to enter amount. Click here to provide further details. Other (describe) $Click here to enter amount. Click here to provide further details. TOTAL for Outreach Activity $ Click here to enter amount. Overall Total for LEPC Outreach $ Click here to enter amount. PREPAREDNESS Please describe the preparedness activities and costs associated with each activity. Not all preparedness activity boxes need to be completed. Additional activity boxes may be added if needed. Preparedness Activity Description Preparedness Activity Description Preparedness Activity Costs Budgeted Cost Supplies $Click here to enter amount. Click here to provide further details. Exercise $Click here to enter amount. Click here to provide further details. Training $Click here to enter amount. Click here to provide further details. Other (describe) $Click here to enter amount. Click here to provide further details. TOTAL for Preparedness Activity $Click here to enter amount. Preparedness Activity Description Preparedness Activity Description Preparedness Activity Costs Budgeted Cost Supplies $Click here to enter amount. Click here to provide further details. Exercise $Click here to enter amount. Click here to provide further details. Training $Click here to enter amount. Click here to provide further details. Other (describe) $Click here to enter amount. Click here to provide further details. TOTAL for Preparedness Activity $ Click here to enter amount. Overall Total for LEPC Preparedness $ Click here to enter amount. BASELINE COSTS BUDGET SUMMARY Budget Category Budgeted Cost LEPC Management, Contractual and Non–Contractual $Click here to enter amount. Outreach Activities $Click here to enter amount. Preparedness Activities $Click here to enter amount. TOTAL BASELINE EXPENSES $ Click here to enter amount. (This must equal projected SERC Baseline funding amount in Table A.) Point of Contact Governmental jurisdiction that will administer funds awarded under this program Click here to enter text. Jurisdiction/make check payable Click here to enter text. Address Click here to enter address. City Click here to enter city. State Click here to enter state. Zip Click here to enter zip. Phone number Click here to enter phone number. Fax number Click here to enter fax number. Email address Click here to enter email address. Signature of Authorized Jurisdiction Representative By the signature below, the governmental jurisdiction noted above provisionally agreed to administer funding awarded to the LEPC by the SERC, pending agreement to the terms of the final funding agreement by all parties. Signature of Authorized Jurisdiction Representative Date Click here to enter a date. Printed Name and Title Click here to enter name and title. Signature of Chairperson or Person Authorized to Represent the LEPC The undersigned certifies this application to be the agreed submittal of the LEPC.

Signature of Chairperson or Person Authorized to Represent the LEPC Date Click here to enter a date. Printed Name and Title Click here to enter name and title.