PSGP_InvestmentJustification_Form_FEMA_Form_089-5.pdf

FEMA FORM 089-5 (01/17) Page 1 of 6

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency

PORT SECURITY GRANT PROGRAM INVESTMENT JUSTIFICATION

SENSITIVE

SECURITY

INFORMATION

OMB Control Number: 1660-0114

Expiration: 05/31/2020

Warning: Please follow the Notice of Funding Opportunity Guidance while completing this form.

PART I - INVESTMENT HEADING

ORGANIZATION NAME (Legal Name Listed On The SF-424): STATE OR TERRITORY IN WHICH THE PROJECT WILL BE

IMPLEMENTED:

TYPE OF ORGANIZATION: STATE OR LOCAL AGENCY:

OTHER:

PROJECT'S CAPTAIN OF THE PORT ZONE: INVESTMENT JUSTIFICATIONS (Ex. 1 of 1): of

PART II - BASIC PROJECT INFORMATION

PROJECT TITLE:

PROJECT SERVICE(S)/EQUIPMENT SUMMARY:

IS THIS PROJECT EXEMPT FROM THE REQUIRED COST SHARE OUTLINED IN 46 U.S.C. 70107?

IF YES, IDENTIFY THE COST SHARE EXEMPTION :

FEDERAL SHARE: COST SHARE: TOTAL PROJECT COST:

(Total Project Cost x 0.75) (Total Project Cost x 0.25) (Fed Share/0.75; or Cost Share/0.25)

PROJECT CATEGORY: NEW CAPABILITY OR MANAGEMENT/SUSTAINMENT:

PART III - ELIGIBILITY INFORMATION

PLEASE REVIEW THE NOTICE OF FUNDING OPPORTUNITY AND 46 U.S.C. 70107

WHICH PLAN(S) APPLIES TO YOUR

ORGANIZATION?:

AREA MARITIME SECURITY PLAN:

PORT-WIDE RISK MANAGEMENT PLAN:

FACILITY SECURITY PLAN:

VESSEL SECURITY PLAN:

IF NONE OF THE ABOVE ARE APPLICABLE, PLEASE LIST OTHER PORT RELATED SECURITY PLANS OR

CIRCUMSTANCES THAT APPLY TO THIS PROJECT AND YOUR ORGANIZATION: N/A

ACTIVE PARTICIPANT OF AN AREA MARITIME

SECURITY COMMITTEE?

IS THIS APPLICATION ON BEHALF OF ANOTHER

ENTITIY OR SUBMITTED AS A CONSORTIUM?

IS THE PROJECT SITE OWNED BY

YOUR ORGANZITION?

IS THE PROJECT SITE OPERATED

BY YOUR ORGANZITION?

IF THE PROJECT SITE IS NOT OWNED OR OPERATED BY YOUR

ORGANIZATON, PLEASE EXPLAIN YOUR ORGANIZATION'S RELATION TO

THE PROJECT SITE:

N/A

IS THE PROJECT SITE A FACILITY OR VESSEL THAT IS REGULATED UNDER THE MARITIME TRANSPORTATION

SECURITY ACT (MTSA) OF 2002, AS AMENDED?

STATE AND LOCAL AGENCIES ONLY - IS YOUR AGENCY REQUIRED TO PROVIDE PORT SECURITY SERVICES TO MTSA

REGULATED FACILITIES?

STATE AND LOCAL AGENCIES ONLY - ARE YOU THE PRIMARY RESPONDING AGENCY TO MTSA REGULATED FACILITY?

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

FEMA FORM 089-5 (01/17) Page 2 of 6

SENSITIVE SECURITY INFORMATION

PART IV - POINT(S) OF CONTACT FOR ORGANIZATION

SIGNATORY AUTHORITY FOR ENTERING INTO A GRANT AWARD

AGREEMENT

AUTHORIZED REPRESENTATIVE FOR THE MANAGEMENT OF

THE PROJECT

NAME: NAME:

ORGANIZATION: ORGANIZATION:

ADDRESS: ADDRESS:

PHONE: PHONE:

E-MAIL: E-MAIL:

PART V - PHYSICAL LOCATION OF PROJECT

The intent of this section is to verify the primary location the project is being implemented to address the PSGP and port area priorities. The applicant's primary area of responsibility for utilizing the project should be identified. This includes training, exercises, interoperable systems, vessel equipment and regionally beneficial projects. Secondary areas of responsibility are not considered the project location. Please identify the location from which the project will be implemented/deployed (the applicant facility address), such as fire or police departments or MTSA regulated facility.

PHYSICAL ADDRESS OF THE PROJECT LOCATION:

Street Address:

City:

State: Zip Code:

LATITUDE & LONGITUDE:

BRIEF DESCRIPTION OF THE PROJECT LOCATION:

STATE AND LOCAL AGENCIES ONLY - ROLE IN PROVIDING LAYERED PROTECTION OF REGULATED ENTITIES DESCRIBE YOUR ORGANIZATION'S SPECIFIC ROLES, RESPONSIBILITIES AND ACTVITIES IN DELIVERING LAYERED PROTECTION.

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

FEMA FORM 089-5 (01/17) Page 3 of 6

PART VI - ALL AGENCIES/ORGANIZATION - IMPORTANT FEATURES

DESCRIBE ANY OPERATIONAL ISSUES YOU DEEM IMPORTANT TO THE CONSIDERATION OF YOUR APPLICATION (e.g., interrelationship of your operations with other eligible high-risk ports, Memorandum of Understanding (MOU) or Memorandum of Agreement (MOA), Etc.). PLEASE LIST ALL AGENCIES WITH WHOM YOU HAVE A MARITIME SECURITY MOU OR MOA.

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

FEMA FORM 089-5 (01/17) Page 4 of 6

PART VII - INVESTMENT JUSTIFICATION ABSTRACT

WHAT WILL THIS PROJECT INVESTMENT FUND (i.e. vessels, radios, cameras, construction, contracts, fencing, etc.)?

ARE ANY PROJECT ITEMS ON THE CONTROLLED

EQUIPMENT LIST

(please reference FEMA Information Bulletin 407):

IF YES, PLEASE PROVIDE THE AUTHORIZED EQUIPMENT LIST

(AEL) NUMBER(S) FOR

CONTROLLED EQUIPMENT:

SUMMARIZE THE PROPOSED INVESTMENT JUSTIFICATION.

THE FOLLOWING MUST BE INCLUDED:

• DESCRIBE HOW THIS INVESTMENT ADDRESSES THE CAPTAIN OF THE PORT'S PRIORITIES

• EXPLAIN HOW THIS INVESTMENT WILL ACHIEVE A MORE SECURE AND RESILIENT PORT AREA

• IDENTIFY ASSETS BEING REQUESTED

• IDENTIFY SIMILAR ASSETS THAT ALREADY EXIST

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

FEMA FORM 089-5 (01/17) Page 5 of 6

PART VIII - NATIONAL PRIORITIES

IDENTIFY ONE NATIONAL PRIORITY THIS INVESTMENT MOST CLOSELY SUPPORTS:

DESCRIBE HOW, AND THE EXTENT THIS INVESTMENT JUSTIFICATION MEETS ONE OR MORE OF THE NATIONAL PRIORITIES.

THE FOLLOWING MUST BE INCLUDED:

• HOW THIS INVESTMENT ADDRESSES VULNERABILITIES IDENTIFIED WITHIN AN AREA MARITIME SECURITY PLAN, FACILITY

SECURITY PLAN, VESSEL SECURITY PLAN, OR OTHER IDENTIFIED PLAN(S).

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

FEMA FORM 089-5 (01/17) Page 6 of 6

PART IX - NATIONAL PREPAREDNESS GOAL

IDENTIFY ONE CORE CAPABILITY THIS INVESTMENT MOST CLOSELY SUPPORTS:

PART X - IMPLEMENTATION PLAN

PROVIDE A HIGH-LEVEL TIMELINE OF MILESTONES FOR THE IMPLEMENTATION OF THIS INVESTMENT, SUCH AS PLANNING, TRAINING, EXERCISES, AND MAJOR ACQUISITIONS OR PURCHASES. UP TO 10 MILESTONES MAY BE SUBMITTED.

THE FOLLOWING MUST BE INCLUDED:

• MAJOR MILESTONES OR RELEVANT INFORMATION THAT IS CRITICAL TO THE SUCCESS OF THE INVESTMENT

• MAJOR TASKS THAT WILL NEED TO OCCUR (E.G. DESIGN AND DEVELOPMENT, CONTRACTUAL AGREEMENTS, PROCUREMENT, DELIVERY, INSTALLATION AND PROJECT COMPLETION)

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

FEMA FORM 089-5 (01/17)

Page of

DEPARTMENT OF HOMELAND SECURITY

Federal Emergency Management Agency

PORT SECURITY GRANT PROGRAM INVESTMENT JUSTIFICATION

SENSITIVE

SECURITY

INFORMATION

OMB Control Number: 1660-0114 Expiration: 05/31/2020 Warning: Please follow the Notice of Funding Opportunity Guidance while completing this form.

PART I - INVESTMENT HEADING

STATE OR TERRITORY IN WHICH THE PROJECT WILL BE IMPLEMENTED:

of

PART II - BASIC PROJECT INFORMATION

(Total Project Cost x 0.75) (Total Project Cost x 0.25) (Fed Share/0.75; or Cost Share/0.25)

PART III - ELIGIBILITY INFORMATION

PLEASE REVIEW THE NOTICE OF FUNDING OPPORTUNITY AND 46 U.S.C. 70107

WHICH PLAN(S) APPLIES TO YOUR

ORGANIZATION?:

ACTIVE PARTICIPANT OF AN AREA MARITIME

SECURITY COMMITTEE?

IS THIS APPLICATION ON BEHALF OF ANOTHER

ENTITIY OR SUBMITTED AS A CONSORTIUM?

IS THE PROJECT SITE OWNED BY

YOUR ORGANZITION?

IS THE PROJECT SITE OPERATED

BY YOUR ORGANZITION?

STATE AND LOCAL AGENCIES ONLY - IS YOUR AGENCY REQUIRED TO PROVIDE PORT SECURITY SERVICES TO MTSA

REGULATED FACILITIES?

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

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CBP-303

FEMA Form 1.0

SENSITIVE SECURITY INFORMATION

PART IV - POINT(S) OF CONTACT FOR ORGANIZATION

SIGNATORY AUTHORITY FOR ENTERING INTO A GRANT AWARD AGREEMENT

AUTHORIZED REPRESENTATIVE FOR THE MANAGEMENT OF THE PROJECT

PART V - PHYSICAL LOCATION OF PROJECT

The intent of this section is to verify the primary location the project is being implemented to address the PSGP and port area priorities. The applicant's primary area of responsibility for utilizing the project should be identified. This includes training, exercises, interoperable systems, vessel equipment and regionally beneficial projects. Secondary areas of responsibility are not considered the project location. Please identify the location from which the project will be implemented/deployed (the applicant facility address), such as fire or police departments or MTSA regulated facility.

PHYSICAL ADDRESS OF THE PROJECT LOCATION:

STATE AND LOCAL AGENCIES ONLY - ROLE IN PROVIDING LAYERED PROTECTION OF REGULATED ENTITIES WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

SENSITIVE SECURITY INFORMATION

PART VI - ALL AGENCIES/ORGANIZATION - IMPORTANT FEATURES

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

SENSITIVE SECURITY INFORMATION

PART VII - INVESTMENT JUSTIFICATION ABSTRACT

ARE ANY PROJECT ITEMS ON THE CONTROLLED

EQUIPMENT LIST

(please reference FEMA Information Bulletin 407):

IF YES, PLEASE PROVIDE THE AUTHORIZED EQUIPMENT LIST (AEL) NUMBER(S) FOR

CONTROLLED EQUIPMENT:

SUMMARIZE THE PROPOSED INVESTMENT JUSTIFICATION.

THE FOLLOWING MUST BE INCLUDED:

• DESCRIBE HOW THIS INVESTMENT ADDRESSES THE CAPTAIN OF THE PORT'S PRIORITIES

• EXPLAIN HOW THIS INVESTMENT WILL ACHIEVE A MORE SECURE AND RESILIENT PORT AREA

• IDENTIFY ASSETS BEING REQUESTED

• IDENTIFY SIMILAR ASSETS THAT ALREADY EXIST

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

SENSITIVE SECURITY INFORMATION

PART VIII - NATIONAL PRIORITIES

DESCRIBE HOW, AND THE EXTENT THIS INVESTMENT JUSTIFICATION MEETS ONE OR MORE OF THE NATIONAL PRIORITIES.

THE FOLLOWING MUST BE INCLUDED:

• HOW THIS INVESTMENT ADDRESSES VULNERABILITIES IDENTIFIED WITHIN AN AREA MARITIME SECURITY PLAN, FACILITY

SECURITY PLAN, VESSEL SECURITY PLAN, OR OTHER IDENTIFIED PLAN(S).

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

SENSITIVE SECURITY INFORMATION

PART IX - NATIONAL PREPAREDNESS GOAL

PART X - IMPLEMENTATION PLAN

PROVIDE A HIGH-LEVEL TIMELINE OF MILESTONES FOR THE IMPLEMENTATION OF THIS INVESTMENT, SUCH AS PLANNING, TRAINING, EXERCISES, AND MAJOR ACQUISITIONS OR PURCHASES. UP TO 10 MILESTONES MAY BE SUBMITTED.

THE FOLLOWING MUST BE INCLUDED:

• MAJOR MILESTONES OR RELEVANT INFORMATION THAT IS CRITICAL TO THE SUCCESS OF THE INVESTMENT

• MAJOR TASKS THAT WILL NEED TO OCCUR (E.G. DESIGN AND DEVELOPMENT, CONTRACTUAL AGREEMENTS, PROCUREMENT, DELIVERY, INSTALLATION AND PROJECT COMPLETION)

WARNING: This record contains Sensitive Security Information that is controlled under 49 CFR parts 15 and 1520. No part of this record may be disclosed to persons without a "need to know", as defined in 49 CFR parts 15 and 1520, except with the written permission of the Administrator of the Transportation Security Administration or the Secretary of Transportation. Unauthorized release may result in civil penalty or other action. For U.S. government agencies, public disclosure is governed by 5 U.S.C. 552 and 49 CFR parts 15 and 1520.

SECURITY COMMITTEE:

DROP DOWN LIST SELECT IS THIS APPLICATION ON BEHALF OF ANOTHER

ENTITIY OR SUBMITTED AS A CONSORTIUM:

DROP DOWN LIST SELECT IS THE PROJECT SITE OWNED BY

YOUR ORGANZITION:

DROP DOWN LIST SELECT IS THE PROJECT SITE OPERATED

BY YOUR ORGANZITION:

REGULATED FACILITIES:

(please reference FEMA Information Bulletin 407):

ENTER IF YES, PLEASE PROVIDE THE AUTHORIZED EQUIPMENT LIST (AEL) NUMBER(S) FOR

CONTROLLED EQUIPMENT: