Fillable PREPARECA JUMPSTART APPLICATION (California)

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PREPARECA JUMPSTART APPLICATION (California)

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  • 8 check-boxes
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PrepareCA JumpStart Application, Version 2.0
California Governor’s Office of Emergency Services 1
PREPARECA JUMPSTART APPLICATION
Introduction
PrepareCA JumpStart is a competitive $15 million dollar grant program that
provides Technical Assistance (TA) and State funding to eligible socially
vulnerable and high hazard risk communities. Through this grant program,
eligible communities can develop local initiatives that foster resilience via
capacity building, mitigation and preparedness activities, community
outreach/education, response and recovery planning, and/or project scoping.
Each application may be up to $1 million dollars in State funds, and applicant
entities may submit multiple applications for distinct activities and initiatives.
Instructions
Cal OES requires this form be completed for all PrepareCA JumpStart
applications.
Prior to beginning this form, applicant entities should access the map linked
below to verify their Activity/Initiative is primarily located in an eligible
community.
Hazard Exposure and Social Vulnerability Map:
https://www.arcgis.com/apps/dashboards/677300969f9b4d4786d75aaa534318e6
Note that some fields are mandatory and are marked with a red asterisk. If you
have questions or need assistance completing the application, please contact
Cal OES via email at: PrepareCAJumpStart@caloes.ca.gov. The Cal OES TA
Team is available to assist communities to scope out potential application
Activities/Initiatives and to assist in completing this application form.
The person completing this application may save their progress and come back
to the form as necessary. The authorizing signature field in this form can
accommodate digital signatures. To apply a digital signature, the applicant
may find it easiest to use Adobe Acrobat or compatible software.
Applicants must submit a completed PrepareCA JumpStart application form
with all mandatory fields completed with the appropriate information.
PrepareCA JumpStart Application, Version 2.0
California Governor’s Office of Emergency Services 2
Applicants have the option to submit additional documents or exhibits relevant
to and referenced in the proposal. Any additional documents must be labelled
and submitted with the application in a single email submission.
If a space provided under a question is insufficient to accommodate an
applicant’s answer, they may attach their response with the additional
documentation.
Upon completion, attach the application in an email with “PrepareCA
Jumpstart” in the subject line and send to Cal OES at:
PrepareCAJumpStart@caloes.ca.gov.
I. Point(s) of Contact
At least one of the points of contact listed below must be a Responsible
Representative of the applicant entity.
A Responsible Representative must have a high-level title within the applicant
entity (e.g. Director, Deputy Director, Chief, Deputy Chief, General Manager,
Administrative Manager, Emergency Services Manager, Chief Financial Officer,
Chief Executive Officer, Superintendent, County Administrator, County
Administrative Officer, City Manager, Assistant City Manager, Mayor).
The Responsible Representative must have signature authority for all
authorizations (pre-award) and grant meditations/reporting/requests (post-
award).
If the person filling this out is not a Responsible Representative, then the
Responsible Representative must be listed as the Secondary Point of Contact.
PrepareCA JumpStart Application, Version 2.0
California Governor’s Office of Emergency Services 3
1. Person Completing Application
*Full Name:
First
M.I
Last
*Entity Name:
*Address:
Street
Unit / Apt #
City
ZIP Code
*Phone:
*Email
2. Secondary Point of Contact
Full Name:
First
M.I
Last
Entity Name:
Address:
Street
Unit / Apt #
City
ZIP Code
Phone:
Email
PrepareCA JumpStart Application, Version 2.0
California Governor’s Office of Emergency Services 4
II. Applicant Information
1. *Applicant Name:
3. *County:
4. *Applicant Type:
Proposal Activity or Initiative Info.
4. FIPS#:
5. EIN:
Activity or Initiative Info.
III. Activity/Initiative Information
1. *Activity Type:
If “Other” is selected, describe:
2. *Has this activity or initiative been submitted previously to
Cal OES?
YES NO
If “yes’, describe:
3. *Has this activity or initiative been submitted previously to
another entity or agency?
YES NO
If “yes’, describe:
PrepareCA JumpStart Application, Version 2.0
California Governor’s Office of Emergency Services 5
4. *Does your entity have an active, or participate in an
active, Local Hazard Mitigation Plan (LHMP)/Tribal plan?
YES NO
If “Yes”, enter approval date:
5. If a Private Non-Profit, does your county have an active
LHMP?
YES NO
If “Yes”, enter approval date:
PrepareCA JumpStart Application, Version 2.0
California Governor’s Office of Emergency Services 6
Title & Summary
Your title should start with “PrepareCA JumpStart” then list the applicant
entity’s name and a BRIEF description of the activity. Example: “PrepareCA
JumpStart City of Baldwin Evacuation Planning”.
6. *Activity/Initiative Title:
7. *Provide a summary of the Activity/Initiative.
Activity summary...
PrepareCA JumpStart Application, Version 2.0
California Governor’s Office of Emergency Services 7
Project Location Details
The applicant must enter location data for the Activity/Initiative.
Census Tracts can be accessed through the online map linked below. Simply
click on your eligible census tract(s) and an information window will display the
required information.
Applicants must submit the Census Tracts that apply to the Activity/Initiative
benefit area and NOT the physical location of their office and/or headquarters.
Hazard Exposure and Social Vulnerability Map:
https://www.arcgis.com/apps/dashboards/677300969f9b4d4786d75aaa534318e6
The latitude and longitude (lat/long) coordinates must apply to the
Activity/Initiative benefit area and be expressed in degrees including five or
more decimal places (e.g. latitude 36.999221, longitude – 109.044884). Lat/long
coordinates can be accessed through many online mapping services. If you
have questions on how to find your Activity/Initiative’s coordinates, please
reach out to Cal OES as directed in the instructions.
8. *Census Tract(s):
9. *Latitude/Longitude:
10. *Provide a summary description of the Activity/Initiative location.
Location summary...
PrepareCA JumpStart Application, Version 2.0
California Governor’s Office of Emergency Services 8
Problem Statement & Solution
11. *Provide a detailed description of the problem that also addresses the
following information: Is the problem causing death, injury, and/or property
damage? If not, what issues are occurring? How long has it persisted? How is it
negatively impacting the community? Briefly describe the community’s
challenges to meet this need.
Problem statement...
PrepareCA JumpStart Application, Version 2.0
California Governor’s Office of Emergency Services 9
12. *Provide a clear and detailed description of your proposed Activity/Initiative
(should match the budget and schedule below). Also address, how does the
solution address the problem “how will the Activity/Initiative solve the problem”?
What happens if the activity or initiative is not implemented? Who is affected?
What is the proposed Activity/Initiative? Where is the Activity/Initiative located?
When is the Activity/Initiative taking place? Why is the Activity/Initiative
needed?
Solution...
PrepareCA JumpStart Application, Version 2.0
California Governor’s Office of Emergency Services 10
13. *Describe the metrics you are using to determine that the Activity/Initiative
goals are being achieved. List any tangible deliverables that will be developed
as part of this Activity/Initiative.
Metrics and deliverables...
PrepareCA JumpStart Application, Version 2.0
California Governor’s Office of Emergency Services 11
Project Schedule
The period of performance is limited to 60 months.
14. *Start Date:
*End Date:
15. *The intent of the project schedule is to provide a realistic appraisal of the
time and tasks required to complete the Activity/Initiative. Describe each of the
major milestones in the description section below. List the milestones in
chronological order starting with the first task needed to be completed and
ending with the last task to be completed. State the name of the milestone
(task) and approximately how long the milestone/task will take to complete in
months. Tasks can be overlapping. The overall period of performance cannot
exceed 60 months/5 years. For example, procurement month 1 to month 4,
alternative analysis month 4 to month 12, etc.
Milestones...
PrepareCA JumpStart Application, Version 2.0
California Governor’s Office of Emergency Services 12
Project Budget
16. *What is the total cost of Activity/Initiative (not to exceed $1 million)?
Applicants will be responsible for project costs that exceed the award amount.
17. *To the greatest extent possible, applicant should breakdown budget items.
Provide a breakdown of the costs for the proposed Activity/Initiative (should
match schedule and scope). Cost items can be a task/milestones from the
project schedule. For example, the applicant would enter the dollar value of the
cost item titled “alternative analysis” here.
Cost Item:
Cost:
Cost Item:
Cost:
Cost Item:
Cost:
Cost Item:
Cost:
Cost Item:
Cost:
Cost Item:
Cost:
Cost Item:
Cost:
Cost Item:
Cost:
Cost Item:
Cost:
Cost Item:
Cost:
Cost Item:
Cost:
Cost Item:
Cost:
Cost Item:
Cost:
Cost Item:
Cost:
$
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PrepareCA JumpStart Application, Version 2.0
California Governor’s Office of Emergency Services 13
Cost Item:
Cost:
Cost Item:
Cost:
Cost Item:
Cost:
Cost Item:
Cost:
Cost Item:
Cost:
Cost Item:
Cost:
0.00
0.00
0.00
0.00
0.00
0.00
PrepareCA JumpStart Application, Version 2.0
California Governor’s Office of Emergency Services 14
18. *The budget narrative should provide a detailed description for each item
identified in the budget. Specifically, the narrative should include the
methodology or source used to estimate each cost, identify by title who will be
performing the work and whether that work will be performed in house or via 3
rd
party contractors, and should include personnel costs that provide details on
the hourly wage for person performing the task (inclusive of fringe benefits).
Budget narrative...
PrepareCA JumpStart Application, Version 2.0
California Governor’s Office of Emergency Services 15
Implementation Plan
19. *Explain how the Activity/Initiative will be managed. For example, will a local
community provide staff as a project manager to oversee the progress? Explain
whether existing or hired staff will be used. Explain the process that the applicant
will follow to implement the Activity/Initiative.
Implementation plan...
PrepareCA JumpStart Application, Version 2.0
California Governor’s Office of Emergency Services 16
Community Benefit
20. *Percentage of the eligible socially vulnerable and high hazard
risk communities impacted/benefited by this Activity/Initiative:
21. *Describe how this percentage was determined. There is no official guidance
about how the population affected should be determined. However, the
number of people who will benefit should be known or estimated.
0%
Community benefit...
PrepareCA JumpStart Application, Version 2.0
California Governor’s Office of Emergency Services 17
Resilience Outcomes
22. * “Resilience” refers to the ability to prepare for anticipated hazards, adapt
to changing conditions, and withstand and recover rapidly from disruption. How
will the proposed Activity/Initiative improve resilience?
23. *How does this project fit your jurisdiction/community’s larger resiliency goals
and programs?
Improve resilience...
Community resilience goals...
PrepareCA JumpStart Application, Version 2.0
California Governor’s Office of Emergency Services 18
24. *How does the Activity/Initiative better prepare the community to respond to
and mitigate the impacts of future disasters and anticipate future conditions
such as climate change, demographic changes, population changes, and/or
land use changes?
Mitigate the impacts of future disasters...
PrepareCA JumpStart Application, Version 2.0
California Governor’s Office of Emergency Services 19
Capacity Building
25. *How will the Activity/Initiative lead to equitable outcomes and benefit those
with the greatest needs?
26. *Explain how the Activity/Initiative will improve the community’s capacity
and capability, increase the community’s resilience to natural hazards,
holistically improve the community’s resilience and reduce risk, and promote
equitable outcomes. How will the community actively participate in the
Activity/Initiative?
Equitable outcomes...
Community capacity building...
PrepareCA JumpStart Application, Version 2.0
California Governor’s Office of Emergency Services 20
27. *How will this Activity/Initiative lead to sustainable long-term resilience
outcomes that benefit the community and complement the community’s
current resilience and mitigation goals?
Sustainable long-term resilience...
PrepareCA JumpStart Application, Version 2.0
California Governor’s Office of Emergency Services 21
Project Partnership
28. *Describe involvement of partners to enhance the Activity/Initiative
outcome. Explain whether other private, non-profit, or public sector partners
would be actively involved.
Private Non-Profits Only
29. Describe how your organization will partner and support the local
jurisdiction/community to build capacity and how this Activity/Initiative will
make the community more resilient in the future. Please provide a letter(s) of
support from the local jurisdiction and/or community where the Activity/Initiative
will occur.
Project partners...
Partnering with the local jurisdiction/community...
PrepareCA JumpStart Application, Version 2.0
California Governor’s Office of Emergency Services 22
Authorization
The undersigned is a Responsible Representative of the applicant entity and
listed as point of contact in this application. The undersigned does herby submit
this application for financial assistance in accordance with the PrepareCA
JumpStart program and certifies that the applicant will fulfill all requirements of
the program as contained in the program guidelines and that all information
contained herein is true and correct to the best of our knowledge.
*Name:
*Title:
*Entity:
*Signature:
*Date:
PrepareCA JumpStart Application, Version 2.0
California Governor’s Office of Emergency Services 23
Application Submission Instructions
Applicants must email their completed application(s) with “PrepareCA
Jumpstart” in the subject line to PrepareCAJumpStart@caloes.ca.gov by
February 28, 2022.
Prior to sending the PDF of your completed PrepareCA JumpStart proposal
application, confirm that you have completed the following:
The mandatory fields identified with an asterisk are complete and correct.
The application is signed by responsible representative.
If your application includes additional documentation, they must be sent in the
same email submission as this completed form.
Thank you! The team at Cal OES greatly appreciates your participation in the
PrepareCA JumpStart program.
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PREPARECA JUMPSTART APPLICATION (California)

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Completed 3 February 2022

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