Pender County, North Carolina
RFP for EWP Management/Consulting Services
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Pender County North Carolina
Request for Proposals (RFP) # 201202-116
Emergency Watershed Protection-
Management/Consulting Services
Proposal Timeline:
Date Issued: Wednesday, December 2, 2020
Pre-Proposal Conference: None
Deadline for Submittal of Questions: Wednesday, December 9, 2020 at 5:00 p.m. EST
Answers to Questions: Friday, December 11, 2020
Deadline for Submittal of Proposals: Friday, December 16, 2020 at 2:00 p.m. EST
Selection and Award: Monday, January 4, 2021
Sole Point of Contact for Communications Regarding this RFP:
Travis Henley, Planning and Community Development Director
Phone: 910-259-2110 | Fax: 910-259-1404 | Email: thenley@pendercountync.gov
Pender County, North Carolina
RFP for EWP Management/Consulting Services
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TABLE OF CONTENTS
SECTION 1: INTRODUCTION ............................................................................................................ 3
SECTION 2: SUBMISSION REQUIREMENTS AND EVALUATION ....................................................... 5
SECTION 3: SCOPE OF WORK ........................................................................................................ 12
SECTION 4: GENERAL TERMS AND CONDITIONS .......................................................................... 15
SECTION 5: SPECIFIC TERMS AND CONDITIONS ........................................................................... 18
ATTACHMENT A: PROPOSAL FORM .............................................................................................. 22
ATTACHMENT B: REFERENCES ...................................................................................................... 26
ATTACHMENT C: PRICE PROPOSAL ............................................................................................... 28
ATTACHMENT D: OFFEROR’S CERTIFICATION FORM ................................................................... 29
ATTACHMENT E: CERTIFICATION REGARDING LOBBYING ............................................................ 30
ATTACHMENT F: W9 ..................................................................................................................... 31
ATTACHMENT G: SAMPLE CONTRACT FOR THE PROVISION OF SERVICES .................................. 38
NOTE:
This is a re-advertisement of RFP # 201021-110 due to an insufficient amount of responses.
SECTION 1: INTRODUCTION
Pender County, North Carolina
RFP for EWP Management/Consulting Services
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SECTION 1: INTRODUCTION
A. PURPOSE
There are several incorporated municipalities within the County including but not limited
to: Burgaw, St. Helena, Atkinson, Wallace, Watha, Surf City and Topsail Beach. Any or all
of the incorporated municipalities in the County may participate in the Terms and
Conditions of the resulting contract. It is the intent of Pender County to allow local
governments and other governmental agencies within its jurisdictional boundaries to
utilize the contract by entering into a Cooperative Purchasing Agreement.
B. BACKGROUND
Pender County was formed in 1875 and now has a present land area of approximately
871 square miles. The County serves a population of approximately 61,000 citizens
according to 2019 US Census data. Due to the geographic location of the County, natural
disasters such as hurricanes and watershed flooding events occur periodically within the
County.
The Pender County Planning and Community Development Department intends to select
a qualified Consultant to help the Planning and Community Development Department
respond to emergency, or non-emergency, work performed through the USDA-Natural
Resources & Conservation Service (NRCS), Emergency Watershed Protection Program.
Municipalities may receive assistance from the EWP Program when sudden watershed
impairment occurs that creates an imminent threat to life or property. An eligible project
sponsor must be a legal subdivision of State government of State Agency or Native
American Tribe or Tribal Organization. The project sponsor must also have the legal
capacity, or responsibility for the areas threatened by a watershed emergency. Pender
County is identified as the sponsor of this contract and EWP program.
The EWP program provides recovery assistance for undertaking emergency measures for
repair and restoration of eligible sites. This can include slope and streambank stabilization
of eligible properties. Eligible recovery measures include practices that conform to all
applicable statutes, regulations, and Executive Orders. The EWP Program helps project
sponsors implement emergency recovery measures to relieve imminent hazard to life or
property created by a natural disaster or man-made disaster. Such hazards often cause
sudden impairment of a watershed. EWP technical and financial assistance may be
available to sponsors when:
1.The President declares an emergency under the Robert T. Stafford Disaster Relief and
Emergency Assistance Act
2.The Secretary of Agriculture declares a drought emergency.
SECTION 1: INTRODUCTION
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3. An appropriation of funding via other Federal or State Programs
Recovery from flooding and watershed disaster events may potentially be addressed by
other federal programs such as the Federal Emergency Management Agency (FEMA)
Public Assistance (PA) guidelines. The Planning and Community Development
Department anticipates that the EWP contract may be implemented in concert with
ongoing FEMA PA Grant reimbursement programs presently underway with the County.
These two programs must not conflict with one another in the recovery process or result
in simultaneous funding from both programs. It is essential that the Consultant selected
for this contract has a thorough and demonstrated knowledge of the FEMA PA Grant
process, and can provide the guidance to the County to prevent duplication of benefits
from occurring by these programs.
C. GENERAL INFORMATION
As permitted in G.S. 143-64.32, Pender County will exempt itself from the Mini Brooks Act
(G.S. 143-64.32) for the EWP Projects.
The RFP may be advertised on one or more State Procurement websites so that it is open
and competitive for all interested qualified firms. In addition, the RFP is advertised on the
Pender County Government website at www.pendercountync.gov. To find this, select I
Want To View All Open RFPs and Bids from the ribbon on the top of the webpage, and
then select the RFP for Emergency Watershed Protection Management/Consulting
Services.
When responding to this RFP, please follow all instructions carefully and exactly as
directed. Respondents should not deviate from required format, quantity, or content
specified in the RFP. Please submit proposal contents according to the outline specified
in Section 2.C Proposal Format Requirements. Also, interested parties should submit
documents according to the instructions contained in Section 2.B, Proposal Submission
Requirements, and elsewhere in this RFP. Failure to follow these instructions specifically
as instructed, may result in a proposal being considered non-responsive and may be
eliminated from consideration. Respondents are also advised not to provide brochures,
marketing, advertising, or any other unspecified promotional materials in addition to
required information that is specified.
Negligence or error on the part of any offeror in preparing its proposal confers no right of
withdrawal or modification of their bid after the designated submittal deadline.
Failure to return the required documents and information specified in this RFP may result
in a determination that the proposal is non-responsive. All costs associated with preparing
a proposal, including any mailing costs, publishing cost, etc. will not be reimbursed by the
County.
SECTION 2: SUBMISSION REQUIREMENTS AND EVALUATION
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RFP for EWP Management/Consulting Services
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SECTION 2: SUBMISSION REQUIREMENTS AND EVALUATION
A. GENERAL REQUIREMENTS
Direct contact with any employee of the County regarding this contract, other
than the designated individual, is expressly forbidden. Violation may result in a
determination that your firm is ineligible for consideration for award.
All proposals must be signed by an officer or employee having the authority to
sign on behalf of the firm or bind the firm legally.
Any interlineations, alterations, or erasures of submitted materials must be
initialed by the signer of the proposal.
The Terms and Conditions in this RFP shall supersede any Terms and Conditions
offered. Any additional conditions or modifications to the Terms and Conditions
that an offeror intends to be considered must be submitted as part of the proposal
and be indicated on Attachment A: Proposal Form. Such exceptions may result in
the proposal being determined non-responsive.
Submission of a proposal by the offeror is not to be construed as an award or
order.
The firm must show evidence that it is registered, and in good standing with the
North Carolina Board for Licensing of Professional Engineers.
The firm must show capability and experience performing civil engineering,
structural engineering, geological, and marine/coastal engineering. This
experience should demonstrate expertise in: engineering evaluations, engineering
design, construction administration, construction management, and construction
materials testing, and construction documentation.
The firm should demonstrate familiarity with geotechnical lab test methods,
geotechnical field test methods, nuclear density test methods, and criteria for
borrow evaluation of granular aggregate fill.
B. PROPOSAL SUBMISSION REQUIREMENTS
The County will receive proposals until Friday, December 16
th
, 2020 at 2:00 PM, Eastern
Standard Time, at the address below. At that time, the County will close the receipt of
proposals and begin the evaluation process. Proposals received after the submittal
deadline will not be accepted or considered. The time of receipt shall be determined by
the time clock in the Pender County Planning and Community Development Department.
The County will not be held responsible for the failure of any mail or delivery service to
deliver a proposal package prior to the stated submittal deadline. Late submittals of RFPs
will not be considered for any reason whatsoever.
SECTION 2: SUBMISSION REQUIREMENTS AND EVALUATION
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RFP for EWP Management/Consulting Services
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Submitting firms should submit one package containing: (1) original and four (4) exact
copies of complete proposal packages along with one (1) electronic PDF version of the
proposal in its entirety saved on a USB drive. All proposal packages must be submitted in
a sealed package and clearly identified with: proposal name, RFP number; offerors name
and address, and the date and time of the submittal deadline clearly marked on the
outside of the package. Proposal packages shall be delivered (FedEx or UPS) to:
Pender County Planning and Community Development
805 S. Walker Street
Burgaw, NC 28425
Attn: Travis Henley, Director
It is solely the offeror’s responsibility to ascertain that they have received all required
and necessary information, documents, and addenda prior to submitting a response and
to ensure that the response is received at the correct location on time.
C. PROPOSAL FORMAT REQUIREMENTS
To facilitate the analysis of proposals, offerors should prepare their proposals according
to the instructions outlined in this RFP and in the order presented below. Proposals
should be prepared as simply as possible with straightforward, concise narratives to
demonstrate an understanding of the project and services required by the County.
Proposals that provide innovative alternatives and creative approaches are encouraged.
Any other information thought to be relevant but not applicable to the categories below
may be provided as an appendix to the proposal.
Submitted proposals should be organized into the following sections:
1. Letter of Transmittal
The letter should, at a minimum, acknowledge the offeror’s intent to provide
timely and professional services to the County and identify the offeror’s main
point of contact for any communications regarding the submitted proposal.
2. Executive Summary
Provide a brief narrative that summarizes the proposal and addresses the key
benefits, qualifications, and capabilities of the offeror.
3. Company Profile
Provide a description of the firm’s history, ownership, business organization,
financial status, overall qualifications, products or services offered, and any
relevant licenses held, if applicable.
o Provide evidence of registration and good standing with the North
Carolina Secretary of State and State Boards governing applicable
professional services required. In the case of out-of-state corporation,
SECTION 2: SUBMISSION REQUIREMENTS AND EVALUATION
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provide a Certificate of Authority as evidence of ability to do business in
North Carolina.
o Describe the overall capability of the offeror to fully perform the
contract requirements and the moral and business integrity and
reliability which will assure the County of good faith performance as
required by these specifications.
4. Understanding and Approach
Provide a description of the offeror’s understanding of the requirements
contained in the Scope of Work described in this RFP. This section should, at a
minimum, address the following:
o Expression of the offeror’s understanding of the services requested and
demonstrated knowledge working on slope restoration projects.
o Offeror’s knowledge of the County physiographic differences and
geographic features, and how these influences completing exigent civil-
construction projects.
o A detailed description of the offeror’s intended approach to providing
the services identified in the Scope of Work.
o A list of all major tasks to be performed by the offeror and the deliverable
products associated with each task. Also include information regarding
the timelines associated with the delivery of required tasks.
o Ability and flexibility to meet the County’s needs; responsiveness under
short notice, and estimated response times to the Planning and
Community Development Department office location when notified in
emergency situations
o Understanding of the content of Damage Survey Reports (DSRs) used in
the EWP planning process and experience preparing DSRs
o Experience obtaining right-of-entry, easements, and access agreements
with private property owners, corporations, and non-profits.
o Understanding of federal/state environmental laws including but not
limited to: Clean Water Act, 401 Water Quality Certification, US Army
Corps Section 404, Identification of Endangered species, and Coastal
Area Management Act.
5. Key Personnel
Identify all key personnel who will be assigned to the resulting contract and their
role on the offeror’s team. Describe each individual’s experience history, relevant
licenses and/or certifications, relevant association memberships, and overall
credentials related to the requested services. Also identify all subcontractors/sub
consultants who will support the work performed under the resulting contract and
define their roles. Respondents must include an organization chart that clearly
identifies personnel assigned to this project and their roles. The organization chart
SECTION 2: SUBMISSION REQUIREMENTS AND EVALUATION
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must clearly illustrate the proposed lines of communication between proposed
team members and the County management.
The RFP should clearly identify personnel with EWP consulting/management
experience, examples of their experience, and their proposed role for this
contract. The RFP should clearly identify the office location that such personnel
are stationed, and their estimated travel to the Pender County Administration
Office, if emergency travel is required during execution of any task order.
6. Past Experience
Summarize the Respondent’s overall past experience providing EWP
consulting/management services, number of contracts (current and past); identify
percent completed, NRCS EWP program familiarity, and detailed information
regarding previously completed EWP projects. Related projects that were similar
in size and scope completed for other government agencies with comparable
requirements, may be submitted in lieu of EWP projects, but may be weighted
less.
7. References
Submit a completed Attachment B: References Form. Offerors should include at
least three references for similar services provided within the past 10 years, with
at least one reference specific to performance and execution of an USDA-EWP
contract for similar services.
8. Price Proposal
Submit a completed Attachment C: Price Proposal.
o Offeror shall provide the total cost to perform the services and a detailed
cost breakdown. The cost breakdown shall identify separately the
offeror’s cost per hour, hours anticipated to accomplish each task, and
the total cost associated with each service/task identified in the Scope of
Work.
o The hourly cost shall be all-inclusive including subsistence, hotel and
other cost(s) associated with housing staff for the project. Mobilization
and de-mobilization cost will not be compensated and should be
included in the hourly rate.
o Services provided during the response and recovery phase of a disaster
event shall be paid based upon the hourly rate provided on Attachment
C: Price Proposal, unless otherwise negotiated at the time of request.
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o The hourly rate provided on Attachment C: Price Proposal shall also be
applicable to any additional work that may be requested beyond that
which has been specified in this RFP.
o Travel time to the project work sites is not a billable period of time unless
authorized by the contract terms and conditions.
o Offerors price should demonstrate how they will be able to execute the
project within the confines of the EWP program with none to minimal
cost to the County.
D.
1. Other Required Forms
Submit a completed and signed copy of the following forms (provided as part of
this RFP):
o Attachment A: Proposal Form
o Attachment B: References
o Attachment C: Price Proposal
o Attachment D: Offeror’s Certification Form
o Attachment E: Certification Regarding Lobbying
o Attachment F: Vendor Application Form and W-9 Form
o Attachment G: Sample Contract for the Provision of Services
E. SIGNATURES
An original signature by an authorized officer of the firm is required on each required
form submitted in the required Original version of the proposal submittal package.
Please include evidence of signatory’s authority to bind the firm in the proposal.
F. ADDENDA
Changes or supplemental instructions to this RFP will be issued in the form of written
addendum. All addenda will be posted online along with this RFP. It is the offeror’s
responsibility to check for addenda prior to the proposal submittal deadline to ensure
that all addenda are received. The County posts all solicitations and related addenda on
the Pender County website (http://www.pendercountync.gov/public-notices/open-rfps-
and-bids/). All addenda issued in conjunction with this RFP must be acknowledged on
Attachment A: Proposal Form.
G. PRE-PROPOSAL CONFERENCE
No pre-proposal conference is planned for this RFP.
H. EVALUATION OF PROPOSALS
Proposals will be evaluated by an appointed Selection Committee according to the
evaluation criteria described in this section. Only submittals that are deemed responsive
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to these criteria from offerors deemed responsible will be evaluated and eligible for
award.
The information provided in each proposal will be evaluated according to the following
criteria:
Demonstrated understanding of the project scope and approach to providing the
requested services, and understanding of the USDA/NRCS EWP Program
Unique capability of the firm to provide the requested services
Demonstrated experience successfully providing similar services in the past to
the USDA-NRCS EWP Program and staff
Experience working with Planning and Community Development Departments,
Emergency Management Departments, FEMA, USDA-NRCS staff, County, and
municipal governments
Specialized experience, qualifications, and demonstrated knowledge of the
offeror’s key personnel
Availability and accessibility to respond on short notice to project sites in Pender
County, and for face-to-face meetings on an as-needed basis
Ability to respond quickly for emergency floodplain, watershed management, or
civil construction issues
Price and timeframe for completion of services and tasks
Completeness of the proposal and inclusion of all requested information
The County may initiate discussions/interviews with all or selected offerors. Once
discussions/interviews are complete, the County may again make a determination
regarding whether an offeror is responsible. The County will conduct negotiations with
offerors being considered for selection and may obtain Best and Final Offers (BFOs)
prior to award.
I. AWARD OF CONTRACTS
The County will award a contract to one (1) offeror from all proposals submitted that is
deemed to be fully qualified and best suited to provide the required services, as
determined solely by the County, taking into consideration price and the evaluation
factors set forth in Section 2.G, Evaluation of Proposals. No other factors or criteria shall
be used in the evaluation of proposal or selection.
At the County’s sole discretion, the County reserves the right to take the following
actions in connection with this RFP:
To request additional information from any or all offerors
To judgmentally select the successful bidder and agreement that best meets the
needs of the County
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To reject any or all proposals if it determines that proposals are not responsive
to the RFP
To reject any or all proposals if it determines doing so to be in the best interest
of the County
To reconsider any proposal submitted at any phase of the procurement
To meet with select offerors at any time to gather additional information
To have discussions with those offerors that it deems to fall within a competitive
range
To enter into negotiations separately with offerors
To award a contract, based on initial offers received, without discussion and
without conducting further negotiations. Under such circumstance, the
acceptance of a proposal by the County shall be deemed to be an acceptance of
an offer and that such acceptance will be binding upon both parties.
The County shall not be deemed to have finally selected an offeror until a contract has
been successfully negotiated and signed by both parties.
SECTION 3: SCOPE OF WORK
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RFP for EWP Management/Consulting Services
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SECTION 3: SCOPE OF WORK
A. GENERAL REQUIREMENTS
To facilitate construction and complete exigent projects, the Consultant will serve as the
primary consultant to the Planning Director or his assigned delegates. The Consultant will
provide consultation, technical assistance, engineering and planning support, bid
procurement, contractor selection, bid tabulations, contract award, scheduling
contractors, coordination of contractors, monitoring/inspecting work in progress,
inspection and certification of completed work, documentation of contractor progress,
review of testing results, borrow evaluation, preparation of progress reports and final
reports, management of payment request, determining consistency and adherence to
project plans & specifications, certification of projects, and project close-out for EWP task
orders. Duties/tasks will include but not be limited to the following:
1. Damage Survey Reports (DSR): Assist the Planning and Community Development
Department with identifying eligible sites and preparing SDRs; conduct site visits
and capture damages; interview property owners and provide programmatic
description/details of the EWP Program; review available mapping (GIS,
topographic, aerial) for providing site descriptions; discuss eligibility
requirements and right-of-entry with owners; prepare SDRs and forward to
NRCS; assist County Soil & Water Conservationist with preparation of grant
requests and task authorizations.
2. Easement Assess/Right-of-Entry: Assist the Planning and Community
Development Department with gaining access authorization to sites placed on
the EWP Eligible Site Inventory list.
3. Title Searches/Land-Ownership: Assist County Soil & Water Conservationist and
legal counsel with title searches and verification of land ownership; assist with
identification/ location of easements, and other hindrances to title.
4. Contract Administration, Bid Solicitation, and Contractor Selection Support:
Provide Planning Director with guidance on developing project Scopes of Work;
assist NRCS as needed with technical support, engineering recommendations, RFP
development, bid solicitations, bid advertisement, bid evaluation/tabulation,
contractor procurement, bid award, and guidance with executing contracts that
are compliant with NRCS and 2 Code of Federal Register (CFR) requirements.
5. Inspections/Construction Documentation: During construction on all exigent
sites, the Consultant or County will provide a qualified construction inspector to
document the construction process and to assure that the work performed is
consistent with the project Plans & Specifications prepared by USDA; observe and
SECTION 3: SCOPE OF WORK
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RFP for EWP Management/Consulting Services
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notate testing results and communicate with the Contractor CQC/CQA consultant;
in the event of deviation from the project plans, the Consultant will notify NRCS
and the County immediately.
6. Contract Management: The Consultant will assist the County with managing
contract cost accounting. The Consultant will review task order budgets, monitor
contractor invoicing, and track project costs to assure that budgets are
maintained. The Consultant will provide the County and NRCS with authorization
to release payment for work completed that is determined to be complete and
performed in accordance with project plans and specifications.
7. Reports/Meetings:
Inspection reports will be prepared by the Consultant on a daily basis. A 5-Day
Report will be prepared each week and submitted to the County and NRCS;
deviations to scope of work, costs, or schedule will be noted in the 5-Day Report.
A Final Report will be prepared at the conclusion of each completed project and
submitted to the NRCS within the time period prescribed by the contract.
Other reports and progress updates may be required by the County or NRCS as
needed. Periodic meetings may be required by the County or NRCS to be held at
office locations defined by the contract or Statement of Work developed for each
project. The Consultant shall attend meetings as requested by the County or NRCS.
8. Engineering Support: The County or NRCS may require the Consultant to
perform periodic review of project engineering plans and specifications that are
prepared by NRCS. NRCS may request design input, recommendations, analysis,
or guidance on project designs on an as needed basis.
9. Training/Preparedness Meetings with Civil Contractors: The Consultant will be
expected to work closely with the County and NRCS to conduct meetings as
required for safety, slope/streambank restoration techniques, scope or contract
changes, contracting/payment specifications, dispute resolution, or other
subjects.
10. New Technologies: The Consultant shall provide the County and NRCS advice,
guidance, and recommendations on new technologies that may be, or may
become available during the contract period that could be utilized during
execution of exigent contract work.
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Manpower Support
o Consultant must provide one individual to serve as Project Manager and function
in the capacity described above. If the Respondent is selected based on an
employee expected to be hired and that employee is not hired, the agreement
may be null and void. Any changes in personnel by the Consultant must be
approved by the Director of Planning.
o Weekly coordination of work assignments will be required. While the Planning and
Community Development Department is the place of daily duty to coordinate in
person, work requirements will dictate the location of any actual in-person
interaction.
o During completion of exigent projects, the Consultant’s Project Manager and/or
staff may be required to be onsite full-time until the until the exigent project is
stabilized or restored to functional order. Pender County will not reimburse the
Consultant for such expenses or provide shelter or food during completion of the
exigent projects.
While general insurance is required, the Consultant is also required to carry professional
insurance or environmental liability insurance because of the nature of this work. Additional
information regarding insurance requirements of the Contractor can be found in Attachment G:
Sample Contract for the Provision of Services, Item I-15, Insurance. A Certificate of Insurance will
be required of the awarded vendor that complies with the requirements outlined in Attachment
G and names the County as an additional insured.
SECTION 4: GENERAL TERMS AND CONDITIONS
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SECTION 4: GENERAL TERMS AND CONDITIONS
A. CONTRACTUAL REQUIREMENTS AND TERMS AND CONDITIONS
The following general Terms and Conditions apply to this RFP solicitation process and
will be incorporated into the resulting contract. Any exceptions to the following
requirements or other sections of this RFP should be addressed in the offeror’s
proposal.
B. ENTIRE AGREEMENT
This RFP, all attachments to this RFP, any additional or supplementary documents
incorporated herein by reference, any resulting contract, and the selected offeror’s
submitted proposal contain all the Terms and Conditions agreed upon by the parties
hereto, and no other agreements, oral or otherwise, regarding the subject matter of this
contract or any part thereof shall have any validity or bind any of the parties hereto. This
contract shall not be modified, altered, changed, or amended unless in writing and signed
by the parties hereto.
C. CONFLICT BETWEEN DOCUMENTS
In the event of a conflict between the contract documents, including these Terms and
Conditions and the terms of a purchase order or related document issued by the Office
of Purchasing, the contract documents shall control.
D. AVAILABILITY OF FUNDS
A contract shall be deemed in force only to the extent of appropriations available to each
department for the purchase of such goods and/or services. The County’s extended
obligations on contracts that include funding through successive fiscal periods shall be
contingent upon actual appropriations for the successive periods (additional years).
E. COOPERATIVE PURCHASE
If authorized by the Consultant, the contract resulting from this RFP may be extended to
other public bodies, public agencies, or institutions within the United States to purchase
at contract prices and terms. Any public entity that uses the contract shall place its own
order(s) directly with the Consultant. Pender County is not a party to such contracts and
is not responsible for placement of orders, payment, or discrepancies of the participating
jurisdictions. It is the Consultant’s responsibility to notify the jurisdictions of the
availability of contract(s). Offerors who do not wish to extend the terms, conditions, and
prices to other public entities shall so indicate in the proposal.
F. NON-DISCRIMINATION
Consultant will take affirmative action not to discriminate against any employee or
applicant for employment or otherwise illegally deny any person participation in or the
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benefits of the program which is the subject of this agreement because of race, creed,
color, sex, age, disability, or national origin. To the extent applicable, Contractor will
comply with all provisions of Executive Order No. 11246 the Civil Rights Act of 1964, (P.L.
88-352) and 1968 (P.L. 90-284), and all applicable federal, state and local laws,
ordinances, rules, regulations, orders, instructions, designations, and other directives
promulgated to prohibit discrimination. Violation of this provision, after notice, shall be a
material breach of this agreement and may result, at County’s option, in a termination or
suspension of this agreement in whole or in part.
G. INDEMNIFICATION
Consultant agrees to defend, indemnify, and hold harmless the County for all loss, liability,
claims, or expense (including reasonable attorney's fees) arising from bodily injury,
including death or property damage, to any person or persons caused in whole or in part
by the negligence or misconduct of the Consultant, except to the extent same are caused
by the negligence or willful misconduct of the County. It is the intent of this section to
require Consultant to indemnify Pender County to the extent permitted under North
Carolina law.
H. LAWS AND REGULATIONS
The Consultant shall keep fully informed of all federal, state, and local laws, ordinances,
and regulations that in any manner affect the conduct of the work. The Consultant shall
at all times observe and comply with all such laws, ordinances, and regulations.
I. RIGHTS UNDER ANTITRUST LAWS
The offeror assigns to the County any and all rights that it may have under the antitrust
laws of the United States and the State of North Carolina in any way arising from or
pertaining to this proposal. This provision is remedial in nature and is to be liberally
construed by any court in favor of the County.
J. IMMIGRATION REFORM AND CONTROL ACT OF 1986
The offeror certifies that he/she does not and shall not during the performance of the
contract for goods and services in the State of North Carolina, knowingly employ
unauthorized aliens as defined in the Federal Immigration Reform and Control Act of
1986, as amended.
K. ASSIGNMENT OF CONTRACT
A contract shall not be assignable by the Consultant in whole or in part without the
written consent of the County.
SECTION 4: GENERAL TERMS AND CONDITIONS
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L. DEFAULT
In event of default by the Consultant, the County reserves the right to procure the goods
and/or services and/or services from other sources and hold the Consultant liable for any
excess cost occasioned thereby.
M. INDEPENDENT CONTRACTOR
The Consultant and any employees, agents, or other persons or entities acting on behalf
of the Consultant shall act in an independent capacity and not as officers, employees, or
agents of the County.
N. NON-EXCLUSIVE CONTRACT
Nothing herein is intended nor shall be construed as creating any exclusive arrangement
with the selected Consultant. The contract shall not restrict the County from acquiring
similar, equal, or like goods and/or services from other sources.
SECTION 5: SPECIFIC TERMS AND CONDITIONS
Pender County, North Carolina
RFP for EWP Management/Consulting Services
Page 18 of 45
SECTION 5: SPECIFIC TERMS AND CONDITIONS
A. CONTRACT TERM
The initial contract period will begin on the date of contract execution and continue for
two (2) years with the option to renew for four (2) additional one (1) year periods, if
mutually agreed upon by both parties.
Written notice of intent to renew shall not be required. Issuance of a purchase order shall
constitute exercise of the renewal option.
B. QUESTIONS
Questions regarding this RFP must be received prior to the deadline indicated on the
cover page.
C. CONTRACTOR QUALIFICATIONS
Firms shall have the capability in all respects to fully perform the services or provide the
goods specified and have the experience necessary to assure the County of good faith
performance of the contract.
D. CONTRACT/AGREEMENT
Following award, a contract/agreement will be executed between the offeror and the
County. A sample contract is included with this RFP as Attachment G: Sample Contract for
the Provision of Services. Do not return the sample contract with the proposal; it is
provided for informational purposes only.
E. PRICE ADJUSTMENT
Prices shall remain firm for the initial contract period. Should the County exercise the
option to renew the contract for additional one-year periods, the Contractor may request
a price increase prior to the end of the then current period. The price increase for each
renewal period shall not exceed the change of the Consumer Price Index (CPI) for
Emergency Management Directors Series ID 11-9161 not seasonally adjusted as published
by the United States Bureau of Labor Statistics for the latest twelve months for which
statistics are available.
The new contract price(s) shall be calculated by applying the published index percentage
change to the then current unit price(s). The newly adjusted price(s) will become effective
as soon as possible but not prior the date of the renewal period, and will apply to goods
or services requested on or after the effective date of the new price. The Consultant shall
submit a written request for a price increase to the County. When applicable,
evidence/proof of price change from the manufacturer or other relevant source shall
accompany the price increase request. Price increases will not be automatic and are
SECTION 5: SPECIFIC TERMS AND CONDITIONS
Pender County, North Carolina
RFP for EWP Management/Consulting Services
Page 19 of 45
subject to approval by the County. If approved by the County, price increases may be
limited to a maximum of 3% for each one-year renewal period.
If a price decrease is provided, such price decrease shall be immediately passed on to
the County.
The County reserves the right to request a reduction in price based on economic factors
or market conditions during contract term according to changes in the specified index or
other factors.
CPI information and detailed statistics including current percentage changes can be
accessed at http://www.bls.gov/cpi.
F. METHOD OF ORDERING
The County will issue a purchase order to the Contractor as authorization to provide the
goods or services specified on the order.
G. EXAMINATION OF CONDITIONS
Each offeror shall fully investigate site conditions and determine work conditions and take
necessary measures to ensure a complete understanding of the specifications and work
requirements. Failure to become familiar with the site conditions or work conditions will
not relieve the offeror from furnishing all materials or performing the work in accordance
with the plans, specifications, or Scope of Work.
H. SCHEDULING AND DELAYS
The parties to a contract resulting from this RFP acknowledge that all or part of the work
to be performed hereunder may be delayed and extended at the option of the County.
Such delays may be caused by delays, denials, and modifications of the various state or
federal permits, or for other reasons. The County shall not be required to pay any of the
Contractor’s direct or indirect costs, or claims for compensation, extended overhead, or
other damage or consequential damages arising out of or related to any delays or
interruptions required or ordered by the County. If the County delays the project for any
reason for a continuous period of ninety (90) days or more, the County and Contractor
will negotiate a mutually agreeable adjustment to the Contractor’s award amount.
I. COMPLIANCE WITH UNIFORM RULES FOR PROCUREMENT (SUPER CIRCULAR,
2 C.F.R.)
Contracts funded with federal grant funds must be procured in a manner that conforms
with all applicable Federal laws, policies, and standards. The following additional Terms
and Conditions are incorporated into this RFP and any resulting contract, as required by
the Uniform Rules for procurement published by the U.S. Office of Management and
SECTION 5: SPECIFIC TERMS AND CONDITIONS
Pender County, North Carolina
RFP for EWP Management/Consulting Services
Page 20 of 45
Budget’s (OMB) Super Circular or the Code of Federal Regulations, Title 2, Chapter 200 (2
C.F.R. 200) as effective December 26, 2014.
i. Debarment and Suspension
(1) This contract is a covered transaction for purposes of 2 C.F.R. pt. 180 and 2 C.F.R.
pt. 3000. As such the Contractor is required to verify that none of the Contractor,
its principals (defined at 2 C.F.R. § 180.995), or its affiliates (defined at 2 C.F.R. §
180.905) are excluded (defined at 2 C.F.R. § 180.940) or disqualified (defined at 2
C.F.R. § 180.935).
(2) The Consultant must comply with 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000,
subpart C and must include a requirement to comply with these regulations in any
lower tier covered transaction it enters into.
(3) This certification is a material representation of fact relied upon by Pender County.
If it is later determined that the Contractor did not comply with 2 C.F.R. pt. 180,
subpart C and 2 C.F.R. pt. 3000, subpart C, in addition to remedies available to the
State of North Carolina and Pender County, the Federal Government may pursue
available remedies, including but not limited to suspension and/or debarment.
(4) The Offeror agrees to comply with the requirements of 2 C.F.R. pt. 180, Subpart C
and 2 C.F.R. pt. 3000, subpart C while this offer is valid and throughout the period
of any contract that may arise from this offer. The Offeror further agrees to include
a provision requiring such compliance in its lower tier covered transactions.
ii. Byrd Anti-Lobbying Amendment
Consultants who apply or bid for an award of $100,000 or more shall file the required
certification. Each tier certifies to the tier above that it will not and has not used Federal
appropriated funds to pay any person or organization for influencing or attempting to
influence an officer or employee of any agency, a member of Congress, officer or
employee of Congress, or an employee of a member of Congress in connection with
obtaining any Federal contract, grant, or any other award covered by 31 U.S.C. § 1352.
Each tier shall also disclose any lobbying with non-Federal funds that takes place in
connection with obtaining any Federal award. Such disclosures are forwarded from tier
to tier up to the recipient.
iii. Access to Records
(1) The Contractor agrees to provide Pender County, the State of North Carolina, the
FEMA Administrator, the Comptroller General of the United States, or any of their
authorized representatives access to any books, documents, papers, and records
of the Consultant which are directly pertinent to this contract for the purposes of
making audits, examinations, excerpts, and transcriptions.
SECTION 5: SPECIFIC TERMS AND CONDITIONS
Pender County, North Carolina
RFP for EWP Management/Consulting Services
Page 21 of 45
(2) The Consultant agrees to permit any of the foregoing parties to reproduce by any
means whatsoever or to copy excerpts and transcriptions as reasonably needed.
(3) The Consultant agrees to provide the NRCS Administrator or his authorized
representative’s access to construction or other work sites pertaining to the work
being completed under the contract.
iv. USDA Seal, Logo, and Flags
The Consultant shall not use the USDA seal(s), logos, crests, or reproductions of flags or
likenesses of USDA agency officials without specific USDA preapproval.
v. Compliance with Federal Law, Regulations, and Executive Orders
This is an acknowledgement that USDA financial assistance will be used to fund the
contract only. The Consultant will comply will all applicable federal law, regulations,
executive orders, USDA policies, procedures, and directives.
vi. No Obligation by Federal Government
The Federal Government is not a party to this contract and is not subject to any
obligations or liabilities to the non-Federal entity, Consultant, or any other party
pertaining to any matter resulting from the contract.
vii. Program Fraud and False or Fraudulent Statements or Related Acts
The Contractor acknowledges that 31 U.S.C. Chap. 38 (Administrative Remedies for False
Claims and Statements) applies to the Consultant’s actions pertaining to this contract.
viii. Full and Open Competition
This RFP is being solicited with the intent to provide full and open competition and no
preferences will be assigned based on geographic location or socio-economic status of
the offeror.
ix. Disadvantaged Business Enterprises
Qualified small businesses, minority-owned businesses, women-owned businesses and
otherwise disadvantaged businesses are encouraged to submit offers in response to this
RFP.
ATTACHMENT A: PROPOSAL FORM
Pender County, North Carolina
RFP for EWP Management/Consulting Services
Page 22 of 45
ATTACHMENT A: PROPOSAL FORMRFP # 201202-116
Completed, signed and notarized form shall be submitted with the proposal. Please attach a
copy of your registration with the North Carolina Secretary of State.
A. OFFEROR INFORMATION:
Firm/Company Name (legal name):
Mailing Address:
Payment Address (if different from mailing address):
Firm Telephone Number:
Federal Employer Identification Number (FEIN):
Social Security Number (only if FEIN is NOT provided):
Representative Name/Title:
Representative Telephone Number:
Representative Email Address:
B. AUTHORIZATION TO TRANSACT BUSINESS IN NORTH CAROLINA
By signature of this form, I certify that the firm identified above in Item A is legally
authorized to transact business in the State of North Carolina. A copy of the Certification of
Existence or registration is attached to this form.
North Carolina Secretary of State Identification Number (SOSID):
- OR -
Firm/company is not required to have/maintain registration because:
ATTACHMENT A: PROPOSAL FORM
Pender County, North Carolina
RFP for EWP Management/Consulting Services
Page 23 of 45
C. PAYMENT TERMS
Net 30
Other (Specify):
If payment terms are not specified above, then the terms shall be Net 30 Days.
D. ADDENDA
Offeror hereby acknowledges receipt of and incorporation of all requirements of any
addenda issued for this RFP:
Addendum No. Dated:
Addendum No. Dated:
Addendum No. Dated:
Addendum No. Dated:
E. EXCEPTIONS
Indicate if exceptions are requested by acknowledging the appropriate statement below, as
applicable:
Offeror understands and agrees to all terms, conditions, requirements, and
specifications stated herein.
Offeror takes exception to terms, conditions, requirements, or specifications stated
herein Offeror must itemize all exceptions below (attach additional pages if
necessary):
The following exceptions are noted (attach additional sheets if necessary):
ATTACHMENT A: PROPOSAL FORM
Pender County, North Carolina
RFP for EWP Management/Consulting Services
Page 24 of 45
NOTE: Exceptions taken from the stated terms and/or specifications may be cause
for proposals to be deemed "non-responsive".
F. COOPERATIVE PURCHASING
Offeror will extend term, conditions and prices to other jurisdictions.
Yes
No
G. PROPOSAL CHECKLIST
This checklist is provided to assist offerors in submitting proposals. The proposal should
include the following information in the quantities specified in Section 2.B Proposal
Submission Requirements.
Proposals developed according to the outline specified in Section 2.C Proposal
Format Requirements and according to the instructions in Section 2.B Proposal
Submission Requirements and elsewhere in this RFP.
Attachment A: Proposal Form
Attachment B: References Form
Attachment C: Price Proposal
Attachment D: Offeror’s Certification Form
Attachment E: Certification Regarding Lobbying
Attachment F: Pender County Vendor Form and Completed W-9 Form
H. CONFLICT OF INTEREST
The offeror certifies that their proposal has not been arrived at collusively or otherwise in
violation of federal, state or local laws. Any purchase order, check requisition or contract
from which any agent, officer or employee of the County or any relative thereof, will realize
a financial gain, directly or indirectly, shall be void, except that before the execution of a
purchase order, check requisition or contract, the County shall have the authority to waive
compliance with this section when it finds such action to be in the best interest of the
County.
ATTACHMENT A: PROPOSAL FORM
Pender County, North Carolina
RFP for EWP Management/Consulting Services
Page 25 of 45
I. AUTHORIZATION
In accordance with the terms, conditions and specifications of this RFP, the undersigned
agrees to furnish the items and/or services requested. The undersigned acknowledges that
the proposal is valid for a period of 180 days from the due date and certifies he/she has
read, understands, and agrees to all terms, conditions, and requirements of this RFP and is
authorized to contract on behalf of firm named below.
Firm Name:
Print Name:
Title:
Signature:
Date:
Subscribed and sworn to before me this day of , 2018.
Notary Public:
My Commission expires:
ATTACHMENT B: References
Pender County, North Carolina
RFP for EWP Management/Consulting Services
Page 26 of 45
ATTACHMENT B: REFERENCES
Completed form shall be submitted with the proposal. Provide at least three references.
References must be for similar services provided and must have been completed within the past
10 years.
Offeror Name:
Reference 1:
Name of Entity or Business:
Street Address:
City, State and Zip Code:
Contact Name and Title:
Phone Number:
Email Address:
Contract Dates:
Contract Amount:
Description of Services Provided:
Reference 2:
Name of Entity or Business:
Street Address:
City, State and Zip Code:
Contact Name and Title:
Phone Number:
Email Address:
Contract Dates:
Contract Amount:
Description of Services Provided:
ATTACHMENT B: References
Pender County, North Carolina
RFP for EWP Management/Consulting Services
Page 27 of 45
Offeror Name:
Reference 3:
Name of Entity or Business:
Street Address:
City, State and Zip Code:
Contact Name and Title:
Phone Number:
Email Address:
Contract Dates:
Contract Amount:
Description of Services Provided:
NOTE: Attach additional pages, as necessary.
ATTACHMENT C: PRICE PROPOSAL
Pender County, North Carolina
RFP for EWP Management/Consulting Services
Page 28 of 45
ATTACHMENT C: PRICE PROPOSAL
Completed form shall be submitted with the proposal to RFP # 201202-116.
Offeror Name:
Hourly Rate: $ /hour
SOW
Item
Description of Task/Service
Estimated
Quantity
(Hours)
Unit Price
(Estimated
Quantity x Hourly
Rate)
1 Damage Survey Reports (DSR) $
2 Easement Access/Right-of-Entry $
3 Title Search/Identification of Land Owners $
4
Contract Administration, Bid Solicitation, Bid
Tabulations, and Contractor Selection Support
$
5 Contract Management $
6
Reports (Daily Reports, 5-Day and Final
Report)/Meetings/Updates
$
7 Engineering Support $
8 Training/Preparedness; Meeting w/ Contractors $
9 New Technologies Assessment $
TOTAL $
NOTE: All rates are to be inclusive of travel, mileage and per diem. No hourly rate or
mobilization fee will be charged for travel to and from home office. If travel is directed by the
County to a conference or other event outside the jurisdiction, reimbursement for such travel
will be considered and will be in accordance with the Federal GSA per diem rates for travel.
ATTACHMENT D: OFFEROR’S CERTIFICATION FORM
Pender County, North Carolina
RFP for EWP Management/Consulting Services
Page 29 of 45
ATTACHMENT D: OFFEROR’S CERTIFICATION FORM
Completed, signed and notarized form shall be submitted with the proposal.
To Whom It May Concern:
I have carefully examined the Request for Proposal (RFP) and any other documents accompanying or
made a part of this RFP.
I hereby propose to perform the services as specified in the Scope of Work of this RFP at the rates
described on the completed Attachment C: Proposal Form.
I certify that all information contained in this proposal is truthful to the best of my knowledge and
belief. I further certify that I am duly authorized to submit this proposal on behalf of the firm as its act
and deed and that the firm is ready, willing and able to perform if awarded a contract by Pender
County.
I further certify, under oath, that this proposal is made without prior understanding, agreement,
connection, discussion, or collusion with any other person, firm or corporation submitting a proposal
for the same product or service; no officer employee or agent of the County of Pender or any other
offeror is interested in said proposal; and that the undersigned executed this Offeror’s Certification
with full knowledge and understanding of the matters therein contained and was duly authorized to do
so.
It is distinctly understood that Pender County reserves the right to reject any or all proposals.
Name of Firm:
Federal Employer Identification Number (FEIN):
Mailing Address:
City, State, Zip Code:
Phone: Email:
Name and Title:
Authorized Signature:
Date:
Subscribed and sworn to before me this day of , 2018.
Notary Public:
My Commission expires:
ATTACHMENT E: CERTIFICATION REGARDING LOBBYING
Pender County, North Carolina
RFP for EWP Management/Consulting Services
Page 30 of 45
ATTACHMENT E: CERTIFICATION REGARDING LOBBYING
Completed and signed form shall be submitted with each proposal offer exceeding $100,000.
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned [Consultant] certifies, to the best of his or her knowledge, that:
1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to
any person for influencing or attempting to influence an officer or employee of an agency, a Member
of Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with the awarding of any Federal contract, the making of any Federal grant, the making of
any Federal loan, the entering into of any cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.
2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress in connection with this
Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit
Standard Form LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions.
3. The undersigned shall require that the language of this certification be included in the award
documents for all sub awards at all tiers (including subcontracts, sub grants, and contracts under
grants, loans, and cooperative agreements) and that all sub recipients shall certify and disclose
accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making or
entering into this transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act
of 1995). Any person who fails to file the required certification shall be subject to a civil penalty of not
less than $10,000 and not more than $100,000 for each such failure.
The Consultant, , certifies or affirms
the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition,
the Contractor understands and agrees that the provisions of 31 U.S.C. § 3801 et seq., apply to this
certification and disclosure, if any.
Signature of Consultant’s Authorized Official:
Name and Title of Consultant’s Authorized Official:
Date:
ATTACHMENT F: W9
Pender County, North Carolina
RFP for EWP Management/Consulting Services
Page 31 of 45
ATTACHMENT F: W9
A completed W-9 Form is required for submittals. Please find this form attached on the following pages.
ATTACHMENT F: W9
Pender County, North Carolina
RFP for EWP Management/Consulting Services
Page 32 of 45
ATTACHMENT G: SAMPLE CONTRACT FOR THE PROVISION OF SERVICES
Pender County, North Carolina
RFP for Emergency Management Consulting Services
Page 33 of 45
ATTACHMENT G: SAMPLE CONTRACT FOR THE PROVISION OF SERVICES
Pender County, North Carolina
RFP for Emergency Management Consulting Services
Page 34 of 45
ATTACHMENT G: SAMPLE CONTRACT FOR THE PROVISION OF SERVICES
Pender County, North Carolina
RFP for Emergency Management Consulting Services
Page 35 of 45
ATTACHMENT G: SAMPLE CONTRACT FOR THE PROVISION OF SERVICES
Pender County, North Carolina
RFP for Emergency Management Consulting Services
Page 36 of 45
ATTACHMENT G: SAMPLE CONTRACT FOR THE PROVISION OF SERVICES
Pender County, North Carolina
RFP for Emergency Management Consulting Services
Page 37 of 45
ATTACHMENT G: SAMPLE CONTRACT FOR THE PROVISION OF SERVICES
Pender County, North Carolina
RFP for Emergency Management Consulting Services
Page 38 of 45
ATTACHMENT G: SAMPLE CONTRACT FOR THE PROVISION OF
SERVICES
Attachment G is provided for the review and reference of offerors only and does not need to be
submitted with proposal offers. The selected Contractor will be expected to enter into an agreement
based upon this sample contract. Any exceptions or deviations to the language contained in the sample
contract or this RFP that the offeror wishes to propose for consideration must be noted on Attachment
A: Proposal Form and submitted with the offeror’s proposal.
Sample Contract for The Provision of Services
Page 1 of 7
Pender County Government
805 S. Walker Street
Burgaw, North Carolina 28425
PO # XXXX
December 3, 2020
This contract is entered into by and between Pender County Government, Burgaw, North Carolina 28560, hereinafter called
the County and hereinafter referred to as Consultant, to provide to Pender County.
1. Contract Specifications: These attachments will be incorporated into the basic contract. The parties hereto agree that
contractor shall provide items and assume obligations set forth herein and in Attachments "A" through "C". In the event
of any inconsistency between terms, conditions or provisions appearing in Attachment "A" through "C", and terms and
conditions of the basic contract, the provisions of the basic contract shall apply. In addition to the terms set forth herein,
this contract consists of:
Attachment (A) Pender County General Provisions
Attachment (B) Pender County Purchase Order (if applicable)
Attachment (C) Contractor Agreement (if applicable)
Attachment (D) RFP and Bid Response
2. Contractor Requirements: Contractor will provide
3. Contract Period: Contract will become effective on date signed by both parties for and conclude when services are
complete on or before __________.
4. Payment: As consideration for Pender County’s receipt and delivery of services described in item “2” above, Pender
County agrees to pay the contractor a payment of $ . The date of issue of the Pender County check is the date
of payment.
5. Place of Services: All services that are the subject of this contract shall be delivered to the following address(es):
.
6. Obligations: Any claims or liabilities created by this contract are the exclusive responsibility of Pender County. This
contract shall not be construed to obligate any other Pender County fund or monies.
7. Taxes: This contract is subject to any applicable taxes. Pender County is not exempt from NC sales tax.
8. Inspection: Inspection will be made after delivery at the destination specified. Any discrepancies with the services not
in conformity with the specification of this contract will be addressed in accordance with the manufacturers warranties.
9. Modifications/Changes: This contract may be modified by written agreement of both parties. The contractor will not
represent in any manner, expressly or by implication, that services purchased under this contract are approved or
endorsed by any element of the local government. Any advertisement by the Contractor, which refers to Pender County
activity, will contain a statement that the advertisement was neither paid for nor sponsored, in whole or in part, by the
particular activity.
10. Entire Agreement: This contract represents the final and entire agreement of the parties and may not be contradicted
by evidence of prior, contemporaneous, or subsequent oral agreements of the parties. No additional agreements, term,
or conditions may be implied. In the event of conflict between the North Carolina General Statutes, the provisions of
the basic contract and the provisions of any attachment hereto, the N.C. General Statutes, followed by the provisions of
the basic contract govern.
Sample Contract for The Provision of Services
Page 2 of 7
11. Choice of Law: Exclusive Venue. Notwithstanding the principles of conflicts of law, the internal laws of the State of
North Carolina shall govern and control the validity, interpretation, performance, and enforcement of this Agreement.
Exclusive venue for any action, whether at law or in equity, shall be Pender County.
Executed By:
For Pender County: For Contractor:
Signature: Signature:
Printed Name: Printed Name:
Title: Title:
Company: Pender County Govt Company Name:
Address: Address:
City: Burgaw City:
State: North Carolina State:
Zip Code 28425 Zip Code:
Phone Number: Phone Number:
Date: Date:
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act.
Finance Officer
Sample Contract for The Provision of Services
Page 3 of 7
General Provisions
Attachment (A)
I-1. Definitions I-16. Warranty
I-2. E-Verify I-17. Item Substitution and Variation
I-3. Gratuities and Contingent Fees I-18. Inspection and Acceptance
I-4. Officials not to Benefit I-19. Availability of Funds
I-5. Oral Representations I-20. Invoicing and Payment
I-6. Non-Appropriation I-21. Withholding
I-7. Representations I-22. Contractor Liability
I-8. Advertisements I-23. Termination
I-9. Subcontracting I-24. Requests for Monetary or other Relief
I-10. Assignment I-25. Notification of Debarment or Suspension Status
I-11. Iran Divestment Act I-26. Equal Employment Opportunity
I-12. Permits and Licenses I-27. Drug-Free Work Place
I-13. Non-Waiver or Defaults I-28. Accident Prevention, Fire Protection, and Sanitation
I-14. Indemnity I-29. Standards
I-15. Insurance I-30. Force Majeure
I-31. Federal Funds
I-1. Definitions: As used throughout this contract, the following terms shall have the meaning set out below:
A. Pender County” refers to the Pender County Government activities and organizations.
B. “Contract” Identifies this contract or any modification thereto.
C. “Finance Director” means a person authorized in writing to execute and administer the contract on behalf of Pender County
or said Finance Director’s successor or successors. (Note: Other Pender County and Government Officials, who by virtue or
their positions are concerned with the administration and operation of this contract, may take certain administrative actions
in behalf of the Finance Director. These Officials may conduct inspections, process and collect contract payments, make
administrative decisions and perform other duties of an administrative nature. They may not waive or change contract terms;
impose additional contract requirements; issue cure, showing cause, or termination notices; or render final decisions
according to Contract terms. (Refer all questions concerning the authority of other Pender County or Government Officials
to the Finance Director.)
D. “Contractor or vendor” means the individual, partnership, corporation, or other entity which is a party to this contract and
who is responsible for all actions, performance and work there under, to include that of any subcontractor or vendor.
I-2. E-Verify: As a condition of payment for services rendered under this agreement, Vendor or Contractor shall comply with the
requirements of Article 2 of Chapter 64 of the General Statutes. Further, if Vendor or Contractor provides the services to the
County utilizing a subcontractor, Vendor or Contractor shall require the subcontractor to comply with the requirements of Article
2 of Chapter 64 of the General Statutes as well. Vendor or Contractor shall verify, by affidavit, compliance of the terms of this
section upon request by the County.
I-3. Gratuities and Contingent Fees: Contractor warrants that no person or selling agency has been employed or retained to secure
this contract upon an agreement or understanding for a commission, percentage, brokerage, or contingent fee excepting bona fide
employees or bona fide established commercial selling agencies retained by contractor or vendor for the purpose of securing
business. Contractor warrants that no gratuities (Entertainment, gifts, etc.) were or will be offered or given by the Contractor or
any person representing the Contractor to any Pender County Commissioner, employee, or spouse of an employee/Commissioner.
For breach of either of the warranties, Pender County may terminate this and all other Pender County Contracts for default and
deduct from amounts due under this or other contracts, or bill contractor or vendor for the total value of any contingent fee or
gratuity.
I-4. Officials Not to Benefit: No person or Commissioner involved in the purchasing process and/or contracting of this agreement,
shall be admitted to any share or part of this contract, or to any benefit that may arise there from; but this provision shall not be
construed to extend to this contract if made with a corporation for its general benefit.
I-5. Oral Representations: This written Contract includes the entire agreement between the parties. Pender County will not be bound
by any oral or written representation not included in the written contract or a change or amendments thereto. Pender County will
not be bound by any terms on contractor or vendor forms or letter unless such terms are specifically agreed to and incorporated
in the contract and signed by the Finance Director.
I-6. Non-Appropriation: All funds for payment by County under this Contract are subject to the availability of any annual
appropriation for this purpose by the Board of Commissioners. In the event of non-appropriation of funds by the Board of
Commissioners under the Contract, County will terminate the Contract, without termination charge or liability, on the last day of
Sample Contract for The Provision of Services
Page 4 of 7
the then-current fiscal year or when the appropriation made for then-current year for the services/items covered by this Contract
is spent, whichever occurs first. If at any time funds are not appropriated for the continuance of this Contract, cancellation shall
be accepted upon three (3) days prior written notice, but failure to give such notice shall be of no effect and County shall not be
obligated under this Contract beyond the date of termination.
I-7. Representations: The Contractor will not represent itself to be an agent or representative of Pender County or any other agency
or instrumentality of the US Government.
I-8. Advertisements: The Contractor will not represent in any manner, expressly or by implication, those items or services purchased
or sold under this contract are approved or endorsed by any element of Pender County Government. Any advertisement, including
cents off coupons, by the Contractor which refers to Pender County activity will contain a statement that the advertisement was
neither paid for nor sponsored, in whole or in part, by the particular activity.
I-9. Subcontracting: Contractor shall not subcontract any part of the work to be performed without the prior written consent of the
Finance Director. Any subcontractor or vendor used in connection with this contract is the agent of the Finance Director.
I-10. Assignment: Contractor may not assign its rights or delegate its obligations under this contract without the prior written consent
of the Finance Director.
I-11. Iran Divestment Act: Seller certifies that: (i) Seller is not listed on the Iran Divestment List created by the State Treasurer
pursuant to N.C.G.S. § 147-86.58 (the “Final Divestment List”), and (ii) Seller will not utilize any subcontractor performing work
under this Purchase Order which is listed on the Final Divestment List. The Final Divestment List can be found on the State
Treasurer’s website at the address www.nctreasurer.com/Iran and should be updated every 180 days.
I-12. Permits and Licenses: Contractor will, at his own expense, obtain all necessary permits, give all notices, pay all license fees
and comply with all laws, rules, ordinances, and regulations relating to the preservation of the public health or applicable to the
services or business carried on under this contract. The burden of determining applicability of licensing requirements, laws,
ordinances, and regulations for Contractor and his employees rests with the Contractor.
I-13. Non-Waiver or Defaults: Any failure by Pender County at any time to enforce or require strict performance of any terms or
conditions of this contract will not constitute waiver thereof and will not affect or impair such terms and conditions in any way
or Pender County’s right at any time to avail itself of such remedies as it may have for breach or breaches of such terms and
conditions.
I-14. Indemnity:
A. Contractor shall indemnify, hold harmless and defend Pender County, their agents, representatives, employees and customers
from any and all suits, judgments and claims, including those established by or pursuant to court decisions, to international
agreements, or duly promulgated regulations of the United States Government, and all charges and expenses incident
thereto which arise out of or in connection with:
1. The alleged or established violation or infringement of any patent, copyright or trademark rights asserted by any
third party with regard to items or services provided by Contractor:
2. Loss, death, damage or injury alleged or established to have arisen out of or in connection with products, services,
or equipment provided by Contractor, unless such loss, death, damage, or injury was caused by Pender County, its
representatives, or employees.
3. Any loss, death, damage, or injury alleged or established to have arisen out of or in connection with any other acts
or omissions of the Contractor, the Contractor’s subcontractor or vendors, representatives, agents, or employees.
B. Pender County will give Contractor notice and an opportunity to defend.
I-15. Insurance: During the term of the Contract, the Contractor or vendor at its sole cost and expense shall provide commercial
insurance of such type and with such terms and limits as may be reasonably associated with the contract. As a minimum, the
Contractor or vendor shall provide and maintain the following coverage and limits.
A. Worker’s Compensation The Contractor or vendor shall provide and maintain worker’s compensation insurance, as
required by the laws of North Carolina, as well as employer’s liability coverage with minimum limits of $150,000, covering
all of Contractor or vendor’s employees who are engaged in any work under the contract. If any work is sublet, the Contractor
or vendor shall require the subcontractor to provide the same coverage for any of his employees engaged in any work under
the contract.
B. Commercial General LiabilityGeneral Liability Coverage, on a Comprehensive Broad Form on an occurrence basis in the
minimum amount of $500,000.00 combined single limit (Defense cost shall be in excess of the limit of liability).
Sample Contract for The Provision of Services
Page 5 of 7
C. Automobile Automobile Liability Insurance, to include liability coverage, covering all owned, hired and non-owned
vehicles used in connection with the contract. The minimum combined single limit shall be $150,000.00 bodily injury and
property damage; $150,000.00 uninsured/under-insured motorist; and $1,000.00 medical payment.
I-16. Warranty: Contractor warrants that:
A. The items furnished shall be merchantable, and fit and sufficient for the use intended and are not “seconds” as the term is
normally understood in the trade. This warranty shall survive acceptance by Pender County of the items and is in addition
to other warranties of additional scope given by the Contractor to Pender County.
B. The items or services furnished under this contract are covered by the most favorable warranties the Contractor gives to any
customer for such items or services and that the rights and remedies provided in the Contractor’s warranties are in addition
to and do not limit any rights afforded to Pender County by any other clause of this contract.
C. Where applicable, the items furnished under this contract have been manufactured in accordance with Underwriter’s
Laboratories, Inc. (UL) standard, or if manufactured overseas, the overseas equivalent of UL and the applicable item and/or
component items carry the appropriate UL or overseas equivalent seal of approval.
D. Items, packing, and packaging provided will comply with all contract terms and with all laws, rules, and regulations
applicable to delivery for domestic resale. Contractor shall comply with the Magnuson-Moss Warranty Act on all sales to
Pender County.
I-17. Item Substitution and Variation in Quantity: No substitution or variation in the quantity of any item called for by this contract
will be accepted unless authorized by the Finance Director.
I-18. Inspection and Acceptance: the government per the following shall make inspection and acceptance:
A. The Contractor shall maintain an in process and end-item quantity control program to ensure shipments to Pender County
activities do not include defective/non-conforming items.
B. Inspection and acceptance shall not be conclusive with respect to latent defects or fraud, or with respect to Pender County
rights under the warranty provisions contained herein.
C. In case any supplies or services are defective in material or workmanship, or are otherwise not in conformity with the
requirements of this contract, the Pender County shall have the right to reject such supplies or services, or to require
replacement or correction. Rejected supplies shall be removed by and at the expense of the Contractor promptly after notice.
When such rejection, correction or replacement requires transportation of the supplies or part thereof, all shipping and
administrative costs to and from the Contractor’s plant shall also be borne by the Contractor.
D. In case of refund, the Contractor shall be liable to the Pender County for the additional costs of re-procurement (if any). In
no event will the liability of Contractor for cost and losses, and for re-procurement exceed an amount equal to the original
purchase price of the defective item.
E. The provisions of this clause do not affect the rights or obligations of either party, as they may be provided for in other
portions of this contract or otherwise under applicable law.
I-19. Availability of Funds: Any and all payments to the Contractor or vendor are dependent upon and subject to the availability of
funds to the County for the purposes set forth in this agreement.
I-20. Invoice and Payment:
A. Invoicing Instructions. In order to be considered proper invoices, invoices must be submitted as follows:
1. Contractor must prepare a separate numbered invoice for each order or part of an order. Do not consolidate multiple
purchase orders on one invoice. Additionally, when partial shipments are authorized, use a separate invoice. Do
not duplicate an invoice number used for prior billings:
2. Invoices must be issued by the company whose name is on the contract/order (unless otherwise authorized by
Finance Director) and must contain the following minimum information to enable timely payment:
(a) Name of Contractor.
(b) Invoice Date. This cannot be a date earlier than the ship date required by the contract or purchase/deliver
order. In the event that the invoice date is a date earlier than the required ship date, Pender County retains
the right either to return the improper invoice to the Contractor for correction or to change the invoice
date to be the required ship date. In the event that an improper invoice is returned to a Contractor because
the date on the invoice is earlier than the required ship date or because the invoice is improper for any
other reason, the invoice date, will be considered to be the date of receipt of the corrected, proper invoice.
(c) Contract/Order Number.
(d) Item Description and Quantity Shipped/Delivered.
(e) Contract/Order Line Item Cost and Total
(f) Any applicable sales tax
(g) Shipping and Discount Terms, and special allowance(s) if included in the contract. Special allowances
must be shown on the invoice using percentage figures only. Do not deduct any of these from the item
cost or from the invoice total.
Sample Contract for The Provision of Services
Page 6 of 7
(h) “Ship To” address as shown on order or contract.
(i) Freight charges (on FOB origin shipments).
(j) Name, title and phone number of Contractor’s contact person.
(k) Complete “Remit To” mailing address on the invoice to indicate where Contractor’s payment is to be
sent. This address must be the same address as on the contract unless otherwise communicated from the
Accounts Payable office
3. Correcting invoices and credit memos must be marked as such and must cross-reference the corrected invoice.
B. Payment.
1. A proper invoice is an invoice which contains all of the information/documentation, specified in paragraph A. (2)
above, and is sent to the address specified in the contract or purchase/delivery order for the designated Pender
County paying office. Improper invoices may be returned without payment to the Contractor.
2. The next payment date for Pender County Contracts is established at 30 days after receipt of a proper invoice.
3. Payment is made:
(a) The date a check for payment is dated.
(b) The date an electronic fund transfer is submitted to the financial institution, regardless of the date the
financial institution posts the transfer.
(c) The date a withholding authorized by the contract is initiated by Pender County.
4. Any questions or inquiries concerning invoice payments should be directed to the Pender County Finance Account
Payable department designated on the contract or purchase/deliver order.
I-21. Withholding: Pender County may withhold payment for amounts due or creditable to Pender County under this contract, E.G.,
returns, damage.
I-22. Contractor Liability:
A. Except as set out specifically elsewhere in the contract, Contractor shall be liable for cost to Pender County associated with
termination for default, rejection of items, and breach of warranty, in addition to reimbursement of payment of the purchase
price and re-procurement costs.
B. Contractor will not be liable for damages if the failure to perform arises out of causes beyond the control and without the
fault or negligence of the Contractor. Such causes may include, but are not restricted to, Acts of God or the public enemy,
Acts of the Government in its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes,
freight embargoes, and unusually severe weather.
I-23. Termination:
A. Mutual Termination. This contract may be terminated at any time upon the mutual agreement of both parties.
B. Termination for Convenience. Pender County by written notice may terminate this contract in whole or in part when it is in
the best interest of the Pender County. To the extent that this contract is for services and is so terminated, Pender County
shall be liable for payment as set forth in the payment provisions of the contract for services rendered prior to the effective
date of termination
C. Termination for Default. Pender County by written notice may terminate this contract in whole or in part for failure of the
Contractor to perform any of the provisions hereof. In such event, the Contractor shall be liable for damages including the
excess costs of re-procuring similar supplies and services provided that if
1. the Contractor was not in default; or
2. the Contractor’s failure to perform is without his/her or his/her Subcontractor or vendor’s control or negligence;
then the termination shall be deemed a “Termination for Convenience.”
D. The rights and remedies of Pender County provided in this clause are in addition to any other rights and remedies provided
by law or under other clauses of this contract.
I-24. Request for Monetary or Other Relief: No request for monetary or other relief by Contractor shall be considered unless
submitted in writing to the Finance Director within 90 days after termination or termination of performance under the contract,
whichever comes first. This clause shall not extend any period for filing, which is further limited by another clause of the contract.
I-25. Notification of Debarment or Suspension Status: The Contractor or Vendor shall provide immediate notice to the Finance
Director in the event of being suspended, debarred or declared ineligible by any state of NC or federal department or agency, or
upon receipt of a notice of proposed debarment from another agency, during the performance of this contract.
I-26. Equal Employment Opportunity: The contractor will take affirmative action in complying with all Federal and State
requirements concerning fair employment and employment of people with disabilities, and concerning the treatment of all
employees without regard to discrimination by reason of race, color, religion, sex, national origin or disability.
I-27. Drug-Free Work Place: The contractor or vendor agrees to make a good faith effort to establish and maintain a drug-free work
place in connection with the performance of this contract. Consistent with the size and organization of its work force, contractor
Sample Contract for The Provision of Services
Page 7 of 7
or vendor may wish to consider taking the following or other appropriate actions in establishing a drug-free work place:
Publicizing a drug-free work place policy; initiating an employee drug awareness program or encouraging participation in existing
community programs; informing employees of the general availability of drug counseling programs; etc.
I-28. Accident Prevention, Fire Protection, and Sanitation: If this contract is performed in whole or in part on premises owned or
under the control of the Pender County Government, the contractor or vendor shall conform to all safety regulations and
requirements concerning such premises in effect any time during contract performance to prevent accidents. Any violations of
safety regulations, unless immediately corrected as directed by the Finance Director, shall be grounds for termination of the
contract under the “Termination for Default” Clause.
I-29. Standards: All manufactured items and/or fabricated assemblies subject to operation under pressure, operation by connection
to an electric source, or operation involving a connection to a manufactured, natural, or LP gas source shall be constructed and
approved in a manner acceptable to the appropriate state inspector which customarily requires the label or re-examination listing
or identification marking of the appropriate safety standard organization; such as the American Society of Mechanical Engineers
for pressure vessels;
The Underwriters Laboratories and/or National Electrical Manufacturers’ Association for electrically operated assemblies; or the
American Gas Association for gas operated assemblies, where such approvals of listings have been established for the type of
device offered and furnished. Further, all items furnished shall meet all requirements of the Occupational Safety and Health Act
(OSHA), and state and federal requirements relating to clean air and water pollution.
All Codes, standards, and specifications such as the National Electrical Code, North Carolina State Building Code, ASTM
specifications, etc. referred to in the project specification shall be the issue in effect on the date of the invitation for bid, request
for quote, and/or award.
I-30. Force Majeure: Neither party shall be deemed to be in default of its obligations hereunder if and so long as it is prevented from
performing such obligations by any act of war, hostile foreign action, nuclear explosion, riot, strikes, civil insurrection,
earthquake, hurricane, tornado, or other catastrophic natural event or act of God.
I-31. Federal Funds: The following federal provisions apply pursuant to 2 C.F.R. § 200.326 and 2 C.F.R. Part 200, Appendix II
(as may be applicable):
A. Equal Employment Opportunity (41 C.F.R. Part 60);
B. Davis-Bacon Act (40 U.S.C. 3141-3148);
C. Copeland “Anti-Kickback” Act (40 U.S.C. 3145);
D. Contract Work Hours and Safety Standards Act (40 U.S.C. 3701-3708);
E. Clean Air Act (42 U.S.C. 7401-76711q.) and the Federal Water Pollution Control Act
(33 U.S.C. 1251-1387);
F. Debarment and Suspension (Executive Orders 12549 and 12689);
G. Byrd Anti-Lobbying Amendment (31 U.S.C. 1352);
H. Procurement of Recovered Materials (2 C.F.R. § 200.322); and
I. Record Retention Requirements (2 C.F.R. § 200.324)
Further, to the extent any of the provisions of this Section I-31 conflicts with any other provisions of the Contract, the provisions of this
Section I-31 shall control and take precedence.
Pender County RFP # 2201202-116
Emergency Watershed Protection-Management/Consulting Services
APPENDIX A - Application and Damage Survey Reports (113 pages)
NRCS-PDM-20
1 of 11
June 2016
Natural Resources Conservation Service
DAMAGE SURVEY REPORT (DSR)
E
mergency Watershed Protection Program Recovery
Section 1B - Sponsor Information
Sponsor Name:
Address:
City/State/Zip:
Telephone Number
Fax:
Section 1A
Date of report
DSR number
Project number
NRCS Entry Only
Eligible: Yes No
Approved: Yes No
Funding priority number (from sect. 4)
Limited Resource Area: Yes No
1 Major disaster declaration
2 Emergency declaration
3 Fire management assistance declaration
4 Local
declaration
Section 1C - Site Location Information
State Congressional District
Longitude
UTM Coordinates
Site name
County:
Latitude
Drainage name
Reach
Damage description
11/7/2019
37-07-18-5038-485
37-07-18-5038-485
2c,d,e & 3c,d,e
Pender County
PO Box 5 – 805 S. Walker Street
Burgaw, NC 28425
910) 259-1200
Pender
NC
07
34.5094
-78.0445
UT Long Creek
Curie 1
400 ft up/downstream of Malpass Corner Rd
Downed trees and other debris are in and/or over the stream.
- - -
NRCS-PDM-20
2 of 11
June 2016
Section 1D - Site Evaluation
All answers in this section must be YES to be eligible for EWP assistance.
Site Eligibility YES NO Remarks
Damage was a result of a natural disaster?
1
Recovery measures would be for runoff retardation or soil
erosion prevention?
1
Threat to life and/or property?
1
Event caused a sudden impairment in the watershed?
1
Imminent threat was created by this event?
2
For structural repairs, not repaired twice within 10 years?
2
Site Defensibility
Economic, environmental, and social documentation adequate
to warrant action? (See completed NRCS-CPA-52 and sections
3 and 4 of DSR.
3
)
Proposed action technically viable? (See section 6.
3
)
1
Statutory
2
Regulation
3
The completed DSR and Form NRCS-CPA-52, “Environmental Evaluation Worksheet,are required to support the decisions recorded on this
summary page. If additional space is needed on this or any other page in this form, add appropriate pages.
Have all the appropriate steps been taken to en
sure that all segments of the affected population have been
informed of the EWP program and its possible effects?
YES NO
Comments:
Section 1E - Proposed Action
Describe the preferred alternative (same as NRCS CPA-52, boxes M and G)
Total installation cost identified in this
DSR from section 6:
DSR NO:
NRCS 75% cost-share:
Sponsor 25% cost-share:
37-07-18-5038-485
Hurricane Florence
Clearing and Snagging
Blocked stream flow can cause flooding of streets, business, homes and
property.
Downed trees & debris reduced stream flow.
Impairment caused an imminent threat
No known repairs in the past 10 years
Action would reduce the imminent threat
to life and property.
Action would reduce threat
Return the stream flow to the pre-storm condition by removing downed trees and other debris from in
and over the stream channel.
$ 13,000.00
$ 9,750.00
$ 3,250.00
NRCS-PDM-20
3 of 11
June 2016
Section 1F - NRCS State Office Review and Approval
Reviewed by:
Date reviewed
State EWP Program Manager
Approved by:
Date approved
State Conservationist
DSR NO:
37-07-18-5038-485
NRCS-PDM-20
DSR NO:
4 of 11
June 2016
Section 2 - Environmental Evaluation and Special Environmental Concerns
See attached NRCS-CPA-52, Environmental Evaluation Worksheet
Section 3 - Economic Considerations
This section must be completed for each alternative considered (attach additional sheets as necessary).
-
Future
Damages ($)
Damage
Factor (%)
Near Term
Damage
Reduction
Properties protected (private)
Properties protected (public)
Business losses
Other
Total near term damage reduction $
Net benefit (total near term
damage reduction minus Cost from section 6)
Completed by:
Date:
-
-
-
- -
-
- -
-
- -
-
37-07-18-5038-485
Road Crossing
$ 30,000.00
50
$ 15,000.00
$ 15,000.00
$ 2,000.00
Alan Walker
11/7/2019
NRCS-PDM-20
DSR NO:
5 of 11
June 2016
Section 4 - Social Consideration
This section must be completed for ea
ch alternative considered (attach additional sheets as necessary).
YES
NO
Remarks
Has there been a loss of life as
a result of the watershed
impairment?
Is there the potential for loss of
life due to damages from the
watershed impairment?
Has access to a hospital or
medical facility been impaired
by watershed impairment?
Has the community as a whole
been adversely impacted by the
watershed impairment (life and
property ceases to operate in a
normal capacity)
Is there a lack or has there been
a reduction of public safety
due to watershed impairment?
Completed by:
Date:
37-07-18-5038-485
No reported loss of life
Blocked stream flow can cause flooding of streets, business
and homes, in addition breaching roads.
No reported impairment.
Blocked stream flow caused flooding of streets,
business and homes which impacted the entire
community.
Blocked stream flow can cause flooding of streets, business
and homes, which reduced public safety.
Alan Walker
11/7/2019
NRCS-PDM-20
6 of 11
June 2016
Group Representation
Number
American Indian/Alaska Native Female Hispanic
American Indian/Alaska Native Female Non-Hispanic
American Indian/Alaska Native Male Hispanic
American Indian/Alaska Native Male Non-Hispanic
Asian Female Hispanic
Asian Female Non-Hispanic
Asian Male Hispanic
Asian Male Non-Hispanic
Black or African American Female Hispanic
Black or African American Female Non-Hispanic
Black or African American Male Hispanic
Black or African American Male Non-Hispanic
Hawaiian Native/Pacific Islander Female Hispanic
Hawaiian Native/Pacific Islander Female Non-Hispanic
Hawaiian Native/Pacific Islander Male Hispanic
Hawaiian Native/Pacific Islander Male Non-Hispanic
White Female Hispanic
White Female Non-Hispanic
White Male Hispanic
White Male Non-Hispanic
Total Group
Census tract(s)
Completed by:
Date:
DSR NO:
Section 5 - Group Representation Information
This section is completed only for the preferred alternative selected.
52
,867
37-07-18-5038-485
18
104
18
103
4
96
4
95
2
4,630
1
4,586
-
21
-
21
597
21,090
592
20,885
Alan Walker
11/7/2019
NRCS-PDM-20
DSR NO:
7 of 11
June 2016
Section 6 - Engineering Cost Estimate
This section must be completed for each alternative considered (attach additional sheets as necessary).
Proposed recovery measure (including mitigation) Quantity Units Unit cost ($)
Total installation cost (enter in sections 1E and 3) $
Unit Abbreviations
AC
acre
CY
cubic yard
EA
each
HR
hour
LF
linear feet
LS
lump sum
SF
square feet
SY
square yard
TN
ton
Other
(specify)
Completed by:
Date:
Amount ($)
37-07-18-5038-485
Debris removal (woody, sediment, etc.)
800
ft
$ 10.00
$ 8,000.00
Mobilization/demobilization
1
Job
$ 5,000.00
5,000.00
13,000.00
Alan Walker
11/7/2019
NRCS-PDM-20
DSR NO:
8 of 11
June 2016
Section 7 - NRCS EWP Funding Priority
Complete the following section to compute the funding priority for the recovery measures in this application (see
instructions on page 9).
Priority Ranking Criteria Yes No
Ranking
Number
Plus
Modifier
1. Is this an exigency situation?
2. Is this a site where there is serious, but not immediate threat to human
life?
3. Is this a site where buildings, utilities, or other important
infrastructure components are threatened?
4. Is this site a funding priority established by the NRCS Chef?
The following are modifiers for the above criteria
Modifier
a. Will the proposed action or alternatives protect or conserve federally
-
listed threatened and endangered species or critical habitat?
b. Will the proposed action or alternatives protect or conserve cultural
sites listed on the National Register of Historic Places?
c. Will the proposed action or alternatives protect or conserve prime or
important farmland?
d. Will the proposed action or alternatives protect or conserve existing
wetlands?
e. Will the proposed action or alternatives maintain or improve current
water quality conditions?
f. Will the proposed action or alternatives protect or conserve unique
habitat, including but not limited to, areas inhabited by State-listed
species, fish and wildlife management area, or State identified sensitive
habitats?
Enter priority computation in section 1A, “NRCS Entry Only” box, in “Funding priority number.
Remarks:
37-07-18-5038-485
2 c,d,e
3 c,d,e
X
X
X
NRCS-PDM-20
DSR NO:
9 of 11
June 2016
Section 8 - Findings
Enter NEPA compliance finding from section Q of the NRCS-CPA-52.
The DSR was reviewed with the sponsors. Yes No
NRCS representative of the DSR team: ___________________________
Title: ______________________________ Date: ____________________
Section 9 - Attachments:
A. Location map
B. Site plan or sketches
C. NRCS-CPA-52, Environmental Evaluation
Worksheet
D. Other (explain)
37-07-18-5038-485
NRCS-PDM-20
10 of 11
June 2016
Instructions for Completing the NRCS-PDM-20, DSR
-
Explanation of Requested Item
Who Completes
Section 1
Enter Site Sponsor, Location, Evaluation, Selected Alternative,
and Reviewed and Approval Signatures.
NRCS completes
with voluntary
assistance from
Sponsor except
for NRCS-only
portion of section
1A.
1A
Enter the Date, DSR Number, and Project Number. For NRCS
only enter Eligible Yes/No, Approved Yes/No, Funding Priority
Number, and Limited Resource Area Yes/No.
1B
Enter Sponsor Name, Address, Telephone, Fax
1C
Enter site location County, State, Congressional District, Latitude,
Longitude, Section, Township, Range, UTM Coordinates,
Drainage name, Reach within drainage, and Damage description.
1D
Enter Yes/No and any Remarks for the Site Evaluation
information. Any No response means the site is not eligible for
EWP assistance and no further information is necessary to
complete the DSR. (See NEWPPM 390-502.03 and 390-502-04)
Enter Yes/No regarding whether the affected public has been
informed of the EWP program.
1E
Enter the proposed treatment and the cost of installation.
NRCS only.
1F
NRCS Review and Approval.
Section 2
Attach NRCS-CPA 52 that addresses environmental evaluation
and special environmental concerns
NRCS only.
Section 3
Identify Property protected both private and public, business
losses and other economic impacts considered for each
alternative. Enter the dollar value of the potential future damages
if no action is taken in the Future Damage (5) column. This
would be the estimate of the value lost if the EWP recovery
measure is not installed. Use the repair cost or damage dollar
method to determine the estimate of future damages. The repair
cost method uses the costs to return the impaired property, good,
or services based on their original prevent condition or value. The
damage dollar method uses an estimate of the future damage to
value (e.g., if the structure is condemned, then enter the value of
the structure). Enter the estimated amount based upon existing
information or information furnished by the sponsor, contractors,
or others with specific knowledge for recovery from natural
disasters for each alternative considered. Often market values for
properties or services can be obtained from personnel at the local
county/parish tax assessment office.
The DSR team needs to determine the Damage Factor (%) which
is a coefficient that indicates the degree of damage reduction to a
property that is attributed to the effect of the proposed EWP
recovery measures. Use an appropriate estimate of how much of
the damage the EWP recovery measure will avoid for the
alternative being considered. If the recovery measures from a
single site will prevent 100 percent of the damage use 100 percent.
The Near Term Damage Reduction is the Future Damage ($) times
the Damage Factor (%). Sum the Near Term Damage Reduction
values to calculate the Total Near Term Damage Reduction. Enter
the Net Benefit which is computed by subtracting the Cost from
Section 6 from the total near term damage reduction. The
NRCS completes
with voluntary
assistance from
Sponsor.
NRCS-PDM-20
11 of 11
June 2016
-
Explanation of Requested Item
Who Completes
economic section must be completed for each alternative
considered. Attach additional sheets as necessary.
Section 4
Enter information to describe the potential social impacts
and considerations for each alternative. Answer Yes or No
and any remarks necessary to adequately address each
question. The information may be obtained through
interviews with community leaders, government officials or
sponsors.
Factors such as road closures, loss of water, electricity, access to
emergency services are used when answering whether the
community as a whole has been impaired.
This information is part of the environmental evaluation (NRCS-
CPA-52) but may be pertinent in section 7 regarding funding
priorities. The Social Considerations section must be completed for
each alternative considered. Attach additional sheets as necessary.
NRCS completes
with voluntary
assistance from
Sponsor.
Section 5
Enter the Group Representation for the preferred alternative. Use
the most recent census tract information based upon where the
EWP recovery measures are located.
NRCS completes
using most recent
U.S. Census data.
Section 6
Enter Proposed Recovery Measure(s) including Quantity, Units,
Unit Cost, and Total Amount Cost.
Enter sum of all Proposed Recovery Measure Costs to calculate
Total Costs. Enter Total Installation Costs in Section 1E. The
Engineering Cost Estimate must be completed for each alternative
considered. Attach additional sheets as necessary.
NRCS completes
with voluntary
assistance from
Sponsor.
Section 7
This section is used to determine the Funding Priority for the
preferred alternative and sequence for initiating recovery
measures
. Enter Yes/No for questions 1 through 4 and enter the
number (exigency 1, serious threat to human life 2, etc.) in the
right column, Ranking Number Plus Modifier. Complete the
Modifier portion by placing the alphabetic indicator a through f in
the Modifier column. Complete the Ranking Number Plus
Modifier column by entering the alphabetic indictor(s) that exists
within the site. The number of the site designates the priority
(e.g., a site with a designation of 2 is a higher priority that a site
with a designation of 3). The modifiers increase the priority for
the same numeric site (e.g., a site with a designation of 1a, would
be a higher priority than a site with a designation of 1, a site with a
designation of 2bc would be a higher priority than a site
designated as 2b). Enter the Funding Priority in Section 1A.
NRCS completes
with voluntary
assistance from
Sponsor.
Section 8
Insert the number of the Finding that was checked in section Q of
the NRCS-CPA-52. If action is required to meet NEPA
requirements, state whether an EA or EIS will be prepared or
adopted.”
NRCS only.
Section 9
Include attachments for location map, site sketch or plan, a
completed NRCS-CPA-52, Environmental Evaluation Worksheet,
and other information as needed.
NRCS completes
with voluntary
assistance from
Sponsor.
NRCS-PDM-20
1 of 11
June 2016
Natural Resources Conservation Service
DAMAGE SURVEY REPORT (DSR)
E
mergency Watershed Protection Program Recovery
Section 1B - Sponsor Information
Sponsor Name:
Address:
City/State/Zip:
Telephone Number
Fax:
Section 1A
Date of report
DSR number
Project number
NRCS Entry Only
Eligible: Yes No
Approved: Yes No
Funding priority number (from sect. 4)
Limited Resource Area: Yes No
1 Major disaster declaration
2 Emergency declaration
3 Fire management assistance declaration
4 Local
declaration
Section 1C - Site Location Information
State Congressional District
Longitude
UTM Coordinates
Site name
County:
Latitude
Drainage name
Reach
Damage description
11/7/2019
37-07-18-5038-486
37-07-18-5038-486
2c,d,e & 3c,d,e
Pender County
PO Box 5 – 805 S. Walker Street
Burgaw, NC 28425
910) 259-1200
Pender
NC
07
34.4904
-78.0739
Big Branch
Curie 2
200 ft. downstream of Malpass Corner Rd
Downed trees and other debris are in and/or over the stream.
- - -
NRCS-PDM-20
2 of 11
June 2016
Section 1D - Site Evaluation
All answers in this section must be YES to be eligible for EWP assistance.
Site Eligibility YES NO Remarks
Damage was a result of a natural disaster?
1
Recovery measures would be for runoff retardation or soil
erosion prevention?
1
Threat to life and/or property?
1
Event caused a sudden impairment in the watershed?
1
Imminent threat was created by this event?
2
For structural repairs, not repaired twice within 10 years?
2
Site Defensibility
Economic, environmental, and social documentation adequate
to warrant action? (See completed NRCS-CPA-52 and sections
3 and 4 of DSR.
3
)
Proposed action technically viable? (See section 6.
3
)
1
Statutory
2
Regulation
3
The completed DSR and Form NRCS-CPA-52, “Environmental Evaluation Worksheet,are required to support the decisions recorded on this
summary page. If additional space is needed on this or any other page in this form, add appropriate pages.
Have all the appropriate steps been taken to en
sure that all segments of the affected population have been
informed of the EWP program and its possible effects?
YES NO
Comments:
Section 1E - Proposed Action
Describe the preferred alternative (same as NRCS CPA-52, boxes M and G)
Total installation cost identified in this
DSR from section 6:
DSR NO:
NRCS 75% cost-share:
Sponsor 25% cost-share:
37-07-18-5038-486
Hurricane Florence
Clearing and Snagging
Blocked stream flow can cause flooding of streets, business, homes and
property.
Downed trees & debris reduced stream flow.
Impairment caused an imminent threat
No known repairs in the past 10 years
Action would reduce the imminent threat
to life and property.
Action would reduce threat
Return the stream flow to the pre-storm condition by removing downed trees and other debris from in
and over the stream channel.
$ 7,000.00
$ 5,250.00
$ 1,750.00
NRCS-PDM-20
3 of 11
June 2016
Section 1F - NRCS State Office Review and Approval
Reviewed by:
Date reviewed
State EWP Program Manager
Approved by:
Date approved
State Conservationist
DSR NO:
37-07-18-5038-486
NRCS-PDM-20
DSR NO:
4 of 11
June 2016
Section 2 - Environmental Evaluation and Special Environmental Concerns
See attached NRCS-CPA-52, Environmental Evaluation Worksheet
Section 3 - Economic Considerations
This section must be completed for each alternative considered (attach additional sheets as necessary).
-
Future
Damages ($)
Damage
Factor (%)
Near Term
Damage
Reduction
Properties protected (private)
Properties protected (public)
Business losses
Other
Total near term damage reduction $
Net benefit (total near term
damage reduction minus Cost from section 6)
Completed by:
Date:
-
-
-
- -
-
- -
-
- -
-
37-07-18-5038-486
Road Crossing
$ 30,000.00
50
$ 15,000.00
$ 15,000.00
$ 8,000.00
Alan Walker
11/7/2019
NRCS-PDM-20
DSR NO:
5 of 11
June 2016
Section 4 - Social Consideration
This section must be completed for ea
ch alternative considered (attach additional sheets as necessary).
YES
NO
Remarks
Has there been a loss of life as
a result of the watershed
impairment?
Is there the potential for loss of
life due to damages from the
watershed impairment?
Has access to a hospital or
medical facility been impaired
by watershed impairment?
Has the community as a whole
been adversely impacted by the
watershed impairment (life and
property ceases to operate in a
normal capacity)
Is there a lack or has there been
a reduction of public safety
due to watershed impairment?
Completed by:
Date:
37-07-18-5038-486
No reported loss of life
Blocked stream flow can cause flooding of streets, business
and homes, in addition breaching roads.
No reported impairment.
Blocked stream flow caused flooding of streets,
business and homes which impacted the entire
community.
Blocked stream flow can cause flooding of streets, business
and homes, which reduced public safety.
Alan Walker
11/7/2019
NRCS-PDM-20
6 of 11
June 2016
Group Representation
Number
American Indian/Alaska Native Female Hispanic
American Indian/Alaska Native Female Non-Hispanic
American Indian/Alaska Native Male Hispanic
American Indian/Alaska Native Male Non-Hispanic
Asian Female Hispanic
Asian Female Non-Hispanic
Asian Male Hispanic
Asian Male Non-Hispanic
Black or African American Female Hispanic
Black or African American Female Non-Hispanic
Black or African American Male Hispanic
Black or African American Male Non-Hispanic
Hawaiian Native/Pacific Islander Female Hispanic
Hawaiian Native/Pacific Islander Female Non-Hispanic
Hawaiian Native/Pacific Islander Male Hispanic
Hawaiian Native/Pacific Islander Male Non-Hispanic
White Female Hispanic
White Female Non-Hispanic
White Male Hispanic
White Male Non-Hispanic
Total Group
Census tract(s)
Completed by:
Date:
DSR NO:
Section 5 - Group Representation Information
This section is completed only for the preferred alternative selected.
52
,867
37-07-18-5038-486
18
104
18
103
4
96
4
95
2
4,630
1
4,586
-
21
-
21
597
21,090
592
20,885
Alan Walker
11/7/2019
NRCS-PDM-20
DSR NO:
7 of 11
June 2016
Section 6 - Engineering Cost Estimate
This section must be completed for each alternative considered (attach additional sheets as necessary).
Proposed recovery measure (including mitigation) Quantity Units Unit cost ($)
Total installation cost (enter in sections 1E and 3) $
Unit Abbreviations
AC
acre
CY
cubic yard
EA
each
HR
hour
LF
linear feet
LS
lump sum
SF
square feet
SY
square yard
TN
ton
Other
(specify)
Completed by:
Date:
Amount ($)
37-07-18-5038-486
Debris removal (woody, sediment, etc.)
200
ft
$ 10.00
$ 2,000.00
Mobilization/demobilization
1
Job
$ 5,000.00
5,000.00
7,000.00
Alan Walker
11/7/2019
NRCS-PDM-20
DSR NO:
8 of 11
June 2016
Section 7 - NRCS EWP Funding Priority
Complete the following section to compute the funding priority for the recovery measures in this application (see
instructions on page 9).
Priority Ranking Criteria Yes No
Ranking
Number
Plus
Modifier
1. Is this an exigency situation?
2. Is this a site where there is serious, but not immediate threat to human
life?
3. Is this a site where buildings, utilities, or other important
infrastructure components are threatened?
4. Is this site a funding priority established by the NRCS Chef?
The following are modifiers for the above criteria
Modifier
a. Will the proposed action or alternatives protect or conserve federally
-
listed threatened and endangered species or critical habitat?
b. Will the proposed action or alternatives protect or conserve cultural
sites listed on the National Register of Historic Places?
c. Will the proposed action or alternatives protect or conserve prime or
important farmland?
d. Will the proposed action or alternatives protect or conserve existing
wetlands?
e. Will the proposed action or alternatives maintain or improve current
water quality conditions?
f. Will the proposed action or alternatives protect or conserve unique
habitat, including but not limited to, areas inhabited by State-listed
species, fish and wildlife management area, or State identified sensitive
habitats?
Enter priority computation in section 1A, “NRCS Entry Only” box, in “Funding priority number.
Remarks:
37-07-18-5038-486
2 c,d,e
3 c,d,e
X
X
X
NRCS-PDM-20
DSR NO:
9 of 11
June 2016
Section 8 - Findings
Enter NEPA compliance finding from section Q of the NRCS-CPA-52.
The DSR was reviewed with the sponsors. Yes No
NRCS representative of the DSR team: ___________________________
Title: ______________________________ Date: ____________________
Section 9 - Attachments:
A. Location map
B. Site plan or sketches
C. NRCS-CPA-52, Environmental Evaluation
Worksheet
D. Other (explain)
37-07-18-5038-486
NRCS-PDM-20
10 of 11
June 2016
Instructions for Completing the NRCS-PDM-20, DSR
-
Explanation of Requested Item
Who Completes
Section 1
Enter Site Sponsor, Location, Evaluation, Selected Alternative,
and Reviewed and Approval Signatures.
NRCS completes
with voluntary
assistance from
Sponsor except
for NRCS-only
portion of section
1A.
1A
Enter the Date, DSR Number, and Project Number. For NRCS
only enter Eligible Yes/No, Approved Yes/No, Funding Priority
Number, and Limited Resource Area Yes/No.
1B
Enter Sponsor Name, Address, Telephone, Fax
1C
Enter site location County, State, Congressional District, Latitude,
Longitude, Section, Township, Range, UTM Coordinates,
Drainage name, Reach within drainage, and Damage description.
1D
Enter Yes/No and any Remarks for the Site Evaluation
information. Any No response means the site is not eligible for
EWP assistance and no further information is necessary to
complete the DSR. (See NEWPPM 390-502.03 and 390-502-04)
Enter Yes/No regarding whether the affected public has been
informed of the EWP program.
1E
Enter the proposed treatment and the cost of installation.
NRCS only.
1F
NRCS Review and Approval.
Section 2
Attach NRCS-CPA 52 that addresses environmental evaluation
and special environmental concerns
NRCS only.
Section 3
Identify Property protected both private and public, business
losses and other economic impacts considered for each
alternative. Enter the dollar value of the potential future damages
if no action is taken in the Future Damage (5) column. This
would be the estimate of the value lost if the EWP recovery
measure is not installed. Use the repair cost or damage dollar
method to determine the estimate of future damages. The repair
cost method uses the costs to return the impaired property, good,
or services based on their original prevent condition or value. The
damage dollar method uses an estimate of the future damage to
value (e.g., if the structure is condemned, then enter the value of
the structure). Enter the estimated amount based upon existing
information or information furnished by the sponsor, contractors,
or others with specific knowledge for recovery from natural
disasters for each alternative considered. Often market values for
properties or services can be obtained from personnel at the local
county/parish tax assessment office.
The DSR team needs to determine the Damage Factor (%) which
is a coefficient that indicates the degree of damage reduction to a
property that is attributed to the effect of the proposed EWP
recovery measures. Use an appropriate estimate of how much of
the damage the EWP recovery measure will avoid for the
alternative being considered. If the recovery measures from a
single site will prevent 100 percent of the damage use 100 percent.
The Near Term Damage Reduction is the Future Damage ($) times
the Damage Factor (%). Sum the Near Term Damage Reduction
values to calculate the Total Near Term Damage Reduction. Enter
the Net Benefit which is computed by subtracting the Cost from
Section 6 from the total near term damage reduction. The
NRCS completes
with voluntary
assistance from
Sponsor.
NRCS-PDM-20
11 of 11
June 2016
-
Explanation of Requested Item
Who Completes
economic section must be completed for each alternative
considered. Attach additional sheets as necessary.
Section 4
Enter information to describe the potential social impacts
and considerations for each alternative. Answer Yes or No
and any remarks necessary to adequately address each
question. The information may be obtained through
interviews with community leaders, government officials or
sponsors.
Factors such as road closures, loss of water, electricity, access to
emergency services are used when answering whether the
community as a whole has been impaired.
This information is part of the environmental evaluation (NRCS-
CPA-52) but may be pertinent in section 7 regarding funding
priorities. The Social Considerations section must be completed for
each alternative considered. Attach additional sheets as necessary.
NRCS completes
with voluntary
assistance from
Sponsor.
Section 5
Enter the Group Representation for the preferred alternative. Use
the most recent census tract information based upon where the
EWP recovery measures are located.
NRCS completes
using most recent
U.S. Census data.
Section 6
Enter Proposed Recovery Measure(s) including Quantity, Units,
Unit Cost, and Total Amount Cost.
Enter sum of all Proposed Recovery Measure Costs to calculate
Total Costs. Enter Total Installation Costs in Section 1E. The
Engineering Cost Estimate must be completed for each alternative
considered. Attach additional sheets as necessary.
NRCS completes
with voluntary
assistance from
Sponsor.
Section 7
This section is used to determine the Funding Priority for the
preferred alternative and sequence for initiating recovery
measures
. Enter Yes/No for questions 1 through 4 and enter the
number (exigency 1, serious threat to human life 2, etc.) in the
right column, Ranking Number Plus Modifier. Complete the
Modifier portion by placing the alphabetic indicator a through f in
the Modifier column. Complete the Ranking Number Plus
Modifier column by entering the alphabetic indictor(s) that exists
within the site. The number of the site designates the priority
(e.g., a site with a designation of 2 is a higher priority that a site
with a designation of 3). The modifiers increase the priority for
the same numeric site (e.g., a site with a designation of 1a, would
be a higher priority than a site with a designation of 1, a site with a
designation of 2bc would be a higher priority than a site
designated as 2b). Enter the Funding Priority in Section 1A.
NRCS completes
with voluntary
assistance from
Sponsor.
Section 8
Insert the number of the Finding that was checked in section Q of
the NRCS-CPA-52. If action is required to meet NEPA
requirements, state whether an EA or EIS will be prepared or
adopted.”
NRCS only.
Section 9
Include attachments for location map, site sketch or plan, a
completed NRCS-CPA-52, Environmental Evaluation Worksheet,
and other information as needed.
NRCS completes
with voluntary
assistance from
Sponsor.
NRCS-PDM-20
1 of 11
June 2016
Natural Resources Conservation Service
DAMAGE SURVEY REPORT (DSR)
E
mergency Watershed Protection Program Recovery
Section 1B - Sponsor Information
Sponsor Name:
Address:
City/State/Zip:
Telephone Number
Fax:
Section 1A
Date of report
DSR number
Project number
NRCS Entry Only
Eligible: Yes No
Approved: Yes No
Funding priority number (from sect. 4)
Limited Resource Area: Yes No
1 Major disaster declaration
2 Emergency declaration
3 Fire management assistance declaration
4 Local
declaration
Section 1C - Site Location Information
State Congressional District
Longitude
UTM Coordinates
Site name
County:
Latitude
Drainage name
Reach
Damage description
11/7/2019
37-07-18-5038-487
37-07-18-5038-487
2c,d,e & 3c,d,e
Pender County
PO Box 5 – 805 S. Walker Street
Burgaw, NC 28425
910) 259-1200
Pender
NC
07
34.469
-78.0968
Deer Valley Branch
Curie 3
400 ft. up and downstream of NC 210
Downed trees and other debris are in and/or over the stream.
- - -
NRCS-PDM-20
2 of 11
June 2016
Section 1D - Site Evaluation
All answers in this section must be YES to be eligible for EWP assistance.
Site Eligibility YES NO Remarks
Damage was a result of a natural disaster?
1
Recovery measures would be for runoff retardation or soil
erosion prevention?
1
Threat to life and/or property?
1
Event caused a sudden impairment in the watershed?
1
Imminent threat was created by this event?
2
For structural repairs, not repaired twice within 10 years?
2
Site Defensibility
Economic, environmental, and social documentation adequate
to warrant action? (See completed NRCS-CPA-52 and sections
3 and 4 of DSR.
3
)
Proposed action technically viable? (See section 6.
3
)
1
Statutory
2
Regulation
3
The completed DSR and Form NRCS-CPA-52, “Environmental Evaluation Worksheet,are required to support the decisions recorded on this
summary page. If additional space is needed on this or any other page in this form, add appropriate pages.
Have all the appropriate steps been taken to en
sure that all segments of the affected population have been
informed of the EWP program and its possible effects?
YES NO
Comments:
Section 1E - Proposed Action
Describe the preferred alternative (same as NRCS CPA-52, boxes M and G)
Total installation cost identified in this
DSR from section 6:
DSR NO:
NRCS 75% cost-share:
Sponsor 25% cost-share:
37-07-18-5038-487
Hurricane Florence
Clearing and Snagging
Blocked stream flow can cause flooding of streets, business, homes and
property.
Downed trees & debris reduced stream flow.
Impairment caused an imminent threat
No known repairs in the past 10 years
Action would reduce the imminent threat
to life and property.
Action would reduce threat
Return the stream flow to the pre-storm condition by removing downed trees and other debris from in
and over the stream channel.
$ 13,000.00
$ 9,750.00
$ 3,250.00
NRCS-PDM-20
3 of 11
June 2016
Section 1F - NRCS State Office Review and Approval
Reviewed by:
Date reviewed
State EWP Program Manager
Approved by:
Date approved
State Conservationist
DSR NO:
37-07-18-5038-487
NRCS-PDM-20
DSR NO:
4 of 11
June 2016
Section 2 - Environmental Evaluation and Special Environmental Concerns
See attached NRCS-CPA-52, Environmental Evaluation Worksheet
Section 3 - Economic Considerations
This section must be completed for each alternative considered (attach additional sheets as necessary).
-
Future
Damages ($)
Damage
Factor (%)
Near Term
Damage
Reduction
Properties protected (private)
Properties protected (public)
Business losses
Other
Total near term damage reduction $
Net benefit (total near term
damage reduction minus Cost from section 6)
Completed by:
Date:
-
-
-
- -
-
- -
-
- -
-
37-07-18-5038-487
Road Crossing
$ 30,000.00
50
$ 15,000.00
$ 15,000.00
$ 2,000.00
Alan Walker
11/7/2019
NRCS-PDM-20
DSR NO:
5 of 11
June 2016
Section 4 - Social Consideration
This section must be completed for ea
ch alternative considered (attach additional sheets as necessary).
YES
NO
Remarks
Has there been a loss of life as
a result of the watershed
impairment?
Is there the potential for loss of
life due to damages from the
watershed impairment?
Has access to a hospital or
medical facility been impaired
by watershed impairment?
Has the community as a whole
been adversely impacted by the
watershed impairment (life and
property ceases to operate in a
normal capacity)
Is there a lack or has there been
a reduction of public safety
due to watershed impairment?
Completed by:
Date:
37-07-18-5038-487
No reported loss of life
Blocked stream flow can cause flooding of streets, business
and homes, in addition breaching roads.
No reported impairment.
Blocked stream flow caused flooding of streets,
business and homes which impacted the entire
community.
Blocked stream flow can cause flooding of streets, business
and homes, which reduced public safety.
Alan Walker
11/7/2019
NRCS-PDM-20
6 of 11
June 2016
Group Representation
Number
American Indian/Alaska Native Female Hispanic
American Indian/Alaska Native Female Non-Hispanic
American Indian/Alaska Native Male Hispanic
American Indian/Alaska Native Male Non-Hispanic
Asian Female Hispanic
Asian Female Non-Hispanic
Asian Male Hispanic
Asian Male Non-Hispanic
Black or African American Female Hispanic
Black or African American Female Non-Hispanic
Black or African American Male Hispanic
Black or African American Male Non-Hispanic
Hawaiian Native/Pacific Islander Female Hispanic
Hawaiian Native/Pacific Islander Female Non-Hispanic
Hawaiian Native/Pacific Islander Male Hispanic
Hawaiian Native/Pacific Islander Male Non-Hispanic
White Female Hispanic
White Female Non-Hispanic
White Male Hispanic
White Male Non-Hispanic
Total Group
Census tract(s)
Completed by:
Date:
DSR NO:
Section 5 - Group Representation Information
This section is completed only for the preferred alternative selected.
52
,867
37-07-18-5038-487
18
104
18
103
4
96
4
95
2
4,630
1
4,586
-
21
-
21
597
21,090
592
20,885
Alan Walker
11/7/2019
NRCS-PDM-20
DSR NO:
7 of 11
June 2016
Section 6 - Engineering Cost Estimate
This section must be completed for each alternative considered (attach additional sheets as necessary).
Proposed recovery measure (including mitigation) Quantity Units Unit cost ($)
Total installation cost (enter in sections 1E and 3) $
Unit Abbreviations
AC
acre
CY
cubic yard
EA
each
HR
hour
LF
linear feet
LS
lump sum
SF
square feet
SY
square yard
TN
ton
Other
(specify)
Completed by:
Date:
Amount ($)
37-07-18-5038-487
Debris removal (woody, sediment, etc.)
800
ft
$ 10.00
$ 8,000.00
Mobilization/demobilization
1
Job
$ 5,000.00
5,000.00
13,000.00
Alan Walker
11/7/2019
NRCS-PDM-20
DSR NO:
8 of 11
June 2016
Section 7 - NRCS EWP Funding Priority
Complete the following section to compute the funding priority for the recovery measures in this application (see
instructions on page 9).
Priority Ranking Criteria Yes No
Ranking
Number
Plus
Modifier
1. Is this an exigency situation?
2. Is this a site where there is serious, but not immediate threat to human
life?
3. Is this a site where buildings, utilities, or other important
infrastructure components are threatened?
4. Is this site a funding priority established by the NRCS Chef?
The following are modifiers for the above criteria
Modifier
a. Will the proposed action or alternatives protect or conserve federally
-
listed threatened and endangered species or critical habitat?
b. Will the proposed action or alternatives protect or conserve cultural
sites listed on the National Register of Historic Places?
c. Will the proposed action or alternatives protect or conserve prime or
important farmland?
d. Will the proposed action or alternatives protect or conserve existing
wetlands?
e. Will the proposed action or alternatives maintain or improve current
water quality conditions?
f. Will the proposed action or alternatives protect or conserve unique
habitat, including but not limited to, areas inhabited by State-listed
species, fish and wildlife management area, or State identified sensitive
habitats?
Enter priority computation in section 1A, “NRCS Entry Only” box, in “Funding priority number.
Remarks:
37-07-18-5038-487
2 c,d,e
3 c,d,e
X
X
X
NRCS-PDM-20
DSR NO:
9 of 11
June 2016
Section 8 - Findings
Enter NEPA compliance finding from section Q of the NRCS-CPA-52.
The DSR was reviewed with the sponsors. Yes No
NRCS representative of the DSR team: ___________________________
Title: ______________________________ Date: ____________________
Section 9 - Attachments:
A. Location map
B. Site plan or sketches
C. NRCS-CPA-52, Environmental Evaluation
Worksheet
D. Other (explain)
37-07-18-5038-487
NRCS-PDM-20
10 of 11
June 2016
Instructions for Completing the NRCS-PDM-20, DSR
-
Explanation of Requested Item
Who Completes
Section 1
Enter Site Sponsor, Location, Evaluation, Selected Alternative,
and Reviewed and Approval Signatures.
NRCS completes
with voluntary
assistance from
Sponsor except
for NRCS-only
portion of section
1A.
1A
Enter the Date, DSR Number, and Project Number. For NRCS
only enter Eligible Yes/No, Approved Yes/No, Funding Priority
Number, and Limited Resource Area Yes/No.
1B
Enter Sponsor Name, Address, Telephone, Fax
1C
Enter site location County, State, Congressional District, Latitude,
Longitude, Section, Township, Range, UTM Coordinates,
Drainage name, Reach within drainage, and Damage description.
1D
Enter Yes/No and any Remarks for the Site Evaluation
information. Any No response means the site is not eligible for
EWP assistance and no further information is necessary to
complete the DSR. (See NEWPPM 390-502.03 and 390-502-04)
Enter Yes/No regarding whether the affected public has been
informed of the EWP program.
1E
Enter the proposed treatment and the cost of installation.
NRCS only.
1F
NRCS Review and Approval.
Section 2
Attach NRCS-CPA 52 that addresses environmental evaluation
and special environmental concerns
NRCS only.
Section 3
Identify Property protected both private and public, business
losses and other economic impacts considered for each
alternative. Enter the dollar value of the potential future damages
if no action is taken in the Future Damage (5) column. This
would be the estimate of the value lost if the EWP recovery
measure is not installed. Use the repair cost or damage dollar
method to determine the estimate of future damages. The repair
cost method uses the costs to return the impaired property, good,
or services based on their original prevent condition or value. The
damage dollar method uses an estimate of the future damage to
value (e.g., if the structure is condemned, then enter the value of
the structure). Enter the estimated amount based upon existing
information or information furnished by the sponsor, contractors,
or others with specific knowledge for recovery from natural
disasters for each alternative considered. Often market values for
properties or services can be obtained from personnel at the local
county/parish tax assessment office.
The DSR team needs to determine the Damage Factor (%) which
is a coefficient that indicates the degree of damage reduction to a
property that is attributed to the effect of the proposed EWP
recovery measures. Use an appropriate estimate of how much of
the damage the EWP recovery measure will avoid for the
alternative being considered. If the recovery measures from a
single site will prevent 100 percent of the damage use 100 percent.
The Near Term Damage Reduction is the Future Damage ($) times
the Damage Factor (%). Sum the Near Term Damage Reduction
values to calculate the Total Near Term Damage Reduction. Enter
the Net Benefit which is computed by subtracting the Cost from
Section 6 from the total near term damage reduction. The
NRCS completes
with voluntary
assistance from
Sponsor.
NRCS-PDM-20
11 of 11
June 2016
-
Explanation of Requested Item
Who Completes
economic section must be completed for each alternative
considered. Attach additional sheets as necessary.
Section 4
Enter information to describe the potential social impacts
and considerations for each alternative. Answer Yes or No
and any remarks necessary to adequately address each
question. The information may be obtained through
interviews with community leaders, government officials or
sponsors.
Factors such as road closures, loss of water, electricity, access to
emergency services are used when answering whether the
community as a whole has been impaired.
This information is part of the environmental evaluation (NRCS-
CPA-52) but may be pertinent in section 7 regarding funding
priorities. The Social Considerations section must be completed for
each alternative considered. Attach additional sheets as necessary.
NRCS completes
with voluntary
assistance from
Sponsor.
Section 5
Enter the Group Representation for the preferred alternative. Use
the most recent census tract information based upon where the
EWP recovery measures are located.
NRCS completes
using most recent
U.S. Census data.
Section 6
Enter Proposed Recovery Measure(s) including Quantity, Units,
Unit Cost, and Total Amount Cost.
Enter sum of all Proposed Recovery Measure Costs to calculate
Total Costs. Enter Total Installation Costs in Section 1E. The
Engineering Cost Estimate must be completed for each alternative
considered. Attach additional sheets as necessary.
NRCS completes
with voluntary
assistance from
Sponsor.
Section 7
This section is used to determine the Funding Priority for the
preferred alternative and sequence for initiating recovery
measures
. Enter Yes/No for questions 1 through 4 and enter the
number (exigency 1, serious threat to human life 2, etc.) in the
right column, Ranking Number Plus Modifier. Complete the
Modifier portion by placing the alphabetic indicator a through f in
the Modifier column. Complete the Ranking Number Plus
Modifier column by entering the alphabetic indictor(s) that exists
within the site. The number of the site designates the priority
(e.g., a site with a designation of 2 is a higher priority that a site
with a designation of 3). The modifiers increase the priority for
the same numeric site (e.g., a site with a designation of 1a, would
be a higher priority than a site with a designation of 1, a site with a
designation of 2bc would be a higher priority than a site
designated as 2b). Enter the Funding Priority in Section 1A.
NRCS completes
with voluntary
assistance from
Sponsor.
Section 8
Insert the number of the Finding that was checked in section Q of
the NRCS-CPA-52. If action is required to meet NEPA
requirements, state whether an EA or EIS will be prepared or
adopted.”
NRCS only.
Section 9
Include attachments for location map, site sketch or plan, a
completed NRCS-CPA-52, Environmental Evaluation Worksheet,
and other information as needed.
NRCS completes
with voluntary
assistance from
Sponsor.
NRCS-PDM-20
1 of 11
June 2016
Natural Resources Conservation Service
DAMAGE SURVEY REPORT (DSR)
E
mergency Watershed Protection Program Recovery
Section 1B - Sponsor Information
Sponsor Name:
Address:
City/State/Zip:
Telephone Number
Fax:
Section 1A
Date of report
DSR number
Project number
NRCS Entry Only
Eligible: Yes No
Approved: Yes No
Funding priority number (from sect. 4)
Limited Resource Area: Yes No
1 Major disaster declaration
2 Emergency declaration
3 Fire management assistance declaration
4 Local
declaration
Section 1C - Site Location Information
State Congressional District
Longitude
UTM Coordinates
Site name
County:
Latitude
Drainage name
Reach
Damage description
11/7/2019
37-07-18-5038-488
37-07-18-5038-488
2c,d,e & 3c,d,e
Pender County
PO Box 5 – 805 S. Walker Street
Burgaw, NC 28425
910) 259-1200
Pender
NC
07
34.4693
-78.0944
Deer Valley Branch
Curie 4
400 ft. up and downstream of Borough Road
Downed trees and other debris are in and/or over the stream.
- - -
NRCS-PDM-20
2 of 11
June 2016
Section 1D - Site Evaluation
All answers in this section must be YES to be eligible for EWP assistance.
Site Eligibility YES NO Remarks
Damage was a result of a natural disaster?
1
Recovery measures would be for runoff retardation or soil
erosion prevention?
1
Threat to life and/or property?
1
Event caused a sudden impairment in the watershed?
1
Imminent threat was created by this event?
2
For structural repairs, not repaired twice within 10 years?
2
Site Defensibility
Economic, environmental, and social documentation adequate
to warrant action? (See completed NRCS-CPA-52 and sections
3 and 4 of DSR.
3
)
Proposed action technically viable? (See section 6.
3
)
1
Statutory
2
Regulation
3
The completed DSR and Form NRCS-CPA-52, “Environmental Evaluation Worksheet,are required to support the decisions recorded on this
summary page. If additional space is needed on this or any other page in this form, add appropriate pages.
Have all the appropriate steps been taken to en
sure that all segments of the affected population have been
informed of the EWP program and its possible effects?
YES NO
Comments:
Section 1E - Proposed Action
Describe the preferred alternative (same as NRCS CPA-52, boxes M and G)
Total installation cost identified in this
DSR from section 6:
DSR NO:
NRCS 75% cost-share:
Sponsor 25% cost-share:
37-07-18-5038-488
Hurricane Florence
Clearing and Snagging
Blocked stream flow can cause flooding of streets, business, homes and
property.
Downed trees & debris reduced stream flow.
Impairment caused an imminent threat
No known repairs in the past 10 years
Action would reduce the imminent threat
to life and property.
Action would reduce threat
Return the stream flow to the pre-storm condition by removing downed trees and other debris from in
and over the stream channel.
$ 13,000.00
$ 9,750.00
$ 3,250.00
NRCS-PDM-20
3 of 11
June 2016
Section 1F - NRCS State Office Review and Approval
Reviewed by:
Date reviewed
State EWP Program Manager
Approved by:
Date approved
State Conservationist
DSR NO:
37-07-18-5038-488
NRCS-PDM-20
DSR NO:
4 of 11
June 2016
Section 2 - Environmental Evaluation and Special Environmental Concerns
See attached NRCS-CPA-52, Environmental Evaluation Worksheet
Section 3 - Economic Considerations
This section must be completed for each alternative considered (attach additional sheets as necessary).
-
Future
Damages ($)
Damage
Factor (%)
Near Term
Damage
Reduction
Properties protected (private)
Properties protected (public)
Business losses
Other
Total near term damage reduction $
Net benefit (total near term
damage reduction minus Cost from section 6)
Completed by:
Date:
-
-
-
- -
-
- -
-
- -
-
37-07-18-5038-488
Road Crossing
$ 30,000.00
50
$ 15,000.00
$ 15,000.00
$ 2,000.00
Alan Walker
11/7/2019
NRCS-PDM-20
DSR NO:
5 of 11
June 2016
Section 4 - Social Consideration
This section must be completed for ea
ch alternative considered (attach additional sheets as necessary).
YES
NO
Remarks
Has there been a loss of life as
a result of the watershed
impairment?
Is there the potential for loss of
life due to damages from the
watershed impairment?
Has access to a hospital or
medical facility been impaired
by watershed impairment?
Has the community as a whole
been adversely impacted by the
watershed impairment (life and
property ceases to operate in a
normal capacity)
Is there a lack or has there been
a reduction of public safety
due to watershed impairment?
Completed by:
Date:
37-07-18-5038-488
No reported loss of life
Blocked stream flow can cause flooding of streets, business
and homes, in addition breaching roads.
No reported impairment.
Blocked stream flow caused flooding of streets,
business and homes which impacted the entire
community.
Blocked stream flow can cause flooding of streets, business
and homes, which reduced public safety.
Alan Walker
11/7/2019
NRCS-PDM-20
6 of 11
June 2016
Group Representation
Number
American Indian/Alaska Native Female Hispanic
American Indian/Alaska Native Female Non-Hispanic
American Indian/Alaska Native Male Hispanic
American Indian/Alaska Native Male Non-Hispanic
Asian Female Hispanic
Asian Female Non-Hispanic
Asian Male Hispanic
Asian Male Non-Hispanic
Black or African American Female Hispanic
Black or African American Female Non-Hispanic
Black or African American Male Hispanic
Black or African American Male Non-Hispanic
Hawaiian Native/Pacific Islander Female Hispanic
Hawaiian Native/Pacific Islander Female Non-Hispanic
Hawaiian Native/Pacific Islander Male Hispanic
Hawaiian Native/Pacific Islander Male Non-Hispanic
White Female Hispanic
White Female Non-Hispanic
White Male Hispanic
White Male Non-Hispanic
Total Group
Census tract(s)
Completed by:
Date:
DSR NO:
Section 5 - Group Representation Information
This section is completed only for the preferred alternative selected.
52
,867
37-07-18-5038-488
18
104
18
103
4
96
4
95
2
4,630
1
4,586
-
21
-
21
597
21,090
592
20,885
Alan Walker
11/7/2019
NRCS-PDM-20
DSR NO:
7 of 11
June 2016
Section 6 - Engineering Cost Estimate
This section must be completed for each alternative considered (attach additional sheets as necessary).
Proposed recovery measure (including mitigation) Quantity Units Unit cost ($)
Total installation cost (enter in sections 1E and 3) $
Unit Abbreviations
AC
acre
CY
cubic yard
EA
each
HR
hour
LF
linear feet
LS
lump sum
SF
square feet
SY
square yard
TN
ton
Other
(specify)
Completed by:
Date:
Amount ($)
37-07-18-5038-488
Debris removal (woody, sediment, etc.)
800
ft
$ 10.00
$ 8,000.00
Mobilization/demobilization
1
Job
$ 5,000.00
5,000.00
13,000.00
Alan Walker
11/7/2019
NRCS-PDM-20
DSR NO:
8 of 11
June 2016
Section 7 - NRCS EWP Funding Priority
Complete the following section to compute the funding priority for the recovery measures in this application (see
instructions on page 9).
Priority Ranking Criteria Yes No
Ranking
Number
Plus
Modifier
1. Is this an exigency situation?
2. Is this a site where there is serious, but not immediate threat to human
life?
3. Is this a site where buildings, utilities, or other important
infrastructure components are threatened?
4. Is this site a funding priority established by the NRCS Chef?
The following are modifiers for the above criteria
Modifier
a. Will the proposed action or alternatives protect or conserve federally
-
listed threatened and endangered species or critical habitat?
b. Will the proposed action or alternatives protect or conserve cultural
sites listed on the National Register of Historic Places?
c. Will the proposed action or alternatives protect or conserve prime or
important farmland?
d. Will the proposed action or alternatives protect or conserve existing
wetlands?
e. Will the proposed action or alternatives maintain or improve current
water quality conditions?
f. Will the proposed action or alternatives protect or conserve unique
habitat, including but not limited to, areas inhabited by State-listed
species, fish and wildlife management area, or State identified sensitive
habitats?
Enter priority computation in section 1A, “NRCS Entry Only” box, in “Funding priority number.
Remarks:
37-07-18-5038-488
2 c,d,e
3 c,d,e
X
X
X
NRCS-PDM-20
DSR NO:
9 of 11
June 2016
Section 8 - Findings
Enter NEPA compliance finding from section Q of the NRCS-CPA-52.
The DSR was reviewed with the sponsors. Yes No
NRCS representative of the DSR team: ___________________________
Title: ______________________________ Date: ____________________
Section 9 - Attachments:
A. Location map
B. Site plan or sketches
C. NRCS-CPA-52, Environmental Evaluation
Worksheet
D. Other (explain)
37-07-18-5038-488
NRCS-PDM-20
10 of 11
June 2016
Instructions for Completing the NRCS-PDM-20, DSR
-
Explanation of Requested Item
Who Completes
Section 1
Enter Site Sponsor, Location, Evaluation, Selected Alternative,
and Reviewed and Approval Signatures.
NRCS completes
with voluntary
assistance from
Sponsor except
for NRCS-only
portion of section
1A.
1A
Enter the Date, DSR Number, and Project Number. For NRCS
only enter Eligible Yes/No, Approved Yes/No, Funding Priority
Number, and Limited Resource Area Yes/No.
1B
Enter Sponsor Name, Address, Telephone, Fax
1C
Enter site location County, State, Congressional District, Latitude,
Longitude, Section, Township, Range, UTM Coordinates,
Drainage name, Reach within drainage, and Damage description.
1D
Enter Yes/No and any Remarks for the Site Evaluation
information. Any No response means the site is not eligible for
EWP assistance and no further information is necessary to
complete the DSR. (See NEWPPM 390-502.03 and 390-502-04)
Enter Yes/No regarding whether the affected public has been
informed of the EWP program.
1E
Enter the proposed treatment and the cost of installation.
NRCS only.
1F
NRCS Review and Approval.
Section 2
Attach NRCS-CPA 52 that addresses environmental evaluation
and special environmental concerns
NRCS only.
Section 3
Identify Property protected both private and public, business
losses and other economic impacts considered for each
alternative. Enter the dollar value of the potential future damages
if no action is taken in the Future Damage (5) column. This
would be the estimate of the value lost if the EWP recovery
measure is not installed. Use the repair cost or damage dollar
method to determine the estimate of future damages. The repair
cost method uses the costs to return the impaired property, good,
or services based on their original prevent condition or value. The
damage dollar method uses an estimate of the future damage to
value (e.g., if the structure is condemned, then enter the value of
the structure). Enter the estimated amount based upon existing
information or information furnished by the sponsor, contractors,
or others with specific knowledge for recovery from natural
disasters for each alternative considered. Often market values for
properties or services can be obtained from personnel at the local
county/parish tax assessment office.
The DSR team needs to determine the Damage Factor (%) which
is a coefficient that indicates the degree of damage reduction to a
property that is attributed to the effect of the proposed EWP
recovery measures. Use an appropriate estimate of how much of
the damage the EWP recovery measure will avoid for the
alternative being considered. If the recovery measures from a
single site will prevent 100 percent of the damage use 100 percent.
The Near Term Damage Reduction is the Future Damage ($) times
the Damage Factor (%). Sum the Near Term Damage Reduction
values to calculate the Total Near Term Damage Reduction. Enter
the Net Benefit which is computed by subtracting the Cost from
Section 6 from the total near term damage reduction. The
NRCS completes
with voluntary
assistance from
Sponsor.
NRCS-PDM-20
11 of 11
June 2016
-
Explanation of Requested Item
Who Completes
economic section must be completed for each alternative
considered. Attach additional sheets as necessary.
Section 4
Enter information to describe the potential social impacts
and considerations for each alternative. Answer Yes or No
and any remarks necessary to adequately address each
question. The information may be obtained through
interviews with community leaders, government officials or
sponsors.
Factors such as road closures, loss of water, electricity, access to
emergency services are used when answering whether the
community as a whole has been impaired.
This information is part of the environmental evaluation (NRCS-
CPA-52) but may be pertinent in section 7 regarding funding
priorities. The Social Considerations section must be completed for
each alternative considered. Attach additional sheets as necessary.
NRCS completes
with voluntary
assistance from
Sponsor.
Section 5
Enter the Group Representation for the preferred alternative. Use
the most recent census tract information based upon where the
EWP recovery measures are located.
NRCS completes
using most recent
U.S. Census data.
Section 6
Enter Proposed Recovery Measure(s) including Quantity, Units,
Unit Cost, and Total Amount Cost.
Enter sum of all Proposed Recovery Measure Costs to calculate
Total Costs. Enter Total Installation Costs in Section 1E. The
Engineering Cost Estimate must be completed for each alternative
considered. Attach additional sheets as necessary.
NRCS completes
with voluntary
assistance from
Sponsor.
Section 7
This section is used to determine the Funding Priority for the
preferred alternative and sequence for initiating recovery
measures
. Enter Yes/No for questions 1 through 4 and enter the
number (exigency 1, serious threat to human life 2, etc.) in the
right column, Ranking Number Plus Modifier. Complete the
Modifier portion by placing the alphabetic indicator a through f in
the Modifier column. Complete the Ranking Number Plus
Modifier column by entering the alphabetic indictor(s) that exists
within the site. The number of the site designates the priority
(e.g., a site with a designation of 2 is a higher priority that a site
with a designation of 3). The modifiers increase the priority for
the same numeric site (e.g., a site with a designation of 1a, would
be a higher priority than a site with a designation of 1, a site with a
designation of 2bc would be a higher priority than a site
designated as 2b). Enter the Funding Priority in Section 1A.
NRCS completes
with voluntary
assistance from
Sponsor.
Section 8
Insert the number of the Finding that was checked in section Q of
the NRCS-CPA-52. If action is required to meet NEPA
requirements, state whether an EA or EIS will be prepared or
adopted.”
NRCS only.
Section 9
Include attachments for location map, site sketch or plan, a
completed NRCS-CPA-52, Environmental Evaluation Worksheet,
and other information as needed.
NRCS completes
with voluntary
assistance from
Sponsor.
NRCS-PDM-20
1 of 11
June 2016
Natural Resources Conservation Service
DAMAGE SURVEY REPORT (DSR)
E
mergency Watershed Protection Program Recovery
Section 1B - Sponsor Information
Sponsor Name:
Address:
City/State/Zip:
Telephone Number
Fax:
Section 1A
Date of report
DSR number
Project number
NRCS Entry Only
Eligible: Yes No
Approved: Yes No
Funding priority number (from sect. 4)
Limited Resource Area: Yes No
1 Major disaster declaration
2 Emergency declaration
3 Fire management assistance declaration
4 Local
declaration
Section 1C - Site Location Information
State Congressional District
Longitude
UTM Coordinates
Site name
County:
Latitude
Drainage name
Reach
Damage description
11/7/2019
37-07-18-5038-489
37-07-18-5038-489
2c,d,e & 3c,d,e
Pender County
PO Box 5 – 805 S. Walker Street
Burgaw, NC 28425
910) 259-1200
Pender
NC
07
34.6265
-77.9933
UT Horse Branch
269 Lake Road
150 ft downstream of Lake Road
Streambank erosion site downstream of Lake Road. Downstream of Penderlea
Lake.
- - -
NRCS-PDM-20
2 of 11
June 2016
Section 1D - Site Evaluation
All answers in this section must be YES to be eligible for EWP assistance.
Site Eligibility YES NO Remarks
Damage was a result of a natural disaster?
1
Recovery measures would be for runoff retardation or soil
erosion prevention?
1
Threat to life and/or property?
1
Event caused a sudden impairment in the watershed?
1
Imminent threat was created by this event?
2
For structural repairs, not repaired twice within 10 years?
2
Site Defensibility
Economic, environmental, and social documentation adequate
to warrant action? (See completed NRCS-CPA-52 and sections
3 and 4 of DSR.
3
)
Proposed action technically viable? (See section 6.
3
)
1
Statutory
2
Regulation
3
The completed DSR and Form NRCS-CPA-52, “Environmental Evaluation Worksheet,are required to support the decisions recorded on this
summary page. If additional space is needed on this or any other page in this form, add appropriate pages.
Have all the appropriate steps been taken to en
sure that all segments of the affected population have been
informed of the EWP program and its possible effects?
YES NO
Comments:
Section 1E - Proposed Action
Describe the preferred alternative (same as NRCS CPA-52, boxes M and G)
Total installation cost identified in this
DSR from section 6:
DSR NO:
NRCS 75% cost-share:
Sponsor 25% cost-share:
37-07-18-5038-489
Hurricane Florence
Streambank stabilization
Blocked stream flow can cause flooding of streets, business, homes and
property.
Streambank erosion contributing to excess sediment in stream corridor.
Impairment caused an imminent threat
No known repairs in the past 10 years
Action would reduce the imminent threat
to life and property.
Action would reduce threat
Return the stream flow to the pre-storm condition by stabilizing streambank.
$ 20,929.00
$ 15,697.00
$ 5,232.00