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OPEN TO ELIGIBLE
JURISDICTIONS ONLY
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State Fiscal Year 2016
Local Emergency Planning
Committees
Baseline Grant Application
Applications DUE by
11:59 p.m., Friday, May 29, 2015
Contact Division of Homeland Security and Emergency
Management (DHS&EM), Program Support Grants Unit
for application details at mva.grants@alaska.gov
(907) 428-7000 or
Toll free 800-478-2337
State Fiscal Year 2016
Baseline Grant Application
for
LOCAL EMERGENCY PLANNING
COMMITTEES
In order to be eligible for funding in State Fiscal Year 2016, the Alaska Division of Homeland
Security and Emergency Management (DHS&EM) must receive applications by 11:59 p.m.,
Friday, May 29, 2015. Completed, signed applications may be mailed, faxed, or emailed.
State of Alaska
Department of Military and Veterans Affairs
Division of Homeland Security and Emergency Management
PO Box 5750
JBER, Alaska 99505–5750
Phone: (907) 428–7000
Toll Free: (800) 478–2337
Fax: (907) 428–7009
Email: mva.grants@alaska.gov
Application Instructions:
The application contains a section to provide the Local Emergency Planning Committee (LEPC) contact
information, hazardous/extremely hazardous substance information, and an evaluation of previous
baseline performance.
An LEPC must also create an anticipated baseline budget in the application. Space is provided to estimate
LEPC Management, Outreach, and Preparedness expenses. The total budget must be equal to the
projected State Emergency Response Commission (SERC) Finance Committee Baseline Funding shown
in Table A.
Expenses under the Outreach and Preparedness categories must be associated with an activity. A narrative
description of the activity is required.
The application must be signed by an authorized local jurisdiction and LEPC representative.
A current LEPC Signatory Authority Form and Membership Roster must be completed and returned with
the Application. These documents can be found on the Division of Homeland Security and Emergency
Management (DHS&EM) Grants website.
The following table reflects the baseline funding level for all current LEPCs, and may change from year
to year depending on the availability of funds and decisions by the SERC Finance Committee. The
baseline funding level for each LEPC was determined by the following:







Number of Tier II reporting facilities
Number of extremely hazardous substances (EHS) in the Local Emergency Planning District (LEPD)
Hazmat transportation issues
Population at risk from an EHS release within the LEPD (excluding work-site population)
Population at risk from all-hazards
Funds available for award
Previous year’s performance
SERC BASELINE FUNDING FOR ACTIVE LEPCs
Table A – SERC Finance Committee SFY2015 Baseline Funding Levels
Funding
LEPC
Amount
Anchorage
$22,983.00
Nome
Fairbanks, City of
$22,983.00
Southern SE (Craig)
Kenai
$22,983.00
Valdez
Ketchikan (KGB)
$18,663.00
Denali
Juneau
$18,663.00
Petersburg
Aleutians Pribilof Island
$13,913.00
Wrangell
Northern SE (Skagway)
$13,913.00
Delta Greely
Sitka
$13,913.00
North Slope Borough
MatSu
$13,913.00
Copper River
Kodiak Island Borough
$11,779.00
Conference Travel for all LEPC’s
*SERC Finance committee will meet to establish SFY16 LEPC funding amounts in June 2015.
LEPC
Funding
Amount
$11,779.00
$11,779.00
$11,779.00
$11,779.00
$9,224.00
$9,224.00
$6,177.00
$6,177.00
$6,177.00
$27,711.00
LOCAL EMERGENCY PLANNING COMMITTEE
State Fiscal Year 2016 LEPC Funding Application
General Information
LEPC Name
Address
City
State
Zip
LEPC Project Manager
Phone Number
Fax Number
Email Address
Click here to enter address.
Click here to enter city.
Click here to enter state.
Click here to enter zip.
Click here to enter text.
Click here to enter phone number.
Click here to enter fax number.
Click here to enter email address.
Membership
Current LEPC membership list is attached.
(**Please use the standard LEPC Membership Roster form located at
http://ready.alaska.gov/grants.htm)
YES☐
NO☐
Hazardous/ Extremely Hazardous Substances Information
Total number of facilities in LEPD reporting one or more Hazardous Substances
Date of last review of number of Hazardous Substances reporting facilities
Total number of facilities in LEPD reporting one or more Extremely Hazardous
Substances (EHS)
Date of last review of number of EHS reporting facilities
Estimated volume of hazardous substances and EHS transported through LEPD
Date of last review of estimated volume of hazardous substances or of EHS
transported in LEPD
Click here to enter text.
Click here to enter a date.
Click here to enter text.
Click here to enter a date.
Click here to enter text.
Click here to enter a date.
Performance of Baseline Requirements in Previous Year
Has LEPC membership been maintained?
YES☐
NO☐
Have rules or bylaws been established and maintained to:
YES☐
NO☐
 Provide for public notification of LEPC meetings and activities?
 Conduct meetings to discuss Emergency Operations Plan with the
public?
 Provide for public distribution of the Emergency Operations Plan?
Have procedures for receiving and processing requests from the public for
YES☐
NO☐
Material Safety Data Sheets (MSDS) and Tier II information been established
and maintained?
Has the LEPC evaluated the need for resources to develop, implement, and
YES☐
NO☐
exercise the EOP?
Did your LEPC act as an advisory committee to the political subdivisions within
YES☐
NO☐
the LEPD?
Did your LEPC attend the scheduled LEPCA workshops and/or SERC meetings?
YES☐
NO☐
Did your LEPC submit timely quarterly reports to DHS&EM in accordance with
YES☐
NO☐
Grant Award documents?
Did your LEPC maintain a current list of all facilities within the LEPD which are
YES☐
NO☐
required to complete a Tier II report?
For any “No” answers, please explain below
Click here to provide further details.
Projected baseline allocation for this LEPC
Choose a baseline allocation.
(See Table A)
LEPC MANAGEMENT
Please describe the LEPC Management expenses. Not all expenses may be applicable to the management of the LEPC. **All
Contractual Services will require DHS&EM pre-approval**
Support Services
Budgeted Cost
Personnel Services
$Click here to enter amount.
Contractual Services
$Click here to enter amount.
TOTAL Support Services
$Click here to enter amount.
Support Services, Non–Contractual
Budgeted Cost
Meeting Rental Costs
$Click here to enter amount.
Utilities (Prorated for LEPC meeting room/office only)
$Click here to enter amount.
Office Supplies
$Click here to enter amount.
Postal Services
$Click here to enter amount.
Printing/Copying
$Click here to enter amount.
Telephone (Land/Mobile Dedicated to LEPC Only)
$Click here to enter amount.
Travel
$Click here to enter amount.
Click here to provide further details.
Per Diem
$Click here to enter amount.
Click here to provide further details.
Lodging
$Click here to enter amount.
Click here to provide further details.
Equipment
$Click here to enter amount.
Click here to provide further details.
Other
$Click here to enter amount.
Click here to provide further details.
TOTAL Support Services, Non–Contractual
$Click here to enter amount.
TOTAL for LEPC MANAGEMENT
$Click here to enter amount.
OUTREACH
Please describe the outreach activities and costs associated with each activity. Not all outreach activity boxes need to be
completed. Additional activity boxes may be added if needed.
Outreach Activity Description
Outreach Activity Description
Outreach Activity Costs
Budgeted Cost
Supplies
$Click here to enter amount.
Click here to provide further details.
Promotional Item
$Click here to enter amount.
Click here to provide further details.
Other (describe)
$Click here to enter amount.
Click here to provide further details.
TOTAL for Outreach Activity
$ Click here to enter amount.
Outreach Activity Description
Outreach Activity Description
Outreach Activity Costs
Budgeted Cost
Supplies
$Click here to enter amount.
Click here to provide further details.
Promotional Item
$Click here to enter amount.
Click here to provide further details.
Other (describe)
$Click here to enter amount.
Click here to provide further details.
TOTAL for Outreach Activity
$ Click here to enter amount.
Overall Total for LEPC Outreach
$ Click here to enter amount.
PREPAREDNESS
Please describe the preparedness activities and costs associated with each activity. Not all preparedness activity boxes need to
be completed. Additional activity boxes may be added if needed.
Preparedness Activity Description
Preparedness Activity Description
Preparedness Activity Costs
Supplies
Click here to provide further details.
Exercise
Click here to provide further details.
Training
Click here to provide further details.
Other (describe)
Click here to provide further details.
TOTAL for Preparedness Activity
Preparedness Activity Description
Preparedness Activity Description
Preparedness Activity Costs
Supplies
Click here to provide further details.
Exercise
Click here to provide further details.
Training
Click here to provide further details.
Other (describe)
Click here to provide further details.
TOTAL for Preparedness Activity
Overall Total for LEPC Preparedness
Budgeted Cost
$Click here to enter amount.
$Click here to enter amount.
$Click here to enter amount.
$Click here to enter amount.
$Click here to enter amount.
Budgeted Cost
$Click here to enter amount.
$Click here to enter amount.
$Click here to enter amount.
$Click here to enter amount.
$ Click here to enter amount.
$ Click here to enter amount.
BASELINE COSTS BUDGET SUMMARY
Budget Category
LEPC Management, Contractual and Non–Contractual
Outreach Activities
Preparedness Activities
TOTAL BASELINE EXPENSES
(This must equal projected SERC Baseline funding amount in Table A.)
Budgeted Cost
$Click here to enter amount.
$Click here to enter amount.
$Click here to enter amount.
$ Click here to enter amount.
Point of Contact
Governmental jurisdiction that will administer funds awarded under this program
Click here to enter text.
Jurisdiction/make check payable
Click here to enter text.
Address
Click here to enter address.
City
Click here to enter city.
State
Click here to enter state.
Zip
Click here to enter zip.
Phone number
Click here to enter phone number.
Fax number
Click here to enter fax number.
Email address
Click here to enter email address.
Signature of Authorized Jurisdiction Representative
By the signature below, the governmental jurisdiction noted above provisionally agreed to administer funding awarded to the
LEPC by the SERC, pending agreement to the terms of the final funding agreement by all parties.
Signature of Authorized Jurisdiction Representative
Date
Click here to enter a date.
Printed Name and Title
Click here to enter name and title.
Signature of Chairperson or Person Authorized to Represent the LEPC
The undersigned certifies this application to be the agreed submittal of the LEPC.
Signature of Chairperson or Person Authorized to Represent the LEPC
Date
Click here to enter a date.
Printed Name and Title
Click here to enter name and title.