Common use of AS OF THIS DATE Clause in Contracts

AS OF THIS DATE. DATE EHSs WERE present on-site during the during the current filing year but ALL WERE REMOVED AS OF THIS DATE: NO EHSs WERE present on-site during the current filing year. ALL EHSs WERE REMOVED AS OF THIS DATE: SECTION 313 Not within covered NAICS Codes. Within covered NAICS Codes, but less than ten (10) employees. Within covered NAICS Codes, but NO Section 313 chemicals WERE present on-site during the current filing year. ALL SECTION 313 CHEMICALS WERE REMOVED AS OF THIS DATE: DATE Within covered NAICS Codes, and Section 13 chemicals WERE present on-site during the current filing year, but only in amounts below the established Threshold Planning Quantities (TPQ). AS OF THIS DATE: DATE OTHER CLOSED FACILITY YES NO CHEMICALS REMOVED YES NO CHEMICALS BELOW ESTABLISHED TPQs YES NO FACILITY CLOSED/CHEMICALS REMOVED BY DATE: NEW FACILITY YES NO DATE EHS(s) WERE ON-SITE: DATE EHS(s) EXCEEDED THE ESTABLISHED TPQ: Further Explanation if Necessary: Certification: (Read and Sign After Completing All Applicable Sections) I certify under penalty of law that I have personally examined and am familiar with the information submitted on this page, and that based on my inquiry of those individuals responsible for obtaining the information, I believe that the submitted information is true, accurate, and complete. Printed Name of Owner/Operator OR Owner/Operator's Authorized Representative Signature Date Signed By signing this Form, I certify to the best of my knowledge and belief that the information reported is in accordance with the Terms and Conditions of the Hazards Analysis Agreement. Signature of LEPC Coordinator/County Official or Authorized Representative Date Signed HMP-13-00 29 2021-22 HA Attachment L Statement of Determination (SOD) Form 4/26/2021 ATTACHMENT M CLOSE-OUT REPORT FORM 2021-2022 HAZARDS ANALYSIS GRANT AGREEMENT This form should be completed and submitted to the Division no later than sixty (60) days after termination date of the Agreement. SUB-RECIPIENT: Pasco County ADDRESS: GRANT # T0161 AGREEMENT AMT: $1,859.05 For Each Deliverable, Enter the Award Amount from Attachment A - Budget and Scope of Work. COST CATEGORY HA AGREEMENT DELIVERABLE AMOUNTS DATE OR QUARTER COMPLETED TOTAL AMOUNT PAID PER DELIVERABLE Deliverable 1 $743.62 Deliverable 2 $743.62 Deliverable 3 $371.81 Total Deliverables Amount: $1,859.05 Total Paid for Completed Deliverables: $0.00 By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the expenditures, disbursements, and cash receipts are for the purposes and objectives set forth in the Terms and Conditions of the State-Funded Hazards Analysis Agreement. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil, or administrative penalties for fraud, false statements, false claims, or otherwise as proscribed by law. Printed Name & Title Preparer Signature Date Signed Grant Manager Signature Date Signed HA AGREEMENT AMOUNT: $1,859.05 AMOUNT PREVIOUSLY PAID: $0.00 UNUSED BALANCE: 2021-22 HA Attachment M Close-Out Report Form 4/26/2021

AS OF THIS DATE. DATE EHSs WERE present on-site during the during the current filing year but ALL WERE REMOVED AS OF THIS DATE: NO EHSs WERE present on-site during the current filing year. ALL EHSs WERE REMOVED AS OF THIS DATE: SECTION 313 Not within covered NAICS Codes. Within covered NAICS Codes, but less than ten (10) employees. Within covered NAICS Codes, but NO Section 313 chemicals WERE present on-site during the current filing year. ALL SECTION 313 CHEMICALS WERE REMOVED AS OF THIS DATE: DATE Within covered NAICS Codes, and Section 13 chemicals WERE present on-site during the current filing year, but only in amounts below the established Threshold Planning Quantities (TPQ). AS OF THIS DATE: DATE OTHER CLOSED FACILITY YES NO CHEMICALS REMOVED YES NO CHEMICALS BELOW ESTABLISHED TPQs YES NO FACILITY CLOSED/CHEMICALS REMOVED BY DATE: NEW FACILITY YES NO DATE EHS(s) WERE ON-SITE: DATE EHS(s) EXCEEDED THE ESTABLISHED TPQ: Further Explanation if Necessary: Certification: (Read and Sign After Completing All Applicable Sections) I certify under penalty of law that I have personally examined and am familiar with the information submitted on this page, and that based on my inquiry of those individuals responsible for obtaining the information, I believe that the submitted information is true, accurate, and complete. Printed Name of Owner/Operator OR Owner/Operator's Authorized Representative Signature Date Signed By signing this Form, I certify to the best of my knowledge and belief that the information reported is in accordance with the Terms and Conditions of the Hazards Analysis Agreement. Signature of LEPC Coordinator/County Official or Authorized Representative Date Signed HMP-13Attachment M Close-00 29 2021Out Report Form 2022-22 HA Attachment L Statement of Determination (SOD) Form 4/26/2021 ATTACHMENT M CLOSE-OUT REPORT FORM 2021-2022 HAZARDS ANALYSIS GRANT AGREEMENT 2023 Hazard Analysis Grant Agreement This form should be completed and submitted to the Division no later than sixty (60) days after termination date of the Agreement. SUB-RECIPIENT: Pasco County ADDRESSCounty, 0000 Xxxxxxxxxx Xx., Xxxx X, Xxx Xxxx Xxxxxx, FL 34654 Grant Agreement #: GRANT # T0161 AGREEMENT AMTT0212 Areement Amount: $1,859.05 1,501.64 For Each Deliverable, Enter the Award Amount from Attachment A - Budget and Scope of Work. COST CATEGORY Cost Category HA AGREEMENT DELIVERABLE AMOUNTS DATE OR QUARTER COMPLETED TOTAL AMOUNT PAID PER DELIVERABLE Agreement Deliverable Amounts Date or Quarter Completed Total Amount Paid Per Deliverable Deliverable 1 $743.62 600.66 $600.66 Deliverable 2 $743.62 600.66 $600.66 Deliverable 3 $371.81 300.33 $300.33 Total Deliverables Amount: $1,859.05 1,501.64 Total Paid for Completed Deliverables: $0.00 1,501.64 By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the expenditures, disbursements, and cash receipts are for the purposes and objectives set forth in the Terms and Conditions of the State-Funded Hazards Analysis Agreement. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil, or administrative penalties for fraud, false statements, false claims, or otherwise as proscribed by law. Xxxxxx X. Xxxxx | Emergency Coordinator | Pasco County Recipient Printed Name & Title Preparer Recipient Signature Date Signed FDEM Grant Manager Signature Date Signed HA AGREEMENT AMOUNTAgreement Amount: $1,859.05 AMOUNT PREVIOUSLY PAID1,501.64 Amount Previously Paid: $0.00 UNUSED BALANCE1,501.64 Unused Balance: 2021-22 HA Attachment M Close-Out Report Form 4/26/20210

AS OF THIS DATE. DATE EHSs WERE present on-site during the during the current filing year but ALL WERE REMOVED AS OF THIS DATE: year. NO EHSs WERE present on-site during the current filing year. ALL EHSs WERE REMOVED AS OF THIS DATE: SECTION 313 Not within covered NAICS Codes. Within covered NAICS Codes, but less than ten (10) employees. Within covered NAICS Codes, but NO Section 313 chemicals WERE present on-site during the current filing DATE DATE DATE DATE DATE year. ALL SECTION 313 CHEMICALS WERE REMOVED AS OF THIS DATE: DATE Within covered NAICS Codes, and Section 13 chemicals WERE present on-site during the current filing year, but only in amounts below the established Threshold Planning Quantities (TPQ). AS OF THIS DATE: DATE OTHER CLOSED FACILITY YES NO CHEMICALS REMOVED YES NO CHEMICALS BELOW ESTABLISHED TPQs YES NO FACILITY CLOSED/CHEMICALS REMOVED BY DATE: NEW FACILITY YES NO Further Explanation if Necessary: DATE EHS(s) WERE ON-SITE: DATE EHS(s) EXCEEDED THE ESTABLISHED TPQ: Further Explanation if Necessary: Certification: (Read and Sign After Completing All Applicable Sections) I certify under penalty of law that I have personally examined and am familiar with the information submitted on this page, and that based on my inquiry of those individuals responsible for obtaining the information, I believe that the submitted information is true, accurate, and complete. Printed Name of Owner/Operator OR Owner/Operator's Authorized Representative Signature Date Signed By signing this Form, I certify to the best of my knowledge and belief that the information reported is in accordance with the Terms terms and Conditions conditions of the Hazards Analysis this Agreement. HMP-13-00 2020-21 HA Attachment L Statement of Determination (SOD) Form Updated on 6/10/2020 Signature of LEPC Coordinator/County Official or Authorized Representative Date Signed HMP-13-00 29 2021-22 HA Attachment L Statement of Determination (SOD) Form 4/26/2021 ATTACHMENT M CLOSE-OUT REPORT FORM 20212020-2022 2021 HAZARDS ANALYSIS GRANT AGREEMENT This form should be completed and submitted to the Division no later than sixty (60) days after the termination date of the Agreement. SUB-RECIPIENT: Pasco County ADDRESS: Lake County 000 Xxxx Xxxx Xx., X.X. Xxx 0000, Xxxxxxx, XX 00000 GRANT # T0161 T0102 AGREEMENT AMT: $1,859.05 8,038.00 For Each Deliverable, Enter the Award Amount from Attachment A - Budget and Scope of Work. COST CATEGORY HA AGREEMENT DELIVERABLE AMOUNTS DATE OR QUARTER COMPLETED SUBMITTED TOTAL AMOUNT PAID PER DELIVERABLE Deliverable 1 $743.62 3,215.20 Deliverable 2 $743.62 3,215.20 Deliverable 3 $371.81 Total Deliverables Amount: $1,859.05 Total Paid for Completed Deliverables: $0.00 By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the expenditures, disbursements, and cash receipts are for the purposes and objectives set forth in the Terms and Conditions of the State-Funded Hazards Analysis Agreement. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil, or administrative penalties for fraud, false statements, false claims, or otherwise as proscribed by law. Printed Name & Title Preparer Signature Date Signed Grant Manager Signature Date Signed HA AGREEMENT AMOUNT: $1,859.05 AMOUNT PREVIOUSLY PAID: $0.00 UNUSED BALANCE: 2021-22 HA Attachment M Close-Out Report Form 4/26/20211,607.60

AS OF THIS DATE. DATE EHSs WERE present on-site during the during the current filing year but ALL WERE REMOVED AS OF THIS DATE: NO EHSs WERE present on-site during the current filing year. ALL EHSs WERE REMOVED AS OF THIS DATE: SECTION 313 Not within covered NAICS Codes. Within covered NAICS Codes, but less than ten (10) employees. Within covered NAICS Codes, but NO Section 313 chemicals WERE present on-site during the current filing year. ALL SECTION 313 CHEMICALS WERE REMOVED AS OF THIS DATE: DATE Within covered NAICS Codes, and Section 13 chemicals WERE present on-site during the current filing year, but only in amounts below the established Threshold Planning Quantities (TPQ). AS OF THIS DATE: DATE OTHER CLOSED FACILITY YES NO CHEMICALS REMOVED YES NO CHEMICALS BELOW ESTABLISHED TPQs YES NO FACILITY CLOSED/CHEMICALS REMOVED BY DATE: NEW FACILITY YES NO DATE EHS(s) WERE ON-SITE: YES NO DATE EHS(s) EXCEEDED THE ESTABLISHED TPQ: Further Explanation if Necessary: Certification: (Read and Sign After Completing All Applicable Sections) I certify under penalty of law that I have personally examined and am familiar with the information submitted on this page, and that based on my inquiry of those individuals responsible for obtaining the information, I believe that the submitted information is true, accurate, and complete. Printed Name of Owner/Operator OR Owner/Operator's Authorized Representative Signature Date Signed By signing this Form, I certify to the best of my knowledge and belief that the information reported is in accordance with the Terms and Conditions of the Hazards Analysis Agreement. Signature of LEPC Coordinator/County Official or Authorized Representative Date Signed HMP-13-00 29 32 2021-22 HA Attachment L Statement of Determination (SOD) Form 4/26/2021 ATTACHMENT M CLOSE-OUT REPORT FORM 2021-2022 HAZARDS ANALYSIS GRANT AGREEMENT This form should be completed and submitted to the Division no later than sixty (60) days after termination date of the Agreement. SUB-RECIPIENT: Pasco County ADDRESS: GRANT # T0161 AGREEMENT AMT: $1,859.05 For Each Deliverable, Enter the Award Amount from Attachment A - Budget and Scope of Work. COST CATEGORY HA AGREEMENT DELIVERABLE AMOUNTS DATE OR QUARTER COMPLETED TOTAL AMOUNT PAID PER DELIVERABLE Deliverable 1 $743.62 Deliverable 2 $743.62 Deliverable 3 $371.81 Total Deliverables Amount: $1,859.05 Total Paid for Completed Deliverables: $0.00 HA AGREEMENT AMOUNT: AMOUNT PREVIOUSLY PAID: UNUSED BALANCE: By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the expenditures, disbursements, and cash receipts are for the purposes and objectives set forth in the Terms and Conditions of the State-Funded Hazards Analysis Agreement. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil, or administrative penalties for fraud, false statements, false claims, or otherwise as proscribed by law. Preparer Signature Grant Manager Signature Printed Name & Title Preparer Signature Date Signed Grant Manager Signature Date Signed HA AGREEMENT AMOUNT: $1,859.05 AMOUNT PREVIOUSLY PAID: $0.00 UNUSED BALANCE: 2021-22 HA Attachment M Close-Out Report Form 4/26/2021

AS OF THIS DATE. DATE EHSs WERE present on-site during the during the current filing year but ALL WERE REMOVED AS OF THIS DATE: year. DATE NO EHSs WERE present on-site during the current filing year. ALL EHSs WERE REMOVED AS OF THIS DATE: SECTION 313 Not within covered NAICS Codes. Within covered NAICS Codes, but less than ten (10) employees. Within covered NAICS Codes, but NO Section 313 chemicals WERE present on-site during the current filing year. ALL SECTION 313 CHEMICALS WERE REMOVED AS OF THIS DATE: DATE Within covered NAICS Codes, and Section 13 chemicals WERE present on-site during the current filing year, but only in amounts below the established Threshold Planning Quantities (TPQ). AS OF THIS DATE: DATE OTHER CLOSED FACILITY YES NO CHEMICALS REMOVED YES NO CHEMICALS BELOW ESTABLISHED TPQs YES NO FACILITY CLOSED/CHEMICALS REMOVED BY DATE: NEW FACILITY YES NO DATE EHS(s) WERE ON-SITE: YES NO DATE EHS(s) EXCEEDED THE ESTABLISHED TPQ: Further Explanation if Necessary: Certification: (Read and Sign After Completing All Applicable Sections) I certify under penalty of law that I have personally examined and am familiar with the information submitted on this page, and that based on my inquiry of those individuals responsible for obtaining the information, I believe that the submitted information is true, accurate, and complete. Printed Name of Owner/Operator OR Owner/Operator's Authorized Representative Signature Date Signed By signing this Form, I certify to the best of my knowledge and belief that the information reported is in accordance with the Terms terms and Conditions conditions of the Hazards Analysis this Agreement. Signature of LEPC Coordinator/County Official or Authorized Representative Date Signed HMP-13-00 29 20212020-22 21 HA Attachment L Statement of Determination (SOD) Form 4/26/2021 Updated on 6/10/2020 ATTACHMENT M CLOSE-OUT REPORT FORM 20212020-2022 2021 HAZARDS ANALYSIS GRANT AGREEMENT This form should be completed and submitted to the Division no later than sixty (60) days after the termination date of the Agreement. SUB-RECIPIENT: Pasco County ADDRESS: GRANT # T0161 AGREEMENT AMT: $1,859.05 For Each Deliverable, Enter the Award Amount from Attachment A - Budget and Scope of Work. COST CATEGORY HA AGREEMENT DELIVERABLE AMOUNTS DATE OR QUARTER COMPLETED SUBMITTED TOTAL AMOUNT PAID PER DELIVERABLE Deliverable 1 $743.62 Deliverable 2 $743.62 Deliverable 3 $371.81 Total Deliverables Amount: $1,859.05 Total Paid for Completed Deliverables: $0.00 By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the expenditures, disbursements, and cash receipts are for the purposes and objectives set forth in the Terms and Conditions of the State-Funded Hazards Analysis Agreement. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil, or administrative penalties for fraud, false statements, false claims, or otherwise as proscribed by law. Printed Name & Title Preparer Signature Date Signed Grant Manager Signature Date Signed HA AGREEMENT AMOUNT: $1,859.05 AMOUNT PREVIOUSLY PAID: $0.00 UNUSED BALANCE: 2021-22 HA Attachment M Close-Out Report Form 4/26/20213