Packet: Regular Formal Council Meeting (10/07/2025)

USFS FEDERAL FINANCIAL ASSISTANCE Provided through the VOLUNTEER FIRE ASSISTANCE (VFA) PROGRAM COOPERATIVE FORESTRY ASSISTANCE ACT OF 1978. Distributed through agreement with the State Forester of the Iowa DNR Forestry. Volunteer Fire Assistance (VFA) APPLICATION - Application Deadline: OCTOBER 31, 2025 1. FED TAX ID#: ____________________________ DUNS #: ____________________________ Name of City/Township of Agency: ________________________________________________ Name of Fire Department: _______________________________________________________ Mailing Address: ________________________________________________________________ City: __________________________ State: Iowa Zip: ________________ 2. Estimated TOTAL project cost: ________________ 3. Date of Application (MM/DD/YYYY): ________________ County: _______________________ 4. Is the requesting community under 10,000 population? [ ] Yes [ ] No 5. Is the local 50% cost share available? [ ] Yes [ ] No 6. How many acres of state owned land are you protecting? __________ acres 7. Is the local agency registered with the State Fire Marshall’s office? [ ] Yes [ ] No 8. Has the local agency provided Iowa Wildland Fire Reports during 2024/25? [ ] Yes [ ] No 9. Has the local agency participated in Wildland Fire training? [ ] Yes [ ] No 10. Does the local agency use wildland fire PPE on wildland fires? [ ] Yes [ ] No 11. Is the completed W-9 Federal Tax ID form attached? [ ] Yes [ ] No 12. Please list the communities that this department has Mutual Aid agreements with: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ The applicant certifies, as a condition of this grant application, that no one within their organization will engage in the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance in conducting any activity with this grant. The applicant further certifies that to the best of his/her knowledge and belief, the information in this application is true and correct and that he/she will comply with the Cooperative Forestry Assistance Act of 1978 and its administration guidelines if the grant is received. Head of Local Government: __________________________ Signature: __________________________ (or Financial Officer) Name (please print): ____________________________________________ Title: ____________________________________________________________________________ Day and Evening Phone: __________________________________________________________ Email Address: _________________________________________________________________ Fire Chief: __________________________ Signature: __________________________ Name (please print): _____________________________________________________________ Day and Evening Phone: __________________________________________________________ Email Address: _________________________________________________________________