[Governmental Agency]

[Gov’t Agency Contact],

[Title] [Address]

[City, ST Zip]

[GOV’T AGENCY LOGO]

[DATE]

Brian Koper

Emergency Management Specialist, Engineering Services Branch

Engineering and Modeling Division | National Flood Insurance Program

U.S. Department of Homeland Security

500 C Street, SW

Washington, DC 20472

RE: Certification of City of Sacramento, California for Application in the National Flood Insurance

Program for [area/region/district]

Dear Brian:

The following information is a request for local model acceptance based on a current local certification

in a separate jurisdiction.

• The model is currently locally accepted for City of Sacramento, California and was previously

reviewed, tested, and accepted by a governmental agency.

• [Entity] is responsible for the implementation of programs for flood control and/or regulation of

floodplains throughout [area/region/district].

• The model should only be used in [area/region/district], under the guidelines of the [entity].

As the [title] for the [entity], I request local acceptance by proxy of [currently locally accepted model],

which meets the requirements of FEMA’s criteria for certification of coastal, hydrologic, and hydraulic

models as stated by the FEMA Guidelines and Standards for Flood Risk Analysis and Mapping.

Sincerely,

[Digital Signature]

[Local Contact]

[Title]

[Entity]

cc: [Name], [Title]

[Name], [Title]