Fort Walton Beach Council agenda — 01-08-13--regular — reading text

620. Packet Pg. 4T  ATTACHMENT " B" Public Assistance Quarterly Report Available for Each Subgrantee on wvnv. FlorhlaPA.org O. m x" d NWa Packet Pg. 42  8. 2. a Attachment " C" Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Subcontractor Covered Transactions: I. The prospective subcontractor of the Subgrantee certifies, by submission of this document, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency. 2. Where the Subgrantee' s subcontractor is unable to certify to the above statement, the prospective subcontractor shall attach an explanation to this form. SUBCONTRACTOR: Name of Company Street Address City, State, Zip Federal Employer Identification Number (FEIN) By. - _ Signature Date Subgrantee' s Name Grantee Agreement Number Packet Pg. 43  8.2. a 11— h- 1 DESIGNATION OF SUBGRANTEE' S AGENT FEMAIGRANTEE PUBLIC ASSISTANCE PROGRAM Florida Division of Emergency Management Sub -Grantee City of Fort Walton Beach Primary Agent Secondary Agent Agent' s Name Agent' s Name Michael Beedie Brandy Ferris Signature Signature Organization / Official Position Organization / Official Position City of Fort Walton Beach, Finance Director City of Fort Walton Beach, City Manager Mailing Address Mailing Address 107 Miracle Strip Pkwy SW 107 Miracle Strip Pkwy SW City , Grantee, Zip City , Grantee, Zip Fort Walton Beach, FL 32548 Fort Walton Beach, FL 32548 Daytime Telephone Daytime Telephone 850 -833 -9512 850- 833 -9612 Facsimile Number Facsimile Number 850- 833 -9640 850 -833 -9640 E -mail Address E -mail Address bfenis@fwb.org mbeedie @fwb. org The above Primary and Secondary Agents are hereby authorized to execute and file Application for Public Assistance on behalf of the Sub -grantee for the purpose of obtaining certain Grantee and federal financial assistance under the Robert T. Stafford Disaster Relief 8 Emergency Assistance Act, (Public Law 93 -288 as amended) or otherwise available. These agents are authorized to represent and act for the Sub -Grantee in all dealings with the Grantee of Florida, Grantee for all matters pertaining to such disaster assistance required by the agreements and assurances printed on page 2 hereof. Additional authorized contacts may be registered on the Grantee' s PA Website Cmwy Flondapa. orc) for full or read only access by the above authorized Agents. Chief Financial Officer Sub -Grantee' s Authority/Board/ Commission Name Official' s Name Brandy Ferris Michael G. Anderson Signature Signature Organization / Official Position Organization / Official Position City of Fort Walton Beach, Finance Director City of Fort Walton Beach, Mayor Mailing Address Mailing Address 107 Miracle Strip Pkwy SW 107 Miracle Strip Pkwy SW City , Grantee, Zip City ,Grantee, Zip Fort Walton Beach, FL 32548 Fort Walton Beach, FL 32548 Daytime Telephone Daytime Telephone 850- 833 -9512 850- 833 -9509 Facsimile Number Facsimile Number 850 -833 -9640 850 -833 -9640 E -mail Address E - mail Address bfer( s@fwb. org manderson @fwb.org Sub- Grantee' s Grantee Cognizant Agency for Single Audit purposes' Florida Division of Emergency Management Sub -Grantee' s Fiscal Year (FY) Start Month: October Day; 1 Sub -Grantee' s Federal Employer' s Identification Number ( EIN) 59 - 6000323 Sub -Grantee' s HIPS Number ( If Known) 12 - 91 - 24475 Sub -Grantee Authority/ Board /Commission Signature Date: 01/ 08/ 2013 Page t Packet P ®. 44:  8. 2.a Attachment E JUSTIFICATION OF ADVANCE PAYMENT RECIPIENT: m L If you are requesting an advance, indicate same by checking the box below 0 j ADVANCE REQUESTED Advance payment of S __ is requested. Balance of payments will be made on a reimbursement basis. These funds are QmvcN 0 U needed to pay staff, award benefits to clients, duplicate forms and c purchase start -up supplies and equipment, We would not be able to operate the program without this advance. E If you are requesting an advance, complete the following chart and line item justification below. Qmdva c Nas BUDGET CATEGORY /LINE ITEMS 20 - 20 Anticipated Expenditures for First Three Months of QUN c0 list applicable line items) Contract For example ADMINISTRATIVE COSTS Include Secondary Administration.) PROGRAM For example EXPENSES TOTAL EXPENSES QnoucAvm mN N c LINE ITEM JUSTIFICATION ( For each line item, provide a detailed justification explaining the need for the EEva cash advance. The justification must include supporting documentation that clearly shows the advance will be Q expended within the first ninety ( 90) days of the contract term. Support documentation should include quotes for purchases, delivery fimclines, salary and expense projections, etc to provide the Division reasonable and 9Cc necessary support that the advance will be expended within the first ninety ( 90) days of the contract term. Any a advance funds not expended within the first ninety ( 90) days of the contract term shall be returned to the vm Division Cashier, 2555 Shumard Oak Boulevard, Tallahassee, Florida 32399, within thirty (30) days of receipt, along with any interest earned on the advance) qCO