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Okaloosa County BOCC — December 4, 2012 — OkaloosaCo Homeland Security Grant 2013 — reading text
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[ ] ADVANCE REQUESTED
[ X ] NO ADVANCE REQUESTED
Advance payment of $ _____________ is requested. Balance of
No advance payment is requested. Payment payments will be made on a reimbursement basis. These funds
will be solely on a reimbursement basis. No are needed to pay staff, award benefits to clients, duplicate
additional information is required. forms and purchase start-up supplies and equipment. We
would not be able to operate the program without this advance.
ADVANCE REQUEST WORKSHEET
If you are requesting an advance, complete the following worksheet
(A) (B) (C) (D)
DESCRIPTION
FFY 20__ FFY 20__ FFY 20__ Total
1 INITIAL CONTRACT ALLOCATION
2 FIRST THREE MONTHS CONTRACT
EXPENDITURES1
3 AVERAGE PERCENT EXPENDED IN
FIRST THREE MONTHS
(Divide line 2 by line 1.)
1
First three months expenditures need only be provided for the years in which you requested an advance. If you do not
have this information, call your consultant and they will assist you.
MAXIMUM ADVANCE ALLOWED CALULATION:
________________________________ X $ ____________________________ = _________________
Cell D3 DEM Award MAXIMUM
(Do not include any match) ADVANCE
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REQUEST FOR WAIVER OF CALCULATED MAXIMUM
[ ] Recipient has no previous DEM/DCA contract history. Complete Estimated Expenses chart and
Explanation of Circumstances below.
[ ] Recipient has exceptional circumstances that require an advance greater than the Maximum Advance
calculated above.
Complete estimated expenses chart and Explanation of Circumstances below. Attach additional pages if
needed.
ESTIMATED EXPENSES
20____-20_____ Anticipated Expenditures for First Three Months of
BUDGET CATEGORY
Contract
ADMINISTRATIVE COSTS
(Include Secondary Administration.)
PROGRAM EXPENSES
TOTAL EXPENSES
Explanation of Circumstances:
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Attachment D
Warranties and Representations
Financial Management
Recipient’s financial management system must include the following:
(1) Accurate, current and complete disclosure of the financial results of this project or program
(2) Records that identify the source and use of funds for all activities. These records shall contain
information pertaining to grant awards, authorizations, obligations, unobligated balances, assets,
outlays, income and interest.
(3) Effective control over and accountability for all funds, property and other assets. Recipient shall
safeguard all assets and assure that they are used solely for authorized purposes.
(4) Comparison of expenditures with budget amounts for each Request for Payment. Whenever
appropriate, financial information should be related to performance and unit cost data.
(5) Written procedures to determine whether costs are allowed and reasonable under the provisions of the
applicable OMB cost principles and the terms and conditions of this Agreement.
(6) Cost accounting records that are supported by backup documentation.
Competition
All procurement transactions shall be done in a manner to provide open and free competition. The Recipient shall be
alert to conflicts of interest as well as noncompetitive practices among contractors that may restrict or eliminate
competition or otherwise restrain trade. In order to ensure excellent contractor performance and eliminate unfair
competitive advantage, contractors that develop or draft specifications, requirements, statements of work, and
invitations for bids and/or requests for proposals shall be excluded from competing for such procurements. Awards
shall be made to the bidder or offeror whose bid or offer is responsive to the solicitation and is most advantageous to
the Recipient, considering the price, quality and other factors. Solicitations shall clearly set forth all requirements
that the bidder or offeror must fulfill in order for the bid or offer to be evaluated by the Recipient. Any and all bids
or offers may be rejected when it is in the Recipient's interest to do so.
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Code of conduct
The Recipient shall maintain written standards of conduct governing the performance of its employees engaged in
the award and administration of contracts. No employee, officer, or agent shall participate in the selection, award, or
administration of a contract supported by public grant funds if a real or apparent conflict of interest would be
involved. Such a conflict would arise when the employee, officer, or agent, any member of his or her immediate
family, his or her partner, or an organization which employs or is about to employ any of the parties indicated, has a
financial or other interest in the firm selected for an award. The officers, employees, and agents of the Recipient
shall neither solicit nor accept gratuities, favors, or anything of monetary value from contractors or parties to
subcontracts. The standards of conduct shall provide for disciplinary actions to be applied for violations of the
standards by officers, employees, or agents of the Recipient.
Business Hours
The Recipient shall have its offices open for business, with the entrance door open to the public, and at least one
employee on site, from 8:00 am to 5:00 pm, Monday - Friday_____________________________________
______________________________________________________________________________________
Licensing and Permitting
All subcontractors or employees hired by the Recipient shall have all current licenses and permits required for all of
the particular work for which they are hired by the Recipient.
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Attachment E
Certification Regarding
Debarment, Suspension, Ineligibility
And Voluntary Exclusion
Subcontractor Covered Transactions
(1) The prospective subcontractor of the Recipient, ____________________________, 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 Recipient’s subcontractor is unable to certify to the above statement, the prospective
subcontractor shall attach an explanation to this form.
SUBCONTRACTOR:
______________________________
By: ____________________________ __________________________________
Signature Recipient’s Name
________________________________ __________________________________
Name and Title DEM Contract Number
________________________________
Street Address
________________________________
City, State, Zip
________________________________
Date
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Attachment F
Statement of Assurances
The Recipient hereby assures and certifies compliance with all Federal statutes, regulations, policies, guidelines and
requirements, including OMB Circulars No. A-21, A-110, A-122, A-128, A-87; E.O. 12372 and Uniform
Administrative Requirements for Grants and Cooperative Agreements 28 CFR, Part 66, Common rule, that govern
the application, acceptance and use of Federal funds for this federally-assisted project. Also the Applicant assures
and certifies that:
1. It will comply with requirements of the provisions of the Uniform Relocation Assistance and Real Property
Acquisitions Act of 1970 (P.L. 91-646) which provides for fair and equitable treatment of persons displaced as a
result of Federal and federally-assisted programs.
2. It will comply with provisions of Federal law which limit certain political activities of employees of a State or
local unit of government whose principal employment is in connection with an activity financed in whole or in part
by Federal grants. (5 USC 1501, et seq.)
3. It will comply with the minimum wage and maximum hour’s provisions of the Federal Fair Labor Standards Act.
4. It will establish safeguards to prohibit employees from using their positions for a purpose that is or gives the
appearance of being motivated by a desire for private gain for themselves or others, particularly those with whom
they have family, business, or other ties.
5. It will give the sponsoring agency or the Comptroller General, through any authorized representative, access to
and the right to examine all records, books, papers, or documents related to the grant.
6. It will comply with all requirements imposed by the Federal sponsoring agency concerning special requirements
of law, program requirements, and other administrative requirements.
7. It will insure that the facilities under its ownership, lease or supervision which shall be utilized in the
accomplishment of the project are not listed on the Environmental Protection Agency's (EPA) list of Violating
Facilities and that it will notify the Federal grantor agency of the receipt of any communication from the Director of
the EPA Office of Federal Activities indicating that a facility to be used in the project is under consideration for
listing by the EPA.
8. It will comply with the flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection
Act of 1973, Public Law 93-234, 87 Stat. 975, approved December 31, 1976, Section 102(a) requires, on and after
March 2, 1975, the purchase of flood insurance in communities where such insurance is available as a condition for
the receipt of any Federal financial assistance for construction or acquisition purposes for use in any area that has
been identified by the Secretary of the Department of Housing and Urban Development as an area having special
flood hazards. The phrase "Federal financial assistance" includes any form of loan, grant, guaranty, insurance
payment, rebate, subsidy, disaster assistance loan or grant, or any other form of direct or indirect Federal assistance.
9. It will assist the Federal grantor agency in its compliance with Section 106 of the National Historic Preservation
Act of 1966 as amended (16 USC 470), Executive Order 11593, and the Archeological and Historical Preservation
Act of 1966 (16 USC 569a-1 et seq.) by (a) consulting with the State Historic Preservation Officer on the conduct of
Investigations, as necessary, to identify properties listed in or eligible for inclusion in the National Register
