Okaloosa County BOCC — October 7, 2014 — Agreement & Attachments — reading text

Project Number LP46040 Date of Request 3. Disbursement Request Number Required Match % 0 4. Type of Request: Partial Final 5. Federal Employer Identification Number 59-6000765 6. Task/Deliverable No. 7. Mail EFT Send Remittance to: Disbursement Details (cumulative amounts rounded to the nearest dollar) Amount this Total NOTE: Can only claim expenses in approved budget. Request Cumulative 1. Contractual Services 2. Total 3. Disbursements previously requested 4. Amount Requested for Disbursement (line 2 minus 3) ** SUBMIT ONE ORIGINAL COPY OF THIS FORM AND SUPPORTING DOCUMENTATION FOR EACH DELIVERABLE TO: ** Florida Department of Environmental Protection State Revolving Fund Management MS 3505 2600 Blair Stone Road Tallahassee, Florida 32399-2400 or email your request to: SRF_Reporting@dep.state.fl.us DEP Agreement No. LP46040, Attachment B, Page 1 of 3  Grant Manager’s Certification of Disbursement Request I, , (name of Grantee’s Grant Manager designated in the Agreement) on behalf of , do hereby certify that: (name of Grantee/Recipient) 1. The disbursement amount requested on Page 1 of this form is for allowable costs for the project described in Attachment A of the Agreement; 2. All costs included in the amount requested have been satisfactorily purchased, performed, received, and applied toward completing the project; such costs are documented by invoices or other appropriate documentation as required in paragraph 3D; 3. The Grantee has paid such costs under the terms and provisions of contracts relating directly to the project; and the Grantee is not in default of any terms or provisions of the contracts; 4. If funds were advanced, all funds received to date have been applied toward completing the project; and 5. All permits and approvals required for the construction which is underway have been obtained. ( Signature of Grant Manager) (Date) DEP Agreement No. LP46040, Attachment B, Page 2 of 3  Engineer’s Certification of Disbursement Request ONLY SUBMIT IF CONSTRUCTION IS PART OF THE PROJECT I, , being the Professional Engineer retained by (name of Professional Engineer) , am responsible for overseeing construction of the (name of Grantee/Recipient) project described in the Agreement and do hereby certify that: 1. Equipment, materials, labor, and services represented by the construction invoices have been satisfactorily purchased or received and applied to the project in accordance with construction contract documents filed with and previously approved by the Department of Environmental Protection; 2. Payment is in accordance with construction contract provisions; 3. Adequate construction supervision is being provided to assure compliance with construction requirements and Florida Administrative Code Chapter 62-600 or Chapter 62-604, as appropriate; 4. Construction up to the point of this disbursement is in compliance with the approved plans and permits; 5. All changes, additions, or deletions to the construction contract(s) have been documented by change order and all change orders have been submitted to the Department; and 6. All additions or deletions to the Project which have altered the Project’s performance standards, scope, or purpose (since issue of the pertinent Department permit) have been identified in writing by amendment to this Agreement. Signature of Professional Engineer Firm or Affiliation (Date) (P.E. Number) DEP Agreement No. LP46040, Attachment B, Page 3 of 3  ATTACHMENT C Contract Payment Requirements Florida Department of Financial Services, Reference Guide for State Expenditures Cost Reimbursement Contracts Invoices for cost reimbursement contracts must be supported by an itemized listing of expenditures by category (salary, travel, expenses, etc.). Supporting documentation must be provided for each amount for which reimbursement is being claimed indicating that the item has been paid. Check numbers may be provided in lieu of copies of actual checks. Each piece of documentation should clearly reflect the dates of service. Only expenditures for categories in the approved contract budget should be reimbursed. Listed below are examples of the types of documentation representing the minimum requirements: (1) Salaries: A payroll register or similar documentation should be submitted. The payroll register should show gross salary charges, fringe benefits, other deductions and net pay. If an individual for whom reimbursement is being claimed is paid by the hour, a document reflecting the hours worked times the rate of pay will be acceptable. (2) Fringe Benefits: Fringe Benefits should be supported by invoices showing the amount paid on behalf of the employee (e.g., insurance premiums paid). If the contract specifically states that fringe benefits will be based on a specified percentage rather than the actual cost of fringe benefits, then the calculation for the fringe benefits amount must be shown. Exception: Governmental entities are not required to provide check numbers or copies of checks for fringe benefits. (3) Travel: Reimbursement for travel must be in accordance with Section 112.061, Florida Statutes, which includes submission of the claim on the approved State travel voucher or electronic means. (4) Other direct costs: Reimbursement will be made based on paid invoices/receipts. If nonexpendable property is purchased using State funds, the contract should include a provision for the transfer of the property to the State when services are terminated. Documentation must be provided to show compliance with Department of Management Services Rule 60A-1.017, Florida Administrative Code, regarding the requirements for contracts which include services and that provide for the contractor to purchase tangible personal property as defined in Section 273.02, Florida Statutes, for subsequent transfer to the State. (5) In-house charges: Charges which may be of an internal nature (e.g., postage, copies, etc.) may be reimbursed on a usage log which shows the units times the rate being charged. The rates must be reasonable. (6) Indirect costs: If the contract specifies that indirect costs will be paid based on a specified rate, then the calculation should be shown. Contracts between state agencies, and or contracts between universities may submit alternative documentation to substantiate the reimbursement request that may be in the form of FLAIR reports or other detailed reports. The Florida Department of Financial Services, online Reference Guide for State Expenditures can be found at this web address: http://www.fldfs.com/aadir/reference_guide.htm DEP 55-219 (05/2008) DEP Agreement No. LP46040, Attachment C, Page 1 of 1  ATTACHMENT D PROGRESS REPORT FORM DEP Agreement No.: LP46040 Grantee Name: OKALOOSA COUNTY Grantee Address: Grantee’s Grant Manager: Telephone No.: Reporting Period: Project Number and Title: Provide the following information for all tasks and deliverables identified in the Project Work Plan: a summary of project accomplishments for the reporting period; a comparison of actual accomplishments to goals for the period; if goals were not met, provide reasons why; provide an update on the estimated time for completion of the task and an explanation for any anticipated delays and identify by task. NOTE: Use as many pages as necessary to cover all tasks in the Project Work Plan. The following format should be followed: Task 1: Progress for this reporting period: Identify any delays or problems encountered: This report is submitted in accordance with the reporting requirements of DEP Agreement No. LP46040 and accurately reflects the activities associated with the project. Signature of Grantee’s Grant Manager Date DEP Agreement No. LP46040, Attachment D, Page 1 of 1  ATTACHMENT G SPECIAL AUDIT REQUIREMENTS The administration of resources awarded by the Department of Environmental Protection (which may be referred to as the "Department", "DEP", "FDEP" or "Grantor", or other name in the contract/agreement) to the recipient (which may be referred to as the "Contractor", Grantee" or other name in the contract/agreement) may be subject to audits and/or monitoring by the Department of Environmental Protection, as described in this attachment. MONITORING In addition to reviews of audits conducted in accordance with OMB Circular A-133 and Section 215.97, F.S., as revised (see “AUDITS” below), monitoring procedures may include, but not be limited to, on-site visits by Department staff, limited scope audits as defined by OMB Circular A-133, as revised, and/or other procedures. By entering into this Agreement, the recipient agrees to comply and cooperate with any monitoring procedures/processes deemed appropriate by the Department of Environmental Protection. In the event the Department of Environmental Protection determines that a limited scope audit of the recipient is appropriate, the recipient agrees to comply with any additional instructions provided by the Department to the recipient regarding such audit. The recipient further agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the Chief Financial Officer or Auditor General. AUDITS PART I: FEDERALLY FUNDED This part is applicable if the recipient is a State or local government or a non-profit organization as defined in OMB Circular A-133, as revised. 1. In the event that the