HomeMy WebLinkAboutSubgrant Forms & ReqmtsSTATE OF FLORIDA
DIVISION OF EMERGENCY MANAGEMENT
SUBGRANT FORMS and REQUIREMENTS
Quarterly Financial History Report/ Status Report (Form 1 and Form 2):
1.
These reports must be completed in full on a quarterly basis. These are required reports and must be submitted no
later than 30 days after the end of each period of the program year in order to be considered in compliance with the
terns of the contract.
2. These reports are to include, but not be limited to, the work that has been completed, the work in progress and the timeline
of the work left to be completed. If any delays from the original timeline have occurred, specify the reason and revise the
completion timeline.
3. If expenditures do not occur during the time frame given, a complete explanation should be given on Form 1 and 2.
Reimbursement Request (Form 3) and Detail of Claims (Form 4):
1.
These forms are to be filed as needed. Complete Reimbursement Request by entering all information needed for
reimbursement.
2. The Detail of Claims form must accompany the Reimbursement Request form, along with the•Budget detail'Worksheet.
3. The Reimbursement Request form must be signed by the contract manager or someone with equal authority.
4. Claims are to be submitted to the following address:
DIVISION OF EMERGENCY MANAGEMENT
BUREAU OF RESPONSE
DHS GRANTS UNIT
Attn: Ms. Carolyn Washington
2555 SHUMARD OAK BOUEVARD
TALLAHASSEE, FLORIDA 32399-2100
Close Out Report - (Form 5):
1. Close Out Reports are due as soon as the final payment has been made and all final expenditures have occurred.
2. The agreement cannot be considered closed until the Close Out Report has been received.
Documentation of project expenditures:
1.
Grantees must maintain documentation of expenditures for a minimum period of five years following the close of
project/program operations unless audits require a longer period of time.
2. Grantees should maintain a financial file with copies of back-up documentation for all paid project/program expenditures
made by the grantee during the grant period. Documentation of expenditures against the program will be reviewed and
verified during on -site monitoring visits or when necessary by the DEM staff. Acceptable documentation includes copies of
purchase orders and paid vouchers, paid invoices or cancelled checks, payroll vouchers, journal transfers, etc. These
documents should be submitted when requesting reimbursement.
3. In order to document hours worked on the program by permanent or temporary staff, the grantee may use its own time and
attendance forms.
4. All claims for reimbursement of expenditures must be submitted on the approved DCA financial reporting forms. Claims
not submitted on the proper form cannot be processed and will be returned for corrections.
IF YOU WISH TO OBTAIN THESE FORMS ELECTONICALLY, PLEASE NOTIFY YOUR CONTRACT MANAGER
SHSGP POETE Report Forms - 09/Instructions, Forms 1, 2 & 3 1 of 4
GRANTEE:
AGREEMENT #
DIVISION OF EMERGENCY; MANAGEMENT
FINANCIAL HISTORY REPORT/QUARTERLY STATUS REPORT
_FARM *AND 2•
(Select the quarter of submission along with year)
QUARTERLY REPORTING DUE DATES
u' JANUARY 1- MARCH 31 - Due no later than April 30,
1 APRIL 1 - JUNE 30 - Due no later Than July 31,
'/- JULY 1- SEPTEMBER 30 - Due no later than October 31,
OCTOBER 1 - DECEMBER 31- Due no later than January 31,
;FI.NANCIAL HISTORY REPORT
THIS IS A REQUIRED DOCUMENT'AND MUST BESUBMITTED QUARTERLY
N/A
N/A
N/A
N/A
CUMULATIVE
TOTAL
ALLOCATED
QUARTERLY FUNDS
EXPENDED
CUM. FUNDS
EXPENDED
REMAINING
BALANCE
1. Planning Costs
$0.00
$0.00
$0.00
$0.00
2. Training Costs
$0.00
$0.00
$0.00
$0.00
3. Exercise Costs
$0.00
$0.00
$0.00
$0.00
4. Organizational Costs
$0.00
$0.00
$0.00
$0.00
5. Equipment Costs
$0.00
$0.00
$0.00
$0.00
67Manamentand Administration
Costs (limited to 3% of the total
$0.00
$0.00
$0.00
$0.00
TOTAL EXPENDITURES
$0.00
$0.00
$0.00
$0.00
TOTAL PAYMENTS PREVIOUSLY RECEIVED
hereby certify that the above costs are true and valid costs incurred in accordance with the project agreement.
Signed:
Contract Manager or Financial Officer
QUARTERLY STATUS REPORT •
• THIS IS :A REQUIRED DOCUMENT AND MUST BE SUBMITTED. SEMI• ANNUALLY
This information must be clearly linked to the project TIMELINE, DELIVERABLES AND THE SCOPE OF WORK.
Report events, progress, delays, etc. that pertain to this project.
(Attach additional page(s) if needed.)
TO BE COMPLETED BY FDEM STAFF
DATE SUBMITTED TO FDEM
SHSGP POETE Report Forms - 09/Instructions, Forms 1, 2 & 3 2 of 4
SHSGP POETE Report Forms - 09/Instructions, Forms 1, 2 & 3 3 of 4
DIVISION OF EMERGENCY MANAGEMENT
REIMBURSEMENT REQUEST
'FORM 3
Grantee
Payment Date
Address
Agreement #
Payment #
Phone #
Amount
COSTS INCURRED DURING THE PERIOD OF:
through
THIS MUST BE ACCOMPANIED BY THE DETAIL OF CLAIMS FORM
1. Planning Expenditures
2. Training Expenditures
3. Exercise Expenditures
4. Organizational Exenditures
5. Equipment Expenditures
Management and Administration Expenditures
6. (limited to 3% of the total award)
TOTAL EXPENDITURES $
I hereby certify that the above costs are true and valid costs incurred in accordance with the project agreement.
Signed:
Contract Manager or Financial Officer
TO BE COMPLETED BY DEM STAFF
AGREEMENT AMOUNT
PREVIOUS PAYMENT(S)
THIS PAYMENT
REMAINING BALANCE
$0.00
$0.00
$0.00
$0.00
TOTAL AMOUNT TO BE PAID
ON THIS INVOICE
DATE SUBMITTED TO FDEM
SHSGP POETE Report Forms - 09/Instructions, Forms 1, 2 & 3 4 of 4
DIVISION OF EMERGENCY MANAGEMENT
DETAIL OF CLAIMS
,FORM 4A
PLEASE SUBMIT A SEPARATE FORM (4) FOR EACH OF THE FOLLOWING CATEGORIES
1, Planning Expenditures
2 Training Expendituires
3 Exercise Expenditures..
4 Organ¢ational Expenditures
5: Equipment Expenditures
6 Management and Administration Expenditures
limited to 3°0 of the:total award
GRANTEE:
COST INCURRED DURING.. THE PERIOD OF:..
CATEGORY
Planning
AGREEMENT #
VENDOR
DATE PAID
CHECK #
AMOUNT
(Requested for reimbursement)
TOTAL EXPENDITURES
$0.00
1. FORM MUST BE COMPILED FROM FORM 4B BY CATEGORY
2. FORM MUST ACCOMPANY THE REIMBURSEMENT REQUEST
DIVISION OF EMERGENCY MANAGEMENT
DETAIL OF CLAIMS
FORM 4A
THIS FORM IS BACKUP AND MUST ACCOMPANY THE REIMBURSEMENT REQUEST AND DETAIL OF
CLAIMS, FORM 4B
The Recipient is required to provide a completed budget detail worksheet, to the Division, which accounts for the total award for issue 08 as
described in the "Proposed Program Budget".
If any changes need to be made to the "Budget Detail Worksheet", after the execution of this contract, contact the contract manager listed in
this contract via email or letter.
Allowable Planning -Costs,
-Quantity
. Unit Cost
Total Cost
Developing scenario plans that incorporate the range of prevention,
protection, response, and recovery activities for a scenario
$0.00
Developing and implementing homeland security suppor_t_programs
and adopting DHS national initiatives
$0.00
Developing related terrorism prevention activities
$0.00
Developing and enhancing plans and protocols
$0.00
Developing or conducting assessments
$0.00
Hiring of full or part-time staff or contractors/consultants to assist with
planning activities (not for the purpose of hiring public safety
personnel fulfilling traditional public safety duties)
$0.00
Conferences to facilitate planning activities
$0.00
Materials required to conduct planning activities
$0.00
Travel/per diem related to planning activities
$0.00
Overtime and backfill costs - Payment of overtime expenses will be
for work performed by award (SAA) or sub -award employees in
excess of the established work week (usually 40 hours) related to the
planning activities for the development and implementation of the
programs under HSGP.
$0.00
Other projects areas with prior approval from FEMA
$0.00
SUB TOTAL
$0.00
Allowable Organizatlonal Costs ` ....
Quantity
Unit Cost .' .
Total `Cost ...-
Overtime for information, investigative, and intelligence sharing
activities (up to 50 percent of the allocation)
$0.OD
Reimbursement of select operational expenses associated with
increased security measures at critical infrastructure sites, incurred
during time periods of DHS-declared alerts (up to 50 percent of the
allocation).
$0.00
Hiring of new staff position/ contractors/consultants for participation in
information/intelligence analysis and sharing groups or fusion center
activities (up to 50 percent of the allocation)
$0.00
SUB TOTAL
so.00
1 of6
DIVISION OF EMERGENCY MANAGEMENT
DETAIL OF CLAIMS
FORM 4A
'Allowable Training, osts .:
Quantity
. Unit Cost
Total,Cost , ;.`• '
Overtime and backfill for emergency preparedness and response
personnel attending FEMA-sponsored and approved training classes.
$0.00
Overtime and backfill expenses for partOtime and volunteer
emergency response personnel Participating in FEMA training.
$0.00
Training, Workshops and Conferences - Grant funds may be used
to plan and conduct training workshops or conferences to include
costs related to planning, meeting space and other meeting costs,
facilitation costs, materials and supplies, travel and training plan
development.
$0.00
Full or Part -Time Staff or Contractors/Consultants - Full or part-
time staff may be hired to support training -related activities. Payment
of salaries and fringe benefits must be in accordance with the policies
of the state or local unit(s) of government and have the approval of
the state or the awarding agency, whichever is applicable. The
services of contractors/consultants may also be procured by the state
in-the-design-devetopmenf-conduct,andevaluation-oFCBRNE
training. The applicant's formal written procurement policy or the
Federal Acquisition Regulations (FAR) must be followed.
$0.00
Travel - Travel costs (i.e., airfare, mileage, per diem, hotel, etc.) are
allowable as expenses by employees who are on travel status for
official business related to the planning and conduct of the training
project(s) or for attending ODP-sponsored courses. These costs
must be in accordance with state law as highlighted in the OJP
Financial Guide. States must also follow state regulations regarding
travel. If a state or territory does not have a travel policy they must
follow federal guidelines and rates, as explained in the OJP Financial
Guide . For further information on federal law pertaining to travel
costs please refer to http://www.ojp.usdoj.gov/FinGuide.
$0.00
Supplies - Supplies are items that are expended or consumed during
the course of the planning and conduct of the training project(s) (e.g.,
copying paper, gloves, tape, and non -sterile masks.)
$0.00
Tuition for higher education
$0.00
Other Items - These costs include the rental of space/locations for
planning and conducting training, badges, etc.
$0.00
^___ ~ SUB TOTAL
$o.00
A complete list of ODP approved courses may be found at www.ojp.usdoj.govlodp/dots/Eligible_Federal_Courses.pdf
1r.Allowable Exercise Costs,
Quantity,
„ Unit Cost
„';Total Cost.' „.
Design, Develop, Conduct and Evaluate an Exercise
$0.00
Exercise Planning Workshop - Grant funds may be used to plan
and conduct an Exercise Planning Workshop to include costs related
to planning, meeting space and other meeting costs, facilitation costs,
materials and supplies, travel and exercise plan development.
$0.00
2 of6
DIVISION OF EMERGENCY MANAGEMENT
DETAIL OF CLAIMS
FORM 4A
Full or Part -Time Staff or Contractors/Consultants - Full or part-
time staff may be hired to support exercise -related activities. Payment
of salaries and fringe benefits must be in accordance with the policies
of the state or local unit(s) of government and have the approval of
the state or the awarding agency, whichever is applicable. The
services of contractors/consultants may also be procured to support
the design, development, conduct and evaluation of CBRNE
exercises. The applicant's formal written procurement policy or the
Federal Acquisition Regulations (FAR) must be followed.
$0.00
3 of6
DIVISION OF EMERGENCY MANAGEMENT
'DETAIL OF CLAIMS
FORM 4A
Overtime and backflll costs — Overtime and backfill costs. including
expenses for part-time and volunteer emergency response personnel
participating in FEMA exercises
$0.00
Implementation of HSEEP
$0.00
Travel - Travel costs (i.e., airfare, mileage, per diem, hotel, etc.) are
allowable as expenses by employees who are on travel status for
official business related to the planning and conduct of the exercise
project(s). These costs must be in accordance with state law as
highlighted in the OJP Financial Guide. States must also follow state
regulations regarding travel. If a state or territory does not have a
$0.00
Supplies - Supplies are items that are expended or consumed during
the course of the planning and conduct of the exercise project(s) (e.g.,
copying paper, gloves, tape, non -sterile masks, and disposable
protective equipment).
$0.00
Otherltems - These costsincludelhe rental of-space/locations-for--
exercise planning and conduct, exercise signs, badges, etc.
$0.00
SUB TOTAL
$o.00
7QuaittitV.:
nit Cost
Total Cost
. .
ThetabIe below highlights the allowable equipment categories for this award. A comprehensive listing of these allowable
equipment specific equipmerit eligible under each category can be found on the web -based Authorized
.....................
Equipment List at: http://www.rkb.us -
, . . • • • ,..• ,•••-• -•••••• - • ,• •-•
+ If you wish to purchase a piece of equipmentfrom any category below, hen, in the space given below that category, put
Personal protective equipment
$0.00
$0.00
Explosive device mitigation and remediation equipment
$0.00
$0.00
CBRNE operational search and rescue equipment
$0.00
$0.00
Information technology
$0.00
$0.00
Cyber security enhancement equipment
$0.00
$o.00
Interoperable communications equipment
$0.00
$0.00
Detection Equipment
$0.00
$0.00
Decontamination Equipment
$0.00
$0.00
Medical supplies
$0.00
$0.00
Power equipment
$0.00
$0.00
CBRNE reference materials
$0.00
- 4 of6
DIVISION OF EMERGENCY MANAGEMENT
DETAIL OF CLAIMS
FORM 4A
-$0.00
CBRNE incident response vehicles
$0.00
$0.00
Terrorism incident prevention equipment
$0.00
$0.00
Physical security enhancement equipment
$0.00
$0.00
Inspection and Screening systems
$0.00
$0.00
Agriculture Terrorism Prevention, Response, and Mitigation
$0.00
$0.00
CBRNE Response watercraft
$0.00
$0.00
CBRNE Aviation Equipment
$0.00
$0.00
CBRNE logistical support equipment
$0.00
$0.00
Intervention equipment
$0.00
$0.00
Other authorized equipment costs (includeany construction or
renovation costs in this category; Written approval must be provided
by FEMA prior to the use of any funds for construction or renovation)
$0.00
-SUB TOTAL
-$0.00
tgible Management and Administration Costs
ianagement andadministratton costs may rc"
exceed,3% of;the Recipient's. total award)`:
Hiring of full-time or part-time staff or contractors/consultants:
• To assist with the management of the FY 2009 UASI
• To assist with application requirements and the implementation of
the FY 2009 UASI
• To assist with the compliancy with reporting and data collection as it
may relate to the FY 2009 UASI
• Meeting compliance with reporting/data collection requirements,
including data calls.
$0.00
Development of operating plans for information collection and
processing necessary to respond to DHS/FEMA data calls.
$0.00
5 of6
DIVISION OF EMERGENCY MANAGEMENT
DETAIL OF CLAIMS
FORM 4A
Overtimeand-backfillcosts—Overtime-expenses-are-defined-as-the -
result of personnel who worked over and above their normal
scheduled daily or weekly worked time in the performance of FEMA —
approved activities. Backfill Costs also called "Overtime as Backfill"
are defined as expenses from the result of personnel who are working
overtime in order to perform the duties of other personnel who are
temporarily assigned to FEMA — approved activities outside their core
responsibilities. Neither overtime nor backfill expenses are the result
of an increase of Full — Time Equivalent (FTEs) employees. These
costs are allowed only to the extent the payment for such services is
in accordance with the policies of the state or unit(s) of local
government and has the approval of the state or the awarding agency,
whichever is applicable. In no case is dual compensation allowable.
That is, an employee of a unit of govemment may not receive
compensation from their unit or agency of government AND from an
award for -a single period of time (e.g., 1:00 pm to 5:00 pm), even
though such work may benefit both activities. Fringe benefits on
overtime hours are limited to Federal Insurance Contributions Act
(FICA), Workers' Compensation and Unemployment Compensation.
_._...__.___...___
_.......__.._..............._..__............._...._.................._..._..._...___.__
$0 00
Travel expenses
$0.00
Meeting -related expenses (For a complete list of allowable meeting -
related expenses, please review the OJP Financial Guide at
http://www.ojp.usdoj.gov/FinGuide).
$0.00
Acquisition of authorized office equipment, including personal .....
computers, laptop computers, printers, LCD projectors, and other
equipment or software which may be required to support the
implementation of the homeland security strategy.
$0.00
The following are allowable only within the contract period:
• Recurring fees/charges associated with certain equipment, such as
cell phones. faxes, etc.
• Leasing and/or renting of space for newly hired personnel to
administer programs within FY09 UASI.
,.
$0.00
• SUB TOTAL
$o.00
TOTAL ALL EXPENDITURES
$o.00
6 of6
DIVISION OF EMERGENCY MANAGEMENT
2555 SHUMARDOAK.BOULEVARD'
LLAHASSEE, FLORDIA 32399 2100
CLOSE OUT REPORT
FORM 5
This form should be completed and submitted to the Division no
later than sixty (60) days after the termination date of the Agreement
GRANTEE
ADDRESS
CITY AND STATE
TOTAL::::.
fXPENDITURES,;:
t. Planning Costs
2. Organizational Activities
3. Training Costs - -
4. Exercise Costs
5. Equipment Acquisition Costs
6. Management and Administration Costs
TOTAL EXPENDITURES
$0.00
Total funds received from the Division of
Emergency Management under this
Agreement (Column 4, Line 7)
Less total grant award expenditures
(Column 2, Line 7)
Equals balance of Agreement owed to
DEM
$0.00
AGREEMENT #
AGREEMENT AMOUNT
AGREEMENT PERIOD
FUNDS RECEIVED UNDER miS AGREEMENT
AMOUNT
TOTAL
$0.00
$0.00 Agreement Amout $0.00
$0.00
Refund due to State? Yes (- No
If Yes, refund check enclosed?
If No, enter date refund will be submitted
Yes f No f`
Less total funds received
under this Agreement
(Column 4, Line 7)
$0.00
Balance of Agreement $0.00
I hereby certifiy that the above costs are true and valid costs
incurred in accordance with the project Agreement, and that the
matching funds, in -kind or cash, were utilized toward the project
In this Agreement.
Refund and/or final interest check are due no later than ninety (90)
days after the expiration date of the Agreement. _ Signed:
Make check payable to : Cashier,
Department of Community Affairs
Date:
Mail to: Division of Emergency Management, 2555 Shumard Oaks Boulevard, Tallahassee, FL 32399-2100