HomeMy WebLinkAboutExhibitOPERATION STONEGARDEN
SUBAWARD AGREEMENT
MIAMI-DADE SHERIFF'S OFFICE AND THE CITY OF MIAMI
Agreement Number: R0925
FAIN: EMW-2023-SS-00058-S01
This Subaward Agreement ("Agreement"), by and between the Miami -Dade
Sheriff's Office ("MDSO"), an independent constitutional office underthe laws of Florida,
and the City of Miami ("City"), a municipality of the State of Florida, through its Miami
Police Department ("MPD") (collectivelythe "Parties" and singularlya "Party"), is effective
as of October 20, 2024 ("Effective Date").
WHEREAS, the Un ited States Department of Homeland Secu rity ("DHS"), through
the Florida Division of Emergency Management ("FDEM"), awarded grant funds in the
amount of $392,040 from the Fiscal Year ("FY") 2023 Homeland Security Grant Program
to Miami -Dade County ("County"), through the Miami -Dade Police Department ("MDPD"),
for the DHS Operation Stonegarden ("OPSG") program, a joint effort between state, local,
tribal, territorial, and federal law enforcement agencies (collectively "Partner Agencies"
and each a "Partner Agency")to secure the United States borders along routes of ingress
from international borders to include travel corridors in states bordering Mexico and
Canada, as well as states and territories with international waters;
WHEREAS, the County, through the MDPD, and FDEM entered into a Federally
Funded Subaward and Grant Agreement Number R0925, and related Modification, for
the funding of OPSG operations in the County from October 20, 2024, through June 30,
2026 (collectively, the "Grant Agreement"), attached hereto as Attachments A and B; and
WHEREAS, on January 7, 2025, the MDPD transitioned to the MDSO and the
County and MDSO agreed that grant funds awarded to the County, through the MDPD,
prior to January 7, 2025, would be managed by the County's Office of Management and
Budget ("OMB") until legal and administrative responsibility for the funds can be
transferred over to the MDSO or the grant expires; and
WHEREAS, the formation of the MDSO independent of the County necessitated
a Subaward Agreement between the County and the MDSO ("Subaward Agreement") to
establish formal financial and operational frameworks that align with the terms of the
original grant, mitigate risks of non-compliance, and maintain the integrity of the grant -
funded activities; and
WHEREAS, the Subaward Agreement provides that MDSO, in conjunction with
overseeing programmatic implementation, reporting, and financial management of the FY
2023 OPSG grant, shall be solely responsible for all related purchases and subcontracts;
and
WHEREAS, the MDSO and the City, through its MPD, have a long history of
partnering on OPSG operations; and
WHEREAS, the City's MPD is one of the Partner Agencies authorized to assist
with FY 2023 OPSG operations in the County; and
WHEREAS, the MDSO and the City desire to enter into this Agreementto provide
a mechanismforreimbursing expenses incurred by the MPD in connection with FY2023
OPSG operations.
OPSG Subaward Agreement
Agreement Number R0925
MDSO & City of Miami
Page 2 of 14
NOW, THEREFORE, in consideration ofthe mutual covenants, promises recorded
herein, the Parties agree as follows:
I. PURPOSE; EXPENDITURES
A. The purpose, goals, and objectives of this Agreement are to fund FY 2023
OPSG operations with grant funds awarded from DHS, through FDEM and the
County, for the enhanced cooperation and coordination among Partner
Agencies to jointly enhance security along the United States land and water
borders.
B. All expenditures made with funds provided under this Agreement shall be for
allowable program expenditures in line with the requirements of the funding
source and approved budget and incurred from October 20, 2024, through May
31, 2026.
II. SCOPE
This Agreement delineates the responsibilities and scope of work expected for
participation in the FY 2023 OPSG program, FAIN EMW-2023-SS-00058-S01.
Funds have been provided to the County by FDEM. FDEM serves as the pass -
through entity for a DHS award, for which the County is the sub -recipient, and
MDSO is the sub-subrecipient.
III. BUDGET; AMOUNT PAYABLE
A. The maximum amountpayable by MDSO to the City underthisAgreementshall
not exceed $68,756.06, unless such amount is changed through a formal
amendment executed by the Parties.
OPSG Subaward Agreement
Agreement Number R0925
MDSO & City of Miami
Page 3 of 14
B. MDSO shall reimburse the City only for allowable costs incurred by the MPD
during FY 2023 OPSG operations. The maximum reimbursement amount for
each authorized cost category is set forth in the matrix below:
Cost Category
Rate
Total
Overtime for information,
investigative, and
intelligence sharing
activities
$63.87/hourX 1,000 hours
$63,870.00
Fringe Benefits
$ 7.65%/Fringe Rate (FICA =
6.2%, MICA = 1.45%)
$4,886.06
Total Reimbursable Amount
$68,756.06
C. Amounts payable u n der th is Agreement are subject to continued funding from
thefunder,anddistributionofsuchfundsfromtheCountytotheMDSO. Should
the availabilityor distribution of grant funding for FY 2023 OPSG be reduced or
terminated, the MDSO reserves the right to proportionally reduce or terminate
the maximum amount payable to the City for the grant award.
D. If MDSO determines that a budget reduction is necessary (i) to implement a
funding cut imposed by the fu n der; (ii) to implementa fu nding distribution freeze
imposed by the County; (iii) to recoup reimbursement for disallowable costs;
(iv) to offset fines or levies imposed by the funderfor noncompliance; or (v) for
other reasons, the MDSO shall provide the MPD with written notice of the
proposed budget reduction along with supporting documentation within thirty
(30) calendardays of the determination. MPD shall have ten (10) calendardays
OPSG Subaward Agreement
Agreement Number R0925
MDSO & City of Miami
Page 4 of 14
from receipt of such notice to submit a written objection, including any
documentation or explanation supporting its position. Upon timely receipt of
such an objection, MDSO and MPD shall meet within ten (10) calendar days in
good faith to discuss the objection and attempt to reach a mutually acceptable
resolution. MDSO shall give due and reasonable consideration to all
information and arguments presented by MPD during this process and shall
document its rationale in any final determination. MDSO's decision following
this meeting shall be final.
IV. RESPONSIBILITIES OF THE CITY
The City, by and through the MPD, agrees to:
A. Participate as a member of the FY 2023 OPSG grant program, to include (i)
providing maritime, land, and air assets with sworn officers for OSPG
operations, (ii) providing K-9 teams in supportof OSPG operations; and (iii)
coordinating with and assisting MDSO in conducting all related law
enforcement operations, in accordance with the Scope of Work set forth in
Attachment A.
B. Abide by all grant requirements, including, but not limited to, budget
authorizations, required accounting and reporting expenditures, and proper
use of funds, as stipulated in Attachment A.
C. Comply with the purpose, goals, and objectives of the FY 2023 OPSG
program as stipulated in Attachment A.
OPSG Subaward Agreement
Agreement Number R0925
MDSO & City of Miami
Page 5 of 14
D. Ensure satisfactory progress towards the grant goals or objectives as
stipulated in Attachment A.
E. Document compliance with the purpose of the grant and all grant
requirements, including progress toward goals or objectives as stipulated in
Attachment A.
F. Submit quarterly reimbursement requests by the tenth (10th) day after the
end of each quarter, using the forms attached hereto as Attachments E
through J, if an expense has occurred.
G. Provide quarterly financial and performance reports to MDSO, as provided
andstipulated in Attachment 1, Financial Historyand Performance Tracking
Form 1A (Attachment C), and Quarterly Status Report Form 1B (Attachment
D), by the tenth (10th) day after the end of each quarter.
H. Provide all programmatic and financial records, documents, and reports as
may be required by MDSO, the funder, or the County, in a timely and
complete manner, including submitting Close -Out Report Form 8
(Attachment K) no later than sixty (60) days after th e Ag reement termination
date specified in section X herein.
I. Be solely responsible for any and all expenses disallowed by the funder or
the County.
J. Provide an administrative liaison to coordinate financial and programmatic
compliance.
OPSG Subaward Agreement
Agreement Number R0925
MDSO & City of Miami
Page 6 of 14
V. RESPONSIBILITIES OF THE MDSO
The MDSO agrees to:
A. Monitor the implementation of this Agreement in accordance with FY 2023
OPSG grant guidelines and requirements, that include, but are not limited
to, operational and administrative performance, financial management,
reporting, and other related grant requirements stipulated in Attachment A.
B. Abide by all grant requirements as stipulated in Attachment A.
C. Comply with the purpose, goals, and objectives of the FY 2023 OPSG grant
as stipulated in Attachment A.
D. Ensure satisfactory progress towards the grant goals or objectives
stipulated in Attach ment A.
E. Document compliance with the purpose of the grant and all grant
requirements, including progress toward goals or objectives as stipulated in
Attachment A.
F. Review submitted reimbursement requests and deliverable reports in
accordance with Attachments C through K.
G. Provide all programmatic and financial records, documents, and reports as
may be required by the County or the funding source, in a timely and
complete manner.
H. Provide quarterly financial and performance reports to the County's OMB
detailing grant progress.
OPSG Subaward Agreement
Agreement Number R0925
MDSO & City of Miami
Page 7 of 14
I. Implement appropriate action as may be necessary to maintain grant
compliance.
J. Provide MPD with reporting deadlines and other information required to
participate in OPSG operations.
K. Make payments within thirty (30) calendar days after receipt of the City's
reimbursement request, unless there is reason to believe that the request
is improper. If the request is found to be improper, it will be returned to the
City for revision. Upon submission of a revised reimbursement request, a
new 30-day calendar period will begin.
L. Provide liaisons to coordinate administrative, programmatic, and financial
compliance with grant requirements, as follows:
1. Administrative Liaison:
Lisette Reyes -Wilcox, Commander
Management and Budget Office
9105 N.W. 25th Street, Suite 3042
Doral, FL 33172
Email: lisi(a�mdso.com
Phone: 305-471-2520
2. Programmatic Liaison:
Sergeant Samir Amado, Grant Award Administrator
Management and Budget Office
9105 N.W. 25th Street, Suite 3042
Doral, FL 33172
Email: samadoAmdso.com
Phone: 305-471-2501
OPSG Subaward Agreement
Agreement Number R0925
MDSO & City of Miami
Page 8 of 14
3. Financial Liaison:
Angela Diaz, Financial Manager
Management and Budget Office
9105 N.W. 25th Street, Suite 3042
Doral, FL 33172
Email: adiaz(a�mdso.com
Phone: 305-471-1704
4. With a copy to:
Andres Brito, Manager of Fiscal Resources
Management and Budget Office
9105 N.W. 25th Street, Suite 3042
Doral, FL 33172
Emai I :abritomdso.com
Phone: 305-471-3130
VI. MDSO AND CITY AGREE:
A. The MPD shall maintain all necessary documentation for grant
expenditures, including invoices, receipts and reports, in compliance with
federal, state, and local requirements.
B. The MPD will provide financial and performance reports in a timely fashion.
C. The MDSO will prepare consolidated reports for submission to the funder,
through theCounty'sOMB, as stipulated in Attachments A through K and
the Subaward Agreement.
D. MDSO and the County are not responsible for personnel salaries, benefits,
workers compensation or time related issues of the MPD personnel.
E. All records received or created shall be made available at all reasonable
times for inspection, review, copying, or audit by the County, MDSO, FDEM,
DHS or other entities as required by law.
OPSG Subaward Agreement
Agreement Number R0925
MDSO & City of Miami
Page 9 of 14
F. All financial commitments herein are made subject to the availability and
distribution of grant funds and the continued mutual agreements of the
parties as identified in Attachment A.
G. FY 2023 OPSG is a reimbursement grant program. As such, the City shall
pay all allowable expenditures in full prior to submitting requests for
reimbursement to the MDSO.
VII. AUDITS
The Parties shall comply with all applicable audit requirements outlined in 2 C.F.R.
200, subpart F, state regulations, and/or Attachments A through K.
VIII. INDEMNIFICATION
Each party to this Agreement agrees to assume responsibility for the acts,
omissions, or conduct of such party's own employees while participating herein
and pursuant to this Agreement, subject to the provisions of Section 768.28,
Florida Statutes, where applicable. "Assume Responsibility" shall mean incurring
all costs associated with any suit, action, or claim for damages arising from the
performance of this Agreement.
IX. NON -ASSIGNABILITY
Neither party shall assign any of the obligations or benefits of this Agreement.
X. TERM
This Agreement shall take effect on the Effective Date and end on May 31, 2026,
unless extended by mutual written agreement.
OPSG Subaward Agreement
Agreement Number R0925
MDSO & City of Miami
Page 10 of 14
XL NOTICES
All notices to include invoices required or permitted underthis Agreement shall be
in writing and delivered by personal service, United States mail, or electronic mail,
to the representatives and addresses listed below:
If to MDSO:
With a copy to:
If to the City:
With a copy to:
SamirAmado, Sergeant
Miami -Dade Sheriff's Office
Management & Budget Office
9105 N.W. 25th Street, Suite 3055
Doral, Florida 33172
Phone: 305-787-5331
E-mail: samadoc mdso.com
Lisette Reyes -Wilcox, Commander
Miami -Dade Sheriff's Office
Management & Budget Office
9105 N.W. 25th Street
Doral, Florida 33172
Phone: 305-471-2520
E-mail: lisi@mdso.com
Miami -Dade Sheriff's Office
Attn: General Counsel's Office
9105 NW 25th Street, Suite 3042
Doral, Florida 33172
Email: gcoinfoAmdso.com
Manuel A. Morales, Chief
Miami Police Department
400 N.W. 2nd Avenue
Miami, Florida 33128
Phone: 305-579-6111
Elizabeth Quijano
Miami Police Department
400 N.W. 2nd Avenue
Miami, Florida 33128
E-mail: 25208Amiami-police.orq
OPSG Subaward Agreement
Agreement Number R0925
MDSO & City of Miami
Page 11 of 14
XII. AMENDMENTS
This Agreement may be amended as may be necessary, including to remain
consistent with FY23 OPSG requirements, amendments, or extensions. Such
amendments shall be made in writing and shall be effective only when signed by
all Parties.
XIII. CANCELLATION
This Agreement may be cancelled by either Party upon providing 90 days' written
notice to the other Party. Cancellation will beat the discretion of the Parties; in the
case of MDSO, the Sheriff is authorized to cancelth isAgreement. This Agreement
shall be considered cancelled should the funderterminate the grant.
SIGNATURES ON FOLLOWING PAGES
OPSG Subaward Agreement
Agreement Number R0925
MDSO & City of Miami
Page 12 of 14
IN WITNESS WHEREOF, the Parties have caused this Agreement to be executed
by their respective and duly authorized officers on the last signature date below.
AGREED TO AND ACKNOWLEDGED BY:
MIAMI-DADE SHERIFF'S OFFICE:
Rosie Cordero-Stutz, Sheriff Date
APPROVED FOR FORM AND LEGAL SUFFICIENCY:
Janet Lewis, General Counsel Date
OPSG Subaward Agreement
Agreement Number R0925
MDSO & City of Miami
Page 13 of 14
CITY OF MIAMI:
Arthur Noriega V., City Manager Date
Manuel A. Morales, Chief Date
Miami Police Department
ATTEST:
Todd B. Hannon
City Clerk
Miami, Florida
APPROVED FOR FORM AND CORRECTNESS:
George Wysong, Esq.
City Attorney
Miami, Florida
APPROVED FOR INSURANCE REQUIREMENTS:
D ate
D ate
David Ruiz, Interim Director of Risk Management Date
OPSG Subaward Agreement
Agreement Number R0925
MDSO & City of Miami
Page 14 of 14
Attachment B
MODIFICATION #1 TO SUBGRANT AGREEMENT BETWEEN
THE DIVISION OF EMERGENCY MANAGEMENT AND
MIAMI-DADE COUNTY
This Modification, effective September 30, 2025, is made and entered into by and
between the State of Florida, Division of Emergency Management ("the Division"), and
Miami -Dade County ("Recipient"), to modify Contract Number R0925, which began on
October 20, 2024 ("the Agreement").
WHEREAS, the Division and the Recipient have entered into the Agreement,
pursuant to which the Division has provided a subgrant to Recipient under the State
Homeland Security Grant Program in the amount of $392,040.00.
WHEREAS, the Agreement expired on September 30, 2025; and,
WHEREAS, the Division and the Recipient desire to reinstate and extend the terms
of the Agreement; and,
WHEREAS, the Division and the Recipient desire to modify the Agreement; and,
WHEREFORE, in consideration of the mutual promises of the parties contained
herein, the parties agree as follows:
1. Paragraph 8 of the Agreement is hereby amended to read as follows:
This Agreement shall begin upon execution by both parties and
shall end on June 30, 2026, unless terminated earlier in accordance with
the provisions of Paragraph (17) of this Agreement. Consistent with the
definition of "period of performance" contained in 2 C.F.R. §200.77, the
term "period of agreement" refers to the time during which the Sub -
Recipient "may incur new obligations to carry out the work authorized
under" this Agreement. In accordance with 2 C.F.R. §200.309, the Sub -
Recipient may receive reimbursement under this Agreement only for
"allowable costs incurred during the period of performance." In
accordance with section 215.971(1)(d), Florida Statutes, the Sub -
Recipient may expend funds authorized by this Agreement "only for
allowable costs resulting from obligations incurred during" the period of
agreement.
2. All provisions not in conflict with this Modification remain in full force and effect
and are to be performed at the level specified in the Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Modification as of
the dates set out below.
RECIPIENT: MIAMI-DADE COUNTY
Bv•
Name and Title:
Date:
David Clodfelter
10/09/2025
DIVISION OF EMERGENCY MANAGEMENT
By: C' a- Z7. l/ gu
for: Name and Title: Kevin Guthrie, Executive Director
Date:
10/13/2025
Attachment C
RECIPIENT / GRANTEE
Financial History Report
Shaded cells are calculated for you. You do not need to e
DIVISION OF EMERGENCY MANAGEMENT
Financial History and Performance Tracking
FORM 1A
AGREEMENT#
R0925
GRANT YEAR
QUARTERLY REPORTING DUE DATES
Drop box list below select the uarter of activity being reported along with year)
Period: Select Period of Performance
l
Category
Total Allocated
Quarterly Funds Expended
Previous Funds Expended
Total Funds Expended
Expenditure(s)
Completion
Percent
Remaining Balance
Planning Costs
$0.00 $0.00
O% $ -
°
0 /° $ -
0% $ -
0% $ -
0% $ -
0%
Training Costs
$0.00 $0.00
Exercise Costs
$0.00
Organization Costs
$0.00 $0.00
Equipment Costs
$0.00 $0.00
M&A Costs
(limited up to 5% of Total Awatd)
Total Expenditures
$0.00
$0.00 $0.00
$0.00
$0.00 ; $0.00
$0.00
Performance Tracking
Project Title Category Start Date Projected End Date Percentage Funds Allocated
1 Complete (Budget)
Project Status
I
I
TOTAL (or Average Percentage)
I S0
Cumulative Amount Previously Submitted for Reimbursement
Total Received
I hereby certify that the above cost are true and valid cost incurred in accordance with the project agreement.
Signed: Date:
Grant Manager
I hereby certify that the above costs are true and valid costs incurred in accordance with the project agreement.
Signed: Date:
Financial Officer
By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the terms
and conditions of the Federal award. 1 am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil or administrative penalties for fraud, false statements, false
claims or otherwise.
Attachment D
Recipient
0
DIVISION OF EMERGENCY MANAGEMENT
Quarterly Status Report
FORM 1 B
AGREEMENT#
R0925 GRANT YEAR
0 INSTRUCTIONS
0 iFor instructions on completeing
0
click the HELP button
PROJECT STATUS (Equipment, Training, Exercise, Organization, Planning) - Must provide a CURRENT status update for each quarter.
TIMELINE OF EVENTS FOR REPORTING PERIOD
OTHER (Optionall:_. Can report intemal expenditures not yet claimed and/or any projected balance and reason (i.e. cost savings or cancelled projects).
TECHNICAL ASSISTANCE
Is technical assistance needed: If "yes", are you requesting, onsite visit or phone call
I hereby certify that the above information provided are true and the cost(s) are valid cost(s) incurred in accordance with the project agreement.
Signed: Date:
Grant Manager
By signing this report, 1 certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the terms
DIVISION OF EMERGENCY MANAGEMENT
REIMBURSEMENT REQUEST
Form 2
Attachment E
RECIPIENT / GRANTEE AGREEMENT# R0925
POC Phone
'COSTS INCURRED DURING THE PERIOD OF:
GRANT YEAR
Agreement Amount
Submission Date
Payment #
Payment Amount
$
Shaded cells are calculated for you. You do not need to enter anything into shaded cells.
1. Planning Expenditures
2. Training Expenditures
3. Exercise Expenditures
THROUGH
THIS MUST BE ACCOMPANIED BY THE DETAIL OF CLAIMS FORM
4. Organizational Expenditures
5. Equipment Expenditures
6. Management and Administration Expenditures
(limited up to 5% 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: Date:
Grant Manager
I hereby certify that the above costs are true and valid costs incurred in accordance with the project agreement.
Signed: Date:
Financial Officer
By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the expenditures, disbursements and cash receipts are for the
purposes and objectives set forth in the terms and conditions of the Federal award. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact,
may subject me to criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise.
TO BE COMPLETED BY DEM STAFF
AGREEMENT AMOUNT
PREVIOUS PAYMENT(S)
THIS PAYMENT
REMAINING BALANCE
DEM FORM OPB - 5 9/14
TOTAL AMOUNT TO BE PAID
ON THIS INVOICE
DATE SUBMITTED TO FDEM
Attachment F
DIVISION OF EMERGENCY MANAGEMENT
DETAIL OF CLAIMS
FORM 3
SCROLL DOWN TO THE APPROPRIATE CATEGORIES AND COMPLETE FOR EACH BEING CLAIMED AGAINST
SHORTCUT LINK TO EACH CATEGORY
1. Planning Expenditures
2. Training Expenditures
3, Exercise Expenditures
4. Organizational Expenditures
5. Equipment Expenditures
6. Management and Administration Expenditures
(limited up to 5% of the total award if passing through funds, sub -awards)
GRANTEE:
COST INCURRED DURING THE PERIOD OF:
AGREEMENT#
THROUGH
R0925
GRANT YEAR
VENDOR
INVOICE DATE
DATE PAID
CHECK #
DESCRIPTION
AMOUNT (Requested
for reimbursement)
Issue Number
TOTAL EXPENDITURES
FORM MUST ACCOMPANY THE REIMBURSEMENT REQUEST
AGREEMENT #
THROUGH
DIVISION OF EMERGENCY MANAGEMENT
DETAIL OF CLAIMS
FORM 3
SCROLL DOWN TO THE APPROPRIATE CATEGORIES AND COMPLETE FOR EACH BEING CLAIMED AGAINST
SHORTCUT LINK TO EACH CATEGORY
1. Planning Expenditures
2. Training Expenditures
3. Exercise Expenditures
4. Organizational Expenditures
5. Equipment Expenditures
6. Management and Administration Expenditures
(limited up to 5% of the total award if passing through funds, sub -awards)
GRANTEE: 0
COST INCURRED DURING THE PERIOD OF:
VENDOR
INVOICE DATE
January 0, 1900
DATE PAID
CHECK #
R0925
September 30, 2014
DESCRIPTION
TOTAL EXPENDITURES
GRANT YEAR 2023
AMOUNT (Requested
for reimbursement)
$0.00
Issue Number
FORM MIDST ACCOMPANY THE REIMBURSEMENT REQUEST
DIVISION OF EMERGENCY MANAGEMENT
DETAIL OF CLAIMS
FORM 3
SCROLL DOWN TO THE APPROPRIATE CATEGORIES AND COMPLETE FOR EACH BEING CLAIMED AGAINST
SHORTCUT LINK TO EACH CATEGORY
1. Planning Expenditures
2. Training Expenditures
3. Exercise Expenditures
4. Organizational Expenditures
5. Equipment Expenditures
6. Management and Administration Expenditures
(limited up to 5% of the total award if passing through funds, sub -awards)
GRANTEE:
0
COST INCURRED DURING THE PERIOD OF:
January 0, 1900
AGREEMENT #
THROUGH
CATEGORY
EXERCISE
R0925
January 0, 1900
GRANT YEAR 2023
VENDOR
INVOICE DATE
DATE PAID
CHECK #
DESCRIPTION
AMOUNT (Requested
for reimbursement)
Issue Number
TOTAL EXPENDITURES
$0 00
FORM MUST ACCOMPANY THE REIMBURSEMENT REQUEST
DIVISION OF EMERGENCY MANAGEMENT
DETAIL OF CLAIMS
FORM 3
SCROLL DOWN TO THE APPROPRIATE CATEGORIES AND COMPLETE FOR EACH BEING CLAIMED AGAINST
SHORTCUT LINK TO EACH CATEGORY
1. Planning Expenditures
2. Training Expenditures
3. Exercise Expenditures
4. Organizational Expenditures
5. Equipment Expenditures
6. Management and Administration Expenditures
(limited up to 5% of the total award If passing through funds, sub -awards)
GRANTEE:
0
COST INCURRED DURING THE PERIOD OF:
January 0, 1900
AGREEMENT #
THROUGH
CATEGORY
ORGANIZATIONAL
R0925
January 0, 1900
GRANT YEAR 2023
VENDOR INVOICE DATE
DATE PAID
CHECK tt
DESCRIPTION
AMOUNT (Requested
for reimbursement)
Issue Number
TOTAL EXPENDITURES
$0.00
FORM MUST ACCOMPANY THE REIMBURSEMENT REQUEST
DIVISION OF EMERGENCY MANAGEMENT
DETAIL OF CLAIMS
FORM 3
SCROLL DOWN TO THE APPROPRIATE CATEGORY AND COMPLETE A FORM FOR EACH BEING CLAIMED AGAINST
SHORTCUT LINK TO EACH CATEGORY
1. Planning Expenditures
2. Training Expenditures
3. Exercise Expenditures
4. Organizational Expenditures
5. Equipment Expenditures
6. Management and Administration Expenditures
(limited up to 5% of the total award if passing through funds, sub -awards)
GRANTEE:
0
COST INCURRED DURING THE PERIOD OF:
January 0, 1900
AGREEMENT #
THROUGH
R0925
January 0, 1900
GRANT YEAR 2023
VENDOR
INVOICE DATE
DATE PAID
CHECK 4
DESCRIPTION
AMOUNT
(Requested for reimbursement)
Issue Number
TOTAL EXPENDITURES
$0.00
FORM MUST ACCOMPANY THE REIMBURSEMENT REQUEST
DIVISION OF EMERGENCY MANAGEMENT
DETAIL OF CLAIMS
FORM 3
SCROLL DOWN TO THE APPROPRIATE CATEGORY AND COMPLETE A FORM FOR EACH BEING CLAIMED AGAINST
SHORTCUT LINK TO EACH CATEGORY
1. Planning Expenditures
2. Training Expenditures
3, Exercise Expenditures
4. Organizational Expenditures
5. Equipment Expenditures
6. Management and Administration Expenditures
(limited up to 5% of the total award 1f passing through funds, sub -awards)
GRANTEE:
0
COST INCURRED DURING THE PERIOD OF:
January 0, 1900
CATEGORY
MANAGEMENT & ADMINISTRATION
LIMITED UP TO 5% OF TOTAL AWARD IF PASSING FUNDS
THROUGH (SUBAWARDS)
AGREEMENT #
THROUGH
R0925
January 0, 1900
GRANT YEAR 2023
VENDOR
INVOICE DATE
DATE PAID
CHECK # DESCRIPTION
AMOUNT
(Requested for reimbursement)
Issue Number
TOTAL EXPENDITURES
$0 00
FORM MUST ACCOMPANY THE REIMBURSEMENT REQUEST
Atachment G
'pivistON`OF`E,[iA RGENCYJAANAG M -L
AGREEMENT #
REIMBURSEMENT BUDGET BREAKDOWN.
R0925 GRANT YEAR
FORM 4
-
Line Item
-
Allowable Planning Costs.
Quantity
Unit Cost
Budget
Total Allocated
Current
Claim Amount
Previous
Claim(s) Total -
Remaining
Balance
Issue #
Oevelopmg hanrdMreat-specAc ames.s that inwrpnt. the mng. of pevernon. Crotectron, map... and recovery
anon«
S -
$ -
S
$ -
$ -
$ -
Osvebping and imPlem. rg homeland seuufy support P-ogrema and &darn g ongoing OHS natmul intm..
5 -
S -
$ -
$ -
$ -
$ -
Developing elated Mrodsm prevention a.Ntief
$ -
$ -
$ -
$ -
$ -
$ -
Developing and enhancing plans &a protocols
S -
$ -
$ -
$ -
$ -
$ -
Developing uconducting assessments
S -
$ -
$ -
$ -
$ -
$ -
Hiring of full or pad2me staff or contractoricgnwlbnb to asiswed planning ...es (not for the purpose of hiring WIN
safety personnel fulfilling traditional public safety data,)
$ -
$ -
$ -
$ -
$ -
$ -
Conferences to facillbfe planning activities
$ -
$ -
$ -
$ -
$ -
$ -
MaNrials required N conduct planning activities
$ -
$ -
$ -
$ -
$ -
$ -
Tr.ve9.r diem related to planning activities
$ -
$ -
S -
$ -
$ -
S -
Overtime and Packfill costs - Payment of overt1111 expenses will be Nr work performed by award (SPA) or ...I'd
employees inm c s of ramsestablished FISOPreek (usu. , 40 hours) related to the planning a...s fox. development andimple
$ -
$ -
$-
S -
$ -
S -
Other projects areas wig prim appoval from FEMA
$ -
$ -
$ -
$ -
S -
S -
Planning - SUB TOTAL
S -
$ -
Line Item
Allowable HSGP and LETP Organizational Costs
Quantity
Unit Cost
Budget
Total Allocated
Current
Claim Amount
Previous
Claim(s) Total
Remaining
Balance
Issue #
Overtone for irhforxnMon, iovestigative. art ktuligence sharing .antes (up to so percent W the al...
S -
$ -
$ -
$ -
S -
S -
Rwmbunement of.el.ct operational exp.nses associated with imposed used mounhy memo. at cr.. mhastucN,. axes.
incurred during time periods of OHS -declared alerts(up to 50 percent of the allocation,.
S -
$ -
$ -
$ -
$ -
S -
Hiring of new staff position, wntractorslconsuhnb for par.p.n in IMpmadoMnbligence analysis and sharing groups or
Nslon center activities (fro to 5Oprcent of the anoca.onl
$ -
$ -
$ -
$ -
$ -
$ -
OrganizationalCost- SUBTOTAL
S -
S -
Line Item
Allowable Training Costs
Quantity
Unit Cost
Budget
Total Allocated
Current
Claim Amount
Previous
Claim(s) Total
Remaining
Balance
Issue #
Overtime and Packtll for emergency Preparedness aM .Pone. pesennel attending FEMA-spo,aped and approved training
$ -
$ -
$ -
Overtime and Paclit expenses for part-time and voluntear emergency response pnsennel participating In FEIM trairdny.
$ -
$ -
$ -
$ -
$ -
$ -
Training. Workshops and Confereocea- Grant NMs may b. used to plan and ...training %mi.. eorconferercesb
include coats relabel to P.M. meeting span and ether me.bg tests, faoliotron cesb, ma.adis and wPplbs, travel aM
framing plan development.
S
$ -
S
$ -
S -
$ -
Full or Part -Time Staff or Contractora/Consultants - Full or part-time cell may b. hired to support raininO9.Gt.l M.N..
Payment of salvias and fringe b.nfib must be in acrdanuwith tha pakcin of the stab or local unite) id government and
have the approval of the state or th. awvdi,p.../..... is appk.bfe. T ...mites of cantracemstanaullania may
also be procured by the sob in fee design. development conduct and evaluation M CSRNE training. The aPPE Ms Nnhul
vmean procurement policy or. Federal ...don Regulations (FAR) must be !Wowed.
S -
$ -
$ -
$ -
$ -
$ -
Travel -Travel co. p.e.. airfare. mileage, per diem, Po. .N.) are albw.ble as eayerea by employ.* an on trnsl
stay. for official business Mated to the planning and condo. of the training prgecps) or M amrdbg OOP -spooned
courses. Then cosh must ....dance with .tote law es hghtpN.d in tla OJP Fnavtl Gad.. Stabs muv else follow
tab regulation regarding travel. I o sob or territory does ....revel policy they must f aow federal guider. and
as explained M fee OJP Fnemial Oak.. For further Information an fed.M ow pertaining to travel coats pease refer to
hhpJMwwojp.uadcl.gov/Fk.Guide.
S -
S -
$ -
$ -
$ -
$ -
Supplies- Supplies are items that are expended or opbumed during.. course of the planning and com. of ,. Gaining
pgects)(e.g..copying paper. gloves. tap. and non-sfenle mesh)
$ -
$ -
$ -
$ -
$ -
$ -
Line Item
-
- Allowable Training Costs -
-
Quantity
Unit Cost -
Budget
Total Allocated
Current
Claim Amount
Previous
Claim(s) Total
Remaining
Balance
Issue #
$ -
$ -
s
Other Items -Those cob in b d.IM rttnint lsac'rto^JEcm for plammg and conducag taming. budges. etc.
$ _
$ -
$
$ -
$ -
$
Training -SUB TOTAL
$ -
$ -
A complete list of OOP approved training courses may be round at www.olp.uscloj.goviodpidoes/Eligible_Federal_Courses.pdf
Line Item
-
- Allowable Exercise Costs
- -
Quantity
Unit Cost
-
Budget
Total Allocated
Current
• Claim Amount
Previous
Claim(s) Total
Remaining
Balance
Issue #
pnign, Develop. Conduct and Evaluate an Exercise
$ -
$ -
$ -
Exercise Planning Workshop -Grua holds may M us.d to plan and conduct an Exercise Planning W.ksisy b iny.d.
.. rW W to homes' g. me.nn9 Waco and M.r mIng cases facWnen wb. ma... and wpp9a. tray. and exercise
P. davalop tent
$ -
$ -
$
$ -
$ -
$
Line Item
Allowable Exercise Costs . -
Quantity
Unit Cost -
-
Budget Total
Allocated
Current
Claim Amount
Previous
Claim(s) Total
Remaining
Balance
Issue #
Fun or Part-time EMIT or Contractors/Consultants -Fun aprtam. see may M laird to support .xm isomo..d
estnt.a. Paymun of salaries and binge b.n.fib must be in accordance who Me pond. of nine state or local unn(s) d
government aM have M. approval dthe state or the wording agency,.McM*.r is appf e.. The servicesal
dontraaPPramsultan. may also b.pocur.db support Ma design. development, co.ud aM evaloa'an of CERNE
exorcises. The apWicants formal sMtlen prouremenl polity oMe Fednal Acquisition Regulations IFAR1 must b. fdlwnd.
$ _
$ -
$
$ -
$ -
$ -
Overtime aM backfill costs—Oanima and bwkfil cone, including ecyonsen Oa Warne end vaunt. emergency
r.o.so persons. padcipating in FEW exercise..
$ _
$ _
$ _
$ -
$
$
Impl.m.ntanonolHSEEP
$ -
$ -
$ -
$ -
$ -
$ -
Travel -Tre .l cos! (1.e.. airfare. nil.aga. per diem. hotel, tab) sae aMnab. as npnsw by nnploy..sthe are on n.val
eels tor olficial business related to Me planning and mMlrt of M. exercise prcj.ct(s). Towe costs must M in acwdanco
with state. as highlighted in ds OJP Financial GYI9.. State must also loll*stab regulations regarding travel. as stab a
rydory does not have a travel policy they must tell*federal guidelines and rates. as explained in Me OJP Financial Guide.
For IuMer information on federal law pertaining to bevel costs please M. to hnpjv oIp.usdol.govFnGuide.
$ -
$ -
$ -
$ -
$ -
$ -
SupP.a - Supplies are items Mat an expended a consumed Otmg M. cause d Me Panning and conduct of the exercise
W%.d(sl (.9...oving pant, gioi.s. tap. non-* masks. aM disposal.prd.We oteeeeten0.
$ -
$ -
$ -
$ -
$ -
$ -
Other Items -These cos include the rental of spaceflocations for axe ross planning and conduct exercise signs. badges. etc.
$ -
S -
$ _
$ -
$ -
$ -
Exercise - SUB TOTAL
S -
$ -
Line Item
Allowable Equipment Costs
Quantity
Unit Cost
Budget
Total Allocated
Current
Claim Amount
Previous
Claim(s) Total
Remaining
Balance
Issue #
Eligible Equipment Acquisition Costs
The table below highlights the allowable equipment categories for this award. A comprehensive listing of these allowable equipment categories, and
specific equipment eligible under each category, are listed on the web -based version of the Authorized Equipment List (AEL) on the Lessons Learned
nformation System at http://llis.aov/. Here is where you will find the appropriate AEL number for the equipment you plan to purchase.
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$ -
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$ -
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S
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S -
S -
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$ -
s -
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$ -
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$ -
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$ -
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S -
$ -
$ -
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S -
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S -
$ -
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S
$ -
$ -
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S -
$ -
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S -
$ -
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S -
S -
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S -
$ -
$
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S -
S -
S -
S -
S -
$ -
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s -
$ -
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$ -
$ -
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$ -
S -
S -
s -
S -
S -
S -
$ -
s -
s -
$ -
$ -
s -
s -
$ -
5 -
5 -
$ -
S -
5 -
$ -
$ -
$ -
s -
$ -
$ -
$ -
$ -
$ -
S -
$ -
5 -
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$ -
5 -
$ -
5 -
$ -
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5 -
$ -
$ -
$ -
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$ -
$ -
$ -
S -
$ -
$ -
$ -
$ -
$ -
$ -
5 -
Equipment SUB TOTAL
S -
Line Item
Eligible Management and Administration Costs (M&A costs may not exceed
5% of the Recipient's total award)
Quantity
Unit Cost
_
Budget
Total Allocated
Current
Claim Amount
Previous
Claim(s) Total
Remaining
Balance
Issue #
Ming. full-time ar part -erne a mar oantratlashmwltanh:
• To assist.. the managamsnt of Mrs gran
• To assistwi. ...ion rpuiremenb an to Implementation delis grant
• To assist... compliancy.. reporting apt dab coaectren as it may relate to this grant
• M..., compliance.. repoNngreats cogs.. requirements. including data cells.
S -
S -
S -
s -
S -
S -
Development of op.ratng plans I. information collection and ppcesaing necessary to respond to DM$,FEMA deb calls.
S
5
$ -
$ -
S -
$ -
s -
$ -
s -
Line Item
Eligible Management and Administration Costs (M&A costs may not exceed
5% of the Recipient's total award)
Quantity
Unit Cost
Budget
Total Allocated
Current
Claim Amount
Previous
Claim(s) Total
Remaining
Balance
Issue #
S -
$ -
s -
Tr.. rumens.
$ -
S -
S -
s -
s -
5 -
Meting -related expenses (Fora complete list of anon.. nesting-r.Iated expenses, please renew.. OJP Financial Guide at
tidpJAvmv ejp.uadoj govfFinGuid.).
5 -
S -
S -
5 -
$ -
s -
....on of .u..mon 4Rce equipment incdrdm9 personal computers. laptop comm. a. pintas. LCD protectors. and other
equipment or software which may I. req... support Me implementation of.e homeland sear. strategy.
5 -
$ -
$ -
$ -
$ -
S -
• Prmumn9 lees/charges associated.. certain equipment such as cell p.n.. faxes,.
• Leasing anchor rent., of space for rm., hired personnel to administer programs.
5
S
$ -
5 -
$ -
s -
Management & Administrative SUB TOTAL
$ -
$ -
TOTAL EXPENDITURES
5 -
$ -
$
DIVISION OF EMERGENCY MANAGEMENT
Procurement Method Report
Form 5
Attachment H
Vendor Name:
Invoice #:
Agreement #:
Invoice Amount:
R0925
GRANT YEAR
Attach to Applicable Invoke
This report must be used to summarize methodology for all procurements. All forms mentioned are available at
0-dos/Ammon, floridadisaster oro/deco/oreoaredness/nrants-unit/
Subrecipients must check the federally debarred/suspended vendors at System for Award Management (previously called Excluded Parties List System) at www.sam.gov prior to execution of any
procurement or contract.
Check appropriate boxes below
System for Award Management (SAM)
•
Checked System for Award Management (SAM) for debarment/suspension (print page and attach). If no search was found for the vendor, complete the FDEM
debarment/suspension form located in the grant agreement.
Affirmative Steps
[ Were necessary affirmative steps taken to assure that minority businesses, women's enterprises, and labor surplus area fines were used? Please provide their information here.
Vendor Name:
Vendor Name:
Vendor Type: Amount:
Vendor Type: Amount:
Sole Source and Single Vendor Response to a Competitive Bid
All sole source procurements and single vendor response to a competitive bid require pre -approval by the Florida Division of Emergency Management Domestic Security Unit
and use of the Sole Source Form. FDEM's sole source approval documentation wit be maintained in both the jurisdictional and FDEM grant files.
State Term Contract
State Term Contract is when contracted vendor(s) provide specific commodites and service purchases to agencies on as as -needed basis for a specified period of time.
Vendor Name
State Term Contract #:
Discretionary Purchases
Purchases up to $2,499: shall be carried out using good purchasing practices which may include written quotations or written record of telephone quotes.
Amount:
L SO - 52,499 — Self-assurance and adequate competition must be documented for jurisdiction's grant files.
Purchases greater than $2,500 but less than 535,000: Requires at least two (2) documented written quotations. Documented quotes must be attached.
[ 52,500 - 534,999 — Certification Statement required for reimbursement (for each procurement).
1. Vendor Name
2. Vendor Name
3. Vendor Name
Selection Method & Justification:
Formal Solicitations
Scope of Work (SOW) must be provided.
Amount:
Amount:
Amount:
Much Additional Easels) as Needed for Explanation of Selection emcees Utilized and Justification for Selection
[ 535,000 - Greater— Written solicitation required and pre -approval from FDEM.
FDEM Pre -Approval received date
Invitation to Bid, Request for Proposal or Invitation to Negotiate documents.
Published advertisement and/or solicitations. List all submitted proposals/vendor and the bid amounts.
Vendor award/selection criteria, Justification statement as to why vendor was chosen.
Contract award/Change Orders/Revisions/Amendments/etc.
Alternative Contract Source
Commodities or Services available to the State via outside contract vehicle. A copy of the executed contract must be submitted.
Sourcing from a Piggyback Contract or General Services Adminisration approved vendor lists (S0-$50,000)
1. Applicable Government Contract
2. Vendor Name
If GSA contract requires additional quotes please submit them along with this report.
I certify the above information is true and accurate and documentation related to this procurement is on file and available upon request.
Grant Manager Signature
Print Name and Title
Date
By signing this report, I certify to the best of my knowledge and belief that the report Is true, complete, and accurate, and the expenditures,
disbursements and cash receipts are for the purposes and objectives set forth in the terms and conditions of the Federal award. I am aware that
any false, fictitious, or fraudulent Information, or the omission of any material fact, may subject me to criminal, civil or administrative penalties
for fraud, false statements, false claims or otherwise.
This report must be used to summarize the methodology for all procurements
Federal/State Procurement References
60-A 1.002 Florida Administrative Code
287-057 F.S. State of Florida Statute
2 CFR 200'317 - 200:326 Cede of Federel Regulations
Attachment I
AGREEMENT # R0925 GRANT YEAR
Required Signatures:
PROJECT TIRE:
DIVISION OF EMERGENCY MANAGEMENT
Cost Analysis
Original Ink
Form 6
BUDGET DETAIL
COST ANALYSIS
Budget items below to be provided by the Contractor. See attached instructions.
Cost Analysis to be completed by the Department Contract Manager. See attached
instructions.
1. PERSONNEL EXPENSES
A. Salaries - (Name/Title/Position) HourN Cost (5) Hours Totals (5)
Allowable
Reasonable
Necessary
COMMEN IS
(Basis for Decision)
t
Total Salaries
B. Fringe Benefits (Rate% * Total Salaries applicable) Rate % Total Sal. APP. Total $
Total Personnel Expenses (A+B)
2. Supplies
Description Unit Cost 5 Ouantiry Totals $
Total Supplies
3. Equipment
Description Unit Cost $ Quantity Totals $
Total Equipment
4. Travel Per Fare/
Purpose/Destination Days Diem $ Rate $ Mileage Totals $
r 1+r 1=
r 1 + f 1=
r 1+f 1=
Total Travel
5. Contractual
Name or Services Fee/Rate 5 Hours Totals 5
Allowable
Reasonable
Necessary
LOMMEN IS
(Basis for Decision)
Total Contractual
6. Miscellaneous
Description Unit Cost $ Quantity Totals 5
Total Miscellaneous
SUBTOTAL (1 thru 6)
7. Overhead/Indirect - Base: Rate % Base $ Total 5
8. Total Budget 5
CERTIFICATION
I certiry that the cost for each line item budget category has been evaluated and determined to be allowable, reasonable, and necessary as required by Section 216.3475, Florida Statutes.
Documentation is attached evidencing the methodology used and the conclusions reached.
Name:
Date
AGREEMENT #
DIVISION OF EMERGENCY MANAGEMENT
TIME AND EFFORT
R0925 GRANT YEAR
Employee Name:
Pay Period:
FORM 7
This form is required to accompany reimbursement claims for salaries charged to the grant.
TO Indicate Contracted Hours for Pay Period
Attachment J
Week 1: Dates to
Week 2 Dates to
Grand Total
Project Type
S
S
M
T
W
T
F Total
S
S
M
T
W
T
F Total
1
SHSP M&A
2
Planning
3
Organization
4
EMPG M&A
5
Planning
6
Vacation
7
Sick Time
8
9
10
11
12
13
14
Daily Totals
Week One Total
Week Two Total
1 hereby certify that the above allocation of my time is accurate for the time
period in which this report covers.
Employee Signature: Date:
1 hereby certify that to the best of my knowledge and belief, the reported time allocation entered in
this report is accurate and in accordance with Local, State, and Federal Regulations and Guidance
pertaining to reimbursement of Homeland Security Grant funds.
Supervisor Signature: Date:
By signing this report, 1 certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the expenditures, disbursements and cash receipts are for
the purposes and objectives set forth in the terms and conditions of the Federal award. 1 am aware that any false, fictitious, or fraudulent information, or the omission of any
material fact, may subject me to criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise.
Attachment K
CLOSE-OUT REPORT
FORM 8
This form should be completed and submitted to the Division no later than sixty (60) days
after completion of projects or the termination date of the Agreement, whichever occurs first.
RECIPIENT / GRANTEE
ADDRESS
CITY AND STATE
(1)
COST CATEGORIES -
(2)
TOTAL
EXPENDITURES
1. Planning Costs
2. Training Costs
3. Exercise Costs
4. Organization Costs
5. Equipment Acquisition Costs
6. Management and Administration Costs
TOTAL EXPENDITURES
Please Indicate Amounts For The Following:
Agreement Amount
Total Expenditures
Deobligated Funds
$
Indicate Amounts Related to Advance(s):
If not applicable, please proceed to next section
Total Amount of Advance(s) Received
Total Expenditures
Deobligated Amount of Advance Rec'd
Interest Earned on Advance
Balance of Agreement owed to FDEM
R0925
AGREEMENT#
GRANT YEAR
AGREEMENT AMOUNT
AGREEMENT PERIOD OF PERFORMANCE
(3) (4)
DATE EXPENDITURE(S) PAYMENT RECEJVED
DATE - AMOUNT
TOTAL
Was Equipment Purchased? Y/N
If yes, provide final equipment list prior to close-out
Were Funds Expended in accordance
with agreement terms? Y/N
All quarterly reports submitted up to
current reporting period? Y/N
REFUND AND/OR FINAL INTEREST CHECK
Refund and/or final interest check is due no later than ninety
(90) days after the expiration date of the Agreement.
Make check Cashier, Division of Emergency
payable to : Management
Mail to: Florida Division of Emergency
2555 Shumard Oak Boulevard
Tallahassee, FL 32399-2100
I hereby certify that the above cost(s) are true and valid cost(s) incurred in accordance with the project agreement.
I hereby certify that the above costs are true and valid costs incurred in accordance with the project agreement.
Signed: Date:
Signed:
Grant Manager
Financial Officer
Date:
By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and
the expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the terms and
conditions of the Federal award. I am aware that any false, fictitious, or fraudulent information, or the omission of any
material fact, may subject me to criminal, civil or administrative penalties for fraud, false statements, false claims or
otherwise.
ATTACHMENT M
FOREIGN COUNTRY OF CONCERN AFFIDAVIT —
PERSONAL IDENTIFYING INFORMATION CONTRACT
Section 287.138, Florida Statutes, prohibits a Florida "Governmental entity"2 from entering
into or extending contracts with any other entity whereby such a contract, or extension thereof,
could grant the other entity access to an individual's personal identifying information if that
entity is associated with a "Foreign Country of Concern."3 Specifically, section 287.138(2),
Florida Statutes, prohibits such contracts with any entity that is owned by the government of
a Foreign Country of Concern, any entity in which the government of a Foreign Country of
Concern has a "controlling interest,"4 and any entity organized under the laws of or which has
its principal place of business in a Foreign Country of Concern.
As the person authorized to sign on behalf of Sub -Recipient, I hereby attest that the company
identified above in the section entitled "Sub -Recipient Vendor Name" is not an entity owned
by the government of a Foreign Country of Concern, no government of a Foreign Country of
Concern has a controlling interest in the entity, and the entity has not been organized under
the laws of or has its principal place of business in a Foreign Country of Concern.
I understand that pursuant to section 287.138, Florida Statutes, I am submitting this affidavit
under penalty of perjury.
Sub -Recipient Vendor Name: Miami Dade Police Department
Vendor FEIN: 59-6000573
Vendor's Authorized Representative Name and Title: Danielle Levine Cava, Mayor
Address: 9105 NW 25 Street
City:
Dora!
Phone Number:
Email Address:
Certified By:
State: FL Zip: 33172
305-471-3518
grants@mdpd.com
James Reyes
Chief of Public Safety
AUTHORIZED SIGNATURE
Print Name and Title:for
Date: 01/03/2024
Daniella Levine Cava, Mayor
2 As defined in Section 287.138 (1)(d), Florida Statutes.
3 As defined in Section 287.138 (1)(c), Florida Statutes.
4 As defined in Section 287.138 (1)(a), Florida Statutes.
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