HomeMy WebLinkAboutExhibitPART I - FACE SHEET
APPLICATION FOR FEDERAL ASSISTANCE 1. TYPE OF SUBMISSION:
Modified Standard Form 424 (Rev.02/07 to confirm to the Corporation's eGrants System) Application X❑ Non -Construction
a. DATE SUBMITTED TO CORPORATION
3. DATE RECEIVED BY STATE
STATE APPLICATION IDENTIFIER:
FOR NATIONAL AND COMMUNITY
PERSON TO BE CONTACTED ON MATTERS INVOLVING THIS APPLICATION (give
DUNS NUMBER: 072220791
SERVICE (CNCS):
12 -JUN -18
N/A
4. DATE RECEIVED BY FEDERAL AGENCY:
FEDERAL IDENTIFIER:
b. APPLICATION ID:
18A C203109
FAX NUMBER:
18A FHFL0010007
5. APPLICATION INFORMATION
LEGAL NAME: City of Miami
NAME AND CONTACT INFORMATION FOR PROJECT DIRECTOR OR OTHER
PERSON TO BE CONTACTED ON MATTERS INVOLVING THIS APPLICATION (give
DUNS NUMBER: 072220791
area codes):
NAME William Porro
ADDRESS (give street address, city, state, zip code and county):
City of Miami Off. of Grants Admin.
TELEPHONE NUMBER: (305) 416-2181
444 NW 2nd Ave., 5th Floor
FAX NUMBER:
Miami FL 33130 - 1910
INTERNET E-MAIL ADDRESS: wporro@miamigov.com
County: Miami -Dade
6. EMPLOYER IDENTIFICATION NUMBER (EIN):
7. TYPE OFAPPLICANT:
7a. Local Government- Township
596000375
7b. Local Government, Municipal
8. TYPE OFAPPLICATION (Check appropriate box).
0 NEW ❑ NEWIPREVIOUS GRANTEE
❑ CONTINUATION AMENDMENT
If Amendment, enter appropriate letter(s) in box (es): El E
A. AUGMENTATION B. BUDGET REVISION
C. NO COST EXTENSION D. OTHER (specify below):
9. NAME OF FEDERAL AGENCY:
Corporation for National and Community Service
10a. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 94.006
11.a. DESCRIPTIVE TITLE OF APPLICANTS PROJECT:
10b. TITLE: AmeriCorps State
City of Miami II
11.b. CNCS PROGRAM INITIATIVE (IF ANY):
12. AREAS AFFECTED BY PROJECT (List Cities, Counties, States, etc):
Miami, FL
13. PROPOSED PROJECT: START DATE 08/01/18 END DATE 07/31/19
14. CONGRESSIONAL DISTRICT OF: a.Applicant FL 27 b.program FL 27
15. ESTIMATED FUNDING: Year #:❑1
16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE
ORDER 12372 PROCESS?
a. FEDERAL
$ 147,441.00
YES. THIS PREAPPLICATION/APPLICATION WAS MADE AVAILABLE
TO THE STATE EXECUTIV E ORDER 12372 PROCESS FOR
$ 181,338.00
b. APPLICANT
REVIEW ON:
c. STATE
$ 0.00
DATE:
NO. PROGRAM IS NOT COVERED BY E.O. 12372
d. LOCAL
$ 0.00
e. OTHER
$ 0.00
17. IS THE APPL ICA NT DELINQUENT ON ANY FEDERAL DEBT?
YES if "Yes," attach an explanation. ® NO
f. PROGRAM INCOME
$ 0.00
g. TOTAL
$ 328,779.00
18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT, THE DOCUMENT HAS BEEN
DULY AUTHORIZED BY THE GOVERNING BODY OF THE A PPLICA NT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE
IS AWARDED.
a. TYPED NAME OF AUTHORIZED REPRESENTATIVE
b. TffLE:
c. TELEPHONE NUMBER:
William Porro
Special Projects Adm
(305) 416-2181
d. SIGNATURE OF AUTHORIZED REPRESENTATIVE:
e. DATE SIGNED:
06/11/18
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Executive Summary
The City of Miami proposes to have 20 half time, equating to to full time AmeriCorps members who
will provide one-on-one and group personalized financial literacy coaching to students and local
residents who are enrolled in 4 Miami -Dade College campuses citywide. At the end of the first
program year, the AmeriCorps members will be responsible for having helped students and local
residents establish bank accountsZparticularly savings accounts; increase amount of dollars saved;
decrease amount of debt; increase credit establishment; and continue healthy management of
budgets.
In addition, the AmeriCorps members will leverage 8 volunteers who will be engaged in promotion of
the financial literacy program. Volunteers will assist AmeriCorps members in advertising via social
media, tables set up in college common areas, making presentations to classrooms, creating weekly
eBlasts and attending college fairs. This program will focus on the CNCS focus area of Economic
Opportunity. The CNCS investment of 261,32o dollars will be matched with 162,721 dollars, 162,721
dollars in public funding and o dollars in private funding.
Rationale and Approach/Program Design
1. NEED- In Miami, nearly 28% of people live below the poverty levels versus only 18% countywide.
Nearly 6 out of 10 Miami households live in or on the edge of poverty. As of 2014, nearly 6o% of
Miami -Dade County households and 67% of Miami households were one financial emergency away
from falling into poverty. 28% of city residents are unbanked with no savings or checking account; 26
of households in the city are underbanked which means they have a bank account, but still relied on
alternative financial services such as costly check cashing or payday loans in the past year. The needs
of the students attending the colleges mentioned above mirror the needs of Miamis residents. Even
with these distressing statistics regarding the Citys poverty rate and financial insecurity, there still
remains a gap in financial education in high schools and colleges.
2. THEORY OF CHANGE AND LOGIC MODEL- The identified community problem that this
proposed AmeriCorps program will address is that students, particularly young adults and adults in
post -secondary schools are not receiving financial education. Without critical financial literacy,
students are plagued by poor financial choices, debt, poor credit, being unbanked and/or underbanked.
As proposed intervention, the City of Miami will partner with AmeriCorps to create a team of
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members to provide 1 -on -1 personalized financial coaching to students, young adults and adults, at 4
of Miami -Dade College campuses. The program will engage 20 AmeriCorps members, all serving half-
time. Each of the 20 members will serve goo hours annually, which totals 18,000 hours of service
provided during the years program. Each of the four Miami -Dade College campuses will have 5
members serving during the program duration. 3 members at each campus will be financial literacy
coaches to lead initial informational group meetings, and then engage participants individually in bi-
weekly meetings. 1 leader will conduct intake meetings for each new student and schedule all bi-
weekly meetings between students and member coaches. 1 member will work with Miami -Dade
College to continually recruit new program participants throughout the duration of the program, as
well as leverage volunteers to assist with recruiting future program participants. This will serve as a
recruiting team to reach students. This recruiting group, supervised by the Program Director, will
work.with Miami -Dade College Student Services Department in order to connect with and provide the
program to students.
First, members will help students to gain an increased understanding of how to spend, save, and
decrease debts, while also developing skill sets for budgeting. By working individually with an
AmeriCorps member financial literacy coach, participants will create a personal budget and review
their credit scores, therefore gaining an increased understanding of debt prevention, with a motivation
to save more than they spend. Members will coach students so that they know how to spend properly
and understand financial stability. The members who are dedicated to program recruitment will
leverage volunteers that will assist with program promotion in order to recruit future program
participants.
By achieving these short-term outcomes, students will progressively achieve more concrete outcomes
throughout the duration of the program. Midway through the program, members will help students
to learn how to balance accounts, to independently develop a budget, and open bank accounts if they
do not already have one. AmeriCorps members will help students to create an action plan that allows
them to road -map to their goals.
By the end of the program, members will help students see the results of their hard work to this point.
Students will steadily maintain their established bank accounts, save money while decreasing debt,
improve credit establishment, and practice continual healthy management of personal budgets. To
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this point, members will have equipped students so that they can independently and effectively
manage a budget and their credit scores.
It is important to use AmeriCorps members to deliver the intervention for this community problem
because they are trained and prepared to build stronger and healthier communities. With profound
community needs such as communitys financial distress with lack of financial education, it is most
effective to utilize individuals who understand how to best serve vulnerable populations affected by the
community problem. By partnering with AmeriCorps and building a program with service provided
by members, many more students can be reached with personalized financial coaching, which
extends the impact on the community exponentially. Additionally, by partnering with Miami -Dade
College, we are collaborating with an entity that is truly representative of Miamis community.
Addressing financial instability in the community to the fullest extent possible will eventually decrease
the number of households in Miami that live in or on the edge of financial poverty.
Since the City of Miamis proposed AmeriCorps program is part of the Economic Opportunity priority,
focusing on Financial Literacy, it will utilize National Performance Measures. The first National
Performance Measure will measure the number of economically disadvantaged individuals receiving
financial literacy services. In this program, economically disadvantaged will include individuals with
poor credit score and/or receiving government benefits such as TANF, SNAP, etc.
Using a multiple session attendance log to track the number of individuals who participate in a series
of financial coaching sessions, AmeriCorps members serving as the financial coaches will be
responsible for taking attendance at the start of all one-on-one and group coaching sessions. These
multiple session attendance logs will serve as the program data showing level of unduplicated student
participation. Program data will be entered into an online system by members, and then the Program
Manager will collect and assess this data and assemble reports to translate the success of the financial
education program on paper.
A pre- and post-test will be used to measure the number of economically disadvantaged individuals
with improved financial knowledge as a result of the program. The content of the pre- and post-tests
will address learning objectives. Questions may be both quantitative and qualitative in order to get a
holistic picture of improved financial knowledge. In order to ensure this measurement tools usability
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and long-term success in collecting the information necessary, the City of Miami will conduct a pilot
test.
3. EVIDENCE BASE- The City of Miamis proposed project qualifies for the Pre -preliminary evidence
tier. Aspects of our logic model have been tested and tracked, and data has been collected and assessed.
The City of Miami has collected data about our financial literacy program model, so as to serve as an
internal outcome study, evaluation outcome study available upon request.
Methods for gathering data for the proposed one-on-one personalized coaching program begin with
an intake process to assess each students initial levels of banking, credit, debt and savings.
Participation of students served is measured through multiple session attendance logs; participant
outcomes and program metrics are listed below. The outcome study from financial coaching is utilized
in the development and updates to the Strategic Plan to determine areas of priority for services. For
example, Economic Access is an established priority area in the City of Miami Strategic Plan and data
provided from the financial coaching has helped inform this aspect of the citywide plan that sets the
course for strategic growth.
From the data regarding the community problem to be addressed, we can determine which target
population is most in need of financial literacy services. Upon determining the economically
disadvantaged target population, the City then decides which data information will be most useful to
collect. In the case of the outcome study and the proposed program, the data that is most effective in
moving the needle for financial literacy includes the participants levels of banking, credit, debt and
savings; financial goals establishment/action plan creation; bank accounts opened/ maintained and
Dollars saved and debt dollars reduced; and budget development/management.
Once the necessary data points are determined, the City adopts effective intervention activities and
direct services that will help participants to achieve financial goals and will provide the program study
with necessary data collection. Intervention activities for both the outcome study and the proposed
program are derived from a model based on one-on-one financial, personalized coaching. Throughout
the program, data is continually collected so that participant progress and program performance can
be measured and assessed. Then data is collected on the intervention activities and direct services, the
level of participation of students served and participant outcomes. This assessment provides the
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foundation for outcome study and further development of future program performance measures.
The City of Miamis project for free one-on-one personalized financial counseling as a municipal
service, is founded on the evidence -based, Financial Empowerment Centers model. First developed in
New York City under the administration of Mayor Michael R. Bloomberg, the Cities for Financial
Empowerment Fund partnered with five large cities nationwide to see how this model might be
successfully replicated in different municipal contexts. In each of the cities, city government
leadership managed the initiative, contracting with a primary nonprofit partner to deliver counseling
services. Counseling efforts and results were tracked on four dimensionscbanking, credit, debt, and
savings, and the City of Miamis proposed program will track results on the same dimensions.
The model from the Financial Empowerment Center outcome study is based on four core tenets, and
the proposed program is based on the same core elements. These include i) Individualized financial
education in order to help participants address barriers that keep them from financial stability 2) High
quality services from financial coaches who have received professional training 3) Financial
literacy/education services provided by a trusted public service agency such as the City of Miami 4)
Integration of other social service resources for participants.
The evidence -based model shows that city government managing the program, and leveraging
partnerships to deliver the financial literacy services, is the most effective service -delivery method. The
proposed program will be led by the City of Miami, and will leverage a close partnership with
AmeriCorps for members to deliver the financial literacy services after gaining skills from professional
training opportunities.
The outcome study for the Financial Empowerment Centers program model can be found at http-
//cfefund.org/wp-content/uploads/2oi7/o7/FEC-Evaluation.pdf. To replicate a similar financial
literacy education program and conduct our own outcome study, the City of Miami managed a
summer -long program, coaching 225 high school juniors and seniors in personalized, one-on-one
financial educationzopening bank accounts, establishing direct deposit, learning to save and avoid
debt, developing and managing budgets. This seasonal intervention was evaluated, and the outcome
study was completed in October 2017.
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Program outcomes and results included in the study were used as the foundation for planning the
outcomes to be measured and anticipated results for the proposed financial literacy program. The
program outcomes included in the outcome study and the results achieved include-
- Number of participants in financial literacy program measured through attendance logs z 225
students participated
- Number of bank/savings accounts opened measured through bank documentation z 130 accounts
opened, the remaining 125 already had established bank accounts
- Healthy maintenance of accounts measured according to bank statements - 225 set up direct
deposit; 130 students split their deposit into savings and transactions accounts
- Amount of dollars saved measured through bank statements - 152 participants saved a total of 86,34
dollars
- Budget management measured through pre and post test results and bank statements - All 225
demonstrated an increased understanding about how to save and coping skills for income/expense
mismatch as they continue to manage their budgets
The proposed project will use the same performance measures and methodologies for collecting data.
However, since the proposed project will take place at college campuses, it is appropriate to include
debt reduction as an outcome. This will be a valuable addition to the existing program performance
measures. The proposed program will use interventions that last for a one year period, so the 12
month program duration will be evaluated on an ongoing basis. Then, upon program completion, a
final evaluation will provide summary of qualitative and quantitative assessment.
The outcome study findings used a large enough number of participants to gather data and assess
impact with confidence. Because the study is based on a 9 -week financial literacy program, the
statistics gathered as result revealed that a lengthier program will improve the participant outcomes
even furtherzhence, the proposed programs year-long duration. The study design yielded results that
directly influence the proposed program design and anticipated achieved outcomes.
4. NOTICE PRIORITY- The City of Miamis proposed program fits within the Economic Opportunity
priority to increase economic opportunities for communities by engaging opportunity youth, either as
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the population served and/or as AmeriCorps members, to prepare them for the workforce. Within the
Economic Opportunity funding priority, our proposed program directly aligns with the Financial
Literacy strategic plan objective. The proposed program includes financial literacy education with
regard to credit management, financial institutions including banks and credit unions, and utilization
of savings plans. The Citys proposed financial literacy program is an evidence -based program design,
so it has been evaluated and has demonstrated positive results for more than one key desired outcome.
5. MEMBERS EXPERIENCE- AmeriCorps members will be integrated throughout the program life
cycle. Prior to the program commencement, members will gain an in-depth understanding of the
community issue of financial insecurity linked to poverty in economically disadvantaged individuals in
Miami. 12 members will be engaged in the evidence -based program through direct service delivery -
personalized financial literacy/education - to economically disadvantaged individuals; 4 members will
be integrated into the program for program developmentcrecruiting members and leveraging
volunteers to assist in program promotion and recruitment; 4 members will serve as leaders to act as
a liaison, conducting intake meetings with participants to assess their financial needs and goals,
scheduling financial literacy meetings between program participants and members, and also serving
as a financial coach.
As a result of professional training for direct service delivery, AmeriCorps members will gain skills on
credit and money management and savings; helping to guide participants on how to get out of debt,
avoid future debt and manage bank accounts. Moreover, as a result of training and service delivery,
members will gain many skills that will be valued by future employers. These skills include the ability
to deliver personalized services to clients on a one-on-one basis; Honed public speaking skills and
experience as financial educators/teachers; Taking initiative and leading clients to achieving goals;
Time management and Social skillsZability to relate to clients and demonstrate patience and empathy;
Case management experience and Understanding of confidentiality with client information; and Data
collection and reporting.
The Program Manager will meet quarterly with all 20 AmeriCorps members throughout the program
duration. These meetings will be conversational in tone so that members feel comfortable and
welcome to share the details about their experience. These meetings will serve as verbal reflections for
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members to share their experience, and will allow for the Program Manager to address any concerns
about service delivery promptly. Between scheduled one-on-one meetings, the Program Manager will
be available to members as necessary. At the midpoint and end of the program, the Program Manager
will provide members with a written questionnaire that will provide a way for members to suggest
program improvements, and provide feedback with anonymity. From previous experience leading
similar programs, the City of Miami has found that anonymous evaluation is an effective way to
gather accurate feedback regarding program/service delivery.
The proposed financial literacy program will recruit AmeriCorps members from the City of Miami and
nearby Miami neighborhoods, the Miami -Dade College system and graduates/alumni from the Citys
2017 summer financial literacy program. Miami is a culturally diverse area with residents from many
different backgrounds. The City of Miami understands that in order to serve a diverse target
population, we must engage a diverse group of AmeriCorps members as service leaders. The program
will be inclusive and culturally sensitive for both members and participants, and it is critical to utilize
different talents and capabilities to the fullest -potential in order to achieve program success.
Organizational Capability
Organizational Capability
1. ORGANIZATIONAL BACKGROUND and STAFFING- The City of Miami has a long established
history of serving its low-income residents including youth and students. The Financial
Empowerment Center and financial counseling are particularly relevant to the Citys priorities and
efforts to assist low-income residents. In partnership with Operation Hope, the City of Miami operates
a Financial Empowerment Center staffed with financial coaches who provide counsel to low-income
residents and business owners.
Before the strategic plan and the Financial Empowerment Center, there was the Assets, Capital,
Community, Education, Savings and Success, or more commonly known as A.C.C.E.S.S. Miami
program, launched in 2005, as a citywide poverty reduction strategy. By focusing on asset
accumulation, access to capital and job creation/retention, ACCESS Miami creates a comprehensive
financial growth strategy rooted in education and savings that promotes economic prosperity for all
small businesses entrepreneurs and residents.
Continuing to build on the City of Miamis strategic priority area of Economic Access, the proposed
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AmeriCorps program will be managed by the Program Manager of the Summer Jobs Connect
Program. This Program Manager also has experience supervising the Citys AmeriCorps VISTA
Program, and serves as a Community Trainer for the Florida Benefit Bank System. Each of the 20
AmeriCorps Members will report to the Program Manager. Overseeing the Program Manager and the
proposed program in general will be the Assistant Director for the City of Miami Office of Grants
Administration responsible for the ACCESS Miami Financial Empowerment Initiatives. For 14 years,
the Assistant Director has coordinated economic initiatives strategies and resources within City
Administration and the Office of the Mayors poverty reduction strategy.
2. COMPLIANCE and ACCOUNTABILITY- The proposed program will provide gear including shirts,
all-weather jackets and caps to each of the members. All gear will present the tri -branding of the
AmeriCorps Florida, Volunteer Florida and lead agency logos.
The City of Miami will comply with AmeriCorps rules and regulations, including those related to
prohibited and unallowable activities at service site locations. The City has experience successfully
complying with AmeriCorps rules and regulations through our current VISTA programming. The
proposed program will not include subgrantees, but will hold service site locations accountable if
instances of risk or noncompliance are identified. Any CNCS-required evaluation reporting will meet
CNCS requirements and will be of the highest quality and will be completed with timeliness. The City
of Miami receives over 50,000,000 dollars in federal grants annually. The City utilizes financial
management systems, procedures and controls to ensure funds are used according to the
requirements of grants and federal regulations. In adherence to 2 CFR 200 Subpart F, a single audit
is completed annually.
3. CULTURE THAT VALUES LEARNING- As an entity dedicated to public service, the City of Miami
offers programming founded upon a culture that values lifelong learning. Management and staff
continually collects information on all aspects of programming, i.e. population -served, outcomes,
performance measures, services delivered, etc., as learning tools. This information serves as the
influence for future decision making regarding City programming, allowing management and staff
grow and change as necessary. Using the information gathered for learning purposes, the City
produces frequent reports to determine the level of success at which our programs are operating.
Assessment of these reports helps to align our programs with our Strategic Plan so as to best serve the
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Miami area residents.
4. MEMBER SUPERVISION- AmeriCorps members will receive guidance and support from the
Program Manager, who will ensure that members understand their roles and responsibilities and will
be adequately trained to follow AmeriCorps and program regulations, priorities and expectations. An
existing City employee will be assigned the Primary Program Manager responsibilities and dedicate
50% of their time to administering this project. The other 50% or 1/2 of an FTE will be covered by an
additional secondary Program Manager who will work on a half-time basis but l00% dedicated to this
project as well. If necessary as the program expands, the Program Managers will transition to a full
time role. The Program Managers will schedule individual monthly meetings with each AmeriCorps
member to promptly address concerns and answer any questions that members may have during the
programs duration. Additionally, the managers will host quarterly group meetings with all of the
members present to provide program updates and encourage teamwork. Between the individual and
group meetings, the Program Managers will be available to members for impromptu meetings and
discussions as necessary. The managers will be stationed in the City of Miami government
administration building, however, he or she will travel between each of the 4 Miami -Dade College
campuses each week in order to also be present and available to members on-site. Members will work
out of the Student Services Department on the 4 Miami -Dade College campuses, and the City of
Miami understands the importance of providing members with sufficient supervision and assistance
during work hours. The Assistant Dean of Student Services at each of the 4 Miami Dade College
campuses will fill the role of providing designated day-to-day onsite supervision for members,
including signing off on timesheets. The Assistant Dean of Student Services at each campus will work
closely with the Program Manager, who will supervise overall.
Cost Effectiveness and Budget Adequacy
See budget.
Evaluation Summary or Plan
Not applicable
Amendment Justification
N/A
Clarification Summary
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N/A
Continuation Changes
N/A
Grant Characteristics
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Pefformance Measures
11Economic opnmnonny:o ome,0mmmunmvpoomoes: I nr/nancialmeraovm90mecl
Table1: MSYsbyFocus Areas Table2: MSYsbyObjectives
MIT
FEco—nomic Opportunity 90% Financial Literacy 90%
[biher —Community Prioritiesl�� Other 10%
% of MSY NFTJ VS Applicant VS Not in ANY
Tab/e2: %MSYy by NPM vs.App|icunivs. Not in ANY
Table4: No o[yNSYand Members by Objective
Primary Focus Area:
Phnary|ntemention:
Secondary Focus Area:
Secondary Intervention:Other
Economic Opportunity
Financial Literacy Education
Other Community Priorities
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FocusNo of 9.00 No of 18
Economic Opportunity Objective: Financial Literacy
Area: MSY's: Members:
Problem Statement:
Students (young adults and adults) in Miami schools are not receiving financial literacy/education, resulting
in poor financial choice, debt, poor credit, etc. This escalates the community problem that nearly 6 out of 10
Miami households live in or on the edge of poverty and the majority of households in the area live in
constant financial insecurity. As of 2014, nearly 60% of Miami -Dade County households and 67% of Miami
households were one financial emergency away from falling into poverty.
Selected Interventions:
Financial Literacy Education
Describe Interventions:
The financial literacy services will be delivered at 4 Miami -Dade College campuses. At each campus, 4 half
time AmeriCorps service members will provide personalized financial education through weekly group
session and bi-weekly one-on-one meetings with individuals for a one year program period. At each
campus, AmeriCorps members will conduct intake meetings with participants to assess their financial
needs and goals, and 1 half time member will lead recruiting efforts and leverage volunteers. A minimum of
150 program participants will be served with financial literacy education services within a one year period.
01 Output:
01: Number of econ disadv individuals receiving financial literacy services.
Target: 150 Economically Disadvantaged Individuals
Measured By: Attendance Log
Described Instrument: A multiple session attendance log will be used to measure the number of
economically disadvantaged individuals that attend ongoing group and one-
on-one financial literacy services.
OUTCM54259 Outcome:
Number of individuals that demonstrate continual healthy management of budget
Target: 105 Individual program participants
Measured By: Other
Described Instrument: A minimum of 105 participants will develop skill sets of budgeting and create a
personal budget, with the assistance of financial coaches
At least 90% of economically disadvantaged participants will demonstrate
proper spending habits (not spending more than they have), so as to work
towards financial stability
At least 70% will practice ongoing hea
OUTCM54257 Outcome:
Percent of participants that increase savings and the total dollar amount of savings increased
Target: 98 Individual program participants
Measured By: Other
Described Instrument: AmeriCorps members will record the number of individuals that increase
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Problem Statement:
Soledledi4ht4tn(eftljcff1 acation
)escribed Instrument: savings. The number of dollars saved as measured by student bank
statements. This self -reporting of bank statements will serve as program
requirement.
A minimum of 65% individuals will achieve savings of $500 _ ..... ___..___.._..._............_......... _._...._._.........
OUTCM54258 Outcome:
Percent of individuals that increase credit establishment (better credit score)
Target: 105 Individual program participants
Measured By: Other
Described Instrument: At least 70% of individuals will improve credit establishment (achieve better
credit score) as a result of the program
AmeriCorps members will record the number of individuals that increase credit
establishment (better credit score), as measured by a self -full of credit score.
This self -reporting of credit scores will serve as program requirement.
OUTCM54255 Outcome:
Percent of individuals that maintain established bank accounts upon program completion
Target: 105 Individual program participants
Measured By: Other
Described Instrument: The number of bank accounts opened, as measured by student participants
submitting proof of account(s) from the financial institution. This self -reporting
will serve as a program requirement for student participants.
At least 70% of individuals will maintain bank accounts with a positive balance
upon program completion
OUTCM54256 Outcome:
Number of individuals that decrease debt and total dollar amount of debt decreased
Target: 50 Individual program participants
Measured By: Other
Described Instrument: A minimum of 50 participants will reduce debt as a result of the program
AmeriCorps members who lead financial literacy coaching will track the number',
of individuals that decrease their debt during the program. The dollar amount of',
debt decreased measured by student bank statements. This self -reporting of
bank statements will serve as program requirement.
09 Outcome:
09: Individuals with improved financial knowledge.
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Performance Measure: Financial Literacy Achievements
Problem Statement:
SoFIndhediaht4ttMcation
Target: 135 Economically Disadvantaged Individuals
Measured By: Pre\ Post Test
Described Instrument: The City of Miami will develop a Financial Literacy Pre -Test and Post -Test to
test students' improved financial knowledge. The content (type of questions
being asked) in our pre- and post-tests will address the financial literacy
program's learning objectives. Questions may be both quantitative and
qualitative in order to get a holistic picture of improved financial knowledge. In
order to ensure this measurement tool's usability and long-term success in
collecting the information necessary, the City of Miami will conduct a pilot test.
A minimum of 135 economically disadvantaged participants will increase
understanding of how to spend, save, decrease debts, as a result of the
program, as measured by pre- and post-tests
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Performance Measure: VolunteerGeneration
Focus Other Community Objective: Other No of 1.00 No of 2
Area: Priorities MSY's: Members:
Problem Statement:
While 4 AmeriCorps members are responsible for recruitment of future members, they will also generate
volunteers to assist with program promotion and recruitment of target student program participants
Selected Interventions:
Members will recruit 24 volunteers
Describe Interventions:
1 half time AmeriCorps member that is dedicated to recruitment efforts at each of the 4 Miami -Dade College
campus program locations, will recruit 6 volunteers per campus (24 volunteers leveraged, total) to serve on
an ongoing basis (not episodic).
OUTPT54260 Output:
Volunteers will assist in program promotion and recruitment of target student program participants
Target: 24 Individual volunteers
Measured By: Other
Described Instrument: A minimum of 6 volunteers at each campus (24 total) to assist with promotion of
the program and program recruitment to students — advertise via social media,
tables in college common areas, make presentations to classrooms, create
eBlasts weekly, college fairs
OUTCM 54261 Outcome:
Number of hours volunteers will work with members to promote program and recruit participants
Target: 6240 Total number of volunteer hours worked
Measured By: Other
Described Instrument: A minimum of 6 volunteers at each campus (24 total) to assist with promotion of
the program and program recruitment to students — advertise via social media,
tables in college common areas, make presentations to classrooms, create
eBlasts weekly, college fairs
Each of the 24 volunteers will give 5 hours per week (approximately 260 hours
per year each)
For Official Use Only
Page 17
Program Information
General Information
*My organization has previously received an AmeriCorps State and National No
Grant. Organizations that have been a host site for AmeriCorps members but
never had a direct grant relationship with either a State Commission or CNCS
should answer "No."
*The organization has sufficiently engaged community members and partner Yes
organizations in planning and implementing its intervention.
*My organization certifies that it will comply with definitions and requirements Yes
outlined in the Performance Measure Instructions.
AmeriCorps Funding Priorities
*Check any priority area(s) that apply to the proposed program. In order to Economic Opportunity
receive priority consideration, applicants must demonstrate that the priority
area is a significant part of the program focus, high quality program design,
and outcomes.
Populations Served
*Check the appropriate box(es) to identify the populations the proposed Adult ESL participants,
program will serve. If you do not plan to serve any of the listed populations, Immigrants and refugees,
select "None of the above." Individuals with disabilities,
Veterans
Grant Characteristics
*Check any characteristics that are a significant part of the proposed Community-based
program. organizations, Geographic
Focus -Urban
AmeriCorps member Population
*Check any grant characteristics that apply to the AmeriCorps member Communities of Color, Low -
population of the proposed program. income individuals, People
with Disabilities, Veterans,
Active Military, or their
Families
AmeriCorps Identity/Co-branding
*AmeriCorps members will wear the AmeriCorps logo every day. Yes
*AmeriCorps members will create and deliver elevator speeches. Yes
*The AmeriCorps logo will be prominently displayed on the front page of the Yes
organization's website.
For Official Use Only
Page 18
Demographics
Other Revenue Funds
Number of episodic volunteers generated by AmeriCorps members
Number of ongoing volunteers generated by AmeriCorps members
Percentage of MSY who are opportunity youth, if any
Number reported in 015 who are opportunity youth
Number reported in 017 who are opportunity youth
For Official Use Only
Page 19
(J
Required Documents
Document Name
Evaluation
Federally Approved Indirect Cost Agreement
Labor Union Concurrence
Other Documents
For Official Use Only
Page 20
Status
Not Applicable
Not Applicable
Not Applicable
Not Applicable
Logic Model
Problem
Inputs
Activities
Outputs
Short -Term
Outcomes
Mid -Term
Outcomes
Long -Term
Outcomes
The community
Resources that
The core activities
Direct products
Changes in
Changes in
Changes in
problem that the
are necessary to
that define the
from program
knowledge, skills,
behavior or action.
condition or status
program activities
deliver the
intervention or
activities.
attitudes and
Depending on
in life. Depending
(interventions) are
program activities
program model
opinions. These
program design,
on program
designed to
(interventions),
that members will
outcomes, if
these outcomes
design, these
address.
including the
implement or
applicable to the
may or may not be
outcomes may or
number of
deliver, including
program design,
measurable during
may not be
locations/sites
duration, dosage
will almost always
the grant year.
measurable during
and number/type
and target
be measurable
the grant year.
of AmeriCorps
population.
during the grant
Some programs,
members.
year.
such as
environmental or
capacity -building
programs, may
measure changes
in condition over a
period as short as
one year.
Economically
Miami -Dade
One-on-one
Financial Literacy
At least 135
Members that
09- At least 135
disadvantaged
College campuses
financial,
Achievements: 01-
participants will
serve as financial
individuals with
students (young
(4)
personalized
The number of
increase
coaches will
improved financial
adults and adults)
20 half time
coaching available
economically
understanding of
introduce financial
knowledge as a
in Miami schools
members (5 at
to all MDC students
disadvantaged
how to spend,
institutions and
result of the
(Miami -Dade
each MDC
that are
students receiving
save, decrease
services to
program, as
College) are not
campus)
considered
financial one -on-
debts
program
measured by pre -
receiving financial
economically
one literacy
participants based
and post-tests
literacy/education,
1 half time leader
disadvantaged
services (at least
At least 135
on their financial
resulting in poor
at each campus
from October 1,
150, as measured
participants will
needs
At least 70 percent
financial choices,
for intake, financial
2018 to September
through a multiple
have developed
assessment
of participants will
debt, poor credit,
literacy scheduling
30, 2019. Financial
session
skill sets of
completed at intake
maintain
and lack of
and coaching = 4
coaches will meet
attendance log)
budgeting
established bank
knowledge on
leaders;
with each
At least 105
accounts upon
banking, saving
participant bi-
At least 90% of
participants will
program
and investing.
12 halftime
weekly during the
economically
open bank
completion
members to
year-long program
disadvantaged
accounts if they
provide the
duration.
participants will
dont already have
A minimum of 65
financial literacy
demonstrate
one- start savings
percent of
coaching = 3 part
1 halftime leaders
proper spending
account if one is
participants will
time coaches at
member (at each
habits (not
not already
increase savings
each school)
campus) to
spending more
established
of 500 dollars
conduct intake
than they have), so
meetings with
as to work towards
Develop financial
At least 50
Page 21
Logic Model
Problem
Inputs
Activities
Outputs
Short -Term
Outcomes
Mid -Term
Outcomes
Long -Term
Outcomes
participants to
financial stability
goals and create
individuals will
assess their
action plan that
decrease debt and
financial needs
allows them to
total dollar amount
and goals,
road -map to goals
of debt decreased
schedule financial
will be tracked
literacy education
sessions for
At least 70 percent
participants with
of individuals will
financial coaches
increase credit
establishment
12 members will
(better credit
serve as financial
score) as a result
literacy coaches
of the program
on MDC
campuses- will
A minimum of 105
lead a group
participants will
presentation to
demonstrate
initially inform
continual healthy
potential
management of
participants; one-
budget
on -one initial
meeting, assess
their financial
situation, establish
financial goals,
develop a financial
model action plan
to achieve
established goals;
bi-weekly
meetings with
individuals; follow-
up.
Economically
1 half time
1 halftime
Volunteer
4 members
24 volunteers will
24 volunteers will
disadvantaged
members at each
recruiting
Generation:
dedicated to
dedicate 5 hours
dedicate 260 hours
students (young
campus For
members (at each
Members to
program
per week to
per year to
adults and adults)
recruiting
campus) will
leverage at least
recruitment will
program
recruitment of
in Miami schools
purposes = 4 total
recruit ongoing
24 volunteers to
leverage a
recruitment
program
(Miami -Dade
for recruiting roles
volunteers (6
assist with
minimum of 24
participants for a
College) are not
(recruiting
volunteers at each
program
volunteers to
total of 6,240
receiving financial
participants and
campus =24 total)
recruitment
assist with
annual volunteer
literacy/education,
volunteers)
to assist with
program promotion
hours
For Official Use Only
Page 22
Logic Model
Problem
Inputs
Activities
Outputs
Short -Term
Outcomes
Mid -Term
Outcomes
Long -Term
Outcomes
resulting in poor
promotion of the
in order to recruit
financial choices,
program -
future student
debt, poor credit,
advertise via social
participants
and lack of
media, tables in
knowledge on
college common
banking, saving
areas, make
and investing,
presentations to
classrooms,
create eBlasts
weekly, college
fairs
For Official Use Only
Page 23
July 19, 2018 11:07 AM
City of Miami II
City of Miami
RPT BGT 424
Application ID: 18AC203109
Budget Dates:
Total Amt
CNCS Share
Grantee Share
Section I. Program Operating Costs
A. Personnel Expenses
54,800
8,800
46,000
B. Personnel Fringe Benefits
15,519
0
15,519
C. Travel
Staff Travel
Travel to CNCS-Sponsored Meetings
1,944
1,944
0 0
Member Travel
Total
$1,944
$1,944
$0
D. Equipment
E. Supplies
4,866
4,866
0
F. Contractual and Consultant Services
G. Training
Staff Training
150
150
0
Member Training
7,200
3,600
3,600
Total
$7,350
$3,750
$3,600
H. Evaluation
I. Other Program Operating Costs
93,743
6,743
87,000
Section I. Subtotal
$178,222
$26,103
$152,119
Section I Percentage
15%
85%
Section ll. Member Costs
A. Living Allowance
Full Time (1700 hrs)
0
0
0
1 -Year Half Time (900 hours)
100,000
100,000
0
Reduced Half Time (675 hrs)
0
0
0
Quarter Time (450 hrs)
0
0
0
Minimum Time (300 hrs)
0
0
0
2 -Year Half Time (2nd Year)
0
0
0
2 -Year Half Time (1st Year)
0
0
0
Three Quarter Time (1200 hours)
0
0
0
Total
$100,000
$100,000
$0
B. Member Support Costs
FICA for Members
7,650
7,650
0
Worker's Compensation
6,320
6,320
0
Health Care
0
0
0
Total
$13,970
$13,970
$0
Section II. Subtotal
$113,970
$113,970
$0
Section Il. Percentages
100%
0%
Section III. Administrative/Indirect Costs
A. Corporation Fixed Percentage
Corporation Fixed Amount
33,640
4,421
29,219
Commission Fixed Amount
2,947
2,947
0
Total
$36,587
$7,368
$29,219
B. Federally Approved Indirect Cost Rate
Section III. Subtotal
$36,587
$7,368
$29,219
Section III Percentage
20%
80%
Section I + Ill. Funding Percentages
16%
84%
Budget Totals
$328,779
$147,441
$181,338
Budget Total Percentage
45%
55%
Required Match
24%
# of years Receiving CNCS Funds
1
Form 424A
Modified SF -424A (4/88 and 12/97)
Page 1
July 19, 2018 11:07 AM
Total MSYs
Cost/MSY
Budget Totals
Budget Total Percentage
Required Match
# of years Receiving CNCS Funds
Total MSYs
City of Miami II
City of Miami
Total Amt
$0
10.00
$14,744
CNCS Share
$0
0%
24%
1
10.00
Grantee Share
$0
0%
RPT BGT 424
Form 424A Modified SF -424A (4/88 and 12/97)
Page 2
7/19/2018 Budget Narrative for 18AC203109
Budget Narrative: City of Miami II for City of Miami
Section I. Program Operating Costs
A. Personnel Expenses
Position/Title -Qty -Annual Salary % Time
CNCS Share
_
Grantee Share
Total Amount
City of Miami Assistant Director: - 1 person(s) at 120000 each x 5 % usage
0 '
6,000
L_ I
6,000
City of Miami - Program Manager: - 1 person(s) at 50000 each x 5 % usage
L 0 11
2,500
2,500
per person) $972 x 2 staff= $1944 total
Miami Dade College - Student Dean: - 1 person(s) at 150000 each x 5 %
0
7,500
7,500 j
usage
0 !
3,4631L
I
Secondary Program Manager: - 1 person(s) at 8800 each x 100 % usage
8,800
0
8,800
Primary Program Manager: - 1 person(s) at 60000 each x 50 % usage
I 0
30,000
�
30,000
CATEGORY Totals �
8,800 �
46,000
54 V800
B. Personnel Fringe Benefits
C. Travel
Staff Travel
Purpose -Calculation11,
CNCS Share
Grantee Share
Total Amount
Purpose -Calculation
CNCS Share
Grantee Share
Total Amount
FICA: 7.65% of total salariesE
0 I[[[
4,1924,192
per person) $972 x 2 staff= $1944 total
Health insurance: Health insurance is 14.35% of wages
0
7,864
�
7,864
Worker s Compensation: Worker's Compensation is 6.32% of wages _=
0 !
3,4631L
3,463
CATEGORY Totals
I_
0 ��15,519
15,519
C. Travel
Staff Travel
Purpose -Calculation11,
CNCS Share
Grantee Share
Total Amount
Travel to CNCS-Sponsored Meetings: 2 staff for 2 days ($500 airfare + 100
0
0
0
ground transportation + $150 hotel x 2 nights + $36 per diem x 2 days = $972
1,944
0
1,944
per person) $972 x 2 staff= $1944 total
CATEGORY Totals
1,94411
0
1,944
Member Travel
Purpose -Calculation
CNCS Share
Grantee Share
Total Amount
CATEGORY Totals
0
0
0
D. Equipment
Item/Purpose -Qty -Unit Cost
CNCS Share I
((€
Grantee Share
Total Amount
CATEGORY Totals
0
0
0
E. Supplies
hftps:Hegrants.cns.gov/espan/main/report.jsp?sid=hZgygfKOgIqZGK831 dtgUyPdgiZRYGDef53X9X1 D99ZiQ2yr8Ezt%21434812672%2115320032180... 115
7/19/2018
Budget Narrative for 18AC203109
Item -Calculation
CNCS Share i
Grantee Share
Total Amount
Office supplies: Consumable office supplies for 4 campuses. 16 toners @ $75
!
0
0
each = $1200, 16 cases of paper @ $50 per case = $800, 10 boxes of
2,106 (
0
2,106
pens/pencils @ $5 per case = $50, 8 boxes of paper clips @ $5 per case =
C
600
1,200
$40, 4 staplers @ $4 each = $16. Total $2106
150
0
150
i
Member shirts - uniforms: $17.50 per shirt for 5 shirts per member = $87.50 +
1 jacket at $35.50 per member + 1 cap at $15 per member = $138 per
2,760
0
2,760
member. Total for 20 member = $2760
3,000
3,000
6,000
CATEGORY Totals ,
4,866
0
4,866
F. Contractual and Consultant Services
Purpose -Calculation -Daily Rate
CNCS Share
Grantee Share
Total Amount
CATEGORY Totals�0
!
0
0
G. Training
Staff Training
Purpose -Calculation -Daily Rate IF-
CNCS Share
i
Grantee Share
Total Amount
Required staff training: $50 per person x (2) staff (PD and finance) = $100 and
0
0
0
PD (1) staff to attend the spring training = $50) = total $150 registration fee for
150
0
150
Volunteer Florida training- Daily Rate of 50
[
I
600
1,200
CATEGORY Totals
150
0
150
Member Training
FE___
Purpose -Calculation -Daily Rate
CNCS Share
[_.!rantee Share JLbtal
Amount
CATEGORY Totals 1=
0
0
0
Financial Ambassadors Training: $15 per member. There will be 4 trainings or
$60 per member, gatherings per year or per quarter @ 261 working days per
600
600
1,200
year- Daily Rate of 9
i
Cities for Financial Empowerment Training: Certification in appropriate
process, protocol & data entry prior to meeting with clients. Contracted vendor
includes estimated travel costs for 5 day training @ $60 per member x 20
3,000
3,000
6,000
members x 5 days = $6000. Daily rate is $60 per member per day.- Daily Rate
of 1000
CATEGORY Totals3,600
3,600
7,200
H. Evaluation
LPurpose -Calculation -Daily Rate
CNCS Share
Grantee Share
Total Amount
CATEGORY Totals 1=
0
0
0
I. Other Program Operating Costs
Purpose -Calculation
CNCS Share
Grantee Share
Total Amount
Office space: Fair market rent at $20 per square foot @ 100 feet per office for
each Financial Ambassador at each campus 10 FTE members
0
20,000
20,000
hftps://egrants.cns.gov/espan/main/report.isp?sld=hZgygfKOglqZGK83ldtgUyPdgiZRYGDef53X9Xl 099ZiQ2yr8Ezt%21434812672%2115320032180... 2/5
7/19/2018
Budget Narrative for 18AC203109
Computers: 10 FTE - computers required at $1500 each0
15,000
15,000
Outcome & Management System: Use Internet based CounselorMax to client
Full Time (1700 hrs): Member(s) at a rate of each
Members W/O allowance
0
information and outcome tracking. Annual Cmax license $595 (includes 5
2,845 0 (
2,845 I
users) + 15 additional users at $150 each. Total $2845
0
100,000
2 -Year Half Time (1st Year): Member(s) at a rate of each
Members W/O allowance
01
0
Meeting space: Fair market rent at $20 per square foot @ 500 square feet for
2 -Year Half Time (2nd Year): Member(s) at a rate of each
Members W/O allowance
0
meeting space, includes utilities, janitorial services, parking located at each
0 ! 40,000
40,000 i
campus for 4 campuses.
j
0
Quarter Time (450 hrs): Member(s) at a rate of each
Members W/O allowance
0
0
Payroll processing: Provide payroll function, including reporting, tracking and
Minimum Time (300 hrs): Member(s) at a rate of each
Members W/O allowance
I
W -2s at end of year. $3695 annual fee (which is $142.15 x 26 payrolls)
3,898 0
3,898
+$166.95 annual fee for Y/E information statement and W-2 + $10.5 W-2
0
0
li
I delivery and $25 set-up fee
100,000
0
Internet, software and IT support: Monthly IT support @ $5 per member per
f
month = $1200, software at $5 per (10) FTE per month = $600, setup @$150
per member = $3000, internet monthly @ $5 monthly per member per month =
0 6,000
6,000
$1200- = total $6000
Telephone & support: At $50/month for 10 FTE or 20 half-time members
0 6,000
6,000
CATEGORY Totals
6,743 4 87,000
93,743
SECTION Totals
26,103 �i 152,119mm
178,222
PERCENTAGE
15% 85%
Section II. Member Costs
A. Living Allowance
1 Item -# Mbrs w/ Allow -Allowance Rate # Mbrs w/o Allow
! CNCS ShareL-
Grantee Share
Total Amount
Full Time (1700 hrs): Member(s) at a rate of each
Members W/O allowance
0
0
0
1 -Year Half Time (900 hours): 20 Member(s) at a rate of 5000 each
Members W/O allowance 0
100,000
0
100,000
2 -Year Half Time (1st Year): Member(s) at a rate of each
Members W/O allowance
01
0
0
2 -Year Half Time (2nd Year): Member(s) at a rate of each
Members W/O allowance
0
{{
i 0
0 !
Reduced Half Time (675 hrs): Member(s) at a rate of each
Members W/O allowance
0
0
0
Quarter Time (450 hrs): Member(s) at a rate of each
Members W/O allowance
0
0
0
Minimum Time (300 hrs): Member(s) at a rate of each
Members W/O allowance
0
0
0
Three Quarter Time (1200 hours): Member(s) at a rate of each
Members W/O allowance
0
0
0
ILCATEGORY Totals
100,000
0
100,000
B. Member Support Costs
Purpose -Calculation
CNCS Share 1LG_ra_ntee
Share11
Total Amount
FICA for Members: @ 7.65% i
7,650
0
7,650
https://egrants.cns.gov/espan/main/report.jsp?sid=hZgygfKOglqZGK83l dtgUyPdgiZRYGDef53X9X1 D99ZiQ2yr8Ezt%21434812672%2115320032180... 3/5
7/19/2018
Budget Narrative for 18AC203109
Worker's Compensation: $6.32 per every $100 paid in wages J
6,320
0
6,320
Health Care:
0 (
0
0
CATEGORY Totals I
i
13,970
��I
13 970
f
SECTION Totals i�
113,970 ��
LLL���...
111 0
113,970
111
PERCENTAGE J�
100%
0%
Section III. Administrative/Indirect Costs
A. Corporation Fixed Percentage
Item -Calculation
CNCS Share
Grantee Share
Total Amount
CATEGORY Totals
0
0
0
Corporation Fixed Amount: .0526 of budget 1 & 2. Total is CNCS Share =
7,368 (
29,219
36,587
(CNCS Section I + II) x.0526 x.60 (Equals 3%) Grantee Share = (Section I +
4,421
29,219
33,640
ll) x .10 (may include up to 10%)
Commission Fixed Amount: CNCS Share = (CNCS Section I + II) x .0526 x .40
(Equals 2%)
2,9470
2,947
�36,w587
CATEGORY Totals
7,368 j
29,219
j
B. Federally Approved Indirect Cost Rate
Calculation -Cost Type -Rate -Rate Claimed -Cost Basis IL
CNCS Share !
Grantee ShareTotal
Amount
CATEGORY Totals
0
0
0
SECTION Totals
7,368 (
29,219
36,587
PERCENTAGE
20% '
80%
`
BUDGET Totals
IL 147,441 'IL
181,338 11
328,779
PERCENTAGE
IL 45%
_
Total MSYs
10.00
1. General funds (City of Miami and Miami Dade College)
Cost/MSY!I-
14,744 IL
State/LocalIn-kind
Source of Funds
Section
Match Description
Amount
Type
Source
1. General funds (City of Miami and Miami Dade College)
=61.519
In Kind
State/LocalIn-kind
local funding for salaries��2.
General Funds (City of Miami and Miami Dade College)
87,000
In Kind
State/Local
In-kind local funding for program operating expense
Source of Funds
3. General funds (City of Miami and Miami Dade College)
In-kind local funding. Assist with supplies, program
F29.219
in Kind
State/Local
operating costs, member support cost, ect.
4. General funds (City of Miami and Miami Dade College)
In-kind local funding. Assist with supplies, program
3,600
In Kind
State/Local
operating cost, member support cost, ect. for training
j
cost -share
https://egrants.cns.gov/espan/main/report.jsp?sid=hZgygfKOglqZGK831 dtgUyPdgiZRYGDef53X9X1 D99ZiQ2yr8Ezt%21434812672%2115320032180... 4/5
7/19/2018
Budget Narrative for 18AC203109
Total Source of Funds 181,338
https://eg rants. cns. gov/espan/main/report.jsp?sid=hZgygfKOgIgZGK831 dtgUyPdgiZRYGDef53X9XIO99ZiQ2yr8Ezt%21434812672%2115320032180... 5/5
Florida Commission on Community Service
Vendor Electronic Funds Transfer:
The authorization form, which is provided, gives Florida Commission on Community
Service and your financial institution authority to deposit funds to your account. Simply
complete the form in order to take advantage of EFT.
All you need do is:
1 •) Mark the box before type of account to indicate whether your deposit will be deposited in
your checking or savings account.
2.) Fill in your company name, financial institution name and location, and date.
3.) Please be sure to fill in your bank routing number and your account number.
NOTE: Be sure to sign the form !
AUTHORIZATION: Please fill out and return to the payer.
The payer will retain this on file for their records.
I authorize Florida Commission on Community Service and the financial institution
Company Name
listed below to initiate/receive electronic credit entries, and if necessary, debit entries for
any credit entries made in error to the following account:
Checking Account Savings Account
This authority will remain in effect until I have cancelled it in writing.
FINANCIAL INSTITUTION
BRANCH
CITY STATE
TRANSIT ROUTING NUMBER
F7, 7
NOTE: Only 9 digits in Routing Numbers
Date:
NAME (PLEASE PRINT)
ACCOUNT NUMBER
SIGNATURE
ACCOUNT NUMBER INFORMATION
TIN, later. or
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and I Employer identification number
Number To Give the Requester for guidelines on whose number to enter. F77 I I I I I
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. 1 am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part Il, later.
Sign Signature of
Here I U.S. person ► Date ►
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099 -INT (interest earned or paid)
• Form 1099 -DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
Cat. No. 10231X Form W-9 (Rev. 11-2017)
Request for Taxpayer
Give Form to the
Form
(Rev. November 2017)
Identification Number and Certification
requester. Do not
Department of the Treasury
send to the IRS.
Internal Revenue Service
► Go to www.irs.gov/Form W9 for instructions and the latest information.
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
2 Business name/disregarded entity name, if different from above
M3
Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the
4 Exemptions (codes apply only to
mfollowing
seven boxes.
certain entities, not individuals; see
0.
o
❑ Individual/sole proprietor or 11C Corporation El Corporation El Partnership E]Trust/estate
instructions on page 3):
U)
ai c
single -member LLC
Exempt payee code (if any)
CL P
❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ►
p
Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check
Exemption from FATCA reporting
y
5
LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is
LLC is from for Otherwise,
if an
code ( y)
a o
w
another that not disregarded the owner U.S. federal tax purposes. a single -member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
N
❑ Other (see instructions) ►
(App#es to accounts maintained outside the U.S.)
C
5 Address (number, street, and apt. or suite no.) See Instructions.
Requester's name and address (optional)
am
(D
U)
6 City, state, and ZIP code
7 List account number(s) here (optional)
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
backup withholding. For individuals, this is generally your social security number (SSN). However, for a- m _
FM
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN, later. or
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and I Employer identification number
Number To Give the Requester for guidelines on whose number to enter. F77 I I I I I
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. 1 am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part Il, later.
Sign Signature of
Here I U.S. person ► Date ►
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099 -INT (interest earned or paid)
• Form 1099 -DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
Cat. No. 10231X Form W-9 (Rev. 11-2017)
Form W-9 (Rev. 11-2017)
By signing the filled -out form, you:
1. Certify that the TIN you are giving is correct (or you are waiting for a
number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt
payee. If applicable, you are also certifying that as a U.S. person, your
allocable share of any partnership income from a U.S. trade or business
is not subject to the withholding tax on foreign partners' share of
effectively connected income, and
4. Certify that FATCA code(s) entered on this form (if any) indicating
that you are exempt from the FATCA reporting, is correct. See What is
FATCA reporting, later, for further information.
Note: If you are a U.S. person and a requester gives you a form other
than Form W-9 to request your TIN, you must use the requester's form if
it is substantially similar to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
• An individual who is a U.S. citizen or U.S. resident alien;
• A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United States;
• An estate (other than a foreign estate); or
• A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or
business in the United States are generally required to pay a withholding
tax under section 1446 on any foreign partners' share of effectively
connected taxable income from such business. Further, in certain cases
where a Form W-9 has not been received, the rules under section 1446
require a partnership to presume that a partner is a foreign person, and
pay the section 1446 withholding tax. Therefore, if you are a U.S. person
that is a partner in a partnership conducting a trade or business in the
United States, provide Form W-9 to the partnership to establish your
U.S. status and avoid section 1446 withholding on your share of
partnership income.
In the cases below, the following person must give Form W-9 to the
partnership for purposes of establishing its U.S. status and avoiding
withholding on its allocable share of net income from the partnership
conducting a trade or business in the United States.
• In the case of a disregarded entity with a U.S. owner, the U.S. owner
of the disregarded entity and not the entity;
• In the case of a grantor trust with a U.S. grantor or other U.S. owner,
generally, the U.S. grantor or other U.S. owner of the grantor trust and
not the trust; and
• In the case of a U.S. trust (other than a grantor trust), the U.S. trust
(other than a grantor trust) and not the beneficiaries of the trust.
Foreign person. If you are a foreign person or the U.S. branch of a
foreign bank that has elected to be treated as a U.S. person, do not use
Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see
Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign
Entities).
Nonresident alien who becomes a resident alien. Generally, only a
nonresident alien individual may use the terms of a tax treaty to reduce
or eliminate U.S. tax on certain types of income. However, most tax
treaties contain a provision known as a "saving clause." Exceptions
specified in the saving clause may permit an exemption from tax to
continue for certain types of income even after the payee has otherwise
become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception
contained in the saving clause of a tax treaty to claim an exemption
from U.S. tax on certain types of income, you must attach a statement
to Form W-9 that specifies the following five items.
1. The treaty country. Generally, this must be the same treaty under
which you claimed exemption from tax as a nonresident alien.
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that contains the
saving clause and its exceptions.
4. The type and amount of income that qualifies for the exemption
from tax.
5. Sufficient facts to justify the exemption from tax under the terms of
the treaty article.
Page 2
Example. Article 20 of the U.S.-China income tax treaty allows an
exemption from tax for scholarship income received by a Chinese
student temporarily present in the United States. Under U.S. law, this
student will become a resident alien for tax purposes if his or her stay in
the United States exceeds 5 calendar years. However, paragraph 2 of
the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows
the provisions of Article 20 to continue to apply even after the Chinese
student becomes a resident alien of the United States. A Chinese
student who qualifies for this exception (under paragraph 2 of the first
protocol) and is relying on this exception to claim an exemption from tax
on his or her scholarship or fellowship income would attach to Form
W-9 a statement that includes the information described above to
support that exemption.
If you are a nonresident alien or a foreign entity, give the requester the
appropriate completed Form W-8 or Form 8233.
Backup Withholding
What is backup withholding? Persons making certain payments to you
must under certain conditions withhold and pay to the IRS 28% of such
payments. This is called "backup withholding." Payments that may be
subject to backup withholding include interest, tax-exempt interest,
dividends, broker and barter exchange transactions, rents, royalties,
nonemployee pay, payments made in settlement of payment card and
third party network transactions, and certain payments from fishing boat
operators. Real estate transactions are not subject to backup
withholding.
You will not be subject to backup withholding on payments you
receive if you give the requester your correct TIN, make the proper
certifications, and report all your taxable interest and dividends on your
tax return.
Payments you receive will be subject to backup withholding if:
1. You do not furnish your TIN to the requester,
2. You do not certify your TIN when required (see the instructions for
Part II for details),
3. The IRS tells the requester that you furnished an incorrect TIN,
4. The IRS tells you that you are subject to backup withholding
because you did not report all your interest and dividends on your tax
return (for reportable interest and dividends only), or
5. You do not certify to the requester that you are not subject to
backup withholding under 4 above (for reportable interest and dividend
accounts opened after 1983 only).
Certain payees and payments are exempt from backup withholding.
See Exempt payee code, later, and the separate Instructions for the
Requester of Form W-9 for more information.
Also see Special rules for partnerships, earlier.
What is FATCA Reporting?
The Foreign Account Tax Compliance Act (FATCA) requires a
participating foreign financial institution to report all United States
account holders that are specified United States persons. Certain
payees are exempt from FATCA reporting. See Exemption from FATCA
reporting code, later, and the Instructions for the Requester of Form
W-9 for more information.
Updating Your Information
You must provide updated information to any person to whom you
claimed to be an exempt payee if you are no longer an exempt payee
and anticipate receiving reportable payments in the future from this
person. For example, you may need to provide updated information if
you are a C corporation that elects to be an S corporation, or if you no
longer are tax exempt. In addition, you must furnish a new Form W-9 if
the name or TIN changes for the account; for example, if the grantor of a
grantor trust dies.
Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN to a
requester, you are subject to a penalty of $50 for each such failure
unless your failure is due to reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. If you
make a false statement with no reasonable basis that results in no
backup withholding, you are subject to a $500 penalty.
Form W-9 (Rev. 11-2017)
Criminal penalty for falsifying information. Willfully falsifying
certifications or affirmations may subject you to criminal penalties
including fines and/or imprisonment.
Misuse of TINS. If the requester discloses or uses TINs in violation of
federal law, the requester may be subject to civil and criminal penalties.
Specific Instructions
Line 1
You must enter one of the following on this line; do not leave this line
blank. The name should match the name on your tax return.
If this Form W-9 is for a joint account (other than an account
maintained by a foreign financial institution (FFI)), list first, and then
circle, the name of the person or entity whose number you entered in
Part I of Form W-9. If you are providing Form W-9 to an FFI to document
a joint account, each holder of the account that is a U.S, person must
provide a Form W-9.
a. Individual. Generally, enter the name shown on your tax return. If
you have changed your last name without informing the Social Security
Administration (SSA) of the name change, enter your first name, the last
name as shown on your social security card, and your new last name.
Note: ITIN applicant: Enter your individual name as it was entered on
your Form W-7 application, line 1a. This should also be the same as the
name you entered on the Form 1040/1040A/1040FZ you filed with your
application.
b. Sole proprietor or single -member LLC. Enter your individual
name as shown on your 1040/1040A/1040EZ on line 1. You may enter
your business, trade, or "doing business as" (DBA) name on line 2.
c. Partnership, LLC that is not a single -member LLC, C
corporation, or S corporation. Enter the entity's name as shown on the
entity's tax return on line 1 and any business, trade, or DBA name on
line 2.
d. Other entities. Enter your name as shown on required U.S. federal
tax documents on line 1. This name should match the name shown on the
charter or other legal document creating the entity. You may enter any
business, trade, or DBA name on line 2.
e. Disregarded entity. For U.S. federal tax purposes, an entity that is
disregarded as an entity separate from its owner is treated as a
"disregarded entity." See Regulations section 301.7701-2(c)(2)(iii). Enter
the owner's name on line 1. The name of the entity entered on line 1
should never be a disregarded entity. The name on line 1 should be the
name shown on the income tax return on which the income should be
reported. For example, if a foreign LLC that is treated as a disregarded
entity for U.S. federal tax purposes has a single owner that is a U.S.
person, the U.S. owner's name is required to be provided on line 1. If
the direct owner of the entity is also a disregarded entity, enter the first
owner that is not disregarded for federal tax purposes. Enter the
disregarded entity's name on line 2, "Business name/disregarded entity
name." If the owner of the disregarded entity is a foreign person, the
owner must complete an appropriate Form W-8 instead of a Form W-9.
This is the case even if the foreign person has a U.S. TIN.
Line 2
If you have a business name, trade name, DBA name, or disregarded
entity name, you may enter it on line 2.
Line 3
Check the appropriate box on line 3 for the U.S. federal tax
classification of the person whose name is entered on line 1. Check only
one box on line 3.
Page 3
IF the entity/person on line 1 is
THEN check the box for ...
a(n) ..
• Corporation
Corporation
• Individual
Individual/sole proprietor or single-
• Sole proprietorship, or
member LLC
• Single -member limited liability
company (LLC) owned by an
individual and disregarded for U.S.
federal tax purposes.
• LLC treated as a partnership for
Limited liability company and enter
U.S. federal tax purposes,
the appropriate tax classification.
• LLC that has filed Form 8832 or
(P= Partnership; C= C corporation;
2553 to be taxed as a corporation,
or S= S corporation)
or
• LLC that is disregarded as an
entity separate from its owner but
the owner is another LLC that is
not disregarded for U.S. federal tax
purposes.
• Partnership
Partnership
• Trust/estate
Trustlestate
Line 4, Exemptions
If you are exempt from backup withholding and/or FATCA reporting,
enter in the appropriate space on line 4 any code(s) that may apply to
you.
Exempt payee code.
• Generally, individuals (including sole proprietors) are not exempt from
backup withholding.
• Except as provided below, corporations are exempt from backup
withholding for certain payments, including interest and dividends.
• Corporations are not exempt from backup withholding for payments
made in settlement of payment card or third party network transactions.
• Corporations are not exempt from backup withholding with respect to
attorneys' fees or gross proceeds paid to attorneys, and corporations
that provide medical or health care services are not exempt with respect
to payments reportable on Form 1099-MISC.
The following codes identify payees that are exempt from backup
withholding. Enter the appropriate code in the space in line 4.
1—An organization exempt from tax under section 501(a), any IRA, or
a custodial account under section 403(b)(7) if the account satisfies the
requirements of section 401(0(2)
2—The United States or any of its agencies or instrumentalities
3—A state, the District of Columbia, a U.S. commonwealth or
possession, or any of their political subdivisions or instrumentalities
4—A foreign government or any of its political subdivisions, agencies,
or instrumentalities
5—A corporation
6—A dealer in securities or commodities required to register in the
United States, the District of Columbia, or a U.S. commonwealth or
possession
7—A futures commission merchant registered with the Commodity
Futures Trading Commission
8—A real estate investment trust
9—An entity registered at all times during the tax year under the
Investment Company Act of 1940
10—A common trust fund operated by a bank under section 584(a)
11—A financial institution
12—A middleman known in the investment community as a nominee or
custodian
13—A trust exempt from tax under section 664 or described in section
4947
Form W-9 (Rev. 11-2017)
The following chart shows types of payments that may be exempt
from backup withholding. The chart applies to the exempt payees listed
above, 1 through 13.
IF the payment is for...
THEN the payment is exempt
for...
Interest and dividend payments
All exempt payees except
for 7
Broker transactions
Exempt payees 1 through 4 and 6
through 11 and all C corporations.
S corporations must not enter an
exempt payee code because they
are exempt only for sales of
noncovered securities acquired
prior to 2012.
Barter exchange transactions and
Exempt payees 1 through 4
patronage dividends
Payments over $600 required to be
Generally, exempt payees
reported and direct sales over
1 through 52
$5,0001
Payments made in settlement of
Exempt payees 1 through 4
payment card or third party network
transactions
1 See Form 1099-MISC, Miscellaneous Income, and its instructions.
2 However, the following payments made to a corporation and
reportable on Form 1099-MISC are not exempt from backup
withholding: medical and health care payments, attorneys' fees, gross
proceeds paid to an attorney reportable under section 6045(f), and
payments for services paid by a federal executive agency.
Exemption from FATCA reporting code. The following codes identify
payees that are exempt from reporting under FATCA. These codes
apply to persons submitting this form for accounts maintained outside
of the United States by certain foreign financial institutions. Therefore, if
you are only submitting this form for an account you hold in the United
States, you may leave this field blank. Consult with the person
requesting this form if you are uncertain if the financial institution is
subject to these requirements. A requester may indicate that a code is
not required by providing you with a Form W-9 with "Not Applicable" (or
any similar indication) written or printed on the line for a FATCA
exemption code.
A—An organization exempt from tax under section 501(a) or any
individual retirement plan as defined in section 7701(a)(37)
B—The United States or any of its agencies or instrumentalities
C—A state, the District of Columbia, a U.S. commonwealth or
possession, or any of their political subdivisions or instrumentalities
D—A corporation the stock of which is regularly traded on one or
more established securities markets, as described in Regulations
section 1.1472-1(c)(1)(1)
E—A corporation that is a member of the same expanded affiliated
group as a corporation described in Regulations section 1.1472-1(c)(1)(i)
F—A dealer in securities, commodities, or derivative financial
instruments (including notional principal contracts, futures, forwards,
and options) that is registered as such under the laws of the United
States or any state
G—A real estate investment trust
H—A regulated investment company as defined in section 851 or an
entity registered at all times during the tax year under the Investment
Company Act of 1940
I—A common trust fund as defined in section 584(a)
J—A bank as defined in section 581
K—A broker
L—A trust exempt from tax under section 664 or described in section
4947(a)(1)
Page 4
M—A tax exempt trust under a section 403(b) plan or section 457(g)
plan
Note: You may wish to consult with the financial institution requesting
this form to determine whether the FATCA code and/or exempt payee
code should be completed.
Line 5
Enter your address (number, street, and apartment or suite number).
This is where the requester of this Form W-9 will mail your information
returns. If this address differs from the one the requester already has on
file, write NEW at the top. If a new address is provided, there is still a
chance the old address will be used until the payor changes your
address in their records.
Line 6
Enter your city, state, and ZIP code.
Part I. Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. If you are a resident alien and
you do not have and are not eligible to get an SSN, your TIN is your IRS
individual taxpayer identification number (ITIN). Enter it in the social
security number box. If you do not have an [TIN, see How to get a TIN
below.
If you are a sole proprietor and you have an EIN, you may enter either
your SSN or EIN.
If you are a single -member LLC that is disregarded as an entity
separate from its owner, enter the owner's SSN (or EIN, if the owner has
one). Do not enter the disregarded entity's EIN. If the LLC is classified as
a corporation or partnership, enter the entity's EIN.
Note: See What Name and Number To Give the Requester, later, for
further clarification of name and TIN combinations.
How to get a TIN. If you do not have a TIN, apply for one immediately.
To apply for an SSN, get Form SS -5, Application for a Social Security
Card, from your local SSA office or get this form online at
www.SSA.gov. You may also get this form by calling 1-800-772-1213.
Use Form W-7, Application for IRS Individual Taxpayer Identification
Number, to apply for an ITIN, or Form SS -4, Application for Employer
Identification Number, to apply for an EIN. You can apply for an EIN
online by accessing the IRS website at www.irs.gov/Businesses and
clicking on Employer Identification Number (EIN) under Starting a
Business. Go to www.irs.gov/Forms to view, download, or print Form
W-7 and/or Form SS -4. Or, you can go to www.irs.gov/OrderForms to
place an order and have Form W-7 and/or SS -4 mailed to you within 10
business days.
If you are asked to complete Form W-9 but do not have a TIN, apply
for a TIN and write "Applied For" in the space for the TIN, sign and date
the form, and give it to the requester. For interest and dividend
payments, and certain payments made with respect to readily tradable
instruments, generally you will have 60 days to get a TIN and give it to
the requester before you are subject to backup withholding on
payments. The 60 -day rule does not apply to other types of payments.
You will be subject to backup withholding on all such payments until
you provide your TIN to the requester.
Note: Entering "Applied For" means that you have already applied for a
TIN or that you intend to apply for one soon.
Caution: A disregarded U.S. entity that has a foreign owner must use
the appropriate Form W-8.
Part II. Certification
To establish to the withholding agent that you are a U.S. person, or
resident alien, sign Form W-9. You may be requested to sign by the
withholding agent even if item 1, 4, or 5 below indicates otherwise.
For a joint account, only the person whose TIN is shown in Part I
should sign (when required). In the case of a disregarded entity, the
person identified on line 1 must sign. Exempt payees, see Exempt payee
code, earlier.
Signature requirements. Complete the certification as indicated in
items 1 through 5 below.
Form W-9 (Rev. 11-2017)
1. Interest, dividend, and barter exchange accounts opened
before 1984 and broker accounts considered active during 1983.
You must give your correct TIN, but you do not have to sign the
certification.
2. Interest, dividend, broker, and barter exchange accounts
opened after 1983 and broker accounts considered inactive during
1983. You must sign the certification or backup withholding will apply. If
you are subject to backup withholding and you are merely providing
your correct TIN to the requester, you must cross out item 2 in the
certification before signing the form.
3. Real estate transactions. You must sign the certification. You may
cross out item 2 of the certification.
4. Other payments. You must give your correct TIN, but you do not
have to sign the certification unless you have been notified that you
have previously given an incorrect TIN. "Other payments" include
payments made in the course of the requester's trade or business for
rents, royalties, goods (other than bills for merchandise), medical and
health care services (including payments to corporations), payments to
a nonemployee for services, payments made in settlement of payment
card and third party network transactions, payments to certain fishing
boat crew members and fishermen, and gross proceeds paid to
attorneys (including payments to corporations).
5. Mortgage interest paid by you, acquisition or abandonment of
secured property, cancellation of debt, qualified tuition program
payments (under section 529), ABLE accounts (under section 529A),
IRA, Coverdell ESA, Archer MSA or HSA contributions or
distributions, and pension distributions. You must give your correct
TIN, but you do not have to sign the certification.
What Name and Number To Give the Requester
For this type of account:
Give name and SSN of:
1. Individual
The individual
2. Two or more individuals Qoint
The actual owner of the account or, if
account) other than an account
combined funds, the first individual on
maintained by an FFI
the account'
3. Two or more U.S. persons
Each holder of the account
point account maintained by an FFI)
4. Custodial account of a minor
The minor=
(Uniform Gift to Minors Act)
5. a. The usual revocable savings trust
The grantor -trustee'
(grantor is also trustee)
b. So-called trust account that is not
The actual owner'
a legal or valid trust under state law
6. Sole proprietorship or disregarded
The owner'
entity owned by an individual
7. Grantor trust filing under Optional
The grantor'
Form 1099 Filing Method 1 (see
Regulations section 1.671-4(b)(2)()
(A))
For this type of account:
Give name and EIN of:
8. Disregarded entity not owned by an
The owner
individual
9. A valid trust, estate, or pension trust
Legal entity4
10. Corporation or LLC electing
The corporation
corporate status on Form 8832 or
Form 2553
11. Association, club, religious,
The organization
charitable, educational, or other tax-
exempt organization
12. Partnership or multi -member LLC The partnership
13. A broker or registered nominee The broker or nominee
Page rJ
For this type of account: I Give name and EIN of:
14. Account with the Department of The public entity
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
15. Grantor trust filing under the Form The trust
1041 Filing Method or the Optional
Form 1099 Filing Method 2 (see
Regulations section 1.671-4(b)(2)(i)(13))
' List first and circle the name of the person whose number you furnish.
If only one person on a joint account has an SSN, that person's number
must be furnished.
Z Circle the minor's name and furnish the minor's SSN.
3 You must show your individual name and you may also enter your
business or DBA name on the "Business name/disregarded entity"
name line. You may use either your SSN or EIN (if you have one), but the
IRS encourages you to use your SSN.
4 List first and circle the name of the trust, estate, or pension trust. (Do
not furnish the TIN of the personal representative or trustee unless the
legal entity itself is not designated in the account title.) Also see Special
rules for partnerships, earlier.
*Note: The grantor also must provide a Form W-9 to trustee of trust.
Note: If no name is circled when more than one name is listed, the
number will be considered to be that of the first name listed.
Secure Your Tax Records From Identity Theft
Identity theft occurs when someone uses your personal information
such as your name, SSN, or other identifying information, without your
permission, to commit fraud or other crimes. An identity thief may use
your SSN to get a job or may file a tax return using your SSN to receive
a refund.
To reduce your risk:
• Protect your SSN,
• Ensure your employer is protecting your SSN, and
• Be careful when choosing a tax preparer.
If your tax records are affected by identity theft and you receive a
notice from the IRS, respond right away to the name and phone number
printed on the IRS notice or letter.
If your tax records are not currently affected by identity theft but you
think you are at risk due to a lost or stolen purse or wallet, questionable
credit card activity or credit report, contact the IRS Identity Theft Hotline
at 1-800-908-4490 or submit Form 14039.
For more information, see Pub. 5027, Identity Theft Information for
Taxpayers.
Victims of identity theft who are experiencing economic harm or a
systemic problem, or are seeking help in resolving tax problems that
have not been resolved through normal channels, may be eligible for
Taxpayer Advocate Service (TAS) assistance. You can reach TAS by
calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD
1-800-829-4059.
Protect yourself from suspicious emails or phishing schemes.
Phishing is the creation and use of email and websites designed to
mimic legitimate business emails and websites. The most common act
is sending an email to a user falsely claiming to be an established
legitimate enterprise in an attempt to scam the user into surrendering
private information that will be used for identity theft.
Form W-9 (Rev. 11-2017)
The IRS does not initiate contacts with taxpayers via emails. Also, the
IRS does not request personal detailed information through email or ask
taxpayers for the PIN numbers, passwords, or similar secret access
information for their credit card, bank, or other financial accounts.
If you receive an unsolicited email claiming to be from the IRS,
forward this message to phishing@irs.gov. You may also report misuse
of the IRS name, logo, or other IRS property to the Treasury Inspector
General for Tax Administration (TIGTA) at 1-800-366-4484. You can
forward suspicious emails to the Federal Trade Commission at
spam@uce.gov or report them at www.ftc.gov/complaint. You can
contact the FTC at www.ftc.gov/idtheft or 877-IDTHEFT (877-438-4338).
If you have been the victim of Identity theft, see www.IdentityTheft.gov
and Pub. 5027.
Visit www.irs.gov//dentityTheft to learn more about identity theft and
how to reduce your risk.
Page 6
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your
correct TIN to persons (including federal agencies) who are required to
file information returns with the IRS to report interest, dividends, or
certain other income paid to you; mortgage interest you paid; the
acquisition or abandonment of secured property; the cancellation of
debt; or contributions you made to an IRA, Archer MSA, or HSA. The
person collecting this form uses the information on the form to file
information returns with the IRS, reporting the above information.
Routine uses of this information include giving it to the Department of
Justice for civil and criminal litigation and to cities, states, the District of
Columbia, and U.S. commonwealths and possessions for use in
administering their laws. The information also may be disclosed to other
countries under a treaty, to federal and state agencies to enforce civil
and criminal laws, or to federal law enforcement and intelligence
agencies to combat terrorism. You must provide your TIN whether or
not you are required to file a tax return. Under section 3406, payers
must generally withhold a percentage of taxable interest, dividend, and
certain other payments to a payee who does not give a TIN to the payer.
Certain penalties may also apply for providing false or fraudulent
information.
VOILinteerfiorida
Exhibit
Contract Provisions
2018-2019
I. PROVIDER AGREEMENTS
A. Compliance.
1. The Provider will utilize AmeriCorps Members in accordance with the application
submitted by the Provider for funding (the "Grantee Application"). The Provider
must comply with the requirements of the National and Community Service
Act of 1990 and the National and Community Service Trust Act of 1993. The
Provider shall also comply with applicable Federal cost principles,
administrative, and audit requirements as well as all applicable Florida Statutes.
Additionally, the Provider will adhere to all federal statutes, regulations, or other
laws related to the Americans with Disabilities Act of 1990, and any
amendments thereto. The Provider is additionally responsible for prohibiting
discrimination in accordance with Terms and Conditions for AmeriCorps State
and National Grants and the General Grant Terms and Conditions (Exhibit IV).
2. All such requirements are incorporated herein by reference.
3. The Provider will rectify all compliance issues identified by the Commission in
writing within the time period set forth by the Commission or all
reimbursements will be withheld until the Commission is satisfied all deficiencies
have been corrected. Written documentation should include how all noted
deficiencies were corrected or an acceptable justification, action plan and
timeline of compliance for any deficiencies not corrected within the time period
set forth.
4. By signing this contract, the Provider acknowledges receipt of the AmeriCorps
Provisions which are identified in Exhibit IV attached hereto and incorporated by
reference herein.
5. The Provider further agrees to adhere to all Terms and Conditions for
AmeriCorps State and National Grants and the General Grant Terms and
Conditions and associated regulations, and the most current policies of the state
of Florida as implemented by the Commission and of the federal government.
The Provider is responsible for ensuring that all staff, agents, volunteers, or any
other individuals or participants acting on behalf of the Provider acts in
accordance with all such regulations and policies.
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B. Program Name. The Provider may not change its program name, as identified in its
Funding Application without the prior written approval of the Commission.
C. Program Performance Measures and Training. Program performance measures,
required trainings, and additional programmatic requirements are incorporated by
reference herein.
1. Staff positions, duties, responsibilities and the number of staff working in the
program may be revised if requested in writing by the provider and approved in
writing by the Commission, provided such revisions do not exceed original
budgeted amounts for staff. The Provider will hire and maintain a minimum of 1.0
FTE Program Director to be responsible for the overall management of the
program.
2. In the event of change in staff, the Provider agrees to provide new staff with a
program operations manual and/or policies and procedures for the AmeriCorps
program. The Provider agrees to notify the Commission in writing within ten (10)
working days of any program staff vacancies funded by this grant.
3. AmeriCorps Member Recruitment and Responsibilities
a. Recruit AmeriCorps Members into service within 60 days of implementation
of this contract. Members will be provided with a living allowance in
accordance with the AmeriCorps Terms and Conditions (Exhibit IV). Members
will provide direct service in areas outlined in the approved proposal (Exhibit
II).
b. The Provider agrees to develop and enter into signed agreement with each
Member using an AmeriCorps Member Service Agreement in compliance
with the AmeriCorps Terms and Conditions and General Grant Terms and
Conditions (Exhibit IV).
c. The Provider agrees to implement the program's Commission
approved Disability Community Development Plan to recruit persons
with disabilities into the program.
d The Provider agrees to establish and maintain a disaster -oriented role with
a partner organization for its members, staff and volunteers to assist in
disaster preparedness, response, recovery and/or mitigation activities.
The Provider agrees to document this disaster -oriented role in writing with
a letter of acknowledgement, at a minimum, from the partnering
organization. See section I.C.3.j. of contract.
e. The positions, position descriptions, and number of Members serving in
this program may be revised if requested in writing by the provider
and approved in writing by the Commission.
f. All Members must be enrolled in the eGrants AmeriCorps Portal. The
Provider further agrees to assign members to a service location within the
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AmeriCorps Portal no more than five days from start of service.
g. Member positions may only be revised through a Member Change of
Status Form completed via the eGrants AmeriCorps Portal for each
Member, approved by the Commission and for the following conditions:
i. suspension,-
ii.
uspension;ii, change of term;
iii. ending service early;
iv. reinstatement to service;
V. utilization of the Family Medical Leave Act; or
vi. transfer to another AmeriCorps program.
The program agrees to keep all documentation associated with Member
Change of Status in a member file. Compelling personal circumstances
related to requested Member exit must be approved by the Commission and
must adhere to Commission guidelines.
h. The Provider will complete a National Service Criminal History Check of
all members and staff supported by CNCS grantee and match funds. National
Service Criminal History Checks include a nationwide name -based check of the
National Sex Offender Public Website (NSOPW), either a name- or
fingerprint -based search of the statewide criminal history registry in the
candidate's State of residence and in the State where the individual will serve
or work; AND a fingerprint -based FBI check. The Provider will complete and
document National Service Criminal History Checks of members and staff in
accordance with CNCS requirements found at
http://www.nationalservice.goy resources/criminal-history-check
The Provider must submit the Volunteer Florida National Service Criminal
History Check Status Form (Exhibit III) with NSOPW clearance documents by
the third month of the contract. Clearance documentation of State of
residence, State of service and FBI checks must also be provided. Failure to
complete the status form may result in delay of program reimbursements.
j. A National Service Trust End of Term of Service/Exit Form must be
completed via the eGrants AmeriCorps Portal for each Member upon
completion of her/his term of service.
k The Provider will complete forms via the eGrants AmeriCorps Portal within
five days upon a member's enrollment in, completion of, lengthy or indefinite
suspension from, or release from, a term of service.
1. The Provider will report member service hours to the Commission in alignment
with Commission reporting requirements and will audit and update member
service hours at least monthly. The Commission reserves the right to
review Member service hours at any time.
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4. AmeriCorps Staff Training
a. The Commission will ensure the provision of training and/or technical
assistance to ensure successful program implementation and operation.
The required trainings include the Volunteer Florida Program Director
Meetings and associated webinars.
b Program Directors must complete a minimum of one (1) disability related
trainings each year. Suggested topics are, but are not limited to the
following:
i. Disability awareness and appreciation
ii. Title I of the Americans with Disabilities Act
iii. Title III of the Americans with Disabilities Act
iv. Supervisory techniques
c. The Commission will ensure the provision of fiscal training and/or
technical assistance to ensure successful fiscal program implementation
and operation. Program fiscal staff will be required to complete the
Volunteer Florida Fiscal Trainings.
5. AmeriCorps Member Training
a. The Provider will ensure the provision of training and/or technical
assistance for members. Required trainings include:
American Red Cross -certified or comparable CPR and First Aid training.
i- The Provider will have all members trained or certified in CPR and First
Aid.
ii. Diversity appreciation
iii, Citizenship
iv. Disability awareness and appreciation training
v. Introduction to disaster preparedness, mitigation, and response.
b. Other suggested training topics include, but are not limited to:
1. Team building
ii, Conflict resolution
iii. Career development
iv. Life after AmeriCorps
V. Additional disaster response training including; Emergency Shelter
Operations, Emergency Temporary Roofing, Points of Distribution,
Volunteer Reception Center Simulation.
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D. Budget. The budget for the delivery of services described in the Provider Agreement,
(the "Program Budget") as well as a budget narrative is identified in Exhibit II, which is
attached hereto and incorporated by reference herein.
1. Match Requirements and Cash or In -Kind Contributions:
The Provider must provide matching funds cash or in-kind contributions as
a dollar amount as stated in Exhibit II of the Provider Budget. State of Florida
appropriation funding should not be used as matching funds. Approval must be
obtained by the Commission if the Provider anticipates utilizing State of Florida
appropriation funding as match.
2. Budget Revisions: Approval must be obtained by the Commission if the Provider
intends to adjust a budget line by ten percent (10%) or more of the Provider
Budget. The Commission reserves the right to disallow any such revisions.
Revisions to the Program Budget must be submitted using the Volunteer Florida
Budget Revision Request Form attached hereto as Exhibit V and incorporated
herein by reference.
E. Property. The Provider agrees that any purchases in furtherance of the Provider
Agreement shall be procured in accordance with the provisions of Florida Statutes §§
403.7065 and 287.045. To be reimbursed by the Commission for the purchase of any
goods to be used in furtherance of the Provider Agreement, which are not identified in
the approved Program Budget and have a purchase price equal to or greater than
$500.00, the Provider mustobtain priorwritten approval from the Commission.
F. Internet Access. The Provider agrees to provide the AmeriCorps Members internet
access and e-mail capability as is necessary for program reporting and
communications related to this Provider Agreement.
G. Planning and Program Reporting.
1. Progress Reports. All AmeriCorps programs are required to complete and
submit Grantee Progress Reports ("Progress Reports") during the term of the
Provider Agreement via a format approved by the Commission. Grantee
Progress Reports shall be submitted by the Provider at designate times,
including mid year and end of year. Notwithstanding, the Commission reserves
the right to require Providers to submit any Progress Report at any point during
the term of the Provider Agreement.
2. Disability Community Development Plan. The Provider will submit a Disability
Community Development Plan ("DCDP"), as defined in the AmeriCorps program
for the purpose of establishing partnerships with third -party organizations
whose primary mission is serving persons with disabilities and for establishing
opportunities for persons with disabilities to have service related experiences
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with individual AmeriCorps programs. The DCDP must be submitted to the
Commission within six (6) months of the Effective Date of the Provider
Agreement,
3. Sustainability Plan. It is understood that the funding provided by the
Commission for this program is "seed money" to be used by the Provider to
provide services to the community, with the assistance of the Commission that
will eventually be continued and managed locally with minimal federal funds or
responsibility for the program. The Commission is not responsible for providing
any goods, services, or other resources, including monetary resources to the
Provider. Accordingly, the Provider will develop or update a sustainability plan in
accordance with the requirements of the Commission ("Sustainability Plan").
H. Other Reports. The Provider agrees to provide other reports as may be requested by
the Commission.
1 Fiscal Online Training. The Provider must submit certification of completion of
the online CNCS Key Concepts of Financial and Grants Mana ement training
located on the CNCS Resource Center website within forty-five (45) days of the
Effective Date. Please use the link http://cncsonlinecourses.litmos.com/self7
signup and token code CNCS-Litmos to set up your Litmos account. The
Program Director and Fiscal Contact, as identified herein, must complete this
online course. Confirmation of completion should be submitted with the first
Reimbursement Invoice, as defined below. If the Provider fails to complete this
online course the Commission reserves the right to withhold payment.
2 National Criminal History Checks Online Training. The Provider must submit
certification of completion of the online CNCS National Service Criminal
History Checks training located on the CNCS Knowledge Network website
within forty-five (45) days of the Effective Date. Please use the link http//
cncsonlinecourses.litmos.com/self-signur� and token code CNCS-Litmos to set
up your Litmos account. The Program Director and Fiscal Contact, as
identified herein, must complete this online course. Confirmation of
completion should be submitted as a grant requirement prior to the first
Reimbursement Invoice, as defined below. If the Provider fails to complete
this online course the Commission reserves the rightto withhold payment.
3. Financial Reports for Reimbursement. The Provider will submit to the
Commission a monthly invoice using the Volunteer Florida Invoice Form
attached hereto as Exhibit VII and incorporated herein by reference (the
'Reimbursement Invoice"). All Reimbursement Invoices are due no later than the
15th of each month. If circumstances occur delaying the Reimbursement
Invoice, an explanation should be sent in writing, electronically, to the
Commission before the Reimbursement Invoice is due. If the provider submits
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invoices late on more than three (3) occasions consecutively the Commission
reserves the right to forfeit payment.
4. First Reimbursement Invoice. The Provider will submit to the Commission their
first monthly invoice within 45 days of start up. Included within this first invoice, a
confirmation of completion of the financial training and of the criminal history
checks training. Failure to provide any one of these documents will result in a
delay of payment.
5. Supporting Documentation. The Provider will submit supporting documentation
for all expenditures related to performance under the Provider Agreement on a
monthly basis. Errors in the Reimbursement Invoices, or any supporting
documentation, will result in delay of payment. The Commission reserves the
right to review any documents related to Reimbursement Invoices at anytime
during the program period.
6r Final Financial Reports for Reimbursement and Close out Checklist. The
Provider agrees to submit its final Reimbursement Invoice within forty-five (45)
calendar days of the ending date of this contract or the date of contract
termination, whichever is earlier. If the Provider fails to submit the final
Reimbursement Invoice within the forty-five (45) calendar days, all rights to any
such payments are forfeited. Provider must also submit a completed AmeriCorps
Program Closeout Checklist (Exhibit XII) within forty- five (45) calendar days after
the ending date of this contract or the date of contract termination, whichever is
earlier. If the Provider fails to submit the Closeout Checklist within the specified
time, final payment will be delayed or forfeited.
7. Audits. The Provider agrees to provide the Commission financial and compliance
audits of the Provider within 180 days after the end of the Provider's fiscal year in
accordance with OMB Circular A-133 and to ensure that all related party
transactions are disclosed to the auditor. The Provider will make every effort to
include funds received from Volunteer Florida within their sample for theA-133
audit.
B. Property. At the end of the Provider Agreement the Provider agrees to submit a
current inventory using the Volunteer Florida Property & Equipment Inventory
Form attached hereto as Exhibit VIII and incorporated herein by reference (the
"Property & Equipment Inventory") of all goods purchased in furtherance of the
Provider Agreement with a purchase price equal to or greater than $500.00, that
were purchased with funds provided through this Provider Agreement, The
Equipment Inventory must include a description of the property, model number
and serial number, date of acquisition, cost, inventory number and information
on the location, condition, transfer, replacement or disposition of the property,
The Equipment Inventory is due to the Commission within thirty (30) days of the
Termination Date, as defined below.
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The Commission has the right, upon termination of this Provider Agreement, to
title and possession of any goods purchased by the Provider in furtherance of
this Provider Agreement. The Provider will act with good faith in to comply with
this provision of the Provider Agreement and ensure the Commission has
knowledge of such goods and access to retrieve same. If the Commission
chooses not to accept title or possession of such goods the Commission may
require the equivalent cash value in lieu of title and possession.
Disposing of property, including technology equipment, will require the program
to follow the Property Disposal Protocol and prior approval bythe Commission.
I. Partnership Development and Site Agreement
1. The Provider may enter into written agreements with other private and public
organizations in the targeted communities, as identified in the Funding
Application, to cooperate and coordinate the provision of services under the
terms of this Provider Agreement.
2. Such partnerships may include, but are not limited to, the following agreements:
a. contributions of cash support for the services provided under the terms
of this contract;
b. contributions of in-kind support for the services provided under the
terms of this contract;
c. coordination of service activities to prevent duplication of effort;
d. evaluation of service activities, member development, etc.;
e. training, training space or trainers;
f. promotions or public relations; and
g. provisions for member supervision orservice site supervision.
3. Agreements with partnering organizations to provide member supervision
and/or service sites must be in writing, adhere to the Terms and Conditions for
AmeriCorps State and National Grants and the General Grant Terms and
Conditions. Members may not be placed in single site service placements unless
approved in advance by the Commission. Agreements should include the
following items:
a. description of services to be provided by members;
b. designation of person(s) responsible for member supervision and
verification of member service hours;
c. description of prohibited member activities; and
d. other supervision orprograrnmatic responsibilities.
4. The Provider shall include a list of its partner organizations on materials as
appropriate including;
a. brochures;
b. flyers;
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c. posters; and
d. public service announcements.
J. Disaster Preparedness, Response, Recovery or Mitigation. CNCS, under agreement
with the Federal Emergency Management Agency (FEMA) and the Commission, under
agreement with the Florida Division of Emergency Management (DEM) requires the
availability of AmeriCorps Members for assignment to provide assistance in disaster
preparedness, response, recovery, mitigation activities, or other emergency related
activities ("Emergency Assistance"). Disasters that could impact Florida include natural
events such as hurricanes, tornadoes, and floods and man-made events, such as
hazardous materials and terrorist events. As part of its commitment to community service,
the Provider agrees to establish and maintain a disaster -oriented role with a partner
organization for its members, staff and volunteers to provide disaster preparedness,
response, recovery or mitigation activities. This may include, but is not limited to:
community preparedness education, shelter operations, mass feeding, debris removal,
community outreach or other disaster related activities. This disaster -oriented role will
be documented in writing with a letter of acknowledgement from the partnering
organization. Providers will work with a partnering organization to ensure its staff,
volunteers, and any other related parties are trained as needed and appropriate for
their disaster -oriented role with their partner organization. All program members are
required to receive basic level emergency management or disaster training.
Program Members may be requested to provide assistance anywhere in the State of
Florida. Provider staff and AmeriCorps Members shall serve under the direction and
control of the Provider and shall not be considered volunteers to FEMA or DEM for
purposes of Florida Statutes, Chapter 110, Part IV. Requests for Emergency Assistance
will be made on behalf of the State Coordinating Officer, as identified in any declaration
of emergency issued by the Governor of the State of Florida, through the Commission's
Director of Emergency Management after consulting with the state CNCS office disaster
coordinator. All related activities undertaken by a Provider will be done in cooperation
with local offices of emergency management.
Approved expenses incurred as a result of Provider activities related to Emergency
Assistance may be reimbursed. According to State of Florida and Federal regulations,
non-profit entities responding in times of disaster may request reimbursement directly
from FEMA. Providers responding at the request of the State Coordinating Officer would
be eligible for reimbursement of Emergency Assistance related expenses. The
Commission will furnish the Provider with additional information about expenditure
reimbursement as necessary. Training costs associated with providing Emergency
Assistance will not be reimbursable unless arrangements are made in advance. The
Commission has identified low and no cost training opportunities statewide. Providers
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may contact the Commission's Director of Emergency Management for specific training
questions and opportunities.
K. Training and Technical Assistance. Training or technical assistance provided by or to
the Provider, including its staff, volunteers, and related parties, or AmeriCorps Members
under this contract must be designed to facilitate the improvement of the services,
strengthen the development of skills and knowledge for the staff and the AmeriCorps
Members, and strengthen the communities in which services are provided. Training or
technical assistance may be provided directly by the Provider, a community partner
(such as a local volunteer center) or other local resources requested from or
coordinated through the Commission.
L. National Service Activities. During the Term of the Provider Agreement the Provider
will schedule and conduct at least one direct service activity as part of the Seasons of
Service, the designated national service days of the Corporation for National & Community
Service.
M. Quality Assurance and Evaluation
1. The Provider will track and document progress made toward accomplishing the
performance measures identified in the Provider's application for funding and
specific deliverables of this Provider Agreement.
2. The Provider agrees to facilitate, conduct and participate in technical assistance,
external reviews, and other continuous improvement activities related to these
services.
3. To be assured of satisfactory performance of the terms and conditions of the
Provider Agreement, the Provider agrees to permit persons duly authorized by
the Commission to inspect any records, papers, documents, facilities, goods
and services of the Provider that are relevant to this contract, or to interview any
clients, employees, volunteers, or any other parties affiliated with the Provider
upon reasonable notice. This includes the Commission's right to conduct on-
site visits of the Providers offices and any location where the Provider is providing
goods or services pursuant to the Provider Agreement. The Provider specifically
agrees to assure that financial records will be subject, at all reasonable times,
to inspection, review or audit by Commission personnel or individuals authorized
by the Commission.
4. The Provider will conduct a minimum of one survey during the course of
performance under the Provider Agreement to examine primary stakeholder
satisfaction with the program services (the "Stakeholder Survey"). The Provider
shall adhere to Commission guidelines in conducting the Stakeholder Survey
which shall seek feedback from multiple parties, including, but not limited to the
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following:
a. service recipients; and
b. any partnering organization as identified in the Provider Agreement.
5. The Provider will facilitate contact with community agencies er individuals for
the Commission or its consultants;
N. Records and Documentation
I. The Provider agrees to maintain records of deliverables, including reports and
program and participant data; financial records, supporting documents, statistical
records and any other documents (including electronic storage media) arising
out of this Provider Agreement for a period of six (6) years after termination of
this Provider Agreement. If an audit has been initiated and audit findings have
not been resolved at the end of six (6) years, the records shall be retained until
resolution of the audit findings or any litigation which may be based on the terms
of this subcontract.
2. The Provider agrees to allow public access to all documents, papers, letters, or
other materials subject to the provisions of Florida statutes, including, but not
limited to, Chapter 119, Fla. Stat., made or received by the Provider in
conjunction with the Provider Agreement. The Provider's refusal to comply with
this provision will constitute a breach of contract.
a. Safeguarding Information. The Provider agrees not to use or disclose
information concerning a recipient of services under this contract for
any purpose not in conformity with any Florida statutes, including, but not
limited to Chapter 119 Florida Statutes, or federal regulations, including,
but not limited to 45 CFR, Part 205.50, except upon written consent of the
recipient or the recipient's responsible parent or guardian when
authorized by law.
b. Assignments and Subcontracts. The Provider may not assign this
Provider Agreement, or sub -contract any portion of the work contemplated
under this Provider Agreement without prior written approval of the
Commission. No such approval by the Commission will be deemed in
any manner to provide for the incurrence of any obligation of the
Commission in addition to the total dollar amount agreed upon in this
contract. All such assignments or sub -contracts will be subject to the
terms and conditions of this Provider Agreement, and any other obligations
the Commission may require. The Provider agrees to include audit and
record keeping requirements in all approved assignments and sub-
contracts entered into by the Provider for any services for $25,000.00 or
greater.
c. Indemnification. Provider agrees to indemnify and holds the
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Commission, its officers, directors, employees, affiliates, licensees, and
agents harmless from any and all costs, (including reasonable attorneys'
fees, disbursements, expenses, and court costs), expenses, damages, or
other liability to third parties arising from or related to this Provider
Agreement. The Provider shall give prompt notice as described herein
to the Commission of any suits, claims, or demands by third parties
which may give rise to any claim for which indemnification may be
required under this Provider Agreement; provided however, that failure
to give such notice shall not relieve the Provider of its obligation to provide
indemnification hereunder except, if and to the extent that such failure
materially and adversely affects the ability of the Provider to defend the
applicable suit, claim, or demand. The Provider shall be entitled to
assume the defense and control of any such claim at its own cost
and expense; provided, however, that the Commission shall have the
right to be represented by its own counsel at its own cost in such matters.
Neither the Provider nor the Commission shall settle or dispose of any
such matter in any manner which would adversely affect the rights or
interests of the other party (including the obligation to indemnify
hereunder) without the prior written consent of the other party, which
shall not be unreasonably withheld or delayed. Each party shall
cooperate with the other party and its counsel in the course of the
defense of any such suit, claim or demand, such cooperation to
include without limitation using reasonable efforts to provide or make
available documents, information and witnesses. Nothing contained
herein shall constitute a waiver by either party of its sovereign immunity
or the provisions of Floridastatute, §768.28.
d. Incident Reporting. In compliance with all applicable Florida Statutes,
including, but not limited to Chapter 415, Florida Statutes an employee
or agent of the Provider who knows, or has reasonable cause to suspect
that a child, elder, or adult with a disability is or has been abused,
neglected or exploited, shall immediately report such knowledge or
suspicion to the abuse registry operated by the Florida Department of
Children and Families on the single statewide toll-free telephone number
at 1-800-96-ABUS E (800-962-2873).
0. Insurance. The Provider agrees to provide adequate liability, workers compensation,
fidelity, property and vehicle insurance coverage on a comprehensive basis and to hold
such insurance at all times during the existence of this subcontract. The Provider accepts
full responsibility for identifying and determining the type(s) and extent of insurance
necessary to provide reasonable financial protections for the Provider and the clients
12
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volunteorflorida
to be served under this subcontract. Upon execution of this subcontract, the Provider will
furnish the Commission written verification supporting both the determination and
existence of all such insurance coverage. The Provider shall provide proof of insurance
coverage to the Commission with executed contract.
P. Sponsorship
1. The Provider agrees to, in publicizing, advertising, or describing the sponsorship
of a program funded wholly or in part by the Commission, state "Sponsored by -
--- and Volunteer Florida". If the sponsorship reference is in written material, the
words "Volunteer Florida" shall appear in the same size letter or type as the
name of the Provider.
2. The Provider agrees to incorporate the Volunteer Florida logo on member service
gear, service site signage and organizational website and other written and
pictorial communication media for all programs funded wholly or in part by the
Commission. The Provider agrees to comply with the Corporation for National and
Community Service's AmeriCorps Brandinq_and Messaging Guidance.
3. The Provider agrees to notify the External Affairs Director of the Commission as
soon as possible when engaging in contact with the media; and to provide the
Commission's tag line as listed below, to all media contacts for all programs
funded wholly or in part by the Commission.
a. Volunteer Florida is Florida's lead agency for volunteerism and national
service, administering more than $32 million in federal, state, and local
funding to deliver high -impact national service and volunteer programs in
Florida. Volunteer Florida promotes and encourages volunteerism to meet
critical needs across the state. Volunteer Florida also serves as Florida's
lead agency for volunteers and donations before, during, and after
disasters. For more information, visit: www.volunteerflorida.org.
Q. Conflict of Interest. The Provider shall affirm that neither the Provider, nor any of
its directors, officers, members or employees has any interest nor shall acquire any
interest, either directly or indirectly, which would conflict in any manner or degree
with performance of the service hereunder. The Provider further agrees that in the
performance of the Provider Agreement, no person having such interest shall be
employed by the Provider.
R. Nepotism. No person may hold a job or position with the Provider in which a member
of his/her immediate family exercises supervisory authority within the program. A
member of an immediate family includes: husband, wife, father, father-in-law,
mother, mother-in-law, brother, brother-in-law, sister, sister-in-law, son, son-in-law,
daughter, daughter-in-law and separated spouses.
13
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volunteerflorida
II. COMMISSION AGREEMENTS
A. Reimbursements. Complete and accurate Reimbursement Invoices will be processed
by the Commission within forty-five (45) days after receipt of the invoice. Failure
to submit a timely or accurate invoice will result in monthly payments being withheld.
B. Technical Assistance. In those instances where the Commission is unable to
provide direct technical assistance to the Provider, the Commission will assist the
Provider in obtaining any necessary technical assistance and training as determined
by the Commission to be necessary for proper performance by the Provider under this
Provider Agreement.
C. Site Visits. Following any quality assurance or continuous improvement review,
the Commission will deliver in a timely fashion to the Provider a written report with
comments and recommendations regarding the manner in which services are
being provided.
D. Contract Continuation. Not applicable.
14
2018 GENERAL GRANT AND COOPERATIVE AGREEMENT
TERMS AND CONDITIONS
Effective November 1, 2017
These Corporation for National & Community Service (CNCS) General Grant and
Cooperative Agreement Terms and Conditions (General Terms and Conditions) are binding
on the recipient. By accepting funds under this award, the recipient agrees to comply with, and
include in all awards and subawards, these General Terms and Conditions, the program -specific
terms and conditions, all applicable Federal statutes, regulations and guidelines, and any
amendments thereto. The recipient agrees to operate the funded program in accordance with the
approved application and budget, supporting documents, and other representations made in support
of the approved application. The term recipient is used to connote either recipient or subrecipient,
as appropriate, throughout these General Terms and Conditions.
TABLE OF CONTENTS
I.
Changes from the 2017 General Terms and Conditions
2
II.
Governing Authorities
2
II.A.
Legislative and Regulatory Authority
2
II.B.
Other Applicable Terms and Conditions
2
II.C.
I Order of Precedence
3
IIl.
General Terms and Conditions
3
III.A.
Responsibilities Under Award Administration Legislative and Regulatory
Authority
3
T1I -B.
Financial Management Standards
3
III.C.
Changes in Budget or Key Personnel
5
IIID.
Bankruptcy
5
III.E.
Prohibited Program Activities
5
III.F.
National Seivice Criminal History Check Requirements
5
III.G.
The Office of Inspector General
6
III.H.
Reporting of Fraud, Waste, and Abuse
6
III.I.
Whistleblower Protection
7
III.J.
Liability and Safety Issues
8
III.K.
Award Monitoring
8
III.L.
Non -Discrimination Public Notice and Records Compliance
8
III.M.
Identification of Funding
10
III.N.
Award Products
10
III.O.
Suspension or Termination of Award
10
III.P.
Trafficking in Persons
10
III.Q.
Central Contractor Registration (CCR) and Universal Identifier
Requirements (Required Provision Under 2 CFR § 25.220)
12
III.R.
Transparency Act Requirements (For Grants and Cooperative Agreements of $25,000
or more)
13
III.S.
Conflict of Interest
16
III.T.
Award Term and Condition for Recipient Integrity and Performance Matters
(Required Provision under 2 CFR § 200.210(b)(iii) for Grants and Cooperative Agreements
of $500,000 or more)
16
IV. I Attachments 1 191
I. CHANGES FROM THE 2017 GENERAL TERMS AND CONDITIONS
Section III.A.3. — Added cross reference language to Section III.H.
Section III.F. — Added the requirement that grant subrecipients receive annual NSCHC compliance
training and documentation must be kept for all years of completion.
Section III.K.3. — Added the CFR citation.
Section IV. — Included a current policy.
II. GOVERNING AUTHORITIES
A. LEGISLATIVE AND REGULATORY AUTHORITY
This award is authorized by and subject to The National and Community Service Act of 1990, as
amended, (42 U.S.C. 12501 et seq.) (NCSA) and/or the Domestic Volunteer Service Act of 1973, as
amended, (42 U.S.C. 4950 et seq.) (DVSA), the Federal Grant and Cooperative Agreement Act
(FGCAA), 31 U.S.C. §§6301-6308, and CNCS's implementing regulations in 45 CFR Chapter XII
and/or XXV. Recipients must comply with the requirements of the NCSA and/or DVSA and
CNCS's implementing regulations, as applicable.
B. OTHER APPLICABLE TERMS AND CONDITIONS
This award is subject to the Uniform Administrative Requirements, Cost Principles, and Audit
Requirements for Federal Awards located at 2 CFR Part 200 and CNCS's implementing regulation
at 2 CFR Part 2205 (hereinafter, the Uniform Guidance). Award recipients must read, understand,
and implement these federal regulations.
The recipient must comply with all other applicable statutes, executive orders, regulations, and
policies governing the award, including, but not limited to, those included in 2 CFR Chapter I, as
well as those cited in these General Terms and Conditions and Program Specific Terms and
Conditions, and the Assurances and Certifications. Some of these requirements are discussed in
these General Terms and Conditions to provide emphasis or additional explanations to recipients.
Other provisions are included in these CNCS's General Terms and Conditions because they are
required by specific laws or regulations.
In addition to the applicable statutes and regulations referred to above, the recipient must comply
with and perform its award consistent with the requirements stated in:
1. The Notice of Grant Award and Signature Page;
2. These General Terms and Conditions;
3. The Program Specific Terms and Conditions;
4. The Notice of Funding Availability;
5. The recipient's approved application (including the final approved budget, attachments, and
pre -award negotiations); and
6. Grant Certification and Assurances.
C. ORDER OF PRECEDENCE
Any inconsistency in the authorities governing the Award shall be resolved by giving precedence in
the following order: (a) applicable Federal statutes, (b) applicable Federal regulations, (c) Notice of
Grant Award and Signature Page; (d) CNCS Program Specific Terms and Conditions, (e) CNCS
General Terms and Conditions, (f) the Notice of Funding Opportunity, and (g) the approved Award
Application including all assurances, certifications, attachments, and pre -award negotiations.
III. GENERAL TERMS AND CONDITIONS
A. RESPONSIBILITIES UNDER A`VARD ADMINISTRATION
1. Accountability of the Recipient. The recipient has full fiscal and programmatic responsibility
for managing all aspects of the award and award -supported activities, subject to the oversight of
CNCS. The recipient is accountable to CNCS for its operation of the program and the use of
CNCS award funds. The recipient must expend award funds in a manner consistent with the cost
principles in 2 CFR and in a reasonable manner, and it must record accurately the service
activities and outcomes achieved under the award. Although recipients are encouraged to seek
the advice and opinion of CNCS on special problems that may arise, such advice does not
diminish the recipient's responsibility for making sound judgments and does not shift the
responsibility for operating decisions to CNCS.
2. Subawards. If authorized by law and permitted by CNCS, a recipient may make subawards in
accordance with the requirements set forth in the Uniform Guidance. The recipient must have
and implement a plan for oversight and monitoring that complies with the requirements
applicable to pass through entities identified at 2 CFR § 200.331 to ensure that each subrecipient
has agreed to comply, and is complying, with award requirements.
A recipient of a Federal award that is a pass-through entity has certain obligations to its
subrecipients. Those requirements are located at 2 CFR § 200.331, §200.207, § 200.338, and 2
CFR Part 200 Subpart F.
3. Notice to CNCS. The recipient will notify the appropriate CNCS Program or Grants Officer
immediately of any developments or delays that have a significant impact on funded activities,
any significant problems relating to the administrative or financial aspects of the award, or any
suspected misconduct or malfeasance related to the award or recipient. The recipient will inform
the CNCS Program or Grants Officer about the corrective action taken or contemplated by the
recipient and any assistance needed to resolve the situation. Recipients should also ensure that
they comply with the mandatory reporting requirements for suspected criminal activity or fraud,
waste or abuse as specified in section III. H.
B. FINANCIAL MANAGEMENT STANDARDS
1. General. The recipient must maintain financial management systems that comply with 2 CFR §
200.302(b). The recipient's financial management systems must be capable of distinguishing
expenditures attributable to this award from expenditures not attributable to this award. The
3
systems must be able to identify costs by program year and by budget category, and to
differentiate between direct and indirect costs. For all recipient's financial management
requirements and responsibilities, refer to Subparts D and E of 2 CFR Part 200.
Allowability of Costs. To be allowable under an award, costs must meet the criteria of 2 CFR §
200.403, which provides that costs must be necessary and reasonable for the performance of the
award, must conform to limitations in the award or 2 CFR Part 200 as to types or amounts of cost
items, must be consistent with policies and procedures that apply uniformly to both Federally
financed and other activities of the recipient, must be adequately documented, and must not be
included as a cost or used to meet cost share or matching requirements of any other Federally -
financed program. Furthermore, the costs must be accorded consistent treatment in like
circumstances as either direct or indirect costs in order to avoid the double -charging of Federal
awards (see 2 CFR § 200.403(d) and § 200.412).
Cost Reporting. Recipients will be reporting their Federal cash disbursements quarterly through
the Payment Management System (PMS) at the Department of Health and Human Services and
their Federal share of grant program expenditures (including indirect costs) semi-annually
through CNCS's eGrants system. Recipient's financial management systems must be able to
routinely produce reports which support and reconcile to the amounts reported to PMS and
eGrants. Recipients must also ensure that the financial management systems of any subrecipients
can routinely produce the same reports. As pant of its ongoing fiscal oversight of recipients,
CNCS will be requesting randomly selected recipients to provide reports supporting their
Federal cash disbursements reported to PMS (including supporting information for cash
disbursements made by subrecipients). CNCS expects recipients' and subrecipients' financial
management systems to be able to produce those supporting reports on a routine basis.
4. Audits. Recipient organizations that expend $750,000 or more in total Federal awards in a fiscal
year shall have a single or program -specific audit conducted for that year in accordance with the
Single Audit Act, as amended, 31 U.S.C. 7501, et seq., and 2 CFR Part 200, Subpart F. If the
recipient expends Federal awards under only one Federal program, it may elect to have a program
specific audit, if it is otherwise eligible. A recipient that does not expend $750,000 in Federal
awards is exempt from the audit requirements for that year. However, it must continue to conduct
financial management reviews of its subrecipients, and its records and its subrecipients' records
must be available for review and audit in accordance with 2 CFR §§ 200.333-200.337 and
§200.331(a)(5). Additionally, a recipient acting as a pass-through entity must issue management
decisions for audit findings pertaining to the Federal award provided to the subrecipient as
required by 2 CFR § 200.521 and ensure follow-up on audit findings in a timely manner to ensure
that the subrecipient corrects any deficiencies identified in the audit.
C. CHANGES IN BUDGET OR KEY PERSONNEL
All budget and programmatic changes must comply with 2 CFR § 200.308 — Revision of budget and
program plans. 2 CFR § 200.407 Prior written approval (prior approval) — provides an exhaustive
list of those other items requiring CNCS's advance approval. CNCS does not waive any of the prior
written approvals required under that section. In addition to the required prior approval for changes
in key personnel identified in the budget, the recipient must also notify CNCS of any changes in the
senior leadership of the recipient and any changes in any positions which are not included in the
approved budget, but which involve leadership oversight of the activity under this award.
D. BANKRUPTCY
The recipient must notify CNCS if, during the term of its award, the recipient or one of its
subrecipients becomes insolvent or is unable to pay its debts as they mature, or files a
voluntary petition in bankruptcy or is the subject of an involuntary petition that is neither
stayed nor dismissed within 60 days after the petition is filed.
E. PROHIBITED PROGRAM ACTIVITIES
The recipient must comply with, and require all subrecipients to comply with, the prohibitions on
use of CNCS funds applicable to their program as identified in sections 132A and 174 of the NCSA
(42 U.S.C. §§ 12584a and 12634) and section 403 of the DVSA (42 U.S.C. § 5043), and provisions
by Congress in annual appropriations acts. More specific guidance on these prohibitions will be
provided in CNCS's Program Specific Terms and Conditions and in other guidance.
F. NATIONAL SERVICE CRIMINAL HISTORY CHECK REQUIREMENTS
The National Service Criminal History Check (NSCHC) is a screening procedure established by law
to protect the beneficiaries of national service. See 45 CFR §§ 2540.200-2540.207 and
http://www.nationalservice.gov/resources/criminal-history-check for complete information and
FAQs. The law requires recipients to conduct and document NSCHCs on any person (including
award -funded staff, national service participant, or volunteer) receiving a salary, living allowance,
stipend or education award through a program receiving CNCS funds. An individual is ineligible to
serve in a position that receives such CNCS funding if the individual is registered, or required to be
registered, as a sex offender or has been convicted of murder. The cost of conducting NSCHCs is
an allowable expense under the award.
Unless CNCS has provided a recipient with a written exemption or written approval of an alternative
search procedure, recipients must perform the following checks:
All award funded staff, national service participants, and volunteers must undergo NSCHCs that
include:
1. A nationwide name -based search of the National Sex Offender Public Website (NSOPW);
and
2. Either:
A name- or fingerprint -based search of the statewide criminal history registry in the
person's state of residence and in the state where the person will serve/work; or
A fingerprint -based FBI criminal history check.
Special Ride for Persons Serving Vulnerable Populations. Award -funded staff, national service
participants, and volunteers with recurring access to vulnerable populations (i.e., children age 17
or younger, individuals age 60 or older, or individuals with disabilities) must undergo NSCHCs that
include:
1. A nationwide name -based check of the NSOPW; and
2. Both:
A name- or fingerprint -based search of the statewide criminal history registry in the
person's state of residence and in the state where the person will serve/work; and
A fingerprint -based FBI criminal history check.
You must retain adequate documentation that you completed the required NSCHC. Inability to
demonstrate that you conducted a required criminal history check component, to include the
NSOPW, as specified in the regulations, may result in sanctions, including disallowance of costs.
In addition, you must ensure that appropriate recipient staff, including grant subrecipients, receives
annual training on NSCHC compliance, as specified by CNCS. This training must be documented
with the course's certificate of completion, for all years of completion.
G. THE OFFICE OF INSPECTOR GENERAL
CNCS's Office of Inspector General (OIG) conducts and supervises independent audits, evaluations,
and investigations of CNCS's programs and operations. Based on the results of these audits, reviews,
and investigations, the OIG recommends disallowing costs and also recommends amending or
adding policies to promote economy and efficiency and to prevent and detect fraud, waste, and abuse
in CNCS's programs and operations.
The OIG conducts and supervises audits of CNCS recipients, as well as legally required audits and
reviews. The legally required audits include evaluating CNCS's compliance with the Improper
Payments Elimination and Recovery Act (IPERA) which may result in grantees being requested to
produce responsive documentation. The OIG uses a risk-based approach, along with input received
from CNCS management, to select recipients and awards for audit. The OIG hires independent audit
firms to conduct some of its audits. The OIG audit staff is available to discuss any audit and can be
reached at (202) 606-9390.
Recipients must cooperate fully with CNCS requests for documentation and OIG inquiries by timely
disclosing complete and accurate information pertaining to matters under investigation, audit or
review, and by not concealing information or obstructing audits, inspections, investigations, or other
official inquiries.
H. REPORTING OF FRAUD, WASTE, AND ABUSE
Recipients must contact the OIG and their Program Officer without delay when they iurst suspect:
Any criminal activity or violations of law has occurred, such as:
• Fraud, theft, conversion, misappropriation, embezzlement, or misuse of funds or
property by any person, including CNCS personnel, grantees, or contractors—even if
no federal funds or property was involved;
• Submission of a false claim or a false statement by any person in connection with any
CNCS program, activity, grant or operations;
• Concealment, forgery, falsification, or unauthorized destruction of government or
program records;
• Corruption, bribery, kickbacks, acceptance of illegal gratuities, extortion, or conflicts
of interest in connection with operations, programs, activities, contracts, or grants;
• Other misconduct in connection with operations, programs, activities, contracts, or
grants; or
• Mismanagement, abuse of authority, or other misconduct by CNCS personnel.
2. Fraud, waste, or abuse.
• Fraud occurs when someone is intentionally dishonest or uses intentional
misrepresentation or misleading omission to receive something of value or to deprive
someone, including the government, of something of value.
• Waste occurs when taxpayers do not receive reasonable value for their money in
connection with a government -funded activity due to an inappropriate act or omission
by people with control over or access to government resources.
• Abuse is behavior that is deficient, objectively unreasonable, or improper under the
circumstances. Abuse also includes the misuse of authority or position for personal
financial gain or the gain of an immediate or close family member or business
associate.
The OIG maintains a hotline to receive this information, which can be reached by email at
hotline acncsoig_gov or by telephone at (800) 452-8210. Upon request, OIG will take appropriate
measures to protect the identity of any individual who reports misconduct, as authorized by the
Inspector General Act of 1978, as amended. Reports to OIG may also be made anonymously.
The recipient should take no further steps to investigate any suspected misconduct, except as
directed by the OIG or to prevent the destruction of evidence or information.
I. WHISTLEBLOWER PROTECTION
1. This award and employees working on this award will be subject to the whistleblower rights and
remedies in the pilot program on Contractor employee whistleblower protections established at
41 U.S.C. 4712 by section 828 of the National Defense Authorization Act for Fiscal Year 2013
(Pub. L. 112-239).
2. Under this pilot program, an employee of a recipient may not be discharged, demoted, or
otherwise discriminated against as a reprisal for disclosing information that the employee
reasonably believes is evidence of gross mismanagement of a Federal contract or award, a gross
waste of Federal funds, an abuse of authority (an arbitrary and capricious exercise of authority
that is inconsistent with the mission of CNCS or the successful performance of a contract or
award of CNCS) relating to a Federal contract or award, a substantial and specific danger to
public health or safety, or a violation of law, rule, or regulation related to a Federal contract
(including the competition for or negotiation of a contract) or award.
3. The recipient shall inform its employees and contractors in writing, in the predominant language
of the workforce or organization, of employee whistleblower rights and protections under 41
U.S.C. 4712, as described above and at http://www.cnesoig.gov/whistleblower-protection.
J. LIABILITY AND SAFETY ISSUES
The recipient must institute safeguards as necessary and appropriate to ensure the safety of members
and volunteers. Members and volunteers may not participate in projects that pose undue safety risks.
Any insurance costs under the award must comply with 2 CFR § 200.447, which outlines what
insurance costs are allowable.
K. A`VARD MONITORING
Site visits. CNCS may make site visits to review and evaluate recipient records,
accomplishments, organizational procedures and financial control systems; to conduct
interviews; and to provide technical assistance as necessary.
2. Desk reviews. CNCS may conduct desk reviews to make limited verifications of recipient
compliance with the terms of their award, conduct a review of the recipient's general
management practices, and identify any practice or procedure that may require further scrutiny.
Responding to information requests. Pursuant to 2 CFR 200.336, CNCS may from time to
time request documentation from recipients in order to monitor the award or to comply with other
legal requirements, such as the Improper Payments Information Act of 2002, as amended.
Failure to make timely responses to such requests may result in award funds being placed on
temporary manual hold, reimbursement only, or other remedies as appropriate.
L. NON-DISCRIMINATION PUBLIC NOTICE AND RECORDS COMPLIANCE
Public Notice of Non-discrimination. The recipient must notify members, community
beneficiaries, applicants, program staff, and the public, including those with impaired vision or
hearing, that it operates its program or activity subject to the non-discrimination requirements
applicable to their program found at § § 175 and 176(f) of the NCSA or § 417 of the DVSA, and
relevant program regulations found at 45 CFR Parts 2540 (AmeriCorps State and National), 2551
(Senior Companion Program), 2552 (Foster Grandparent Program), 2553 (RSVP), and 2556
(AmeriCorps VISTA). The notice must summarize the requirements, note the availability of
compliance information from the recipient and CNCS, and briefly explain procedures for filing
discrimination complaints with CNCS.
Sample language is:
This program is available to all, without regard to race, color, national origin, disability, age, sex,
political affiliation, or, in most instances, religion. It is also iinla-�.fitl to retaliate against any
person who, or organization that, files a complaint about such discrimination. In addition to
filing a complaint with local and state agencies that are responsible for resolving discrimination
complaints, you may bring a complaint to the attention of the Corporation for National and
Community Service. If you believe that you or others have been discriminated against, or if yoit
want more information, contact:
(frame, address, phone number — both voice and TTY, and preferably toll free — FAX
number and email address of the recipient) or
Office of Civil Right and Inclusiveness
Corporation for National and Community Service
250 E Street, SW
TVashington, DC 20525
(800) 833-3722 (TTY and reasonable accommodation line)
(202) 565-3465 (FAX); eo@cns.gov (email)
The recipient must include information on civil rights requirements, complaint procedures and
the rights of beneficiaries in member or volunteer service agreements, handbooks, manuals,
pamphlets, and post in prominent locations, as appropriate. The recipient must also notify the
public in recruitment material and application forms that it operates its program or activity subject
to the nondiscrimination requirements. Sample language, in bold print, is: This program is
available to all, without regard to race, color, national origin, disability, age, sex, political
affiliation, or, in most instances, religion. Where a significant portion of the population eligible
to be served needs services or information in a language other than English, the recipient shall
take reasonable steps to provide written material of the type ordinarily available to the public in
appropriate languages.
2. Prohibition Against National Origin Discrimination Affecting Limited English Proficient
(LEP) Persons. Pursuant to Executive Order (EO) 13166 — Improving Access to Services for
Persons with Limited English Proficiency, recipients are required to provide meaningful access
to their programs and activities by LEP persons. For more information, please see the policy
.guidance at 67 FR 64604.
Records and Compliance Information. The recipient must keep records and make available
to CNCS timely, complete, and accurate compliance information to allow CNCS to determine if
the recipient is complying with the civil rights statutes and implementing regulations. Where a
recipient extends Federal financial assistance to subrecipients, the subrecipients must make
available compliance information to the recipient so it can carry out its civil rights obligations in
accordance with the records requirements at 2 CFR §§ 200.333-200.337 and § 200.331(a)(5).
4 Obligation to Cooperate. The recipient must cooperate with CNCS so that CNCS can ensure
compliance with the civil rights statutes and implementing regulations. The recipient shall permit
access by CNCS during normal business hours to its books, records, accounts, staff, members or
volunteers, facilities, and other sources of information as may be needed to determine
compliance.
N1. IDENTIFICATION OF FUNDING
When issuing statements, press releases, requests for proposals, bid solicitations and other
documents describing projects or programs funded in whole or in part with Federal money, all
grantees receiving CNCS funds included, shall clearly state— (1) the percentage of the total costs
of the program or project which will be financed with Federal money; (2) the dollar amount of
Federal funds for the project or program; and (3) the percentage and dollar amount of the total
costs of the project or program that will be financed by non-governmental sources.
N. AWARD PRODUCTS
Sharing Award Products. To the extent practicable, the recipient agrees to make products
produced under the award available at the cost of reproduction to others in the field.
2. Acknowledgment of Support. Publications created by members, volunteers or award -funded
staff must be consistent with the purposes of the award. The appropriate program CNCS logo
shall be included on such documents. The recipient is responsible for assuring that the following
acknowledgment and disclaimer appears in any external report or publication of material based
upon work supported by this award:
"This material is based upon work supported by the Corporation for National and Community
Service (CNCS) icnder Grant No. . Opinions or points of view expressed in this document
are those of the authors and do not necessarily reflect the official position of, or a position that
is endorsed by, CNCS or [the relevant CNCS Program]. "
O. SUSPENSION OR TERMINATION OF AWARD
CNCS may suspend or terminate this award in accordance with 2 CFR §§ 200.338 and 200.339 and
applicable CNCS regulations and statutes. In addition, a recipient may suspend or terminate
assistance to one of its subrecipients in accordance with 2 CFR §§ 200.338 and 200.339, provided
that such action complies with 2 CFR § 200.341.
P. TRAFFICKING IN PERSONS
This award is subject to requirements of Section 106(g) of the Trafficking Victims Protection Act of
2000, as amended (22 U.S.C. § 7104).
1. Provisions applicable to a recipient that is a private entity.
a. You as the recipient, your employees, subrecipients under this award, and subrecipients'
employees may not:
i. Engage in severe forms of trafficking in persons during the period of time that the
award is in effect;
ii. Procure a commercial sex act during the period of time that the award is in effect; or
iii. Use forced labor in the performance of the award or subawards under the award..
b. We as the Federal awarding agency may unilaterally terminate this award, without
penalty, if you or a subrecipient that is a private entity
10
i. Is determined you have violated a prohibition in paragraph (a.) of this award term; or
ii. Has an employee who is determined by the agency official authorized to terminate the
award to have violated a prohibition in paragraph (a.) of this award term through
conduct that is either:
(A.) Associated with performance under this award; or
(B.) Imputed to you or the subrecipient using the standards and due process for
imputing the conduct of an individual to an organization that are provided in
2 CFR Part 180, "OMB guidelines to Agencies on Government -wide
Debarment and Suspension (Nonprocurement)," as implemented by our
agency at 2 CFR Part 2200.
2. Provisions applicable to a recipient other than a private entity. We as the Federal awarding agency
may unilaterally terminate this award, without penalty, if a subrecipient that is a private entity—
a. Is determined to have violated an applicable prohibition of paragraph (1)(a.) of this award
term; or
b. Has an employee who is determined by the agency official authorized to terminate the
award to have violated an applicable prohibition in paragraph (1)(a)(i) of this award term
through conduct that is —
i. Associated with performance under this award; or
ii. Imputed to you using the standards and due process for imputing conduct of an
individual to an organization that are provided in 2 CFR Part 180, "OMB Guidelines
to Agencies on Government -wide Debarment and Suspension (Nonprocurement)," as
implemented by our agency at 2 CFR Part 2200.
3. Provisions applicable to any recipient.
a. You must inform us immediately of any information you receive from any source alleging
a violation of a prohibition in paragraph (1)(a) of this award term.
b. Our right to terminate unilaterally that is described in paragraph (1) and (2) of this section:
i. Implements section 106(g) of the Trafficking Victims Protection Act of 2000
(TVPA), as amended (22 U.S.C. 7104(g)), and
ii. Is in addition to all other remedies for noncompliance that are available to us under
this award.
C. You must include the requirements of paragraph (1)(a) of this award term in any subaward
you make to a private entity.
4. Definitions. For purposes of this award term:
a. "Employee" means either:
i. An individual employed by you or a subrecipient who is engaged in the performance
of the project or program under this award; or
ii. Another person engaged in the performance of the project or program under this
award and not compensated by you including, but not limited to, a volunteer or
individual whose service are contributed by a third party as an in-kind contribution
toward cost sharing or matching requirements.
11
b. "Forced labor" means labor obtained by any of the following methods: the recruitment,
harboring, transportation, provision, or obtaining of a person for labor or services,
through the use of force, fraud, or coercion for the purpose of subjection to involuntary
servitude, peonage, debt bondage, or slavery.
C. "Private entity":
i. Means any entity other than a State, local government, Indian tribe, or foreign public
entity, as those terms are defined in 2 CFR § 175.25.
ii. Includes:
(a.) A nonprofit organization, , including any non-profit institution of higher
education, hospital, or tribal organization other than one included in the
definition of Indian tribe at 2 CFR § 175.25(b).
(b.) A for-profit organization.
d. "Severe forms of trafficking in persons," "commercial sex act," and "coercion" have the
meanings given at section 103 of the TVPA, as amended (22 U.S.C. § 7102).
Q. SYSTEM OF AWARD MANAGEMENT (SAM) and UNIVERSAL IDENTIFIER
REQUIREMENTS (Required provision under 2 CFR § 25.220)
1. Requirement for Central Contractor Registration (CCR): Unless you are exempted from this
requirement under 2 CFR § 25.110, you as the recipient must maintain the currency of your
information in the SAM until you submit the final financial report required under this award or
receive the final payment, whichever is later. This requires that you review and update the
information at least annually after the initial registration, and more frequently if required by
changes in your information or another award term.
2. Requirement for Unique Entity Identifier: If you are authorized to make subawards under this
award, you:
a. Must notify potential subrecipients that no entity (see definition in paragraph e of this
award term) may receive a subaward from you unless the entity has provided its unique
entity identifier to you. (CNCS's eGrants system r'equir'es a DUNS number.)
b. May not make a subaward to an entity unless the entity has provided its unique entity
identifier to you.
3. Definitions. For purposes of this award term:
a. System of Award Management (SAM) means the Federal repository into which an entity
must provide information required for the conduct of business as a recipient. Additional
information about registration procedures may be found at the SAM Internet site
(currently at https://www.sam.gov/portal/public/SAM/).
b. Unique Entity Identifier means the identifier required for SAM registration to uniquely
identify business entities. (CNCS's eGrants system requires DUNS numbers. DUNS
stands for Data Universal Numbering System (DUNS) number a nine -digit number
established and assigned by Dun and Bradstreet, Inc. (D&B) to uniquely identify business
entities. A DUNS number may be obtained from D&B by telephone (currently 866-705-
5711) or the Internet (currently at http://fedgov.dnb.com/webfonn).
12
C. Entity, as it is used in this award term, means all of the following, as defined at 2 CFR
part 25, subpart C:
i. A Governmental organization, which is a State, local government, or Indian Tribe;
ii. A foreign public entity;
iii. A domestic or foreign nonprofit organization;
iv. A domestic or foreign for-profit organization; and
v: A Federal agency, but only as a subrecipient under an award or subaward to a non -
Federal entity.
d. Subaward:
i. This term means a legal instrument to provide support for the performance of any
portion of the substantive project or program for which you received this award and
that you as the recipient award to an eligible subrecipient.
ii. The term does not include your procurement of property and services needed to carry
out the project or program (for further explanation, see 2 CFR § 200.330.
iii. A subaward may be provided through any legal agreement, including an agreement
that you consider a contract.
e. Subrecipient means an entity that:
i. Receives a subaward from you under this award; and
ii. Is accountable to you for the use of the Federal funds provided by the subaward.
R. TRANSPARENCY ACT REQUIREMENTS (for Grants and Cooperative Agreements
of $25,000 or More)
Reporting Subawards and Executive Compensation:
1. Reporting of first-tier subawards.
a. Applicability. Unless you are exempt as provided in paragraph 4, of this award term
(below), you must report each action that obligates $25,000 or more in Federal funds that
does not include Recovery funds (as defined in section 1512(a)(2) of the American
Recovery and Reinvestment Act of 2009, Pub. L. 111-5) for a subaward to an entity (see
definitions in paragraph 5. of this award term).
b. Where and when to report.
i. You must report each obligating action described in paragraph l .a. of this award term
to http://www.fsrs.gov.
ii. For subaward information, report no later than the end of the month following the
month in which the obligation was made. (For example, if the obligation was made
on November 7, 2010, the obligation must be reported by no later than December 31,
2010.)
C. What to report. You must report the information about each obligating action that the
submission instructions posted at htip://www.fsrs.gov specify.
2. Reporting Total Compensation of Recipient Executives.
a. Applicability and what to report. You must report total compensation for each of your
five most highly compensated executives for the preceding completed fiscal year, if --
13
i. The total Federal fiinding authorized to date under this award is $25,000 or more;
ii. In the preceding fiscal year, you received --
(a.) 80 percent or more of your annual gross revenues from Federal procurement
contracts (and subcontracts) and Federal financial assistance subject to the
Transparency Act, as defined at 2 CFR § 170.320 (and subawards); and
(b.) $25,000,000 or more in annual gross revenues from Federal procurement
contracts (and subcontracts) and Federal financial assistance subject to the
Transparency Act, as defined at 2 CFR § 170.320 (and subawards); and
iii. The public does not have access to information about the compensation of the
executives through periodic reports filed under section 13(a) or 15(d) of the Securities
Exchange Act of 1934 (15 U.S.C. §§ 78m(a), 78o(d)) or section 6104 of the Internal
Revenue Code of 1986. (To determine if the public has access to the compensation
information, see the U.S. Security and Exchange Commission total compensation
filings at http://www.sec.gov/answers/execom�htm.)
b. Where and when to report. You must report executive total compensation described in
paragraph (2.)(a.) of this award term:
i. As part of your registration profile at https://www.sam.gov/portal/public/SAM/.
ii. By the end of the month following the month in which this award is made, and
annually thereafter.
3. Reporting of Total Compensation of Subrecipient Executives.
a. Applicability and what to report. Unless you are exempt as provided in paragraph 4. of
this award term, for each first-tier subrecipient under this award, you shall report the
names and total compensation of each of the subrecipient's five most highly compensated
executives for the subrecipient's preceding completed fiscal year, if --
i. In the subrecipient's preceding fiscal year, the subrecipient received --
(a.) 80 percent or more of its annual gross revenues from Federal procurement
contracts (and subcontracts) and Federal financial assistance subject to the
Transparency Act, as defined at 2 CFR § 170.320 (and subawards); and
(b.) $25,000,000 or more in annual gross revenues from Federal procurement
contracts (and subcontracts), and Federal financial assistance subject to the
Transparency Act, as defined at 2 CFR § 170.320 (and subawards); and
ii. The public does not have access to information about the compensation of the
executives through periodic reports filed under section 13(a) or 15(d) of the Securities
Exchange Act of 1934 (15 U.S.C. §§ 78m(a), 78o(d)) or section 6104 of the Internal
Revenue Code of 1986. (To determine if the public has access to the compensation
information, see the U.S. Security and Exchange Commission total compensation
filings at http://www.sec.,Rov/answers/execomp.htm.)
b. Where and when to report. You must report subrecipient executive total compensation
described in paragraph 3.a. of this award term:
i. To the recipient.
ii. By the end of the month following the month during which you make the subaward.
For example, if a subaward is obligated on any date during the month of October of a
given year (i.e., between October 1 and 31), you must report any required
compensation information of the subrecipient by November 30 of that year.
14
4. Exemptions. If, in the previous tax year, you had gross income, from all sources, under $300,000,
you are exempt from the requirements to report:
a. Subawards, and
b. The total compensation of the five most highly compensated executives of any
subrecipient.
5. Definitions. For purposes of this award term:
a. Entity means all of the following, as defined in 2 CFR Part 25:
i. A Governmental organization, which is a State, local government, or Indian tribe;
ii. A foreign public entity;
iii. A domestic or foreign nonprofit organization;
iv. A domestic or foreign for-profit organization;
v. A Federal agency, but only as a subrecipient under an award or subaward to a non -
Federal entity.
b. Executive means officers, managing partners, or any other employees in management
positions.
C. Subaward:
i. This term means a legal instrument to provide support for the performance of any
portion of the substantive project or program for which you received this award and
that you as the recipient award to an eligible subrecipient.
ii. The term does not include your procurement of property and services needed to carry
out the project or program (for further explanation, see 2 CFR § 200.330).
iii. A subaward may be provided through any legal agreement, including an agreement
that you or a subrecipient considers a contract.
d. Subrecipient means an entity that:
i. Receives a subaward from you (the recipient) under this award; and
ii. Is accountable to you for the use of the Federal funds provided by the subaward.
e. Total compensation means the cash and noncash dollar value earned by the executive
during the recipient's or subrecipient's preceding fiscal year and includes the following
(for more information see 17 CFR §229.402(c)(2)):
i. Salary and bonus.
ii. Awards of stock, stock options, and stock appreciation rights. Use the dollar amount
recognized for financial statement reporting purposes with respect to the fiscal year
in accordance with the Statement of Financial Accounting Standards No. 123
(Revised 2004) (FAS 123R), Shared Based Payments.
iii. Earnings for services under non -equity incentive plans. This does not include group
life, health, hospitalization or medical reimbursement plans that do not discriminate
in favor of executives, and are available generally to all salaried employees.
iv. Change in pension value. This is the change in present value of defined benefit and
actuarial pension plans.
v. Above -market earnings on deferred compensation which is not tax -qualified.
vi. Other compensation, if the aggregate value of all such other compensation (e.g.
severance, termination payments, value of life insurance paid on behalf of the
employee, perquisites or property) for the executive exceeds $10,000.
15
S. CONFLICT OF INTEREST
You must disclose in writing any potential conflict of interest to your CNCS Program Officer, or to
the pass-through entity if you are a subrecipient or contractor. This disclosure must take place
immediately. The CNCS conflict of interest policies apply to subawards as well as contracts, and are
as follows:
1. As a non -Federal entity, you must maintain written standards of conduct covering conflicts of
interest and governing the performance of your employees engaged in the selection, award, and
administration of subawards and contracts.
2. None of your employees may participate in the selection, award, or administration of a subaward
or contract supported by a Federal award if he or she has a real or apparent conflict of interest.
Such a conflict of interest 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 herein, has a financial or other interest in or a tangible
personal benefit from an organization considered for a subaward or contract. The officers,
employees, and agents of the non -Federal entity must neither solicit nor accept gratuities, favors,
or anything of monetary value from subrecipients or contractors or parties to subawards or
contracts.
3. If you have a parent, affiliate, or subsidiary organization that is not a State, local government, or
Indian tribe, you must also maintain written standards of conduct covering organizational
conflicts of interest. Organizational conflicts of interest mean that because of relationships with
a parent company, affiliate, or subsidiary organization, you are unable or appear to be unable to
be impartial in conducting a subaward or procurement action involving a related organization.
T. AWARD TERM AND CONDITION FOR RECIPIENT INTEGRITY AND
PERFORMANCE MATTERS (Required provision under 2 CFR § 200.210(b)(iii) for
grants and cooperative agreements of $500,000 or more)
1. General Reporting Requirement
If the total value of your currently active grants, cooperative agreements, and procurement
contracts from all Federal awarding agencies exceeds $10,000,000 for any period of time during
the period of performance of this Federal award, then you as the recipient during that period of
time must maintain the currency of information reported to the System for Award Management
(SAM) that is made available in the designated integrity and performance system (currently the
Federal Awardee Performance and Integrity Information System (FAPIIS)) about civil, criminal, or
administrative proceedings described in paragraph 2 of this award term and condition. This is a
statutory requirement under section 872 of Public Law 110-417, as amended (41 U.S.C. 2313). As
required by section 3010 of Public Law 111-212, all information posted in the designated integrity
and performance system on or after April 15, 2011, except past performance reviews required for
Federal procurement contracts, will be publicly available.
Proceedings About Which You Must Report
M
Submit the information required about each proceeding that:
a. Is in connection with the award or performance of a grant, cooperative agreement, or
procurement contract from the Federal Government;
b. Reached its final disposition during the most recent five year period; and
C. Is one of the following:
(1) A criminal proceeding that resulted in a conviction, as defined in paragraph 5 of this
award term and condition;
(2) A civil proceeding that resulted in a finding of fault and liability and payment of a
monetary fine, penalty, reimbursement, restitution, or damages of $5,000 or more;
(3) An administrative proceeding, as defined in paragraph 5 of this award term and
condition, that resulted in a finding of fault and liability and your payment of either
a monetary fine or penalty of $5,000 or more or reimbursement, restitution, or
damages in excess of $100,000; or
(4) Any other criminal, civil, or administrative proceeding if.
(i) It could have led to an outcome described in paragraph 2.c.(1), (2), or (3) of
this award term and condition;
(ii) It had a different disposition arrived at by consent or compromise with an
acknowledgment of fault on your part; and
(iii) The requirement in this award term and condition to disclose information
about the proceeding does not conflict with applicable laws and regulations.
3. Reporting Procedures
Enter in the SAM Entity Management area the information that SAM requires about each
proceeding described in paragraph 2 of this award term and condition. You do not need to submit
the information a second time under assistance awards that you received if you already provided
the information through SAM because you were required to do so under Federal procurement
contracts that you were awarded.
4. Reporting Frequency
During any period of time when you are subject to the requirement in paragraph I of this award
term and condition, you must report proceedings information through SAM for the most recent five
year period, either to report new information about any proceeding(s) that you have not reported
previously or affirm that there is no new information to report. Recipients that have Federal
contract, grant, and cooperative agreement awards with a cumulative total value greater than
$10,000,000 must disclose semiannually any information about the criminal, civil, and
administrative proceedings.
5. Definitions
For purposes of this award term and condition:
a. Administrative proceeding means a non judicial process that is adjudicatory in nature in
order to make a determination of fault or liability (e.g., Securities and Exchange
17
Commission Administrative proceedings, Civilian Board of Contract Appeals proceedings,
and Armed Services Board of Contract Appeals proceedings). This includes proceedings at
the Federal and State level but only in connection with performance of a Federal contract or
grant. It does not include audits, site visits, corrective plans, or inspection of deliverables.
b. Conviction, for purposes of this award term and condition, means a judgment or conviction
of a criminal offense by any court of competent jurisdiction, whether entered upon a verdict
or a plea, and includes a conviction entered upon a plea of nolo contendere.
c. Total value of currently active grants, cooperative agreements, and procurement contracts
includes—
(1) Only the Federal share of the funding under any Federal award with a recipient
cost share or match; and
(2) The value of all expected funding increments under a Federal award and options,
even if not yet exercised.
18
IV. ATTACHMENT
Grant Pro -ram Civil Rights and Non -Harassment Policy
The Corporation for National and Community Service (CNCS) has zero tolerance for the harassment
of any individual or group of individuals for any reason. CNCS is committed to treating all persons
with dignity and respect. CNCS prohibits all forms of discrimination based upon race, color, national
origin, gender, age, religion, sexual orientation, disability, gender identity or expression, political
affiliation, marital or parental status or military service. All programs administered by, or receiving
Federal financial assistance from CNCS, must be free from all forms of harassment. Whether in CNCS
offices or campuses, in other service -related settings such as training sessions or service sites, or
at service -related social events, such harassment is unacceptable. Any such harassment, if found,
will result in immediate corrective action, up to and including removal or termination of any CNCS
employee or volunteer. Recipients of Federal financial assistance, be they individuals, organizations,
programs and/or projects are also subject to this zero tolerance policy. Where a violation is found,
and subject to regulatory procedures, appropriate corrective action will be taken, up to and
including termination of Federal financial assistance from all Federal sources.
Slurs and other verbal or physical conduct relating to an individual's gender, race, ethnicity, religion,
sexual orientation or any other basis constitute harassment when it has the purpose or effect of
interfering with service performance or creating an intimidating, hostile, or offensive service
environment. Harassment includes, but is not limited to: explicit or implicit demands for sexual favors;
pressure for dates; deliberate touching, leaning over, or cornering; offensive teasing, jokes, remarks, or
questions; letters, phone calls, or distribution or display of offensive materials; offensive looks or
gestures; gender, racial, ethnic, or religious baiting; physical assaults or other threatening
behavior; or demeaning, debasing or abusive comments or actions that intimidate.
CNCS does not tolerate harassment by anyone including persons of the same or different races,
sexes, religions, or ethnic origins; or from a CNCS employee or supervisor; a project, or site
employee or supervisor; a non-employee (e.g., client); a co-worker or service member.
I expect supervisors and managers of CNCS programs and projects, when made aware of alleged
harassment by employees, service participants, or other individuals, to immediately take swift and
appropriate action. CNCS will not tolerate retaliation against a person who raises harassment
concerns in good faith. Any CNCS employee who violates this policy will be subject to discipline,
up to and including termination, and any grantee that permits harassment in violation of this policy
will be subject to a finding of non-compliance and administrative procedures that may result in
tennination of Federal financial assistance from CNCS and all other Federal agencies.
Any person who believes that he or she has been discriminated against in violation of civil rights laws,
regulations, or this policy, or in retaliation for opposition to discrimination or participation in'
discrimination complaint proceedings (e.g., as a complainant or witness) in any CNCS program or
project, may raise his or her concerns with our Office of Civil Rights and Inclusiveness (OCRI).
Discrimination claims not brought to the attention of OCRI within 45 days of their occurrence may not
be accepted in a formal complaint of discrimination. No one can be required to use a program, project
or sponsor dispute resolution procedure before contacting OCRI. If another procedure is used, it does
19
not affect the 45 -day time limit. OCRI may be reached at (202) 606-7503 (voice), (202) 606-3472
(TTY), eo(2dcns.gov, or through www .nationalservice.gov.
3/1/2017
Date Kim Mansaray, Acting Chief Executive Officer
20
2018 Terms and Conditions for AMERICORPS STATE and
NATIONAL GRANTS
These Corporation for National & Community Service (CNCS) Grant Program
Specific Terms and Conditions and the General Terms and Conditions, are binding
on the recipient.
TABLE OF CONTENTS
I.
Changes from the 2017 AmeriCorps Grant Terms and Conditions
2
H.
Definitions
2
III.
Affiliation with the AmeriCorps National Service Network
4
IV.
Member Recruitment, Selection, and Exit
5
V.
Supervision and Support
7
VI.
Changes in Member Positions
10
VII.
Release from Participation
12
VIII.
Living Allowances, Other In -Service Benefits, and Taxes
13
IX.
Member Records and Confidentiality
16
X.
Budget and Programmatic Changes
18
XI.
Reporting Requirements
19
XII.
Award Period and Incremental Funding
21
XIII.
Program Income
22
XIV.
Safety
22
XV.
National Service Criminal History Check Training
23
XVI.
Fixed Amount Awards
23
XVII.
Breaches of Personally Identifiable Information
24
CHANGES FROM THE 2017 AMERICORPS GRANT TERMS AND
CONDITIONS
For your convenience, we have identified changes from last year's AmeriCoips State and
National grant terms and conditions. The list below is general and informational in
nature, not comprehensive. We reiterate the importance of reviewing all award terms and
conditions, because recipients are responsible for knowing, understanding, and
complying with all award terms and conditions.
1. Section N.A. — Added the section "Member Listings/Position Descriptions in the
My AmeriCorps Portal."
2. Section N.B. - Added the section "Pre -enrollment of selected members."
3. Section N.C. - Revised the language related to notification of the Trust.
4. Section IV.E. - Updated language related to reasonable accommodation.
Removed the reference to the FAQ and included an email for additional
information.
5. Section IV.F. - Changed the requirement to assign members to service locations
from 30 days to five days.
6. Section IV.I. — Updated the language for Penalties for False Information.
7. Section V.E. — Updated the language related to performance reviews.
8. Section VI.A. — Added the requirement for CNCS approval to convert any
position to a three-quarter time member.
9. Section VI.C. — Added the conditions for changing a Term of Service for an
enrolled Member for a three-quarter time position.
10. Section VIII.E. — Added Professional Corps programs are excluded from
childcare payments and updated the FAQ link.
11. Section IX.B. — Updated language regarding verification of eligibility and
submitting documentation to CNCS.
12. Section XI.B. — Added a requirement for an evaluation plan and learning memo
for evidence based intervention planning grantees.
13. Section XV — Updated the link for the e -Course and included Litmos access '
information.
14. Removed all references to Partnership Challenge grants.
II. DEFINITIONS
A. Recipient, for the purposes of this agreement, means the direct recipient
of this award. The recipient is legally accountable to CNCS for the use of
award funds, or member positions, and is bound by the provisions of the
award. The recipient is responsible for ensuring that subrecipients or other
organizations carrying out activities under this award comply with all
applicable Federal requirements, including the CNCS General Terms and
Conditions, these specific terms and conditions, regulations applicable to
the program, and the NCSA.
2
B. Planning Grant, for the purposes of this agreement, is an award or
subaward for the planning of a national service program. State Service
Commissions may also award planning grants as part of their Formula
Cost Reimbursement prime award. Planning grants do not include member
positions. Planning grants are awarded for a maximum of one year, and
may not exceed $75,000 per program.
C. Subrecipient refers to an organization receiving AmeriCorps award funds
or member positions from a recipient of CNCS funds. See 2 CFR §
200.93.
D. Operating site means the organization that manages the AmeriCorps
program and places members into service locations. State subrecipients
(programs) are operating sites. National recipients must identify at least
one operating site to which they can assign service locations in the state
where they are placing members.
E. Program refers to the activities supported under the award.
F. Service Location means the organization where or with which a member
actually provides his or her service in the community. Typical service
locations are schools, food banks, health clinics, community parks, etc.
The service location may be the same as the operating site, but only if the
member actually serves at or with the operating site organization. A
member may serve at multiple service locations, all of which must be
listed in the portal, although the program must select only one for the
member's primary assignment.
G. Member or participant means an individual:
1. Who has been selected by a recipient or subrecipient to serve in an
approved national service position;
2. Who is a U.S, citizen, U.S. national, or lawful permanent resident
alien of the United States;
3. Who is at least 17 years of age at the commencement of service
unless the member is out of school and enrolled in a full-time,
year-round youth corps or full-time summer program as defined in
the NCSA (42 U.S.C. § 12572 (a)(3)(B)(x)), in which case he or
she must be between the ages of 16 and 25, inclusive, and
4. Who has received a high school diploma or its equivalent, agrees to
obtain a high school diploma or its equivalent (unless this
requirement is waived based on an individual education assessment
conducted by the program) and the individual did not drop out of
an elementary or secondary school to enroll in the program, or is
enrolled in an institution of higher education on an ability to
3
benefit basis and is considered eligible for funds under 20 U.S.C. §
1091 (See Section IX. B.).
H. NCSA means the National and Community Service Act of 1990, as
amended. See 45 U.S.C. §§ 12501-12657.
III. AFFILIATION WITH THE AMERICORPS NATIONAL SERVICE
PROGRAM
A. Identification as an AmeriCorps Program or Member. The recipient
shall identify the program as an AmeriCorps program and members as
AmeriCorps members. All agreements with subrecipients, operating sites,
or service locations, related to the AmeriCorps program must explicitly
state that the program is an AmeriCorps program and AmeriCorps
members are the resource being provided.
B. The AmeriCorps Name and Logo. AmeriCorps is a registered service
marls of CNCS. CNCS provides a camera-ready logo. All recipient and
subrecipient websites shall clearly state that they are an AmeriCorps
recipient and shall prominently display the AmeriCorps logo. Recipients
and subrecipients shall use the AmeriCorps name and logo on service gear
and public materials such as stationery, application forms, recruitment
brochures, on-line position postings or other recruitment materials,
orientation materials, member curriculum materials, signs, banners,
websites, social media, press releases, and publications related to their
AmeriCorps program in accordance with CNCS requirements.
To publicize the relationship between the program and AmeriCorps, the
recipient shall describe their program as "an AmeriCorps program."
Recipients shall provide information or training to their AmeriCorps
members about how their program is part of the national AmeriCorps
program and about the other national service programs of CNCS.
Recipients are strongly encouraged to place signs that include the
AmeriCorps name and logo at their service sites and may use the slogan
"AmeriCorps Serving Here." AmeriCorps members should state that
they are AmeriCorps members during public speaking opportunities.
The recipient may not alter the AmeriCorps logo, and must obtain written
permission from CNCS before using the AmeriCorps name or logo on
materials that will be sold, or permitting donors to use the AmeriCorps
name or logo in promotional materials. The recipient may not use or
display the AmeriCorps name or logo in connection with any activity
prohibited by statute, regulation, or CNCS General Terms and Conditions,
and these specific award terms and conditions.
IV. MEMBER RECRUITMENT, SELECTION, AND EXIT
Member recruitment and selection requirements are in CNCS's regulations at 45
CFR §§ 2522.210 and Part 2540, subpart B. In addition, the recipient must ensure
that the following procedures are followed:
A. Member Listings/Position Descriptions in the My AmeriCorps Portal.
Programs must list their member listings/position descriptions by creating
Service Opportunity Listings in the My AmeriCorps Portal.
B. Pre -enrollment of selected members. Programs must enter applicants
into the Portal prior to their first day of service and in sufficient time to
ensure that the future member is citizenship eligible. Program staff must
also certify that the future member's required NSOPW/NSOPR has been
run, reviewed, and approved as well as the State and/or FBI criminal
history checks initiated. Members will not be permitted to enroll in the
National Service Trust prior to those steps occurring.
C. Notice to CNCS's National Service Trust. The recipient must notify
CNCS's National Service Trust, via the My AmeriCorps Portal, within 30
days of a member's completion of, suspension from, or release from, a
term of service. Suspension of service is defined as an extended period
during which the member is not serving, nor accumulating service hours or
receiving AmeriCorps benefits. AmeriCorps members must complete
their own enrollment and exit forms on-line in the My AmeriCorps
Member Portal.
The recipient also must notify the Trust, via the My AmeriCorps Portal,
when a change in a member's term of service is approved and changed
(i.e. from full-time to less than full-time or vice versa). Failure to report
such changes within the required time frames may result in sanctions to
the recipient, up to and including, suspension or termination of the award.
Recipients or subrecipients meet notification requirements by using the
appropriate electronic system to inform CNCS of changes within the
required time frames. Any questions regarding the Trust should be
directed to the Trust Office (800) 942-2677.
D. Parental Consent. Parental or legal guardian consent must be obtained
for members under 18 years of age before members begin a term of
service. Recipients may also include an informed consent form of their
own design as part of the member service agreement materials.
E. Reasonable Accommodation. Programs and activities must be accessible
to persons with disabilities, and the recipient must provide reasonable
5
accommodation for the known mental or physical disabilities of otherwise
qualified members, service recipients, applicants, and staff. All selections
and project assignments must be made without regard to the need to
provide reasonable accommodation. As such, inquiries about the need for
reasonable accommodation should take place after a member has been
offered an AmeriCorps position. Please email Accommodations(? ens. go
for more information.
F. Assigning Members to Service Locations. The recipient is required to
ensure that all operating sites and all service locations are entered in the
My AmeriCorps portal for all members within five days of members'
starting a term of service. The recipient is required to include the name of
the organization, and the full address or zip -plus -four of the service
locations where each member will be serving. If a member is serving at
multiple service locations, the program must select as the member's
primary assignment the one where the member serves a majority of his or
her hours. However, all service locations must be listed in the portal.
G. Completion of Terms of Service. The recipient must ensure that each
member has sufficient opportunity to complete the required number of
hours of service to qualify for the education award. Members must be
exited within 30 days of the end of their term of service. If this award
expires or is not renewed, a member who was scheduled to continue in a
term of service may either be placed in another program, where feasible,
or if the member has completed at least 15% of the service hour
requirement, the member may receive a pro -rated education award.
H. Member Exit. In order for a member to receive an education award from
the National Service Trust, the recipient must certify to the National
Service Trust that the member satisfactorily and successfully completed
the term of service, and is eligible to receive the education benefit. The
recipient (and any individual or entity acting on behalf of the recipient) is
responsible for the accuracy of the information certified on the end -of -
term certification.
I. Penalties for false information: Any recipient who makes a materially
false statement or representation in connection with the approval or
disbursement of an education award or other payment from the National
Service Trust may be liable for the recovery of funds and subject to civil
sanctions. Any individual involved malting a materially false statement
may be subject to criminal sanctions.
6
V. SUPERVISION AND SUPPORT
A. Planning for the Term of Service. The recipient must develop member
positions that provide for meaningful service activities and performance
criteria that are appropriate to the skill level of members. The recipient is
responsible for ensuring that the positions do not include or put the
AmeriCoips member in a situation in which the member is at risk for
engaging in any prohibited activity (see 45 CFR § 2520.65), activity that
would violate the non -duplication and non-displacement requirements (see
45 CFR § 2540. 100), or exceeding the limitations on allowable fundraising
activity (see 45 CFR §§ 2520.40-.45). The recipient must accurately and
completely describe the activities to be performed by each member in a
position description. Position descriptions must be provided to CNCS
upon request. The recipient must ensure that each member has sufficient
opportunity to complete the required number of hours to qualify for an
education award. In planning for the member's term of service, the
recipient must account for holidays and other time off, and must provide
each member with sufficient opportunity to make up missed hours.
B. Member Service Agreements. The recipient must require that each
member sign a member sei vice agreement that includes, at a minimum,
the following:
1. Member position description;
2. The minimum number of service hours (as required by statute) and
other requirements (as developed by the recipient) necessary to
successfully complete the term of service and to be eligible for the
education award;
3. The amount of the education award being offered for successful
completion of the terms of service in which the individual is
enrolling,
4. Standards of conduct, as developed by the recipient or sub
recipient;
5. The list of prohibited activities, including those specified in the
regulations at 45 CFR § 2520.65 (see paragraph C, below);
6. The text of 45 CFR § § 2540.100(e) -(fl, which relates to
Nonduplication and Nondisplacement;
7. The text of 45 CFR §§ 2520.40-.45, which relates to fundraising by
members;
S. Requirements under the Drug -Free Workplace Act (41 U.S.C. §
701 et seq.);
9. Civil rights requirements, complaint procedures, and rights of
beneficiaries;
10. Suspension and termination rules;
11. The specific circumstances under which a member may be released
for cause;
12. Grievance procedures; and
13. Other requirements established by the recipient.
The recipient should ensure that the service agreement is signed before
commencement of service so that members are fully aware of their rights
and responsibilities.
C. Prohibited Activities. While charging time to the AmeriCoips program,
accumulating service or training hours, or otherwise performing activities
supported by the AmeriCorps program or CNCS, staff and members may
not engage in the following activities (see 45 CFR § 2520.65):
1. Attempting to influence legislation;
2. Organizing or engaging in protests, petitions, boycotts, or strikes;
3. Assisting, promoting, or deterring union organizing;
4. Impairing existing contracts for services or collective bargaining
agreements;
5. Engaging in partisan political activities, or other activities designed
to influence the outcome of an election to any public office;
6. Participating in, or endorsing, events or activities that are likely to
include advocacy for or against political parties, political
platforms, political candidates, proposed legislation, or elected
officials;
7. Engaging in religious instruction, conducting worship services,
providing instruction as part of a program that includes mandatory
religious instruction or worship, constructing or operating facilities
devoted to religious instruction or worship, maintaining facilities
primarily or inherently devoted to religious instruction or worship,
or engaging in any form of religious proselytization;
Providing a direct benefit to—
a. A business organized for profit;
b. A labor union;
C. A partisan political organization;
d. A nonprofit organization that fails to comply with the
restrictions contained in section 501(c)(3) of the Internal
Revenue Code of 1986 related to engaging in political
activities or substantial amount of lobbying except that
nothing in these provisions shall be construed to prevent
participants from engaging in advocacy activities
undertaken at their own initiative; and
e. An organization engaged in the religious activities
described in paragraph C. 7. above, unless CNCS
assistance is not used to support those religious activities;
9. Conducting a voter registration drive or using CNCS funds to
conduct a voter registration drive;
10. Providing abortion services or referrals for receipt of such services;
and
11. Such other activities as CNCS may prohibit.
AmeriCoips members may not engage in the above activities directly or
indirectly by recruiting, training, or managing others for the primary
purpose of engaging in one of the activities listed above. Individuals may
exercise their rights as private citizens and may participate in the activities
listed above on their initiative, on non-AmeriCorps time, and using non-
CNCS funds. Individuals should not wear the AmeriCorps logo while
doing so.
D. Supervision. The recipient must provide members with adequate
supervision by qualified supervisors consistent with the award. The
recipient must conduct an orientation for members, including training on
what activities are prohibited during AmeriCorps service hours, and
comply with any pre -service orientation or training required by CNCS.
The recipient must ensure that it does not exceed the limitation on member
service hours spent in education and training set forth in 45 CFR §
2520.50.
E. Performance Reviews. The recipient must conduct and keep a record of
at least a midterm and an end -of -term written evaluation of each member's
performance for Full -Time members and an end -of -term written
evaluation for Three -Quarter Time and less than Half-time members. The
end -of -term evaluation should address, at a minimum, the following
factors:
1. Whether the member has completed the required number of hours;
2. Whether the member has satisfactorily completed assignments; and
3. Whether the member has met other performance criteria that were
clearly communicated at the beginning of the term of service.
F. Timekeeping. The recipient is required to ensure that time and attendance
recordkeeping is conducted by the AmeriCorps member's supervisor.
This time and attendance record is used to document member eligibility
for in-service and post -service benefits. The recipient must have a
timekeeping system that is compliant with 2 CFR § 200.430.
If a Professional Corps program wants to follow the timekeeping practices
of its profession and certify that members have completed the minimum
required hours, excluding sick and vacation days, it must get advance
written approval from CNCS. If a State Commission Formula funded
Professional Corps program wants to follow the timekeeping practices of
its profession and certify that members have completed the minimum
required hours, excluding sick and vacation days, it must get advance
written approval from the State Commission.
G. Member Death or Injury. The recipient must immediately report any
member deaths or serious injuries to the designated CNCS Program
Officer.
VI. CHANGES IN MEMBER POSITIONS
A. Changes that Require CNCS Approval. Circumstances may arise
within a program that necessitate changing the type of unfilled
AmeriCoips member positions awarded to a recipient or subrecipient, or
changing the term of service of a currently enrolled member. Note that
once a member is exited with a partial education award, the remaining
portion of that education award is not available for use. The following
changes require written approval from CNCS's Office of Grants
Management as well as written approval and concurrence from the State
Commission or Direct (including National Direct, State Direct, Tribal,
Territory Direct, or Education Award Only (EAP)) recipient:
1. A change in the number of member service year (MSY) positions
in the award;
2. A change in the funding level of the award; and/or
3. A conversion of any position(s) to a three-quarter time member,
regardless of whether it changes the number of member service
year (MSY) positions in the award.
B. Changing Types of Unfilled member positions. Recipients or
subrecipients may change the type of member positions awarded to their
program if:
1. The change does not increase the total MSYs authorized in the
Notice of Grant Award (e.g. one half-time position cannot be
changed to one full-time position); and
2. The change does not result in an increase in the value of the
education award; and,
3. If the award is a Full -cost Fixed Amount or Professional Corps
Fixed Amount award, the member position will be filled by a
member serving in a full-time capacity.
to
Changes in types of member positions may be made by the recipient
directly in the My AmeriCorps Portal.
C. Changing a Term of Service for an enrolled Member. Changes in
terms of service for enrolled members may not result in an increased
number of MSYs for the program. With the exception of Education Award
only awards, recipients with Fixed Amount awards may not convert
members to less -than -full-time member positions. All changes to types of
member positions are subject to availability of funds in the Trust.
Full-time. State Commissions and National Direct Organizations
may authorize or approve occasional changes of currently enrolled
full-time members to less than full-time members. Impact on
program quality should be factored into approval of such requests.
CNCS-provided or funded health care or childcare costs are not
available for less than full-time members. Recipients and
subrecipients may not transfer currently enrolled full-time
members to a less than full-time status simply to provide the
member a less than full-time education award.
2. Three-quarter time. State Commissions and National Direct
Organizations may not authorize or approve changes of currently
enrolled three-quarter time or unfilled three-quarter time members.
Any conversion to a reduced full-time member slot must be
approved by the CNCS PO and GO.
3. Less than Full-time. CNCS discourages changing less than
fulltime members to full-time because it is very difficult to
manage, unless done very early in the member's term of service.
State Commissions and Direct recipients (including National
Direct, State Direct, Tribal, Territory Direct, and Education Award
Only recipients) may authorize or approve such changes so long as
their current budget can accommodate such changes. Programs
must keep in mind that a member's minimum 1700 hours must be
completed within 12 months of the member's original start date.
4. Refilling Member Positions. With the exception of recipients
whose awards have special award conditions under 2 CFR §§
200.207 or 200.338, AmeriCorps State and National programs that
have fully enrolled their awarded member positions are allowed to
replace any member who terminates service before completing 30
percent of his/her term provided that the member who is terminated
is not eligible for and does not receive a pro -rated education
award. Programs may not refill the same member position more
than once.
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As a fail-safe mechanism to ensure that resources are available in
the National Service Trust to finance all earned education awards,
CNCS will suspend refilling if either:
a. Total AmeriCorps enrollment reaches 97 percent of
awarded member positions; or
b. The number of refills reaches five percent of awarded
member positions.
5. Direct recipients may transfer refill member positions between
operating sites as long as they can ensure and document that the
same member position is not refilled more than once. Recipients
and subrecipients will require the assistance of a CNCS Program
Officer in order to transfer refill member positions between
operating sites. Refilled member positions may not be combined
with unfilled member positions.
D. Formula and State Competitive Award Member Position Transfers.
State commissions are allowed to transfer member positions among their
state formula and competitive subrecipients within a given prime grant in
order to maximize enrollment and cost effectiveness without prior
approval. State commissions may not transfer member positions between
competitive and formula subrecipients, or vice -versa. State commissions
may not transfer funds among their competitive subrecipients.
E. Notice to Childcare and Healthcare Providers. Recipients and
subrecipients must immediately notify CNCS's designated agents, in
writing, when a Member's status changes in a manner that affects their
eligibility for childcare or healthcare. See Section VIII.D.
VII. RELEASE FROM PARTICIPATION
Recipients may release members from participation for two reasons: (a) for
compelling personal circumstances; and (b) for cause. See 45 CFR § 2522.230 for
requirements. Whether the reason for the release amounts to circumstances
beyond the member's control is determined by the recipient, consistent with the
criteria listed in 45 CFR § 2522.230(a). Failure to follow the requirements set
forth in regulation (e.g., releasing an individual for a non -compelling personal
circumstance, such as when the individual is leaving to go to school) is considered
non-compliance with award requirements and may result in disallowed costs and
other remedies for non-compliance. The recipient should retain the
documentation supporting its determination to release an individual for
compelling personal circumstances. In addition to the regulations, the following
applies:
12
No Automatic Disqualification if Released, for Cause: A release for cause
covers all circumstances in which a member does not successfully complete
his/her term of service for reasons other than compelling personal circumstances.
Therefore, it is possible for a member to receive a satisfactory performance
review and be released for cause. For example, a member who is released for
cause from a first term–e.g. the individual has decided to take a job offer–but
who -otherwise performed well -would, not be disqualified from enrolling for a
subsequent term as long as the individual received a satisfactory performance
evaluation for the first period of service.
VIII. LIVING ALLOWANCES, OTHER IN-SERVICE BENEFITS, AND TAXES
Requirements related to member living allowances and benefits are in 45 CFR §§
2522.240 and 2522.250. In addition, recipients must ensure that the following
procedures are followed:
A. Living Allowance Distribution. A living allowance is not a wage.
Recipients must not pay a living allowance on an hourly basis. Recipients
should pay the living allowance in regular increments, such as weekly or
bi-weekly, paying an increased increment only on the basis- of increased
living expenses such as food, housing, or transportation. Payments should
not fluctuate based on the number of hours served in a particular time
period, and must cease when the member's service ceases.
If a member serves all required hours and is permitted to conclude his or
her term of service before the originally agreed upon end of term, the
recipient may not provide a lump sum payment to the member. Similarly,
if a member is selected after the program's start date, the recipient must
provide regular living allowance payments from the member's start date
and may not increase the member's living allowance incremental payment
or provide a lump sum to make up any missed payments.
Education Award Program Fixed Amount awards (EAPs) may provide a
living allowance or other in-service benefits to their members, but are not
required to do so. Full -cost and other Fixed Amount recipients must
provide a living allowance to their members.
B. Waiving the Living Allowance. If a living allowance is paid, a member
may waive all or part of the payment of a living allowance if, for example,
he or she believes his or her public assistance may be lost or decreased
because of the living allowance. Even if a member waives his or her right
to receive the living allowance, it is possible—depending on the specific
public assistance program rules—that the amount of the living allowance
that the member is eligible to receive will be deemed available. A
member who has waived the living allowance may revoke the waiver at
13
any time and may begin receiving the living allowance going forward
from the date the individual revoked the waiver. A member may not
receive any portion of the living allowance for the period of time the
living allowance was waived.
C. Taxes and Insurance.
1. Liability Insurance Coverage. The recipient is responsible for
ensuring adequate general liability coverage for the organization,
employees and members, including coverage of members engaged
in on- and off-site project activities.
2. FICA (Social Security and Medicare taxes). Unless the recipient
obtains a ruling from the Social Security Administration or the
Internal Revenue Service that specifically exempts its AmeriCorps
members from FICA requirements, the recipient must pay FICA
for any member receiving a living allowance. The recipient also
must withhold 7.65% from the member's living allowance.
3. Income Taxes. The recipient must withhold Federal personal
income taxes from member living allowances, requiring each
member to complete a W-4 form at the beginning of the term of
service and providing a W-2 form at the close of the tax year. The
recipient must comply with any applicable state or local tax
requirements.
4. Worker's Compensation. Some states require worker's
compensation for AmeriCorps members. Recipients must check
with State Departments of Labor or state commissions to determine
worker's compensation requirements. If worker's compensation is
not required, recipients must obtain Occupational, Accidental, and
Death and Dismemberment coverage for members to cover in-
service injury or incidents.
D. Healthcare Coverage. Except for EAPs, Professional Corps, or members
covered under a collective bargaining agreement, the recipient must
provide, or make available, healthcare insurance to those members serving
a 1700 -hour full-time term who are not otherwise covered by a healthcare
policy at the time the member begins his/her term of service. The recipient
must also provide, or make available, healthcare insurance to members
serving a 1700 -hour full-time term who lose coverage during their term of
service as a result of service or through no deliberate act of their own.
CNCS will not cover healthcare costs for dependent coverage.
Less -than -full-time members who are serving in a full-time capacity for a
sustained period of time (e.g. a full-time summer project) are eligible for
healthcare benefits. Programs may provide health insurance to less -than -
14
full-time members serving in a full-time capacity, but they are not required
to do so. For purposes of this provision, a member is serving in a full-time
capacity when his/her regular term of service will involve performing
service on a normal full-time schedule for a period of six weeks or
more. A member may be serving in a full-time capacity without regard to
whether his/her agreed term of service will result in a full-time Segal
AmeriCorps Education Award.
Any of the following health insurance options will satisfy the requirement
for health insurance for full-time AmeriCorps members (or less than
fulltime members serving in a full-time capacity): staying on parents' or
spouse plan; insurance obtained through the Federal Health Insurance
Marketplace of at least the Bronze level plan; insurance obtained through
private insurance broker; Medicaid, Medicare or military benefits.
AmeriCorps programs purchasing their own health insurance for members
must ensure plans are minimum essential coverage (MEC) and meet the
requirements of the Affordable Care Act.
On Friday May 2, 2014 the U.S. Department of Health and Human
Services (HHS) announced a Special Enrollment Period (SEP) for
members in AmeriCorps State and National programs, who are not
provided health insurance options or who are provided short-terin limited
duration coverage or self-funded coverage not considered MEC. Members
in the AmeriCorps State and National programs and their dependents in
the Federally -facilitated Marketplace (FFM) are eligible to enroll in
Marketplace coverage when they experience the following triggering
events:
• On the date they begin their service terms; and
• On the date they lose any coverage offered through their program
after their service term ends. (Source: 45 CFR § 155.420(d)(9)).
Members have 60 days from the triggering event to select a plan.
Coverage effective date is prospective based on the date of plan selection.
A copy of the HHS Notice, which provides instructions on how to activate
the special enrollment period, is available at
https://www. cros. gov/CCIIO/Resources/Regulations-and-
Guidance/Downloads/SEP-and-hardship-FAQ-5-1-2014.pdf. Members
can also visit healthcare.gov for additional information about special
enrollment periods: https://www.healtheare.gov/coverage-outside-
openenrollment/special-enrollment-period/.
If coverage is being provided via the Healthcare Marketplace, and thus
third party payment is not an option, programs must develop a process to
reimburse members for monthly premiums. Reimbursements for health
insurance premiums are considered taxable income for the member, and
programs must have a way to document such reimbursements.
15
E. Administration of Childcare Payments. In general, CNCS will provide
for childcare payments, which will be administered through an outside
contractor. Requirements and eligibility criteria are in the AmeriCorps
regulations, 45 CFR § 2522.250. CNCS will not cover childcare costs for
members who served on a less than full-time basis for a sustained period
of time, or who have ceased serving or who are serving in a Professional
Corps program. Programs may provide child care to less -than -full-time
members serving in a full-time capacity, but they are not required to do so.
Recipients that choose to provide childcare and will claim the costs of
childcare as matching costs, as approved in their budget, may contact the
childcare contractor for technical assistance. The criteria for member
eligibility are contained in 45 CFR § 2522.250. Also see the
FAQs,
(http://www.nationalservice. gov/sites/default/files/upload/policy%20FAQs
%207.31.14%20fina1%20worlcin,g%20hyperlink.12df) for more detailed
information on administering childcare and healthcare benefits.
F. Notice to Childcare Benefit Administrator and Providers. The program
must notify CNCS's designated agents in writing within five business days
after a member's status changes in a manner that affects the member's
eligibility for childcare. After five days, the recipient will be liable for any
erroneous payments made to a childcare provider for an AmeriCorps
member ineligible to receive AmeriCorps childcare benefits. Examples of
changes in status include: changes to a member's scheduled service so that
he/she is no longer serving on a full-time basis, terminating or releasing a
member from service, suspending a member for cause for a lengthy or
indefinite time period, temporarily suspending a member for cause for a
lengthy or indefinite time period, temporarily suspending a member and/or
any other change in the member's service status that could have an impact
on childcare benefit eligibility. Program directors should contact the
childcare provider on childcare related changes.
IX. MEMBER RECORDS AND CONFIDENTIALITY
A. Recordkeeping. The recipient must maintain records, including the
position description, sufficient to establish that each member was eligible
to participate and that the member successfully completed all program
requirements. A program may store member files electronically and use
electronic signatures if the program can ensure the validity and integrity of
the record and signature is maintained.
The program's electronic storage procedures and system must provide for
the safe -keeping and security of the records, including:
16
1. Sufficient prevention of unauthorized alterations or erasures of
records;
2. Effective security measures to ensure that only authorized persons
have access to records;
3. Adequate measures designed to prevent physical damage to
records; and
4. A system providing for back-up and recovery of records; and
The electronic storage procedures and system provide for the easy retrieval
of records in a timely fashion, including:
1. Storage of the records in a physically accessible
location;
2. Clear and accurate labeling of all records; and 3.
Storage of the records in a usable, readable format.
B. Verification of Eligibility. Unless an individual's social security number
and citizenship are verified through the My AmeriCorps Portal, the
recipient must obtain and maintain documentation as required by 45 CFR
§ 2522.200(c). Programs that receive notice where one of their members
was not verified — either the member's social security number or their
citizenship was not verified — should provide the requested documentation
to CNCS prior to enrolling the member in the program.
Enrolling in the My AmeriCorps portal requires members to certify their
high school status. Such certification fulfills the recipient's verification
requirement to obtain and maintain documentation from the member
relating to the member's high school education. If the member is
incapable of obtaining a high school diploma or its equivalent, as
determined by an independent evaluation, the recipient must retain a copy
of the supporting evaluation.
C. Confidential Member Information. The recipient must maintain the
confidentiality of information regarding individual members. The recipient
must obtain the prior written consent of all members before using their
names, photographs and other identifying information for publicity,
promotional or other purposes. Recipients may release aggregate and
other non -identifying information, and are required to release member
information to CNCS and its designated contractors. The recipient must
permit a member who submits a written request for access to review
records that pertain to the member and were created pursuant to this
award.
17
D. National Service Criminal History Check. The specific requirements of
the National Service Criminal History Check, including the timing and
recordkeeping requirements, are specified at 45 CFR §§ 2540.200 -.207.
See also the final rule and the CNCS website for more information. You
must retain a record of the NSOPW search and associated results either by
printing the screen(s) or by some other method that retains paper or digital
images of the NSOPW checks, inclusive of the date record for when the
search was performed. Inability to demonstrate that you conducted an
NSOPW or the required criminal history check, as specified in the
regulations, may result in sanctions, including disallowance of all or part
of the costs associated with the non-compliance or other remedies that may
be legally available (see 2 CFR § 200.338).
X. BUDGET AND PROGRAMMATIC CHANGES
A. Programmatic Changes. The recipient must first obtain the prior written
approval of the AmeriCorps Program Office before making any of the
following changes (1-3):
1. Changes in the scope, objectives or goals of the program, whether
or not they involve budgetary changes;
2. Substantial changes in the level of member supervision;
3. Entering into additional sub awards or contracts for AmeriCorps
activities funded by the award, but not identified or included in the
approved application and award budget.
Upon notification to the AmeriCorps Program Office, recipients
may make programmatic changes due to, or in response to, an
officially -declared state or national disaster without written
approval from CNCS. As soon as practicable, recipients making
disaster -related programmatic changes must discuss the
recordkeeping, member activities, performance measure
adjustments, and other AmeriCorps award requirements with the
AmeriCorps Program Office. While written approval from CNCS
is not required before making disaster -related programmatic
changes, CNCS reserves the right to limit or deny disaster -related
programmatic changes, including disallowing costs associated with
the disaster related activities.
B. Program Changes for Formula Programs. State Commissions are
responsible for approving the above changes for state formula programs.
18
C. Budgetary Changes. The recipient must obtain the prior written approval
of CNCS's Office of Grants Management before deviating from the
approved budget in any of the following ways:
Specific Costs Requiring Prior Approval before Incurrence under
the uniform administrative requirement, cost principles, and audit
requirements for Federal awards at 2 CFR Parts 200 and 2205.
Certain cost items in 2 CFR Parts 200 and 2205 require approval of
the awarding agency for the cost to be allowable such as pre -award
costs. Please ensure you consult the regulations prior to incurring
costs to ensure allowability.
2. Purchases of Equipment over $5,000 using award funds, unless
specified in the approved application and budget.
3. Unless the CNCS share of the award is $100,000 or less, changes
to cumulative and/or aggregate budget line items that amount to 10
per cent or more of the total budget must be approved in writing in
advance by CNCS. The total budget includes both the CNCS and
recipient shares. Recipients may transfer funds among approved
direct cost categories when the cumulative amount of such
transfers does not exceed 10 percent of the total budget.
D. Approvals of Programmatic and Budget Changes. CNCS's Grants
Officers are the only officials who have the authority to alter or change the
teens and conditions or requirements of the award. The Grants Officers
will execute written amendments, and recipients should not assume
approvals have been granted unless documentation from the Grants Office
has been received. Programmatic changes also require final approval of
CNCS's Office of Grants Management after written recommendation for
approval is received from the Program Office.
E. Exceptions for Fixed Amount Awards. Recipients with Fixed Amount
awards are not subject to the requirements in Section C., Budgetary
Changes, above.
XI. REPORTING REQUIREMENTS
This section applies only to the recipient. The recipient is responsible for timely
submission of periodic financial and progress reports during the project period
and a final financial report and for setting submission deadlines for its respective
subrecipients that ensure the timely submission of recipient reports.
A. Recipient Progress Reports. The recipient shall complete and submit
progress reports in eGrants to report on progress toward achievement of its
approved performance targets.
19
Due Date Reporting Period Covered
April 30 Start of award through March 31
October 31 Start of award year through end of award year or
September 30, whichever is earlier
B. Evidence Based Intervention Planning Grantees Evaluation Plan and
Learning Memo. An evidence based intervention planning grant
recipient must submit a draft evaluation plan and a learning memo 60 days
before the end of the grant period. CNCS will work with the recipient to
ensure that the draft evaluation plan shall include:
1, a description of the theory of change, or why the proposed
intervention is expected to produce the proposed results;
2. clear and measurable outcomes that are aligned with the theory of
change and will be assessed during the evaluation;
3. concrete evaluation questions (or hypotheses) that are clearly
connected to the outcomes; and
4. a proposed research design for the evaluation (to include proposed
data collection methods, instruments, and analysis plans), and
timeline, for the evaluation.
The learning memo should include a statement if the evidence based
intervention planning grant recipient plans to apply for an implementation
grant, and reasons underlying the recipient's decision to apply or not apply
for the implementation grant.
C. Financial Reports. The recipient shall complete and submit financial
reports in eGrants (Financial Status Reports on menu tree) to report the
status of all funds. The recipient must submit timely cumulative financial
reports in accordance with CNCS guidelines according to the following
schedule:
Due Date Reporting Period Covered
April 30 Start of award through March 31
October 31 April 1 — September 30
A recipient must set submission deadlines for its respective subrecipients
that ensure the timely submission of recipient reports.
Cost reimbursement Professional Corps recipients submit one financial
report per year.
All recipients, including Fixed Amount recipients, must submit the Federal
Financial Report (FFR) - Cash Transactions Report on a quarterly basis to
the Department of Health and Human Services Payment Management
System per the Electronic Funds Transfer Agreement.
20
D. Reporting Other Federal Funds. The recipient shall report the amount
and sources of federal funds, other than those provided by CNCS, claimed
as matching funds. This includes other federal funds expended by
subrecipients and operating sites and claimed as match. This information
shall be reported annually on the financial report due October 31St or at the
time the final financial report is submitted if the final report is due prior to
October 31st. Fixed Amount recipients are not required to report this
information.
E. Requests for Extensions. Each recipient must submit required reports by
the given dates. Extensions of reporting deadlines will be granted only
when 1) the report cannot be furnished in a timely manner for reasons, in
the determination of CNCS, legitimately beyond the control of the
recipient, and 2) CNCS receives a written request explaining the need for
an extension before the due date of the report.
Extensions of deadlines for financial reports may only be granted by the
Office of Grants Management, and extensions of deadlines for progress
reports may only be granted by the AmeriCorps Program Office.
F. Final Financial Reports. A recipient must submit, in lieu of the last
semi-annual financial report, a final financial report. This final report is
due no later than 90 days after the end of the project period.
G. Final Progress Reports. A recipient must submit, in addition to the last
semi-annual project report, a final project report. This final report is due
no later than 90 days after the end of the project period.
H. Financial Reports for Fixed Amount Awards. Fixed Amount recipients
are not required to submit financial reports to CNCS, including the final
financial report.
XII. AWARD PERIOD AND INCREMENTAL FUNDING
For the purpose of the award, a project period is the complete length of time the
recipient is proposed to be funded to complete approved activities under the
award. A project period may contain one or more budget periods. A budget
period is a specific interval of time for which Federal funds are being provided to
fund a recipient's approved activities and budget.
Unless otherwise specified, the award covers a three-year project period. In
approving a multi-year project period, CNCS generally makes an initial award for
the first year of operation. Additional funding is contingent upon satisfactory
performance, a recipient's demonstrated capacity to manage an award and comply
21
with award requirements, and the availability of Congressional appropriations.
CNCS reserves the right to adjust the amount of an award, or elect not to continue
funding for subsequent years. The project period and the budget period are noted
on the award document.
A planning grant covers a one-year project period.
XIII. PROGRAM INCOME
A. General. Income, including fees for service earned as a direct result of
the award -funded program activities during the award period, must be
retained by the recipient and used to finance the award's non-CNCS share.
B. Excess Program Income. Program income earned in excess of the
amount needed to finance the recipient share must follow the appropriate
requirements of 2 CFR Part 200 and be deducted from total claimed costs.
Recipients that earn excess income must specify the amount of the excess
in the comment box on the financial report.
C. Fees for Service. When using assistance under this award, the recipient
may not enter into a contract for or accept fees for service performed by
members when:
1. The service benefits a for-profit entity,
2. The service falls within the other prohibited activities set forth in
these award provisions, or
3. The service violates the provisions of 42 U.S.C. § 12637 —
Nonduplication and Nondisplacement.
D. Full -Cost and Professional Corps Fixed Amount Awards. The
recipient must notify its Grants Officer if it earns program income in
excess of the amounts needed to cover all expenditures under the award.
The Grants Officer will determine the disposition of the excess program
income.
XIV. AFETY
The recipient must institute safeguards as necessary and appropriate to ensure the
safety of members. Members may not participate in projects that pose undue
safety risks.
22
XV. NATIONAL SERVICE CRIMINAL HISTORY CHECK TRAINING
All recipients and subrecipients must complete CHCS' National Service Criminal
History Check (NSCHC) training every year. The CNCS designated e -course
provides a thorough overview of the requirements and can be found at:
https://cncsonlinecourses.litmos.com/home/course/325500?1=False&ts=63658973
0256389711. Please use the link http://cncsonlinecourses.litmos.com/self-signup/
and token code CNCS-Litmos to set up your Litmos account. Each grant
recipient and subrecipient must identify at minimum one staff person who has
some responsibility for NSCHC compliance to fulfill this requirement on behalf
of the recipient or subrecipient. The grant recipient and subrecipient must retain
the certificate of completion and assign staff to retake the course annually prior to
the expiration of the certificate. Grant recipients and subrecipients should save
certificates of completion from each year as grant records.
XVI. FIXED AMOUNT AWARDS
Fixed Amount awards are not subject to the cost principles in 2 CFR, Part 200,
Subpart E. Fixed Amount awards must comply with the remaining provisions of
2 CFR Part 200, including Subpart F relating to audit requirements. Fixed
Amount awards include Education Award program (EAP) Fixed Amount awards,
Professional Corps Fixed Amount awards, and Full -Cost Fixed Amount awards.
For Education Award programs (EAP), the fixed federal assistance amount of the
award is based on the approved and awarded number of full-time members
specified in the award. For full -cost and Professional Corps Fixed Amount
awards, the fixed federal assistance amount of the award is based on the approved
and awarded numbers of full-time members and the members' completion of their
terms of service.
For EAPs, the final amount of award funds that the recipient may retain is
dependent upon the recipient's notifying CNCS's National Service Trust of the
members that it has enrolled. All EAP members must carry out activities to
achieve the specific project objectives as approved by CNCS. At closeout, CNCS
will calculate the final amount of the award based on Trust documentation.
CNCS will recover any amounts drawn down by the recipient in excess of the
final award amount allowed based on member selection documentation in the My
AmeriCorps Portal.
For all other Fixed Amount awards, the recipient may draw funds from the HHS
Payment Management System based on the number of members who complete a
full term of service or if the member leaves before completing service, a pro -rated
amount based on hours served.
23
Full -cost and Professional Corps programs may draw up to 20% of the funds
within the first two months to cover start-up costs (recruitment and application,
training, criminal history checks, etc.); however, total funds drawn should be
based on the number of members on board at the time and the percentage of hours
completed. Bi -annually, in some cases quarterly, and at closeout, CNCS will
calculate the final amount of the award for the year or entire project period (at
closeout) based on the number of successfully completed terms of service (as
certified by the program) as well as the hours served that were not certified as
successfully completed.
XVII. BREACHES OF PERSONALLY IDENTIFIABLE INFORMATION (PII)
All recipients and subrecipients need to be prepared for potential breaches of
Personally Identifiable Information, PII. OMB defines PII as any information
about an individual, including, but not limited to, education, financial
transactions, medical history, and criminal or employment history and information
which can be used to distinguish or trace an individual's identity, such
as their name, social security number, date and place of birth, mother's maiden
name, biometric records, etc., including any other personal information which is
linked or linkable to an individual. All recipients and subrecipients must ensure
that they have procedures in place to prepare for and respond to breaches of PII,
and notify the Federal awarding agency in the event of a breach.
If your CNCS grant -funded program or project creates, collects, uses, processes,
stores, maintains, disseminates, discloses, or disposes of PII within the scope of
that Federal grant award, or uses or operates a Federal information system, you
must establish procedures to prepare for and respond to a potential breach of PII,
including notice of a breach of PII to CNCS. Grantees experiencing a breach
should immediately notify CNCS' Office of Information Technology, your CNCS
Program Officer, and CNCS' Office of Inspector General.
24
Exhibit VI
AMENDMENT #
This amendment is made BETWEEN
The Florida Commission on Community Service 3800
Esplanade Way, Suite 180
Tallahassee, Florida 32311
referred to herein as the "Commission"
INSERT
LEAD AGENCY NAME ADDRESS
CITY, STATE, ZIP
referred to herein as the "Provider" amends
2018-2019 Contract for (Insert Program Name)
1. Section , Paragraph is hereby amended to read:
2. This amendment shall begin on . or on the date on which
the amendment has been signed by both parties, whichever is later.
3. All provisions in the contract and any attachments thereto in conflict with this amendment shall
be and are hereby changed to conform with this amendment.
4. All provisions not in conflict with this amendment are still in effect and are to be performed at the
level specified in the contract.
5. This amendment and all its attachments are hereby incorporated into and made a part of the
above cited contract.
IN WITNESS THEREOF, the parties hereto have caused this contract to be executed by their
undersigned officials as duly authorized.
PROVIDER COMMISSION
Signed by: Signed by:
Signature Signature
I<F1iIr
Title
Date
Name
Title
Date
Volunteer Florida
AmeriCorps Program Contract Closeout Checklist
2018-2019 Contract Year
Exhibit XII
PROGRAM NAME:
Instructions: Please initial beside each applicable line item once the task has been completed, indicate "N/A" for any
line item that is not applicable, have the Executive Director or designated authority of your agency sign the certification
located at the bottom, and then return the completed form (with the required attachments) to yourVolunteer Florida
Program Manager.
Mid -year Member Evaluation Forms, End -of -year Member Evaluation Forms, and Member Exit Forms
have been completed for each member and each have been filed in the appropriate member's file.
All Members have been exited on the AmeriCorps Portal with up-to-date contact information (name, email,
phone/cell number).
All Member issues, including those related to an approved national on-line reporting system,
have been satisfactorily oJkd
All Members have been provided information on obtaining their educational award including the number
and website to the Trust office.
All Member timesheets have been audited to ensure accuracy and document that the AmeriCorps
Member met all requirements to earn post service benefits.
All Progress Reports (including final data) has been completed utilizing an approved Volunteer Florida form.
The organization's final report of the 2018-2019 Performance Measures is accurate. Performance
Measurement documentation and records are already on file. The organization agrees to ensure the
adequate maintenance and proper retention of the same, as required for audit purposes (retained for a
period of six years).
The organization has completed the online 2018-2019 AmeriCorps Program Annual Survey, accurately reporting
additional program impact.
Final invoice has been reviewed for compliance with the contractually agreed to match requirements and
subsequently has been approved and submitted on an approved Volunteer Florida form. NOTE: If match
requirements were not satisfied, the final reimbursement amount may be reduced accordingly.
Final expenses, as reported on the final invoice, agree with and have been accurately captured on the
organization's general ledger and accounting system.
All asset and liability accounts applicable to the grant have been properly adjusted to reflect a $0 balance.
All staff member time charged to the grant (including in-kind) is documented and appropriately stored
according to OMB requirements.
All equipment or supplies having an aggregate value of $500 or greater, that were purchased with grant funds
have been properly reported to Volunteer Florida using the Property Inventory Listing.
To be completed for AmeriCorps Programs not continuing beyond the 2018-2019 contract year:
PROGRAM NAME:
All equipment and supplies that were purchased with grant funds have been distributed in
accordance with the instructions provided by Volunteer Florida.
All individual accounts (deposit, accounting, or otherwise), established or maintained with grant funds,
have been closed.
All agreements, equipment rental contracts, grant specific insurance policies, etc., that were established or
m a i n t a i n e d with grant funds have been canceled, effective no later than the grant's contracted expiration
date.
A listing of the individuals designated as the primary contacts for any future Volunteer Florida communication
related to the grant have been attached to this checklist.
NOTE: As a requirement of program closeout, Volunteer Florida requires each organization to
attach a list including the names, titles and current contact information for at least three
individuals who are appropriately positioned to serve as future primary contacts
should Volunteer Florida require additional information (examples: Chair of Board,
Executive Director, and Finance Officer).
Adequate provisions have been made to ensure the satisfactory maintenance and proper retention of all grant
reco rd s for the required period of 6 years, beginning with either the contracted expiration date or the final
res o I u ti o n date of all audit findings, whichever is later.
Location of records:
Contact Person for records:
PROGRAM NAME:
EXECUTIVE DIRECTOR CERTIFICATION:
I certify that (name of agency) has,
to the best of my knowledge:
• satisfiedeach of the applicable requirements indicated by my initials above,
• verified that all required documents and records, including those inferred by the applicable requirements noted herein
arealreadyonfile, and
• agrees to ensure the adequate maintenance and proper retention of the same, as required for audit purposes. I
understand that failureto produce required documentation may result in paybackof federal funds.
Signature of Executive Director or Designated Official
For the use by Volunteer Florida staff.
Date Signed
3
U MW
oi,_ ^r z fIorida
Approval for disbursement of final reimbursement is hereby granted by the Program Office; the
programmatic contract file is complete and no further information is needed.
Signature of authorized Program Staff
Date Signed
Approval for disbursement of final reimbursement is hereby granted by the Finance Office; the
Fiscal contract file is complete and no further information is needed.
Signature of authorized Finance Staff
Date Signed
!!
Volunteer Florida
2018-2019 Property/Equipment Inventory List
Exhibit VIII
Lead Agency:
Program Name:
Contract Number:
Contract Period:
Cumulative inventory list of all property, regardless of purchase date, that has a purchase price of $500 or more bought with funds provided through this subcontract with the Commission.
This includes all computers, desktops and laptop computers, and speciality software other than Windows and Microsoft Office Suite, regardless of the acquisition cost or value.
rand Total
Exhibit X 9/26/2018
Exhibit III: Volunteer Florida National Criminal History Check Status Form
2018-2019 CONTRACT YEAR
8/1/2018
itional Service Criminal History Check Status Form must be completed and submitted online as a Grant Requirement by the
BI and State clearance documents (or proof of initiation, if pending clearance) must accompany the Exhibit III. The NSOPW (NSOPW.gov) must be completed for
vork or service, and the FBI and State checks must be initiated prior to the start of work or service; failure to comply will result in cost disallowance. Failure to
submit this form may result in withholding of reimbursement.
Note: If cells turn red this indicates the check was not compliant
Hire Date NSOPW State 6f Residency Criminal History Check ; FBIFingerprint Criminal History Check
Completed Date Initiated Date Completed Date Initiated Date Completed Date
-dinator 181112018 8/1/2018 8/1/2018 1811512018 8/1/2018 1811512018
P tvned
?ction A. of budget narrative), funded through AmeriCorps CNCS share or grantee share in the Staff tab of
t name.
the current program year in the member tab of this spreadsheet, in alphabetical order by last name.
rs who have not had a break in service of 120 days are not required to conduct new State and FBI checks,
SOPW.
t match dates on the source documentation.
i enrollment date in eGrants.
VOLUNTEER FLORIDA
Attachment V
Updated: 716112
VOLUNTEER FLORIDA
Attachment V
Exhibit V LEAD AGENCY:
PROGRAM:
PROGRAM YEAR: 2018-2019
DATE REVISION SUBMITTED:
Ori final Budget 0 Bud getChan ges
Revised Budget
Justification
Increases/- ) Decreases
CNCS I Grantee I Total 11 JI CNCS I Grantee Total
N.=Grantee Total
SECTION Ill. M
A. Corporation Fixed Percentage
Corporation Fixed Amount $0.00 $0.001 $0.0011
A
$0.(101- $0.00 $0.00
$0.00 so.oill $0.001
Commission Fixed Amount $0.00 $0.00 30 00
$o.DD $0.00 $0.00
30.00 $0.00 $0,00
A. Corporation/Commission Fixed Subtotal: $0.00 $0.00
$0.00
$0.00 $0.001
B. Federally Approved Indirect Cost Rate $0.00 $0.00
-,$0-00
-��f--$0.00
.0 $00
o�r,�,��."'Ll.��ll,"",!rl�"-.,��'�,',
SECTION Ill. SUBTOTAIL- 7 0.0
,$ 0
$ $0.00 JJ�, .�
. 0
so -00 F!", $$,0);00, 0- 0
1'11,��,,ZW,� y; ,
TOTAL $ $ $0.00
CNCS / Gnant ee, Share: #Dl;�/0-10'001 #DFV-10!�� #DrV/01
#DIVID!
#DIV/()!
I #DIV/[)!
i `�: :�.'APPROVED; BY
Date Revision Request sent to Volunt6er Floriclad
.(Following fines to be filled out by Volunteer Florida staff only)
Date Revision Requestreceived by Volunteer Florida: I
VF APPROVAL BY:
Revision Request Approved by Volunteer Florida:
Updated: 7/6/12
VOLUNTEER FLORIDA
Invoice Worksheet
Attachment VII
Effective: 7/6/12
VOLUNTEER FLORIDA Attachment VII
Invoice Worksheet
INVOICE DATES: TO
PROGRAM YEAR: 2018-2019
CURRENT MONTH EXPENSES
CNCS Grantee Total
A. Corporation Fixed Amount $0,00
B. FederalIX Agproved Indirect Cost Rate$o.00
S 0 1d it e? $0.00 $o.00 $0.00
--Commission Fixed Hate.(payaole to VF; VF. will tlraw down; n0 not --:- -
include in total PER Amount $0.00
APPROVED BY must be typed or signed by program) :
Date PER sent to Volunteer Florida:
Effective: 716112