PURCHASE ORDER - PSR52Attachment I
AGREEMENT BETWEEN
FLORIDA DEPARTMENT OF HEALTH
205 Dr. Martin Luther King Jr. St. N., St. Petersburg, FL 33701
AND
CITY OF CLEARWATER
112 S. OSCEOLA AVENUE
CLEARWATER, FL 33756
The State of Florida Purchase Order, being a legal and binding agreement, is sufficient to
procure goods and /or services. This agreement has been created as an attachment to Purchase
Order Number PSR52. The terms and conditions of this agreement shall become part of the
purchase order upon execution May 1, 2015 or when the agreement is signed by both parties,
whichever is later, until termination September 30, 2015. The criteria must be met by completion
of this contract end date.
A. Services to be Provided
1. Definition of Terms.
a. Agreement Terms.
1) Health Department. The Florida Department of Health
(Department) is an executive branch state agency which provides
public health services in Pinellas County. Its county health
department is both state and county funded to provide services in
Pinellas County.
2) Provider. The City of Clearwater, Florida, created by Chapter
9710, Special Laws of Florida, 1923, as amended, exists as a
municipal corporation with all governmental, corporate and
proprietary powers to enable it to conduct municipal government,
perform municipal functions and render municipal services.
3) Partnerships to Improve Community Health (PICH) is a three -year
grant funded by the U.S. Department of Health and Human
Services Centers for Disease Control (CDC) to support
implementation of voluntary policy and systems changes to
encourage healthy choices in physical activity and nutrition local,
state and nationwide.
b. Program Specific Terms.
Corner Stores - Small food stores, which are common in low -
income areas with a high proportion of racial /ethnic minorities,
with limited healthy options and are associated with
overconsumption of high -fat, high -sugar foods and high rates of
obesity and chronic disease.
(http://www.cdc.00v/pcd/issues/2012/11 0015. htm)
Food Deserts - areas characterized by relatively poor access to
healthy and affordable food.
(http: / /www.cdc.gov /pcd /issues /2009/1ul/08 0163.htm)
"Fun Bites Campaign — A local campaign promoting healthy, lower
cost food options in municipal venues including Parks and
Recreation concession stands.
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Attachment 1
At Risk Populations - those of ethnic and /or racial minority status
who experience a disproportionate burden of preventable disease,
death, and disability compared with non - minorities.
http://www.cdc.00v/minoritvhealth/populations/remp.html
2. General Description.
a. General Statement. The Provider will provide a person to assess and
compile a report of the City's current statutes, codes and policies
relating to barriers and /or opportunities for healthy food and
beverage access and improved access to safe, low cost physical
activity opportunities.
b. Authority. Grant Title: Partnerships to Improve Community Health,
CFDA# 93.331, Cooperative Agreement 1 U58DP005597, F.S.
381.0054
c. Scope of Service. The Department received and administers a
federal grant (PICH). The Department will work with public entities
including the Provider to achieve the overall goal of reducing the
prevalence of obesity and chronic diseases in Pinellas County. The
goal through the Provider's purchase order is to provide improved
access to environments with healthy food and beverage options and
improved access to safe, low cost physical activity opportunities.
B. Manner of Service Provision
1. Service Tasks.
a. Task List.
1) Employ, either through the use of existing staff or consulting staff,
a Policy Analyst with a working knowledge of statutes, codes and
policies to assess and compile a report relating to barriers and /or
opportunities for healthy food and beverage access and improved
access to safe, low cost physical activity opportunities.
2) Conduct assessments /surveys of:
i City vending ordinances related to mobile produce sales
ii Assess current parks and trails access points and write a plan
to increase knowledge of access points and usage
iii Conduct farmer's market needs assessments in at risk
population areas as designated by the Department
iv Create a list of corner stores in at risk population areas or
food deserts as designated by the Department and conduct a
survey of local residents regarding the need for fresh produce
in those stores
3) Provide an evaluation plan as requested by PICH evaluation
team.
4) Submit reports required by the Department and CDC.
5) Policy Analyst or delegate will attend monthly in- county meetings.
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Attachment 1
2. Provider Responsibilities
Provider Unique Activities:
The Provider agrees to comply with agreement specifications listed in
B.1.a., C. and D.
3. Health Department Responsibilities
a. The Department will provide technical support for reports and other
information required by CDC.
b. The Department has final authority over approving the quality and
acceptability of service deliverables.
C. Deliverables
1. Designate a Policy Analyst for the PICH Program.
2. Create and perform assessments /surveys of:
i. City vending ordinances related to mobile produce sales
ii. Assess current parks and trails access points and write a plan to
increase knowledge of access points and usage
iii. Conduct farmer's market needs assessments in at risk population
areas as designated by the Department
iv. Create a list of corner stores in at risk population areas or food
deserts and survey local residents on the need for fresh produce
in those stores
3. Attend regularly scheduled monthly PICH partner meetings beginning May, 2015.
D. Minimum Performance Levels
1. Policy Analyst is hired and in place by May 30, 2015.
2. Assessments /surveys submitted to the Department:
i City vending ordinances by June 30, 2015
ii Parks and trails access point plan by July 30, 2015
iii Famers Markets needs assessment by August 30, 2015
iv. Corner store list/survey by September 30, 2015
3. Attend or send delegate to all scheduled PICH partner meetings
Financial Consequences: If monthly deliverables are not met a 5% reduction in
payment will be applied to that month's invoice.
3
E. Method of Payment
1. Payment.
Attachment I
This is a fixed price (fixed fee) agreement. The Department will pay
the Provider for completion of deliverables in accordance with the
terms and conditions of this agreement $7,500 per month for 5
months, for a total dollar amount not to exceed $37,500 subject to
the availability of funds.
2. Invoice Requirement.
a. The Provider shall request payment on a monthly basis through
submission of a properly completed invoice within thirty (30) days
following the end of the month for which payment is being requested.
The invoice must be submitted with the supporting documentation
including a progress report of Section D.
b. Any portion of the deliverable payments received that are not
supported by documentation will be returned to the Health
Department. Deliverables that have not been received or have been
received and determined to be unacceptable will not be paid.
F. CDC Funding Restrictions
1. Funding Restrictions include:
• Provider may not use funds for research.
• Provider may not use funds for clinical care.
• Provider may use funds only for reasonable program purposes,
including personnel, travel, supplies, and services.
• Provider may not use funds to purchase furniture or equipment.
2. No funds may be used for:
• Publicity or propaganda purposes, for the preparation, distribution, or
use of any material designed to support or defeat the enactment of
legislation before any legislative body
• The salary or expenses of any grant or contract recipient, or agent
acting for such recipient, related to any activity designed to influence
the enactment of legislation, appropriations, regulation, administrative
action, or Executive order proposed or pending before any legislative
body
G. Special Provisions
a. Monitoring.
1) The Provider agrees to maintain fiscal records documenting all
expenditures that are applicable to this contract, participant
records, and curriculum materials used in the provision of
services. Records will be available for review by the Department.
4
Attachment 1
2) Monitoring and Evaluation Methodology.
By execution of this agreement the Provider hereby acknowledges
and agrees that its performance under the agreement must meet
the standards set forth above and will be bound by the conditions
set forth below. If the Provider fails to meet these standards, the
department, at its exclusive option, may allow up to one (1) month
for the Provider to achieve compliance with the standards. If the
Department affords the Provider an opportunity to achieve
compliance and the Provider fails to achieve compliance within the
specified time frame, the Department will terminate the agreement
in the absence of any extenuating or mitigating circumstances.
The determination of the extenuating or mitigating circumstances
is the exclusive determination of the health department.
b. No Lobbying. State funds cannot be used to lobby the Executive or
Legislative branches of the Federal Government in connection with
the health department
c. Discriminatory Vendor List. Provider acknowledges it is informed
of provisions of 287.134 (2)(a), F.S., and represents to the health
department that those provisions do not prohibit the health
department from contracting with the Provider or any subcontractors
hereunder.
d. E- Verify system. Provider agrees to utilize the U.S. Department of
Homeland Security's E- Verify system, https: / /e- verify.uscis.gov /emp,
to verify the employment eligibility of all new employees hired during
the contract term by the provider.
e. Public Access. Allow public access to all documents, papers,
letters or other materials subject to the provisions of Chapter 119,
FS, made or received by the Provider in conjunction with this
contract. It is expressly understood that the Provider's refusal to
comply with this provision shall constitute an immediate breach of
contract.
H. Termination
1. Termination at Will
This contract may be terminated by either party upon no Tess than thirty
(30) calendar days' notice in writing to the other party, without cause,
unless a lesser time is mutually agreed upon in writing by both parties.
Said notice shall be delivered by certified mail, return receipt requested,
or in person with proof of delivery.
2. Termination Because of Lack of Funds
In the event funds to finance this contract become unavailable, the
Department may terminate the contract upon no less than twenty -four
(24) hours' notice in writing to the provider. Said notice shall be
delivered by certified mail, return receipt requested, or in person with
proof of delivery. The Department shall be the final authority as to the
availability and adequacy of funds. In the event of termination of this
contract, the provider will be compensated for any work satisfactorily
completed prior to notification of termination.
5
Attachment 1
3. Termination for Breach
This contract may be terminated for the provider's non - performance
upon no Tess than twenty -four (24) hours' notice in writing to the
provider. If applicable, the Department may employ the default
provisions in Chapter 60A- 1.006(3), F.A.C. Waiver of breach of any
provisions of this contract shall not be deemed to be a waiver of any
other breach and shall not be construed to be a modification of the
terms of this contract. The provisions herein do not limit the
Department's right to remedies at law or in equity.
I. Special Provisions for Federal Funds.
a. Authority. Grant Title: Partnerships to Improve Community Health,
Cooperative Agreement 1 U58DP005597, F.S. 381.0054
b. Federal Fund Clause. The approximate amount of federal funds
contained in the total contract amount is $37,500. The Catalogue of
Federal Domestic Assistance (CFDA) number is CFDA# 93.331.
End of Text
6
Attachment I
Attachments: Purchase Order Terms & Conditions
Attachment II Financial and Compliance Audit
FLORIDA DEPARTMENT OF HEALTH in City of CLEARWATER, FLORIDA
PINELLAS COUNTY
By: C:—.C) �,.t..0 / By:
Claude M. aramraj, MD, MPH, F
County Health Department Director
Date: C t (2 , t S Date:
7
City Signature Page for Agreement between
Florida Department of Health and City of Clearwater
Countersigned:
ceor,t nv<V k�
George N. Cretekos
Mayor
Approved as to form:
aa
Ma ewM. S ah
Assistant City Attorney
CITY OF CLEARWATER, FLORIDA
By:
Attest:
14,A6A,Z.
William B. Horne, II
City Manager
Attachment II
ATTACHMENT II
FINANCIAL AND COMPLIANCE AUDIT
The administration of resources awarded by the Department of Health to the Provider may be subject to audits
and /or monitoring by the Department of Health, as described in this section.
MONITORING
In addition to reviews of audits conducted in accordance with OMB Circular A -133, as revised, and Section 215.97,
F.S., (see "AUDITS" below), monitoring procedures may include, but not be limited to, on -site visits by Department of
Health staff, limited scope audits as defined by OMB Circular A -133, as revised, and /or other procedures. By
entering into this agreement, the Provider agrees to comply and cooperate with any monitoring
procedures /processes deemed appropriate by the Department of Health. In the event the Department of Health
determines that a limited scope audit of the Provider is appropriate, the Provider agrees to comply with any additional
instructions provided by the Department of Health to the Provider regarding such audit. The Provider further agrees
to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the Chief
Financial Officer (CFO) or Auditor General.
AUDITS
PART I: FEDERALLY FUNDED
This part is applicable if the Provider is a State or local government or a non - profit organization as defined in OMB
Circular A -133, as revised.
1. In the event that the Provider expends $500,000 or more in Federal awards during its fiscal year, the
Provider must have a single or program- specific audit conducted in accordance with the provisions of OMB
Circular A -133, as revised. EXHIBIT 1 to this agreement indicates Federal resources awarded through the
Department of Health by this agreement. In determining the Federal awards expended in its fiscal year, the
Provider shall consider all sources of Federal awards, including Federal resources received from the
Department of Health. The determination of amounts of Federal awards expended should be in accordance
with the guidelines established by OMB Circular A -133, as revised. An audit of the Provider conducted by
the Auditor General in accordance with the provisions of OMB Circular A -133, as revised, will meet the
requirements of this part.
2. In connection with the audit requirements addressed in Part I, paragraph 1, the Provider shall fulfill the
requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A -133, as revised.
3. If the Provider expends less than $500,000 in Federal awards in its fiscal year, an audit conducted in
accordance with the provisions of OMB Circular A -133, as revised, is not required. In the event that the
Provider expends less than $500,000 in Federal awards in its fiscal year and elects to have an audit
conducted in accordance with the provisions of OMB Circular A -133, as revised, the cost of the audit must be
paid from non - Federal resources (i.e., the cost of such audit must be paid from Provider resources obtained
from other than Federal entities.)
4. An audit conducted in accordance with this part shall cover the entire organization for the organization's
fiscal year. Compliance findings related to agreements with the Department of Health shall be based on the
agreement's requirements, including any rules, regulations, or statutes referenced in the agreement. The
financial statements shall disclose whether or not the matching requirement was met for each applicable
agreement. All questioned costs and liabilities due to the Department of Health shall be fully disclosed in the
audit report with reference to the Department of Health agreement involved. If not otherwise disclosed as
required by Section .310(b)(2) of OMB Circular A -133, as revised, the schedule of expenditures of Federal
awards shall identify expenditures by funding source and contract number for each agreement with the
Department of Health in effect during the audit period. Financial reporting packages required under this part
must be submitted within the earlier of 30 days after receipt of the audit report or 9 months after the end of
the Provider's fiscal year end.
8
Attachment 11
PART II: STATE FUNDED
This part is applicable if the Provider is a nonstate entity as defined by Section 215.97(2), Florida Statutes
1. In the event that the Provider expends a total amount of state financial assistance equal to or in excess of
$500,000 in any fiscal year of such Provider (for fiscal years ending September 30, 2004 or thereafter), the
Provider must have a State single or project- specific audit for such fiscal year in accordance with Section
215.97, Florida Statutes; applicable rules of the Department of Financial Services; Chapters 10.550 (local
governmental entities) or 10.650 (nonprofit and for - profit organizations), and Rules of the Auditor General.
EXHIBIT 1 to this agreement indicates state financial assistance awarded through the Department of Health
by this agreement. In determining the state financial assistance expended in its fiscal year, the Provider
shall consider all sources of state financial assistance, including state financial assistance received from the
Department of Health, other state agencies, and other nonstate entities. State financial assistance does not
include Federal direct or pass- through awards and resources received by a nonstate entity for Federal
program matching requirements.
2. In connection with the audit requirements addressed in Part 11, paragraph 1, the Provider shall ensure that
the audit complies with the requirements of Section 215.97(8), Florida Statutes. This includes submission of
a financial reporting package as defined by Section 215.97(2), Florida Statutes, and Chapter 10.550 (local
governmental entities) or 10.650 (nonprofit and for - profit organizations), Rules of the Auditor General.
3. If the Provider expends less than $500,000 in state financial assistance in its fiscal year (for fiscal years
ending September 30, 2004 or thereafter), an audit conducted in accordance with the provisions of Section
215.97, Florida Statutes, is not required. In the event that the Provider expends less than $500,000 in state
financial assistance in its fiscal year and elects to have an audit conducted in accordance with the provisions
of Section 215.97, Florida Statutes, the cost of the audit must be paid from the nonstate entity's resources
(i.e., the cost of such an audit must be paid from the Provider resources obtained from other than State
entities).
4. An audit conducted in accordance with this part shall cover the entire organization for the organization's
fiscal year. Compliance findings related to agreements with the Department of Health shall be based on the
agreement's requirements, including any applicable rules, regulations, or statutes. The financial statements
shall disclose whether or not the matching requirement was met for each applicable agreement. All
questioned costs and liabilities due to the Department of Health shall be fully disclosed in the audit report
with reference to the Department of Health agreement involved. If not otherwise disclosed as required by
Rule 691- 5.003, Fla. Admin. Code, the schedule of expenditures of state financial assistance shall identify
expenditures by agreement number for each agreement with the Department of Health in effect during the
audit period. Financial reporting packages required under this part must be submitted within 45 days after
delivery of the audit report, but no later than 9 months after the Provider's fiscal year end for local
governmental entities. Non - profit or for - profit organizations are required to be submitted within 45 days after
delivery of the audit report, but no later than 9 months after the Provider's fiscal year end. Notwithstanding
the applicability of this portion, the Department of Health retains all right and obligation to monitor and
oversee the performance of this agreement as outlined throughout this document and pursuant to law.
PART III: REPORT SUBMISSION
Copies of reporting packages for audits conducted in accordance with OMB Circular A -133, as revised, and
required by PART 1 of this agreement shall be submitted, when required by Section .320 (d), OMB Circular
A -133, as revised, by or on behalf of the Provider directly to each of the following:
9
Attachment II
A. The Department of Health as follows:
SingleAudits anflhealth.gov
Audits must be submitted in accordance with the instructions set forth in Exhibit 3 hereto,
and accompanied by the "Single Audit Data Collection Form." Files which exceed 8 MB may
be submitted on a CD or other electronic storage medium and mailed to: Bureau of Finance
& Accounting, Attention: Single Audit Review, 4052 Bald Cypress Way, Bin B01 (HAFA),
Tallahassee, FL 32399 -1729.
B. The Federal Audit Clearinghouse designated in OMB Circular A -133, as revised (the number of copies
required by Sections .320 (d), OMB Circular A -133, as revised, should be submitted to the Federal Audit
Clearinghouse), at the following address:
Federal Audit Clearinghouse
Bureau of the Census
1201 East 10th Street
Jeffersonville, IN 47132
C. Other Federal agencies and pass- through entities in accordance with Sections .320 (e) and (f), OMB
Circular A -133, as revised.
Pursuant to Sections .320(f), OMB Circular A -133, as revised, the Provider shall submit a copy of the
reporting package described in Section .320(c), OMB Circular A -133, as revised, and any management letter
issued by the auditor, to the Department of Health as follows:
SingleAudits a(�flhealth.gov
Audits must be submitted in accordance with the instructions set forth in Exhibit 3 hereto,
and accompanied by the "Single Audit Data Collection Form." Files which exceed 8 MB may
be submitted on a CD or other electronic storage medium and mailed to: Bureau of Finance
& Accounting, Attention: Single Audit Review, 4052 Bald Cypress Way, Bin B01 (HAFA),
Tallahassee, FL 32399 -1729.
3. Additionally, copies of financial reporting packages required by Part II of this agreement shall be submitted
by or on behalf of the Provider directly to each of the following:
A. The Department of Health as follows:
SingleAudits(a)flhealth.gov
Audits must be submitted in accordance with the instructions set forth in Exhibit 3 hereto,
and accompanied by the "Single Audit Data Collection Form." Files which exceed 8 MB may
be submitted on a CD or other electronic storage medium and mailed to: Bureau of Finance
& Accounting, Attention: Single Audit Review, 4052 Bald Cypress Way, Bin B01 (HAFA),
Tallahassee, FL 32399 -1729.
B. The Auditor General's Office at the following address:
Auditor General's Office
Claude Pepper Building, Room 401
111 West Madison Street
Tallahassee, Florida 32399 -1450
4. Any reports, management letter, or other information required to be submitted to the Department of Health
pursuant to this agreement shall be submitted timely in accordance with OMB Circular A -133, Florida
Statutes, and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for - profit organizations),
Rules of the Auditor General, as applicable.
10
Attachment II
5. Providers, when submitting financial reporting packages to the Department of Health for audits done in
accordance with OMB Circular A -133 or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit
and for - profit organizations), Rules of the Auditor General, should indicate the date that the reporting
package was delivered to the Provider in correspondence accompanying the reporting package.
PART IV: RECORD RETENTION
The Provider shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period
of six years from the date the audit report is issued, and shall allow the Department of Health or its designee, the
CFO or Auditor General access to such records upon request. The Provider shall ensure that audit working papers
are made available to the Department of Health, or its designee, CFO, or Auditor General upon request for a period
of six years from the date the audit report is issued, unless extended in writing by the Department of Health.
End of Text
11
Purchase Order #: PSR
EXHIBIT 1
Attachment 11
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS AGREEMENT CONSIST OF
THE FOLLOWING:
Federal Program 1 PICH CFDA# 93.331 Title Partnerships to Improve Community Health $ 37,500
Federal Program 2 CFDA# Title $
TOTAL FEDERAL AWARDS $ 37,500
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO THIS
AGREEMENT ARE AS FOLLOWS:
STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS AGREEMENT CONSIST OF THE FOLLOWING:
State financial assistance subject to Sec. 215.97, F.S.: CSFA# Title $
State financial assistance subject to Sec. 215.97, F.S.: CSFA# Title $
TOTAL STATE FINANCIAL ASSISTANCE AWARDED PURSUANT TO SECTION 215.97, F.S. $
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS AGREEMENT
ARE AS FOLLOWS:
Financial assistance not subject to Sec. 215.97, F.S. or OMB A -133: $
Financial assistance not subject to Sec. 215.97, F.S. or OMB A -133: $
Matching and Maintenance of Effort *
Matching resources for federal program(s):
Program: CFDA# Title $
Maintenance of Effort (MOE):
Program: CFDA# Title $
*Matching Resources, MOE, and Financial Assistance not subject to Sec. 215.97, F.S. or OMB A -133 amounts should not be
included by the Provider when computing the threshold for single audit requirements totals. However, these amounts could be
included under notes in the financial audit or footnoted in the Schedule of Expenditures of Federal Awards and State Financial
Assistance (SEFA). Matching, MOE, and Financial Assistance not subject to Sec. 215.97, F.S. or OMB A -133 is not considered
State /Federal Assistance.
12
Attachment 11
EXHIBIT 2
PART 1: AUDIT RELATIONSHIP DETERMINATION
Providers who receive state or federal resources may or may not be subject to the audit requirements of OMB Circular A -133, as
revised, and /or Section 215.97, Fla. Stat. Providers who are determined to be recipients or subrecipients of federal awards and /or
state financial assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part 1 and /or
Part 11 of Exhibit 1 is met. Providers who have been determined to be vendors are not subject to the audit requirements of OMB
Circular A -133, as revised, and /or Section 215.97, Fla. Stat. Regardless of whether the audit requirements are met, Providers
who have been determined to be recipients or subrecipients of Federal awards and /or state financial assistance must comply with
applicable programmatic and fiscal compliance requirements.
In accordance with Sec. 210 of OMB Circular A -133 and /or Rule 691- 5.006, FAC, Provider has been determined to be:
Vendor not subject to OMB Circular A -133 and/or Section 215.97, F.S.
X Recipient/subrecipient subject to OMB Circular A -133 and/or Section 215.97, F.S.
Exempt organization not subject to OMB Circular A -133 and/or Section 215.97, F.S. For Federal awards, for - profit
organizations are exempt; for state financial assistance projects, public universities, community colleges, district school
boards, branches of state (Florida) government, and charter schools are exempt. Exempt organizations must comply with
all compliance requirements set forth within the contract or award document.
NOTE: If a Provider is determined to be a recipient/subrecipient of federal and or state financial assistance and has been
approved by the department to subcontract, they must comply with Section 215.97(7), F.S., and Rule 691- .5006, FAC [state
financial assistance] and Section _ .400 OMB Circular A -133 [federal awards].
PART 11: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive Federal awards, state
maintenance of effort funds, or state matching funds on Federal awards and who are determined to be a subrecipient, must
comply with the following fiscal laws, rules and regulations:
STATES, LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR 225 a /k/a OMB Circular A -87 — Cost Principles*
OMB Circular A -102 — Administrative Requirements **
OMB Circular A -133 — Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
NON - PROFIT ORGANIZATIONS MUST FOLLOW:
2 CFR 230 a /k/a OMB Circular A -122 — Cost Principles*
2 CFR 215 a /k/a OMB Circular A -110 — Administrative Requirements
OMB Circular A -133 — Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
EDUCATIONAL INSTITUTIONS (EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT) MUST FOLLOW:
2 CFR 220 a /k/a OMB Circular A -21 — Cost Principles*
2 CFR 215 a /k/a OMB Circular A -110 — Administrative Requirements
OMB Circular A -133 — Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
*Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in the OMB
Circular A -133 Compliance Supplement, Appendix 1.
* *For funding passed through U.S. Health and Human Services, 45 CFR 92; for funding passed through U.S. Department
of Education, 34 CFR 80.
STATE FINANCIAL ASSISTANCE. Providers who receive state financial assistance and who are determined to be a
recipient/subrecipient, must comply with the following fiscal laws, rules and regulations:
Section 215.97, Fla. Stat.
Chapter 691 -5, Fla. Admin. Code
State Projects Compliance Supplement
13
Attachment 11
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
Additional audit guidance or copies of the referenced fiscal laws, rules and regulations may be obtained at
http: / /www.doh.state.fl.us/ by selecting "Contract Administrative Monitoring" in the drop -down box at the top of the Department's
webpage. * Enumeration of laws, rules and regulations herein is not exhaustive or exclusive. Fund recipients will be held to
applicable legal requirements whether or not outlined herein.
14
Attachment II
EXHIBIT 3
INSTRUCTIONS FOR ELECTRONIC SUBMISSION
OF SINGLE AUDIT REPORTS
Single Audit reporting packages ( "SARP ") must be submitted to the Department in an electronic format. This change will eliminate
the need to submit multiple copies of the reporting package to the Contract Managers and various sections within the Department
and will result in efficiencies and cost savings to the Provider and the Department. Upon receipt, the SARP's will be posted to a
secure server and accessible to Department staff.
The electronic copy of the SARP should:
➢ Be in a Portable Document Format (PDF).
➢ Include the appropriate letterhead and signatures in the reports and management letters.
Be a single document. However, if the financial audit is issued separately from the Single Audit
reports, the financial audit reporting package may be submitted as a single document and the Single
Audit reports may be submitted as a single document. Documents which exceed 8 megabytes (MB)
may be stored on a CD and mailed to: Bureau of Finance & Accounting, Attention: Single Audit
Review, 4052 Bald Cypress Way, Bin B01 (HAFA), Tallahassee, FL 32399 -1729.
➢ Be an exact copy of the final, signed SARP provided by the Independent Audit firm.
➢ Not have security settings applied to the electronic file.
➢ Be named using the following convention: [fiscal year] [name of the audited entity exactly as stated within the audit
report].pdf. For example, if the SARP is for the 2009 -10 fiscal year for the City of Gainesville, the document should be
entitled 2010 City of Gainesville.pdf.
➢ Be accompanied by the attached "Single Audit Data Collection Form." This document is necessary to ensure that
communications related to SARP issues are directed to the appropriate individual(s) and that compliance with Single
Audit requirements is properly captured.
Questions regarding electronic submissions may be submitted via e-mail to SingleAuditsflhealth.gov or by telephone to
the Single Audit Review Section at (850) 245 -4444 ext. 4186.
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Single Audit Data Collection Form
GENERAL INFORMATION
1. Fiscal period ending date for the Single Audit.
Month Day Year
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2. Auditee Identification Number
a. Primary Employer Identification Number (EIN)
b. Are multiple EINs covered in this report ID Yes El No
c. If "yes ", complete No. 3.
3. ADDITIONAL ENTITIES COVERED IN THIS REPORT
Employer Identification #
Name of Entity
4. AUDITEE INFORMATON
a. Auditee name:
b. Auditee address (number and street)
City
State Zip Code
City
Title:
State
Zip Code
c. Auditee contact
Name:
Title:
d. Auditee contact telephone
( ) -
e. Auditee contact FAX
( ) -
f. Auditee contact E -mail
5. PRIMARY AUDITOR INFORMATION
a. Primary auditor name:
b. Primary auditor address (number and street)
City
State Zip Code
c. Primary auditor contact
Name:
Title:
d. Primary auditor contact telephone
( ) -
e. Primary auditor E -mail
( ) -
f. Audit Firm License Number
6. AUDITEE CERTIFICATION STATEMENT — This is to certify that, to the best of
my knowledge and belief, the auditee has: (1) engaged an auditor to perform
an audit in accordance with the provisions of OMB Circular A -133 and /or
Section 215.97, Fla. Statutes, for the period described in Item 1; (2) the auditor
has completed such audit and presented a signed audit report which states
that the audit was conducted in accordance with the aforementioned Circular
and /or Statute; (3) the attached audit is a true and accurate copy of the final
audit report issued by the auditor for the period described in Item 1; and (4)
the information included in this data collection form is accurate and complete.
I declare the foregoing is true and correct.
AUDITEE CERTIFICATION
Date Audit Received From Auditor:
Name of Certifying Official:
(Please print clearly)
Title of Certifying Official:
(Please print clearly)
Signature of Certifying Official:
Date
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