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FY 2016 EDWARD BYRNE JAG GRANTU.S. DEPARTMENT OF JUSTICE OFFICE OF JUSTICE PROGRAMS Approved: OMB No. 1121 -0329 Expires 12/31/2018 The financial management system of each non - Federal entity must provide for the following • Retention requirements for records • Requests for transfer of records • Methods for collection, transmission and storage of information • Access to records • Restrictions on public access to records (1) Identification, in its accounts, of all Federal awards received and expended and the Federal programs under which they were received. Federal program and Federal award identification must include, as applicable, the CFDA title and number, Federal award identification number and year, name of the Federal agency, and name of the pass- through entity, if any. (2) Accurate, current, and complete disclosure of the financial results of each Federal award or program. (3) Records that identify adequately the source and application of funds for federally- funded activities. These records must contain information pertaining to Federal awards, authorizations, obligations, unobligated balances, assets, expenditures, income and interest and be supported by source documentation. (4) Effective control over, and accountability for, all funds, property, and other assets. The non - Federal entity must adequately safeguard all assets and assure that they are used solely for authorized purposes (5) Comparison of expenditures with budget amounts for each Federal award. (6) Written procedures to document the receipt and disbursement of Federal funds including procedures to minimize the time elapsing between the transfer of funds from the United States Treasury or the pass - through entity and the disbursement by the non - Federal entity whether the payment is made by electronic funds transfer, or issuance or redemption of checks, warrants, or payment by other means (7) Written procedures for determining the allowability of costs. APPLICANT ORGANIZATIONAL INFORMATION 1. Name of Organization and Address: City of Clearwater P.O. Box 4748, Clearwater, FL 33758 -4748 2. Authorized Representative's Name and Title: William B. Horne 11, City Manager 3. Phone: 727 - 562 - 4040 ext. 4. Fax: 727 -562- 4052 6. Year Established: 7. Employer Identification Number (EIN): 1915 59 - 6000289 5. Email: William.Horne @MyCleare 8. DUNS Number: 7 - 830 - 7303 9. Type of Organization: fl State Jd Municipality 0 Non - Profit fl Higher Education E Tribal El For - Profit ID Other Page 1 of 3 U.S. DEPARTMENT OF JUSTICE OFFICE OF JUSTICE PROGRAMS Approved: OMB No. 1121 -0329 Expires 12/31/2018 AUDIT INFORMATION An audit is conducted using generally accepted auditing standards (GAAS) Governmental Auditing Standards (GAGAS) and results in an audit report 10. The organization has had the undergone the following types of audit(s)(Please or Generally Accepted with an opinion. check all that apply): Contract Agency Audit (DCAA) • OMB A -133 Single Audit • Financial Statement Audit ❑ Defense ❑ None ❑ Programmatic Audit & Agency: ❑ Other Audit & Agency: 11. Fiscal Year of Last Audit: 2015 Name of Audit Agency /Firm: Cherry Bekaert LLP AUDITOR'S OPINION: 12. On the most recent audit, what was the auditor's opinion? or Adverse Opinions O Unqualified Opinion $ Qualified Opinion * Disclaimer, Going Concern Please enter the number of findings: 1 financial statement finding Please enter the amount of questioned costs: $ 0 Were material weaknesses noted in either the Financial Statement or Single Audit? C Yes ® No ACCOUNTING SYSTEM 13. Which of the following best describes your accounting system: ® Manual M Automated l Combination 14. Does the accounting system identify the receipt and expenditure of program funds separately for each grant? I Yes * No ® Not Sure 15. Does the accounting system provide for the recording of expenditures for each grant/contract by budget cost categories shown in the approved budget? O Yes l No ■ Not Sure 16. Does your accounting system have the capability to document the recording of cost sharing or match for each grant? Can you determine if documentation is available to support recorded match or cost share? D Yes M No M Not Sure 17. Are time distribution records maintained for each employee that specifically identify effort charged to a particular grant or cost objective? O Yes 1 No ® Not Sure 18. Does the accounting /financial system include budgetary controls to preclude incurring obligations or costs in excess of total funds available or by budget cost category (e.g. Personnel, Travel, etc.)? Yes ® No M Not Sure 19. Is the organization familiar with the existing Federal regulation and guidelines containing the Cost Principles and procedures for the determination and allowance of costs in connection with Federal grants? 0 Yes ® No Illl Not Sure Page 2 of 3 U.S. DEPARTMENT OF JUSTICE OFFICE OF JUSTICE PROGRAMS Approved: OMB No. 1121 -0329 Expires 12/31/2018 PROPERTY STANDARDS, PROCUREMENT STANDARDS, AND TRAVEL POLICIES PROPERTY STANDARDS 20. Does your property management system(s) provide for maintaining: (1) a description of the equipment; (2) an identification number; (3) source of the property, including the award number; (4) where title vests; (5) acquisition date; (6) federal share of property cost; (7) location and condition of the property; (8) acquisition cost; & (9) ultimate disposition information? Yes 0 No 0 Not Sure PROCUREMENT STANDARDS 21. Does your organization maintain written procurement procedures which (1) avoid unnecessary purchases; (2) provide an analysis of lease and purchase altematives; and (3) provide a process for soliciting goods and services? Yes Q No D Not Sure 22. Does your procurement system provide for the conduct to determine selection on a competitive basis and documentation of cost or price analysis for each procurement action? Yes D No 0 Not Sure 23. Does your procurement system indude provisions for checking the "Excluded Parties List" system for suspended or debarred sub - grantees and contractors, prior to award? httos: / /www.sam.gov/ Yes 0 No © Not Sure TRAVEL POLICY 24. Does your organization: (a) maintain a standard travel policy? D Yes 0 No (b) adhere to the Federal Travel Regulation? (FTR) D Yes 0 No SUBRECIPIENT MANAGEMENT AND MONITORING 25. (For Pass - through entities only). Does your organization have controls in place to monitor activities of subrecipients, as necessary, to determine that Federal awards are used for authorized purposes in compliance with laws, regulations, and the provisions of the award and that performance goals are achieved (2 CFR200)? D Yes No ❑ Not Sure N/A (Your organization does not make subawards.) STANDARDS FOR FINANCIAL MANAGEMENT SYSTEMS AND APPLICANT CERTIFICATION certify that the above information is complete and correct to the best of my knowledge. This document must be certified by the organization's Authorized Representative, Executive Director, Chief Financial Officer, Chairman of the Board of Directors, or similar position. Name: William B. Horne 11 L4L4 Q- 4-LL1 Date: ro - Title: ® Executive Director f Chief Financial Officer 0 Chairman Other: City Manager Phone: 727 - 562 - 4040 ext. Page 3 of 3 DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure.) Approved by OMB 0348 -0046 1. Type of Federal Action: 2. Status of Federal Action: /application award 3. Report Type: change Change Only: quarter b a. contract b. b a. bid /offer a a. initial filing grant c. cooperative agreement d. loan e. loan guarantee f. loan insurance b. initial c. post -award b. material For Material year date of last report 4. Name and Address of Reporting Entity: , if known: 4c 5. If Reporting Entity in No. 4 is a Subawardee, Enter Name and Address of Prime: Congressional District, if known: © Prime • Subawardee Tier Congressional District, if known: 6. Federal Department/Agency: DOJ /OJP/BJA 7. Federal Program Edward Byrne Memorial CFDA Number, if Name /Description: Justice Assistance Grant Program applicable: 16.738 8. Federal Action Number, if known: 9. Award Amount, if known: $ 51,192 10. a. Name and Address of Lobbying Registrant (if individual, last name, first name, MI): Van Scoyoc Associates 101 Constitution Ave. Ste 600 West Washington, DC 20001 b. Individuals Performing Services (including address if different from No. 10a) (last name, first name, MI): Burns, Greg Sarah Hanson 11, Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Signature: w �� g Print Name: William B. Home II Title: City Manager p 727- 562 -4040 Telephone No.: Date: Federal Use On Authorized ze o Local epr uctto n for Reproduction Standard Form LLL (Rev. 7 -97)