2014-20 Land & Water Conservation Fund Program GrantRESOLUTION 2014 -20
A RESOLUTION OF THE VILLAGE COUNCIL OF THE VILLAGE OF NORTH
PALM BEACH, FLORIDA, APPROVING A PROJECT AGREEMENT WITH
THE STATE OF FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
FOR THE RECEIPT OF $200,000 IN MATCHING GRANT FUNDS FOR THE
ANCHORAGE PARK IMPROVEMENTS PROJECT AND AUTHORIZING THE
MAYOR AND VILLAGE CLERK TO EXECUTE SAME; AUHORIZING THE
APPROPRIATION OF MATCHING FUNDS; PROVIDING FOR CONFLICTS;
AND PROVIDING FOR AN EFFECTIVE DATE.
WHEREAS, the Village and the State of Florida Department of Environmental Protection ( "DEP ")
Land and Water Conservation Fund Program seek to enter into a Project Agreement whereby DEP
will provide the Village with $200,000 in matching grant funds for the Anchorage Park
Improvements Project; and
WHEREAS, the approval of the Project Agreement will require the Village to appropriate $200,000
from the Unassigned Fund Balance to provide matching funds by separate ordinance; and
WHEREAS, the Village Council determines that approval of the Project Agreement and the
appropriation of matching funds benefits the health, safety and welfare of the Village and its residents.
NOW, THEREFORE, BE IT RESOLVED BY THE VILLAGE COUNCIL OF THE VILLAGE OF
NORTH PALM BEACH, FLORIDA, as follows:
Section 1. The foregoing recitals are hereby adopted and incorporated herein.
Section 2. The Village Council hereby approves the Project Agreement between the Village and
DEP, a copy of which is attached hereto and incorporated herein, and authorizes and directs the
Mayor and Village Clerk to execute the Agreement on behalf of the Village. The Village Council
further authorizes the appropriation of $200,000.00 in matching funds from the Unassigned Fund
Balance to be accomplished by separate ordinance.
Section 3. All resolutions and parts of resolutions in conflict herewith are hereby repealed the
extent of such conflict.
Section 4. This Resolution shall take effect immediately upon adoption.
PASSED AND ADOPTED THIS 27th DAY OF MARCH, 2014.
(VillagA Seal)
ATTEST:
VILLAGE CLERK
k OC4"'��
'L-4� I AYOR
12 -00604
(LWCF Project Number)
LW604
DEP Contract Number
CFDA Number: 15.916
FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
LAND AND WATER CONSERVATION FUND PROGRAM
FY 2012 -2013
PROJECT AGREEMENT - DEVELOPMENT
This Project Agreement is entered into between the FLORIDA DEPARTMENT
OF ENVIRONMENTAL PROTECTION, whose address is 3900 Commonwealth
Boulevard, Tallahassee, Florida 32399 -3000 (hereinafter called the "Department "), and
the Village of North Palm Beach, whose address is 501 US Hwy 1 , North Palm
Beach, Florida, 33408 (hereinafter called the "Grantee "), a local government, in
furtherance of the Anchorage Park Project, an approved Outdoor Recreation Project.
WHEREAS, the Department receives funds from the U.S. Department of the
Interior, National Park Service, for the purpose of passing through the agency as grants
to other entities in accordance with Section 375.021(4), Florida Statutes; and,
WHEREAS, Chapter 375, Florida Statutes, further authorizes the Department to
receive grants for Outdoor Recreation and conservation; and,
WHEREAS, the Grantee has submitted Project Application number 776, which
has been approved by the Department.
NOW, THEREFORE, in consideration of the mutual covenants contained herein,
the Department and Grantee do hereby agree as follows:
1. This Project Agreement shall become effective upon execution by both parties
and the Grantee shall complete construction of all Project Elements on or before
(hereinafter referred to as the Project Completion Date).
Within thi y (30) days from this project completion date, all payment requests
and completion documentation will be due to the Department. The Project
\ Agreement shall be performed in accordance with Chapter 62D -5, Part VII,
\ Florida Administrative Code (F.A.C.), effective July 15, 2001 (hereinafter called
the Rule); the Land and Water Conservation Fund (LWCF) Act of 1965, Public
Law 88 -578, 78 Stat 897, as amended, (hereinafter called the LWCF Act or the
Program); and with general provisions for such agreements prescribed by the
United States Department of the Interior (hereinafter called the USDOI) in the
LWCF Grants -in -Aid Manual, (hereinafter called the Manual) including the Code
of Federal Regulations (CFRs) referenced below. The Manual refers to the
DEP 55 -239 (9/12)
DEP Agreement No LW604, Page 1 of 17
CFRs applicable. _)this Project Agreement. The follo�..,ig table identifies several
of the key CFRs addressed in the Manual, but does not limit the Grantee to
compliance with only the CFRs identified in the table.
CFR Cite
Title
36 CFR 59
Land and Water Conservation Fund Program Assistance to States; Post-
Completion Compliance. Responsibilities
36 CFR 800.8
Coordination With.the National Environmental Policy Act
43 CFR 12
Administrative and Audit Requirements and Cost. Principles for Assistance
Programs.
43 CFR 17
Nondiscrimination in. Federally Assisted Programs of the Department of
Interior
The Grantee agrees to become familiar with all provisions and comply with the
Rule and Manual, including the above- stated provisions of the CFR, which are
incorporated into this Project Agreement by reference, as if fully set forth herein.
In the event a dispute should arise. between the parties concerning the intent of
any language herein contained, the same shall be resolved by the adoption of
that meaning which furthers the intent and purpose of the Program and the
general provisions governing this Project Agreement as set forth in the Manual
No construction shall be contrary to the requirements of any Act of Congress or
of the regulations of the Secretary of the - Interior. This Project Agreement shall
be read in conjunction with the Rule. Unless defined. herein, capitalized terms
used in this Project. Agreement shall have the same meaning as those set forth in
the Rule.
2. The Department has found that public Outdoor Recreation is the primary purpose
of the Project known as Anchorage Park (Land and Water Conservation Fund,
LWCF Project Number 12- 00604), hereinafter called the Project, and enters into
this Project Agreement with the Grantee for the Development of that Real
Property identified in the Project Application, the legal description of which shall
be submitted to the Department on the Land and Water Conservation Fund
Program Approved Project Documentation Form, DEP . Form FPS -A048. The
approved Project Work Plan, which includes the Project Elements (description of
Project detailed budget, and anticipated deliverables) identified in the Project
Application, is incorporated into this Project Agreement as Attachment A,
Project Work Plan.
3. The Grantee shall construct, or cause to be constructed, specified .public Outdoor
- Recreation Facilities and improvements consisting of the following Project
Elements: Multi -use trail, kayak launch; .nature. observation deck, renovation
of picnic facility and bike trail; landscaping and lighting and other related
support facilities, as identified in the Grantee's approved Project Application
and Attachment A. These Project Elements may be modified by the Department
if the Grantee shows good cause and the Department approves the modification.
Any revisions to the Project Elements as set forth in the approved Project Work
Plan must be formally requested by the Grantee and, if agreed upon by the
DEP 55- 239(9/12)
DEP Agreement No LW604, Page 2 of 17
Department, the modifications will be reduced to writing in an amendment to this
Project Agreement..
4. The Project Elements identified in paragraph 3 herein shall be designed and
constructed substantially in accordance with the conceptual site Development
plan contained in the approved Project Application and Attachment A. Project
Site Facilities shall be attractive for public use, and generally consistent and
compatible with the environment. Plans and specifications for Project Site
improvements and Facilities shall be in accordance . with current and established
engineering and architectural standards and practices. Emphasis should be
given to the health and safety of users, accessibility to the general public, and the
protection of the recreational and natural values of the area. This site
Development plan may be altered by the Grantee, only after written approval by
the Department. Any and all utility lines . installed within the site shall be placed
underground. The Grantee shall have the final site Development plan (site
engineering and architectural) prepared by a registered architect or engineer
licensed in accordance with the laws of the State of Florida.
5. A. As consideration for the services rendered by the Grantee under the terms
of this Project Agreement, the Department shall pay the Grantee on a cost
reimbursement basis in an amount not to exceed $200,000.00 toward the
total Project Cost described in the approved Project Work Plan. Program
fund limits are based upon the following:
Total Grantee Amount $ 200,000.00 (paid by the Department)
Grantee Match Amount $ 200,000.00 (paid by the Grantee)
Total Project Cost $400,000:00
Type of Match Cash and /or In -Kind Services
B. The Grantee shall submit a request for payment upon submittal of all
documentation required in Attachment A. Within sixty (60) days after
receipt of a request for payment from the Grantee, the Department's Grant
Manager shall review the completion documentation and payment request
from the Grantee for the Project. If the documentation is sufficient and
meets the requirements of the Land and Water Conservation Fund
Program Required Project Completion Documentation Form, DEP Form
FPS -A051, referenced in Rule 62D- 5.073(7)(e)2, F.A.C., the Department
will approve the request for payment. A final payment request must be
submitted to the Department no later than thirty (30) days from the Final
Completion Date, to assure the availability of funds for payment. Each
payment request submitted shall document all matching funds and /or
Match efforts (i.e. In -Kind services) provided during the period covered by
each request. The final payment will not be processed until the Match
requirement has been met.
6. In addition to the invoicing requirements contained in paragraph 5.13. above, and
DEP 55 -239 (9/12)
DEP Agreement No LW604, Page 3 of 17
with the exceptL. of the documentation required L, )paragraph 9 below, :the
Department will periodically request proof of a transaction (invoice, payroll
register, etc.) to evaluate the appropriateness of costs to the Project Agreement
pursuant to State and Federal guidelines (including cost allocation guidelines), as
appropriate. When requested, this information. must be provided within thirty (30)
calendar days of such request The Grantee may also be required to submit a
cost allocation plan to the Department in support of its multipliers (overhead;
indirect, general administrative costs, and fringe benefits). All bills for amounts
due under this Project Agreement shall be submitted in detail sufficient for a
proper pre -audit and post -audit thereof. State. guidelines. for allowable -costs can
be found in the Department of Financial Services' Reference Guide for State
Expenditures at http://www.fldfs.com/aadir/reference%5F uide; allowable costs
for Federal Programs can be found under 48 CFR Part 31 and Appendix E of 45
CFR Part 74, at http: / /www.access.gpo.gov/ nary /cfr /cfr- table- search.html and
OMB Circulars A -87(2 CFR, Part 225), A -122 (2 CFR; Part 230), A -21 (2 CFR,
Part 220); and administrative requirements can be found in OMB Circulars A -102
2 CFR, 215 at:
and A -110 R
http : / /www.whitehouse.gov /omb /circulars /index.html #numerical.
7. Reimbursement for travel expenses is not authorized under this Project
Agreement.
8. The purchase of non - expendable equipment is not authorized under the terms of
this Project Agreement.
9. Contractual (Subcontractors) - Payments to subcontractors must .be
substantiated by copies of invoices with backup documentation identical to that
required from the Grantee. Subcontracts which involve payments for direct
salaries shall clearly identify the personnel involved, salary rate per hour, and
hours /time spent on the project. All multipliers used (i.e. fringe benefits,
overhead, and /or general and administrative rates) shall be supported by audit.
If the Department determines that multipliers charged by any subcontractor
exceeded the rates supported by audit, the Grantee shall be required to
reimburse such funds to the Department within thirty (30) days of written
notification. Interest on the excessive charges shall be calculated based on the
prevailing rate used by the State Board of Administration. Additionally,
independent of the Grantee's contract; obligations to the Subcontractor, the
Department shall not reimburse any of the following types of charges: cell phone
usage, attorneys' fees other than title work, civil or administrative penalties,
handling fees, such asset percent overages associated with purchasing supplies
or equipment. All subcontracts are subject to the provisions of paragraphs 6; 29
and 30 and any other appropriate provisions of this Agreement which affect
subcontracting activities
10. The Grantee agrees to comply with the Division of Recreation and. Parks'
Financial Reporting Procedures, formerly known as the Grant and Accountability
DEP 55- 239(9/12)
DEP Agreement No LW604, Page 4 of 17
Procedures (het - Wafter called "the Procedure ") inc_.porated into this Project
Agreement by reference as if fully set forth herein. All purchases of goods and
services for accomplishment of the Project shall be secured in accordance with
the procurement requirements specified in 43 CFR 12.76: Expenses
representing the Project Costs, including the required matching contribution, shall
be reported to the Department and summarized on certification forms referenced
in the Procedure. The Department and Grantee agree to use the Procedure
guidelines in accounting for LWCF funds disbursed under, the Project. The
parties .further agree that the principles for determining. the eligible costs,
supporting documentation and minimum reporting requirements of the Procedure
shall be used.
11. Allowable indirect costs, as defined in the Procedure, shall not exceed 15% of
the. Grantee's eligible salaries /wages. Indirect costs that exceed 15% must be
approved .in advance and in writing .by. the Department to be considered eligible
Project expenses,
12. Project funds may be reimbursed for eligible Preagreement Expenses (as
defined in Rule 62D- 5.069(31) F.A.C.) incurred by the Grantee prior to execution
of this Project Agreement as set forth in Rule 62D= 5:073(2); F.A.C. The
Department and the Grantee fully understand and agree that there shall be no
reimbursement of Project funds by the Department for any expenditure made
prior to the execution of this Project Agreement with the exception of the
following expenditures, which meet the requirements of the foregoing sections of
the Rule.
Preagreement Expenses Approved:
Total Preagreement Expenses Approved:
$0
13. A. Prior to commencement of Project Development, the Grantee shall submit
to the Department the documentation required by the Land and Water
Conservation Fund Program Required Project Commencement
Documentation Form, DEP Form FPS -A050, referenced in Rule 62D-
5.073(7)(e), F.A.C. Upon determining that the documentation complies
with the Rule, the Department will give written notice to Grantee to
commence the Development and approve the request for payment.
B. Upon execution of this Project Agreement, the Grantee acknowledges the
prior receipt of the LWCF Grants-in-Aid Manual, the Division of Recreation
and Parks' Financial Reporting Procedures, and the 'required Project
DEP 55 -239 (9/12)
DEP Agreement No LW604, Page 5 of 17 -
11
comment,..vent documents Listed: below. that' ..,Gst be .completed by the
Grantee; if applicable; and returned to the Department. within sixty (60)
days following the execution date of this Project Agreement. This date
may be extended upon written approval from the Department Grant
Manager, who is authorized to sign such approval letters.
C. Required Project Commencement Documentation for Development
Agreements:
1. A professional site plan (detail specifications not required). A
graphic document of the proposed Development that shows the
location of all existing and proposed buildings, . Facilities, etc. that is
signed and dated by the Project liaison. If part of a larger
simultaneous Development or part of a phased Project, please
color . code the current Project Elements and /or any
phases /existing elements: (3 copies)
2. Commencement Certification (Form FPS -A035)
3. A boundary survey of the Project Site, which includes a legal
description and sketch of the site's boundaries, display known
easements and encroachments, if any, be legally sufficient to
identify the site, and must be signed and sealed by a professional
surveyor and mapper licensed under provisions of Chapter 472;
F.S. The boundary survey submitted must not be larger than 11 in. x
17in. (3 copies)
4. The results of a title search or opinion prepared by a member of the
Florida Bar or Licensed title insurer of the Project area covering the
thirty (30) year period prior to approval by Department Secretary,
which attests to a clear title Owned. by the Grantee, with no liens,
encumbrances or taxes held against the property or a copy of title
insurance. A warranty deed will not suffice,
5. If Land Value will be used as a Match, send either a copy of the
taxed assessed value or a complete appraisal supporting fair market
value of land utilized as Project matching funds. Appraisal must be
no earlier than one year prior to the closing date of the submission
period. The appraisal must be prepared by an appraiser
included. on the list of approved appraisers maintained by. the
Department's Division of State Lands (DSL). (CALL 850 -245-
2658) (1 Copy)
6. Certification of Manual Possession (Form FPS -A059)
14. The Grantee shall obtain all required local, state and federal permits and
approvals prior to commencement of Project construction and shall certify that it
DEP 55- 239(9/12)
DEP Agreement No LW604, Page 6 of 17 -
has done so to LJ Department by completing the Lai. ;and Water Conservation
Program Commencement Certification, DEP Form FPS -A052 referenced in Rule
- 62D- 5.073(7)(e)(1), F.A.C.
15. The Grantee shall complete all ProJect construction as identified in Attachment A,
by the completion date established in paragraph 1, above.
16. Project completion means the Project is open and available for use by the public.
The Project must be verified to have. reached Project completion prior to release
of final reimbursement.
17. A. The Grantee shall maintain books, records and documents directly
pertinent to performance under this Project Agreement in accordance with
generally accepted accounting. principles consistently applied. The
Department, the.. State, or their authorized representatives shall have
access to such records for audit purposes during the term of this Project
Agreement and for five (5) years following Project. Agreement completion.
In the event any work is subcontracted, the Grantee shall similarly .require
each subcontractor to maintain and allow access to such records for audit
purposes.
B. The Grantee agrees that if any litigation; claim, or audit is started before
the expiration of the record retention . period established above, the
records shall be retained until all litigation, claims or audit findings
involving the records have been resolved and final action taken:
I
18. A. In addition to the requirements .of the preceding paragraph; the Grantee
shall comply with the applicable. provisions contained in Attachment. B
(Special Audit Requirements), attached hereto and made a part hereof.
Exhibit 1. to Attachment B summarizes the funding sources :supporting
the Project Agreement for purposes of assisting the Grantee in complying
with the requirements of Attachment B.. A revised copy of Exhibit 1 must
be provided to the Grantee for each amendment which. authorizes a
funding increase or decrease. If the Grantee fails to receive a revised
copy of Exhibit 1, the Grantee.: shall notify the Department's Grant
Manager identified in paragraph 22, to request a copy of the updated
information.
B. The Grantee is hereby advised that the Federal and /or Florida Single
Audit Act Requirements may further apply to lower tier transactions that
may be a result of. this Project Agreement. The Grantee shall consider the
type of financial assistance (federal and /or state) identified in Attachment
B, Exhibit 1 when making its determination. For federal financial
assistance, the Grantee shall utilize the guidance provided under OMB
Circular A -133, Subpart B, Section .210 for determining whether the
relationship represents that of a subrecipient or vendor. For state financial
DEP 55- 239 (9/12)
DEP Agreement No LW604, Page 7 of 17
assistanc,, %the Grantee shall utilize the fL-11 entitled "Checklist for
Nonstate Organizations Recipient/Subrecipient vs. Vendor Determination"
(form number DFS- A2 -NS) that can be found under the "Links /Forms'
section appearing at the following website.:
https \ \apps.fldfs.com \fsaa
The Grantee should confer with its chief financial officer, audit: director or
contact the Department . for assistance with questions pertaining to the
applicability of these requirements.
C. In addition, the Grantee agrees to complete and submit the Certification
of Applicability to Single Audit Act Reporting, Attachment C, attached
hereto and made a part hereof, within four (4) months following the end of
the Grantee's fiscal _year. Attachment C shall be submitted to the
Department's Grants Development and Review Manager at 3900
Commonwealth Boulevard, Mail Station 93, Tallahassee, Florida 32399-
3000. The Grants Development and Review Manager is available to
answer any questions at (850) 245 -2361.
19. Following receipt of an audit report identifying any reimbursement due the
Department for the Grantee's noncompliance with this Project Agreement, the
Grantee will be allowed a maximum. of thirty (30) days to submit additional
pertinent documentation to offset the amount identified as being' due to the
Department. The Department, following a review of the documentation submitted
by the Grantee, will inform the Grantee of any reimbursement due the
Department.
20. The Grantee, as an independent contractor and not an agent, representative, or
employee of the Department, agrees to carry adequate liability and other
appropriate forms of insurance. If the Grantee is self - funded for liability
insurance, as appropriate and allowable' under Florida law, then the Grantee
_warrants and represents that such self- insurance offers protection. applicable to
the Grantee's officers, employees,. servants and agents while acting within the
scope of their employment with the Grantee The Department shall have no
liability except as specifically provided in this Project Agreement.
21. To the extent required by law, the Grantee will be self- insured against, or will
secure and maintain during the life of this Project Agreement, Workers'
Compensation Insurance for all of its employees connected with the work of this
Project and, in case any work is subcontracted, the Grantee shall require the
subcontractor to similarly provide Workers' Compensation Insurance for all of the
subcontractor's employees unless such employees are covered by the protection
afforded by the Grantee. Such self- insurance program or insurance coverage
shall comply fully with the Florida Workers' Compensation law. In case any class
of employees engaged in hazardous work under this Project Agreement is not
protected under Florida Workers' Compensation laws .,!fe Grantee shall provide,
and cause each subcontractor to provide, .adequate insurance satisfactory to the
Department, for the protection of those employees not otherwise protected.
22. The Department's Grant Manager, as identified below, or his /her successor for
the purpose of this Project Agreement shall be responsible for ensuring
performance of its terms and conditions and shall approve all reimbursement
requests prior to payment. The Grantee's Liaison Agent (also known as
Grantee's Grant Manager), as identified in the Project Application, or successor,
shall act on behalf of the Grantee relative to the provisions of this Project
Agreement. The Grantee's Liaison Agent shall submit to the Department signed
Project status reports three times per year, due on January 5, May 51. and
September 5, summarizing the work accomplished, problems encountered,
percentage of completion, and other information which may be requested by the
.Department. Photographs to reflect.the construction work accomplished shall be
submitted when the Department requests them. Any and all notices shall be
deemed effective and sufficient if sent via U.S. mail, facsimile (fax), electronic
mail, or by hand- delivery to the parties at the following addresses:
Grantee's Liaison Agent
Name: Mark Hodgkins, Director, Parks and
Recreation or his /her Successor
Entity: Village of North Palm Beach
Address: 501 US Hwy 1
City, State, Zip: North Palm Beach, FL 33408
Phone: 561 841- 3384
Fax:
Email - mhodgkins @village- npb.org -
Department's Grant Manager
Name: Mary Ann Lee, or his /her Successor
Entity: Florida Department of Environmental
Protection
Address: 3900 Commonwealth Boulevard, MS585
City, State, Zip: Tallahassee, Florida 32399 -3000
Phone: (850) 245 -2501
Fax: (850) 245 -3050
Email: Mary.ann.lee @dep.state.fl.us
Any changes to the above - stated contact information must be noticed in writing
to the other party within ten (10) days of the change.
DEP 55 -239 (9/12)
DEP Agreement No LW604, Page 9 of 17
23. Prior to final reii...jursement, the Grantee must ereci permanent informational
sign on the Project Site which credits Project funding or a portion thereof, from
the Land and Water Conservation. Fund . Program through the USDOI, the
National Park Service, and the Department. The sign shall include the LWCF
Program logo;
24. The Department and USDOI have the right to inspect the Project and any and all
records related thereto: at any reasonable time:
25. This Project. Agreement may be unilaterally canceled by the. Department for
refusal by the Grantee to allow public access to all documents, papers, letters,, or
other material made or received by the Grantee in conjunction with this Project
Agreement, unless the records are exempt from Section 24(a) of Article I of the
State Constitution and Section 119:07(1) (a), Florida Statutes.
26. Prior to the closing of the Project, the Department shall have the right to demand
a refund, either in whole or in part, of the LWCF funds :provided to the Grantee
for non- compliance with the.. material terms of this Project Agreement. The
Grantee, upon such written notification from the Department, shall refund, and
shall forthwith pay to the Department, the amount of money demanded by the
Department. Interest on any refund shall be calculated and determined pursuant
to Section 55.03(1) of the Florida Statutes. Interest shall be calculated from the
date(s) of payment(s) to the Grantee by the Department to the date repayment is
made by Grantee. After closing of the Project, the Grantee may not repay the
funds but shall go through the conversion process described by the Manual and
the Rule.
27. If the United States, acting through the USDOI, the Secretary of the Interior; .or
any other branch of the government of the United States, acting within the scope
of its lawful authority, should for I any reason demand a refund from the
Department, in whole or in part, of the funds. provided to the Grantee under the
terms of this Project Agreement, the Grantee, upon notification from the
Department; agrees to pay the refund and will forthwith repay directly to the
Department the amount of money demanded.
28. The Grantee shall comply with all federal, state and, local laws, rules, regulations
and ordinances in developing this Project. The Grantee acknowledges. that this
requirement includes compliance with all federal, state and local health and
safety rules and regulations including all applicable building codes. The. Grantee
further agrees to ensure that, in the event work is subcontracted, the Grantee's
contract will include the requirements of this paragraph in all subcontracts made
to perform this Project Agreement.
29. The Grantee may subcontract work under this Project Agreement without the
prior written consent of the Department's Grant Manager. The Grantee shall
submit a copy of each executed subcontract to the Department within ten (10)
DEP 55 -239 (9/12)
DEP Agreement No LW604, Page 10 of 17 -
days after execLJn. The Grantee agrees to be resp. , sible for the fulfillment of
all work elements included in any subcontract and agrees to be responsible for
the payment of all 'monies due under any subcontract. It is understood and
agreed by the Grantee that the Department, shall not be liable to any
subcontractor for any expenses or liabilities incurred under the subcontract and
that the Grantee shall be solely liable to the subcontractor for all expenses and
liabilities incurred under the subcontract:
30. Competitive open bidding and purchasing for construction of said Project
Facilities or improvements shall comply with all applicable laws and the Manual,
Following completion of Project construction, the Grantee's Liaison Agent shall
provide the Department with a statement certifying that all purchases or contracts
for construction were competitively bid pursuant to applicable law and the
Manual:
31. If asphalt paving is required for the Project; it shall conform to the Florida
Department of Transportation's specifications for road and bridge construction.
Bid specifications, contracts and /or purchase orders of the Grantee must specify
thickness of asphalt and square yards to be paved.
32. By acceptance of the provisions of this Project Agreement, the Grantee does
hereby agree to dedicate the Project Site and all land within the Project
boundaries, identified in paragraph 2 herein; in perpetuity as an Outdoor
Recreation site for the use and benefit of the public, as stated in Rule 62D-
5.074(l), F.A.C. Execution of this Project Agreement by the Department shall
constitute an acceptance of said dedication on behalf of the general public of the
State of Florida. The Grantee represents that it has sufficient site control to
enable this dedication. The dedication must be promptly recorded in the county's
official public records by the Grantee and Grantee shall provide a certified copy
to the Department.
33. The Grantee agrees to operate and maintain the Project Site as stated in Rule
_62D- 5.074(2), . F.A.C. The Project Site, Project-,related Facilities, and any future
Outdoor Recreation Facilities developed on the Project Site shall be open to the
general public for Outdoor Recreation use, maintained in accordance with
applicable health and safety standards, and kept in good repair to prevent undue
deterioration and provide for safe public use. The Grantee covenants that it has
full legal authority and financial ability to develop, operate and maintain said
Project- related Facilities and improvements as specified within the terms of this
Project Agreement. The Grantee shall obtain Department approval prior to any
and all current or future Development of Facilities on the Project Site, if said
Development is not described in paragraph 3 herein.
34, The Grantee shall not, for any reason, convert all or any portion of the site for
any purpose other than public Outdoor Recreation without prior approval of the
USDOI and thet apartment pursuant to Section 6(k,,:5) of the.LWCF Act, the
Manual, and Rule 62D- 5:074(3), F.A.C.
35. A. Failure to comply with the provisions of the Rule or the terms and
conditions of this Project Agreement will. result in termination of the Project
Agreement by the Department. In the event of violation of the Rule or the
provisions of this Project Agreement by Grantee, the Department shall
provide thirty (30) days written notice of its intent to terminate. The written
notice shall provide a reasonable amount of time to :cure the violations;
however, if the Grantee does not cure or obtain an extension of time within
the time period stated in the notice, this Project Agreement shall be
automatically terminated on the following calendar day.
B. The Department may terminate this Project Agreement when both parties
agree that the. continuation. of. the Project would not produce beneficial
results commensurate with the further expenditure of funds. Notice shall
be sent by the Grantee to the Department in writing indicating that the
Grantee wishes to cancel the Project. The Grantee shall not incur. new
obligations for the Project after the notice is sent to the Department and
shall cancel as many, outstanding obligations as possible. The
Department shall respond. with a termination notice and, in such notice,
shall set out the procedures for proper closeout of the Agreement. Once
all closeout procedures have been fulfilled, the Agreement shall
automatically terminate on the following calendar day:
C. If no reimbursements have been paid and Grantee wishes to withdraw the
Project, the parties hereto may agree to terminate this Agreement for
convenience as evidenced by written notice from the Department to the
Grantee.. The Grantee shall counter -sign the notice and the Agreement
shall terminate on the date of .Grantee's counter- signature:
36_ In the event of conflict in the provisions of the Rule, the Project Agreement and
the Project Application; the provisions of the Rule shall control over this Project
Agreement and this Project Agreement shall control over the Project Application
documents:
37. If the Department determines that site control is not sufficient under the Rule or
has been compromised, the Department shall give the Grantee a notice, in
- writing, and a reasonable time to comply. If the deficiency. cannot be reasonably
corrected within the time specified in the notice, the Department shall terminate
this Project Agreement.
38. In accordance with the LWCF Act, Program funds will be made available
contingent upon an annual appropriation to each State by Congress. The State
of Florida's performance and obligation to pay under this. Project Agreement is
contingent upon an annual appropriation of spending authority by the Florida
DEP 55- 239 (9/12)
DEP Agreement No LW604, Page 12 of 17
Legislature. Thy, , arties hereto understand that this`, ,bject Agreement is not a
commitment of future appropriations.
39. A. The Grantee certifies that no Federal appropriated funds have been paid:
or will be paid by or on behalf of the Grantee, to any person for influencing
or attempting to influence an officer or employee of an agency, a Member
of Congress, an officer or employee of Congress; or an employee of a
Member of Congress; in connection with the awarding; .renewal, amending
or modifying of any Federal contract; grant, or cooperative. agreement. If
any non - Federal funds are used for.lobbying activities.as described above,
the Grantee shall submit Attachment D, Form DEP 55 -221, effective
January 2001, "Disclosure of Lobbying Activities" (attached hereto and
made a part hereof), and shall file quarterly updates of any material
changes. The Grantee shall require the language of this certification to be
included in all subcontracts, and all subcontractors shall certify and
disclose accordingly. (43 CFR, Part 18)
B. In accordance with section 216.347, Florida Statutes, the Grantee is
hereby prohibited from using funds provided by this Project Agreement for
the purpose of lobbying the Legislature, the judicial branch or a state
- agency.
40. A. No .person on the grounds of race, religion, creed, color, national origin,
age, sex, marital status or disability, shall be excluded from participation
in, be denied the proceeds or benefits of, or be otherwise subjected to
discrimination in the performance of this Project Agreement.
B. An entity or affiliate who has been placed on the discriminatory vendor list
may not: submit a bid on a contract to provide goods or services to a
public entity; submit a bid on a contract with a public entity for the
construction or repair of a public building or public work; submit bids on
leases of Real Property to a public entity; award or perform work as a
contractor, supplier; subcontractor, or .consultant under contract with any
public entity; nor transact business with any public entity. The Florida
Department of Management Services is responsible for maintaining the
discriminatory vendor list and intends to post the list on its website.
Questions regarding the discriminatory vendor list may be directed to the
Florida Department of Management Services, Office of Supplier Diversity
at (850) 487 - 0915.
41. A. The accounting systems for all Grantees must ensure that these funds are
not commingled with funds from other agencies. Funds from each agency
must be accounted for separately. Grantees are prohibited from
commingling funds on either a program -by- program or.a project -by- project
basis. Funds specifically budgeted and /or received for one project may
not be used to support another project. Where a Grantee's, - or
DEP 55- 239 (9/12)
DEP Agreement No LW604, Page 13 of 17
subrecipii,rltls, accounting system cannot cor,�,liy with this requirement,
the Grantee, or subrecipient, shall establish a system to provide adequate
fund accountability for each project it has been awarded.
B. If the Department finds that these funds. have been commingled, the
Department shall have the right to demand a refund, either in whole or in
part, of the funds provided to the Grantee under this Agreement for non-
compliance with the material terms of this Agreement. The Grantee, upon
such written notification from the Department shall refund, and ..shall
forthwith pay to the Department, the amount of money demanded by the
Department. Interest on any refund shall be calculated based on the
prevailing rate used by the State Board of Administration. Interest shall be
calculated from the date(s) the original payment(s) are received from the
Department by the Grantee to the date repayment is made by the .Grantee
to the Department.
C. In the event that the Grantee recovers costs, incurred under this
Agreement and reimbursed by the Department, from another source(s),
the Grantee shall reimburse the Department for all recovered funds
originally provided under this Agreement. Interest on -any refund shall be
calculated based on the prevailing rate used by the State Board of
Administration. interest shall be calculated from the date(s) the
payment(s) are recovered by the Grantee to the date repayment is made
to the Department by the Grantee.
. . . . . . . . . . . . . . . . . . . . . . . . ...
42. Each party hereto agrees that it shall be solely responsible for the negligent or
wrongful acts of .its employees and agents. However, nothing contained herein
shall constitute a waiver. by either party of its sovereign immunity or the
provisions of Section 768.28, Florida Statutes, and other statutes that provide
immunity to the Department or the State.
43. _A person or affiliate who has been placed on the convicted vendor list following a
conviction for public entity crime may not perform work as a grantee, contractor,
supplier, subcontractor, or consultant under a contract with any public entity, and
may not transact business with any public entity in. excess of the Category Two
threshold amount provided in s. 287:017;, Florida Statutes, for a period of 36
months from the date of being placed on the convicted vendor list.
44. In accordance with: Executive Order 12549, Debarment and Suspension (2 CFR,
Part .1400), the Grantee shall agree and certify that neither it, nor its principals, is
presently debarred, suspended, proposed for debarment declared ineligible, or
voluntarily excluded from participation in this transaction by any federal
department or agency; and, that the Grantee shall not knowingly enter into any
lower tier contract, or other covered transaction, with a person who is similarly
- debarred or suspended from participating in this covered transaction, unless
DEP 55 -239 (9/12)
DEP Agreement No LW604, Page 14 of 17
.\ -.1
authorized in whL., ig by USDOI to the Department. Th-trantee shall include the
language of this section, in all subcontracts or lower tier agreements executed to
support the Grantee's work under this Project Agreement.
45. This Project Agreement has been delivered in the State of Florida and shall be
construed in accordance with .the laws of Florida. Wherever possible, each
provision of this Project Agreement shall be interpreted in such manner as to be
effective and valid Under applicable law, but if any provision of this Project
Agreement shall be prohibited or invalid under applicable Florida law, such
provision shall be ineffective to the extent of such prohibition or invalidity, without
invalidating the remainder of such provision or, the remaining provisions of .this
Project Agreement. Any action hereon or in connection :herewith shall be brought
in Leon County, Florida unless prohibited by applicable law:
46. No delay or failure to exercise any right, power or remedy accruing to either party
upon breach or default by either party under this Project Agreement, shall impair
any such right, power or remedy of either party; nor shall such delay or failure. be
construed as a waiver of any such breach or default, , or any similar breach or
default thereafter.
47. This Project Agreement is not intended nor shall it be construed as granting any
rights, privileges or interest in any third party without mutual written agreement of.
the parties hereto.
48. The Grantee agrees to comply with; and include as appropriate in contracts and
subgrants; the provisions contained in Attachment E, Contract Provisions,
attached hereto and made a part hereof. In addition, the Grantee acknowledges
that the applicable regulations listed in Attachment F, Regulations, attached
hereto and made a part hereof, shall apply to this Project Agreement.
49. The federal funds awarded under this Agreement must comply with The Federal
Funding Accountability and Transparency Act ( FFATA) of 2006. Prior to
execution of this Project Agreement by the Department, the Grantee shall submit
Attachment G, Federal Funding Accountability and Transparency Act Form
which is attached hereto and incorporated herein. The intent of the FFATA is to
empower every. American with the ability to hold the government accountable for
each spending decision. The end result is to reduce wasteful Spending in the
government. The FFATA legislation requires that information .on federal awards
(federal financial assistance and expenditures) be made available to the public
via a single, searchable website, which is www.USASpendinq_gov. Grant
Recipients awarded a new Federal grant greater than or equal . to $25,000
awarded on or after October 1, 2,010 are subject to the FFATA. The Grantee
agrees to provide the information necessary, over the life of this Agreement, for
the Department to comply with this requirement.
DEP 55- 239 (9/12)
DEP Agreement No LW604, Page 15 of 17 -
r
50. This Project Ag, - �ment is an exclusive contract are, may not be assigned in
whole or in part without the prior written: approval of the Department.
51. The parties hereto acknowledge and agree that the provisions contained in
paragraphs 16, 23, 31, 32, and 33 shall, extend beyond the end date of this
Project Agreement, as established in paragraph 1.:
52. This Project Agreement represents the entire agreement of the parties. Any
alterations, variations, changes, modifications or waivers of provisions. of this
Project Agreement shall only be valid when. they have been reduced to writing,
duly executed by each of the parties hereto, and attached to the original of this
Project Agreement.
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
IN WITNESS WHEREOF, the parties hereto have caused this Project Agreement
to be duly executed, the day and year last written below.
FLORIDA DEPARTMENT
OF ENVIRONMENTAL PROTECTION
By:
Division Director
Division of Recreation and Parks
and State Liaison Officer
(or designee)
Date: <� l — aO(Y
Address:
Office of Information and Recreation
Services (MS 585)
Division of Recreation and Parks
3900 Commonwealth Boulevard
Tallahassee, Florida 32399 -3000
DEP G ant a ager
Approved as to form and legality for
use for one year by Reagan Russell,
Assistant General Counsel on
September 18, 2012.
Attachments:
Attachment A
Attachment B
Attachment C
Attachment D
Attachment E
Attachment F
Attachment G
Village of North Palm Beach
By: L S f r a,
Darrvl C. Aubrey
Printed Name
%yo r
Title
Date: ,31d 711
FEID No.: 59- 6017984
Address:
501 U.S. Highway 1
Plorth Palm Beach, FL 33403
...0 -
Grantee's Attorney
Project Work Plan (# Pages)
Special Audit Requirements (5 Pages)
Certification of Applicability to Single Audit Act Reporting (3
Pages)
Disclosure of Lobbying Activities (2 Pages)
Contract Provisions (4 Pages)
Regulations (1 Page)
Federal Funding Accountability and Transparency Act Form (4
Pages)
DEP 55 -239 (9/12)
DEP Agreement No LW604, Page 17 of 17
Grantee Name:: Village of North Palm Beach
Please list each project element along with its objective and estimated budget amount:
Project Element(s):
The project reimbursement is limited to one (1) invoice upon completion of all Project Elements shown
above and submittal of all required documentation identified in . the .table below. Any changes to the
Project Elements will require an amendment to this Agreement.
ELEMENT TO BE SUBMITTED UPON
ELEMENTS/WORK BUDGET COMPLETION BEFORE
TO BE AMOUNT FOR MATCH AMOUNT REIMBURSEMENT CAN BE
COMPLETED REIMBURSEMENT TO BE CLAIMED APPROVED
Project Completion Certification
Final as -built site. plan
I
under the Land and Water Conservation Fund grant program; approved-plans and application approved for funding.
Financial Consequences: Failure to meet the performance standard will.result in the rejection of the invoice for
reimbursement and claim for match:
DEP Agreement No. LW604; Attachment A, Page 1 of 2
DEP 55 -231 (06/10)
INSTRUCTIONS FOR CO. 1LETING PROTECT WORK PLAN:
ELEMENTS/WORK TO BE COMPLETED: Identify ALL elements that will be completed under this
Agreement.
ELEMENT BUDGET AMOUNT FOR REIMBURSEMENT: Must provide a budget for each element
and identify the expense category and budget detail. Provide description of the costs as follows: Salaries:
identify the position title /hourly rate /# of hours to complete the deliverable; Fringe benefits: identify the % used to
calculate the fringe benefits; Contractual Services.:: identify what service will be paid for under the contract for
services; Equipment: the purchase of equipment is not allowed under this Agreement, the rental of equipment is the
only costs allowed that are associated with equipment; Supplies and Materials: identify what supplies /materials
will be purchased Other costs: identify what other costs are being requested (such as.printing costs, other costs that
do not fit into the other established cost, .categories (salaries,, fringe benefits; equipment, supplies, indirect,
contractual services); Indirect Costs: identify the percentage that is used for the indirect being claimed for
reimbursement (cannot exceed. 15% unless prior approval has been obtained by.the Department)::
MATCH AMOUNT TO BE CLAIMED: The same level of detail must be provided for match as .for
reimbursement.
DOCUMENTATION/DELIVERABLES TO BE SUBMITTED UPON COMPLETION: All of these
deliverables must be submitted before final reimbursement can be processed.
Completion Documentation required prior to. Reimbursement
ATTACHMENT B
SPECIAL AUDIT REQUIREMENTS
The administration of resources awarded by the Florida Department of Environmental Protection (which, may be
referred to as the "Department ", "DEP ", 7DEP or "Grantor'; or other name in the contract /agreement) to the
recipient (which may be referred to as the "Contractor ", Grantee" or other name in the contract /agreement) may be
subject to audits and/or monitoring by the Department of Environmental Protection, as described -in this attachment.
MONITORING
In addition to reviews of audits conducted in accordance with OMB Circular A -133 and Section 215.97, F.S., as
revised (see "AUDITS" below), monitoring procedures may include, but not be. limited to, on -site visits by
Department staff, limited scope audits as defined by OMB Circular A -133, as revised, and/or other procedures. By
entering into this Agreement, the . recipient agrees to comply and cooperate with any monitoring
procedures /processes deemed appropriate by the Department of Environmental Protection. In the event the
Department of Environmental Protection determines that a limited scope audit of the recipient is appropriate, the
recipient agrees to comply with any additional instructions provided by the Department to the recipient regarding
such audit. The recipient further agrees to comply and cooperate with any inspections, reviews, investigations, or
audits deemed necessary by the Chief Financial Officer. or Auditor General.
AUDITS
PART I: FEDERALLY FUNDED
This part is applicable if the recipient 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 recipient expends $500,000 or more in Federal awards in its fiscal year, the recipient
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 Attachment indicates Federal funds awarded through the Department
of Environmental Protection by this. Agreement. In determining the Federal awards expended in its fiscal
year, the recipient shall consider all sources of Federal awards, including Federal resources received from
the Department of Environmental Protection. 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 recipient 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 recipient shall fulfill the
requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A -133, as
revised.
3. If the recipient 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
recipient 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 an audit must be paid from recipient resources
obtained from other than Federal entities).
4. The recipient may access information regarding the Catalog of.Federal Domestic Assistance (CFDA) via
the internet at http: / /12.46.245.173 /cfda /efda.html.
PART II: STATE FUNDED /
This part is applicable if the recipient is a nonstate entity as defined by Section 215.97(2)(m), Florida Statutes.
1. In the event that the recipient expends a total amount of state financial assistance equal to or in excess of
$500,000 in any fiscal y ear of such recipient, the recipient 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; and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for -profit
organizations), Rules of the Auditor General. EXHIBIT .1 to this Attachment indicates state financial
assistance awarded through the Department of :Environmental Protection by this Agreement. In
determining the state financial assistance expended in its fiscal year, the recipient shall consider all sources
of state financial assistance, including state financial assistance received from the Department of
Environmental Protection, 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 II, paragraph 1; the. recipient shall ensure that
the audit complies with. the requirements of Section 215.97(7), Florida Statutes. This includes submission
of a financial reporting package as defined by Section 215:97(2), Florida Statutes; and Chapters 10.550
(local governmental entities) or 10.650 (nonprofit and for -profit organizations), Rules. of the Auditor
General.
3. If the recipient expends less than $500,000 in state financial assistance in its fiscal year, an audit conducted
in accordance with the provisions of Section 215.97, Florida Statutes, is not required. In the event that the
recipient 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 non- state entity's resources (i.e., the cost of such an audit must be paid from the
recipient's resources obtained from other than State entities).
4. For information regarding the Florida Catalog of State Financial. Assistance (CSFA), a recipient should
access the Florida Single Audit Act website located at https:Happs.fidfs.com /fsaa for assistance. In
addition to the above websites, the following websites may be accessed for information: Legislature's
Website at http: / /www.lep.state.fl.us /Welcome /hidex.cfm, State of Florida's website at
http: / /www.myflorida.cOm /, Department of Financial Services' Website at http: / /www.fldfs.com/ and the
Auditor General's Website at http : / /www.state.fl.us /audgen.
PART III: OTHER AUDIT REQUIREMENTS
(NOTE: This part would be used to sped any additional audit requirements imposed by the State awarding entity
that are solely a matter of that State awarding entity's policy (i. e., the audit is not required by Federal or State laws
and is not in conflict with other Federal or State audit requirements). Pursuant to Section 215:97(8), Florida
Statutes, State agencies may conduct or arrange for audits of State financial assistance that are in addition to audits
conducted in accordance with Section 215.97, Florida Statutes. In such an event, the State awarding agency must
arrange for funding the full cost of such additional audits.)
PART IV: REPORT SUBMISSION
I. Copies of reporting packages for audits conducted in accordance with OMB Circular A -133, as revised; and
required by PART I of this Attachment shall be submitted, when required by .Section .320 (d) OMB
Circular A -133, as revised, by or on behalf of the recipient directly to each of the following:
DEP 55 -215 (03/09)
DEP Agreement No. LW604, Attachment B, Page 2 of 5
A. The Departi� _,t of Environmental Protection at the following dress:
Audit Director
Florida Department of Environmental Protection
Office of the Inspector General, MS 40
3900. Commonwealth Boulevard
Tallahassee, Florida 32399 -3000
B. The Federal Audit Clearinghouse designated in OMB Circular A -133, as revised (the number of
copies required by Sections .320 (d)(1) and (2), 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
Submissions of the Single Audit reporting package for fiscal periods ending on or after January 1,
2008, must be submitted using the. Federal Clearinghouse's Internet Data Entry System which can
be found at hM2:Hharvester.census.gov/fac/
C. Other Federal agencies and pass- through entities in accordance with Sections .320 (e) and (fl,
OMB Circular A -133, as revised.
2. Pursuant to Section .320(f), OMB Circular A -133, as revised, the recipient shall submit a copy of the
reporting package described in Section .320(c), .OMB Circular A -133; as revised, and any management
letters issued by the auditor, to the Department of Environmental Protection at the following address:
Audit Director
Florida Department of Environmental Protection
Office of the Inspector General, MS 40
3900 Commonwealth Boulevard
Tallahassee, Florida 32399 -3000
3. Copies of financial reporting packages required by PART Il of this Attachment shall be submitted by or on
behalf of the recipient directly to each of the following:
A. The Department of Environmental Protection at the following address:
Audit Director
Florida Department of Environmental Protection
Office of the Inspector General, MS 40
3900 Commonwealth Boulevard
Tallahassee, Florida 32399 -3000
B. The Auditor General's Office at the following address:
State of Florida Auditor General
Room 401, Claude Pepper Building
111 West Madison Street
Tallahassee, Florida 32399 -1450
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
DEP 55 -215 (03/09)
DEP Agreement No. LW604, Attachment B, Page 3 of 5
4. Copies of reports or management letters required by PART III of this Attachment shall be submitted by or
on behalf of the recipient directly to the Department of Environmental Protection at the following address:
Audit Director
Florida Department of Environmental Protection
Office of the Inspector General, MS 40
3900.Commonwealth Boulevard
Tallahassee, Florida 32399 -3000
5. Any reports, management letters, or other information required to be submitted to the Department of
Environmental Protection pursuant to this Agreement shall be .submitted timely in accordance with OMB
Circular A 7133, Florida Statutes, or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and
for -profit organizations), Rules of the Auditor General, as applicable:
6. Recipients, when submitting financial reporting packages to the Department of Environmental Protection
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 recipient in correspondence accompanying the reporting
package.
PART V: RECORD RETENTION
The recipient shall retain sufficient records demonstrating its compliance with the terms of this Agreement for a
period of 5 years from the date the audit report is issued, and shall allow the Department of Environmental
Protection, or its designee, Chief financial Officer; or Auditor General access to such records. upon request. The
recipient shall ensure that audit working papers are made available to the. Department of Environmental Protection,
or its designee, Chief Financial Officer, or Auditor General upon request for a, period of 3 years from the date the
audit report is issued, unless extended in writing by the Department of Environmental Protection.
DEP 55- 215 (03/09)
DEP Agreement No. LW604, Attachment B, Page 4 of 5
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Grantee's Name:
Grantee Fiscal Year Period: FROM: TO:
Total State Financial Assistance Expended during Grantee's most recently completed Fiscal Year:
Total Federal Financial Assistance Expended during Grantee's most recently completed Fiscal Year:
INSTRUCTIONS FOR COMPLETING THE ATTACHMENT
Grantee Fiscal Year Period: FROM: Month/Year TO: Month/Year
NOTE: THIS SHOULD BE THE GRANTEE'S FISCAL YEAR FROM (MONTHNEAR) TO
(MONTH/YEAR).
Total State Financial Assistance Expended during Grantee's most recently completed Fiscal Year:
NOTE: THIS AMOUNT SHOULD BE THE TOTAL STATE FINANCIAL ASSISTANCE
EXPENDED FROM ALL STATE AGENCIES, NOT JUST DEP.
Total Federal Financial Assistance Expended during Grantee's most recently completed Fiscal Year:
NOTE: THIS AMOUNT SHOULD BE THE TOTAL FEDERAL FINANCIAL ASSISTANCE
EXPENDED FROM ALL FEDERAL AGENCIES, NOT JUST THROUGH DEP.
The Certification should be signed by your Chief Financial. Officer,
Please print the name and include the title and date of the signature:
DEP Agreement No LW604, Attachment C, Page 2 of 3
CERTIFICATION. OF APPLICABILITY TO SINGLE AUDIT ACT REPORTING
FREQUENTLY ASKED QUESTIONS
1. Question: Do I complete and return this form when I return my signed
Agreement /Amendment?
Answer: No, this form is to be completed and signed by your Chief Financial Officer
and returned 4 months after the end of your fiscal year.
2. Question: Can I fax the form to you?
Answer: Yes, you can fax the Certification form, the fax number is 850/245- 2411.
3. Question: How can I submit the form if our, audit is not completed by the due date of
this letter?
Answer: You should be able to complete the form from the information in your
accounting system. This is just to let our Office of the Inspector General know which
entities they should be getting an audit from. If you are under the threshold you do not
have to submit a copy of your audit, only the Certification form:
4. Question: Do you only want what we received from DEP?
Answer: No, the Single Audit. is the TOTAL AMOUNT of funds that you expended
towards all state or federal grants that you receive. You should list those that are specific
to DEP on the form:
5. Question: Do I have to submit the completed form and a copy of my audit?
Answer: No, you do not have to submit your audit unless you are over the threshold of
$500,000. If you would prefer to submit your audit (CAFR) instead of the form, that is
fine.
64 Question: Our CAFR will not be ready before your due date and we don't have the
information necessary to complete the certification. Can we get an extension?
Answer: Yes, just send us an Email letting us know, when you will have your CAFR
completed and we will place the Email with your letter in our file so that you don't get a
2nd notice:
7. Question: Can I submit my Certification Form or CAFR electronically?
Answer: Yes, you can submit them by Email to Debbie. skeltonndep.state.fl.us
DEP Agreement No LW604; Attachment C, Page 3 of 3
s � _
/ ATTACHMENT D Approved by OMB
0348-0046
DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
(See reverse for public burden disclosure.)
1. Type of Federal Action:
2. Status of Federal Action:.
3. Report Type:
a. contract
a. bid /offer /application
a. initial filing
b. grant
b. initial award
b. material change
c. cooperative agreement
c. post -award
d. loan
For Material Change Only:
e. loan guarantee
f. loan insurance
year quarter
date of last report .
4. Name and Address of Reporting Entity:
5. If Reporting Entity in No. 4 is Subawardee, Enter Name
and Address of Prime:
El Prime ❑ Subawardee
Tier if known._
Congressional District, if known:
Congressional District, if known:
6. Federal Department /Agency:
7. Federal Program Name/Description;
CFDA Number, f applicable:
8. Federal Action Number, if known:
9. Award Amount, if known:
10. a. Name and Address of Lobbying Entity
b. Individuals Performing Services (including address if
(if individual, last name, first name, MI):
different from No. IOa)
(last name, first name, MI):
(attach Continuation Sheet(s)
SF -LLLA; if necessary)
Signature:
11. Information requested through this form is authorized by title 31 U.S.C.
section 1352. This disclosure of lobbying activities is a material
print Name:
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 reported to Congress
Title:
semi - annually and will be available for public inspection. Any person who
fails to file the required disclosure shall be subject to a civil penalty of not
Telephone No.: Date:
less than $10,000 and not more than $100,000 for each such failure.
Federal Use Only,:
Authorized for LocaCReproduction
Standard Form — LLL (Rev 7 — 97)
INSTRUCTIONS FOR'._.�MPLETION OF SF -LLL, DISCLOSURE !LOBBYING ACTIVITIES .
This disclosure form shall be completed by the reporting entity, whether, subawardee or prime Federal recipient, at
the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31
U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any
lobbying entity for influencing or attempting to influence an officer or employee of .any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered
Federal action. Complete all items that apply for both the initial filing and material change report. Refer to the
implementing guidance published by the Office of Management and Budget for additional information.
1 Identify the type of covered Federal action for which lobbying activity is and /or has been. secured to
influence the outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a followup report caused by a material
change to the information previously reported, enter the year and quarter in which the change occurred.
Enter the date of the last previously submitted report by the reporting entity for: this covered Federal
action.
4. Enter the full. name, address, city, state and zip code. of the reporting entity. Include Congressional
District, if known. Check the appropriate classification of the reporting entity that designates if it is or
expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first
subawardee. of the prime is the 1st tier. Subawards include but are not limited to subcontracts,
subgrants and contract awards under grants.
5. If the organization filing the report in item 4 checks "Subawardee ", then enter the full name, address,
city, state and zip code of the prime Federal recipient. Include Congressional District, if known..
6. Enter the name of the Federal agency making the award or loan commitment. Include at least one
organizational level below agency name, if known. For example, Department of Transportation, United
States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (item 1). .:If known, enter
the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative . agreements,
loans, and loan commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identified in
item 1 (e.g., Request for Proposal (RFP) number; Invitation for Bid (IFB) number; grant announcement
number; the contract, grant, or loan award number; the application /proposal control number assigned
by the Federal agency). Include prefixes, e.g., "RFP- DE -90- 001,"
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency,
enter the Federal amount of the award /loan commitment for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting
entity identified in item 4 to influence the covered Federal action.
(b) Enter the full names of the individual(s) performing services, and include full address if different
from 10 (a). Enter Last Name, First Name, and Middle Initial (MI).
11. The certifying official shall sign and date the form, print his /her name, title and telephone number.
According to the Paperwork Reduction Act, as amended, no persons are required to - respond to a collection of information unless it
displays a valid OMB Control Number. The valid OMB control number for this:inforination collection is OMB No. 0348 -0046. Public
reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining, the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348 - 0046), Washington, D.C..20503.
Form DEP 55- 221 (0 1/0 1)
DEP Agreement No. LW604, Attachment D, Page 2 of 2
ATTACHMENT E j
Contract Provisions
All contracts awarded by a recipient, including small purchases, shall contain the following provisions as
applicable:
1. Equal Employment Opportunity - All contracts shall contain a provision requiring compliance
with Executive Order (E.O.) 11246, "Equal Employment Opportunity," as amended by E.O.
11375; "Amending Executive Order 11246 Relating to Equal Employment Opportunity, ". and as
supplemented by regulations. at 41 CFR part 60, "Office of Federal Contract Compliance
Programs, Equal Employment Opportunity, Department of Labor.
2. Copeland "Anti- Kickback" Act (18 U.S.C. 874 and 40 U.S.C. 276c) - All contracts and
subgrants in excess of $2000 for construction or. repair. awarded by recipients and subrecipients
shall include a provision for compliance with the Copeland "Anti-Kickback" Act (18 U.S.C. 874);
as supplemented by Department of Labor regulations (29 CFR part 3, . "Contractors and
Subcontractors on Public Building or Public Work Financed in Whole or. in Part by Loans or
Grants from the United States "). The Act provides that each contractor or subrecipient shall be
prohibited from inducing, by any means, any person employed in the construction, completion, or
repair of public work, to give up any:part of the compensation to which he is otherwise entitled.
The recipient shall report all suspected orreported violations to the Federal awarding agency.
3. Davis- Bacon Act, as amended (40 U.S.C. 276a to a -7) When required by Federal program
legislation, all construction contracts awarded by the recipients and subrecipients of more than
$2000 shall include a provision for compliance with the Davis -Bacon Act (40 U.S.C. 276a to a -7)
and as supplemented by Department of Labor regulations (29 CFR part 5, "Labor . Standards
Provisions. Applicable to Contracts Governing Federally Financed and Assisted Construction").
Under this Act, contractors shall be required to pay wages to laborers and mechanics at a rate not
less than the minimum wages specified in a wage determination made by the Secretary of Labor.
In addition, contractors shall be required to pay wages not less than once a week. The recipient
shall place a copy of the current prevailing wage determination issued by the Department of Labor
in each solicitation and the award of a contract shall :be conditioned upon the acceptance of the
wage determination. The recipient shall report all suspected or reported violations to the Federal
awarding agency:
4. Contract Work Hours and Safety Standards Act (40 U.S.C. 327 -333) - Where applicable, all
contracts awarded by. recipients in excess of $2000 for construction contracts and in excess of
$2500 for other contracts that involve the employment of mechanics or laborers shall include a
provision for compliance with Sections. 102 and 107 of the Contract Work Hours and Safety
Standards Act (40 U.S.C. 327 -333), as supplemented by Department of Labor regulations (29 CFR
part 5). Under Section .102 of the Act, each contractor shall be required to compute. the wages of
every mechanic and laborer on the basis of a standard work week of 40 hours. Work in excess of
the standard work week is permissible provided that the worker is compensated at a rate of not less
than 1 '/2 times the basic rate of pay for all hours worked in excess of 40 hours in the work week.
Section 107 of the Act is applicable to construction work and provides that no laborer or mechanic
shall be required to work in surroundings or under working conditions which are unsanitary;
hazardous or dangerous. These requirements do not apply to the purchases of supplies or materials
or articles ordinarily available on the open market; or contracts for transportation or transmission
of intelligence:
5. Rights to Inventions Made Under a Contract or Agreement Contracts or agreements for the
performance of experimental, developmental,. or research work shall provide for the rights of the
Federal Government and the recipient in any resulting invention in accordance with 37 CFR part
401, "Rights to- Inventions Made by Nonprofit Organizations and Small Business Firms Under
Government Grants, Contracts and Cooperative Agreements," and any. implementing regulations
issued by the awarding agency:
DEP Agreement No. LW604, Attachment E, Page 1 of 4
6. Clean Air Act \ !U.S.C. 7401 et seq.) and the Federal Wh .� Pollution Control Act, as
amended (33 U.S.C. 1251 et seq.) Contracts and subgrants of amounts in excess of $100,000
shall contain a provision that requires the recipient to agree to comply with all applicable
standards; orders or regulations issued pursuant to the Clean Air Act (42 U.S.C. 7401 et seq.) and
the Federal Water Pollution Control Act as. amended (33 U.S.C. 1251 et seq.). Violations shall.be
reported to the Federal awarding agency and the Regional Office of the Environmental Protection
Agency (EPA).
7. Byrd .Anti- Lobbying Amendment (31 U.S.C. 1352) - Contractors.who apply or bid for an award
of $100,000 or more shall file the required certification. Each tier certifies to the tier above that it
will not and has not used Federal appropriated funds to pay any person or organization for
influencing or attempting to influence an officer or employee of any agency, a member of
Congress, officer or employee of Congress, or an employee of a member of Congress in
connection with obtaining any Federal contract, grant or any other award covered by 31 U.S.C:
1352. Each tier shall also disclose any lobbying with. non- Federal funds that takes place .in
connection . with obtaining any Federal award. Such disclosures are forwarded from tier to tier up
to the recipient.
8. Debarment and Suspension (E.O.s 12549 and 12689) - No contract shall be made to parties
listed on the General Services Administration's List of Parties Excluded from Federal Procurement
or Nonprocurement Programs in accordance with E.O.s 12549 and 12689, "Debarment and
Suspension." This list contains the names of parties debarred, suspended, or otherwise excluded by
agencies, and contractors declared ineligible under statutory or regulatory authority other than
E.O. 12549. Contractors with awards that exceed the small purchase threshold shall provide the
required certification regarding its exclusion status and that of its principal employees.
9. Section 508 of the Federal.Water Pollution Control Act, as amended (33 U.S.C. 1368) and
Section 1424(e) of : the : Safe Drinking Water Act (42 U.S.C. 300h -3(e)) - Contracts and
subgrants of amounts in excess of $100,000 shall contain a provision that requires the recipient to
agree to comply with all applicable standards, . orders or regulations issued pursuant to Section 508
of the. Federal Water Pollution Control Act, as amended (33 U.S.C. 1368.) and Section 1424(e) of
the Safe Drinking Water Act (42 U.S.C. 300h- 3(e)). Violations shall be reported to the Federal
awarding agency and the Regional Office of the Environmental Protection Agency (EPA). .
10. Compliance with all Federal statutes relating to nondiscrimination - These include but are not
limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L: 88 -352), which prohibits
discrimination on the basis of sex; (b) Section 504 of the Rehabilitation Act of 1973, as amended
(29 U.S.C: 795), which prohibits discrimination on the basis of handicaps; (c) the Age
Discrimination Act of 1975; as amended (42 U.S.C. 6101 - 6107), which prohibits discrimination
on the basis of age; (d) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92 -255), as
amended, relating to nondiscrimination on the basis of drug abuse; (e) the Comprehensive Alcohol
Abuse: and. Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91 -616), as
amende& relating to nondiscrimination on the basis of alcohol abuse or alcoholism; :(f) Sections
523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. 290 dd -3 and 290 ee -3), as
amended, relating to confidentiality of alcohol and drug abuse patient records; (g) .Title. VIII of the
Civil Rights Act of 1968 (42 U.S.C. 3601.et seq:), as amended, relating to nondiscrimination in
the sale, rental or financing of housing; (h) any other nondiscrimination provisions in the specific
statute(s) made; and, (i) the requirements of any other nondiscrimination statute(s) that may apply.
11. Compliance with the requirements of Titles IT and III of the Uniform Relocation Assistance
and Real Property Acquisition. Policies Act of 1970 (P.L. 91 -646) that provide for fair and
equitable treatment of persons displaced or whose property is acquired as a result of Federal or
federally assisted programs. These requirements apply to all interests in real property acquired for
project purposes regardless of Federal participation in purchases.
12. Compliance with the provisions of the Hatch Act (5 U.S.C. 1501 -1508 and 7324 -7328) that
limit the political activities of employees whose principal employment activities are funded in
whole or in part with Federal funds.
DEP Agreement No. LW604, Attachment E, Page 2 of 4
13.
Compliance, if N, �licable, with flood insurance purchase reql , ements of Section 102(a) of
the Flood Disaster Protection Act of 1973 (P.L. 93 -234) that requires recipients in a special
flood hazard area to participate in the program and to purchase flood insurance if the total cost of
insurable construction and acquisition is $10,000 or more:
14.
Compliance with environmental standards which may be prescribed to the following: (a)
institution of environmental quality control measures under the National Environmental Policy
Act of 1969 (P.L. 91 -190) and Executive Order 11514; (b) notification of violating facilities
pursuant to E.O.. 11738; (c) protection of wetlands pursuant to E.O. 11990; (d) evaluation of flood
hazards in floodplains in accordance with E;O. 1:1988; (e) assurance of project consistency with
the approved State. management program developed under the Coastal Zone. Management Act of
1972 (16 U.S.C. 1451 et seq.); (f) conformity with Federal actions to State (Clean Air)
Implementation Plans under Section 176(c) of the Clean Air Act of 1955, as amended (42 U.S.C.
7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking
Water Act of 1974, as amended (P.L. 93 -523); and (h) protection of endangered species under the
Endangered Species Act of 1973, as amended (P.L. 93 -205).
15.
Compliance with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. 1271 et seq.) related to
protecting components or potential components of the national wild and scenic rivers system. .
16.
Compliance with Section 106 of the National Historic Preservation Act of 1966, as amended
(16 U.S.C. 470), E.O. 11593 (identification and protection of historic properties), and the
Archaeological and Historic Preservation Act of 1974 (16 U:S.C. 469a -1 et seq.).
17.
Compliance with P.L. 93 -348 regarding the protection of human subjects involved in research,
development, and related activities. supported by this award of assistance.
18.
Compliance with the Laboratory Animal Welfare Act of 1966 (P.L. 89 -544, as amended, 7
U.S.C. 2131 et seq.) pertaining to the care, handling, and treatment of warm blooded animals held
for research, teaching; or other activities supported by this Agreement.
19.
Compliance with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C. 4801 et seq.) that
prohibits .the use of lead -based paint in construction or rehabilitation of residence structures.
20.
Compliance with the mandatory standards and policies relating to energy efficiency that are
contained in the State energy conservation plan. issued in accordance with the Energy. Policy and
Conservation Act (Pub. L. 94 -163, 89 Stat. 871).
21.
Compliance with the Drug Free Workplace Act. The recipient shall comply with the provisions
of the Drug -Free Workplace Act of 1988 (Public Law 1007690, Title V, Sec. 5153, as amended by
Public Law 105 -85, Div. A, Title VIII, Sec. 809, as codified at 41 U.S.C. § 702) and DoC
Implementing regulations published at 43 CFR Part 43, "Governmentwide Requirements for
Drug -Free Workplace (Financial Assistance)" published in the Federal Register on November 26,
2003, 68 FR 66534); which require that the recipient take steps to provide a. drug -free workplace.
22.
Compliance with the Buy American Act (41 U.S.C. 10a -10c) By accepting funds under this
Agreement, the Grantee agrees to comply with sections 2 through 4 of the Act of March 3, 1933;
popularly known as the "Buy American Act." The Grantee should review the provisions of the
Act to ensure that expenditures made under this Agreement are in accordance with it. It is the
sense of the Congress that, to the greatest extent practicable, all equipment and products purchased
with funds made available under this Agreement should be American - made.
23.
Compliance with the Trafficking Victims Protection Act of 2000 (2 CFR Part 175) By
accepting funds under this Agreement, the Grantee agrees to implement the requirements of (g) of
section 106 of the .Trafficking Victims Protection Act of 2000 (TVPA), as .amended (22 U.S.C.
7104(g)
24.
Compliance with the Americans with Disabilities Act: (ADA) of 1990, Public. Law 100 -336,
American with Disabilities act Accessibility Guidelines.at28 CFR 36 and the Americans with
Disability Act Title II at 28 CFR 35. By accepting funds under this Agreement, the Grantee
agrees to comply with the provisions under the ADA regulations stated above.
DEP Agreement No. LW604, Attachment E, Page 3 of 4
25. Registrations anu identification Information, the Grantee .,grees to maintain current
registration.in the. Central Contractor. Registration (www.ccr.gov) at all times.during which
they have active project funded with these funds. A Dun and Bradstreet. Data Universal
Numbering System (DUNS) Number (www;dnb.com) . is one of the requirements for
registration in the Central Contractor Registration;
Formal regulations concerning administrative procedures for.Department of Interior (DOI) grants appear
in Title 43 of:the Code of Federal Regulations.:. The following list contains regulations and Office of
Management and Budget Circulars which may apply to the workperformed under this Agreement.
General
43 C.F.R. 17 Nondiscrimination in federall assisted programs of the DOI
Grants and Other Federal Assistance
43 C.F.R. 12 Subpart C Uniform administrative requirements for grants and cooperative
a reements to state and local governments
43 C.F.R. 12 Subpart F - Uniform administrative requirements for grants and agreements with
institutions of higher education, hospitals and other nonprofit organizations
43 C.F.R. 18 New restrictions on lobbying
43 C.F.R. 43 Governmentwide reauirements for drug -free workplace
Other Federal Regulations:.
2 G.F.R. 1400 Suspension and Debarment
48 C.F.R. 31 Contract Cost Principles and Procedures
Office of Management and Budget Circulars
A -21 (2 CFR 220) Cost Principles for Educational Institutions
A -87 (2 CFR 225) Cost Principles for State, Local, and Indian Tribal Governments
A- 122 (2 CFR Cost Principles for Non -Profit Organizations
230)
A -.133 Audit Requirements
DEP Form 55 -230 Federal Transparency Form
Attachment G Notes
The attached form, DEP 55 -230, must be completed prior to the department's final execution of
your project agreement. Most of the requested information is self- explanatory but there are a
few things to note to help ensure that the information gets entered correctly:
Make sure that the DUNS# is correct. You can use this website to check the DUNS #:
https: / /iupdate.dnb .com /iUpdate /comPanylookuP.htm
Make sure that the Principal Place of Business as well as the Principal Place of Project
Performance has the zip code + 4 (it can't be entered into the system without the +4);
You can confirmed with the U.S. Postal Service, at the following website:
htt0s://tools.usps.com/go/`ZipLookUpActionlinput.action
The Catalog of Federal Domestic Assistance (CFDA #) for your LWCF grant is: 15.916
Please provide a brief and clear description of the grant project, not.just the title in the block
provided on page 2 of 4; this should include the elements /facilities being developed or the acres
being acquired with the grant, the contract number and name Of Grantee.
F: \GROUPS \IRS \grants \LWCF \LWCF 2012 \Fed Transarency Act Form DEP-55-230 NOTES.doc
ATTACHMENT G
FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT FORM
INFORMATION FOR A
SUSAWARD TO A RECIPIENT
PURPOSE: The Federal Funding Accountability and Transparency Act (FFATA) was signed on
September 26, 2006. The intent of this legislation is to empower every American with the
ability to hold the government accountable for each spending decision. The FFATA legislation
requires information on federal awards (federal assistance and expenditures) be made available
to the public via a single, searchable website, which is http:l /www.usaspending.goy /,
The FFATA Subaward Reporting System (FSRS) is the reporting tool the Florida Department of
Environmental Protection ( "DEP" or "Department") must use to capture and report subaward
and executive compensation data regarding first tier subawards that obligate $25,000 or more
In Federal funds (excluding Recovery funds as defined in section 1512(a)(2) of the American
Recovery and Reinvestment Act of 2009, Pub. L. 111 -5).
{Note: This reporting requirement is not applicable for the procurement of property and
services obtained by the DEP through a Vendor relationship. Refer to 2 CFR Ch.1 Part 170
Appendix A, Section I.c,3 for the definition of "subaward'.)
ORGANIZATION AND PROJECT INFORMATION
The following Information must be provided to the DEP prior to the DEP's issuance of a
subaward (Agreement) that obligates $25,000 or more in federal funds as described above.
Please provide the following information and return the signed form to the Department as
requested. if you have any questions, please contact the DEP's Procurement Administrator at
850/245 -2361 for assistance.
DUNS# `
DU NS+4#:
* if your company or organization does not have a DUNS number, you will need to obtain
one from Dun & Bradstreet at 866 - 705 -5711 or use the webform
(htta: / /fedsov.dnb.com /webform). The process to request a DUNS number takes about ten
minutes and is free of charge.
BUSINESS NAME:
DBA NAME (IF APPLICABLE):
DEP 55 -230 (08/2011)
DEP Agreement No. LW604, Attachment G, Page 1 of 4
PRINCIPAL PLACE OF BUSINESS ADDRESS:
ADDRESS LINE 1:
ADDRESS LINE 2:
ADDRESS LINE 3:
CITY: STATE:
PARENT COMPANY DUNS# (IF APPLICABLE):
CATALOG OF FEDERAL DOMESTIC ASSISTANCE (CFDA #):
DESCRIPTION OF PROJECT (UP TO 4000 CHARACTERS):
ZIP CODE +4 * *:
PRINCIPAL PLACE OF PROJECT PERFORMANCE (IF DIFFERENT THAN PRINCIPAL PLACE OF
BUSINESS):
ADDRESS LINE 1:
ADDRESS LINE 2:
ADDRESS LINE 3:
CITY: STATE: ZIP CODE +4 * *:
CONGRESSIONAL DISTRICT FOR PRINCIPAL PLACE OF PROJECT PERFORMANCE:
"Providing the Zip +4 ensures that the correct Congressional District is reported.
EXECUTIVE COMPENSATION INFORMATION:
1. In your business or organization's previous fiscal year, did your business or organization
(including parent organization, ail branches, and all affiliates worldwide) receive (a) 80
percent or more of your annual gross revenues from Federal procurement contracts
(and subcontracts) and Federal financial assistance (e.g. loans, grants, subgrants, and /or
cooperative agreements, etc.) subject to the Transparency Act, as defined at 2 CFR
170.320; and, (b) $25,000,000 or more in annual gross revenues from U.S. Federal
procurement contracts (and subcontracts) and Federal financial assistance (e.g. loans,
grants, subgrants, and /or cooperative agreements, etc.) subject to the Transparency
Act? Yes ❑ No ❑
DEP Agreement No. LW604, Attachment G, Page 2 of 4
DPP 55 -230 (08/2011)
If the answer to Question 1 is "Yes," continue to Question 2. If the answer to
Question 1 is "No ", move to the signature block below to complete the certification
and submittal process.
2. Does the public have access to information about the compensation of the executives in
your*business or organization (including parent organization, all branches, and all
affiliates worldwide) 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? Yes ❑ No ❑
if the answer to Question 2 is "Yes," move to the signature. block below to complete
the certification and submittal process. [Note: Securities Exchange Commission
information should be accessible at http / /www.sec.gov /answers /execomp.htm.
Requests for Internal Revenue Service (IRS) information should be directed to the local
IRS for further assistance.]
If the answer to Question 2 is "No" FFATA reporting is required. Provide the
information required in the "TOTAL COMPENSATION CHART FOR MOST RECENTLY
COMPLETED FISCAL YEAR" appearing below to report the "Total Compensation" for
the five (5) most highly compensated "Executives ", in rank order, in your organization.
For purposes of this request, the following terms apply as defined in.2 CFR Ch. 1 Part
170 Appendix A:
"Executive" is defined as "officers, managing partners, or other employees in
management positions ".
"Total Compensation" is defined as the cash and noncash dollar value earned by the
executive during the most recently completed fiscal year and includes the following:
1. 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 12311), Shared Based Payments.
ill. 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.
DEP Agreement No. LW604, Attachment G, Page 3 of 4
DEP 55 -230 (08/2011)
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.
TOTAL COMPENSATION CHART FOR MOST RECENTLY COMPLETED FISCAL YEAR
(Date of Fiscal Year Completion (mm /dd /yyyy)):
THE UNDERSIGNED AS (enter position title) OF (enter Business Name) CERTIFIES
THAT ON THE DATE WRITTEN BELOW, THE INFORMATION PROVIDED HEREIN IS ACCURATE.
Signature
Name and Title
Date
DEP Agreement No. LW604, Attachment G, Page 4 of 4
DEP 55 -230 (0812011)
Total
Rank
Compensation for
(Highest
Most Recently
to
Name
Completed Fiscal
Lowest)
(Last, First, MI)
Title
Year
1
2
3
4
S
THE UNDERSIGNED AS (enter position title) OF (enter Business Name) CERTIFIES
THAT ON THE DATE WRITTEN BELOW, THE INFORMATION PROVIDED HEREIN IS ACCURATE.
Signature
Name and Title
Date
DEP Agreement No. LW604, Attachment G, Page 4 of 4
DEP 55 -230 (0812011)