5. a)
b)
c)
d)
e)
f)
g)
6. a)
b)
c)
7. 8.
SECTION D: SUB-RECIPIENT'S CERTIFICATION
The following numerals provide the instructions to fill in the corresponding numeral in the form:
1. 2.
3. 4 &
5. SECTION C:
(Continued)
If the expenditures that you are claiming were purchased thru a vendor or contractor, please enter the invoice # in the grid area. Please note that you are responsible for following acceptable purchasing policies and for documenting your procurement process. Additionally please include the following documentation with your claim:
Copy of the invoice
: Please attach an invoice that provides sufficient information to be used as a cross reference with the items described in your grant line item and AEL #. When the invoice includes items that are not being claimed or that belong to different claims or grants, please circle and designate on the invoice the items that you are requesting for reimbursement. Each item circled must have a project #, a funding source, and a total. Purchase orders and price quotes will not be accepted in the place of the invoice.
Copy of the purchase order
Print out of the corresponding AEL # (Authorized Equipment List number).
The AEL listing can be found at:
https://www.rkb.us/fema_grants.cfm
Proof of payment of the invoice:
The proof of payment for L.A. County Departments is the printout from e-CAPS showing that the check cleared the bank. The proof of payment for
other
than L.A. County Department is the corresponding copy of the bank's cleared check .
Calculations for use tax paid:
When use tax is paid, clearly show the calculations of the use tax in the invoice included in your claim.
Proof of payment of the use tax
: Please provide official documents which authenticate the remittance of the use tax to the state, the amount and the reference to the invoice being claimed.
Federal Debarment Listing:
Please provide a screen print out of the queried Federal Debarment Listing at http://www.sam.gov/portal/public/SAM
. (you will need a username and a password; if you don't please create an account) .
The listing
needs to be queried
prior
to the selection of the vendor.
If you are claiming services, supplies, training related costs, or any other type of items purchased thru a vendor or contractor or government agency, please indicate with an X the method that you used to acquire the items (do not
leave blank or mark more than one). Please note that competitive bid, non-competitive bid or sole source are the only valid purchasing methods.
Competitive Bid:
for projects that received more than one bid. Please indicate number of bids received (must be more than one).
Non-Competitive Bid:
for single bid purchases of $250,000 or more (effective June 21, 2018) to a single vendor or a single project, please attach the approval from the State. The approval needs to be requested from the State prior
to the start of the project.
Sole Source:
for non-bid purchases of $250,000 or more effective (June 21, 2018) to a single vendor or a single project, please attach the approval from the State. The approval needs to be requested from the State prior
to the start of the project.
Enter the amount of your claim after you verify that your budget is sufficient to cover your request. When the amount of the budget is not sufficient, please let your Program Coordinator know of the possible need for budget modification.
Enter the "Total Amount" by adding the subtotal claims included in each line.
Please read and check the box provided if you are an authorized signor.
Please read and check the box provided if you are an authorized signor.
Please sign the Grant payment request if you are an authorized signor of your agency.
When the authorized person is the same as the contact person in Section B you do not need to enter the authorized contact information. If the authorized person and the contact person in Section B are different, please enter all the fields in this area as requested.
Revised on 11/20/2017
a)
For Training Claims
:
a)
b)
c)
If you are including
personnel cost
with your training
claim, please add the following:
d)
e)
f)
g)
h)
i)
ADDITIONAL ITEMS THAT YOU NEED TO ATTACH TO YOUR GRANT PAYMENT REQUEST :
For Equipment Claims
:
Equipment Inventory Listing (Print out & Excel File):
Please include both the printout of the listing and the corresponding excel file with your claim. The excel file is used to submit your claim with the state and the printout as backup document for audits. If there is no serial # for your equipment please assign a valid ID tag, or write "Consumable" (if it applies) or write N/A. please do NOT leave the corresponding space blank.
*1
Please refer to the
Instructions to Equip Inty Tab for completion procedures of Equipment Inventory.
Additionally, please enter the appropriate CBRNE Mission (Chemical, Biological, Radiological, Nuclear, or Explosive) in the column titled "Equipment Description & Quantity". This only applies to vehicles with AEL # 12VE-00-MISS (Vehicle Specialized Mission:CBRNE).
You need to inform us of any changes on the items above *1
. This applies to each piece of equipment added in the Inventory Listing, including when the items are disposed and/or no longer useful. We will update the master inventory listing (per grant requirement) according to the information you give us. Please make sure that you include all the attachments that are necessary to provide us with the requested information.
State Sole Source Approval:
If you are claiming training related costs thru a Non-Competitive Bid or Sole Source training provider, regardless the purchased amount, please attach the State's approval (effective December 03, 2018). The approval needs to be requested from the State prior to the start of the project.
State-Sponsored Training Reporting Form (with the tracking request #):
Please add this form along with the Training Request Form Training Officer (POC), which you completed at the website, to the claim's backup documentation. All the backup documentation submitted for the training claim needs to agree with the training period and the detail description on the Training Reporting Form and the line item of the Grant. Training request #'s must be obtained from the State prior to the start of the project.
Receipts and paid invoices:
please include the complete copy of the receipts and paid invoices with your claim for itemized costs such as air plane tickets, hotel stays, instructor's fees, workshop cost, facilities fees, consulting services, etc. Additionally, you will need to include the documents requested in numeral 5 under Section C.
Personnel List (Print out & Excel File):
Please include both the printout of the listing and the corresponding excel file with your claim. The excel file is used to submit your claim with the state and the printout as backup document for audits.
Documents that certify completion of the training:
please attach supporting documents that show the class name, dates of training, # of hours of the training class, printed name and signature of individual taking the class and approval signature from supervisor or trainer (attach the information for backfilled positions also). Examples of documents that certify completion of training are:
Attendance sheets (signed by employee and instructor)
Sign in sheets (same as above)
Signed training certificates
Summary Listing of Charges:
Please use the
Training Summary Sheet
form provided in this claim packet that
clearly
shows the
breakdown of the training charges per employee and that match the total claimed. This form includes the following: employee name, assignment, job title, date, salary, hours claimed, regular rate, overtime rate, employee benefits rate, claim amount per employee, clear calculations of amount claimed per employee and total (equal to the amount claimed).
Please ensure that the Training Summary Sheet is verified/approved by an authorized signatory, with printed name and title, and dated.
Backup for the Benefits Rate:
If you are adding benefits to your claim, please make sure that you include the official calculation for the rate used.
Timecards:
Include a printout of the corresponding timecards. Manual timecards need to indicate the # of hours charged per day to the grant, supervisor's signature, employee name and signature. Automatic system generated timecards need to be approved and include the name of the employee and hours charged per day to the grant.
Explanation of timekeeping codes:
When the supporting documentation (timesheet, payroll register, etc.) includes timekeeping codes please provide a printout with the explanation of the usage as detailed as possible.
Revised on 11/20/2017
j)
k)
For Planning
Claims:
a)
b)
c)
d)
a)
b)
c)
Deliverable (or final product):
Please include with your claim the final product of the planning activity (deliverable) that was identified in the grant award.
Payroll register:
The payroll register needs to clearly support and explain the amount claimed per employee. It also needs to show the salary, hourly rate, employee benefits and overtime rate.
Roster of backfilled positions:
When you are claiming overtime for a backfilled position, please attach the backfilled roster to your claim.
The roster needs to include the name of the backfilling employees, a short description of duties performed, the corresponding employee whose duties were covered and the dates accordingly. Please make sure that the roster is signed and that you include documentation corresponding to the employee covered by the backfilling position.
Signed Certificate of Completion:
The certificate of completion can be an e-mail confirming that the planning activity was completed.
Invoices:
If your planning claim includes charges invoiced by vendors, please see requirements and documents you need to attach to your claim form under Section C (numeral 5 and numeral 6).
Supporting Documentation for Personnel Cost:
When your planning claim includes personnel cost, please see d) to i) under Training Claim (supporting documents needed) and add to the documentation.
For Exercise Claims:
Proof of State Approval of After Action Report (AAR):
In order for your AAR to be approved you have to submit it to the State using the ODP Portal (see link below), within 90 days after completion of the exercise. You need to notify the State when the AAR is uploaded so they can proceed with the approval process.
https://hseep.dhs.gov/DHS_SSO/
Invoices:
If your exercise claim includes charges invoiced by vendors please see requirements and documents you need to attach to your claim form under Section C (numeral 5 and numeral 6).
Supporting Documentation for Personnel Cost:
When your exercise claim includes personnel cost, please see d) to i) under Training Claim (supporting documents needed) and add to the documentation.
For Organization Claims: Please see above b) and c) under Exercise Claims Revised on 11/20/2017
GRANT NAME: