SCE P
STATE & COMMUNITY ENERGY PROGRAMS
EECBG Program PRE - AWARD INFORMATION SHEET
EachEnergyEfficiency andConservationBlock Grant (EECBG) Programrecipient shallprovide the following information on behalf of itself and all subrecipients and certify that the information is accurate and complete.
Recipientsmay chooseto provide this information in whateverformatthey like, asthis form is optional.
EECBG Program recipients representing local and tribal entities may select from two options: 1) a grant or 2) a voucher for technical assistance and/ or equipment rebates. EECBG Program recipients choosing a grant must provide data requested in sections 1 through 8 below. EECBG Program recipients choosing a voucher may skip sections 4 through 7. Please submit your completed document to EECBG@hq. doe.gov.
SECTION 1: CONTACT & LOCATION INFORMATION ( All recipients) Recipient Name: City of Chula Vista
UEI: NA
Business Officer
BO): Miranda Evans
BO Phone
Number: 619) 409- 5913
BO
Email:
mevans@chulavistaca. gov
Project Director/ PI Phone PI
Principal
C o le e n W is n iews ki Number: 619- 409- 5828 Email: cwisniewski@chulavistaca. gov Investigator PI):
Note: PI is the designatedprimary point of contactfor the EECBG grant, suchasthe Projector ProgramManager.
Business Officer is the authorized individual responsible for financial management of the EECBG grant.
Additionally, UEI numberis required for grant applicants, but not for voucher applicants.
A. TYPE OF ORGANIZATION — Please indicate the type of organization of the Recipient by selecting one of the following:
QLocal Government
0 TribalGovernment
OState
OTerritory
B. LOCATION AND CONGRESSIONAL DISTRICT
List the addressandCongressional(s) district for the primary location wherethe grantwill beperformed.
Street Address: 276 4th Avenue
City: Chula Vista
State: California
Zip: 91910
Congressional District( s): 52nd and 53rd
Revised March 21, 2023
SECTION 2: GRANT OR VOUCHER ( All recipients)
EECBG Program recipients representing local and tribal entities must select whether to receive their EECBG Program award in the form of a grant or a voucher for technical assistance and/ or equipment rebates. Please indicate your choice here. All States & Territories must select " Grant." ( Selectoneoption) [responseto this questionis non -bindings QVoucher forTechnicalAssistance
Voucher for Equipment Rebate
QVoucher forbothTechnicalAssistanceandEquipmentRebate
O
Grant
SECTION 3: BUSINESS ASSURANCES ( All recipients)
A. DISCLOSURE OF POTENTIAL IMPROPRIETIES
Below, please disclose if any of the following conditions exist. If the answer to any question ( a) through ( g) below is yes, provide a detailed explanation in an attachment to this form. a. Is the proposed Recipient, Subrecipient( s), or any of the Recipient' s or Subrecipient' s principals' under investigation for or charged with a covered offense'?
OYes
@No
b. Has the proposed Recipient, Subrecipient( s), or any of the Recipient' s or Subrecipient' s principals been convicted of a covered offense in the last five years or had a civil judgment rendered against them for one of those offenses in that time period?
OYes
@No
c. Is the proposed Recipient, Subrecipient( s), or any of the Recipient' s or Subrecipient' s principals under investigation for potential violation of U. S. export control laws and regulations, or has the proposed Recipient, Subrecipient(s), or anyof the Recipient's or Subrecipient's principals beenconvicted of any violations of U. S. export control laws and regulations? OYes
No
d. Is the proposed Recipient or Subrecipient( s) under investigation for potential violations of the Drug -Free Workplace Act of 1988, or hasthe proposedRecipient or Subrecipient(s) beenconvictedof anyviolations of the Drug -Free Workplace Act of 1988?
Yes
No
1 For this form, " principal" means: ( 1) An officer, director, owner, partner, PI, or other person ( as defined in 2 C. F. R. 180. 95) within the Project Team with management or supervisory responsibilities related to this project and any resulting transaction; or ( 2) A consultant or other person, whether or not employed by the Recipient, Subrecipient, or their principals, or paid with Federal funds, who a) is in a position to handle Federal funds, ( b) is in a position to influence or control the use of those funds, or ( c) occupies a technical or professionalposition capableof substantiallyinfluencing the developmentor outcomeof an activity requiredto perform the transaction, including but not limited to, any Co -PIs. 2 For this form, " coveredoffenses" include: (1) Commission of fraud or a criminal offensein connectionwith obtaining, attemptingto obtain, or performing a public or private agreementor transaction; (2) Violation of Federalor Stateantitrust statutes, including those proscribing price fixing betweencompetitors, allocation of customersbetweencompetitors, andbid rigging; ( 3) Commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, receiving stolen property, making false claims, or obstruction of justice; or (4) Commission of any other offenseindicating a lack of businessintegrity or business honesty that seriously and directly affects the Recipient' s present responsibility.
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e. Is the proposed Recipient, Subrecipient( s), or any of the Recipient' s or Subrecipient' s principals under investigation for research misconduct, or has the proposed Recipient, Subrecipient( s), or the Recipient' s or Subrecipient' s principals been convicted of research misconduct? Q Yes
Q No
f. Has any Federal Agency recommended or initiated proceedings against the proposed Recipient, Subrecipient( s), or the Recipient' s or Subrecipient' s principals for suspension or debarment, or is the proposed Recipient, Subrecipient( s), or the Recipient' s or Subrecipient' s principals debarred, suspended, publicly banned from doing business with the Federal government, or otherwise declared ineligible from receiving Federal Contracts, subcontracts or financial assistance? QYes
QNo
g. Is the proposed Recipient or Subrecipient( s) delinquent on federal debt or insolvent or at risk of insolvency or havetheproposedRecipientor Subrecipient(s) filed for bankruptcy in any domesticor foreign jurisdiction?
QYes
F)No
B. POTENTIAL CONFLICTS OF INTEREST
1. Financial Conflicts of Interest. The Recipient must disclose in writing any managed or unmanageable financial conflicts of interest involving a member of the project team ( i.e., Investigators) and include sufficient information to enable DOE to understand the nature and extent of the financial conflict, and to assessthe appropriateness of the non -Federal entity' s management plan. See Section V( b)( 3) of the DOE Interim Conflict of Interest Policy. As part of this DOE fundedproject, doesthe recipient or any subrecipientshaveany managedor unmanageablefinancial conflicts of interestinvolving a member of the project team ( i. e., Investigators)?
QNo
QYes. If yes, in a separateattachment, the Recipient must provide relevantdisclosures/supporting documentation as required by the DOE Interim Conflict of Interest Policy Section V( b)(3).
C. Organizational Conflicts of Interest'. The Recipient must disclose in writing any potential or actual organizational conflict of interest to DOE. See DOE Interim Conflict of Interest Policy Section VI and 2 CFR 200.318 for more information. As part of this DOE fundedproject, doestherecipient or any subrecipientsintendto engagein a procurementwith aparent, affiliate, or subsidiaryorganizationthat is not a state, local government, or Indian tribe?
QNo
QYes. Ifyes, inaseparateattachment, theRecipientmustproviderelevantdisclosures/supporting documentation as required by the DOE Interim Conflict of Interest Policy Section VI.
Recipients choosing a voucher may skip to Section 8**
3 OrganizationalConflictof Interestmeansasituationwherebecauseof relationshipswith aparentcompany, affiliate, or subsidiaryorganization, thenon -Federalentity is unable or appearsto be unable to be impartial in conducting aprocurement action involving a related organization. 2 CFR 200318( c)(2).
Revised March 21, 2023 Page 3 of 10
SECTION 4: PAYMENT INFORMATION ( Grant recipients only) Provide ( 1) the awardee seven - digit ASAP ( Automated Standard Application for Payment System) ID number that is under the DOE / Golden Field Office ( GO) Agency Locator Code ( ALC) and Region Code (# 8900- 0001- 04) if available; 2) the name, phone number and email for the ASAP / Payments Contact Person; and ( 3) indicate whether the preferred payment method is by advance or reimbursement. Note: If ASAP number is not available, please leave field ( 1) blank and proceed with filling out ( 2) and (3).
1) ASAP Number:
2) ASAP/ Payments Contact Person:
3) Indicate Preferred Payment Method: ®
Payment by Advance ® Payment by Reimbursement
SECTION 5: PERFORMANCE AND FINANCIAL INFORMATION REQUEST ( Grant recipientsonly) Before providing this information, pleasereadthe ADDITIONAL INFORMATION at the endof this form. Eachfield identified below must be completed.
Has the Recipient had prior Federal awards? OYes ONo
If Yes:
Is the Recipient up to date on all reporting requirements on all other current and ® Yes O No prior awards, including submitting acceptable final technical reports, with other Federal or non - Federal organizations? If you check No to this question, please attach an explanation.
2a. Has the Recipient had an independent Single Audit or independent Compliance OYes ® No Audit per Federalregulations, or hada prior DefenseContractAudit Agency (DCAA) Audit performed? Please see attached instructions regarding Independent Audit requirements.) 2b. Has the Recipient undergone a Financial Audit within the last 3 years? 0 Yes 1No If Yes to either 2a. or 2b.:
a. A copy of the audit is attached to this form. 0 Yes ® No b. An electronic copy of the audit was provided with application package. 0l Yes No An electronic copy of the audit can be found at
If audit was not provided, please explain why it has not been completed and/or provided:
Recipient' s fiscal year end date is
4a. Identify the FederalAgency providing the preponderanceof funding from ALL GovernmentAwards which the Recipient' s organization is/was the prime recipient, including any DOE Awards.
Provide Agency name, CognizantAgency point of contact (individual in chargeof negotiatingbilling rates), phone number, and e- mail.
If the Recipient' s organization has a DCAA contact, please provide this information in 4( c) below):
Agency:
Revised March 21, 2023 Page 4 of 10
Point of Contact:
Phone/ Email:
4b. DCAA Contact Information:
DCAA Office:
Point of Contact:
Phone/ Email:
SECTION 6: FINANCIAL MANAGEMENT SYSTEM — ACCOUNTING SYSTEM SURVEY ( Grant recipients only)
To qualify for Financial Assistance, compliance with 2 CFR 200 as amended by 2 CFR 910 is required. This includes assurance of an adequate accounting system for estimating, accounting, and billing for governmental funding received.
Please complete the checklist below as assurance of this requirement.
For additional information, please visit https:// www. dcaa.mil. Please refer specifically to the " Pre -award Accounting System Adequacy Checklist" under CUSTOMERS --> Checklists and Tools.
1. Is the Accounting System in accordance with Generally Accepted Accounting Principles applicable to the circumstances and associated applicable Federal regulations?
2. Accounting System provides for:
a. Segregation of direct costs from indirect costs.
b. Identification and accumulation of direct costs by project. c. A logical and consistent method for the allocation of indirect costs to intermediate and final cost objectives. ( Project line items are final cost objective) d. Accumulation of costs under general ledger control.
e. A timekeeping system that identifies employees' labor by intermediate and final cost objective ( i. e., project level, division level). f. A labor distribution system that charges direct and indirect labor to appropriate cost objectives.
g. Interim ( at least monthly) determination of costs charged to a project through routine posting of books of account.
h. Excluding costs charged to Government projects which are not allowable in terms of FAR 31, Contract Cost Principles and Procedures, or other provisions. i. Identification of costs by project line item and by units ( as if each unit or line item were a separateproject) if required by the proposed award.
Yes No NA
wore
000
000
0 0 0
COC
000
000
0 0 0
3. Is the Accounting System designed, and are the records maintained in such a manner that 0adequate, reliable data are developed for use in developing cost proposals? 00
4. Is the Accounting System currently in full operation? Revised March 21, 2023 Page 5 of 10
SECTION 7: REPRESENTATION/ CERTIFICATION ( Grant recipients only) Certification of the information is required by the organization' s authorized representative I certify that I haveregisteredin the Systemfor Award Management (SAM).
I certify that I have registered in FedConnect. net in order to receive award documentation.
I certify that all subrecipientcostinformation hasbeenreviewed, andthat all subrecipientcostsarereasonable, allowable, and allocable in accordance with the applicable cost principles. All subrecipient budget documents should be available upon DOE request.
I certify that all direct costs proposed in the application ( under the personnel, travel, equipment, supplies, contractual, construction, and/ or other direct costs categories) are direct to the project and are not duplicated in the proposed indirect costs.
I certify that the processes undertaken to solicit any subrecipients, subawards, subcontracts and vendors comply with our organization' s written procurement procedures as outlined in " Procurement Standards" 2 CFR 200. 317 through 2 CFR 200. 326 inclusive.
I certify the Recipient:
1) Has in effect an up to date, written, and enforced administrative process to identify and manage conflicts of interest with respect to all projects for which financial assistance funding is sought or received from DOE; 2) Shall promote and enforce Investigator compliance with DOE' s Interim Conflict of Interest ( COI) Policy' s requirements including those pertaining to disclosure of significant financial interests; 3) Shall manage financial conflicts of interest and provide initial and ongoing financial conflicts of interest reports to DOE;
4) Agrees to make information available, promptly upon request, to DOE relating to any Investigator disclosure of financial interests and the Recipient' s review of, and response to, such disclosure, whether or not the disclosure resulted in the Recipient' s determination of a financial conflict of interest; and 5) Shall fully comply with the requirements of the DOE Interim COI Policy.
SECTION 8: SIGNATURES ( All recipients)
I, the Authorization Official named below, represent by my signature that I am authorized to certify this information on behalf of the Recipient. I certify to the best of my knowledge and belief that the information contained in this Pre - Award Information Sheet is true, complete and accurate. I understand that any false, fictitious, or fraudulent information, misrepresentations, half- truths, or omissions of any material fact, may subject me to criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise. ( 18 U. S. C. §§ 1001 and 287, and 31 U. S.C. 3729- 3730 and 3801- 3812). I further understand and agree that ( 1) the statements and representations made herein arematerial to DOE' s funding decision, and (2) 1havea responsibility to updatethe disclosuresduring the period of performance of the award should circumstances change which impact the responses provided above.
Name:
Title:
Signature of Authorized
Official:
Revised March 21, 2023 Page 6 of 10
Date:
I, the Principal Investigator namedbelow, certify to the bestof my knowledge andbelief that theinformation contained in this Pre -Award Information Sheet is true, complete and accurate. I understand that any false, fictitious, or fraudulent information, misrepresentations, half- truths, or omissions of any material fact may subject me to criminal, civil, or administrative penalties for fraud, false statements, false claims or otherwise. ( 18 U. S. C. §§ 1001 and 287, and 31 U. S.C. 3729- 3730 and 3801- 3812). I further understand and agree that ( 1) the statements and representations madehereinarematerial to DOE' s funding decision, and (2) I havearesponsibility to updatethe disclosuresduring the period of performance of the award should circumstances change which impact the responses provided above.
Name:
Title:
Signature of Principal
Date:
Revised March 21, 2023 Page 7 of 10
ADDITIONAL INFORMATION
This information will assist DOE in determining: 1) cognizance; 2) whether the Recipient has adequate internal financial andmanagementcontrols; and3) whetherthe Recipienthasan adequateaccountingsystem. Generally, cognizancemeans thatan organizationhasa Federaloversight agency (cognizantagency). Cognizanceof anorganizationis usedfor many purposes including: determining which agency is responsible for verifying correct allocation of indirect rates to incurred costs; issuingthe Provisional andFinal Indirect RateAgreements; andordering audits. Adequateinternal controlsand accounting systems are essential to ensure that the Recipient' s costs are correctly estimated, recorded, and billed. The Recipienthastheresponsibilityto ensurethatthesesystemsarein place. ThecognizantAgencyhastheresponsibilityfor verifying these systems through audits or other methods.
For additional information, pleasevisit https://www..dcaa.mil. Pleaserefer specifically to the "Pre -awardAccounting System Adequacy Checklist" under CUSTOMERS --> Checklists and Tools.
Cognizanceis determinedby TOTAL Federalaward/contractdollars receivedby the Recipient/Contractorfrom all Federal agencies. This information is usedto determinewhich Federalagencyhasthe largestpreponderanceof funding andis cognizant. Once a Federal agency assumes cognizance for a contractor, it should remain cognizant for at least 5 years to ensure continuity and ease of administration.
Cognizancerelated dutiesarethe responsibility of the CognizantFederalAgency (CFA). The CFA is the Federalagency e.g., Department of Defense, Department of Energy, Navy, etc.) that provided the preponderance ( largest amount) of funding for your awards, acrossall federal agencies. It is very important to confirm thatyou work with the correctoffice.
General Rule of Thumb: Department of Health & Human Services ( DHHS) is usually the CFA for Universities, Cities, States, and Counties. DHHS cognizance is not usually transferred.
If it is determinedthat the Departmentof Energy/GoldenField Office (GO) is the CognizantFederalOffice, the Recipient will have the following ANNUAL responsibilities:
1. Submit a Certified Annual Incurred Cost Claim ( ICE Model — see # 3 below) to the GO Cost/ Price mailbox CostPricenee.doe.gov). This should represent the total organization' s costs (representing the Company General Ledger), not just the Recipient' s DOE award( s).
2. Due Date: 180 days after the Recipient' s fiscal year end.
3. . For an example of the ICE Model, please visit his:// www. dcaa. mil. Under " CUSTOM ERS ->Checklists and Tools", click on ICE ( Incurred Cost Electronically) Model and download the ICE model.
Once the information is received, GO will have the responsibility of providing your organization with an annual indirect rate agreement. This indirect rate must be used on all Federal grants and contracts.
If it is determined that GO is not the Cognizant Federal Office, the Recipient should contact the Cognizant Office for additional instructions.
Revised March 21, 2023 Mage 8 of 10
ANNUAL AUDIT REQUIREMENTS
Independent ( Single & Compliance) Audit Requirements
2 CFR 200, Section F located at:
hgp:// www. ecfr.gov/ cgi- bin/ text-
idx? SID= 6e187b05cfeca4f534c659f20983bl4e& mc= true& node— pt2. 1. 200& r— div5 For - Profits: 2 CFR 910, Section F located at:
hqp://www. ecfr.gov/cgi-bin/text-idx?nodefpt2. 1.910&rgn--div5 Below are excerpts from Section F.
Audit requirements.
a) Audit required. A non -Federalentity that expends $750,000 or more duringthe non -Federalentity'sfiscal year in Federal awards must have a single ( program - specific, not applicable for For - Profits) or compliance audit conducted for that year in accordance with the provisions of this part. b) Single audit. A non -Federal entity that expends $750,000 or more during the non -Federal entity' s fiscal year in Federal awards must have a single audit conducted in accordance with § 200. 514 - Scope of audit except when it elects to have a program - specific audit conducted in accordance with paragraph ( c) of this section. b) Compliance audit. ( 1) If a for- profit entity has one or more DOE awards with expenditures of $ 750,000 or more during the for- profit entity' s fiscal year, they must have a compliance audit for each of the awards with $ 750,000 or more in expenditures. A compliance audit should comply with the applicable provisions in § 910.514— Scope of Audit.
The remaining awards do not require, individually or in the aggregate, a compliance audit. c) Program - specific audit election. ( Not applicable to For - Profits). When an auditee expends Federal awards under only one Federal program ( excluding R& D) and the Federal program' s statutes, regulations, or the terms and conditionsof the Federalawarddo not require a financial statementaudit of the auditee, the auditeemay elect to have a program - specific audit conducted in accordance with § 200. 507 Program - specific audits. A program - specific audit may not be electedfor R&D unlessall of the Federalawardsexpendedwerereceivedfrom the sameFederalagency, or the same Federal agency and the same pass-through entity, and that Federal agency, or pass-through entity in the case of a subrecipient, approves in advance a program - specific audit. d) Exemption when Federal awards expended are less than $ 750,000. A non -Federal entity that expends less than 750,000 during the non -Federal entity' s fiscal year in Federal awards is exempt from Federal audit requirements for that year, except as noted in § 200. 503 Relation to other audit requirements, but records must be available for review or auditby appropriateofficials of the Federalagency, pass-through entity, andGovernmentAccountability Office GAO).
e) Federally Funded Research and Development Centers ( FFRDC). Management of an auditee that owns or operates a FFRDC may elect to treat the FFRDC as a separate entity for purposes of this part. f) Subrecipients and Contractors. An auditee may simultaneously be a recipient, a subrecipient, and a contractor.
Federal awards expended as a recipient or a subrecipient are subject to audit under this part. The payments received for goods or services provided as a contractor are not Federal awards. Section § 200. 331 Subrecipient and contractor determinations sets forth the considerations in determining whether payments constitute a Federal award or a payment for goods or services provided as a contractor.
Revised March 21, 2023 Page 9 of 10
g) Complianceresponsibility for contractors. In mostcases, the auditee'scomplianceresponsibility for contractorsis only to ensurethat the procurement, receipt, andpaymentfor goodsandservicescomply with Federalstatutes, regulations, andthe terms andconditionsof Federalawards. Federalawardcompliancerequirementsnormally do not pass through to contractors. However, the auditee is responsible for ensuring compliance for procurement transactions which are structured such that the contractor is responsible for program compliance or the contractor' s records must be reviewed to determine program compliance. Also, when these procurement transactions relate to a major program, the scopeof the auditmust include determiningwhetherthesetransactionsarein compliancewith Federalstatutes, regulations, and the terms and conditions of Federal awards. h) For-profit subrecipient. Sincethis part doesnot apply to for-profit subrecipients, the pass-through entity is responsiblefor establishingrequirements, asnecessary, to ensurecomplianceby for-profit subrecipients. The agreement with the for- profit subrecipient must describe applicable compliance requirements and the for- profit subrecipient' s compliance responsibility. Methods to ensure compliance for Federal awards made to for- profit subrecipientsmay includepre -awardaudits, monitoring during the agreement, andpost -awardaudits. Seealso 200. 332 Requirements for pass- through entities.
Revised March 21, 2023 Page 10 of 10