Land and Water Conservation Fund Program FY 2014-2015 2..ot2 -- 2185
12-00622 LW622
(LWCF Project Number) DEP Contract Number
CFDA Number: 15.916
FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
LAND AND WATER CONSERVATION FUND PROGRAM
FY 2014 -2015
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 City of
Miami Beach, whose address is 1700 Convention Center Drive, Miami Beach, Florida,
33139 (hereinafter called the "Grantee"), a local government, in furtherance of the Par 3
Project 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 LW622, 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
OAGArrtee shall complete construction of all Project Elements on or before
I, chOtS .J hereinafter referred to as the Project Completion Date
( P )
Within thirty (30) calendar 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 Section 375.021(4),
Florida Statutes, Rules 62D-5.068 through 62D-5.074, Florida Administrative Code
(F.A.C.), as may be amended from time to time (hereinafter collectively called the
Rule); the Land and Water Conservation Fund (LWCF) Act of 1965, Public Law
88-578, 78 Stat 897, as amended, 16 U.S.C. § 4601-4, et.seq. (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
USD01) in the LWCF. State Assistance Program, Federal Financial Assistance
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DEP Agreement No.LW622,Page 1 of 19
Manual (hereinafter called the Manual) (formerly known as the Grants-in-Aid
Manual) including the Code of Federal Regulations (CFRs) referenced below. The
Manual refers to the CFRs applicable to this Project Agreement. The following
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 Par 3 Project (Land and Water Conservation Fund, LWCF
Project Number 12-00622), 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
contained on the boundary survey and Title Search Report submitted to the
Department among the documents itemized 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 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: Playground, tennis court, splash pad, parking, restrooms, with related
support Facilities, as identified on Attachment A and detailed on the final Project
Plans (as defined in paragraph 4 herein). 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,
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requested by the Grantee and, if agreed upon by the 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 Project Commencement Documentation required under Form
FPS-A050. 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
conceptual 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 plans
(site, engineering, and architectural) prepared for the proper and full completion of
the Project Elements, sealed by a registered architect or engineer licensed in
accordance with the laws of the State of Florida (collectively the "Project Plans"),
and shall deliver a complete original, signed and sealed, set of the Project Plans
to the Department as a condition to commencement.
5. 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 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 (paid by the Department)
Grantee Match Amount $ 200,000 (paid by the Grantee)
Total Project Cost . $400,000
Type of Match Cash and/or In-Kind Services
6. 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.
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Preagreement Expenses Approved:
Description of Work Performed Amount Approved
Preapproved Elements Preapproved Amount
N/A N/A
Total Preagreement Expenses Approved: Preapproved Amount
7. 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.
B. Upon execution of this Project Agreement, the Grantee acknowledges the
prior receipt of the LWCF Manual, the Division of Recreation and Parks'
Financial Reporting Procedures Form FPS-A058 (the "Procedures"),
available at www.dep.state.fl.us/parks/oirs, (formerly known as the Grant
and Accountability Procedures), and notice of the required Project
commencement documents listed below that must be completed by the
Grantee, if applicable, and returned to the Department within sixty (60)
calendar 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), and Project
construction schedule
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
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boundary survey submitted must not be larger than 11 in. x 17in. (3
copies)
4. Prior to approval by the Secretary the results of a title search of the
Project area (at minimum, a Title Search Report), covering the thirty
(30)year period prior to Project approval, which attests to a clear title
owned by the Grantee, with no liens, encumbrances or taxes held
against the property, or a copy of Grantee's owner's title insurance
policy. A warranty deed by itself 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)
8. The Grantee shall obtain all required local, state and federal permits and approvals
prior to commencement of Project construction and shall certify that it has done so
to the Department by completing and delivering the Land and Water Conservation
Program Commencement Certification, DEP Form FPS-A052, referenced in Rule
62D-5.073(7)(e)(1), F.A.C., together with the required set of Project Plans.
9. The Grantee shall complete all Project construction as outlined in Attachment A
and detailed in the Project Plans, by the Project Completion Date established in
- paragraph 1 above.
10. The Grantee shall submit a request for payment upon the completion of all Work
set forth in the approved Project Plans and submission of all deliverables. Within
sixty (60) calendar 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)calendar days from the Final Completion Date,
to assure the availability of funds for payment. Payment requests submitted shall
document all matching funds and/or Match efforts (i.e. In-Kind services) provided
during the period covered by the request. The final payment will not be processed
until the Match requirement has been met.
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11. In addition to the other documentation requirements contained in this Project
Agreement,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%5Fguide; 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/nara/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 and
A-110 (2 CFR, Part 215)
at: http://www.whitehouse.gov/omb/circulars/index.html#numerical.
12. Reimbursement for travel expenses is not authorized under this Project
Agreement.
13. The purchase of non-expendable equipment is not authorized under the terms of
this Project Agreement.
9
14. Allowable indirect costs, as defined in the Procedure, shall not exceed 15% of the
Grantee's eligible salaries/wages.
15. The GRANTEE recognizes that the State of Florida, by virtue of its sovereignty, is
. not required to pay any taxes on the services or goods purchased under the terms
of this Agreement.
16. Contractual (Subcontractors)- Payments to subcontractors must be substantiated
by copies of invoices with backup documentation identical to that required from the
Grantee. When requested, Grantee shall submit such documentation within thirty
(30) calendar days of receipt of the Department's request. 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)calendar 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,
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handling fees, such as set percent overages associated with purchasing supplies
or equipment. All subcontracts are subject to the provisions of paragraphs 11, 30,
and 31 and any other appropriate provisions of this Agreement which affect
subcontracting activities.
17. The Grantee agrees to comply with the Procedures, which are incorporated 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 Procedures. The Department and Grantee agree to use
the Procedures 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
Procedures shall be used.
18. Project completion means the Project Work is fully completed and the Project Site
is open and available for use by the public. The Project must be verified to have
reached Project completion as set forth in the Project Completion Certification
Form FPS-A-40 prior to the Department's release of final reimbursement.
19. 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.
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•
20. 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 25 below, 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 assistance,
the Grantee shall utilize the form 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/Iinks.aspx
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.
21. 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)calendar 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.
22. Use the language in 22. A., B., and C. if the Grantee is not self-insured.
A. The Grantee shall secure and maintain Commercial General Liability
insurance including bodily injury and property damage. The minimum limits
of liability shall be $100,000 each occurrence and $300,000 aggregate.
This insurance will provide coverage for all claims that may arise from the
services and/or operations completed under this Agreement, whether such
services and/or operations are by the Grantee or anyone directly or
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DEP Agreement No.LW622, Page 8 of 19
indirectly employed by him. Such insurance shall include the State of
Florida as an Additional Insured for the entire length of the Agreement.
B. The Grantee shall secure and maintain Commercial Automobile Liability
insurance for all claims which may arise from the services and/or operations
under this Agreement, whether such services and/or operations are by the
Grantee or by anyone directly, or indirectly employed by him. The minimum
limits of liability shall be as follows:
$300,000 Automobile Liability Combined Single Limit for Company
Owned Vehicles, if applicable
$300,000 Hired and Non-owned Liability Coverage
C. All insurance policies shall be with insurers licensed or eligible to do
business in the State of Florida. The Grantee's current certificate of
insurance shall contain a provision that the insurance will not be canceled
for any reason except after thirty(30)days written notice(with the exception
of non-payment of premium which requires a 10 day notice) to the
Department's Procurement Administrator.
The following language may replace the language in A, B and C above if the
Grantee is self-insured: (make sure you have something in writing from the
CFO confirming they are self-insured) NOTE: All state agencies are self-
insured.
The Grantee warrants and represents that it is self-funded for liability insurance,
appropriate and allowable under Florida law, and that such self-insurance offers
protection applicable to the Grantee's officers, employees, servants and agents
• n while acting within the scope of their employment with the Grantee.
23. 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 law, the Grantee shall provide,
and cause each subcontractor to provide, adequate insurance satisfactory to the
Department, for the protection of those employees not otherwise protected.
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24. Certificates of Insurance showing coverage of Worker's Compensation,
Commercial, General Liability and Auto Limits, (or written confirmation of self-
insurance, if applicable), must be submitted PRIOR to execution of this Agreement.
25. 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 5, and September 5, summarizing the work
accomplished, problems encountered, percentage of completion, any deviations
from, or proposed changes to, the Project Plans or Project Construction Schedule,
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: Ms. Judy Hoanshelt, Grants Manager
or his/her Successor
Entity: City of Miami Beach
Address: 1700 Convention Center Drive
City, State, Zip: Miami Beach, Florida 33139
Phone: (305) 673-7510
Email: judyhoanshelt @miamibeachfl.gov
Department's Grant Manager
Name: Tamika Bass, 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
Email: Tamika.Bass @dep.state.fl.us
Any changes to the above-stated contact information must be noticed in writing to
the other party within ten (10) calendar days of the change.
26. Prior to final reimbursement, the Grantee must erect a permanent informational
sign on the Project Site which credits Project funding or a portion thereof, from the
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Land and Water Conservation Fund Program through the USDOI, the National
Park Service,and the Department. The sign shall include the LWCF Program logo.
27. The Department and USDOI have the right to inspect the Project and any and all
records related thereto at any reasonable time.
28. 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.
29. 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 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.
30. 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.
31. The Grantee may subcontract work under this Project Agreement without the prior
written consent of the Department's Grant Manager. The Grantee shall, upon
request, submit a copy of each executed subcontract to the Department within ten
(10) calendar days of such request. Regardless of any subcontract, the Grantee
is ultimately responsible for all work performed under this Agreement. The
Grantee agrees to be responsible 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.
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32. 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.
33. 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.
34. 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 the documents listed in the Approved Project
Documentation Form required by 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(1), 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.
35. 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.
36. 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 the Department pursuant to Section 6(f)(3) of the LWCF Act, the Manual, and
Rule 62D-5.074(3), F.A.C. (See Chapter 8, Section E of the Manual, and 36 CFR
Part 59).
37. A. If for any reason the Grantee should fail to perform in a timely manner the
obligations under this Project Agreement, or if the Grantee should violate
any of the federal, state, or local laws pertinent to the Land and Water
Conservation Fund Program, the Rule, or the Manual, as referenced in
paragraph 1., or any of the terms or conditions of this Project Agreement,
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L
the Department shall thereafter have the right to terminate this Project
Agreement with prior notice. In the notice, the Department will set the
effective date of the termination, which may be upon receipt. The
Department may, in its sole discretion, provide the Grantee the opportunity
to cure the violations. In the event the Department terminates this Project
Agreement for these reasons, the Department is not required to
compensate Grantee for any expenses incurred before or after such
termination.
B. The Department may terminate this Project Agreement for convenience by
providing the Grantee with thirty (30) calendar days written notice. The
Grantee shall not incur new obligations for the Project after the notice is
received and shall cancel as many outstanding obligations as possible. The
notice shall set out the procedures for proper closeout of the Project
Agreement.
C. This Project Agreement may be unilaterally cancelled 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 Florida Constitution and section 119.07(1), Florida
Statutes.
D. 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.
38. No reimbursement will be made for unsatisfactory deliverables. In the event that
the DEPARTMENT'S Grant Manager deems a deliverable unsatisfactory, the
GRANTEE shall re-perform the services needed for submittal of a satisfactory
deliverable, at no additional cost to the DEPARTMENT. The DEPARTMENT shall
notify the GRANTEE of an unsatisfactory deliverable by written notice and the
GRANTEE shall resubmit the deliverable within ten (10) calendar days. If a
satisfactory deliverable is not submitted within the ten (10) calendar day period,
the DEPARTMENT may, in its sole discretion, either: 1) terminate this PROJECT
AGREEMENT for failure to perform, or 2) specify in writing the failure of
performance under this PROJECT AGREEMENT and request that a proposed
Corrective Action Plan (CAP) be submitted by the GRANTEE to the
DEPARTMENT.
A. A CAP shall be submitted within ten (10) calendar days of the date of the
written request from the DEPARTMENT. The CAP shall be sent to the
DEPARTMENT'S Grant Manager for review and approval. Within ten (10)
calendar days of receipt of a CAP, the. DEPARTMENT shall notify the
DEP 55-239(11/14) .
DEP Agreement No.LW622,Page 13 of 19
Grantee, in writing, whether the CAP proposed has been accepted. If the
CAP is not accepted, the Grantee shall have ten (10) calendar days from
receipt of the DEPARTMENT'S rejection of the proposed CAP to submit a
revised proposed CAP. If the DEPARTMENT rejects the revised proposed
CAP, the GRANTEE shall be entitled to no further revision of the proposed
CAP and the DEPARTMENT may terminate this PROJECT AGREEMENT
for failure to perform.
B. Upon the DEPARTMENT'S notice of acceptance of a proposed CAP, the
Grantee shall have ten (10) calendar days to commence implementation of
the accepted plan. Acceptance of the proposed CAP by the DEPARTMENT
does not relieve the GRANTEE of any of its obligations under this
PROJECT AGREEMENT. In the event the approved CAP fails to correct
or eliminate performance deficiencies by the Grantee, the DEPARTMENT
shall retain the right to require additional or further remedial steps, or to
terminate this PROJECT AGREEMENT for failure to perform. No actions
approved by the DEPARTMENT or steps taken by the Grantee shall serve
to stop the DEPARTMENT from subsequently asserting any deficiencies in
performance. The Grantee shall continue to implement the CAP until all
deficiencies are corrected. Reports on the progress of the CAP will be
provided to the DEPARTMENT as requested by the DEPARTMENT'S
Grant Manager. If a satisfactory deliverable is not submitted within the
timeframe specified in the approved CAP, the DEPARTMENT may, in its
sole discretion, terminate this PROJECT AGREEMENT for failure of the
GRANTEE to perform. The approved CAP shall be hereby incorporated
into this PROJECT AGREEMENT by this reference and upon the
DEPARTMENT'S approval.
C. Failure to respond to a DEPARTMENT request for a CAP may result in
termination of.this PROJECT AGREEMENT. -
The remedies set forth above are not exclusive and the DEPARTMENT reserves
the right to exercise other remedies in addition to or in lieu of those set forth above,
as permitted by this PROJECT AGREEMENT.
39. 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.
40. 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 or enter into the conversion process outlined in Rule 62D-5.074, Fla.
Admin. Code.. Failure to remedy conversion to the Department's and the National
DEP 55-239(11/14)
DEP Agreement No.LW622, Page 14 of 19
Park Service's satisfaction shall result in Grantee remaining out of compliance and
thereby ineligible for further grant funding pursuant to Rule 62D-5.074(4), Fla.
Admin. Code.
41. 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
Legislature. The parties hereto understand that this Project Agreement is not a
commitment of future appropriations.
42. It is understood by the GRANTEE that the amount of this PROJECT AGREEMENT
may be reduced should the Governor's Office declare a revenue shortfall and
assess a mandatory reserve. Should a shortfall be declared, the amount of this
PROJECT AGREEMENT may be reduced by the amount deemed appropriate by
the DEPARTMENT.
43. 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 C, 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.
44. 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
DEP 55-239(11/14)
DEP Agreement No.LW622, Page 15 of 19
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.
45. 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 subrecipient's,
accounting system cannot comply 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.
46. 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.
47. 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
DEP 55-239(11/14)
DEP Agreement No.LW622, Page 16 of 19
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.
48. 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 authorized in
writing by USDOI to the Department. The Grantee 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.
49. 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.
50. 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.
51. 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.
52. The Grantee agrees to comply with, and include as appropriate in subcontracts,
the provisions contained in Attachment D, Contract Provisions, attached hereto
and made a part hereof. In addition,the Grantee acknowledges that the applicable
regulations listed in Attachment E, Regulations,attached hereto and made a part
hereof, shall apply to this Project Agreement.
53. 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 F, 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
DEP 55-239(11/14)
DEP Agreement No.LW622, Page 17 of 19
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, 2010 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.
54. This Project Agreement is an exclusive contract and may not be assigned in whole
or in part without the prior written approval of the Department.
55. The parties hereto acknowledge and agree that the provisions contained in this
Project Agreement shall extend beyond the Project Completion Date established
in paragraph 1. By way of illustration (not limitation), such provisions include the
Grantee's submission of the Required Project Completion Documentation and the
Department's review thereof and release of final payment.
56. 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.
57. This Project Agreement is a legally-binding obligation and must be duly executed
by an authorized representative of Grantee. Grantee's signatory below warrants
that he/she is acting under the authority of Grantee to make and enter into this
Project Agreement in the name of and on behalf of the Grantee. Upon the
Department's request, Grantee's signatory shall produce the resolution or
delegation of authority evidencing such signatory's authorization to execute and
deliver this Project Agreement on Grantee's behalf. The Department is entitled to
rely on such resolution or delegation of authority until Grantee delivers written
notice of the contrary to the Department.
If Grantee's signatory is someone other than the chairperson of the governing body of
the Grantee, Grantee must provide a resolution or other document evidencing the
delegation of authority by the governing body to such signatory to execute and deliver
this Project Agreement on Grantee's behalf.
[The Remainder of this Page is Intentionally Blank.]
DEP 55-239(11/14)
DEP Agreement No.LW622, Page 18 of 19
The parties hereto have caused this Project Agreement to be duly executed, the
day and year last written below.
FLORIDA DEPARTMENT City of Miami Beach
OF ENVIRONMENTAL PROTECTION
Director
Office of Operations and State
Liaison Officer My iL . fr+AR A L1S
(or designee) Printed Name
G �Ty AGERP
Date: 5 . i i5 Title
Date: Li I 20 5
FEID No.: 59-6000372
Address: Address:
Land and Recreation Grants Section 1700 Convention Center Drive
Office of,Operations Miami Beach, FL 33139
3900 Commonwealth Boulevard
MS 585
Tallahassee, Florida 32399-3000
3611:14 g' ill it,/.� & e 3 ,
DEP Grant Manager • • . . Grantee's Attorney
Approved as to form and legality:
ArAt
D P At •rney (IP 4-/ ,/ff"
Attachments:
Attachment A Project Work Plan (2 Pages)
Attachment B Special Audit Requirements (5 Pages)
Attachment C Disclosure of Lobbying Activities (2 Pages)
Attachment D Contract Provisions (4 Pages)
Attachment E Regulations (1 Page)
Attachment F Federal Funding Accountability and Transparency Act Form
(4 Pages)
DEP 55-239(11/14)
DEP Agreement No.LW622,Page 19 of 19
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ATTACHMENT B
SPECIAL AUDIT REQUIREMENTS
The administration of resources awarded by the Department of Environmental Protection(which may be referred to
as the"Department", "DEP", "FDEP"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
interne at http://12.46.245.173/cfda/cfda.html.
DEP 55-215(06/14)
DEP Agreement No.LW622,Attachment B,Page 1 of 5
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 year 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://apps.fldfs.com/fsaa for assistance. In addition to the
above websites, the following websites may be accessed for information: Legislature's Website
at http://www.leg.state.fl.us/Welcome/index.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 specify 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
1. 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(06/14)
DEP Agreement No.LW622,Attachment B,Page 2 of 5
A. The Department of Environmental Protection at one of the following addresses:
By Mail:
Audit Director
Florida Department of Environmental Protection
Office of the Inspector General,MS 40
3900 Commonwealth Boulevard
Tallahassee,Florida 32399-3000
Electronically:
FDEPSingleAudit @dep.state.fl.us
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 http://harvester.census.gov/fac/
C. Other Federal agencies and pass-through entities in accordance with Sections.320(e)and(f),
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 one the following addresses:
By Mail:
Audit Director
Florida Department of Environmental Protection
Office-of the Inspector General,MS 40
3900 Commonwealth Boulevard
Tallahassee,Florida 32399-3000
Electronically:
FDEPSingleAudit @dep.state.fl.us
3. Copies of financial reporting packages required by PART II 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 one of the following addresses:
By Mail:
Audit Director
Florida Department of Environmental Protection
Office of the Inspector General,MS 40
3900 Commonwealth Boulevard
Tallahassee,Florida 32399-3000
Electronically:
FDEPSingleAudit@,dep.state.fl.us
DEP 55-215(06/14)
DEP Agreement No.LW622,Attachment B,Page 3 of 5
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
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 one of the following
addresses:
By Mail:
Audit Director
Florida Department of Environmental Protection
Office of the Inspector General,MS 40
3900 Commonwealth Boulevard
Tallahassee,Florida 32399-3000
Electronically:
FDEPSingleAudit @dep.state.fl.us
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-133,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.
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
DEP 55-215(06/14)
DEP Agreement No.LW622,Attachment B,Page 4 of 5
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ATTACHMENT C 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 [11 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:
❑ Prime ❑ Subawardee
Tier ,if known:
Congressional District,if known: Congressional District,if known:
6. Federal Department/Agency: 7. Federal Program Name/Description:
CFDA Number,if applicable:
i known:
8. Federal Action Number,f 9. Award Amount,,f
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 Local Reproduction
Standard Form—LLL(Rev 7—97)
Form DEP 55-221(01/01)
DEP Agreement No.LW622,Attachment C,Page 1 of 2
INSTRUCTIONS FOR COMPLETION OF SF-LLL,DISCLOSURE OF 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 information 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 (01/01)
DEP Agreement No.LW622,Attachment C,Page 2 of 2
ATTACHMENT D
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 or reported 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 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.
6. 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.)-Contracts and subgrants of amounts in excess of$100,000 shall
DEP Agreement No.LW622,Attachment D,Page 1 of 4
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 amended,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 II 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.
13. Compliance,if applicable, with flood insurance purchase requirements 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.
DEP Agreement No.LW622,Attachment D,Page 2 of 4
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. 11988;(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.);(0 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 100-690,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. l0a-IOc) 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 (TWA), 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 at 28 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.
25. Registrations and Identification Information, the Grantee agrees 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.
DEP Agreement No.LW622,Attachment D,Page 3 of 4
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DEP Agreement No.LW622,Attachment D,Page 4 of 4
ATTACHMENT E
REGULATIONS
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 work performed under this Agreement.
General
43 C.F.R. 17 Nondiscrimination in federally assisted programs of the DOI
Grants and Other Federal Assistance
43 C.F.R. 12 Subpart C-Uniform administrative requirements for grants and cooperative
agreements 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 requirements for drug-free workplace
Other Federal Regulations
2 C.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
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DEP Agreement No.LW622,Attachment E,Page 1 of 1
ATTACHMENT F
FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT FORM
INFORMATION FOR A
SUBAWARD 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://www.usaspending.gov/.
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# *:
DUNS+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
(http://fedgov.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):
Page 1 of 4
DEP 55-230(08/2011)
PRINCIPAL PLACE OF BUSINESS ADDRESS:
ADDRESS LINE 1:
ADDRESS LINE 2:
ADDRESS LINE 3:
CITY: STATE: ZIP CODE+4**•
PARENT COMPANY DUNS# (IF APPLICABLE):
CATALOG OF FEDERAL DOMESTIC ASSISTANCE (CFDA#):
DESCRIPTION OF PROJECT(UP TO 4000 CHARACTERS):
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, all 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❑
Page 2 of 4
DEP 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 n
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:
i. 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 123R), Shared Based Payments.
iii. 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.
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)):
Total
Rank Compensation for
(Highest Most Recently
to Name Completed Fiscal
Lowest) (Last, First, MI) Title Year
1
2
3
4
5
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
Page 4 of 4
DEP 55-230(08/2011)