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HomeMy WebLinkAboutCopy of 25055 City of Sebastian - Attachment E_BA Tracking and Reporting Forms1. 2. 3. B6. B7. B8. B9. E5. E7. E8. H8. B26- B29. C26- C29. Header Section City, State Zip Code: Enter the legal City, State and Zip code of the address matching the recipient's FEIN. POC Name/Phone Number: Enter the Point of Contact's (POC) first and last name followed by a backslash and then their phone number. (e.g. John Smith/248-434-5508) Start Date: Indicate the actual start date for the work under the respective Category or the anticipated start date if the work has not begun. For each applicable category identify the amount allocated, quarterly funds expended, and total funds expended to date. All shaded cells will auto-populate. Total Allocated (Award & Match): Enter the total amount of funds allocated to each category of work - each cell should reflect the sum of the awarded funds and the recipient's contributions (if any). These values should align with the Agreement budget outlined in Attachment A, Scope of Work, Section 5. Budget revisions must be requested and approved by the FWC Grant Manager and may require execution of an amendment to the grant Agreement to modify scope and/or budget. Unused categories may be left blank. C13- C21. For the Performance section of the reporting form, each Category budgeted in this Agreement should be reported separately to reflect the current status. H13- H21. Category: Budget categories with listed funding will auto-fill in these cells. Relate the following columns to this Category by row. Financial Section Performance Section Agreement: The Agreement # and project title will autofill from cell E3 and E4 of the Instructions sheet. Reporting Period: Enter the appropriate year for the reporting period. Reporting Period: Select the appropriate reporting period from the drop-down menu. Agreement End Date: Fill in the current Agreement end date. Total Funds Expended: This column should reflect the entire amount of funds expended up to the last day of the reporting period. This figure should equal the Total Funds Expended (Column E) from the PREVIOUS quarter combined with the Quarterly Funds Expended (Column D) in the current quarter as applicable to the categorical row specified in column B. You will need to reference the previous quarterly report's Total Funds Expended column (E). G13- G21. Expenditure(s) Percent: These cells auto-populate to reflect the percentage of funds expended based on the Total Allocated (Award & Match) (column C) and Total Funds Expended (column E) per applicable categorical row specified in column B. ATTACHMENT E - BOATING ACCESS PERFORMANCE TRACKING AND REPORTING FORMS Recipient: Fill in the grant recipient's agency/organization name, which must match with the Federal Employer Identification Number (FEIN) provided in the application and other agreement forms and documents. Form 1 – Quarterly Progress Report D13- D21. Completed on a quarterly basis. In order to be considered in compliance with the terms of the Agreement, the required reports must be submitted no later than 15 days after the end of each Quarterly Reporting period. These reports are to include, but not be limited to, the work that has been completed, the work in progress and the timeline of the work left to be completed. If any delays from the original timeline have occurred, specify the reason and revise the completion timeline. Note if ahead of schedule or unexpected cost savings. If expenditures do not occur during the Quarter being reported, a Quarterly Report should still be submitted along with a complete explanation on Forms 1A and 1B. Not submitting Quarterly Reports can result in a delay of receiving funds. No funds will be dispersed until all Quarterly Reports are current. 25055 AWARD AMOUNT:$200,000.00 Street Address: Provide the legal street address/PO Box congruent with the FEIN. The reporting requirements noted in this section are designed to provide the state with sufficient information to monitor grant implementation and goal achievement. To support effective monitoring of the grant, progress reports must be: AGREEMENT NUMBER: Remaining Balance: These cells auto-populate to reflect the remaining balance based on Total Allocated (Award & Match) (column C) and Total Funds Expended (column E). Quarterly Funds Expended: This column should reflect total funds expended during the quarterly reporting period ONLY. Do not retain data from previous reports. Report only spending which occurred during the reporting quarter. For each cell, report the sum of the grant award and recipient's contribution applicable to the corresponding categories presented in Column B. Unused categories may be left blank. E13- E21. General Notes for Completing Attachment E Digital Forms Many cells will be inaccessible and blocked to the end user in order to ensure form consistency. These cells do not need to be manipulated or filled in. They have been verified to auto-fill with information entered in prior forms, or perform calculations from the data input. If one of these cells is displaying an error state or does not fill, please bypass and notify your FBIP project manager. PROJECT TITLE:Main Street Boat Ramp X D26- D29. G26- G29. D31. G31. B33. E33. B37. E37. B42. B56. B68. B79. E79. A6- A9. E5. F6. F7. F8. B17- B25. D17- D25. F17- F25. G17- G25. Request Amount: Should reflect the amount being requested for this reimbursement request. If there is only one request, this will be the amount awarded by the Commission or the percent of the total cost stated in the Agreement Scope of Work (whichever is less). Total Allocated (Award & Match): Should reflect the total project cost stated in the Agreement. Cumulative Amount Previously Submitted for Reimbursement: Enter the sum of all reimbursement requests made to date. Date: Enter the date signed by the Grant Manager. Financial Officer: This space must be signed by the Recipient's Financial Officer with a digitally-secured and valid e-signature, or printed and signed with indelible pen. Date: Enter the date signed by the Financial Officer. Programmatic Section Invoice Date: The date this invoice is/was submitted. Total Received: Enter the sum of all funds reimbursed by the Commission to date. Date: Enter the date the document was signed by the Grant Manager. Total: These cells will auto-calculate and reflect the total project costs by category. (If there is only one reimbursement request the Total should align with the Total Funds Expended column on the Final Quarterly Progress Report.) Other: This should reflect the total amount of other funding not provided by the previous sources mentioned. The values entered should correspond to each applicable category. Non-applicable cells may be left blank. Match/Cost Share: This should reflect the total amount of funding provided by the Recipient which corresponds to each applicable category. Non- applicable cells may be left blank. FBIP Grant Cost: This should reflect the eligible amount claimed against each corresponding category which is being requested for FBIP reimbursement. These values cannot exceed the award amounts specified in the Agreement's Attachment A, Section 5. Budget. Non-applicable categories may be left blank. Project costs in excess of the agreed upon amount must be covered by other funding sources. (E.g. FBIP awarded $100,000 for design/engineering, but the project's total engineering costs were $120,000 - $100,000 can be claimed in cell B19, but the other $20,000 must be met by "Match/Cost Share" (Column D) or "Other" (Column F) sources. C13 & F13. Costs incurred during the period of: This should reflect the timeframe in which funds were expended for purchase and/or service. The dates entered must occur within the period of performance stated in the Agreement (Execution Date through Agreement End Date, unless a retroactive start date was approved). E26- E29. Percent Complete: Identify progress made as a percentage, showing how close to completion the project category is (i.e. 0% to 100% scale). For non- construction projects this may be estimated, and for construction projects refer to standards set by the American Institute of Architects as outlined in form AIA G702. Project Status: Select the appropriate status of the respective Category from the drop-down menu. If "Delayed" or "Other" are selected, please elaborate on the status in the Programmatic portion of the reporting form. ***Both Grant Manager and Financial Officer should verify and sign off on this section. *** Grant Manager: This space must be signed by the Recipient's Grant Manager with a digitally-secured and valid e-signature, or printed and signed with indelible pen. Recipient: These cells will autofill from Form 1 data with agency/organization name, address, point of contact name, and phone number. Agreement: The Agreement number and project title will autofill from cell E3 and E4 of the Instructions sheet. Completion Date: Indicate the actual completion date for the work under the respective Category or the anticipated completion date if the work has not been finished. Timeline of Events for Quarterly Reporting Quarter: Provide project milestones by date, that occurred during the quarter’s report period, followed by a brief description of the milestone. (e.g. 1/10/25 FDEP application was submitted, 2/4/25 Industry Inc. was selected for engineering, 2/15/25 meeting with Industry Inc. to review contract language, 3/20/25 construction was postponed until further notice due to hurricane Debby.) F9. Grant Manager: The Recipient's Grant Manager must sign, certifying that the information provided within the quarterly report is true and the cost(s) are valid cost(s) incurred in accordance with the Project Agreement. Project Status for Quarterly Reporting Period: Provide a detailed narrative status update for each portion of work included in this project. (e.g. Permitting 15% - FDEP application submitted, currently putting together USACE application. Design/Engineering 10% - Contractor selected, currently reviewing the contract agreement. Construction 0% - Delayed due to hurricane Debby and high-water levels.) Other: Provide any additional informative project notes. If a portion of the project will not be completed on schedule indicate the reason for the delay, the effect of these challenges on the remaining timeline, and provide a timeframe for completion. (e.g. Currently communicating with USACE on the application/exemption process for this project. Due to the high-water levels from the hurricane the construction is being postponed until the levels recede and there is a notice to proceed. We will update FWC when construction has resumed and the timeline has been revised. The cost of the environmental surveys came out under budget, so there should be cost savings for this project. Or there are no additional notes at this time.) Reimbursement #: Should be the numeric value representing the reimbursement submission in sequential order. Form 2 - Reimbursement Request Row 26. G26. Row 27. A29. D29. A31. D31. A38. A39. A40. A41. F41. D44. D45. C5. K5. F8 & K8. B11- B28. C11- C28. F11- F28. H11- H28 I11- I28. L11- L28. M11- M28. N11- N28. Rows 7,9, & 11 G9. G11. Totals: These cells will auto-calculate the sum of the column values entered above and should represent the total costs being covered by each of the three possible sources (FBIP Grant Cost, Match/Cost share, and Other). Percent: These cells will auto-calculate the percentage of total project costs covered by each of the funding sources for each category. Totals Total: This cell will auto-calculate the sum of all project costs specified. (If there is only one reimbursement request the Total should align with the Total Funds Expended on the Final Quarterly Progress Report.) Total Allocated (Award & Match): This will autofill from the Instructions sheet. It is the maximum amount which FWC has agreed to reimburse the recipient for applicable project costs. Date Submitted/Resubmitted to FWC: The date that the recipient first submits this reimbursement request followed by final resubmission date, if applicable. Total Amount to be Paid on this Invoice: This amount will align with B40 for the current reimbursement #. Remaining Balance: This amount will be the total FBIP award amount minus the total reimbursements requested to date. This Payment: This will be the requested reimbursement amount for this reimbursement #. Previous Payment(s): This amount will be the total sum of Commission reimbursements made to date. This section of the form need not be filled by the Recipient/submitting party. Please do not alter this section which should be completed by FBIP staff. Costs incurred during the period of: These dates should match C13 & G13 on Form 2 and reflect the timeframe in which funds were expended for purchase and/or service. The dates entered must occur within the period of performance stated in the Agreement. Date: Enter the date signed by the Grant Manager. ***Both Grant Manager and Financial Officer should verify and sign off on this section. *** Recipient: This cell will autofill with the agency/organization name. Category: Select the appropriate category from the drop down menu and itemize all costs within that category that are applicable to the reimbursement request. Form 3 - Detail of Claims FORM 4 - Close Out Report Recipient Information: These cells will autofill with the Recipient's agency/organization name, address, Agreement number and project title. Agreement Period of Performance: These dates must align with the Execution Date (or the retroactive start date, if approved) through the current Agreement End Date. Financial Summary Vendor: Indicate the vendor used for purchase/service. Agreement: The Agreement number and project title will autofill. FBIP Grant Cost: The amount that FWC has agreed to reimburse the recipient through FBIP. Grant Manager: This space must be signed by the Recipient's Grant Manager with a digitally-secured and valid e-signature, or printed and signed with indelible pen. Financial Officer: This space must be signed by the Recipient's Financial Officer with a digitally-secured and valid e-signature, or printed and signed with indelible pen. Date: Enter the date signed by the Financial Officer. Total Allocated (Award & Match): This amount will autofill from Form 1 cell C22. It should reflect the total project cost stated in the Agreement, which includes any modifications to the budget. Match/Cost Share: The amount the Recipient expended on the project that will not be reimbursed. Description: Brief description of purchase/service provided. Check # or EFT ID: Indicate check number or identification number of payment if check was not utilized. (e.g. Electronic Funds Transfer (ETF) tracking number) Date Paid: This should indicate the date the payment was made for the purchase and/or service. Total: This will be auto-calculated. This column will reflect the total amount of costs expended on the project reflected in the/each Reimbursement Request. (If there is only one reimbursement request the Total should align with the Total Funds Expended on the Final Quarterly Progress Report.) Date Eligible for Reimbursement: This will be the date that the Commission Grant Manager receives all correct and necessary documentation for the reimbursement. X D16- D24. D25. G16: I24. I25. F28. F29. F30. F31. H35: I35. H36: I36. H37: I37. H38: I38. H39: I39. G40. B43. G43. B46. G46. A7- A9. I5. B11. C14. H17. B22. I22. B34. B36. I36. B39. B43. Division: This will be the Division of Law Enforcement. Grant Program: Indicate the grant program from which funding was received. Total Reimbursement(s) Requested: The sum of the previously paid reimbursement(s) and the final reimbursement request amount. The cumulative total to be remitted to the Recipient for the project. Signature: The Recipient’s Grant Manager or signature authority should sign with a digitally-secured and valid e-signature or printed and signed with an indelible ink. FWC Agreement #: This cell with autofill from the Instruction Sheet and is reflected in the Agreement. Name of Recipient Agency/Organization: Input the Recipient's agency/organization name. Date: Include the date the report was signed by the Financial Officer. Financial Officer: The Recipient's Financial Officer must sign the report in confirmation of the statement presented in cell A42. This should be done with a digitally-secured and valid e-signature or printed and signed with an indelible ink. Date: Include the date the report was signed by the Grant Manager. Sign, date, and submit the form to the FWC manager within thirty (30) days of completion of the project. Name of Inspector/Reviewer: This will be the name of the individual that conducted the construction project inspection or the name of the individual that reviewed the design and engineering plans for the project. Print or Type Name and Title: This will be the name and title of the Commission's Project Manager or the Program Administrator. Date: The date that the Project Manager signs. Signature: The Commission's Project Manager will sign once all necessary documentation has been received. Date: Input the date that the report was signed by the Recipient. ***Both Grant Manager and Financial Officer should verify and sign off on this section. *** Form 5 - Certification of Completion Total Funds Expended: Indicate the total amount expended per budget category even if it is in excess of the anticipated amount. These expenditures should align with the Total Funds Expended on the Final Quarterly Progress Report. FBIP Reimbursement(s) Received (if Applicable): Enter the date and amount of any previous reimbursement payments received over the course of the project. Was income earned on the project during the period of performance?: This would be any income earned by the Recipient that is directly generated by use of a grant-supported project, or earned as a result of the grant, during the grant period. Was incomes earned as defined? If yes, include a check for the income with the close-out report. Were all quarterly reports submitted up until the Certification of Completion signature date?: Quarterly reports must be submitted starting from the first entire quarter in which there was an Executed Agreement, up until the Certification of Completion was signed by the Recipient. Has the Certification of Completion been signed?: Form 5 must be signed by the Recipient within thirty (30) calendar days of the project's completion. Is the documented match/cost share sufficient?: Does the match/cost share contributed to the project by the Recipient meet the requirements outlined in the Agreement's Attachment A, Section 5? Were funds expended in accordance with Agreement terms?: All expenditures should be in accordance with applicable policies and procedures: Federal, State, and Local level, including agreement terms. If any costs were reimbursed but determined later to be ineligible for funding, refund of funds is required within thirty (30) calendar days of completion of the project. Certification by Commission Print or Type Name and Title: Enter the Recipient’s Grant Manager or signature authority. This section of the form need not be filled by the Recipient/submitting party. Please do not alter this section which should be completed by FBIP staff. Grant Manager: The Recipient's Grant Manager must sign the report in confirmation of the statement presented in cell A42. This should be done with a digitally-secured and valid e-signature or printed and signed with an indelible ink. Agreement: The Agreement # and project title will autofill. Total: This amount will auto-calculate as the sum of the rows above it. Total Expenditures: This will autofill from cell D25 and represents the sum of all funds expended over the life of the agreement. Total Allocated (Award & Match): This amount will autofill from Form 1 cell C22. It should reflect the total project cost stated in the Agreement which includes any modifications to the budget. Date that the Certification of Completion was signed by the Recipient: Enter the date that aligns with the signature date on Form 5. Award Amount: This will autofill from the Instructions sheet. It is the maximum amount which FWC has agreed to reimburse the recipient for applicable project costs. Total: This amount will auto-calculate the sum of the rows above it. X I43. Row 47. Row 48. C5. G5. Rows 21- 52. A21. A23. A26. A27. A7- A10. F7. F8. F9. F10. C12. G12. A17- A20. B17- B20. C17- C20. D17- D20. E17- E20. F17- F20. H17- H20. I17- I20. J17- J20. J21. A31. D31. B5. J5. Agreement #: This cell will autofill the FWC Agreement number as referenced from the Instructions sheet. Project Inspected: Check yes, no, or not applicable for construction inspection. Date of Inspection/Approval: This will be the date that the project inspection was passed or the date that the design plans were approved. Sign: The Project Manager must sign the report certifying the information presented above in cell A30. This should be done with a digitally-secured and valid e-signature or printed and signed with indelible ink. Date: Include the date the report is signed. Total Allocated (Award and Match): This amount will autofill and should reflect the total project cost stated in the Agreement, which includes any modifications to the budget. Date: This date should align with when the form is filled out. FWC Agreement: The Agreement # and project title will autofill. UEI: This is the Unique Entity Identifier number and should align with the Recipient's information. FEIN: This is the Recipient's Federal Employer Identification Number and must align with all other document in the Agreement. Agreement #: This cell will autofill the FWC Agreement number as referenced from the Instructions sheet. Recipient: This cell will autofill the FBIP Grant Recipient's Identity. This form is only applicable for construction projects after they have been completed for a full year. Refer to the Agreement to verify requirement. Payment Amount: This should be the dollar amount paid to the respective subcontractor entity. E-Verify Reg./Affidavit Received: Provide the E-Verification Registration date or the Affidavit date. Design Reviewed: Check yes, no, or not applicable for plan review. Fill in the names of any entities intended to be selected to implement work under this Agreement. Submit list to Grant Manager prior to entering a contract so that applicable review and verification may be completed by FWC. FORM 8 - Post Project Completion Annual Report Form 7 - Subcontractor Minority Status Report Form 6 - Subcontractor List Recipient Information: These cells will autofill from Form 1 data with agency/organization name, address, point of contact name, and phone number. COI Certification Received: Provide the Conflict of Interest Certification signature date. Recipient: This cell will autofill the FBIP Grant Recipient's Identity. Unique Entity ID (UEI): Provide the unique entity identification for the contractor (either the FEIN, DUNS, or UEI). Vendor/Contractor: Provide the Subcontractors Vendor name. Total of Subcontractor Payment(s): This will auto-calculate with the sum of the payments to subcontractors. This is required so that FWC can report to Florida Department of Management Services' Office of Supplier Diversity the amount and vendor information when funds are paid to a Minority business. Name: This cell will autofill with the Recipient's agency/organization name. ²CBE Code: Certified Business Enterprise Codes show what kind of minority an entity is. The code options are below the table. Invoice #: This number should align with the invoice # from the subcontractors. Payment Amount: This should be the dollar amount paid to the respective subcontractor entity. Name: Provide the subcontractor's vendor name(s). FEIN or UEI #: Enter the Federal Employer Identification Number or Unique Entity Identifier number for the subcontractors used for this project. Invoice Number: This number should align with the FWC reimbursement #. Description of Service: Brief description of purchase/service provided. ²CBE Code: Certified Business Enterprise Codes show what kind of minority an entity is. The code options are below the table. C7. C9. E11. K11. C13. A18. A25. F28. A32. H36. B42. I42. B44.Name/Title: Include the full name and formal position of the signing individual. Date: Include the date the report is signed. Actual or Estimated: Is this amount recorded or estimated? Revenue: This is the amount of money that the Recipient has acquired from permits or fees charged to the public to use the facility. If site usage can be covered by a county-wide or multiple-site permit, please prorate and include those funds accordingly. (E.g. Smith County charges a $5 launch fee at ramps under their maintenance, but offers citizens a $45 annual launch permit to cover all ramp usage for a year. If Smith County has 4 equally- utilized ramps and has collected $1080 in annual permits, they should include $270 (25%) with any single-use fees collected during the State's Fiscal Year. If usage is unequal, please estimate the fraction as closely as possible. Condition of Facility: Provide information on the status of the facility that was funded by the Florida Boating Improvement Program. This should include any repairs that are needed and plans to address the issues, repairs or work that have been completed, any issues or concerns, and any possible informative notes on the condition of the site and facilities. Reporting Year: Select the applicable period from the drop down list starting with the first entire State Fiscal Year (July 1 – June 30) that the project has been completed. All subsequent Annual Reports should regard the period between July 1st and June 30th. Site Dedication End Date: Twenty (20) years from the date that the Site Dedication was signed. Certification of Completion Date: The date that the Certification of Completion was signed by the Recipient. Project Address: Input the PROJECT SITE'S location. Do not include the Recipient's address. If no site address is available, coordinates may suffice if the geodetic reference is included (Google Earth utilizes WGS84). A location description may also be utilized or included with the coordinates, if helpful to understanding the geographic location of the project. Annual Users: Estimated number of users within the reporting year for the boat access facility. Permit or Fee Adjustment: If permit or fee increases/decreases are anticipated, provide the current and proposed amounts and the reason for the change. Increases in fees at grant funded sites must be approved in advance by FWC's Boating Access Unit. Sign: The Project Manager (or their successor/delegate) should sign the report certifying the information presented above in cell A40. This should be done with a digitally-secured and valid e-signature or printed and signed with indelible ink. Project Title: This information will autofill the formal Project Title as reflected throughout the signed Agreement documents.