HomeMy WebLinkAboutPre-Award_Information_Sheet_SignedEECBG Program PRE-AWARD INFORMATION SHEET
Each Energy Efficiency and Conservation Block Grant (EECBG) Program recipient shall provide the following information on behalf of itself and all subrecipients and certify that the information is accurate and complete.
Recipients may choose to provide this information in whatever format they like, as this form is optional.
EECBG Program recipients representing local and tribal entities may select from two options: 1) a grant or 2) a voucher for technical assistance and/or equipment rebates. EECBG Program recipients choosing a grant must provide data requested in sections 1 through 8 below. EECBG Program recipients choosing a voucher may skip
sections 4 through 7. Please submit your completed document to EECBG@hq.doe.gov.
SECTION 1: CONTACT & LOCATION INFORMATION (All recipients)
Recipient Name:
UEI:
Business Officer (BO): BO Phone Number: BO Email:
Project Director/ Principal Number: Email:
Note: PI is the designated primary point of contact for the EECBG grant, such as the Project or Program Manager. Business Officer is the authorized individual responsible for financial management of the EECBG grant. Additionally, UEI number is required for grant applicants, but not for voucher applicants.
A. TYPE OF ORGANIZATION – Please indicate the type of organization of the Recipient by selecting one of thefollowing:
☐Local Government
☐Tribal Government
☐State
☐Territory
B.LOCATION AND CONGRESSIONAL DISTRICT
List the address and Congressional(s) district for the primary location where the grant will be performed.
Revised March 21, 2023
City of Palm Desert
XLREHY4MDGW4
Joe Barron 760-776-6491 jbarron@palmdesert.gov
Veronica Chavez 760-776-6344 vchavez@palmdesert.gov
73510 Fred Waring DR
Palm Desert
California
92260-2524
25th Congressional District
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SECTION 2: GRANT OR VOUCHER (All recipients)
EECBG Program recipients representing local and tribal entities must select whether to receive their EECBG Program award in the form of a grant or a voucher for technical assistance and/or equipment rebates. Please indicate your choice here. All States & Territories must select “Grant.” (Select one option) [response to this question is non-binding]
☐Voucher for Technical Assistance
☐Voucher for Equipment Rebate
☐Voucher for both Technical Assistance and Equipment Rebate
☐Grant
SECTION 3: BUSINESS ASSURANCES (All recipients)
A.DISCLOSURE OF POTENTIAL IMPROPRIETIES
Below, please disclose if any of the following conditions exist. If the answer to any question (a) through (g) below isyes, provide a detailed explanation in an attachment to this form.
a.Is the proposed Recipient, Subrecipient(s), or any of the Recipient’s or Subrecipient’s principals1 underinvestigation for or charged with a covered offense2?
☐Yes
☐No
b.Has the proposed Recipient, Subrecipient(s), or any of the Recipient’s or Subrecipient’s principals beenconvicted of a covered offense in the last five years or had a civil judgment rendered against them for oneof those offenses in that time period?
☐Yes
☐No
c.Is the proposed Recipient, Subrecipient(s), or any of the Recipient’s or Subrecipient’s principals underinvestigation for potential violation of U.S. export control laws and regulations, or has the proposedRecipient, Subrecipient(s), or any of the Recipient’s or Subrecipient’s principals been convicted of anyviolations of U.S. export control laws and regulations?
☐Yes
☐No
d.Is the proposed Recipient or Subrecipient(s) under investigation for potential violations of the Drug-FreeWorkplace Act of 1988, or has the proposed Recipient or Subrecipient(s) been convicted of any violations
of the Drug-Free Workplace Act of 1988?
☐Yes☐No
1 For this form, “principal” means: (1) An officer, director, owner, partner, PI, or other person (as defined in 2 C.F.R. 180.95) within the Project Team with management or supervisory responsibilities related to this project and any resulting transaction; or (2) A
consultant or other person, whether or not employed by the Recipient, Subrecipient, or their principals, or paid with Federal funds, who (a) is in a position to handle Federal funds, (b) is in a position to influence or control the use of those funds, or (c) occupies a technicalor professional position capable of substantially influencing the development or outcome of an activity required to perform thetransaction, including but not limited to, any Co-PIs.
2 For this form, “covered offenses” include: (1) Commission of fraud or a criminal offense in connection with obtaining, attempting toobtain, or performing a public or private agreement or transaction; (2) Violation of Federal or State antitrust statutes, including those
proscribing price fixing between competitors, allocation of customers between competitors, and bid rigging; (3) Commission ofembezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, receiving stolenproperty, making false claims, or obstruction of justice; or (4) Commission of any other offense indicating a lack of business integrityor business honesty that seriously and directly affects the Recipient’s present responsibility.
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e.Is the proposed Recipient, Subrecipient(s), or any of the Recipient’s or Subrecipient’s principals under
investigation for research misconduct, or has the proposed Recipient, Subrecipient(s), or the Recipient’sor Subrecipient’s principals been convicted of research misconduct?
☐Yes
☐No
f.Has any Federal Agency recommended or initiated proceedings against the proposed Recipient,Subrecipient(s), or the Recipient’s or Subrecipient’s principals for suspension or debarment, or is the
proposed Recipient, Subrecipient(s), or the Recipient’s or Subrecipient’s principals debarred, suspended,publicly banned from doing business with the Federal government, or otherwise declared ineligible fromreceiving Federal Contracts, subcontracts or financial assistance?
☐Yes
☐No
g. Is the proposed Recipient or Subrecipient(s) delinquent on federal debt or insolvent or at risk ofinsolvency or have the proposed Recipient or Subrecipient(s) filed for bankruptcy in any domestic orforeign jurisdiction?
☐Yes
☐No
B.POTENTIAL CONFLICTS OF INTEREST
1.Financial Conflicts of Interest. The Recipient must disclose in writing any managed or unmanageable
financial conflicts of interest involving a member of the project team (i.e., Investigators) and includesufficient information to enable DOE to understand the nature and extent of the financial conflict, and toassess the appropriateness of the non-Federal entity's management plan. See Section V(b)(3) of the DOE
Interim Conflict of Interest Policy. As part of this DOE funded project, does the recipient or anysubrecipients have any managed or unmanageable financial conflicts of interest involving a member of theproject team (i.e., Investigators)?☐No☐Yes. If yes, in a separate attachment, the Recipient must provide relevant disclosures/supporting
documentation as required by the DOE Interim Conflict of Interest Policy Section V(b)(3).
C.Organizational Conflicts of Interest3. The Recipient must disclose in writing any potential or actual
organizational conflict of interest to DOE. See DOE Interim Conflict of Interest Policy Section VI and 2CFR 200.318 for more information. As part of this DOE funded project, does the recipient or anysubrecipients intend to engage in a procurement with a parent, affiliate, or subsidiary organization that isnot a state, local government, or Indian tribe?
☐No
☐Yes. If yes, in a separate attachment, the Recipient must provide relevant disclosures/supporting
documentation as required by the DOE Interim Conflict of Interest Policy Section VI.
**Recipients choosing a voucher may skip to Section 8**
3 Organizational Conflict of Interest means a situation where because of relationships with a parent company, affiliate, or subsidiary organization, the non-Federal entity is unable or appears to be unable to be impartial in conducting a procurement action involving a related organization. 2 CFR 200.318(c)(2).
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SECTION 4: PAYMENT INFORMATION (Grant recipients only)
Provide (1) the awardee seven-digit ASAP (Automated Standard Application for Payment System) ID number that is under the DOE / Golden Field Office (GO) Agency Locator Code (ALC) and Region Code (#8900-0001-04) if available; (2) the name, phone number and email for the ASAP / Payments Contact Person; and (3) indicate whether the preferredpayment method is by advance or reimbursement. Note: If ASAP number is not available, please leave field (1) blank andproceed with filling out (2) and (3).
1)ASAP Number:2)ASAP/Payments Contact Person:
3)Indicate Preferred Payment Method:
SECTION 5: PERFORMANCE AND FINANCIAL INFORMATION REQUEST (Grant recipients only)
Before providing this information, please read the ADDITIONAL INFORMATION at the end of this form. Each field identified below must be completed.
1.Has the Recipient had prior Federal awards?☐Yes ☐ No
If Yes:
Is the Recipient up to date on all reporting requirements on all other current and ☐Yes ☐ No
prior awards, including submitting acceptable final technical reports, with other
Federal or non-Federal organizations? If you check No to this question, pleaseattach an explanation.
2a. Has the Recipient had an independent Single Audit or independent Compliance ☐Yes ☐ No
Audit per Federal regulations, or had a prior Defense Contract Audit Agency (DCAA) Audit performed? (Please see attached instructions regarding Independent Audit requirements.)
2b. Has the Recipient undergone a Financial Audit within the last 3 years? ☐Yes ☐ No
If Yes to either 2a. or 2b.:
a.A copy of the audit is attached to this form.☐Yes ☐ No
b. An electronic copy of the audit was provided with application package.☐Yes ☐ No
If audit was not provided, please explain why it has not been completed and/or provided:
4a. Identify the Federal Agency providing the preponderance of funding from ALL Government Awards which the Recipient’s organization is/was the prime recipient, including any DOE Awards.
Provide Agency name, Cognizant Agency point of contact (individual in charge of negotiating billing rates), phone number, and e-mail. (If the Recipient’s organization has a DCAA contact, please provide this information in 4(c) below):
Revised March 21, 2023
Payment by AdvancePayment by Advance Payment by Reimbursement
June 30th
Dept. of Housing and Urban Development
Joe Barron
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4b. DCAA Contact Information:
SECTION 6: FINANCIAL MANAGEMENT SYSTEM – ACCOUNTING SYSTEM SURVEY (Grant recipients only)
To qualify for Financial Assistance, compliance with 2 CFR 200 as amended by 2 CFR 910 is required. This includes assurance of an adequate accounting system for estimating, accounting, and billing for governmental funding received. Please complete the checklist below as assurance of this requirement.
For additional information, please visit https://www.dcaa.mil. Please refer specifically to the “Pre-award Accounting System Adequacy Checklist” under CUSTOMERS-->Checklists and Tools.
Yes No NA
applicable to the circumstances and associated applicable Federal regulations?☐☐ ☐
2.Accounting System provides for:
a.Segregation of direct costs from indirect costs.☐☐ ☐
b. Identification and accumulation of direct costs by project.☐☐ ☐
c.A logical and consistent method for the allocation of indirect costs to intermediate
and final cost objectives. (Project line items are final cost objective)☐☐ ☐
d.Accumulation of costs under general ledger control.☐☐ ☐
e.A timekeeping system that identifies employees’ labor by intermediate and final
cost objective (i.e., project level, division level).☐☐ ☐
f.A labor distribution system that charges direct and indirect labor to appropriate
cost objectives.☐☐ ☐
g.Interim (at least monthly) determination of costs charged to a project through
routine posting of books of account.☐☐ ☐
h.Excluding costs charged to Government projects which are not allowable in terms
of FAR 31, Contract Cost Principles and Procedures, or other provisions.☐☐ ☐
i.Identification of costs by project line item and by units (as if each unit or line item
were a separate project) if required by the proposed award.☐☐ ☐
3.Is the Accounting System designed, and are the records maintained in such a manner thatadequate, reliable data are developed for use in developing cost proposals?☐☐ ☐
4.Is the Accounting System currently in full operation?☐☐ ☐
Revised March 21, 2023
Mary Ann T. Gray
(213) 534-2586 / maryann.t.gray@hud.gov
N/A
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SECTION 7: REPRESENTATION/CERTIFICATION (Grant recipients only)
Certification of the information is required by the organization’s authorized representative
☐I certify that I have registered in the System for Award Management (SAM).
☐I certify that I have registered in FedConnect.net in order to receive award documentation.
☐I certify that all subrecipient cost information has been reviewed, and that all subrecipient costs are reasonable,
allowable, and allocable in accordance with the applicable cost principles. All subrecipient budget documentsshould be available upon DOE request.
☐I certify that all direct costs proposed in the application (under the personnel, travel, equipment, supplies,
contractual, construction, and/or other direct costs categories) are direct to the project and are not duplicated in theproposed indirect costs.
☐I certify that the processes undertaken to solicit any subrecipients, subawards, subcontracts and vendors comply
with our organization’s written procurement procedures as outlined in “Procurement Standards” 2 CFR 200.317
through 2 CFR 200.326 inclusive.
☐I certify the Recipient:
(1) Has in effect an up to date, written, and enforced administrative process to identify and manage conflicts of
interest with respect to all projects for which financial assistance funding is sought or received from DOE;
(2) Shall promote and enforce Investigator compliance with DOE’s Interim Conflict of Interest (COI) Policy'srequirements including those pertaining to disclosure of significant financial interests;
(3) Shall manage financial conflicts of interest and provide initial and ongoing financial conflicts of interest reportsto DOE;
(4) Agrees to make information available, promptly upon request, to DOE relating to any Investigator disclosure of
financial interests and the Recipient’s review of, and response to, such disclosure, whether or not the disclosureresulted in the Recipient’s determination of a financial conflict of interest; and
(5) Shall fully comply with the requirements of the DOE Interim COI Policy.
SECTION 8: SIGNATURES (All recipients)
I, the Authorization Official named below, represent by my signature that I am authorized to certify this information on behalf of the Recipient. I certify to the best of my knowledge and belief that the information contained in this Pre-Award Information Sheet is true, complete and accurate. I understand that any false, fictitious, or fraudulent
information, misrepresentations, half-truths, or omissions of any material fact, may subject me to criminal, civil or
administrative penalties for fraud, false statements, false claims or otherwise. (18 U.S.C. §§ 1001 and 287, and 31 U.S.C. 3729-3730 and 3801-3812). I further understand and agree that (1) the statements and representations made herein are material to DOE’s funding decision, and (2) I have a responsibility to update the disclosures during the period of performance of the award should circumstances change which impact the responses provided above.
Name:
Title:
Revised March 21, 2023
L. Todd Hileman
City Manager
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Date:
I, the Principal Investigator named below, certify to the best of my knowledge and belief that the information contained in this Pre-Award Information Sheet is true, complete and accurate. I understand that any false, fictitious, or fraudulent information, misrepresentations, half-truths, or omissions of any material fact may subject me to criminal,
civil, or administrative penalties for fraud, false statements, false claims or otherwise. (18 U.S.C. §§ 1001 and 287, and 31 U.S.C. 3729-3730 and 3801-3812). I further understand and agree that (1) the statements and representations made herein are material to DOE’s funding decision, and (2) I have a responsibility to update the disclosures during the period of performance of the award should circumstances change which impact the responses provided above.
Name:
Title:
Date:
Revised March 21, 2023
7/28/2023
Veronica Chavez
Finance Director
7/28/2023
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ADDITIONAL INFORMATION
This information will assist DOE in determining: 1) cognizance; 2) whether the Recipient has adequate internal financial and management controls; and 3) whether the Recipient has an adequate accounting system. Generally, cognizance means that an organization has a Federal oversight agency (cognizant agency). Cognizance of an organization is used for many
purposes including: determining which agency is responsible for verifying correct allocation of indirect rates to incurred costs; issuing the Provisional and Final Indirect Rate Agreements; and ordering audits. Adequate internal controls and accounting systems are essential to ensure that the Recipient’s costs are correctly estimated, recorded, and billed. The Recipient has the responsibility to ensure that these systems are in place. The cognizant Agency has the responsibility for verifying these systems through audits or other methods.
For additional information, please visit https://www.dcaa.mil. Please refer specifically to the “Pre-award Accounting System Adequacy Checklist” under CUSTOMERS-->Checklists and Tools.
Cognizance is determined by TOTAL Federal award/contract dollars received by the Recipient/Contractor from all Federal agencies. This information is used to determine which Federal agency has the largest preponderance of funding and is cognizant. Once a Federal agency assumes cognizance for a contractor, it should remain cognizant for at least 5 years to ensure continuity and ease of administration.
Cognizance related duties are the responsibility of the Cognizant Federal Agency (CFA). The CFA is the Federal agency (e.g., Department of Defense, Department of Energy, Navy, etc.) that provided the preponderance (largest amount) of funding for your awards, across all federal agencies. It is very important to confirm that you work with the correct office.
General Rule of Thumb: Department of Health & Human Services (DHHS) is usually the CFA for Universities, Cities, States, and Counties. DHHS cognizance is not usually transferred.
If it is determined that the Department of Energy/Golden Field Office (GO) is the Cognizant Federal Office, the Recipient will have the following ANNUAL responsibilities:
1. Submit a Certified Annual Incurred Cost Claim (ICE Model – see #3 below) to the GO Cost/Price mailbox(CostPrice@ee.doe.gov). This should represent the total organization's costs (representing the CompanyGeneral Ledger), not just the Recipient’s DOE award(s).
2.Due Date: 180 days after the Recipient’s fiscal year end.
3.For an example of the ICE Model, please visit https://www.dcaa.mil. Under “CUSTOMERS->Checklists and Tools”,
click on ICE (Incurred Cost Electronically) Model and download the ICE model.
Once the information is received, GO will have the responsibility of providing your organization with an annual indirect rate agreement. This indirect rate must be used on all Federal grants and contracts.
If it is determined that GO is not the Cognizant Federal Office, the Recipient should contact the Cognizant Office for additional instructions.
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ANNUAL AUDIT REQUIREMENTS
Independent (Single & Compliance) Audit Requirements
2 CFR 200, Section F located at:
http://www.ecfr.gov/cgi-bin/text-idx?SID=6e187b05cfeca4f534c659f20983b14e&mc=true&node=pt2.1.200&rgn=div5
For-Profits: 2 CFR 910, Section F located at:
http://www.ecfr.gov/cgi-bin/text-idx?node=pt2.1.910&rgn=div5
Below are excerpts from Section F.
Audit requirements.
(a)Audit required. A non-Federal entity that expends $750,000 or more during the non-Federal entity's fiscal year inFederal awards must have a single (program-specific, not applicable for For-Profits) or compliance audit conductedfor that year in accordance with the provisions of this part.
(b)Single audit. A non-Federal entity that expends $750,000 or more during the non-Federal entity's fiscal year inFederal awards must have a single audit conducted in accordance with §200.514 - Scope of audit except when it elects
to have a program-specific audit conducted in accordance with paragraph (c) of this section.
(b)Compliance audit. (1) If a for-profit entity has one or more DOE awards with expenditures of $750,000 or moreduring the for-profit entity's fiscal year, they must have a compliance audit for each of the awards with $750,000 ormore in expenditures. A compliance audit should comply with the applicable provisions in §910.514—Scope of Audit.The remaining awards do not require, individually or in the aggregate, a compliance audit.
(c) Program-specific audit election. (Not applicable to For-Profits). When an auditee expends Federal awards under
only one Federal program (excluding R&D) and the Federal program's statutes, regulations, or the terms andconditions of the Federal award do not require a financial statement audit of the auditee, the auditee may elect to havea program-specific audit conducted in accordance with §200.507 Program-specific audits. A program-specific audit
may not be elected for R&D unless all of the Federal awards expended were received from the same Federal agency,or the same Federal agency and the same pass-through entity, and that Federal agency, or pass-through entity in thecase of a subrecipient, approves in advance a program-specific audit.
(d) Exemption when Federal awards expended are less than $750,000. A non-Federal entity that expends less than$750,000 during the non-Federal entity's fiscal year in Federal awards is exempt from Federal audit requirements for
that year, except as noted in §200.503 Relation to other audit requirements, but records must be available for review oraudit by appropriate officials of the Federal agency, pass-through entity, and Government Accountability Office(GAO).
(e) Federally Funded Research and Development Centers (FFRDC). Management of an auditee that owns or operates a
FFRDC may elect to treat the FFRDC as a separate entity for purposes of this part.
(f)Subrecipients and Contractors. An auditee may simultaneously be a recipient, a subrecipient, and a contractor.
Federal awards expended as a recipient or a subrecipient are subject to audit under this part. The payments received forgoods or services provided as a contractor are not Federal awards. Section §200.331 Subrecipient and contractordeterminations sets forth the considerations in determining whether payments constitute a Federal award or a payment
for goods or services provided as a contractor.
Revised March 21, 2023
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only to ensure that the procurement, receipt, and payment for goods and services comply with Federal statutes,regulations, and the terms and conditions of Federal awards. Federal award compliance requirements normally do not
pass through to contractors. However, the auditee is responsible for ensuring compliance for procurement transactionswhich are structured such that the contractor is responsible for program compliance or the contractor's records must bereviewed to determine program compliance. Also, when these procurement transactions relate to a major program, the
scope of the audit must include determining whether these transactions are in compliance with Federal statutes,regulations, and the terms and conditions of Federal awards.
(h) For-profit subrecipient. Since this part does not apply to for-profit subrecipients, the pass-through entity isresponsible for establishing requirements, as necessary, to ensure compliance by for-profit subrecipients. Theagreement with the for-profit subrecipient must describe applicable compliance requirements and the for-profitsubrecipient's compliance responsibility. Methods to ensure compliance for Federal awards made to for-profitsubrecipients may include pre-award audits, monitoring during the agreement, and post-award audits. See also§200.332 Requirements for pass-through entities.
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