Complete copy of signed DHS Standard Language Document (SLD) Checklist, DVS and Award Letter 1 Executive Order 129 Source Disclosure Certification of Suspension or Debarment 1 Standardized Board Resolution indicating who is authorized to sign: Contracts and Checks Annex A Parts I and II (including summary sheets, – supporting schedules and LOS). Annex B Form (Expense Summary, Details –Budget 3 and Schedules 1-6) and required Budget Narrative. List of Grants / Contracts 1 Contract Acquired Equipment Inventory Liability Insurance 1 Bonding Certificate Names, Titles, Addresses and Terms of Board of 1 Freeholders / Directors 1 Copy of Audit Report Current Affirmative Action Certificate or copy of 1 renewal application sent to Treasury (AA302) Disclosure In Investment Activities in Form 1 Federal Funding Accountability and Transparency Act 1 (FFATA) Worksheet (if applicable) Copies of Subcontracts 1 Document Number of Copies to be submitted Notification of Licensed Public Accountant (NLPA) 1 (include copy of Certification) Accountant’s Private/Public Donor Agreement for Match 1 Responsibilities Organization Chart 1 Conflict of Interest Policy 1 1 Disclosure In Investment Activities in Form 1 As Applicable:
Complete copy of signed DHS Standard Language Document (SLD) Checklist, DVS and Award Letter 1 Executive Order 129 Source Disclosure Certification of Suspension or Debarment 1 Standardized Board Resolution indicating who is authorized to sign: Contracts and Checks Annex A – Parts I and II (including summary sheets, supporting schedules and LOS). Annex B –Budget Form (Expense Summary, Details and Schedules 1-6) and required Budget Narrative. 3 List of Grants / Contracts 1 Contract Acquired Equipment Inventory Liability Insurance 1 Bonding Certificate Names, Titles, Addresses and Terms of Board of Freeholders / Directors 1 Copy of Audit Report 1 Current Affirmative Action Certificate or copy of renewal application sent to Treasury (AA302) 1 Disclosure In Investment Activities in Form 1 Federal Funding Accountability and Transparency Act (FFATA) Worksheet (if applicable) 1 Copies of Subcontracts 1 Document Number of Copies to be submitted Notification of Licensed Public Accountant (NLPA) (include copy of Accountant’s Certification) 1 Private/Public Donor Agreement for Match Responsibilities 1 Organization Chart 1 Conflict of Interest Policy 1 1 Disclosure In Investment Activities in Form 1 As Applicable:
fy17_ha_annex_a.docx