HomeMy WebLinkAbout2018-112DEP AGREEMENT NO. S0839
INDIAN RIVER COUNTY
AMENDMENT NO. 1
THIS AGREEMENT as entered into on March 8, 2016, between the FLORIDA DEPARTMENT OF
ENVIRONMENTAL PROTECTION (hereinafter referred to as the "Department") and INDIAN RIVER COUNTY
(hereinafter referred to as the "Grantee") is hereby amended.
WHEREAS, the Grantee has requested a revision in the scope of work, a reallocation of the budget for the
project, and an extension of the Agreement; an extension is needed because of a change in the project location; and,
WHEREAS, certain provisions of the Agreement need revision and several provisions need to be added to
the Agreement.
NOW, THEREFORE, the parties hereto agree as follows:
The Agreement is effective from July 1, 2015, to September 30, 2021.
Section 3. of the Agreement is hereby deleted in its entirety and replaced with the following:
FUNDING/CONSIDERATION/INVOICING:
A. As consideration for the satisfactory completion of services rendered by the Grantee under the
terns of this Agreement, the Department shall pay the Grantee on a cost reimbursement basis up to
a maximum of $50,000. It is understood that any additional funds necessary for the completion of
this project are the responsibility of the Grantee. The parties hereto understand and agree that this
Agreement does not require a match on the part of the Grantee.
B. Prior written approval from the Department's Grant Manager shall be required for changes to this
Agreement.
A Change Order to this Agreement is required when task timelines within the current
authorized Agreement period change, and/or when the cumulative transfer of funds
between approved budget categories, as defined in Attachment A, are less than ten
percent (10%) of the total budget as last approved by the Department. All Change Orders
are subject to the mutual agreement of both parties as evidenced in writing.
ii. A formal Amendment to this Agreement is required for changes which cause any of the
following: an increase or decrease in the Agreement funding amount, a change in the
Grantee's match requirements, a change in the expiration date of the Agreement, and/or
changes to the cumulative amount of funding transfers between approved budget
categories, as defined in Attachment A, exceeds or is expected to exceed ten percent
(10%) of the total budget as last approved by the Department. All Amendments are
subject to the mutual agreement of both parties as evidenced in writing.
C. The Grantee shall be reimbursed on a cost reimbursement basis for all eligible project costs upon
the completion, submittal and approval of each deliverable identified in Attachment A, in
accordance with the schedule therein. Reimbursement shall be requested utilizing Attachment B,
Payment Request Summary Form. To be eligible for reimbursement, costs must be in
compliance with laws, rules and regulations applicable to expenditures of State funds, including,
but not limited to, the Reference Guide for State Expenditures, which can be accessed at the
following web address: http://www.myfloridacfo.com/aadir/referenceug ide/. All invoices for
amounts due under this Agreement shall be submitted in detail sufficient for a proper pre -audit and
post -audit thereof. A final payment request should be submitted to the Department no later than
DEP Agreement No. 50839, Amendment No. 1, Page 1 of 7
sixty (60) calendar days following the completion date of the Agreement, to assure the availability
of funds for payment. All work performed pursuant to Attachment A must be performed on or
before the completion date of the Agreement, and the subsequent sixty-day period merely allows
the Grantee to finalize invoices and backup documentation to support the final payment request.
D. The State Chief Financial Officer requires detailed supporting documentation of all costs under a
cost reimbursement agreement. The Grantee shall comply with the minimum requirements set
forth in Attachment C, Contract Payment Requirements. The Payment Request Summary
Form shall be accompanied by supporting documentation and other requirements as follows for
each deliverable: Reimbursement shall be limited to the following budget categories:
Contractual (Subcontractors) — Reimbursement requests for payments to subcontractors
must be substantiated by copies of invoices with backup documentation identical to that
required from the Grantee. Subcontracts which involve payments for direct salaries shall
clearly identify the personnel involved, salary rate per hour, and hours spent on the
project. All multipliers used (i.e., fringe benefits, overhead, indirect, 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. Subcontracts,
which involve equipment purchases as part of an installation/retrofit or that include
infrastructure and/or infrastructure improvements, as defined in Florida Chief Financial
Officer (CFO) Memorandum No. 5 (2011-2012), must be capitalized in accordance with
Chapter 69I-72, Florida Administrative Code (F.A.C.). The Grantee shall be responsible
for maintaining appropriate property records for any subcontracts that include the
purchase of equipment as part of the delivery of services. The Grantee shall comply with
this requirement and ensure its subcontracts issued under this Agreement, if any, impose
this requirement, in writing, on its subcontractors.
For fixed-price (vendor) subcontracts, the following provisions shall apply:
a. The Grantee may award, on a competitive basis, fixed-price subcontracts to
consultants/contractors in performing the work described in Attachment A.
Invoices submitted to the Department for fixed-price subcontracted activities
shall be supported with a copy of the subcontractor's invoice and a copy of the
tabulation form for the competitive procurement process (i.e., Invitation to Bid
or Request for Proposals) resulting in the fixed-price subcontract.
The Grantee may request approval from the Department to award a fixed-price
subcontract resulting from procurement methods other than those identified in
the paragraph above. In this instance, the Grantee shall request the advance
written approval from the Department's Grant Manager of the fixed price
negotiated by the Grantee. The letter of request shall be supported by a detailed
budget and Scope of Services to be performed by the subcontractor. Upon
receipt of the Department Grant Manager's approval of the fixed-price amount,
the Grantee may proceed in finalizing the fixed-price subcontract.
C. All subcontracts are subject to the provisions of paragraph 12 and any other
appropriate provisions of this Agreement which affect subcontracting activities.
E. In addition to the invoicing requirements contained in paragraphs 3.C. and D. above, the
Department will periodically request proof of a transaction (invoice, payroll register, etc.) to
DEP Agreement No. S0839, Amendment No. 1, Page 2 of 7
evaluate the appropriateness of costs to the Agreement pursuant to State and Federal guidelines
(including cost allocation guidelines), as appropriate. This information, when requested, 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). State guidelines for allowable costs can be
found in the Department of Financial Services' Reference Guide for State Expenditures at
http://www.myfloridacfo.com/aadir/reference guide/.
F. i. 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.
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.
iii. 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.
Section 5. of the Agreement is hereby deleted in its entirety and replaced with the following:
REPORTS:
A. The Grantee shall utilize Attachment D, Progress Report Form, to describe the work performed
during the reporting period, problems encountered, problem resolutions, scheduled updates, and
proposed work for the next reporting period. Quarterly reports shall be submitted to the
Department's Grant Manager no later than twenty (20) calendar days following the completion of
the quarterly reporting period. It is hereby understood and agreed by the parties that the term
"quarterly" shall reflect the calendar quarters ending March 31, June 30, September 30 and
December 31. The Department's Grant Manager shall have thirty (30) calendar days to review the
required reports and deliverables submitted by the Grantee.
B. The Grantee will identify the expected return on investment for this project and provide this
information to the Governor's Office of Policy and Budget (OPB) within three months of
execution of this Agreement. For each full calendar quarter thereafter, the Grantee will provide
quarterly update reports directly to OPB, no later than 20 days after the end of each quarter,
documenting the positive return on investment to the state that results from the Grantee's project
and its use of funds provided under this Agreement. Quarterly reports will continue until the
Grantee is instructed by OPB that no further reports are needed, or until the end of this Agreement,
whichever occurs first. All reports shall be submitted electronically to OPB at
DEP Agreement No. S0839, Amendment No. 1, Page 3 of 7
env.roK( Iaspbs.state. fl. us, and a copy shall also be submitted to the Department at
1 egi sl ativeaffairs(a,dep. state.fl.us.
4. Section 11. of the Agreement is hereby deleted in its entirety and replaced with the following:
SPECIAL AUDIT REQUIREMENTS:
A. In addition to the requirements of the preceding paragraph, the Grantee shall comply with the
applicable provisions contained in Attachment E, Special Audit Requirements, attached hereto
and made a part hereof. Exhibit 1 to Attachment E summarizes the funding sources supporting
the Agreement for purposes of assisting the Grantee in complying with the requirements of
Attachment E. 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 Grants Development and Review Manager at
(850) 245-2361 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 Agreement. The Grantee shall
consider the type of financial assistance (federal and/or state) identified in Attachment E, Exhibit
1 when making its determination. For federal financial assistance, the Grantee shall utilize the
guidance provided under 2 CFR §200.330 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
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.
5. Section 16. of the Agreement is hereby deleted in its entirety and replaced with the following:
NOTICE:
All notices and written communication between the parties shall be sent by electronic mail, U.S. Mail, a
courier delivery service, or delivered in person. Notices shall be considered delivered when reflected by an
electronic mail read receipt, a courier service delivery receipt, other mail service delivery receipt, or when
receipt is acknowledged by recipient. Any and all notices required by this Agreement shall be delivered to
the parties at the addresses identified under paragraph 17.
Section 21. is deleted and replaced with RESERVED.
Section 27. of the Agreement is hereby deleted in its entirety and replaced with the following:
EXECUTION IN COUNTERPARTS:
This Agreement, and any Amendments or Change Orders thereto, may be executed in two or more
counterparts, each of which together shall be deemed an original, but all of which together shall constitute
one and the same instrument. In the event that any signature is delivered by facsimile transmission or by e-
mail delivery of a ".pdf' format data file, such signature shall create a valid and binding obligation of the
party executing (or on whose behalf such signature is executed) with the same force and effect as if such
facsimile or ".pdf' signature page were an original thereof.
8. Section 30. is added to the Agreement as follows:
DEP Agreement No. S0839, Amendment No. 1, Page 4 of 7
PUBLIC RECORDS ACCESS:
A. Grantee shall comply with Florida Public Records law under Chapter 119, F.S. Records made or
received in conjunction with this Agreement are public records under Florida law, as defined in
Section 119.011(12), F.S. Grantee shall keep and maintain public records required by the
Department to perform the services under this Agreement.
B. This Agreement may be unilaterally canceled by the Department for refusal by the Grantee to
either provide to the Department upon request, or to allow inspection and copying of all public
records made or received by the Grantee in conjunction with this Agreement and subject to
disclosure under Chapter 119, F.S., and Section 24(a), Article I, Florida Constitution.
C. If Grantee meets the definition of "Contractor" found in Section 119.0701(1)(a), F.S.; [i.e., an
individual, partnership, corporation, or business entity that enters into a contract for services with a
public agency and is acting on behalf of the public agency], then the following requirements apply:
Pursuant to Section 119.070 1, F.S., a request to inspect or copy public records relating to
this Agreement for services must be made directly to the Department. If the Department
does not possess the requested records, the Department shall immediately notify the
Grantee of the request, and the Grantee must provide the records to the Department or
allow the records to be inspected or copied within a reasonable time. If Grantee fails to
provide the public records to the Department within a reasonable time, the Grantee may
be subject to penalties under s. 119. 10, F.S.
Upon request from the Department's custodian of public records, Grantee shall provide
the Department with a copy of the requested records or allow the records to be inspected
or copied within a reasonable time at a cost that does not exceed the cost provided in
Chapter 119, Florida Statutes, or as otherwise provided by law.
iii. Grantee shall identify and ensure that all public records that are exempt or confidential
and exempt from public records disclosure requirements are not disclosed except as
authorized by law for the duration of the Agreement term and following completion of the
Agreement if the Grantee does not transfer the records to the Department.
iv. Upon completion of the Agreement, Grantee shall transfer, at no cost to Department, all
public records in possession of Grantee or keep and maintain public records required by
the Department to perform the services under this Agreement. If the Grantee transfers all
public records to the Department upon completion of the Agreement, the Grantee shall
destroy any duplicate public records that are exempt or confidential and exempt from
public disclosure requirements. If the Grantee keeps and maintains public records upon
completion of the Agreement, the Grantee shall meet all applicable requirements for
retaining public records. All records that are stored electronically must be provided to
Department, upon request from the Department's custodian of public records, in a format
that is accessible by and compatible with the information technology systems of
Department.
D. IF THE GRANTEE HAS QUESTIONS REGARDING THE
APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO
THE GRANTEE'S DUTY TO PROVIDE PUBLIC RECORDS
RELATING TO THIS AGREEMENT, CONTACT THE
DEPARTMENT'S CUSTODIAN OF PUBLIC RECORDS by
DEP Agreement No. 50839, Amendment No. 1, Page 5 of 7
telephone at (850) 245-2118, by email at
ombudsman2dep.state. fl.us, or at the mailing address below:
Department of Environmental Protection
ATTN: Office of Ombudsman and Public Services
Public Records Request
3900 Commonwealth Blvd, Mail Slot 49
Tallahassee, FL 32399
9. Section 31. is added to the Agreement as follows:
SCRUTINIZED COMPANIES:
A. Grantee certifies that it and its subcontractors are not on the Scrutinized Companies that Boycott
Israel List. Pursuant to Section 287.135, F.S., the Department may immediately terminate this
Agreement at its sole option if the Grantee or its subcontractors are found to have submitted a false
certification; or if the Grantee, or its subcontractors are placed on the Scrutinized Companies that
Boycott Israel List or is engaged in the boycott of Israel during the term of the Agreement.
B. If this Agreement is for more than one million dollars, the Grantee certifies that it and its
subcontractors are also not on the Scrutinized Companies with Activities in Sudan, Scrutinized
Companies with Activities in the Iran Petroleum Energy Sector List, or engaged with business
operations in Cuba or Syria as identified in Section 287.135, F.S. Pursuant to Section 287.135,
F.S., the Department may immediately terminate this Agreement at its sole option if the Grantee,
its affiliates, or its subcontractors are found to have submitted a false certification; or if the
Grantee, its affiliates, or its subcontractors are placed on the Scrutinized Companies that Boycott
the Scrutinized Companies with Activities in Sudan List, or Scrutinized Companies with Activities
in the Iran Petroleum Energy Sector List, or engaged with business operations in Cuba or Syria
during the term of the Agreement.
C. The Grantee agrees to observe the above requirements for applicable subcontracts entered into for
the performance of work under this Agreement.
D. As provided in Subsection 287.135(8), F.S., if federal law ceases to authorize these contracting
prohibitions then they shall become inoperative.
10. Attachment A, Grant Work Plan, is hereby deleted in its entirety and replaced with Attachment A-1,
Revised Grant Work Plan, attached hereto and made a part of the Agreement. All references in the
Agreement to Attachment A, shall hereinafter refer to Attachment A-1, Revised Grant Work Plan.
11. Attachment B, Disbursement Request Package, is hereby deleted in its entirety and replaced with
Attachment B-1, Payment Request Summary Form, attached hereto and made a part of the Agreement. All
references in the Agreement to Attachment B, shall hereinafter refer to Attachment B-1, Payment Request
Summary Form.
12. All other terms and conditions of the Agreement remain in effect. If and to the extent that any inconsistency
may appear between the Agreement and this Amendment, the provisions of this Amendment shall control.
DEP Agreement No. S0839, Amendment No. 1, Page 6 of 7
IN WITNESS WHEREOF, the parties have caused this amendment to Agreement S0839 to be duly
executed, the day and year last written below.
.. •.p.lMlss.•
INDIAN RIVER COUNTY •��y,.•• -• O, ATE OF FLORIDA DEPARTMENT OF
•�pJ� ' �JURONMENTAL PROTECTION
By: f By;
e
Chairman 'We cretaryor Designee
••9LR��£.R COU �;F; •'
Peter D. O' Bryan, Chairman "• `? I lr 1 I1 q V �� �' I /,C(µ�V
Print Name of Authorized Person Print Name and Title of Authorized Person
Date: June 12, 2018
ATTEST: Jeffrey R. Smith, Clerk/of
Couiq and Canptr 1
BY:
jD6tt —le rk
FEID No.:59-6000674
Date:
Evan Beitsch, DEP Grant Manager
San -a Waters, DEP QC Reviewer
List of attachments/exhibits included as part of this Amendment:
Specify Type
Attachment
Attachment
Letter/
Number Description (include number of pages)
A -I Revised Grant Work Plan (2 Pages)
B-1 Payment Request Summary Form (6 Pages)
APPROVED AS TO FORM
AND LEGAL SUFFICIENCY
BY KATE P. COTNER
ASST TANT COUNTY ATTORNEY
DEP Agreement No. S0839, Amendment No. 1, Page 7 of 7
ATTACHMENT A-1
REVISED GRANT WORK PLAN
PROJECT TITLE: Indian River County Oyster Bed Project
PROJECT LOCATION: Latitude/ Longitude: 27.651817, -80.371698
PROJECT BACKGROUND: The Indian River Lagoon has more than 2100 species of plants and 2200
species of animals making it North America's most diverse estuary. Indian River County (Grantee) is
committed to protecting and preserving the Indian River Lagoon. In the past, the Grantee has successfully
established an oyster bed reef in an area adjacent to Spoonbill Marsh in Vero Beach, Florida, which has
reduced the amount of total nitrogen (TN) and total phosphorus (TP) entering into the Indian River Lagoon
in the area. The Grantee wishes to continue its efforts by constructing a living shoreline/oyster reef along
the shoreline of Foot Island. Foot Island is a roughly 2,750 sq. foot island located within Vero Beach,
Florida. Evidence of erosion has been observed along the western and southern portions of the island where
dead mangroves were exposed, likely due to boat wake and a relatively large fetch. The purpose of the
proposed oyster reef would be to a) stabilize the Foot Island shoreline and b) improve water quality
conditions of discharges from the adjacent Florida Department of Transportation (FDOT) outfall pipe into
the Indian River Lagoon. At this point in time, the project's conceptual design is complete and the Grantee
has received permission from the Indian River Board of County Commissioners to proceed with the
proposed project.
PROJECT DESCRIPTION: The project will require the Grantee to construct living shoreline/oyster reef
along much of the Foot Island shoreline with emphasis on the western and southern portions of the island.
The southern and western portions of the island are also adjacent to the FDOT outfall pipe. The oyster
bags will be stacked to create void spaces throughout the reef structure of differing sizes, dimensions, and
openings to the Indian River Lagoon. The proposed oyster reef is approximately 27,500 square feet. The
reef location is close enough to the Foot Island that it will not inhibit the navigability of the area. The reef
provides a habitat for attached and encrusting organisms such as oysters, and other invertebrates such as
stone crabs, juvenile fish species, and game fish species. In turn, the reef will act as an in-situ water
treatment system to facilitate the removal of total nitrogen (TN) and total phosphorus (TP) from stormwater
discharged through the FDOT outfall into the Indian River Lagoon. The reef is self-perpetuating in that the
attached and encrusting invertebrates and turf algae will continue to overgrow any bare areas created in the
future.
TASKS and DELIVERABLES:
Task 1: Construction
Task Description: The Grantee will construct an oyster bed reef in accordance with the construction
contract documents.
Deliverables: Construction completed to date as described in this task, as evidenced by these deliverables:
1) Dated color photographs of on-going work representing the time period covered in the payment request;
2) signed acceptance and brief description of the completed work to date by the Grantee; 3) written
verification that the Grantee has received record drawings and any required final inspection report(s) for
the project (as applicable); and 4) signed statement from a Florida Licensed Professional Engineer
indicating construction has been completed in accordance with the construction contract documents (as
applicable).
DEP Agreement No. S0839, Attachment A-1, Page 1 of 2
Performance Standard: The Department's Grant Manager will review the deliverables to verify that they
meet the specifications in the Grant Work Plan and this task description.
Payment Request Schedule: The deliverables must be submitted and accepted prior to each payment
request and may be submitted no more frequently than monthly.
PROJECT TIMELINE & BUDGET DETAIL: The tasks must be completed by, and all deliverables
received by, the corresponding task end date.
Task
Budget
Budget
Task Start
Task End
Task Title
No.
Cate or
Amount
Date
Date
Contractual
1
Construction
$50,000
07/01/2015
03/31 /2021
Services
Total:
$50,000
Note that, per paragraph 4 of the agreement, authorization for continuation and completion of work and any
associated payments may be rescinded, with proper notice, at the discretion of the Department if the
Legislature reduces or eliminates appropriations. Extending the contract end date carries the risk that funds
for this project may become unavailable in the future. This should be a consideration for the Grantee with
this and future requests for extension.
DEP Agreement No. 50839, Attachment A-1, Page 2 of 2
DEP Agreement No.
Grantee:
(Name & Mailing Address)
Grantee's Grant Manager
Attachment B-1
PAYMENT REQUEST SUMMARY FORM
Payment Request No. Request
Task No(s). Task Amount(s) Requested: S.
GRANT EXPENDITURES SUMMARY SECTION
GRANTEE CERTIFICATION
Complete Grantee's Certification of Payment Request on Page 2 to certify that the amount being requested for reimbursement above was for items that
were charged to and utilized only for the above cited grant activities.
Attachment B-1, DEP Agreement No. 50839, Page 1 of6
TOTAL
PREVIOUS
MATCHING
TOTAL
AMOUNT OF THIS
CUMULATIVE
AUTHORIZED TASKS
PAYMENT
FUNDS FOR THIS
CUMULATIVE
REQUEST
PAYMENT
REQUESTS
REQUEST
MATCHING FUNDS
REQUESTS
Task 1:
$ -
$ -
$ -
$ -
$ -
Task 2:
$
$
$
$
$
Task 3:
$
$
$
$
$
Task 4:
$
$
$
$
$
Task 5:
$
$
$
S
$
Task 6:
$
$
$
$
$
Task 7:
$
$
$
$
$
Task 8:
$
$
$
$
$
Task 9:
$
$
$
$
$
TOTAL AMOUNT
$
$
$
$
$
TOTAL BUDGET
$
$
(ALL TASKS)
LESS TOTAL CUMULATIVE
$
$
PAYMENT REQUESTS OF:
TOTAL REMAINING
$
$
(ALL TASKS)
GRANTEE CERTIFICATION
Complete Grantee's Certification of Payment Request on Page 2 to certify that the amount being requested for reimbursement above was for items that
were charged to and utilized only for the above cited grant activities.
Attachment B-1, DEP Agreement No. 50839, Page 1 of6
Grantee's Certification of Payment Request
I, , on behalf of
(Print name of Grantee's Grant Manager designated in the Agreement)
(Print name of Grantee)
DEP Agreement No.
and Payment Request No.
, do hereby certify for
that:
1. The disbursement amount requested is for allowable costs for the project described in Attachment 3 of the Agreement.
2. All costs included in the amount requested have been satisfactorily purchased, performed, received, and applied toward
completing the project; such costs are documented by invoices or other appropriate documentation as required in the Agreement.
The Grantee has paid such costs under the terms and provisions of contracts relating directly to the project; and the Grantee is not in
default of any terms or provisions of the contracts.
Grantee's Grant Manager's Signature
Print Name
Grantee's Fiscal Agent Signature
Print Name
Telephone Number Telephone Number
Attachment B-1, DEP Agreement No. 50839, Page 2 of 6
Engineer's Certification
of Disbursement Request
ONLY SUBMIT IF CONSTRUCTION IS PART OF THE PROJECT
, being the Professional Engineer retained by
(name of Professional Engineer)
, am responsible for overseeing construction of the project
(name of Grantee)
described in the Agreement and do hereby certify that for DEP Agreement No. and Payment Request No.
1. All permits and approvals required for the construction, which is underway, have been obtained.
2. Payment is in accordance with construction contract provisions.
3. Construction up to the point of this payment request is in compliance with the approved plans and permits.
4. Equipment, materials, labor, and services represented by the construction invoices have been satisfactorily purchased or received and
applied to the project in accordance with construction contract documents filed with and previously approved by the Department of
Environmental Protection.
Signature of Professional Engineer
Firm or Affiliation
(Date) (P.E. Number)
Attachment 13-1, DEP Agreement No. S0839, Page 3 of 6
INSTRUCTIONS FOR COMPLETING
PAYMENT REQUEST SUMMARY FORM
DEP AGREEMENT NO.: This is the number on your grant agreement.
PAYMENT REQEUST NUMBER: Number of payment request
REQUEST DATE: Date reqeust is submitted
GRANTEE: Enter the name of the grantee's agency.
MAILING ADDRESS: Enter the address that you want the state warrant sent.
GRANTEE'S GRANT MANAGER: This should be the person identified as grant manager in the grant Agreement.
TASK NO.: This is the number of the task that you are requesting payment for and/or claiming match for (must agree with the current Grant Work Plan).
TASK AMOUNT REQUESTED: This should match the amount on the "TOTAL TASK BUDGET AMOUNT" line for the "AMOUNT OF THIS REQUEST" column.
GRANT EXPENDITURES SUMMARY SECTION:
"AMOUNT OF THIS REQUEST" COLUMN: Enter by authorized category of expenditure the amount for which you are requesting reimbursement for this task. This must
agree with the currently approved budget in the current Grant Work Plan of your grant Agreement. Do not claim expenses in a budget category that does not have an approved
budget. Do not claim items that are not specifically identified in the current Grant Work Plan. Enter the column total on the "TOTAL AMOUNT" line. Enter the amount of all
Tasks on the "TOTAL BUDGET (ALL TASKS)" line. Enter the total cumulative amount of this request and all previous payments on the "LESS TOTAL CUMULATIVE
PAYMENT REQUESTS OF" line. Deduct the "LESS TOTAL CUMULATIVE PAYMENT REQUESTS OF" from the "TOTAL BUDGET (ALL TASKS)" for the amount to enter
on the "TOTAL REMAINING (ALL TASKS)" line.
"PREVIOUS PAYMENT REOUESTS" COLUMN: Enter the total cumulative amount that has been paid in previous requests. Do not include the current regeusted amount in
this total. Do not enter anything in the shaded areas.
"TOTAL CUMULATIVE PAYMENT REQUESTS" COLUMN: Enter the cumulative amounts that have been requested to date for reimbursement by budget category. The
final request should show the total of all requests; first through the final request (this amount cannot exceed the approved budget amount for that budget category for the Task(s)
you are reporting on). Enter the column total on the "TOTAL PAYMENT REQUEST" line. Do not enter anything in the shaded areas.
"MATCHING FUNDS" COLUMN: Enter the amount to be claimed as match for the performance period for the Task(s) you are reporting on. This needs to be shown under
specific budget categories according to the currently approved Grant Work Plan. Enter the total on the "TOTAL AMOUNT" line for this column. Enter the match budget amount
on the "TOTAL BUDGET (ALL TASKS)" line for this column. Enter the total cumulative amount of this and any previous match claimed on the "LESS TOTAL CUMULATIVE
PAYMENTS OF" line for this column. Deduct the "LESS TOTAL CUMULATIVE PAYMENTS OF" from the "TOTAL BUDGET (ALL TASKS) " for the amount to enter on the
"TOTAL REMAINING (ALL TASKS) " line.
"TOTAL CUMULATIVE MATCHING FUNDS" COLUMN: Enter the cumulative amounts you have claimed to date for match by budget category. Put the total of all on
the line titled "TOTAL PAYMENT REQUEST." The final request should show the total of all claims, first claim through the final claim, etc. Do not enter anything in the
shaded areas.
GRANTEE'S CERTIFICATION: Must be signed by both the Grantee's Grant Manager as identified in the grant agreement and the Grantee's Fiscal Agent.
ENGINEER'S CERTIFICATION: Must be signed by Professional Engineer when Construction is being reqeusted for reimbursement.
Documentation for match claims must meet the same requirements as those expenditures for reimbursement.
Attachment 13-1, DEP Agreement No. S0839, Page 4 of 6
FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
REQUEST FOR PAYMENT — PART 11
REIMBURSEMENT DETAIL
Grantee Name:
Payment Request No.:
DEP Agreement No.:
Vendor Name
Local Share or Other
Invoice Invoice Date Invoice Amount Funding or Amount
Number (1) Not Requested (2)
rable
Requested Amount (3) Check Number Task/, ber (44))
Number
S
$
S
$
S
$
S
$
S
$
S
$
S
$
$
$
Totals:
$ -
$
Attachment B-1, DEP Agreement No. S0839, Page 5 of 6
Instructions for Completing Request for Payment - Part II
Include the Grantee Name, Payment Request No., and DEP Agreement Number. List vendor invoices that are associated
with the Project by Task/Deliverable.
1 Invoice Amount: Amount of Invoice being submitted for reimbursement.
Local Share or Other Funding or Amount Not Requested: Portion of invoice paid for by Grantee,that is not
2 being requested for reimbursement by this grant
Requested Amount: Subtract Grantee's Local Share or Other Funding or Amount Not Requested (2) from Invoice
3 Amount (1).
Deliverable Number: Must identify completed deliverable(s) for each invoice. If invoice covers multiple
deliverables, that invoice would be listed multiple times, a line item for each deliverable with any portion not
4 applicable to that Task/Deliverable identified under (2).
Submittal Instructions
Instructions for E -mailing:
The program now accepts reimbursement requests electronically, please E-mail to Water and Springs Restoration
Program. When scanning please be sure that the minimum scan resolution must be 300 DPI (dots per inch). When
reimbursement requests are sent electronically, please do not also send a hard copy by postal mail.
Please redact all sensitive financial information from the invoices and other supporting documentation
to be submitted with this Payment Request Form.
Remit Payment Request by E-mail to: WSRP(cDdep.state.fl.us
Be sure the E-mail payment request includes the following:
Cc: Department's Grant Manager
Subject: Project Number—Disbursement Number: example — LP14025—Dish 1
Attachments:
1) Exhibit D Payment Request Summary
2) Request for Payment Part II Reimbursement Detail
3) Copies of invoices
4) Proof of payment (copies of canceled checks, front and back or EFT verification)
5) Other supporting documentation, as needed
For questions or concerns regarding these forms or if you would like the payment request forms listed above in
electronic format please contact:
Name & Phone Number of contact
Email address of contact
Attachment B-1, DEP Agreement No. 50839, Page 6 of 6