HomeMy WebLinkAboutAUGUSTA BURN CENTER INDIGENT CARE $250,000
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Grant No. 06-C-L-050
Duplicate Original Counterpart of
Augusta, Georgia
SPECIAL PROJECT LOCAL ASSISTANCE GRANT
BY THE DEPARTMENT OF COMMUNITY AFFAIRS
With Subrecipient
THIS GRANT AGREEMENT is made as ofthe6-~ day of ~ 2~,
between the Department of Community Affairs of the State of Georgia ("Department") and Augusta,
Georgia of the State of Georgia ("Recipient").
1. Appropriation and Authority. ful Appropriation. The Department has determined, and
Recipient affirms, that Recipient is the eligible recipient for a "Local Assistance Grant" authorized by
the General Assembly in the general appropriations Act for Fiscal Year 2005-2006, as follows (the
"Grant Appropriation"):
LAG# APPROPRIATION PURPOSE
50 "To provide funding to the Augusta Bum Center for
indigent care"
GRANT AMOUNT
$250,000
2005 Ga. Laws Act No. 396, Section 16, following line 254 (RB. 85, signed into law May 5, 2005).
(Q) Authority. Such grants with specified purpose, recipient and amount are commonly referred
. to as "special project grants", e.g. O.C.G.A. S 36-81-8.1(a), and the Department makes such grants
under O.C.G.A. S 50-8-8(a).
!il Grant Purpose and "Failsafe Clause". The general appropriations Act further contains the
following, failsafe provision ("Failsafe Clause") applicable to the Appropriation Purpose:
If a local assistance grant incorrectly identifies the local government recipient for the
stated purpose, then the intended recipient is the local government entity with
responsibility for the purpose. If a local assistance grant states an ineligible purpose, the
intended purpose is eligible activity of the stated recipient with substantially similar
character. Where a local assistance grant states that it is for the operation of a private
program or a private entity, the intent is that the local government recipient contract for
services of such a nature from the private entity. If a local assistance grant states that it is
for the purchase of property for a private entity or for the improvement of property of a
."
. ..
private entity, the intent is that recipient contract for services of the private entity using
the property.
For this Grant the Grant Purpose will be as stated in the Appropriation Purpose. If Recipient
determines that it is not the correct local government recipient or that the Grant Purpose is not within
Recipient's legal powers, then Recipient will promptly notify Department, and Department will
determine whether to change recipient or restate purpose. Recipient may not exercise the "Failsafe
Clause" independently of the Department. If Recipient determines that it is not the correct local
government recipient or that the Appropriation Purpose is not within Recipient's legal powers, then
Recipient will notify Department, and Department will determine whether to change recipients or restate
purpose. Recipient may not implement the first two sentences of the Failsafe Clause independently of
the Department. However, Recipient will comply with the third and fourth sentences of the Failsafe
Clause in its contract or contracts with the Subrecipient identified immediately below, as applicable.
@ "Subrecipient". Code Section 36-81-8.1 also provides specially for local assistance grants
which designate a "subrecipient" as defined in subsection 36-81-8.1 (a). The Department has
determined, and Recipient affirms, that the Grant Appropriation designates a subrecipient
("Subrecipient") identified more fully below as to name, business organization type, chief executive
officer, registered agent, and respective addresses:
Joseph M. Still Bum Centers, Inc.
Attention Robert F. Mullis
P.O. Box 3726
Augusta, GA 30914
Registered Agent:
Robert F. Mullis
P.O. Box 3726
Augusta, GA 30914
Recipient will require Subrecipient to give Recipient and Department written notice of any change in the
foregoing information. Recipient will implement the Grant by contracting for the services of
Subrecipient. The services must be for the Grant Purpose and must provide Recipient a substantial
benefit in aid of a public function or service consistent with the Grant Purpose and within Recipient's
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lawful powers. In its contract or contracts with Subrecipient, Recipient must incorporate this Grant
Agreement and
. require Subrecipient to perform its Agreement with Recipient in compliance with the
Grant Agreement and so as to enable Recipient to comply with the Grant Agreement;
. require Subrecipient to acknowledge and promise to honor its statutory liability to
Department under O.C.G.A. S 36-81-8.1, and
. make Department a third party beneficiary of the Recipient's contract with
Subrecipient without responsibility, liability or obligation to Subrecipient.
2. Grant and Acceptance. The Department, therefore, now makes, and Recipient accepts,
this local assistance grant (the "Grant") authorized by the Grant Appropriation, in the Grant Amount and
for the Grant Purpose set forth in Section 1, upon the terms and conditions of this Agreement.
3. Disbursement. When Department delivered to Recipient its original counterpart of this
Agreement fully executed by both parties, Department also delivered to Recipient the Department's
check in the amount of $187,500, as an initial, partial payment ("Initial Payment") of the Grant,
representing three-fourths of the Grant Amount. Department will disburse the balance ("Final
Payment") of the Grant Amount by its check to Recipient when Recipient has spent or contractually
obligated the Initial Payment in full and has delivered to Department its "Request for Final Payment" in
the form annexed as Appendix A". Together the Initial Payment and the Final Payment constitute the
"Grant Funds"
4. Use. ill} Permitted Puq>oses. Recipient may use the Grant Funds only for the Grant
Purpose set forth in Section 1 or for reimbursement of expenditures of other funds by Recipient, which
expenditures were made for the Grant Purpose and were made in express anticipation of the Grant after
the Grant Appropriation became law (or, if before the effective date, the Commissioner has agreed in
writing to the reimbursement.) For purposes ofthis Agreement, such a reimbursement will be
considered an expenditure of Grant Funds.
(Q) Deadlines. Except as extended by written permission of the Commissioner of Community
Affairs, the following deadlines will be in force:
(1) Expenditure or Obligation. Recipient must expend or contractually obligate the full amount
of the Grant within 12 calendar months from the date of this Agreement. At the end of that time, the
authority to expend unencumbered Grant Funds or to obligate them contractually will expire, and
Recipient must repay to Department all Grant Funds paid to Recipient which Recipient has not spent or
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contractually obligated by the end of the following calendar month, unless the Commissioner of
Community Affairs consents to a new deadline for good cause in a writing specifically referring to this
Grant by number.
(2) Duty to Wrap Up. Recipient will move along the implementation of the Grant expeditiously,
imposing terms and managing the Subrecipient contract so as to fulfill the Grant Purpose and to cause
Subrecipient to complete its services and expenditures of Grant Funds by the end of two calendar years
from the date of this Agreement (the "Wrapping Up Date"). Before the end of the second month
following the Wrapping Up Date, Recipient must report to Commissioner that Grant Funds are
expended or return to Department any unspent Grant Funds, whether contractually obligated or not,
unless the Commissioner of Community Affairs consents to a new deadline for good cause in a writing
specifically referring to this Grant by number.
5. Accountability. ful Accounting. Recipient will amend the Grant Funds into its annual
budget consistently with their proper treatment under the "Uniform Chart of Accounts for Local
Governments in Georgia" and will account for Grant Funds in accord with generally accepted
governmental accounting principles. Recipient will also account for the Grant Funds and keep track of
their application in such a way that their receipt, deposit, budgeting, contractual commitment,
expenditure and uses may be determined and confirmed chronologically by auditors at all times. In its
contracts with Subrecipient, Recipient will require Subrecipient also to account for the Grant Funds in
accord with generally accepted accounting principles and to provide it with the information and
documents necessary for Recipient to submit the statutory certifications required by O.C.G.A. S 36-81-
8.1 and Section 5(e) below.
(Q) Audit. Recipient will allow, obtain and cooperate with any audit or investigation of Grant
administration requested or undertaken by the Department, the State Auditor or other officers of the
State with power to conduct or request such audit or investigation. In its contracts with Subrecipient and
any other third parties for the expenditure of Grant Funds, Recipient will require its opposite parties to
promise also to allow and cooperate with such audits. Recipient will retain the authority in its contract
with Subrecipient to obtain or perform an audit of Subrecipient in any manner related to the Grant.
Recipient also will require Subrecipient to provide to it, Department or any other state officer with
jurisdiction any management representations, statements of expenditures and financial statements
reasonably required by them in respect of the Grant and Recipient's agreement with Subrecipient.
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!il Records Retention. Recipient will maintain and require Subrecipient to maintain the records
described in subsection 5(a) for at least three years after Recipient and Subrecipient have fully spent or
returned to Department the amount of all Grant Funds.
@ Written Contracts. Any external expenditure or obligation of Grant Funds by Recipient must
be under a contract in writing.
~ Statutory Certification. Regardless of the size of a Grant, Recipient must certify as required
by O.C.G.A. S 36-81-8.1 "that the grant funds were used solely for the express purpose or purposes for
which the grant was made." This means Recipient must certify it has determined that Subrecipient has
applied Grant Funds paid to Subrecipient to services for Recipient in accord with the Grant Purpose and
the agreement between Recipient and Subrecipient. As explained immediately below, in the case of
grants in excess of $5000, Recipient's certification must be verified by audit, and in the case of grants of
$5000 or less, Recipient's certification must be supported by Subrecipient's affidavit. More
particularly:
(1) Grants in excess of$5000. (i) If the Grant Amount is greater than $5,000, this Grant is
conditioned upon receipt by the State Auditor of the properly completed grant certification form or
forms as required by O.C.G.A. S 36-81-8.1. The current "Grant Certification Form and Independent
Accountant's Report" as designed by the State Auditor is annexed as Appendix "B", but Recipient will
determine from the State Auditor the correct form to use at the time for submission. In original
signatures as required on the Grant Certification Form, Recipient (by its chief elected officer and its
chief financial officer) and Recipient's independent auditor must certify that the Grant Funds were used
solely for the express purpose or purposes for which the Grant was made, i.e. for the Grant Purpose. For
Grant Funds paid to Subrecipient, the certification by Recipient's auditor required by this subsection
may also be made by an in-house or internal auditor of Recipient local government who meets the
education requirements contained in subparagraph (a)(3)(A) of Code Section 43-3-6. The in-house
auditor must do more than confirm that Recipient has contracted with Subrecipient for Grant Purposes;
the in-house auditor must take steps reasonable for an in-house auditor to confirm that Subrecipient is
applying the Grant Funds as required by the Grant.
(ii) Recipient must cause the Grant Certification Form to be filed with the State Auditor for each
fiscal year in which Recipient or Subrecipient expends Grant Funds or after which Recipient or
Subrecipient has an unexpended balance in Grant Funds. The Grant Certification Form must be filed
with the State Auditor in conjunction with the periodic audits or reports required of Recipient under
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O.c.G.A. S 36-81-7 by the time such audit or report is due, annually unless Recipient qualifies and
elects to proceed with a biennial audit under O.C.G.A. S 36-81-7(a)(2).
(iii) The cost of performing any audit required by subsection (b) ofO.C.G.A. S 36-81-8.1 or
paragraph (1) of subsection (d) of that Code section shall be an eligible expense of the Grant. However,
Recipient may not charge against Grant Funds more than 2 percent of the Grant Amount or $250.00 per
required audit, whichever is less.
(2) Grants of$5000 or less. If the Grant Amount is equal to or less than $5,000, this Grant is
likewise conditioned upon receipt by the State Auditor of the properly completed grant certification
form or forms as required by O.C.G.A. S 36-81-8.1, and Grantee must submit to the State Auditor the
properly completed grant certification form required by subsection O.C.G.A. S 36-81-8.1(b) and
Paragraph (1) above, except that:
(i) Recipient may certify alone that the Grant Funds were used solely for the express
purpose or purposes for which the Grant was made without certification by its independent
auditor, and
(ii) Recipient must require the Subrecipient to submit to Recipient a notarized affidavit
executed by the executive director, president, chairperson, chief executive officer, or other
responsible party representing the Subrecipient, reasonably acceptable to the Local Government,
to whom the Grant Funds have been disbursed. The affiant must certify under oath that the
Grant Funds received by Subrecipient were used solely for the express purpose or purposes for
which the Grant was made, i.e. the Grant Purpose, and that any Grant Funds contractually
committed to Subrecipient are for Grant Purposes. The affidavits must be submitted annually to
Recipient for each year that Grant Funds paid to Subrecipient are expended or remain
unexpended according to a schedule established by Recipient. The affidavits must be made on
the form designed by the State Auditor annexed in its current form as Appendix "C". Recipient
will determine from the State Auditor the correct form to use at the time for submission.
Recipient must include a copy of the affidavit when submitting its Section 36-81-8.1 certification
to the State Auditor.
6. Remedies. ill} Remedies Cumulative. The following remedies are cumulative of one
another and of all other remedies at law or in equity which Department may have.
(Q) Remedies. (1) Statutory Forfeiture under o.C.G.A. ~36-81-8.1. The failure to comply with
the requirements ofO.C.G.A. S 36-81-8.1 and with subsection 5(e) of this Agreement will result under
Page 6 of 22
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law and this Agreement in forfeiture of the Grant and Grant Funds, whether paid to Recipient or not and
whether spent, unspent, or contractually obligated. Except as qualified in the immediately following
paragraph, Recipient will then repay and return to the Department the amount of any Grant Funds paid
to Recipient.
Subrecipient will be responsible for the return to the Department of any Grant Funds if it is
determined that the Grant Funds were not used by Subrecipient for the express Grant Purpose.
Department will not consider Subrecipient an agent of the Recipient nor will Department require
Recipient to indemnify Department or hold Department harmless for any negligence, misfeasance, or
malfeasance of the Subrecipient, and Recipient will not be liable to Department for any expenditure of
Grant Funds by a Subrecipient. However, this sentence does not relieve Recipient of its obligations and
terms under this Agreement including the obligation to require Subrecipient to perform its obligations to
Recipient.
(2) Non-conforming Use. Except as qualified in Paragraph (1) above, Recipient must also repay
Department the amount of any Grant Funds spent or contractually committed for purposes outside the
Grant Purpose or in violation of this Agreement, promptly and in any event no later than the end of the
month following any such expenditure or contractual commitment.
(3) Ineligibility for other Grants. Recipient and Subrecipient will not be eligible to receive
funds from the Governor's emergency fund or from a special project appropriation until Grant Funds
required to be repaid to Department are returned to Department. However, Recipient will not be
ineligible for such funds where Subrecipient has not used funds it received for the express Grant
Purpose, but this sentence does not otherwise relieve Recipient of its obligations and terms under this
Agreement.
(4) o.C.G.A. ~ 36-11-1 Ante Litem Notices. No ante litem notice, including by way of
illustration but not limitation, O.C.G.A. S 36-11-1, will apply to claims for repayment of Grant Funds or
to any other claim, action or proceeding under or respecting this Agreement. To the extent that
O.C.G.A. S 36-11-1 or other requirement of ante litem notice might apply, Recipient waives its
application.
(5) Withholding of Grants for Unresolved Findings. Except as to matters for which Subrecipient
is liable under Section 6(b)(1) above and O.C.G.A. S 36-81-8.1, the Commissioner of Community
Affairs may in the Commissioner's sole discretion withhold from Recipient any other grants of state or
federal funds so long as any audit or report findings respecting the Grant remain unresolved as
Page 7 of 22
determined by the Commissioner in the Commissioner's sole discretion or during any other time in
which Recipient is not in compliance with this Agreement, as determined by the Commissioner in the
Commissioner's sole discretion.
(6) Material Breach. The Department may terminate this Agreement for material breach, after
first allowing a reasonable time for correction determined in the sole discretion of the Commissioner of
Community Affairs. Except as qualified in regard to Subrecipient above, Recipient must then return to
Department by the deadline all remaining and unexpended Grant Funds, whether contractually obligated
or not, the amount of any Grant Funds spent outside the Grant Purpose, and, if the Commissioner of
Community Affairs so determines, the amount of any other Grant Funds spent or obligated improperly
under the Agreement.
(7) Interest. Any Grant Funds required to be returned to Department by Recipient or
Subrecipient under Paragraphs 6(b)(1), -(2), and -(6) above must be returned with interest at the average
rate at which the Grant Funds would have earned in the state treasury from the dates of their payments to
Recipient, as determined by the Office of Treasury and Fiscal Services in its sole discretion.
7. General Terms. ful Compliance with Law. (1) Generally. The award of the Grant does
not itself empower Recipient in any way in which it is not already empowered by law, and Recipient
will implement the Grant only in accord with such powers and all other applicable law. Without
limiting the preceding statements, Recipient will comply with the following in accepting and
implementing the Grant and will exercise due diligence in factual inquiries in order to do so.
(2) Conflicts of Interest. Recipient will not implement the Grant if it learns that the origination
of the Grant or its implementation present a conflict of interest for any public officer or employee,
whether statutory, or at common law or under the Constitution of Georgia.
(3) Sectarian Aid. Recipient will not implement the Grant in violation of the prohibition against
sectarian aid, Ga. Const. art. I, sec. II, par. VII.
(4) Gratuities. Recipient may not make Grant Funds available in violation of the prohibition
against gratuities in Ga. Const. art. III, sec. VI, par. VI.
(5) Open Meetings and Open Records. In activities respecting the Grant, Recipient will comply
with the open meetings law in Chapter 50-14 of the Official Code of Georgia, Annotated, and with open
records law in Chapter 50-18.
Page 8 of 22
(6) General Governmental Requirements. Recipient will comply with all general and local law
applicable to its Grant activities, including without limitation budgeting, accounting, audits,
procurement, and contracting activities.
(Q) Enforceable and Legally Binding Act. By entering into this Agreement, Recipient
undertakes to have complied with all law applicable to its participation in the Agreement and to make
the Agreement binding, including proper meeting conduct (in compliance with open meeting law
requirements and otherwise) and with proper entries into its minutes.
!il Relationship of Parties. Neither this Agreement nor any actions of the parties or their
officers or employees will create any agency relationship, joint venture, or other intergovernmental
affiliation between the Department and the Recipient except that of grantor and grantee of a local
government grant under Ga. Const. art. VII, sec. III, par. III, as provided by O.C.G.A. S 50-8-8. The
Department is not an agent or representative of the Recipient and the Recipient is not an agent or
representative of the Department. Except as qualified in Section 6(b)(1) above and O.c.G.A. S 36-81-
8.1, the Recipient shall be solely responsible for its activities respecting the Grant and this Agreement.
The Recipient may not delegate away its responsibility and obligations under the Agreement or assign
any rights it may have under it.
@ Notices. Department and Recipient will give one another notice in writing by first class
United States mail, return receipt requested; by equivalent commercial carrier with return receipt
requested, or by hand delivery, to their respective, chief executive officers at the address of record at
Department for Recipient and Department. The chief executive officers may designate another officer
or employee for receipt or giving of notice by personal, written communication to their counterpart, with
specific reference to this Agreement. The date of receipt of notice will be the effective date.
~ Time of Essence. Time is of the essence of this Agreement.
ill No Waiver. No delay by the Department in enforcing this Agreement will estop, waive or
otherwise adversely affect the Department's right and power to enforce the Agreement and require
performance of any provision.
{g} No Third Party Beneficiaries. There are no third party beneficiaries of this Grant
Agreement.
ili2 Counterparts. The parties have executed and delivered duplicate original counterparts to one
another, each of which will be equal in dignity to the other.
Page 9 of 22
ill Headings. The captions in this Agreement are for convenience and not for use in
interpretation.
ill Severability. If a part of this Agreement is invalid, the parties intend to preserve the
remainder if the remaining terms provide each party the substantial benefit of its bargain.
(k) Entire Agreement. This Agreement constitutes the entire agreement between Department
and Recipient respecting its subject matter, superseding all prior discussions or understandings. A
writing of equal dignity is required for its amendment.
IN WITNESS WHEREOF, the Department and Recipient have executed this Agreement as of
the date first written above.
Augusta, Georgia
(RECIPIENT)
DEPARTMENT OF COMMUNITY AFFAIRS
By:
LL€4.~/'
By: ~Jz,- ~
MIKE BEATTY
COMMISSIONER OF COMMUNITY AFFAIRS
Name:
~ David S. Copenhaver
~ Title:}A. ~ cJR
Atte~~
Name:
Lena J. Bonner
Title: C Ll?f....k of C()\)-\~(S--J", 0fV
58-22042-74
Federal Employer (Tax) Identification No.:
Page 10 of 22
LOCAL ASSISTANCE GRANT
REQUEST FOR FINAL PAYMENT
GEORGIA DEPARTMENT OF
COMMUNITY AFFAIRS
60 Executive Park South, N.E. . Adanta, Georgia 30329-223
Recipient: Augusta, Georgia
Local Assistance Grant # 06-C-L-050
General Instructions:
Complete and return this form when Recipient has spent or contractually obligated the Initial Payment
under this Grant in full, in compliance with the Grant Agreement. Be sure to indicate the official name of
the Recipient and the Department's grant number as shown on the Agreement at the top of this form. The
Grant Recipient is the entity that appears in the Grant Agreement and the Grant number appears in the
upper left-hand corner of the Agreement.
The certification statement below must be signed by the Chief Elected Official or by another officer or
employee who demonstrates authority to execute on the Recipient's behalf. Please return the form to the
above listed address. If you have any questions, please contact Bobby Stevens at (404) 679-4943.
Certification:
This is to request Final Payment on the Local Assistance Grant identified by number above. In making this
request, I hereby certify on behalf of Recipient that
. the Grant Agreement and Grant Purpose are being implemented in compliance with their terms;
. the Initial Payment previously paid to Recipient under this Grant has been spent or contractually
obligated in accordance with the Grant Agreement;
. Recipient is prepared to spend or contractually obligate the Final Payment expeditiously in
accord with the Grant Agreement.
Authorized Signature: cQJ~. (c-
Print Name and Title:'j),,4V:;:C)> S. C-~ r6-J~~vC~
,'"
Uate: z-I'Z v (010
cf'1.. 4- '-I CJ If.-
o/jo
Page 12 of 22
State of Georgia Grant Certification Form
Instructions
As required by O.C.G.A. S 36-81-8.1, each grant of state funds to a local government from the
Governor's Emergency Fund or from a special project appropriation shall be conditioned upon the
receipt by the State Auditor of a properly completed grant certification form. This means Recipient
must certify it has contracted with Subrecipient and Subrecipient has applied Grant Funds paid to
Subrecipient to services for Recipient in accord with the Grant Purpose and the agreement between
Recipient and Subrecipient. As explained immediately below, in the case of grants in excess of $5000,
Recipient's certification must be verified by audit, and in the case of grants of $5000 or less, Recipient's
certification must be supported by Subrecipient's affidavit.
One grant certification form should be prepared for each grant awarded to the local government. The
grant certification formes) should be submitted to the State Auditor with one copy of the annual (or,
when allowed, biennial) audit report. Questions concerning the preparation and submission of this form
should be referred to the Nonprofit and Local Government Audits Division of the Georgia Department
of Audits and Accounts.
Instructions for Completion
Complete lines A through N of the grant certification form. The form was designed as an Excel
spreadsheet and may be completed by entering data in the appropriate cells. Edit checks are built into
the spreadsheet to assist in the proper preparation of the form. If you would like to have the Excel file
sent to you via e-mail, request the form by sending an e-mail to locgov@audits.state.ga.us. Please note
that one form should be submitted for each grant from the Governor's Emergency Fund or from a special
project appropriation. A form must be submitted for each year in which the funds are expended or
remain unexpended by the local government or its Subrecipient. Data should be provided in Column 1
for the fiscal year upon which the local government is reporting. Data in column 2 should represent
cumulative totals from the year of grant award through the fiscal year upon which data is provided in
Column 1.
The appropriate officials should sign and date the section entitled "Certification of Local Government
Officials" .
. Where the grant is in excess of $5000 and is not expressly designated by the Department of
Community Affairs as involving a "subrecipient", as that term is defined in O.c.G.A. S
36-81--8.1 (a), by use of a form expressly for subrecipient grants, the certification must be made
by the recipient local government and by the local government auditor.
o An example Independent Accountant's Report to be used when the local government is
determined to be in compliance with the provisions of OCGA 36-81-8.1 is included in
this instruction package. If the government is not in compliance with these provisions,
the AICP A's Codification of Statements on Standards for Attestation Engagements,
Section 601 provides guidance on the appropriate reporting format.
. Where the grant in excess of $5000 is designated by the Department of Community Affairs as
involving a "subrecipient," as that term is defined in O.c.G.A. S 36-81-8.1(a), by the use ofa
grant form expressly for subrecipient grants, the certification by the local government auditor
Page 14 of 22
required by subsection O.C.G.A. S 36-81-8.1(b) may also be made by an in-house or internal
auditor of the local government, who meets the education requirements contained in
subparagraph (a)(3)(A) of Code Section 43-3-6. The in-house auditor must do more than
confirm that Recipient has contracted with Subrecipient for Grant Purposes; the in-house auditor
must take steps reasonable for an in-house auditor to confirm that Subrecipient is applying the
Grant Funds as required by the Grant.
. Where the grant is for $5000 or less and is not expressly designated by the Department of
Community Affairs as involving a "subrecipient," as that term is defined in O.C.G.A. S 36-81-
8.1 (a), by the use of a grant form expressly for subrecipient grants:
o recipient local government must submit the properly completed grant certification form
except that only the local government need certify, and the certification of an auditor is
not required.
. However, ifthe grant for $5000 or less also is designated by the Department of Community
Affairs as involving a "subrecipient," as that term is defined in O.C.G.A. S 36-81-8.1(a), by the
use of a grant form expressly for subrecipient grants, local government must also require the
subrecipient to submit to local government a notarized affidavit.
o The affidavit must be executed by the executive director, president, chairperson, chief
executive officer, or other responsible party representing the subrecipient reasonably
acceptable to Recipient, by whatever name or title, to whom the grant funds are
disbursed.
o The affidavit shall be in the form approved by the State Auditor.
o Such affidavit shall be submitted annually (or biennially when allowed by O.C.G.A. S
36-81-7) for each year that grant funds are expended or remain unexpended according to
a schedule established by the local government and shall be made on the form annexed
below.
o Local government must submit a true copy of the affidavit to the Department of Audits
and Accounts when submitting its certification.
Mail the Grant Certification Form (including Independent Accountant's Report, report of in-house or
internal auditor, and copy of affidavit as the case may be) with one copy of the audited annual financial
report to:
State of Georgia, Department of Audits and Accounts
Nonprofit and Local Government Audits Division
270 Washington Street, SW
Suite 1-156
Atlanta, Georgia 30334
If the local government meets the eligibility criteria for an agreed upon procedures engagement in
accordance with the provisions of the Official Code of Georgia Annotated Section 36-81-7, the local
government is responsible for ensuring that the procedures performed by its independent certified public
accountant are sufficient in scope to enable the CPA to complete the Independent Accountant's Report.
These procedures include examination of grant application and award documentation to become familiar
with the terms and conditions of the grant; verification of receipt of grant proceeds; and evaluation of
Page 15 of 22
the local government's documentation of expenditures. The purpose of these procedures is to comply
with the provisions O.C.G.A. S 36-81-8.1, requiring certification that the grant funds were used solely
for the express purpose or purposes for which the grant was made.
Whether the local government engages an independent certified public accountant to perform an audit or
perform the agreed upon procedures, for purposes of meeting the requirements ofO.C.G.A. S 36-81-8.1,
the independent CPA should be engaged to examine management's assertion of compliance with the
requirement to use grant funds solely for the express purpose or purposes for which the grant was made.
The independent CPA should conduct the engagement in accordance with the standards for examination
engagements for compliance attestation contained in the Codification of Statements on Standards for
Attestation Engagements.
This form and the accompanying Independent Accountant's Report is required to be filed with the state
auditor in conjunction with the annual audit for each year in which grant funds are expended or remain
unexpended by the local government.
Questions concerning the provisions of O.C.G.A. S 36-81-8.1, the State of Georgia Grant Certification
Form, the affidavit or attestation engagements should be referred to Edward Blaha, Director, Nonprofit
and Local Government Audits Division, at the address listed above; telephone (404) 651-5115; fax (404)
651-5608; or e-maillocgov@audits.state.ga.us
Page 16 of 22
State of Geore:ia Grant Certification Form
Local Government Recipient
LINE
Local Government
A
State Awarding Agency
B
Grant Identification Number
C
Grant Title
D
Grant Award Date
E
Grant Amount
F
G.
Amount of Contract with Joseph
M. Still Bum Centers, Inc.
(Subrecipient)
H
Balance - Prior Year
(Cash or Accrued or Deferred
Revenue
Grant Receipts or Revenue
J Reco nized
Grant Disbursements to
Subrecipient (EXCLUDING
K AUDIT FEES
Disbursements or
L Ex enditures for Audit Fees
Balance - Current Year (Cash
or Accrued or Deferred
Revenue) [Line I (col1 only) +
M Line J - Line K - Line L
Amount Expended by
Subrecipient on Grant
N Pur ose
Augusta, Georgia
Department of Community Affairs
06-C-L-050
'SPECIAL PROJECT LOCAL ASSISTANT GRANT BY THE
DEPARTMENT OF COMMUNITY AFFAIRS with Subrecipient"
$250,000
COLUMN 1
Current Year Activity
~ COLUMN 2
I Cumulative Grant Activity
I Through the Vear Ended:
I
For the Year Ended:
$0.00
$0.00 ~
$0.00 I
$0.00 ~
$0.00 I
$0.00 I
$0.00
$0.00
$0.00
$0.00
$0.00
EDIT CHECKS IF FORM COMPLETED ON EXCEL SPREADSHEET:
Column 1, Line M equals Column 2, Line M. Line A Must Be Completed
Grant Receipts/Revenue Does Not Exceed Grant Award. Line B Must Be Completed
Date Must Be Provided in Line H, Column 1. Line C Must Be Completed
Page 17 of 22
Date Must Be Provided in Line H, Column 2.
Year End Dates On Line H
Agree.
Column 1, Line M Foots
Correctly.
Line D Must Be Completed
Line E Must Be Completed
Column 2, Line M Foots
Correctly.
Line F Must Be Completed
Audit Fee is authorized for Grant
in excess of $5000 and is within
2% Limit ($250 max). See
O.C.G.A. ~ 36-81-8.1.
Certification of Local Government Officials
I have reviewed the information presented above and certify that it is accurate and correct. I
further certify that the proceeds of the grant award identified above were used solely for the express
purpose or purposes for which the grant was made. Further, Augusta, Georgia ("Recipient") has
contracted with Joseph M. Still Burn Centers, Inc. ("Subrecipient") as required by the Grant, and
Subrecipient has applied Grant Funds paid to it toward services for Recipient in accord with the Grant
Purpose and the Agreement between Recipient and Subrecipient. I understand that the failure to
comply with the requirements of Code Section 36-81-8.1 will result in a forfeiture of the state Grant and
the return to the State of any such grant funds which have been received by the local government,
qualified in that, in the case of a state grant awarded to a Subrecipient, the Subrecipient shall be
responsible for the return to the State of any such Grant Funds if it is determined that the funds were not
used for the express purpose or purposes for which the Grant was made. Further, a grant Recipient or
Subrecipient shall be ineligible to receive funds from the Governor's emergency fund or from a special
project appropriation until all unallowed expenditures are returned to the State, except that a Recipient
local government shall not be ineligible for such funds where a Subrecipient has not used funds it
received for the express purpose or purposes for which the Grant was made. Recipient understands that
the Subrecipient's direct liability to the State does not relieve Recipient of the duty to enforce the
Agreement with Subrecipient in order to ensure that Recipient receives the benefit of the expenditure of
public funds.
C).JQ Signature of Chio/ Elected Official
fJ'tO Date 2.- ('[,.0 (0 b
Signature of Chief Financial Officer
Date /f:r-8/ Db
~~.
~
Page 18 of 22
[FIRM LETTERHEAD]
State of Geor2ia Grant Certification Form under O.C.G.A. 36-81-8.1
Independent Accountant's Report
06-C-L-050
We have examined management's assertion included in the accompanying State of Georgia Grant
Certification Form(s) about [name of government]'s compliance during the fiscal year ended [date] with
the requirement to use grant proceeds solely for the purpose or purposes for which the grant was made
for each of the following grant award(s):
Management is responsible for [name of government]'s compliance with this requirement. Our
responsibility is to express an opinion on management's assertion about the [name of government]'s
compliance based on our examination.
Our examination was conducted in accordance with attestation standards established by the American
Institute of Certified Public Accountants and, accordingly, included examining, on a test basis, evidence
about [name of government]'s compliance with this requirement and performing such other procedures
as we considered necessary in the circumstances. We believe that our examination provides a
reasonable basis for our opinion. Our examination does not provide a legal determination on [name of
government]'s compliance with the specified requirement.
In our opinion, management's assertion that [name of government] complied with the aforementioned
requirement for the fiscal year ended [date] is fairly stated, in all material respects.
This report is intended solely for the information and use of the Georgia Department of Audits and
Accounts and the State grantor agency identified on the Grant Certification Form and is not intended to
be and should not be used by anyone other than the specified parties.
[Signature]
[Name]
[Title]
[Organization]
[Date]
Page 19 of 22
LINE
A
. .
Affidavit under O.C.G.A. ~36-81-8.1(c)
Given on behalf of Joseph M. Still Burn Centers, Inc.
(Subrecipient)
(Two Pages)
Local Government
AUQusta, GeorQia
Department of Community Affairs
06-C-L-050
"SPECIAL PROJECT LOCAL ASSISTANCE GRANT BY THE
DEPARTMENT OF COMMUNITY AFFAIRS with Subrecipient"
$250,000
$
State Awarding Agency
B
DCA Grant Identification Number*
C
Grant Title
D
Grant Award Date
E
Grant Amount
F
G.
Total Amount Contracted to be
Paid to Subrecipient
COLUMN 1
Current Year Activity
~ COLUMN 2
I Cumulative Grant Activity
I Through the Vear Ended
I
For the Year Ended:
H
Subrecipient's Balance - Prior
Year (Cash or Accrued or
Deferred Revenue
Grant Receipts or Revenue
J Reco nized
Grant Disbursements or
K Ex enditures
$0.00
$0.00 ~
$0.00 ~
$0.00
$0.00
Subrecipient's Balance -
Current Year (Cash or
Accrued or Deferred
Revenue) [Line I (col1 only) +
L Line J - Line K
I
$0.00 I
$0.00
EDIT CHECKS IF FORM COMPLETED ON EXCEL SPREADSHEET:
Column 1, Line L equals Column 2, Line L. Line A Must Be Completed
Grant Receipts/Revenue Does Not Exceed Grant Award. Line B Must Be Completed
Date Must Be Provided in Line H, Column 1. Line C Must Be Completed
Date Must Be Provided in Line H, Column 2. Line D Must Be Completed
Page 21 of 22
..
. ..
Yearl:nd Dates On Line H
Agree.
Column 1, Line L Foots
Correctly.
Line E Must Be Completed
Column 2, Line L Foots
Correctly.
Line F Must Be Completed
Audit Fee is Within 2% Limit ($250
max). Certification cont. on next
page.
I have reviewed the information presented above and certify under oath that it is accurate and correct.
I further certify under oath:
. that Augusta, Georgia entered into an Agreement with Joseph M. Still Burn Centers, Inc.
(USubrecipient") dated by which Subrecipient has undertaken to perform services
for Recipient for the purposes of the local assistance grant identified above, in consideration of
which Recipient has paid or is paying Subrecipient) the amount shown above from grant
proceeds, and
. that the proceeds of the grant award identified above paid to Subrecipient) and expended by it
have been used solely for the express purpose or purposes for which the grant was made in
accord with the agreement. We understand that any balance of the amount paid to Subrecipient)
must also be so spent.
I understand that the failure to comply with the requirements of Code Section 36-81-8.1 and the Grant
Agreement between Recipient and the Department of Community Affairs will result in a forfeiture of the state grant
and the return to the state of any such grant funds which have been received by the local government, qualified in
that, in the case of a state grant awarded to a subrecipient, in this case our organization, the subrecipient shall be
responsible for the return to the state of any such grant funds if it is determined that the funds were not used for
the express purpose or purposes for which the grant was made. Further, a grant recipient or subrecipient shall be
ineligible to receive funds from the Governor's emergency fund or from a special project appropriation until all
unallowed expenditures are returned to the state, except that a recipient local government shall not be ineligible
for such funds where a subrecipient has not used funds it received for the express purpose or purposes for which
the grant was made.
I hereby declare under penalty of perjury that the foregoing is trufJ1n correct.
(y >f (I
Name: yAJ..::Ci7 S-. CoyefPtft4V6^--
Title: J1.J4 -t D I-
.::.:>
~..i
Sworn to and subscrlPed before me
this~lf~day of <..U_IAu~, 20a
~ to '-/J;~
Notary PI IC Nat-.v Public, Columbia County, Georgia
My Commission expires: My Commission Expires Aug. 1, 2006
(Notary
Seal)
Page 22 of 22