01/21/2004 Agreement
DANNY L. KOLHAGE
CLERK OF THE CIRCUIT COURT
DATE:
January 27, 2004
TO:
Timothy McGarry, Director
Growth Management Division
ATTN:
George Garrett, Director
Marine Resources
FROM:
Pamela G. Hanco~..
Deputy Clerk CY
At the January 21, 2004, Board of County Commissioner's Meeting the Board granted
approval and authorized execution of DEP Agreement No. LE507 for CV A03-361 between
Mgnroe County and the Department of Environmental Protection to receive $250,000 in Clean
Vessel Act (CV A) Funds.
Attached is a copy of the above-mentioned for your records. Four duplicate originals,
executed on behalf of Monroe County, were forwarded directly to DEP in the FedEx envelope
you provided. When you receive the fully executed "Monroe County Clerk's Office
Original" and "Monroe County Finance Department's Original" please forward to our
office immediately.
NOTE: I contacted Mr. Jan Delaney this date regarding Attachment E and whether it
required a signature. He asked what the attachment was and I advised him that it was the
Disclosure of Lobbying Activities. He told me that it did require a signature. I then asked if I
could attach the work sheet, behind Attachment E, that you sent down with your signature. He
said that would be fine and asked that I identify it as the original for DEP, which I did.
Should you have any questions please feel free to contact our office.
cc: County Administrator w/o document
Finance w/o document
County Attorney
File /
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DEP AGREEMENT NO. LE507
For CV A03-361
STATE OF FLORIDA
GRANT AGREEMENT
PURSUANT TO
CLEAN VESSEL ACT GRANT PROGRAM
THIS AGREEMENT is entered into between the STATE OF FLORIDA DEPARTMENT OF
ENVIRONMENTAL PROTECTION, whose address is 3900 Commonwealth Boulevard, Tallahassee, Florida 32399-3000
(hereinafter referred to as the "Department" or "DEP") and Monroe County Board of County Commissioners, whose
address is 2798 Overseas Highway, Suite 420, Marathon, Florida 33050 (hereinafter referred to as "Grantee" or
"Recipient"), a local government, to conduct a project approved under the Clean Vessel Act Grant.
WHEREAS, the Department is the recipient of federal fmancial assistance from the U.S. Fish and Wildlife Service
(FWS); and,
WHEREAS, the Agreement shall be performed in accordance with Public Law 102-587, the Clean Vessel Act of
1992, and the Federal Clean Vessel Act Grant Program Guidelines (50 CFR Parts 80 and 85), which are hereby
incorporated by reference as if fully set forth herein; and
WHEREAS, as the result of this Agreement the Grantee has been determined to be a subrecipient of federal
fmancial assistance from the U.S. Fish and Wildlife Service; and,
WHEREAS, the Florida Department of Environmental Protection was awarded funding by the U.S. Fish and
Wildlife Service pursuant to Grant Agreement No. V-I 0, Segment 1; and,
WHEREAS, the Grantee is responsible for complying with the appropriate federal guidelines in performance of its
activities pursuant to this Agreement.
NOW, THEREFORE, in consideration of the premises and the mutual benefits to be derived here from, the
Department and the Grantee do hereby agree as follows:
1 , The Grantee does hereby agree to perform in accordance with the terms and conditions set forth in this Agreement,
Attachment A (Grant Work Plan), and all attachments and exhibits named herein which are attached hereto and
incorporated by reference. For purposes of this Agreement, the terms "Contract" and "Agreement" and the terms
"Grantee", "Recipient" and "Contractor", are used interchangeably.
2, This Agreement shall begin upon execution by both parties and end no later than October 1, 2006, inclusive. The
Grantee must ensure that project facilities that are constructed under this grant are available to participating marine
facilities for a minimum of five (5) years after the completion date of the project established above. This
Agreement may be amended to provide for additional services if additional funding is made available by U.S. Fish
and Wildlife Service and/or the Legislature,
3.
A.
As consideration for the services rendered by the Grantee under the terms of this Agreement, the
Department shall pay the Grantee on a cost reimbursement basis in an amount not to exceed $250,000
toward the total project cost described in Attachment A.
B. The Grantee shall be reimbursed on a cost reimbursement basis for all eligible project costs upon receipt
and acceptance of a properly completed Payment Request Summary Form (provided as Attachment B).
In addition to the summary form, the Grantee must provide from its accounting system, a listing of
expenditures charged against this Agreement. The listing shall include, at a minimum, a description of the
DEP Agreement No. LE507 for CV A03-361, Page 1 of 8
goods or services purchased, date of the transaction, voucher number, amount paid, and vendor name. No
travel expenses are authorized under the terms of this Agreement.
C. In addition to the invoicing requirements contained in paragraph 3.B. above, the Department will
periodically request proof of a transaction (invoice, payroll register, etc.) to 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 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). All bills for
amounts due under this Agreement shall be submitted in detail sufficient for a proper pre-audit and post-
audit thereof. State guidelines for allowable costs can be found in the Department of Financial Services'
Reference Guide for State Expenditures at www.dbf.state.fl.us/aadir/reference guide and allowable costs
for Federal Programs can be found under 48 CFR Part 31 at httn://www.access.gpo.gov/naralcfr/cfr-table-
search.html and OMB Circulars A-87, A-122, A-21, at
htto:llwww.whitehouse.l!:ov/omb/circularslindex.html#numerical.
D. The parties hereto understand and agree that this Agreement does require a cost sharing or match on the
part of the Grantee. The Grantee is responsible for providing a minimum of twenty-five percent (25%) of
the total amount actually expended on the project or $62,500, whichever is less, in cash or third party in-
kind, towards the work funded under this Agreement. All cost sharing/match shall meet the federal
requirements established in 50 CFR Part 85.40 and 43 CFR Part 12.64, Subpart C.
E. Allowable costs will be determined in accordance with the cost principles applicable to the organization
incurring the costs. For purposes of this Agreement, the following cost principles are incorporated by
reference.
Ore:anization Tvoe Applicable Cost Principles
State, local or Indian tribal government. OMB Circular A-87
Private non-profit organization other than an (1) OMB Circular A-122
institution of higher education, (2) hospital, or (3)
organization named in OMB Circular A-122 as not
subiect to that circular.
Education Institutions OMB Circular A-21
For-profit organization other than a hospital and an 48 CFR Part 31, Contract Cost Principles and
organization named in OMB A-122 as not subject Procedures, or uniform cost accounting standards
to that circular. that comply with cost principles acceptable to the
federal agency.
F. The table below identifies the funding supporting this Agreement and FWS Grants providing the funds.
CFDA
15.616
Fundin Amount
$250,000.00
$250,000.00
4. The State of Florida's performance and obligation to pay under this Agreement is contingent upon an annual
appropriation by the Legislature. The parties hereto understand that this Agreement is not a commitment of future
appropriations.
5.
A.
The Grantee shall submit quarterly invoices in conjunction with quarterly progress reports. The Grantee
shall utilize the Progress Reporting Form, attached hereto and made a part hereof as Attachment C, for
submitting its quarterly progress report. Quarterly reports shall be submitted to the Department's Grant
Manager no later than twenty (20) 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
fifteen (15) calendar days to review deliverables submitted by the Grantee. The Grantee shall submit a
DEP Agreement No. LE507 for CV A03-361, Page 2 of 8
fmal invoice to the Department no later than October 15,2006, to assure the availability of funds for fmal
payment.
6. Each party hereto agrees that it shall be solely responsible for the negligent or wrongful acts of its employees and
agents. However, nothing contained herein shall constitute a waiver by either party of its sovereign immunity or
the provisions of Section 768.28, Florida Statutes.
7.
A.
The Department may terminate this Agreement at any time in the event of the failure of the Grantee to
fulfill any of its obligations under this Agreement. Prior to termination, the Department shall provide
thirty (30) calendar days written notice of its intent to terminate and shall provide the Grantee an
opportunity to consult with the Department regarding the reason( s) for termination.
B. The Department may terminate this Agreement for convenience by providing the Grantee with thirty (30)
calendar days written notice.
C. The parties hereto may agree to terminate this Agreement for convenience as evidenced by written
amendment of this Agreement. The amendment shall establish the effective date of the termination and
the procedures for proper closeout of the Agreement.
D. This Agreement may be unilaterally canceled by the Department for refusal by the Grantee to allow public
access to all documents, papers, letters, or other material made or received by the Grantee in conjunction
with this Agreement, unless the records are exempt from Section 24(a) of Article I of the State
Constitution and Section 119.07(1), Florida Statutes.
8. If the Grantee materially fails to comply with the terms and conditions of this Agreement, including any Federal or
State statutes, rules or regulations, applicable to this Agreement, the Department may take one or more of the
following actions, as appropriate for the circumstances.
A. Temporarily withhold cash payments pending correction of the deficiency by the Grantee.
B. Disallow (that is, deny both use offunds and any applicable matching credit for) all or part of the cost of
the activity or action not in compliance.
C. Wholly or partly suspend or terminate this Agreement.
D. Withhold further awards for the project or program.
E. Take other remedies that may be legally available.
F. Costs of the Grantee resulting from obligations incurred by the Grantee during a suspension or after
termination of the Agreement are not allowable unless the Department expressly authorizes them in the
notice of suspension or termination. Other Grantee costs during suspension or after termination which are
necessary and not reasonably avoidable are allowable if the following apply.
1. The costs result from obligations which were properly incurred by the recipient before the
effective date of suspension or termination, are not in anticipation of it, and in the case of
termination, are noncancellable.
2. The cost would be allowable if the Agreement were not suspended or expired normally at the end
of the funding period in which the termination takes place.
G. The remedies identified above, do not preclude the Grantee from being subject to debarment and
suspension under Executive Orders 12549 and 12689.
9.
A.
The Grantee shall maintain books, records and documents directly pertinent to performance under this
Agreement in accordance with generally accepted accounting principles consistently applied. The
DEP Agreement No. LE507 for CV A03-361, Page 3 of 8
Department, the State, or their authorized representatives shall have access to such records for audit
purposes during the term of this Agreement and for five years following Agreement completion. In the
event any work is subgranted or subcontracted, the Grantee shall similarly require each subgrantee and
subcontractor to maintain and allow access to such records for audit purposes.
B. The Grantee agrees that if any litigation, claim, or audit is started before the expiration of the record
retention period established above, the records shall be retained until all litigation, claims or audit fmdings
involving the records have been resolved and fmal action taken.
C. Records for real property and equipment acquired with Federal funds shall be retained for five years
following fmal disposition.
10. In addition to the provisions contained in paragraph 9 above, the Grantee shall comply with the applicable
provisions contained in Attachment D, Special Audit Requirements. A revised copy of Attachment D, Exhibit-
1, must be provided to the Grantee with each amendment which authorizes a funding increase or decrease. The
revised Exhibit-l shall summarize the funding sources supporting the Agreement for purposes of assisting the
Grantee in complying with the requirements of Attachment D, Special Audit Requirements. If the Grantee fails
to receive a revised copy of Attachment D, Exhibit-I, the Grantee shall notify the Grants Development and
Review Manager at (850) 245-2361 to request a copy of the updated information.
11.
12.
A.
The Grantee may not subcontract work under this Agreement without the prior written consent of the
Department's Grant Manager. The Grantee agrees to be responsible for the fulfillment of all work
elements included in any subcontract and agrees to be responsible for the payment of all monies due under
any subcontract. It is understood and agreed by the Grantee that the Department shall not be liable to any
subcontractor for any expenses or liabilities incurred under the subcontract and that the Grantee shall be
solely liable to the subcontractor for all expenses and liabilities incurred under the subcontract.
B. The Department of Environmental Protection supports diversity in its procurement program and requests
that all subcontracting opportunities afforded by this Agreement embrace diversity enthusiastically. The
award of subcontracts should reflect the full diversity of the citizens of the State of Florida. The
Department will be glad to furnish a list of minority owned businesses for consideration in subcontracting
opportunities.
A.
The Grantee certifies that no Federal appropriated funds have been paid or will be paid, on or after
December 22, 1989, by or on behalf of the Grantee, to any person for influencing or attempting to
influence an officer or employee of an agency, a Member of Congress, an officer or employee of
Congress, or an employee of a Member of Congress, in connection with the awarding, renewal, amending
or modifying of any Federal contract, grant, or cooperative agreement. If any non-Federal funds are used
for lobbying activities as described above, the Grantee shall submit Attachment E, Standard Form-LLL,
"Disclosure of Lobbying Activities" (attached hereto and made a part hereof), and shall file quarterly
updates of any material changes. The Grantee shall require the language of this certification to be included
in all subcontracts, and all subcontractors shall certify and disclose accordingly. (50 CFR Parts 80 and
85]
B. In accordance with Section 216.347, Florida Statutes, the Grantee is hereby prohibited from using funds
provided by this Agreement for the purpose of lobbying the Legislature, the judicial branch or a state
agency.
C. Pursuant to the Lobbying Disclosure Act of 1995, any organization described in Section 501(c)4 of the
Internal Revenue Code of 1986 shall not be eligible for subgrants under this Agreement, unless such
organization warrants that it does not, and will not, engage in lobbying activities prohibited by the Act as
a special condition of the subgrant. This restriction does not apply to loans made pursuant to approved
revolving loan programs or to contracts awarded using proper procurement procedures.
13. The Grantee shall comply with all applicable federal, state and local rules and regulations in performing under this
Agreement. The Grantee acknowledges that this requirement includes compliance with all applicable federal, state
DEP Agreement No. LE507 for CV A03-361, Page 4 of 8
and local health and safety rules and regulations. The Grantee further agrees to include this provision in all
subcontracts issued as a result of this Agreement.
14. The Department's Grant Manager (which may also be referred to as the Department's Project Manager) for this
Agreement is identified below.
Jan R.. Delaney
Florida Deoartment of Environmental Protection
Division of Law Enforcement
3900 Connnonwealth Boulevard
Tallahassee, FL 32399-3000
Teleohone No.: (850) 245-2929, extension 4847
SunComNo.: 205-2847
Fax No.: (850) 245-2859
SunCom Fax No.: 205-2859
E-mail Address: J an.Delaney@deD.state.fl.us
15. The Grantee's Grant Manager (which may also be referred to as the Grantee's Project Manager) for this Agreement
is identified below.
16. To the extent required by law, the Grantee will be self-insured against, or will secure and maintain during the life
of this Agreement, Workers' Compensation Insurance for all of his employees connected with the work of this
project and, in case any work is subcontracted, the Grantee shall require the subcontractor similarly to provide
Workers' Compensation Insurance for all of the latter's employees unless such employees are covered by the
protection afforded by the Grantee. Such self-insurance program or insurance coverage shall comply fully with the
Florida Workers' Compensation law. In case any class of employees engaged in hazardous work under this
Agreement is not protected under Workers' Compensation statutes, the Grantee shall provide, and cause each
subcontractor to provide, adequate insurance satisfactory to the Department, for the protection of his employees
not otherwise protected.
17. The Grantee, as an independent contractor and not an agent, representative, or employee of the Department, agrees
to carry adequate liability and other appropriate forms of insurance. The Department shall have no liability except
as specifically provided in this Contract.
18. The Grantee covenants that it presently has no interest and shall not acquire any interest which would conflict in
any manner or degree with the performance of services required.
19. Upon satisfactory completion of this Agreement, the Grantee may retain ownership of the equipment purchased
under this Agreement. However, the Grantee shall complete and sign a Property Reporting Form, provided as
Attachment F, and forward it along with the appropriate invoice to the Department's Grant Manager. The
following terms shall apply:
A The Grantee shall have use of the equipment for the authorized purposes of the contractual arrangement as
long as the required work is being performed.
DEP Agreement No. LE507 for CV A03-361, Page 5 of 8
B. The Grantee is responsible for the implementation of adequate maintenance procedures to keep the
equipment in good operating condition.
C. The Grantee is responsible for any loss, damage, or theft of, and any loss, damage or injury caused by the
use of, non-expendable personal property or equipment purchased with state funds and held in his
possession for use in a contractual arrangement with the Department.
20. The Department may at any time, by written order designated to be a change order, make any change in the work
within the general scope of this Agreement (e.g., specifications, time, method or manner of performance,
requirements, etc.). All change orders are subject to the mutual agreement of both parties as evidenced in writing.
Any change order which causes an increase or decrease in the Grantee's cost or time shall require formal
amendment to this Agreement.
21. The Hotel and Motel Fire Safety Act of 1990 (Public Law 101-391) establishes a number of fire safety standards
which must be met for hotels and motels. The Grantee acknowledges that Federal funds may not be used to
sponsor a conference, meeting, or training seminar held in a hotel or motel which does not meet the requirements
of the Hotel and Motel Safety Act of 1990.
22.
A.
No person, on the grounds of race, creed, color, national origin, age, sex, or disability, shall be excluded
from participation in; be denied the proceeds or benefits of; or be otherwise subjected to discrimination in
performance of this Agreement.
B. An entity or affiliate who has been placed on the discriminatory vendor list may not submit a bid on a
contract to provide goods or services to a public entity, may not submit a bid on a contract with a public
entity for the construction or repair of a public building or public work, may not submit bids on leases of
real property to a public entity, may not award or perform work as a contractor, supplier, subcontractor, or
consultant under contract with any public entity, and may not transact business with any public entity.
The Florida Department of Management Services is responsible for maintaining the discriminatory vendor
list and intends to post the list on its website. Questions regarding the discriminatory vendor list may be
directed to the Florida Department of Management Services, Office of Supplier Diversity at 850/487-
0915.
23.
A.
In accordance with Executive Order 12549, Debarment and Suspension (43 CFR Part 12), the Grantee
shall agree and certify that neither it, nor its principals, is presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any
Federal department or agency; and, that the Grantee shall not knowingly enter into any lower tier contract,
or other covered transaction, with a person who is similarly debarred or suspended from participating in
this covered transaction, unless authorized in writing by Monroe County Board of County Commissioners
to the Department.
B. Upon execution of this Agreement by the Grantee, the Grantee shall complete, sign and return a ~ of
the form entitled "Certification Regarding Debarments, Suspension, Ineligibility and Voluntary Exclusion
- Lower Tier Federally Funded Transactions", attached hereto and made a part hereof as Attachment G.
C. As required by paragraphs A and B above, the Grantee shall include the language of this section, and
Attachment G in all subcontracts or lower tier agreements executed to support the Grantee's work under
this Agreement.
DEP Agreement No. LE507 for CV A03-361. Page 6 of 8
25. The U.S. Fish and Wildlife Service and Department, reserve a royalty-free, nonexclusive, and irrevocable license
to reproduce, publish or otherwise use, and to authorize others to use, for government purposes:
A. The copyright in any work developed under a grant, subgrant, or contract under a grant or sub grant.
B. Any rights of copyright to which a grantee, subgrantee or a contractor purchases ownership with grant
support.
26. This Agreement represents the entire agreement of the parties. Any alterations, variations, changes, modifications
or waivers of provisions of this Agreement shall only be valid when they have been reduced to writing, duly signed
by each of the parties hereto, and attached to the original of this Agreement, unless otherwise provided herein.
(REMAINDER OF PAGE INTENTIONALLY LEFT BLANK)
DEP Agreement No. LE507 for CV A03-361, Page 7 of 8
IN WITNESS WHEREOF, the parties have caused this Agreement to be duly executed, the day and year last written
below.
MONROE COUNTY
BOARD OF COUNTY COMMISSIONERS
~(~
Chair or designee
STATE OF FLORIDA DEPARTMENT OF
ENVIRONMENTAL PROTECTION
BY:~~
Director, Divisio of Law Enforcement
or designee
Date: January 21, 2004
Date:
llL-'6lvL{
<Z,D\.L
Jan R. Delaney, DEP Grant Manager
~,tQ, ~
DEP Contracts Administrator
Ap roved as to form and legality:
t~-
FEID No.: 59-6000749
*For Agreements with governmental boards/commissions: If someone other than the Chairman signs this Agreement, a
resolution, statement or other document authorizing that person to sign the Agreement on behalf of the governmental
board/commission must accompany the Agreement.
List of attachments/exhibits included as part of this Agreement:
Specify
Type
Letter/
Number
Description (include number of pages)
Attachment
Attachment
Attachment
Attachment
Attachment
Attachment
Attachment
~
-1L
~
-.lL
l
l
~
Project Work Plan (3 Pages)
Payment ReQuest Summary Form (1 Page)
Progress Report Form (2 Pages)
Special Audit Requirements (5 Pages)
Disclosure of Lobbying Activities (2 Pages)
Property Reporting Form (1 Page)
Certification Regarding Debarment/Suspension (2 Pages)
See next page for a copy of Monroe County Attorney's legal sufficiency.
DEP Agreement No. LES07 for CV A03-361, Page 8 of 8
IN WITNESS WHEREOF, the parties have caused this Agreement to be duly executed, the day and year last written
below.
MONROE COUNTY
BOARD OF COUNTY COMMISSIONERS
By. /Jt-..;; (~
STATE OF FLORIDA DEPARTMENT OF
ENVIRONMEl'.T'fAL PROTECTION
Chair or designee
By:
I~~
n of Law Enforcement
Date, 3-~7 ", LOO'l
Date:
\ \C~ \ COy..
(L
J R. Delaney, DEP Grant M ger
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DEP Contracts Administrator
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L,' IYC:"Cf(X
A proved as to form and legality:
b~
Attorney
FEID No.: 59-6000749
*For Agreements with governmental boardslconnnissions: If someone other than the Chainnan signs this Agreement, a
resolution, statement or other document authorizing that person to sign the Agreement on behalf of the governmental
boardlconnnission nmst accompany the Agreement.
List of attachments/exhtbits included as part of this Agreement:
""
Specify Letter! :x: c::::>
c:::>
Type Description (include number of pages) 0 c- ..c-
Number -- '-
-- :a:. ,."
:;1.) J~
C:.' - C a
Attachment ..lL Proiect Work Plan (3 Pages) 1""1' G')
n .."
Attachment .JL Payment Request Summary Form (I Page) ,::;,C..; Q) <:)
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Attachment ~ Progress Report Form (2 Pages) -- ::u
,( .; f
Attachment -1L S1Jecial Audit ReQuirements (5 Pages) :<:-f:J: :Jt rt"1
..., y ...,
Attachment -1L Disclosure ofLobbving Activities (2 Pages) '!? .-
,.... CJ -'
Attachment .L Property Reporting Form (1 Page) > fT1 -"""
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Attachment .Ji Certification Regarding Debarment/Suspension (2 Pages) ...... r::;
DEP Agreement No. LE507 for CV A03-361, Page 8 of 8
ATTACHMENT A
Clean Vessel Act Grant Program
Scope of Work
PURPOSE
The purpose of the grant is 1) to establish a dump or transfer station in Key West for the
collection of recreational vessel sewage waste from participating marine facilities in order to
encourage marine facilities to install pumpout equipment and collect sewage from recreational
vessels for proper disposal for free of charge or for a fee not to exceed $5 per vessel per pumpout
event, 2) offset cost of sewage hauling fees to participating marine facilities through contractual
arrangements between the GRANTEE and independent sewage haulers, and 3) provide a
contract to the City of Marathon for reimbursement of75% of the cost of collection and disposal
of vessel sewage waste. The purpose of these conditions is to ensure compliance with 50 CFR
Part 85, Subpart D - Conditions on Use/Acceptance of Funds, for the Agreement period
extending beyond the date of equipment installation or construction completion. These
conditions cover pumpout activities using Clean Vessel Act Grant funds.
This is a cost reimbursement Agreement with matching requirement based on the amount
actually paid by the DEPARTMENT to the GRANTEE. The DEPARTMENT agrees to pay the
GRANTEE, on a cost reimbursement basis, a grant award in the amount of $250,000 and the
GRANTEE agrees to undertake the project as described and submitted by the GRANTEE in the
Grant Application, CV A 03-360, and provide a minimum of twenty-five percent (25%) of the
total amount actually expended on the project or $62,500, whichever is less in non-federal
matching funds.
CONDITIONS
Reimbursement
1. The request for payment shall consist of an invoice on the GRANTEE's letterhead,
clearly marked as invoice. Quarterly invoices and a final invoice are allowed under this
Agreement. The GRANTEE shall maintain an itemized listing (by category) of all
expenditures claimed, including the dates of service, on GRANTEE invoices submitted to
the DEPARTMENT. Receipts and cancelled checks clearly reflecting the dates of
service and back-up documentation shall be submitted to the DEPARTMENT along with
GRANTEE invoices for auditing purposes. Invoices for the deliverables described on
page three (3) of this attachment must explicitly reference the deliverables and the grant
award amounts associated with each deliverable.
2. The GRANTEE shall obtain all required permits and approvals prior to commencement
of the project. A grant award is not an indication of permitability of a project. For any
construction or installation of facilities a Permit Certification Form, supplied by the
DEPARTMENT, shall be sent to and be on file with the DEPARTMENT before invoices
will be processed for payment.
DEP Agreement No. LE507 for CV A03-361, Attachment A, Page 1 00
3. Match documentation shall be provided in accordance with instructions and on forms
available from the DEPARTMENT. Any credit for the match by the GRANTEE shall be
based on forms completed and documented to the satisfaction ofthe DEPARTMENT.
4. The DEPARTMENT shall have fifteen (15) days to review and approve all invoices and
reports. Upon review and approval of each invoice and report, the DEPARTMENT will
process the invoice for payment.
5. The final invoice shall be accompanied by a completed and signed project completion
form to be provided by the DEPARTMENT, summary of sewage hauling services
contracted, summary of facilities receiving sewage hauling services, and photographs of
various stages of construction ofthe dump or transfer station funded under this grant.
Operations
1. Each participating marine facility provided vessel sewage hauling services under this
project shall be open and available to the recreational boating public on a first come first
serve basis. Marine facilities provided disposal services through Monroe County or its
contractor shall provide pumpout or dump station services to the boating public free of
charge or for a fee not to exceed $5 per vessel per pumpout event.
2. The GRANTEE will provide to participating marine facilities marine sanitation and
pumpout information for boat owners and pump out operators. These services may be
provided through such methods as information materials, on-site instruction or audio-
visual methods by the GRANTEE.
3. The location of each pumpout facility or dump station will be continually identified
through informational markers. All informational markers located on the waters of the
state shall be with prior approval of the DEPARTMENT as required by permitting
procedures established by Florida Statutes and the Florida Administrative Code.
4. Participating marine facilities shall post in a clearly visible location informational
placards stating fees, hours of operations, instructions, and operator name and telephone
number. The placard shall have posted emergency phone numbers for reporting service
problems and shall include the following statement:
Disposal of Sewage Waste Funded in part by the U. S. Fish and
Wildlife Service, Clean Vessel Act Program through the Florida
Department of Environmental Protection, Division of Law
Enforcement and Monroe County.
5. The GRANTEE shall maintain records and submit to the DEPARTMENT the first day of
each calendar quarter beginning with the quarter during which sewage hauling services
have been contracted and provided. Records shall document the number of pumpout
DEP Agreement No. LE507 for CV A03-361, Attachment A, Page 2 on
services events, gallons pumped, fees charged, and maintenance, labor, or other
operational costs incurred.
DELIVERABLES
The following is a schedule of deliverables and related amounts. The specific grant award
amounts for each of the deliverables listed in the schedule below may vary; however, the
maximum grant award amount is as stated on page 1 of this Attachment. The grant award
amount to be provided by the DEPARTMENT is based on the amount recommended and
approved by the DEPARTMENT for this specific project. The dollars expended or in-kind effort
by the GRANTEE shall provide a minimum of twenty-five percent (25%) of the total amount
actually expended on the project or $83,335, whichever is less in non-federal matching funds.
Schedule of Deliverables and Amounts
Deliverables Detail Project Grant Amount
Amount
Permitting State and local permits required for $2,667 $2,000
installation of Key West dump or
transfer station.
Construction Labor and materials required to $44,000 $33,000
prepare site for Key West dump or
transfer station.
Equipment Purchase Equipment and associated piping $6,667 $5,000
necessary for Key West dump or
transfer station.
Equipment installation Plumbing supplies, delivery and $6,667 $5,000
labor for Key West dump or transfer
station.
Sewage Hauling Services Cost of sewage hauling services. $266,667 $150,000
Education and instructional Brochures or handout information $6,667 $5,000
materials about the Clean Vessel Act and the
services available for public use.
Total Pro.iect Amount $333,335
Total Grant Award Amount $250,000
Total Match Amount $83,335
REMAINDER OF PAGE INTENTIONALL Y LEFT BLANK
DEP Agreement No. LE507 for CV A03-361, Attachment A, Page 3 of 3
ATTACHMENT B
PAYMENT REQUEST SUMMARY FORM
GRANTEE:
GRANTEE'S GRANT MANAGER:
DEP AGREEMENT NO.:
DATE OF REQUEST:
PAYMENT REQUEST NO.:
PERFORMANCE
PERIOD:
PERCENT MATCHING
REQUIRED:
AMOUNT
REQUESTED:$
GRANT EXPENDITURES SUMMARY SECTION
rEffective Date of Grant through End-of-Grant Period
AMOUNT OF TOTAL MATCHING TOTAL
CATEGORY OF EXPENDITURE TmS REQUEST CUMULATIVE FUNDS CUMULATIVE
PAYMENTS MATCHING
FUNDS
Permitting $ $ $ $
Subcontracting:
Sewage Hauling $ $ $ $
Construction $ $ $ $
Construction Related Costs $ $ $ $
Equipment Purchases & Installation $ $ $ $
Educational & Instructional Materials $ $ $ $
TOTAL $ $ $ $
TOTAL GRANT AGREEMENT
Less Total Cumulative Payments of:
TOTAL REMAINING IN GRANT
GRANTEE CERTIFICATION
The undersigned certifies that the amount being requested for reimbursement above
was for items that were charged to and utilized only for the above cited grant activities.
Grantee's Grant Manager's Signature Grantee's Fiscal Agent
Print Name Print Name
Telephone Number Telephone Number
DEP Form 55-223
DEP Agreement No. LE507 for CV A03-361, Attachment B, Page 1 of 1
ATTACHMENT C
PROGRESS REPORT FORM
DEP A2reement No.:
Grantee Name:
Grantee Address:
Grantee's Grant Mana2er: I Telephone No.: I
Quarterlv Reportin2: Period:
Pro.iect Number and Title:
Provide a summary of project accomplishments to date. (Include a comparison of actual
accomplishments to the objectives established for the period. If goals were not met,
provide reasons why.)
Provide an update on the estimated time for completion of the project and an explanation
for any anticipated delays.
Provide any additional pertinent information including, when appropriate, analysis and
explanation of cost overruns or high unit costs.
DEP55-228
DEP Agreement No. LE507 for CV A03-361, Attachment C, Page 1 of 2
(continued from page 1)
Identify below, and attach copies of, any relevant work products being submitted for the
project for this reporting period (e.g., report data sets, links to on-line photographs, etc.)
Provide a project budget update, comparing the project budget to actual costs to date.
Expenditures
Prior to this Expenditures
Budget Total Project Reporting this Reporting Project Funding
Cateeory Budeet Period Period Balance
This report is submitted in accordance with the reporting requirements ofDEP Agreement No.
LE507 and accurately reflects the activities and costs associated with the subject project.
Signature of Grantee's Grant Manager
Date
DEP55-228
DEP Agreement No. LE507 for CV A03-361, Attachment C, Page 2 of 2
ATTACHMENTD
SPECIAL AUDIT REQUIREMENTS
The administration of resources awarded by the Department of Environmental Protection (which may be referred to
as the "Department", "DEP", "FDEP" or "Grantor", or other name in the contract/agreement) to the recipient
(which may be referred to as the "Contractor", Grantee" or other name in the contract/agreement) may be subject
to audits and/or monitoring by the Department of Environmental Protection, as described in this attachment.
MONITORING
In addition to reviews of audits conducted in accordance with OMB Circular A-133 and Section 215.97, F.S., as
revised (see "AUDITS" below), monitoring procedures may include, but not be limited to, on-site visits by
Department staff, limited scope audits as defined by OMB Circular A-133, as revised, and/or other procedures. By
entering into this Agreement, the recipient agrees to comply and cooperate with any monitoring procedures/processes
deemed appropriate by the Department of Environmental Protection. In the event the Department of Environmental
Protection determines that a limited scope audit of the recipient is appropriate, the recipient agrees to comply with
any additional instructions provided by the Department to the recipient regarding such audit. The recipient further
agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the
Chief Financial Officer or Auditor General.
AUDITS
PART I: FEDERALLY FUNDED
This part is applicable if the recipient is a State or local government or a non-profit organization as defmed in OMB
Circular A-133, as revised.
1. In the event that the recipient expends $300,000 or more in Federal awards in its fiscal year, the recipient must
have a single or program-specific audit conducted in accordance with the provisions of OMB Circular A-
133, as revised. EXHffiIT 1 to this Agreement indicates Federal funds awarded through the Department of
Environmental Protection by this Agreement. In determining the Federal awards expended in its fiscal year,
the recipient shall consider all sources of Federal awards, including Federal resources received from the
Department of Environmental Protection. The determination of amounts of Federal awards expended
should be in accordance with the guidelines established by OMB Circular A-133, as revised. An audit of the
recipient conducted by the Auditor General in accordance with the provisions ofOMB Circular A-133, as
revised, will meet the requirements of this part.
2. In connection with the audit requirements addressed in Part I, paragraph 1., the recipient shall fulfill the
requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A-133, as
revised.
3. If the recipient expends less than $300,000 in Federal awards in its fiscal year, an audit conducted in
accordance with the provisions of OMB Circular A-133, as revised, is not required. In the event that the
recipient expends less than $300,000 in Federal awards in its fiscal year and elects to have an audit
conducted in accordance with the provisions ofOMB Circular A-133, as revised, the cost of the audit must
be paid from non-Federal resources (i.e., the cost of such an audit must be paid from recipient resources
obtained from other than Federal entities).
4. The recipient may access infonnation regarding the Catalog of Federal Domestic Assistance (CFDA) via
the internet at http://aspe.os.dhhs.gov/cfda.
DEP 55-215 (01102)
DEP Agreement No. LE507 for CY A03-361, Attachment D, Page I of 5
PART II: STATE FUNDED
This part is applicable if the recipient is a nonstate entity as defined by Section 215.97(2)(1), Florida Statutes.
1. In the event that the recipient expends a total amount of State fmancial assistance equal to or in excess of
$300,000 in any fiscal year of such recipient, the recipient must have a State single or project-specific audit
for such fiscal year in accordance with Section 215.97, Florida Statutes; applicable rules of the Executive
Office of the Governor and the Chief Financial Officer; and Chapters 10.550 (local governmental entities)
or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General. EXHffiIT 1 to this
Agreement indicates State financial assistance awarded through the Department of Environmental
Protection by this Agreement. In determining the State fmancial assistance expended in its fiscal year, the
recipient shall consider all sources of State financial assistance, including State fmancial assistance received
from the Department of Environmental Protection, other state agencies, and other nonstate entities. State
fmancial assistance does not include Federal direct or pass-through awards and resources received by a
nonstate entity for Federal program matching requirements.
2. In connection with the audit requirements addressed in Part II, paragraph 1, the recipient shall ensure that
the audit complies with the requirements of Section 215.97(7), Florida Statutes. This includes submission of
a fmancial reporting package as defmed by Section 215.97(2)(d), Florida Statutes, and Chapters 10.550
(local governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor
General.
3. If the recipient expends less than $300,000 in State fmancial assistance in its fiscal year, an audit conducted
in accordance with the provisions of Section 215.97, Florida Statutes, is not required. In the event that the
recipient expends less than $300,000 in State fmancial assistance in its fiscal year and elects to have an
audit conducted in accordance with the provisions of Section 215.97, Florida Statutes, the cost of the audit
must be paid from the non-State entity's resources (i.e., the cost of such an audit must be paid from the
recipient's resources obtained from other than State entities).
4. For information regarding the Florida Catalog of State Financial Assistance (CSFA), a recipient should
access the Florida Single Audit Act website located at http://sun6.dms.state.fl.us/fsaa/catalog.htm or the
Governor's Office of Policy and Budget website located at http://www.eog.state.fl.us/for assistance. In
addition to the above websites, the following websites may be accessed for information: Legislature's
Website htto://www.leg.state.fl.us/, Governor's Web site htto://www.flgov.coml, Department of Financial
Services' Website http://www.dbf.state.fl.us/and the Auditor General's Website
htto:/ /www.state.fl.us/audgen.
PART III: OTHER AUDIT REQUIREMENTS
(NOTE: This part would be used to specifY any additional audit requirements imposed by the State awarding entity
that are solely a matter of that State awarding entity's policy (i.e., the audit is not required by Federal or State laws
and is not in conflict with other Federal or State audit requirements). Pursuant to Section 215.97(7)(m), Florida
Statutes, State agencies may conduct or arrange for audits of State financial assistance that are in addition to audits
conducted in accordance with Section 215.97, Florida Statutes. In such an event, the State awarding agency must
arrange for funding the full cost of such additional audits)
PART IV: REPORT SUBMISSION
1. Copies of reporting packages for audits conducted in accordance with OMB Circular A-B3, as revised, and
required by PART I of this Agreement shall be submitted, when required by Section .320 (d), OMB
Circular A-B3, as revised, by or on behalf of the recipient directly to each of the following:
DEP 55-215 (01/02)
DEP Agreement No. LE507 for CV A03-361, Attachment D, Page 2 of 5
A. The Department of Environmental Protection at the following address:
Audit Director
Florida Department of Environmental Protection
Office of the Inspector General, MS 40
2600 Blair Stone Road
Tallahassee, Florida 32399-2400
B. The Federal Audit Clearinghouse designated in OMB Circular A-133, as revised (the number of
copies required by Sections .320 (d)(l) and (2), OMB Circular A-133, as revised, should be
submitted to the Federal Audit Clearinghouse), at the following address:
Federal Audit Clearinghouse
Bureau of the Census
1201 East 10th Street
Jeffersonville, IN 47132
C. Other Federal agencies and pass-through entities in accordance with Sections .320 (e) and (f),
OMB Circular A-133, as revised.
2. Pursuant to Section .320(f), OMB Circular A-133, as revised, the recipient shall submit a copy of the
reporting package described in Section .320(c), OMB Circular A-133, as revised, and any management
letters issued by the auditor, to the Department of Environmental Protection the following address:
Audit Director
Florida Department of Environmental Protection
Office of the Inspector General, MS 40
2600 Blair Stone Road
Tallahassee, Florida 32399-2400
3. Copies of fmancial reporting packages required by P ART II of this Agreement shall be submitted by or on
behalf of the recipient directlv to each of the following:
A. The Department of Environmental Protection at the following address:
Audit Director
Florida Department of Environmental Protection
Office of the Inspector General, MS 40
2600 Blair Stone Road
Tallahassee, Florida 32399-2400
B. The Auditor General's Office at the following address:
State of Florida Auditor General
Room 401, Claude Pepper Building
III West Madison Street
Tallahassee, Florida 32399-1450
4. Copies of reports or management letters required by PART III of this Agreement shall be submitted by or
on behalf of the recipient directly to the Department of Environmental Protection at the following address:
Audit Director
Florida Department of Environmental Protection
Office of the Inspector General, MS 40
2600 Blair Stone Road
Tallahassee, Florida 32399-2400
DEP 55-215 (01/02)
DEP Agreement No. LE507 for CY A03-361, Attachment D, Page 3 of 5
5. Any reports, management letters, or other information required to be submitted to the Department of
Environmental Protection pursuant to this Agreement shall be submitted timely in accordance with OMB
Circular A-133, Florida Statutes, or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and
for-profit organizations), Rules of the Auditor General, as applicable.
6. Recipients, when submitting fmancial reporting packages to the Department of Environmental Protection for
audits done in accordance with OMB Circular A-133, or Chapters 10.550 (local governmental entities) or
10.650 (nonprofit and for-profit organizations), Rules of the Auditor General, should indicate the date that
the reporting package was delivered to the recipient in correspondence accompanying the reporting
package.
PART V: RECORD RETENTION
The recipient shall retain sufficient records demonstrating its compliance with the terms of this Agreement for a
period of 5 years from the date the audit report is issued, and shall allow the Department of Environmental
Protection, or its designee, Chief Financial Officer, or Auditor General access to such records upon request The
recipient shall ensure that audit working papers are made available to the Department of Environmental Protection,
or its designee, Chief Financial Officer, or Auditor General upon request for a period of 3 years from the date the
audit report is issued, unless extended in writing by the Department of Environmental Protection.
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
DEP 55-215 (01/02)
DEP Agreement No. LE507 for CV A03-361, Attachment D, Page 4 of 5
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ATTACHMENT E
Approved by OMB
0348-0046
DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 D.S.C. 1352
(See reverse for public burden disclosure.)
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
~ a. contract ~ a. bid/offer/application GJ a. initial filing
b. grant b. initial award b. material change
c. cooperative agreement c. post-award
d. loan For Material Change Only:
e. loan guarantee
f. loan insurance year quarter
date oflast report
4. Name and Address of Reporting Entity: 5. Ir Reporting Entity in No.4 is Subawardee, Enter Name
QJ Prime and Address of Prime:
0 Subawardee
Tier , if known: None
Congressional District, if known: 18 Congressional District, if known:
6. Federal Department/Agency: 7. Federal Program NamelDescription:
Dept. of Interior/U.S.Fish & Wildlif e CFDA Number, if applicable: 15-616
8. Federal Action Number, ifknown: 9. Award Amount, ifknown:
V-lO $ 250,000.00
10. a. Name and Address of Lobbying Entity b. Individuals Performing Services (including address if
(if individual, last name, first name, Ml): differentfrom No. lOa)
Connnonwealth Consulting (last name, first name, Ml):
1800 N Kent Street, Suite 907
Arlington VA 22209 N/A
(attach Continuation Sheet(s) SF-LLLA, ifnecessarv)
11. Information requested tbrough tbis form is autborized by title 31 u.S.C. Signature:
section 1352. Tbis disclosure of lobbying activities is a material Print Name: George Garrett
representation of fact upon wbicb reliance was placed by tbe tier above
wben tbis transaction was made or entered into. Tbis disclosure is required Title: Director of Marine Resources
pursuant to 31 U.S.C. 1352. Tbis information will be reported to Congress
semi-annually and will be available for public inspection. Any person who 005 ) 289-2507 1/27/04
fails to file tbe required disclosure sball be subject to a civil penalty of not Telephone No.: Date:
less than SIO,OOO and not more tban Sloo,ooo for eacb such failure.
Federal Use Only: Authorized for Local Reproduction
Standard F orrn - LLL (Rev 7 - 97)
Form DEP 55-221 (01101)
MONROE COUNTY ATTOiiNEY Page 1 of2
~:ERM
O~t~IE(~~~~ ATTORNEY
DEP Agreement No. LE507 for CV AOJ-36l, Attachment E, Page I of 2
/:
A TT ACHMENT E
Approved by OMB
0348-0046
DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disdose lobbying llctivities pursuant to 31 U.S,c. 1352
(See reverse for public burden disclosure.)
1. Typt: of Federlll Action:
2. Status of Federal Attion:
rID
~
3. ReportType:
@d
ll. initial filing
b, material change
a. bid/offer/application
b. initialawlll"d
c. post-award
a. contract
b. graTlt
c. ooopeT1ltive lIweement
d. loan
e. loan gulll1lntee
r. loan insurance
4. Name And Address ofReportilg Entity:
~Prime
o SubllWlU'dcc
Tier
----' if /mown:
Cnn~ressional J)i~'ltrict.1f lent,....".'
lY
6. Federal Deplllrbnentli\J;:tncy:
1>.tff 01 J:"V)~(\or
lO. a. Name lllld Address of Lobbying Entity
(!find/'IIidual. lcut na~e, M/):
~D~;~~~
W\~ ~ vr'l- :'~:::'i"_"
For Material Cban.:e Only:
year qUlIrter
d~ of last report
5. IfRepnrting Entity in No.4 is Subawllrdec:, Enl1:r Nil Me
and J\ddress of J>rime:
0~
Congressional District, if mown:
7. Fed~1 F~ram NameIDc:scrlption:
CFDA Number, 1/ applicable.'
1~-~
9. AWA,d Amollnt, ifknown:
S Z~OJ~
b. tndivlduals Perrorming Scrvices (including address 1/
different/rom NQ. lOa)
(last name.jir3/ name, MI):
JJ rt
J 1. Infonn"tilln rcqlJl"!lted 'br9lJJ:lI 'hi, fonn is DUlhor17.ed by title 31 U.S.C,
,~dllln 1352. Thi. di5cl05l,n of 10bbyilll1: aetlviti~ i, a material
represCfltlllinn of fft'" upon wbj~b relianee ..a, placcd by th~ tkr .blWl!
1Nben thl~ tmn,.cllon WIL~ .ado 0'" tntered Into. This dl,l:Io~urt is required
punta.nt to 31 U.S.C. }J52. 'IlI1, infnntUI!ion will he repOI1~ tll COJIltn:ss Titlt:
'''rlli.annllally and will be .vail.ble for public In,peditHl. Any ~""Iln who
f"ib III file the nquired di!lClll.ure ,hall be .ubje<:t to . c;vil pnally of nClt Telephonc No.:
Ic:ss than S10,OOO .nd no' mot'\: thlln S100,OOO fnr tlch such rlllilur~.
F'eder.1 Use Only:
Form DEP 55-221 (01101)
DE:P Agreement No. LE507 for CV A03.36I, Attachment E. P;lge I of 2
Authorized fQ1' Locnl Rcproductl<>n
SI~ndlTd FOml - 1rI..L (Rev 7 - 97)
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether sub awardee or prime Federal recipient, at
the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31
U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any
lobbying entity for inOuencing or attempting to inOuence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered
Federal action. Complete all items that apply for both the initial filing and material change report. Refer to the
implementing guidance published by the Office of Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to
inOuence the outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a followup report caused by a material
change to the information previously reported, enter the year and quarter in which the change occurred.
Enter the date of the last previously submitted report by the reporting entity for this covered Federal
action.
4. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional
District, if known. Check the appropriate classification of the reporting entity that designates if it is or
expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first
subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts,
subgrants and contract awards under grants.
5. If the organization filing the report in item 4 checks "Sub awardee", then enter the full name, address,
city, state and zip code of the prime Federal recipient. Include Congressional District, if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at least one
organizational level below agency name, if known. For example, Department of Transportation, United
States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter
the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements,
loans, and loan commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identified in
item 1 (e.g., Request for Proposal (RFP) number; Invitation for Bid (IFB) number; grant announcement
number; the contract, grant, or loan award number; the application/proposal control number assigned
by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001."
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency,
enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting
entity identified in item 4 to inOuence the covered Federal action.
(b) Enter the full names of the individual(s) performing services, and include full address if different
from 10 (a). Enter Last Name, First Name, and Middle Initial (MI).
11. The certifying official shall sign and date the form, print his/her name, title and telephone number.
According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it
displays a valid OMB Control Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public
reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions
for reducin this burden, to the Office of Mana ement and Bud et, Pa erwork Reduction Pro' eet 0348-0046, Washin on, D.C. 20503.
Form DEP 55-221 (01/01) Page 2 of 2
DEP Agreement No. LE507 for CV A03-361, Attachment E, Page 2 of 2
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ATTACHMENT G
CERTIFICATION REGARDING DEBARMENTS, SUSPENSION, INELIGIBILITY AND
VOLUNTARY EXCLUSION-LOWER TIER FEDERALLY FUNDED TRANSACTIONS
DEP AGREEMENT NO: LE507
I . The undersigned hereby certifies that neither it nor its principals is presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency.
2. The undersigned also certifies that it and its principals:
(a) Have not within a three-year period preceding this certification been convicted of or had a civil judgment rendered
against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or
performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or
State anti-trust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records,
making false statements, or receiving stolen property.
(b) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or
local) with commission of any ofthe offenses enumerated in paragraph 2.(a) of this Certification; and
(c) Have not within a three-year period preceding this certification had one or more public transactions (Federal, State or
local) terminated for cause or default.
3. Where the undersigned is unable to certify to any of the statements in this certification, an explanation shall be attached to this
certification.
Dated this
21st
day of
January
,20~.
~(~
Authorized Signature/Contractor
Murray E. Nelson, Mayor/Chairman
Typed Namerritle
Monroe County Board of County Commissioners
Contractor's Firm Name
2798 Overseas Highway
Street Address
Suite 400
Building, Suite Number
Marathon FL 33050
City/State/Zip Code
(305) 289-2500
Area Code/Telephone Number
Form DEP 55-220 (01/01)
MONROE COUNTY ATTORNI:.J?ge 1 of2
&Z~~M
ROBERT. LFE
O~t~~S~T_~NJ{~OH~Y
DEP Agreement No. LE507 for CV A03-361, Attachment G, Page 1 of 2
INSTRUCTIONS FOR CERTIFICATION REGARDING DEBARMENT,
SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION-
LOWER TIER FEDERALLY FUNDED TRANSACTIONS
1. By signing and submitting this form, the certifying party is providing the certification set out below.
2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was
entered into. If it is later determined that the certifying party knowingly rendered an erroneous certification, in addition to other
remedies available to the Federal Government, the Department of Environmental Protection (DEP) or agencies with which this
transaction originated may pursue available remedies, including suspension and/or debarment.
3. The certifying party shall provide immediate written notice to the person to which this contract is submitted if at any time the
certifying party learns that its certification was erroneous when submitted or has become erroneous by reason of changed
circumstances.
4. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary
covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the
Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this
contract is submitted for assistance in obtaining a copy of those regulations.
5. The certifying party agrees by submitting this contract that, should the proposed covered transaction be entered into, it shall not
knowingly enter into any lower tier contract, or other covered transaction with a person who is proposed for debarment under 48
CFR 9, subpart 9.4, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered
transaction, unless authorized by the DEP or agency with which this transaction originated.
6. The certifying party further agrees by executing this contract that it will include this clause titled "Certification Regarding
Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered Transaction," without modification, in all
contracts or lower tier covered transactions and in all solicitations for lower tier covered transactions.
7. A participant in a covered transaction may rely upon a certification ofa prospective participant in a lower tier covered transaction
that it is not is proposed for debarment under 48 CFR 9, subpart 9.4, debarred, suspended, ineligible, or voluntarily excluded
from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and
frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the
Nonprocurement List (Telephone No. (202) 501-4740 or (202) 501-4873.)
8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good
faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that
which is normally possessed by a prudent person in the ordinary course of business dealings.
9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction knowingly
enters into a lower tier covered transaction with a person who is proposed for debarment under 48 CFR 9, subpart 9.4,
suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies
available to the Federal Government, the DEP or agency with which this transaction originated may pursue available remedies,
including suspension and/or debarment.
Form DEP 55-220 (01101)
Page 2
DEP Agreement No. LES07 for CV A03-361, Attachment G, Page 2 of 2