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Post-Award Reference Documents under USAIDs Ambassadors Fund Program

Small Grants and Ambassadors Fund Program

Small Grants and Ambassadors Fund Programme National Project Office:

House # 10, Street #30, Sector F 7/1

Islamabad, Pakistan T: 051-2656433-35; Fax. No. 051-2656436 Email: info@sgafp.org.pk Website: www.sgafp.org.pk

Small Grants and Ambassadors Fund Program

USAID Disclaimer: This application guideline and form for the Ambassadors Fund Program is made possible with support from the American people delivered through the United States Agency for International Development (USAID). The contents are the sole responsibility of National Rural Support Programme (NRSP) and do not necessarily reflect the views of USAID or the United States Government.

SGAFPs Post Award Reference Documents under US Ambassadors Fund Program

Small Grants and Ambassadors Fund Program

Table of Contents
POST-AWARD REFERENCE DOCUMENTS UNDER SMALL GRANTS PROGRAM.........4 1. POST AWARD PAYMENTS AND REFUNDING OF THE UNUSED BUDGET ...........5 Award of Contract .............................................................................................. 5 Payments to Grantees........................................................................................ 5 Unused funds ..................................................................................................... 6 Income generated from the grants ....................................................................6 2. POST-AWARD GRANTEE REPORTING REQUIREMENTS AND TEMPLATES ...........7 Monthly Progress Report..................................................................................... 7 Monthly Expenditure Report SGAFP Funding....................................................9 Monthly Expenditure Report Grantee Cost Share...........................................10 Grant Disbursement Request Form..................................................................11 Timesheet......................................................................................................... 13 Grant Modification Request Form.....................................................................15 Grant Completion Report.................................................................................. 17 Grant Completion Certificate............................................................................21 Grant Closeout Plan.......................................................................................... 22 Contractor Employee Biographical Data Sheet.................................................25 3. Pre-Award Certifications .................................................................................28 Drug-free Workplace Certification....................................................................28 Debarment and Suspension Certification.........................................................30 Local Cost Financing......................................................................................... 32 Cost Sharing Certification.................................................................................34 Certification Regarding Terrorist Financing......................................................38 Certification Regarding Operational Transparency...........................................40

SGAFPs Post Award Reference Documents under US Ambassadors Fund Program

Small Grants and Ambassadors Fund Program

POST-AWARD REFERENCE DOCUMENTS UNDER SMALL GRANTS PROGRAM Post-award reference documents is a set of SGAFPs official documents under contractual obligations that give an insight about the bindings of grantee after entering into grant agreement with Small Grants & Ambassadors Fund Program. Three types of the post-award reference document include the following: 1. Post-award payments and refunding of the unused budget 2. Post-award grantee reporting requirements and templates a. Monthly progress reports b. Monthly expenditure report i. SGAFP funding ii. Grantee cost share c. Grant disbursement request form d. Timesheet e. Grant modification request form f. Grant completion report g. Grant completion certificate h. Grant closeout plan i. Contractor employee biographical data sheet 3. Pre-award certifications a. Drug-free workplace certification b. Debarment and suspension certification c. Local cost financing d. Cost sharing certification e. Certification regarding terrorist financing f. Certification regarding operational transparency

SGAFPs Post Award Reference Documents under US Ambassadors Fund Program

Small Grants and Ambassadors Fund Program

1. POST AWARD PAYMENTS AND REFUNDING OF THE UNUSED BUDGET


Award of Contract Following the receipt of final approval from USAID, the SGAFP project office will initiate contract preparation and the same will be negotiated with the Grantee organizations. The Grantee organizations will have to meet the pre-conditions by providing the following documents before the contract is signed: A designated bank account number, internal bank code and swift code; A bank reference letter on prescribed format issued by the bank; A work plan and month-wise budget as per the given format;

The grantees shall maintain current bank accounts. However if the grant exceeds USD 120,000 per year, an interest bearing bank account shall be required. Interest earned on interest bearing accounts will be remitted to USAID if it is more than USD 250 per year. In addition, the grantee organization is required to sign the following certifications as a pre-condition: Drug free workplace certification Debarment and suspension certification Local cost financing certification Cost sharing certification Certification regarding Terrorist Financing Certification regarding Operational Transparency

After meeting the above conditions, the SGAFP project office will sign a contract agreement with the Grantee Organization.

Payments to Grantees
Grant payments are linked to achieving task milestones. Advances to grantees who have limited cash flow shall be restricted to the minimum amount needed to meet current disbursement needs under each immediate milestone. All payments are supported by a grantee certification that the respective milestone has been successfully achieved using the disbursement request form. SGAFP reserves the right to independently verify milestones. 80% or more of the prior tranche must have been utilized prior to the submittal of applications for the release of subsequent tranches, (however, this rule may be reviewed in exceptional circumstances and with the prior approval of the DCOP). All funds will be transferred to Grantee Accounts through official banking channels only. The grantee must provide: 1. 2. Request for funds (as indicated in budget) being duly signed by the relevant authority For subsequent tranches, bank statement and bank reconciliation statement shall be submitted to SGAFP.

SGAFPs Post Award Reference Documents under US Ambassadors Fund Program

Small Grants and Ambassadors Fund Program

Upon receiving the fund request the SGAFP will open a Ledger Account in the name of Grantee and allocate an account code. All transactions will be recorded in Grants Database for tracking purposes. The funds will be transferred to grantees account and booked as Advance to the grantee.

Unused funds
The grantee is required to refund any unused funds that were disbursed by the SGAFP. The grantee does not have any right to disburse from the unallocated funds after project completion. SGAFP reserves the right to require a refund by the recipient of any amount which the recipient did not spend in accordance with the terms and conditions of the grant agreement.

Income generated from the grants


Program income is income earned by the grantee that is directly generated by a supported grant activity or earned as a result of the grant award during the period of the grant agreement. Program income may be earned both from grantee activities and from services provided by an individual performing a role in the grant activity. Recipients shall have no obligation for program income earned after the end of the project/grant period. The grantee will inform SGAFP of any program income generated under the grant.

SGAFPs Post Award Reference Documents under US Ambassadors Fund Program

Small Grants and Ambassadors Fund Program

2. POST-AWARD GRANTEE REPORTING REQUIREMENTS AND TEMPLATES


Monthly Progress Report
For the month of: Name of the Grantee Organization: Project Title: Grant Agreement Number: Project Location: Province

Project Startup Date: Distric t: Tehs il:

Project end date: Union Council:

Summary of Achievements Targets Project Activities Total Target s Current month A As of this month B Achievements Curre nt month C As of this month D Variance Current month E = A-C As of this month F = B-D Reasons of Variance

Total Please give brief notes on the following 1. Major outcomes/impacts of the activities undertaken so far

2. Major issues during project implementation and suggestions to overcome these issues:

3. Major activities planned for the next month:

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Small Grants and Ambassadors Fund Program

__________________________________________ Signature of Project Director/Authorized Person

Date:

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Monthly Expenditure Report SGAFP Funding Name of Grantee Organization: Project Title: For the Month Grant Agreement of: Number:

Grant Agreement Funds (PKR) Budget line items Total SGAFP budget A Funds received to date B Expenditure for the period C Cumulative Expenditure To date D Budget balance E = A-D Funds Balance F = B-D

Total

Invoice-wise Breakup of Expenditure Invoice Number Date Description of Expenditure Amount (PKR)

Total Declaration I, the undersigned, certify that the above information is correct, and that upon request, supporting documentation will be furnished to SGAFP. Furthermore, all expenditures have been made according to the terms of the Grant Agreement, and in the event of disallowed costs a prompt refund will be made to SGAFP. __________________________________________ Signature of Project Director/Authorized Person Date:

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Monthly Expenditure Report Grantee Cost Share Name of Grantee Organization: Project Title: For the Month Grant Agreement of: Number:

Budget line items

Total cost share A

Grantee Cost Share (PKR) (Cash/in-kind) Cumulative Expenditure for the Expenditure period To date B C

Cost share balance D = A-C

Total Invoice-wise Breakup of Expenditure Invoice/payment voucher/reference document number Date Description of Expenditure Amount (PKR)

Total Declaration I, the undersigned, certify that the above information is correct, and that upon request, supporting documentation will be furnished to SGAFP. Furthermore, all expenditures have been made according to the terms of the Grant Agreement, and in the event of disallowed costs a prompt refund will be made to SGAFP.

__________________________________________ Signature of Project Director/Authorized Person

Date:

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Grant Disbursement Request Form This request form must be sent with relevant financial reports 1. Name of Grantee Organization 2. Grant Agreement Number 3. Project name 4. Date that funds are required: 5. Funding Request Summary (PKR) Project months covered under this disbursement: Amount requested through this disbursement Total funds received to date: Total Expenditure to date: Unspent Funds: Current Request: Funds to transfer: Budget line/Activity Total Budget

Total Expenditure

Current Request

Total BENEFICIARY CERTIFICATION: I certify that, to the best of my knowledge and belief, the data reported above and the attached monthly financial statements are correct and that this request and our entire grant program are in full compliance with the terms and conditions of the grant agreement. Signature of Authorized Name: Date: Person FOR SGAFP GRANTS FUND MANAGEMENT OFFICE USE ONLY Checked by Signature of Manager Name: Date: FA&C

Authorized by Signature of DCOP

Name:

Date:

FOR SGAFP GRANTS ACCOUNTING OFFICE USE ONLY A/C Payee Name:
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Cheque #: Cheque Amount: Date: Note: Grantees are required to acknowledge the receipt of funds .

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Timesheet
All the SGAFP project staff/consultants/volunteers shall fill in this form on monthly basis. Name Title Reporting Period Account Category Monthly Timesheet columns of weekends & official holidays must be highlighted 1 2 3 4 5 6 7 8 9 1 0 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 2 0 2 1 2 2 2 3 2 4 2 5 2 6 2 7 2 8 2 9 2 9 3 0 3 1 Fro m To

Total days/hours worked:

Certifications Employee/Consultant /Volunteers: I certify that the above time and attendance information is true and complete to the best of my knowledge. Signatures of Employee/Consultant /Volunteers Supervisor or Project Director: I certify that the above time and attendance information is true and complete to the best of my knowledge. Signatures of Supervisor/Project Director

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Date:

Date:

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Grant Modification Request Form


SGAFP DCOP/Grants Manager, We hereby request to modify the [GRANT AGREEMENT NUMBER] on behalf of [NAME OF ORGANIZATION] as follows: Justification for the proposed modification in comparison to the original grant agreement:

Proposed budget revision and justification, if any:


Budget Head/Activi ty Approv ed Budget (PKR) Approve d Duratio n (months ) Propose d/ Revised Amount (PKR) Revised Duratio n Varian ce in amoun t (PKR)

Justificati on

Total Amount

* if this is only a time extension, please request this with your justification, no amounts are required. If less than 10% of the original budgeted amount a formal modification request may not be necessary, in such cases please contact the SGAFP staff for guidance. We fully understand that this will not result in an overall increase in the grant budget. We will not consider this approved until we receive written approval from SGAFP. We certify that the modification will not affect the original objectives of the project and the modification does not include any new line items which are unallowable expenditures under the grant agreement. Thank you for your consideration. Regards,

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Authorized Signature: Name: Designation:

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Grant Completion Report Report Submission Date: Project title: Grantee organization: Grant agreement number: Period covered by report: Activities From: To:

Targets

Achievements

Variance

Remarks

Beneficiaries Activities Target Men Women Men Actual Women

SGAFP Fund Position Total Project Budget Amount received under this agreement Total Expenses Remaining Balance

Amount (PKR)

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Grantees Cost Share Position Total agreed cost share Total Expenses Remaining Balance Activities and Achievements

Amount (PKR)

Describe to what extent the objectives of the agreement were accomplished: Please use additional sheets if needed 1. Overall Progress of the Project & Impacts- support with the help of numbers, employment generated, improvement in the status of health/education/infrastructure etc. _____________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________ 2. Progress against each objective please provide details on the progress against each objective Objective No. 1: ______________________________________________________________________________________________________________ Progress _____________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________ Objective No. 2: ______________________________________________________________________________________________________________ Progress _____________________________________________________________________________________________________________________________

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_____________________________________________________________________________________________________________________________

Issues, Recommendations and Lessons Learnt Major Issues Faced During the Project Implementation Issues/problems faced Steps taken to resolve the issues

Lessons Learned & Recommendations Signature of authorized representative: Name of authorized representative:

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Narrative reports must contain, as a minimum: A comparison of actual accomplishments against planned objectives, any obstacles should be included. Other information includes analysis and explanation of cost overruns or high unit costs. Two copies of any publications, including books, brochures, newsletters, bulletins, and single copies of all other products such as newspaper clippings, project announcements, and audited financial statements (if available) should be included.

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Grant Completion Certificate

Grantee Organization: __________________________________________________ Project Title: _________________________________________________________ Grant Agreement Number: _______________________________________________ With reference to the SGP/AFP Grant Agreement, that was entered into with NRSP/SGAFP in my capacity as the Grantee Agent, I hereby certify that: Technical Completion With reference to all material aspects of our technical proposal, and any subsequent mutually agreed-upon modification(s), my organization has achieved the stated grant objectives and verifiable results as presented in the Grant Agreement, with the exception of the following: (Please write if any or write NIL) Financial Plan With reference to the Grant Agreement the final financial reconciliation is as follows:
Total Approved Total Reimbursed Total Expended Variance Action Required or Resolution Agreement

Thus, it is hereby agreed by the grantee and NRSP/SGAFP that all technical, administrative, and financial aspects of the referenced SGP/AFP Agreement have been brought to a condition of completion, and as such, neither the Grantee nor NRSP/SGAFP has any further obligations of any nature with regard to the aforementioned Grant Agreement.

On Behalf of the Grantee: NRSP/SGAFP:

On Behalf of

__________________________ Grantee Agent Date Date

__________________________ COP-SGAFP

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Grant Closeout Plan Small Grants and Ambassadors Fund Program A. General information Type of Grant: Ambassadors Fund /Small Grants: _______________________________ 1. Name of Grantee Organization: __________________________________________ 2. Grant Number: ______________ 3. Grant Duration: From: _________ To: ________ 4. Project Name: _______________________________________________________ 5. Location: Province(s): ___________ District(s): _____________ Tehsil(s): _________ Union Council(s): ______________________________________________________ 6. Total Grant Amount (PKR): ________ SGAFP Share: _______ Grantee Share: _______ B. Post-project activities with surplus budget (if any) Estimate Activity Purpose d cost (PKR) Responsi ble Person(s)

Note: in case organization does not foresee any surplus at the completion of project, this table can be left blank. C. Non-cash assets procured from Grants Fund & post-project utilization Type of Asset Current Proposed PostResponsible Value Project Use Person for (PKR) Operation & Maintenance

Note: Provide details of all assets procured under with SGAFP funding and also explain how your organization plans to use this equipment after the completion of project. D. List of activities to be undertaken to close the project S. Activity Completion No. date

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Note: Provide details of the activities that your organization will undertake to close the project. For example submission of arranging project ending workshop if needed, preparation for financial and program audit if required by SGAFP and responding to the audit queries etc., sharing information with project beneficiaries and other stakeholder, postproject follow ups with beneficiaries and technical assistance etc.

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E. Project audit and evaluation In case SGAFP request a project closeout audit and/or project evaluation, please provide details of the concerned persons and their roles and responsibilities to coordinate the activity: Activity Person(s) Assigned responsible roles/responsibilities Financial audit Project evaluation Compliance of actions suggested after audit and/or evaluation

Closeout Plan Preparation Date: Closeout plan submitted by: Name Designation

Signature

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Small Grants and Ambassadors Fund Program

Contractor Employee Biographical Data Sheet


1. Full Name 3. Employees Address 2. Contractors Name 4. Contract Number 6. Proposed Salary 8. Telephone Number (include city code) 9. Place of Birth 5. Position Under Contract

7. Duration of Assignment 10. Citizenship

11. Names, Ages, and Relationship of Dependents to Accompany Individual to Country of Assignment 12. EDUCATION (include all college or university degrees) 13. LANGUAGE PROFICIENCY Proficiency Name and location of Major Degree Date Language institution Speaking

Proficiency Reading

14. EMPLOYMENT HISTORY 1. Give lasts three (3) years. List salaries separate for each year. Continue on separate sheet of paper if required to list all employment related to duties of proposed assignment. 2. Salary definition basic periodic payment for services rendered. Exclude bonuses, profit-sharing arrangements, commissions, consultant fees, extra or overtime work payments, overseas differential or quarters, cost of living or dependent education allowances. Employers name and Dates of employment Annual salary address (mm/dd/yyyy) Position title Point of contact & From To Rupees telephone number

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15. SPECIFIC CONSULTANT SERVICES (give last three (3) years) Dates of Employers name and employment address Services performed (mm/dd/yyyy) Point of contact & telephone # From To

Days at rate

Daily rate In dollars

16. CERTIFICATION: To the best of my knowledge, the above facts as stated are true and correct. Signature of Employee Date Grantee certifies that he/she has taken reasonable steps to verify the information contained in this form. Contractor understands that USAID may rely on the accuracy of such information in negotiating and reimbursing personnel under this contract. The making of certifications that are false, fictitious, or fraudulent, or that are based on inadequately verified information, may result in appropriate remedial action by USAID, taking into consideration all of the pertinent facts and circumstances, ranging from refund claims to criminal prosecution. Signature of Grantees Representative Date

Instructions Indicate your language proficiency in block 13 using the following numeric interagency Language Roundtable levels (Foreign Service Institute levels). Also, the following provides brief descriptions of proficiency levels 2, 3, 4, and 5. S indicates speaking ability and R indicates reading ability. For more in-depth description of the levels refer to USAID Handbook 28. 2.Limited working proficiency S. Able to satisfy routine social demands and limited work requirements. R. Sufficient comprehension to read simple, authentic written material in a form equivalent to usual printing or typescript on familiar subjects. 3. General professional proficiency S. Able to speak the language with sufficient structural accuracy and vocabulary to participate effectively in most formal and informal conversations.

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R. Able to read within a normal range of speed and with almost complete comprehension. 4. Advanced professional proficiency S. Able to use the language fluently and accurately on all levels. R. Nearly native ability to read and understand extremely difficult or abstract prose, colloquialisms and slang. 5. Functional native proficiency S. Speaking proficiency is functionally equivalent to that of a highly articulate well-educated native speaker. R. Reading proficiency is functionally equivalent to that of the well-educated native reader . Paperwork reduction act information The information requested by this form is necessary for prudent management and administration of public funds under USAID contracts. The information helps USAID estimate overseas logistic support and allowances; the educational information provides an indication of qualifications; the salary information is used as a means of cost monitoring and to help determine reasonableness of proposed salary. Paperwork reduction act notice Public reporting burden for this collection of information is estimated to average thirty minutes per response, including the 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 this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to both of the following address: United States Agency for International Development Office of Management and Budget Procurement Policy Division (M/OP/P) Paperwork Reduction Project (0412-0520) Washington, DC 20523-1435; Washington, DC 20503

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3. Pre-Award Certifications

Drug-free Workplace Certification (To be submitted by grantee on signing of grant agreement) The grant beneficiary of this Grant Agreement hereby certifies the following: 1 That this certification is a material representation of fact from the grant beneficiary upon which reliance was placed when SGAFP awarded the grant; That the grant beneficiary understands that if it is later determined that the grant beneficiary knowingly rendered a false certification, or otherwise violated the requirements of the Drug-Free Workplace Act, SGAFP , in addition to any other remedies available, may take action authorized under the Drug-Free Workplace Act; and That the Beneficiary currently maintains and will continue to maintain and provide throughout the life of the grant a Drug-Free Workplace by: a. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the grant beneficiary's workplace and specifying the actions that will be taken against employees for violation of such prohibition: b. Establishing a Drug-Free awareness program to inform employees about: i. The dangers of drug abuse in the workplace; ii. The grant beneficiarys policy of maintaining a Drug-Free Workplace; iii. Any available drug counseling, rehabilitation, and employee assistance programs; and iv. The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; c. Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph (a); d. Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will: i. Abide by the terms of the statement; and

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ii. Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after such conviction; e. Notifying SGAFP within ten days after receiving notice under subparagraph (d) (3) from an employee or otherwise receiving actual notice of such conviction: f. Taking one of the following actions, within 30 days of receiving notice under subparagraph (d) (3), with respect to any employee who is so convicted: i. Taking appropriate personnel action against such an employee, up to and including termination; or

ii. Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by local health law enforcement, or other appropriate agency; g. Making a good-faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a), (b), (c), (d), (e) and (f). The grant beneficiary further certifies that the site(s) for the performance of work to be done in connection with the grant is: Street address: City, postal code: The grant beneficiary certifies that, as a condition of the grant, it will not engage in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance in conducting any activity with the grant.

Certified by:

[Signature of Authorized Grantee Organization]

Representative

of

Name: Title: Date:

[Name of Authorized Representative] [Title of Authorized Representative] _________________________________

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Debarment and Suspension Certification (To be submitted by grantee on signing of grant agreement) A. The grant beneficiary certifies to the best of its knowledge and belief, that it and its principals: 1. are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any United States Federal Department or agency; 2. have not within a three-year period preceding this proposal 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 antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; 3. are not presently indicated for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in this certification; and 4. have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default. B. The grant beneficiary agrees that, unless authorized by the SGAFP , it will not knowingly enter into any sub-agreements or contracts under this grant with a person or entity that is included on the Lists of Parties Excluded from Federal Procurement or Non-Procurement Programs. C. The grant beneficiary further agrees to include the following provision in any sub-agreements or contracts entered into under this grant. D. The Beneficiary/contractor 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. E. The policies and procedures applicable to debarment, suspension and ineligibility under AID-financed transactions are set forth in 22 CFR Part 208. On behalf of the grant beneficiary, I hereby acknowledge our understanding and acceptance of the terms and conditions of this Certification.

Certified by:

[Signature of Authorized Grantee Organization]

Representative

of

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Name: Title: Date:

[Name of Authorized Representative] [Title of Authorized Representative] _________________________________

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Local Cost Financing (To be submitted by grantee on signing of grant agreement) a. Financing local procurement involves the use of appropriated funds to finance the procurement of goods and services supplied by local businesses, dealers or producers, with payment normally being in the currency of the cooperating country. b. All locally financed procurements must be covered by source, origin or nationality waivers as set forth in USAID ADS Chapter 310, with the following exceptions. 1. Locally available commodities of U.S. origin, which are otherwise available for financing, if the value of the transaction does not exceed the local currency equivalent of $100,000, exclusive of transportation costs. 2. Commodities of geographic Code 935 origin if the value of the transaction does not exceed the local currency equivalent of $5,000. 3. Professional Services contracts estimated not to exceed $250,000. 4. Construction Services contracts estimated not to exceed $5,000,000. 5. Commodities and Services available only in the local economy (no specific transaction value applies to this category). This category includes the following items: A. Utilities including fuel for heating and cooking, waste disposal, and trash collection; B. Communication - telephone, fax, postal, and courier services; C. Rental costs for housing and office space; D. Petroleum, oils, and lubricants for operating vehicles and equipment; E. Newspapers, periodicals, and books published in the cooperating country; and F. Other commodities and services that, by their nature, or as a practical matter, can only be acquired, performed, or incurred in the cooperating country, e.g. vehicle maintenance, hotel accommodations, etc.

Certified by:

[Signature of Authorized Grantee Organization]

Representative

of

Name: Title: Date:

[Name of Authorized Representative] [Title of Authorized Representative] _________________________________

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Cost Sharing Certification (To be submitted by grantee on signing of grant agreement when cost sharing is applicable) a. For each year (or funding period) under this grant, the grantee agrees to expend from non-USAID funds an amount at least equal to __________ as agreed in the cost share budget provided. The schedule of this grant may also contain restrictions on the application of cost sharing (matching) funds. b. Eligibility of funds applied to satisfy cost sharing requirements under this grant are set forth below: (matching)

1. Charges incurred by the grantee as project costs. Not all charges require cash outlays by the grantee during the project period; examples are depreciation and use charges for buildings and equipment; 2. Project costs financed with cash contributed or donated to the grantee by other non-Federal public agencies (may include public international organizations or foreign governments) and institutions, and private organizations and individuals; and 3. Project costs represented by services and real and personal property, or use thereof, donated by other non-Federal public agencies and institutions, and private organizations and individuals. c. All contributions, both cash and in-kind, shall be accepted as part of the grantee's cost sharing (matching) when such contributions meet all of the following criteria: 1. Are verifiable from the grantee's records; 2. Are not included as contributions for any other Federally assisted program; 3. Are necessary and reasonable for proper and efficient accomplishment of project objectives; 4. Are types of charges that would be allowable under the applicable Federal cost principles; 5. Are not paid by the Federal Government under another grant or agreement (unless the grant or agreement is authorized by Federal law to be used for cost sharing or matching); 6. Are provided for in the approved budget when required by USAID; and 7. Conform to other provisions of this paragraph. d. Values for grantee in-kind contributions will be established in accordance with the applicable Federal cost principles. e. Specific procedures for the grantee in establishing the value of in-kind contributions from non-Federal third parties are set forth below: 1. Valuation of volunteer services: Volunteer services may be furnished by professional and technical personnel, consultants, and other skilled and unskilled labor. Volunteer services may be counted as
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cost sharing or matching if the service is an integral and necessary part of an approved program. i. Rates for volunteer services: Rates for volunteers should be consistent with those paid for similar work in the grantee's organization. In those instances in which the required skills are not found in the grantee's organization, rates should be consistent with those paid for similar work in the labor market in which the grantee competes of the kind of services involved. ii. Volunteers employed by other organizations: When an employer other than the grantee furnishes the services of an employee, these services shall be valued at the employee's regular rate of pay (exclusive of fringe benefits and overhead costs) provided these services are of the same skill for which the employee is normally paid. 2. Valuation of donated expendable personal property: Donated expendable personal property includes such items as expendable equipment, office supplies, laboratory supplies or workshop and classroom supplies. Value assessed to expendable personal property included in the cost (matching) share should be reasonable and should not exceed the market value of the property at the time of the donation. 3. Valuation of donated nonexpendable personal property, buildings, and land or use thereof: i. The method used for charging cost sharing or matching for donated nonexpendable personal property, buildings, and land may differ according to the purpose of the grant as follows: A. If the purpose of the grant is to assist the grantee in the acquisition of equipment, buildings or land, the total value of the donated property may be claimed as cost sharing or matching. B. If the purpose of the grant is to support activities that require the use of equipment, buildings, or land; depreciation or use charges for equipment and buildings may be made. The full value of equipment or other capital and fair rental charges for land may be allowed provided that AID has approved the charges. ii. The value of donated property will be determined in accordance with the usual accounting policies of the grantee, with the following qualifications: A. A. Land and buildings: The value of donated land and buildings may not exceed its fair market value at the time of donation to the grantee as established by an independent appraiser, and certified by a responsible official of the grantee. B. Nonexpendable personal property: The value of donated nonexpendable personal property shall not exceed the fair market value of equipment and property of the same age and condition at the time of donation.

SGAFPs Post Award Reference Documents under US Ambassadors Fund Program

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Small Grants and Ambassadors Fund Program

C. Use of space: The value of donated space shall not exceed the fair rental value of comparable space as established by an independent appraisal of comparable space and facilities in a privately owned building in the same locality. D. Borrowed equipment: The value of borrowed equipment shall not exceed its fair rental value. f. The following requirements pertain to the grantee's supporting records for in-kind contributions from non-Federal third parties: 1. Volunteer services must be documented and, to the extent feasible, supported by the same methods used by the grantee for its employees. 2. The basis for determining the valuation for personal services, material, equipment, buildings and land must be documented. g. Individual expenditures do not have to be shared or matched provided that the total expenditures incurred during the year (or funding period) are shared or matched in accordance with the agreed-upon amount or percentage set forth in the schedule of the grant. h. If at the end of any year (or funding period) hereunder, the grantee has expended an amount of non-Federal funds less than the agreed-upon amount or percentage of total expenditures, the difference may be applied to reduce the amount of USAID funding the following year (or funding period), or, if this grant has expired or been terminated, the difference shall be refunded to USAID. i. Failure to meet the cost sharing (matching) requirements set forth in paragraph above shall be considered sufficient reason for termination of this grant for cause in accordance with paragraph a. entitled "For Cause" of the standard provision of this grant entitled "Termination and Suspension". Notwithstanding paragraph, the parties agree that in the event of any disallowance of expenditures from USAID grant funds provided hereunder, the grantee may substitute expenditures made with funds provided from non-Federal sources provided they are otherwise eligible in accordance with paragraph b. of this provision.

j.

Certified by:

[Signature of Authorized Grantee Organization]

Representative

of

Name: Title: Date:

[Name of Authorized Representative] [Title of Authorized Representative] ____________________________________

SGAFPs Post Award Reference Documents under US Ambassadors Fund Program

36

Small Grants and Ambassadors Fund Program

SGAFPs Post Award Reference Documents under US Ambassadors Fund Program

37

Small Grants and Ambassadors Fund Program

Certification Regarding Terrorist Financing (To be submitted by grantee on signing of grant agreement) As a condition to entering into the referenced agreement, the organization listed below hereby certifies that it has not provided and will not provide material support or resources to any individual or entity that it knows, or has reason to know, is an individual or entity that advocates, plans, sponsors, engages in, or has engaged in terrorist activity, including but not limited to the individuals and entities listed in the Annex to Executive Order 13224 and other such individuals and entities that may be later designated by the United States under any of the following authorities: 219 of the Immigration and Nationality Act, as amended (8 U.S.C. 1189), the International Emergency Economic Powers Act (50 U.S.C. 1701 et seq.), the National Emergencies Act (50 U.S.C. 1601 et seq.), or 212(a)(3)(B) of the Immigration and Nationality Act, as amended by the USA Patriot Act of 2001, Pub. L. 107-56 (October 26, 2001)(8 U.S.C. 1182). The below named organization further certifies that it will not provide material support or resources to any individual or entity that it knows, or has reason to know, is acting as an agent for any individual or entity that advocates, plans, sponsors, engages in, or has engaged in, terrorist activity, or that has been so designated, or will immediately cease such support if an entity is so designated after the date of the referenced agreement. For purposes of this certification, material support and resources includes currency or other financial securities, financial services, lodging, training, safe houses, false documentation or identification, communications equipment, facilities, weapons, lethal substances, explosives, personnel, transportation, and other physical assets, except medicine or religious materials. For purposes of this certification, engage in terrorist activity shall have the same meaning as in section 212(a)(3) (B)(iv) of the Immigration and Nationality Act, as amended (8 U.S.C. 1182(a)(3)(B)(iv)). For purposes of this certification, entity means a partnership, association, corporation, or other organization, group or subgroup. This certification is an express term and condition of the agreement and any violation of it shall be grounds for unilateral termination of the agreement by USAID prior to the end of its term. Solicitation Number:___________________________________________ Grant Agreement Number (if applicable): ___________________________ Date of Application: ___________________________________________ Name of Grantee Organization: __________________________________ Name and Title of authorized representative: ________________________

SGAFPs Post Award Reference Documents under US Ambassadors Fund Program

38

Small Grants and Ambassadors Fund Program

Signature: ______________________________ Date:________________

SGAFPs Post Award Reference Documents under US Ambassadors Fund Program

39

Certification Regarding Operational Transparency (To be submitted by grantee on signing of grant agreement) The grant beneficiary of this Grant Agreement hereby certifies to the best of its knowledge and belief, that: A. The grant beneficiary has never been involved in any financial malpractices. B. The grant beneficiary was never blacklisted by any national or international donor agency. C. The grant beneficiary will maintain financial and programmatic transparency. D. In case of any willful misconduct by any employee of the grantee, the grant beneficiary will instantly document the incident and inform SGAFP office in black and white and take disciplinary action against the guilty staff. E. In case the grant beneficiary faces any undue pressure from any stakeholder, including the staff of SGAFP, the same shall be reported to SGAFP F. The grant beneficiary will provide conducive work environment to all employees working with it under SGAFPs sponsored project The grant beneficiary understands that: 1. SGAFPs staff in regions is not the sole representative of USAID. 2. SGAFPs staff cannot exert influence over the grant beneficiary for procurement of goods and services from a particular place/ person and grantee has no pressure to abide by the oral or written instructions of SGAFPs employee thereof until and unless, otherwise, directed by the SGAFPs DCOP from the central office. 3. The grant beneficiary has no bar in contacting with SGAFPs central office for issues pertaining to SGAFPs project during implementation and/or unacceptable, undue and authoritative directions of SGAFPs regional staff. On behalf of the grant beneficiary, I hereby acknowledge our understanding and acceptance of the terms and conditions of this Certification.

Certified by:

[Signature of Authorized Grantee Organization]

Representative

of

Name: Title:

[Name of Authorized Representative] [Title of Authorized Representative]

Date:

____________________________________

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