HomeMy WebLinkAboutAgreements/Contracts - New Hope DV/SAt "RANT COUNTY j
COMMISSIONERS AGENDA MEETING REQUEST FORM
(Must be submitted to the Clerk of the Board by 12:00pm on Thursday)
REQUESTING DEPARTMENT:New Hope
REQUEST SUBMITTED BY:SuziFode
CONTACT PERSON ATTENDING ROUNDTABLE:n/a
CONFIDENTIAL INFORMATION: EYES WN0
DATE. 2.11.25
PHONE:
4.3 US.SUBM-ITTED:
(CHECK ALL
THAT: APPL
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E-J Financial
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Request permission for Suzi Fode to docu-sign a cooperative agreement
with National Children s Alliance
for the period January 1, 2025 through December 31, 2025 in the amount of $50,000 to provide core
services at Kids Hope,
If necessary, was this document reviewed by accounting? [I YES El NO W N/A
If necessary, was this document reviewed by legal? P YES El NO 0 N/A
DATE OF ACTION: r_2- DEFERRED OR CONTINUED TO:
APPROVE: DENIED
D1:
D2:
Al,
D3:
AM C%-r A I K I
WITHDRAWN:
RECEIVED
FEB - 6 2025
4/23/24 GRANT COUNTY COMMISSIONERS
National Children's Alliance
Cooperative Agreement Cover Sheet
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The Force Behind
Children"s Advocacy Centers
Section I - Subrecipient
Information
Subrecipient Name
Subrecipient DBA-.
County of Grant
Kids Hope
Tax Identification #: UEI #0
Subrecipient Place of Performance:
91-6001319 ZL6WM26K8KR5
311 W. Third Avenue, Moses Lake, WA, 98837
Section 11 - General Grant
Information
Federal Subaward Amount: Subaward Number (Docket Subaward Type,
$50t000.00 MOSE-WA-CORE25 2025 Core Direct CAC. Services
Subaward Period of Performance.-
Subaward Budget Period.
January 1, 2025 - December 31, 2025
January 1, 2025 - December 31, 2025
SectionFederal Award
Information
Fed era l.Awarding Agency: Federal Award Description*, Federal Award Date.
Office of Justice Programs Office of National Subgrants Program September 27, 2024
Juvenile Justice Delinquency Prevention
Federal Awarding Identification
Federal Award Amount,#
R&D#
15PJDP-24-GK-04107-MUMU
$26,359,714.00
No
Pass -through EntILY;
Pass -through Entity UEI #*
NCA Indirect Cost Rate for
National Children's Alliance
KV79V2J2AKF9
Federal Award: 17.65%
- -----------
Statutory Authority*.
-
CFD-A. Number.
Section 214 of the Victims of Child Abuse Act (34 U.S.C. §
16.758 - Improving the Investigation and Prosecution
20304) and FY24 TYP: 34 U.S.C. 11171-72; Pub. L. No. 118-
of Child Abuse and the Regional and Local Children's
421138 Stat. 25, 150
Advocacy Centers; 16.731 - Tribal Youth Program
Contact Information-,
Special Conditions.
Jennifer Read, Director of Grants Management
This project is approved subject to such conditions or
Ph: 202-548-0090 x108 Email: jread@nca-online.org
limitations as set forth in the attached Cooperative
Agreement.
Section IV - Additional
Award Information
Progress and Financial Report Due Dates-,
Performance Measures Report Due Dates.
April 10, 2025 October 10, 2025
July 31, 2025
July 10, 2025 January 12, 2026
January 12, 2026
National
children s
A f nce�,
The Force Behind
Children's Advocacy Centers
Cooperative Agreement between 2025
Subrecipient and National Children's Alliance
This agreement establishes the terms between your agency and the National Children's Alliance (NCA) regarding federal
funding awarded by NCA through a cooperative agreement with the Department of Justice's Office of Juvenile Justice
Delinquency Prevention (OJJDP).
Due to the substantial involvement contemplated in completion of this project, NCA has elected to enter into a
cooperative agreement rather than a grant. This decision is based on NCA's ongoing responsibility to assist and
coordinate projects that relate to the funded activities. NCA will provide input and re -direction to the project, as
needed, in consultation with the recipient, and will actively monitor the project by methods including, but not limited
to, ongoing contact with the recipient, reviewing major project generated documents and materials used in the
provision of project services. In meeting programmatic responsibilities, INCA, and the subrecipient will be guided by
the following principles- responsibility for the day-to-day operations of this project rests with the subrecipient in
implementation of the subrecipient s approved proposal, the subrecipient's approved budget, and the terms and
conditions specified in this award. Responsibility for general oversight and redirection of the project, if necessary,
rests with NCA. NCA will also provide guidance in significant project planning meetings and may elect to participate
in project sponsored training events or conferences. In addition to its programmatic reporting requirements, the
recipient agrees to provide necessary information as requested by NCA. Information requests may include, but are
not limited to, specific submissions related to performance, including measurement of project outputs/outcomes;
meeting performance specifications; developmental decision points; changes in project scope or personnel;
budget modifications; and/or coordination of related projects.
1. Grant Award and Acceptance
1.1. Award Acceptance. Subrecipient must accept this award within 45 days of the award date. Failure to accept within
this timeframe may result in loss of funds.
1.2. Project Implementation. Subrecipient shall commence use of funds within 90 days of the contract start date, and
if they are not, the subrecipient must report to NCA the steps taken to initiate the grant activities, the reasons for
the delay, and the expected start of the use of the funds, If meaningful implementation steps have not begun after
90 days of the grant start date, NCA reserves the right to cancel the subaward.
2. Monitoring, Compliance, and Oversight
2.1. Federal Requirements. Subrecipient shall comply with: (a) 2 C.F.R. Part 200 Uniform Requirements (b) DOJ Grants
Financial Guide (c) All applicable federal statutes, regulations, and requirements (d) Special conditions listed in
Attachment A (e) Requirements specified in the Grant Award Notification (f) NCA Engage Grantee Resource
Page requirements (9) Terms of the original Request for Proposals.
2.1.1.For more information and resources on the Part 200 Uniform Requirements as they relate to OJP awards and
subawards, see the OJP website at https://ojp.gov/funding/Part200UniformRequirements.
2.2. Attend Mandatory On -Demand Trainings. Programmatic and fiscal representatives of each subrecipients program
must attend all NCA Mandatory OnDemand Trainings. Failure to meet this requirement may result in additional
reporting requirements. Dates for all required trainings can be found on the Grantee Resource Page.
2.3. Eligible Use of Funds. Subrecipient's use of the Grant funds is limited to those expenditures necessary to
i rnplement the project. All expenses must be eligible under applicable federal law, and as described in the NCA
Grantee Guidelines and DOJ Grant Financial Guide fit within the requirements of the NCA Engage Grantee
Resource Page, NCA RFP, and as designated by the U.S. Dept. of Justice and under the OMB 2 CFR 200 - Uniform
Guidance. Furthermore, subreciplent's expenditure of grant funds must be in accordance with the approved
project budget.
2.4. Ineligible Uses of Grant Funds. Subreciptent shall not use the Grant funds for costs that don't meet the
requirements of 2.3 Eligible Uses of Grant or unallowable costs as listed in 2 CFR Part 200 for any purpose
prohibited by any provision of this Agreement. A detailed list of unallowable costs can be found on the NCA
Grantee Resource Page. NCA may change its requirements regarding allowable expenses at anytime to reflect
changes in federally allowable costs or necessary updates to policies. Changes will be published on the NCA
Engage Grantee Resource Page.
2.5. Prior Approval for Modifications. Subrecipient shall obtain prior approval from NCA for budgetary changes that
result in:(!) a redirection of funds, in or out of a cost category that is greater than 10% ('110changes affecting project
scope (iiii) the addition/removal of budget categories. Additionally, prior approval from NCA is required for any
deviation from the approved timeline or revised grant program implementation plan.
2.6. Monitoring. Subrecipient shall cooperate with all monitoring activities conducted by NCA and the Office of Justice
Programs COX% including but not limited to: (a) Desk reviews; (b) Site visits; (c) Documentation requests; and (d)
Compliance evaluations,
2.7. OJP Training Guiding Principles. Any training or training materials that the recipient --or any subrecipient
( Itsubgrantee") at any tier -- develops or delivers with OJP award funds must adhere to the OJP Training Guiding
Principles for Grantees and Subgrantees, available at https-://www,oj'p.gov/funding/implement/training-guiding-
princioles-grantees-and-subgrantees.
2.8. Compliance with applicable rules regarding approval, planning, and reporting of conferences, meetings,
trainings, and other events. The subrecipient must comply with all applicable laws, regulations, policies, and
official NCA and DOJ guidance (including specific cost limits, prior approval and reporting requirements, where
applicable) governing the use of federal funds for expenses related to conferences (as that term is defined by
D0J),including the provision of food and/or beverages at such conferences, and costs of attendance at such
conferences. in -formation on the pertinent DOJ definition of conferences and the rules applicable to this award
appears in the DOJ Grants Financial Guide (currently, as section 3.10 of "Postaward Requirements" in the "DOJ
Grants Financial Guide").
2.9. Record retention and access. Records pertinent to the award that the subrecipient must retain -- typically for a
period of 3 years from the date of submission of the pass -through entity's final expenditure report -- and to which
the subrecipient must provide access, include performance measurement information, in addition to the financial
records, supporting documents, statistical records, and other pertinent records indicated at 2 C.F.R. 200.334,
2.10. Access to Records. The subrecipient must permit NCA authorized representatives and auditors to have access to
all such books, records, documents, accounting practices and procedures, and other information for inspection,
audit, and coping to fulfill its monitoring requirement and to meet the requirements of 2 C.F.R. Part 200, The
Subrecipient will provide proper facilities for such access and inspection.
3. Hnanci 0 al Management and Reporting
3.1. Financial Systems. subrecipient shall maintain accounting systems that: (a) Accurately track receipt and
expenditure of Award Funds (b) Maintain separate accounting for each federal award (C) Support required
financial reporting (d) Meet federal standards for fund management,
3.2. Reporting Requirements. Subrecipient shall provide NCA with quarterly progress and financial reports no later
than 10 days after the end of the calendar quarters ending March 31, June 30, September 30, and December 31,
Subreciplents shall also provide INCA with performance measures semi-annually, reports covering January - June
are due on July 31, and reports covering July - December are due on January 10 following the close of the
project period. Failure to submit timely reports will result in forfeiture of funds,
3.3. Requirement for data on performance and effectiveness under the award. The recipient must collect and maintain
data that measure the performance and effectiveness of work under this award. The data must be provided to OJP
in the manner (including within the timeframes) specified by OJP in the program solicitation or other applicable
written guidance. Data collection supports compliance with the Government Performance and Results Act (GPRA)
and the GPRA Modernization Act of 2010, and other applicable laws.
3.4. Program Income. If NCA funds are used to support any part of a revenue producing venture, such as a training or
conference at which registration fees are charged, revenues shall be considered program income, The
subrecipient will report any related program income to NCA within 30 days and submit a budget modification
request showing how those revenues will be used to further the purpose of the approved NCA grant. Revenues
must be expended within the grant year that they were accrued.
3.5. Spenddown Plans. Subrecipients are required to submit a detailed Spendclown Plan during the second half of the
grant year. This plan should align with the current approved budget and outline a clear, achievable strategy for
fully expending the awarded funds by the end of the grant period. The spendclown plan must demonstrate how
funds will be allocated across planned activities, ensuring that all awarded funds are used effectively and in
accordance with the project goals, objectives, and activities. The specific due date for the submission of the final
BMR will be established during the first programmatic call for the grant period. Based on the completion of this
spendclown plan, NCA may elect to deobliciate a portion of the awarded amount.
W
3.6. Payment Method. Payments will be made as a reimbursement sub*Jectto: (a) Submission of required reports (b)
compliance with agreement terms (c) Adequate documentation of expenditures as detailed in the NCA Grantee
Resource Page.
3.7. Payment Processing, Subrecipient must establish a Bill.corn vendor account (b) Bank account changes must be
made by subrecipient in their Bill-com vendor account and require updating 15 business days' prior to the next
established payment/report schedule.
3.8, Audit Requirements. Subrecipients that expend $750,000 or more in Federal funds (from all sources including
pass -through subawards) in their fiscal year are required to arrange for a single organization -wide audit conducted
in accordance with the provisions of Title 2 C.F.R., Subpart F. A copy of the audit must be sent to NCA no later than
9 months after the subrecipient's fiscal year end. NCA may require additional audits based on performance.
3.8.1.Audit Costs. Audit costs for audits not required in accordance with 2 CFR Part 200, subpart F are unallowable,
If Subrecipient did not expend $750,000 or more in -federal funds in its fiscal year but contracted with a
certified public accountant to perform an audit, costs for performance of that audit shall not be charged to this
Grant.
3.8.2.Effect of failure to address audit issues. The subrecipient understands and agrees that NCA may withhold
award funds, or may impose other related requirements, if (as determined by NCA) the recipient does not
satisfactorily and promptly address outstanding issues from audits required by the Part 200 Uniform
Requirements (or by the terms of this award), or other outstanding 'issues that arise in connection with audits,
investigations, or reviews of DOJ awards.
3.8.3.Payment of Amounts Found Due to Audit. In the event an audit or inspection by a certified or registered
public accountant or an authorized agent of the NCA reveals that monies are due and owing to the NCA. from
the Subrecipient, for whatever reasons, then the Subrecipient shall pay such -sums to NCA within thirty (30)
days of written notification of the findings of such audit or inspection.
3.9. Procurement. If NCA funds are to be used for any product or service in excess of $10,000.00, at least three quotes
must be obtained to ensure that the selection process is competitive. The procurement process is outlined in DOJ
Guide to Procurement Procedures, which is included as part of the Grantee Resource Page on the NCA Engage
website(https://engage.nationalchildrensalliance.org/grantee-resource-page), Consideration must: be given to
ensure more economical, cost effective, and efficient ways to obtain or use common or shared goods or services as
well as assessment of available resources. Any charges for such expenditures or requests for sole source contracts
are subject to prior approval by NCA and review of the procurement documentation to ensure it meets DOJ
guidelines. The procurement entity must avoid "splitting" of purchases or transactions to circumvent the dollar
threshold limitations.
No subrecipient may (in any procurement transaction) discriminate against any person or entity on the basis of
such person or entity's status as an "associate of the federal government" (or on the basis of such person or entity's
status as a parent, affiliate, or subsidiary of such an associate), except as expressly set out in 2 C.F.R. 200.319(a) or
as specifically authorized by USDOJ.The recipient's monitoring responsibilities include monitoring of subrecipient
compliance with this condition.
Specific post -award approval is required to use a noncompetitive approach in any procurement contract that
would exceed $250,000. The subrecipient must comply with all applicable requirements to obtain specific
advance approval to use a noncompetitive approach in any procurement contract that would exceed the
Simplified Acquisition Threshold (currently, $250,000).
The details of the requirement for advance approval to use a noncompetitive approach in a procurement contract
under an OJP award are posted on the OJP web site at
https://ojp.gov/funding/Explore/Noncompet*itiveProcurement.htm (Award condition: Specific post -award approval
required to use a noncompetitive approach in a procurement contract (if contract would exceed $250,000)), and
are incorporated by reference here.
If VIT
4. Compliance ana tnforcement
4.1. Determination of suitability to interact with participating minors. All subrecipients must make determinations of
suitability be -fore certain individuals may interact with any participating minors. It is the responsibility of the
subrecipient agency to review the full details of this award condition found on OJPs website.
To meet this requirement, subrecipient agencies must (1) Establish written policies and procedures that ensure
determination of suitability to interact with minors is assessed (1i) Assess suitability to interact with minors and
create written determination of the individual's suitability to interact with minors (iii) Document that specific public
sex offender and child abuse websites/registries were checked (iv) Document that specific background checks
were completed (v) Document that the written determination of suitability is reviewed and updated every five
years.
Additional guidance on how to meet the requirements of this Federal Special Condition can be found on INICA's
Grantee Resource Pages. (Award condition: Determination of suitability required, in advance, for certain
individuals who may interact with participating minors), and are incorporated by reference here.
4.2. Employment eligibility verification for hiring under the award. Subrecipients must ensure that the hiring process
for any position funded in whole or in part with award funds includes verification of employment eligibility. It is
subrecipient's responsibility to review the full details of this award condition found on OJP's website. (Award
condition: Employment eligibility verification for hiring under the award), and are incorporated by reference here.
4.3. Requirement to report actual or imminent breach of personally identifiable information (PI11). The subrecipient
must have written procedures in place to respond in the event of an actual or imminent "breach" (OMB M-1 7-12) if
it (or a subrecipient) -- (1) creates, collects, uses, processes, stores, maintains, disseminates, discloses, or disposes
of "Personally Identifiable Information (P11)" (2 CFR 200.1) within the scope of an OJP grant -funded program or
activity, or (2) uses or operates a "Federal information system" (OMB Circular A-1 30). The recipient's breach
procedures must include a requirement to report actual or imminent breach of Pill to NCA no later than 24 hours
after an occurrence of an actual breach, or the detection of an imminent breach,
4.4. Reporting potential fraud, waste, and abuse, and similar misconduct. The subrecipients must promptly refer to
NCA and the DOJ Office of the Inspector General (011G) any credible evidence that a principal, employee, agent,
subrecipient, contractor, subcontractor, or other person has, in connection with funds under this award-- (1)
submitted a claim that violates the False Claims Act; or (2) committed a criminal or civil violation of laws pertaining
to fraud, conflict of interest, bribery, gratuity, or similar misconduct. Additional information is available from the
DOJ OIG website at https://oig.justice.aovlhotline.
4.5. Requirement to disclose whether recipient is designated "high risk" by a federal grant -making agency outside of
130.1. If the recipient is designated "high risk" by a federal grant -making agency outside of DOJ, currently or at any
time during the course of the period of performance under this award, the recipient must disclose that fact and
certain related information to OJP by email at OJP.ComplianceReporting@ojp.usdoj.gov. For purposes of this
disclosure, high risk includes any status under which a federal awarding agency provides additional oversight due
to the recipient's past performance, or other programmatic or financial concerns with the recipient. The recipient's
disclosure must include the following: 1. The federal awarding agency that currently designates the recipient high
risk, 2. The date the recipient was designated high risk, 3. The high -risk point of contact at that federal awarding
agency (name, phone number, and email address), and 4. The reasons for the high -risk status, as set out by the
federal awarding agency.
4.6. Potential imposition of additional requirements. The recipient agrees to comply with any additional
requirements that may be imposed by NCA during the period of performance for this award, if the recipient is
designated as "high- risk" for purposes of the DOJ high -risk grantee list.
4.7. NCA Certifications Regarding Lobbying; Debarment, Suspension, and Other Responsibility Matters; and Drug -
Free Workplace Requirements. Subrecipients must follow all requirements outlined on the NCA General
Conditions page regarding lobbying; debarment, suspension, and other responsibility matters; and drug -free
workplace requirements. See the Award Conditions for, NCA Awards page for additional information.
4.8. Avoid Conflicts of Interest. Subrecipients Must comply with federal and state rules which prohibit the use of public
funds for personal gain. Subrecipients must avoid any actions which might result in, or create the appearance of,
using public funds or publicly funded positions for private gain, for giving preferential treatment to any person, or
adversely affecting the confidence of the public in the integrity of the government or the subrecipients program.
4.9. Mandatory Disclosure. All recipients must disclose, in a timely manner, in writing to NCA all violations of Federal
criminal law involving fraud, bribery, or gratuity violations potentially affecting the Federal award. Per 2 CFR
200.113, recipients that have received a Federal award including the term and condition for recipient Integrity and
Performance Matters are required to report certain civil, criminal, or administrative proceedings to SAM. Failure to
make required disclosures may place the recipient in bad standing with NCA and may result in establishment of
special conditions and/or forfeiture of grant funds or other provisions outlined in 2 CFR § 200.339.
4.10. NCA Critical Incident Policy. All Subrecipients are subject to the Critical Incident Policy at NCA and are required to
report any uncovered embezzlement, theft of grant funds and active investigations for such cases in their
organization.
4.11. Good Standing with NCA. Subrecipients who are NCA Accredited, Associate/Developing, Affiliate, or Chapter
Members must maintain their membership status and remain in good standing for the duration of the performance
period. This includes staying current with reporting requirements - including timely submission of statistical reports
(due in January and July) and/or grant reports), having a signed license and NCA accreditation materials and
annual affidavit of accreditation standards compliance (as appropriate), and remaining current with annual dues.
Chapter recipients must also meet the participation requirements of the annual GAP Analysis and OMS Projects.
4.12. Closeout. The subrecipient's obligation to NCA shall not end until all closeout requirements are completed.
Activities undertaken during this closeout period shall include, but are not limited to: submission of semi-annual
performance measures reports; Submitting final expenditure requests and detailed general ledger reports; closing
out program income balances,
4.13. Remedies for Noncompliance. Failure to comply with federal statutes, regulations, or award terms and conditions,
may result in additional specific award conditions, as described in 2 CFR § 200.339. These additional conditions
may be applied if the subrecipient has a history of non-compliance with general or specific terms and conditions
of a federal award; if the subrecipient fails to meet the goals of the award; or if the subrecipient is not otherwise
responsible.
NCA will notify subrecipients on the nature of the noncompliance; the reason for their imposition; the nature of
the action needed to remove the additional requirement; the nature of the action needed, and the time allowed
for completing the actions, if applicable.
If it is determined that noncompliance cannot be remedied by imposing additional conditions, NCA may take one
or more of the following actions: temporarily withhold cash payments pending correction of the deficiency,
disallow all or part of the cost of activities or actions not in compliance, fully or partly suspend or terminate the
award, designate the award red pie ntas a high -risk recipient, withhold future awards, or take other remedies.
NCA mayterminate in whole or in part an award for failure to complywith the statutes, regulations, or award terms
and conditions. NCA will provide sub red pie ntswith a notice of termination.
By executing this Agreement, Subrecipient's authorized official accepts all material requirements, assurances, and
certifications associated with this federal award. Subrecipient shall complywith all financial and administrative
requirements set forth in: (a) the GrantAward Notification; (b) Department of Justice Special Conditions on
National Chi Idren'sAlIiance Awards; (c)the Cooperative Agree mentCover Sheet; (d) NCA Engage Grantee
Resource Page; (e) Request for Proposals; (f) Department of Justice Grants Financial Guide; (g) 2 C.F.R. Part 200
Uniform Requirements; and (h)Any applicable federal statutes, rules, Executive Orders, guidance, and
requirements, whether existing as of the date hereof or implemented during the period of performance.
Subrecipient Authorized Agency Representative*:
I certify that I have the legal authority to enter into this
agreement on behalf of the subrecipient entity.
S� Gam
Si
Signature
me
sfode@grantcountywa.gov
Pass -through Entity Awarding Officials:
Jennifer M. Read
Director of Grants Management
National Children'sAlliance
Email Address �
Feb 13, 2025
Date Teresa Huizar
CEO
National Children'sAlliance
Additional Contact Information
Only for Chapters/Centers who are independent no n-profit
agencies (ifgovt./umbre I I a enter ma and answer be I ow)
Board President Name:
Board President Email:
na
na
Only for Chapters/Centers who are part of a government
-based or umbrella/parent agency
Chapter/Center Director Name:
Chapter/Center Director Email:
Suzi Fode
sfode@grantcountywa.gov
Advisory Board Representative Name:
Advisory Board Representative Email:
Elisa Adolphsen
eadolphsen@grantcountywa.gov
Designate Signing Authority for Reporting
2 C.F.R. §200.415 requires certification by an official who is authorized to legally bind the non-federal entity in
order to ensure that expenditures are proper and in accordance with the terms and conditions of the federal
award and approved project budgets. If you, the Authorized Agency Representative, wish to designate the
signing authorhyto another party for subrecipient reporting, please entertheir information below.
Single Audit Certification and Federal Funding Accountability and
Transparency Act (FFATA)Supplemental Information
Subrecipient Name Subaward Amount: UEI #:
County of Grant $50,000.00 �ZILMIM261<81KR5
Our most recently completed fiscal year is: 2023
0 Our entity is subjectto the 2 CFR 200 Subpart F Single Audit requirements, as our entity expended $750,000* or
more in total Federal awards for the most recent fiscal year ending. An audit will be completed and submitted to the
Federal Audit Clearinghouse per 2 CFR 200 Section 200.512 with an electronic copy also being submitted to NCA.
OR
0 Our entity is exempt from the Single Audit/2CFR 200 Subpart F requirements for the following reason:
❑ Our entity expended less than $750,000* in total federal awards for the fiscal year noted above.
❑ Other:
*The increased threshold of$1,000,000 applies only to fiscal years beginning on or after October 9, 2024. All awards
with a start date prior to October 9, 2025 will be subject to the $750,000 threshold.
NCA is required to report all awardees information listed below into the FFATA Subaward ReportingSystem (FSRS) for
awards greater than or equal to $30,000.
In your business or organization's(the legal entity to which the Unique Entity ID (UEI) number you provided belongs)
preceding completed fiscal year, did you receive:
1) 80 percent or more of your annual gross revenues in U.S. federal contracts, subcontracts, loans, grants,
subgrants, and/or cooperative agreements AND
2) $25,000,000 or more in annual gross revenues from U.S. federal contracts, subcontracts, loans, grants, subgrants, and/
or cooperative agreements
13 *Yes ®No (If you answered "No', please proceed to CERTIFICATION section below)
* If you answered "yes' to question 1 and 2 above, then please complete question 2a:
2a). Does the public have access to information about the compensation of the executives in your business or
organization (the legal entity to which the UEI number you provided belongs) through periodic reports filed under
section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal
Revenue Code of 1986?
OYes (proceed to CERTIFICATION section) 0No (continue to question 2b)
2b) **If you answered 'no' to the question 2a, then please complete the below question:
Please provide the names and total compensation of the top 5 employees:
Certification:
I cennyto the best of my knowledge and beIlet that the information provided herein is true, complete, and accurate. I am aware that the provision of
false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil, or administrative consequences
including, but not limited to violations of U.S. Code Title 18, Sections 2, 1001, 1343 and Title 31, Sections 3729-3730 and 3801-3812.
C� F�Le