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TOTAL PAYMENT REQUEST
$1269580.00
$48,173.38
225914.38 $55,492.24
Everything below this tine is for Dept of Commerce
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'NUMBER:
621FO320
NZ
$
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21-62210-005
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SIGNATURE OF ACCOUNTING PREPARER FOR PAYMENT DATE WARRANT TOTAL
ACCOUNTING APPROVAL FOR PAYMENT
DATE
STATE OF WASHINGTON COMMUNITY DEVELOPMENT BLOCK GRANT - PUBLIC SERVICES GRANTS
DEPT OF COMMERCE
ATTN: CDBG PROGRAM
PO BOX 42525 CERTIFICATION: I. certify that the information on this form is a
OLYMPIA, WA 98504-2.525 true and accurate report of the cash status and that all reported
expenditures are properly chargeable to the referenced grant.
COMMUNITY ACTION AGENCY SUBRECiPIENT;
CONTRACT NO: Signature:
OIG OF WASHINGTON 21-62210-005Mr lu
$1.5_.FRUITVALE.BLVD REPORT PERIOD: Printed Name: DEREJE MEKURIA
YAKWA WA 98.902 Apr-22
REPORT NUMBER: Title: CFO
10
Date: 6/28/2022
TOTAL AMOUNT REQUESTED THIS PERIOD: $22,914.38
1. Name of Service Program: Asset Development & Other Asset Development 80 ICDBG amount requested for these program activities thisperiod: $4,104.09
Description of service program how low- and moderate-income (LMI) persons were served this period: Housing counseling, credit coaching,
foreclosure services, business start-up, financial education workshops and high school classes. Free tax-prep.
2. Name of Service Program: Energy Assistance 148 11CDBG amount requested for these program activities thisperiod: $7,670.80
Description of service program how low- and moderate-income (LMI) persons were served this period: Energy assistance and conservation
education.
3.Name of Service Activity: Asset Develop/Energy Develop/EnergyAssist Admin-Indirect Admin IICDBG amount requested for these program activities this period: $119139.49
Description of service program how low- and moderate-income (LMI) persons were served this period: General administration expenses associated
with managing energy assistance and asset development activities oversight and assessments. Indirect admin.
Contract 21-62210-005
Submitted to GC by: OIC OF WASHINGTON
Request for Reimbursement No. 09
APRIL 2022
Grant County's Subrecipient Checklist:
State Auditor's Office Audit Procedures for Testing Activities Allowed
And Not Allowed, As Published In 2007
Questions to ask before submitting a payment request
Was the expenditure or cost:
X Made for an allowable activity under the grant guidelines?
X Authorized (or not prohibited) under state or local laws or regulations?
X Approved by the federal awarding agency, if required?
N/A Allowable per Circular A-87 (June 2004 version), Attachment B, items 1-43?
For payroll transactions:
X Does the employee's time and effort documentation meet the requirements of
Circular A-1 22?
X Allocable to the program? (i.e., was the dollar amount charged to the program
relative to the benefits received by the program? Is the federal grantor being
charged its fair share of the cost?)
X Based on actual costs, not budgeted or projected amounts?
X Applied uniformly to federal and non-federal activities (i.e., is the federal
government being charged the same amount as if non-federal funds were being
used to pay the cost)?
X Given consistent accounting treatment within and between accounting periods?
(Consistency in accounting requires that costs incurred for the same purpose, in
like circumstances, be treated as either direct costs only or indirect costs only
with respect to ' final cost objectives).
X Calculated in conformity with generally accepted accounting principles, or
another comprehensive basis of accounting, when required under the applicable
cost principles?
X Not included as a cost (or used to meet cost sharing requirements) of other
federally -supported activities of the current or a prior period?
X Net of all applicable credits? (e.g., volume or cash discounts, insurance
recoveries, refunds, rebates, trade-ins, adjustments for checks not cashed, and
scrap sales).
N/A Not included as both a direct billing and as a component of indirect costs?
N/A Properly classified (e.g., some costs may be incorrectly claimed as a direct cost
instead of being incorporated as part of the indirect cost rate).
X Supported by appropriate documentation? (e.g., approved purchase orders,
receiving reports, vendor invoices, canceled checks, and time and attendance
records.) Documentation may be in an electronic form.
X Correctly charged to the proper account code and grant period?
C:\Users\Eliza Baysinger\Accounting_yliza\Grants—contracts\Grants—Contracts 20222023\267CDBG (EB)\2- Billings\04-
2022\Subrecipient Checklist 2020-21.doc Page 1
General Ledger System
OIC OF WASHINGTON
For User: Eliza Baysinger
RW Expenditure report for: 267 - 267 CDBG
Report year: 7/1/2021 thru 6/30/2022 Period ending: April 2022
------------Monthly-----------------------------To Date ------------
Account
Adrnn Admin - Asset Dev/Energy Asst
Asst Asst Dev & Othr Asst Developern
Ener Energy Assistance
Report Totals
0 0 *
2 5 hi, 2 4 Ar
5 4 5 0: +
2 2 9 1 1.
Page: Page 1 of 1
Date: 6/24/2022
TIrne: 10:04:42 AM
Budget Expenditures Pct Budget
Expenditures
Pct Annual budget
Unexpended
$2,051.00 $8,685.25 423.46% $20,510.00
$14,899.11
72.64% $24,616.00
$9,716.89
$6,416.00 $4,049.59 63.12% $64,046.00
$41,553.51
64.88% $77,017.00
$35,463.49
$1,783.00 $7,670.80 430.22% $17,830.00
$14,635.14
82.08% $21,447.00
$6,811.86
$10,250.00(E—,4:0:564199.08% $102,396.00
$71,087.76
69.43% $123,080.00
$51,992.24
Billing Category txtperiod year
Fundl Deptl Prog Subl' Objectl objectname Transactior Transactiol Documentl` Description
AmountDR
Asset Dev & Ot March 2022
267
01*0
25
5602
DEPRECIATION EXP EQ 5/10/2022
AJE
141488
3/22 Server Depreciation Expe
$6.47
Asset Dev & Ot March 2022
267
010
50
5601
DEPRECIATION EXP BLI5/10/2022
AJE
141475
3/22 depreciation expe.
$48.03
Asset Dev & Othr Total
March 2022
Admin Indirect
267
009
02
53:12
SALARY ADM. ALLOCK 5/16/2022
AJE
141584
Admin Pool Salary &Benefits
2/.22Alloc
$1,534.04
March 2022
Admin Indirect
267
009
02
5354
P/R TAX & BEN. ADM AL 5/16/2022
AJE
141584
.3/Admin Pool Salary & Benefits
Alloc
$659.50
Admin Indirect March 2022
267
009
02
5999
NON PERSONNEL ADM. 5/16/2022
AJE
141571
03/2022 Admin Pool Allocation
$260.70
" '"itotal
Admin Indid
454:24
Grand Total
!$21,508.74
General Ledger System
OIC OF WASHINGTON
For User: Eliza Baysinger
Fund Expenditure report for: 267 - CDBG PS 7/1/21-6/30/22 (Fund status: Active)
Report year: 7/1/2021 thru 6/30/2022 Period ending: April 2022
Page: Page 1 of 2
Date: 6/24/2022
Time: 10:04:04 AM
-------------Monthly-,---------
----------------To Date ------------
Account
Budget
Expenditures
Pct
Budget
Expenditures
Pct
Annual budget
Unexpended
Department: 009 INDIRECT ADMIN
Program: 02 ADMIN. POOL -BASE
5312 SALARY ADM. ALLOCATION
$1,191.00
$4,725.40
396.76%
$11,910.00
$8,333.27
69.97%
$14,293.00
$5,959.73
5354 P/R TAX & BEN. ADM ALLOC.
$586.00
$2,085.40
355.87%
$5,860.00
$3,861.34
65.89%
$7,035.00
$3,173.66
5999 NON PERSONNEL ,ADM. ALLOC.
$274.00
$1,874.45
684.11%
$2,740.00
$2,704.50
98.70%
$3,288.00
$583.50
Total for sub program
$2,051.00
$8,685.25
423.46%
$20,510.00
--- - ---------- - --
$14,899.11
72.64%
$24,616.00
- - --- ----------------
$9,716.89
Total for program 02 ----->
$2,051.00
$8,685.25
423.46%
$20,510.00
$14,899.11
72.64%
$24,616.00
$9,716.89
Total for department 009 _.>
$2,051.00
$8,685.25
423.46%
$20,510.00
$14,899.11
72.64%
$24,616.00
$9,716.89
Department: 010 PROGRAM
Program: 25 PROGRAM SUPPORT
5311 SALARIES,WAGES EXPENSE
$4,162.00
$2,405.00
57.78%
$41,620.00
$26,619.76
63.96%
$49,954.00
$23,334.24
5351 FICA,OIC EXP
$303.00
$176.77
58.34%
$3,030.00
$1,941.59
64.08%
$3,647.00
$1,705.41
5352 L AND I,OIC SHARE
$23.00
$14.89
64.74%
$230.00
$156.61
68.09%
$287.00
$130.39
5353 STATE UCI(ES),OIC EXP
$64.00
$34.15
53.36%
$640.00
$424.02
66.25%
$777.00
$352.98
5355 PAID FAMILY MEDICAL LEAVE
$26.00
$14.43
55.50%
$260.00
$167.45
64.40%
$321.00
$153.55
5360 DISABILITY OIC EXPENSE
$57.00
$31.14
54.63%
$570.00
$360.75
63.29%
$689.00
$328.25
5361 MEDICAL INSURANCE,01C EXP
$879.00
$403.89
45.95%
$8,790.00
$5,630.76
64.06%
$10,550.00
$4,919.24
5362 LIFE INSURANCE,01C EXP
$22.00
$12.35
56.14%
$220.00
$143.12
65.05%
$274.00
$130.88
5363 PENSION,OIC EXP
$312.00
$168.35
53.96%
$3,120.00
$1,953.55
62.61%
$3,750.00
$1,796.45
5364 ACCRUED PTO EXP
$473.00
$181.11
38.29%
$4,730.00
$3,186.86
67.38%
$5,686.00
$2,499.14
5602 DEPRECIATION EXP EQUIP
$0.00
$2.09
0.00%
$0.00
$8.56
0.00%
$9.00
$0.44
5910 INSURANCE
$19.00
$3.02
15.89%
$76.00
$77.93
102.54%
$114.00
$36.07
5960 COMMUNICATION
$56.00
$349.11
623.41%
$560.00
$439.33
78.45%
$682.00
$242.67
Total for sub program ----->
$6,396.00
$3,796.30
59.35%
$63,846.00
$41,110.29
64.39%
$76,740.00
$35,629.71
Sub program: 54 ENERGY ASSISTANCE
5311 SALARIES,WAGES EXPENSE
$1,191.00
$5,181.96
435.09%
$11,910.00
$9,758.27
81.93%
$14,300.00
$4,541.73
5351 FICA,OIC EXP
$87.00
$382.40
439.54%
$870.00
$712.77
81.93%
$1,045.00
$332.23
General Ledger System
OIC OF WASHINGTON
For User: Eliza Baysinger
Page: Page 2 of 2
Fund Expenditure report for: 267 - CDBG PS 7/1/21-6/30/22 (Fund status: Active)
Date: 6/24/2022
Report year: 7/1/2021 thru 6/30/2022
Period ending: April
2022
Time: 10:04:05
AM
---------------Monthly----_________
_...--------------To
Date--___--------
Account
Budget
Expenditures Pct
Budget
Expenditures
Pct
Annual budget
Unexpended
5352 L AND I,OIC SHARE
$7.00
$31.92 456.00%
$70.00
$62.01
88.59%
$91.00
$28.99
5353 STATE UCI(ES),OIC EXP
$18.00
$73.56 408.67%
$180.00
$147.26
81.81%
$216.00
$68.74
5355 PAID FAMILY MEDICAL LEAVE
$7.00
$32.56 465.14%
$70.00
$61.83
88.33%
$91.00
$29.17
5360 DISABILITY OIC EXPENSE
$16.00
$75.06 469.13%
$160.00
$138.59
86.62%
$203.00
$64.41
5361 MEDICAL INSURANCE,OIC EXP
$223.00
$812.87 364.52%
$2,230.00
$1,828.31
81.99%
$2,679.00
$850.69
5362 LIFE INSURANCE,OIC EXP
$6.00
$29.83 497.17%
$60.00
$55.12
91.87%
$81.00
$25.88
5363 PENSION,OIC EXP
$88.00
$379.97 431.78%
$880.00
$721.36
81.97%
$1,057.00
$335.64
5364 ACCRUED PTO EXP
$136.00
$659.18 484.69%
$1,360.00
$1,115.29
82.01%
$1,634.00
$518.71
5910 INSURANCE
$4.00
$11.49 287.25%
$40.00
$34.33
85.83%
$50.00
$15.67
Total for sub program 54 ----->
$1,783.00
$7,670.80 430.22%
$17,830.00
$14,635.14
82.08%
$21,447.00
$6,811.86
Total for program 25 ----->
$8,179.00
$11,467.10 140.20%
$81,676.00
$55,745.43
68.25%
$98,187.00
$42,441.57
Program: 50 BLDG MAINT/FACILITY
5601 DEPRECIATION EXP BLDG.
$5.00
$39.29 785.80%
$50.00
$87.32
174.64%
$70.00
($17.32)
5602 DEPRECIATION EXP EQUIP
$0.00
$0.03 0.00%
$0.00
$0.03
0.00%
$0.00
($0.03)
5611 SPACE
$3.00
$76.31 2543.67%
$30.00
$101.75
339.17%
$37.00
($64.75)
5630 UTILITIES
$5.00
$51.63 1032.60%
$50.00
$97.34
194.68%
$67.00
($30.34)
5640 BUILD. REPAIR/MAINT.
$6.00
$70.75 1179.17%
$60.00
$127.66
212.77%
$83.00
($44.66)
5910 INSURANCE
$0.00
$0.03 0.00%
$0.00
$0.03
0.00%
$0.00
($0.03)
5912 LIABILITY INSURANCE
$1.00
$15.25 1525.00%
$10.00
$29.09
290.90%
$20.00
($9.09)
..............
Total for sub program ----->
. .......... ..
$20.00
$253.29 1266.45%
..
$200.00
........
$443.22
221.61%
$277.00
($166.22)
Total for program 50 ----->
$20.00
$253.29 1266.45%
$200.00
$443.22
221,61%
$277.00
($166.22)
Total for department 010 ---->
$8,199.00
$11,720.39 142.95%
$81,876.00
$56,188.65
68.63%
$98,464.00
$42,275.35
Fund Totals
$10,250.00
$20,405.64 99.08%
$102,386.00
$71,087.76
69.43%
$123,080.00
$51,992.24