HomeMy WebLinkAbout20202532.tiffDocuSign Envelope ID: 069EAE87-3081-4C93-84FC-E7DFE6C058A7
DOLA
August 13, 2020
COLORADO
Department of Local Affairs
Division of Local Government
Mike Freeman, Commissioner
Weld County
PO Box 758
Greeley, CO 80632-0758
CVRF
CDFA# 21.019
RE: CVRF-CM-187 - Weld County CVRF 2020 - Allocation and Next Steps Agreement
Dear Commissioner Freeman:
The Colorado Department of Local Affairs (DOLA) has reviewed your opt -in form for the
Coronavirus Relief Fund Program (CVRF), the CARES Act fund authorized under Section II of
Governor Polis' Executive Order 2020 081. As DOLA's Executive Director, I am pleased to
inform you of your allocation of $20,285,692.00. Your submitted opt -in form and this allocation
letter serve as your agreement with the State. Recipients of these funds do not require any
additional contracts.
By accepting the funding, you as the CVRF recipient are agreeing to spend the funds for expenses
related to the public health emergency with respect to Coronavirus Disease 2019 (COVID-19) and
are agreeing to the attached Terms & Conditions.
Payment requests must be submitted using DOLA's online portal system and be accompanied by
the attached "Reimbursement Request" form. Requests may be submitted as often as needed and
at a minimum within 30 days after the end of each quarter (September and December).
Thank you for your interest in the Coronavirus Relief Fund Program. Please contact Audrey Field
at 303-864-7897 with any questions.
Sincerely,
i1.
Rick M. Garcia
Executive Director
cc: Barbara Connolly, Responsible Administrator
Chris La May, DOLA Regional Manager
Governor Jared S. Polis I Rick M. Garcia, Executive Director I Chantal Unfug, Division Director
1313 Sherman Street, Room 521, Denver, CO 80203 P 303.864.7720 TDD/TTY 303.864.7758 www.dola.colorado.eov
etiwu 244 7 7-14-,20A0
2020-2532
DocuSign Envelope ID: 069EAE87-3081-4C93-84FC-E7DFE6C058A7
In accordance with §24-30-202 C.R.S., this Agreement is not valid until signed and dated below by the
State Controller or an authorized delegate.
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
CDocuSigned by:
� L -04d
9C3D102D59B2427...
By: Yingtse Cha, Controller Delegate
Department of Local Affairs
Effective Date: 8/13/2020 I 1:11 PM MDT
CMS# 162549 VCUST# 14294 ADDR CN007 EFT DLG# F2ICVRFCM187
THE REST OF THIS PAGE INTENTIONALLY LEFT BLANK
Governor Jared S. Polls I Rick M. Garcia, Executive Director I Chantal Unfug, Division Director
1313 Sherman Street, Room 521, Denver, CO 80203 P 303.864.7720 TDD/TTY 303.864.7758 www.dola.colorado.gov
DocuSign Envelope ID: 069EAE87-3081-4C93-84FC-E7DFE6C058A7
Coronavirus Relief Fund
Terms & Conditions
1. Catalog of Federal Domestic Assistance (CFDA) Number: 21.019
2. Funding Period: March 1, 2020 through December 30, 2020
3. Use of Funds
a . Recipient shall spend the funds only on necessary expenditures incurred due to
the public health emergency with respect to COVID-19 in accordance with
Section 5001(d) of the CARES Act for costs incurred during the above Funding
Period and were not accounted for in the local government's budget most recently
approved as of March 27, 2020 (the date of enactment of the CARES Act).
b . Recipient incurring costs shall refer to the most current guidance and answers to
frequently asked questions on the CARES Act, which includes those from the
U.S. Treasury, the Office of State Controller, and the Department of Local Affairs
(DOLA).
c . Ineligible Expenses
i. Recipient acknowledges that the Duplication of Benefits, or assistance
from more than one source that is used for the same mitigation purpose or
activity, is prohibited.
ii. Expenditures that do not adhere to official federal guidance including
Section 5001(d) of the CARES Act and State guidance are ineligible and
shall be returned to DOLA within 30 days of identification of improper
fund use.
iii. Refer to guidance from the U.S. Treasury, the Office of the State
Controller, and DOLA's Nonexclusive Examples of Ineligible
Expenditures for further guidance.
4. Compliance
a . Recipient shall follow the Federal Funding Accountability and Transparency Act
(FFATA) terms and conditions, OMB's Uniform Guidance (2 C.F.R. Part 200): 2
C.F.R 2 §200.303 regarding internal controls, 2 C.F.R. §§200.330 through
200.332 regarding subrecipient monitoring and management, and subpart F
regarding audit requirements, and the 2019 OMB Compliance Supplement. If
Recipient plans to subaward parts of its allocation to other local governments,
Recipient shall first obtain DOLA's approval. If DOLA approves, the Recipient
shall comply with the responsibilities of a pass -through entity per the Uniform
Guidance. Use this link for access to the FFATA reporting form.
b . Recipient shall comply with the CARES Act and official federal guidance as
determined by the State, including any requirements added or amended in the
future due to additional guidance from the federal government (Office of
Management and Budget (OMB) or U.S. Treasury), and any guidance from the
State including the Office of the State Controller (OSC), the Office of State
Planning and Budgeting (OSPB), and DOLA.
5. Documentation. Recipient shall retain documentation on all uses of the funds, including
invoices, sales receipts, time and effort reporting, data and financial records, and any
other documentation that establishes compliance for up to five (5) years after final
payment is made using CRF funds. Such documentation shall be provided to DOLA or its
duly authorized representatives upon request.
6. Monitoring.
a . DOLA shall randomly select recipient counties, municipalities, or special districts
for detailed monitoring of program fund expenditures. Recipient shall provide
Page 1
DocuSign Envelope ID: 069EAE87-3081-4C93-84FC-E7DFE6C058A7
supporting documentation for program fund expenditures promptly to DOLA, if
requested, to conduct necessary monitoring.
b . DOLA, the State of Colorado, or federal government reserves the right to initiate
detailed monitoring or auditing of any recipient at its sole discretion.
c . Monitoring may be onsite or by desk review and will include verification of
quarterly reports using receipts and other financial documentation as provided by
the recipient.
d. The review shall provide assurance that the information self -reported by Recipient
is accurate and complete, and identify unallowable or questionable expenditures
for follow-up. When concerns are noted during the review process, the Recipient
shall provide documentation of the expenditures or accounting practices to DOLA
for verification.
7. Financial Reporting.
a . Recipient shall provide DOLA with itemized reimbursement requests as often as
needed and at a minimum within 30 days after the end of each quarter
(September, and December).
b . Recipient shall report costs in the categories listed on the reimbursement request
form.
c . Recipient shall inform DOLA immediately if funds allocated will not be fully
utilized by December 30, 2020. DOLA, at its sole discretion, may unilaterally
deobligate such balances and make them available, in whole or in parts, for use by
other recipients.
d . All final reporting and any required documentation shall be completed by your
organization and returned to DOLA by January 31, 2021. DOLA will deobligate
any remaining balances.
8. In the event of a conflict between the terms and conditions of the Opt -in Form, and the
terms and conditions of this allocation letter, the terms and conditions of this allocation
letter shall prevail.
THE REST OF THIS PAGE INTENTIONALLY LEFT BLANK
Page 2
DocuSign Envelope ID: 069EAE87-3081-4C93-84FC-E7DFE6C058A7
CORONAVIRUS RELIEF FUND (CVRF)
REIMBURSEMENT REQUEST
Please only enter information on this sheet in the yellow highlight areas. Do..
7/28/2020°`ra°
COLORADO
Athii
Department cif IAds
ohtiRevised:
1. Grantee Organization:
5. Service Dates:
2. Contract Number:
Start Date
End Date
3. Reimbursement Request #:
4. Final Request? Enter Yes or No
Totals in Rows 7 and 10 on this Sheet will autofill from the 10 Transfer/Expense tabs. DO NOT enter financial information in cells E7 and E10.
6a. TOTAL CVRF FUNDS CURRENTLY BEING REQUESTED
$0.00
6b. TOTAL CONTRACT AMOUNT
6c. CONTRACT BALANCE BEFORE THIS REQUEST
6d. CONTRACT BALANCE AFTER THIS REQUEST
$0.00
Eligible transfers or expenses incurred due to the public health emergency
Cells below
heels. the 10
expense sheets.
7a
7a - Funds Transferred to Other Governments
$0.00
7b - Payroll Expenses for Public Health and Safety Employees
$0.00
7c - Expenses for Budgeted Personnel and Services Diverted to a Substantially Different Use
$0.00
7d - Expenses to Improve Telework Capabilities of Public Employees
$0.00
7e - Medical Expenses
$0.00
7f - Public Flealth Expenses
$0.00
7g - Expenses to Facilitate Distance Learning
$0.00
7h - Expenses Providing Economic Support
$0.00
7i - Expenses Associated with Issuance of Tax Anticipation Notes
$0.00
7j - Other COVID-19 related expenses reasonably necessary to governments function
$0.00
8. Compliance with CARES Act: This request includes only necessary expenditures:
a.) incurred due to the public health emergency with respect to the Coronavirus Disease 2019,
b.) were not accounted for in the budget most recently appproved as of March 27, 2020, and
c.) were incurred during the period that begins on March 1, 2020 and ends on December 30, 2020.
Check "Yes" or "No" in the 3
cells below.
U Yes U vo
9. Please confirm that your organization is retaining all supporting documentation for this request and any audits.
Q Yes ❑ No
10. Please confirm that your organization is not using other Federal funds for the reimbursements in this request.
❑ Yes Li No
11. Federal Funding Compliance Certification
By signing this report, I certify to the best of my knowledge and belief that the report
is true, complete, and accurate, and the expenditures, disbursements and cash
receipts are for the purposes and objectives set forth in the terms and conditions of
the Federal award. I am aware that any false, fictitious, or fraudulent information, or
the omission of any material fact, may subject me to criminal, civil or administrative
penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18,
12. SIGNATURE OF AUTHORIZED INDIVIDUAL below:
- -
PRINT NAME, TITLE, and DATE below:
Section 1001 and Title 31, Sections 3729-3730 and
3801-3812).
Submittal Note: When complete, print or save all tabs in this spreadsheet (11 sheets total) as a PDF. Then submit as a single PDF in your Portal acct.
DocuSign Envelope ID: 069EAE87-3081-4C93-84FC-E7DFE6C058A7
1
2
3
4
5
6
7
8
9
10
7a Funds Transferred/Passed Through to Other Governments due to the COVID-19 public
health emergency
Eligible fund transfers include: funds that your organization has passed through to another unit of local government. See Federal Guidance.
Ineligible fund transfers include: Expenses that have or will be reimbused by another federal program, reimbursement to donors, workforce bonuses
other than hazard pay, severance pay and legal settlements. See Federal Guidance.
Notes: Please retain all backup and supporting documentation including but not limited to email communications, contracts, receipts, invoices, budget
records and ledgers for possible monitoring and audit for 5 years after final transfer is made. Do not provide any of that backup documentation with this
request. Totals on this sheet will autofill to the Request Form. Add as many rows below as needed.
Total Transfer
$
Date of
Transfer
List of Local Government Pass Through Entities
Amount Transferred
DocuSign Envelope ID: 069EAE87-3081-4C93-84FC-E7DFE6C058A7
1
2
3
4
5
6
7
8
9
10
7b Payroll Expenses for Public Health and Safety Employees due to the COVID-19 public health
emergency
Eligible expenses include: payroll for public health and public safety employees whose services are substantially dedicated to mitigating or responding to the
COVID-19 public health emergency. See Federal Guidance.
Ineligible expenses include: Expenses that have or will be reimbused by another federal program, reimbursement to donors, workforce bonuses other than
hazard pay, severance pay and legal settlements. See Federal Guidance.
Notes: Please retain all backup and supporting documentation including but not limited to email communications, contracts, receipts, invoices, budget records
and ledgers for possible monitoring and audit for 5 years after final payment is made. Do not provide any of that backup documentation with this request.
Totals on this sheet will autofill to the Request Form. Add as many rows below as needed.
Total Request
$ -
Date of
Payment
Invoice or
Billing Number
Description of Public Health and/or Public Safety Employee Expenses
Amount
DocuSign Envelope ID: 069EAE87-3081-4C93-84FC-E7DFE6C058A7
1
2
3
4
5
6
7
8
9
10
7c Expenses on Budgeted Personnel Diverted to a Substantially Different Use due to the COVID-
19 public health emergency
Eligible expenses include: Costs incurred for a "substantially different use" include, but are not necessarily limited to, costs of personnel and services that
were budgeted for in the most recently approved budget but which, due entirely to the COVID-19 public health emergency, have been diverted to substantially
different functions. This would include, for example, the costs of redeploying corrections facility staff to enable compliance with COVID-19 public health
precautions through work such as enhanced sanitation or enforcing social distancing measures; the costs of redeploying police to support management and
enforcement of stay-at-home orders; or the costs of diverting educational support staff or faculty to develop online learning capabilities, such as through
providing information technology support that is not part of the staff or faculty's ordinary responsibilities. See Federal Guidance.
Ineligible expenses include: Expenses that have or will be reimbused by another federal program, reimbursement to donors, workforce bonuses other than
hazard pay, severance pay and legal settlements. See Federal Guidance.
Notes: Please retain all backup and
and ledgers for possible monitoring
Totals on this sheet will autofill to the
supporting documentation including but not limited to email communications, contracts, receipts, invoices,
and audit for 5 years after final payment is made. Do not provide any of that backup documentation
budget records
with this request.
Request Form. Add as many rows below as needed.
Total Request
$ -
Date of
Payment
Invoice or
Billing Number
Description of Budgeted Personnel Expenses Diverted to Substantially Different Use
Amount
DocuSign Envelope ID: 069EAE87-3081-4C93-84FC-E7DFE6C058A7
1
2
3
4
5
6
7
8
9
10
7d Expenses on Improving Telework Capabilities of Public Employees due to the COVID-19 public
health emergency
Eligible expenses include: Telework expenditures must be limited to those that are necessary due to the public health emergency. See Federal Guidance.
Ineligible expenses include: Expenses that have or will be reimbused by another federal program, reimbursement to donors, workforce bonuses other than
hazard pay, severance pay and legal settlements. See Federal Guidance.
Notes: Please retain all backup and
and ledgers for possible monitoring
on this sheet will autofill to the Request
supporting documentation including but not limited to email communications, contracts, receipts, invoices,
and audit for 5 years after final payment is made. Do not provide any of that backup documentation with
budget records
this request. Totals
Form. Add as many rows below as needed.
Total Request
$ -
Date of
Payment
Invoice or
Billing Number
Description of Telework Expenses
Amount
DocuSign Envelope ID: 069EAE87-3081-4C93-84FC-E7DFE6C058A7
1
2
3
4
5
6
7
8
9
10
7e Medical Expenses incurred due to the COVID-19 public health emergency
Eligible expenses include: costs of testing, emergency response, establishing telemedicine. See Federal Guidance.
Ineligible expenses include: Expenses that have or will be reimbused by another federal program, reimbursement to donors, workforce bonuses other
than hazard pay, severance pay and legal settlements. See Federal Guidance.
Notes: Please retain all backup and
records and ledgers for possible monitoring
request. Totals on this sheet will autofill
supporting documentation including but not limited to email communications, contracts, receipts,
and audit for 5 years after final payment is made. Do not provide any of that backup documentation
invoices, budget
with this
to the Request Form. Add as many rows below as needed.
Total Request
$
Date of
Payment
Invoice or
Billing Number
Description of Medical Expenses
Amount
DocuSign Envelope ID: 069EAE87-3081-4C93-84FC-E7DFE6C058A7
1
2
3
4
5
6
7
8
9
10
7f Public Health Expenses incurred due to the COVID-19 public health emergency
Eligible expenses include: communication and enforcement, acquisition and distribution of medical and protective equipment, disinfection, public safety
measures and quarantine expenses. See Federal Guidance.
Ineligible expenses include: Expenses that have or will be reimbused by another federal program, reimbursement to donors, workforce bonuses other than
hazard pay, severance pay and legal settlements. See Federal Guidance.
Notes: Please retain all backup and
and ledgers for possible monitoring
Totals on this sheet will autofill to
supporting documentation including but not limited to email communications, contracts, receipts, invoices,
and audit for 5 years after final payment is made. Do not provide any of that backup documentation with
budget records
this request.
the Request Form. Add as many rows below as needed.
Invoice or
Billing
Number
Total Request
$ -
Date of
Payment
Description of Public Health Expenses
Amount
DocuSign Envelope ID: 069EAE87-3081-4C93-84FC-E7DFE6C058A7
7g Distance Learning Expenses incurred due to the COVID-19 public health emergency
1
2
3
4
5
6
7
8
9
10
Eligible expenses include: Expenses related to facilitating Distance Learning that are necessary for the public health emergency. See Federal Guidance.
Ineligible expenses include: Expenses that have or will be reimbused by another federal program, reimbursement to donors, workforce bonuses other
than hazard pay, severance pay and legal settlements. See Federal Guidance.
Notes: Please retain all backup and supporting documentation including but not limited to email communications, contracts, receipts, invoices, budget
records and ledgers for possible monitoring and audit for 5 years after final payment is made. Do not provide any of that backup documentation with this
request. Totals on this sheet will autofill to the Request Form. Add as many rows below as needed.
Total Request
$
Date of
Payment
Invoice or
Billing
Number
Description of Distance Learning Expenses
Amount
DocuSign Envelope ID: 069EAE87-3081-4C93-84FC-E7DFE6C058A7
7h Economic Support Expenses incurred due to the COVID-19 public health emergency
1
2
3
4
S
6
7
8
9
10
Eligible expenses include: cost of provision of grants to small businesses, state, local or tribal payroll support, and unemployment insurance costs related to
the COVID-19 health emergency. See Federal Guidance.
Ineligible expenses include: Expenses that have or will be reimbused by another federal program, reimbursement to donors, workforce bonuses other than
hazard pay, severance pay and legal settlements. See Federal Guidance.
Notes: Please retain all backup and
records and ledgers for possible monitoring
request. Totals on this sheet will autofill
supporting documentation including but not limited to email communications, contracts, receipts, invoices,
and audit for 5 years after final payment is made. Do not provide any of that backup documentation
budget
with this
to the Request Form. Add as many rows below as needed.
Total Request
$ -
Date of
Payment
Invoice or
Billing
Number
Description of Economic Support Expenses
Amount
DocuSign Envelope ID: 069EAE87-3081-4C93-84FC-E7DFE6C058A7
1
2
3
4
5
6
7
8
9
10
7i Expenses Associated with Issuance of Tax Anticipation Notes due to the COVID-19 public
health emergency
Eligible expenses include: Costs associated with issuance of tax anticipation notes. See Federal Guidance.
Ineligible expenses include: Expenses that have or will be reimbused by another federal program, reimbursement to donors, workforce bonuses other
than hazard pay, severance pay and legal settlements. See Federal Guidance.
Notes: Please retain all backup and
records and ledgers for possible monitoring
request. Totals on this sheet will autoflll
supporting documentation including but not limited to email communications, contracts, receipts,
and audit for 5 years after final payment is made. Do not provide any of that backup documentation
invoices, budget
with this
to the Request Form. Add as many rows below as needed.
Total Request
$
®ate of
Payment
Invoice or
Billing
Number
Description of Tax Anticipation Note Issuance Expenses
Amount
DocuSign Envelope ID: 069EAE87-3081-4C93-84FC-E7DFE6C058A7
1
2
3
4
5
6
7
8
9
10
7j Other Related Expenses Incurred due to the COVID-19 public health emergency
Eligible expenses include: expenses for items not listed in the other categories on the combined reimbursement form. See Federal Guidance.
Ineligible expenses include: Expenses that have or will be reimbused by another federal program, reimbursement to donors, workforce bonuses other than
hazard pay, severance pay and legal settlements. See Federal Guidance.
Notes: Please retain all backup and
records and ledgers for possible monitoring
request. Totals on this sheet will autofill
supporting documentation including but not limited to email communications, contracts, receipts, invoices,
and audit for 5 years after final payment is made. Do not provide any of that backup documentation
budget
with this
to the Request Form. Add as many rows below as needed.
Total Request
$
Date of
Payment
invoice or
Billing Number
Description of Other Related Expenses
Amount
Hello