**RENEWABLE ENERGY SYSTEM AND ENERGY EFFICIENCY IMPROVEMENT GRANT
(RES/EEI)**

  ------------------- ---------------------------------------------------
  Name of Grantee:         

  Purpose of Grant:        

  Amount of Grant:         

  Date of Obligation:      

  Name of Project:         
  ------------------- ---------------------------------------------------

+----+-------------------------------------------------+----+----+----+
| ** | **Question**                                    | *  | ** | *  |
| \# |                                                 | *Y | No | *N |
| ** |                                                 | es | ** | /A |
|    |                                                 | ** |    | ** |
+----+-------------------------------------------------+----+----+----+
| 1  | Have any changes in the project costs, source   |    |    |    |
| \. | of funds, use of funds, or any other            |    |    |    |
|    | significant changes in the project been         |    |    |    |
|    | reported and approved by the USDA Rural         |    |    |    |
|    | Development State Office and are part of the    |    |    |    |
|    | file?                                           |    |    |    |
+----+-------------------------------------------------+----+----+----+
| 2  | Have all Requirements and Certifications        |    |    |    |
| \. | required in the Grant Agreement and Letter of   |    |    |    |
|    | Conditions been met? Are documents in the file? |    |    |    |
|    | \[RES/EEI Grant Agreement; Letter of            |    |    |    |
|    | Conditions\]                                    |    |    |    |
+----+-------------------------------------------------+----+----+----+
| 3  | Is the Grantee providing adequate information   |    |    |    |
| \. | with SF 271 "Outlay Report and Request for      |    |    |    |
|    | Reimbursement for Construction Programs" when   |    |    |    |
|    | requesting reimbursements, and does it provide  |    |    |    |
|    | the source and application of funds for         |    |    |    |
|    | grant-supported activities?                     |    |    |    |
+----+-------------------------------------------------+----+----+----+
| 4  | Has the Grantee provided satisfactory evidence  |    |    |    |
| \. | to the **Agency** that bonding or insurance for |    |    |    |
|    | the amount of the grant covers all officers and |    |    |    |
|    | employees of the grantee's organization         |    |    |    |
|    | authorized to receive or disburse Federal       |    |    |    |
|    | funds, and is it in the file? \[Letter of       |    |    |    |
|    | Conditions\]                                    |    |    |    |
+----+-------------------------------------------------+----+----+----+
| 5  | Were grant funds disbursed after all other      |    |    |    |
| \. | funding sources were expended? \[Grant          |    |    |    |
|    | Agreement\]                                     |    |    |    |
|    |                                                 |    |    |    |
|    | Does the file contain information that          |    |    |    |
|    | indicates that the Agency is tracking fund      |    |    |    |
|    | usage and that matching funds and grant funds   |    |    |    |
|    | are used in required proportions?               |    |    |    |
+----+-------------------------------------------------+----+----+----+
| 6  | Has the **Agency** received the quarterly       |    |    |    |
| \. | SF-269 'Financial Status Report' due on April   |    |    |    |
|    | 30, July 31, October 30, and December 31?       |    |    |    |
|    |                                                 |    |    |    |
|    | \[Grant Agreement\]                             |    |    |    |
|    |                                                 |    |    |    |
|    | *- GLS Page: BP Fund Request View Page-Open     |    |    |    |
|    | Routine Servicing Actions*                      |    |    |    |
+----+-------------------------------------------------+----+----+----+
| 7  | Has the Agency received the project performance |    |    |    |
| \. | reports as required by the Grant Agreement due  |    |    |    |
|    | on April 30, July 31, October 30, and December  |    |    |    |
|    | 31?                                             |    |    |    |
|    |                                                 |    |    |    |
|    | \[Grant Agreement\]                             |    |    |    |
|    |                                                 |    |    |    |
|    | *- GLS Page: BP Fund Request View Page-Open     |    |    |    |
|    | Routine Servicing Actions*                      |    |    |    |
+----+-------------------------------------------------+----+----+----+
| 8  | For the year in which the grant funds are       |    |    |    |
| \. | received, has the **Agency** received the       |    |    |    |
|    | annual financial statement (GAAP) within 90     |    |    |    |
|    | days of the end of the Grantee's fiscal year?   |    |    |    |
|    | \[Letter of Conditions\]                        |    |    |    |
|    |                                                 |    |    |    |
|    | *- GLS Page: BP Fund Request View Page-Open     |    |    |    |
|    | Routine Servicing Actions*                      |    |    |    |
+----+-------------------------------------------------+----+----+----+
| 9  | If the project has been completed and all funds |    |    |    |
| \. | have been disbursed, is the *final report* in   |    |    |    |
|    | the case file and does the final report include |    |    |    |
|    | a detailed project funding and expense summary; |    |    |    |
|    | summary of facility installation/construction   |    |    |    |
|    | process including recommendations for           |    |    |    |
|    | development of similar projects by future       |    |    |    |
|    | applicants to the program? \[Grant Agreement\]  |    |    |    |
+----+-------------------------------------------------+----+----+----+
| 10 | Is **Agency** conducting Compliance Reviews as  |    |    |    |
| \. | required (prior to grant closing and 3 years    |    |    |    |
|    | later, unless the final disbursement of grant   |    |    |    |
|    | funds has occurred prior to that date) and      |    |    |    |
|    | completing Compliance Review Demographics       |    |    |    |
|    | information in GLS?                             |    |    |    |
|    |                                                 |    |    |    |
|    | \[RD Instruction 1901-E, § 1901.204(e)\]        |    |    |    |
|    |                                                 |    |    |    |
|    | *- GLS Page: BP Fund Request View Page -- Open  |    |    |    |
|    | Routine Servicing Actions & Routine Servicing   |    |    |    |
|    | Actions*                                        |    |    |    |
+----+-------------------------------------------------+----+----+----+
| ** | **Question**                                    | *  | ** | *  |
| \# |                                                 | *Y | No | *N |
| ** |                                                 | es | ** | /A |
|    |                                                 | ** |    | ** |
+----+-------------------------------------------------+----+----+----+
| 11 | Is GLS up to date, and does it reflect the      |    |    |    |
| \. | current status of the file?                     |    |    |    |
+----+-------------------------------------------------+----+----+----+
| 12 | Is the "Purchase of Renewable Energy System     |    |    |    |
| \. | Project Report" in the case file? *It is due    |    |    |    |
|    | the first full calendar year following the year |    |    |    |
|    | in which project construction was completed and |    |    |    |
|    | continuing for 3 full years.*                   |    |    |    |
|    |                                                 |    |    |    |
|    | \[Grant Agreement\]                             |    |    |    |
+----+-------------------------------------------------+----+----+----+
| 13 | Is the "Energy Efficiency Improvement Project   |    |    |    |
| \. | Report" in the case file? *It is due the first  |    |    |    |
|    | full calendar year following the year in which  |    |    |    |
|    | project construction was completed and          |    |    |    |
|    | continuing for 2 full years.*                   |    |    |    |
|    |                                                 |    |    |    |
|    | \[Grant Agreement\]                             |    |    |    |
+----+-------------------------------------------------+----+----+----+
| 14 | Has the grantee retained financial records,     |    |    |    |
| \. | supporting documents, statistical records, and  |    |    |    |
|    | all other records pertinent to the grant for a  |    |    |    |
|    | period of at least 3 years after final grant    |    |    |    |
|    | disbursement?                                   |    |    |    |
|    |                                                 |    |    |    |
|    | \[Grant Agreement\]                             |    |    |    |
+----+-------------------------------------------------+----+----+----+
| 15 | Has there been any disposition of property?     |    |    |    |
| \. |                                                 |    |    |    |
|    | Disposition requirements \[Grant Agreement\]    |    |    |    |
|    | for real property shall expire 20 years from    |    |    |    |
|    | the date of final grant disbursement.           |    |    |    |
|    |                                                 |    |    |    |
|    | Disposition requirements \[Grant Agreement\]    |    |    |    |
|    | for equipment will expire at the end of each    |    |    |    |
|    | item's useful life.                             |    |    |    |
+----+-------------------------------------------------+----+----+----+

  ---------------------------- --------- --------------------------------
                                         

  **Certifier\'s Signature**             **Certification Date**
  ---------------------------- --------- --------------------------------