will provide ICM services to assist the individual or family to secure an affordable housing arrangement, and will be authorized to provide transitional EA-like payments (e.g., rental payments, security deposits, moving expenses, etc.) for up to six additional months following the SSI-HAP or HHE closing. Required Contract Documents Contracts are to be prepared using the Standard Language Document (SLD), Annex A, and Annex B. Two Standard Language Documents with original signatures must be completed and received at DFD by the date indicated on the award letter. The enclosed checklist and Document Verification Sheet details all required documents and the number of copies that must be returned to DFD. Annex A Instructions The Annex A consists of the written Program narrative.. Please complete the Annex A narrative utilizing the attached outline, answering all questions. The narrative description should include the name the agency that will provide the service and all funding source(s) for the service. The outline, when completed and approved, will become the Annex A and be an integral part of the contract. Total dollar amount of funding allocated and/or maximum unit costs should not be recorded in the Annex A outline Annex B Instructions The Annex B is used to submit the budget and also to report the actual quarterly expenditures. The Annex B Budget must reflect all county costs to administer the program regardless if funding from the contract is utilized to cover the costs. The budget must also properly report the direct and indirect costs including the basis of allocation (i.e. indirect cost allocation methodology) for all costs including the allocation of costs to other programs or unallowable activities per DHS regulations. Under the Personnel Category, identify all staff working directly on the program. Include staff names and titles and specify the hours per week allocated for services in this contract period. Column 1 should reflect the actual annual salary all the salary should be allocated to each service component (including other activities or unallowable costs as applicable per the guidance in the DHS regulations). Please insure that the funding allocations recorded in the Annex B match the funding allocations on the Projected LOS forms. Any costs not recovered by the contract and funded from other sources should be detailed in the Schedule 2 – Other revenue and included in the revenue line. Shelter costs cannot exceed the Division of Family Development approved emergency assistance per diem for the specific shelter or transitional housing facility. Motel costs cannot exceed the payment rates identified at N.J.A.C. 10:90-6.7.
Executive Order 129 Source Disclosure 1 Certification of Suspension or Debarment 1 Standardized Board Resolution indicating who is authorized to sign: Contracts and Checks 1 Annex A – Parts I and II (including summary sheets, supporting schedules and LOS). 3 Annex B –Budget Form (Expense Summary, Details and Schedules 1-6) and required Budget Narrative. 3 List of Grants / Contracts 1 Contract Acquired Equipment Inventory 1 Liability Insurance 1 Bonding Certificate 1 Names, Titles, Addresses and Terms of Board of Freeholders / Directors 1 Copy of Audit Report 1 Current Affirmative Action Certificate or copy of renewal application sent to Treasury (AA302) 1 Disclosure In Investment Activities in Form 1 Federal Funding Accountability and Transparency Act (FFATA) Worksheet (if applicable) 1 Copies of Subcontracts 1 Document Number of Copies to be submitted Notification of Licensed Public Accountant (NLPA) (include copy of Accountant’s Certification) 1 Private/Public Donor Agreement for Match Responsibilities 1 Organization Chart 1 Conflict of Interest Policy 1 1 Disclosure In Investment Activities in Form 1 As Applicable: ACH – Credit authorization for automatic deposits (for new requests only) 1 W-9 Form (for new providers) 1 Other: 1