Identify any changes, challenges, limitations, restrictions, and priorities on meeting the of work requirements. Identify past year program goals and summarize performance outcomes. Provide a summary of select agency accomplishments. If this is a renewal contract, describe at a minimum how has your program developed and made progress toward its goals in the past. What barriers, if any, have impacted your agency’s ability to meet program goals? Describe the agency’s outreach efforts and communication efforts for the program. If fees will be collected from recipients of any services outlined in the Contract Requirements, state the anticipated annual amount of revenue. Also state how those revenues will be used to offset the contract’s costs. STATE OF NEW JERSEY DIVISION OF FAMILY DEVELOPMENT CONTRACT ADMINISTRATOR: CONTRACT NUMBER: NAME OF AGENCY: CONTRACT PERIOD: INDEX OF REQUIRED CONTRACT DOCUMENTS This index provides details of all required documents that must either be included with the contract package (see checklist) or must be available on site for inspections as noted in the Document Verification Sheet (DVS). Forms that are not included in the following pages, can be found by accessing the website at and clicking on the link for Standard Contract Documents. Document Required with Contract and as Amended Required Annually and as Amended Checklist Required for on-site - DVS Form Check if submitted with package Contract Documents Standard Language Document (SLD) with original signatures (additional copies requested must also have original signature) 2 copies Annex A (including summary sheet and supporting schedules) 3 copies B – Budget Form with all required forms, schedules, and signatures 3 copies Executive Order 129 (Public Law 2005, Chapter 92) Source Disclosure Certification Form ● Federal Funding Accountability and Transparency Act (FFATA) Worksheet (if applicable) ● Certification of Suspension and Debarment ●
CONTRACT CHECKLIST CONTRACT ADMINISTRATOR: CONTRACT NUMBER: NAME OF AGENCY: CONTRACT PERIOD: PROVIDER INSTRUCTIONS: This checklist must be completed and returned with all documents prior to contract approval. The correct number of copies and any additional Division documents must be returned to your Contract Administrator. Forms that are not included in the following pages, can be found by accessing the website at and clicking on the link to Standard Contract Documents. Document Number of copies to be submitted Please check if submitted with package If not submitted with package, indicate anticipated date of submission or reason for non-submission Complete copy of signed DHS Standard Language Document (SLD) 2 Checklist, DVS and Award Letter 1 Executive Order 129 Source Disclosure 1 Certification of Suspension or Debarment 1 Standardized Resolution indicating who is authorized to sign: Contracts and Checks 1 Annex A (including summary sheet and supporting schedules) 3 Annex B –Budget Form (Expense Summary, Details and Schedules 1-6) 3 List of Contracts 1 Equipment Inventory 1 Liability Insurance 1 Bonding Certificate 1 Titles, Addresses and Terms of Board of Directors 1 Copy of Audit Report 1 Current Affirmative Action Certificate or copy of renewal application sent to Treasury (AA302) 1 Chapter 51, Public Law 2005—For-Profit agencies only 1 Federal Funding Accountability and Transparency Act (FFATA) Worksheet (if applicable) 1 Copies of Subcontracts 1
STATE OF NEW JERSEY DIVISION OF FAMILY DEVELOPMENT List of Contracts/Grants Check here if this information already appears on the Annex B, Contract Information Form. If so, do not duplicate information here. Contracting Division/Office Program Name Type of Service Contract Number Contract Term Amount Division/Office Contact Person and Number Provider Agency Contact Person and Phone Number