Backup Documents 09/09/2014 Item #16J1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SI P
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT I
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SI A
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office JAB 9/12/14
4. BCC Office Board of County TN by
Commissioners "OD A k( t9 l l a)l j
5. Minutes and Records Clerk of Court's Office
M f(2--(14 2: a:
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Melissa Blazier, CERA,MFCEP Phone Number 252-8333
Contact/ Department Chief Dep ty Supervisor of Elections
Agenda Date Item was 9/9/14 Y Agenda Item Number 16-J-1
Approved by the BCC
Type of Document Supervisor of Elections Certificates Number of Original Two
Attached Documents Attached
PO number or account Contact Melissa when ready
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A" in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? JAB
2. Does the document need to be sent to another agency for additional signatures? If yes, JAB
provide the Contact Information(Name; Agency;Address; Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be JAB
signed by the Chairman, with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's JAB
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the JAB
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's JAB
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip JAB
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 9/9/14 and all changes made during the JAB
meeting have been incorporated in the attached document. The County Attorney's ;�.
Office has reviewed the changes.,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the JAB
pp Y
BCC,all changes directed by the BCC have been made, and the document is ready for the
Chairman's signature. 0
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MEMORANDUM
Date: September 16, 2014
To: Melissa Blazier, Chief Deputy
Supervisor of Elections Office
From: Ann Jennejohn, Deputy Clerk
Board Minutes & Records Department
Re: Agreement authorizing acceptance of federal election activity
funds and Chairman's signature on certificates regarding
matching funds and equipment for casting and counting ballots
Attached for further processing with Florida's Division of Elections are the original
signed documents referenced above, (Item #16J1) approved by the Board of County
Commissioners on September 9, 2014.
Our office will maintain copies of the documents for the Board's Official Record.
If you have any questions, please feel free to contact me at 252-8406.
Thank you.
Attachment
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FLORIDA DEPARTMENT Of STATE
RICK SCOTT KEN DETZNER
Governor Secretary of State
MEMORANDUM
To: Supervisors of Elections
■From: Maria Matthews, Esq.
Director, Division of Elections�� ' ��
■
Date: July 11, 2014
Subject: FY 2014-15 Federal Election Activities Funds
The 2014 Legislature appropriated $3,000,000 from the Help America Vote Act funds. These
funds are allocated and will be distributed to the Supervisors of Elections based on a formula
using the number of active registered voters in each county as of the 2012 General Election's
book closing.
These funds can only be spent for one or more of the following federal election activity
categories:
• Voter Education;
• Poll Worker Training;
• Standardizing Election Results Reporting;
• Other Federal Election Administration Activities, as approved by the Department of
State.
Please read the following attached documents carefully as some have been revised to clarify
allowable expenses. Before receiving the funds for FY 2014-2015. you must execute and return
to the Division of Elections the documents italicized below:
• Memorandum of Agreement, Receipt and Use of HA VA Funds for Federal Election
Administration Activities (MOA 42014-201 5-0001)
• Attachment A, Compliance Requirements
• Attachment A-I, Federal Election Activities Plan (Form DS-DE 126)
• Attachment A-2, Certificate Regarding Matching Funds (Form DS-DE 127)
• Attachment A-3, Certification Regarding Debarment, Suspension, Ineligibility and
Voluntary Exclusion Lower Tier Covered Transactions, ED Form GCS-009
It■ Division of Elections
R.A. Gray Building. Suite 316 • 500 South Bronough Street •Tallahassee, Florida 32399
850.245.6200. 850.245.6217 (Fax) election.dos.state.fl.us FLORIDA
Promoting Florida's History and Culture VivaFlorida.org ELECTIONS 4
In FIORIOA.
FY 2014-2015 Federal Election Activities Funds
July 11, 2014 16 J 1
Page 2 of 2
• Attachment A-4, Certificate of Equipment for Casting and Counting Ballots(Form DS-
DE 135)
• Attachment B, FY 2014-15 Federal Election Activities Funds Spreadsheet.
In an effort to assist you with expenditures, we have also attached a spreadsheet, "HAVA Funds
Remaining Balance as of June 30, 2013", that captures the HAVA balances as of June 30, 2013
and for all HAVA grants for each fiscal year since FY 2003-04. We do not yet have the balance
reports through June 30, 2014. This spreadsheet includes the allowable expenses of HAVA
funds by year. As you can see, some counties have balances for grant funds from many years
ago.
Please use your older HAVA funds before spending the more current funds. For example,
expenses for sample ballots is an expense allowed in all grants since FY 2003-04. Also if your
plan has changed for how you want to use the funds, you can always amend your plan to reflect
another activity,provided that activity is allowed during the specific grant year. The amended
plan must be submitted and approved by the Division of Elections prior to expenditures. The
benefit to you is multi-fold. If you use up your older grant funds (including interest accrued)
sooner—you will have fewer reports to submit, fewer funds to track, fewer potential bank fees to
pay for multiple accounts with or without activity, and less time before you can dispose of your
records.
The Division of Elections will provide you a copy of the agreement upon full execution. If you
have any questions, please do not hesitate to contact me or the HAVA team.
MM/jd
Enclosures
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RECEIPT AND USE OF HAVA FUNDS
FOR FEDERAL ELECTION ADMINISTRATION ACTIVITIES
This agreement is between the State of Florida, Department of State, Division of Elections
("Department"), R.A. Gray Building, 500 South Bronough Street, Tallahassee, FL 32399-0250 and
The Honorable Jennifer J. Edwards, Supervisor of Elections ("Supervisor"), on behalf of Collier
County, 3295 Tamiami Trail E, Rev. Dr. Martin Luther King, Jr. Building, Naples, Florida 34112-
4907. This agreement is effective as of the date fully executed by the parties.
(. GOVERNING LAW
The Department is authorized pursuant to specific appropriation 3097 of the 2014-2015 General
Appropriations Act (see section 6, chapter 2014-51, Laws of Florida), to disburse a total of
$3,000,000 from the Federal Grants Trust Fund (HAVA Account # 261011) to the county
supervisors of elections for the fiscal year 2014-2015 ("FY 2014-2015 funds"). Therefore, funds
are made available through section 251 of the Help America Vote Act of 2002 (HAVA) and the
Catalog of Federal Domestic Assistance (CFDA) 90.401, Help America Vote Act Requirements
Payments for improving the administration of federal elections.
II. INCORPORATED DOCUMENTS
This agreement incorporates by reference the following documents:
• Attachment A: Compliance Requirements
• Attachment A-1: Federal Election Activities Plan (Form DS-DE 126, rev. 6/4/2014).
• Attachment A-2: Certificate Regarding Matching Funds (Form DS-DE 127, rev. 6/4/2013).
• Attachment A-3: Certification Regarding Debarment, Suspension, Ineligibility and
Voluntary Exclusion Lower Tier Covered Transactions (ED federal form GCS-009, v. 6/88)
• Attachment A-4: Certificate of Equipment for Casting and Counting Ballots (Form DS-DE
145, rev. 07/10/2013)
• Attachment B: Federal Election Activities-Funds Allocation/County Matching Fund
III. SCOPE OF USE AND RESTRICTIONS
The FY 2014-2015 funds granted shall be used for federal election administration scope of work
as more specifically set forth in paragraph 1 of Attachment A and detailed in Attachment A-1.
In addition,the funds shall:
• Be used to support election activities related only to federal elections (that is, elections in
which a federal candidate is on the ballot). If any of these funds are used for an election in
which a federal candidate is not on the ballot, the cost must be pro-rated for the portion of
the expenditure that is allocable to a federal election.
• Not be used to support state or federal lobbying activities but this does not affect the right,
or that of any other organization to petition Congress, or any other level of Government,
through the use of other resources.
MOA# 2014-2015-0001-COL
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• Not be distributed until the Supervisor first submits in accordance with paragraph 3 of
Attachment A: 1) The Supervisor's plan for using the funds (Attachment A-1) any change,
modification or deviation from the activities or expenses initially provided in the plan for
use of the funds must be reviewed and approved by the Department prior to expenditure;
2)The governing body's certification that it will provide matching funds equal to 15%of the
HAVA funds received (Attachment A-2); 3)Certification Regarding Debarment, Suspension,
Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions form (Attachment A-
3); and 4) if applicable, Certificate of Equipment for Casting and Counting Ballots
(Attachment A-4).
• Be placed in a separate interest bearing account in a qualified public depository as set out
in section 280.03, Florida Statutes, and in accordance with accounting requirements as set
forth in paragraphs 4 and 5 of Attachment A.
• Be reported timely and accounted for in accordance with this agreement and specifically
paragraphs 6 and 7 of Attachment A, including any request for supplemental clarification
or documentation.
IV. DISBURSEMENT
Subject to Section III, the Department shall distribute to each eligible county supervisor of
elections upon request an amount equal to the funding level per voter multiplied by the number
of active registered voters in the county for the 2012 General Election. The Supervisor shall
receive a sum certain as outlined in Attachment B.
IV. MONITORING,AUDITS,AND REPORTS
The administration and use of funds are subject to monitoring, audits, and reports as follows:
A. Monitoring
In addition to reviews of audits conducted in accordance with OMB Circular A-133 (as revised),
the Department may provide additional monitoring including on-site visits, and/or other
procedures permitted under federal and state law. The Supervisor shall comply and cooperate
with any monitoring procedures/processes the Department deems appropriate.
The Department shall closely monitor the Supervisors' annual expenditure reports required by
paragraph 6 of Attachment A to ensure that the Supervisors expend HAVA funds in accordance
with approved plans and will require reimbursement for all expenditures not approved or
otherwise authorized. Also, the Department shall ensure that Supervisors report the
expenditures made with HAVA funds separately from expenditures made with county funds.
B. Audits
1. Federal audit/OMB Circular A-133 (as revised)
If the Supervisor expends $500,000 ($300,000 for fiscal years ending before December 31, 2003)
or more in federal awards in its fiscal year, a single or program-specific audit must be conducted
in accordance with the provisions of OMB Circular A-133 (as revised). This may be satisfied by an
MOA # 2014-2015-0001-COL
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16J �.
audit of the Supervisor of Elections conducted by the Auditor General in accordance with OMB
Circular A-133 (as revised). In determining the federal awards expended in its fiscal year, the
Supervisor shall consider all sources of federal awards. Attachment A indicates federal resources
are being awarded under this Agreement. The determination of amounts of federal awards
expended shall be in accordance with the guidelines established by OMB Circular A-133 (as
revised). In connection with an audit herein, the Supervisor shall fulfill the requirements relative
to auditee responsibilities as provided in Subpart C of OMB Circular A-133 (as revised).
If the Supervisor expends less than $500,000 ($300,000 for fiscal years ending before December
31, 2003) in federal awards in its fiscal year,an audit pursuant to OMB Circular A-133 (as revised),
is optional. If the Supervisor elects to have an audit conducted in accordance with the provisions
of OMB Circular A-133 (as revised), the cost of the audit must be paid from non-federal resources
(i.e., from sources other than federal entities).
2. Other audits
The Department may conduct a limited scope audit of federal funds as defined by OMB Circular
A-133 (as revised) or other financial analysis or review of federal funds as permitted by federal
law. In the event the Department determines that such audit analysis, or review is appropriate,
the Supervisor agrees to comply with any additional instructions provided by Department staff
to the Supervisor regarding such process. If the Department determines that federal funds
received under this Agreement were used for any unauthorized purpose or that the Supervisor
did not comply with this agreement or state or federal requirements for receipt, expenditure,
or accounting, the Supervisor must return or repay these federal funds in an amount sufficient
to ensure or obtain compliance, including expenses for any corrective or remedial action.
Additionally, the Department may withhold funds, otherwise due, in an amount sufficient to
cover any costs associated with the limited scope audit or financial analysis or review to
determine or ensure compliance.
The Supervisor further agrees to comply and cooperate with any inspections, reviews,
investigations, or audits of federal funds deemed necessary by the Department of State, Chief
Financial Officer (CFO) or Auditor General.
For additional guidance to state and federal monitoring and auditing requirements, refer to:
http://election.dos.state.fl.us/hava/index.shtml and http://www.eac.gov.
C. Reports
Copies of financial reporting packages as described in section .320(c), OMB A-133 (as revised)for
audits conducted by or on behalf of the Supervisor pursuant to Section IV.B.1 of this agreement,
shall be submitted as required by sections .320(d) of such circular to:
Department of State Department of State Auditor General's Office Federal Audit Clearinghouse
Division of Elections Office of Inspector General Room 401,Pepper Bldg Bureau of the Census
R.A.Gray Building,Ste 316 R.A. Gray Bldg., Rm 406 111 West Madison St. 1201 East 10t St.
500 S.Bronough Street 500 S. Bronough Street Tallahassee, FL Jeffersonville, IN 47132
Tallahassee, FL 32399-0250 Tallahassee, FL 32399-0250 32399-1450
Other Federal agencies and pass-through entities in accordance with Sections.320(e)and(f),OMB Circular A-133(as revised).
MOA# 2014-2015-0001-COL
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Any reports, management letter, or other required information shall be submitted timely in
accordance with OMB Circular A-133 (as revised), the Florida Single Audit Act, and Chapters
10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of
the Auditor General, as applicable. When submitting financial reporting packages to the
Department for audits conducted in accordance with the aforementioned circular or Rules of the
Auditor General, the Supervisor shall include within the information the date the Supervisor
received the reporting package.
V. RECORD RETENTION
The Supervisor shall keep and maintain accurate and detailed records (e.g., invoices, receipts,
and other documentation) sufficient to identify how and whether expenditures were used for
authorized purposes, to support financial reporting, and to conduct audits as may be required or
requested. In accordance with the guidelines of the Department of Financial Services and the
Office of the Auditor General, these records must be retained for five fiscal years after the last
report that all funds have been fully expended or funds are returned by the county,or three years
after the date an audit report is issued, whichever is earlier. The Supervisor shall allow the
Department or its designee, CFO, or Auditor General access to such records, including the audit
working papers upon request. Failure to provide adequate documentation shall result in a
request to return the funds to the Department.
VI. ENTIRETY OF THE AGREEMENT
All terms and conditions of this agreement are fully set forth in this
document and attachments incorporated by reference and shall be governed by the laws of the
State of Florida regardless of any conflict of laws provisions. In any proceeding or action brought
under this section, the parties agree that the prevailing party will be entitled to its reasonable
attorney's fees from the other party. The parties agree that proper venue will be in Leon County,
Florida.
IN WITNESS THEREOF, the parties have caused this Agreement to be executed by their
undersigned officials as duly authorized.
Cou y Supervi or of lect' nsl4 FL Department of State/Division of Elections
By: ' /t(, c . /
By
I
1 3� sr'. :>Gt tr`),`S /6 U L
(print name/title) (print name/title)
County FEID Number: `'.� # 2-S c 27 t0 Z
Witness: kaI " L Witness:
Date: -2 ° 18' • I 'T Date:
Please complete, sign & return this Agreement and the required certifications to:
Joyce Durbin, HAVA Funds Coordinator, Florida Department of State, Division of Elections,
R.A. Gray Building, Room 316, 500 South Bronough Street, Tallahassee, Florida 32399-0250
MOA # 2014-2015-0001-COL
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ATTACHMENT A to MOA# 2014-2015-0001-COL
Federal Program: Federal Help America Vote Act—Catalog of Federal Domestic
Assistance (CFDA) §90.401 Help America Vote Act Requirements Payments
Compliance requirements applicable to the federal resources awarded under this agreement
are as follows:
1. Scope of Work. The Supervisor shall only use the FY 2014-2015 Funds (amount specified in
Attachment B) for one or more of the following federal election administration scope of work
in the following categories (the Federal Election Activity Plan, Attachment A-1, contains more
specific examples).
• Voter Education
• Poll Worker Training
• Standardizing Election Results Reporting
• Other Federal Election Administration Activities, as approved by the Department of
State.
2. Minimum Performance Standards. The Supervisor will submit an annual report (DS-DE 128,
Revised 11-15-13) on December 31 of every year until the funds are expended to show the
deliverables have been achieved. The Supervisor must attach to the report billing or itemized
receipts in support of the expenditures for the services or products used to provide voter
education concerning voting procedures voting rights or voting technology, and/or poll worker
training payroll registers, as well as MOVE Act Implementation and Maintenance and Software
and Hardware Technology as described in Attachment A-1.
3. Submissions. Prior to receipt of FY 2014-2015 funds under this Agreement, the Supervisor
must additionally submit to the Department:
• A Federal Election Activities Plan (DS-DE 126, Revised 6/4/2014) that contains a detailed
description of the programs that will be implemented. Boxes should be marked for
federal election administration activities that will be used as well as for all sources of
funding that apply, i.e. include the source of funds (federal, county matching funds,
interest earned and other county funds (local) being used for each federal election
activity set forth in the plan. This form is attached hereto as Attachment A-1. Please
provide SAMPLES of all voter education printed documents and transcripts of audio and
video recordings or clips.
• A written certification from the county governing body (e.g. Board of County
Commissioners) (DS-DE 127, Revised 6/4/2013) that matching funds will be provided in
an amount equal to fifteen percent(15%) of the amount to be received from the state.
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This form is attached hereto as Attachment A-2. If the county governing body fails to
appropriate the matching funds, the Supervisor must return or repay to the State the
portion of the funds for which the matching funds applied.
• A completed ED Form GCAS-009 (6/88), entitled "Certification Regarding Debarment,
Suspension, Ineligibility, and Voluntary Exclusion Lower Tier Covered Transactions", and
attached hereto as Attachment A-3. [Executive Order 12549, Debarment and
Suspension, 45 CFR 1183.35, prohibits the disbursement of federal funds to the
intended recipient of such funds or to any sub-recipient thereunder unless such
recipient and each sub-recipient, if any, certify that they are not excluded or disqualified
from receiving federal funds by any federal department or agency.)
• A completed "Certificate of Equipment for Casting and Counting Ballots" (DS-DE 135,
Effective 7/10/13), attached hereto as Attachment A-4. This is required if the request, in
part or in full, is to use HAVA funds for the purpose of purchasing emerging or
enhancing software and hardware technology.
4. Interest bearing account/public depository. The Supervisor must establish and maintain
the FY 2014-2015 funds in an interest bearing account in a "qualified public depository" as
required by section 280.03, Florida Statutes. The Supervisor must segregate federal funds and
required county matching dollars in a separate account established to hold only such funds or
in an account in which funds may be tracked by different account codes. For example, do not
comingle HAVA funds for voting systems assistance with funds for voter education.
Funds in this account must be used only for the activities for which the funds were received.
Funds shall remain in the account to be used for the same purposes for subsequent years or
until such funds are expended.
Please note that separate public depository requirements apply under chapter 280, Florida
Statutes, but are outside the scope of enforcement of this agreement. You will be required to
execute and retain in your records a "Public Deposit Identification and Acknowledgment Form"
(DFS-JI-11295) and to submit a Public Depositor Annual Report (DFS-J1-1009) to the Public
Deposits Program, Florida Department of Financial Services. Refer to
httpj/www.myfloridacfo.corn/Division1AA1Forms/default.htm for forms; and for more
information, contact the program administrator at: 850-413-3360.
5. Accounting. The Supervisor shall maintain separate accounting records for each of the funding
sources identified under its plan submitted pursuant to paragraph 4.
6. Financial reports. The Supervisor shall submit the following written financial reports to the
Department:
• An expenditure report is due every year in which HAVA funds remain and/or are expended.
If expenses are made at any time from the date of initial receipt of the FY2014-15 Federal
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Election Activities grant funds through September 30 of the year received, the first report is
due on December 31 of that year. Thereafter, an expenditure report is only due on
December 31 of every year in which expenditures were made or funds remain to cover the
preceding October 1st through September 30th period until all funds are fully expended.
• The report shall be filed using Form DS-DE 128 (rev. 11-15-13) provided by the Department.
The report must include documentation (such as appropriation statement, committee
meeting minutes approving appropriation, or account statement) that the county governing
body appropriated matching funds as certified under paragraph 3. Failure to appropriate
the county matching funds or reversion of those funds back to the county for any reason
must be reported to the Department.
Each financial report shall include the billing or itemized receipts in support of the
expenditures for the services or products used. The voter education publications must
provide voter education concerning voting procedures, voting rights or voting
technology. If deemed necessary after review of a financial report, you may be asked
and will be required to provide any requested supplemental documentation. For
products, that may include a copy of or the actual product or publication and an
indication of how many individual items were produced or printed, or for services, that
may include a copy of or the actual newspaper article, audio recording, or video clip
and/or template or transcript thereof, and an indication of how many times it was
published, aired, or accessed, or a copy of the graphics template and content layout for a
special created webpage.
• Annual remaining balance report
Supervisors of Elections shall report to the Department of State any unspent funds remaining
on June 30 of each fiscal year. The report form (DS-DE 129, Revised 7/5/11) will be provided
by the Department. This report is due on or before July 31 of every year until such funds are
fully expended.
7. Copies. Copies of any reports or other submissions required by paragraphs 2 and 6 of this
Attachment shall be submitted by or on behalf of the Supervisor directly to: Department of State,
Division of Elections, R.A. Gray Building, 500 S. Bronough Street, Tallahassee, Florida 32399-0250.
State Resources Awarded to the Supervisor
Under this Agreement Consist of the Following: N/A
Matching Resources for Federal Programs: N/A
Subject to section 215.97, Florida Statutes
(Florida Single Audit Act): N/A
Compliance requirements applicable to state resources
awarded pursuant to this Agreement are as follows: N/A
Page 3 %�"j
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16J1
ATTACHMENT A-2 of MOA 2014-2015-0001-COL
Certificate Regarding Matching Funds
I, Tow\ \t t%1M 14 G , Chairman of the Board of County Commissioners of
Collier County, Florida, do hereby certify that the Board of County Commissioners will provide
matching funds for the Federal Election Activities grant in county FY 2014-2015 to the
Supervisor of Elections in an amount equal to at least 15% of the amount to be received from
the state, which for Collier County is $6,808.19. I understand that if the Board fails to
appropriate the matching funds, all funds received from the state for this grant during the
2014-2015 state fiscal year will be required to be returned to the Department of State.
I
, 1.°:40, -- 1
Chairman, Board of County V )mmissioners
Tory% 11tk)0 G
Date
ATTEST;
DWIGHT E. 3ROC , Cllr* Approved as to form and legality
'
O41A ' i ts �A
-s.
Att t as rman's - J 1 Assi County Atto 1 ‘
zz„w4-
signature only. Item#
Agenda OVIil
Date 1
Date "M2A4
DS-DE 127 Recd.-
Revised 6/4/13 lb� C,
De uty e
n . -p .- • * 5. a rA m a, a1 rD O C O O -I 7-r--1 46J liii
rD ^ N O n G °; S N 3 o lb N .. V, 3 n s �' Qo rD v C 5 4. O p a '^ » ^ '"
.. -< r- 7 ._, a X < N Oa N - '0 n r<9 .. O d ap ."-.. n ti ... ^
O O � p o N n ., O O a� -L O p O O a n O n rt" •� H < o, dr a O
O ^ D C f D O Q O rc j n =a °- S p > j v' F = < is - w -w r: v 0 C N c ?
M °— o' d n0 c-nO t 1' r a °_. co n a °: < a _ro ? o , ? fD �" , IA < X N re
rn ro ° ca c < ; c `^ ... ,-. r� = < 0 KT c 0 opo c ro o o d a c, a
;L7 ^. n " D — * OD a n a f3D (@—D 5 - n0 c ro ail v N 3 1. O a n E a d o O' a,
O n O 5 N Fr Cr fD O, - 7 aa a, n oo C p ? W < N a, O n 0 M a C 7
O C rS 3 ra n O r" ry c ,• -• o- ^ O ,.+ N• rD 2, ,^ LA O� C •+ N = x x C G
a , O c., N -0 < d ro 2 a ? O w ,. ., '< O ^ O a, " -p F,, O O rp n Da A L < ..
m a N N n < 3 as p ro o .z c O rD N .3 < 0 c -" ,p — a, O O. w N O N =! rfl
rn ;. m c a—' ft i
INSTRUCTIONS FOR CERTIFICATION 16 J
1. By signing and submitting this proposal, the prospective lower tier participant is providing the certification set
out below.
2. The certification in this clause is a material representation of fact upon which reliance was placed when this
transaction was entered into. If it is later determined that the prospective lower tier participant knowingly
rendered an erroneous certification, in addition to other remedies available to the federal government, the
department or agency with which this transaction originated may pursue available remedies, including
suspension and/or debarment.
3. The prospective lower tier participant shall provide immediate written notice to the person to which this
proposal is submitted if at any time the prospective lower tier participant learns that its certification was
erroneous when submitted or has become erroneous by reason of changed circumstances.
4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction,"
"participant," "person,""primary covered transaction," "principal," "proposal," and "voluntarily excluded," as
used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing
Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in
obtaining a copy of those regulations.
5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered
transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person
who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered
transaction, unless authorized by the department or agency with which this transaction originated.
6. The prospective lower tier participant further agrees by submitting this proposal that it will include the clause
titled "Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion-Lower Tier
Covered Transactions," without modification, in all lower tier covered transactions and in all solicitations for
lower tier covered transactions.
7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier
covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered
transaction, unless it knows that the certification is erroneous. A participant may decide the method and
frequency by which it determines the eligibility of its principals. Each participant may, but is not required to,
check the Nonprocurement List(Telephone Number).
8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order
to render in good faith the certification required by this clause. The knowledge and information of a
participant is not required to exceed that which is normally possessed by a prudent person in the ordinary
course of business dealings.
9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered
transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred,
ineligible, or voluntary excluded from participation in this transaction, in addition to other remedies available
to the federal government, the department or agency with which this transaction originated may pursue
available remedies, including suspension and/or debarment.
ED Form GCS-009,6188
16J1
Attachment A-3 to MOA 2014-2015-0001-COL
CERTIFICATION REGARDING
DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION
LOWER TIER COVERED TRANSACTIONS
This certification is required by the regulations implementing Executive Order 12549, Debarment
and Suspension, 45 CFR 1183.35, Participants' responsibilities. The regulations were published as
Part VII of the May 26, 1988 Federal Register(pages 19160-19211). Copies of the regulations may be
obtained by contacting the person to which this proposal is submitted.
(BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON REVERSE)
(1) The prospective lower tier participant certifies, by submission of this proposal, that neither it
nor its principals are presently debarred. suspended. proposed for debarment, declared ineligible. or
voluntarily excluded from participation in this transaction by any federal department or agency.
(2) Where the prospective lower tier participant is unable to certify to any of the statements in this
certification. such prospective participant shall attach an explanation to this proposal.
) 51/te ,i2v) s6g_ 46f`)
ame and Title orized Re A resentative
14&[e. Utde
i azure ( Date
1 `v
ED Form GCS-009.6/88
S
16J1
ATTACHMENT A-4 of MOA 2014-2015-0001-COL
Certificate of Equipment for Casting and Counting Ballots
We, The Honorable Jennifer J. Edwards, Supervisor of Elections and TOM 44 f 1,14(7
Chairperson of Board of County Commissioners, of Collier County, Florida, do hereby certify
that prior to the receipt and use of fiscal year 2014-2015 HAVA funds for the purchase of State-
approved or certified (whichever is applicable) emerging or enhancing software or hardware
technology as allowable per Attachment A-1, the county has purchased and made available
sufficient equipment for casting and counting ballots to meet the needs of the county electors
for the next regularly scheduled general election. If the Florida Department of State determines
that there is insufficient equipment for casting and counting ballots for the next regularly
scheduled general election as herein certified, we shall return the HAVA funds that were used
to purchase other emerging or enhancing software and hardware technology to the State.
l
I -
S •ervisor of 'lectio f Chairman, Board of Co , y Commissioners
Th%iv. Irk fe„nt Nttic.
rte} . 1 5 . 1 Li 1 i f 1 k--1-
Date Date
" * Approved as to form and legality
,T. , eROCK, Clerk -.
`�Q.0 • Assistant County At 4►
Attest rman's ��
DS-DE 135 signature only.
Revised 7/10/13
l It
ATTACHMENT B to MOA 2014-2015-0001
DEPARTMENT OF STATE
DIVISION OF ELECTIONS i 6 j 1
FEDERAL ELECTION ACTIVITIES
FY 2014-2015
2012 Federal Election County
General Activities Matching
Election Funding Funds
County Registered Voters Per County 15%
Okeechobee 19,185 $ 4,822.60 $ 723.39
Orange 690,645 $ 173,609.65 $ 26,041.45
Osceola 163,384 $ 41,070.36 $ 6,160.55
Palm Beach 870,186 $ 218,741.45 $ 32,811.22
Pasco 310,322 $ 78,006.64 $ 11,701.00
Pinellas 626,348 $ 157,447.11 $ 23,617.07
Polk 351,119 $ 88,261.91 $ 13,239.29
Putnam 43,581 $ 10,955.10 $ 1,643.26
St.Johns 152,849 $ 38,422.14 $ 5,763.32
St.Lucie 175,554 $ 44,129.57 $ 6,619.44
Santa Rosa 116,941 $ 29,395.83 $ 4,409.38
Sarasota 277,672 $ 69,799.30 $ 10,469.90
Seminole 277,376 $ 69,724.90 $ 10,458.73
Sumter 73,946 $ 18,588.04 $ 2,788.21
Suwannee 25,043 $ 6,295.14 $ 944.27
Taylor 12,585 $ 3,163.53 $ 474.53
Union 7,313 $ 1,838.29 $ 275.74
Volusia 332,556 $ 83,595.67 $ 12,539.35
Wakulla 18,501 $ 4,650.66 $ 697.60
Walton 38,368 $ 9,644.69 $ 1,446.70
Washington 14,668 $ 3,687.14 $ 553.07
ITOTAL 1 11,934,4461 $ 3,000,000.00 1 $ 450,000.00 I
FY 2014-2015 APPROPRIATION-FEDERAL ELECTION ACTIVITIES $3,000,000
2012 General Election-Total Number of registered voters in the state 11,934,446
FUNDING LEVEL PER INDIVIDUAL VOTER $0.2514
(Based on FY 2014-2015 appropriation for Federal Election Activities
divided by the total number of registered voters in the state
for the 2012 General Election.)
7/10/2014 ��
Attach B-FEA Funds FY 2014-2015 FINAL 2 i
ATTACHMENT B to MOA 2014-2015-00011 616I 1
DEPARTMENT OF STATE
DIVISION OF ELECTIONS
FEDERAL ELECTION ACTIVITIES
FY 2014-2015
2012 Federal Election County
General Activities Matching
Election Funding Funds
County Registered Voters Per County _ 15%
Alachua 164,912 $ 41,454.46 $ 6,218.17
Baker 14,006 $ 3,520.73 $ 528.11
Bay 112,915 $ 28,383.81 $ 4,257.57
Bradford 15,491 $ 3,894.02 $ 584.10
Brevard 380,469 $ 95,639.71 $ 14,345.96
Broward 1,140,454 $ 286,679.58 $ 43,001.94
Calhoun 8,278 $ 2,080.87 $ 312.13
Charlotte 115,050 $ 28,920.49 $ 4,338.07
Citrus 98,639 $ 24,795.20 $ 3,719.28
Clay 132,585 $ 33,328.32 $ 4,999.25
Collier 180,560 $ 45,387.95 $ 6,808.19
Columbia 35,539 $ 8,933.55 $ 1,340.03
DeSoto 16,376 $ 4,116.49 $ 617.47
Dixie 10,229 $ 2,571.30 $ 385.69
Duval 557,282 $ 140,085.77 $ 21,012.86
Escambia 198,275 $ 49,841.02 $ 7,476.15
Flagler 69,597 $ 17,494.82 $ 2,624.22
Franklin 7,174 $ 1,803,35 $ 270.50
Gadsden 29,625 $ 7,446.93 $ 1,117.04
Gilchrist 11,121 $ 2,795.52 $ 419.33
Glades 6,668 $ 1,676.16 $ 251.42
Gulf _ 9,030 $ 2,269.90 $ 340.49
Hamilton 7,963 $ 2,001.68 $ 300.25
Hardee 12,312 $ 3,094.91 $ 464.24
Hendry 17,264 $ 4,339.71 $ 650.96
Hernando 123,346 $ 31,005.88 $ 4,650.88
Highlands 62,076 $ 15,604.24 $ 2,340.64
Hillsborough 747,587 5 187,923.34 $ 28,188.50
Holmes 11,560_5 2,905.87 $ 435.88
9
Indian River 93,569 23,520.74 $ 3,528.11
Jackson 29,003 $ 7,290.58 $ 1,093.59
Jefferson 9,517 $ 2,392.32 $ 358.85
Lafayette 4,568 $ 1,148.27 $ 172.24
Lake 201,652 $ 50,689.91 $ 7,603.49
Lee 388,947 $ 97,770.86 $ 14,665.63
Leon 190,574 $ 47,905.20 $ 7,185.78
Levy 25,053 $ 6,297.65 $ 944.65
Liberty 4,410 $ 1,108.56 $ 166.28
Madison 12,001 $ 3,016.73 $ 452.51
Manatee 209,468 $ 52,654.64 $ 7,898.20
Marion 223,478 $ 56,176.38 $ 8,426.46
Martin 101,835 $ 25,598.59 $ 3,839.79
Miami-Dade 1,313,850 $ 330,266.69 $ 49,540.00
Monroe 51,524 $ 12,951.75 $ 1,942.76
Nassau 51,607 $ 12,972.62 $ 1,945.89
Okaloosa 128,865 $ 32,393.21 $ 4,858.98
Attach B-FEA Funds FY 2014-2015 FINAL 1 7/10/2014 )
16J1
BUDGET AMENDMENT REQUEST For Budget/Finance Use Only
BA#
JE#
BAR#
APH Date
080 Supervisor of Elections
Fund No. Fund Description(type on line above)
Date Prepared: 7/18/2014 (Attach Executive Summary)
Approved by BCC on: Item No.
Expense Budget Detail
Fund Center Title: Elections-Administration Fund Center No.: 511010
Funded Program(Project)Title: 5-digit Fd Prog#:
(only one Fund Center/Funded Program should be entered into this section. If amendment Is for Funded Program,must enter Fund Center info)
Fund Funded Commit Commitment Item Increase Current Revised
Center Program Item Description (Decrease) Budget Budget
511010 634999 Other Contractual (6,808.19) 55,000.00 48,191.81
Net Change to Budget $ (6,808.19)
Expense Budget Detail
Fund Center Title: SOE Interfund Transfers Fund Center No.: 929030
Funded Program(Project)Title: 5-digit Fd Prog#:
(only one Fund Center/Funded Program should be entered into this section. If amendment is for Funded Program,must enter Fund Center info)
Fund Funded Commit Commitment Item Increase Current Revised
Center Program Item Description (Decrease) Budget Budget
929030 910810 Transfer to 081 6,808.19 6,808.19
Net Change to Budget $ 6,808.19
Revenue Budget Detail
Fund Center Title: Fund Center No.:
Funded Program(Project)Title: 5-digit Fd Prog#:
(only one Fund Center/Funded Program should be entered into this section. If amendment is for Funded Program,must enter Fund Center info)
Fund Funded Commit Commitment Item Increase Current Revised
Center Program Item Description (Decrease) Budget Budget
Net Change to Budget $ -
l6Ji
Revenue Budget Detail
Fund Center Title: Fund Center No.:
Funded Program (Project)Title: 5-digit Fd Prog#:
(only one Fund Center/Funded Program should be entered into this section. If amendment is for Funded Program,must enter Fund Center info)
Fund Funded Commit Commitment Item Increase Current Revised
Center Program Item Description (Decrease) Budget Budget
Net Change to Budget $ -
EXPLANATION
Why are funds needed?(type below)
To provide a county match for the 2014/2015 Federal Election Acivities Grant.
Where are funds available?(type below)
Funds are available in the SOE Administration Budget.
REVIEW PROCESS
Cost Center Director*: Date
Division Administrator*: Date
Budget Department: Date
Agency Manager i� A� '4 A
me i 1 —ill Date 1 1 ' 3 Li-
Finance Department: Date
Clerk to the Board Admin: Date
Inputted by: Date
BA number(SAP)
If this is uploaded into Novus with an Executive Summary, no signatures are required from the Cost Center Director or
Division Administer.
If this is uploaded into Novus, please do NOT sent a paper copy of the Budget Amendment to the Office of Management and
Budget office, OMB will download all budget amendments from Novus and will process after the BCC meeting.
I:\Forms\County Forms\Budget\Budget Amendment Form.xls (excel format)
16J1
BUDGET AMENDMENT REQUEST For Budget/Finance Use Only
BA#
JE#
BAR#
APH Date
081 Supervisor of Elections Grants
Fund No. Fund Description(type on line above)
Date Prepared: 7/18/2014 (Attach Executive Summary)
Approved by BCC on: Item No.
Expense Budget Detail
Fund Center Title: SOE Grants Fund Center No.: 511017
Funded Program (Project)Title: 14/15 Fed Election 5-digit Fd Prog#: 33359
(only one Fund Center/Funded Program should be entered into this section. If amendment is for Funded Program,must enter Fund Center info)
Fund Funded Commit Commitment Item Increase Current Revised
Center Program Item Description (Decrease) Budget Budget
511017 33359 634999 Other Contractual 45,387.95 45,387.95
Net Change to Budget $ 45,387.95
Expense Budget Detail
Fund Center Title: Fund Center No.:
Funded Program(Project)Title: 5-digit Fd Prog#:
(only one Fund Center/Funded Program should be entered into this section. If amendment is for Funded Program,must enter Fund Center info)
Fund Funded Commit Commitment Item Increase Current Revised
Center Program Item Description (Decrease) Budget Budget
Net Change to Budget $ -
Revenue Budget Detail
Fund Center Title: SOE Grants Fund Center No.: 511107
Funded Program(Project)Title: 14/15 Fed Election 5-digit Fd Prog#: 33359
(only one Fund Center/Funded Program should be entered into this section. If amendment is for Funded Program,must enter Fund Center info)
Fund Funded Commit Commitment Item Increase Current Revised
Center Program Item Description (Decrease) Budget Budget
511017 33359 331100 Fed-General Govt 45,387.95 45,387.95
Net Change to Budget $ 45,387.95
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Revenue Budget Detail
Fund Center Title: SOE Interfund Transfers Fund Center No.: 929030
Funded Program(Project)Title: 14/15 Fed Election 5-digit Fd Prog#: 99081
(only one Fund Center/Funded Program should be entered into this section. If amendment is for Funded Program,must enter Fund Center info)
Fund Funded Commit Commitment Item Increase Current Revised
Center Program Item Description (Decrease) Budget Budget
929030 33359 481080 Transfer from 080 6,808.19 6,808.19
Net Change to Budget $ 6,808.19
EXPLANATION
Why are funds needed?(type below)
To provide a county match and to recognize the 2014/2015 Federal Election Activities Grant.
Where are funds available?(type below)
Funds are available in the SOE Administration Budget.
REVIEW PROCESS
Cost Center Director*: Date
Division Administrator`: Date
Budget Department: Date
r t' I ' 7
Agency Manager i+ / ! . . /A A. u Lt./y ��d Date 1 • I • f L
Finance Department: -` Date
Clerk to the Board Admin: Date
Inputted by: Date
•
BA number(SAP)
If this is uploaded into Novus with an Executive Summary, no signatures are required from the Cost Center Director or
Division Administer.
If this is uploaded into Novus, please do NOT sent a paper copy of the Budget Amendment to the Office of Management and
Budget office. OMB will download all budget amendments from Novus and will process after the BCC meeting.
I:\Forms\County Forms\Budget\Budget Amendment Form.xls (excel format)