Backup Documents 09/10/2013 Item #16J10 .. ,
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLI ,j TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 0
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNA
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 and 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 SRT 9/10/13
4. BCC Office Board of County Gil la-`
Commissioners /5/ \3���
5. Minutes and Records Clerk of Court's Office
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 Jennifer Edwards, Supervisor of Elections Phone Number 252-8827
Contact/ Department
Agenda Date Item was 9/10/13 / Agenda Item Number 16 4-10
Approved by the BCC
Type of Document Certificate Regarding Matching Funds Number of Original One
Attached Documents Attached
PO number or account N/A
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? SRT
2. Does the document need to be sent to another agency for additional signatures? If yes, SRT
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 SRT
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 SRT
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 SRT
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 SRT
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip SRT
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 9/10/13 and all changes made during the SRT
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 th SRT
BCC,all changes directed by the BCC have been made,and the document is ready fo the
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
16JiO
MEMORANDUM
Date: September 16, 2013
To: Jennifer Edwards, Supervisor of Elections
Office of the Collier County Supervisor of Elections
From: Martha Vergara, Deputy Clerk
Board Minutes & Records Department
Re: FY 2013-2014 Federal Election Activities Funds
Attached is one (1) Original of the document referenced above (Agenda Item
#16J10), adopted by Collier County's Board of County Commissioners on
Tuesday, September 16, 2013.
If you have any questions, please call me at 252-7240.
Thank you.
Attachment
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I
FLORIDA DEPARTMENT Of STATE
RICK SCOTT KEN DETZNER
Governor Secretary of State
MEMORANDUM
r
To: Supervisors of Elections. r.'
From: Maria Matthews, Esq, '',
Director, Division of Efedt 'iris
Date: July 18, 2013
Subject: FY 2013-14 Federal Election Activities Funds
The 2013 Legislature appropriated $2,000,000 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 any of the following federal election activities:
• Voter education;
• Poll worker training;
• Standardizing election results reporting;
• Other federal election administration activities, as approved by the Department of State,
such as implementing and maintaining the provisions of the Military and Overseas Voter
Empowerment (MOVE) Act and the Uniformed and Overseas Citizens Absentee Voting
Act (UOCAVA); or
• Any software or hardware technology, including but not limited to any emerging
technology, that enhances or facilitates the delivery of absentee ballots, the casting and
counting of valid votes, voting system audits or recount processes, and the certification of
accurate and complete official election results. Such technology or any pilot program that
uses such technology must first be certified or approved, whichever is applicable, by the
Department of State. Additionally, before the Supervisor can receive and use funds to
purchase emerging or enhancing technology in this category, the county supervisor of
elections and the chairperson of the county governing body must certify that the county
has purchased and made available sufficient equipment for casting and counting ballots to
meet the needs of the county electors including reducing the wait time at the polls during
the early voting period and on election day for the next regularly scheduled general
election.
Division of Elections
A
R.A. Gray Bldg., Rm. 316 • 500 S Bronough St. • Tallahassee, Florida 32399-0250
Telephone: (850) 245-6200 • Facsimile: (850) 245-6217 elections.myflorida.com
_lik-,
VIVA FLORIDA�0�. Commemorating 500 years of Florida history www.fla500.com
VIVA FLORIDA 5g.
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6 ,110
FY 2013-2014 Federal Election Activities Funds
July 18, 2013
Page 2 of 2
In order to receive and use these funds, you must execute the following documents which are
attached:
• Memorandum of Agreement, Receipt and Use of HAVA Funds for Federal Election
Administration Activities, MOA #2013-2014-0001 (Supervisor of Elections must sign)
• Attachment A, Compliance Requirements
• Attachment A-1, Federal Election Activities Plan,form DS-DE 126 (Supervisor of
Elections must complete and return)
o Simply place an X in the box for the programs that you plan to carry out this fiscal
year, and place an X in the box for the topics that apply to each activity. Please also
put an X in the appropriate boxes indicating which funds will be used for each
activity. There is no need to enter specific dollar amounts on the plan. The dollar
amounts will be addressed when you submit your annual financial report due
December 31, 2013. If you need to make any changes to your original plan, the
revised plan must be submitted in advance of the purchase, in writing and approved
by the Department of State.
• Attachment A-2,Certificate Regarding Matching Funds,form DS-DE 127
o The Chairperson of the Board of County Commissioners must certify in writing that
the county will match the state funds with a 15% county match. If the county
governing body fails to appropriate the matching funds, the Supervisor must return or
repay to the State a portion of the funds for which the matching funds applied. Both
the federal funds and the county matching funds must be held in a separate interest
bearing account to be used solely for federal election activities purposes.
• Attachment A-3, Certification Regarding Debarment, Suspension, Ineligibility and
Voluntary Exclusion Lower Tier Covered Transactions, ED form GCS-009 (Supervisor of
Elections must sign)
• Attachment A-4, Certificate of Equipment for Casting and Counting Ballots,form DS-DE
135 (if applicable, the Supervisor of Elections and the Chairperson of the Board of
County Commissioners must sign)
• Attachment B, FY 2013-14 Federal Election Activities Funds Spreadsheet.
Please return all of these documents to the Division of Elections. You will be provided a copy of
the agreement upon execution by the Division.
If you have any questions, please don't hesitate to contact me or the HAVA team.
MM/jd/ma
Enclosures
16J1G
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. MLK, Jr. Building, Naples, FL 34112-5758. This
agreement is effective as of the date fully executed by the parties.
I. GOVERNING LAW
The Department is authorized pursuant to specific appropriation 3106 of the 2013-2014
General Appropriations Act (see section 6, chapter 2013-040, Laws of Florida), to disburse a
total of $2,000,000 from the Federal Grants Trust Fund (HAVA Account # 261011) to the county
supervisors of elections for the fiscal year 2013-2014 ("FY 2013-2014 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. SCOPE OF USE AND RESTRICTIONS
The funds granted shall be used for federal election administration activities as more
specifically set forth in paragraph 1 of Attachment A, which is hereby incorporated by
reference. In addition, the FY 2013-2014 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.
• Not be distributed until the Supervisor first submits in accordance with paragraph 2 of
Attachment A: 1) A Federal Election Activities plan (DS-DE 126, Revised 6/4/2013] that
details the planned use of the funds; 2) Certification from the county governing body to
provide matching funds equal to 15% of the HAVA funds received, [DS-DE 127, Revised
6/4/2013; 3) Certification Regarding Debarment, Suspension, Ineligibility and Voluntary
Exclusion Lower Tier Covered Transactions form; and 4) if applicable, Certificate of
Equipment for Casting and Counting Ballots (DS-DE 135, Effective 7/10/13). 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.
MOA# 2013-2014-0001
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1
6 ) 10
• 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 3 and 4 of Attachment A.
• Be reported timely and accounted for in accordance with this agreement and specifically
paragraphs 5 and 6 of Attachment A, including any request for supplemental clarification
or documentation.
III. DISBURSEMENT
The Department shall distribute to each eligible county supervisor of elections 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, incorporated by reference.
IV. MONITORING,AUDITS,AND REPORTING
The administration of resources awarded to the Supervisor is subject to the following
monitoring, audits, and reporting:
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 5 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 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
MOA# 2013-2014-0001
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16J10
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. Reporting
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 10`h St.
500 S. Bronough Street 500 5.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).
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
MOA# 2013-2014-0001
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16J10
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. The Supervisor shall retain in accordance with the guidelines of the Department
of Financial Services and the Office of the Auditor General these records 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.
Count Supervisor of Election . Department of State, Division of Elections
�.% 1 I,0► �� ' By:
Pri ted nam- an. title_ Printed name and title
/
► Ir . login r17LL.�..—
itness Witness
Date: 1 ' 13 Date:
6g . 25(v2-7g2-
County FEID Number
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# 2013-2014-0001
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16J10
ATTACHMENT A to MOA#2013-2014-0001
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. The Supervisor shall only use the FY 2013-2014 Funds (amount specified in Attachment B)
for one or more of the following federal election administration activities:
• Voter education;
• Poll worker training;
• Standardizing election results reporting;
• Other federal election administration activities, as approved by the Department of
State, such as implementing and maintaining the provisions of the Military and Overseas
Voter Empowerment (MOVE) Act and the Uniformed and Overseas Citizens Absentee
Voting Act (UOCAVA); or
• Any software or hardware technology, including but not limited to any emerging
technology, that enhances or facilitates the delivery of absentee ballots, the casting and
counting of valid votes, voting system audits or recount processes, and the certification
of accurate and complete official election results. Such technology or any pilot program
that uses such technology must first be certified or approved, whichever is applicable,
by the Department of State. Additionally, before the Supervisor can receive and use
these funds to purchase emerging or enhancing technology in this category, the county
supervisor of elections and the chairperson of the county governing body must certify
that the county has purchased and made available sufficient equipment for casting and
counting ballots to meet the needs of the county electors including reducing the wait
time at the polls during the early voting period and on election day for the next regularly
scheduled general election. See Certificate of Equipment for Casting and Counting
Ballots as set forth in the last bullet point in paragraph 2 of this attachment.
These are the acceptable uses for the funds under the categories listed above:
• Mailing or publishing sample ballots which must include additional information on
voting procedures, voting rights or voting technology;
• Voter information cards which must include additional voter education information on
voting procedures, voting rights or voting technology;
• Advertising or publications outlining voting procedures, voting rights or voting
technology;
• Voting System demonstrations;
• Poll worker training stipends;
• Training materials for poll workers;
• Voter guides which must include voter education information concerning voting
procedures, voting rights, or voting technology but shall not contain elected officials'
contact information other than the supervisor's contact information; or
Page 1 of 3
16J10
• Maintaining online or web-based absentee ballot request and ballot tracking and
precinct-finder system as relates to use in federal elections and for the costs for
upgrades and future license fees and maintenance fees for the MOVE Act and other
UOCAVA expenditures.
2. Prior to receipt of FY 2013-2014 funds under this Agreement, the Supervisor must
additionally submit to the Department:
• A Federal Election Activities Plan (DS-DE 126, Revised 6/4/2013) that contains a detailed
description of the Supervisor's plan to use the funds for federal election administration
activities and include the source of funds (federal, county matching funds 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.
• A written certification from the county governing body (e.g. Board of County
Commissioners) (DS-DE 127, Revised 6/4/2013) that the county will provide matching
funds in the amount of 15%. 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", attached
hereto as Attachment A-4 (DS-DE 135, Effective 7/10/13). 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 in the last bullet under paragraph 1.
3. The Supervisor must establish and maintain the FY 2013-2014 funds in an interest bearing
account in a "qualified public depository" as required by section 280.03, Florida Statutes. The
Supervisor must segregate funds for federal election administration activities and required
county matching dollars in a separate account established to hold only those funds. Any funds
remaining at the end of the fiscal year shall remain in the account to be used for the same
purposes for subsequent years or until such funds are fully 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-J1-2009) to the Public
Deposits Program, Florida Department of Financial Services. Refer to
Page 2of3
16J10
http://www.fltreasury.org/ for forms; and for more information, contact the program
administrator at: 850-413-3383 or 850-413-3324.
4. The Supervisor shall maintain separate accounting records for each of the funding sources
identified under its plan submitted pursuant to paragraph 2.
5. The Supervisor shall submit the following written financial reports to the Department:
• One-time annual report for all actual expenditures from the date of receipt through
September 30, 2013. Report forms will be provided by the Department (DS-DE 128, Revised
7/5/11). 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 2. Failure to appropriate the
matching funds must be reported to the Department. This report is due on or before
December 31, 2013.
Each financial report shall include the 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. 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 for unspent HAVA funds remaining on June 30 of each
year being reported. The report form will be provided by the Department (DS-DE 129, Revised
7/5/11). This report is due on or before July 31 of every year until such funds are fully
expended.
6. Copies of any reports or other submissions required by paragraphs 2 and 5 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 5. 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 of 3
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16J10
ATTACHMENT A-2 of MOA 2013-2014-0001
Certificate Regarding Matching Funds
I, Georgia A. Hiller , 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 2013-2014 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 $4,538.79. I understand that if the Board fails to
appropriate the matching funds, all funds received from the state for this grant during the
2013-2014 state fiscal year will be required to be returned to the Department of State.
L
-an, Board of County Commissioners
-orgia A. Hiller
September. 10, 2013
Date
Approved as to fo and legality
?
D'ATit;FiTe: BROCK, CLERK j
Via` t Scott R.Teach, Deputy County Attorney
!
AtteM as to a F
signaft�re
DS-DE 127
Revised 6/4/13
1
6J10
Attachment A-3 to MOA 2013-2014-0001
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.
ice _;
Name and e o Aut7izec j•pr: entative
1/001fe-• fAittV/DS) 60b �7• z� i 1
Date
ED Form GCS-009,6/88
INSTRUCTIONS FOR CERTIFICATION 6 J 1 0
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-009,6/88
•
16J10 1
ATTACHMENT B to MOA 2013-2014-0001
DEPARTMENT OF STATE
DIVISION OF ELECTIONS
FEDERAL ELECTION ACTIVITIES
FY 2013-2014
2012 Federal Election County
General Activities Matching
Election Funding Funds
County Registered Voters _ Per County 15%
Alachua 164,912 $ 27,636.31 $ 4,145.45
Baker 14,006 $ 2,347.16 $ 352.07
Bay 112,915 $ 18,922.54 $ 2,838.38
Bradford 15,491 $ 2,596.01 $ 389.40
Brevard 380,469 $ 63,759.81 $ 9,563.97
Broward 1,140,454 $ 191,119.72 $ 28,667.96
Calhoun 8,278 $ 1,387.24 $ 208.09
Charlotte 115,050 $ 19,280.33 $ 2,892.05
Citrus 98,639 $ 16,530.13 $ 2,479.52
Clay 132,585 $ 22,218.88 $ 3,332.83
Collier 180,560 $ 30,258.63 $ 4,538.79
Columbia 35,539 $ 5,955.70 $ 893.36
DeSoto 16,376 $ 2,744.33 $ 411.65
Dixie 10,229 $ 1,714.20 $ 257.13
Duval 557,282 $ 93,390.51 $ 14,008.58
Escambia 198,275 $ 33,227.35 $ 4,984.10
Flagler 69,597 $ 11,663.21 $ 1,749.48
Franklin 7,174 $ 1,202.23 $ 180.34
Gadsden 29,625 $ 4,964.62 $ 744.69
Gilchrist 11,121 $ 1,863.68 $ 279.55
Glades 6,668 $ 1,117.44 $ 167.62
Gulf 9,030 $ 1,513.27 $ 226.99
Hamilton 7,963 $ 1,334.46 $ 200.17
Hardee 12,312 $ 2,063.27 $ 309.49
Hendry 17,264 $ 2,893.14 $ 433.97
Hernando 123,346 $ 20,670.59 $ 3,100.59
Highlands 62,076 $ 10,402.83 $ 1,560.42_
Hillsborough 747,587 $ 125,282.23 $ 18,792.33
Holmes 11,560 $ 1,937.25 $ 290.59
Indian River 93,569 $ 15,680.49 $ 2,352.07_
Jackson 29,003 $ 4,860.38 $ 729.06
Jefferson 9,517 $ 1,594.88 $ 239.23
Lafayette 4,568 $ 765.52 $ 114.83
Lake 201,652 $ 33,793.27 $ 5,068.99
Lee 388,947 $ 65,180.57 $ 9,777.09
Leon 190,574 $ 31,936.80 $ 4,790.52
Levy 25,053 $ 4,198.44 $ 629.77
Liberty 4,410 $ 739.04 $ 110.86
Madison 12,001 $ 2,011.15 $ 301.67
Manatee 209,468_$ 35,103.10 $ 5,265.46
Marion 223,478_$ 37,450.92 $ 5,617.64
Martin 101,835 $ 17,065.73 $ 2,559.86
Miami-Dade 1,313,850 $ 220,177.79 $ 33,026.67
Monroe 51,524 $ 8,634.50 $ 1,295.18
Nassau 51,607 $ 8,648.41 $ 1,297.26
Okaloosa 128,865 _ $ 21,595.47 $ 3,239.32
Attach B-FEA Funds FY 2013-2014-FINAL 1 7/17/2013
16J10 1 0
ATTACHMENT B to MOA 2013-2014-0001
DEPARTMENT OF STATE
DIVISION OF ELECTIONS
FEDERAL ELECTION ACTIVITIES
FY 2013-2014 •
2012 Federal Election County
General Activities Matching
Election Funding Funds
County Registered Voters _ Per County 15%
Okeechobee 19,185 $ 3,215.06 $ 482.26
Orange 690,645 $ 115,739.77 $ 17,360.97
Osceola 163,384 $ 27,380.24 $ 4,107.04
Palm Beach 870,186 $ 145,827.63 $ 21,874.14
Pasco 310,322 $ 52,004.42 $ 7,800.66
Pinellas 626,348 $ 104,964.74 $ 15,744.71
Polk 351,119 $ 58,841.27 $ 8,826.19
Putnam 43,581 $ 7,303.40 $ 1,095.51
St.Johns 152,849 $ 25,614.76 $ 3,842.21
St. Lucie 175,554 $ 29,419.71 $ 4,412.96
Santa Rosa 116,941 $ 19,597.22 $ 2,939.58
Sarasota 277,672 $ 46,532.87 $ 6,979.93
Seminole 277,376 $ 46,483.26 $ 6,972.49
Sumter 73,946 $ 12,392.03 $ 1,858.80
Suwannee 25,043 $ 4,196.76 $ 629.51
Taylor 12,585 $ 2,109.02 $ 316.35
Union 7,313 $ 1,225.53 . $ 183.83
Volusia 332,556 $ 55,730.45 $ ' 8,359.57
Wakulla 18,501 $ 3,100.44 $ 465.07
Walton 38,368 $ 6,429.79 $ 964.47
Washington 14,668 $ 2,458.09 $ 368.71
(TOTAL 11,934,446 $ 2,000,000.00 $ 300,000.00I
FY 2013-2014 APPROPRIATION-FEDERAL ELECTION ACTIVITIES $2,000,000
2012 General Election-Total No.of registered voters in the state 11,934,446
FUNDING LEVEL PER INDIVIDUAL VOTER $0.1676
(Based on FY 2013-2014 appropriation for Federal Election Activities
divided by the total number of registered voters in the state
for the 2012 General Election.)
Attach B-FEA Funds FY 2013-2014-FINAL 2 7/17/2013