non-state capital outlay training manual outlay/non-state manual - chapter 06.pdf · non-state...

Non-State Capital OutlayTraining Manual

Chapter 6: Non

State Capital OutlayTraining Manual

Non-State Entity Guidelines

State Capital Outlay

FP&C’s Role in Administering Non-State Capital Outlay Projects

Is “reactive," and is in place to:

Ensure that the project will be functional and within the intent of the CapitalOutlay Request and Act.

Ensure that the Project is in conformance with the Public Bid Law.

Administer the project in accordance with FP&C approved contractsincluding that of the Cooperative Endeavor Agreement

[includes 1999 Non-State Guidelines].

Ensure reasonable costs are paid by the State.

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Downloading the Non-State Entity Capital Outlay AdministrativeGuidelines

The Cooperative Endeavor Agreement will reference the following:

Non-State Entity Capital Outlay Administrative Guidelines, July 1999 edition

This document is available online, at http://www.doa.louisiana.gov/fpc/nstate.htm.

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Non-State EntityCapital OutlayAdministrativeGuideline s

Facility Planning and Control July 1999Division of Administration

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July 1999

TABLE OF CONTENTS

Introduction 1

Chapter 1. Allowable Costs 3

Real Estate Acquisition 3Planning 5Construction 6Miscellaneous 8Equipment 8Escrow 11Administrative 12

Chapter 2. Other Requirements 13

Authorized Representative 13Local Match 13

Appendix i

Instructions for Completing FormsRequest for Disbursement iiRequest for FP&C Concurrence in Real Estate Closing ivRequest for FP&C Concurrence in Construction Contract Award viRequest for FP&C Concurrence in Equipment Purchase viii

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July 19996-5

July 1999 1

INTRODUCTIONThe State Capital Outlay Act tradition-

ally has included funding for non-state entitycapital projects. These projects, while fundedby the State, are not State owned facilities.The Capital Outlay Act appropriates funds forthese non-state projects to the Office of Fa-cility Planning and Control (FP&C) within theLouisiana Division of Administration. FP&Cdisburses the State funds to the non-stateentities on an as-needed basis while assuringthat:

� State funds are used for the projectscope as described in the Capital Out-lay Act and/or Capital Outlay RequestForm

� A functional facility is in place upon fulldisbursement of the State funds

FP&C administers non-state projects un-der cooperative endeavor agreements betweenthe State and the non-state entities. The Non-State Entity Capital Outlay Administrative Guide-lines (Guidelines) is part of the cooperative en-deavor agreement (by reference) and thereforeis a component of a legally binding contract be-tween the State and a non-state entity.

A principal component of the CapitalOutlay non-state entity program is certifica-tion by the non-state entity. All requests forState disbursements, except those associatedwith real estate purchase prices, must bemade with a Request for Disbursement form(see Figure 1). On this form the non-stateentity certifies that:

“... each of the invoices on this list andattached list(s) is in accordance with theterms of the applicable contracts and/or agreements and that the serviceshave been performed or the goods re-ceived ... this certification also indicatescompliance with the terms and condi-tions of the cooperative endeavor agree-ment ...”

There are some cases where FP&C re-quires submittals in addition to the certifica-tion. The Guidelines is arranged so thatFP&C’s administrative requirements for eachcomponent of a project can be quickly re-viewed. For example, if a non-state entitywishes to know what FP&C requires whenacquiring land with Capital Outlay funds, thesection Real Estate Acquisition in Chapter 1should be referenced. All of the forms men-tioned in the Guidelines are customized foreach project and are provided with the ex-ecuted cooperative endeavor agreement.

Each non-state project is assigned to aProject Manager at FP&C. This individual isidentified in the FP&C letter that transmits theexecuted cooperative endeavor agreement.All communication with FP&C should bethrough this individual. Since the cooperativeendeavor agreement is between the State anda non-state entity, FP&C will not directly en-gage with a non-state entity’s contracted con-sultants or contractors. Refer to the Autho-rized Representative section of Chapter 2 fora discussion on the requirement for the non-state entity to designate a project represen-tative.

FP&C has attempted to make this pro-gram as simple as possible while still main-taining oversight of the disbursement of Statefunds. Many non-state projects fundedthrough State Capital Outlay have been suc-cessfully completed, with hundreds more cur-rently in progress. By following the simpleprocedures outlined in the cooperative en-deavor agreement and the Guidelines, a non-state entity will assure its dealings with theState run smoothly.

FP&C wishes you well with your project.

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2 July 1999

Figure 1. Form Used When Requesting Disbursement of State Funds

Request for Disbursement Request No. _______

Project Number: Grantee:

Contact Person:Project Name:

Phone Number:

Invoices Enclosed:InvoiceNumber

Vendor Name CostCode*

Amount

Total

This document will hereby certify that each of the invoices on this list and attached list(s) is inaccordance with the terms of the applicable contracts and/or agreements and that the serviceshave been performed or the goods received. Furthermore, this certification also indicatescompliance with the terms and conditions of the cooperative endeavor agreement by andbetween the State of Louisiana and (Grantee).

Certified Correct by Grantee: ____________________________ Date:______________

(Signature)

____________________________(Type or Print Name)

Remit to: Facility Planning & Control *Cost Code CategoryLA Division of Administration RQ Real EstatePost Office Box 94095 PN PlanningBaton Rouge, La. 70804-9095 CN Construction

MI MiscellaneousEQ Equipment

(Signature)

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July 1999 3

Real Estate Acquisition

When acquiring land or immovable prop-erty with Capital Outlay funds, prior to clos-ing FP&C must review and approve the fol-lowing information provided by the non-stateentity:

❏ State Certified General appraisal

❏ Preliminary title opinion attesting thatthe non-state entity will have good,clear, and merchantable title upon ex-ecution of the act of sale, or title insur-ance

❏ Phase I environmental assessment, pre-pared by an environmental professionalaccording to current ASTM standardpractice, that also considers asbestoscontaining materials, lead-based paint,lead in drinking water and wetlands

❏ Draft act of sale with warranty that theproperty is free of CERCLA defined haz-ards and petroleum products identifiedin the environmental assessment as ex-isting or suspected

The non-state entity would submit a Re-quest for FP&C Concurrence in Real EstateClosing form, with this required information

attached (see Figure 2). Faxes will not beaccepted. After FP&C concurs in closing,FP&C will initiate its check writing process.The State disbursement for a real estate sell-

ing price cannot exceed the appraised valueas determined by a State Certified Generalappraisal. The non-state entity should planon closing within two weeks after FP&C dis-burses the funds. A copy of the executed actof sale as recorded in the local Clerk of Courtoffice must be provided to FP&C after closing.

State funds can also be used for reimburse-ment of actual reasonable costs for title work,appraisals, abstracts, property surveys, legalfees associated with the purchase of property,and other such similar costs as determined byFP&C to be allowable. Requests for FP&C pay-ments for these costs must be made with a Re-quest for Disbursement form (see Figure 1).

All services for which State funds will beused for payments must be done under writ-ten contracts. Copies of executed contractsmust be submitted to FP&C prior to or con-current with Associated Request(s) for Dis-bursement. The products of professional con-tracts must be provided to FP&C when thecontract fee is greater than or equal to$25,000 in order to receive disbursements as-sociated with these contracts.

Contracts executed prior to the date ofthe cooperative endeavor agreement, or priorto the date cash was made for the State ap-propriation, are not eligible for State partici-pation. For unconditional General Fund Di-rect monies and NRP bonds, the date cash ismade available is the date the Capital OutlayAct is approved. For General Obligationbonds, the date the cash is made available isthe date the Bond Commission approves acash line of credit.

If desired by a non-state entity, FP&C willprovide courtesy reviews of draft contracts inorder to confirm that costs will be eligible forState participation.

CHAPTER 1 ALLOWABLE COSTS

When real estate is to be acquiredwith Capital Outlay funds, FP&Cmust concur that the sale isready for closing.

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Figure 2. Form Used for Concurrence in Real Estate Closing

Request for FP&C Concurrence in Real Estate Closing



Phone Number:

To be completed by the Grantee

The following information is attached and Grantee requests FP&C’s concurrence that the transaction is ready for closing.

� State Certified General appraisal

� Preliminary title opinion attesting that the non-state entity will have good, clear, andmerchantable title upon execution of the act of sale, or title insurance

� Phase I environmental assessment, prepared by an environmental professional according tocurrent ASTM standard practice, that also considers asbestos containing materials, lead-basedpaint, lead in drinking water and wetlands

� Draft act of sale with warranty that the property is free of CERCLA defined hazards andpetroleum products identified in the environmental assessment as existing or suspected.

Grantee: Date:(Signature)

(Type or Print Name)

To be completed by FP&C and returned to the Grantee

� FP&C concurs that the transaction is ready for closing

(FP&C will initiate writing a check in the amount of $

� FP&C does not concur that the transaction is ready for closing

Reason:

(Grantee must resolve and then submit another Request for FP&C Concurrence in Real EstateClosing)

ProjectManager: Date:

(Signature)

Remit to: Facility Planning & ControlLA Division of AdministrationPost Office Box 94095Baton Rouge, La. 70804-9095 Thank you for your cooperation!

)

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July 1999 5

Planning

Planning costs associated with the ap-proved project can be eligible for State par-ticipation, up to the amount listed in the co-operative endeavor agreement project bud-get.

All Planning services where State fundswill be used for payments must be done un-der written contracts. Copies of executedwritten contracts must be submitted to FP&Cprior to or concurrent with the first associ-ated Request(s) for Disbursement. Faxes willnot be accepted. A copy of the final productof a professional contract must be providedto FP&C in order for funds to be disbursedwhen the fee is greater than or equal to$25,000.

Contracts executed prior to the date ofthe cooperative endeavor agreement or, priorto the date cash was made available for theState appropriation, are not eligible for Stateparticipation. For unconditional General FundDirect monies and NRP bonds, the date cashis made available is the date the Capital Out-lay Act is approved. For General Obligationbonds, the date the cash is made available isthe date the Bond Commission approves acash line of credit.

If desired by the non-state entity, FP&Cwill provide courtesy reviews of draft contractsin order to confirm that costs will be eligiblefor State participation.

Contracts for the preparation of construc-tion documents where the fee is greater thanor equal to $25,000 will need to have the prod-ucts of the schematic/preliminary design

phase (including a cost estimate) submittedto FP&C in order to receive an interim dis-bursement associated with that phase. Non-state entities are encouraged to allow FP&Cto provide a courtesy review of the plans atthe schematic/preliminary phase for allprojects to confirm that the planned facility isfunctional and within the intent of the CapitalOutlay Act/Request.

For all projects, the construction docu-ments/final design products (plans and speci-fications) will be reviewed by FP&C to con-firm that the planned facility is functional andwithin the intent of the Capital Outlay Act/Request. This review can take place eitherprior to or after advertisement for bidding, butthe review must be made prior to award ofthe construction contract. Non-state entitiesare encouraged to submit the plans and speci-fications with a cost estimate for review priorto advertising for bids.

Contracts for the preparation of construc-tion documents where the fee is greater thanor equal to $25,000 will need to have the prod-ucts of the construction documents/final de-sign phase (including a cost estimate) sub-mitted to FP&C in order to receive a disburse-ment associated with that phase.

State funds can be used for actual costsfor design services, surveys, geotechnical in-vestigation, supplemental resident inspection,production and distribution of contract docu-ments and other such similar costs determined

State disbursements forPlanning costs cannot exceed10% of the construction cost. For all projects, FP&C will

review final plans/specs toconfirm that the plannedfacility is functional andwithin the intent of theCapital Outlay Act/Request.

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6 July 1999

by FP&C to be allowable. All requests for FP&Cpayments for these costs must be made with aRequest for Disbursement form (see Figure 1).FP&C payments for Planning costs cannot ex-ceed 10% of the construction cost.

Construction

If State funds are to be used for construc-tion costs, FP&C must be provided the fol-lowing information prior to construction con-tract award (FP&C considers exhibits to beconstruction):

❏ Final construction documents (plansand specifications)

❏ Construction document addenda

❏ Certification that the cooperative en-deavor agreement’s ownership of prop-erty requirements have been met

❏ Evidence of current commitment andavailability of match and/or in-kindmatch

❏ Certified proof of publication of adver-tisement for procurement

❏ Certified tabulation of bids or propos-als with recommendation for award

❏ Certification that the procurement wasin accordance with the Public Bid law

This information must be providedthrough a Request for FP&C Concurrence inConstruction Contract Award form (see Fig-ure 3), with the required information attached.Faxes will not be accepted. Evidence of avail-ability of match or in-kind match is only re-quired when other funds (in addition to theCapital Outlay funds) or services are neededin order to award a contract, or if volunteerlabor or donated materials are to be used.Evidence of availability of cash match canbe in the form of bank statements, resolu-tions from the entity’s governing authority, etc.

FP&C must concur in contract awardprior to the actual award. If a constructioncontract is awarded prior to FP&C concur-rence, then the costs are not eligible for Stateparticipation.

Once FP&C concurs in contract award,the construction costs are considered eligiblefor State participation. Interim State disburse-ments can be made based on certified appli-cations for payment (e.g., AIA DocumentG702) that are submitted with a Request forDisbursement form (see Figure 1). Copiesof the fully executed construction contractwith performance bond (or other form of se-curity, if allowable by law) must be providedto FP&C prior to or concurrent with the firstconstruction Request for Disbursement.

In order to disburse funds associated withthe 100% application (minus retainage), thepunch list(s) will need to be submitted alongwith written confirmation that the punch list(s)items have been addressed. This written con-firmation is in addition to the certified appli-cation for payment. FP&C will hold retainageuntil the 45-day Clear Lien Certificate is pro-vided. Any liquidated damages will be to thebenefit of FP&C; if local match is involved,proportionately between FP&C and the non-state entity.

Change orders must be approved byFP&C in order to be eligible for State partici-pation. Non-state entities are encouraged tosubmit draft change orders to FP&C prior toexecution in order for FP&C to confirm thatthe costs will be eligible for State participa-tion. As stipulated in the Public Bid Law,FP&C will require negotiated change ordersto be fully documented and itemized as to

FP&C must concur in contractaward in order for constructioncosts to be eligible for Stateparticipation.

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July 1999 7

Figure 3. Form Used for Concurrence in Construction Contract Award

Request for FP&C Concurrence in Construction Contract Award



Phone Number:


The following information is attached and the Grantee requests FP&C’s concurrence in the award

$of the construction contract for to .(Total Bid) (Contractor)

� Final construction documents (plans and specifications)

� Construction document addenda

� Certification that the cooperative endeavor agreement’s ownership of property requirements have been met

� Evidence of current commitment and availability of match and/or in-kind match

� Certified proof of publication of advertisement for procurement

� Certified tabulation of bids or proposals with recommendation for award

� Certification that the procurement was in accordance with the Public Bid Law




� FP&C concurs in construction contract award

(Grantee must submit a Request for Disbursement Form(s) to draw from State funds)

� FP&C does not concur in construction contract award

Reason:

(Grantee must resolve and then submit another Request for FP&C Concurrence in Construction Contract Award)

Project Manager:Date:

(Signature)


Remit to:

Thank you for your cooperation!

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8 July 1999

costs, including material quantities, materialcosts, taxes, insurance, employee benefits,other related costs, profit and overhead.

Miscellaneous

Miscellaneous costs associated with theapproved project can be eligible for State par-ticipation, up to the amount listed in the coop-erative endeavor agreement project budget.

State funds can be used for actual capi-tal project costs including, but not necessarilylimited to laboratory testing services, recor-dation fees, advertisement for bids, environ-mental assessments, surveys, geotechnical in-vestigations, supplemental resident inspection,builders risk insurance and other such similarcosts determined by FP&C to be allowable.FP&C payments for Miscellaneous costs can-not exceed 5% of the construction cost.

All Miscellaneous services where Statefunds will be used for payments must be doneunder written contracts. Copies of executedwritten contracts must be submitted to FP&Cprior to or concurrent with associatedRequest(s) for Disbursement (see Figure 1).Faxes will not be accepted. The final prod-uct of a professional contract must be pro-vided to FP&C in order for funds to be dis-bursed when the fee is greater than or equalto $25,000.

Contracts executed prior to the date ofthe cooperative endeavor agreement, or priorto the date cash was made available for theState appropriation, are not eligible for Stateparticipation. For unconditional General FundDirect monies and NRP bonds, the date cashis made available is the date the Capital Out-lay Act is approved. For General Obligationbonds, the date the cash is made available isthe date the Bond Commission approves acash line of credit.

If desired by the non-state entity, FP&Cwill provide courtesy reviews of draft contractsin order to confirm that costs will be eligiblefor State participation.

Equipment

Actual, reasonable costs for moveableequipment/furnishings required for the projectcan be eligible for State participation. FP&Creferences State purchasing contract pricesin determining the reasonableness of equip-ment costs, and the amount eligible for Stateparticipation. Some items that are not eli-gible for State participation include rollingstock (e.g., automobiles, tractors, etc.), sup-plies, computers, and telephones.

All equipment purchases where Statefunds will be used for payments must be doneunder written contracts or purchase orders.When purchasing equipment through Statecontract, copies of the equipment list andexecuted contracts or purchase orders mustbe submitted to FP&C prior to or concurrentwith the associated Request for Disbursement(see Figure 1). Faxes will not be accepted.If desired by a non-state entity, FP&C will pro-

Change orders must be approvedby FP&C in order to be eligiblefor State participation.

State disbursements forMiscellaneous costs cannotexceed 5% of the construction cost.

Prior to procurement, it is a goodidea to submit the equipmentlists to FP&C for confirmation ofeligible items.

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July 1999 9

vide courtesy reviews of draft contracts or pur-chase orders prior to procuring the equipmentin order to confirm that costs will be eligiblefor State participation. When procuringequipment through State contract, non-stateentities are strongly encouraged to submit theequipment lists for FP&C review prior to pro-curement.

If equipment is to be procured through abidding process, FP&C must be provided thefollowing information prior to a non-state en-tity accepting a bid:

❏ Equipment list (with specifications, ifapplicable)

❏ Certified proof of publication of ad-vertisement for procure-ment

❏ Certified tabulation of bidsor quotes with recom-mendation for accep-tance

❏ Certification that the pro-curement was in accor-dance with Public Bid law

This information must beprovided through a Request forFP&C Concurrence in EquipmentPurchase form (see Figure 4),with the required information at-tached. Faxes will not be ac-cepted. FP&C must concur in ac-ceptance prior to the actual ac-ceptance. If equipment procure-ment is by bidding and a contractor purchase order is executedprior to FP&C concurrence, thenthe costs are not eligible for Stateparticipation. After FP&C hasconcurred in acceptance, and theequipment is obtained, requestsfor FP&C payments for equip-ment costs must be made with aRequest for Disbursementform(s) (see Figure 1).

Whether procuring equipment throughState contract, or through bidding, contractsor purchase orders executed prior to the dateof the cooperative endeavor agreement, orprior to the date cash was made available forthe State appropriation, are not eligible forState participation. For unconditional Gen-eral Fund Direct monies and NRP bonds, thedate cash is made available is the date theCapital Outlay Act is approved. For GeneralObligation bonds, the date the cash is madeavailable is the date the Bond Commissionapproves a cash line of credit.

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10 July 1999

Figure 4. Form Used for Concurrence in Equipment Purchase (when procured by bidding)

Request for FP&C Concurrence in Equipment Purchase (Required if equipment is to be procured through a bidding process)



Phone Number:


The following information is attached and Grantee requests FP&C’s concurrence inpurchasing equipment from in the amount of $ .

(Supplier) (Total Bid)

� Equipment list (with specifications, if applicable)


� Certified tabulation of bids or quotes with recommendation for acceptance





� FP&C concurs with the equipment purchase(Grantee must submit a Request for Disbursement Form to draw from State funds)

� FP&C does not concur with the equipment purchaseReason:

(Grantee must resolve and then submit another Request for FP&C Concurrence for theequipment purchase)

� FP&C concurs with the equipment purchase, with exceptions (see attachment)

ProjectManager: Date:

(Signature)


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July 1999 11

Escrow

Since Capital Outlay is a multi-year pro-gram, occasionally an appropriation may bean amount that cannot be completely spentin the early stages of the project development.For instance, say a project is in the prelimi-nary stage and has a total construction costestimate of $5 million. Assume the CapitalOutlay appropriation is for $1 million with nolocal match. Since only $500,000 (10% ofconstruction cost) can be budgeted for Plan-ning costs, and in this example assume only$30,000 is anticipated for Miscellaneouscosts, the remaining funds (minus FP&C ad-ministrative) can be assigned to the Escrow

This escrow category is not a costcategory; it is a bookkeepingcategory.

category for future use. These remainingfunds could then be moved to the Construc-tion category if/when supplemental fundswere obtained in future years to implementconstruction. Thus, Escrow is not a cost cat-egory; it is a bookkeeping category. Refer toFigure 5 for a sample cooperative endeavoragreement project budget illustrating this sce-nario.

Figure 5. Example Project Budget with Funds in Escrow

EXHIBIT "A"

COOPERATIVE ENDEAVOR AGREEMENT BETWEEN

THE STATE OF LOUISIANA AND NON-STATE ENTITY

Project Name

FP&C No. 50-XX-99-1 Planning and Construction

Parish

COSTS AND FUNDS THIS AGREEMENT ($) :

COSTCATEGORIES

CAPITALOUTLAY

CASH

NON-CASHLINE OFCREDIT

OTHER TOTAL

REAL ESTATE 0 0 0 0

PLANNING 500,000 0 0 500,000

CONSTRUCTION 0 0 0 0

MISC. 30,000 0 0 30,000

EQUIPMENT 0 0 0 0

ESCROW 450,000 0 0 450,000

FP&C ADMIN. 20,000 0 0 20,000

TOTAL COSTSAND FUNDS 1,000,000 0 0 1,000,000

Notes:

1. Planning Costs shall not exceed 10% of Construction Costs. Miscellaneous Costs shall

not exceed 5% of Construction Costs.

2. Capital Outlay Cash includes General Funds, NRP Bonds, Cash Line of Credit and/or

Bonds sold

3. Estimated total project construction cost is $5,000,000

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Administrative

The Capital Outlay Act authorizes FP&Cto retain up to 6% of the appropriation for Stateadministrative costs. The amount retainedby the FP&C is typically much less than 6%.

Operating and maintenance expenses ofa non-state entity are not eligible for Stateparticipation. Also, historically typical owneradministrative responsibilities are not eligiblefor State participation, even if a contractedconsultant is used (e.g., a project manage-ment consultant in addition to a professionaldesigner).

Operating andmaintenance expensesof a non-state entity arenot eligible for Stateparticipation.

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July 1999 13

Authorized Representative

Each non-state entity is required to pro-vide FP&C a copy of a resolution designatingand authorizing an official of the non-stateentity to act on behalf of the non-state entityin all matters pertaining to the Capital Outlayproject, including certifying requests for Statedisbursements. This resolution should be in-cluded when the non-state entity transmits toFP&C the signed cooperative endeavor agree-ment. No State funds can be disbursed with-out the resolution being provided to FP&C.

The authorized individual must be fromthe non-state entity, and not a contracted con-sultant. Costs for historically typical owneradministrative responsibilities are not eligiblefor State participation.

Local Match

If an appropriation includes “match”,then the match can be cash match or some-thing other than cash (in-kind match). If anappropriation specifically calls for “cashmatch”, then the match must be cash. If anappropriation specifically calls for “in-kindmatch”, then the match can be cash or some-thing other than cash. The cooperative en-deavor agreement budget will reflect theamounts of State funds and “other” funds inthe cost categories’ budgets (“other” fundscan be cash match, the value of in-kindmatch, or both, depending on the appropria-tion language).

For construction costs at or below theConstruction budget in the cooperative en-deavor agreement, State participation will beat the percentage reflected in the coopera-tive endeavor agreement’s Construction bud-get. If an eligible construction project is bidat an amount greater than the Constructionbudget in the cooperative endeavor agree-

ment, and the entity wishes to fund the differ-ence, then the State participation percentagewill be the percentage the State Constructionbudget amount is to the total eligible construc-tion cost.

If volunteer labor is to be used to in-stall manufactured materials or equipmentthat is to be acquired with Capital Outlayfunds, the materials or equipment must bepurchased and installed prior to FP&C dis-bursements for the materials or equipmentcosts.

Third party in-kind match is allowable.

CHAPTER 2 OTHER REQUIREMENTS

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July 1999 15July 1999 i

APPENDIX

Instructions for Completing Forms:

Request for Disbursement .................................................................. ii

Request for FP&C Concurrence in Real Estate Closing ...................... iv

Request for FP&C Concurrence in Construction Contract Award ....... vi

Request for FP&C Concurrence in Equipment Purchase.................. viii

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Instructions for Completing the Requestfor Disbursement Form

The following comments are referenced to the Request for Disbursement form on thenext page. The numbers relate to the form spaces that are filled in by an entity when request-ing a disbursement of State funds.

Each time a request for disbursement is made, the sequential number of that requestshould be provided. For example, the first request for disbursement would be a “1”.The second request, at a later date, would be “2”, and so on.

This is for the vendor’s invoice number. For construction contracts, this shouldbe the number on the contractor’s application for payment. If a non-state entity hasalready paid for the invoiced service and is seeking State reimbursement, a copy ofthe check the entity used to pay for service must be included with the Request forDisbursement.

Vendor name associated with the particular invoice. If a non-state entity has alreadypaid for the invoiced service and is seeking State reimbursement, a copy of the checkthe entity used to pay for service must be included with the Request for Disbursement.

This is the Cost Code for the cost categories as listed in this booklet. Refer to thetable at the bottom right corner of the Request for Disbursement form.

The actual dollar amount associated with a particular invoice. FP&C will calculate theamount that is State eligible.

The total actual dollar amount of all invoices associated with the request for disburse-ment. FP&C will calculate the amount that is State eligible.

Signature of the individual authorized by the non-state entity to certify invoices (seeChapter 2 for requirement of authorization resolution).

Date that the authorized individual signs the form.

Typed or printed name of the authorized individual who signed the form.

1

2

3

4

5

6

7

8

9

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July 1999 17July 1999 iii

Request for Disbursement Request No. _�_



Phone Number:

Invoices Enclosed:InvoiceNumber

Vendor Name CostCode*

Amount

� � � ❺

Total ❻

This document will hereby certify that each of the invoices on this list and attached list(s)is in accordance with the terms of the applicable contracts and/or agreements and thatthe services have been performed or the goods received. Furthermore, this certificationalso indicates compliance with the terms and conditions of the cooperative endeavoragreement by and between the State of Louisiana and the Grantee.

Certified Correct by Grantee: ___________❼_______________ Date: ____❽______

(Signature)

___________❾_______________ (Type or Print Name)

Remit to: Facility Planning & Control *Cost Code CategoryLA Division of Administration RQ Real EstatePost Office Box 94095 PN PlanningBaton Rouge, La. 70804-9095 CN Construction

MI MiscellaneousEQ Equipment

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Instructions for Completing the Request for FP&CConcurrence in Real Estate Closing

The following comments are referenced to the Request for FP&C Concurrence in RealEstate Closing form on the next page. The numbers relate to the form spaces that are filled inby an entity.

Check boxes indicating the information required and attached to the form.

Signature of the individual authorized by the non-state entity to certify invoices (seeChapter 2 for requirement of authorization resolution).

Date that the authorized individual signed the form.


1

2

3

4

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July 1999 19July 1999 v

Request for FP&C Concurrence in Real Estate Closing



Phone Number:


The following information is attached and Grantee requests FP&C’s concurrence that thetransaction is ready for closing.

↓❶ State Certified General appraisal

Preliminary title opinion attesting that the non-state entity will have good, clear, andmerchantable title upon execution of the act of sale, or title insurance

Phase I environmental assessment, prepared by an environmental professional according tocurrent ASTM standard practice, that also considers asbestos containing materials, lead-basedpaint, lead in drinking water and wetlands

Draft act of sale with warranty that the property is free of CERCLA defined hazards and petroleumproducts identified in the environmental assessment as existing or suspected.

Grantee: ❷ Date: ❸(Signature)

❹(Type or Print Name)


FP&C concurs that the transaction is ready for closing(FP&C will initiate writing a check in the amount of $ ___________________________ )

FP&C does not concur that the transaction is ready for closingReason:

(Grantee must resolve and then submit another Request for FP&C Concurrence in Real EstateClosing)

Project Manager: Date:(Signature)


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Instructions for Completing the Request for FP&CConcurrence in Construction Contract Award Form

The following comments are referenced to the Request for FP&C Concurrence in Con-struction Contract Award form on the next page. The numbers relate to the form spaces thatare filled in by an entity.

The total amount of the recommended bid or proposal, including all alternates.

Name of the contractor who submitted the recommended bid or proposal.

Check boxes indicating the information required and attached to the form. If matchor in-kind match is not to be used, write “N/A” over the match item’s checkbox. If thecontract price is such that public advertisement is not required, write “N/A” over thecheckbox pertaining to proof of ad publication.

Occasionally an entity will recommend executing change orders contemporaneouslywith the contract in order to bring the project within the available funds. If this is done,the change orders must be attached to this form. Other information may be includedon a project by project basis.

Signature of the individual authorized by the non-state entity to certify invoices(see Chapter 2 for requirement of authorization resolution).

Date that the authorized individual signs the form.


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2

3

4

5

6

7

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July 1999 21July 1999 vii

Request for FP&C Concurrence in Construction Contract Award



Phone Number:


The following information is attached and the Grantee requests FP&C’s concurrence in the award

of the construction contract for $ ❶ to

❷ .

↓❸� Final construction documents (plans and specifications)

� Construction document addenda

� Certification that the cooperative endeavor agreement’s ownership of property requirements have been met

� Evidence of current commitment and availability of match and/or in-kind match


� Certified tabulation of bids or proposals with recommendation for award


� Other �

Grantee: � Date: �(Signature)

�(Type or Print Name)


� FP&C concurs in construction contract award

(Grantee must submit a Request for Disbursement Form to draw from State funds)

� FP&C does not concur in construction contract award

Reason:

(Grantee must resolve and then submit another Request for FP&C Concurrence in Construction Contract Award)



(Total Bid) (Contractor)

6-26

22 July 1999viii July 1999

Instructions for Completing the Request for FP&CConcurrence in Equipment Purchase

The following comments are referenced to the Request for FP&C Concurrence in Equip-ment Purchase form on the next page. This form must be submitted to FP&C when equip-ment is to be procured through a bidding process. The numbers relate to the form spaces thatare filled in by an entity.

Name of the supplier who submitted the recommended bid or proposal.

The total amount of the recommended bid or proposal.

Check boxes indicating the information required and attached to the form. If thecontract price is such that public advertisement is not required, write “N/A” over thecheckbox pertaining to proof of ad publication.

Signature of the individual authorized by the non-state entity to certify invoices(see Chapter 2 for requirement of authorization resolution).

Date that the authorized individual signed the form.


1

2

3

4

5

6

6-27

July 1999 23July 1999 ix

Request for FP&C Concurrence in Equipment Purchase (Required if equipment is to be procured through a bidding process)



Phone Number:


The following information is attached and the Grantee requests FP&C’s concurrence in

purchasing equipment from ________________❶__________________ in the amount

$ __________❷____________.

↓❸� Equipment list (with specifications, if applicable)


� Certified tabulation of bids or quotes with recommendation for acceptance


Grantee: ❹ Date: ❺(Signature)

❻(Type or Print Name)


� FP&C concurs with the equipment purchase(Grantee must submit a Request for Disbursement Form to draw from State funds)

� FP&C does not concur with the equipment purchaseReason:

(Grantee must resolve and then submit another Request for FP&C Concurrence for the equipmentpurchase)

� FP&C concurs with the equipment purchase, with exceptions (see attachment)



(Supplier)

(Total Bid)

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