Pennsylvania Office of Vocational Rehabilitation (Rev. 04/10/2014)

(717) 787-5244 Voice

(717) 787-4885 TTY

(717) 783-5221 Fax

1521 North Sixth Street Harrisburg, PA 17102

Stephen Suroviec, Executive Director

(800) 442-6351 Voice

(866) 830-7327 TTY

District Office Administrators and

Assistant Administrator(s) Counties Served

ALLENTOWN (#15)

45 North 4th Street Allentown, PA 18102-3413

(610) 821-6441 Voice (610) 821-6144 TTY 1-800-922-9536*

1-888-377-9207* TTY Fax: (610) 821-6110

Richard Walters Susan Storm

Carbon

Lehigh Monroe Northampton

ALTOONA (#05) 1130 12TH Avenue, Suite 500

Altoona, PA 16601 (814) 946-7240 Voice/TTY 1-800-442-6343* Voice

1-866-320-7955* TTY Fax: (814) 949-7918

Colleen Woodring Vacant

Bedford

Blair Centre Fulton

Huntingdon

DUBOIS (#07)

199 Beaver Drive DuBois, PA 15801-2499 (814) 371-7340 Voice

(814) 371-7505 TTY 1-800-922-4017* Voice/TTY Fax: (814) 913-1002

Ralph Serafini Christina Palmer

Cameron Clearfield Elk

Jefferson McKean

ERIE (#08)

3200 Lovell Place Erie, PA 16503

(814) 871-4551 Voice (814) 871-4535 TTY 1-800-541-0721* Voice

1-888-217-1710* TTY Fax: (814) 871-4631

Jack Hewitt Kim Garnon

Clarion Crawford Erie

Forest Mercer Venango

Warren

HARRISBURG (#01) Forum Place, 555 Walnut St.

8th Floor Harrisburg, PA 17101 (717) 346-2755 Voice

(717) 787-4013 TTY 1-800-442-6352* 1-877-497-6545* TTY

Fax: (717) 783-7245

Janice Mazzitti Vacant

Dauphin

Cumberland Juniata Lebanon

Mifflin Perry

District Administrators and

Assistant Administrator(s) Counties Served

JOHNSTOWN (#10) 727 Goucher Street, Section 10

Johnstown, PA 15905 (814) 255-6771 Voice (814) 255-5510 TTY

1-800-762-4223* Voice 1-866-862-6891* TTY Fax: (814) 255-1185

Tammy Burke Chris Roken

Cambria Indiana Somerset

Westmoreland

NEW CASTLE (#12) 100 Margaret Street

New Castle, PA 16101 (724) 656-3070 Voice (724) 656-3252 TTY

1-800-442-6379* 1-888-870-4476* TTY Fax: (724) 656-3265

Gail Steck Roberta White-Prentice

Armstrong Beaver Butler

Lawrence

NORRISTOWN (#11)

1875 New Hope Street Norristown, PA 19401-3146 (484) 250-4340 Voice

(484) 250-4357 TTY 1-800-221-1042* Voice 1-888-616-0470* TTY

Fax: (484) 250-4356

Kevin Sand

Catherine Getchell

Bucks Chester

Delaware Montgomery

PHILADELPHIA (#02) 444 N. 3rd Street, 5th Floor Philadelphia, PA 19123

(215) 560-1900 Voice (215) 560-6144 TTY 1-800-442-6381*

1-800-772-9031* TTY Fax: (215) 560-3796

Wayne Trout Shari Brightful

Rose Higby Philadelphia

PITTSBURGH (#03) 531 Penn Avenue

Pittsburgh, PA 15222 (412) 392-4950 Voice (412) 392-5921 TTY

1-800-442-6371* 1-888-870-4474* TTY Fax: (412) 565-7587

Marci Katona Shannon Austin Richard Musser

Allegheny

READING (#06) 3602 Kutztown Road Suite 200

Reading, PA 19605 (610) 621-5800 Voice (610) 916-8965 TTY

1-800-442-0949* 1-877-475-7326* TTY Fax: (610) 916-2470

Denise Verchimak (Acting)

Judith Pena (Acting)

Lynn Zale

Berks Schuylkill

District Administrators and

Assistant Administrator(s) Counties Served

WASHINGTON (#16) 201 W. Wheeling Street Washington, PA 15301

(724) 223-4430 Voice 1-800-442-6367* Voice (724) 223-4443 TTY

1-866-752-6163* TTY Fax: (724) 223-4463

Lori Kaczmarek Darla Openbrier

Fayette

Greene Washington

WILKES-BARRE (#04)

300G Laird Street Wilkes-Barre, PA 18702-7013 (570) 826-2011 Voice

(570) 826-2023 TTY 1-800-634-2060* Voice 1-888-651-6117* TTY

Fax: (570) 826-2235

Heather Nelson

Michael Huber

Bradford Columbia

Luzerne Lackawanna Pike

Sullivan Susquehanna Wayne

Wyoming

WILLIAMSPORT (#09) The Grit Building, Suite 102 208 W. 3rd Street

Williamsport, PA 17701 (570) 327-3600 Voice (570) 327-3620 TTY

1-800-442-6359* 1-800-706-0884* TTY Fax: (570) 327-3611

Susan Swartz Cherylene Moore

Clinton Lycoming Northumberland

Potter Snyder

Tioga Union Montour

YORK (#14) 2550 Kingston Road, Suite 101

York, PA 17402 (717) 771-4407 Voice (717) 771-4433 TTY

1-800-762-6306* 1-866-466-1404* TTY

Fax: (717) 771-4421

Susan Richeson Alicia Brownell

Adams Franklin Lancaster

York

HIRAM G. ANDREWS CENTER

(#99) 727 Goucher Street Johnstown, PA 15905

(814) 225-8200 Voice (814) 225-5873 TTY 1-800-762-4211*

Fax: (814) 255-3406

Director: Carol Mackel

Deputy Director: Jill Moriconi

Bureau of Blindness and Visual Services

District Administrators and

Assistant Administrator(s) Counties Served

ALTOONA BBVS

1130 12th Avenue, Suite 300 Altoona, PA 16601 (814) 946-7330 Voice

(814) 949-7956 TTY 1-866-695-7673* 1-866-320-7956* TTY

Fax: (814) 949-7995

Anne Strollo

Susan Friedenberger

Bedford

Blair Cambria Centre

Clinton Columbia Fulton

Huntingdon

Juniata

Lycoming Mifflin Montour

Northumberland Snyder Somerset

Union

ERIE BBVS 4200 Lovell Place Erie, PA 16503

(814) 871-4401 Voice (814) 871-4599 TTY

1-866-521-5073* 1-888-884-5513* TTY Fax: (814) 871-4746

Dawn Sokol Chris Cowan

Cameron Clarion

Clearfield Crawford Elk

Erie Forest

Jefferson Lawrence

McKean Mercer Potter

Venango Warren

HARRISBURG BBVS Forum Place, 555 Walnut Street

8th Floor Harrisburg, PA 17101 (717) 346-2750 Voice

(717) 787-1733 TTY 1-866-375-8264* 1-888-575-9420* TTY

Fax: (717) 772-0589

Wilhelmenia Murry Belinda Crobak

Adams Cumberland

Dauphin Franklin

Lancaster Lebanon

Perry York

PHILADELPHIA BBVS 444 N. 3rd Street, 5th Floor Philadelphia, PA 19123

(215) 560-5700 Voice (215) 560-5725 TTY 1-866-631-3892*

1-888-870-4473* TTY Fax: (215) 965-4873

Lynn Heitz Vacant

Bucks

Chester Delaware

Montgomery Philadelphia

PITTSBURGH BBVS

531 Penn Avenue Pittsburgh, PA 15222 (412) 565-5240 Voice

(412) 565-3678 TTY 1-866-412-4072* 1-877-255-5082* TTY

Fax: (412) 565-2296

Rich Fischer

Janet Wisloski

Allegheny Armstrong Beaver

Butler Fayette

Greene Indiana

Washington Westmoreland

WILKES-BARRE BBVS 300G Laird Street Wilkes-Barre, PA 18702-7013

(570) 826-2361 Voice (570) 826-2023 TTY 1-866-227-4163* Voice

1-888-651-6117* TTY Fax: (570) 826-2538

Karen Walsh-Emma Vacant

Berks Bradford Carbon

Lackawanna Lehigh Luzerne

Monroe Northampton

Pike Schuylkill Sullivan

Susquehanna Tioga

Wayne Wyoming

Attachment B

DOMESTIC WORKFORCE UTILIZATION CERTIFICATION (07/22/09)

To the extent permitted by the laws and treaties of the United States, each proposal will be scored for its

commitment to use the domestic workforce in the fulfillment of the contract. Maximum consideration

will be given to those offerors who will perform the contracted direct labor exclusively within the

geographical boundaries of the United States or within the geographical boundaries of a country that is a

party to the World Trade Organization Government Procurement Agreement. Those who propose to

perform a portion of the direct labor outside of the United States and not within the geographical

boundaries of a party to the World Trade Organization Government Procurement Agreement will receive

a correspondingly smaller score for this criterion. In order to be eligible for any consideration for this

criterion, offerors must complete and sign the following certification. This certification will be included

as a contractual obligation when the contract is executed. Failure to complete and sign this certification

will result in no consideration being given to the offeror for this criterion.

I, ______________________[title] of ____________________________________[name of

Contractor] a _______________ [place of incorporation] corporation or other legal entity,

(“Contractor”) located at __________________________________________________________

[address], having a Social Security or Federal Identification Number of ________________________, do

hereby certify and represent to the Commonwealth of Pennsylvania ("Commonwealth") (Check one of

the boxes below):

All of the direct labor performed within the scope of services under the contract will be

performed exclusively within the geographical boundaries of the United States or one of the

following countries that is a party to the World Trade Organization Government Procurement

Agreement: Aruba, Austria, Belgium, Bulgaria, Canada, Chinese Taipei, Cyprus, Czech

Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hong Kong, Hungary, Iceland,

Ireland, Israel, Italy, Japan, Korea, Latvia, Liechtenstein, Lithuania, Luxemburg, Malta, the

Netherlands, Norway, Poland, Portugal, Romania, Singapore, Slovak Republic, Slovenia, Spain,

Sweden, Switzerland, and the United Kingdom

OR

________________ percent (_____%) [Contractor must specify the percentage] of the

direct labor performed within the scope of services under the contract will be performed within

the geographical boundaries of the United States or within the geographical boundaries of one of

the countries listed above that is a party to the World Trade Organization Government

Procurement Agreement. Please identify the direct labor performed under the contract that will

be performed outside the United States and not within the geographical boundaries of a party to

the World Trade Organization Government Procurement Agreement and identify the country

where the direct labor will be performed: ____________________________________________

______________________________________________________________________________

[Use additional sheets if necessary]

The Department of General Services [or other purchasing agency] shall treat any misstatement as

fraudulent concealment of the true facts punishable under Section 4904 of the Pennsylvania Crimes Code,

Title 18, of Pa. Consolidated Statutes.

Attest or Witness: ______________________________

Corporate or Legal Entity's Name

_____________________________ ______________________________

Signature/Date Signature/Date

_____________________________ ______________________________

Printed Name/Title Printed Name/Title

BUDGET PROPOSAL - ORGANIZATION

Document #4XXXXXXXXX Contract Year X BNXX

Vendor #XXXXXX

STAFF CATEGORY

SALARIES

Executive Director: $XX,XXX.XX * XX% -$

Staff member : $XX,XXX.XX * XX% -$

Staff member: $XX,XXX.XX * XX% -$

Salary Subtotal -$

BENEFITS

Executive Director @ XX.X% -$

Staff member @ XX.X% -$

Staff member @ XX.X% -$

Benefits Subtotal -$

STAFF TOTAL -$

EQUIPMENT CATEGORY

EQUIPMENT PURCHASE

Copier Purchase -$

EQUIPMENT LEASE/RENTAL

Copier Lease -$

EQUIPMENT MAINTENANCE AGREEMENTS

Copier Lease/Maintenance -$

Computer/Server/Website Maintenance Agreements -$

EQUIPMENT TOTAL -$

OTHER CATEGORY

PROFESSIONAL SERVICES

Attorney -$

Audit -$

Bookkeeping/Accounting -$

Information Technology -$

Liability Insurance - Office -$

Budget Line Item

Amount

Liability Insurance - Directors & Officers -$

Marketing/Outreach -$

Worker's Comp -$

Payroll Service -$

Printing/Reproduction -$

Staff Training/Education -$

Computer Software -$

Meeting Room Charge -$

PROFESSIONAL MEMBERSHIP DUES/SUBSCRIPTIONS

Organizational Membership Dues -$

Other Membership Dues -$

Newspaper Meeting Notices -$

Office Supplies -$

Program Supplies -$

Postage and Overnight Mail -$

REASONABLE ACCOMMODATIONS

Interpreter Services -$

OCCUPANCY EXPENSES

Rent -$

Cleaning/Maintenance -$

Utilities -$

TELEPHONE/INTERNET/FAX

Cell phone service -$

Land line telephone service -$

Teleconference Line -$

Internet service -$

TRAVEL

Travel - Lodging -$

Travel - Meals -$

Travel - Transportation -$

Administrative Overhead -$

OTHER TOTAL -$

GRAND TOTAL -$

Attachment - D

GENERAL CONDITIONS AND INSTRUCTIONS TO BIDDERS

FOR REQUEST FOR QUOTE

1. SUBMISSIONS OF BIDS:

a. Bids are requested for the item(s) described in the Request for Quote and all

the documents referenced in the form (collectively called the RFQ). Bidders

must complete and properly sign, in ink, the Request for Quote form. Bid prices

must be typewritten or in ink. Bids that are priced or signed in pencil will be

rejected.

b. The completed and signed Request for Quote form, as well as the other

documents required by the RFQ (collectively referred to as the "Bid"), shall be

emailed to the individual listed on the RFQ form by the date and time

specified.

c. Bids must be firm. If a Bid is submitted with conditions or exceptions or not in

conformance with the terms and conditions referenced in the RFQ Form, it shall

be rejected. The Bid shall also be rejected if the items offered by the Bidder are

not in conformance with the specifications as determined by the

Commonwealth.

d. The Bidder, intending to be legally bound hereby, offers and agrees, if this Bid is

accepted, to provide the awarded items at the price(s) set forth in this Bid at

the time(s) and place(s) specified.

2. BIDDER'S REPRESENTATION AND AUTHORIZATION:

a. Each Bidder, by making its Bid, understands, represents, and

acknowledges that:

1) The Bidder has read and understands the terms and conditions of

the RFQ and the Bid is made in accordance with those terms and

conditions.

2) The item(s) offered in the Bid will be in conformance with the

specifications referenced on the RFQ without exceptions.

3) The price(s) and amount of the Bid have been arrived at

independently and without consultation, communication, or

agreement with any other contractor, bidder, or potential bidder.

4) Neither the price(s) nor the amount of the bid, and neither the

approximate price(s) nor the approximate amount of the Bid, have

been disclosed to any other firm or person who is a bidder or

potential bidder, and they will not be disclosed before Bid opening.

2

5) No attempt has been made or will be made to induce any firm or

person to refrain from bidding on the contract, or to submit a bid

higher than the Bid, or to submit any intentionally high or

noncompetitive bid or other form of complementary bid.

6) The Bid is made in good faith and not pursuant to any agreement

or discussion with, or inducement from, any firm or person to submit

a complementary or other noncompetitive bid.

7) To the best of the knowledge of the person signing the Bid for the

Bidder, the Bidder, its affiliates, subsidiaries, officers, directors, and

employees are not currently under investigation by any

governmental agency and have not in the lasts four years been

convicted or found liable for any act prohibited by State or Federal

law in any jurisdiction, involving conspiracy or collusion with respect

to bidding on any public contract, except as disclosed by the

Bidder in its Bid.

8) Neither the bidder, nor any subcontractors, nor any suppliers are

under suspension or debarment by the Commonwealth, or any

governmental entity, instrumentality, or authority, and if the bidder

cannot so certify, then it shall submit, along with the Bid, a written

explanation of why such certification cannot be made.

9) To the best of the knowledge of the person signing the Bid for the

Bidder, and except as otherwise disclosed by the Bidder in its Bid,

the Bidder has no outstanding, delinquent obligations to the

Commonwealth including, but not limited to, any state tax liability

not being contested on appeal or other obligation of the Bidder

that is owed to the Commonwealth.

10) The Bidder has not, under separate contract with the

Commonwealth, made any recommendations to the

Commonwealth concerning: the RFQ, the need for the item(s)

described in the RFQ, or the specification for the item(s) described

in the RFQ.

11) All information provided by, and representations made by, the

Bidder in the Bid are material and important and will be relied upon

by the Commonwealth in awarding the contract. Any

misstatement shall be treated as fraudulent concealment from the

Commonwealth of the true facts relating to the submission of the

Bid. A misrepresentation shall be punishable under Section 4904 of

Title 18 P.C.S.A.

b. Each Bidder, by making its Bid, authorizes all Commonwealth agencies to

release to the Commonwealth information related to liabilities to the

Commonwealth including, but not limited to taxes, unemployment

compensation, and workers' compensation liabilities.

3

c. If an award is made to the Bidder, the Bidder agrees that it intends to be

legally bound to the contract which is formed between the

Commonwealth and the Bidder.

Appendix E Page 1 of 1

APPENDIX E

Lobbying Certification Form

Certification for Contracts, Grants, Loans, and Cooperative Agreements

The undersigned certifies, to the best of his or her knowledge and belief, that:

(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned,

to any person for influencing or attempting to influence an officer or employee of any agency, a member of

Congress , an officer or employee of Congress, or an employee of a member of Congress in connection with the

awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering

into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any

federal contract, grant, loan, or cooperative agreement.

(2) If any funds other than federal appropriated funds have been paid or will be paid to any person

for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an

officer or employee of Congress, or an employee of a member of Congress in connection with this federal

contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL,

"Disclosure of Lobbying Activities," in accordance with its instructions.

(3) The undersigned shall require that the language of this certification be included in the award

documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans,

and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance is placed when this transaction was

made or entered into. Submission of this certification is a prerequisite for making or entering into this

transaction imposed under Section 1352, Title 31, U.S. Code. Any person who fails to file the required

certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for such

failure.

SIGNATURE: _________________________________________________________

TITLE: _______________________________________________________________

DATE: _______________________________________________________________

DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046

(See reverse for public burden disclosure.) 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:

a. contract a. bid/offer/application a. initial filing b. grant b. initial award b. material change c. cooperative agreement c. post-award For Material Change Only: d. loan year _________ quarter _________ e. loan guarantee date of last report ______________ f. loan insurance

4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is a Subawardee, Enter Name and Address of Prime:

Tier ______, if known :

Congressional District, if known : Congressional District, if known : 6. Federal Department/Agency: 7. Federal Program Name/Description:

CFDA Number, if applicable: _____________

8. Federal Action Number, if known : 9. Award Amount, if known :

$

10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address if ( if individual, last name, first name, MI): different from No. 10a )

(last name, first name, MI ):

11. Signature:

Print Name:

Title:

Telephone No.: _______________________

Authorized for Local Reproduction

Standard Form LLL (Rev. 7-97)

Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be available for public inspection. required disclosure shall be subject to a not more than $100,000 for each such failure.

Prime Subawardee

Federal Use Only:

Date:

who fails to file the Any person $10,000 and than civil penalty of not less

INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES

This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employeeof any agency, a Member of Congress, an officer or employeeof Congress, or an employeeof a Member of Congress in connectionwith a coveredFederalaction. Completeall items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.

1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.

2. Identify the status of the covered Federal action.

3. Identify the appropriateclassification of this report. If this is a followup report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action.

4. Enter the full name, address, city, State and zip code of the reporting entity. Include CongressionalDistrict, if known. Check the appropriateclassification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee,e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

5. If the organization filing the report in item 4 checks "Subawardee," then enter the full name, address, city, State and zip code of the prime Federal

recipient. Include Congressional District, if known.

6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizationallevel below agency name, if known. For

example, Department of Transportation, United States Coast Guard.

7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance

(CFDA) number for grants, cooperative agreements, loans, and loan commitments.

8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001."

9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan

commitment for the prime entity identified in item 4 or 5.

10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action.

(b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a). Enter Last Name, First Name, and Middle Initial (MI).

11. The certifying official shall sign and date the form, print his/her name, title, and telephone number.

According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB Control Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, DC 20503.

1

ATTACHMENT G

FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT (FFATA)

The Subgrantee must complete Federal Funding Accountability and Transparency Act (FFATA) form

attached here. This form is to be completed and incorporated as part of this agreement.

Failure to provide accurate information for the Subgrantee named as a party to this agreement or to

complete the FFATA form will cause the inability of the Commonwealth to process this grant and

resulting in delay or loss of funds to the Subgrantee. The Subgrantee’s documentation will be considered

incomplete until such time that Subgrantee provides accurate FFATA information.

(a) Registration and Identification Information – The Subgrantee must maintain current registration in

the Central Contractor Registration (www.ccr.gov) at all times during which they have active

federal awards funded pursuant to this agreement. A Dun and Bradstreet Data Universal

Numbering System (DUNS) Number (www.dnb.com) is one of the requirements for registration

in the Central Contractor Registration. Subgrantee must provide its DUNS number, and DUNS +

4 number if applicable, to the Commonwealth along with the signed grant agreement.

(b) Primary Location - Subgrantee must provide to the Commonwealth the primary location of

performance under the award, including the city, State, and zip+4. If performance is to occur in

multiple locations, then Subgrantee must list the location where the most amount of the grant

award is to be expended pursuant to this grant agreement.

(c) Compensation of Officers - Subgrantee must provide to the Commonwealth the names and total

compensation of the five most highly compensated officers of the entity if-

1. the entity in the preceding fiscal year received—

a. 80 percent or more of its annual gross revenues in Federal awards; and

b. $25,000,000 or more in annual gross revenues from Federal awards: and

c. the public does not have access to information about the compensation of the senior

executives of the entity through periodic reports filed under section 13(a) or 15(d) of

the Securities Exchanges Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of

the Internal Revenue Code of 1986. If the Subgrantee does not meet the conditions

listed above, then it must specifically affirm to the Commonwealth that the

requirements of this clause are inapplicable to the Subgrantee. Subgrantee must

provide information responding to this question along with Subgrantee’s return of the

signed grant agreement. The Commonwealth will not process this grant until such

time that Subgrantee provides such information responding to this question.

2

Federal Funding Accountability and Transparency Act Sub-recipient Data Sheet

Grantee must provide information along with Grantee’s return of the signed grant agreement. The Co mmonwealth will not process the grant until such time that Grantee provides such information.

DUNS NUMBER

DUNS Number:

DUNS Number + 4 (if applicable):

[INSTRUCTIONS: Grantee must provide its assigned DUNS number, and DUNS + 4 number if applicable. Grantee must maintain current registration in the Central Contractor Registration (www.ccr.gov) at all times during which they have active federal awards funded pursuant to their sub-grant agreement. A Dun and Bradstreet Data Universal Numbering System (DUNS) Number (www.dnb.com) is one of the requirements for registration in the Central Contractor Registration.]

PRIMARY LOCATION

City:

State:

Zip+4:

[INSTRUCTIONS: Grantee must provide to the Commonwealth the primary location of performance under the award, including the city, State, and zip code including 4-digit extension. If performance is to occur in multiple locations, then Grantee must list the location where the most amount of the grant award is to be expended pursuant to the grant agreement.]

Compensation of Officers

Officer 1 Name:

Officer 1 Compensation:

Officer 2 Name:

Officer 2 Compensation:

Officer 3 Name:

By marking the following box

Officer 3 Compensation:

Grantee affirms they do not meet

Officer 4 Name:

the conditions for reporting highly

Officer 4 Compensation:

compensated officials

Officer 5 Name:

Officer 5 Compensation:

[INSTRUCTIONS: Grantee must provide to the Commonwealth the names and total compensation of the five most highly compensated officers of the entity if-- (i) the entity in the preceding fiscal year received— (I) 80 percent or more of its annual gross revenues in Federal awards; and (II) $25,000,000 or more in annual gross revenues from Federal awards: and (ii) the public does not have access to information about the compensation of the senior executives of the entity through periodic reports filed under section 13(a) or 15(d) of the Securities Exchanges Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986. If the Grantee does not meet the conditions listed above, then it must specifically affirm to the Commonwealth that the requirements of this clause are inapplicable to the Grantee.

1

Office of Vocational Rehabilitation

Innovation and Expansion Project

Implementing Guidelines

(Name of Agency)

(Address)

The purpose of this project, as described specifically in the Statement of

Work, is the development of an Innovation and Expansion Project to provide

new strategies and programs to improve employment outcomes for individuals

with the most significant disabilities as defined in the Rehabilitation Act of

1973, as amended. OVR is seeking community projects that result in

competitive employment of persons with the most significant disabilities. This

project is funded with Title I funds through the Rehabilitation Act of 1973, as

amended – CFDA #84.126 – Rehabilitation Services – Vocational

Rehabilitation Grants to States.

A. Any project or program information released by the Contractor through

the news media or for public information must identify the Office of

Vocational Rehabilitation as a funding source, and a copy of the release

must be forwarded to the Contractor and Grantee Services Division, OVR

Central Office.

B. OVR shall monitor and evaluate the program, the financial operation of

this project, and any subcontracts. .

C. Contractor shall notify all subcontractors of the provisions of these

Guidelines, conduct compliance reviews at reasonable times to insure

adherence to all civil rights and discrimination laws and other applicable

provisions of this project, and notify OVR of any violations or suspected

violations.

The Contractor certifies that it shall be adequately staffed with personnel

qualified to carry out the project, and that funds for staffing may be utilized

only during the term of the Project.

Direct salary charges for project staff must be supported by time/activity

reports (Staff Certification Forms) completed by each employee and verified

by his/her supervisor.

Staff Certification Forms must be completed and submitted monthly and must

reflect the total time the employee spends in project supported activities, as

CONTRACTOR

STAFF REQUIRED

FOR PROJECT

2

well as any changes in assignment. All project-related activities and the

number of hours spent accomplishing these activities must be described on the

Staff Certification Form.

Salaries for project staff shall be based upon the Contractor’s established

salary and wage scales for comparable positions (classifications). General

raises should also be extended to the project staff; however, project monies

may be used to fund such raises only if such anticipated raises have been

included in the Contractor’s budget.

Project funds may not be used to finance building expansion.

The Contractor shall be adequately prepared to carry out the funded project.

The Contractor certifies that equipment requested for its use in administering

this project is not already on hand and is required for the operation of the

Project.

All purchases (including, but not limited to, equipment) made by the

Contractor with a cost of five thousand dollars ($5,000) or more per individual

item shall be competitively bid. The Contractor shall request written bids

from at least three (3) vendors, which include a description of the equipment

and price quote. The lowest responsible bid shall be accepted.

If a competitive bid is not possible, the Contractor shall provide OVR with a

written explanation of the circumstances that preclude a competitive bid and

request sole source approval for the proposed purchase. Written OVR

approval of the sole source justification must pre-date expenditure of project

funds.

OVR shall hold first lien on all equipment, with a cost of $5,000 or more per

individual item, purchased with project funds for a period of five (5) years.

The value of OVR’s lien, as registered with the PA Department of State, will

equal the portion of the equipment purchase price financed by OVR through

this Purchase Order/Funds Commitment. The Contractor will file OVR’s lien

with the PA Department of State using the Financing Statement, Uniform

Commercial Code UCC-1.

Ownership of such equipment will revert to OVR if the terms of the DGS

Contract are violated, or if the project has terminated while OVR holds the

aforementioned lien.

Equipment purchased with project funds may not be offered as collateral in

any transactions while OVR holds a lien against such equipment.

The Contractor shall file the Form UCC-1, Uniform Commercial Code

Financing Statement with the PA Department of State in order to register

OVR’s interest in project-purchased equipment. The Contractor (Debtor, as

identified in the UCC-1 filing), shall pay all filing fees required by the

Commonwealth of PA and the Contractor shall furnish OVR with proof that

BUILDING AND

FACILITY

EQUIPMENT

EQUIPMENT

TITLE

EQUIPMENT

REGISTRATION

3

OVR’s security interest has been registered in an effective and timely manner.

Filing fees may not be paid with project funds.

The Contractor will obtain copies of form UCC-1 Financing Statement from

the PA Department of State. The UCC-1 Financing Statement and

instructions are available online at

http://www.dos.state.pa.us/portal/server.pt/community/corporations/12457/for

ms/571880 through the PA Department of State voice mail system by calling

(717) 772-1057.

Information concerning filing fees is available online at

http://www.dos.state.pa.us/portal/server.pt/community/corporations/12457/fee

s___payment/571873 or by telephone at (717) 787-1057.

If Project-purchased equipment is placed in rented premises, a Landlord’s

waiver must be executed by the landlord prior to the placement of the

equipment on the premises.

The Contractor, subcontractors, and participating employers shall:

A. Comply with applicable laws and regulations relating to employee

health, safety, and sanitation.

B. Comply with applicable laws with respect to fire protection, safety

devices or guards on machinery, and accident hazards.

C. Comply with applicable federal, state, and local minimum wage and

hour laws.

D. Comply with applicable Workers Compensation statutes relating to work

accidents and occupational diseases.

E. Safeguard the rights and welfare of human subjects who are involved in

activities supported by Federal funds. For purposes of this policy, a

human subject is an individual who may be exposed to the possibility of

physical, psychological, sociological or other harm as a result of any

activity that goes beyond the application of those established and

accepted methods necessary to meet the subject’s needs.

The Contractor shall perform an analysis of the total project that will identify

the results and effectiveness of the project as measured by the Statement of

Work, Deliverables, goals and objectives, and the benefits to the individuals

and communities served. The Contractor shall conduct surveys of project

participants’ satisfaction with services rendered under the project.

The Contractor shall maintain adequate accounting records for the project,

separate and apart from records kept for its usual operation and other

contracts/grants, to assure reconciliation of all project costs.

LANDLORD

WAIVER

COMPLIANCE

WITH

APPLICABLE

LAWS

EVALUATION

COMPONENT

CONTROL OF

EXPENDITURES

4

The Contractor shall make its records available at its office, at all reasonable

times during the term of this project, for inspection, audit or reproduction by

an authorized representative of the Secretary of Labor and Industry or the

Auditor General. Invoices for all equipment and other expenditures must be

retained and are subject to audit. If non-project items are noted on the same

invoice, items that are project-related must be identified. If this project is

terminated, the records relating to this project shall be retained and available

for a period of six (6) years from the date of any final settlement.

I. Monies received by the Contractor from OVR must be immediately

deposited into a separate interest-bearing checking or savings account,

or assigned to a dedicated cost center through which the movement of

project funds may be readily traced. Earned interest and program

income may be used to support Project operations with approval from

OVR.

A. Checks used in project-related transactions must be clearly imprinted

with or otherwise show the indelible notation of OVR I&E Project–

2014 and refer to the dedicated cost center.

B. All transactions must have supporting documentation in the project

file and must be related to the project purposes.

C. Funds may not be commingled. If funds are commingled, the total

monies paid under this Purchase Order/Funds Commitment must be

returned to OVR upon demand.

Commingle means depositing or recording funds in a general

account without the ability to identify each specific source of

funds for any expenditure.

The funds from each funding source must be identifiable with a

clear audit trail for each source. As expenditures occur it is

appropriate for those funds to be consolidated for carrying out a

common purpose.

D. Project funds may be used only for the purposes of this project.

Temporary transfers such as payment of debts and/or purchase of

non-project items with project funds may not be made from the

project funds. If funds are improperly transferred, the total monies

paid under this project must be returned to OVR upon demand.

E. For Projects of $100,000 or more, the Contractor shall secure an

independent audit of funds awarded for the project and submit the

audit report within 180 days after the end of the project period. OVR

requires an independent audit that is completed by a Certified Public

Accountant (CPA). The CPA should have no dealings with, nor

receive compensation from, the organization during the audit time

period. The audit must be a bound copy or it can be emailed to us in

.pdf format by the auditor. The audit is to be an in-depth examination

5

of the financial statements for the entire organization with a written

opinion by the CPA regarding those statements. The audit shall

cover the contractor’s receipts and expenditures for the project. It

should also include all items required by an audit conducted in

conformance with the Generally Accepted Auditing Standards and

be accompanied by reports that are prepared and signed by the

auditor. Such audit shall be performed for the period(s) of the

Purchase Order/Funds Commitment. The report of the audit shall be

provided to OVR within 180 days after the end of each project

period.

If the Contractor is subject to audit under the terms of Circular A-

133, then such independent A-133 audit will satisfy the independent

audit requirements of this project.

Delivery of the A-133 audit report to OVR will occur in a timely

manner consistent with A-133 regulations. If the A-133 audit cannot

be presented to OVR within 180 days, The Contractor is responsible

for notifying OVR of that fact. Notification will take the form of a

letter addressed to the Division Chief, OVR Contractor and Grantee

Services Division, advising OVR of when the A-133 audit will be

submitted. OVR’s written acceptance of the projected submittal date

waives the project’s 180-day audit due date. The Contractor will

retain the OVR 180-day waiver with the records of this project.

II. Project monies shall be expended in accordance with the approved

Budget.

A. The Contractor may pay wages and fringe benefits for staff funded

through this project from its General or Payroll Account, then

reimburse its General or Payroll Account for such advance using

project funds. Reimbursement may be every pay period but, at

minimum, must be every calendar quarter. The Contractor may

reimburse gross payroll each payday, reimburse life insurance and

health care insurance each month, and reimburse taxes the month

succeeding the calendar quarter. Vouchers for each check written

must be maintained to document each transfer from the project

account to the General or Payroll Account. Any such reimbursement

must closely parallel the payment to be made from the General

Account or Payroll Account.

B. Contractors electing Unemployment Compensation coverage as

reimbursable employers may not use project money to build a

contingency fund against possible future Unemployment

Compensation claims. Project payment for Unemployment

Compensation claims filed against the Contractor electing this form

of coverage is not permitted.

C. Use of project funds for expenditures other than those approved in

the project budget, or in a subsequent Budget Revision Request

6

(BRR), is prohibited. Project funds shall not be transferred to any

other Contractor accounts. Exception to this provision is permitted

only in the case of payroll, as noted previously, and for transfer of

project funds to cover expenditures incurred after the effective date

of the project, but prior to receipt of project funds.

D. In Budgets with more than one expenditure category (e.g., staffing

and equipment) the monies allotted to each expenditure category

may not be exceeded without an approved Budget Revision Request.

OVR recognizes that actual expenditures may exceed allowances;

however, if expenditure will exceed an estimate by twenty-five

percent (25%), the BRR must be approved by OVR prior to the

expenditure. If Salary for a project staff position, combined with

Fringe Benefits for that position, will exceed the estimate by ten

percent (10%), the BRR must be approved by OVR prior to the

expenditure.

If the total amount for a budget category is exceeded, the Contractor

is liable for the excess, unless the Program Analyst, OVR Contractor

and Grantee Services Division, approves the expenditure in writing.

E. If, in the expenditure category Staff, the project narrative includes

part-time positions and the actual time on project activities exceeds

the percentage indicated on the application, then the percentage of

time specified on the application will take precedence. As a general

rule, the percentage of time associated with a staff position would be

equally distributed throughout the project year. For example, if a

staff position is for forty percent (40%) of the time on the Project,

the project account should fund the position for two (2) days a week

for 52 weeks. Staffing covers the normal work day or work week for

the position. Any variations should be specified in the Budget

narrative or will require a BRR with approval prior to implementa-

tion.

F. Travel costs should be reported in the expenditure category Other.

OVR shall recognize travel costs associated with the project. All

such travel costs must be consistent with Commonwealth Travel

Regulations.

III. Project budgets may be revised.

A. Line items in the Project budget may be revised as noted in Parts

II, C and II, D, CONTROL OF EXPENDITURES. Surplus,

undesignated funds resulting from an approved Budget Revision

Request may be used for other program-related items if written

permission to do so is secured from the Program Analyst, OVR

Contractor and Grantee Services Division.

B. OVR’s written approval of the Budget Revision Request,

whenever applicable, must be retained by the Contractor for six

7

(6) years from the date of any final settlement. It is the

responsibility of the Contractor to obtain written approval from

the OVR Contractor and Grantee Services Division Program

Analyst to make changes.

C. All items purchased with project monies, but not specifically

approved in the original budget or through a Budget Revision

Request, will be considered as audit exceptions. If audit

exceptions are not overturned, the Contractor must make

appropriate refunds to OVR.

IV. Items approved by the original Budget or subsequent Budget Revision

Requests must be purchased and/or obligated prior to the expiration

date of the project.

A. Documentation that the funds were obligated prior to the expira-

tion date will require Contractor to provide purchase orders or

signed purchase contracts. OVR’s approval of a Budget Revision

Request permits expenditure for those approved items, but does

not constitute obligation of funds by the Contractor for their

purchase.

B. Staff salaries and fringe benefits may not be obligated for future

payment.

C. If obligated funds are not supported by purchase orders or signed

contracts, the Contractor must make appropriate refunds to OVR.

The Contractor shall submit to the OVR/BBVS District Administrator and to

the Contractor and Grantee Services Division, within fifteen (15) days after

the end of each calendar quarter of the project, a Program Narrative and

Financial Statement Report. The Quarterly Narrative Report shall

demonstrate the Contractor’s implementation of its Program Evaluation

System.

The narrative report shall include at least the following information:

A summary of project activity to include the status of each Deliverable in

the Statement of Work and other goals and objectives;

Data driven summary of outcomes being tracked; including starting point,

current status and goal;

Challenges and/or barriers involved in meeting proposed outcomes;

Strategies to address challenges and/or barriers;

Identification of technical assistance requirements.

QUARTERLY

NARRATIVE

AND FINANCIAL

STATEMEMT

REPORT

8

(NOTE: Failure to provide OVR Quarterly Reports in a timely manner,

as specified in paragraph one of this Section, will result in interruption of

OVR project payments.)

A Final Expenditures Report and Narrative Report covering project activities

over the entire project period must be submitted within 30 days after the end

of the project. The Contractor shall email the final report to the Contractor

and Grantee Services Division, Central Office, and to the OVR/BBVS District

Administrator. At least the following information must be included in the

narrative:

a. A statement of the progress toward achieving the Project’s

Deliverables, goals and objectives.

b. Itemization of how project funds were utilized, including:

(i) The project staff hired, if applicable.

(ii) Equipment purchased by the Contractor. (List equipment and

purchase price.)

(iii) Other benefits resulting from the project.

c. Description of the major problems and difficulties encountered in

the project and their resolution.

d. Status of plans for continuing project activities after expiration of

project support for the project.

A. This project may be terminated by the Commonwealth in whole, or in

part, if for any reason the OVR Executive Director shall determine such

termination is in the best interest of the Commonwealth. Any such

termination shall be effected by delivering to the Contractor a notice of

termination specifying the extent to which performance of the work under

the project is terminated and the date on which such termination becomes

effective. The project shall be equitably adjusted to compensate for such

termination and the project modified accordingly.

B. If the project is terminated by the Commonwealth, in addition to any

other rights provided in this paragraph, the Commonwealth may require

the Contractor to deliver to the Commonwealth, in the manner and to the

extent directed by the OVR Executive Director, such partially completed

reports or other documentations as the Contractor has specifically

produced or specifically acquired in connection with this project.

C. The rights and remedies of the Commonwealth provided in this paragraph

shall not be exclusive and are in addition to any other rights and remedies

provided by law or under this Purchase Order/Funds Commitment.

FINAL

NARRATIVE

REPORT

TERMINATION

9

Unless provided for in the DGS contract, no subcontract shall be made by the

Contractor with any other party to furnish any of the work or services herein

contracted without written approval from OVR. Any subcontract hereunder

entered into, subsequent to the execution of this project, must be approved by

OVR. Any subcontract entered by the Contractor with a value of five

thousand dollars ($5,000) or more shall be competitively bid or supported by

sole source justification approved in writing by OVR in advance of entering

the subcontract.

This provision does not require the approval of contracts of employment

between the Contractor and its personnel assigned for services thereunder.

Any approved subcontractor must comply with the terms and conditions of the

DGS contract and must make available to OVR any records for inspection or

other documentation related to the subcontract or this project. The

Commonwealth may undertake or award other contracts for additional or

related work, and the Contractor shall fully cooperate with other Contractor,

subcontractors and Commonwealth employees.

The Contractor hereby certifies that it is not in receipt of funds from any other

Federal source covering any portion of the project. If this certification is

false, this project may be revoked in whole or in part, and any monies paid

hereunder shall be refunded to OVR with any penalties that may be imposed

by law or regulations.

The term of the Purchase Order/Funds Commitment is upon the effective date

until September 30, 2015 with an option to renew for 12 additional months

and is subject to satisfactory compliance with the terms and conditions of the

DGS contract and these Guidelines, including compliance with the approved

Statement of Work, unless otherwise modified in accordance with the DGS

contract. Services will not be accepted and work will not begin until the

Purchase Order/Funds Commitment is processed and completely executed.

The Commonwealth will not be obligated to pay for services without a

completely executed and approved Purchase Order/Funds Commitment. The

Purchase Order/Funds Commitment will be in effect on October 1, 2014 or

the date upon approval of the final Commonwealth signatory, which ever date

comes later.

A. Purchase Order/Funds Commitment is being funded for the initial time

period mentioned above in the amount of: (Dollars).

B. For any subsequent renewal periods, the Contractor must submit a budget,

work plan, and other required documents prior to March 1 of such

period, and such submission is approved in writing by OVR. OVR shall

notify the Contractor in writing of the total cost authorized during each

period. The approved total cost for the first Purchase Order/Funds

Commitment period is set forth in Section A., above. The total cost of

each subsequent renewal period must be approved by (1) execution by

OVR and its Comptroller, the form shown as this Purchase Order/Funds

Commitment’s FUNDING ADJUSTMENT FORM, and (2) written

SUBCONTRACTS

DISCLAIMER

TERM OF

PURCHASE

ORDER/FUNDS

COMMITMENT

PURCHASE

ORDER/FUNDS

COMMITMENT

COST

COST

10

approval by OVR of the Contractor’s budget for each period. Copies of

the afore-mentioned documents shall be incorporated in and made part of

the projects file. The Contractor must utilize such funding in accordance

with the approved budget for the period.

C. If OVR determines that additional Title I monies are available for use

during any period within the term of this Purchase Order/Funds

Commitment, OVR may, at its option, increase the approved total cost for

any such period by an amount not to exceed One Hundred Thousand

dollars ($100,000).

If an increase in funds is anticipated, OVR shall notify the Contractor in

writing of the potential increase. Within thirty (30) days of receipt of

notification of the potential increase, the Contractor shall submit to the

Program Analyst for approval a revised budget and project narrative

reflecting the anticipated increase.

If the revised budget and project narrative are approved by OVR, the

Program Analyst shall notify the Contractor, in writing, of the approved

amount of increase.

The increases up to $100,000 for any such period must be approved by (1)

the form executed by OVR and the Comptroller shown as the Purchase

Order/Funds Commitment’s FUNDING ADJUSTMENT FORM, and,

(2) written approval by the Program Analyst of a revised project budget

and project narrative. Copies of the aforementioned documents shall be

incorporated in and made part of the project file.

D. OVR may, in its sole discretion, reduce the total cost of the Purchase

Order/Funds Commitment for any period if (1) the funds appropriated by

the General Assembly or by the Federal Government are less than

anticipated by OVR or (2) the funds appropriated are made unavailable by

a reduction in funds. In either case, OVR shall notify the Contractor

promptly of the reduced total cost for any period of the Purchase

Order/Funds Commitment. Such notice shall be incorporated in and made

a part of the project file. The Contractor shall submit to OVR for its

approval a revised budget to conform to the decreased amount of funds. If

the Contractor does not submit a revised budget, or the parties are unable

to agree on the revised budget for the period in question, OVR, after

consultation with the Contractor, shall unilaterally establish the revised

budget. The revised budget for the annual period shall be evidenced by

the execution by OVR and its Comptroller of the form attached herein as

FUNDING ADJUSTMENT FORM, and a copy of the revised project

budget. These documents shall be incorporated in and made a part of the

project file.

E. OVR may, at any time, review the Contractor’s use of funds during any

Purchase Order/Funds Commitment period either through request for

documentation or onsite visit. OVR may, after review of the Contractor’s

performance, reduce the total amount of the Purchase Order/Funds

11

Commitment. If OVR exercises this right, it shall notify the Contractor in

writing.

The reduction shall be effective upon mailing of the written notice.

Within thirty (30) days of the date of such notice, the Contractor shall

submit for Program Analyst approval a revised budget and project

narrative that reflects the reduction. If the Contractor does not submit a

revised budget and project narrative, or if OVR and the Contractor are

unable to agree on a revised budget, OVR, after consultation with the

Contractor, may unilaterally establish the revised budget. The revised

budget for the period will be evidenced by the execution by OVR and its

Comptroller of the form attached herein as FUNDING ADJUSTMENT

FORM and a copy of the revised project budget. These documents shall

be incorporated in and made a part of the project file.

A. Contractor will submit to OVR a Request for Funds (RFF) for advance

payment for anticipated costs to perform services during each quarter

under the Purchase Order/Funds Commitment. OVR will provide a

template form for the RFF, as well as instructions for its use, a

submission schedule, and a spreadsheet to maintain a record of monthly

expenses. This RFF must be submitted electronically to the OVR

Resource Account.

B. Upon receipt OVR will process the RFF and arrange for payment to be

issued in the amount requested. Payment will be effected through the

Automated Clearing House Network, as outlined in the PA Electronic

Payment Program, per Management Directive 310.30, issued May 22,

2009.

C. If more funds are advanced than actually used by the Contractor during a

particular quarter, those funds will be offset against future advance

payment requests.

D. If additional funds were utilized by the Contractor during a particular

quarter, the contractor will submit a supplemental RFF.

E. The Contractor will provide documents, invoices, receipts, and other

verification of expenditures to OVR. This documentation should be

supplied electronically, on a quarterly basis.

F. OVR will review the documentation in support of expenditures and

perform a reconciliation to determine whether expenditures were

appropriate under the Purchase Order/Funds Commitment. Expenses

deemed questionable will require additional justification. Expenses

deemed inappropriate will be deducted from future requests for

reimbursement. Any expenses deemed inappropriate at the end of each

fiscal year must be returned to OVR, along with any interest earned on

the amount deemed inappropriate.

ADVANCE PAYMENT

PROCESS

12

A. The Commonwealth will make payments to the Contractor through the

Automated Clearing House (ACH) Network. Within 10 days of the

Purchase Order/Funds Commitment award, the Contractor must submit or

must have already submitted its ACH and electronic addenda information,

if desired, to the Commonwealth’s Payable Service Center, Vendor Data

Management Unit at 717-214-0140 (FAX) or by mail to the Office of the

Comptroller Operations, Bureau of Payable Services, Payable Service

Center, Vendor Data Management Unit, 555 Walnut Street, - 9th

Floor,

Harrisburg, PA 17101.

B. The Contractor recipient must submit a unique invoice number with each

invoice submitted. The unique invoice number will be listed on the

Commonwealth of Pennsylvania’s ACH remittance advice to enable the

Contractor to properly apply the state agency’s payment to the respective

invoice or program.

C. It is the responsibility of the Contractor to ensure that the ACH informa-

tion contained in the Commonwealth’s Central Vendor Master File is

accurate and complete. Failure to maintain accurate and complete

information may result in delays in payments.

A. The Contractor will comply with Titles VI and VII of the Civil Rights Act

of 1964 (P.L. 88-352) and all requirements imposed by the Department of

Health and Human Services (45 CFR Part 80) issued pursuant to that title,

to the end that, in accordance with Titles VI and VII of that Act and the

Regulation, no person in the United States shall, on the grounds of race,

color, or national origin, be excluded from participation in, be denied the

benefits of, or be otherwise subjected to discrimination under any program

or activity for which the Applicant receives Federal financial assistance

from OVR; and HEREBY GIVES ASSURANCE THAT it will

immediately take any measures necessary to effectuate this agreement.

B. The Contractor will comply with Title VI of the Civil Rights Act of 1964

(42 USC 2000d) prohibiting employment discrimination where a) the

primary purpose of a project is to provide employment or b)

discriminatory employment practices will result in unequal treatment of

persons who are, or who should be, benefiting from the project-aided

activity.

C. The Contractor will comply, as applicable, with the programs of Title V,

Sections 503 and 504 of the Rehabilitation Act of 1973, as amended or

stated as administered by the Office of Federal Contract Compliance

Program and the Office of Civil Rights, respectively, which prohibit

discrimination against qualified job applicants on the basis of physical or

mental disability and has executed the Assurance of Compliance with

Section 504 of the Rehabilitation Act of 1973, as amended.

D. The Contractor will comply, as applicable, with the provisions of the

National Environmental Policy Act of 1969 (P.L. 90-190).

PA ELECTRONIC

PAYMENT

PROGRAM (PEPP)

GENERAL

13

E. The Contractor will establish safeguards to prohibit employees from

using their positions for a purpose that is, or gives the appearance of

being, motivated by a desire for private gain for themselves or others,

particularly those with whom they have family, business, or other ties.

F. The use of Federal funds by an approved Contractor under the

Rehabilitation Act of 1973, as amended, must not result in a decrease in

level of effort to provide services to persons with significant disabilities.

Services provided under the Act should strengthen and integrate, not

duplicate or replace, existing service.

G. An approved Contractor shall encourage and allow, wherever possible,

maximum community participation.

H. It is understood by the Contractor and agreed that any issues or situations

arising relative to this Purchase Order/Funds Commitment, but not

specifically covered in the text of this Purchase Order/Funds

Commitment nor stated in the project narrative, are subject to and

governed by other existing Contracts Administration Regulations and/or

policies as established by the Federal Office of Management and Budget

(OMB), Rehabilitation Services Administration (RSA) or the State VR

agency, whichever takes precedence.

I. OVR has a monitoring and evaluation responsibility for all Purchase

Order/Funds Commitment awarded to another service agency. This

responsibility applies to program and financial aspects of this Purchase

Order/Funds Commitment and any subcontracts.

J. The Contractor agrees that the Commonwealth may set off the amount of

any state tax liability or other debt of the Contractor or its subsidiaries

that is owed to the Commonwealth and not being contested on appeal

against any payments due the contractor under this Purchase Order/Funds

Commitment or any contract with the Commonwealth.

K. AUDIT CLAUSE TO BE USED IN AGREEMENTS WITH

SUBRECIPIENTS RECEIVING FEDERAL AWARDS FROM

THE COMMONWEALTH

SINGLE AUDIT REPORT REQUIREMENTS.

The [NAME OF SUBRECIPIENT] must comply with all federal and state

audit requirements including: The Single Audit Act Amendments of 1996;

Office of Management and Budget, Circular A-133, Audits of States, Local

Governments, and Non-Profit Organizations, (OMB Circular A-133) as

amended; and any other applicable law or regulation, and any amendment to

such other applicable law or regulation which may be enacted or promulgated

by the federal government.

If the [NAME OF SUBRECIPIENT] is a local government or non-profit

organization and expends total federal awards of $500,000 or more during its

14

fiscal year, received either directly from the federal government or indirectly

from a recipient of federal funds, the [NAME OF SUBRECIPIENT] is

required to have an audit made in accordance with the provisions of OMB

Circular A-133.

If the [NAME OF SUBRECIPIENT] is a local government or non-profit

organization and expends total federal awards of $500,000 or more during its

fiscal year under one federal program, received either directly from the

federal government or indirectly from a recipient of federal funds, the [NAME

OF SUBRECIPIENT] can submit a program-specific audit in lieu of a single

audit in accordance with the provisions of OMB Circular A-133.

If the [NAME OF SUBRECIPIENT] expends total federal awards of less than

$500,000 during its fiscal year, it is exempt from these audit requirements, but

is required to maintain auditable records of federal awards and any state funds

that supplement such awards, and to provide access to such records by federal

and state agencies or their designees.

If the [NAME OF SUBRECIPIENT] is a for-profit entity, it is not subject to

the auditing and reporting requirements of OMB Circular A-133. However,

the pass-through commonwealth agency is responsible for establishing

requirements, as necessary, to ensure compliance by for-profit subrecipients.

The contract with the for-profit subrecipient should describe applicable

compliance requirements and the for-profit subrecipient’s compliance

responsibility. Methods to ensure compliance for federal awards made to for-

profit subrecipients may include pre-award audits, monitoring during the

contract, and post-award audits. The post-award audits may be in the form of

a financial audit in accordance with Government Auditing Standards, a single

audit report or program-specific audit report in accordance with OMB

Circular A-133. However, these post-award audits must be submitted directly

to the affected commonwealth agency that provided the funding. Only single

audit reports for local governmental and non-profit subrecipients are

electronically submitted to the Office of the Budget, Office of Comptroller

Operations, Bureau of Audits.

COMPONENTS OF THE SINGLE AUDIT REPORTING PACKAGE.

The [NAME OF SUBRECIPIENT] must submit an electronic copy of the

audit report package to the commonwealth, which shall include:

1. Auditor’s reports

a. Independent auditor’s report on the financial statements, which

expresses an opinion on whether the financial statements are

presented fairly in all material respects in conformity with the

stated accounting principles.

b. Independent auditor’s report on the supplementary Schedule of

Expenditures of Federal Awards (SEFA), which expresses an

opinion on whether the SEFA is presented fairly in all material

15

respects in relation to the financial statements taken as a whole.

This report can be issued separately or combined with the

independent auditor’s report on the financial statements.

c. Report on internal control over financial reporting and on

compliance and other matters based on an audit of financial

statements performed in accordance with Government Auditing

Standards.

d. Report on compliance for each major program and report on internal

control over compliance.

e. Schedule of findings and questioned costs.

2. Financial statements and notes to the financial statements

3. SEFA and notes to the SEFA

a. All single audit reporting packages must contain a SEFA prepared

by the subrecipient, not the subrecipient’s auditor. In accordance

with §___.310 (b) of OMB Circular A-133, all SEFAs, at a

minimum, shall:

(1) List individual federal programs by federal agency. For

federal programs included in a cluster of programs, list

individual programs within a cluster of programs. For

research and development (R&D), the total federal awards

expended shall be shown either by individual award or by

federal agency and major subdivision within the federal

agency;

(2) For federal awards received as a subrecipient, include the

name of the pass-through entity and the identifying

number assigned by the pass-through entity;

(3) Provide the total federal awards expended for each

individual federal program and the CFDA number or other

identifying number when the CFDA information is not

available;

(4) Include notes that describe the significant accounting

policies used in preparing the SEFA;

(5) For federal awards received as a pass-through entity,

identify, to the extent practical, the total amount provided

to subrecipients from each federal program;

(6) Include, in either the SEFA or a note to the SEFA, the value

of federal awards expended in the form of noncash

16

assistance, the amount of insurance in effect during the

year, and loans or loan guarantees outstanding at year end.

b. In addition to the requirements of OMB Circular A-133, single audit

reporting packages containing federal funding passed through a

commonwealth agency must include the following components in

the SEFA as required by the pass-through agency:

(1) A breakdown of federal funds passed through the

commonwealth, by federal grantor, CFDA number,

CFDA name and state program name (if different from

CFDA name), state program year, and state contract

number (if applicable);

(2) Contract period beginning and ending dates for federal

funds passed through each commonwealth agency, by

contract;

(3) Program or award amount for each commonwealth agency,

by contract;

(4) Total received during the year for each commonwealth

agency, by contract;

(5) Accrued or deferred revenue at the beginning of the year

for each commonwealth agency, by contract;

(6) Revenue recognized during the year for each

commonwealth agency, by contract;

(7) Accrued or deferred revenue at the end of the year for each

commonwealth agency, by contract.

4. Schedule of Findings and Questioned Costs

5. Summary schedule of prior audit findings

6. Corrective action plan (if applicable)

7. Data collection form

8. Management letter (if applicable)

In instances where a federal program-specific audit guide is available, the

audit report package for a program-specific audit may be different and should

be prepared in accordance with the appropriate audit guide, Government

Auditing Standards, and OMB Circular A-133.

17

SUBMISSION OF THE AUDIT REPORT

The Office of the Budget, Office of Comptroller Operations, Bureau of Audits

accepts only electronic submissions of single audit/program-specific audit

reporting packages. Instructions and information regarding submission of the

single audit/program-specific audit reporting package are available to the

public on the Single Audit Submissions page of the Office of the Budget

website (http://www.budget.state.pa.us).

AUDIT OVERSIGHT PROVISIONS.

The [NAME OF SUBRECIPIENT] is responsible for obtaining the necessary

audit and securing the services of a certified public accountant or independent

governmental auditor.

The commonwealth reserves the right for federal and state agencies or their

authorized representatives to perform additional audits of a financial or

performance nature, if deemed necessary by commonwealth or federal

agencies. Any such additional audit work will rely on work already performed

by the [NAME OF SUBRECIPIENT]'s auditor and the costs for any

additional work performed by the federal or state agencies will be borne by

those agencies at no additional expense to the [NAME OF SUBRECIPIENT].

Audit documentation and audit reports must be retained by the [NAME OF

SUBRECIPIENT]'s auditor for a minimum of five years from the date of

issuance of the audit report, unless the [NAME OF SUBRECIPIENT]'s

auditor is notified in writing by the commonwealth, the cognizant federal

agency for audit, or the oversight federal agency, for audit to extend the

retention period. Audit documentation will be made available upon request to

authorized representatives of the commonwealth, the cognizant federal agency

for audit, the oversight federal agency for audit, the federal funding agency, or

the Government Accountability Office.

COMPLIANCE REVIEW Return To:

Chief

Contractor and Grantee Services Division

Office of Vocational Rehabilitation

1521 North Sixth Street

Harrisburg, PA 17102 Document Number

THIS FORM SHOULD BE COMPLETED AND RETURNED 15

DAYS AFTER THE AWARD OF ANY CONTRACT, PURCHASE

ORDER, AGREEMENT, ETC.

PART I -- All questions must be answered completely.

1A. Name and address of contractor's principal facility involved in

contract. (Include county and telephone number)

Telephone:

1B. Name, address and telephone number of parent company (if an

affiliate corporation).

1C. County Where Work is Performed

2A. Employer's Federal Identification Number (Enter your Employer's

I.D. number as assigned by the Internal Revenue Service and shown

on your quarterly tax return. If Internal Revenue Service number is

not applicable, indicate Social Security Number).

2B. Type of Business (check appropriate block)

Contractor Supplier

Subcontractor Other (specify)

Vendor

2C. Are you now a recipient of other contracts with the Commonwealth

of Pennsylvania?

Yes No

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

With what agencies are you holding contracts?

2D. Have any of the above or other agencies conducted a desk audit/

on-site review of your company/organization within the past two

years?

Yes No

If yes, attach a copy of the compliance notice.

3A. Type of Contract

Construction Nonconstruction

Other

3B. $

3C. Effective Date

Termination Date

4. Does the company/organization have a written EEO plan?

Yes No

(Do not submit your EEO plan unless requested)

5. Does the company/organization agree to notify all subcontractors,

unions, vendors or suppliers of their responsibilities to comply with

state regulations/non-discrimination clause?

Yes No

6. Does the company/organization agree to send each subcontractor,

union or supplier of employees or materials the non-discrimination

poster with instructions to post it at job sites?

Yes No

7. Does the company/organization agree not to use subcontractors,

vendors or suppliers on State contracts who are reported to be in

noncompliance by a State authorized representative?

Yes No

PERSONNEL TRANSACTIONS WITHIN THE LAST 12 MONTHS (New Hires, Promotions and Terminations)

Use additional 8 1/2 x 11 sheets, if needed)

PERIOD

FROM TO

NAME RACE SEX

TYPE OF TRANSACTION

(CHECK AS APPROPRIATE) DATE OF

TRANSACTION JOB CLASSIFICATION

NEW HIRE PROMOTION TERMINATION

PART II - CURRENT WORK FORCE BREAKDOWN OF MAIN OFFICE/ORGANIZATION INVOLVED IN CONTRACT.

1.

Job

Categories

Total Employees in Establishment

Minority Group Employees

Total

Employees

Including

Minorities

(1)

Total

Male

Including

Minorities

(2)

Total

Female

Including

Minorities

(3)

Male

Female

Black

(4)

Asian/

Pacific

Islander

(5)

American

Indian/

Alaskan

Native

(6)

Hispanic

(7)

Black

(8)

Asian/

Pacific

Islander

(9)

American

Indian/

Alaskan

Native

(10)

Hispanic

(11)

Officials & Managers

Professionals

Technicians

Sales Workers

Office & Clerical

Craftworkers (Skilled)

Operators

(Semi-skilled)

Laborers (unskilled)

Service Workers

TOTALS

Total Employment one

year prior to this report

(TRAINEES BELOW SHOULD ALSO BE INCLUDED IN THE FIGURES FOR THE APPROPRIATE OCCUPATIONAL CATEGORIES ABOVE.)

Formal

On-the-Job Trainees (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11)

White-Collar

Production

2. Dates of Payroll Period Used (Both dates must be completed.) Weekly, Bi-weekly or Monthly Only.

BEGINNING PERIOD: / / ENDING PERIOD: / / .

MONTH DAY YEAR MONTH DAY YEAR

3. Will there be a change in the workforce as a result of this contract? Yes No

If yes, how many employees do you anticipate hiring?

PART III – PRESIDENT/CHIEF EXECUTIVE OFFICER OR EQUAL EMPLOYMENT OPPORTUNITY OFFICER (Return the signed original

copy.)

Name and Title (Type or print)

Signature

Phone No. FAX No.

Date

CONTRACTOR SHALL PROMPTLY GRANT ACCESS TO ITS FACILITIES TO AUTHORIZED STATE AGENCY

REPRESENTATIVE(S) FOR REVIEW OF DOCUMENTS, INFORMATION, AND INTERVIEWS OF COMPANY

PERSONNEL.

ATTACHMENT - J

Project Timeline

Timeline for Project Implementation

Start

Date

(mm/yy)

End

Date

(mm/yy)

Planned Major Tasks Responsible Party

1

2

3

4

5

6

7

Cells will expand as necessary. ______________________________________ _____________________ __________ Signature of Authorized Representative Title Date