REQUEST FOR APPLICATION (RFA)

Issuance Date: May/03/2017Pre Application Conference Kabul: May/10/2017Pre Application Conference Nangarhar: May/11/2017Deadline for Question: May/14/2017Closing Date: May/25/2017- 3PM Afghanistan Local Time

Subject: Request for Applications (RFA) Number RFA-RADP-E-17-003Promotional Grant Program

Reference: Issued Under Regional Agriculture Development Program-East (RADP-E) USAID Contract No. AID-306-C-16-00011

The Regional Agricultural Development Program – East (RADP-E) is a five year USAID-funded program to expand sustainable agriculture-led economic growth in the eight target provinces of Ghazni, Kapisa, Laghman, Logar, Nangahar, Parwan, Wardak, and Kabul. Program activities will support the apricot, tomato, poultry and dairy value chains through the provision of training, technical assistance, and small grants targeting small and medium enterprises (MSMEs), agricultural producers, input suppliers and agro-processors. RADP-E will identify private sector actors on either end of the farmer in each value chain—the commercial vendors of the goods and services that farmers need to grow higher volumes of quality produce, and the processors and traders who purchase farmers’ harvests. RADP-E is seeking qualified, innovative and determined private-sector actors who are interested and committed to strengthening and expanding their business. RADP-E will award Promotional Grants not to exceed US$25,000 to qualified businesses who meet the program criteria set forth in this request for applications. All grants will require a minimum of 50% cost-share contribution in order to be considered for funding. Please refer to the Program Description for a complete statement of goals and expected results. Subject to the availability of funds, DAI intends to provide grant/s to one or more small and medium enterprises (MSMEs), agricultural producers, input suppliers and agro-processors up to a maximum amount of US $25,000 per award. The expected duration of DAI support or the period of performance is 12 months. DAI, as primary implementer of the RADP-E, reserves the right to fund any or none of the applications submitted.

For the purposes of this program, this RFA is being issued and consists of this cover letter and the following:

Section A – Grant Application Instructions Section B – Special Grant Requirements

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Section C – Selection Process Section D – Program Description Annexes

Applications must be received at the RADP-E offices in Kabul indicated at the top of this cover letter at the place designated below for receipt of applications. Applications and modifications thereof shall be submitted in pdf, word or other electronic format to the RADP-E Grants Department at Grants_RADPE@dai.com or hard copy to the following address:

RADP-E Office, Darya Village Hotel and Business ParkHawa Shinasee Road Khwaja RawashKabul AfghanistanMob: 0789753227

Award will be made to the responsible applicant(s) whose application(s) offers the best value.

Issuance of this RFA does not constitute an award commitment on the part of DAI, nor does it commit DAI to pay for costs incurred in the preparation and submission of an application. Further, DAI reserves the right to reject any or all applications received. Applications are submitted at the risk of the applicant. All preparation and submission costs are at the applicant's expense.

Any questions concerning this RFA should be submitted in writing not later than the date and time specified for questions submissions to RADP-East Grants office by email to Grants_RADPE@dai.com. Applicants should retain for their records one copy of all enclosures, which accompany their application.

Pre-Application Conference The Pre-Application Conference will be conducted by RADP-E on May 10 2017 in Kabul and on May 11 2017 in Jalalabad to provide necessary guidance to Potential Applicants on this RFA and on the grant application. The conference venue will be circulated to potential applicants who confirm their attendance by sending the following information by email to Grants_RADPE@dai.com not later than May 8 2017 at 1200 PM: (i) Name of the organization (ii) Name and title of the attendee (iii) Attendee’s phone # (iv) Attendee’s email address

A maximum of two (02) persons per organization will be allowed to attend the conference. Although attendance to this pre-application conference is not mandatory, however, all potential applicants who decide to submit an application are encouraged to attend the conference. All necessary information on these conferences will be posted on the ACBAR website (http://www.acbar.org/RFP/).

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Thank you for your interest in USAID RADP-E grant activities.

Sincerely,

Robert JacobiChief of PartyUSAID RADP-E

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Promotional Grant ProgramTable of Contents

Section A – Grant Application Instructions.............................................41. Application Procedure.....................................................................4

A. Completion and submission of applications................................4B. Preparation Instructions – Technical............................................5C. Preparation Instructions – Financial and Administrative Documentation................................................................................6

B. Special Grant Requirements..............................................................7C. Selection Process...............................................................................9D. Program Description.......................................................................12Annex 1: Mandatory Standard Provisions............................................13Annex 2: Application Form...................................................................14Annex 3: Budget..................................................................................19Annex 4: CV Form and BioData Form..................................................21Annex 5: Financial Capability Questionnaire........................................22

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Section A – Grant Application Instructions

1. Application Procedure

A. Completion and submission of applications

Eligibility Requirements

To be considered for assistance, applicants must meet the following criteria:

Submit a completed Grant Application form. Be a legally registered Afghan business or detail in the application the

plan to become registered. Have a minimum of AFN 100,000in monthly sales. Have activities in RADP-E’s coverage areas. For monitoring and evaluating purposes, agree to full financial records

disclosure. Provide a minimum of 50% in-kind contribution as part of their activity. Have a minimum of 3 full time employees Be within the apricot, tomato, poultry and /or dairy Value Chains. Demonstrate immediate (4-6 months) and measurable impact as a

result of RADP-E assistance.

Application Submission Requirements

Applications may be submitted only by email or hand-delivered. Applications must include:

Completed Application Form Projected Grant Budget and Budget Notes CVs and BioData forms of key project team members. Completed Financial Capability Questionnaire and attachments Current/up to date License or plan for obtaining License

Deadlines

Applications must be received at USAID RADP-E Office, as indicated in the cover letter. Applications and modifications thereof shall be submitted in word or pdf (preferred) at Grants_RADPE@dai.com and all submissions must be submitted in English and budgets must be in the local currency (Afghani). Please hand delivers your application to the following address:

RADP-E Office, Darya Village Hotel and Business ParkHawa Shinasee Road Khwaja RawashKabul AfghanistanMob: 0789753227

Late Applications All applications received by the deadline will be reviewed for responsiveness and programmatic merit according to the specifications outlined in these

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guidelines and the application format. Section C addresses the evaluation procedures for the applications. Applications, which are submitted late or are incomplete, run the risk of not being considered in the review process.

B. Preparation Instructions – Technical

Applicants must complete the attached Promotional Grant Application Form.

B. Special Grant Requirements

The applicant shall bear in mind the following special requirements for any grants awarded in response to this RFA:

Separate Account: A separate account must be established to house all funds provided under the grant, as well as all interest income.

Use of Funds: Funds provided under any grant awarded shall be used exclusively to achieve USAID RADP E objectives and goals. Diversion of grant funds to other uses will result in cancellation of award and retrieval of funds disbursed to the grant recipient.

Reporting Procedures: A description of reporting requirements will be included in the Grant Agreements. The types of reporting required, along with the schedule of reporting, will depend on the grant type and project duration.

Project Monitoring: DAI staff will monitor projects in terms of both programmatic and financial aspects. Grant recipients will be expected to facilitate monitoring by making relevant information available to DAI staff.

Restrictions: The Grant Funds provided under the terms of this Agreement shall not be used to finance any of the following:

1. Goods or services which are to be used primarily to meet military requirements or to support police or other law enforcement activities,

2. Surveillance equipment,3. Equipment, research and/or services related to involuntary

sterilization or the performance of abortion as a method of family planning,

4. Gambling equipment, supplies for gambling facilities or any hotels, casinos or accommodations in which gambling facilities are or are planned to be located,

5. Activities which significantly degrade national parks or similar protected areas or introduce exotic plants or animals into such areas, or

6. Establishment or development of any export processing zone or designated area where the labor, environmental, tax, tariff, and/or safety laws of the country in which such activity takes place would not apply.

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7. Pharmaceuticals,8. Pesticides,9. Logging equipment,10. Luxury goods (including alcoholic beverages and jewelry),11. Establishing or expanding any enterprise that will export raw

materials that are likely to be in surplus in world markets at the time such production becomes effective and that are likely to cause substantial injury to U.S. producers,

12. Activities which would result in the loss of forest lands due to livestock rearing, road construction or maintenance, colonization of forest lands or construction of dams or other water control structures, 13. Activities which are likely to have a significant adverse effect on the environment, including any of the following (to the extent such activities are likely to have a significant adverse impact on the environment):i.) Activities which may lead to degrading the quality or

renewability of natural resources;ii.) Activities which may lead to degrading the presence or health

of threatened ecosystems or biodiversity;iii.) Activities which may lead to degrading long-term viability of

agricultural or forestry production (including through use of pesticides);

iv.) Activities which may lead to degrading community and social systems, including potable water supply, land administration, community health and well-being or social harmony.

14. Activities which are likely to involve the loss of jobs in the United States due to the relocation or expansion outside of the United States of an enterprise located in the United States, or

15. Activities which the Grantee is aware are reasonably likely to contribute to the violation of internationally or locally recognized rights of workers,

C. Selection Process

Within 7 working days of the deadline for submitting applications, a review panel will convene. The review panel will include team members from technical, finance and M&E departments. Throughout the evaluation process, DAI shall take steps to ensure that members of the review panel do not have any conflicts of interest or the appearance of such with regard to the organizations whose applicants are under review. An individual shall be considered to have the appearance of a conflict of interest if that person, or that person’s spouse, partner, child, close friend or relative works for or is negotiating to work for, or has a financial interest (including being an unpaid member of a Board of Directors) in any organization that submitted an application currently under the panel’s review. Members of the panel shall neither solicit nor accept gratuities, favors, or anything of monetary value from parties to the awards.

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All applications that meet the application requirements will be reviewed by the review panel. Verification of the application submission requirements will be conducted at the USAID RADP E Office by RADP E staff.

If suitable applications are received, one or more awards will be made within 30 working days of the review panel meeting provided that the awardee (s) furnishes USAID RADP E with all the required documentation as itemized in Section A of this RFA.

The applications will be evaluated according to the evaluation criteria set forth below. To the extent necessary (if award is not made based on initial applications), negotiations may be conducted with each applicant whose application, after discussion and negotiation, has a reasonable chance of being selected for award. Award will be made to responsible applicants whose applications offer the best value.

Applications will be evaluated according to the following criteria. A total of 100 points is possible. Applicants should understand these criteria serve to: (a) identify the significant issues applicants should address in their applications, if any, and (b) set the standard against which all applications will be selected.

Evaluation criteria1. Completeness of Application (20 points) Relates to section I (General Information) of the grant application.

Is the application clear and legible? Is the contact information accurate? Is there proof of registration to operate as a legal business entity

in Afghanistan? Is there a good description and understanding of the estimated

cost and grantee cost-share? Ability for the reviewer to understand the grant application. What

they propose to do, how they will do it, what they need, impact and sustainability?

2. Proposed Grant Activity (50 points)Relates to section II (Proposed Grant Activity) of the grant application.

Is the Activity Description section of the application completed with sufficient detail to understand what the applicant is proposing?

Are the Project Objectives clear on what the applicant will accomplish with this grant?

Is there information on how the applicant will use the materials that they are requesting from RADP-E?

Is there information on how the applicant will measure increased sales resulting from the grant activity?

How will the applicant keep records and any changes resulting from the grant?

3. Sustainability (30 points) Does the applicant have staff whom are responsible for marketing

activities?

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Will the applicant continue to market these types of products once RADP-E assistance ends?

Does the applicant have a plan on applying for or receiving loans or other resources to continue the activity once RADP-E assistance ends?

Is there a plan for how the applicant will market their products once RADP-E assistance ends?

Signing of Grant Agreements

Upon USAID concurrence of the applicant, a Grant Agreement will be prepared. All reporting and contractual obligations will be explained to the grant recipients. Before receiving the first grant installment, all grant recipients must open a separate bank account as this is the only means by which grant funds will be transferred from DAI to the grant recipient.

DAI and USAID reserve the right to fund any or none of the applications received

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D. Program Description

A review of lessons learned since 2014 indicate that many agriculture input suppliers and processors in Afghanistan view implementers of development assistance projects in Afghanistan as primary customers for the purchase of agriculture inputs, or as the primary suppliers of equipment and market access for agro-processors. Agribusinesses (suppliers and processors), farmers and cooperatives have come to rely on donor support for many types of agriculture-related assistance. In many cases this assistance has had profound impacts in addressing food security, increasing agricultural production, introducing new technologies, expanding market opportunities and building the capacity of various actors across several value chains. However, the downside is that implementers of donor assistance programs run the risk of distorting market systems by becoming key market actors (i.e. customers or suppliers). The objective for RADP-E is to break this cycle and to facilitate key transactions at either end of the farmer in targeted value chains – the commercial vendors of the goods and services that farmers need to grow higher volumes of quality produce, and the processors and traders who purchase farmers’ harvests. The goal is to design and implement innovative program activities that facilitate closer linkages between Agribusinesses (input suppliers and processors) and Producers (farmers and cooperatives). The input suppliers and agro-processors will serve as 'leverage points' for enhancing market effectiveness and competitiveness across the target value chains.In short, RADP-E will: a) examine specific transactions that occur between actors across our target value chains; b) facilitate linkages between key actors in those value chains; and where necessary, through Promotional Grants (IGs), RADP-E will co-invest with innovators in these value chains to bring about sustainable and measurable impact. Key in this solicitation is the need to find innovative ideas from the private sector. Rather than provide the exact details of what RADP-E will fund, we are looking for ideas that the applicant wants to implement but is unable to due to high cost, risk or lack of resources.

Examples of the types of grants: Support the introduction, sale and/or use of a new or improved

technology for input suppliers. Support marketing activities such as SMS messaging, Radio

programming, participation in local (and international) trade and agricultural fairs.

Support activities for input suppliers to make business connections (local and international) for the import, distribution and sale of new and/or improved goods and services.

To support input suppliers in introducing new technologies to farmers. To support input suppliers in marketing activities for their goods and

services.

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Annex 1: Mandatory Standard Provisions

All Mandatory Standard Provisions and Required as Applicable will be included and be part of the resultant grant award(s).

Mandatory Standard Provisions for Non-US Nongovernmental Recipients:(http://www.usaid.gov/missions/sa/usaidsa/mandatorystandard.pdf)

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PROMOTIONAL GRANT APPLICATION FORMFor Agricultural Input Suppliers

I. GENERAL INFORMATION

A. APPLICANT CONTACT INFORMATIONName of Applicant:

NAME PHONE NUMBER

Name of alternate contact:

NAME PHONE NUMBER

Name of Enterprise: Date established:

Email of Enterprise:

Location:PROVINCE DISTRICT VILLAGE

RegistrationAISA# ACCI# Other (name and #)

Registration Status

a. valid b. expired

c. in process

Circle one

B. GRANT REQUEST AMOUNTRequest from RADP-E (US$):(estimate)

Grantee Contribution (US$):(estimate)

TOTAL GRANT VALUE:

Value / Type of Grantee Contribution(s):

Estimated Duration of Project(Estimated number of days from date of signing grant agreement to final close out)

a. Type of assistance requested

Type of Assistance:Circle all that apply

SMS Radio Promotional Materials

OTHER

b. Current business activity

NOTE: This form is used to apply for Grant Assistance from RADP-E. Submitting this form does not constitute an award commitment on the part of RADP-E, nor does it commit RADP-E to pay for costs incurred in the preparation and submission of an application.

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Target Value Chain Apricot Tomato Dairy PoultryCircle all that applyRole in Value Chain Input

SupplyProducer Processor Trader

Circle all that apply Wholesaler Retailer Exporter Other

Describe what you are currently doing

c. Products and Market (What you sell, where you sell and to whom)

Products Rank

Sales Area (Provinces)

PrimaryCustomers*

Annual Sales (AFS)

Primary Competitors

Rank 1 = most important*Primary customers: traders, wholesalers, retailers, specific markets, other businesses, etc.

d. EmployeesFull Time Part Time/Seasonal

Now *Proposed Now *ProposedMenWomen*Proposed: This is the total number of employees plus any you will hire as a result of the grant.

Describe any new positions created as a result of this activity

e. ImpactAverage monthly sales now (AFS) Attach any supporting

documentsAverage monthly sales after grant (AFS)

Describe (increase in sales, income, exports, ect.)

Current products:Any new Products/Activities after grant:

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Finance/AccountingDescribe how you currently keep records and any changes you will make as a result of this grant. How will you measure the impact of this grant.

II. PROPOSED GRANT ACTIVITY(In your own words, please describe what you are proposing to do, how you will do it, what do you need from RADP-E and what will be the end result? Use as much space as you need and add attachments to the application as needed)

a. Farmer OutreachDescribe below what your firm is going to do to market your products/services to farmers (for example: radio ads, SMS marketing, farmer field days, demonstration plots, trainings, attendance at ag. Fairs, etc..). NOTE: Successful applicants will need to include in their application plans for conducting farmer outreach.

b. CoordinationDescribe below how your firm will do plans to involve or coordinate with local MAIL/DAIL, Universities or other agencies in the implementation of this activity.

c. MarketingDescribe how you currently market your products and services.

d. Value Chain ImpactApplicants who propose activities that only impact them or their business activity will score low. Applicants must demonstrate how RADP-E assistance will improve or provide benefits across the value chain.

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III. Sustainability of Grant Activity

a. Other ResourcesList all current, past or planned assistance you have received from any other NGO/donor program.

Describe in detail any loans or financing you have or are planning to receive. If NO then state why you have not tried to obtain formal (or informal) loans.

b. SustainabilityDescribe below how you will continue with the activities proposed in this application after RADP-E assistance ends.

c. Other (Describe below any information that you feel is important regarding your application. Also Please attach any supporting documentation, copy of valid registration, specifications for items to be procured, pro-forma invoices, site drawings, maps, photos, land agreements, farmer contracts, forward contracts, or any other supporting documentation related to the application

For RADP-E Review and Evaluation Committee UseRecommendation: Comments

Reject

Request additional information

Accept

Review Committee Members:

NAME TITLE SIGNATURE DATE

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1

2

3

4

5

6

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Annex 4: Budget

BUDGET Applicant/Organization Name Grant Title Exchange Rate:

1 USD = ____ AFS

Description Quantity

Unit

Unit rate AFS

Total Amount AFS. (Quantity*Unit Rate)

RADP-E Funding (USD)

Grantee/Other Contribution (USD)

Total (USD)

Wages/Per diem

Subtotal Materials and Supplies

Subtotal Travel and Transportation

Subtotal Other Direct Costs

Subtotal Totals

Description of Budget Line Items:1. Wages/Per Diem – Under “Description” list the title or type of activity i.e. Wages or Per Diem for… Supervisor, Unskilled labor, etc. Under “Unit” put P/D (Person Days). Under “Quantity” put the number of days worked (to

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be verified by signed time sheets). Under “Unit Price” list the amount to be paid per unit. Indicate if it is a community contribution or to be paid by CLP grant funds. Under NO circumstances do we pay Government Employee Salaries.

2. Materials and Supplies - List items to be purchased/used for the grant activity and show the basis for computation (unit cost). Generally, supplies include any materials that are expendable or consumed during the course of the project. Include materials and supplies contributed or purchased by the applicant as well as those to be purchased with RADP-E funds.

3. Travel and Transportation - Itemize travel expenses of project personnel by purpose (e.g., travel to work site, travel to farmer field days, project monitoring etc.). Show the basis of computation (e.g., six people to work site at $X bus/taxi fare). Will require verification and proof of expense such as fuel receipts, bus/taxi tickets or justification to be approved by RADP-E. Remember to include Travel and Transport costs that are Grantee contributions and can be verified.

4. Other Direct Costs –List items that are not covered under Materials and Supplies (e.g., rent, contractor for specific design/construction or installation activities, security during construction etc.) indicate the basis of the computation.

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Annex 5: CV Form and BioData FormANNEX 5

Curriculum Vitae

Proposed position in the project:

Name (First, Middle, Last):

Citizenship:

Education:Name and location of institution

Major(s) or Degree(s) obtained:

Language proficiency – indicate proficiency on a scale of 1 (poor) to 5 (native):

Language Reading Speaking Writing

Membership of NGOs or other professional bodies:

Key skills and qualifications relevant to the project (e.g. computer literacy, etc.):

Employment history:

Position Title

Employer’s name and address

Dates of employment Short description

of tasks performedFrom(month, year)

To(month, year)

Other relevant information: (e.g. publications, seminars/courses etc.):

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Annex 6: Financial Capability QuestionnaireAnnex 6

Accounting System and Financial Capability QuestionnaireFor DAI Grant Recipients

The main purpose of this questionnaire is to understand the systems adopted by your institution for financial oversight and accounting of grant funds, especially those provided through the U.S. Federal Government. The questionnaire will assist DAI program and accounting staff to identify the extent to which your institution's financial systems match the requirements of the U.S. Federal Government. This information will help the program staff work with you and your institution to review any problem areas that may be identified; thereby avoiding any problems or oversights which would be reportable should an audit of the program or institution be required.

The questionnaire should be completed by the financial officer of your institution in collaboration with DAI program staff. This questionnaire is informational only, and will not have any bearing on the agreement to support your institution based on the technical merit of the proposal. Therefore, please answer all questions to the best of your knowledge.

While 22 CFR 226 does not cover awards to non-U.S. recipients, DAI shall rely on the standards established in that regulation in determining whether potential non-U.S. recipients are responsible to manage Federal funds. A determination shall be made on the potential recipient's ability, or potential ability, to comply with the following USAID and federal-wide policies:

1) 22 CFR 226.20 - 226.28 (Financial and Program Management) (See Mandatory Reference, 22 CFR 226.20 - 226.28);

2) 22 CFR 226.30 - 226.37 (Property Standards) (See Mandatory Reference, 22 CFR 226.30 - 226.37);

3) 22 CFR 226.40 - 226.49 (Procurement Standards) (See Mandatory Reference, 22 CFR 226.40 - 226.49); and

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4) 22 CFR 226.50 - 226.53 (Reports and Records) (See Mandatory Reference, 22 CFR 226.50 - 226.53).

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SECTION A: General Information

Please complete this section which provides general information on your institution.

Name of Institution:

Name and Title of Financial Contact Person:

Name of Person Filling out Questionnaire:

Mailing Address:

Street Address (if different)

Telephone, Fax, Email (if applicable)

Enter the beginning and ending dates of your institution's fiscal year:

From: (Month, Day) To: (Month, Day)

SECTION B: Internal Controls

Internal controls are procedures which ensure that: 1) financial transactions are approved by an authorized individual and are consistent with U.S. laws, regulations and your institution's policies; 2) assets are maintained safely and controlled; and 3) accounting records are complete, accurate and maintained on a consistent basis. Please complete the following questions concerning your institution's internal controls.

1. Does your institution maintain a record of how much time employees spend on different projects or activities?

Yes: No: 2. If yes, how?

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3. Are timesheets kept for each paid employee?

Yes: No: 4. Do you maintain an employment letter or contract which includes the

employee’s salary?

Yes: No: 4. Do you maintain inventory records for your institution's equipment?

Yes: No: (if no, explain)

5. How often do you check actual inventory against inventory records?

6. Are all financial transactions approved by an appropriate official?

Yes: No: 7. The person responsible for approving financial transactions is: ________________ Title: ______________

8. Is the person(s) responsible for approving transactions familiar with U.S. Federal Cost principles as described in OMB Circular A-122?

Yes: No:

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9. Does your institution use a payment voucher system or some other procedure for the documentation of approval by an appropriate official?

Yes: No: 10. Does your institution require supporting documentation (such as original receipts) prior to payment for expenditures?

Yes: No: 11. Does your institution require that such documentation be maintained over a period of time?

Yes: No: If yes, how long are such records kept?

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12. Are different individuals within your institution responsible for approving, disbursing, and accounting of transactions?

Yes: No: 13. Are the functions of checking the accuracy of your accounts and the daily recording of accounting data performed by different individuals?

Yes: No: 14. Who would be responsible for financial reports? ________________________________________

SECTION C: Fund Control and Accounting Systems

Fund Control essentially means that access to bank accounts and/or other cash assets is limited to authorized individuals. Bank balances should be reconciled periodically to the accounting records. If cash cannot be maintained in a bank, it is very important to have strict controls over its maintenance and disbursement.

An Accounting System accurately records all financial transactions, and ensures that these transactions are supported by documentation. Some institutions may have computerized accounting systems while others use a manual system to record each transaction in a ledger. In all cases, the expenditure of funds provided by the USAID-funded program must be properly authorized, used for the intended purpose, and recorded in an organized and consistent manner.

1. Does your institution maintain separate accounting of funds for different projects by:

Separate bank accounts: A fund accounting system:

2. Will any cash from the grant funds be maintained outside a bank (in petty cash funds, etc.)?

Yes: No: If yes, please explain the amount of funds to be maintained, the purpose and person responsible for safeguarding these funds.

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4. If your institution doesn't have a bank account, how do you ensure that cash is maintained safely?

5. Does your institution have written accounting policies and procedures?

Yes: No: 6. How do you allocate costs that are “shared” by different funding sources, such as rent, utilities, etc.?

7. Are your financial reports prepared on a:

Cash basis: Accrual basis: 8. Is your institution's accounting system capable of recording transactions, including date, amount, and description?

Yes: No: 9. Is your institution's accounting system capable of separating the receipts and payments of the grant from the receipts and payments of your institution’s other activities?

Yes: No:

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10. Is your institution's accounting system capable of accumulating individual grant transactions according to budget categories in the approved budget?

Yes: No: 10. Is your institution's accounting system designed to detect errors in a timely manner?

Yes: No: 11. How will your institution make sure that budget categories and/or overall budget limits for the grant will not be exceeded?

12. Are reconciliations between bank statements and accounting records performed monthly and reviewed by an appropriate individual?

Yes: No: 13. Briefly describe your institution’s system for filing and keeping supporting documentation.

SECTION D: Audit

The grant provisions require recipients to adhere to USAID regulations, including requirements to maintain records for a minimum of three years to make accounting records available for review by appropriate

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representatives of USAID or DAI, and, in some cases, may require an audit to be performed of your accounting records. Please provide the following information on prior audits of your institution.

1. Is someone in your institution familiar with U.S. government regulations concerning costs which can be charged to U.S. grants (OMB Circular A-122 "Cost Principles for Nonprofit Institutions" and OMB Circular A-110 "Uniform Administrative Requirements for Grants and Agreements with Institutions of Higher Education, Hospitals and Other Non-Profit Institutions")?

Yes: No: 2. Do you anticipate that your institution will have other sources of U.S. government funds during the period of this grant agreement?

Yes: No: 3. Have external accountants ever performed an audit of your institution's financial statements?

Yes: No: If yes, please provide a copy of your most recent report.

4. Does your institution have regular audits?

Yes: No: If yes, who performs the audit and how frequently is it performed?

5. If you do not have a current audit of your financial statements, please provide this office with a copy of the following financial statements, if available:

a. A "Balance Sheet" for the most current and previous year; and b. An "Income Statement" for the most current and previous year.

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6. Are there any circumstances that would prevent your institution from obtaining an audit?

Yes: No: If yes, please provide details:

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CHECKLIST AND SIGNATURE PAGE

DAI requests that your institution submit a number of documents along with this completed questionnaire. Complete this page to ensure that all requested information has been included.

Complete the checklist: Copy of your organization's most recent audit is attached. If no recent audit, a "Balance Sheet" "Income Statement" for the most current and previous fiscal year. All questions have been fully answered. An authorized individual has signed and dated this page.

Optional: Incorporation Papers or Certificate of Registration and Statute is attached. Information describing your institution is attached. Organizational chart, if available is attached (if applicable).

The Financial Capability Questionnaire must be signed and dated by an authorized person who has either completed or reviewed the form.

Approved by:

_________________________

Print Name

_________________________

Signature

__________________________Title Date _____________

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