Division of family development contract administration contract award



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DEPARTMENT OF HUMAN SERVICES

DIVISION OF FAMILY DEVELOPMENT

CONTRACT ADMINISTRATION

CONTRACT AWARD or RENEWAL PACKAGE

Family Development Credential (FDC)

Contract Renewal Package

Required Documents and Forms


Annex A:
Program Summary

Contract Summary Sheet

Authorized Signatures

Service Delivery Information

Program Narrative

Renewal Documents:

Index of Required Contract Documents

Contract Checklist

Document Verification Sheet (DVS)

Executive Order 129

Certification of Suspension and Debarment

List of Contracts/Grants

Contract Forms (List of Required Documents Available on DFD Website)

Annex B Helpful Hints

Federal Award Information








Instructions
Program Summary

Enter the information on the site where services for this program are provided.


Contract Summary Sheet
Enter Agency Name, Address, Telephone and Contract No., Federal Identification No., Contract effective dates (as noted in the DFD contract award letter) and contract ceiling (per Annex B).

Enter CEO and Agency notice information. All data must be completed.

Authorized Signatories



Enter Authorized Signatory for the Contract (as authorized by Agency Bylaws or Board Resolution).
IMPORTANT - This is the address where the signed contract and all relevant legal correspondence will be mailed – so please ensure this is the accurate address.

Service Delivery Information



Service will be provided as follows for each day of the week, enter the hours the agency will provide contracted services. Please indicate if there is a difference among any of the contracted services in the program specific narrative.
Emergency Provisions Describe any special arrangements which have been made to handle emergencies, e.g. voice mail instructions, special telephone numbers etc.
Service will not be provided on the following occasions List the occasions and dates when service will not be provided, e.g. December 25-Christmas, July 4-Independence Day, etc.
Program Narrative
*Please see specific instructions attached to this section

ANNEX A - Program Summary


Program Name:

     

Site Address:

     

City, State, and Zip

     

Site Phone Number:

    -     -     

Program Director/Coordinator

     

Telephone #:

    -     -     

Fax:

    -     -     

E-Mail:

     

STATE OF NEW JERSEY - DIVISION OF FAMILY DEVELOPMENT


ANNEX A – CONTRACT SUMMARY SHEET


Provider Agency

     

Contract #

     

Mailing Address

     

Federal ID #

     




     







     




Telephone Number

    -     -    




Provider Agency Fiscal Year End

     

























Contract Effective Date

     

to

     

Contract Ceiling

$     













Organization Type

County












Municipal (i.e. School)












Private, Non-Profit












Private, For-Profit



     %

Indicate % of profit charged towards contract




Faith-Based











Hospital-Based












Chief Executive Officer

     




Title

     




Mailing Address

     







     







     




Telephone Number

    -     -    




Fax Number

    -     -    




E-Mail Address

     
















All routine notices relevant to the administration of the program should be sent to:

Name & Title

     




Mailing Address

     







     







     




Telephone Number

    -     -    




Fax Number

    -     -    




E-Mail Address

     




Do you currently receive payment by Automatic Deposit (ACH) for this contract?
 Yes  No

Division of Family Development

Annex A

Authorized Signatures
List names and positions of persons authorized to sign the following and number of persons required to sign each transaction.





Name/Address

Position

# of Signatures Required

Contract



1      

     

1

2      

     

3      

     

Quarterly and Final Financial Reports

1      

     

1

2      

     

3      

     

Contract

Budget Modification



1      

     

1

2      

     

3      

     

Checks



1      

     

  

2      

     

3      

     

Other Contracts and Agreements

1      

     

  

2      

     

3      

     


Note 1 - Enter Authorized Signatory for the Contract (as authorized by Agency Bylaws or Board Resolution). This is the address where the signed contract and all relevant legal correspondence will be mailed. This should be the individual who signs the SLD (page 23). This may not be the same individual as noted in the Annex A summary sheet. In the event of emergency notification, please include e-mail and fax number.


Contract Signatory

     

Title

     

Mailing Address

     




     




     

Telephone Number

    -     -    

Fax Number

    -     -    

E-Mail Address

     


Contract #

     

Division of Family Development

Annex A

Service Delivery Information


Program Name:

     

Site Address:

     

City, State, and Zip

     

Site Phone Number:

    -     -     

Program Director/Coordinator

     

Telephone #:

    -     -     

Fax:

    -     -     

E-Mail:

     


Service will be provided as follows (designate time):





From




To

Sunday

     




     

Monday

     




     

Tuesday

     




     

Wednesday

     




     

Thursday

     




     

Friday

     




     

Saturday

     




     


Services will not be provided on the following occasions:


Date (s)




Occasion

     




     

     




     

     




     

     




     

     




     

     




     

     




     

     




     

     




     

     




     

     




     

     




     

     




     

     




     


Division of Family Development

ANNEX A

PROGRAM OPERATIONS NARRATIVE
Introduction and Instructions:

Following are the contract components to be administered for the program. The Provider Agency shall describe the components as they are administered internally. The Annex A, Program Description information should match the details included in the Annex B - Budget.


The Provider Agency must provide information in the Annex A narrative describing how each service component of this contact will be administered including internal processes and controls for each program/service component. Answer all questions by providing information that is quantifiable and qualifiedly measurable to the extent feasible.
Please note that the contract term may be Calendar Year (starts 1/1), State Fiscal Year (SFY) (starts 7/1) or Federal Fiscal Year (FFY) (starts 10/1).
Key Statutory and Regulation Requirements under this contract



  1. Determine who is eligible to receive Federal and State financial assistance;

  2. Have internal controls and performance measures to determine whether the rules are accurately applied;

  3. Adherence to applicable Federal rules and State program compliance requirements; and

  4. Assurance of appropriate use of allowable government funds to carry out the goals and objectives of the program.

The Provider Agency assures that it will comply with the following statutory requirements and ensure Federal and State funds are applied to:


Eligible Clients – By statue – only families that meet program eligibility criteria
The agency agrees that a minimum it will provide the following required minimum staffing:
Personnel Requirements
The Agency Director or program designee must attend and participate in DFD-sponsored in-person meetings and trainings, or conference calls as directed by the Program Staff.
Fiscal Standards and Accountability
Recipients and sub-recipients of Federal and State funds are responsible for the proper use of such fund. Simply, this means that the funds are used for the intended purpose with compliance with all Federal, State and contract regulations. All parties are responsible for the transparency and accountability for the funds and are subject to administrative, contractual and legal sanctions for the misuse and/or improper use of these funds. Provider Agencies are considered sub-grantee/recipients under this contract and are subject to Federal laws, regulations and provisions of this contract as set forth in this document; and must ensure adherence to all applicable regulations.
The agency must meet all contract expectations as described in the RFP as well as those detailed in this contract. Failure to meet any performance standard and contract expectations can be grounds for revision of the contract whereby current funding is reduced, contract is suspended or terminated and can affect future consideration for funding.
In addition to the core areas of program delivery, Provider Agencies must maintain administrative and fiscal accountability, meet reporting requirements, and ensure program integrity to meet all program compliance and performance standards. As recipients of government funds, all agencies must adhere to all federal and state laws and regulations as stated above.

Reporting Requirements
The agency is required to submit program and fiscal reports within the required timeframes. At a minimum, the following reports are required:


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