Weatherization Manual Policies and Procedures Supporting Documents for United States Department of Energy (doe) United States Department of Health and Human Services (hhs) Bonneville Power Administration



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Training and Technical Assistance Expense Form



Training Received Dates Attended
1.

2.


3.

4.


5.

Total Cost

$

Name and Title of Individual(s) Attending:

Name Title Training Attended


Peer Exchange Proposal Form


Name of Agency: Date:

Contact: Phone:

Email:

Describe training need:



Who will provide the training?

Where will the training be provided?

Describe why this person was selected:

When would you like the training?


Who will receive the training? (Provide names and titles)

Are the people listed above assigned only to the weatherization program? Yes No

If no, how much will be contributed by other programs? $

Who will travel? (Check one) Trainer Trainee


What is the cost?

Trainer Trainee

Salary:


Fringe:

Travel: Trainer Trainee

Lodging: # of Nights?

Per Diem:

Other: Describe:

Total:
Documentation

Is a written, signed agreement attached? Yes No

If not, when will it be available?



Commerce ONLY

Training Coordinator:

Will the proposal meet a local agency need? Yes No

Is the letter of agreement complete? Yes No

Is cost share required? Yes No

Recommendation Yes No

Signature Date

Approval by HIP Unit Manager: Yes No

Signature Date

Equipment/Vehicle Purchase Request/Approval Form


USE A SEPARATE FORM FOR EACH CONTRACT


(If request is for a vehicle, allow 90 days for DOE approval)
Contract: Commerce Representative:

Local Agency:

Address:

Contact Person: Phone Number:

Email:

Equipment/Vehicle Requested

Provide 3 quotes/bids from different vendors for this purchase (include shipping & taxes):

Description Quantity Max Price Budget Total Cost

(List each item) (Number) $ each Category

(Include sales tax)

If equipment/vehicle, will it be used full-time or part-time?

Reason & Purpose for purchase (Attach additional sheets if necessary):

Will other programs use capital asset/equipment/vehicle? Yes No

If yes, shared purchase, use, maintenance, or rental fee? List other programs and percent of time used. (A rental fee or proportionate time use is required if a program does not share in the purchase.)
Briefly describe how procurement will be done and confirm that all Agency, State, and Federal

procurement guidelines will be met. (WPN 09-1B, 3/12/09).

Is this a request for a replacement, or an expansion for ramp-up? (WPN 09-1B, 3/12/09).

Provide statement that lowest bid will be selected or sufficient justification of “best value selection” if low bid not recommended for awarding agency approval: (WPN 09-1B, 3/12/09)

Was a lease alternative explored? Yes No
If yes provide: Terms, Condition, & Purchase Option: (WPN 09-1B, 3/12/09)
List all funding sources used for this purchase:


Local agency certifies that procurement records will be on file and available for review. Local agency further certifies that this purchase will be in accordance will all applicable rules, procedures, and guidelines per contract referenced above.
** Authorized person must sign request**

Local Agency

Authorized Signature Date

Title
Commerce Approvals (DOE approval attached for vehicles/DOE contract)

Commerce Representative Date

Managing Director Date

Equipment Reserve Fund Application

Agency:


Address:

Contact Person:

Phone Number: Email:

Equipment Requested

Equipment Description:

Justification – Use criteria in Policies, Section 6.6. Criteria include need, condition of equipment, availability of other funds, and existence of recent similar purchases.



Quantity

Estimated Price ($ each, include sales tax)

Total Funds Requested Per Item

1.
Justification:










2.
Justification:










3.
Justification:










Total funds requested:




Attach additional sheets for further items or explanation if necessary.
Will non-weatherization programs use this equipment? Yes No
If yes, indicate shared purchase, use, maintenance, or rental fee. List other programs and percent of time used. Note: A rental fee for proportionate time use is required if a program does not share in the purchase.
Submit this form to your agency’s field representative.

Link toActive Form: Exhibit 6.7, Budget Revision Request Form



Link to Active Form: Exhibit 7.1A, Quality Control Inspection QCI Form

Exhibit 8.3A Page 1 of 1
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