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<br />Form RA 12 <br /> <br />Th'DEPENDE]'>,'T ANNUAL AUDIT CERTIFICATION <br /> <br />The grantee hereby assures compliance by itself and its applicable sub-recipients (contractors) with the Single <br />Audit Act Amendments of ]996, PL l04 - ]56 and, particularly, with the requirements ofOMB Circular A-l33 <br />as follows (check one): <br /> <br />Grant(s) expenditures of$300,000 or more in federal funds- <br />.tvJ annual single audit by an independent auditor made in accordance with the <br />Single Audit Act Amendments of 1996 and OMB Circular A-l33. <br /> <br />Grant(s) expenditures of $300,000 or more in state funds _ <br />An annual single audit by an independent auditor made in accordance with the <br />Uniform Grant and Contract Management Standards (UGCMS). <br /> <br />Grant(s) expenditures ofless than $300,000 in federal funds- <br />Exempt from the Single Audit Act. However, CJD may require a limited scope <br />audit as defined in OMB Circular A-l33. <br /> <br />Grant(s) expenditures Jess than $300,000 but $50,000 or more in state funds _ <br /> <br />A program-specific audit. <br /> <br />Grants(s) expenditures less than a total of $50,000 in slate funds- <br />Financial statements audited in accordance with Generally Accepted Auditing <br />Standards (GAAS). <br /> <br />NOTE: Grantees exempt from the Single Audit Act requirements (i.e. those expending less than $300,000 in <br />total federal financial assistance) are prohibited from charging the cost of a Sin Audit to a Federal award. <br /> <br />I. <br /> <br />x <br /> <br />2. <br /> <br />3. <br /> <br />4. <br /> <br />5. <br /> <br /> <br /> <br />Authorized Official (Signature) <br /> <br />b,~ <br /> <br />Financial Officer (Signature) <br /> <br />11 / 26 / 97 <br />Date <br /> <br />City of Pari s <br />Grantee Organization <br /> <br />]] <br /> <br />/ ?fi / 97 <br />Date <br /> <br />Grant Number <br /> <br />Regardless of items checked above, the grantee should, within 60 days following the date of the grant award, <br />furnish the following information: <br /> <br />1. The identity of the organization conducting the audit <br />2. Approximate time audit will be conducted <br />3. Audit coverage to be provided <br /> <br />25 <br />em Forms Packet <br />Revised: September, 1997 <br />