HomeMy Public PortalAbout18-9455 Amendment 2 to the LP13037 Loan Agreement with the Florida Department of Enviromental Sponsored by: City Manager
RESOLUTION NO. 18-9455
A RESOLUTION OF THE CITY COMMISSION OF THE CITY
OF OPA-LOCKA, FLORIDA, AUTHORIZING THE CITY
MANAGER TO EXECUTE AMENDMENT 2 TO THE LP13037
LOAN AGREEMENT WITH THE FLORIDA DEPARTMENT
OF ENVIRONMENTAL PROTECTION, RELATING TO THE
STATE REVOLVING FUND (SRF) LOAN PROGRAM FOR
OPA-LOCKA NW 127TH STREET — CAIRO LANE TO NW 32ND
AVENUE PROJECTS; PROVIDING FOR INCORPORATION
OF RECITALS; PROVIDING FOR AN EFFECTIVE DATE.
WHEREAS, Amendment 2 to the City of Opa-locka's ("City") State Revolving
Fund Loan Agreement LP13037 extends the Agreement to December 31, 2018; and
WHEREAS, the City Commission finds that it is in the best interest of the City to
accept the new terms of the loan agreement.
NOW THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF
THE CITY OF OPA LOCKA, FLORIDA:
Section 1. RECITALS ADOPTED.
The recitals to the preamble herein are incorporated by reference.
Section 2.AUTHORIZATION
The City Commission hereby authorizes the City Manager to execute Amendment 2
to the LP 13037 Loan Agreement with the Florida Department of Environmental
Protection, relating to the State Revolving Fund (SRF) loan program for Opa-Locka
NW 127th Street— Cairo Lane to NW 32nd Avenue Projects attached hereto as Exhibit
A.
SECTION 3. SCRIVENER'S ERRORS.
Sections of this Resolution may be renumbered or re-lettered and corrections of
typographical errors which do not affect the intent may be authorized by the City
Manager, or the City Manager's designee, without need of public hearing, by filing a
corrected copy of same with the City Clerk.
Section 4. EFFECTIVE DATE.
This Resolution shall take effect immediately upon adoption and is subject to the
approval of the Governor or his designee.
PASSED AND ADOPTED this 24th day of January, 2018.
Resolution No. 18-9455
1
lYlyra L. ' aylor
Mayor
Attest to: Approved as to form and legal sufficiency:
Jo. na Flores BROWN LAW GROUP, LLC
City Clerk City Attorney
Moved by: VICE MAYOR KELLEY
Seconded by: COMMISSIONER RILEY
Commissioner Vote: 4-0
Commissioner Holmes: NOT PRESENT
Commissioner Riley: YES
Commissioner Pigatt: YES
Vice Mayor Kelley: YES
Mayor Taylor: YES
itc'd.L
City of Opa-Locka
Agenda Cover Memo
Department Department
Director: Director Signature:
Budget Ernesto Reyes Budget
Administrator: Administrator/ACM
Signature: '. `I
Finance Director: Bryan Hamilton FD Signature: 1 4'
Department 1
Asst City Manager: William Green ACM Signature:
City Manager: Ed Brown CM Signature: "1 Ail l'-_A;.
Commission 01.24.18 Item Type: µ'
Meeting Date: X
(EnterXin box)
Fiscal Impact: Ordinance Reading:
(Enter X in box) (Enter X in box)
x Public Hearing: ,,,w,
(EnterXin box) x - x
Funding Source: (Enter Fund& Advertising Requirement:
Account#: Dept) (EnterXin box) x
Ex:
State Revolving Loan
127th Street-Cairo
Lane to NW 32nd
Avenue Projects
Contract/P.O. RFP/RFQ/Bid#:
Required: x
(EnterXin box)
Strategic Plan Strategic Plan Priority Area: Strategic Plan Obj./Strategy: (list
Related Enhance Organizational o the specific objective/strategy this item will
(EnterXin box) X Bus.&Economic Dev -� address)
Public Safety Q'
Quality of Education El
Qual.of Life&City Image J
_ Communication CI
Sponsor Name City Manager Department: City Manager
A resolution authorizing the City Manager To propose amendment 2 to the LP13037 Loan Agreement with
the Florida Department of Environmental Protection relating to the State Revolving Loan.
It is in the best interest of the City to seek Commission authorization to amend the LP13037 Loan Agreement
with the Florida Department of Environmental Protection, Relating to the State Revolving Fund. The
amendment provides for an extention of the agreement to be extended to December 31, 2018.
I ikepO rd
Staff recommends the adoption of the Resolution to authorize the City Manager to execute an amendment to
the LP13037 Loan Agreement.
DEP AGREEMENT NO.LP13037
CITY OF OPA-LOCKA
AMENDMENT NO.2
THIS AGREEMENT as entered into on January 7, 2015, and amended on March 16, 2017, between the
FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION(hereinafter referred to as the"Department")
and the CITY OF OPA-LOCKA(hereinafter referred to as the"Grantee")is hereby amended.
WHEREAS, the Grantee has requested an extension of the Agreement; an extension is needed because of
construction delays due to subcontractor payment issues and delays in permit approval;and,
WHEREAS, certain provisions of the Agreement need revision and a provision needs to be added to the
Agreement.
NOW,THEREFORE,the parties hereto agree as follows:
1. The Agreement,as amended,is effective from July 1,2014,to December 31,2018.
2. Section 8.of the Agreement is hereby deleted in its entirety and replaced with the following:
DEFAULT/TERMINATION/FORCE MAJEURE:
A. Termination for Convenience. The Department may terminate the Agreement in whole or in part
by giving 30 days' written notice to the Grantee, when the Department determines, in its sole
discretion,that it is in the State's interest to do so.The Department shall notify the Grantee of the
termination for convenience with instructions as to the effective date of termination or the
specific stage of work at which the Agreement is to be terminated. The Grantee shall not furnish
any service or deliverable after it receives the notice of termination,unless otherwise instructed in
the notice.The Grantee shall not be entitled to recover any cancellation charges or lost profits.If
the Agreement is terminated before performance is completed,the Grantee shall be paid only for
that work satisfactorily performed for which costs can be substantiated.
B. Termination for Cause. The Department may terminate this Agreement if any of the events of
default described below occur or in the event that the Grantee fails to fulfill any of its other
obligations under this Agreement. The Grantee shall continue work on any portion of the
Agreement not terminated. If, after termination, it is determined that the Grantee was not in
default,or that the default was excusable,the rights and obligations of the parties shall be the same
as if the termination had been issued for the convenience of the Department. The rights and
remedies of the Department in this clause are in addition to any other rights and remedies
provided by law or under this Agreement.
C. Grantee Obligations upon Notice of Termination. After receipt of a notice of termination or
partial termination,is directed by the Department,the Grantee shall stop performing services on
the date,and to the extent specified,in the notice.
D. Force Majeure.The Grantee shall not be responsible for delay resulting from its failure to perform
if neither the fault nor the negligence of the Grantee or its employees or agents contributed to the
delay and the delay is due directly to acts of God, wars, acts of public enemies, strikes, fires,
floods,or other similar cause wholly beyond the Grantee's control,or for any of the foregoing that
affect subcontractors or suppliers if no alternate source of supply is available to the Grantee. In
case of any delay the Grantee believes is excusable, the Grantee shall notify the Department in
writing of the delay or potential delay and describe the cause of the delay either(1)within ten days
after the cause that creates or will create the delay first arose, if the Grantee could reasonably
DEP Agreement No.LP13037,Amendment No.2,Page 1 of 5
foresee that a delay could occur as a result;or(2)if delay is not reasonably foreseeable,within five
days after the date the Grantee first had reason to believe that a delay could result. THE
FOREGOING SHALL CONSTITUTE THE GRANTEE'S SOLE REMEDY OR EXCUSE
WITH RESPECT TO DELAY. Providing notice in strict accordance with this paragraph is a
condition precedent to such remedy. No claim for dwages, other than for an extension of time,
shall be asserted against the Department. The Grantee shall not be entitled to an increase in the
Agreement price or payment of any kind from the Department for direct, indirect, consequential,
impact or other costs, expenses or damages, including but not limited to costs of acceleration or
inefficiency, arising because of delay, disruption, interference, or hindrance from any cause
whatsoever. If performance is suspended or delayed, in whole or in part, due to any of the causes
described in this paragraph, after the causes have ceased to exist the Grantee shall perform at no
increased cost, unless the Department determines, in its sole discretion, that the delay will
significantly impair the value of the Agreement to the Department, in which case the Department
may (1) accept allocated performance or deliveries from the Grantee, provided that the Grantee
grants preferential treatment to Department with respect to products subjected to allocation; (2)
contract with other sources (without recourse to and by the Grantee for the related costs and
expenses)to replace all or part of the products or services that are the subject of the delay,which
purchases may be deducted from the Agreement quantity;or(3)terminate the Agreement in whole
or in part.
3. Section 21.of the Agreement is hereby deleted in its entirety and replaced with the following:
INSURANCE:
A. Required Coverage. At all times during the Agreement the Grantee, at its sole expense, shall maintain
insurance coverage of such types and with such terms and limits described below. The limits of
coverage under each policy maintained by the Grantee shall not be interpreted as limiting the Grantee's
liability and obligations under the Agreement.All insurance policies shall be through insurers licensed
and authorized to issue policies in Florida, or alternatively, Grantee may provide coverage through a
self-insurance program established and operating under the laws of Florida. Additional insurance
requirements for this Agreement may be required elsewhere in this Agreement, however the minimum
insurance requirements applicable to this Agreement are:
i. Commercial General Liability Insurance.
The Grantee shall provide adequate commercial general liability insurance coverage and hold
such liability insurance at all times during the Agreement. The Department of Environmental
Protection, its employees,and officers shall be named as an additional insured on any general
liability policies.The minimum limits shall be$200,000 each individual's claim and$300,000
each occurrence.
a. Workers'Compensation and Employer's Liability Coverage.
The Grantee shall provide workers' compensation, in accordance with Chapter 440,
F.S.,and employer's liability insurance with minimum limits of$100,000 per accident,
$100,000 per person, and $500,000 policy aggregate. Such policies shall cover all
employees engaged in any work under the Agreement.
b. Commercial Automobile Insurance.
If the Grantee's duties include the use of a commercial vehicle, the Grantee shall
maintain automobile liability, bodily injury, and property damage coverage. Insuring
clauses for both bodily injury and property damage shall provide coverage on an
occurrence basis. The Department of Environmental Protection, its employees, and
officers shall be named as an additional insured on any automobile insurance policy.
The minimum limits shall be as follows:
DEP Agreement No.LP13037,Amendment No.2,Page 2 of 5
$300,000 Automobile Liability Combined Single Limit for Company- Owned
Vehicles,if applicable
$300,000 Hired and Non-owned Automobile Liability Coverage
c. Other Insurance.
Additional insurance may be required by federal law, where applicable, if any work
proceeds over or adjacent to water, including but not limited to Jones Act,
Longshoreman's and Harbor Worker's, or the inclusion of any applicable rider to
worker's compensation insurance, and any necessary watercraft insurance, with limits
of not less than $300,000 each. Questions concerning required coverage should be
directed to the U.S. Department of Labor
(http://www.dol.gov/owcp/dlhwc/lscontac.htm)or to the parties'insurance carrier.
B. Insurance Requirements for Sub-Grantees and/or Subcontractors. The Grantee shall require its
sub-grantees and/or subcontractors, if any, to maintain insurance coverage of such types and
with such terms and limits as described above. The Grantee shall require all its sub-grantees
and/or subcontractors, if any, to make compliance with the insurance requirements of this
Agreement a condition of all contracts related to this Agreement. Sub-grantees and/or
subcontractors must provide proof of insurance upon request.
C. Exceptions to Additional Insured Requirements. If the Grantee's insurance is provided through
an insurance trust, the Grantee shall instead add the Department of Environmental
Protection, its employees, and officers as an additional covered party everywhere the
Agreement requires them to be added as an additional insured. Further, notwithstanding the
requirements above, if Grantee is self-insured, then the Department of Environmental
Protection,its employees, and officers do not need to be listed as additional insureds.
D. Deductibles. The Department shall be exempt from, and in no way liable for, any sums of
money representing a deductible in any insurance policy. The payment of such deductible
shall be the sole responsibility of the Grantee providing such insurance.
E. Proof of Insurance. Upon execution of this Agreement, the Grantee shall provide the
Department documentation demonstrating the existence and amount for each type of applicable
insurance coverage prior to performance of any work under this Agreement. Upon receipt of
written request from the Department, the Grantee shall furnish the Department with proof of
applicable insurance coverage by standard form certificates of insurance, a self-insured
authorization,or other certification ofself-insurance.
F. Failure to Maintain Coverage.In the event that any applicable coverage is cancelled by the insurer
for any reason, the Grantee shall immediately notify the Department of such cancellation and
shall obtain adequate replacement coverage conforming to the requirements herein and provide
proof of such replacement coverage within ten (10) calendar days after the cancellation of
coverage.
4. Section 35.is added to the Agreement as follows:
PROHIBITED GOVERNMENTAL ACTIONS FOR PUBLIC WORKS PROJECTS
Pursuant to Section 255.0992, F.S., state and political subdivisions that contract for public works projects
are prohibited from imposing restrictive conditions on certain contractors, subcontractors, or material
suppliers and prohibited from restricting qualified bidders from submitting bids.
A. "Political subdivision" means separate agency or unit of local government created or established by
law or ordinance and the officers thereof. The term includes, but is not limited to, a county; a city,
town, or other municipality; or a department, commission, authority, school district, taxing district,
DEP Agreement No.LP13037,Amendment No.2,Page 3 of 5
water management district, board,public corporation, institution of higher education, or other public
agency or body thereof authorized to expend public funds for construction, maintenance, repair or
improvement of public works.
B. "Public works project"means an activity of which fifty percent(50%)or more of the cost will be paid
from state-appropriated funds that were appropriated at the time of the competitive solicitation and
which consists of construction, maintenance, repair, renovation, remodeling or improvement of a
building, road, street, sewer, storm drain, water system, site development, irrigation system,
reclamation project,gas or electrical distribution system,gas or electrical substation,or other facility,
project,or portion thereof that is owned in whole or in part by any political subdivision.
C. Except as required by federal or state law,the state or political subdivision that contracts for a public
works project may not require that a contractor, subcontractor or material supplier or carrier engaged
in such project:
i. Pay employees a predetermined amount of wages or prescribe any wage rate;
ii. Provide employees a specified type,amount,or rate of employee benefits;
iii. Control,limit,or expand staffing;or
iv. Recruit,train,or hire employees from designated,restricted,or single source.
D. For any competitive solicitation that meets the criteria of this section,the state or political subdivision
that contracts for a public works project may not prohibit any contractor, subcontractor, or material
supplier or carrier able to perform such work who is qualified, licensed, or certified as required by
state law to perform such work from submitting a bid on the public works project, except for those
vendors listed under Section 287.133 and Section 287.134,F.S.
E. Contracts executed under Chapter 337,F.S.are exempt from these prohibitions.
5. Attachment A-1, Revised Project Work Plan, is hereby deleted in its entirety and replaced with
Attachment A-2, Revised Project Work Plan, attached hereto and made a part of the Agreement. All
references in the Agreement to prior Attachment A's, shall hereinafter refer to Attachment A-2,Revised
Project Work Plan.
6. Attachment B, Disbursement Request Package, is hereby deleted in its entirety and replaced with
Attachment B-1,Payment Request Summary Form,attached hereto and made a part of the Agreement. All
references in the Agreement to Attachment B,shall hereinafter refer to Attachment B-1,Payment Request
Summary Form.
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
DEP Agreement No.LP13037,Amendment No.2,Page 4 of 5
IN WITNESS WHEREOF, the parties have caused this amendment to Agreement LP13037 to be duly
executed,the day and year last written below.
CITY OF OPA-LOCKA STATE OF FLORIDA DEPARTMENT OF
ENVIRONMENTAL PROTECTION
By: By:
City Manager Secretary or designee
Print Name of Authorized Person Print Name and Title of Authorized Person
Date: Date:
Thomas Montgomery,DEP Grant Manager
Zachary Easton,DEP QC Reviewer
FEID No.: 59-6000394
List of attachments/exhibits included as part of this Amendment:
Letter/
Specify Type Number Description(include number of pages)
Attachment A-2 Revised Grant Work Plan(2 Pages)
Attachment B-1 Payment Request Summary Form(5 Pages)
DEP Agreement No.LP13037,Amendment No.2,Page 5 of 5
ATTACHMENT A-2
REVISED PROJECT WORK PLAN
PROJECT TITLE: Opa-Locka NW 127th Street—Cairo Lane to NW 32 Avenue
PROJECT LOCATION: The project is located in the city limits of Opa-Locka, Miami-Dade County,
Florida. The hydrological unit code for this project is 03090202.
PROJECT BACKGROUND:The design build project for the 127th Street work involves the construction
of a new drainage system to alleviate the existing flooding problem. Some portion of the road experiences
frequent flooding problems from a short duration and a very low frequency rain event. The proposed
drainage system will consist of the construction of inlet structures with baffles, conveyance pipes,
manholes,and exfiltration trenches to collect surface runoff for improved roadway condition.
This group of stormwater drainage,transportation and street projects are part of a low-lying area within the
City of Opa-Locka,that does not have an existing drainage system.Consequently,during the rainy season,
this situation leads to major flooding of the roadway including property damage to adjacent businesses and
residential homes. These roads provide access to a critical medical clinic and other services for the
community. The saturated soil, the low-lying condition, and the higher water table are all factors that
exacerbate the flooding.The resultant ponding hastens mosquitoes,litter and potential contamination from
flooding of the adjacent sanitary sewer system creating a health hazard.
This funding will enable the City of Opa-locka to address this flooding and associated issues by constructing
an adequate stormwater drainage system, reduce pollution and provide adequate treatment of runoff
discharge for improved water quality.These improvements will use best management practices to alleviate
this situation and provide effective mitigation for future disaster.
PROJECT DESCRIPTION: NW 127th Street is currently a dirt road adjacent to industrial properties.
The city proposes to design and construct the following: a roadway, stormwater drainage, sidewalks with
handicap ramps,and traffic signs.
The Grantee does not anticipate that the funding under this agreement will result in a fully completed
project,so this agreement will cover a portion of the work.
TASKS and DELIVERABLES:
Task 1: Professional Services
Task Description: Professional Services needed for the design build project that includes work on NW
127th Street. Please note this task is for the design services that are outside of the design build contract.
Deliverable 1: Copy of the executed contract(s) and contractor's payment application(s)totaling$6,450
for the engineering services associated with the design build project that includes the proposed NW 127th
Street work.
Performance Standard: The DEP Grant Manager will review periodic requests for funds for the
deliverables to ensure they are eligible for reimbursement.
DEP Agreement No.LP13037,Attachment A-2,Page 1 of 2
Task 2: Construction
Task Description: The Grantee will construct roadway,stormwater drainage and sidewalks on North West
127th Street in accordance with the construction contract documents.
Deliverables: Construction completed to date as described in this task,as evidenced by these deliverables:
1)Dated color photographs of on-going work representing the time period covered in the payment request;
2) signed acceptance and brief description of the completed work to date by the Grantee; 3) written
verification that the Grantee has received record drawings and any required fmal inspection report(s) for
the project (as applicable); and 4) signed statement from a Florida Licensed Professional Engineer
indicating construction has been completed in accordance with the construction contract documents (as
applicable).
Performance Standard: The Department's Grant Manager will review the deliverables to verify that they
meet the specifications in the Grant Work Plan and this task description.
Payment Request Schedule: The deliverables must be submitted and accepted prior to each payment
request and may be submitted no more frequently than monthly.
PROJECT TIMELINE & BUDGET DETAIL: The tasks must be completed by, and all deliverables
received by,the corresponding task end date.
1 Professional Services Contractual $6,450 07/01/14 Completed
Services
2 Construction Contractual $393,550 07/01/14 6/30/18
Services
Total: $400,000
Note that,per paragraph 4 of the agreement,authorization for continuation and completion of work and
any associated payments may be rescinded,with proper notice,at the discretion of the Department if the
Legislature reduces or eliminates appropriations. Extending the contract end date carries the risk that
funds for this project may become unavailable in the future. This should be a consideration for the
Grantee with this and future requests for extension.
DEP Agreement No.LP13037,Attachment A-2,Page 2 of 2
EXHIBIT D
PAYMENT REQUEST SUMMARY FORM
DEP Agreement No. Agreement Effective Dates:
Grantee:
(Name A Mailing Address)
Grantee's Grant Manager
Performance Period(Stan date—End date): Date of Request:
Task/Deliverable No(s). Task/Deliverable Amount Requested: S
GRANT EXPENDITURES SUMMARY SECTION
PREVIOUS TOTAL MATCHING TOTAL
CATEGORY OF EXPENDITURE AMOUNT OF THIS CUMULATIVE
(As&Whorl
zed) REQUEST PAYMENT PAYMENT FUNDS FOR THIS CUMULATIVE
REQUESTS QIS REQUEST MATCHING FUNDS
Task 1: $ - $ - S - $ - $ -
Task 2: $ - $ - $ - $ - $ -
Task 3: $ - S - $ - $ - S -
Task 4: S - S - S - S - S -
Task 5: $ - $ - $ - $ - $ -
Task 6: $ - $ - $ - $ - $ -
Task 7: $ - $ - $ - $ - $ -
Task 8: $ - S - $ - $ - $ -
Task 9: $ - $ - $ - $ - $ -
TOTAL AMOUNT $ $ S $ $
TOTAL BUDGET
(ALL TASKS) $ $
LESS TOTAL CUMULATIVE
PAYMENT REQUESTS OF: $ $
TOTAL REMAINING
(ALL TASKS) S $
GRANTEE CERTIFICATION
Complete Grantee's Certification of Payment Request on Page 2 to certify that the amount being requested for reimbursement above was for items that
were charged to and utilized only for the above cited grant activities.
Attachment B-1,DEP Agreement No.1213037,Page 1 of 5
Grantee's Certification of Payment Request
1, ,on behalf of
(Print name of Grantee's Grant Manager designated in the Agreement)
,do hereby certify for
(Print name of Grantee)
DEP Agreement No. and Payment Request No. that:
O The disbursement amount requested is for allowable costs for the project described in Attachment A of the Agreement.
O All costs included in the amount requested have been satisfactorily purchased,performed,received,and applied toward completing
the project;such costs are documented by invoices or other appropriate documentation as required in the Agreement.
0 The Grantee has paid such costs under the terms and provisions of contracts relating directly to the project;and the Grantee is not in
Check all that apply:
❑ All permits and approvals required for the construction,which is underway,have been obtained.
❑ Construction up to the point of this disbursement is in compliance with the construction plans and permits.
❑ The Grantee's Grant Manager relied on certifications from the following professionals that provided services for this project during
the time period covered by this Certification of Payment Request,and such certifications are included:
Professional Service Provider(Name/License No.) Period of Service(mm/dd/yy—mm/dd/yy)
Grantee's Grant Manager's Signature Grantee's Fiscal Agent Signature
Print Name Print Name
Telephone Number Telephone Number
Attachment B-1,DEP Agreement No.LP13037,Page 2 of 5
INSTRUCTIONS FOR COMPLETING
PAYMENT REQUEST SUMMARY FORM
DEP AGREEMENT NO.: This is the number on your grant agreement.
AGREEMENT EFFECTIVE DATES: Enter agreement execution date through end date.
GRANTEE: Enter the name of the grantee's agency.
MAILING ADDRESS: Enter the address that you want the state warrant sent.
GRANTEE'S GRANT MANAGER: This should be the person identified as grant manager in the grant Agreement.
PERFORMANCE PERIOD: This is the beginning and ending date of the performance period for the task/deliverable that the request is for(this must be within the timeline
shown for the task/deliverable in the Agreement).
TASK/DELIVERABLE NO.: This is the number of the task/deliverable that you are requesting payment for and/or claiming match for(must agree with the current Grant Work
Plan).
TASK/DELIVERABLE AMOUNT REQUESTED: This should match the amount on the"TOTAL TASK/DELIVERABLE BUDGET AMOUNT"line for the`AMOUNT OF
THIS REQUEST"column.
GRANT EXPENDITURES SUMMARY SECTION:
"AMOUNT OF THIS REQUEST"COLUMN: Enter by authorized category of expenditure the amount for which you are requesting reimbursement for this task. This must
agree with the currently approved budget in the current Grant Work Plan of your grant Agreement. Do not claim expenses in a budget category that does not have an approved
budget. Do not claim items that are not specifically identified in the current Grant Work Plan. Enter the column total on the"TOTAL AMOUNT"line. Enter the amount of all
Tasks on the"TOTAL BUDGET(ALL TASKS)"line. Enter the total cumulative amount of this request and all previous payments on the"LESS TOTAL CUMULATIVE
PAYMENT REQUESTS OF"line. Deduct the"LESS TOTAL CUMULATIVE PAYMENT REQUESTS OF"from the"TOTAL BUDGET(ALL TASKS)"for the amount to enter
on the"TOTAL REMAINING(ALL TASKS)"line.
"PREVIOUS PAYMENT REOUESTS" COLUMN:Enter the total cumulative amount that has been paid in previous requests.Do not include the current reqeusted amount in
this total Do not enter anything in the shaded areas.
"TOTAL CUMULATIVE PAYMENT REOUESTS"COLUMN: Enter the cumulative amounts that have been requested to date for reimbursement by budget category. The
final request should show the total of all requests;first through the final request(this amount cannot exceed the approved budget amount for that budget category for the Task(s)
you are reporting on). Enter the column total on the"TOTAL PAYMENT REQUEST"line. Do not enter anything in the shaded areas.
"MATCHING FUNDS"COLUMN: Enter the amount to be claimed as match for the performance period for the Task(s)you are reporting on. This needs to be shown under
specific budget categories according to the currently approved Grant Work Plan. Enter the total on the"TOTAL AMOUNT"line for this column. Enter the match budget amount
on the"TOTAL BUDGET(ALL TASKS)"line for this column. Enter the total cumulative amount of this and any previous match claimed on the"LESS TOTAL CUMULATIVE
PAYMENTS OF"line for this column. Deduct the"LESS TOTAL CUMULATIVE PAYMENTS OF"from the"TOTAL BUDGET(ALL TASKS)"for the amount to enter on the
"TOTAL REMAINING(ALL TASKS)"line.
"TOTAL CUMULATIVE MATCHING FUNDS"COLUMN: Enter the cumulative amounts you have claimed to date for match by budget category. Put the total of all on
the line titled"TOTAL PAYMENT REQUEST." The final request should show the total of all claims,first claim through the final claim,etc. Do not enter anything in the
shaded areas.
GRANTEE'S CERTIFICATION:Check all boxes that apply. Identify any licensed professional service providers that certified work or services completed during the period
included in the request for payment.Must be signed by both the Grantee's Grant Manager as identified in the grant agreement and the Grantee's Fiscal Agent.
Documentation for match claims must meet the same requirements as those expenditures for reimbursement.
Attachment B-1,DEP Agreement No.LP13037,Page 3 of 5
FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
REQUEST FOR PAYMENT—PART II
REIMBURSEMENT DETAIL
Grantee Name: Payment Request No.:
DEP Agreement No.:
Local Share or Other TasklDslivemble
Vendor Name Number Invoice Dab invoice��Amount Funding or Amount Requested Amount (3) Check Number Number(4)
Not Requested(2)
$ - $
$ - $
$ - $
$ - $
$ - $
$ - $
$ - $
$ - $
$ - $
$ - $
$ - $
$ - $
Attachment B-1,DEP Agreement No.LP13037,Page 4 of 5
Instructions for Completing Request for Payment- Part H
Include the Grantee Name,Payment Request No.,and DEP Agreement Number. List vendor invoices that are associated
with the Project by Task/Deliverable.
1 Invoice Amount: Amount of Invoice being submitted for reimbursement.
2 Local Share or Other Funding or Amount Not Requested: Portion of invoice paid for by Grantee.
Requested Amount: Subtract Grantee's Local Share or Other Funding or Amount Not Requested(2)from Invoice
3 Amount(1).
Deliverable Number: Must identify completed deliverable(s)for each invoice. If invoice covers multiple
deliverables,that invoice would be listed multiple times,a line item for each deliverable with any portion not
4 applicable to that Task/Deliverable identified under(2).
Submittal Instructions
Instructions for E-mailing:
The program now accepts reimbursement requests electronically,please E-mail to WSRP. When scanning please be sure
that the minimum scan resolution must be 300 DPI(dots per inch). When reimbursement requests are sent
electronically,please do not also send a hard copy by postal mail.
Please redact all sensitive financial information from the invoices and other supporting documentation
to be submitted with this Payment Request Form.
Remit Payment Request by E-mail to: WSRP(c deo.state.fl.us
Be sure the E-mail payment request includes the following:
Cc: Department's Grant/Project Manager
Subject: Project Number_Disbursement Number: example—LP14025_Disb_1
Attachments:
1) Exhibit D Payment Request Summary
2) Request for Payment Part II Reimbursement Detail
3) Copies of invoices
4) Other supporting documentation,as needed
For questions or concerns regarding these forms or if you would like the payment request forms listed above in
electronic format please contact:
Thomas Montgomery (850)245-2967
Thomas.Montgomer\, dep.state.fl.us
Attachment B-1,DEP Agreement No.LP13037,Page 5 of 5