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Closeout Documentation
Once the project is completed, you must submit the
following documentation based on your project type:
- New Construction – N
- Renovation – R
- Design-Only – D
- Equipment-Only – E
Documentation
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Project
Type |
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N/R |
E
|
D |
A SF 269A Financial Status Report |
X |
X |
X |
An Insurance Form
Insurance Information Certification
Statement
The grantee organization will submit the following
statement. The document may be modified as necessary
to meet the specific conditions of the project.
I hereby certify that (name of grantee organization)
has done the following:
Item 1:
- Purchased an insurance policy on the Government-funded
facility which insures the facility at the
full replacement value of the property. The
insurance policy protects the property from
total or partial physical destruction and
will be maintained as long as the grant assisted
property is owned by the facility; or
- Effectively self-insured against physical
destruction and foreclosable liens, and that
the grantee organization has sufficient funds
available in the form of (describe source
of the funds) to replace and/or repair the
facility or satisfy a lien.
Item 2:
- Purchased a title insurance policy covering
the full appraised value of the facility.
The policy will be maintained as long as the
grant assisted property is owned by the facility
(Title insurance is not required if a legal
or title opinion is provided.); or
- Holds fee simple title to the site, in
the form of the attached legal or title opinion,
free of all mortgages or other foreclosable
liens to all land, rights-of-way, and easements
necessary for the project.
_____________________________________
(Signature of Authorized Grantee Official)
___________________
(Title)
___________________
(Date) |
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X |
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A SF 424C budget page showing
the actual, final project costs . See page 15
of General
Information and Instructions for Grant Application
(PDF - 910 KB) |
X |
X |
X |
An itemized equipment list, if
applicable. If the list has items that have a
unit cost of less than $5,000, a signed and dated
statement from the head of the grantee’s
Accounting Department should also be submitted
affirming that all items listed as equipment are
being treated as capital items under the grantee's
accounting system. |
X |
X |
X |
Any outstanding items per conditions
in the Notice of Grant Award |
X |
X |
X |
A certificate of occupancy issued
by the local authority having jurisdiction, if
applicable. |
X |
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A copy of the Certificate of
Substantial Completion. |
X |
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Photos (with brief descriptions)
of the completed project. Exterior shots (front,
rear of building) and major rooms would suffice.
|
X |
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A letter stating that the project
has been: completed in accordance with the previously
certified contract documents; constructed in accordance
with all applicable federal statutes and regulations;
and that the project is free of mechanics' liens.
The letter should also include a statement certifying
to the validity of the final project costs as
provided in the attached SF 424C budget page.
This letter is to be dated and signed by the grantee's
authorized representative. |
X |
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A letter certifying to the validity
of the final project costs as provided in the
attached SF 424C budget page. This letter is to
be dated and signed by the grantee’s authorized
representative. |
X |
X |
X |
A letter that addresses the
following (it may be modified as necessary to
meet the specific conditions of the project):
I hereby certify that on (date) (name of A/E
firm) completed the final working drawings and
final technical specifications for the (describe
project) in accordance with the Owner/Architect
Agreement signed and executed on (date). I further
certify that the project was designed in accordance
with all mandatory requirements imposed on federally-assisted
construction projects by specific laws enacted
by Congress, Presidential Executive Orders,
or Departmental Policy, as well as all applicable
program standards, state codes, and local codes
and ordinances.
_____________________________________
(Signature of A/E firm’s authorized
representative)
___________________
(Date) |
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X |
A copy of the final floor plan(s)
design. The format should be formatted no larger
than 11 x 17 and should include a graphic scale.
The plan (or plans, if multiple stories are involved)
should depict the basic intent of the design area
without including details typical in construction
drawings. |
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X |
Grants awarded in FY 2008 must submit closeout documentation
through the EHB's. All other grants must submit closeout
documentation to the Program Office at HCOFTA@hrsa.gov.
For More Information
- Construction program questions:
HCOFTA@hrsa.gov
or 301-443-3665
- Drawdown of funds questions:
Payment
Management System or 1-877-614-5533
- Terms
and conditions of grant: Contact the grants
management specialist listed in your Notice of Grant
Award
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