IDIS - Attachment G - Home Certification Form.docx

DOCX document 18 KB Posted Jul 27, 2011

Attached to: Program Business Process Analysis and Training Content Development and Management Services
Solicitation number: R-OPC-23859
Issued by: Department of Housing and Urban Development CPO Community Services and Housing Support

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R-OPC-23589 - Attachment G - Home Certification Form.doc

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File	Type	Posted
Questions and Answers 8-11-11.pdf	PDF	Aug 11, 2011
Attachment C - Evaluation Factors.pdf	PDF	Aug 11, 2011
Attachment F - Past Performance Survey.pdf	PDF	Aug 9, 2011
Cover Letter.pdf	PDF	Aug 9, 2011
Attachment D - Representations and Certifications.pdf	PDF	Aug 9, 2011
Attachment A Statement of Work-Schedule of Charges.pdf	PDF	Aug 9, 2011
Amendment 1.pdf	PDF	Aug 9, 2011
Attachment E Contract Clauses.pdf	PDF	Aug 9, 2011
Attachment G - Home Certification Form.pdf	PDF	Aug 9, 2011
Table of Contents.pdf	PDF	Aug 9, 2011
Attachment B - Solicitation Provisions.pdf	PDF	Aug 9, 2011
IDIS - SF1449.pdf	PDF	Aug 9, 2011
Attachment C - Evaluation Factors.pdf	PDF	Aug 9, 2011
IDIS - Table of Contents.doc	DOC document	Jul 27, 2011
IDIS - Cover Letter.doc	DOC document	Jul 27, 2011
IDIS - Attachment F - Past Performance Survey.docx	DOCX document	Jul 27, 2011
IDIS - Attachment A - Description of Services - Schedule of Charges 7-13-11.docx	DOCX document	Jul 27, 2011
IDIS - Attachment D - Representations and Certifications.docx	DOCX document	Jul 27, 2011
IDIS - Attachment B - Solicitation Provisions.docx	DOCX document	Jul 27, 2011
IDIS - Attachment C - Evaluation Factors.docx	DOCX document	Jul 27, 2011
IDIS - Attachment E - Contract Clauses.docx	DOCX document	Jul 27, 2011

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Attachment G – Home Certification Form

ANNUAL HOME 20% CERTIFICATION

CONTRACTOR’S NAME: __________________________________________________________________________

CONTRACT/GRANT NUMBERS OF ALL HOME FUNDED PROJECTS:

The certification at the time of proposal submission is based on information at the time of proposal submission and assumes that HOME funds constitute (100%) of the total evaluated amount of the base period and assumes on award an award at the time of proposal submission. In addition, the offeror shall include all OTHER HOME funded projects in the calculation. If the amount of HOME funds crosses fiscal years, it is to be assumed that HOME funds will be allocated equally over a period of 12 months.

Actual for last fiscal year:

FOR FISCAL YEAR ENDING (Month, Day and Year):

TOTAL HOME FUNDS AWARDED:

FIRM’S OPERATING BUDGET (revenue):

PERCENT OF HOME FUNDS IN OPERATING BUDGET (item 2 divided by item 3):

Projected for current fiscal year:

FOR FISCAL YEAR ENDING (Month, Day and Year):

TOTAL HOME FUNDS AWARDED:

FIRM’S OPERATING BUDGET (revenue):

PERCENT OF HOME FUNDS IN OPERATING BUDGET (item 2 divided by item 3):

The firm’s operating budget is attached.

I hereby certify that the amount of HOME funds expended by this organization from all awarded HOME-funded contract, cooperative agreements, and grants did not exceed 20 percent of this organization’s revenue during the fiscal year.

Signature of Authorized Official Title Date

File details come from the government source that posted it. Updated Nov 14, 2017.