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Office of the Attorney General (OAG) Bureau of Advocacy and Grants Management Victims of Crime Act (VOCA) Sub-grantee Self-evaluation Sub-grantee Legal Name Sub-grantee Doing Business As (DBA) Sub-grantee Mailing Address Area Code/Phone Number Area Code/Fax Number Email Address Contract Period of Performance October 2011 – September 2012 Sub-grantee Contact Name and Title Certification I (We) certify that the information contained in this Subgrantee Self-Evaluation is true and accurate. I (We) acknowledge by obligation to notify the OAG Grant Manager for this contract of any changes to statements made. Signature of Agency Director Date Self-Evaluation Completed ________________________________________ __________________________ Type or Print Name and Title _________________________________________ Signature of Board President (for Non-profits only) Date Signed by Board President _________________________________________ ___________________________ Sub-grantee Self-evaluation Instructions: The Subgrantee Self-Evaluation is one of several documents that the OAG reviews to gauge subgrantee compliance with applicable state and federal laws and rules, program guidelines, and the VOCA agreement. Please review and answer the following questions. If you have any questions, please contact your Grant Manager. Please attach explanations as needed. 1. Sub-grantee maintains documentation to substantiate its organization structure and tax status (i.e. Articles of Incorporation, Bylaws, State of Florida Business License). Yes No If “No,” please explain: 2. Sub-grantee maintains all insurance necessary and appropriate for its agency’s operations. Yes No If “No,” please explain: 3. Is the sub-grantee currently, or within the past year, involved in any litigation or administrative dispute resolution proceeding, including civil rights complaints, by current or past employees or service recipients? Yes No If “Yes,” please explain: 4. In the past year, has the sub-grantee received any findings or a corrective action plan from any financial audit, license renewal, administrative proceeding, or contract monitoring review? Yes No If “Yes,” please explain: 5. Has the sub-grantee’s VOCA program undergone any major restructuring within the past year? Yes No If “Yes,” please explain: 6. Has there been turnover in the program’s management within the past year? Management includes the executive director, program director, accounting/fiscal managers, etc. Yes No If “Yes,” please explain: 7. Has there been turnover of direct services program staff within the past year? Program staff includes advocates and other direct service staff. Yes No If “Yes,” please explain: 8. If the sub-grantee is required to have and maintain a board of directors, what are the minimum and maximum number of board members required, in accordance with the agency’s bylaws? 9. How many board members are currently on the board of directors? Sub-grantee Self-Evaluation Page 2 10. In accordance with the agency’s bylaws, what constitutes a quorum? 11. Please list any and all family relationships that exist between the board of directors, the agency’s principal officers, the agency’s employees, and any independent contractors. 12. In the past 12 months, has the board taken any action without having the required quorum present? Yes No If “Yes,” please explain: 13. Does the board schedule and conduct meetings on a regular basis and in accordance with the agency’s bylaws? Yes No If “No,” please explain: 14. Are there any amounts or reports due to the Internal Revenue Service and any other taxing agency that have not been paid or filed? Specify amounts, reports, and due dates. 15. Have any service-related grievances/complaints been filed against the agency? If yes, what were the grievance(s), date(s), and other pertinent information?
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