Inventory Agreement

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					          COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT

         SUBRECIPIENT CERTIFICATION OF PHYSICAL INVENTORY

Subrecipient Name:                               Contact Person:
Address:                                         Phone Number:




I hereby certify that all property/equipment previously purchased with or transferred from the
Comprehensive Employment and Training Act (CETA) or the Job Training Partnership Act
(JTPA) program to the Workforce Investment Act (WIA) programs or purchased under any
Colorado Department of Labor and Employment (CDLE) federally funded grant or transferred
with the CDLE’s approval is included in the attached listing for the above-noted subrecipient.

The attached listing has been verified by a physical inventory. Changes/revisions are:

                             Noted                        Not Applicable

I certify that this property is being used for purposes that it was originally purchased for and
will be repaired or replaced by my insurance if damaged, lost, or stolen.

I certify that all property/equipment previously purchased with or transferred from the CETA
or the JTPA programs to WIA program or purchased under a CDLE federally funded grant or
transferred with the CDLE’s approval with a fair market value (FMV), established by our
existing local procedures, of $5,000 or more, has been identified.

I further certify that the proceeds of all property/equipment previously purchased with or
transferred from the CETA or JTPA program to the WIA program, with a FMV of $5,000 or
more, will be returned to CDLE, in order to return the proceeds to the U.S. Department of




             Subrecipient Director's Signature                             Date
OYMENT

ENTORY




ansferred from the
ng Partnership Act
 chased under any
grant or transferred
oted subrecipient.

visions are:



purchased for and


 ed from the CETA
ally funded grant or
established by our


purchased with or
 FMV of $5,000 or
Department of
                                            COLORADO DEPARTMENT OF LABOR AND EMPLOY


                                                    CONTRACT CLOSEOUT TAX CERTIFICATION



In the performance of Contract/Grant Agreement Number
Expenditure Authorizations (EAs) awarded under said Contract/Grant Agreement, identified
as VAX/FCS123 number(s) :                                                    ,
            ,                           ,                                    ,
            ,                           ,                                    ,
            ,                           ,                                    ,
            ,                           ,                                    ,
I certify that I have complied with requirements of the law and the Colorado Department of Labor and Em



                                       Grant Recipient Name:

                                   Grant Recipient Address:



                                  Grant Recipient Employer:

                        Employer's Identification Number:


This certification has been executed this                        day of


                                                           By
                                                                                    Authorized Signature

                                                         Title
OF LABOR AND EMPLOYMENT


UT TAX CERTIFICATION



                                               , including the
ement, identified
                                    ,                              ,
                                    ,                              ,
                                    ,                              ,
                                    ,                              ,
                                    ,                              ,
o Department of Labor and Employment, regarding the obtaining of




                     , 2005.



           Authorized Signature
                      GRANT RECIPIENT'S ASSIGNMENT OF REFUNDS, REBATES, AND CREDITS

 Grant Recipient's Name:                                                                         Contract/Grant Agreement
         Street Address:                                                                         No:
          City and State:

Pursuant to the terms of Contract/Grant Agreement Number                                                             , including the
Expenditure Authorizations (EAs) awarded under said Contract/Grant Agreement, identified as
VAX/FCS123 number(s) :                                                  ,                                  ,                               ,
         ,                           ,                                  ,                                  ,                               ,
         ,                           ,                                  ,                                  ,                               ,
         ,                           ,                                  ,                                  ,                               ,
         ,                           ,                                  ,                                  ,                               ,
         ,                           ,                                  ,                                  ,                               ,

and in consideration of the reimbursement of costs and payment of fee, as provided in the said Contract/Grant Agreement and any
assignment thereunder, the Grant Recipient's Name and Address (hereinafter called the Grant Recipient) does hereby:

      1.          Assign, transfer, set over and release to the Colorado Department of Labor and Employment (hereinafter called
                  CDLE), all right, title and interest to all refunds, rebates credits or other amounts (including any interest thereon)
                  arising out of the performance of the said contract/grant agreement, together with all the rights of action accrued
                  on which may hereafter accrue thereunder.



      2.          Agree to take whatever action may be necessary to effect prompt collection of as such refunds, rebates, credits
                  or other amounts (including any interest thereon due or which may become due, and to forward promptly to
                  CDLE.

      3.          Agree to cooperate fully with CDLE as to any claim or suit in connection with such refunds, rebates, credits or
                  other amounts due (including an interest thereon): execute any protest, pleading, application, power of attorney
                  or other papers in connection therewith; and to permit CDLE to represent it at an hearing, trial or other
                  proceeding arising out of such claim or suit.



This assignment has been executed this                             day of                                  , 2006.


                                  By
                                                             Authorized Signature

                                Title
       COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT

                      SCHEDULE OF UNCLAIMED CHECKS

                   Grant Recipient Name:

     Contract/Grant Agreement Number:

                             Release Date:


VAX/FSC123 Check                                                      Check   Payee's Last Known
  Number Number                        Payee                         Amount        Address




                                        Total Amount Unclaimed


This schedule has been executed this         day of                 , 2006.


                             By
                                             Authorized Signature

                            Title
                                                                      COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT

                                                                                           GRANT RECIPIENT'S RELEASE

Grant Recipient's Name:
Address:

Pursuant to the terms of Contract/Grant Agreement Number                                                                                                                               , including the Expenditure
Authorizations (EAs) awarded under said Contract/Grant Agreement, as VAX/FCS123 number(s):
            ,                                ,                                     ,                                                     ,                                 ,                      ,
            ,                                ,                                     ,                                                     ,                                 ,                      ,
            ,                                ,                                     ,                                                     ,                                 ,                      ,
            ,                                ,                                     ,                                                     ,                                 ,                      ,
and in consideration of the sum of Total amount paid of                                                                                                                                                              and payable of
                                                                                                                              ($ of Unclaimed Checks Total) under the said Contract to
                                                                                                                                                                                                (Contractor's Name and Address)
hereafter called the Grant Recipient or to its assignees, if any, the Grant Recipient, upon payment of the said sum by the COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT, hereinafter called CDLE, does remise,
release, and discharge CDLE, its officers, agents, and employees, of and from all liabilities, obligations, claims, and demands whatsoever under or arising from said Contract/Grant Agreement except:


        1.
             Specified claims in stated amounts or in estimated amounts where the amounts are not susceptible of exact statement by the Grant Recipient, as follows( if none, so state):

                    VAX/                        Invoice                                                                                                                                                              Expected
                   FCS123                         Date                                                        Invoice                        Line                       Cost                                         Payment
                   Number                     (If Known)                          Vendor                      or P.O. #                      Item                     Category               Amount                   Amount




        2.

             Claims, together with reasonable expenses incidental thereto, based upon the liabilities of the Grant Recipient to third parties arising out of the performance of the said contract, which are not known to the Grant
             Recipient on the date of the execution of this release and of which the Grant Recipient gives notice in writing to the CDLE within the period specified in the said Contract/Grant Agreement.
        3.
             Claims after closeout, for costs which results from the liability to pay Unemployment Insurance costs under a reimbursement system or to settle Worker's Compensation claims.

This release has been executed this                                                                           day of                                                     , 2005.


                                                                                                              By
                                                                                                                                              Authorized Signature

                                                                                                            Title
nditure
              ,
              ,
              ,
              ,
              ,
          and payable of

tor's Name and Address)
led CDLE, does remise,




          Expected
          Payment
           Amount




not known to the Grant
          COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT                                                                                    Attachment I
                                                                                                                                           Page 6 of 6

                                 PHYSICAL INVENTORY LIST

                     Grant Recipient Name:

       Contract/Grant Agreement Number:

                               Release Date:


  VAX/FSC123        Purchase                                                  Property   Program Funding     SERIAL #    Property Property
    Number            Date                Description of Property              Costs         Sources       if applicable Location Condition




                                                         Total Amount


I certify to the best of my knowledge and belief the above reported information is accurate and complete
for the period reported.

This Physical Inventory List has been executed this                                    2006
                                                                        day of ___________________, 2005


                                    By
                                                       Authorized Signature

                                  Title



   Revised: 6/05                                                                                             6085b542-28ef-43bf-bab7-40d5a4f309c4.xls

				
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