Laserfiche WebLink
2 CFR Part 200 Subpart F Audit Certification Form <br />$XGLWVRI6WDWHV/RFDO*RYHUQPHQWV,QGLDQ7ULEHVDQG1RQ3URILW2UJDQL]DWLRQV <br /> <br />&RQWDFW,QIRUPDWLRQ <br />6XEUHFLSLHQW1DPH $JHQF\/RFDO*RYHUQPHQWRU2UJDQL]DWLRQ  <br />$XWKRUL]HG&KLHI)LQDQFLDO2IILFHU FHQWUDODFFRXQWLQJRIILFH  <br />$GGUHVV <br />(PDLO3KRQH <br />Purpose:$VDSDVVWKURXJKHQWLW\RIIHGHUDOJUDQWIXQGV WKH:DVKLQJWRQ0LOLWDU\'HSDUWPHQW(PHUJHQF\0DQDJHPHQW'LYLVLRQ 'HSDUWPHQW  <br />LVUHTXLUHGE\&)53DUW6XESDUW)WRPRQLWRUDFWLYLWLHVRIVXEUHFLSLHQWVWRHQVXUHIHGHUDODZDUGVDUHXVHGIRUDXWKRUL]HGSXUSRVHVDQG <br />YHULI\WKDWVXEUHFLSLHQWVH[SHQGLQJRUPRUHLQIHGHUDODZDUGVGXULQJWKHLUILVFDO\HDUKDYHPHWWKH&)53DUW6XESDUW)$XGLW <br />5HTXLUHPHQWV<RXUHQWLW\LVDVXEUHFLSLHQWVXEMHFWWRVXFKPRQLWRULQJE\0,/(0'EHFDXVHLWLVDQRQIHGHUDOHQWLW\WKDWH[SHQGVIHGHUDOJUDQW <br />IXQGVUHFHLYHGIURPWKH'HSDUWPHQWDVDSDVVWKURXJKHQWLW\WRFDUU\RXWDIHGHUDOSURJUDP&)53DUW6XESDUW)VKRXOGEHFRQVXOWHG <br />ZKHQFRPSOHWLQJWKLVIRUP <br />Directions: $VUHTXLUHGE\&)53DUW6XESDUW)QRQIHGHUDOHQWLWLHVWKDWH[SHQGLQIHGHUDODZDUGVLQDILVFDO\HDUVKDOOKDYH <br />DVLQJOHRUSURJUDPVSHFLILFDXGLWFRQGXFWHGIRUWKDW\HDU,I\RXUHQWLW\is notVXEMHFWWRWKHVHUHTXLUHPHQWV\RXPXVWFRPSOHWH6HFWLRQ$RI <br />WKLV)RUP,I\RXUHQWLW\is VXEMHFWWRWKHVHUHTXLUHPHQWV\RXPXVWFRPSOHWH6HFWLRQ%RIWKLVIRUP:KHQFRPSOHWHG\RXPXVWVLJQGDWH <br />DQGUHWXUQWKLVIRUPZLWK\RXUJUDQWDJUHHPHQWDQGHYHU\ILVFDO\HDUWKHUHDIWHUXQWLOWKHJUDQWDJUHHPHQWLVFORVHG)DLOXUHWRUHWXUQWKLV <br />FRPSOHWHG$XGLW&HUWLILFDWLRQ)RUPPD\UHVXOWLQGHOD\RIJUDQWDJUHHPHQWSURFHVVLQJZLWKKROGLQJRIIHGHUDODZDUGVRUGLVDOORZDQFHRIFRVWV <br />DQGVXVSHQVLRQRUWHUPLQDWLRQRIIHGHUDODZDUGV <br />SECTION A: Entities NOT subject to the audit requirements of 2 CFR Part 200 Subpart F <br />2XUHQWLW\LVQRWVXEMHFWWRWKHUHTXLUHPHQWVRI&)53DUW6XESDUW)EHFDXVH FKHFNDOOWKDWDSSO\  <br />:HGLGQRWH[SHQGRUPRUHRItotalIHGHUDODZDUGVGXULQJWKHILVFDO\HDU <br />:HDUHDIRUSURILWDJHQF\ <br />:HDUHH[HPSWIRURWKHUUHDVRQV GHVFULEH  <br />+RZHYHUE\VLJQLQJEHORZ,DJUHHWKDWZHDUHVWLOOVXEMHFWWRWKHDXGLWUHTXLUHPHQWVODZVDQGUHJXODWLRQVJRYHUQLQJWKHSURJUDP V LQ <br />ZKLFKZHSDUWLFLSDWHWKDWZHDUHUHTXLUHGWRPDLQWDLQUHFRUGVRIIHGHUDOIXQGLQJDQGWRSURYLGHDFFHVVWRVXFKUHFRUGVE\IHGHUDODQGVWDWH <br />DJHQFLHVDQGWKHLUGHVLJQHHVDQGWKDW:0'(0'PD\UHTXHVWDQGEHSURYLGHGDFFHVVWRDGGLWLRQDOLQIRUPDWLRQDQGRUGRFXPHQWDWLRQWR <br />HQVXUHSURSHUVWHZDUGVKLSRIIHGHUDOIXQGV <br /> <br />SECTION B: Entities that ARE subject to the audit requirements of 2 CFR Part 200 Subpart F <br /> &RPSOHWHWKHLQIRUPDWLRQEHORZDQGFKHFNWKHDSSURSULDWHER[  <br /> :HFRPSOHWHGRXUODVW&)53DUW6XESDUW)$XGLWRQ>HQWHUGDWH@BBBBBBBBIRU)LVFDO<HDUHQGLQJ>HQWHUGDWH@BBBBBBBB7KHUH <br />ZHUHQRILQGLQJVUHODWHGWRIHGHUDODZDUGVIURP:0'(0'1RIROORZXSDFWLRQLVUHTXLUHGE\:0'(0'DVWKHSDVVWKURXJKHQWLW\  <br />A complete copy of the audit report, which includes exceptions, corrective action plan and management response, is <br />either provided electronically to contracts.office@mil.wa.gov or provide the state auditor report number <br />BBBBBBBBBBBBBBBBBBB <br /> :HFRPSOHWHGRXUODVW&)53DUW6XESDUW)$XGLWRQ>HQWHUGDWH@BBBBBBBBIRU)LVFDO<HDUHQGLQJ>HQWHUGDWH@BBBBBBBB7KHUH <br />ZHUHILQGLQJVUHODWHGWRIHGHUDODZDUGV <br />A complete copy of the audit report, which includes exceptions, corrective action plan and management response, is either <br />provided electronically to contracts.office@mil.wa.gov or providethe state auditor report number:BBBBBBBBBBBBBBBBBBBBBB <br /> 2XUFRPSOHWHG&)53DUW6XESDUW)$XGLWZLOOEHDYDLODEOHRQBBBBBBBB>HQWHUGDWH@IRU)LVFDO<HDUHQGLQJ <br />BBBBBBBB>HQWHUGDWH@:HZLOOSURYLGHHOHFWURQLFFRS\RIWKHDXGLWUHSRUWWRcontracts.office@mil.wa.govDWWKDWWLPHRU <br />SURYLGHWKHVWDWHDXGLWRUUHSRUWQXPEHUBBBBBBBBBBBBBBBBBBBBBBBB <br />I hereby certify that I am an individual authorized by the above identified entity to complete this form. Further, I certify that the <br />above information is true and correct and all relevant material findings contained in audit report/statement have been disclosed. <br />Additionally, I understand this Form is to be submitted every fiscal year for which this entity is a subrecipient of federal award <br />funds from the Department until the grant agreement is closed. <br />6LJQDWXUHRI$XWKRUL]HG&KLHI)LQDQFLDO2IILFHU  'DWH  <br />3ULQW1DPH 7LWOH <br />:0')RUP8SGDWHG <br />County of Kittitas <br />Judy Pless <br />205 West 5th Avenue, Suite 105 Ellensburg WA 98926 <br />judy.pless@co.kittitas.wa.us 509.962.7502 <br />09-28-2017 2016 <br />1019951 <br />December 5, 2017 <br />Judy Pless