USAID Liberia Local Empowerment for Accountability and Decentralization (LEAD) Activity
Request for Application (RFA)
Issuance Date: February 1, 2024
Closing Date: March 6, 2024 (35 days after issuance date)
Closing Time: 4:30PM
Subject: Request for Applications (RFA) Number DAI/LEAD/RFA/0002/2024 Civil Society Advocacy to improve Domestic Revenue Mobilization,Budget Transparency, and Local Development and Service Delivery in Bong County and Gbarnga City.
Reference: Issued Under USAID Liberia Local Empowerment for Accountability and Decentralization (LEAD) Activity. USAID Contract No.
7200AA21D00016
LEAD Background
The USAID Liberia Local Empowerment and Accountability for Decentralization (LEAD) Activity was awarded to DAI Global LLC for a period of five years, from May 19, 2023, to May 18, 2028. The goal of this activity is to improve the capacities of targeted ministries, agencies, and commissions (MACs) and local governments to formulate and administer sound tax policies, improve budget transparency, deepen decentralization, and deliver quality services at the national, and sub-national level through the following objectives:
Objective1: Domestic Resource Mobilization (DRM) Improved, which comprises of three sub objectives:
❖ 1.1 Tax policy formulation strengthened.
❖ 1.2 Tax Administration system strengthened.
❖ 1.3 Citizen participation in DRM improved.
Objective 2: Budget transparency improved, which comprises three sub-objectives. ❖ 2.1 Disclosure of public and fiscal information enhanced.
❖ 2.2 Coordination of budget transparency strengthened.
❖ 2.3 Citizen participation in budget processes increased.
Objective 3: Local development and service delivery improved, which comprises of three sub-objectives.
❖ 3.1 Local government capacity enhanced.
❖ 3.2 Sub-national DRM and PFM systems strengthened.
❖ 3.3 Citizen participation in local governance increased.
LEAD applies an integrated Governance Systems Approach which recognizes the complex challenges facing the Government of Liberia (GOL) in building a well-functioning governance system with effective DRM and fiscal decentralization, budget transparency, and local
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governance frameworks. While these frameworks need to work well independently, they also must work well together within the local system to enable good governance. LEAD will build local capacity and pilot county-specific interventions, complemented with technical assistance at national level to accelerate reforms. LEAD will provide support within the context of the existing legal framework, identifying opportunities to facilitate complementary action from the national government to accelerate reforms.
The primary counterparts for LEAD are the therefore ministries, agencies as well as the partner counties and cities. However, an active civil society and professional media that provide effective oversight of government financial management and ensure proper use of revenues is critical to the process of proposed interventions.
Pursuant to 2 CFR 700.13, it is USAID policy not to award profit under assistance instruments such as grant awards. However, all reasonable, allocable, and allowable expenses, both direct and indirect, which are related to the grant program and are in accordance with applicable cost standards (2 CFR 200 Subpart E for all US-based and for non-US based non-profit organizations, and the Federal Acquisition Regulation (FAR) Part 31 for for-profit organizations), may be paid under the grant.
For non-US organizations, the Standard Provisions for Non-US Nongovernmental Recipients will apply. For US organizations, 2 CFR 200 and the Standard Provisions for U.S. Nongovernmental Recipients will apply. See Annex 1 for Standard Provisions.
DAI is soliciting application from experienced and legally register organizations (CSOs, NGOs, Private sector, and others) to implement the LEAD activities in the County of Bong and the respective city of Gbarnga. The role of the CSOs will be to carry out awareness to improve domestic revenue mobilization, budget transparency, and local development and service delivery. Please refer to the Program Description for a complete statement of goals and expected results
Subject to the availability of funds, DAI intends to provide grants to one or more legally registered organizations (CSOs NGOs, Private Sector, Others) in grant amounts ranging from 50,000 to 70,000 USD each depending on the type and size of the proposed solution. The expected duration of DAI support or the period of performance is to be determined based on the presented activities and not to exceed 18 months. DAI, as primary implementer of the LEAD Project, reserves the right to fund any or none of the applications submitted.
For the purposes of this program, this RFA is being issued and consists of this cover letter and the following:
Section A – Grant Application Instructions
Section B – Special Grant Requirements
Section C – Selection Process
Section D – Program Description
Annexes
Applications must be received at DAI via e-mail not later than 35 days after the date of issuance indicated at the top of this cover letter at the place designated below. Applications and modifications thereof shall be submitted in pdf (preferred) or other electronic format to the grants team at LEAD_GrantsApplications@dai.com.
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Award will be made to the responsible applicant(s) whose application(s) offers the best value.
Issuance of this RFA does not constitute an award commitment on the part of DAI, nor does it commit DAI to pay for costs incurred in the preparation and submission of an application. Further, DAI reserves the right to reject any or all applications received. Applications are submitted at the risk of the applicant. All preparation and submission costs are at the applicant’s expense.
DAI intends to hold an orientation session one week after issuance of this RFA. The orientation session is intended to guide potential eligible applicants on this application process in an attempt to allow all interested parties to have a fair chance in understanding the requirements and submitting relevant proposals. All interested applicants can submit the names of their representatives (not to exceed 2) to the orientation session. All communication should be addressed to LEAD_GrantsApplication@dai.com within three working days upon the issuance of this RFA. DAI will be reaching out via mail about the various dates of the training.
Any questions concerning this RFA or a request for the Microsoft Word version of the application templates (Annex 03, Annex 04 and Annex 05) should be submitted in writing not later 5 working days prior to the closing date shown above to LEAD_GrantsApplication@dai.com. Applicants should retain for their records one copy of all enclosures which accompany their application.
Thank you for your interest in DAI’s USAID funded Liberia Local Empowerment for Accountability and Decentralization (LEAD) Activity.
Sincerely,
George Akl
Chief of Party
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Civil Society Advocacy to Improve Domestic Revenue Mobilization, Budget Transparency, and Local Development and Service Delivery.
Table of Contents
Section A – Grant Application Instructions……………………………………………………………….5 1. Application Procedure …………………………………………………………………………………….. 5 A. Completion and submission of applications…………………………………………………… 5 B. Preparation Instructions – Technical …………………………………………………………….. 6 C. Preparation Instructions – Financial and Administrative Documentation …………. 7 Section B. Special Grant Requirements……………………………………………………………………..8 Section C. Selection Process ………………………………………………………………………………….11 Section D. Program Description ……………………………………………………………………………14 Annex 1: Mandatory Standard Provisions ………………………………………………………………..16 Annex 2: Certifications, Assurances, Other Statements of the Recipient……………………17 Annex 3: Application Form…………………………………………………………………………………….18 Annex 4: Workplan……………………………………………………………………………………………….22 Annex 5: PROJECT BUDGET ………………………………………………………………………………..23 Annex 6: CV Form and BioData Form…………………………………………………………………….24 Annex 7: Financial Capability Questionnaire ……………………………………………………………26
Annex 8: Instructions for Obtaining an Unique Entity ID (SAM) – DAI’S Vendors, Subcontractors and Grantees…………………………………………………………………………………36 Annex 9:Self Certification for Exemption from Unique Entity ID (SAM) Requirement ..37 Annex 10: Application Checklist …………………………………………………………………………….38
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Section A – Grant Application Instructions
Eligibility Requirements
For organizations to be eligible for consideration by DAI under this LEAD Activity, organizations must meet the following eligibility requirements:
o A project manager expert with at least 5 years’ experience in designing, managing and implementing advocacy and local governance programs and managing similar projects.
o A public finance expert with at least 3 years of relevant experience.
(the above two positions can be merged in one)
o A communications/social media expert with at least 3 years’ experience managing communication outreach and social media platforms.
o An M&E and Reporting Specialist on the team with at least 3 years’ experience. o A pool of trainers that they can refer to when customizing the capacity development programs.
Application Submission Requirements
➢ Applications must be submitted only by e-mail to LEAD_GrantsApplications@dai.com . ➢ In case of hard copy of any document that supports the application is needed, it can be hand-delivered to DAI LEAD offices on 18th Street and Warner Avenue, Sinkor, Monrovia. ➢ Applications must include:
Deadlines
Applications must be received on the 6th of March 2024 not later than 35 days of the date of issuance indicated in the cover letter. Applications and modifications thereof shall be submitted in electronic form, pdf format to the grants team on the following address: LEAD_GrantsApplications@dai.com .
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Late Applications
All applications received by the deadline will be reviewed for responsiveness and programmatic merit according to the specifications outlined in these guidelines and the application format. Section C addresses the evaluation procedures for the applications. Applications which are submitted late or are incomplete run the risk of not being considered in the review process.
Page Limitation: Applications should be specific, complete, presented concisely and shall not exceed 15 pages (exclusive of an annexes).
Applications submitted in response to this RFA must include the following information:
The application must include a cover page that provides general information about the organization including, but not limited to, its email and physical addresses, names and addresses of its head and contact person, purpose/mission of the organization, etc.
The applicant must provide a detailed description of the project, specifying its goal, activities, and results. The information should clearly indicate what the project will accomplish, in addition to why and how it will be implemented.
The applicant should define, to the maximum extent possible at the application stage, results, and benchmarks for monitoring the performance towards attainment of Project objective.
Project should respond to the following minimum indicators:
➢ Number of educational material developed on public participation
➢ Number of people with enhanced knowledge on public participation in local development
➢ Number of community based organizations trained
➢ Number of consultative meetings between citizens and local government to discuss planning and budgeting
➢ Number of talk shows conducted
➢ Number of people reached through social and other media platforms
➢ Citizens’ charter developed and shared
M&E Plans should be able to generate lessons learnt and success stories. The applicant’s M&E Plan should be tailored based on project activities.
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outlined in the statement of work and in accordance with the evaluation factors found herein. DAI will evaluate the CV to determine the individual’s knowledge, skills and abilities in the areas listed herein. During the implementation stage, any changes in personnel should be approved by the LEAD team.
In-kind contributions are allowable as cost share, in accordance with 2 CFR 200.306. This includes such things as proportionate shares of management and other employee time, equipment, office supplies, and other costs of program operation. Rates for employee services shall be consistent with those paid for similar work in the recipient’s organization. The value of equipment (i.e., computers) shall not exceed the fair market value of equipment of the same age and condition. The basis for determining the valuation of services, equipment and supplies shall be documented in the application.
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There is a mandatory requirement for the applicant to provide a Unique Entity ID (SAM)to DAI. Without an Unique Entity ID (SAM), DAI cannot deem an applicant to be “responsible” to conduct business with and therefore, DAI will not enter into an agreement with any such organization. The award of a grant resulting from this RFA is contingent upon the winner providing an Unique Entity ID (SAM) to DAI. Organizations who fail to provide an Unique Entity ID (SAM)will not receive an agreement and DAI will select an alternate awardee.
All U.S. and foreign organizations which receive a grant with a value of $25,000 and above are required to obtain an Unique Entity ID (SAM)prior to signing of the agreement. Organizations are exempt from this requirement if the gross income received from all sources in the previous tax year was under $300,000. DAI requires that grant applicants sign the self-certification statement if the applicant claims exemption for this reason. For those required to obtain an Unique Entity ID (SAM), see Annex 8- Instructions for Obtaining an Unique Entity ID (SAM)- DAI’S Vendors, Subcontractors and Grantees. For those not required to obtain an Unique Entity ID (SAM), see Annex 9- Self Certification for Exemption from Unique Entity ID (SAM)Requirement
Section B. Special Grant Requirements
The applicant shall bear in mind the following special requirements for any grants awarded in response to this RFA:
Separate Account: A separate account must be established to house all funds provided under the grant, as well as all interest income.
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Permitted Uses of Program Income: The Grantee will inform DAI of any program income generated under the grant and agrees to follow USAID’s disposition requirements for such program income, which is in accordance with 2 CFR 200.307. Program income earned under this agreement shall be applied and used in the following descending order:
If the terms and conditions of the award do not specify how program income is to be used, then number 2) shall apply automatically. Grantees who are commercial organizations may not apply Option 1) to their program income.
Use of Funds: Funds provided under any grant awarded shall be used exclusively to cover the costs of the awarded applicant’s project activities. Diversion of grant funds to other uses will result in cancellation of award and retrieval of funds disbursed to the grant recipient.
Reporting Procedures: A description of reporting requirements will be included in the Grant Agreements. The types of reporting required, along with the schedule of reporting, will depend on the grant type and project duration. Reporting forms will be provided to grant recipients. Types of reporting will include the following:
Issuance of the final installment of grant funds is contingent upon DAI’s receipt and acceptance of Final Financial and Final Program Reports.
Project Monitoring: DAI staff will monitor projects in terms of both programmatic and financial aspects. Grant recipients will be expected to facilitate monitoring by making relevant information available to DAI staff. Grantees will be expected to facilitate field visits for DAI’s LEAD team, and coordination meetings with the implementing team will be requested.
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Restrictions: The Grant Funds provided under the terms of this Agreement shall not be used to finance any of the following:
i.) Activities which may lead to degrading the quality or renewability of natural resources;
ii.) Activities which may lead to degrading the presence or health of threatened ecosystems or biodiversity;
iii.) Activities which may lead to degrading long-term viability of agricultural or forestry production (including through use of pesticides);
iv.) Activities which may lead to degrading community and social systems, including potable water supply, land administration, community health and well-being or social harmony.
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Other: As mentioned, grants will be made available to qualified organizations in grant amounts ranging up from USD70,000 to USD90,000 subject to the availability of funds and the type and size of the proposed solution but should not exceed 18 months (all grants will be distributed in United State Dollars). Payment will be made according to a monthly or installment schedule, and in no event will more than 90% of the total agreed budget be disbursed prior to receiving and approving the Final Financial and Final Program Report.
Section C. Selection Process
Within 5 working days of the deadline for submitting applications, a review panel will convene. The review panel will include LEAD staff members who will be nominated as the Grants Evaluation Committee. DAI shall take steps to ensure that members of the review panel do not have any conflicts of interest or the appearance of such with regard to the organizations whose applicants are under review. An individual shall be considered to have the appearance of a conflict of interest if that person, or that person’s spouse, partner, child, close friend or relative works for or is negotiating to work for, or has a financial interest (including being an unpaid member of a Board of Directors) in any organization that submitted an application currently under the panel’s review. Members of the panel shall neither solicit nor accept gratuities, favors, or anything of monetary value from parties to the awards.
All applications that meet the application requirements will be reviewed by the review panel. Verification of the application submission requirements will be conducted at the USAID Liberia Local Empowerment for Accountability and Decentralization (LEAD) Activity Headquarters by its grants team.
If suitable applications are received, one or more awards will be made within 35 working days of the review panel meeting provided that the awardee (s) furnish (es) DAI with all the required documentation as itemized in Section A of this RFA.
The applications will be evaluated according to the evaluation criteria set forth below. To the extent necessary (if award is not made based on initial applications), negotiations may be conducted with each applicant whose application, after discussion and negotiation, has a reasonable chance of being selected for award. Award will be made to responsible applicants whose applications offer the best value.
Awards will be made based on the ranking of applications by the review panel according to the evaluation criteria and scoring system identified below noting that the passing grade is 60/100:
The applicant’s past experience and capabilities in conducting projects of a similar nature with good understanding of the relevant county dynamics.
Very good = 10 points; good = 8 points; average = 6 points; poor = 4 points;
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Very poor.
How clear and achievable are the problem statement and advocacy goal?
Very good = 10 points; good = 8 points; average = 6 points; poor = 4 points; Very poor= 0 point.
What tangible or specific changes in knowledge, attitudes, practices, and/or behaviors does your organization anticipate that this grant will be achieved?
Very good = 20 points; good = 15 points; average = 10 points; poor = 5 points; Very poor= 0 point.
Is the design innovative, creative and realistic?
Very good = 15 points; good = 12 points; average = 9 points; poor = 6 points; Very poor= 0 point.
Alignment of proposed monitoring and evaluation activities with LEAD indicators
Very good = 10 points; good = 8 points; average = 6 points; poor = 4 points; Very poor = 0 point.
To what extent does the proposed project include gender equity and social inclusion?
Very good = 10 points; good = 8 points; average = 6 points; poor = 4 points; Very poor=0 point.
Is the project or its benefits likely to continue after grant funding ends?
Very good = 10 points; good = 8 points; average = 6 points; poor = 4 points; Very poor=0 point.
Qualifications and cost reasonableness of the proposed team in terms of the expected results?
Very good = 15 points; good = 12 points; average = 9 points; poor = 6 points; Very poor= 0 point.
DAI and USAID reserve the right to fund any or none of the applications received
Signing of Grant Agreements
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Upon USAID concurrence of the applicant, a Grant Agreement will be prepared. After DAI and the successful applicant have signed the Grant Agreement, DAI will provide training on financial management and reporting on grant funds. All reporting and contractual obligations will be explained to the grant recipients. Before receiving the first grant installment, all grant recipients must open a separate bank account as this is the only means by which grant funds will be transferred from DAI to the grant recipient.
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Section D. Program Description
This grant program falls under the overarching LEAD mandate to enhance civil society advocacy to improve domestic revenue mobilization, budget transparency, local development and service delivery.
Aligned with the Integrated Governance Systems Approach, DAI is launching this RFA to collaborate with qualified entities, CSOs, capacity development firms and other private sector firms to advance systems improvements in support of decentralization and local governance, while fostering transparency and accountability at the local level.
DAI will use this grants program to equip each grantee with the technical and financial capacity to manage and execute activities. The applicant is expected to propose activities to scale innovation in engaging citizens in local decision-making processes and use of social accountability tools to oversee service delivery at the County of Bong and the city of Gbarnga level.
DAI will encourage diversity among grantees by streamlining the application process, identifying women’s and youth organizations, and ensuring equitable allocation of grant funding. Recognizing that new partners may be new to the USAID grant guidelines, DAI has provided hereto clear processes that minimize the burden on grant applicants. Where possible, DAI will strengthen grantees capacities to integrate the voices of marginalized populations by engaging groups representing diverse constituencies, including LGBTQI+ and People with disabilities (PWD).
Proposed interventions should cover most, if not all the following objectives and activities at both the County and the City level:
➢ Produce and disseminate public information programs using user friendly formats over multiple media platforms to educate citizens on local governments mandates and recent policy changes, including Local Governance Act 2018, municipal fees and services.
➢ Partner and train local CSOs on mastering the Local Governance Act of 2018 and facilitate town hall meetings for local CSOs to spread awareness about the Act.
➢ Design debates and talk shows to discuss revenue sharing bill as well as fiscal and administrative decentralization.
➢ Train citizens and community groups on county and city development process ➢ Organize and facilitate county public dialogues and engagement events between citizens, county councils, local legislature caucus and local government officials
➢ Organize awareness sessions with various communities to include:
o Roles and responsibilities of county council
o Roles and responsibilities of county Administration
o Roles and responsibilities of County Service Centers
o Conduct pre and post test to measure percentage improvement in knowledge gained on roles and responsibilities of county administration
➢ Support County Councils logistics in terms of office location/venue, needed office equipment as well as mobilization of monthly meetings
➢ Facilitate training workshops for local officials on citizens’ participation in local decision making to include:
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o Engage in consultative Budgetary planning
o Budget allocation and expenditure
o Revenue Analysis Exercise
➢ Collaborate with other players if need be to organize and facilitate public dialogues addressing the youth at high schools, community colleges and universities, as well as marginalized groups, LGBTQ and People with disabilities (PWD), to build awareness about public participation and include trainings in topics such as but not limited to: o Persuasive speaking
o Advocacy
o Lobbying
➢ Update the quick reference pamphlet on local decision making and ensure proper distribution and outreach
➢ Establish a consultative process to develop a citizens’ charter that reflects standards of service delivery in Community Service Centers
Indicators to measure impact of the above activities can include but not limited to:
➢ Number of educational materials developed on public participation
➢ Number of citizens, including women, youth, and people with disabilities (PWD) who participate in local government process
➢ Number of local organizations and CSOs trained on Local Governance Art and public participation
➢ Number of consultative meetings held between communities and County administration to include County Councils
➢ Percent change in citizens’ awareness of local government functions
➢ Number of persons trained to advance outcomes consistent with gender equality or female empowerment through their roles in public or private sector institutions or organizations
➢ Number of talk shows conducted
➢ Number of people reached through social and other media platforms ➢ Citizens’ charter developed and shared
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Annex 1: Mandatory Standard Provisions
Mandatory Standard Provisions for US Nongovernmental Recipients: https://www.usaid.gov/sites/default/files/documents/1864/303maa.pdf or
Mandatory Standard Provisions for Non-US Nongovernmental Recipients: https://www.usaid.gov/sites/default/files/documents/1868/303mab.pdf
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Annex 2: Certifications, Assurances, Other Statements of the Recipient
In accordance with ADS 303.3.8, DAI will require successful grant applicants to submit a signed copy of the following certifications and assurances, as applicable:
In addition, the following certifications will be included Part II – Key Individual Certification Narcotics Offenses and Drug Trafficking (Note: Only as required per ADS 206 for Key Individuals or Covered Participants in covered countries.)
Part III – Participant Certification Narcotics Offenses and Drug Trafficking (Note: Only as required per ADS 206 for Key Individuals or Covered Participants in covered countries.)
Part IV – Representation by Organization Regarding a Delinquent Tax Liability or a Felony Criminal Conviction
Part V – Other Statements of Recipient
Part VI – Standard Provisions for Solicitations
(Note: Parts V & VI – Are included in the grant file as part of the grant application.)
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Annex 3: Application Form
Annex 3
A P P L I C A T I O N F O R M
(please include also acronyms, if any)
(please include official address as well as postal address)
Official address:
Postal address:
(if applicable)
Location: [city / commune], [county]
Duration: ____ months, from [month] [year] to [month] [year]
Total budget (USD) (100%) ▪ Amount requested (%)
(USD) |
▪ Applicant contribution (USD) (%)
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(Please list all partner organizations involved in the project; insert as many lines as necessary)
NAME OF PARTNER | ROLE IN THE PROJECT | CONTACT DATA |
Official address: Phone and fax: E-mail: Contact person: | ||
Official address: Phone and fax: E-mail: Contact person: |
III. PROJECT DESCRIPTION ADJUST THIS ENTIRE SECTION AS NECESSARY
(Please provide a brief summary of your project and any necessary background information; the summary must be no more than 2 pages and should clearly address what your project will accomplish, in addition to why and how it will be implemented.)
(Please provide accurate and detailed information, no more than 2 pages.)
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(Explain the cost share to the project in terms of type of contribution and value.)
(Please include the tools you will use to monitor project activities and evaluate project results) 5. Sustainability
(Based on the activities listed in section III.2(b) above, please fill in the work plan using the template provided in Annex 4)
Please list all project team members, including their position, role in the project and a short description of their assigned responsibilities. (Insert as many lines as necessary). (Please attach CVs for key personnel involved in the project, using the template provided in Annex 6; also include a 1420 BioData Form to be filled out by all key personnel)
NO | NAME & SURNAME | POSITION | ROLE IN THE PROJECT | DESCRIPTION |
1 | ||||
2 | ||||
3 | ||||
4 | ||||
5 | ||||
6 | ||||
7 | ||||
8 |
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Annual income over the past three years, mentioning the names of your main financial contributors (where applicable)
YEAR | TOTAL ANNUAL INCOME (in USD) | MAIN FINANCIAL CONTRIBUTORS |
Please describe no more than three major projects in which your organization was involved over the past three years, using the table below.
organization
(leader, partner)
types of funding
(grants, contract, or
other)
Please include contact
information for funding
sources.
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Annex 4: Workplan
ANNEX 4
Name of applicant:
Insert desired workplan format here
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Annex 5: PROJECT BUDGET
Kindly click the icon below to access the grant budget and budget notes template:
Annex – 5 Budget and
Budget Notes Template
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Annex 6: CV Form and BioData Form
ANNEX 6
Curriculum Vitae
Proposed position in the project:
Name (First, Middle, Last):
Citizenship:
Education:
Name and location of institution | Major(s) or Degree(s) obtained: |
Language proficiency – indicate proficiency on a scale of 1 (poor) to 5 (native):
Language | Reading | Speaking | Writing |
Membership of NGOs or other professional bodies:
Key skills and qualifications relevant to the project (e.g. computer literacy, etc.):
Employment history:
Position Title | Employer’s name and address | Dates of employment | Short description of tasks performed | |
From (month, year) | To (month, year) | |||
Other relevant information: (e.g. publications, seminars/courses etc.):
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STATEMENT OF LIABILITY
I, the undersigned, being the person responsible in the applicant organization for this project, certify that the information given in this application is true and accurate.
Name and surname: | |
Position: | |
Signature & stamp: | |
Date and Place: |
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Annex 7: Financial Capability Questionnaire
Accounting System and Financial Capability Questionnaire For DAI Grant Recipients
The main purpose of this questionnaire is to understand the systems adopted by your institution for financial oversight and accounting of grant funds, especially those provided through the U.S. Federal Government. The questionnaire will assist DAI program and accounting staff to identify the extent to which your institution’s financial systems match the requirements of the U.S. Federal Government. This information will help the program staff work with you and your institution to review any problem areas that may be identified; thereby avoiding any problems or oversights which would be reportable should an audit of the program or institution be required.
The questionnaire should be completed by the financial officer of your institution in collaboration with DAI program staff. This questionnaire is informational only, and will not have any bearing on the agreement to support your institution based on the technical merit of the proposal. Therefore, please answer all questions to the best of your knowledge.
While 2 CFR 200 does not cover awards to non-U.S. recipients, DAI shall rely on the standards established in that regulation in determining whether potential non-U.S. recipients are responsible to manage Federal funds. A determination shall be made on the potential recipient’s ability, or potential ability, to comply with the following USAID and federal-wide policies:
1) 2 CFR 200 Subpart D (Financial and Program Management);
2) 2 CFR 200 Subpart D (Property Standards);
3) 2 CFR 200 Subpart D (Procurement Standards); and
4) 2 CFR 200 Subpart D (Performance and Financial Monitoring and Reporting).
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SECTION A: General Information
Please complete this section which provides general information on your institution. Name of Institution:
Name and Title of Financial Contact Person:
Name of Person Filling out Questionnaire:
Mailing Address:
Street Address (if different)
Telephone, Fax, Email (if applicable)
Enter the beginning and ending dates of your institution’s fiscal year:
From: (Month, Day) To: (Month, Day)
SECTION B: Internal Controls
Internal controls are procedures which ensure that: 1) financial transactions are approved by an authorized individual and are consistent with U.S. laws, regulations and your institution’s policies; 2) assets are maintained safely and controlled; and 3) accounting records are complete, accurate and maintained on a consistent basis. Please complete the following questions concerning your institution’s internal controls.
Yes: No:
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Yes: No:
Yes: No:
Yes: No:
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Yes: No:
Yes: No:
Yes: No:
If yes, how long are such records kept?
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Yes: No:
Yes: No:
SECTION C: Fund Control and Accounting Systems
Fund Control essentially means that access to bank accounts and/or other cash assets is limited to authorized individuals. Bank balances should be reconciled periodically to the accounting records. If cash cannot be maintained in a bank, it is very important to have strict controls over its maintenance and disbursement.
An Accounting System accurately records all financial transactions, and ensures that these transactions are supported by documentation. Some institutions may have computerized accounting systems while others use a manual system to record each transaction in a ledger. In all cases, the expenditure of funds provided by the USAID-funded program must be properly authorized, used for the intended purpose, and recorded in an organized and consistent manner.
A fund accounting system:
If yes, please explain the amount of funds to be maintained, the purpose and person responsible for safeguarding these funds.
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Cash basis: Accrual basis:
Yes: No:
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Yes: No:
Yes: No:
Yes: No:
SECTION D: Audit
The grant provisions require recipients to adhere to USAID regulations, including requirements to maintain records for a minimum of three years to make accounting records available for review by appropriate representatives of USAID or DAI, and, in some cases,
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may require an audit to be performed of your accounting records. Please provide the following information on prior audits of your institution.
Yes: No:
Yes: No:
Yes: No:
If yes, please provide a copy of your most recent report.
Yes: No:
If yes, who performs the audit and how frequently is it performed?
If yes, please provide details:
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CHECKLIST AND SIGNATURE PAGE
DAI requests that your institution submit a number of documents along with this completed questionnaire. Complete this page to ensure that all requested information has been included.
Complete the checklist:
Copy of your organization’s most recent audit is attached.
If no recent audit, a “Balance Sheet” “Income Statement” for the most current and previous fiscal year.
All questions have been fully answered.
An authorized individual has signed and dated this page.
Incorporation Papers or Certificate of Registration and Statute is attached. Information describing your institution is attached.
Optional:
Organizational chart, if available is attached (if applicable).
The Financial Capability Questionnaire must be signed and dated by an authorized person who has either completed or reviewed the form.
Approved by:
_________________________
Print Name
_________________________
Signature
__________________________
Title Date _____________
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Annex 8: Instructions for Obtaining an Unique Entity ID (SAM) – DAI’S Vendors, Subcontractors and Grantees
Form 3.9 Attachment
A – Instructions for Obtaining an Unique Entity ID.docx
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Annex 9: Self Certification for Exemption from Unique Entity ID (SAM) Requirement
Form 3.10 – Self
Certification for Exemption from Unique Entity ID Requirement (2).pdf
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Annex 10: Application Checklist
Before submitting your application, please check to make sure the following are included:
The application dossier is comprised of ___ original and ___ copies of all documents If applicable: The application is submitted also in electronic format
Applicable certifications and assurances are signed and included (see Annex 2) If applicable: The workplan is included (Annex 4)
Budget is included
If minimum cost-share required include the following: In the budget, the applicant’s contribution is identified and is at least _____% of total project costs
The CVs and BioData Forms are included (Annex 6)
The statement of liability is signed and stamped (last page of application form – Annex 3) Completed Financial Capability Questionnaire (Annex 7)
Audited Financial Reports: Copy of the applicant’s most recent financial report, which has been audited by a certified public accountant or other auditor satisfactory to DAI. If no recent audit, a “Balance Sheet” and “Income Statement” for the most current and previous fiscal year.)
Incorporation Papers or Certificate of Registration and Statute
Organizational Chart
Documentation that the applicant has the ability to comply with the award conditions, taking into account all existing and currently prospective commitments of the applicant. The applicant must demonstrate its ability to segregate funds obtained from the award of a capital grant from other activities of the organization. A separate bank account is required should a grant award be made. (Documentation may include certification from the applicant’s bank or a summary of previous awards, including type of funding, value, client, etc.)
Documentation that the applicant has a satisfactory record of integrity and business ethics. (Documentation may include references from other donors or clients and a summary of previous awards, including type of funding, value, client, etc..) Evidence of a UEI Number or a Self Certification for Exemption from UEI Requirement.
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