Sample Documents for Recipients & Contractors

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• Easements, Covenants, Preservation Agreements
• National Environmental Policy Act
• National Historic Preservation Act
• Project Sign

In addition to interim reports, final reports, and compliance documentation, grantees are often required to comply with other grant award terms and conditions. To assist grantees, we have assembled a variety of sample or model documents.

These model documents include matching fund documentation, volunteer services documentation, sample contract approval documentation, model easement, project sign guidance.

Sample documents provided for your reference; they can and should be modified to meet the needs of your organization's policies, 2 CFR 200, and the terms of your grant agreement.

Value of Donated Labor

Sample Document for Historic Preservation Fund Grants

Project Name and Grant Number
Name of Person Contributing Donated Time				Kind of Work Performed
The basis for the selected hourly rate should be the Federal minimum wage unless the person donating time is professionally skilled in the work they are performing on the project. When this is the case, the wage rate this individual is normally paid for performing this service may be charged to the project. The maximum hourly rate may not exceed 120% of a General Schedule (GS) Federal employee at Grade 15, Step 10.
Date	Time of Work				Total Work Hours	Hourly Rate ($)	Value (Donated Hours x Rate)
	Start	End	Start	End
1.
2.
3.
4.
Total Value of Donation
Signature of Person Donating Time							Date
Signature of Supervisor Verifying Accuracy							Date

Value of Donated Equipment Use

Sample Document for Historic Preservation Fund Grants

Project Name and Grant Number
Donor
Value of Donated Equipment
Date	Type & Size of Equipment				Total Hours of Use	Hourly Rate ($)	Value (Donated Hours x Rate)	Equipment Operator's Signature
1.
2.
3.
4.
Total Value of Donation
Signature of Supervisor Verifying Accuracy								Date

Value of Donated Material

Sample Document for Historic Preservation Fund Grants

Project Name and Grant Number
Donor
Description of Material Donated	Date of Donation	Current Fair Market Value	Basis of Value
1.
2.
3.
4.
Total Value of Donation
Signature of Supervisor Verifying Accuracy			Date

Competitive Negotiation and Small Purchases Contracting Documentation

Sample Document for Historic Preservation Fund Grants

This format can be used for contracts for professional services and other procurement actions to document compliance with Federal procurement standards.

Project Name and Grant Number
Contract Type (check one) [ ] Professional Service [ ] Printing [ ] Equipment/Supplies [ ] Other
Name of Contractors Contacted	Address		Contact Name
A.
B.
C.
D.
E.
F.
G.
Comparative Summary of Responses Received
Firm Name or Letter ID (above)	Date Quote Obtained	Price Quotation	How obtained?
A.
B.
C.
D.
E.
F.
G.
Basis for Selection (check one)		[ ] Lowest Price	[ ] Other
Selection criteria does not have to be lowest price; however, the explanation for the basis used must be provided.
Description of basis for selection:
Signature of Supervisor Verifying Accuracy			Date

Subgrant or Contract Payment Approval Checklist

Sample document for Historic Preservation Fund grants.

Project Name and Grant Number
Date Received	Date Payment Due
Authorized Official Payment Approval
Authorized Official (name)		Date Received
Comments
[ ] Payment is approved
[ ] Payment is not approved
Project Manager Review
Project Manager (name)		Date Received
Comments
[ ] Draft or final product is eligible and complies with the appropriate Secretary of the Interior's Standards, 2 CFR 200, and the Historic Preservation Fund Grants Manual
[ ] Products are acceptable and in compliance with the grant agreement
[ ] Cost charged are reasonable, allowable, allocable, and necessary for the products received
[ ] Payment is approved
Grant Manager Review
Grant Manager (name)		Date Received
Comments
[ ] Required documentation (invoices, canceled checks, timesheets) have been received and reviewed
[ ] Adding machine total confirms the amount requested (attach calculator tape)
[ ] Costs claimed are for work conducted during the subgrant/contract period
[ ] Costs claimed are in accordance with the approved subgrant/contract budget
[ ] Costs claimed are reasonable, allowable, allocable, and necessary
[ ] Mileage rates/per diem does not exceed allowable rate
[ ] Consultant rate claimed does not exceed allowable rate
[ ] Professional qualifications for consultant are on file
[ ] Non-cash matching share contributes are identified and their value has been documented
Signature of Authorized Official
Signature of Project Manager
Signature of Grant Manager