WORKFORCE PARTNERSHIP OF GREATER RHODEISLAND

CONTRACT CLOSEOUT REPORT

I.GENERAL INFORMATION

Agency/Organization:
Address:
Contract Number: Federal Employer ID Number
Funding Period: From: To:
Contact Person: Phone:

Funding Title: (check all that apply) WIA JDF
  1. TRANSMITTAL INFORMATION

As required or applicable to the closeout of the referenced contract, the following reports or documents are included as indicated: (Check as appropriate)

Financial Reconciliation Worksheet

Detailed Expenditures Report

Property Inventory Report

Contractor Assurances

Check for Unspent Funds

Not-for-profit______$500,000 of Federal Expenditures

  1. CONTRACTOR CERTIFICATION

I, the undersigned, assure and certify that the Contractor has complied with all the requirements contained in this report and that all funds have been expended in accordance with the terms and conditions set forth in the applicable WIA or JDF contract.

Signature: ______Date: ______

Typed Name: ______Title: ______

IV. FINANCIAL RECONCILIATION WORKSHEET

A. FUNDS

WIA / JDF / TOTAL
1. Total Funds Received
2. Total Expenditures
3. Funds On Hand (Line 1 less line 2)
4. Program Income Generated
5. Program Income Expended
6. Balance of Program Income (Line 4 less line 5)
7. Total Contracted Funds
8. Unexpended Allocation
(Line 7 less line 2)
9. % Of Funds Expended
(Line 2 divided by line 7)

B. CONTRACTOR LEVERAGED FUNDS

WIA / JDF / TOTAL
1. Total Leveraged Funds Expenditures
2. Total Leveraged Funds
3. Unexpended Funds (Line 2 less line 1)
4. % Of Funds Expended
(Line 1 divided by line 2)

C. IN-KIND FUNDS

WIA / JDF / TOTAL
1. Total In-Kind Funds Expenditures
2. Total In-Kind Funds
3. Unexpended Funds
(Line 2 less line 1)
4. % Of Funds Expended
(Line 1 divided by line 2)

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  1. DETAILED EXPENDITURES REPORTS

Funding Title: (Check one) WIA JDF

A. FUNDS

COST ITEMS / PROGRAM / FOLLOW-UP / TOTAL

B.CONTRACTOR LEVERAGED FUNDS

COST ITEM / PROGRAM / FOLLOW-UP / TOTAL
  1. IN-KIND COSTS

COST ITEMS / PROGRAM / FOLLOW-UP / TOTAL
  1. PARTICIPANT SUPPORT SERVICES

Complete each section as appropriate to indicate actual expenditures by type of participant support.

1. WORK EXPERIENCE WAGES AND FRINGE PAYMENTS

No. Participants / Rate Per Hour x / Total Hours = / TOTAL EXPENDED
$ / $
Fringe Type / Percentage Rate x / Total Wages = / TOTAL
FICA / % / $
WORKER COMP. / % / $
  1. OTHER SERVICES (List Below) TOTAL EXPENDED

$
TOTAL SERVICES EXPENDITURES / $
  1. PROPERTY INVENTORY REPORT

WIA funds

Instructions: Complete this report relative to any property acquired with (check one) JDF funds

used in the performance of this contract. Check the applicable section(s) and provide any information which may be required. Attach additional list if necessary.

A. CONTRACT WITHOUT PROPERTY

The Contractor certifies that no property was furnished or acquired under the terms and conditions of this contract.

B. CONTRACT WITH PROPERTY

The Contractor certifies that the below inventory listing is complete, and includes all property or equipment furnished or purchased for use in the performance of this contract.

QUANTITY / IDENTIFICATION NO. / DESCRIPTION / PURCHASE DATE
  1. PROPERTY WITH NEW CONTRACT

The above property or equipment will be retained by the Contractor for use in Contract No. ______.

  1. RETURN OF PROPERTY

The above listed property or equipment will be returned to the Workforce Partnership of Greater Rhode Island within ninety (90) days of the submittal date of this closeout report.

  1. CONTRACTOR ASSURANCES

The Contractor, in performance of this contract, assures and certifies the Workforce Partnership of Greater Rhode Island the following:

  1. FINANCIAL

That the expenditures reported in this report are true and accurate in all respects and that all disbursements have been made in accordance with contractual provisions.

  1. TAXES

That all requirements of the law regarding employer identification account numbers, collection, payment, deposit, reporting of federal, state, and local taxes; and the provision of W-2 forms to all employees, now and formerly a part of this contract have been complied with.

  1. RETENTION AND EXAMINATION OF RECORDS

That all financial records pertinent to the contractwill be retained for a period of four (4) years from the date of the final financial close-out submission in accordance with Section 667.300 of the WIA Regulations; and shall grant access to and the right to examine any books, documents, paper, and records relative to this contract to the U.S. Secretary of Labor, the Comptroller General, the Governor of Rhode Island, the State Workforce Investment Office (SWIO), the Workforce Partnership of Greater Rhode Island (WPGRI), or any duly authorized representative of the aforementioned, until the expiration of the four (4) year period.

Note: Unresolved issues (which may include but are not limited to audit findings, litigation and bankruptcy) would necessitate a longer retention period. The four (4) year period would be adjusted to begin after resolution of the issue and/or submission of a revised closeout report.

  1. RELEASE FROM LIABILITY

That, the contractor, in consideration of payment received per the terms and conditions of this contract does release and discharge the Workforce Partnership of Greater Rhode Island, its officers, agents and employees, of and from all liabilities, obligations, claims, and demands whatsoever under or arising from this contract.

  1. REFUNDS / REBATES / CREDITS

That all rights, title and interest to all funds, rebates, credits, or other amounts(including any interest) arising from the performance of this contract are assigned, transferred and released to the Workforce Partnership of Greater Rhode Island, and agrees to effect prompt collection of any funds, and will cooperate fully with the Workforce Partnership of Greater Rhode Island in whatever action necessary to secure any of the preceding.

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