City of Dallas - BidNet



City of Dallas

Housing/Community Services Department

Housing Opportunities for Persons with AIDS (HOPWA) Program

Exhibit 4

Federal Funding Accountability and

Transparency Act Worksheet

To be submitted with Bid or Proposal

Note – there are four signature blocks on this worksheet

|Agency Name: | |

Dear Bidder or Proposer:

Thank you for submitting your bid or proposal for this project. Please note that this project is federally funded, and as such, is subject to the requirements of the Federal Funding Accountability and Transparency Act of 2006, as amended (the “Transparency Act’), as well as the Texas Public Information Act, and other federal, state, and local requirements. This following explanations and form were designed to ensure proper reporting under the Transparency Act.

My signature below indicates that I have received, read, understand and agree to adhere to the reporting deadlines set by the City of Dallas. My signature further indicates that I understand and agree that, if awarded this contract, failure to meet deadlines as stipulated will be considered as non-compliance and may result in immediate termination of your contract.

Signature (Bidder/Proposer) Date

Federal Subaward Reporting System (FSRS) and

The Transparency Act requires information disclosures concerning entities receiving Federal assistance through Federal awards such as Federal contracts, subcontracts, grants, and subgrants. Specifically, the Transparency Act requires prime awardees (like the City of Dallas) to report certain information regarding subawards to the Federal Subaward Reporting System (FSRS). This information includes:

• Name of the entity receiving the award;

• Amount of the award;

• Information on the award (type, funding agency, CFDA number, program source, award title descriptive of purpose of the award)

• Location of the entity receiving the ward and primary location of performance under the award (city, State, congressional district)

• Unique identifier of the entity receiving the ward (i.e., DUNS number)

• Names and total compensation of the five most highly compensated officers of the entity (in certain circumstances).

In some cases, information from the entity’s SAM registration (described below) may be used to pre-populate data in the FSRS system.

Information reported to the FSRS will be posted on-line at , a centralized system that is searchable by the public and is designed to provide information on federal spending awards to the public.

DUNS Number

A Data Universal Numbering System (DUNS) number is required to receive funding. A DUNS number is a unique nine-digit identification number assigned to your business by Dun and Bradstreet (D&B). You may apply for a DUNS number via the internet at or by phone at 1-866-705-5711. A DUNS number is provided free of charge to federal grant recipients – select the option for “U.S. Government Contractors, Vendors, and Grant Recipients.“ You will need to provide the following data:

• Legal Name

• Trade style, Doing Business As (DBA), or other name by which your organization is commonly recognized

• Physical Address, City, State, and Zip Code

• Mailing Address (if separate)

• Telephone Number

• Contact Name

• SIC Code (Line of Business)

• Number of Employees at your location

• Headquarters name and address (if there is a reporting relationship to a parent corporate entity)

• Is this a home-based business?

System for Award Management

The System for Award Management (SAM) registration is also required to receive funding. SAM replaced the old federal Central Contractor Registry (CCR) in July 2012. All applicants (other than individuals) for federal assistance must maintain current registration in the SAM database. SAM is the primary registrant database for the U.S. Federal Government. SAM collects, validates, stores, and disseminates data in support of agency acquisition missions, including Federal agency contract and assistance awards. Please note that the term "assistance awards" includes grants, cooperative agreements and other forms of federal assistance. Whether applying for assistance awards, contracts, or other business opportunities, all entities are considered "registrants". Registrants are required to complete a one-time registration to provide basic information relevant to procurement and financial transactions.

SAM validates the registrant information and electronically shares the secure and encrypted data with the federal agencies’ finance offices to facilitate paperless payments through electronic funds transfer (EFT). Additionally, SAM shares the data with federal government procurement and electronic business systems. Please note that any information provided in your registration may be shared with authorized federal government offices. However, registration does not guarantee business with the federal government.

SAM registration may be completed on-line at . To register on SAM, go to the website, and follow the instructions to first “Create User Account” and then “Register/Update Entity.” Online registration can be completed in about 30 minutes, but it may take 3-5 business days or longer for your registration to become active once the IRS validates your information. The following information will be required in order to register with SAM:

Data Universal Numbering System (DUNS) Number

Tax Identification Number (TIN) and Taxpayer Name used in Federal tax matters (be sure the entity name matches the name associated with the TIN)

CAGE code if you have one

General Information about your business

Electronic Funds Transfer (EFT) Information

Executive Compensation

Proceedings Detail

Points of Contact

SAM registrations expire after one year, and must be updated. All applicants are advised to keep their SAM registration up-to-date at all times. Your SAM registration may be verified by the City of Dallas at any time via the on-line system at . As well, information from your SAM registration may be used to pre-populate data in the FSRS system described above.

My signature below indicates that I have received, read, understand and agree to adhere to the SAM requirements set by the City of Dallas. My signature further indicates that I understand and agree that, if awarded this contract, failure to provide SAM registration information as stipulated will be considered as non-compliance and may result in the termination of your contract.

Signature (Bidder/Proposer) Date

Please complete and submit the following information:

| |Question |Answer |

|1. |Formal Name of your Company: | |

|2. |Your Corporate Address. If your corporation has multiple offices or locations, | |

| |please use the location that will be most central to the work being done for this | |

| |project. | |

|3. |Your federal DUNS number. | |

| |(It is a Federal requirement to have a DUNS number in order to participate in | |

| |federal grant-funded programs) | |

|4. |If you have a parent company, the formal name of your parent company. Otherwise, | |

| |write “NA.” | |

|5. |If you have a parent company, the federal DUNS number of your parent company. If | |

| |your parent company does not have a DUNS number, then print its mailing address. | |

| |If you do not have a parent company, write “NA.” | |

|6. |How much did your company (not your parent company) receive for federally funded | |

| |work in the most recent completed fiscal year? Please include all federally | |

| |funded projects, even if your client was a state, local, or private entity. |$ |

| | | |

| | | |

| | | |

|7. |Total gross revenue for the most recently completed fiscal year of your company | |

| |(not your parent company). |$ |

| | | |

| | | |

|8. |Divide your answer from #6 by your answer to #7. | |

| | | |

| | |% |

| | | |

|9. |Was your answer to question #6 greater than or equal to $25 million? | Yes No |

|10. |Was your answer to question #8 greater than or equal to 80%? | Yes No |

| |

|My signature below indicates that I certify that the above information is true and accurate. |

| |

| |

| |

|Signature (Bidder/Proposer) Date |

| |

|IMPORTANT: If you answered “YES” to BOTH question #9 AND question #10, you must fill out the Supplemental Questionnaire below. |

Transparency Act Worksheet: Supplemental Questionnaire

Fill out this section IF you answered YES to BOTH question #9 and question #10 above.

Please list the names of the five highest earning employees in your organization, along with their total earnings for the most recently completed fiscal year:

| |Employee Name |Position / Title |Total Earnings |

|1. | | |$ |

|2. | | |$ |

|3. | | |$ |

|4. | | |$ |

|5. | | |$ |

| |

|My signature below indicates that I certify that the above information is true and accurate. |

| |

| |

| |

| |

|Signature (Bidder/Proposer) Date |

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To be Filled out by the City of Dallas Employee who is the Project Manager for this endeavor:

| | | |

|1. |Name of this project | |

|2. |Contract Amount |$ |

|3. |Catalog of Federal Domestic Assistance | |

| |Number (CFDA) | |

| |Available from the Stimulus Workspace | |

| |intranet site. | |

|4. |Name of the Federal Program funding this | |

| |project (Grant Name) | |

| | | |

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