Fillable Printable VA Form 40-0895-14
Fillable Printable VA Form 40-0895-14
VA Form 40-0895-14
CHECKLIST OF MAJOR REQUIREMENTS FOR STATE OR
TRIBAL GOVERNMENT CEMETERY CONSTRUCTION GRANTS
STATE OR TRIBAL GOVERNMENT CEMETERY PROJECT LOCATED AT DATE RECEIVED (Grants.gov)
TIME RECEIVED (Grants.gov)
DESCRIPTION OF PROJECT
SECTION A - PREAPPLICATION PHASE (Deadline is July 1 each year for VA receipt)
NO. REQUIREMENT
CHECK
RECEIPT
DATE
1.
Form SF 424, 424C, and 424D and project narrative submitted through grants.gov.
2.
State or Tribal Government Application Identifier Number
NUMBER (If applicable)
3.
Federal Application Identifier (FAI) Number
FAI NUMBER (To be assigned by VA)
4.
DUNS Number
5.
VA Receipt Notification Letter to Applicant
6.
Governor's or Tribal Government's designation of authorized official.
AUTHORIZED OFFICIAL
7.
Governor's or Tribal Government's designation contact person.
CONTACT PERSON
8.
State or Tribal Government authorization for the project (copy of the legislation)
9.
Certification of matching A&E funds to be ranked in highest priority grouping. VA must have
on file, by August 15, a copy of the Act appropriating the funds and certification from an
authorized state or tribal government budget official that the funds are available, how long the
funds will remain available, and that no further action is required by the state or tribal
government to make such funds available.
10.
Title to the State or Tribal Government Cemetery Property
11.
Phase I Environment Survey: site plan/'map, site survey, and soil investigation (if applicable)
12.
Phase II Environmental Assessment (if applicable)
13.
Letter from state or tribal government historical preservation officer
14.
State Clearinghouse Comments (E.O. 12372) or Tribal Government Comments
15.
Master Plan for facility approved
16.
Schematic drawings for the proposed project (if applicable) approved
17.
Design development drawings and specifications (35 percent) approved
18.
Updated Form SF 424 and SF 424C
19.
A schedule of when each of the remaining requirements will be met
20.
Building Space Program Analysis (if applicable)
21.
Final drawings and specifications (100 percent) approved
VA FORM
DEC 2012
40-0895-14
PAGE 1 OF 2
SECTION A - PREAPPLICATION PHASE (Deadline is April 1 each year for VA receipt) (Continued)
NO. REQUIREMENT
CHECK
RECEIPT
DATE
22.
Updated Form SF 424, SF 424C, SF 424D
23.
Updated schedule when each of the remaining requirements will be met.
24.
VA Notification to Precede to Bid the Project to Applicant
NOTE: The following certifications from the authorized state or tribal government official must be submitted to VA as part of the
Preapplication Phase.
25.
A. Compliance with VA Form 40-0895-2, Certification of Compliance with Provisions of the
Davis-Bacon Act
26.
B. Compliance with VA Form 40-0895-7, Certification Regarding Debarment, Suspension, and
Other Responsibility Matters - Primary Covered Transactions (State or Tribal Government)
27.
C. Compliance with VA Form 40-0895-8, Certification Regarding Drug-Free Workplace
Requirements for Grantees other than individuals
28.
D. Compliance with VA Form 40-0895-9, Certification Regarding Lobbying
29.
E. Compliance with VA Form 40-0895-15, Certification of Cemetery Maintained in Accordance
With National Cemetery Administration Standards.
SECTION B - APPLICATION PHASE (Deadline is July 15 for that FY Grant Award)
30.
Advertisement for bids
31.
Bid tabulations
32.
VA Form 40-0895-10, Certification of Compliance with Federal Requirements-State or
Tribal Government Cemetery Construction Grant.
33.
Final application - SF 424, based on bids and consistent with SF 424C
34.
Revised budget page (SF 424C) based on bids
35.
Compliance with VA Form 40-0895-12, Certification Regarding Debarment, Suspension,
Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions (Contractor)
36.
Three (3) signed copies of the Memorandum of Agreement (VA Form 40-0895-11)
SECTION C - POST GRANT AWARD
37.
Submit a written request to the Director, State Cemetery Grants Service (41E), requesting the
Department of Veterans Affairs to schedule a final grant program review. Include the name and
telephone number of the local point of contact for the project.
38.
Submit the project equipment list; (if there is no equipment involved in the grant, please make a
statement to that effect in the request for a final grant program review.
39.
Add the following statement to the SF 271, Outlay Report and Request for Reimbursement for
Construction Programs and add the statement to the HHS final reimbursement request.
"IT IS HEREBY AGREED THAT THE MONETARY COMMITMENT OF THE FEDERAL
GOVERNMENT WILL HAVE BEEN MET AND THE PROJECT WILL BE CONSIDERED
TERMINATED UPON PAYMENT OF THIS VOUCHER."
40.
Compliance with the Single Audit Act requirements
41.
Final Master Plan (one copy for SCGP and one copy for state cemetery), if appropriate.
42.
As Built Drawings (one copy for SCGP and one copy for state cemetery)
43.
Custody and Transfer Receipt Final Release of Claims Final Invoice - one copy for SCGP, if
appropriate.
44.
Close out grant.
VA FORM
DEC 2012
40-0895-14
PAGE 2 OF 2
