Agenda - 11-15-2011 - 5i - Laserfiche WebLink

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~achme~+ ~ U.S. DEPARTMENT OF ENERGY 67 FINANCIAL ASSISTANCE PROPERTY CLOSEOUT CERTIFICATION Award Number Recipient (Name and address) _. The purppse of this report is to facilitate the closeout of-the Award.. Based on the_ records marntairied by the :Recipient in.accordance. , . _ , -.with the PropertyManagement sfahdar'ds setfor#ti in the Award, ttie following data reflects the Recipient's:;closeogt inveritory:of teal and.. personai~ propertyahat was provided by the Department;of Energy (DOE) or partially or wholly acquired with protect; funds - I. EQUIPMENT A. Federally-Owned: (Government Furnished Equipment): (10 CFR 600.133(a), 600.232, 600.322, or Federal Demonstration Partnership (FDP) General Terms and Conditions No. 33, as applicable): ^ No ^ Yes (If yes, attach property inventory list that includes item description, manufacturer, model, serial number, original acquisition date, original acquisition cost and disposal condition code per the Federal Management Regulation 102-36.240) B. Equipment Acquired with Award Funds where Title Vests in the Recipient with further obligations to DOE: (10 CFR 600.133, 600.134, 600.232, or 600.321, as applicable) ^ No ^ Yes If yes, does the equipment have a per unit fair market value of $5,000 or more? ^ No ^ Yes (If yes, attach a property inventory list that includes item description, manufacturer, model, serial number, original acquisition date, original acquisition cost, disposal condition code per the Federal Management Regulation 1026-240 and one of the disposition codes listed below) (1) The property will continue to be used for the purposes authorized in the Award. (2) The property is no longer needed for the purposes of the Award, and will be used on another Federally sponsored activity (List Activity and Federal Agency): (3) The Recipient wishes to retain the property and compensate DOE for its share of the current per unit fair market value. (ldent-fy the fairmarket value on the attached prope-ty inventory list and describe how the value was determined). (4) The property is no longer needed for the purposes of the Award or other Federally sponsored activities and the Recipient requests DOE disposition instructions. II. SUPPLIES (10 CFR 600.135, 600.233, 600.324, or FDP General Terms and Conditions No. 35, as applicable ) Does the residual inventory of unused supplies exceed $5,000 in total aggregate value? ^ No ^ Yes (if yes,check block below) ^ The supplies will be used on another Federally sponsored activity (List Activity and Federal Agency). ^ The supplies will be sold or retained for use on non-Federally sponsored activities and the Recipient will compensate DOE for its share. of the safes proceeds (or estimate of current fair market value). Attach a list of the supplies and complete the following Worksheet: Sale proceeds or estimate of current fair market value .............................. $ Percentage of Federal partiapation ................................................. Federal share ......................................................................... $ Selling and handling allowance ........................................................ $ Amount to be remitted to DOE ........................................................ $ Page 1 of 3