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U.S. DEPARTMENT OF ENERGY ' _ff JU05 <br />FINANCIAL ASSISTANCE <br />PROPERTY CLOSEOUT CERTiFiCATinN <br />Award Number <br />Recipient (Name and address) <br />The purpose of this report is to facilitate the closeout of the Award. Based on the records' maintained by the Recipient in accordance <br />with the Property Management standards set forth in the Award, the following data reflects' the Recipient's' closeout inventory of real and <br />personal property that was provided by the Department of Energy (DOE) or partially or wholly acquired with project funds.' <br />I. EQUIPMENT <br />A. Federally- Owned: (Government Furnished Equipment): (10 CFR 600.133(a), 600.232, 600.322, or Federal Demonstration <br />Partnership ( FDP) General Terms and Conditions No. 33, as applicable): ❑ No ❑ Yes <br />(If yes, attach property inventory list that includes item description, manufacturer, model, serial number, original acquisition <br />date, original acquisition cost and disposal condition code per the Federal Management Regulation 102 - 36.240) <br />B. Equipment Acquired with Award Funds where Title Vests in the Recipient with further obligations to DOE: <br />(10 CFR 600.133, 600.134, 600.232, or 600.321, as applicable) <br />❑ No ❑ Yes <br />If yes, does the equipment have a per unit fair market value of $5,000 or more? ❑ No ❑ Yes <br />(If yes, attach a property inventory list that includes item description, manufacturer, model, serial number, original acquisition <br />date, original acquisition cost, disposal condition code per the Federal Management Regulation 102 -36 -240 and one of the <br />disposition codes listed below) <br />(1) The property will continue to be used for the purposes authorized in the Award. <br />(2) The property is no longer needed for the purposes of the Award, and will be used on another Federally sponsored <br />activity (List Activity and Federal Agency): <br />(3) The Recipient wishes to retain the property and compensate DOE for its share of the current per unit fair market value. <br />(Identify the fair market value on the attached property inventory list and describe how the value was determined). <br />(4) The property is no longer needed for the purposes of the Award or other Federally sponsored activities and the Recipient <br />requests DOE disposition instructions. <br />II. SUPPLIES (10 CFR 600.135, 600.233, 600.324, or FDP General Terms and Conditions No. 35, as applicable) <br />Does the residual inventory of unused supplies exceed $5,000 in total aggregate value? ❑ No ❑ Yes (if yes,check block below) <br />❑ The supplies will be used on another Federally sponsored activity (List Activity and Federal Agency). <br />❑ The supplies will be sold or retained for use on non- Federally sponsored activities and the Recipient will compensate DOE for <br />its share of the sales proceeds (or estimate of current fair market value). Attach a list of the supplies and complete the <br />following Worksheet: <br />Sale proceeds or estimate of current fair market value .............................. $ <br />Percentage of Federal participation <br />Federalshare .......................................... ............................... $ <br />Selling and handling allowance ......................... ............................... $ <br />Amount to be remitted to DOE ......................... ............................... $ <br />Page 1 of 3 <br />