Contract Exhibits

The exhibits included in the FY 2010-2011 contracts with certified domestic violence centers, legal service providers, and law enforcement agencies are located in this section. The forms should be downloaded and saved for use by the provider when submitting required reports and information to FCADV.

Contract Exhibits for Certified Domestic Violence Centers FY 10/11

• Exhibit A: Deliverables (PDF)
  This document lists all of the tasks and deliverables to be provided by the certified domestic violence centers. This document is tailored specific to each center. General domestic violence and prevention services have the same deliverables and units of service for all centers. This document also includes the deliverables for centers who receive Rural and American Recover and Reinvestment Act funding (ARRA). The deliverables are the same for all centers that receive this funding, but the units of service vary among the centers.
• Exhibit B: Payment Chart (PDF)
  This document details the unit rate for all deliverables in the contract template. This document is specific to each center. All deliverables are the same for centers, but the unit rates may vary.
• Exhibit C: 2010-2011 Fixed Price Monthly Invoice (Excel)
  Certified domestic violence centers that are on a fixed price contract shall use this electronic document to prepare their request for reimbursement for services rendered. The invoice is due to the FCADV Contract Manager no later than the 15th day of the month following the month in which services were delivered. This invoice must be submitted electronically.
• Exhibit C: 2010-2011 Cost Reimbursement Monthly Invoice (Excel)
  Certified domestic violence centers that are on a cost reimbursement contract shall use this electronic document to prepare their request for reimbursement for services rendered. The invoice is due to the FCADV Contract Manager no later than the 15th day of the month following the month in which services were delivered. This invoice must be submitted electronically along with full and complete back-up.
• Exhibit C: 2010-2011 CPI Cost Reimbursement Monthly Invoice (Excel)
  Certified domestic violence centers that are on a cost reimbursement contract shall use this electronic document to prepare their request for reimbursement for services rendered. The invoice is due to the FCADV Contract Manager no later than the 15th day of the month following the month in which services were delivered. This invoice must be submitted electronically along with full and complete back-up.
• Exhibit C: 2010-2011 DDP Cost Reimbursement Monthly Invoice (Excel)
  Certified domestic violence centers that are on a cost reimbursement contract shall use this electronic document to prepare their request for reimbursement for services rendered. The invoice is due to the FCADV Contract Manager no later than the 15th day of the month following the month in which services were delivered. This invoice must be submitted electronically along with full and complete back-up.
• Exhibit D: Alice Monthly Report Sample (Excel)
  The Monthly Statistical Report shall be submitted by the 15th day of the month following the month in which services were rendered. Centers have the option of reporting this data through the Alice report system or through STARS.
• Exhibit E: Status Report for DV Center (Word)
  This is a monthly narrative report of domestic violence related activities for the month. The status report is due to the FCADV Contract Manager no later than the 15th day of the month following the month in which services were delivered.
• Exhibit F: Monthly Financial Report: General DV, Prevention Services and Rural Only (Excel)
  The center shall submit the Monthly Financial Report each month during the 4th quarter documenting total expenditures for the period in accordance with their approved operating budget. This report shall be submitted to the Contract Manager no later than the 15th day of the month following the month in which services were delivered and must accompany the Exhibit C. This report must be submitted electronically in excel format.
• Exhibit F: Monthly Financial Report: American Recovery and Reinvestment Act - ARRA (Excel)
  The center shall submit the Monthly Financial Report each month during the 4th quarter documenting total expenditures for the period in accordance with their approved operating budget. This report shall be submitted to the Contract Manager no later than the 15th day of the month following the month in which services were delivered and must accompany the Exhibit C. This report must be submitted electronically in excel format.
• Exhibit F: Monthly Financial Report: DCF VAWA STOP (Excel)
  The center shall submit the Monthly Financial Report each month during the 4th quarter documenting total expenditures for the period in accordance with their approved operating budget. This report shall be submitted to the Contract Manager no later than the 15th day of the month following the month in which services were delivered and must accompany the Exhibit C. This report must be submitted electronically in excel format.
• Exhibit G: Quarterly Financial Report: General DV,Prevention Services and Rural Only (Excel)
  The center shall submit the Quarterly Financial Report documenting total expenditures for the period in accordance with their approved operating budget. This report shall be submitted by the 15th day of the month following the quarter in which expenditures were made. This report must be submitted electronically in excel format.
• Exhibit G: Quarterly Financial Report: American Recovery and Reinvestment Act - ARRA (Excel)
  The center shall submit the Quarterly Financial Report documenting total expenditures for the period in accordance with their approved operating budget. This report shall be submitted by the 15th day of the month following the quarter in which expenditures were made. This report must be submitted electronically in excel format.
• Exhibit G: Quarterly Financial Report: DCF VAWA STOP (Excel)
  The center shall submit the Quarterly Financial Report documenting total expenditures for the period in accordance with their approved operating budget. This report shall be submitted by the 15th day of the month following the quarter in which expenditures were made. This report must be submitted electronically in excel format.
• Exhibit G: Quarterly Financial Report: L & C (Excel) The center shall submit the Quarterly Financial Report documenting total expenditures for the period in accordance with their approved operating budget. This report shall be submitted by the 15th day of the month following the quarter in which expenditures were made. This report must be submitted electronically in excel format.
• Exhibit H and/or I: Legal Clearinghouse Service Activity Report (STARS) (PDF)
  This is a monthly narrative and statistical report of Legal Clearinghouse related activities for the month. This report is to be completed on-line at forms.fcadv.org. The activity report is due to the FCADV Contract Manager, through the STARS system no later than the 15th day of the month following the month in which services were delivered.
• Exhibit H: Rural Service Activity Report (STARS) (PDF)
  This is a monthly statistical report of rural domestic violence related activities for the month. This report is to be completed on-line at forms.fcadv.org. The activity report is due to the FCADV Contract Manager, through the STARS system no later than the 15th day of the month following the month in which services were delivered.

Contract Exhibits for Legal Clearinghouse

• Exhibit A: Provider Attorney Listing (Word)
  Legal Clearinghouse providers who will have more than one attorney performing services shall use this form to list the contact information for each attorney.
• Exhibit B: Legal Clearinghouse Budget Form (Excel)
  This form is to be used to develop a line item budget to support the funding being awarded.
• Exhibit C: Legal Clearinghouse Claim Request Invoice (Word)
  Legal Clearinghouse providers shall use this electronic document to prepare their request for reimbursement for services rendered. The invoice is due to the FCADV Grants Specialist no later than the 15th day of the month following the month in which services were rendered.
• Exhibit D: Activity Report (Word)
  Legal Clearinghouse providers shall use this electronic document to report monthly on the status of contract deliverables. The activity report is due to the FCADV Grants Specialist no later than the 15th day of the month following the month in which services were rendered.
• Exhibit E: Direct Deposit Authorization (Word)
  This form shall be completed upon contract execution to ensure timely payment for services rendered through electronic funds transfer.
• Exhibit F: IRR Form (Word)
  This is the official form to be used when requesting to purchase Information Technology Resources. Written approval shall be obtained from the FCADV Grants Specialist prior to making a purchase using the Information Resource Request (IRR) Form
• Exhibit G: Apportionment of Service Units Form (Word)
  Legal Clearinghouse providers who will be accepting referrals from multiple domestic violence centers should use this form to report the number of contract deliverables being assigned to each center.
• Exhibit H: Quarterly Expenditure Report (Excel)
  Providers shall submit the Quarterly Expenditure Report documenting total expenditures for the period in accordance with their approved operating budget. This report shall be submitted by the 15th day of the month following the quarter in which expenditures were made. This report must be submitted electronically in excel format. Supporting documentation from provider's accounting system must accompany this report.
• Provider Contact Information Form (Word)
  This form shall be used to document any changes in key staff within the provider's agency. The form shall be completed and submitted within five days of a key position being vacated.

Contract Exhibits for ARRA Stimulus Funding Legal Project

• Exhibit A: Provider Attorney Listing (Word)
  Providers who will have more than one attorney performing services shall use this form to list the contact information for each attorney.
• Exhibit B: Stimulus Funding Legal Project Budget Form (Excel)
  This form is to be used to develop a line item budget to support the funding being awarded.
• Exhibit C: Stimulus Funding Legal Project Claim Request Invoice (Word)
  Providers shall use this electronic document to prepare their request for reimbursement for services rendered. The invoice is due to the FCADV Grants Specialist no later than the 15th day of the month following the month in which services were rendered.
• Exhibit D: Stimulus Funding Legal Project Activity Report (Word)
  Providers shall use this electronic document to report monthly on the status of contract deliverables. The activity report is due to the FCADV Grants Specialist no later than the 15th day of the month following the month in which services were rendered.
• Exhibit E: Direct Deposit Authorization (Word)
  This form shall be completed upon contract execution to ensure timely payment for services rendered through electronic funds transfer.
• Exhibit F: IRR Form (Word)
  This is the official form to be used when requesting to purchase Information Technology Resources. Written approval shall be obtained from the FCADV Grants Specialist prior to making a purchase using the Information Resource Request (IRR) Form.
• Exhibit G: Apportionment of Service Units Form (Word)
  Providers who will be accepting referrals from multiple domestic violence centers should use this form to report the number of contract deliverables being assigned to each center.
• Exhibit H: ARRA Quarterly Project Performance Report (Word)
  Providers shall submit the Quarterly Project Performance Report documenting activities completed specific to the services and deliverables. Report must include a narrative which describes activities undertaken during the relevant quarter. This report shall be submitted by the 2nd day of the month following the quarter in which activities were completed.
• Exhibit I: ARRA Quarterly Financial Report (Excel)
  Providers shall submit the ARRA Quarterly Financial Report documenting total expenditures for the quarter and year to date in accordance with their approved operating budget. This report shall be submitted by the 15th day of the month following the quarter in which expenditures were made. This report must be submitted electronically in excel format. Supporting documentation from provider's accounting system must accompany this report.
• Provider Contact Information Form (Word)
  This form shall be used to document any changes in key staff within the provider's agency. The form shall be completed and submitted within five days of a key position being vacated.
• ARRA Monthly Jobs Report (PDF)
  This form shall be used to document information about the Recovery Act funded employees specific to services and deliverables under the contract. The employees reported herein must be those employees included in the provider's approved operating budget. This report shall be submitted electronically by the 2nd day of each month for the previous month's activities.

Contract Exhibits for InVEST Law Enforcement

• Exhibit A: InVEST Budget Form (Excel)
  This form is to be used to develop a line item budget to support the funding being awarded.
• Exhibit B: InVEST Claim Request Invoice (Excel)
  Providers shall use this electronic document to prepare their request for reimbursement for services rendered. The invoice is due to the FCADV Grants Specialist no later than the 15th day of the month following the month in which services were rendered.
• Exhibit C: InVEST Activity Report (Word)
  Providers shall use this electronic document to report monthly on the status of contract deliverables. The activity report is due to the FCADV Grants Specialist no later than the 15th day of the month following the month in which services were rendered.
• Exhibit D: Direct Deposit Authorization (Word)
  This form shall be completed upon contract execution to ensure timely payment for services rendered through electronic funds transfer.
• Exhibit E: IRR Form (Word)
  This is the official form to be used when requesting to purchase Information Technology Resources. Written approval shall be obtained from the FCADV Grants Specialist prior to making a purchase using the Information Resource Request (IRR) Form.
• Exhibit F: Quarterly Expenditure Report (Excel)
  Providers shall submit the Quarterly Expenditure Report documenting total expenditures for the period in accordance with their approved operating budget. This report shall be submitted by the 15th day of the month following the quarter in which expenditures were made. This report must be submitted electronically in excel format. Supporting documentation from provider's accounting system must accompany this report.
• Provider Contact Information Form (Word)
  This form shall be used to document any changes in key staff within the provider's agency. The form shall be completed and submitted within five days of a key position being vacated.

Contract Exhibits for InVEST Legal

• Exhibit A: Provider Attorney Listing (Word)
  Providers who will have more than one attorney performing services shall use this form to list the contact information for each attorney.
• Exhibit B: InVEST Budget Form (Excel)
  This form is to be used to develop a line item budget to support the funding being awarded.
• Exhibit C: InVEST Legal Claim Request Invoice (Word)
  Providers shall use this electronic document to prepare their request for reimbursement for services rendered. The invoice is due to the FCADV Grants Specialist no later than the 15th day of the month following the month in which services were rendered.
• Exhibit D: InVEST Legal Activity Report (Word)
  Providers shall use this electronic document to report monthly on the status of contract deliverables. The activity report is due to the FCADV Grants Specialist no later than the 15th day of the month following the month in which services were rendered.
• Exhibit E: Direct Deposit Authorization (Word)
  This form shall be completed upon contract execution to ensure timely payment for services rendered through electronic funds transfer.
• Exhibit F: IRR Form (Word)
  This is the official form to be used when requesting to purchase Information Technology Resources. Written approval shall be obtained from the FCADV Grants Specialist prior to making a purchase using the Information Resource Request (IRR) Form.
• Exhibit G: Quarterly Expenditure Report (Excel)
  Providers shall submit the Quarterly Expenditure Report documenting total expenditures for the period in accordance with their approved operating budget. This report shall be submitted by the 15th day of the month following the quarter in which expenditures were made. This report must be submitted electronically in excel format. Supporting documentation from provider's accounting system must accompany this report.
• Provider Contact Information Form (Word)
  This form shall be used to document any changes in key staff within the provider's agency. The form shall be completed and submitted within five days of a key position being vacated.