WA ST Military Department 10/9/2019

2 CFR Part 200 Subpart F/OMB Circular A-133 Audit Certification Form Audits of States, Local Governments, Indian Tribes, and Non-Profit Organizations -Contact Information � . .. Subrecipient(Sub-Grantee)Name(Agency,Local Government,or Organization): Authorized Chief Financial Officer(Central Accounting office): Address: Email: Phone#: Purpose: As a pass-through entity of federal grant funds,the Washington Military Department/Emergency Management Division(WMD/EMD)is required by 2 CFR Part 200 Subpart F/Office of Management and Budget (OMB) Circular A-133 to monitor activities of subrecipients to ensure federal awards are used for authorized purposes and verify that subrecipients expending$750,000 or more in federal awards during their fiscal year have met the 2 CFR Part 200 Subpart F/OMB Circular A-133 Audit Requirements,as applicable. Your entity is a subrecipient subject to such monitoring by MIL/EMD because it is a non-federal entity that expends federal grant funds received from MIL/EMD as a pass-through entity to carry out a federal program. 2 CFR Part 200 Subpart F/OMB Circular A-133 should be consulted when completing this form. Directions: As required by 2 CFR Part 200 Subpart F/OMB Circular A-133,non-federal entities that expend$750,000 in federal awards in a fiscal year shall have a single or program-specific audit conducted for that year. If your entity subject to these requirements, you must complete Section A of this Form. If your entity jg subject to these requirements, you must complete Section B of this form. When completed,you must sign,date,and return this form with your grant agreement contract and every fiscal year thereafter until the grant agreement contract is closed. Failure to return this completed Audit Certification Form may result in delay of grant agreement processing, withholding of federal awards or disallowance of costs,and suspension or termination of federal awards. SECT,ON,r#:ErlikiasNOTsubjectiothearilioplikenisOceSCRIthigNOSillipiltMillavtdarit t ..,....' Our entity is not subject to the requirements of 2 CFR Part 200 Subpart F/OMB Circular A-133 because(check all that apply): ❑We did not expend$750,000 or more of total federal awards during the fiscal year. O We are a for-profit agency. O We are exempt for other reasons(describe): However,by signing below,I agree that we are still subject to the audit requirements,laws and regulations governing the program(s)in which we participate,that we are required to maintain records of federal funding and to provide access to such records by federal and state agencies and their designees,and that WMD/EMD may request and be provided access to additional information and/or documentation to ensure proper stewardship of federal funds. is Entities that ..,. s "et to the audit ', `Af§: 'f :l t r"d i;L. I a;f� ,,(Coriapjete,the information below awl the appropriate b°14 faiVe completed our last 2 CFR Part 200 Subpart LA-133 Audit on]enter date " for Fiscal Year ending]enter date]I7.I311 f ere were no findings related to federal awards from WMD/EMD. No follow-up action is required by VMD/EMD as the pass-through entity. A complete copy of the audit report,which includes exceptions,cormcave action plan and management response,is either provided eledronically to contracts.office@miLwa.gov or provide the state auditor report number: O We completed our last 2 CFR Part 200 Subpart F/A-133 Audit on(enter date] for Fiscal Year ending]enter date] There were findings related to federal awards. A complete copy of the audit report,which includes exceptions,corrective action plan and management response,is either provided electronically to contracts.office@miLwa.gov or provide the state auditor report number ____ O Our completed 2 CFR Part 200 Subpart F/A-133 Audit will be available on]enter date]_ _for Fiscal Year ending (enter date] . We We will forward a copy of the audit report to contracts.office@mil.wa.gov at that time or provide the state auditor report number: I hereby certify that I am an individual authorized by the above identified entity to complete this form. Further,I certify that the above information is true and correct and all relevant material findings contained in audit report/statement have been disclosed.Additionally,I understand this Form is to be submitted every fiscal year for which this entity is a subrecipient of federal grant funds from MIL/EMD until the grant agreement contract is closed. Signature of Authori 44 Chief Fip.r cial Officer:b / ►,1/_Mai_._I�1L Date: 1 a14 1q / Print Name&Title: � A . WMD Form 1009-13,8/19/2013,Updated 2/9/2015