WA State Military Department 12/14/2016

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) City of Everett Office of Emergency Management Authorized Chief Financial Officer(Central Accounting Office): Debra Bryant, CAO-CFO Address:City of Everett, 2930 Wetmore Avenue, Everett WA 98201 Email: dbryant@everettwa.gov Phone#:(425) 257-8700 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 Pail 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 firm. Directions: As required by 2 CFR Part 200 Subpart F/OMB Circular A-133,non-federal entities that expend$7.50,00(in federal awards in a fiscal year shall have a single or program-specific audit conducted for that year. If your entity is not subject to these requirements, you must complete Section A of this Form. If your entity is subject to these requirements, you must complete Section B of this form. When completed, you must sign,elate,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. $ECTIONA;ErditiesNOT su ect to the auditrequizementsuflCT%Rjart 00SubpattF/OMBamid&A-133 Our entity is not subject to the requirements of 2 CFR Part 200 Subpart F/OMB Circular A-133 because(check all that apply): EWe did not expend$750,000 or more of total federal awards during the fiscal year. ❑ We are a for-profit agency. ❑ 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. SECTIONS;Emit es tbatAREsubject*"the audit requirements ofI CFR Part 200 SubpartF/OMB Circular A-1 33 (Complete the information below and check the appropriate box) . Ig We completed our last 2 CFR Part 200 Subpart F/A-133 Audit on tenter date S go for Fiscal Year ending tenter date) �OI C. There were no findings related to federal awards from WMD/EMD. No follow-up ac nn it required by WMD/EMD as the pass-through entity. A complete copy of the audit report,which includes exceptions,corrective action plan and managegisnt/4wa.gov is either provided electronically to contracts.ofhce@mtl.wa.gov or provide the state auditor report number:_ _ . ❑ We completed our last 2 CFR Part 200 Subpart KA-133 Audit on tenter date) for Fiscal Year ending tenter(late)____`_. 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.ofceemil.wa.gov or provide the state auditor report number. 0 Our completed 2 CFR Part 200 Subpart F/A-133 Audit will be available on tenter date)_____hr Fiscal Year ending tenter datel___ _ We will forward a copy of the audit report to contracts.oflice@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 complet:this form. Further,I certify that the above information is true and correct and all relevant material findings contained in au'it report/s ment have been disclosed.Additionally,i understand this Form is to be submitted every fi yea or which,f' ity is a s 1 . - '1 t of federal grant unds fro MIL/EMD until the grant agreement contract is closed. (' \\ L` Signature of Authorized Chief Financial fficer: Date: Print Name&Title: Debra Bryant,CAO/CFO,City of rett WMD Form 1009-13,8/19/2013,Updated 2/9/2015