HomeMy WebLinkAboutCOM 0082.002 2004-2006 tv os
Harry Kim Jane H. Testa
Mayor ~ Uirecmr
r
'i'.
h~oi~wi'~
County of Hawaii
DEPARTMENT OF RESEARCH AND DEVELOPMENT
25 Aupuni SVeel, Room 109 • Hilo, Hawaii 96720-4252 - -
(SOR) 961-8366 • Fax (808) 935-1205
E-mail: clvesdev@intetpac.net
r
MEMORANDUM
TO: Gary Safarik, Chairman and Members of the Hawai' i County Council
THRU: Deanna Sako, Controller
FROM: Jane H. Testa, Director.~~~f
DATE: January 19, 2005
SUBJECT: NOTIFICATION OF GRANT AWARD
Compliance with Ordinance No. 03-91, Section 7(1)
Name of Grant Program: Energy Coordinator
Grantor: State of Hawai' i - DEBDT
County Grantee Department or Agency: Department of Research and Development
Grant No. (IF KNOWN):
Amount of Grant: $58,600
Amount of County Match: $30,830
County Revenue & Expenditure Account Numbers: Revenue: 3304.46; exp.: 010-161-5162.85
Grant Period (Commencement & Completion): July 1, 2003 -June 30, 2004
Purpose of Grant: State Energy Program
Is final report required by grantor? ®Yes ? No
Notification attached: ~ Yes ? No, because
Comm. No. 0 2
Ref. To:
Ref. Uate ~A~
Hawari County is an Equal Opportunity Provider and Employer Form NUA 6/01
STATE OF HAWAII
CONTRACT FOR GOODS AND SERVICES
(IN THE FOLLOWWG CATEGORIES: EXEMPT; SMALL PURCHASE;
SOLE SOURCE; OR EMERGENCY) w3~~E>~
Y This Contract, executed on the respective dates indicated below, is effective as of
clT 20 n.'t•betweenthe Department of Business Economic Development -nd Touri:
(Insert name ojslate department, ogency, board or commission)
State of Hawaii (hereinafter "STATE"), by its State Director
(Inser!!i!/e ojperson signingjor S!aleJ
(hereinafter "PROCUREMENT OFFICER"), whose address is No. 1 Cap i tot District Bui 1 di ng,
250 S. Hotel St., Honolulu,HI 96813and tha fnnnty of uawaii
(Insert name ojcompmry/personJ
(hereinafter "CONTRACTOR'; a County i n the State of Hawai i
(Insert corporction, parp,ership, joint venture, sole proprietorship, anther legal
farm ojlhe ConlmclarJ
under the laws of the State of Hawaii .whose business address and taxpayer
identification number are as follows: 25 Aupuni St. Room 21 Hi 7 n Ht oF~~n
RECITALS
A. The STATE is in need of the goods or services, or both, (also referred to as
"goods and services"), described in this Contract and its.attachments. The CONTRACTOR is
agreeable to providing the goods and services.
B. This Contract is for (check one box):
C~ (I) A procwement expenditure ofpublic funds for goods and services
that is otherwise exempt from public bidding as set forth in section 103D-102, Hawaii Revised
Statutes (HRS), and chapter 3-120, Hawaii Administrative Rules (I-IAR); or
or '
? (2) A small purchase procwement of goods and services as set forth
in section ] 03D-305, HRS, and subchapter 8, chapter 3-122, HAR; or
? (3) A sole source procurement of goods and services as set forth in
section 103D-306, HRS, and subchapter 9, chapter 3-122, HAR; or
? (4) An emergency procurement of goods and services as set forth in
section ]03D-307, HRS, and subchapter ] 0, chapter 3-122, HAR.
I AG/SPO FORM-K(2) (1/Ol)
C. Money is available to fund this Contract pursuant to:
(1) (ldenl~ Srale sourns)
or (2) U.S. Department of Energy. State Fnaray Program grant
(/deny £edera! source)
or both, in the following amounts: State
Federal $ 58 , 600 00
D. The agency's Chief Procurement Officer is Aaron F~a;o~a
who O has approved this procurement or ®is not required to approve this procurement.
NOW, THEREFORE, in consideration of the promises contained in this Contract,
the STATE and the CONTRACTOR agree as follows:
1. Scope of Services. The CONTRACTOR shall, in a proper and satisfactory
manner as determined by the STATE, provide all the goods or services set forth in Attachment 1,
which is hereby made a part of this Contract.
2. Comnensation. The CONTRACTOR shall be compensated iri a total amount
not to exceed Fifty-Eight Thousand Six Hundred and 00/100
DOLLARS ($58,600.00 1, including approved costs incurred and taxes, according to the
Compensation and Payment Schedule set forth in Attachment 2, which is hereby made a part of this
Contract.
3. Bonds. The CONTRACTOR Ois required to provide ~Jis not required to
provide D a performance bond ~ a payment bond D a performance and payment bond in the
amount of
DOLLARS
4. Standazds of Conduct Declaration. The Standards of Conduct Declaration of
the CONTRACTOR, is attached and is made a part of this Contract.
5. Other Terms and Conditions. The General Conditions and any Special
Provisions aze attached hereto and made apart of this Contract. In the event of a conflict between
the General Conditions and the Special Provisions, the Special Provisions shall control.
6. Liquidated Damages. Liquidated damages shall be assessed in the amount
of N/A DOLLARS N/A 1
per day, in accordance with the teens of paragraph 9 of the General Conditions.
Z AG/SPO FORM-K(2) (1/01)
7. Notices. Any written notice required to be given by any party to this Contract
shall be (a) delivered personally, or (b) sent by United States fast class mail, postage prepaid. Notice
required to be given to the Procurement Officer or the CONTRACTOR shall be sent to the
respective address as indicated in this Contract. A notice shall be deemed to have been received three
(3) days after mailing or at the time of actual receipt, whichever is earlier. The CONTRACTOR is
responsible for notifying the STATE in writing of any change of address.
IN VIEW OF THE ABOVE, the parties execute this Contract by their signatures, on
the dates below, to be effective as of the date first above written.
RECOMMED APPROVAL: - "
~i
l ~~..n.ti--~
Jane H. Testa, Director
Dept. of Research and Development fSignnrnreJ
Theodore E. Liu
(Print Name)
APPROVED AS TO FORM AND LEGALITY: Dire for
(`~j~~ (Print 77W1 2 9 tad
P ~ \J'\t~ (DareJ~R17~
()'"~l4 v o ~v
Deputy Corporation Counse
CONTRACTOR
CORPORATE SEAL
(If available)
County of Hawaii
(~~oJConhaeforJ
(Si%nanneJ
Dixie Kaetsu
(Print Nome)
Managing Director
AU~r~O 4
2003
(Dale)
APPROVED AS TO FORM:
i
~
eputy ttome~y General _
~yi e of authority of the CONTRACTOR'S representative to sign this Contract for the CONTRACTOR must be attached. -
3 AG/SPO FORM-K(2) (1/O])
STATE OF HAWAII )
SS.
COUNTY OF HAWAII )
On this ~~frY day of ~C~~-~~z' , 2003, before me
personally appeared DIXIE KAETSU, to me personally known, who, being by me duly
sworn, did say that she is the Managing Director of the County of Hawaii, a municipal
corporation of the State of Hawaii; that the seal affixed to the foregoing instrument is
the corporate seal of said County of Hawaii; that the foregoing instrument was signed
and sealed in behalf of the County of Hawaii by authority given to said Mayor of the
County of Hawaii by Section 5-1.3(g) of the County Charter, County of Hawaii (1991),
as amended, and assigned by the Mayor to the Managing Director pursuant to
Section 6-1.3(h) of the County Charter; and said DIXIE KAETSU acknowledged said
instrument to be the free act and deed of said County of Hawaii.
2~~ceL2 ~~a ~etx_~,<_,
VI GINIA M. TOLENTINO
otary Public, State of Hawaii
My commission expires: 4/22/2005
o`,~~iltillip)ry~
\2~ ~ ~l
~~a
Fay ~ :Eke
st:
tP?'. pUB {.~G'
~~~~4
~.OF Np~``.
CONTRACTOR'S ACKNOWLEDGMENT
S~'ATE OF )
SS.
COUNTY OF 1
this day of , 20 ,before me appeared
and to
me known, to be the pe on(s) described in and, who, being by me duly sworn, did say that
he/she/they is/aze and of
the CONTRACTOR named in the foregoing
instrument, and that he/she/they is/aze thorized to sign said instrument on behalf of the
CONTRACTOR, and acknowledges that he/s they executed said instrument as the free act and
deed of the CONTRACTOR.
(SignamreJ
(Print Name)
(Notary Seal)
Notary Public, State of
My commission expires:
4 AG/SPO FORM-K(2) (1/01)
CERTIFICATE OF EXEMPTION FROM CIVIL SERVICE
I. By Heads of Departments or Agencies as Delegated by the Director of Human
Resources Development (a.)
Pursuant to a delegation of the authority by the Director of Human Resources Development,
1 certify that the services provided under this Contract, and the person(s) providing the
services under this Contract are exempt from the civil service, pursuant to §76-16, Hawaii
Revised Statutes (HRS), or if the services under this Contract are not exempted from civil
service by §76-16, HRS, they are exempted from civil service by Section 8, Act 230, 1998
Hawaii Session Laws 785, 788.
fore)
Theodore E. Liu
(Prim Name)
Director
(Print Ti(!e)
AUG 2 92003
r~iei
a. Item 1 of this certificaate may be used by all department heads and others to whom the
Director of Human Resources Development (DHRD) has delegated authority to certify §76-
16, HRS, civil service exemptions. The specific paragraph(s) of §76-16, HRS, upon which
an exemption is based should be noted in the contract file.
NOTE: if authority to certify exceptions under §§76-16(2) and 76-16(3), HRS, has not been
delegated, only the Director of DHRD may certify §§76-16(2) and 76-16(3)
exceptions.
S AC/SPO FORM-K(2) (1/O1)
J, ~ 7
- CERTIFICATE OF EXEMPTION FROM CIVIL SERVICE
2. By the Director of Human Resources Development, State of Hawaii (b.)
I certify that the services to be provided under t}lis Contract, and the person(s) providing the
services under this Contract are exempt from civil service, pursuant to §76-16, Hawaii
Revised Statutes (HRS), or if the services under this Contract are not exempted from civil
service by §76-16, HRS, they are exempted from civil service by Section 8, Act 230, 1998
Hawaii Session Laws 785, 788.
C~~''til/~ t'
. (Signdture)
DIXIE KAETSU
(Prim Name)
Managing Director
(Prim! Ti!(e, ijderigneesojlhe Director ojONROJ
AUG 0 4 10n3
(Dale)
b. Item 2 of this certificate may be used only by the Duector of Human Resources Development
(DHRD) or the Director's designee.
NOTE: If authority to certify exemptions under §§76-16(2) and 76-16(3), HRS, has not
been delegated, only the Director of DHRD may certify §§76-16(2) and 76-16(3) exceptions.
6 AG/SPO FORM-K(2) (3/01)
STANDARDS OF CONDUCT DECLARATION
For the purposes of this declazation:
"Agency" means and includes the State, the legislature and its committees, all executive
departments, boazds, commissions, committees, bureaus, offices, the University of Hawaii,
and all independent commissions and other establishments of the state government but
excluding the courts.
"Controlling interest" means an interest in a business or other undertaking which is sufficient
in fact to control, whether the interest is greater or less than fifty per cent (50%).
"Employee" means any nominated, appointed, or elected officer or employee of the State,
including members of boazds, commissions, and committees, and employees under contract
to the State or of the constitutional convention, but excluding legislators, delegates to the
constitutional convention, justices, and judges.
On behalf of the Countv of Hawaii CONTRACTOR, the undersigned does
declare as follows:
1. CONTRACTOR O is* ~]Ss not a legislator or an employee or a business in which
a legislator or an employee has a controlling interest.*
2. CONTRACTOR has not been assisted or represented by a legislator or employee for
a fee or other compensation to obtain this Contract and will not be assisted or represented by a
legislator or employee for a fee or other compensation in the performance of the Contract, if the
legislator or employee had been involved in the development or award of the Contract.
3. CONTRACTOR has not been assisted or represented for a fee or other compensation
in the award of this Contract by an agency employee or, in the case of the Legislature, by a
legislator.
4. CONTRACTOR has not been represented or assisted personally on matters related
to the Contract by a person who has been an employee of the agency within the preceding two (2)
years and who participated while in state office or employment on the matter with which the
Contract is directly concerned.
5. CONTRACTOR has not been represented or assisted on matters related to this
Contract, for a fee or other consideration by an individual who, within the past twelve (12) months,
has been an agency employee, or in the case of the Legislature, a legislator.
'Reminder to agency: ]f the "is" block is checked, the agency is required, under section 84-I5, IiRS, to post a notice
of its intent to award the contract and file a copy of the notice with the State Ethics Commission, ten (10) days before
entering into [he Contract.
~ AG/SPO FORM-K(2) (1/Ol)
6. CONTRACTOR has not been represented or assisted in the award of this Contract
for a fee or other consideration by an individual who, a) within the past twelve (12) months, served
as an agency employee or in the case of the Legislature, a legislator, and b) participated while an
employee or legislator on matters related to this Contract.
CONTRACTOR understands that the Contract to which this document is attached is voidable on
behalf of the STATE if this Contract was entered into in violation of any provision of chapter 84,
Hawaii Revised Statutes, commonly referred to as the Code of Ethics, including the provisions
which are the source of the declarations above. Additionally, any fee, compensation, gift, or profit
received by any person as a result of a violation of the Code of Ethics may be recovered 6y the
STATE.
DATED: Honolulu, Hawaii,
CONTRACTOR
onset! name ofConhatfor)
(SignanneJ
(Frio! Name)
(Print Tif(e)
(Date)
*Reminder to agency: If the "is" block is checked, the agency is required, under section 84-15, HRS, to post a notice
of its intent to award the contract and file a copy of the notice with the State Ethics Commission, ten (10) days before
entering into [he Contract.
8 AC/SPO FORM-K(2) (1/01)
Attachment 1
SCOPE OF SERVICES
The CONTRACTOR shall perform and provide, in a satisfactory and proper
manner as determined by the STATE, the following services:
I. Submit for STATE approval a Work Order for each quarter at least four (4) weeks
prior to the start of each quarter. The first quarter Work Order shall be submitted
within ten (10) days of the effective date of this Contract.
A. Work Orders shall be in accordance with Exhibit A, "Pro-Forma for Work
Orders," attached hereto and incorporated herein. Work Orders shall include,
but not be limited to, planned activities, deliverables, and an estimated budget
for each project.
B. A notice to proceed will be issued by the STATE upon approval of each Work
Order.
C. Work Orders may be amended with prior written approval of the STATE.
II. Upon receipt of an approved Work Order from the STATE, the CONTRACTOR shall
perform the following energy outreach programs:
A. Project Group A: Participate in Regulatory and Legislative Programs to promote
the efficient use of energy, safeguard the ability to provide needed governmental
services, protect the public interest, monitor electricity costs, and avoid negative
impacts on land use planning and energy emergency planning.
1. Monitor, participate and coordinate Public Utilities Commission (PUC) and
energy utility-related Integrated Resource Planning activities, including, but
not limited to, PUC dockets, workshops, advisory group meetings, and Hawaii
Electric Light Company Advisory Group meetings. Work with State, County,
and citizen's groups to ensure that energy utility plans are consistent with
State and County goals and objectives.
2. Monitor the progress of energy related bills being considered by the State
legislature and submit written or oral testimony on bills which serve to ensure
safe and reliable energy and protect specific County and State concerns.
3. Work collaboratively with the STATE, utilities, community groups, and private
business interests in an effort to optimize the planning programs.
B. Project Group B: Economic Development Projects
1. Represent the County of Hawaii and participate in the Energy Emergency
Preparedness (EEP) planning and development with the STATE's Energy
Planning and Policy Group. Coordinate EEP programs and participate in
emergency exercises to ensure a high degree of readiness.
2. Energy Efficiency Retrofits:
a. Continue verification of energy savings to the Hawaii County Building
resulting from the energy retrofit provided through performance contracts.
b. Coordinate retrofit construction activities implemented under a
performance contract for energy efficiency retrofits of various County
agencies including Public Works, Police and Parks and Recreation
Departments. Verify energy savings upon completion of projects.
c. Facilitate the implementation of the Hawaii County Department of Water
Supply measures in developing appropriate methods, including
performance contracting, for implementing energy efficiency measures in
their facilities.
3. Model Energy Code (MEC): Provide required services to Hawaii County
Building Division in regard to compliance software, monitoring and
enforcement of the MEC, including drafting legislation to amend provisions of
the MEC as required.
C. Project Group C: Technology Marketing Projects
1. Continue implementing the Action Plan for Rebuild Hawaii Island. Report on
energy savings achieved through retrofits of Hawaii County facilities and
provide assistance to other governmental agencies and private interests
interested in implementing energy efficiency measures.
2. Support the promotion of renewable energy development through the Million
Solar Roofs program initiated and coordinated by groups such as, but not
limited to, Ka'u High School's Energy Smart Schools program, the Utility
Photovoltaic Group, and County, private sector and local utility groups.
3. Promote the development and use of renewable energy technologies and
efficiency by developing and issuing Requests for Proposals (RFP's) for
projects funded in part by the County of Hawaii, and administering the
contracts awarded.
4. Attend meetings of the Rebuild Hawaii consortium, Western Region Peer
Exchange and National forums of the Rebuild America program.
5. Promote the use of cogeneration, fuel cells, microturbines, photovoltaics and
other high-efficiency and renewable technologies in conjunction with Hawaii
Electric Light Company and other organizations.
D. Project Group D: Program Planning and Administration. Duties shall include, but
not be limited to:
1. Developing and revising budgets, reports, grants, and other written and visual
preparations;
2. Providing administrative functions required in daily operations that are not
directly related to the specific projects listed above, including but not limited
to, preparation of legislative testimony, review of planning documents, reports
and environmental impact statements;
3. Interfacing with federal, state and county agencies, businesses, and the
general public;
4. Participating in any professional development and skill enhancement training
related to the optimum function of the Energy Coordinator; and
5. Other energy-related tasks as approved by the STATE.
III. Reporting requirements: Submit for STATE approval the following reports:
A. Quarterly reports (original and two copies): Quarterly program reports shall be
submitted no later than five (5) working days after the ending of each quarter.
Quarterly program reports shall include, but not be limited to, a summary of the
CONTRACTOR's activities in meeting the goals and deliverables of the
approved Work Order, the requirements of this Contract, and any
recommendations or concerns regarding the projects.
1. Any deliverables not accomplished during a designated quarter should
include an explanation and a brief plan for the next quarter.
2. Quarterly reports shall include reports on meetings, workshops, and
conferences attended; who scheduled the meeting, workshop; the purpose;
who attended and what was discussed or what actions were taken;
conclusions reached, if any; and the CONTRACTOR'S evaluation and
recommendations.
B. A certified fiscal report shall summarize quarterly charges for deliverables in
accordance with the format specified in the attached Exhibit B, "Quarterly Fiscal
Report," incorporated herein, and submitted with quarterly invoices as specified
in the attached Exhibit C, "Quarterly Invoice," incorporated herein.
C. Final reports: A Final Report shall be submitted no later than fifteen (15)
calendar days prior to the termination date of this Contract (original and five
copies). The Final Report shall include, but not be limited to, a summary of the
CONTRACTOR'S overall efforts in meeting the requirements of this Contract and
an evaluation of all projects and recommendations for follow-up and future
activities. A certified final fiscal report, which shall also be the fiscal report for the
fourth quarter, shall summarize all charges for deliverables during the period of
the contract in accordance with the format specified in the attached Exhibit B,
"Quarterly Fiscal Report," incorporated herein.
D. All reports shall be submitted to Mr. Maurice H. Kaya, Chief Technology Officer,
Energy, Resources Division, Department of Business, Economic Development,
and Tourism, P.O. Box 2359, Honolulu, Hawaii 96804-2359.
Attachment 2
TIME OF PERFORMANCE
Performance of services by the CONTRACTOR shall commence on the
effective date of this Contract, and all of the services required under this
Contract shall be completed by June 36, 2004, unless this Contract is sooner
terminated or extended as hereinafter provided.
Attachment 3
COMPENSATION AND PAYMENT SCHEDULE
The compensation for the services to be performed by the
CONTRACTOR under this Contract shall be the sum of money not to exceed
FIFTY EIGHT THOUSAND SIX HUNDRED AND NO/100 DOLLARS
($58,600.00), which sum shall be paid in accordance with the following:
A. Payment shall be made by the STATE to the CONTRACTOR upon receipt of
invoices, in accordance with the attached Exhibit C, "Quarterly invoice," and
subject to the other provisions of this section.
B. Payments shall be made in accordance with the preapproved quarterly Work
Order budget.
1. Payment by Deliverables: Payment shall be made only after the STATE
has determined that the work has been satisfactorily performed and that
the CONTRACTOR is entitled to receive payment under the terms of this
Contract. Deliverables are due on or before the end of the quarter, as
stated in the Work Order, unless otherwise approved by the STATE.
2. Cost Reimbursable Basis: Costs will be paid on a cost reimbursable
basis to comply with Appendix A, General Provisions, of the U.S.
Department of Energy's "Grant Provisions for State and Local
Governments," paragraph 1.b., which states:
"This grant is funded on an allowable cost basis without fee or profit to
the grantee organization, not to exceed the amount awarded as indicated
on the face page and is subject to a refund of unexpended funds to
DOE."
C. If an amount for a reported deliverable is determined by the STATE to be
inappropriate and unallowable, the STATE may deduct an equivalent
amount from the current or next payable invoice and may withhold payment
of the amount of monies equivalent to the questioned deliverable until later
resolution of the discrepancy by audit or other means.
D. Final payment shall be made upon the receipt and approval of a final
program and fiscal report and of all other deliverables and other materials to
be submitted by the CONTRACTOR to the STATE, resolution of all
discrepancies in performance of services, and completion of all other
outstanding matters under this Contract.
E. The CONTRACTOR shall comply with all applicable federal laws and rules,
including U.S. Office of Management and Budget Circular A-87 and A-133;
the State Energy Program Regulations; and the U.S. Department of Energy
Financial Assistance Rules, 10 CFR Chapter II, Part 600, which are
available for inspection in the office of the State of Hawaii Department of
Business, Economic Development, and Tourism's Energy, Resources, and
Technology Division, 235 South Beretania Street, Room 506, Honolulu,
Hawaii.
F. Funds budgeted for individual projects are estimates and are listed in Work
Orders. Funds within a project group may be shifted from one project to
another within the group upon notification to the STATE. No more than five
percent (5%) of budgeted funds in any project group can be shifted to
another project group within a Work Order without authorization from the
STATE.
G. The entire amount of the CONTRACTOR'S compensation as described
herein is payable out of federal funds and this contract shall be construed
strictly to be a contract to pay said compensation to the CONTRACTOR only
out of federal funds when such are so received. This contract shall not be
construed as a contract to pay the CONTRACTOR'S compensation out of
any other funds than federal funds, when received from the federal
government, under any other circumstances
Attachment 4
SPECIAL CONDITIONS
1. Retention and Examination of Records
Financial records, supporting documents, statistical records and all other records
pertinent to this Agreement shall be retained for a period of three years following
the completion of this Agreement. The CONTRACTOR agrees that DBEDT or any
of its duly authorized representatives shall have access to, and the right to
examine and audit any directly pertinent books, documents, paper, and records of
CONTRACTOR involving transactions related to this Agreement for a period of
three (3) years following completion of this Agreement. If any litigation, claim,
negotiation, audit or other action involving records has been started before the
expiration of the three-year period, the records will be retained until completion of
the action and resolution of all issues which arise from it, or until the end of the
regular three-year period, whichever is later.
b. Lobbying, Debarment, Suspension and Other Responsibility Matters.
U.S. Department of Energy "Certifications Regarding Lobbying; Debarment,
Suspension And Other Responsibility Matters; And Drug-Free Workplace
Requirements" and "Assurance of Compliance Nondiscrimination in Federally
Assisted Programs" are made a part of this Agreement. Copies of these
documents are available upon request from the Energy, Resources, and
Technology Division.
c. Contractor shall comply with applicable provisions of U.S. Department of Energy
State Energy Program Grant Number DE-FG51-028021337 General Terms and
Conditions for Financial Assistance Awards, Intellectual Property Provisions
Assistance. Copies of these documents are available upon request from the
Energy, Resources, and Technology Division.
d. Publication of the results of this award is encouraged subject to any applicable
restrictions in 10 CFR 600.27, "Patents, Data, and Copyrights," and 10 CFR
600.234, "Copyrights." Any article published shall include an acknowledgment that
any research was supported, in whole or in part, by the U.S. Department of Energy
Grant Number DE-FG51-028021337 and a statement that such support does not
constitute an endorsement by DOE of the views expressed in the article.
e. Acknowledgment Statement. CONTRACTOR may publish results or other
materials of their work. However, all publications and reports produced under this
Agreement are subject to the patent rights provisions of the federal grant funding
this Agreement and shall contain the following statement:
"This (material) was prepared with the support of the U.S. Department of Energy,
Grant No. DE-FG51-028021337. However, any opinions, findings, conclusions, or
8/2000 Page 1 of 2
recommendations expressed herein are those of the author and do not necessarily
reflect the views of the U.S. Department of Energy, the State of Hawaii, nor any
agency or employee thereof."
8/2000 Page 2 of 2
EXHIB/T A
PRO-FORMA FOR WORK ORDERS
State Energy Program -Neighbor Island Energy Assistance Program
Date:
County of
Contract No.
Contract Period:
Contract Amount: (Total amount for the Agreement)
Work Order No.
Period of Performance: (Quarter)
Date Approved:
Budget Amount for Work Order:
I. (First Project Title)
A. Expected Outcomes
1. Project Goal
2. Project Objectives to Accomplish the Goal
B. Planned Activities -Work Plan
(Tasks to be performed to achieve Project Objectives, including
methodologies)
II. (Second Project Title), etc.
III. Budget and Deliverables
Deliverables are due on or before the end of the quarter listed above, unless
otherwise approved by the STATE.
Deliverable County Funds State Funds Budget
Amount
Project
Deliverable
Deliverable
Project
Deliverable
Total for the Quarter
Costs shall not exceed estimated amounts without prior approval of the STATE. Costs
will be paid on acost-reimbursable basis.
(A Notice to Proceed will be issued after Work Order is approved by the STATE)
EXHIBIT B
QUARTERLY FISCAL REPORT
State Energy Program -Neighbor Island Energy Assistance Program
Reporting Period: (From) (To)
County of
Contract Number:
Contract Period:
Contract Amount: (Total amount for the Agreement)
I. Fiscal Report for Reporting Period
cap rol cal cd>
Invoice Variance
Budget in County Amount Amount Percentage
Work Order and IState Fund) fa + c1 ~)-(al
Work Order (xxx) (xxx) (xxx) (xxx) (xxx)
II. Source of County Funds
III. Balance of Funds in Contract
Total Contract Cumulative to Balance
Amount the Quarter Amount Percentaee
(xxx) (xxx) (xxx) (xx.xx%)
CERTIFICATION: I certify to the best of my knowledge and belief that this report is
correct and complete and that all charges are for the purpose and conditions of
the Agreement.
Signature Date
Type Name and Title Telephone Number
EXHIBIT C
QUARTERLY INVOICE
State Energy Program -Neighbor Island Energy Assistance Program
INVOICE #
DATE
Reporting Period: (From) (To)
County of
TO: Mr. Maurice H. Kaya
Energy, Resources, and Technology Program Administrator
DBEDT-ERTD
P.O. Box 2359
Honolulu, HI 96804-2359
CONTRACT NUMBER:
CONTRACT PERIOD:
CONTRACT AMOUNT: (Total amount for the Agreement)
AMOUNT REQUESTED:
Amount County State Actual
from Funds Funds Amount
Charges by Work Order # _ Work Order Expended Expended Expended
Project
Deliverable (xxx) (xxx) (xxx) (xxx)
Deliverable (xxx) (xxx) (xxx) (xxx)
Project
Deliverable (max) (xxxl
Total:
CERTIFICATION: I certify to the best of my knowledge and belief that this invoice is
correct and complete and that all charges are for the purpose and conditions of the
Agreement.
Signature Date
Type Name and Title Telephone Number
Please submit original and three copies together with detail for cost reimbursements.