Emergency Management Preparedness Program (EMPP)

2017/2018EMPP Compliance Reporting Form

www.aema.alberta.ca/grants

This program supports expanding and enhancing emergency management preparedness.

Section 1: Compliance Reporting Instructions and Deadline

As outlined in the 2017/2018 EMPP Program Guidelines, and Section 5 of the signed Conditional Grant Agreement (CGA), each grant recipient is required to complete and submit the following EMPP Compliance Reporting Form , after carrying-out the approved projects per Schedule A of the CGA.

The deadline for submitting the form is June 30, 2019.

Section 2: Entity Contact Information

Name of entity reporting:      

Legal status of entity (if applicable):

(i.e. Municipality, Métis settlement, Inter-municipal partnership, or other)

     

Contact name and title:      

Contact phone number:      

Contact Email address:      

Contact mailing address:      

Contact Information of individual(s) who prepared this form (if different from above):

     

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Section 3: Statement of Project Funding and Expenditures

For each approved project that was completed by the entity under the 2017/2018 EMPP grant initiative, please prepare a ‘Statement of Project Funding and Expenditures’ spreadsheet, similar in layout to Example A shown below. Using the invoices from the project(s), the spreadsheet should include the following information:

Names of the vendors or contractors (listed separately on each row of the spreadsheet). A description of items purchased. The invoice date(s). The invoice number(s). The total amount of each invoice (including the Goods and Services Tax - GST). The total amount of GST charged. The total amount of each invoice (excluding the GST). The total amount of the grant which was awarded to the entity as noted in the signed CGA. The total amount of the grant awarded less the combined project expenditures:

o Per terms of the CGA, a positive total on the above (i.e. a grant surplus) will need to be repaid. Any such refunds can be made by a cheque payable to the ‘Government of Alberta’, and returned with this form per Section 6.

Note: In order to be eligible for reimbursement, all expenditures must have been incurred between the project start and end dates, as noted in Section 7 of this form.

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Section 4: Project Results

Output: Quantity List the actual number of Trained Personnel that resulted from the projects which were completed:      

If the above output is less than the expected output (which was identified in sub-section 4.2 of the 2017/2018 EMPP Application Form), please explain this variance below:

     

Section 5: Program Evaluation

As a means of improving future delivery of the EMPP grant initiative, please provide any feedback, and/or suggestions below:

     

Section 6: Supporting Documentation and Surplus Refunds

Once completed, please scan the signed EMPP Compliance Reporting Form along with the supporting documentation below, into a single PDF file, and email this package to the AEMA Grants Unit at: aema.grants@gov.ab.ca

Please Include:

A hardcopy of the spreadsheet as per Section 3*. Photocopies of receipts and/or invoices for eligible project expenses. Class lists for projects that were carried out (as applicable). Course lists for projects that were carried out (as applicable).

*Please also include an electronic copy of the spreadsheet with your email submission.

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Note: If a surplus on the grant was calculated per Section 3, this surplus will need to be refunded. Please make all refund cheques payable to the ‘Government of Alberta’, and mail to:

Grants UnitAlberta Emergency Management Agency200 Park Plaza, 10611-98 AvenueEdmonton AB T5K 2P7Email: aema.grants@gov.ab.ca

Section 7: Compliance Reporting Certification

I certify that:

All information within the EMPP Compliance Reporting Form and attached supporting documentation is true and correct, and complies with the terms and conditions of the 2017/2018 EMPP Program Guidelines, Application Form, and executed CGA;

All non-approved projects and non-eligible costs have been excluded and/or deducted from actual EMPP project expenditures herein;

The entire grant awarded by Municipal Affairs under the EMPP (plus any income earned on the grant, as applicable) was used to carry-out the projects as set out in Schedule A of the CGA, without material alteration;

No projects were started, nor grant monies used, prior to the Minister’s signing date in the CGA; No projects were started, nor grant monies used, after the CGA project completion date of

May 31, 2019 (unless a formal extension was approved by way of an Amending CGA); and The Minister of Municipal Affairs retains the right to conduct an evaluation or audit of the project at

any time.

____________________________________________________________________________________Print Name - Duly Authorized Representative and Title (Entity)

__________________________________________________________ _____________________Signature Date

Section 8: Next Steps and File Closure A completed and signed EMPP Compliance Reporting Form package is received from the entity by

the Alberta Emergency Management Agency’s Grants Unit. The form and documentation is reviewed to confirm that the information meets all requirements. In cases of deficiencies, the reporting entity is contacted for further information, as needed. Once all compliance reporting requirements have been met by the entity, the Grants Unit will send

an email notification to the entity informing them that the file will be closed.

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