Checklist for Initial Disbursement 5B 05-16

OMB Number: 0610-0096
Expiration Date: 11/30/2021

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ECONOMIC DEVELOPMENT ADMINISTRATION
CHECKLIST FOR INITIAL DISBURSEMENT
EDA Award Number:

Date:

Recipient:
Co-Recipient(s):
Recipient’s Authorized Representative:
Name & Phone Number

The initial disbursement amount request is $

Y

1. All Special Award Conditions requiring action prior to initial disbursement have been
satisfied.
2. A complete and signed Form SF-271 for pay request number one has been
submitted to EDA.
3. All partial pay estimates and invoices have been listed on the project’s EDA
financial spreadsheet and the spreadsheet has been submitted to EDA.
4. The current quarterly progress report has been submitted to and accepted by EDA.
5. The current semi-annual Federal Financial Report (SF-425) has been submitted to
and accepted by EDA.
6. The Project/Grant Administration contract has been reviewed and accepted by EDA.
7. The Architect/Engineer contract has been reviewed and accepted by EDA.
8. All required land, easements, and rights-of-way have been secured and the Site
Certificate or other title opinion has been approved by EDA.
9. The first priority lien or covenant has been executed, recorded, and submitted to and
accepted by EDA.
10. Davis-Bacon wage rates (Federal wage rates) are incorporated into all construction
contracts.
11. Copies of the weekly certified payrolls are on file and are available to the
Government upon request.
12. The project/grant administrator has certified that all contractors and subcontractors
have complied with Davis-Bacon wage rate requirements.
13. The “EDA Contracting Provisions for Construction Projects” has been incorporated
into all construction contracts.
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N

NA

OMB Number: 0610-0096
Expiration Date: 11/30/2021

Y
14. The proposed bid documents, including final plans, specifications, and contract
documents have been submitted to and accepted by EDA.
15. Bid opening documents, including bid tabs and certified minutes of the bid opening
have been submitted to and accepted by EDA. This includes written justification
from the Recipient if the Award has been made to other than the lowest bidder.
16. All contractors (including general contractor and subcontractors) have been
searched for on www.SAM.gov and none of the contractors are subject to any
active exclusions (e.g., suspensions, debarments) imposed by a Federal Agency.
17. The surety company listed for the low bidder is included on the Treasury
Department Circular 570 and possess sufficient capability to insure the project.
18. All construction contracts required for completion of the project have been executed
by the EDA Grant Recipient and accepted by EDA.
19. If the answer to the previous question is “N,” a request for phasing has been made to
and accepted by EDA.
20. Matching funds for the Recipient’s share are on hand or immediately available.
21. All work accomplished by change order(s) that is part of the claim for initial
disbursement has been approved by EDA.
22. All proposed or actual changes to the EDA-approved budget have been approved by
EDA.
23. A photo of the EDA project sign has been submitted to EDA.

Prepared By (Signature)

Date

Prepared By (Typed or Written Name & Title)

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N

NA