Arizona Department of Veterans’ Services
Veterans’ Donations Fund A.R.S. § 41-608
Proposal for VDF Grant $4,999.99 or Less
CY19 VDF Grant Proposal $4,999.99 or Less rev. 07/01/2020 Page 1 of 13
© Arizona Department of Veterans’ Services. All rights reserved. www.azdvs.gov
VDF 2020 Grant Year (FY21)
APPLICANTS ARE STRONGLY ENCOURAGED TO READ THE ENTIRE SOLICITATION
It is recommended that VDF Proposals be submitted via email to vdf@azdvs.gov or fax to (602)
297-6687.
All Awards are subject to availability of VDF Money.
Notification of the Department’s decision will be made within 30 days upon receipt of the
completed proposal.
VDF Grant Program Manager:
Arizona Department of Veterans’ Services
3839 North 3rd Street
Phoenix, AZ 85012
Jennifer Harris
602-234-8413 or 602-255-3373
Email: vdf@azdvs.gov
CY20 VDF Grant Proposal $4,999.99 or Less rev. 07/20 Page 2 of 13
© Arizona Department of Veterans’ Services. All rights reserved. www.azdvs.gov
Definitions
For the purposes of this solicitation:
ADVSArizona Department of Veterans’ Services
Applicantthe agency/organization who submits a proposal under this solicitation
Arizona competitive grant processSee A.R.S. § 41-2701 et seq
A.R.SArizona Revised Statutes
DepartmentADVS
Directorthe Director of ADVS
EventVeteran service plan proposed in a submitted written VDF Grant Proposal, the
performance of which is completed on the day or over a few days of performance (generally, 3 to
7 days) during the VDF Grant Year in which the VDF Grant is made by the Department
Grantfurnishing of financial or other assistance, including state funds or federal grant funds, by
any state governmental unit to any person for the purpose of supporting or stimulating
educational, cultural, social or economic quality of life. A.R.S. § 41-2503(22) and 41-2701(1)
Grantee any person who submits, or for whom is submitted, a written proposal which is
accepted and, upon due review, consideration and determination of the VDF-RFGP by the
Department, is subsequently awarded a VDF money grant by the Department based on the
proposal
GrantorADVS
Line Itemeach service or product that is to be paid for or purchased with the Grant monies and
is identified and listed on a separate line
Person any corporation, business, individual, committee, club or other organization or group of
individuals. See A.R.S. §41-2701(2).
Program/Projecta Veteran service plan proposed in a submitted written VDF Grant Proposal,
the performance of which is performed and completed during the VDF Grant Year in which the
VDF Grant is made by the Department or beyond such VDF Grant Year.
RFGPrequest for grant proposal
State the State of Arizona
SOSstatement of service
VDF – Veterans’ Donations Fund established under A.R.S. § 41-608
VDF Grant grant of available VDF money only
VDF Grant Process the Arizona competitive grant process applied to A.R.S. § 41-608
VDF Grant ProposalGrantee’s written proposal submitted in response to this solicitation that is
accepted by the Department for the Department’s consideration under the VDF-RFGP
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© Arizona Department of Veterans’ Services. All rights reserved. www.azdvs.gov
VDF Grant Authority
Authority: VDF monies, “may be used for the benefit of [Arizona Veterans]” under the
Department’s administration (A.R.S. § 41-608), subject to the Arizona competitive
grant process (A.R.S. § 41-2701 et seq.).
Objective: The Department intends to grant appropriated VDF money, as may be available for
award through the Department’s VDF Grant Process during the given VDF grant
year, for service events, programs, and projects throughout Arizona that benefit
Arizona Veterans and specifically support and are compatible with the Department’s
objectives determined by the Director.
Policy: The Department seeks to engage the community and veteran service organizations
in the Department’s efforts to inform Arizona’s nearly 600,000 Veterans about
veterans’ benefits and lawfully assist them in their claims for the benefits. VDF
monies available during the given VDF grant year may be used for service events,
programs, and projects that the Department finds will benefit Arizona’s Veterans,
and which specifically support and are compatible with Department objectives
determined by the Director.
Procedure: During the given VDF grant year, VDF-Grant Proposal applicants may propose and
the Department may grant, through the VDF Grant Process, appropriated VDF
monies that are available for service events, programs, and projects that benefit
Arizona’s Veterans and which specifically support and are compatible with
Department objectives determined by the Director. VDF grants of less than
$5,000.00 will be competitively awarded as much as practicable.
VDF Grants: Any grant of VDF money for this VDF-RFGP will be awarded under Applicant’s
written VDF Grant Proposal, as and when such is accepted and awarded by the
Department, which shall then become an enforceable VDF grant service contract by
and between the State of Arizona and the Grantee. All VDF Grant Awards are
subject to the availability of VDF money for the grant year.
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© Arizona Department of Veterans’ Services. All rights reserved. www.azdvs.gov
General Instructions to VDF Applicants
1. Changes to, alterations of, or failure to complete this VDF-RFGP format, including
Attachments One, Two and Three, when submitted as Grantee’s VDF Grant Proposal in
response to this solicitation may be grounds for the State to decline to accept the proposal
or to decline to award any grant there under.
2. No proposal for $5,000.00 or more shall be divided into separate proposals for less than
$4,999.99 to bypass solicitation requirements.
3. Proposal submission requirements can be found on Pages 6-9.
4. Delivery of a VDF Grant Proposal alone does not mean completion, acceptance, or
approval of the proposal.
5. The Department may require:
Written and/or oral clarification of the VDF Grant Proposal submitted by or for the
proposed grantee; and
Information in addition to that submitted in or with Grantee’s VDF Grant Proposal.
6. The name of each VDF Grant Proposal applicant and grantee will be publicly available.
7. Persons with disabilities may request special accommodations such as interpreters,
alternate formats, or assistance with physical accessibility. Requests for special
accommodations must be made with 72 hours prior notice. Such requests are to be
addressed to the VDF grant program manager identified herein.
8. Contact (602) 234-8415 for assistance in downloading the documents from the ADVS
website.
Applicant’s Responsibilities
It is and shall remain the responsibility of the VDF Grant Proposal applicant and proposed
grantee to check the ADVS website for any amendments to this solicitation.
Respond to all solicitation contract requirements on pages 7-9.
Attach and wholly incorporate additional sheets as necessary to complete Grantee’s VDF-
RFGP.
Identify all attachments to the VDF Grant Proposal and identify each particular VDF-RFGP
requirement responded to in the attachments.
Complete and submit all of the following:
Attachment One Certification and Authorization
Attachment Two Organization Information
Attachment Three Statement of Service Event/Program/Project $4,999.99 or Less
Attachment Four Budget Worksheet (template available, as needed for use by Grantee)
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© Arizona Department of Veterans’ Services. All rights reserved. www.azdvs.gov
VDF Grant Instructions
1. Arizona Department of Veterans' Services
ADVS’ mission is to enrich and honor Arizona’s veterans and their families through education, advocacy and
s
ervice, subject to A.R.S. § 41-603(B). One of many ways ADVS looks to accomplish our mission is in
cooperation and coordination between ADVS, the Veteran community, and veteran service organizations through
the VDF Grant Process.
2. Funding Source for VDF Grants
A. A.R.S. § 41-608 establishes the Veterans’ Donations Fund (VDF) and charges the Arizona Department of
Veterans’ Services with its administration. The VDF is limited to donations for Veterans and proceeds from
the sale of certain Arizona license plates that are received by the Department. The standard within § 41-608
is that VDF money may be used for the benefit of Arizona Veterans.
B. Once received, all VDF monies become State funds and thus subject to applicable Arizona law. The grant of
any VDF money by the Department is subject to the § 41-608 use standard and the Arizona competitive grant
process under A.R.S. § 41-2701 et seq.
C. The Department receives, reviews, and duly considers written proposals for VDF money grants from many
applicants who propose various veteran service events, programs, and projects. As VDF money is limited i
n
am
ount and use and the Department is charged to provide Veteran services, among which is VDF
administration, the Department is necessarily selective in its procedure to determine how VDF money may be
granted and used to benefit Arizona Veterans.
3. Money Available for VDF Grants
A. The total VDF money available for VDF money grants will not exceed the amount appropriated under A.R.S. §
41
-608. The State of Arizona, ADVS and the Director, individually and jointly, are not expressly and impliedly
authorized and obligated to disburse, expend or obligate other funds or monies for any VDF grant and any
VDF grant purpose and use.
B. The Director, or his or her designee expressly designated in writing signed and dated by the Director,
determines:
(1) The term of any VDF grant year or other period;
(2) The total amount of appropriated VDF money available for grant during the given VDF grant year or other
period; and
(3) The amount, if any, of available VDF grant money to be awarded to each VDF proposal duly review
ed
and c
onsidered during the given VDF grant year or other period.
C. The State of Arizona, ADVS and the Director, individually and jointly, are not expressly and impliedly
obligated to award the VDF grant money so made available for the given VDF grant year or other period.
VDF grant monies available for a given VDF grant year or other period that are not awarded during that time
are not obligated for award in subsequent VDF grant years or other periods.
D. Proposed competitive VDF grants of $5,000.00 or more will be separately issued and reviewed an
d
c
onsidered by ADVS for award one time during the given VDF Grant Year. Proposed VDF grants for
$4,999.99 or less may be awarded at any time during the VDF Grant Year. A.R.S. § 41-2706(B)(9) provides
that the Arizona competitive grant process under A.R.S. § 41-2701 et seq. does not apply to VDF grants of
less than five thousand dollars if the Department adopts rules or policies governing these grants that
encourage as much competition as practicable.
4. Eligibility for VDF Grants
Grantee must be a 501(c) charitable organization. Preferable to ADVS, Grantee has a primary mission of
providing benefits to Arizona’s veterans and Applicant supports, and is compatible with, ADVS’ objectives
determined by the Director.
5. Notice of Award or Notice of Declination of Award to VDF-RFGP Grantee
A. The Director, or designee, will notify the Applicant of the Department’s decision to either award or decline all
or part of Grantee’s VDF proposal.
B. Notice of the Department’s decision to Grantee will be made by letter to Grantee at Grantee’s street address
and by e-mail to Grantee’s e-mail address provided in Grantee’s written proposal. Notice will be as
prescribed herein.
C. Should the Grantee disagree in whole or in part with the Department’s decision in this matter, Grantee may
submit a written request for reconsideration to the Director. Such writing must be submitted to and received
b
y the Director not later than the Department’s close of business on the fourteenth business day after the date
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© Arizona Department of Veterans’ Services. All rights reserved. www.azdvs.gov
VDF Grant Instructions, continued
of notice, and must provide reasons which support the request for reconsideration. The Director shall have
not less than 14 business days to reply to Grantee’s request for reconsideration. Such reply shall constitute
the Director’s final decision in the matter.
D. The Grantee may appeal the Director’s final decision under A.R.S. § 41-2704.
6. VDF-RFGP Preparation and Submission Instructions and Requirements
A. VDF-RFGP Proposal Submittal
(1) Proposal Submission: Grantee’s proposal shall be submitted via e-mail to vdf@azdvs.gov or faxed to
(602) 297-6687.
(2) Failure to include the requested information may have a negative impact on the evaluation of the
proposal.
B. Evaluation
(1) The proposal has three (3) attachments to be completed and submitted by the Grantee for evaluation.
Attachment One Certification and Authorization
Attachment Two Organization Information
Attachment Three Statement of Service (SOS) of Event/Program/Project
o This attachment identifies substantive and verifiable information about the proposed service event,
program, or project. The SOS must provide a clear and concise description of Grantee’s proposed
service of event, program, or project including how performance and completion of the proposed
service event, program or project, in compliance with the VDF Grant, would benefit Arizona
Veterans, and how it would specifically support and be compatible with Department objectives
determined by the Director. Grantee’s SOS shall include, at a minimum, the information requested
in Attachment Three. Please provide the information in the order presented in Attachment Three.
Attachment Four Budget Worksheet (template provided for use as needed by Grantee)
o This worksheet is being provided to Grantee for use. Spreadsheets of a similar format by Grantee
will also be accepted. Budget worksheets submitted should show line-item breakdown of all
revenue and expenses for which organization is applying for VDF grant.
o VDF Grant request revenue over expenses should equal zero.
o Administrative costs requested may not exceed 12.5% of total VDF grant request.
(2) VDF proposals submitted and accepted accordingly will be reviewed and considered according to the
VDF grant process and grant requirements under A.R.S. § 41-2702. Grantee’s completed Attachment
Three, as submitted and received, will be used as the basis to evaluate Grantee‘s proposal and
determine: (i) whether or not the proposed event, program, or project meets the minimum requirements
for grant award and (ii) award all, part, or none of the grant amount proposed.
C. Multiple Awards
In order that any ensuing VDF grant will allow ADVS to fulfill its objectives determined by the Director, ADVS
reserves the right to award available VDF grant money to multiple grantees during any given VDF grant year.
D. Costs of Grant Proposals
The State and ADVS as Grantor will not pay or reimburse for the costs of preparing and submitting any VDF
grant proposal. Applicant is responsible for all such costs.
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© Arizona Department of Veterans’ Services. All rights reserved. www.azdvs.gov
VDF Grant Contract Terms and Conditions and Scope of Work
1. Contract Terms and Conditions
A. Contract Amendments: Any change in this VDF Grant (the Contract), including its Scope of Work, shall only
be accomplished by a formal, written Contract Amendment, signed and dated by ADVS. Any such
amendment shall be within the scope of the Contract and shall specify the change; any increase or decrease
in Contract amount and the effective date of the change. The VDF Grantee expressly and explicitly
understands and agrees that no other method and/or no other document, including correspondence, acts and
oral communications by or from any person, shall be used or construed as an amendment to the Contract.
B. Term of Contract: The term of the Contract shall commence upon signature of Award of Grant and shall
continue for one (1) year, unless sooner terminated as provided below.
C. Termination: Notwithstanding anything contained in section B to the contrary, this Contract may be
terminated as follows:
(1) Mutual Contract. By mutual written agreement of the parties at any time.
(2) Without Cause. By either party, upon not less than (30) days prior written notice to the other party.
(3) Pursuant to subsection I, Availability of Funds for the Next State Fiscal Year or subsection J, Availability
of Funds for the Current State Fiscal Year.
D. Cancellation for Conflict of Interest. Pursuant to A.R.S. § 38-511, ADVS may cancel the Contract within
three (3) years after Contract execution without penalty or further obligation if any person significantly
involved in initiating, negotiating, securing, drafting or creating the Contract on behalf of ADVS is or becomes
at any time while the Contract or an extension of the Contract is in effect an employee of or a consultant to
any other party to the Contract with respect to the subject matter of the Contract. The cancellation shall be
effective when the Grantee receives written notice of the cancellation unless the notice specifies a later time.
E. Arbitration. The parties to the Contract agree to resolve all disputes arising out of or relating to the Contract
through arbitration, after exhausting applicable administrative review, to the extent required by A.R.S. § 12-
1518, except as may be required by other applicable statutes (A.R.S. Title 41).
F. Compliance with Applicable Laws. The materials and services supplied under the Contract shall comply
with all applicable Federal, state and local laws, and the Grantee shall maintain all applicable licenses and
permit requirements.
G. Non-Discrimination. The Grantee shall comply with State Executive Order No. 2009-09 and all other
applicable Federal and State laws, rules and regulations, including the Americans with Disabilities Act.
H. Suspension or Debarment Status. An Applicant who is currently debarred, suspended or otherwise lawfully
prohibited from any public procurement activity shall be rejected. If any such preclusion from participation
from any public procurement activity is currently pending, the Applicant shall fully explain the circumstances
relating to the pending preclusion in the application. The Applicant shall include a letter with the application
setting forth the name and address of the governmental unit considering the preclusion from procurement, the
possible effective date and duration of the suspension or debarment, and the relevant circumstances relating
to the pending suspension or debarment.
I. Availability of Funds for the Next State Fiscal Year. Funds may not presently be available for performance
under this Contract beyond the current state fiscal year. No legal liability on the part of ADVS for any payment
may arise under this Contract beyond the current state fiscal year until funds are made available for
performance of this Contract.
J. Availability of Funds for the Current State Fiscal Year. Should the legislature enter back into session and
reduce the appropriations or for any reason and these goods or services are not funded, ADVS may take any
of the following actions:
(1) Accept a decrease in grant amount offered by the Grantee;
(2) Cancel the Contract; or
(3) Cancel the Contract and re-solicit the VDF-RFGP.
K. Audit. Pursuant to A.R.S. § 35-214, all Grantee’s books, accounts, reports, files and other records relating to
performance and completion of the Contract shall be subject at all reasonable times to inspection and audit by
the State and/or ADVS and, where applicable, the Federal Government, at any time during performance of
the Contract and five (5) years after completion of the Contract. Grantee shall retain all such books, accounts,
reports, files and other records for five (5) years after completion of the Contract. Should the Grantee not
desire to retain the audit documentation in its entirety for a period of five (5) years from the date of the audit
report, they shall be given to the Arizona Auditor General for safekeeping.
L. Accounting Requirements. All Grantee’s books, accounts, reports, files and other records relating to
performance and completion of the Contract shall be prepared and maintained in accordance with Generally
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© Arizona Department of Veterans’ Services. All rights reserved. www.azdvs.gov
VDF Grant Contract Terms and Conditions and Scope of Work, continued
Accepted Accounting Principles. Grantee’s Contract financial records shall accurately record and track all
expenditures of VDF grant money to the Contract.
M. Advertisement Restrictions. Applicants will provide a copy of all printed or broadcast media or any other
materials developed using funds awarded under this VDF Grant to ADVS for approval. Media and/or printed
materials will adhere to the required wording as follows: Funded in part by the Arizona Department of
Veterans Services as made available through the Arizona Veterans’ Donations Fund. The ADVS logo should
be included on printed materials.
N. Indemnification. Grantee shall indemnify, defend, save and hold harmless ADVS, its departments, agencies,
boards, commissions, universities and its officers, officials, agents, and employees (hereinafter referred to as
“Indemnitee”) from and against any and all claims, actions, liabilities, damages, losses, or expenses (including
court costs, attorneys’ fees, and costs of claim processing, investigation and litigation) (hereinafter referred to
as “Claims”) for bodily injury or personal injury (including death), or loss or damage to tangible or intangible
property caused, or alleged to be caused, in whole or in part, by the negligent or willful acts or omissions of
Grantee or any of its owners, officers, directors, agents, employees or subcontractors. This indemnity
includes any claim or amount arising out of or recovered under the Workers’ Compensation Law or arising out
of the failure of such Grantee to conform to any federal, state or local law, statute, ordinance, rule, regulation
or court decree. It is the specific intention of the parties that the Indemnitee shall, in all instances, except for
Claims arising solely from the negligent or willful acts or omissions of the Indemnitee, be indemnified by
Grantee from and against any and all claims. It is agreed that Grantee will be responsible for primary loss
investigation, defense and judgment costs where this indemnification is applicable. In consideration of the
award of this Contract, the Grantee agrees to waive all rights of subrogation against the State of Arizona, its
officers, officials, agents and employees for losses arising from the work performed by the Grantee for the
State of Arizona. This indemnity shall not apply if the Grantee or sub-contractor(s) is/are an agency, board,
commission or university of the State of Arizona.
O. Federal Immigration Laws, Compliance by State Grantees. By entering into the Contract, the Grantee
warrants compliance with Federal Immigration and Nationality Act (FINA) and all other federal immigration
laws and regulations related to the immigration status of its employees. The Grantee shall obtain statements
from its subcontractors certifying compliance and shall furnish statements to the Procurement Officer upon
request. These warranties shall remain in effect through the term of the Contract. The Grantee and its
subcontractors shall also maintain Employment Eligibility Verifications forms (I-9) as required by the U.S.
Department of Labor’s Immigration and Control Act, for all employees performing work under the Contract. I-
9 forms are available for download from the U.S. Citizenship and Immigration Services Website.
P. Compliance. ADVS may request verification of compliance with the VDF Grant in any form and by any
manner from any Grantee or subcontractor performing work under the Contract. The Grantee or
subcontractor so requested shall provide such requested verification or verifications of compliance to ADVS.
Should ADVS suspect or find that the Grantee or any of its subcontractors are not in compliance, ADVS may
pursue any and all remedies allowed by law, including, but not limited to: suspension of work, termination of
the Contract for default, and suspension and/or debarment of the Grantee. All costs necessary to verify
compliance are the responsibility of the Grantee.
Q. Bond. ADVS as grantor may require Grantee to post a bond, satisfactory to ADVS, for performance and
completion of the VDF Grant.
R. Disbursement of VDF Grant Money. ADVS will disburse all available VDF grant money awarded under this
Contract in the form of check made payable to the Grantee named herein only.
S. Incremental Disbursements. ADVS, at its discretion as Grantor, may at any time during the term of this
Contract disburse available VDF grant money awarded in increments to be established by ADVS. ADVS may
require from Grantee proof of performance and completion, satisfactory to ADVS, of increment requirements
established by ADVS prior to disbursement or further disbursement of VDF grant money.
2. Scope of Work
A. Statement of Service. Grantee must submit a written Statement of Service (SOS) (see Attachment Three).
The SOS is a necessary and integral part of the Contract. Grantee’s SOS must tell ADVS:
(1) How the proposed event, program, or project will benefit Arizona Veterans and specifically support and
are compatible with ADVS’ objectives determined by the Director; and
(2) What Grantee intends to do with the grant money.
B. Budget. The VDF Grant Proposal must include a written budget for use and expenditure of the grant funds.
The budget must identify:
(1) Line Items;
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© Arizona Department of Veterans’ Services. All rights reserved. www.azdvs.gov
VDF Grant Contract Terms and Conditions and Scope of Work, continued
(2) Amount
expected to be expended for each Line Item;
(3) Expected date or dates of expenditures for each Line Item; and
(4) Expected completion date of each Line Item.
C. Deliverables. Grantee shall deliver the following to the Department:
(1) Prior to starting the project/program/event, the names and phone numbers of Grantee’s organization staff
who will perform and complete the event or project.
(2) Results
of the event, program, or project to include quantitative and other details on achievement of the
event, program, or project purpose and digital photos or other electronic media examples of results.
(3) Within 90 days of completion of the project/program/event, a written report of expenditures to include:
Cost statement, which must show and compare actual expenditures to expenditures projected in the
budget submitted with Grantee’s proposal; and
Explanation for differences between projected and actual Line Item expenditure amounts.
(4) Grantee must provide or be ready and able to show to ADVS all original written receipts or other written
and verifiable proofs of grant money expenditures that are acceptable to ADVS.
(5) Grantee must return to ADVS all VDF Grant money awarded that is not expended for the event, program,
or project purpose.
CI. Contract Completion. Completion of the Contract shall be determined by the entirety of the Contract.
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© Arizona Department of Veterans’ Services. All rights reserved. www.azdvs.gov
Attachment OneCertification and Authorization
Grantee hereby certifies, by signature in the Authorization section below: In accordance with A.R.S. § 35-393 et seq.,
the Grantee does not have scrutinized business operations in Iran; and in accordance with A.R.S. § 35-391 et seq., the
Grantee does not have scrutinized business operations in Sudan.
Grantee
’s Chief Executive Officer authorizes this VDF Proposal? Yes
No
An offi
cer of Grantee’s governing body (such as a board member) must sign this VDF Grant Proposal.
The undersigned, an authorized officer of the Grantee organization, does hereby certify that the information set
forth in this VDF grant proposal is true and correct; that the federal tax exemption determination is valid and the
present operation of the grantee organization and its current sources of support are not inconsistent with the
Grantee organization’s continuing tax exempt classification. Furthermore, monies provided under this VDF grant
will be used only for the proposed purpose. Misuse of monies or failure to provide the required reporting
documentation is, including but not limited to, cause for denial of any future grant request or proposal to ADVS.
Name (Print)
Title or Position
Signature
Date
Acceptance of Proposal and VDF Grant Award
(For ADVS Use Only)
1. By this notice, you, the applicant, are notified of the Department’s decision to either grant or decline, in whole or in
part, the funding as proposed by your written VDF proposal in response to ADVS Request for VDF Grant Proposal
$4,999.99 or Less as received, accepted, reviewed and considered by the Department.
The Department in whole accepts your proposal and grants money in the amount of $
for the Veterans’ services specified in the VDF-RFGP.
OR
The Department in part accepts your proposal and grants money in the amount of $
for the Veterans’ services specified in the VDF-RFGP limited to the following Veterans’ services:
2. If your proposal is accepted as described above, you are now bound to perform as Grantee based upon the VDF
Grant as granted above.
You are hereby cautioned not to commence any work or provide any material or service under this VDF Grant until you
receive a VDF Grant release document, or written notice to proceed, if applicable from the VDF Program Manager.
Award
ed this _______ day of _______________, 2019
_____________________________________________
ADVS Director
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© Arizona Department of Veterans’ Services. All rights reserved. www.azdvs.gov
Attachment TwoVDF Grantee’s Organization Information
Submit organization’s information as indicated below:
Attach and wholly incorporate additional sheets as necessary to respond to this Attachment Two.
Identify any such attachment as Attachment to Attachment Two.”
Identify, by its number below, each requirement responded to in the attachments.
1. Representative or Agent
Applicant is the Proposed Grantee that proposes to perform and complete the described event, program, or project and
Statement of Work for ADVS as Grantor.
OR
Applicant is the representative or agent for the Proposed Grantee that proposes to perform and complete the described
event, program, or project and Statement of Work for ADVS as Grantor.
If Applicant is a representative or agent of the Proposed Grantee, attach a true and full copy of the power of attorney or
other written instrument or instruments by which the Applicant is duly appointed as representative or agent for the
Proposed Grantee and which expressly states the authority and powers of the appointment.
2. Veterans Service Organization (VSO) Charter
Grantee is a VSO? Yes No If yes, chartered by:
(Chartering state or national VSO)
3. Grantee’s Form of Organization
Grantee’s Business Name:
Include: VSO post or chapter number and/or, if any, other organization designation, e.g.: Sole Proprietor / Co. / Inc. / LTD / LLC / Partnership, etc.
Street Address:
City:
ZIP:
Phone:
Fax:
Email:
Website:
State of Incorporation/Organization:
Date Incorporated/Organized:
Grantee is in good standing with its state of incorporation or organization? Yes No
4. Grantee’s Operations
Chief Staff Officer:
Contact Person:
Contact Person’s Email:
Phone:
Grantee’s fiscal year:
From Mo/Day
To Mo/Day
Total Operating Budget:
Past Year
Current Year
Grantee’s Staff:
Paid FT
Paid PT
Volunteers
Total Employees
Grantee’s EIN*:
___________________________
Federal Tax Exempt Status? Yes No
*Federal Employer Tax Identification Number If no, explain why not on attachment.
Has Grantee’s governing board approved a policy, which states that the organization does not discriminate as to age, race,
religion, disability, sexual orientation, sex or national origin?
Yes
No If Yes, when? ______________________
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© Arizona Department of Veterans’ Services. All rights reserved. www.azdvs.gov
Attachment Three Statement of Service Event/Program/Project
Complete the SOS below. Provide specific responses.
Attach and wholly incorporate additional sheets as necessary to respond to this Part Three.
Identify any such attachment as “Attachment to Part Three.”
Identify, by its number below, each requirement responded to in the attachments.
1. Veteran Service Event/Program/Project Proposed
Total VDF Grant amount proposed by Grantee for the Event/Program/Project:
$
Total Budget for the Event/Program/Project:
$
Event/Program/Project Title:
Description:
Location:
Event/Program/Project Dates:
To
Date(s) Funds are Required:
2. Target Arizona Veteran Population
Target veteran population:
Benefits to target veteran population from Event/Program/Project:
3. Grantee’s Plan for Event/Program/Project
Date Grantee began or will begin preparation for event/program/project:
How Grantee will involve target veteran population in planning of event/program/project:
How Grantee will involve the target veteran population in event/program/project:
What Grantee will do at and during event/program/project:
CY20 VDF Grant Proposal $4,999.99 or Less rev. 07/20 Page 13 of 13
© Arizona Department of Veterans’ Services. All rights reserved. www.azdvs.gov
Attachment Three Statement of Service Event/Program/Project, Continued
Who else will perform and complete event/program/project:
How Grantee will advertise event/program/project to target veteran population:
Date(s) when Grantee will advertise event/program/project:
4. Results
Describe how Grantee will show how the veteran population benefited from event/program/project proposed:
How Grantee will compare and show actual expenditure to proposed budget:
5. Mission and Qualification
Briefly describe Grantee’s service and support mission to veterans:
Briefly explain how grantee is qualified to perform and complete proposed event/ program/ project:
6. Event/Program/Project Funding Considerations
Total dollar amount Grantee needs for performance and completion of event/program/project:
$
Total dollar amount Grantee will request from other funders for event/program/project:
$
Please list other event/program/project funding sources here and dollar amount:
NAME
AMOUNT REQUESTED
$
$
$