Ethan Frome

GREAT SOUTHERN DEVELOPMENT COMMISSION

GREAT SOUTHERN REGIONAL GRANT SCHEME

FINAL ACQUITTAL REPORT

1.SUMMARY INFORMATION

Name of Organisation:

Organisation

Postal Address:

Details

Telephone: Fax: Email:

Contact Person: Position: Date:

General Project

Project Title:

Information

Description:

Total Project Cost

(Cash+ In-Kind)

(Excluding GST)

Funding from GSRGS

(Excluding GST)

Actual Project Commencement Date

Actual Project

Completion Date

$

$

Please ensure this tallies with information shown in tables 12 and 13 (Pages 9 and 10)

Forward completed forms to:

Great Southern Development Commission

PO Box 280, ALBANY WA 6331

Ph: 08 9842 4888 Fax: 08 9842 4828

Form available electronically by emailing gsdc@gsdc.wa.gov.au

PLEASE NOTE THAT INFORMATION PERTAINING TO THIS GRANT, INCLUDING THE GRANT RECIPIENT, AMOUNT OF GRANT AND THE PURPOSE FOR WHICH THE GRANT HAS BEEN GIVEN MAY BE ACCESSED BY THE PUBLIC OR TABLED IN PARLIAMENT.

CHECKLIST

As part of the State Government’s accountability and performance process, the Commission is required to undertake a full evaluation of how the grants provided from Royalties for Regions were utilised and what benefits were accrued from the project through the provision of those funds.

The final acquittal report is a condition of your Regional Grant Scheme (RGS) Grant Agreement as detailed in Schedule 2.

The intention of the acquittal is to compare the actual outcomes (e.g. economic, social, financial, environmental) to the original proposal. This includes project outcomes and benefits, and financial aspects such as the total project cost, other partners, various incomes, how the money was spent compared to the proposal. A financial report is required, as per points 2 and 3 of Schedule 2 of the Grant Agreement, to ensure that government funds have been appropriately expended and that all conditions of the grant have been met.

Please make sure the following items have been addressed, completed or provided, otherwise the acquittal will either be returned or you will be requested to provide the additional information.

Have you:

|_|Completed the acquittal document signed by the appropriate people?

|_|Completed and attached the Statement of Income and Expenditure for the Project and had it signed by the appropriate people?

|_|Checked you reported on each objective as detailed in original application?

|_|Attached Audited Financial Statements for the Project if specified in your grant agreement?

|_|Referred to Schedule 2 of the Grant Agreement to confirm that all of the appropriate documentation including milestone reports has been provided, such as copies of media promoting the project and indicating the WA Government and Great Southern Development Commission’s support and logo, reports, photos etc?

Please contact the Grants Coordinator or the relevant Development Officer at the Commission should you be have any queries about this process. Please refer to front page for contact details.

2.PROJECT BACKGROUND

Give a brief overview of the project.

3. PROJECT AIMS, BENEFITS AND OBJECTIVES – GENERAL

Describe the following:

· How effective has the project been in achieving the aims and objectives as detailed in your Grant Application in section 3.1 and 3.2?

· Did any new aims and objectives emerge during the project’s development? Please detail.

4. PROJECT AIMS AND OBJECTIVES – ROYALTIES FOR REGIONS

How has the project met the Royalties for Regions Scheme objectives, as stated in your GSRGS Application under the heading 5.3? Please tick the ones that apply to your project and explain in detail how they have been met.

|_| Increase capacity for local strategic planning and decision-making.

|_| Retain and build the benefits of regional communities.

|_| Promote relevant and accessible local services.

|_| Assist communities to plan for a sustainable economic and social future.

|_| Enable communities to expand social and economic opportunities.

|_| Assist regional communities to prosper through increased employment opportunities, business and industry development opportunities, and improved local services.

5. PROJECT AIMS AND OBJECTIVES – GREAT SOUTHERN DEVELOPMENT COMMISSION STRATEGIC PLAN

How has the project contributed to the Great Southern Development Commission’s regional development strategic planning and other relevant existing regional planning as stated in your GSRGS Application under the heading 5.5? Please tick the ones that apply to your project and outline how they have been met.

6. PROJECT SUSTAINABILITY

Describe how the project will be sustained and/or further developed in the future?

7. PROJECT PARTNERSHIPS

Describe any partnerships formed during the project with the business sector, general community, or the various levels of Government.

8. PROJECT JOB OPPORTUNITIES

a) During the project phase, did the project result in any job opportunities in the region? If yes, please give the number and a description of the job opportunities in the following table.

No. of Jobs

Type of Job (position, trade, and whether fulltime, casual, part time, contract etc)

No of FTE*s

Location of Position(s)

b) Did the project result in any new ongoing jobs in the region? If yes, please give the number and a description of the job opportunities in the following table.

No. of Jobs

Type of Job (position, trade, and whether fulltime, casual, part time, contract etc)

No of FTE*s

Location of Position(s)

*An FTE (full time equivalent) is the hours worked by one employee on a full-time basis. The concept is used to convert the hours worked by several part-time employees into the hours worked by full-time employees. On an annual basis, an FTE is considered to be 1,950 hours, which is calculated as: 7.5 hours per day x 5 work days per week x 52 weeks per year = 1,950 hours per year.

9. REPORT ON THE GREAT SOUTHERN DEVELOPMENT COMMISSION’S DISABILITY ACCESS AND INCLUSION PLAN (this document is available at www.gsdc.wa.gov.au )

To what extent did your project address the needs of people with disabilities?

1. Were people with disabilities given the same opportunities as other people to access the services and events? If yes, please explain how.

2. Were people with disabilities given the same opportunities as other people to access the buildings and other facilities? If yes, please explain how.

3. Were people with disabilities given information relating to the project in a format that enabled them to access the information as readily as other people were able to access it? If yes, please explain how.

4. Were people with disabilities given the same level and quality of service as other people? If yes, please explain how.

5. Were people with disabilities given the same opportunities as other people to make complaints? If yes, please explain how.

6. Were people with disabilities given the same opportunities as other people to participate in any public consultation? If yes, please explain how.

7. Were people with disabilities given the same opportunities as other people to obtain and maintain employment as part of the project (where applicable). If yes, please explain how.

10. REPORT ATTACHMENTS

Please include attachments for the following:

· Evidence of acknowledgement and use of logos, promotional material, publications, media etc;

· Any reports, research or documents as a result of the project;

· Photos which detail progress or change of a project; and

· Any other information which may be relevant e.g. compliance with special Grant Agreement conditions.

11. OBLIGATIONS

The Financial Management Act 2006 requires evidence showing grant funds were expended in accordance with the approved application and grant agreement made with the Great Southern Development Commission.

Please ensure that all requirements for financial obligations detailed in the grant agreement have been complied with and supplied. This includes the Audited Financial Report with the Final Acquittal Report.

Please refer to additional information in the Checklist on page 2 of this document.

12. INCOME AND EXPENDITURE

Please complete the table below or attach an income and expenditure report for your project

INCOME - CASH

Actual amount received

$ GST Exclusive

$ GST

RGS Grant Funding

Your Cash Contribution

Other Funding (list below, add more rows as required)

TOTAL CASH INCOME

EXPENDITURE - CASH

Actual amount spent

$ GST Exclusive

$ GST

Detail Items funded through Great Southern Regional Grant Scheme

(As per Grant Agreement, please list below, add more rows as required)

Detail Items funded through your cash contribution

(add more rows as required)

Detail Items funded through other cash contributions

(add more rows as required)

TOTAL CASH EXPENDITURE

13. IN-KIND CONTRIBUTION

Please provide details as to how any in-kind contributions have been calculated and acquitted.

IN-KIND

Actual In-Kind

Subtotal

$ Value (ex GST)

Specify how In-Kind contribution was calculated (attach evidence if appropriate)

Detail in-kind items contributed by your organisation

(add more rows as required)

Detail in-kind items contributed by other sources

(add more rows as required)

TOTAL IN-KIND VALUE

14. ECONOMIC BENEFIT – LOCAL/REGIONAL/STATE/OTHER

Please provide estimates of project spend across the following areas…

Estimate of CASH spent on goods and services purchased in the following categories

$

%

In your Local Government (LG) area

Outside the LG area but within the Great Southern Region#

Outside the Great Southern Region but within Western Australia

Outside Western Australia

TOTAL

100%

# The Great Southern Region comprises the City of Albany and the Shires of Broomehill-Tambellup, Cranbrook, Denmark, Gnowangerup, Jerramungup, Katanning, Kent, Kojonup, Plantagenet and Woodanilling.

Great Southern Regional Grants Scheme Final Acquittal Form – Page 11

Great Southern Regional Grants Scheme Final Acquittal Form – Page 7

15. BUDGET

Please review the budget as at attachment A in your project’s Grant Agreement and compare it to the project’s final income and expenditure report.

Select the correct statement from the following two:

|_|

I declare that the project’s final income and expenditure report and in-kind contributions above match the budget as declared in Attachment A of the project’s Grant Agreement.

|_|

I declare that the project’s final income and expenditure report and in-kind contributions above have varied from the budget as declared in Attachment A to the project’s Grant Agreement.

If you select this statement please explain in the space overleaf the reason for the variation(s).

Explanation of budget variation…

16. DECLARATIONS

I _____________________________ of ___________________________________

do hereby declare that the information provided in this report is a true and correct record of the acquittal of funds received through the Great Southern Regional Grant Scheme for the project as described.

Signed by …………………………..…….. this …….….. Day of ……………..…….. 20…..

(Chief Executive Officer/Chairperson or equivalent)