Grant Applicant Guide

Bosnia-Herzegovina Growth-Oriented Local Development Project (GOLD)
GRANT APPLICANT GUIDE

BOSNIA AND HERZEGOVINA GROWTH-ORIENTED LOCAL DEVELOPMENT (GOLD)
PROJECT
Grant Applicant Guide

Project Name: Growth-Orientated Local Development (GOLD) Project in Bosnia and
Herzegovina
Sponsoring USAID Office: USAID/Sarajevo
Contract Number: AID-168-C-13-00001
Contractor: Deloitte Consulting LLP
Date of Publication: July 31, 2014

Disclaimer
The authors views expressed in this publication do not necessarily reflect the views of USAID or the United
States Government.
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Table of Contents

1. Introduction ...................................................................................................................... 5
2. Summary of USAID Sida GOLD Project Grants Program ......................................... 5
1.1 Goals ...................................................................................................................................... 5
1.2 General Approach ................................................................................................................ 5
1.3 Special Considerations ......................................................................................................... 6
1.4 Available Funding ................................................................................................................ 6
1.5 Focal Areas ............................................................................................................................ 6
3. Types of Grants ................................................................................................................. 7
4. Announcements of Grant Opportunities ........................................................................ 7
5. Eligibility Requirements .................................................................................................. 8
5.1. Eligible Recipients ..................................................................................................................... 8
5.2. Ineligible Recipients ................................................................................................................... 9
5.3. Eligible Activities ..................................................................................................................... 10
5.4. Ineligible Activities and Unallowable Costs .......................................................................... 10
5.5. Cost Sharing ............................................................................................................................. 12
6. Applying for Funding ..................................................................................................... 12
6.1. Grant Concept Papers ............................................................................................................. 12
6.2. Grant Applications .................................................................................................................. 13
6.3. Unsolicited Requests ................................................................................................................ 14
6.4. Evaluations ............................................................................................................................... 14
6.5. Pre-award Survey .................................................................................................................... 15
6.6. Approval by USAID ................................................................................................................ 15
7. Award / Terms and Conditions ..................................................................................... 16
8. Project Contact Information ......................................................................................... 16
Annexes .................................................................................................................................. 17
Annex 1: Grant Concept Paper Form ........................................................................................... 18
Annex 2: Grant Application Form and Guidelines ..................................................................... 24
Annex 3: Pre-Award Survey (for Standard Grants) ................................................................... 60
Annex 4: FOG Entity Eligibility Checklist (for Fixed-Obligation Grants) ............................... 67
Annex 5: Grant Presentation Template ........................................................................................ 69

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List of Acronyms and Abbreviations

Acronym Definition
ADS Automated Directives System
APS Annual program Statement
BiH Bosnia and Herzegovina
COP Chief of Party
DEC Development Experience Clearinghouse
FOG Fixed Obligation Grants
GOLD Project Growth-Oriented Local Development Project
NGO Non-Governmental Organization
RFA Request for Application
Sida Swedish International Development Cooperation Agency
TEC Technical Evaluation Committee
USAID United States Agency for International Development
USD United States Dollar

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1. Introduction

Deloitte Consulting LLP (Deloitte), under a contract with USAID, executes grants for the USAID
Sida GOLD Project, implemented by Deloitte and jointly funded by the United States Agency for
International Development (USAID) and Swedish International Development Cooperation Agency
(Sida). This Grant Applicant Guide provides general information and guidance for organizations
interested in applying for a grant under the USAID Sida GOLD Project, including types of grants, types
of organizations eligible to receive grants, types of activities that will be considered for grant support,
budgetary considerations, grant application options, and key conditions of a grant award.

It is important that potential applicants understand that final approval of grant awards come from
USAID; as an agency of the US Government, there are a number of terms and conditions with which
any Recipient will have to comply. Applicants will be carefully evaluated during the application process
on whether they are able to comply with these conditions.
2. Summary of USAID Sida GOLD Project Grants
Program
1.1 Goals
The USAID Sida GOLD Project Grants Program aims to complement, disseminate, promote, and
support the tools and approaches developed by the other Project activities in order to increase the level
of economic activity in selected localities in BiH with a focus on high growth opportunity, potential for
investment, and high-value job creation. The main goals of the USAID Sida GOLD Grants Program are
to i) provide a source of flexible funding in support of the Project objectives/components, and ii) fund
or cost-share specific discretionary items that can lead to increase in overall economic growth and
development.
1.2 General Approach
Grants to local partners are a critical aspect of the USAID Sida GOLD Project and one of the main tools
for reaching the Project objectives and results. The USAID Sida GOLD Project Grants Program will
fund result-oriented activities that contribute to the four main Project objectives:
1. Improved Local Economic Management Capacity
2. Improved Economic Tools for Economic Activity
3. Functioning, Sustainable, Transparent, Institutionalized Mechanisms for Engaging Public and
Private Sector Actors
4. Strengthened Capacity of the Private Sector.
Activities funded through grants should focus on the following key impact indicators:
1. Creating new jobs;
2. Increasing the amount of foreign direct and direct investment;
3. Increasing the amount of sales/revenues; and
4. Increasing the amount of exports.
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While the grants may be awarded to support projects implemented in other localities, preference will be
given to funding activities that support the following USAID Sida GOLD Project partner
cities/municipalities/district: Banja Luka, Biha, Bijeljina, Bilea, Bosanska Krupa, Brko Distrikt,
Buim, Cazin, Centar Sarajevo, apljina, itluk, Doboj, Gorade, Graanica, Gradaac, Gradika,
Ilida, Istona Ilida, Istono Novo Sarajevo, Konjic, Kotor Varo, Laktai, Lopare, Lukavac, Ljubuki,
Mrkonji Grad, Nevesinje, Novi Grad Sarajevo, Novo Sarajevo, Pale, Prijedor, Sanski Most, Stari Grad
Sarajevo, Srebrenik, iroki Brijeg, Tesli, Teanj, Tomislavgrad, Trebinje, Tuzla, Ugljevik, Velika
Kladua, Visoko, Vogoa, Zenica, Zvornik and ivinice. In addition, USAID Sida GOLD Project will
cooperate with and provide assistance to the private sector in the city of Mostar.
The USAID Sida GOLD Project will introduce a private investment approach to the Grants Program as
one of its implementing principles, with specific cost-sharing targets. Grants will therefore be
strategically geared to priming the pump, helping to make markets, and leveraging pre-existing
commitments wherever possible. As part of its overall implementation approach, the USAID Sida
GOLD Project will be working on creating linkages of variety of funding facilities, including
Government-to-Government (G2G) incentive fund and Development Credit Authority (DCA)
commercial funding mechanism. In order to create synergies, Grants Program will aim to support
activities complementary to those supported through these funding mechanisms.
In order to avoid overlapping and duplication of efforts and market distortion, Grants Program will take
into account the existing and the anticipated donor-funded grant initiatives, in particular those targeted
to the private sector. This is also expected to help creating synergies and increasing program
additionality.
1.3 Special Considerations
Extra attention will be paid to ensuring grants do not inadvertently undermine private sector activity or
create distortion in the local market by providing financial assistance to selected
organizations/companies. Grantees will be required to identify concrete mitigation measures and
activities to address any potential market distortion that may be created through specific grant activities.
Along with this overarching approach, the Grants Program will also help to achieve cross-cutting results
through dissemination of best practice, strong emphasis on youth involvement and womens economic
empowerment, as well as research, and training and policy advocacy.
1.4 Available Funding
The USAID Sida GOLD Project Grants Program is budgeted to USD 3.5 million. It will be implemented
through several rounds through full and open competition, during the period from 2014-2017. The
maximum amount of individual grants awarded under USAID Sida GOLD Project is USD 100,000.
Grant concept papers and applications with the budget lower than USD 5,000 will not be taken into
consideration.
1.5 Focal Areas
The total USD 3.5 million budget available for the Grants Program will be used to support activities in
three broad focal areas, each with different targeted recipients, aims, and expected results, as follows:
Municipal Development: Activities funded through grants will focus on supporting Public-
Private Partnerships (PPPs), training and information dissemination, certifications, and other
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activities that contribute to developing a municipalitys overall ability to attract investment and
jobs;
Business Development: Activities funded through grants will focus on business expansion,
innovation, and export enhancement among others;
Workforce Development: Activities funded through grants will focus on developing on-demand
workforce skills and increased employment capacity to fill the jobs of the future.

Distribution of the Grants Program budget and the number of grants awarded across the three focal areas
will depend on the quality of project proposals and their potential to achieve the maximum impact on
the USAID Sida Project goals, focusing on creating new jobs, increasing sales, revenues, exports and
investment.
3. Types of Grants
USAID Sida GOLD Project considers awarding three types of grants: standard grants, fixed-obligation
grants (FOGs), and in-kind grants. Selection of grant types will be made based on specific goals the
USAID Sida GOLD Project aims to achieve and the context in which the grant activities are to be
implemented. Table 1 summarizes types of grants, their purposes and time limits.
Table 1: Types of Grants
Grant Type Grant Purpose
Maximum Time
Limit
Standard
Grants
Provide funding for Recipients activities consistent with both
Recipients and USAID Sida GOLD Project objectives, and that
contribute to the Recipients growth and sustainability as part of its
long-range plan. Disbursement is made periodically for reimbursement
of costs generated by the Recipient, and depends on the conditions
stated in the Grants Award.
TBD, not to exceed
Dec 31, 2017.
Fixed
Obligation
Grants
(FOGs)*
Provide a fixed amount of funding as grant recipient achieves each part
of a fixed set of grant activity benchmarks/milestones. Disbursement is
made based on the verified completion of these
benchmarks/milestones.
Up to 3 years, not
to exceed Dec 31,
2017.
In- Kind
Grants

USAID Sida GOLD Project uses grant funding to procure tangible
assets for grantees.

TBD, not to exceed
Dec 31, 2017.
* When used appropriately, a FOG provides several advantages for both the USAID Sida GOLD Project and the recipient. It focuses on outputs
and results, limits risk for both parties, and requires only limited financial and management capacity. Appropriate activities for FOGs include,
but are not limited to: Conferences; Studies; Surveys; Workshops; Policy papers; Disaster or humanitarian relief and assistance and/or
Technical development assistance when costs can be segregated by milestones. In preparing for the FOG Applications, the applicant must
provide sufficient cost information for the USAID Sida GOLD Project to negotiate milestones as well as ensure that the total FOG award
amount is a reasonable and realistic indication of the actual cost of the effort. A thorough and reasonable cost analysis of the activity is
critical to the successful use of the FOG mechanism.
4. Announcements of Grant Opportunities
USAID Sida GOLD Project will solicit grantees through full and open competition, using Annual
Program Statement (APS) and Request for Applications (RFA) as the grant solicitation mechanisms:
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Annual Program Statement (APS): Each year, the USAID Sida GOLD Project may announce
its overall expected program of activities for the coming period. Organizations may wish to use
APSs to evaluate their own plans for the period to determine if there is an overlap.
Requests for Applications (RFAs): USAID Sida GOLD Project may compete grant
opportunities through a Request for Applications in cases where grant program goals and
activities are expected to be very specific. The Project, based on selection criteria approved by
USAID and Sida and subject to other considerations, will evaluate grant applications and
propose potential grant recipients to USAID for its approval.

In both cases, organizations are reminded that grant concepts should track closely to the USAID Sida
GOLD Projects stated goals and objectives as outlined in Section 2.

All grant opportunities will be announced at USAID Sida GOLD Project web page
(http://goldproject.ba). In addition, USAID Sida GOLD Project will advertise in the most significant
local newspapers and/or through other applicable means of outreach that target a wide, relevant
audience. The announcement will generally describe the purpose and focus of the grant program,
eligibility requirements, the timeline and process, criteria against which submissions will be evaluated,
and where to find additional information.

Informational training sessions for potential grantees will be conducted in selected localities following
the announcement of specific solicitation, to ensure maximum reach within the community. The aim of
these sessions is to present the goals and expected outcomes of the Grants Program and specific
solicitation, as well as to explain in details the grants award process to interested organizations.

Announcement of grant opportunities does not constitute any award promise or commitment on the part
of USAID Sida GOLD Project, Deloitte (or any member of Deloitte Touche Tohmatsu Limited, or any
of their affiliates), or USAID and Sida, nor does it commit USAID Sida GOLD Project; Deloitte (or any
member of Deloitte Touche Tohmatsu Limited, or any of their affiliates), or USAID and Sida to pay for
any costs incurred in the preparation and submission of a grant application or concept paper. All costs
associated with the preparation and submission of any concept paper or grant application, as well as any
other pre-award grant costs, are the applicant's responsibility and expense
5. Eligibility Requirements
Eligibility Criteria will be included in individual Annual Program Statements and Requests for
Applications. There are three sets of general eligibility criteria, relating to:
Organizations that are eligible to apply for a grant;
Types of projects and activities eligible for support;
Budget and cost share considerations.
5.1. Eligible Recipients
Eligible recipients for USAID Sida GOLD Project grants are non-U.S. organizations, either for profit or
nonprofit, legally established in BiH. In general, the following types of organizations may be eligible to
apply for grants:
Local or regional independent, for-profit, or nonprofit organizations and companies;
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Municipal, Professional and Business associations and other membership entities including
RDAs
1
; and
Local or regional academic institutions, including state-sponsored universities (if their charters
allow the receipt of grant funds).
Institutions that receive government funding may still be eligible for grants through this program, as
long as they are non-governmental organizations and not founded by the government as per the
organizations charter. Only eligible organizations that meet the following additional conditions may
receive a grant:
The organization must have demonstrated experience in technical areas relevant to the scope of
work or grant focus;
The organization must have been in existence for more than three years
2
;
The organization must currently be implementing activities in the geographic area or technical
area for which it is submitting an application;
The organization has minimum absorptive capacity as demonstrated by past performance;
The organization has a functional financial management system;
The organizations other relationships, partnerships, activities, and interests do not create a
conflict of interest that could prevent full impartiality in implementation of the grant activities;
Effective October 1, 2010, Data Universal Numbering System (DUNS) numbers are required
for all organizations, foreign or domestic doing business with the Federal Government.
Recipients of grant awards in excess of $25,000 will be required to obtain a Data Universal
Numbering System (DUNS) Number.

Specific eligibility criteria will be outlined with each solicitation issued under the USAID Sida GOLD
Project Grants Program. Such specific criteria will be determined based on specific activities to be
funded and specific objectives to be achieved through specific solicitation.
5.2. Ineligible Recipients
Ineligible for USAID Sida GOLD Project grants are the following:
Individuals;
Governmental organizations, entities or officials (whether from national, regional, district, local
or municipal levels, etc.), or organizations and entities owned or founded by the Government;
Political parties, organizations and associations, and their affiliates;
Religious-based organizations whose proposed grant activities have religious purposes and are
inconsistent with the USAID Sida GOLD Project objectives.

Organizations associated with terrorism or otherwise precluded from receiving U.S. Government
funding will not be eligible for grants. If an organization or its key personnel, shareholders, directors or
partners appear on any of the following lists, it is automatically ineligible to receive a grant:
Specially Designated Nationals and Blocked Persons, which list is maintained by the U.S.
Treasury's Office of Foreign Assets Control (OFAC) and is available online at OFAC' s
website: http://sdnsearch.ofac.treas.gov/ and
Department of State: http://www.state.gov/j/ct/list/index.htm:
o Foreign Terrorist Organization List (FTO)

1
If an RDA applying for grant is majority owned by the Government, USAID waiver will be required.
2
If applicable, a start-up funding will be provided through a recipient organization that has the requisite
experience and financial processes to administer the funding.
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o Exclusion List (TEL):
o Executive Order 13224:
Terrorism Designation Page: http://www.state.gov/j/ct/rls/other/des/index.htm
Excluded Parties List System: http://www.sam.gov.
United Nations Consolidated List (Resolution 1267):
http://www.un.org/sc/committees/1267/narrative.shtml

In addition, the following organizations will not be eligible to receive USAID Sida GOLD Project
grants:
Organizations whose objectives are not consistent with the broad objectives of the USAID Sida
GOLD Project;
Organizations that are not legally registered;
Organizations that have misused the USAID or Sida funds in the past;
Organizations that refuse to sign the necessary certifications;
Organizations that advocate, promote or accept anti-democratic political opinions and illegal
activities;
Organizations that do not meet applicable requirements or specific eligibility criteria defined
under individual USAID Sida GOLD Project solicitations will not be eligible for grants under
these solicitations.

5.3. Eligible Activities
Grant activities eligible for funding will be defined in individual grant solicitation. Only grant activities
that contribute to the stated objectives of the USAID Sida GOLD Project target areas and the main
impact indicators (including number of new jobs created, increased investment, sales, revenues and/or
exports) will be considered for funding. Grants selected for award must demonstrate clear and
achievable objectives, clear and measurable outcomes that focus on USAID GOLD Project impact
indicators, a realistic work plan, and an acceptable timeline within the stated periods.

An organizations proposed grant activities should tie closely to the organizations own overall mission
and strategy and advance its key objectives or should be complementary to the work implemented by
the organization for other programs and projects with similar to USAID Sida GOLD Project goals.
Finally, proposed activities under a grant should be reasonably supported by the applicants existing
organizational capabilities.
5.4. Ineligible Activities and Unallowable Costs
Activities that are not eligible for grant funding include, but are not limited to:
Promotion of political parties or candidates or elected officials on a political platform, religion,
or lobbying;
Religious events or activities that promote a particular faith;
Fundraising;
Revolving credit funds;
Law enforcement activities;
Distribution of emergency/humanitarian assistance or funds;
Reconstruction or building rehabilitation projects that are not accompanied by plans for wide
community use and maintenance;
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For-profit business activities that benefit a small select group, rather than providing increased
opportunities to the larger community;
Activities that pose unacceptable environmental threats and for which an adequate
Environmental Mitigation and Monitoring Plan cannot be developed to eliminate these effects
and alternatives are not feasible;
Activities that demonstrate potential negative impact on well-being of certain categories, such
as women or youth;
Activities that pose market distortion effects and for which appropriate market distortion
mitigation strategy cannot be developed.

The following costs will not be allowable and not reimbursable costs under a grant:
Creation of endowments;
Any commodity which does not comply with or which is not procured in a manner that
complies with the U.S. Government procurement procedures and regulations;
Any previous obligations by USAID to the recipient;
Bad debts of the recipient;
Fines imposed on the recipient;
Penalties imposed on the recipient;
Alcoholic beverages and any expenses related to representation, entertainment, ceremonies,
parties, and celebrations;
The purchase of any goods restricted and prohibited under USAID regulations;
Any expenses related to purchases or activities which are illegal under the BiH laws;
The purchase of surveillance equipment, military equipment or arms, whether new or surplus,
police or law enforcement equipment, abortion equipment and services, weather modification
equipment, fertilizers, luxury goods, and gambling equipment;
Any expenses related to purchases or activities which are illegal under BiH or U.S. law;
For FOGs: recurrent operational costs of the recipient, construction activities, and purchase of
any real property;
International travel (international travel is allowed only with prior USAID approval e.g., for
study tours; and only when part of a milestone);

No value-added tax (VAT) costs will be reimbursed under any circumstances under grants. USAID Sida
GOLD Project will not pay VAT costs to grant recipient and these costs will be covered by grant
recipient out of its own funds.

Sub awards will not be allowed under USAID Sida GOLD Project Grants Program. Subaward means
an award of financial assistance to carry out the purposes of the program in the form of money, or
property in lieu of money, made under an award by a recipient to an eligible subrecipient or by a
subrecipient to a lower tier subrecipient. The term includes financial assistance when provided by any
legal agreement, even if the agreement is called a contract. A subaward does not include a procurement
contract for commodities or services.
The following costs are restricted by USAID and require prior approval from Deloitte and USAID:
agricultural commodities;
motor vehicles;
pharmaceuticals;
pesticides;
fertilizer;
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used equipment; and
U.S. Government-owned excess property.

5.5. Cost Sharing
To be eligible for a grant award under the USAID Sida GOLD Project Grants Program, applicants will
be expected to demonstrate they are sharing the costs of the program activity for which they are
requesting funding. The minimum cost share requirement for all grants awarded under USAID Sida
GOLD Project Grants Program is 50% of the total budget of grant activity being covered by the cost
share. Higher cost share may be required through specific solicitations. Cost share contribution may be
financial or in-kind (in form of goods or services) and include costs incurred by the recipient from its
own funds, or project costs financed with cash, services or property contributed or donated to the
recipient from other non U.S. Government sources. In-kind contributions that would be acceptable if
not reimbursed may include donated office space, volunteer time dedicated exclusively to the activities,
supplies and materials, media time focused on the program activities, vehicle costs, and equipment and
other property.

All costs shared by the applicants (both financial and in-kind) must be:
o verifiable from the recipients records;
o necessary and reasonable for proper and efficient accomplishment of grant activity
objectives;
o allowable under the applicable Mandatory Standard Provisions
o must not be included as cost share contributions for any other U.S. Government
assisted program;
o must not be paid by the U.S. Government under another grant or agreement (unless the
grant or agreement is authorized to be used for Cost Share).

Applicants and grant recipients will be required to sufficiently document both, financial and in-kind cost
share contribution. Fulfilment of cost share commitments by grant recipients will be monitored on an
ongoing basis by the USAID Sida GOLD Project.
6. Applying for Funding
An organization may submit a response to one of the grant opportunity announcement mechanisms
described in Section 4. An organization may also submit an unsolicited request for grant funding. Grant
opportunity announcements will contain detailed information about the type of response expected from
interested organizations, as summarized below, as well as the information about the submission process.
6.1. Grant Concept Papers
When APS is used as grant solicitation mechanism, potential recipients will be asked to first submit a
concept paper for USAID Sida GOLD Project review and feedback. Organizations that submit the most
successful concept papers may be invited to develop a full grant application. Developing a concept paper
provides potential Recipients with the opportunity to define and refine their thinking about the proposed
project or activity and provides the USAID Sida GOLD Project with an opportunity to see how well the
concept aligns with its key objectives and expected results.
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Concept papers should be short - generally not more than five pages. Ideas should be clear, concise, to
the point and should provide an overview of what is planned, who will benefit, the results expected.
Concept paper should also provide a notional estimate of the proposed budget linked to the components
of activities planned, or project milestones. This summary will form the basis of the grant application
should the potential recipient be invited to the next stage. Concept paper will include the following
sections:
1. Information about the applicant;
2. Technical proposal:
a. Problem analysis/statement of need
b. Goals and objectives of grant activity
c. Approach to grant activity (including gender and youth considerations, market
distortion and environmental issues)
d. Beneficiaries
e. Expected results and verifiable indicators of achievement of these results along
with the indication of their targets, including as a minimum the USAID Sida
GOLD Project indicators of new job creation, sales/revenues, investment and
export increase
f. Sustainability
g. Activity plan/overview of the main project milestones and proposed timeframe;
3. Budget summary and cost share.

The suggested Concept Paper outline above is designed to assure that key points have been covered.
This summary will form the basis of the grant application should the potential Recipient be invited to
the next stage producing a full grant application. Applicants are required to submit concept papers
using the Concept Paper Form with guidelines provided in Annex 1.
6.2. Grant Applications
When RFA is used as grant solicitation mechanism, applicants will be asked to submit a full grant
application. Also, organizations whose concept papers are considered to be most successful may be
asked to submit a full grant application. A full grant application should explain in greater detail what
the organization proposes to do under the grant and how. The application package should include the
following:
Grant Application Form consisting of a cover letter and the following attachments:
Technical Proposal (not more than 10 pages, excluding the summary sheet)
Budget and Budget Notes
Information about Applicant
Certifications and Assurances from Applicant, including:
o Assurance of Compliance with Laws and Regulations Governing Non-
Discrimination in Federally Assisted Programs
o Certification Regarding Lobbying
o Prohibition on Assistance to Drug Traffickers for Covered Countries and
Individuals (ADS 206)
o Certification Regarding Terrorist Financing, Implementing Executive
Order 13224
Annexes to Grant Application Form, including:
Grant Activity Implementation Plan
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Monitoring and Evaluation Plan, if applicable
Information of Previous Assistance Awards/Contracts
Data supporting cost estimates
Documents Demonstrating Applicants Eligibility and Capabilities (including the
minimum organizations registration documents and the most recent financial
statements for the past three years, as applicable)
Completed Environmental Self-Assessment Form
Survey on Ensuring Equal Opportunities to Applicants (optional, upon
Applicants Request)

Applicants are required to submit grant applications using the comprehensive grant application package
(Grant Application Form with detailed guidelines and required certifications) provided in Annex 2.
6.3. Unsolicited Requests
Those organizations that wish to request grant funding without waiting for a specific announcement may
do so at any time. However, USAID Sida GOLD Project suggests that, in such a case, the organization
submit a concept paper, without investing the time and expense necessary to submit a full application.
This will allow the USAID Sida GOLD Project to determine if the concept fits within the objectives of
its Grants Program. Unsolicited requests should be sent in electronic form to the USAID Sida GOLD
Project Grants Manager. Typically unsolicited requests are evaluated during the next available review
cycle but may be held until later if the subject matter deals with an upcoming announcement. Either
way, the USAID Sida GOLD Project will inform the organization of the status and ultimate decision.
6.4. Evaluations
All submissions will be reviewed to check for eligibility and completeness of the submission. All eligible
and complete submissions will be reviewed by USAID Sida GOLD Project Technical Evaluation
Committee (TEC). TEC will evaluate eligible submissions against the evaluation criteria specified in
grant solicitation (APS, RFA or invitation for submission of grant application). TEC will adhere to a
number of guidelines and processes agreed with USAID and Sida to avoid potential conflicts of interest
and lack of transparency, and to support fair, objective, and consistent review of all concept papers and
applications.

After a submission has been reviewed and evaluated, the USAID Sida GOLD Project Grants Manager
will notify the organization of the decision. Submissions that are not selected for funding may not be
revised and resubmitted. Submissions recommended for funding must be finalized and all review
comments and questions must be addressed to the satisfaction of the TEC. Applicants may be required
to provide additional information and certifications and other statements to ensure the organization has
adequate management and financial systems in place and is otherwise a responsible organization.
Possible recommendations to applicant and conditions for grant award are summarized in Table 2.

Table 2: Possible Recommendations / Conditions for Grant Award
Possible recommendations may include: Possible conditions may include:
Fully fund the project
Partially fund the project
Fully fund the project, with conditions
Partially fund the project, with
conditions
Not fund the project
Grants management technical assistance before or
during the period of the grant
Amendments to technical areas of the grant activity
Amendments to the grant activity budget
Requirements for additional information prior to the
start of the grant agreement
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Any other conditions deemed necessary

The Grants Manager and other relevant USAID Sida GOLD Project staff will work with applicants to
reasonably facilitate the grant application process and educate the applicants on grant compliance
requirements before the grant is awarded. The Grants Manager will report to the Project Chief of Party
(COP) on this compliance.

6.5. Pre-award Survey
A due diligence review of the applicant organization is performed as part of the evaluation process. The
USAID Sida GOLD Project will ask applicants for standard grants to complete a pre-award survey (see
Annex 3) so that the USAID Sida GOLD Project may assess whether a potential recipient is able to
successfully comply with the financial, management and programmatic requirements of the grant. The
potential recipient should be a registered entity and should have an accounting and management system
that allows it to produce both accurate and current financial records, and to properly account for all
equipment purchased with grant funds. The recipient should also have sufficient financial and
managerial strength to operate successfully and complete the work for which it has been awarded a
grant. Potential recipients may be asked to provide information reasonably required by the USAID Sida
GOLD Project to perform this due diligence. In addition, potential recipients may have to provide any
appropriate pre-award certifications, assurances and other statements that may be reasonably requested
by the USAID Sida GOLD Project. The pre-award review will also include a potential recipients check
against various lists of entities and individuals who are restricted from receiving U.S. federal funding
and a conflict of interest and independence check.

Before a final award determination is made, the Grants Team may conduct an on-site review of an
applicant organization to review the organizational policies and procedures and determine whether they
meet the stringent requirements for accounting for grant funds under a USAID-funded grants program.
The Grants Administrator will review answers to the Pre-Award Survey, as well as other pertinent
financial documents, to evaluate the applicant's capacity to comply with the accounting and financial
reporting under a USAID-funded grants program. If the Grants Administrator determines that an
applicant organization demonstrates a weakness in its grants management capacity, s/he will note this
and may recommend corrective measures.

For FOG the USAID Sida GOLD Project will use the FOG Entity Eligibility Checklist (Annex 4) to
assess the applicants capacity and capability for accomplishing the milestones and the applicant should
carefully review the information requested.

Prior to making any grant award, USAID Sida GOLD Project will identify potential environmental
impact of the proposed grant activities and processes. Activities that pose significant and unmitigable
adverse environmental effects and for which an adequate Environmental Mitigation and Monitoring
Plan cannot be developed to eliminate these effects and alternatives will not be funded.
6.6. Approval by USAID
All proposed Recipients, grant scopes of work and award amounts must be submitted to USAID for
approval. An award will only be made with USAID approval. In addition, the applicant may be required
to make a formal oral presentation of the proposed project to USAID Sida GOLD Project, or USAID
and Sida, in order to get a fuller picture of the proposed activity and the Recipients organization. Should
16

such a presentation be required, the applicant should summarize the proposed activity into a standard
presentation using the template provided in Annex 5.

Applicants should be aware that USAID reserves the right to terminate a grant after award.
7. Award / Terms and Conditions
The grant award document sets forth the terms and conditions applicable to the Recipients grant. The
grant award document will be issued to the Recipient upon USAIDs approval of the award. Once signed
by the Recipient, the grant award document becomes binding on the Recipient. Grant terms and
conditions set forth in the grant award document may be enforced by USAID or by Deloitte.

Upon finalization, the Grants Manager will arrange for a kick-off meeting with the Recipient. USAID
grants are subject to a number of conditions with which the Recipient will need to become familiar.
Recipients must comply with the terms and conditions of the grant specified in the grant award
document. In addition, Recipients should understand USAID grants conditions that USAID posts on its
website at the following address: http://www.usaid.gov/policy/ads/300/303mab.pdf. Among the
provisions are the following:
Records retention. Recipients must keep the accounting books and other records supporting
the grant for 3 years from the end-date of the grant.
Audits. If a Recipient receives more than US $300,000 in a single year, it must pay for and have
an audit carried out in accordance with US Government audit guidelines.
Separate Bank Accounts. For Standard Grants, the Recipient must establish a separate bank
account solely for use of grant funds.
Budgets. Changes to the approved budget must be approved by the USAID.
Termination. USAID may direct Deloitte to terminate the Grant at any time.
Branding and Marking. Deliverables, including event announcements and materials must be
marked with the appropriate USAID and Sida logo and/or legend.
Procurement. Procurement of some goods and services and equipment is prohibited or
restricted.
Source and Origin. Nationality restrictions as to the source or origin of goods or services
procured with Grant funds may apply.

Grant Recipient Handbook available at http://goldproject.ba provides more details on these provisions
for grant recipients.
8. Project Contact Information
For any questions related to grant application process, applicants can contact USAID Sida GOLD
Project Grants Manager, Zuhra Osmanovi-Pai at zpasic@goldproject.ba, or at telephone number
+387 33 944 993.

17

Annexes
Annex 1: Grant Concept Paper Form
Annex 2: Grant Application Form and Guidelines
Annex 3: Pre-award Survey (for Standard Grants)
Annex 4: FOG Entity Eligibility Checklist (for FOGs)
Annex 5: Grant Presentation Template

18

Annex 1: Grant Concept Paper Form
Grant Concept Paper
I INFORMATION ABOUT THE ORGANIZATION (APPLICANT)
1. Full Legal Name of Organization:
2. Address of Organization:
3. Date and Number of Organizations Registration:
4. Tax Identification Number:
5. Telephone Number:

6. Fax Number:

7. E-mail:

8. Name of Key Contact Person:

9. Fathers Name:

10. Title of Key Contact Person:
11. Telephone number:
12. E-mail:
13. Type of Organization (mark the relevant fields): For-profit Private
Non-profit Public
14. Brief Description of Organization (briefly state the Organizations mission, vision and main
goals/activity areas):

15. Is Organization Owned by a Parent Company? (mark the relevant field) Yes No
16. Does Organization have any subsidiaries or own 5%, or more, of any other entity?
(mark the relevant field) Yes No
17. Are there any owners (shareholders) of Organization that own 5% or more of Organization?
If the answer is yes, please list the owners and their percentage owned:
Name of Owner/Shareholder Type of Owner (mark the
relevant field)
Percentage
owned (%)

Individual Company

Individual Company

[Repeat as necessary]
Individual Company

Also, please list any other entities which the owner/shareholder controls (greater than 50% ownership
or voting rights) and, if the shareholder is an individual, list any other entities in which this
shareholder serves as an officer or director:
Name of Owner/Shareholder Entities the owner/
shareholder controls
Entities in which owner/
shareholder serves as an
officer/director

18. Does the Organization have a computerized accounting system in place? Yes No
19. Who is the Organizations auditor?
19

20. Is Organization or any subsidiary an audit client of Deloitte? Yes No
If the answer is yes, please provide the names of organization/its subsidiaries audited by Deloitte:

21. Please provide the Organizations financial information required below:
Category Data as of Dec 31, 2013
Total Annual Revenue/Sales (BAM):
Total Assets (BAM):
Total Equity (BAM):
Equity Contribution from Other Donors (BAM):
Number of Employees:
___ Total ___Women ___ Men
Number of Women on Managerial Positions:
22. Provide information on the Organizations prior experience related to the proposed grant activity,
listing specific projects/activities that the Organization has implemented/supported, as applicable.

23. Provide the following information on prospective/existing partners (organizations, companies)
Full Legal Name of Partner Organization:
Address of Partner Organization:
Is Partner Organization an audit client of Deloitte? Yes No
Describe the partners prior experience related to the proposed grant activity:

[Repeat this section for as many partners as applicable]II TE
II TECHNICAL PROPOSAL
24. Title of Grant Activity (maximum one line):

25. Problem Analysis and Statement (maximum half a page):

26. Goals and Objectives of Grant Activity (please provide link with USAID Sida GOLD project key
objectives) (maximum half a page):

27. Approach to the Activity describe the proposed approach by answering the following questions
(maximum one page):
20

How will the Activity be carried out?
Who will carry out the Activity (identify project team and other relevant stakeholders)?
Where will the Activity be implemented (identify location/s)?
When will the Activity be implemented (provide the anticipated start date and finish date)?
Will the Activity involve investing in new technologies, and if yes, what type technology?
If the Activity is expected to create market distortion, how will this distortion be mitigated?
What impact (if any) will the activity have on the position of women and youth?
What environmental impact (if any) will the activity have and how will impact be
monitored/addressed?

28. Project Beneficiaries Identify direct and indirect project beneficiaries and their number, and
explain how they will benefit from the grant. (maximum half a page):

29. Expected Results (maximum half a page):
Identify the results expected to be achieved by the Activity and provide the link to the grant
objectives defined under section #26 above.
Also, identify verifiable indicators of achievement of these results and their estimated targets.
As the minimum, provide the values for the following key USAID Sida GOLD Project impact
indicators by completing the table below. Add additional indicators as necessary. Please use
quantitative indicators wherever possible.

Name of Indicator Target Value at Project Completion
Number of new jobs created: Total ____ Men: ____ Women: ____
Increase in investment (BAM):
Increase in revenues/sales (BAM):
Increase in exports (BAM):
Add additional indicator [Name]
30. Sustainability - explain how the Organization will sustain the impact of Activity and monitor and
report on results after the grant is closed (maximum half a page):

31. Activity Plan/Milestones indicate the proposed project duration/timeframe and provide the
overview of the main project activities/milestones (maximum half a page)
[Milestones are provided for Fixed-obligation grants (FOGs). Milestones are for a verifiable
project product, task, deliverable, or goal. For FOGs, monitoring is made by milestones, budget
is produced by milestones, and grant funds disbursement is made following the verification of
successful milestone completion. For Standard and In-kind grants, define activities.]
Activity/Milestone Anticipated Start Anticipated Finish
[Name 1:]
21

[Name 2:]
[Name 3:]
Etc.

III BUDGET
a) Provide a brief budget narrative indicating the total estimated cost of the proposed activity, the
share requested from USAID Sida GOLD Project and the cost share provided by the
Organization or contributed to the Organization by the third parties. Explain the structure of
cost share and describe in-kind contributions. For Fixed-obligation Grants (FOGs), provide
budget by project milestones and explain how the costs of each milestone were estimated. For
Standard Grants, provide budget by line item and explain how the costs of each line item were
estimated. For In-kind grants, provide budget by equipment/commodities items, with
explanation.
All amounts required from the USAID Sida GOLD Project should be before Value-Added Tax
(VAT). VAT costs will not be paid to grantees by the USAID Sida GOLD Project and they will
therefore be covered by grantees. All amounts should be in BAM and without decimal places.
(Maximum one page)
22

b) Complete the table below by providing the details of estimated costs by milestones and by funding sources. The Table is available in MS Excel format
at http://goldproject/.ba. Data should be entered only in white cells. The shaded cells contain formulas and should not be changed.
Budget Item / Milestone
Description
of Costs
Total Grant
Activity Cost
(A+B+C)
(A) Requested from
GOLD
(B) Applicants
Contribution
(C) Third Party
Contribution to
Applicant
Name of Third Party/ies
Contributing Funds
BAM BAM % BAM % BAM %
[Name 1]

-
0% 0% 0%
[Name 2]

-
0% 0% 0%
[Name 3]

-
0% 0% 0%
[Name 4]

-
0% 0% 0%
Etc.

-
0% 0% 0%

-
0% 0% 0%
Project Total:

-

-
0%

-
0%

-
0%

-

(A+B+C) Total Grant Activity Costs (BAM) - 0%
(A) Requested from USAID Sida GOLD (BAM) - 0%
(B+C) Cost Share (BAM) 0%
(B) Applicant's Contribution (BAM) - 0%
Financial 0%
In-kind 0%
(C) Third-party Contribution to Applicant (BAM) - 0%
Financial 0%
IN-kind 0%
23

Name and Signature of the
Organizations Authorized Representative:
Date of Submission of
Grant Concept Paper:

Name:
_____________________________________
Title:
_____________________________________
Full Legal Name of the Organization:
_____________________________________

____________________________________
(dd/mm/yyyy)
Signature:
_____________________________________

24

Annex 2: Grant Application Form and Guidelines
Grant Application
Name of Organization: ____________________
Address of organization: ____________________
Name of contact person: ____________________
Telephone/Fax number: ____________________
E-mail: ____________________
Date: ____________________

[Name], Grants Manager
USAID Sida GOLD Project
Ljubljanska 9, 71000 Sarajevo

Subject: Grant Application

With this letter and attachments, _________________ [insert Organizations Name] is applying for a grant
from the USAID Sida GOLD Project. We are requesting a grant to: [insert one sentence description of
activity to be funded by grant].

The total value of our grant request from the USAID Sida GOLD Project is BAM_______, or____% of the
total cost of grant activity. The costs of grant activity to be shared by our organization amount to BAM
____, or ___% of the total cost of grant activity, consisting of ___ BAM (__ %) financial contribution and
___ BAM (___ %) in-kind contribution.
We are applying for [mark the relevant field]:
Standard Grant Standard grant provides funding to Recipient periodically, for reimbursement of
costs generated during the period. USAID Sida GOLD Project Standard Grants
are limited to $100,000.
Fixed-Obligation Grant (FOG)
FOG provides a fixed amount of funding as Recipient achieves each part of a fixed
set of project milestones/benchmarks. USAID Sida GOLD Project FOGs are
limited to $100,000 and up to three years duration.
In-kind Grant. Grant funding is used to procure tangible assets for Recipient. USAID Sida GOLD
Project in-kind grant is limited to $100,000 and grant award duration is to be
determined, but should not exceed December 31, 2017.

The estimated start date for proposed grant activity: _____________[dd/mm/yyyy].
The estimated end date for proposed grant activity: ______________[dd/mm/yyyy].

This application consists of the following materials:
Attachment 1 Technical Proposal
Annex A. Grant Activity Implementation Plan
Annex B. Grant Activity Monitoring and Evaluation Plan (if applying for Standard
Grant)
25

Annex C. Information of Previous Assistance Awards/Contracts
Attachment 2 Budget and Budget Notes
Annex D. Supporting Data for Cost Estimates
Attachment 3 Information about Applicant
Attachment 4 Certifications and Assurances from Applicant
Annex E. Documents Demonstrating Applicants Eligibility and Capabilities
Annex F. Environmental Self-Assessment Form
Annex G. Survey on Ensuring Equal Opportunities to Applicants (optional, upon
Applicants Request)

Sincerely,

_________________________________ [Name of the Applicants Authorized Representative]
_________________________________ [Title of the Applicants Authorized Representative]
_________________________________ [Full Legal Name of the Organization]
_________________________________ [Signature of the Applicants Authorized Representative]
_________________________________ [Date of Submission of Grant Application]

26

ATTACHMENT 1: TECHNICAL PROPOSAL
SUMMARY SHEET
[This sheet must not exceed one page. If it contains two pages, only the first page will be read]
Title of Grant
Activity:
[Maximum one line]
Location(s) of
Implementation:
[Indicate the geographic areas where the project activities will be implemented and areas that
will benefit from project activities. Provide the names of beneficiary municipalities/cities or
regions.]
Costs of Grant Activity:
(A+B) Total Costs
BAM

(A) Requested from
GOLD
(B) Cost Share
(Applicants or Third Party Cash or In-kind Contribution)
BAM % Total (BAM) % Cash BAM % In-Kind BAM %

Duration of
Grant Activity:
___________ months
Estimated Start Date: ________________ Estimated End Date: ________________
Objectives of
Grant Activity:
[General and specific objectives]

Partners: [Organizations responsible for carrying out the proposed activities together with Applicant, in the
manner and scope defined in this application]

Target
Group(s):

[Groups/entities that will be directly positively affected by the grant activity at the project
purpose/general objectives level]
3

Final
Beneficiaries:
[Organization/persons who will benefit from the grant activity in the long term at the level of the
society or sector at large]
4

Expected
Results:

[Indicate the main results of grant activity and key verifiable indicators of their achievement
(outcome or impact indicators), along with their targets.]

Main Activities/
Milestones

[List the main activities if applying for Standard or In-kind grant, and milestones if applying for
FOG]

3
E.g., if the Project aims to increase public administration capacities, target group can be municipal specialists.
4
E.g., if the effectiveness of municipal administration services increases, local population and business will benefit.
27

1. BACKGROUND/STATEMENT OF NEED [maximum 1 page]
Provide a detailed presentation and analysis of the problems and their interrelation at all levels.
Provide a detailed description of the target groups and final beneficiaries, and their estimated
number.
Clearly identify the specific problems to be addressed by the grant activity, as well as the perceived
needs and constraints of the target group(s).
Demonstrate the relevance of the grant activity to the needs and constraints of the target areas in
general and to the target groups/final beneficiaries in particular, and how the grant activity will
provide the desired solutions, in particular for the target beneficiaries. Use evidence and data to
support your justification.
Demonstrate the relevance of the grant activity to the objectives and priorities of the USAID Sida
GOLD Project.

2. GOALS, OBJECTIVES AND GEOGRAPHIC FOCUS OF GRANT ACTIVITY [max 1 page]
Describe the overall objective(s) to which the proposed grant activity aims to contribute.
Describe the specific objective(s) that the proposed grant activity aims to achieve. Specific
objectives should be SMART (specific, measurable, achievable, realistic and time-bound).
State where the grant activity will be implemented (identify geographic areas, location/s,
municipalities/cities). Organization must demonstrate its ability to effectively implement services
in that target area (e.g. is already working in that area or has strong relationships and can quickly
expand services in that area). Applicant must be able to demonstrate additonality of the proposed
grant activity, which is defined as a rapid scale-up or expansion of an existing program that will
require minimal overhead and operational costs.

3. EXPECTED RESULTS AND TECHNICAL STRATEGIES [max 3 pages]
3.1. Expected Results
Indicate how the proposed grant activity will improve the situation of target
groups/beneficiaries and technical and management capabilities of target groups and/or local
partners, where applicable. Provide link to goals and objectives defined under section 2 above.
Identify verifiable indicators of achievement of these results and their estimated targets. As
minimum, provide the data for the four USAID Sida GOLD Project key indicators listed below
in order to illustrate how the proposed activity will contribute to the main USAID Sida GOLD
Project targets. Add additional indicators as necessary. Use quantitative indicators wherever
possible.
Name of Result Indicator Target Value (cumulative)
Year 1 Year 2 Year 3
1. Number of new jobs created: Total: ___
Women: ___
Men: ___
Youth
5
: ___
Total: ___
Women: ___
Men: ___
Youth: ___
Total: ___
Women: ___
Men: ___
Youth: ___
2. Increase in revenues/sales
(BAM)

3. Increase in investment (BAM)
4. Increase in exports (BAM)

5
Youth is defined as persons from 18-30 years of age.
28

3.2. Methodology
Describe the methods of implementation of the proposed activities and reasons for the proposed
methodology.
If the grant activity is the prolongation of a previous action, explain how it is intended to build
on results from the previous action.
If the grant activity is part of a larger program, explain how it fits or is coordinated with this
program. Identify potential synergies with any other current or planned future initiatives, in
particular those funded by the USAID and/or Sida.
Describe the stakeholders attitude to the proposed grant activity in general, and to the specific
activities in particular.
If the grant activity will involve investing in new technologies, describe the type of technology
and explain how this will benefit the sector as a whole.
Explain what environmental impacts (if any) will the proposed grant activity have and how will
this impact be monitored and addressed.
If the grant activity is expected to create market distortion, explain how this distortion will be
mitigated and provide the relevant market distortion mitigation activities in Implementation
Plan.
Explain how the women and youth will directly benefit from the grant activity (if so) and what
impact (if any) will the grant activity have on gender equity and equality and the position of
youth.

3.3. Beneficiaries
Indicate who will be the final beneficiaries of grant activity and provide their estimated
number(s), if possible by year of implementation of grant activity.
Where applicable, provide the gender disaggregated data on beneficiaries, and indicate the
number(s) of youth that will benefit from the grant activity, if possible by year of
implementation of grant activity.

3.4. Sustainability
Describe the main preconditions and assumptions for grant activity, during and after the
implementation stage.
Identify the main risks associated with proposed grant activity, mitigation strategy and possible
contingency plans. A sound risk analysis should address a range of relevant risk types, such as
physical, environmental, political, economic and social risks.
Explain how sustainability will be ensured after completion of grant activity, i.e. how the
benefits will be produced by grant activity after external funding has ended. This may include
specific measures and strategies built into the grant activity, such as institutionalization of
activity results, policy support, follow-up activities, ownership by target groups/beneficiaries
etc. The following types of sustainability may be addressed:
o Economic/financial sustainability (ensuring acceptable level of financial and economic
return; ensuring financing for follow-up activities and future operating and/or
maintenance costs etc.);
o Institutional-level sustainability (ensuring institutional and management support to
activities and operations after external funding has ended, local ownership of outputs
and results etc.);
o Policy-level sustainability (institutionalization of policy initiatives and outcomes);
29

o Environmental sustainability (what environmental implications will the grant activity
have and how will potential negative impacts on the environment be avoided or
mitigated).

4. IMPLEMENTATION PLAN / MILESTONES [maximum 2 page]
State when the grant activity will be implemented (provide the anticipated start and finish dates).
Describe in details specific activities that will be undertaken to produce the expected results, also
describing activities to be implemented by target population or project partners, justifying the
choice of activities, indicating their sequence and interrelation, and specifying where applicable the
roles of each partner.
For FOGs: Provide the list of grant activity milestones using the table below. Milestones are for a
verifiable product, task, deliverable or goal of the applicant to be accomplished. For FOGs, budget
is produced by milestones and fund disbursement is made based on verification of milestone
completion. Grant activities will be monitored and evaluated against these milestones.

Milestone Name Milestone Verification Expected Time of
Completion
[Name of Milestone 1] How will the recipient document the
completion of the product, task, deliverable, or
goal?

[Name of Milestone 1]
Etc.
Provide the detailed Implementation Plan using the provided format and guidelines in Annex A.
5. MONITORING AND EVALUATION [For Standard Grants only]

Provide a narrative description of how the Organization will use monitoring data to guide
programming decisions and interventions.
Provide the detailed information about activities performance monitoring in Annex B, using the
provided format and guidelines.

6. COORDINATION AND COLLABORATION [maximum 1 page]
Describe roles and involvement of various actors and stakeholders in grant activity, including local
authorities, target groups and partners, and explain why these roles have been assigned to them.
Indicate how the grant activity will be coordinated with other relevant projects in the target area.
Describe how the grant activity will be integrated into other projects/services your Organization
already offers.

7. MANAGEMENT PLAN [maximum 1 page]
Describe how the project will be managed. Describe systems that exist or will be put in place to
enable Organization to effectively manage the grant activity.
If applying for Standard Grant, describe the composition and organizational structure of the
proposed project team, and titles, roles and responsibilities of key personnel. Provide the CVs of
up to three key personnel in annex, including the Project Manager. CVs should not exceed one page
each.
Include information on technical and managerial experience of the proposed project manager as
well as any other technical personnel. Experienced, qualified personnel in relevant disciplines and
areas should be provided for project management and staff.
30

Indicate who will liaise with USAID Sida GOLD Project.

8. ORGANIZATIONAL CAPACITY [maximum 1 page]
Provide a statement of your corporate capabilities. This should be a one-paragraph summary of
your organization's key qualifications and capabilities, along with a value proposition for the
proposed grant activity. It should indicate who your organization is and what it does, and what a
client can expect from your organization.
Provide a brief description of your present and ongoing actions/projects that have a direct
relationship to the proposed grant activity and the actions/projects that demonstrate past experience
in implementing similar programs. Describe your Organization's relationship with the target
population and demonstrate commitment to working closely with the target population. If
applicable, describe relevant collaborative efforts your organization has undertaken jointly or in
coordination with other institutions.
If your organization is a new one, describe the past experience and efforts that resulted in its
formation. Please also provide a concise summary of the positive impact that resulted from this
past experience.
Applicants may also provide a list/brief description of any publications or reports that demonstrate
any special qualification and experience that your organization has, related directly to the proposed
activities (do not attach the publications or reports).
Provide brief information on up to three (preferably similar) actions/projects managed by your
organization for which your organization has received assistance awards or contracts over the
past three years in Annex B.
31

ANNEX A GRANT ACTIVITY IMPLEMENTATION PLAN
Provide detailed implementation plan for grant activity using the format provided in table below.
If applying for a FOG, define milestones. Milestones are for a verifiable product, task, deliverable or goal of the organization/applicant.
The name of the milestone should therefore be a description of the product, task, deliverable or goal to be accomplished. Grant activities
will be monitored and evaluated based on milestones, grant budget will be produced by milestones, and funds disbursement will be made
following verification of successful milestone completion.
If applying for Standard or In-Kind grant, define main project components/results and activities that lead to their completion.
o Activities are smallest units of work that have the definite duration, logical relationship with other activities in the project,
resource consumption and associated costs.
o If the nature of grant activity is such that it has to start in specific month/year, than this specific month/year should be indicated. In
all other cases, implementation periods should be indicated as Month 1, Month 2 etc. Any interim time periods (months) when
activities will not be implemented must be included in implementation plan
6
.
o The most probable duration of each activity is recommended to be indicated, rather than the most optimistic (shortest) duration, in
order to account for all factors that may affect the implementation timetable.
Implementing body mean either the applicant and/or any of the partners.
For Standard and In-kind grant define output of each activity. For FOG, define the verification method.

Activity/
Milestone
Implementing
Body(ies)
Activity
Output /
Milestone
verification
method
Implementation Period [Mark the months in which the milestone/ activity will be implemented]
Year 1 Year 2
M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12 M1 M2 M3 Etc.
[Name 3]
[Name 2]
[Name 3]
[Name 3]
Etc.

6
As indicated in the Cover Page of this Application Form, the maximum duration of FOG grants is three years. Maximum duration of standard grants and in-kind
grant is to be determined. All grants must be closed by December 31, 2017 the latest.
32

ANNEX B GRANT ACTIVITY MONITORING AND EVALUATION PLAN (applicable only if applying for Standard Grant)
Complete the table below and include clear performance indicators and their targets to measure progress.
Activities should be identical to those provided in Annex A Grant Activity Implementation Plan.
Performance indicators should indicate outputs or results of individual activities. Quantitative indicators should be used wherever possible.
Target value should indicate the desired value of performance indicator at the completion of grant activity. For quantitative indicators,
target values should be numbers, either in absolute or percentage terms.
Data Source should indicate the source from which the performance indicator target data will be collected.
Frequency should indicate the frequency of data collection for performance indicator (i.e. monthly, quarterly etc.)
Data Verification Method should indicate how the collected performance indicators data should be verified.

Activity
Performance
Indicator
Target
Value
Data Source
Data
Collection
Method
Frequency
Data
Verification
Method
[Activity 1 - Name]
[Activity 1.1. - Name]
Etc.
[Activity 2 - Name]
Etc.

33

ANNEX C INFORMATION ON PREVIOUS ASSISTANCE AWARDS/CONTRACTS
Provide brief information on up to three (preferably similar) actions/projects managed by your organization
for which your organization has received assistance awards or contracts over the past three years. The tables
must not exceed one page each. If table has two pages, the second page will not be read.
Name of Project/Activity 1:
Sector:
Location of Implementation:
Period of Implementation: From: (mm/yy) To: (mm/yy)
Name of Donor and Point of Contact:
Address, phone and e-mail:
Amount Contributed by Donor:
Amount Cost-shared by Organization:
Project/Activity Partners:
Main Objectives:
Main Results:

Sector:
Main Objectives:
Main Results:

Sector:
Main Objectives:
Main Results:

34

ATTACHMENT 2: BUDGET AND BUDGET NOTES
1. BUDGET
Applicants should provide a realistic, reasonable, complete and justifiable budget necessary to
implement the proposed activities/milestones described under the technical proposal.
If applying for Standard Grant, applicants must provide budget by main line items (such as salary,
fringe, travel cost etc). Detailed explanation of how the costs of each line item were calculated should
be provided under Budget Notes section
If applying for FOG, applicants must provide budget by project milestones (milestones are for a
verifiable project product, task, deliverable, or goal). Detailed explanation of how the costs of each
milestone were calculated should be provided under Budget Notes section.
If applying for In-kind grant, applicants should provide the budget by specific items of
assets/equipment, indicating unit costs, number of items and total costs.
All amounts required to be funded by USAID Sida GOLD Project should be before Value-Added Tax
(VAT). VAT costs will not be paid to grantees by USAID Sida GOLD Project and will therefore be
covered by grantees.
All amounts should be in BAM and without decimal places. Awards will be denominated in US dollars
but paid out in local currency.
All tables provided below are available in MS Excel on http:/www.goldproject/.ba
Applicants should provide:
completed Table 1
completed Table 2(a) if applying for Standard Grant, or Table 2(b) if applying for FOG or
Table 2(c) if applying for In-Kind grant; and
budget notes.
Applicant should provide supporting documentation for calculation of staff costs in Annex D (copies
of pay slips, complete Bio-data form or other document). Additional supporting data for cost calculation
may be required prior to awarding a grant (such as copies of organizational policies, vendor quotes
etc.).

35

Complete the Table 1 below by providing the estimated costs by line items, project year and funding sources. If applying for Standard Grant, line-
items must correspond to main budget lines, as shown in Table 2(a). If applying for FOG, line-items must correspond to project milestones. If
applying for In-kind grant, line items should correspond to equipment items.

Table 1: Grant Activity Budget and Cost Share Contribution

36

If applying for Standard Grant, complete the Table 2(a) below by providing the details of costs to be funded by USAID Sida GOLD Project, by
budget line item.

Table 2(a): Detailed Cost Estimate by Budget Line Item

37

If applying for FOG, complete the Table 2(b) below by providing the details of costs to be funded by USAID Sida GOLD Project, by milestone and
line item.

Table 2(b): Detailed Cost Estimate by Milestone for FOG

38

If applying for In-kind grant, complete the Table 2(c) below by providing the details of assets/equipment to be purchased by USAID Sida GOLD
Project.
Table 2(c): Detailed Cost Estimate for In-kind grant
Description of
Assets/Equipment
Type of Assets/Equipment No. of
units
Unit
Cost
BAM
Total Cost Requested
from GOLD (BAM)
Cost Share (BAM)

39

2. BUDGET NOTES
The purpose of budget notes is to help USAID Sida GOLD Project Grants Program Technical Evaluation
Committee and donors better understand the organizations budget, specifically the rationale for unit
costs and quantities. Use this template to guide the development of your budget notes. Add additional
information as necessary to clarify your budget inputs, and delete information that is not relevant to your
budget.
2.1. Introduction
Briefly explain the purpose and rationale for budget notes. For example:
[Organization Name] is pleased to provide this budget narrative for the grant activity titled [Grant
Activity Title], estimated to be implemented in the period from [Grant Activity Estimated Start Date] to
[Grant Activity Estimated End Date], in duration of [Grant Activity Estimated Duration in Months].
The purpose of this narrative is to describe the rationale for our grant activity budget. Costs presented
in our budget reflect our proposed scope of work, as outlined in Attachment 1 Technical Description,
and are based on our experience implementing projects and activities with a similar scope and duration,
as well as additional information on the costs of necessary resources. We are happy to provide any
additional information or support upon request.
2.2. Detailed Budget Notes
7

I f applying for Standard Grant:
For Standard Grants, the grant activity application budget is the budget summary table presented in
Section 2 Budget and Cost Share Contribution, which presents the grant activity budget by budget lines
described below.
Salaries and Wages
Salaries and wages represent any direct payments of grant funds to staff (either Organization's current
employees or staff to be hired for grant activity) for their direct engagement on grant activity. All salaries
and wages costs presented under this budget line are base rates and do not include any fringe benefits
8
.
All salaries and wages under this budget line should include tax as per the relevant local legislation.
Describe all positions that will contribute to grant activity using the table below. Provide a copy of your
current payroll register to support the salary rates for current staff named in this budget, or a signed copy
of a completed Bio-data (1420) form to support the salary rates of proposed staff that are named in the
budget but not yet employed by your organization. For those positions where a specific individual has
not been named, describe justification for proposed salary rate and list the supporting documentation
included in the annex.
Position
Title
Name
Level of
Effort
Responsibilities
Rate
Justification
Proposed rate
including tax (per
month)
E.g. Project
Manager
Charles
Smith
100%
(12
months)
Oversee implementation
of project activities;
supervise staff
Bio-data (1420)
form
BAM 4,000 per
month
E.g. Finance
Manager
John
Adams
25% (3
months)
Manage financial
systems; oversee project
spending; ensure
expenses are in line
with project budget
Current payroll
register
BAM 2,500 per
month
Etc.

7
For funds requested from USAID Sida GOLD Project.
8
Contributions from salary in line with local Bosnia and Herzegovina legislation (Doprinosi iz plate) should
be included under this budget line as part of salaries and wages. Contributions paid on salary (Doprinosi na
platu) should be treated as Fringe Benefits (item 3.2.2.).

40

Fringe Benefits
Fringe Benefits are paid for the relevant portions of staff salaries, in line with the relevant local
legislation and Organizations established policy. Describe the Fringe Benefits that your Organization
will pay to staff directly engaged on grant activity using the table below. In the column Rate
Justification/Applicability indicate what type of staff is eligible for specific Benefit (e.g. only
permanently employed staff, temporary staff, consultants, volunteers, others) and legal basis for specific
Benefit (e.g. applicable local labor laws, Organizations internal policy, other). Include a copy of any
such supporting Organizations internal policy documents as an Annex.
Fringe Benefit Name Fringe Benefit Description
Rate
Justification/Applicability
Rate (% and basis)
E.g. Contributions on
Salary
9

Mandatory Social
Contributions
Rulebook on Contributions
Payment
10,5% on gross
salary
E.g. Annual Bonus Performance-based annual
salary increase
Organization policy
(attach)
Up to 3% of net
salary
Etc.

Consultants
Consultants costs are direct payments to staff engaged for providing specific technical support during
a limited period of time during grant implementation.
State the total number of consultants anticipated to support the grant activity.
Provide the details on each consultant by completing the table below. Include copies of
documents supporting the proposed consultancy rates (e.g. Bio-data form, organizational policy
etc.) as an Annex.
Consultant Role/Responsibility
# of persons
& days
Rate Justification
Proposed Rate
E.g. Education
Trainer
Conduct a 3 day workshop to
train peer educators
1 person x 5
days
Bio-data (1420)
form
300 BAM/day
E.g. Technical
expert
Provide technical support on
[describe the area] 5 days a
month
15 persons x
5 days x 12
months
Rate dictated by
organization policy
200 BAM/day
Etc.

Travel and Transportation
Travel and Transportation costs include local or international travel and per diem costs for staff engaged
on grant activity and/or beneficiary staff, as well as the costs of transportation of materials for
implementation of grant activity.
Describe how the travel and transportation costs for staff and/or beneficiaries are estimated (e.g.
according to the anticipated scope of work and organizations previous experience on similar
projects).
Describe the basis for air travel rates (e.g. economy class fares) and support this by quotes
provided as an Annex.
Describe the basis for ground transportation rates (taxis, hired cars, personal vehicle use),
providing the rationale for unit costs.
Describe the per diem policy, explaining to whom your organization provides per diem (e.g.
staff on travel, volunteers, participants at workshops etc.). Describe the basis for per diem rates
(e.g. organization policy, local government rates etc.)

9
Contributions on Salary (Doprinosi na platu) are considered Fringe Benefits, in line with local legislation in
Bosnia and Herzegovina.

41

Provide details on all the trips anticipated to be taken to support the grant activity by completing
the table below.
Destination
(travel
relation)
Transporta
tion Mode
No. of
trips
No/titles of
persons on trip
Purpose of trip Unit Cost
E.g. Sarajevo-
Frankfurt-
Sarajevo
Airplane 1 12 (10
beneficiary and 2
project staff)
Investment
promotion at the
industrial fair
600 BAM per
return air ticket
E.g. Sarajevo-
Tuzla-
Sarajevo
Taxi or
hired car
7 2 project staff Oversight and
participation at the
workshop
1 BAM per
kilometer (taxi);
400 BAM per day
(hired car)
E.g. Tuzla-
Banja Luka-
Tuzla
Project
vehicle
3 20 beneficiary
staff
Participation at
business fair
0,25 BAM per
kilometer
E.g. Sarajevo-
Mostar
Personal
vehicle
10 1 project staff 0,25 BAM per
kilometer

Other Direct Costs
Other Direct Costs cover various operating costs of implementation of grant activity, excluding staff
and travel and transportation costs. These may be general operating expenses that are shared across
several projects implemented by your organization, or expenses that are fully allocated to grant activity
(e.g. the costs of events organized under grant activity.
Explanation/justification for calculation of each type of costs under this budget line should be provided.
For general operating expenses that are shared across several projects implemented by your
organization, a percentage of these costs should be budgeted and charged to grant activity.
Explanation/justification of how this percentage was calculated should be provided. For example:
Office Rent: The organization has an office located in [XXX place(s)] where staff working on this grant
activity will be based. The total [monthly/yearly] rent for the organizations offices spaces is [XX BAM
amount], as documented in the [indicate the documentation provided] included in the Annex. X% of
this total amount has been charged to the grant activity based on [calculation for shared expenses for
grant activity, or describe other justification for this %].
Office Utilities: The organization pays for utilities including [e.g. electricity, water, Internet etc.] on a
[monthly/quarterly/yearly] basis, as documented in the [indicate the documentation provided] included
in the Annex. We have budgeted XX BAM for utilities per [month/year] for this grant activity, based
on the following calculation: [describe calculation or justification]. Costs are budgeted on a
[monthly/annual/one time] basis over the life of the grant activity.
Office Supplies: We have budgeted for general office supplies that will be required specifically for day
to day management and implementation of this grant activity in amount of XX BAM per [month/year].
These supplies include: [list items, e.g. paper, toner, binders, flipcharts, pens]. The total
[monthly/annual] cost for the organizations office supplies is [XX BAM], as documented in the
[indicate the documentation provided] included in the Annex. In addition to office supplies specifically
budgeted for this grant activity, XX% of this total amount has been charged to grant activity based on
[calculation for shared expenses for grant activity, or describe other justification for %]. Costs are
budgeted on a [monthly/annual /one time] basis over the life of the grant activity.
Postage, Delivery, Courier: We have budgeted funds to cover the costs for regular postage,
delivery/courier of financial reports or other materials required over the course of the grant activity. The
budgeted rate in amount of XX BAM per [month/year] is based on [describe justification for rate] and
supported by [describe documentation to support rate]. Costs are budgeted on a [monthly/annual/one
time] basis over the life of the grant activity.
Printing Materials: We have budget funds to cover printing/reproduction of materials for day to day
grant activity operations. The budgeted rate in amount of XX BAM per [month/year] is based on

42

[describe justification for rate] and supported by [describe documentation to support rate]. Costs are
budgeted on a [monthly/annual/one time] basis over the life of the grant activity.
Communications: We have budgeted funds to cover communication expenses for [e.g. telephone,
fax
10
]. The budgeted rate in amount of XX BAM per [month/year] is based on [describe justification
for rate] and supported by [describe documentation to support rate]. Costs are budgeted on a
[monthly/annual/one time] basis over the life of the grant activity.
Bank Fees: We have budgeted funds to cover bank fees associated with the grant activity. The budgeted
rate in amount of XX BAM per [month/year] is based on [describe justification for rate] and supported
by [describe documentation to support rate]. Costs are budgeted on a [monthly/annual/one time] basis
over the life of the grant activity.
Audit Costs: We have budgeted funds to costs of an audit. The budgeted rate is based on [describe
justification for rate] and supported by [describe documentation to support rate]. Costs are budgeted on
a [monthly/quarterly/one time] basis over the life of the grant activity.
Activities and Events: Describe all costs for each activity and event proposed in the grant activity
budget and proposal. Provide justification of cost calculation, similar as for the other costs stated above.
Equipment
Provide justification for each piece of equipment/personal property that is required for implementation
of this grant activity by completing the table below. The unit costs for each piece of equipment should
be based on vendor quotes provided in an Annex.
Description of
Equipment
Justification/Use for
grant activities
No. of units Unit Cost
BAM
Total Cost
BAM

I f applying for FOG:
For FOGs, the grant activity application budget is the budget summary table presented in Section 2
Budget and Cost Share Contribution, which presents the grant activity budget for costs associated with
achieving proposed milestones. Payment for FOGs will be made in tranches, following verification of
milestone completion.
Milestones are for a verifiable product, task, deliverable, or goal of the recipient. The milestones will
generally have three parts: (1) a description of the product, task, deliverable, or goal to be accomplished;
(2) a description of how the recipient will document the completion of the product, task, deliverable, or
goal (verification method); and (3) the amount that USAID Sida GOLD Project will pay the recipient
for the deliverable/milestone. Some milestones may also have dates indicating when the milestone is
expected or required to be completed. However, depending on the nature of the activities in the award,
a milestone date may not be necessary or appropriate and/or milestone completion may or may not be
sequential when dates are estimated/required.
Although FOGs cannot cover indirect costs, grant funding can cover direct costs that will be incurred
by the recipient to provide identifiable administrative and management support to the activity. Budget
notes for FOGs should include a detailed description of how the costs of each milestones were
calculated, by budget line item.
Construction activities are not allowed under FOGs. Purchase of any real property is not allowed under
FOGs. Real property means land, including land improvements, structures and appurtenances thereto,

10
Internet costs should be treated as Office Utilities costs.

43

but excludes movable machinery and equipment. Personal property is any tangible or intangible property
other than real property.
Grant activity may include procurement of equipment or personal property in order to accomplish a
milestone. Unless a milestone is itself the purchase of the equipment or personal property, milestones
must not list equipment or personal property a recipient may potentially purchase to accomplish the
milestone, but the costs of such equipment or personal property may be included in the budget from
which milestone payment amounts are estimated and negotiated. The distinction between whether
purchase of the equipment or personal property is a milestone or is one possible means by which the
recipient may accomplish a milestone is important for certain aspects of the grant award. When the
purchase of equipment or personal property is itself a milestone and such purchase is specifically named
in that milestone, the recipient will be required to comply with USAID eligibility rules for procurement
of commodities and services
11
. Otherwise, purchases of the recipient that are incidental to the recipients
completion of a milestone are not deemed financed by the FOG notwithstanding that their costs were
included in the estimate upon which the total FOG award amount was negotiated.
International travel is allowed only with prior USAID approval, and should also be noted as part of a
milestone.
I f applying for I n-Kind grant:
Provide justification for each piece of equipment/personal property that is required for implementation
of grant activity. The unit costs for each piece of equipment should be based on vendor quotes which
may be required if the application is proposed for funding.

2.3. Cost Share
Applicant is required to share the costs of grant activity in the amount of minimum 50% of the total
costs of grant activity. Cost share is required for all grants. Cost share contribution may be financial or
in-kind. Cost share may include costs financed from the Applicants own funds, or costs financed with
cash, services, or property contributed or donated to the Applicant from another non-U.S. Government
sources.
All costs shared by the Applicant (both financial and in-kind) must be:
o verifiable from the recipients records;
o necessary and reasonable for proper and efficient accomplishment of grant activity
objectives;
o allowable under the applicable Standard Provisions (see Attachment 4)
o must not be included as cost share contributions for any other U.S. Government
assisted program;
o must not be paid by the U.S. Government under another grant or agreement (unless the
grant or agreement is authorized to be used for Cost Share).
In-kind contribution may include volunteer services, donated supplies and equipment, donated property
or office space etc. Rates for volunteers must be consistent with those paid for similar work in the
Organization, or those paid for similar work in the labor market in which the Organization competes.
The assessed value of donated supplies and equipment must be reasonable and must not exceed the fair
market value at the time of the donation. The value of donated property must be determined in
accordance with the usual accounting policies of the Organization. Only if the purpose of grant award
is to assist the recipient in the acquisition of property or equipment, the total value of the donated
property or equipment may be claimed as Cost Share. Otherwise, only depreciation or use charges for
property and equipment may be made. The value of donated equipment must not exceed the fair market
value of equipment of the same age and condition at the time of donation. The value of donated space
must not exceed the fair rental value of comparable space and facilities in a privately owned building in

11
See Standard Provisions for Fixed-obligation Grants to Nongovernmental Organizations, RAA4: USAID
Eligibility Rules for Procurement of Commodities and Services, http://www.usaid.gov/ads/policy/300/303mat

44

the same locality, as determined by adequate market research. The value of loaned equipment must not
exceed its fair rental value.
Describe the cost share provided by the Applicant, indicating financial and/or in-kind
contribution.
Provide a detailed explanation of how the value of in-kind contribution (if any) was calculated.

45

ANNEX D SUPPORTING DATA FOR COST ESTIMATES
(Please provide copies, as necessary.)

46

ATTACHMENT 3: INFORMATION ABOUT APPLICANT
1. Full Legal Name of Organization:
2. Address of Organization:
3. Date and Number of Organizations Registration:
4. Tax Identification Number:
5. Telephone Number:

6. Fax Number:

7. E-mail:

8. Name of Key Contact Person:

9. Fathers Name:

10. Title of Key Contact Person:
11. Telephone: 12. E-mail:
13. Type of Organization (mark the relevant fields): For-profit Private
Non-profit Public
14. Is Organization Owned by a Parent Company? (mark the relevant field) Yes No
15. Does Organization have any subsidiaries or own 5%, or more, of any other entity?
16. Are there any owners (shareholders) of Organization that own 5% or more of Organization?
If the answer is yes, please list the owners and their percentage owned:
Name of Owner/Shareholder Type of Owner (mark the
relevant field)
Percentage
owned (%)

Individual Company

Individual Company

Individual Company

Also, please list any other entities which the owner/shareholder controls (greater than 50% ownership or
voting rights) and, if the shareholder is an individual, list any other entities in which this shareholder
serves as an officer or director:
Name of Owner/Shareholder Entities the owner/
shareholder controls
Entities in which owner/
shareholder serves as an
officer/director

17. Does the Organization have a computerized accounting system in place? Yes No
18. Who is the Organizations auditor?

19. Is Organization or any subsidiary an audit client of Deloitte? Yes No
If the answer is yes, please provide the names of organization/its subsidiaries audited by Deloitte:

20. Please provide the Organizations financial information required below:
Category Data as of Dec 31, 2013
Total Annual Revenue/Sales (BAM):
Total Assets (BAM):
Total Equity (BAM):
Equity Contribution from Other Donors (BAM):

47

Number of Employees: _____Total ____Women ____Men
Number of Women on Managerial Positions:
Fiscal Year Period: From ______________ to __________________
21. Provide the following information on each prospective/existing partners (organizations,
companies):
Full Legal Name of Partner Organization:
Address of Partner Organization:
Is Partner Organization an audit client of Deloitte? Yes No
Describe the partners prior experience related to the proposed grant activity:

[Repeat for as many partners as applicable]

48

ATTACHMENT 4: CERTIFICATIONS AND ASSURANCES FROM APPLICANT
We hereby confirm that:
a. Our organization has not received any funding from the USAID Sida GOLD Project for the
preparation of this Application.
b. Our organization has no advances from USAID or a USAID contractor which have been
outstanding and un-liquidated for longer than 90 days, and our organization has no grant
completion report required under a grant from USAID or a USAID contractor which is more than
30 days past due.
c. Our organization has legal authority to apply for USAID-Sida-sponsored assistance and the
institutional, managerial and financial resources to ensure proper implementation of the proposed
grant activity, including funds necessary to pay our contribution to the total cost of the proposed
grant activity.
d. Our organization is not requesting funding for any indirect organizational costs under this
application.
e. At the time of application there exists no condition within our organization or with respect to our
organizations management which renders the organization ineligible for a grant directly or
indirectly funded by USAID.
f. Our organization will give the USAID Sida GOLD Project and /or USAID/Sida and/or their
designees, access to and the right to examine all records, books, papers, or documents related to
grant award; and will establish a proper accounting system in accordance with generally accepted
accounting standards or agency directives.
g. No motion for enforcement has been filed before the competent court for the purpose of collecting
claims over financial resources of our Organization.
h. Our organization will initiate and implement the required Branding and Marking requirements
after the receipt of the approval of the award and will comply with environmental standards which
may be prescribed.
i. Our organization will comply with the relevant regulations of the United States Government
applicable for the awards under the USAID Sida GOLD Project Grants Program
j. In order to demonstrate our organizations eligibility and capabilities, we have provided the
following documents in Annex D (mark all that apply mandatory documents are marked):
A copy of our organizations formal registration as evidence of our legal status (Court
Register Excerpt or other relevant document) (mandatory)
A copy of the most recent audited annual financial statements for the past three years, as
applicable (mandatory)
Copies of documentation indicating our organizations managerial commitment to
implementing objectives that are consistent with grant application:
Organization's statute
Strategic plans (multi-annual)
Annual narrative report for the previous year
Other [please specify]
A copy of our organizational chart
The names of staff authorized to represent the organization, including their dates of birth,
places of birth and addresses (mandatory)
By affixing my signature below, I certify that the above statements are true and may be relied upon by
the USAID Sida GOLD Project in determining eligibility for grant award.


49

_________________________________ [Date]

50

1. Assurance of Compliance with Laws and Regulations Governing Non-Discrimination in
Federally Assisted Programs

Note: This certification applies to Non-U.S. organizations if any part of the program will be undertaken
in the United States.
(a) The recipient hereby assures that no person in the United States shall, on the bases set forth below,
be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination
under, any program or activity receiving financial assistance from USAID, and that with respect to the
Cooperative Agreement for which application is being made, it will comply with the requirements of:
(1) Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352, 42 U.S.C. 2000-d), which prohibits
discrimination on the basis of race, color or national origin, in programs and activities receiving Federal
financial assistance;
(2) Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), which prohibits discrimination on
the basis of handicap in programs and activities receiving Federal financial assistance;
(3) The Age Discrimination Act of 1975, as amended (Pub. L. 95-478), which prohibits discrimination
based on age in the delivery of services and benefits supported with Federal funds;
(4) Title IX of the Education Amendments of 1972 (20 U.S.C. 1681, et seq.), which prohibits
discrimination on the basis of sex in education programs and activities receiving Federal financial
assistance (whether or not the programs or activities are offered or sponsored by an educational
institution); and
(5) USAID regulations implementing the above nondiscrimination laws, set forth in Chapter II of Title
22 of the Code of Federal Regulations. 06/23/2011 Partial Revision
(b) If the recipient is an institution of higher education, the Assurances given herein extend to admission
practices and to all other practices relating to the treatment of students or clients of the institution, or
relating to the opportunity to participate in the provision of services or other benefits to such individuals,
and shall be applicable to the entire institution unless the recipient establishes to the satisfaction of the
USAID Administrator that the institution's practices in designated parts or programs of the institution
will in no way affect its practices in the program of the institution for which financial assistance is
sought, or the beneficiaries of, or participants in, such programs.
(c) This assurance is given in consideration of and for the purpose of obtaining any and all Federal
grants, loans, contracts, property, discounts, or other Federal financial assistance extended after the date
hereof to the recipient by the Agency, including installment payments after such date on account of
applications for Federal financial assistance which was approved before such date. The recipient
recognizes and agrees that such Federal financial assistance will be extended in reliance on the
representations and agreements made in this Assurance, and that the United States shall have the right
to seek judicial enforcement of this Assurance. This Assurance is binding on the recipient, its successors,
transferees, and assignees, and the person or persons whose signatures appear below are authorized to
sign this Assurance on behalf of the recipient.

2. Certification Regarding Lobbying

The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to
any person for influencing or attempting to influence an officer or employee of any agency, a Member
of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection
with the awarding of any Federal contract, the making of any Federal Cooperative Agreement, the
making of any Federal loan, the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment or modification of any Federal contract, grant, loan, or cooperative
agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress in connection with this
Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit
Standard Form-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions.

51

(3) The undersigned shall require that the language of this certification be included in the award
documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants,
loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making or
entering into this transaction imposed by section 1352, title 31, United States Code. Any person who
fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not
more than $100,000 for each such failure.

Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief, that: If any funds have been paid
or will be paid to any person for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with this commitment providing for the United States to insure or guarantee a
loan, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report
Lobbying," in accordance with its instructions. Submission of this statement is a prerequisite for making
or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to
file the required statement shall be subject to a civil penalty of not less than $10,000 and not more than
$100,000 for each such failure.

3. Prohibition on Assistance to Drug Traffickers for Covered Countries and Individuals (ADS
206)
USAID reserves the right to terminate this Agreement, to demand a refund or take other appropriate
measures if the Grantee is found to have been convicted of a narcotics offense or to have been engaged
in drug trafficking as defined in 22 CFR Part 140. The undersigned shall review USAID ADS 206 to
determine if any certifications are required for Key Individuals or Covered Participants.
If there are COVERED PARTICIPANTS: USAID reserves the right to terminate assistance to or take
other appropriate measures with respect to, any participant approved by USAID who is found to have
been convicted of a narcotics offense or to have been engaged in drug trafficking as defined in 22 CFR
Part 140.

4. Certification Regarding Terrorist Financing, Implementing Executive Order 13224

By signing and submitting this application, the prospective recipient provides the certification set out
below:

1. The Recipient, to the best of its current knowledge, did not provide, within the
previous ten years, and will take all reasonable steps to ensure that it does not and will not knowingly
provide, material support or resources to any individual or entity that commits, attempts to commit,
advocates, facilitates, or participates in terrorist acts, or has committed, attempted to commit, facilitated,
or participated in terrorist acts, as that term is defined in paragraph 3.

2. The following steps may enable the Recipient to comply with its obligations under paragraph 1:
a. Before providing any material support or resources to an individual or entity, the Recipient
will verify that the individual or entity does not (i) appear on the master list of Specially
Designated Nationals and Blocked Persons, which is maintained by the U.S. Treasurys
Office of Foreign Assets Control (OFAC), or (ii) is not included in any supplementary
information concerning prohibited individuals or entities that may be provided by USAID to the
Recipient.
b. Before providing any material support or resources to an individual or entity, the Recipient
also will verify that the individual or entity has not been designated by the United Nations
Security (UNSC) sanctions committee established under UNSC Resolution 1267 (1999) (the
1267 Committee) [individuals and entities linked to the Taliban, Usama bin Laden, or the Al

52

Qaida Organization]. To determine whether there has been a published designation of an
individual or entity by the 1267 Committee, the Recipient should refer to the consolidated list
available online at the Committees website:
http://www.un.org/Docs/sc/committees/1267/1267ListEng.htm.
c. Before providing any material support or resources to an individual or entity, the Recipient
will consider all information about that individual or entity of which it is aware and all public
information that is reasonably available to it or of which it should be aware.
d. The Recipient also will implement reasonable monitoring and oversight
procedures to safeguard against assistance being diverted to support terrorist activity.

3. For purposes of this Certification-
a. Material support and resources means currency or monetary instruments or financial
securities, financial services, lodging, training, expert advice or assistance, safehouses, false
documentation or identification, communications equipment, facilities, weapons, lethal
substances, explosives, personnel, transportation, and other physical assets, except medicine or
religious materials.
b. Terrorist act means-
(i) an act prohibited pursuant to one of the 12 United Nations Conventions and Protocols
related to terrorism (see UN terrorism conventions Internet site:
http://untreaty.un.org/English/Terrorism.asp); or
(ii) an act of premeditated, politically motivated violence perpetrated against noncombatant
targets by subnational groups or clandestine agents; or
(iii) any other act intended to cause death or serious bodily injury to a civilian, or to any
other person not taking an active part in hostilities in a situation of armed conflict, when the
purpose of such act, by its nature or context, is to intimidate a population, or to compel a
government or an international organization to do or to abstain from doing any act.
c. Entity means a partnership, association, corporation, or other organization, group or
subgroup.
d. References in this Certification to the provision of material support and resources shall not
be deemed to include the furnishing of USAID funds or USAID-financed commodities to the
ultimate beneficiaries of USAID assistance, such as recipients of food, medical care, micro-
enterprise loans, shelter, etc., unless the Recipient has reason to believe that one or more of these
beneficiaries commits, attempts to commit, advocates, facilitates, or participates in terrorist acts,
or has committed, attempted to commit, facilitated or participated in terrorist acts.
e. The Recipients obligations under paragraph 1 are not applicable to the
procurement of goods and/or services by the Recipient that are acquired in the ordinary course
of business through contract or purchase, e.g., utilities, rents, office supplies, gasoline, etc.,
unless the Recipient has reason to believe that a vendor or supplier of such goods and services
commits, attempts to commit, advocates, facilitates, or participates in terrorist acts, or has
committed, attempted to commit, facilitated or participated in terrorist acts.

This Certification is an express term and condition of any agreement issued as a result of this application,
and any violation of it shall be grounds for unilateral termination of the agreement by USAID prior to
the end of its term.

5. Certification of Recipient

By signing below the recipient provides certifications and assurances for (1) the Assurance of
Compliance with Laws and Regulations Governing Non-Discrimination in Federally Assisted Programs,
(2) the Certification Regarding Lobbying, (3) the Prohibition on Assistance to Drug Traffickers for
Covered Countries and Individuals (ADS 206) and (4) the Certification Regarding Terrorist Financing
Implementing Executive Order 13224 above.
RFA No. ___________
Date of Application: _______

53

_________________________________ [Date]

54

ANNEX E DOCUMENTS DEMONSTRATING APPLICANTS ELIGIBILITY AND
CAPABILITIES
(Please provide copies)

55

ANNEX F - ENVIRONMENTAL SELF-ASSESSMENT FORM
All applicants seeking to implement grant activities under USAID Sida GOLD Project must complete and submit
this Environmental Self-Assessment Form as an annex to Grant Application. Information obtained from this
form will assit the UASID Sida GOLD Project in estimating potential environmental impact of proposed grant
activity. Grant recipients will be required to comply with environmental standards that may be prescribed, in line
with Federal Regulations (22CFR216) and the USAIDs Automated Directive System (ADS) parts 201 and 204.

1. Legal, Regulatory and Permitting Requirements

1.1. Does your Organization have the following valid permits required for your activities and
facilities?
Environmental Permit:
Yes No
Planning Permission:
Yes No
Construction Permit:
Yes No
Use Permit:
Yes No
Approvals for utility services:
Yes No
Any other valid permit related to environment, safety at work etc.(please list):

1.2. Has your production facility been inspected regarding environmental and work safety
issues?
Yes No
If yes, do you have evidence of the results of these inspection report?
Yes No

1.3. Does your Organization have any of the following certifications:
ISO 14001 EMS
Yes No
ISO 9000
Yes No
HCCP
Yes No
SA 8000
Yes No
GREENGUARD
Yes No
Global Gap
Yes No
Fair Trade
Yes No
Environmental Product Declarations
Yes No
Grean Seal
Yes No
Any other valid certifications, or certifications planned to be obtained (please list):

2. Safety and Integrity Requirements
2.1. Does your Organization uses heavy equipment in the production process?
No Yes, please describe: _________________________________________________

2.2. What protective measures does your Organization undertake to ensure workers' safety at work,
(describe specific activities and policies, such as training, availability and use of protective
equipment for workers etc.)?
_______________________________________________________________________________

3. Environmental and Health Requirements

56

3.1. List the types of solid and liquidwaste your Organization produce in its production process (such
as pesticides, chemical, industrial, medical, other solid or hazardous wastes etc.) and average
quantities of such waste that you produce annually:
______________________________________________________________________________
3.2. Describe how you treat and dispose specific types of solid and liquid wastes created in production
process:
______________________________________________________________________________
3.3. Does your production process includes convertion of land and extraction of natural resources (e.g.
granite, limestone, coal, oil, etc.)

3.4. Do your activities have impact on cultural/hitorical sites with unique ethnic or traditional cultures?

4. Additional Information
Please provide any additional information related to environmental impact of your activities:
__________________________________________________________________________________

57

ANNEX G SURVEY ON ENSURING EQUAL OPPORTUNITIES FOR APPLICANTS
(OPTIONAL)
Purpose:
The Federal government is committed to ensuring that all qualified applicants, small or large, non-
religious or faith-based, have an equal opportunity to compete for Federal funding. In order for us to
better understand the population of applicants for Federal funds, we are asking nonprofit private
organizations (not including private universities) to fill out this survey. Upon receipt, the survey will be
separated from the application. Information provided on the survey will not be considered in any way
in making funding decisions and will not be included in the Federal grants database. While your help in
this data collection process is greatly appreciated, completion of this survey is voluntary.

I nstructions for Submitting the Survey:
If you are applying using a hard copy application, please place the completed survey in an envelope
labeled "Applicant Survey." Seal the envelope and include it along with your application package. If
you are applying electronically, please submit this survey along with your application.

USAID Sida GOLD RFA Number: ____________________________

Applicants (Organization) Name: ____________________________

Grant Name: ____________________________

58

Survey on Ensuring Equal Opportunities for Applicants

1. Does the applicant have 501(c)(3) status?
Yes No

2. How many full-time equivalent employees does the
applicant have? (Check only one box).

3 or Fewer 15-50
4-5 51-100
6-14 over 100
6. Is the applicant an intermediary that will
manage the grant on behalf of other
organizations?
Yes No

3. What is the size of the applicant's annual budget?
(Check only one box.)

Less Than $150,000
$150,000 - $299,999
$300,000 - $499,999
$500,000 - $999,999
$1,000,000 - $4,999,999
$5,000,000 or more

7. Has the applicant ever received s
government grant or contract (Federal,
State or local)?
Yes No

4. Is the applicant a faith-based/religious organization?
Yes No

8. Is the applicant a local affiliate of a
national organization?
Yes No

5. Is the applicant a non-religious community-based
organization?
Yes No

59

Explanations:
1. 501(c)(3) status is a legal designation provided on application to the Internal Revenue Service
by eligible organizations. Some grant programs may require nonprofit applicants to have
501(c)(3) status. Other grant programs do not.
2. For example, two part-time employees who each work half-time equal one full-time equivalent
employee. If the applicant is a local affiliate of a national organization, the responses to survey
questions 2 and 3 should reflect the staff and budget size of the local affiliate.
3. Annual budget means the amount of money your organization spends each year on all of its
activities.
4. Self-identify.
5. An organization is considered a community based organization if its headquarters/service
location shares the postal code as the clients you serve.
6. An intermediary is an organization that enables a group of small organizations to receive and
manage government funds by administering the grant on their behalf.
7. Self-explanatory.
8. Self-explanatory.

60

Annex 3: Pre-Award Survey (for Standard Grants)
Management Questionnaire for Grantee Evaluation Under the USAID Sida GOLD Project

Accepting a grant from the USAID Sida GOLD Project creates a legal duty for the awardee to use the
funds in accordance with the requirements of the USAID Sida GOLD Project agreement and United
States federal regulations. Prior to making an award, USAID Sida GOLD Project must assess the
adequacy of the financial and accounting systems of a prospective grantee to ensure responsibility and
accountability if an award is made.

In filling out the Questionnaire, each question should be answered as completely as possible, using extra
pages if necessary. Please return your completed questionnaire to USAID Sida GOLD Project at
zpasic@goldproject.ba.

Complete the questionnaire and checklist on page 7, sign and return it (along with any attachments) to
USAID Sida GOLD Project.

If you have questions, please contact USAID Sida GOLD Project Grant Manager, Zuhra Osmanovi-
Pai at zpasic@goldproject.ba, or at +387 33 944 993.

61

CONTACT INFORMATION

Please complete this section with information on how we can communicate with each other.

Legal Name of Organization (that will sign the
grant agreement and accept responsibility for USAID
Sida GOLD Project funds):

Mailing Address:

Street Address: (used for express delivery)

Telephone:
Fax Number:
E-mail:

To help us communicate with your organization, please indicate your current capabilities and
preferences below. Paper copies will always be available and can be sent by fax, mail or courier
service.
1. Does your organization have the computer capability needed to receive documents sent by e-mail?
Yes No
2. Please check the software programs you can receive documents in by email:
MS Excel MS Word MS Adobe MS Power Point

SECTION A: General Information

1. Does your organization have the computer capability needed to receive documents sent by e-mail?
Yes No

2. Is your organization incorporated or legally registered?
Yes No (Explain)

__________________________

3. When and where was your organization incorporated or registered?

_______

4. Please provide copies of any materials which describe your organization, its mission and history.
Enclosed Not Enclosed (Explain)

__________________________________________________________

5. Is your organization affiliated with any other organization (governmental, quasi-governmental,
public or private)?
Yes No

62

If yes, please provide details:

________________________________________________________________

6. Please list the names of your organizations officers and provide an organizational chart, if
available.
President/Director:
Chief Financial Officer:

7. List the number of employees your organization has:

Full-Time Employees: __ Part-Time Employees: ___ Volunteers: ___ Men: __ Women: ___

8. Will your organization have other sources of U.S. government funds (such as USAID, OTI, or
USIA/USIS) during the period of the USAID Sida GOLD Project grant?
Yes No

8a. If yes, please provide the name of the U.S. federal agency or agencies, the grant period and
amount of funds provided.

9. Will you receive support from non-U.S. government sources during the grant period?
Yes No

9a. If yes, please provide an estimate of all significant (more than 5% of your total expected revenues)
support you expect to receive and include both monetary and non-monetary (equipment, free
services) amounts to support your program.

Source: ______________________________
Support: ______________________________

Source: ______________________________
Support: ______________________________

Source: ______________________________
Support: ______________________________

SECTION B: Internal Controls

Internal controls are procedures that ensure:

1) financial transactions are approved by an authorized individual and follow laws, regulations and
the organization's policies,
2) assets are kept safely,
3) accounting records are complete, accurate and kept on a regular basis.

Please complete the following questions concerning your organization's internal controls:

1. List the name, position/title, and telephone number for the individuals responsible for checking
expenditures to make sure they are allowable:

63

______

2. Responsible for maintaining accounting records: ____________________________________

3. Responsible for preparing financial reports: ______________________________________

4. Responsible for preparing narrative reports: ______________________________________

5. Are timesheets kept for each paid employee?
Yes No

6. Is your organization familiar with U.S. government regulations concerning costs which can be
charged to U.S. grants (OMB Circular A-122 "Cost Principles for Nonprofit Organizations" or
OMB Circular A-21 "Cost Principles for Educational Institutions")?

Yes No

SECTION C: Accounting System

The purpose of an accounting system is to1) accurately record all financial transactions, 2) ensure that
all financial transactions are supported by invoices, timesheets and other documentation, and 3) ensure
that transactions can be segregated if project specific cost reporting is required or if any final
determinations might be necessary and are based on costs incurred. The type of accounting system often
depends on the size of the organization. Some organizations may have computerized accounting
systems, while others use a manual system to record each transaction in a ledger. In either case, USAID
Sida GOLD Project grant funds must be properly authorized, used for the intended purpose and recorded
in an organized and regular manner.

1. Briefly describe your organization's accounting system including: a) any manual ledgers used to
record transactions (general ledger, cash disbursements ledger, suppliers ledger etc.); b) any
computerized accounting system used (please indicate the name); and c) how transactions are
summarized in financial reports, (by the period, project, cost categories)?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

2. Does your organization have written accounting policies and procedures?
Yes No

3. Are your financial reports prepared on a:
Cash basis Accrual basis (bill for costs before they are incurred)

4. Can your accounting records separate the receipts and payments of the USAID Sida GOLD
Project grant from the receipts and payments of your organization's other activities?
Yes No

5. Can your accounting records summarize expenditures from the USAID Sida GOLD Project grant
according to different budget categories such as salaries, rent, supplies and equipment?

64

Yes No

6. How do you allocate costs that are shared by different funding sources, such as rent, utilities,
etc.?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
7. How often are financial reports prepared?
Monthly Quarterly Annually Not Prepared (explain)
_______________________________________________________________________________

8. How often do you input entries into the financial system?
daily weekly monthly ad hoc/as needed

9. How often do you do a cash reconciliation?
daily weekly monthly by accountants decision

10. Do you keep invoices, vouchers and timesheets for all payments made from grant funds?
Yes No

SECTION D: Funds Control

USAID Sida GOLD Project awardees must maintain a separate bank account registered in the name of
the organization for the purpose of safeguarding the funds. The bank account may be in local currency
or U.S. dollars depending upon local requirements. Access to the bank account must be limited to
authorized individuals. Bank balances should be compared each month with your accounting records. If
cash cannot be kept in a bank, it is very important to keep the cash in a strong safe and have strict
controls over cash maintenance and disbursement. For petty cash, it is very important to keep the cash
in a strong safe and have strict controls over cash maintenance and disbursement.

1. Do you have a bank account registered in the name of your organization?
Yes No

1a. If not, how do you plan to receive funds from a possible grant?

______

2. Will funds in the bank account be in:
BAM U.S. dollars

3. Will the bank account draw interest:
Yes No

4. Are all bank accounts signers authorized by the organization's Board of Directors or Trustees or
other authorized persons?
Yes No

5. Will any funds from USAID Sida GOLD Project be kept outside the bank account (in petty cash
funds, etc.)?
Yes No

65

5.a. If yes, please explain the amount of funds to be kept and the name and position/title of the person
responsible for safeguarding cash.

6. If your organization doesnt have a bank account, how is cash kept safely?

SECTION E: Audit

USAID Sida GOLD Project may require an audit of your organization's accounting records. An audit
is a review of your accounting records by an independent accountant who works for an accounting
firm. An audit report contains your financial statements as well as an opinion by the accountant that
your financial statements are correct. Please provide the following information on prior audits of your
organization.

1. Does your organization have regular independent audits that you contract and pay for?
Yes (please provide the most recent copy) No audits performed

2. If yes, who performs the audit?
_______________________________________________________________________________

3. How often are audits performed?
quarterly yearly every 2 years other (explain)
_______________________________________________________________________________

4. If your organization does not have a current audit of its financial statements, please provide a copy
of the following financial information, if available:
a. A "Balance Sheet" for your prior fiscal or calendar year; and
b. A "Revenue and Expense Statement" for your prior fiscal or calendar year.

5. Are there any reasons (local conditions, laws, or institutional circumstances) that would prevent an
independent accountant from performing an audit of your organization?
Yes No

If yes, please explain: ___
_________
__________________________________________________________________________

66

CHECKLIST AND SIGNATURE PAGE

USAID Sida GOLD Project requests that your organization submit a number of documents along with
this completed questionnaire. Complete this page to ensure that all requested information has been
included.

Please complete the checklist below, then sign and return the questionnaire and any other requested
documents to USAID Sida GOLD Project.

1. Complete the checklist:
Certificate of Registration and Statute (requested on page 2) is attached.
Information describing your organization (requested on page 2-3) is attached.
Organizational chart, if available, (requested on page 4) is attached, (if applicable).
Copy of your organization's most recent audit (requested on page 6) is attached.
If no recent audit, a "Balance Sheet" and "Revenue and Expense Statement" for the prior fiscal
year (requested on page 7).
All questions have been fully answered.
An authorized individual has signed and dated this page.

The Accounting Questionnaire must be signed and dated by an authorized person who has either
completed or reviewed the form.

Approved by:

_______________ __________________________
Print Name Signature
______________ __________________________
Title Date

67

Annex 4: FOG Entity Eligibility Checklist (for Fixed-Obligation Grants)

1. Organizational Integrity

a. Obtain a copy of the articles of incorporation or other documentation which substantiates the
legal character/registration of the entity in country/region of operation.
b. Identify principals/key personnel/organization structure.
c. Vet the organization/principals through the
i. Regional Security Officer or other checkpoints to validate good standing in the local
community (integrity, reputation, internal controls) and ensure that the minimum statutory
requirements are met.
ii. Excluded Parties List System (EPLS).
iii. Terrorism/Special Designated Nationals (SDN)/Blocked Persons/Office of Foreign Assets
Control (OFAC)/etc.

2. Organizational Capacity to Achieve the Proposed FOG Activity

a. Assess management and staff expertise/resources to accomplish the FOG activity
b. Intellectual property to be applied
c. Technology resources to be applied
d. Other assets available and commitments incurred to determine cash flow
e. Assess ability to procure/manage property/personnel

3. Past Performance in the Sector

a. Identify similar activities the entity has implemented
b. Obtain third-party information on performance related to quality of performance, timeliness of
completion, and input from past funding entities and activity beneficiaries
c. Review, if available, objective performance documentation, such as evaluations

4. FOG Activity Implementation Viability

a. Are the milestones appropriate to the activity?
b. Can USAID reasonably define the accomplishments required to achieve the purpose of the
grant in the milestones?
c. Are the milestones verifiable?
d. Is there sufficient information available on estimated costs to:
i. price milestones such that the FOG represents a good value to the Agency?
ii. identify risks to both the implementing entity and Agency, and mitigate the risks through
special conditions?
e. Are the milestones priced to balance liquidity with incentives for the recipient to keep
performing?

5. FOG Pre-Award Financial Review Checklist Applicable for Authorizing Advances of Funds,
if Necessary

a. Is there a properly established bank account to receive USAID advances?

68

b. Are account-related unused bank checks and petty cash on hand adequately safeguarded?
c. Are there appropriate controls established over account disbursements?
d. Are procedures established adequate to document account disbursement usage for grant
activities?
e. Are appropriate procedures established for regular reconciliation of bank account statements
with internal records?
f. If recipient had prior experience with managing advances from external sources, was past
accountability adequate and were any past issues resolved? (Note: prior advance management
experience not required).
g. Does recipient have a comprehensive cash-flow projection for the proposed activity which
supports the proposed implementation plan?
h. Does the recipient understand USAID cash management requirements using either the 30-day
rolling advance process or the working capital advance type methodology (see ADS 303,
Awarding Fixed Obligation Grants Additional Help Document)?
i. A written report of findings on the above points should be made as part of the FOG checklist
documentation. The report should provide a summary assessment of the overall advance
fiduciary risks as high, medium or low, with a brief summary supporting narrative.

6. Certifications/Representations Included/Obtained, as Appropriate
Use the certifications as specified in ADS 303.3.8 with particular attention given to applicability for
Non-U.S. Non-Governmental Organization (NGO) recipients when awarding to a Non-U.S. NGO.

303mak_031212

69

Annex 5: Grant Presentation Template
Slide 1
[Organizations Name]
[Grant Activity Title]
Application for grant funds
from USAID Sida GOLD Project

Slide 2
1. What will grantee do under the grant the major
activities:
2. Location of implementation:
3. Period of implementation:
4. Why is grant activity needed?
5. What objectives are expected to be achieved:
A.
B.
C.
A. Abstract of Grant Activity

Slide 3
6. This grant activity will be carried out by:
[Summary description of the approach/methodology]
[Key team members/ stakeholders/ partners]
7. Project beneficiaries:
A. Abstract of Grant Activity (continued)

70

Slide 4

8. This grant activity will have the following impact:
Number of new jobs created
Amount of investment
Amount of sales/revenue:
Amount of export
Other [specify]
9. We will monitor the impact of grant activity by:
10. We will report on these impacts as follows:
Frequency of reporting?
How will the information be gathered?

Slide 5
11. Sustainability Plan
How will you sustain the impact of grant activity after the
grant period is over?
How will the grantee report on results after the grant
period is over?
12. How will potential market distortion be mitigated?
13. What impact will grant activity have on women or youth, if
any?

Slide 6

71

B. Budget Summary
Budget Item (Milestone)
(A) Requested from GOLD (B) Applicants Contribution
(C) Third Party
Contribution to
Applicant
Name of Third
Party/ies
Contributing Funds
BAM % BAM % BAM %
Project Total: - 0% - 0% - 0% -
(A+B+C) Total Grant Activity Costs 100%
(A) Requested from GOLD - 0%
(B+C) Cost Share 0%
Financial 0%
In-kind 0%

Slide 7
Provide attachment of not more than 3 pages
organized around the main concept
paper/application topics. This should include the
budget.
C. Narrative of Grant Activity

Slide 8
D. Information about Applicant
Date & Place Established:
Type: For profit/Non profit/Private/Public
No. of Employees:
Annual Revenue (BAM):
Total Assets (BAM):
Total Equity (BAM):
Mission / main areas:
Prior relevant experience: [Name of activity 1/ period of implementation]
[Name of activity 2/ period of implementation]
Name of activity 3/ period of implementation]

72

Slide 9
Thank you!

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