BoR - 0001R - Prequalification Risk Assessment (ReUp)

Instructions

This form must be completed by parties wishing to qualify to apply for projects and to enter into a contractual agreement with NJDOT as a prime recipient entity.

Attach your organization's most recent audit report to this form. If your organization has expended more than $750,000 in federal grant funds within a year, please attach an A-133 audit form.

 

IMPORTANT: This form is for parties who are re-affirming their Risk PreQualification Assessment Form (per the anual requirement).  You will need your original University/Organization ID to complete this form.  If you do not have this ID ready, please contact the Bureau of Research by phone at (609) 963-2242, or via email at Research.Bureau@dot.nj.gov.

The entity filling out this form has three chances to complete and correct incomplete/incorrect information.

If on the third attempt, the form is not remedied as instructed, your application will be rejected and the form answers you provided will not be kept. You will be provided with a new identification number upon reapplying.

 

For Survey Questions:

#14: These records must contain information pertaining to grant or subgrant and authorizations, obligations, unobligated balances, assets, liabilities, outlays or expenditures, and income.

#25: Apply the following definitions to these terms:

Unqualified means the financial information is presented fairly and in conformance with Generally Accepted Accounting Principles - GAAP.

Qualified means the financial reports essentially are in conformance with Generally Accepted Accounting Principles, except for one or a few areas where the auditor cannot, or does not want to, assert conformance.

Adverse / Disclaimer means the audited financial statements do not fairly represent the organization's financial position or financial performance, and that there are significant departures from GAAP that need to be addressed.

#26: Significant deficiencies include the design or operation of a control over compliance that does not allow management or employees, in the normal course of performing their assigned functions, to prevent, or detect and correct, noncompliance with a type of compliance requirement of a federal program on a timely basis.

University/Organization Information

Authorized Fiscal Officer (AFO) of Organization Information

Financial Management Systems

1. Is your organization new?
2. Does your organization have experience managing federal funds?
4. Does your organization have a policy regarding delegation of contract and signatory authority by staff position and/or board? YES requires an explanation attached to this form (see ATTACHMENTS section)
5. Does your organization have a board-approved operating budget prior to the beginning of the fiscal year?
6. Are bank statements opened and reviewed by the executive director or other staff member who is not the fiscal officer?
7. Is mail opened and checks logged daily by a staff member who is not the fiscal officer?
9. Would the financial management system utilized be able to identify receipts and expenditures of program funds separately for each award?
10. Does your organization's accounting and financial management systems follow generally accepted administrative rules, cost principals, and audit requirements?
11. Do your financial management systems permit the preparation of reports required by applicable statutes and regulations?
12. Do your systems permit the tracing of funds to a level of expenditures adequate to establish that funds have not been used in violation of applicable statutes?
13. Do your systems produce accurate, current, and complete disclosure of the financial activities in accordance with the reporting requirements of the grant?
14. Does your system contain information that adequately identifies the source and application of funds provided for financially assisted activities?
15. Does your system provide effective control over and accountability for all funds, property and other assets?
16. Does your system adequately safeguard all state assets and assure that it is used solely for authorized purposes?
17. Does your system allow for comparison of actual expenditures or outlays with budgeted amounts of each grant?
18. Does your system relate financial information to performance or productivity data, including the development of unit cost information whenever appropriate or specifically required in the grant agreement?
19. Does your system provide procedures to assess the completeness/accuracy of bills and determine the allocability/allowability of costs in accordance with 2 CFR 200?
20. Does your organization have a current federally negotiated rate agreement?

Audit Information

21. Has your organization expended more than $750,000 in federal grant funds within a year?
22. Is an independent audit or an A-133 Single Financial Audit of your organization conducted annually?
23. If your organization received more than $750,000 in federal grant funds in the past 12 months, was your organization audited in at least one of the two most recent years?
24. Most recent A-133 and/or other type of audit report submitted and attached to this form?

Procurement Management Systems

29. Do your procurement procedures prevent purchasing unnecessary or duplicative items by requiring a review of proposed procurements with regard to grants?
30. Do you conduct a cost and price analysis in connection with every procurement action?
31. Do nonprofit/university recipient records for purchases in excess of their small purchase threshold include basis for contractor selection, justification for lack of competition when competitive bids or offers were not obtained, and basis for award cost or price?
32. Do you take the necessary affirmative steps to assure that minority firms, women’s business enterprises, and labor surplus firms are used when possible?
33. Does your organization have written policies and procedures to ensure federal‐aid contracts are only awarded to bidders who make a good faith effort to meet DBE goals established by NJDOT?
34. Do your organization’s DBE goal procedures have provisions to monitor DBE participation to ensure goals are met at project completion?
35. Do your procurement procedures meet the requirements laid out in 2 CFR 200.320 for small purchases, sealed bids, competitive proposals, and noncompetitive proposals?
36. To the maximum extent practical, are your procurement actions conducted in a manner providing full and open competition?

Personnel Systems

37. Do you maintain an employee handbook or personnel manual?
38. Do you have written, current position descriptions?
39. Are staff in each position qualified, based on position description?
42. Do you have a written recruiting and hiring procedure that ensures fairness and compliance with all applicable federal and state requirements?
43. Are your fringe benefits reasonable and consistently applied, e.g., same benefits regardless of funding source for the person’s position?

Property Management Systems

45. Do you maintain equipment records that include: property description, serial or identification number, title holder, acquisition date, cost, percentage of federal participation in cost, location and condition, including date information was reported and disposition date, including disposal date and sales price?
46. Do you conduct a physical inventory of equipment at least once every two years, including reconciliation with property records?
47. Do you have a control system to ensure property is safeguarded to prevent loss, damage and theft?
48. For federally owned equipment, do you submit annual inventory listings?
49. Does your organization maintain insurance on equipment and real property acquired with federal funds equivalent to insurance on their own property?
50. Do your procedures cover requesting disposition instructions from the federal agency when real property is no longer needed on the project?
51. Do your procedures for equipment disposition require valuation when equipment is no longer needed on federally supported projects?
52. Do your procedures cover calculating the residual value of supplies at closeout?

Document Retention Policy

53. Does your organization have a document retention policy (i.e. how long specific documents are maintained and location of documents)? YES requires an explanation attached to this form (see ATTACHMENTS section)
55. Does your organization have a records management program for research projects? YES requires an explanation attached to this form (see ATTACHMENTS section)

Project Schedule Managment System

56. Does your organization’s written policy and procedures for project schedules include provisions to monitor contract progress and evaluate impacts on contract time? YES requires an explanation attached to this form (see ATTACHMENTS section)
57. Do your project schedule procedures include requirements for the project schedule to be kept current?
58. Does your organization have written policies and procedures to ensure a project’s progress, payments and contract completion adhere to the approved project schedule and specified contract time?

Attachments

1. Attach most recent audit report.
2. Attach most recent A-133 audit form if your organization has expended more than $750,000 in federal grants in a year.
3. Attach multiple PDF files with explanations and/or weblinks for the following required query answers:

    A). #4 if Yes is selected.
    B). #53 if Yes is selected.
    C). #55 if Yes is selected.
    D). #56 if Yes is selected.

 

Certification

The foregoing information and any attachments thereto are true, accurate, and consistent with the records maintained by the individual, government agency, partnership, university, research center, or corporation submitting this PREQUALIFICATION RISK ASSESSMENT (2 CFR 200).

I acknowledge that the New Jersey Department of Transportation is relying on the information contained herein and I am aware that any false statement or misrepresentation may subject me ad/or my agency to debarment, criminal penalties, and disclosure to OMB as per 2 CFR 200.113.

Please type your signature in the space next to TYPE in the signature field. Do NOT draw or upload signature.

Assessment Scoring

Total Assessment Score:

1. Is your organization new? 

     Score:

2. Does your organization have experience managing federal funds?

     Score:

3. At what frequency will your organization submit invoices?

     Score:

4. Does your organization have a policy regarding delegation of contract and signatory authority by staff position and/or board?

     Score:

5. Does your organization have a board-approved operating budget prior to the beginning of the fiscal year?

     Score:

6. Are bank statements opened and reviewed by the executive director or other staff member who is not the fiscal officer?

     Score:

7. Is mail opened and checks logged daily by a staff member who is not the fiscal officer?

     Score:

8. What type of financial management system does your organization have in place to track and record program expenditures?

     Score:

9. Would the financial management system utilized be able to identify receipts and expenditures of program funds separately for each award?

     Score:

10. Does your organization's accounting and financial management systems follow generally accepted administrative rules, cost principals, and audit requirements?

     Score:

11. Do your financial management systems permit the preparation of reports required by applicable statutes and regulations?

     Score:

12. Do your systems permit the tracing of funds to a level of expenditures adequate to establish that funds have not been used in violation of applicable statutes?

     Score:

13. Do your systems produce accurate, current, and complete disclosure of the financial activities in accordance with the reporting requirements of the grant?

     Score:

14. Does your system contain information that adequately identifies the source and application of funds provided for financially assisted activities?

     Score:

15. Does your system provide effective control over and accountability for all funds, property and other assets?

     Score:

16. Does your system adequately safeguard all state assets and assure that it is used solely for authorized purposes?

     Score:

17. Does your system allow for comparison of actual expenditures or outlays with budgeted amounts of each grant?

     Score:

18. Does your system relate financial information to performance or productivity data, including the development of unit cost information whenever appropriate or specifically required in the grant agreement?

     Score:

19. Does your system provide procedures to assess the completeness/accuracy of bills and determine the allocability/allowability of costs in accordance with 2 CFR 200?

     Score:

20. Does your organization have a current federally negotiated rate agreement?

     Score:

21. Has your organization expended more than $750,000 in federal grant funds within a year?

     Score:

22. Is an independent audit or an A-133 Single Financial Audit of your organization conducted annually?

     Score:

23. If your organization received more than $750,000 in federal grant funds in the past 12 months, was your organization audited in at least one of the two most recent years?

     Score:

24. Most recent A-133 and/or other type of audit report submitted and attached to this form?

     Score:

25. Single Audit Opinion on Major Program Compliance:

     Score:

26. How many Significant Deficiencies in Internal Control Over Compliance were included in the most recent audit?

     Score:

27. How many findings for Non-Compliance for Federal Awards were included in the most recent audit? (include intentional, unintentional, minor, serious and/or continuing):

     Score:

28. Program Complexity as it relates to federal program compliance:

     Score:

29. Do your procurement procedures prevent purchasing unnecessary or duplicative items by requiring a review of proposed procurements with regard to grants?

     Score:

30. Do you conduct a cost and price analysis in connection with every procurement action?

     Score:

31. Do nonprofit/university recipient records for purchases in excess of their small purchase threshold include basis for contractor selection, justification for lack of competition when competitive bids or offers were not obtained, and basis for award cost or price?

     Score:

32. Do you take the necessary affirmative steps to assure that minority firms, women’s business enterprises, and labor surplus firms are used when possible?

     Score:

33. Does your organization have written policies and procedures to ensure federal‐aid contracts are only awarded to bidders who make a good faith effort to meet DBE goals established by NJDOT?

     Score:

34. Do your organization’s DBE goal procedures have provisions to monitor DBE participation to ensure goals are met at project completion?

     Score:

35. Do your procurement procedures meet the requirements laid out in 2 CFR 200.320 for small purchases, sealed bids, competitive proposals, and noncompetitive proposals?

     Score:

36. To the maximum extent practical, are your procurement actions conducted in a manner providing full and open competition?

     Score:

37. Do you maintain an employee handbook or personnel manual?

     Score:

38. Do you have written, current position descriptions?

     Score:

39. Are staff in each position qualified, based on position description?

     Score:

40. Staff Experience (Choose the statement that applies)

     Score:

41. Organization Staffing Occupancy Level

     Score:

42. Do you have a written recruiting and hiring procedure that ensures fairness and compliance with all applicable federal and state requirements?

     Score:

43. Are your fringe benefits reasonable and consistently applied, e.g., same benefits regardless of funding source for the person’s position?

     Score:

44. Organization Experience (choose the statement that applies)

     Score:

45. Do you maintain equipment records that include: property description, serial or identification number, title holder, acquisition date, cost, percentage of federal participation in cost, location and condition, including date information was reported and disposition date, including disposal date and sales price?

     Score:

46. Do you conduct a physical inventory of equipment at least once every two years, including reconciliation with property records?

     Score:

47.  Do you have a control system to ensure property is safeguarded to prevent loss, damage and theft?

     Score:

48.  For federally owned equipment, do you submit annual inventory listings?

     Score:

49. Does your organization maintain insurance on equipment and real property acquired with federal funds equivalent to insurance on their own property?

     Score:

50. Do your procedures cover requesting disposition instructions from the federal agency when real property is no longer needed on the project?

     Score:

51. Do your procedures for equipment disposition require valuation when equipment is no longer needed on federally supported projects?

     Score:

52.  Do your procedures cover calculating the residual value of supplies at closeout?

     Score:

53. Does your organization have a document retention policy (i.e. how long specific documents are maintained and location of documents)?

     Score:

54. How often are financial records archived and/or shredded?

     Score:

55. Does your organization have a records management program for research projects?

     Score:

56. Does your organization’s written policy and procedures for project schedules include provisions to monitor contract progress and evaluate impacts on contract time?

     Score:

57. Do your project schedule procedures include requirements for the project schedule to be kept current?

     Score:

58. Does your organization have written policies and procedures to ensure a project’s progress, payments and contract completion adhere to the approved project schedule and specified contract time?

     Score: