Certification of Intent to Comply with

Federal and State Agency Audit Requirements

Fiscal Year Ending

This is to certify that the (Name of Non profit) is subject to comply with item number ______(select 1, 2 or 3 below) for the Fiscal Year Ending

(Last Day of Entity Fiscal Year):

1.  Our Non Profit Entity Expended $500,000 or more in federal financial assistance during our fiscal year. We understand that a copy of our Federal Single Audit Report must be submitted to DECD within the earlier of 30 days after receipt of the auditor’s report, or nine months after the end of the Fiscal Year. We will ensure that such audit shall be in accordance with OMB Circular A-133, “Audits of States, Local Governments, and Non-Profit Organizations." The Federal Audit Clearinghouse (FAC) offers federal single audit reference material and provides answers to frequently asked questions (FAC’s) Internet Homepage address is http://harvester.census.gov/sac/).

2.  Our Non Profit Entity expended $500,000 or more in federal financial assistance on a single federal program, therefore we have elected to have a program-specific audit of the contract in lieu of a single audit. We understand that a copy of our program-specific audit must be submitted to DECD within the earlier of 30 days after receipt of the auditor’s report, or nine months after the end of the audit period. We will ensure that such program-specific audit shall be in accordance with DECD’s Consolidated Audit Guide for Audits of DECD Programs, using the applicable federal award compliance supplement from OMB Circular A-133, “Audits of States, Local Governments, and Non-Profit Organizations."

3.  Our Non Profit Entity expended a total amount of federal financial assistance less than $500,000 during the fiscal year therefore we are exempt with respect to filing a Federal Single Audit Report for that year. We understand however, that we may be asked to provide access to the records we are required to maintain concerning such federal assistance and or a development cost certification.

We understand that a copy of the applicable audit report must be submitted by the required deadline to the:

State of Connecticut

Department of Economic and Community Development

Attention: Michael J. Lettieri, Community Development Director

Office of Financial Review - Audit Section

505 Hudson Street

Hartford, CT 06106

We further understand that our failure to submit the applicable audit report(s) by the required deadline may result in the suspension of payments on our existing federal grant and/or prevent the award of future grants from DECD.

Signature of Authorized Official Date

Title of Authorized Official

Certificate of Intent to Comply with Federal and State Agency Audit Requirements for Fiscal Years ending AFTER 1/01/04