GASCOYNE DEVELOPMENT COMMISSION
GASCOYNECOMMUNITY CHEST FUND
FINAL ACQUITTAL REPORT
(Hereunder the GCCF)
1.SUMMARY INFORMATION
Name of Organisation:Organisation
Details / Postal Address:Telephone:
Fax:
Email:
Contact Person:
Position:
Date:
General Project
Information / Project Title:Description:
Total Project Cost
(Excluding GST) / Approved Funding from GCCF
(Excluding GST) / Actual Project Commencement Date / Actual Project
Completion Date
$ / $
a)Final Acquittal Form – Page 1
Forward completed and signed forms to:Gascoyne Development Commission
PO Box 781, CARNARVON WA 6701
Ph: 08 9941 7000 Fax: 08 9941 2576
Form available electronically at / Important Note:
This report and attachments will be assessed by the Gascoyne Development Commission. Once all terms of the agreement have been satisfied the final acquittal of your project will be confirmed in writing by the GDC.
PLEASE NOTE THAT INFORMATION PERTAINING TO THIS GRANT, INCLUDING THE GRANT RECIPIENT, AMOUNT OF GRANT AND THE PURPOSE FOR WHICH THE GRANT HAS BEEN GIVEN MAY BE ACCESSED BY THE PUBLIC OR TABLED IN PARLIAMENT.
2.PROJECT BACKGROUND
Give a brief overview of the project.3. PROJECT AIMS AND OBJECTIVES – GENERAL
Describe the following:- How effective has the project been in achieving the aims and objectives originally proposed in the application?
- Detail any new aims and objectives emerge during the project’s development.
4. PROJECT AIMS AND OBJECTIVES – RELEVANT TO THE COMMISSION AND THE FUND
a)How has the project met the Royalties for Regions Scheme objectives? Please tick the box below to indicate which objective your project planned to meet. Explain in detail how this objective has been met.Increase capacity for local strategic planning and decision-making.
Retain and build the benefits of regional communities.
Promote relevant and accessible local services.
Assist communities to plan for a sustainable economic and social future.
Enable communities to expand social and economic opportunities.
Assist regional communities to prosper through increased employment opportunities, business and industry development opportunities, and improved local services.
*If additional space is required please attach a list.
b)How has the project contributed to relevant regional development strategic planningobjectives, as nominated in the application/agreement?If the project resulted in any short or long term job opportunities in the regionplease describe the number and nature of job opportunities in the following table.
No. of Jobs / Type of Job (position, trade, and whether fulltime, casual, part time, contract etc)
5.PROJECT PARTNERSHIPS
Describe any partnerships formed during the project with the business sector, general community, or the various levels of Government.6.PROJECT SUSTAINABILITY
Describe how the project will be sustained and/or further developed in the future.7.ACKNOWLEDGEMENT OF FUNDING
It is a requirement of the Gascoyne Community Chest Fund that the State Government and Royalties for Regions are adequately acknowledge by funding recipients.a)Please provide details on how you have acknowledged the State Government support and Royalties for Regions funding.
b)Please provide photographic evidence that suitable signage has been adequately installed at the project site acknowledging the State Government support and Royalties for Regions funding.
Please include attachments which indicate the following:
- Evidence of acknowledgement and use of logos in promotional material, publications, media etc;
- Photographic evidence of permanent signage adequately installed at the project site acknowledging the State Government support and Royalties for Regions funding.
- Any reports, research or documents that have resulted from the project;
- Photos which detail the progress of the project or any changes to the project; and
- Any other information which may be relevant.
8. FINANCIAL OBLIGATIONS
The Financial Management Act 2006 requires evidence showing grant funds were expended in accordance with the approved application and grant agreement made with the Gascoyne Development Commission.
Please ensure that all requirements for financial obligations detailed in the grant agreement have been complied with and supplied.
For funding of $20,000 or less you must provide:
- Income and Expenditure Statement signed by the CEO, Chairperson or authorised officer.
- Details of what the grant funds were spent on.
- Evidence of grant expenditure – please include copies of Tax Invoices / receipts.
- Details of in-kind contributions including calculations of in-kind value.
Please refer to additional information in the Checklist on page 10.
9. DECLARATION
I ______of______
do hereby declare that the information provided in this report is a true and correct record of the acquittal of funds received through the Gascoyne Community Chest Fund for the project as described.
Signed by……………………………………………………..……..…….. this…….……….... Day of ……………..………….. 20…...
(CEO or equivalent)
a)Final Acquittal Form – Page 1
GASCOYNE COMMUNITY CHEST FUNDSTATEMENT OF INCOME AND EXPENDITURE
(for total project income and expenditure, not just GCCF grant)
Name of Organisation:
Project Title:
Is the organisation registered for GST? / □ Yes / □ No
INCOME / BUDGETED amount
(refer to Attachment A in your Grant Agreement)
$ GST Exclusive / ACTUAL
Funds received to date
$ GST Exclusive / $ GST
GCCF Grant(this should be the $ received by your organisation to date, not the total amount granted)
Organisation's Cash Contribution
Other Funding(list below, add more rows as required)
In-kind Contributions(list source, which element of the project and how $ value has been calculated)
INCOME TOTALS
EXPENDITURE
(refer to Attachment A of Grant Agreement) / BUDGETED
(refer to Attachment A in your Grant Agreement)
$ GST Exclusive / ACTUAL
GCCF Expenditure
$ GST Exclusive / ACTUAL
Other Funds Expenditure
$ GST Exclusive / TOTAL PROJECT EXPENDITURE $ GST Exclusive / $ GST
(list expenditure items below, add more rows as required)
EXPENDITURE TOTALS
CHECKLIST
As part of the State Government’s accountability and performance process, the Commission is required to undertake a full evaluation of how the grants provided from Royalties for Regions were utilised and what benefits were accrued from the project through the provision of those funds.
The intention of the acquittal is to compare the actual outcomes (e.g. economic, social, financial, environmental) to the original proposal. This includes project outcomes and benefits, and financial aspects such as the total project cost, other partners, various incomes, how the money was spent compared to the proposal. An independent audit report is required to ensure that government funds have been appropriately expended and that all conditions of the grant have been met.
Please make sure the following items have been addressed, completed or provided, otherwise the acquittal will either be returned or you will be requested to provide the additional information.
Have you:
Completed the acquittal document and had it signed by the appropriate person?
Reported on each objective as detailed in original application?
Completed and attached the Statement of Income and Expenditure for the project and copies of relevant tax invoices/receipts as evidence of expenditure?
Attached copies of media promoting the project showing that appropriate acknowledgement of the support received through Royalties for Regions funding and the Gascoyne Development Commission has been included?
Attached copies of any reports, commissioned research outcomes, feasibility studies, etc that have resulted from the project?
Attachedphotographic evidence of permanent signage adequately installed at the project site acknowledging State Government support and Royalties for Regions funding?
Should you be unsure or require a copy of the grant agreement, original application etc, please contact the Gascoyne Development Commission who will assist you.
Gascoyne Development Commission
PO Box 781, CARNARVON WA 6701
Ph: 08 9941 7000 Fax: 08 9941 2576
Email:
a)Final Acquittal Form – Page 1