OMB Number 2900-0661
Estimated burden: 6 hours
MEMORANDUM OF AGREEMENT FOR A GRANT TO
CONSTRUCT OR ACQUIRE A STATE VETERANS HOME
This Memorandum of Agreement is hereby made by and between The Department of Veterans Affairs
(VA), 810
Vermont Avenue, NW, Washington, D.C. 20420, and
has submitted to VA an application for a grant to
construct or
acquire a
facility for veterans in
Description
Location
The Federal Application Identifier (FAI) Number for this project is
. The parties agree that this
application meets the requirements of Federal Law for this grant. The estimated total cost of
, including
equipment, in which VA will participate, is $
. The VA grant will total up to $
, but
will not exceed sixty-five (65) percent of the actual cost of
as determined at final audit.
In consideration of the foregoing, the parties hereto mutually agree as follows:
(1)
certifies that the plans and specifications included in the application meet all
applicable Federal requirements.
(2)
agrees that it will
construct or
acquire a
(a description of the
, to be completed in accordance with the documentation
project, including number of beds added or replaced)
submitted by the State.
(3)
agrees to comply strictly with the assurances contained in the documentation
submitted by the state.
(4)
agrees to enter into a contract to
construct or
acquire a
(a description of the project, including number of beds added or replaced)
within 90 days of the date on which both parties have signed this agreement.
agrees to periodically inspect the project and certify to the Chief Consultant ,
(5)
Office of Geriatrics and Extended Care, 810 Vermont Avenue, NW, Washington, D.C. 20420, for payment of such sums
which it deems are payable by VA.
VA FORM
10-0388-11
PAGE 1 OF 2
MAR 2003