2009-32Equitable Sharing
Agreement and
`~~K~ y . ;;~~ -~~ Certification
~M8 Number 1713-UUl 7
Expires 7-31-2011
0 Police Department ~ Sheriffs Office ~ Task Force (Complete Table A, page2)
Prosecutor's Office 0 Other (specify)
Agency Name: Clermont Police Department
NCIC/ORI/Tracking Number: F L 0 3 5 0 3 0 0
Street Address: PO Box 120219
City: Clermont
Contact: Title: Chief
Contact Phone:
Contact a-mail:
State: FL Zip: 34712
First: Stephen Last: Graham
(352) 394-5588 Contact Fax: (352) 394-1644
Last Fiscal Year End: 09/30/2009
O New Participant: Read the Equitable Sharing Agreement (page 5) and sign the Affidavit (page 6)
O Existing Participant: Complete the Annual Certification Report, read the Equitable Sharing Agreement
(page 5), and sign the Affidavit (page 6)
O Change in Administration: Select to report change to Agency or Governing Body head DURING the current fiscal
year. Read the Equitable Sharing Agreement (page 5) and sign the Affidavit (page 6).
O Amended Form: Revise the Annual Certification Report, read the Equitable Sharing Agreement (page
5), and sign the Affidavit (page 6).
Annual Certification Report
Summary of Equitable Sharing Activity Justice Funds Treasury Funds
~ Beginning Equitable Sharing Fund Balance (must match $119,076.41
Ending Equitable Sharing Fund Balance from prior FY)
2 Federal Sharing Funds Received $4,990.10
3 Federal Sharing Funds Received from Other Law Enforcement
Agencies and Task Forces (complete Table B, page 2)
4 Other Income
5 Interest Income Accrued $297.07
Check box if non-interest-bearing account
6 Total Equitable Sharing Funds (total of lines 1 - 5) $124,363.58 $0.00
7 Federal Sharing Funds Spent (total oflines a - n below) $4,065.80 $0.00
8 Ending Balance (difference between line 7 and line 6) $120,297.78 $0.00
Page 1 of 6 March 2009
Versiort 1.7
Summary of Shared Monies Spent Justice Funds Treasury Funds
a Total spent on salaries for new, temporary, not-to-exceed
one year employees (See Guide to Equitable Sharing)
b Total spent on overtime
c Total spent on informant and "buy money"
d Total spent on travel and training
e Total spent on communications and computers
f Total spent on firearms and weapons
9 Total spent on body armor and protective gear
h Total spent on electronic surveillance equipment
i Total spent on building and improvements
~ Total spent on other law enforcement expenses (complete
Table C, page 3)
$4,065.80
k Total transfers to other state and local law enforcement
agencies (complete Table D, page 3)
I Total 15°~ Expenditures in Support of Community-based
Programs (complete Table E, page 3)
r" Total 25% Windfall Transfers to Other Government Agencies
(complete Table F, page 3)
n Total spent on matching grants (complete Table G, page 3)
Total $4,065.80 $0.00
Miscellaneous Data
o Agency's budget for current fiscal year $5,748,862.00
p Jurisdiction's budget for current fiscal year $50,590,592.00
q Appraised Value of Other Assets Received
Table A: Members of Task Force
Agency Name
Address
Table B: Equitable Sharing Funds Received from other Agencies
Transferring Agency Name, City, and State
Justice Funds Treasury Funds
Date Agency Name
NCIC/ORIlTracking Number
Page 2 of 6 March 2009
Version 7.7
Table C: Other Law Enforcement Expenses
Description of Expense
Justice Funds Treasury Funds
K-9 Purchase $4,065.80
Table D: Equitable Sharing Funds Transferred to Other Agencies
Receiving Agency Name, City, and State
Justice Funds Treasury Funds
Date Agency Name
C~ NCIC/ORI/Tracking Number
Table E: 15% Expenditures in Support of Community-based Programs
Recipient
Justice Funds
Table F: 25% Windfall Transfers to Other Government Agencies
Recipient Justice Funds Treasury Funds
Table G: Matching Grants
Matching Grant Name
Justice Funds Treasury Funds
Table H: Civil Rights Cases
Name of Case
Tvoe of Discrimination Alleged
Status
f Cl ® Race ~ Color ~ National
Origin ~ Gender
Q Settled
ermont
R. Rodriquez vs. Ciry o
0 Pending
Disability ~ Age ~ Other
® Race ~ Color ~ National ~ Gender
Origin Qi Settled
f
Clermont
E. Wells vs. City o
Pending
Disability ~ Age ~ Other
Page 3 of 6 March 2009
Version 1.7
Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it
displays a valid OMB control number. We try to create accurate and easily understood forms that impose the least
possible burden on you to complete. The estimated average time to complete this form is 30 minutes. If you have
comments regarding the accuracy of this estimate, or suggestions for making this form simpler, please write to the
Asset Forfeiture and Money Laundering Section, Program Management and Strategic Planning Unit, 1400 New York
Avenue, N.W., Second Floor, Washington, DC 20005.
Page 4 of 6 March 2009
Version 1.7
Equitable Sharing Agreement
This Federal Equitable Sharing Agreement, entered into among (1) the Federal Government, (2) the above-stated
law enforcement agency ("Agency'), and (3) the governing body, sets forth the requirements for participation in
the federal equitable sharing program and the restrictions upon the use of federally forfeited cash, property,
proceeds, and any interest earned thereon, which are equitably shared with participating law enforcement
agencies. By its signatures, the Agency agrees that it will be bound by the statutes and guidelines that regulate
shared assets and the following requirements for participation in the federal equitable sharing program. Receipt
of the signed Equitable Sharing Agreement and Certification (this "Document") is a prerequisite to receiving any
equitably shared cash, property, or proceeds.
1. Submission. This Document must be submitted to aca.submit@usdoj.gov within 60 days of the end of the
Agency's fiscal year. This Document must be submitted electronically with the Affidavit/Signature page (page 6)
submitted by fax. This will constitute submission to the Department of Justice and the Department of Treasury.
2. Signatories. This agreement must be signed by the head of the Agency and the head of the governing body.
Examples of Agency heads include police chief, sheriff, director, commissioner, superintendent, administrator,
chairperson, secretary, city attorney, county attorney, district attorney, prosecuting attorney, state attorney,
commonwealth attorney, and attorney general. The governing body's head is the person who allocates funds or
approves the budget for the Agency. Examples of governing body heads include city manager, mayor, city
council chairperson, county executive, county council chairperson, director, secretary, administrator,
commissioner, and governor.
3. Uses. Any shared asset shall be used for law enforcement purposes in accordance with the statutes and
guidelines that govern the federal equitable sharing program as set forth in the current edition of the
Department of Justice's Guide to Equitable Sharing (Justice Guide), and the Department of the Treasury's Guide to
Equitable Sharing for Foreign Countries and Federal, State, and Local Law Enforcement Agencies (Treasury Guide).
4. Transfers. Before the Agency transfers cash, property, or proceeds to other state or local law enforcement
agencies, it must first verify with the Department of Justice or the Department of Treasury, depending on the
source of the funds, that the receiving agency is a federal equitable sharing program participant and has a
current Equitable Sharing Agreement and Certification on file.
5. Internal Controls. The Agency agrees to account separately for federal equitable sharing funds received
from the Department of Justice and the Department of the Treasury. Funds from state and local forfeitures and
other sources must not be commingled with federal equitable sharing funds. The Agency shall establish a
separate revenue account or accounting code for state, local, Department of Justice, and Department of the
Treasury forfeiture funds. Interest income generated must be accounted for in the appropriate federal forfeiture
fund account.
The Agency agrees that such accounting will be subject to the standard accounting requirements and practices
employed for other public monies as supplemented by requirements set forth in the current edition of the
Justice Guide and the Treasury Guide.
The misuse or misapplication of shared resources or the supplantation of existing resources with shared assets is
prohibited. Failure to comply with any provision of this agreement shall subject the recipient agency to the
sanctions stipulated in the current edition of the Justice or Treasury Guides, depending on the source of the
funds/property.
6. Audit Report. Audits will be conducted as provided by the Single Audit Act Amendments of 1996 and OMB
Circular A-133. The Department of Justice and Department of the Treasury reserve the right to conduct periodic
random audits.
Page S of 6 March 2009
Version 1.7
Affidavit
Under penalty of perjury, the undersigned officials certify that they have read and understand their obligations under
the Equitable Sharing Agreement and that the information submitted in conjunction with this Document is an accurate
accounting of funds received and spent by the Agency under the Justice and/or Treasury Guides during the reporting
period and that the recipient Agency is in compliance with the National Code of Professional Conduct for Asset Forfeiture.
The undersigned certify that the recipient agency is in compliance with the nondiscrimination requirements of the
following laws and their Department of Justice implementing regulations: Title VI of the Civil Rights Act of 1964 (42 U.S.C.
§ 2000d et seq.), Title IX of the Education Amendments of 1972 (20 U.S.C. § 1681 et seq.), Section 504 of the Rehabilitation
Act of 1973 (29 U.S.C. § 794), and the Age Discrimination Act of 1975 (42 U.S.C. § 6101 et seq.), which prohibit
discrimination on the basis of race, color, national origin, disability, or age in any federally assisted program or activity, or
on the basis of sex in any federally assisted education program or activity.
During the past fiscal year, has the Agency been part of any
proceedings alleging discrimination by the Agency? Q Yes Q No
If you answered yes, complete Table H. Please disclose (1) all proceedings pending
before any court or administrative agency, (2) any nondiscrimination laws the
Agency has been found in violation of, and (3) any settlement agreements the
Agency has entered into during the last fiscal year.
Agency Head f~ ~; i
7 / .!,
Signature: ,~
Name: St lien Graham
Title: Chief of Police
Governing Body Head
~-
Sign re• .,-~/~''..~~
Name: Harold Turville
Title:
Date: %~ "% ~' ~' ~~ Date:
Final Instructions:
Mayor
l 1-2y- ~a
Step 1: Click button to save in PDF format for your records
Step 2: Click button to save in XML format
Step 3: E-mail the XML file as attachment to aca.submit@usdoj.gov
Step 4: Fax a signed copy of THIS PAGE ONLY to (202) 616-1344
Note: The Agency will not be in compliance until the a-mail and the fax of this page are received.
FOR AGENCY USE ONLY
Entered by
Entered on
FY End: 09/30/2009
NCIC: FL0350300 Agency:Clermont Police Department Phone:(352) 394-5588
State:FL Contact:Stephen Graham
E-mail:sgraham@clermontfl.org
Page 6 of 6 March 2009
Version 1.7