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Contract Template

HFI

Date: _________________

Dear ___________,

The Miami County Health Department is pleased to inform you that your application for funding has received approval in the amount of [insert dollar amount] to support the following: [insert title of approved project].

This letter and its attachments outline the terms and conditions of accepting our grant. Please read all the terms and conditions carefully, sign, and return along with this signed contract letter no later than [date to be returned]. The award will be made in a single payment upon the execution of this agreement.

The funds must be used specifically for the designated purpose(s) by December 31, 2025. You must submit a written request to us in advance if the funds are not expended by this date.

Upon signing this contract, your organization states that you agree to provide us with quarterly reports due by March 31,2025, June 30, 2025, September 30, 2025, and December 30, 2025.

Congratulations on this recognition of your important efforts. We look forward to working with you during the coming year.

Sincerely,

ACCEPTED AND AGREED:

__________________________________

(Authorized MCHD Signature)

Miami County Health Department

Grant Terms and Conditions

In addition to the specific terms and conditions in the grant award letter dated ________, to which these Grant Terms and Conditions are attached, the Miami County Health Department is awarding this grant to you as the Grantee contingent upon the following:

Expenditure of Funds:

This grant is made for the purpose outlined in the grant award letter and may not be expended for any other purpose.

If the grant is intended to support a specific project, any portion of the grant unexpended at the completion of the project or the end of the period shall be returned immediately to the Miami County Health Department.

You may not expend any grant funds on personal items, items not related to IC 16-46-10-3, alcoholic beverages, duplicate payments or overpayments, capital expenses not permitted by IC 16-46-10-3(c) (such as vehicles, motorized items, trailers, buildings/structures, renovations, etc.), scholarships, donations, State or Federal Lobbying or any Political Activity, food/beverages, any unallowable expenditure as determined by the Indiana State Board of Accounts, any expenditure not allowed by Indiana State Law, incentives (unless educational or a protective public health measure in nature and with prior approval by the Miami County Health Department), and other activities or purchases deemed inappropriate by the Miami County Health Department.

Records and Reports:

You are required to keep a record of all receipts and expenditures relating to this grant and to provide the Miami County Health Department with written quarterly reports due by March 31, 2025, June 30, 2025, September 30, 2025 and December 30, 2025 (dates dependent on state requirements). The Miami County Health Department will provide a form to your organization. Your reports should describe your progress in achieving the purposes of the grant and include a detailed accounting of the uses or expenditure of all grant funds. You also agree to provide any other information reasonably requested by the Miami County Health Department.

Required Notification

You are required to provide the Miami County Health Department written notification of: (1) your inability to expend the grant funds for the purposes described in the grant award letter; or (2) any expenditure from this grant made for any purpose other than those for which the grant was intended.

Advertising

You are required to recognize the Miami County Health Department as a program sponsor in all media releases and printed materials utilized related to the grant. Logos will be provided to you.

Miami County Health Department Board Meeting

At least 50% of Miami County Health Department board meetings must be attended by you or another representative from your applying organization. The following is a list of dates, times and locations of the scheduled 2025 board meetings:

  • January 7, 2025 at 5:30 PM - Miami County Health Department
  • April 8, 2025 at 5:30 PM – Miami County Health Department
  • July 8, 2025 at 5:30 PM – Miami County Health Department
  • October 7, 2025 at 5:30 PM – Miami County Health Department

Contact Information:

Morgan Townsend

Projects Coordinator / School Liaison

12 S Wabash Street

765.473.0283, Ext. 1293

mtownsend@miamicountyin.gov

Partner name

Partner representative

Position

Address

Telephone

Fax

E-mail

________________________ Date:

Authorized MCHD Signature

Miami County Health Department

________________________ Date:

(Partner signature)

(Partner name, organization, position)