HomeMy WebLinkAboutFederal Government-10/1/2012Equitable Sharing
Agreement and
Certification
OMB Number 1123-0011
Expires 7-31-2011
Police Department 0 Sheriffs Office ® Task Force (Complete Table A, page2)
0 Prosecutor's Office 0 Other (specify)
Agency Name: Waterloo Police Department
NCIC/ORI/Tracking Number:
I
A
0
0
7
0
3
0
0
Street Address: 715 Mulberry Street
City: Waterloo
Contact: Title: Captain
State: IA
Zip: 50703
First: Timothy Last: Pillack
Contact Phone: 319-291-4336 Contact Fax:
Contact e-mail: pillackt@waterloopolice.com
Last Fiscal Year End (mm/dd/yyyy):
0 New Participant:
® Existing Participant:
0 Change in Administration:
® Amended Form:
06/30/2012
319-291-4332
Read the Equitable Sharing Agreement (page -1) and sign the Affidavit (page -1)
Complete the Annual Certification Report, read the Equitable Sharing Agreement
(page -1), and sign the Affidavit (page -1)
Select to report change to Agency or Governing Body head DURING the current fiscal
year. Read the Equitable Sharing Agreement (page -1) and sign the Affidavit (page -1).
Revise the Annual Certification Report, read the Equitable Sharing Agreement (page
-1), and sign the Affidavit (page -1).
Annual Certification Report
Summary of Equitable Sharing Activity
Justice Funds
Treasury Funds
1
Beginning Equitable Sharing Fund Balance (must match
Ending Equitable Sharing Fund Balance from prior FY)
2
Federal Sharing Funds Received
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
Check box if non-interest-bearing account.
6
Total Equitable Sharing Funds (total of lines 1 - 5)
$0.00
$0.00
7
Federal Sharing Funds Spent (total of lines a - n below)
$0.00
$0.00
8
Ending Balance (subtract line 7 from line 6)
$0.00
$0.00
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Summary of Shared Monies Spent
Justice Funds
Treasury Funds
a
Total spent on salaries for new, temporary, not -to -exceed
one year, employees
p
b
Total spent on overtime
q
Appraised Value of Other Assets Received
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
1
Total spent on other law enforcement expenses (complete
Table C, page 3)
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)
m
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
$0.00
$0.00
Miscellaneous Data
o
Agency's budget for current fiscal year
p
Jurisdiction's budget for current fiscal year
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
Agency Name
Agency Address
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Justice Funds
Treasury Funds
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Table C: Other Law Enforcement Expenses
Description of Expense
Table D: Equitable Sharing Funds Transferred to Other Agencies
Receiving Agency Name, City, and State
Agency Name
Agency Address
Table E: 15% Expenditures in Support of Community-based Programs
Recipient
Table F: 25% Windfall Transfers to Other Government Agencies
Recipient
Table G: Matching Grants
Matching Grant Name
Table H: Civil Rights Cases
Name of Case
Type of Discrimination All
Justice Funds
Justice Funds
Justice Funds
Justice Funds
Justice Funds
Treasury Funds
Treasury Funds
Treasury Funds
Treasury Funds
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 Unit, 1400 New York Avenue, N.W., Second Floor,
Washington, DC 20005.
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Version 15
Race
Color
National
Origin
Gender
0 Settled
0 Pending
Disability
Age
Other
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 Unit, 1400 New York Avenue, N.W., Second Floor,
Washington, DC 20005.
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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 -1)
submitted by fax. This will constitute submission to the Department ofJustice 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 ofJustice 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 ofJustice 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 ofJustice, 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 ofJustice and Department of the Treasury reserve the right to conduct periodic
random audits.
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Affidavit - New Participant
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 @ 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
Signature:
Name: Daniel J. Trelka
Title: Director of Safety Services
Date: 09/24/2012
Governing Body Head
Signature:
Name: Ernest Clark
Title: Mayor
Date: 09/24/2012
Final Instructions:
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 e-mail and the fax of this page are received.
FOR AGENCY USE ONLY
Entered by
Entered on
FY End: 06/30/2012
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111
NCIC: IA0070300 Agency:Waterloo Police Department Phone:319-291-4336
State:IA Contact:Timothy Pillack E-mail:pillackt@waterloopolice.com
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