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local Government Records Management Improvement Fund DO NOT WRITE IN THIS SPACE
Log Number Da1e Reoelved
Grant Project Application
2001-2002
I Application Type (Check one): it Individual o Cooperative o Complex
llcant Infonnatlon
Local Government (Name) DepartmentlUnll (REQUIRED) Coonly
Town of Southold Town Clerk's Office Suffolk
Chief AdmInIstrative Officer (Last Name, F/n;/ Name, Mr .Ms.)
Cochran Jean Mrs.
TIUe Telephone NumberlExtenslon E-mail Address
Su ervisor (631 ) 765-1889
Address (SIn1et CIly, ZIp Code)
53095 Main Road P.O. Box 1179 Southold NY 11971
PmjeclDlrector(l.astname, F/n;/Name, Mr.Ms) IsPmjeclDlrectorlheRMO? ti(J Yes 0 NO"
"v" 'zab
TIUe Telephone NumberlExtenslon E-mail Address
(631 ) 765-1800
Address (SIn1et CIly, Zip Code)
53095 Main Road, P.O. Box 1179, Southord, NY 11971
no more than 1 cat and 1 subcat
o RECORDS 0 Needs AssessmentlFeaslblllty StudIes
CREATION 0 Business Process Analysis and Design
AND SYSTEM .
DESIGN 0 Implementing Recordkeeplng Systems
o ACTIVE
RECORDS
o Files Management
o Disaster & Business Recovery Planning
o Indexing and Access
o Needs Assessment 0 Physical Facility
o Outreach/Public Programs
(no subcategories)
I'!]fNACTfVE
RECORDS
o Needs Assessment
!id" Storage & Retrieval System Development
o ARCHIVAL
RECORDS
o MICROFILMING
o AnangementlDescription 0 Preservation
o EDl)CATIONAL USES (no subcategories)
Amount Requested: I $ 22,858.00
Pro eet Summa Must be com feted in this box. Brief!
Number of Grants Previously Received: W
The Town of Southold is proposing to use LGRMIF grant funds to purchase a large
format scaimer for the Southold Town Clerk's Records Management Program.
The large format scanner will be capable of scanning documents up t050" wide onto the
LaserFiche Program.
The purchase of a large format scanner by the Records Management Office will enable
the staff to scan blueprints, maps and other large documents onto the LaserFiche system
and various Town departments will be able to use Personal Computers to quickly locate,
view and instantly retrieve the data stored in these files.
New York State Archives. Government Records Services
Fonn LaRS-. (/12000)
.
Assemble the application in the following order:
(" Items marked with an asterisk are required of all projects)
a. *Grant Project Application (LGRS-1)
b. Other Local Governments Participating in Cooperative Effort (LGRS-2)
c. * Application narrative [consisting of four sections]
d. *Records Management Program Questionnaire (LGRS-3)
e. *Projects Previously Funded by the LGRMIF (LGRS-20)
f. Project Position Description (LGRS-4) [if hiring staff with grant funds]
g. Consultant resume [if consultant is identified in the application]
h. Vendor Quote Form (LGRS-10)
i. Microfilm Project Information Form (LGRS-6) [for every records series proposed for filming]
j. Indexing Project Information Form (LGRS-11) [for all indexing projects]
k. Other required materials: needs assessments, archival and conservation vendor/consultant
treatment proposals, floor plans, etc.
I. Letters of intent [for cooperative projects only]
m. *Budget Form (FS-10)
Eligibility Checklist - Ineligible applications will not be processed
Records Management Officer (RMO) appointed? ~es 0 No 0 N1A Appropriate schedule adopted? ~es 0 No 0 N1A
Year RMO was appointed: 8/9/1988 Year schedule was adopted: 8/12/1980
Certification and Approval
The following signatures provide certification that all eligibility requirements as outlined in Grant Application
and Reference Materials 2001-2002 have been met and Indicate approval of the application by the Chief
Administrative Officer and the Records Management Officer (RMO).
CHIEF AOMINISTRATIVE OFFICER ~,.... \:;::> ('
SiQii8iijn'.........._....._.___.H_.~'-.",.....\......o..k~_._....~......_..._.......DiiiS-....
Type'~~~'--na~~~itl~of~.,.)&~eJl~jjv,.-6IIlcer-.._...-_...._..__._-_....JJrnUil.o,-2.6.......2.D.JlL....
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Type or prinllhe name and tiDe of Ihe Records Management OffIcer
Submit an original and eight (8) copies to:
New York State Archives
Training and Grants Support Services
9A81 Cultural Education Center
Albany, New Yorl< 12230
(Governments submitting more than one application must send each under separate cover)
New York State Archives. Government Records Services
Fonn LGRS-I (112000)
Local Government Records Management Improvement Fund
Other Local Governments Participating
in Cooperative Effort
Instructions: Provide the name of each local government participating in the cooperative project. Indicate
whether each local gov~menthas adopted the appropriate schedule (yes, no, or not applicable). Please indicate
the year the schedule was adopted.
See the section on Eligibility Requirements in Grant Application and Reference Materials to determine whether
adoption of a schedule is not applicable to any of the local governments participating in the cooperative project.
Lead Local Government
(applicant listed on the LGRS-1): Town of Southold
1. Name of Cooperating Local Government:
"RMO appointed? D Yes D No ON/A "Appropriate schedule(s) adopted? DYes D No D N1A
Year current RMO was appointed: 1 QRR Year schedule was adopted: 1980
2. Name of Cooperating Local Government:
"RMO appointed? DYes DNo D N1A "Appropriate scheduIe(s) adopted? D Yes D No D tJlA
Year current RMO was appolnted: Year schedule was adopted:
3. Name of Cooperating Local Government:
"RMO appointed? DYes DNo D N1A "Appropriate schedule(s) adopted? D Yes D No D N1A
Year current RMO was appointed: Year schedule was adopted:
4. Name of Cooperating Local Government:
"RMO appointed? DYes D No D N1A "Appropriate schedule(s) adopted? DYes D No D N1A
Year current RMO was appointed: Year schedule was adopted:
*These two items are eligibility requirements which must be met by the lead local government and by EACH
partlclpant in the project BEFORE the grant application Is submitted.
New York Stalo Archlves . Govemment Records Services
Form LGRS-2 (712000)
:d
I....
l
New York State Local Government Records
Management Improvement Fund
PROJECT NARATIVE
I. STATEMENT OF THE PROBLEM
The Town of Southold is rapidly running out of storage space in our Records Storage
area and access to these archived documents is not always readily available, due to a
limited staff.
The Records Storage area is located in the basement, directly below the Town Clerk's
Office. The Town Clerk's Office receives requests for these archived records on a daily
basis from the public and various Town departments.
II. INTENDED RESULTS
The Town of South old is proposing to use LGRMIF grant funds to purchase a large
format color scanner to scan records onto the LaserFiche Program.
The Records Management staff would scan and digitally converted large format maps,
site plans, blueprints and other files from paper records to a CD-ROM. Once these
documents are converted onto a CD, various Town departments will be able to use their
Personal Computers to quickly locate, view and instantly retrieve data stored in these
larger format files.
The Town received several quotes on large format scanners ranging from $12,778. to
$22,858. Based on the recommendation of the Director of the Southold Town Data
Processing Office the Town selected the Super wide 6050 DSP Color 50" wide, Full
Scale Scanner for the Records Management Department. This large format scanner is
capable of scanning oversize documents (50") from various Town departments into the
LaserFiche System.
III. PLAN OF WORK
The Town of South old has established, in the 2001 Capital Budget, a town wide records
management system including document imaging and minute's management to facilitate
access to Town records by all departments as well as the general public. The estimated
cost of the software/hardware, training, extra ram server, and scanner is $75,000. Once
the archival records have been put into the LaserFiche Program the Town estimates that
over 450 sheets of paper will be scanned daily into the system. A large format scanner
was not included into the 2001 Capital Budget.
IV. LOCAL GOVERNMENT SUPPORT FOR RECORDS MANAGEMENT
Since our first LGRMIF grant award in 1991, the Town of South old has proceeded
methodically and successfully in completing a records management plan that will
preserve the archival records in our inactive records storage facility. With the assistance
of six (6) LGRMIF grants the Town of Southold has planned, inventoried all our
active/inactive records and improved the environmental conditions in our archival records
storage rooms by creating the proper environment for the preservation and conservation
of these documents. In addition, the Town of South old in the process of installing a
comprehensive office automation system to create a more efficient records management
program. A large format scanner would increase the Town's efforts to successfully
complete a modem and efficient records management plan.
Local Government Records Management Improvement Fund
RECORDS MANAGEMENT PROGRAM QUESTIONNAIRE FORM
Each applicant and each member of a proposed cooperative project must complete this form. Attach
additional sheets if further explanation is necessary.
Local Government Name<D
Town of Southold .
. Population Served <2> Annual Openting Budgct$ Total Number of EmployeesiD .
20,996 $29,922,538. . Full-time: 231 Part-time: 40
Program Development
Records management program has been formalized through the adoption of local Efyes 0 No
legislation, ordinances, or resolutions
Records Advisory Board has been appointed BYes 0 No
Records management plan haS been written I:itYes 0 No
Separate line item for records management has been established in the budget (}'yes 0 No
Support for Records Management
The level of funding budgeted for records management
.The number of employees dedicated to records management
$ 32,613.
1 full time
Inventory Information
Volume of active and inactive records with archival (permanent) value
IJtYes ONo
(ilYes ONo
l3'Yes ONo
2054 cu. ft.
2769 cu. ft.
4079 cu. ft.
A records inventory has been completed
State Archives inventory worksheets were used in conducting the inventory
Results of the inventory were used to complete a needs assessment
Total volume of active records in the custody of the local government
Total volume of inactive records in the custody of the local government
Continued on next page
New Yorl< s_ Archives . Government Records Setvlces
Fcnn LGRS-3 (712000)
Program Activities
Records are destroyed when their minimum retention periods are met Ij(yes ONo I
Inactive records are stored in a secure inactive storage area or facility ijfy es ONo
. . . lJ)'Yes ONo
If yes, is steel shelving designed for one cubic~foOt boxes used?
Policies and procedures are in place to eitsure inactive records are routinely .I9'Yes ONo
transferred from office space to inactive storage
A program is in place to ensure the .security, permanent storage, preservation, aiyes ONo
and use of archival records
Micrographic processes are used as a records managexnent tool o Yes a"No
Automated information systems are used to assist in the managexnent of records nes ONo
..........
..
<DLocal Government: Name of the local government whose information is being reported.
<IDPopulation: Data from the 1990 Census or a recent official estimate. School districts should enter
total resident population of the geographic area covered by the school district Certain special-
pwpose units of local government may not be able to provide population figures.
@Annual Operating Budget: Locill government's total operating budget figure for the current fiscal
year, not just the budget for records management.
@Total number of employees: Total number of employees working for your local government, not
just records management staff.
New YCKk S_ Archives . Government Records Services
Fcnn LGRS-3 (712000)
Local Government Records Management Improvement Fund .
Projects Previously Funded by the LGRMIF
this form must be completed by each applicant and each member of a proposed cooperative project.
Describe all LGRMIF grants your local government has received In the last five (5) years. Include special initiatives.
Space has been allowed to enter information on up to six (6) grants. Photocopy this form as needed.
Name of Local Government: Town of Southold
Local government has never participated in an LGRMIF grant 0
Local government participated in an LGRMIF grant awarded prior to 1996 13'"
Grant year: 1991-1992 I Category: LGRMIF 0580-92-0170 I Award: $17,583.
Project's purpose, objectives and results (qualitative and quantitative):
The grant award in 1991-1992 was utilized to initate a program of inventory, planning
and purchase of steel shelving. The amount of Town Records inventoried in the
grant cycle was 1,383 cubic feet.. The amount of records destroyed in accordance
with the MU-l Shcedule was 261.2 cubic feet.
Grant year: 1992-1993 I Category: LGRMIF 058-93-0780
Project's purpose, objectives and results (qualitative and quantllative):
I Award: $15 ~~~
The grant award in 1992-1993 was used to complete the inventory of all active town
records and begin planning for inactive records management. The inventory of all
active records was completed. The active records was 1921 cubic feet and the inactive
records was 2158 cubic feet. A needs assessment was conducted and policies and
procedures were developed for town departments to transmit records to the storage
rooms.
Grant year: 1993-1994 1 Category: LGRMIF 0580 94 1552 I Award: $15 947.
Project's purpose, objectives and results (qualitative and quantitative):
The grant award in 1993-1994 was used for the start-up and operation of our inactive
records center. We completed the installation of metal shelving in the vault room
and installed metal shelving in the storage room. We re-boxed about half of the
inactive records during this cycle. We developed an index key listing on our computer
word processing to aid in the retrieval of our records. Records have been organized
by a record locator by row, shelf and box number.
CONTINUED ON BACK
New YOlk Stale Archives . Government Records SelVices
Form LGR5-20 (7/2000)
local Government Records Management Improvement Fund
Projects Previously Funded by the LGRMIF
This form must be completed by each applicant end each member of a proposed cooperative project.
Describe all LGRMIF grants your local government has received In the last five (5) years. Include special initiatives.
Space has been allowed to enter Information on up to six (6) grants. Photocopy this form as needed.
Name of Local Government: Town of Southold
Local govemment has never participated in an LGRMIF grant 0
Local government participated in an LGRMIF grant awarded prior to 1996 0
Grant year: 1994-1995 I Category: LGRMIF 0580-95-2291
Projecl's purpose, objectives and results (qualitative and quantitative):
I Award: $ 8316.
The 1994-1995 grant award was used to hire an archival consultant to prepare a
conservation assessment of the archival records and to begin conservation treatment
and preservation work on the four (4) earliest volumes of town records dating back
"to the settlement of Sou"thold Town in 1640. " "
Grant year: T Category:
Projecl's purpose, objectives and results (qualitative and quantitative):
I Award: $
1995-1996 No grant funds were recieved.
1996-1997 No grant funds were recieved.
Grant year: 1998-1999 T Category: LGRMIF 0580-99-5644
Projecl's purpose, objectives and results (qualitative and quantitative):
The Town of Southold implementated the recommendations found in the "Town of
Southold Archival Records Collection Conservation Assessment" by installing a new
autonomous self-contained heating, ventilating and air conditioning systems for the
vault and storage areas. In addition, the vault and storage area have an ionization
and photoelectiric smoke dectors installed that are tied into the existing building
to provide an early warning detection.
-\ Award: $24 200.
CONTINUED ON BACK
New Yoo1< Stale ArchiveS . Government Records SeIVices
Form LGR8-20 (7/2000)
Local Govemment Records Management Improvement Fund
Projects Previously Funded by the LGRMIF
This form must be completed by each applicant and each member of a proposed cooperative project.
Describe all LGRMIF grants your local government has received In the last five (5) years. Include special initiatives.
Space has been allowed to enter information on up to six (6) grants. Photocopy this form as needed.
Name of Local Government: Town of Southold
Local government has never participated in an LGRMIF grant 0
Local government participated In an LGRMIF grant awarded prior to 1996 0
Grant year: 1999-2000 I Category: LGRMIF 0580-01-0157
Project's purpose, objectives and results (qualitative and quantitative):
I Award: $ 5,500.
The 1999-2000 grant award is for the installation of software systems and training for
a Records Management System and Minutes Tracking System in the Southold Town
Clerk's Office. These software systems will up-grade and improve the Town of Southold
ability to 'efficiently handle the increased demands on the Town Clerk's Office by
unprecedent grown in the volume of minutes and resolution.
Grant year: I Category:
Project's purpose, objectives and results (qualitative and quantitative):
I Award: $
Grant year: I Category:
Project's purpose, objectives and results (qualitative and quantitative):
I Award: $
CONTINUED ON BACK
New York State Ald1lves . Government Records Services
Form LGR8-20 (7/2000)
Local Govemment Records M8n8gemenllmprovemenl Fund
Project Position Description Form
Please complete this form for each proposed employee position (including
consultants) to be paid with grant funds. Do not complete this form for any position to
be paid for solely with local government funds. Instructions for completing this form
are on the reverse side. .
Name of Local Government
Grant Project Employment
Title of Proposed Position
Full-time 0 Part-time
Hours Per Week
Hourly Rate of Pay
x Total Number of Wee
x Total Number of H rs
= Total Hours
= Total Salary .
',Other Local Gove ent Employment
Will the employee filling the above position also be mployed by the local government at the same time?
Title of Position
o Full~tlme
o Part-time
Hours Per Week
Hourly Rate of Pay
x otal Number of Weeks
l ;Total ~umber of Hou\,& .
= Total Hours
= Total Salary
') ",;..,
_~a..._____________ __________.___________________________________________---------.-----------------------------------------------
. .
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.~~1~--~:.-~~~~-----~t~i~~-r~~'rn\~~-~:r~.~i-~~;~r:r..~~-~~~~-.~~~.~-.~..~r-~~~~~~-~~~~~-~~~~~~-.~~~..~~~-~--~.--.-----
-'.;,'y.,':., -::.-{., "t . '.~)F;.f\ ~.r" .." .tH",t_~l'_-. "i'~
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.....".,rL :.~:~~ ~f~'-.!1'-F-~,.V!:f,i:<~J'CfM~..~~ tu',~ ?~HJ
. 'New York Stale Archives IIId ~ AdmlnIitratIoIP.. GOvenmient ~ lICrvIcCS ,.,. ,..',,, :. .
PClI'IIi OOJtS.4 (8198:
FS-10 Page 2
SALARIES FOR PROFESSIONAL STAFF: Code 15
Include only staff that are employees of the agency. Do not Include consultants or per diem" staff. Do not
include central administrative staff that are considered to be indirect costs, e.g., businesS office staff.
One full-lime equivalent (FTE) equals one person working an entire week each week of the project.
Express partial FTE's in decimals, e.g., a teacher working one day per week equals .2 FTE.
I
~
,
Specific Position
Title
Full-Time
E ulvalent
;
;
Annualized Rate
ofPa
Subtotal - Code 15
Project
Sala
Include salaries for teacher aides, secretarial an clerical assistance, and for personnel in pupil
transportation and building operation and maintenance. Do not include central administrative staff that
" are considered to be indirect costs, e.g., account clerks.
Specific Position
Title
Full-Time
E ulvalent
Subtotal - Code 16
Project
Sala
FS-10 Page 3
PURCHASED SERVICES: Code 40
Include consultants (indicate per diem rate), rentals, tuition, and other contractual services. Copies of
contracts may be requested by the State Education Department. Purchased Services from a 60CES, if
other than applicant agency, should be budgeted under Purchased Services with 60CES, Code 49.
Provider of
Services
Calculation
of Cost
Proposed
Expenditure
Subtotal - Code 40
Include computer software, library books and equipment I
under $1,000 per unit.
Deseri tlon of Item
Quanti
Proposed
Ex nditure
,
,.
t
,
I
~
r
I
Subtotal - Code 45
FS-10 Page 4
TRAVEL EXPENSES: Code 46
Include pupil transportation. conference costs and travel of staff between instructional sites. Specify
agency approved mileage rate for travel by personal car or school-owned vehicle.
Position of
Traveler
Social Security
Retirement
Health Insurance
Worker's Compensation
Unemployment Insurance
Other (Identify)
Destination
and Pur ose
Calculation
of Cost .
Proposed
Ex enditures
Subtotal - Code 46
Benefit
Proposed Expenditure
New York State Teachers
New York State Employees
Other
Subtotal - Code 80
FS-10 Page 5
INDIRECT COST: Code 90
A. Direct Cost Base - Sum of all preceding subtotals (codes 15, 16, $
40,45, 46 and 80).
B. Approved Restricted Indirect Cost Rate
C. (A) x (B) = Total Indirect Cost Subtotal - Code 90 $
(A)
% (B)
(C)
PURCHASED SERVICES WITH BOCES: Code 49
Name of BOCES
Calculation
of Cost
. Proposed
nditure .
Subtotal - Code 49
Allowable costs include salaries, associa
and supplies and materials related to alteratio
employee benefits, purchased services,
to existing sites.
Description of Work
To be Performed
Proposed
Ex nditure
Subtotal - Code 30
FS-10 Page 6
EQUIPMENT: Code 20
All equipment to be purchased in support of this project with a unit cost of $1,000 or more should be
itemized in this category. Equipment Items under $1,000 should be budgeted under Supplies and
Materials, Code 45. Repairs of equipment should be budgeted under Purchased Services, Code 40.
Proposed
DescriDtion of Item Quantitv Unit Cost Exoendlture
Superwide 6050 D~ P 1 $22,858. $22,858.
50" Wide Scanner
..
Subtotal - Code 20 $22,858.
Local Govemment Records Management Improvement Fund
Vendor Quote Form
Local governments submitting grant proposals totaling $5,000 or less
are not required to complete Vendor Quote Forms
Please complete this form to provide evidence that you have contacted three vendors for price
quotes. Photocopy the form if you must submit more than one Vendor Quote Form. Instructions for
completing the form are on tha reverse side.
Vendor's Name and Address Description of Item State Contract Quoted
or Service> Number Price
1.
General Code Publishers 36" Ideal 8300 Scanner $14,850.
72 Hinchey Road
Rochester, NY 111624
.
2.
Ideal Scanners & System 50" Ideal 2251 Scanne $17,608.
11810 Parklawn Drive Monochrome
Rockville, MD 20852
3.
Ideal Scanner & Systems 50" Color Scanner $22,858.
11810 Parklawn Drive 6050 DSP
Rockville, MD 20852
>For services rendered. provide more detail in the grant narrative.
New York State Archives. Government Records Services
Form LGRS-10 (7/2000)
Local Government Records Management Improvement Fund
Vendor Quote Form
Local governments submitting grant proposals totaling $5,000 or less
are not required to complete Vendor Quote Forms
Please complete this form to provide evidence that you have contacted three vendors for price
quotes. Photocopy the form if you must submit more than one Vendor Quote Form. Instructions for
completing the form are on the reverse side.
Vendor's Name and Address Description of Item State Contract Quoted
or Service" Number Price
4. Ideal Scanners 36" Ideal 8300 $12,778.
11810 Parklawn Drivle
Rockville, MD 20852
,
2.
3.
"For services rendered. provide more detail in the grant narrative.
New York State Archives. Government Records Services
Form LGRS-10 (7/2000)
.........
.,
BUDGET SUMMARY
SUBTOTAL CODE PROJECT COSTS
Professional Salaries 15 -0-
Support Staff Salaries 16 -0-
Purchased Services 40 -0-
Supplies and Materials 45 -0-
Travel Expenses 46 -0-
Employee Benefits 80 -0-
Indirect Cost 90 -0-
BOCES Services 49 -0-
Minor Remodeling 30 -0-
Equipment 20 $22,858.
Grand Total $22,858.
CHIEF ADMINISTRATOR'S CERTIFICATION
I hereby certify that the requested budget amounts are necessary for
the Implementation of this project and that this agancy Is In
compliance with applicable federal and state laws and regulations.
Date ~~\~ ~~n~~
Jean W. Cochran, Supervisor
Name and Title of Chief Administrative Officer.
.......4.~..
.,1t
..'..--.
-
FS-10 Page 8
Agency
Code:
Project #
(If pre-assigned)
CD ITIIJ
ITITJ CD ITIIJ
Tracking/Contract #:
(Special legislative projects only)
Federal Employer 10 #:
(New non-municipal agencies only)
"
Agency Naine: '-
FOR DEPARTMENT USE ONLY
Funding Dates:
/ /
From
/ /
To
Program
Approval:
Date:
Fiscal Year
Amount Budaeted
First Pavment
Voucher Payment
First Payment
Finance:
I I
I I
Log
Approved
MIR
The University of the State of New York
THE STATE EDUCATION DEPARTMENT
(see instructions for mailing address)
PROPOSED BUDGET FOR A
FEDERAL OR STATE
PROJECT
FS-10 (5/98)
Local Agency Information
Funding Source: 2001 - 2002 LGRMIF
Contact Person: Elizabeth Neville, Southold Town Clerk
Agency Name: Town of Southold
Mailing Address: 53095 Main Road, P.O. Box 1179
Street
Southold, NY 11971
City State Zlo Cone
Telephone #: (63j 765-1800 County: Suffolk
E-Mail Address:
Project Operation Dates: 2 Mon1rhs from contract date I I .
Start End
INSTRUCTIONS
(0 Submit the original budget and the required number of copies along with the completed
application directly to the appropriate State Education Department office as Indicated In the
application Instructions for the grant program for which you are applying. DO NOT submit
this form to the Grant Finance Unit.
+ Enter whole dollar amounts only.
+ Prior approval by means of an approved budget (FS-10) or budget amendment (FS-10-A) is
required for:
. Personnel positions, number and type
. Equipment Items having a unit value of $1 ,000 or more, number and type .
. Minor remodeling
. Any increase in a budget subtotal (professional salanes, purchased services, travel, etc.)
by more than 10 percent or $1,000, whichever is greater
. Any increase in the total budget amount.
(0 Certification on page 8 must be signed by Chief Administrative Officer or designee.
(0 The Federal Employer Identification Number on page 8 should be entered only by first-time non-
municipal applicants.
+ High quality computer generated reproductions of this form may be used.
+ Changes in agency or payee address must be submitted under separate cover to the New York
State Education Department, Grants Finance Unit, Room SlOW EB, Washington Ave, Albany, NY
12234. Please include 9-digit zip code.
+ For further information on budgeting, please refer to the Fiscal Guidelines for Federal and State
Aided Grants or call the Grants Financial Unit at (518) 474-4815.
L' ..
Check #~'I//S
Town of Southold
BILL OF
.rd~~l.SQt"I.'l"'y." . . . . .
Vendor No 'fQ {is
Invoic~VsT--a,:6~'Lil' . . .
. ..............
Invoice Date . (,//3/( . . . . . .
Amount Claimed $ :2/:j7~?OrJ
Purchase Order NoO ~~?S::'. . .
For Services and hivfrZ...., ,
Disbursements as
.U1,i".fiv~f~;~tl.~
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Sep ~5,01 15:29 No.008 P.03
IDEAL
=1tEl~
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IDEAL SCANNERS & SYSTEMS, INC.
11810 Parklawn Drive
Rockvllle, MO 20852
Phone: (301) 468-0123
Fax: (301) 230-0813
Web: www.ldeal.com
INVSTOO2046
Town Of Southold
Altn: John Scpenoski
Data Processing Dep't
53095 Rte 25
Southold NY 1\97\
Town Of Southold
Altn: John Sepenoski
Data Processing Dep't
53095 Rte 25
Soulhold NY 11971
Telephone;
Fax:
(631 )765~ 1891 Ex\. 0000
(631)765~5178 Ex!,OOOO
Tekphone:
Fax
(631) 765.1891 Ext, ??oo
(631) 765~5178 Ex!. ??oo
CUSTOMER P,O,#: 08278 INVOICE DATE: 6/13/01 TERMS: Net 30
SALESPERSON: AGG REQUEST DATE: 6/22101 ACCT#: 6955
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SUPERW1DB 50
972
SUPERWIDE SMART CARD 6050
SUPERWIUE SCANNER SUPPORT STAND
WIDEimage Interface, Kit
202JETlMAGB.PRO
Imalion Warranty Coltve,rsion - 24 months coverage
24,900,00
2,000,00
890,00
990,00
0.00
1,725.00
$16,185.00
$1,300,00
$578.50
$643.50
$0,00
$1,725.00
Special Requirements:
SublOlll!
Freight
Mise
Tax
Paid
$20,432,00
$335,00
$0,00
$0,00
$0.00
C...d,...,",..... no'i"1. C"llhIOl"t t"... Cl I)r-:o/~ r/~H.:.tr.rklnf'1 fAA
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TOWN OF SOUTHOLD
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Pu rchase 0 rder #
Date G, III II
'08278
Tax Exempt # A163554
Account # H I "'to::;. ]'<:.0. i d()
I Deliver and send billing to:
DepartmentDc,14 /::>I'l)(:. ,,-5.,: "J
Address 3015" Ro.:t ( Qr
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"Return this copy and Town of Southold voucher itemized and signed for payment"
ITEM
QUANTITY
I
I
DESCRIPTION
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TOTAL
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THIS PURCHASE ORDER IS NOT VALID WITHOUT THE SIGNATURES OF THE DEPT, HEAD AND THE SUPERVISOR
I CERTIFY THAT THERE ARE
SUFFICIENT FUNDS AVAILABLE
Il>J:THE APPrOPRIATION CHARGED
\/1yi, .(J""1~?.J '
t6ept. Head I .
DEPARTMENT'S CERTIFICATION OF GOODS OR
SERVICES
I CERTIFY THIS TO BE A JUST
AND TRUE PURCHASE ORDER
('\ \, ('
'--~Qr~" W " be \v-",.
Sup isor
I certify that the goods or services were received by this
Department and all exceptions duly noted,
~ -4.. h4f'Y:L
Srgned . Title
loll/I
"
Date
, "
,
,
The University of the State of New York
THE STATE EDUCATION DEPARTMENT
Grants Finance Unit, Rm. SlOW ED
Albany, NY 12234
Project #
~GGJ~
REQUEST FOR FUNDS FOR A
FEDERAL OR STATE PROJECT
FS-25 (5/98)
Tracking/Contract #
Agency Code:
IT] ITID
Funding Source:
lDcal Government Records Manaqement Fund
Agency Name:
Town of Southold
Mailing Address: PO Box 1179
, 53095 Main Road
Street
Southold
City
NY
State
11971
Zip Code
Contact Person: Flh"h..th A N..vill.. Sollthn'''' Tn..." C.1..rk "- RUn
Telephone #:
(631) 765-1800
Report Period
GIJ rn
Month Year
CHIEF ADMINISTRATOR'S CERTIFICATION
I hereby certify that all information reported he,., 'n is true and accurate.
Date:
11/18/02
Signature:
1. Amount of Approved Budget (Include approved amendments)
$ 12,778.00
$ 6,389.00
$ 12,778.00
$ 6,389.00
$ 6.389.00
2. Project Payments Received to Date
3. Project Cash Expenditures to Date
4. Cash Expenditures Anticipated During Next: D Month ~ Quarter
5. Additional Funds Requested (Entries 3 plus 4 minus 2)
FOR DEPARTMENT USE ONLY
Fiscal Year
Payment Split
$
$
$
$
$
Voucher #
I I
Finance:
Log MIR
~
\
FS-25 Page 2
\
INSTRUCTIONS
This report must be completed for each approved Federal or State Grant funded through the State
Education Department. Send one signed original of this report directly to the Grants Finance Unit for
each project. (See the filing requirements below for Special Legislative Projects.)
A first payment is made automatically upon initial approval of a project application and budget. In
order to receive additional funds, this report must be filed until the project has terminated or payments
of 90 percent of the total project budget have been made.
To facilitate processing, it is requested that this report be filed with this Department no later than 10
days after the end of the report period.
Report all dollar amounts in whole dollars only.
FILING SCHEDULE
Projects $100,000 and less:
This report should be filed at the end of each
calendar quarter beginning with the quarter during
which the first project payment is received.
Projects greater than $100,000:
This report should be filed at the end of each month
after the first project payment is received.
Special Legislative Projects only:
For Special Legislative Projects, one original and
one copy are needed. This report should be filed
when the agency has incurred expenditures equal to
75% of the approved budget total. Upon SED
approval a payment will be processed equal to 50%
of the approved budget total.
,.
.
i
RECEIVED
581005640067
APR 8 2002
TOWN OF SOUTHOLD
PO BOX 1179
SOUTHOLD, NY 11971
Southold Town C.rl
TO:
FROM:
SUBJECT:
Chief Administrative Officer
Margaret Zollo, Supervisor
Federal and State Grant Quarterly Status Report
The enclosed Federal and State Grant Quarterly Status Report provides information on all
current year projects and any open prior years' projects which have been processed through
Grants Finance of the New York State Education Department. Please use the Quarterly Status
Report to reconcile your grant records. Report fields are defined as follows:
Project #
The # assigned by SED at the time of project approval.
The name of the Federal or State grant program under which
the project is funded.
The current approved budget (FS-lO) including all approved
amendments.
Funding Source
Budget
Scheduled/
Paid to Date
The total amount of payments processed, including payments
that are scheduled but not paid. An asterisk (.) indicates that
the Final Expenditure Report (FS-I0-F) has been received. If
the FS-I0-F has been audited and closed, Paid to Date will
equal Budget.
The funding dates of the project, including any approved
extensions. Funding dates are the dates in which project
encumbrances can be made. Projects showing zero dates have
been recently received in Grants Finance; initial financial edit
has not been completed and funding dates are not yet
available for display on this report.
If you have any questions about the Quarterly Status Report. please call Grants Finance
at (518) 474-4815.
Start/End
CF560:11/27/00:ss
(SEE OTHER SIDE)
~ .
,
\
FEDERAL AND STATE GRANT QUARTERLY STATUS REPORT
TOWN OF SOUTHOLD
03/29/02
2 (,0;2'; ~J<P\JECTS
PROJECT # FUNDING SOURCE
0580021300 LOCAL GOV'T RECORD
BUDGET
SCHEDULED/
PAID TO DATE
START
END
; .:~,:-\
12,778
6,389 07/01/01 06/30/02
TOTAL
J 91) "'1 hi :\.",,'1778
1 ~ li'~ '" .~~, .it...(",
6,389
CFOOO
. _.~ ,
J
THE STATE EDUCATION DEPARTMENT I THE UNIVERSITY OF THE STATE OF NEW YORK I ALBANY, NY 12230
The New York Slate Archives
Training and Grants Support Services Unit
LGRMIF Grant Acceptance Form
Local Government: Town of South old
Project Number: 0580-02-1300
Budget Summary:
Code 15 Professional Salaries:
$ 0
$ 0
$ 0
$ 0
$ 0
$ 0
$ 0
$ 0
$12,778
$12,778
Code 16 Support Staff Salaries:
Code 40 Purchased Services:
Code 45 Supplies and Materials:
Code 46 Travel Expenses:
Code 80 Employee Benefits:
Code 49 BDCES Services:
Code 30 Minor Remodeling:
Code 20 Equipment:
Amount of Grant Award:
I hereby accept a grant from the Local Government Records Management Improvement Fund in the amount indicated above and
agree to comply with all reporting requirements. These funds will be expended in accordance with the budget as detailed above
and approved by the State Education Department.
Authorizing Official:
Jean W. Cochran
Signature:
~WLo~
Supervisor. Town of Southold
Title:
Date:
JiJIY3J..20(l1
Complete this form and retnrn it to:
If you have any questions, please contact the
Training and Grants Snpport Services Unit:
The New York State Archives
Training and Grants Support Services Unit
9 A8l Cultural Education Center
Albany, NY 12230
Telephone: (518) 474 - 6926
E-mail: archgrants@mail.nysed.gov
RECEIVED
581005640067
APR 8 2002
TOWN OF SOUTHOLD
PO BOX 1179
SOUTHOLD, NY 11971
Southol. Towo a.rl
TO:
FROM:
SURJECT:
Chief Administrative Officer
Margaret Zollo. Supervisor
Federal and State Grant Quarterly Status Report
The enclosed Federal and State Grant Quarterly Status Report provides information on all
current year projects and any open prior years' projects which have been processed through
Grants Finance of the New York State Education Department. Please use the Quarterly Status
Report to reconcile your grant records. Report fields are defined as follows:
Project #
Funding Source
The # assigned by SED at the time of project approval.
The name of the Federal or State grant program under which
the project is funded.
The current approved bUdget (FS-I0) including all approved
amendments.
Budget
Scheduled/
Paid to Date
The total amount of payments processed. including payments
that are scheduled but not paid. An asterisk (.) indicates that
the Final Expenditure Report (FS-IO-F) has been received. If
the FS-I0-F has been audited and closed. Paid to Date will
equal Budget.
The funding dates of the project. including any approved
extensions. Funding dates are the dates in which project
encumbrances can be made. Projects showing zero dates have
been recently received in Grants Finance; initial financial edit
has not been completed and funding dates are not yet
available for display on this report.
If you have any questions about the Quarterly Status Report, please call Grants Finance
at (518) 474-4815.
Start/End
CF560:11/27/00:ss
(SEE OTHER SIDE)
FEDERAL AND STATE GRANT QUARTERLY STATUS REPORT
TOWN OF SOUTHOLD
03/29/02
2 m~t;pJ(01JECTS
PROJECT # FUNDING SOURCE
0580021300 LOCAL GOV'T RECORD
BUDGET
SCHEDULED/
PAID TO DATE START
END
"
.'
ft9A
12,778
6,389 07/01/01 06/30/02
TOTAL
J18I) owoT LU;iJ778
6,389
CFOOO
-.
a
.
.
THE STATE EDUCATION DEPARTMENT /THE UNIVERSITY OF THE STATE OF NEW YORK I ALBANY, NY 12230
The New York Stale Archives
Training and Grants Support Services Unit
LGRMIF Grant Acceptance Form
Local Government: Town of South old
Project Number: 0580-02-1300
Budget Summary:
Code 15 Professional Salaries:
$ 0
$ 0
$ 0
$ 0
$ 0
$ 0
$ 0
$ 0
$12,778
$12,778
Code 16 Support Staff Salaries:
Code 40 Purchased Services:
Code 45 Supplies and Materials:
Code 46 Travel Expenses:
Code 80 Employee Benefits:
Code 49 BOCES Services:
Code 30 Minor Remodeling:
Code 20 Equipment:
Amount of Grant Award:
I hereby accept a grant from the Local Government Records Management Improvement Fund in the amount indicated above and
agree to comply with all reporting requirements. These funds will be expended in accordance with the budget as detailed above
and approved by the State Education Department.
Authorizing Official:
Jean W. Cochran
Signature:
rWG,&~
Supervisor. Town of Southold
Title:
Date:
July 31. 2001
Complete this form and retDrn It to:
ICyou have any qnestions, please contact the
Training and Grants Support Services Unit:
The New Yark State Archives
Training and Grants Support Services Unit
9A81 Cultural Education Center
Albany, NY 12230
Telephone: (518) 474 - 6926
E-mail: archgrants@mail.nysed.gov