Asset Acquisition Request

All requests for furniture, equipment, and advanced technologies in an amount over $500.00 must be pre-approved by ICDVVA, even if it is within your approved budget. Without pre-approval, reimbursement will be denied, regardless of your need. Please allow 30 days for approval.

The following criteria must be met for any asset acquisition:

Direct services to crime victims cannot be offered without ICDVVA support of these expenses;
The sub-grant agency has no other source of support for them;
Only limited amounts of ICDVVA funds will be used for these purposes.

Depending on the type of asset, you must provide additional answers to the questions particular to that asset.

Place "N/A" in any field that does not apply to your acquisition.

Program Name *

Requester Name *

First Name Last Name

Email *

example@example.com

Date *

Date

Please choose one of the following statements about this purchase:

This purchase was anticipated in our budget narrative for this grant year. This purchase was not anticipated in our budget narrative for this grant year.

If the purchase was not anticipated, please explain why it has become necessary:

Advanced Technologies:

1. How will the computer equipment enhance services to crime victims? *

2. How will it be integrated into or enhance the recipient's current system? *

3. What is the cost and date of installation? *

4. What is the cost of staff training in using the computer equipment? *

5. What are the ongoing operational costs, such as maintenance agreements and supplies and how will these additional costs will be supported? *

Furniture and Equipment:

ICDVVA funds may be used to buy furniture and equipment that provide or enhance direct services to crime victims.
ICDVVA cannot support the entire cost of an item that is not used exclusively for victim related activities,but can support a prorated share of such an item.
A detailed description of the furniture or equipment item to be purchased must be provided.

Examples of allowable costs may include: beepers, typewriters and word processors, camcorders and VCR’s for interviewing children, two-way mirror, and equipment and furniture for shelters, work spaces, victim waiting rooms and children’s play areas.

Describe furniture and equipment to be purchased, along with the cost. *

Please attach the invoice for the item you would like to purchase, plus any competing bids you have collected.

Browse Files

If you are not submitting competing bids, please explain why.

At minimum, sub-grantees must maintain property records with the following information:

A description of the property and the serial number or other identifying number:

Serial #
Description

Identification of the title holder:
The acquisition date:
The cost and percentage of ICDVVA funds supporting the purchase:
- Cost $
- ICDVVA Funds %
The location, use and condition of the property
Disposition data, including the date of disposal and sale price

Requesting Program Executive Director's Name: *

Requesting Program Executive Director's Signature: *

Clear

ICDVVA Action:

Approved Denied

Reason for denial:

ICDVVA Approval Signature

Date: