NOTE 1: Mechanical, electrical and other engineering/utility areas, in addition to engineering workshops and circulation space, are not included in the Space Analysis or the Percentage of Participation calculations. NOTE 2: All areas not shown on this form must be justified, on a programmatic medical care or state imposed regulatory basis, in order for VA to participate in the funding of that space. (1) VA Form 10-5348-SAMPLE MEMORANDUM OF AGREEMENT. Department of Veterans Affairs SAMPLE MEMORANDUM OF AGREEMENT to Construct or Acquire a State Veterans Home This Memorandum of Agreement is hereby made by and between 810 Vermont Avenue, NW, Washington, D.C. 20420, and 15 has submitted to VA an application for a grant to (construct, acquire) a (nursing home, domiciliary, adult day healthcare) facility for veterans in (Federal Application Identifier: FAI) for this project The parties agree that this application meets the requirements of Federal Law for this grant. The estimated total cost of (construction and/or acquisition), including equipment, in which VA will participate, is $. The VA grant will total up to but will not exceed sixty-five(65) percent of the actual cost of (construction, acquisition) as determined by the final audit. In consideration of the foregoing, the parties hereto mutually agree as follows: (1) requirements. certifies that the plans and specifications included in the application meet all applicable Federal agrees that it will (construct, acquire) the facility, (a description of the project, including number of beds are added or replaced), to be completed in accordance with the documentation submitted by the State. (2) (3) (4) agrees to comply strictly with the assurances contained in the documentation submitted. agrees to enter into a contract to (construct, acquire) (a description of the project, including number of beds are added or replaced), within 90 days of the date on which both parties have signed this agreement. (5) agrees to periodically inspect the project and certify to the Chief Consultant for Geriatrics and Extended Care Strategic Healthcare Group, 810 Vermont Avenue, NW, Washington, D.C. 20420, for payment of such sums which it deems are payable by VA. (6). (7) and operate the facility. (8) project area is filled. (9) agrees to furnish any additional State funds needed to complete the project. agrees that, upon completion of the project, it will provide adequate financial support to maintain agrees that following completion of the project, it will open at least eight beds per month until the agrees that it will use the facilities principally to furnish veterans (nursing home care, domiciliary care, adult day health care) and that not more than 25 percent of the bed occupancy at any one time will consist of residents who are not receiving such level of care as veterans. (10). agrees that it will operate and maintain the facility in conformance with State standards and with all applicable State and local laws, codes, regulations and ordinances, and in conformance with the standards prescribed by VA. (11). agrees that it will make such reports in such form and containing such information as the Secretary may from time to time reasonably require, and give the Secretary, upon demand, access to the records upon which such information is based. certifies its The Secretary of the Department of Veterans Affairs hereby approves the project. Afteṛ. (construction, acquisition) costs as set forth in paragraph (5) above, the Secretary agrees to make partial payments of the grant to cover the costs certified. VA payments will be limited to the unpaid obligated balance of the grant for actual incurred costs for this project. This grant is subject to the recapture provisions stated in 38 CFR 59.110. IN WITNESS WHEREOF, the parties have hereunto affixed their signature on the dates indicated |