CATPA Grant Inventory Certification Form

General Information

Grantee Name: Grant #: Date:

Instructions Consistent with the CATPA Interagency Agreement, equipment over $5,000 purchased with the funds under a CATPA grant shall be retained and continued to be used for purposes of this grant. The retention ends when the value of the equipment has depreciated to a value less than $5,000 or grant retention requirements of five (5) years have been met, whichever comes first. Grantee shall request pre-approval by contacting the CATPA Office to dispose of equipment in value over $5,000 within grant retention requirements and no longer needed on the project. The equipment can be traded or sold for replacement equipment, sold at fair market value and funds returned to the CATPA or transfer the equipment to the property of the State. Equipment that is valued under $5,000 no longer requires inventory. As equipment is purchased, an inventory shall be maintained by the Grantee and submitted at the term of the grant and annually using this form for the subsequent

five years during the retention period.

Inventory Certification

I certify that to best of my knowledge and belief of the information contained in the attached pages of inventory records are correct. I also understand that failure to report completely and accurately may result in sanctions by the Colorado Automobile Theft Prevention Authority to this grant project, future grant requests and applicable state and federal statutes.

Printed Name: Signature: DateSubmitted:

Revised: 01/01/2016Page 1 of 11

CATPA Grant Inventory Certification Form

Inventory Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Initials:

Revised: 01/01/2016Page 2 of 11

CATPA Grant Inventory Certification Form

Inventory Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Initials:

Revised: 01/01/2016Page 3 of 11

CATPA Grant Inventory Certification Form

Inventory Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Initials:

Revised: 01/01/2016Page 4 of 11

CATPA Grant Inventory Certification Form

Inventory Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Initials:

Revised: 01/01/2016Page 5 of 11

CATPA Grant Inventory Certification Form

Inventory Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Initials:

Revised: 01/01/2016Page 6 of 11

CATPA Grant Inventory Certification Form

Inventory Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Initials:

Revised: 01/01/2016Page 7 of 11

CATPA Grant Inventory Certification Form

Inventory Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Initials:

Revised: 01/01/2016Page 8 of 11

CATPA Grant Inventory Certification Form

Inventory Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Initials:

Revised: 01/01/2016Page 9 of 11

CATPA Grant Inventory Certification Form

Inventory Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Initials:

Revised: 01/01/2016Page 10 of 11

CATPA Grant Inventory Certification Form

Inventory Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Type: Purchase Year: Cost: Make: Model: Style: Serial/Product ID #:

Warranty: Location/Assignment: Policy for Use: Policy Year: CATPA Inventory Number: - INTERNAL USE ONLY -

Description:

Initials:

Revised: 01/01/2016Page 11 of 11