Sustainable Water Fund (FDW) call 2, 2014 – Model form Annex 3c: MODEL FINAL REPORT FDW project number: FDW14…… Title of the project: ………. Name applicant: ………. Reporting period ………. ………. Filing date progress report ………. Instructions: - This final report presents a summary of all the achieved results as defined in Annex 1 to the Subsidy Ordinance (‘beschikking’). - This report and attached documents must be in English. - Send one (1) hard copy by postal mail to RVO.nl and one (1) copy by e-mail to the PPP project officer. - RVO.nl should receive the Final Report according to the date included in the Subsidy Ordinance. - The final report should be signed by both Applicant and all project partners (not being the Applicant). - Blue text can be deleted from this format. A. General Contact information Were there changes in contact information of the applicant or project partners during the reporting period? Yes No - If there are any changes, please list them below, otherwise proceed with section B. Name of applicant/partner: Correspondence address: Visiting address: Name contact person: Email-address: IBAN: Other: Phone: BIC: B. Progress of project and result(s) achieved Summary Please summarise (max 800 words) the project results and achievements. - This includes achievements that are direct and indirectly linked to the project implementation. Also pay attention to the cooperation between the project partners and relevant external stakeholders. - In the next paragraphs specific progress at the level of the Results and Sub-results as included in the Subsidy Ordinance should be provided. Progress achieved under Result 2 Were activities for result 2 carried out in the reporting period? FDW Tender 2 (2014) Annex 3c - page 1 Yes No 160208 - If yes, please describe the specific activities carried out. Are any sub-results of result 2 completed during the reporting period? Yes No - If yes, please specify the sub-results and submit all the corresponding Means of Verification (MoVs) for the completed sub-results with reference and numbering in accordance to Annex 1 to the Subsidy Ordinance. E.g. if sub-result 3 of result 2 is completed, please specify so with reference to sub-result 2.3 Is result 2 fully completed? Yes No. - All MoVs have been provided together with this, and/or previous progress reports. Progress achieved under Result 3 Were activities for result 3 carried out in the reporting period? - If yes, please describe the specific activities carried out. Yes No Are any sub-results of result 3 completed during the reporting period? Yes No - If yes, please specify the sub-results and submit all the corresponding Means of Verification (MoVs) for the completed sub-results with reference and numbering in accordance to Annex 1 to the Subsidy Ordinance. E.g. if sub-result 3 of result 3 is completed, please specify so with reference to sub-result 3.3 Is result 3 fully completed? Yes No. - All MoVs have been provided together with this, or earlier progress reports. In case of more than 3 results please add these manually Bottlenecks and risks - Please describe if there were any bottlenecks or risks identified hindered the progress of the project. Describe what measures the partnership implemented to mitigate the bottlenecks and risks. Sustainability and cross-cutting themes - More elaborated guidelines on how to report on the sustainability check and sustainability compact will follow shortly, and will be included in a revised format of this report. ICSR Is one of the first essential suppliers or one of the project partners possibly using child labour or forced labour? Yes No - If yes, please identify the partner and elaborate on the situation. - With regard to the implementation of the project according to ILO Conventions 138 and 182 against child labour and ILO Conventions 29 and 105 against forced labour, you must establish that no use is made of child labour or forced labour at the partners involved in the partnership, or at the first essential supplier to the project. You are legally bound to provide RVO.nl with any information you may have about the possible use of child labour or forced labour by such partners or suppliers. If one of the aforementioned partners or suppliers is found to be using child labour or forced labour, or if you fail to pass on information you have received on this subject to RVO.nl the subsidy may be withdrawn. Provide an evaluation on the status of the identified ICSR risks in the project plan and as part of Result 1 and how these risks were minimized or mitigated. - Describe whether all mitigating measures as described in the ICSR risk analysis of result 1 are successfully implemented. If an EIA was required for implementation of the project, are additional mitigating measures implemented? FDW Tender 2 (2014) Annex 3c - page 2 160208 - If relevant, elaborate on how mitigating measures as prescribed by the EIA are successfully implemented. Sustainability and cross cutting themes. Provide information on the sustainability of the project. - Sustainability is defined as Financial, Institutional. Environmental, Technical and Social sustainability (FIETS) with a special focus to the cross cutting themes ‘Environment’, ‘Climate’, ‘Gender’ and ‘Good governance’. More information can be found in annex 3h FIETS-checklist. In reference to Financial sustainability: Did the project generated revenues e.g. from project products or services during the reporting period? - If so, please specify and quantify. In reference to Technical sustainability: please provide annual updates on: - The percentage of durable hardware purchased by the project that is still fully in use and is properly maintained and functioning? - If this percentage is less than 100%, please clarify. - The method used for establishing the above mentioned percentage (e.g. sample size of methodology used) Sustainability compact Please provide finalised sustainability compact as an annex to this progress report. - What activities are carried out to further draft the sustainability compact? Are there any modifications compared to the document available at the previous progress report? - Refer to result framework (annex 1 to Subsidy Ordinance) C. Monitoring and Evaluation Provide an final report on monitoring and evaluation. - For projects with a total project budget above € 5 million are obliged to be evaluated by an independent external party. This at least entails evaluation of the project output and outcome as defined in the result framework of the project (Annex 1 to the Subsidy Ordinance) - Provide an update on monitoring data as defined in the M&E plan of the project and in the result framework (annex 1 to the Subsidy Ordinance). - Where relevant please break down the collected data by gender and vulnerable groups1. - Compare the monitoring data to the baseline situation and set targets by showing baseline data, monitoring data and targets in a table. Provide a comprehensive evaluation on the presented data and achievements of the project. - If some of the original project targets are not met (with approval of RVO.NL), evaluate whether it is expected they will be met in the future. What will be necessary to reach these targets? - Does the evaluation lead to recommendations for future intervention? D. Future prospects Elaborate on the future prospects of the project or spin-off/effects of the project. - At least pay attention to: 1 Vulnerable groups are individuals or households who are especially at risk to be excluded from water related services and infrastructure (water, sanitation and hygiene, extension work). These groups vary depending on the context in which the programme is implemented. It is common practice for example to distinguish the number of people reached with house connections from the number of poor households reached with communal water points. Most common vulnerable groups are:a) Income poor: People living below the locally determined poverty line or below the international poverty line of US1.25 per day. b) Women and children: E.g. Women in general or Female headed households. c) People living far away from existing services. d) Ethnic groups. e) Religious groups. f) Handicapped FDW Tender 2 (2014) Annex 3c - page 3 160208 - How the sustainability and continuity of the taken interventions are guaranteed. Describe substantiate and quantify how Financial, Institutional, Environmental, Technical and Social sustainability is obtained. What future activities, related to the project or project results are foreseen by the partnership? E. Financial report Provide an audited report on the financial and labour realisation as well as the realisation on hardware purchases. - Please use the mandatory Annex 3d (MS Excel) for this. - The final financial report has to be audited according the Audit protocol, Annex 4 to the Subsidy Ordinance. - Where relevant, a textual clarification on the financial report can be given here. F. Project modifications Substantial changes in the project in relation to the Subsidy Ordinance and original project plan have to be approved by RVO.nl. Substantial changes are defined as changes resulting in a different project results (output/outcome, reflected in MoVs), changes in partnership, planning, changes in staff at project management and senior level and changes in budget allocation >10% of a result budget. Please, keep in mind that reallocation of budget between Technical Assistance and Hardware is not allowed Update work plan Please indicate whether the project work plan has been adjusted in the last reporting period. In case of an adjustment, please give a detailed description and motivation. - In case of a substantial change prior approval of RVO.nl is required. Project budget - Please indicate and explain whether a change in project budget allocation of more than 10% of a result budget was needed over the latest reporting period. - Please indicate and motivate all changes in the hardware budget, as compared to the originally approved budget, in Table 1 below. Changes in hardware already reported to RVO.nl in earlier progress reports or through a Request for Market Conformity Check (RMCC) can be excluded from this progress report. Substantial changes in hardware (>10% of hardware budget) have to be approved by RVO.nl. - Changes in hardware already reported to RVO.nl in earlier progress reports or through a Request for Market Conformity Check (RMCC) can be excluded from this progress report. Table 1 Changes in hardware items compared to the hardware result 1 (Annex 3d). Please, only include hardware that will be Item2 Description and Quantity Price in € Motivation of proposed change3 list provided with the progress report on modified. New/ Original Adjusted approved amount amount in € in € Add more lines manually TOTAL 2 Please use item order as in the original Hardware List and label new HW with ‘NEW-’ e.g. ‘NEW-Description item 3’ 3 e.g. new HW replaces old item, budget left over, etc FDW Tender 2 (2014) Annex 3c - page 4 160208 G. List of annexes - Please make sure all Annexes mentioned below are adhered to this report Annex 3d, Financial report - Final financial report for the entire project period - Audit report on project finance (see Audit protocol, Annex 4 to the Subsidy Ordinance) Hardware (mandatory) - Copy of all hardware invoices adding up to the full reported amount of € ……. - Copy of all Market Conformity check Certificates on hardware (for more information refer to Annex 3f), received during the reporting period. - For all purchased hardware worth € 25.000,- or more: Annex 3g Protocol of Receipt. Final report on Monitoring and Evaluation Sustainability compact Means of verification (MoVs) - As specified under section B, ‘Progress of project and result(s) achieved. Please mark the MoVs with the corresponding number (e.g. Result 3.3.2) Other annexes - Other relevant annexes provided, please specify here. H. Declaration and signature - By signing this progress report the applicant and all partners declare that the information in this final report is accurate and complete: Applicant Organisation: Partner 1 Organisation: Name: Position: Name: Position: Date: Signature: Date: Signature: Partner 2 Partner 3 Organisation: Name: Organisation: Name: Position: Date: Position: Date: Signature: Signature: Partner 4 Organisation: Partner 5 Organisation: Name: Position: Name: Position: Date: Signature: Date: Signature: FDW Tender 2 (2014) Annex 3c - page 5 160208 If the partnership has more than 5 partners, please add these manually to this document. FDW Tender 2 (2014) Annex 3c - page 6 160208