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Attachment E <br /> JUSTIFICATION OF ADVANCE PAYMENT <br /> Recipient : <br /> Indicate by checking one of the boxes below, if you are requesting an advance. If an advance payment is <br /> requested, budget data on which the request is Based must be submitted. Any advance payment under this <br /> Agreement is subject to s. 216.181 (16)(a)(b), Florida Statutes. The amount which may be advanced shall not <br /> exceed the expected cash needs of the recipient within the initial three months. <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br />- - - - - - - - - - - - - - - - - - - <br /> ] NO ADVANCE REQUESTED [ ] ADVANCE REQUESTED <br /> , No advance payment is requested. Payment . Advance payment of $ is requested. Balance of <br /> will be solely on a reimbursement basis. No ; payments will be made on a reimbursement basis. These funds are <br /> , additional information is required. needed to pay staff, and purchase start-up supplies and equipment. We <br /> - - - - - - - - - - - - - - - would not be able to operate the program without this advance. <br /> ' - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> ADVANCE REQUEST WORKSHEET <br /> If you are requesting an advance, complete the following worksheet <br /> (A) (B) (C) (D) <br /> DESCRIPTION FFY 2004 FFY 2005 FFY 2006 Total <br /> I INITIAL CONTRACT ALLOCATION <br /> 2 FIRST THREE MONTHS CONTRACT <br /> EXPENDITURES' <br /> 3 AVERAGE PERCENT EXPENDED IN <br /> FIRST THREE MONTHS <br /> (Divide line 2 by line 1. <br /> First three months expenditures need only be provided for the years in which you requested an advance. If you do <br /> not have this information, call your consultant and they will assist you. <br /> MAXIMUM ADVANCE ALLOWED CALULATION: <br /> X S = <br /> Cell D3 EMPA Award MAXIMUM ADVANCE <br /> (do not include match) <br /> 31 <br />