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Attachment D <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 requested, budget data on <br /> which the request is based must be submitted. Any advance payment under this Agreement is subject to s. 216.181(16)(a)(b), Florida <br /> Statutes. The amount which may be advanced shall not exceed the expected cash needs of the recipient within the initial three <br /> months. <br /> [ ] ADVANCE REQUESTED <br /> [� NO ADVANCE REQUESTED <br /> Advance payment of s is requested. Balance of <br /> No advance payment is requested. Payment payments will be made on a reimbursement basis. These funds <br /> will be solely on a reimbursement basis. No are needed to pay staff, award benefits to clients, duplicate <br /> additional information is required. forms and purchase start-up supplies and equipment. We <br /> would not be able to operate the program without this advance. <br /> ADVANCE REQUEST WORKSHEET <br /> If you are requesting an advance, complete the following worksheet <br /> (A) (B) (C) (D) <br /> FFY 2005 FFY 2006 FFY 2007 Total <br /> DESCRIPTION <br /> I INITIAL CONTRACT ALLOCATION <br /> 2 FIRST THREE MONTHS CONTRACT <br /> EXPENDITURES ` <br /> 3 AVERAGE PERCENT EXPENDED IN FIRST <br /> THREE MONTHS <br /> Divide line 2 b line 1 . <br /> First three months expenditures need only be provided for the years in which you requested an advance. If you do not have this <br /> information, call your consultant and they will assist you. <br /> MAXIMUM ADVANCE ALLOWED CALULATION : <br /> X S <br /> Cell D3 DCA Award M MMUM <br /> (Do not include any match) ADVANCE <br /> REQUEST FOR WAIVER OF CALCULATED MAXIMUM <br /> [ J Recipient has no previous DCA contract history. Complete Estimated Expenses chart and Explanation of <br /> Circumstances below. <br /> [ ] Recipient has exceptional circumstances that require an advance greater than the Maximum Advance calculated above. <br /> Complete estimated expenses chart and Explanation of Circumstances below. Attach additional pages if needed. <br /> 22 <br />