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Attachment C <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 <br /> is requested , budget data on which the request is based must be submitted . Any advance payment <br /> under this Agreement is sub'ect to s . 216. 181 ( 16)(a)(b), Florida Statutes . The amount which may be <br /> advanced shall not exceed the expected cash needs of the recipient within the initial three months. <br /> [ ] NO ADVANCE REQUESTED [ ] ADVANCE REQUESTED <br /> Advance payment of $ is requested. Balance of <br /> No advance payment is requested. Payment payments will be made on a reimbursement basis . These funds <br /> will 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 /> DESCRIPTION FFY 2002 FFY 2003 FFY 2004 Total <br /> 1 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 by line 1 . ) <br /> First three months expenditures need only be provided for the years in which you requested an <br /> advance . If you do not have this information , call your consultant and they will assist you . <br /> MAXIMUM ADVANCE ALLOWED CALULATION : <br /> X $ <br /> Cell D3 DCA Award MAXIMUM <br /> o 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 <br /> Explanation of <br /> Circumstances below. <br /> ( ] Recipient has exceptional circumstances that require an advance greater than the Maximum Advance <br /> calculated above . <br /> Complete estimated expenses chart and Explanation of Circumstances below. Attach additional <br /> pages if needed . <br /> 31 <br />