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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. H 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 /> , , <br /> [ ] NO ADVANCE REQUESTED [ ] ADVANCE REQUESTED <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> No advance payment is requested . ;Advance payment of $ is requested. Balance of <br /> 'payments will be made on a reimbursement basis. These funds are <br /> Payment will be solely on a reimbursement 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 /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> ADVANCE REQUEST WORKSHEET <br /> ff you are requesting an advance, complete the following worksheet <br /> (A) (B) (C) (D) <br /> DESCRIPTION FFY 2005 FFY 2006 FFY 2007 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 EMPA Award MAXIMUM ADVANCE <br /> (do not include match) <br /> 32 <br />