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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 subject to s . 216 . 181 ( 16 ) , Florida Statutes . The amount which may be <br /> advanced shall not exceed the expected cash needs of the Recipient within the initial three months of <br /> the Agreement. <br /> [ ] ADVANCE REQUESTED <br /> [X ] NO ADVANCE REQUESTED <br /> Advance payment of $ is requested . Balance of <br /> No advance payment is requested . payments will be made on a reimbursement basis . These funds <br /> Payment will be solely on a are needed to pay staff, award benefits to clients , duplicate forms <br /> reimbursement basis . No additional and purchase start- up supplies and equipment . We would not be <br /> information is required . 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 FFY FFY Total <br /> DESCRIPTION <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 advance . If <br /> you do not have this information , call your consultant and he or she will assist you . <br /> MAXIMUM ADVANCE ALLOWED CALULATION : <br /> X $ _ <br /> Cell D3 DEM Award MAXIMUM <br /> ( Do not include any match ) ADVANCE <br /> REQUEST FOR WAIVER OF CALCULATED MAXIMUM <br /> [ ] Recipient has no previous DCA/DEM contract history . Complete Estimated Expenses chart and <br /> Explanation of Circumstances below. <br /> [ ] Recipient has exceptional circumstances that require an advance greater than the Maximum <br /> Advance calculated above . <br /> Complete Estimated Expenses chart and Explanation of Circumstances below. Attach additional <br /> pages if needed . <br /> 30 <br />