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, . <br /> a , . v <br /> W pi . <br /> � m <br /> GRANTEE : Claim # <br /> County Name : <br /> Address : <br /> (Select the quarter of submission) <br /> QUARTERLY REPORTING DUE DATES <br /> July 1 — September 30 — Due no later than October 31 <br /> Point Of Contact: October 1 - December 31 - Due no later than January 31 <br /> Telephone #' January 1 - March 31 - Due no later than April 30 <br /> AGREEMENT # April 1 - June 30 — Due no later than July 31 <br /> CUM . FUNDS REMAINING <br /> CUMULATIVE TOTAL ALLOCATED CURRENT CLAIM EXPENDED BALANCE <br /> 1 . Organizational Costs <br /> 2 . Planning Costs <br /> I Training Costs <br /> 4 . Exercise Costs <br /> rEq5 . uipment Costs <br /> Management and Administration Costs <br /> (limited to 5% of the total award) <br /> TOTAL $0 . 00 $0 . 00 $0 .00 <br /> TOTAL AMOUNT TO BE PAID ON THIS INVOICE $ 0 . 00 <br /> EMPG MATCH <br /> Federal funds provided under this Agreement shall be matched by the Recipient dollar for dollar from non-federal funds. NOTE: If the <br /> amount entered below is NOT EMPA, provide appropriate back-up/supporting documentation. <br /> MATCH EMPA LOCAL OTHER NON-FEDERAL <br /> I hereby certify that the above costs are true and valid costs incurred in accordance with the project agreement. <br /> Signed : <br /> Grantee Contract Manager or Financial Officer Date <br /> k N11 <br /> ^." , ,3a „ ;. leer, <br /> This information below is required EACH QUARTER . This information MUST be clearly linked <br /> to the project TIMELINE , DELIVERABLES AND SCOPE OF WORK. <br /> Report event, progress , delays , etc. , that pertain to this project (i. e. , incidents , activities , meetings , reporting training and <br /> /or exercises) <br /> 79 <br /> x <br /> Attach additional eage s if needed . <br /> le le <br /> THIS SECTION BELOW IS TO BE COMPLETED BY DEM WITH EACH QUARTERLY FINANCIAL PAYMENT <br /> Total EMPG Federal Amount <br /> Prior Payments <br /> This Payment <br /> Unexpended Funds <br />