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C. The recipient must provide an estimated budget for each quarter covered by the agreement. The summary information should include salaries, <br /> fringe benefits, overhead, contracts (specify services to be contracted out), equipment, if authorized (specify items to be purchased), supplies, <br />travel, <br /> and other costs. <br /> A sample summary format is provided below. The summary should include the breakdown for each quarter of the agreement period. <br /> Description First Quarter Second Quarter Third Quarter Fourth Quarter <br /> Salaries <br /> (identify personnel/titles) <br /> Fringe Benefits <br /> Contractual Services <br /> (list services and estimated costs <br /> Equipment <br /> (identify each item and cost) <br /> Supplies <br /> Travel <br /> Other (specify) <br /> Overhead/Indirect <br /> Total: <br /> Certification Statement <br /> The forgoing information is presented to the Florida Department of Environmental Protection in support of our request for advance <br /> payment. I <br /> certify that the information provided accurately reflects the financial issues facing the entity at this time. <br /> By : <br /> Type Name of Signatory : Date <br /> Title: Chief Financial Officer or designee <br /> DEP Program Area Review/Approval <br /> Recommendation : ❑ Approve Request ❑ Deny Request <br /> By: <br /> Type Name of Signatory : Date <br /> Title : Division: <br /> The DEP Program Area should forward this information to the Contracts Disbursements Section at MS78 . The Contracts Disbursements <br /> Section <br /> will forward requests for advance payment to the State Comptroller for review and legislature consultation, as appropriate, <br /> Bureau of Finance & Accounting Use Only <br /> DEP Agreement No . 14IR2, Attachment B , Page 3 of 3 <br />