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ATTACHMENT G <br />ADVANCE PAYMENT JUSTIFICATON FORM <br />Use of this form is not required unless the advance requested requires the prior approval of the State Chief Financial <br />Officer. For advance requests that are equal to or less than the purchasing threshold of category two as defined in <br />Section 287.017, Florida Statutes, and meet one of the advance payment requirements identified in Section 215 422(14), <br />Florida Statutes, use of this form is waived. However, the purchase requisition or contract review form must clearly <br />identify the criteria being met under 215.422(14), Florida Statutes that allows the advance to be made without prior Chief <br />Financial Officer's approval. <br />DEP Agreement No. LP31010, Attachment G, Page 1 of 3 <br />Name/Address of the Vendor/Recipient: <br />Contact Person/Phone No.: <br />Agreement No./Purchase Order No. (if known): <br />LP31010 <br />Commodities/Services/Project Description: <br />Organizational Structure <br />(i.e. local gov't, non-profit corporation, etc.) <br />Value of Purchase or Grant: <br />Advance Payment Amount Requested: <br />Period Advance Payment to Cover: <br />90 days startup <br />Quarterly <br />❑ Full Contract Period <br />❑ Other (specify): <br />■ <br />❑ <br />Indicate Statutory Authority: <br />❑ 215.422, F.S <br />❑ 216.181, <br />F.S. <br />GAA Year and Line Item Info: <br />SFY: <br />Line Item: <br />1. Reason advance payment <br />is required: <br />2. The following information required for advances requested pursuant to 215.422, Florida Statues <br />(and the Reference Guide for State Expenditures) which exceed the purchasing threshold of category <br />two as defined in 287.017, Florida Statues. <br />A. Document, <br />greater <br />(%) savings <br />the State, <br />850/413-3165 <br />than <br />if applicable, the cost savings <br />the amount the State would <br />to be realized. In calculating <br />information may be obtained <br />regarding the current Treasury <br />to be incurred as a result of an <br />earn by investing the funds and paying <br />the percent savings as compared to <br />from the Department of Financial <br />earnings rate. <br />advance <br />the <br />Services, <br />payment that are equal or <br />in arrears. Include the percent <br />percent that can be earned by <br />Division of Treasury at <br />B. Document, if applicable, <br />they are available only <br />how the goods or services <br />if advance payment is made: <br />are essential to the operation of the Department and why <br />DEP Agreement No. LP31010, Attachment G, Page 1 of 3 <br />