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DEP 55-222 (03-02) DEP Agreement No. LP3 1010, Attachment G, Page 3 of 3 3. The recipient must provide an estimated budget for each quarter covered by the agreement. summary information should include salaries, fringe benefits, overhead, contracts (specify services be contracted out), equipment, if authorized (specify items to be purchased), supplies, travel, other costs. A sample summary format is provided below. The summary should include the breakdown for each quarter agreement period. The to and of the Description First Quarter Second Quarter Third Quarter Fourth Quarter Salaries (identify personnel/titles) Fringe Benefits Contractual Services (list services costs) and estimated Equipment (identify each item and cost) Supplies Travel Other (specify) Overhead/Indirect Total: Certification The forgoing By: Statement information request for advance issues facing the is presented to the Florida Department of Environmental Protection payment. I certify that the information provided accurately reflects entity at this time. in support of our the financial Type Name of Signatory: Date Title: Chief Financial Officer or designee DEP Program Area Review/Approval Recommendation: ❑ Approve Request By: ❑ Deny Request Type Title: Name of Signatory: Bureau: Date Division: The DEP Program Area should forward Contracts Disbursements Section will and legislature consultation, as appropriate. this information to the Contracts Disbursements Section at forward requests for advance payment to the State Comptroller MS78. for review The Bureau of Finance & Accounting Use Only DEP 55-222 (03-02) DEP Agreement No. LP3 1010, Attachment G, Page 3 of 3