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I <br /> DIVISION OF EMERGENCY MANAGEMENT <br /> EMEkGENCYIMANAGEMENT PERFORMANCE GRANT = EMPG BASE GENT <br /> QARTER <br /> U_ LFINANCIAL•= <br /> Y REPORT., - - <br /> FORM <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: I October 1-December 31-Due no later than January 31 <br /> Telephone#: ! January 1-'March 31-Due no later thanApril 30 <br /> AGREEMENT# <br /> IApril 1-June 30-Due no later than July 31 <br /> ;THIS1..:'IS?A-REQUIRED'DOCUMENT,•'ANDMUST+iQUARTERL <br /> BE•SUBMITTEU S 1' `t �j"�- ''•n. <br /> . •<.•.-- .1 v ', ;.F.: Y • yk, - <br /> t <br /> i <br /> CUMULATIVE TOTAL ALLOCATED CURRENT CLAIM REMAINING BALANCE <br /> 1.Organizational Costs <br /> 2. Planning Costs <br /> 3.Training Costs <br /> 4. Exercise Costs <br /> 5 Equipment Costs <br /> 6. Management and Administration Costs <br /> (limited to 5%of the total award) <br /> TOTAL $0.00 $0.00 <br /> TOTAL AMOUNT TO BE PAID ON THIS INVOICE <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 /> ?+xray a f: �yrj':e: N✓' $' "o-:. s_ 3 3{' `, j,.2. Y - �.:e.- r •„ <br /> J':�.1•�''�ailt' r2�e': ''.)' "3t a'R 3 lF.', t� :. �li� i <br /> QUARTERLI(STATUS;f2EPrk ORT a ��` %• <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/or exercises) <br /> I <br /> (Attach additional page(s)if needed.) <br /> '`: - - L- ;r-:'- •• ?;•� .'`i..'r_. J,',�at;.t—_s`ir',=J?':r�;�"; -iy,k:'.L�. .4 l i f' ." - ...-. ::�Yt; <br /> Y.`. :-,. 'l >', '';. <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 /> 155 <br />