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DIVISION OF EMERGENCY MANAGEMENT <br />EMERGENCY MANAGEMENT PREPAREDNESS AND ASSISTANCE 'GRANT - EMPA BASE GRANT <br />'i <br />QUARTERLY -FINANCIAL REPORT <br />GRANTEE• <br />County Name: <br />Address: <br />Point of Contact: <br />Telephone #: <br />AGREEMENT # <br />Claim # <br />(Select the quarter of submission) <br />QUARTERLY REPORTING DUE DATES <br />Juy 1 — September 30 — Due no later than October 31 <br />October 1 — December 31 - Due no later than January 31 <br />January 1 — March 31 — Due no later than April 30 <br />April 1 - June 30 — Due no later than July 31 <br />THIS IS A REQUIRED DOCUMENT AND MUST BE SUBMITTED QUARTERLY <br />CUMULATIVE <br />TOTAL ALLOCATED <br />CURRENT CLAIM <br />REMAINING BALANCE <br />1 Salary and Benefits <br />2. Other Personal /Contractual Services <br />3. Expenses <br />4 Operating Capital Outlay (000) <br />5 Fixed Capital Outlay (FCO) <br />TOTAL <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 <br />Date <br />QUARTERLY STATUS'REPORT <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 />(Attach additional page(s) if needed ) <br />THIS SECTION BELOW IS TO BE COMPLETED BY DEM WITH EACH QUARTERLY FINANCIAL PAYMENT <br />Total EMPA (State) Amount <br />Prior Payments <br />This Payment <br />Unexpended Funds <br />