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F EMERGE C-_Y'-M' A' N"_AG* _E_M_ E' N' TJ <br /> r. DIVISION.0 N' <br /> ATe <br /> EMERGENCY*'MANAGEMENT,;10�kEOAiktbi4tgt�,,ANb�A§'SISTANCE'_GKAKIT.-EMPK-SASE:�GRA <br /> P T- <br /> 'Q INANdIA <br /> GRANTEE: Claim# <br /> County Name: <br /> Address: (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: October I-December 31-Due no later than January 31 <br /> Telephone M January I-March 31-Due no later than April 30 <br /> AGREEMENT# April I-June 30-Due no Later than July 31 <br /> CUMULATIVE TOTAL ALLOCATED CURRENT CLAIM REMAINING BALANCE <br /> 1. Salary and Benefits <br /> 2.Other Personal/Contractual Services <br /> 3. Expenses <br /> 4. Operating Capital Outlay(OCO) <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 Date <br /> M., <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 /> -F: <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 /> 103 <br />