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C. The recipient must provide an estimated budget for each quarter covered by the agreement. The summary information should include salaries, <br /> r. fringe benefits,overhead,contracts(specify services to be contracted out),equipment,if authorized(specify items to be purchased),supplies,travel, <br /> and other costs. <br /> A sample summary format is provided below. The summary should include the breakdown for each quarter of the agreement period. <br /> Description First Quarter Second Quarter Third Quarter Fourth Quarter <br /> Salaries <br /> (identify personnel/titles) <br /> Fringe Benefits <br /> Contractual Services <br /> list services and estimated costs <br /> Equipment <br /> (identify each item and cost) <br /> Supplies <br /> Travel <br /> Other(specify) <br /> Overhead/Indirect <br /> Total: <br /> Certification Statement <br /> The forgoing information is presented to the Florida Department of Environmental Protection in support of our request for advance payment. I <br /> certify that the information provided accurately reflects the financial issues facing the entity at this time. <br /> By: <br /> Type Name of Signatory: Date <br /> Title: Chief Financial Officer or designee <br /> DEP Program Area Review/Approval <br /> vr. <br /> Recommendation: ❑Approve Request ❑Deny Request <br /> By: <br /> Type Name of Signatory: Date <br /> Title: Division: <br /> The DEP Program Area should forward this information to the Contracts Disbursements Section at MS78. The Contracts Disbursements Section <br /> will forward requests for advance payment to the State Comptroller for review and legislature consultation,as appropriate. <br /> Bureau of Finance&Accounting Use Only <br /> DEP Agreement No. 14IR2,Attachment B, Page 3 of 3 <br /> 46 <br />