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JUSTIFICATION FOR ADVANCE PAYMENT_ <br /> RECIPIENT: i Sir -E OF FLORIDA �^ <br /> If you are requesting an advance, indicate same by checking the box below. INDIAN RIVER COUNTY <br /> THIS IS TO CERTIFY THAT THIS IE <br /> A TRUE AND CORRECT COPY OF <br /> THE ORIGINAL ON FILE iN THIS <br /> [ ]ADVANCE REQUESTED OFFICE <br /> JIEF-REYR Sh" CLERK <br /> Advance pa ment of is requested. ••+•i'43�• I �� <br /> •�66T7V1i'S <br /> Balance of payments will be made on a reimbursement basis. These •;J���t• "' ""•S�p�. <br /> F�;•y <br /> funds are needed to pay staff, award benefits to clients, duplicate forms <br /> and purchase start-up supplies and equipment. We would not be able to <br /> operate the program without this advance <br /> 5 <br /> If you are requesting an advance, complete the following chart and line item justification below <br /> ESTIMATED EXPENSES <br /> BUDGET CATEGORY/LINE ITEMS 20 -20_Anticipated Expenditures for First Three Months of <br /> (list applicable line items) Contract <br /> For example <br /> ADMINISTRATIVE COSTS <br /> (Include Secondary Administration.) <br /> For example <br /> PROGRAM EXPENSES <br /> TOTAL EXPENSES <br /> LINE ITEM JUSTIFICATION (For each line item,provide a detailed justification explaining the need for the cash advance. <br /> The justification must include supporting documentation that clearly shows the advance will be expended within the first ninety <br /> (90) days of the contract term. Support documentation should include quotes for purchases, delivery timelines, salary and <br /> expense projections,etc.to provide the Division reasonable and necessary support that the advance will be expended within the <br /> first ninety(90)days of the contract term.Any advance funds not expended within the first ninety(90)days of the contract term <br /> must be returned to the Division Cashier,2555 Shumard Oak Boulevard,Tallahassee, Florida 32399,within thirty(30)days of <br /> receipt,along with any interest earned on the advance) <br /> Attachment "F" <br />