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DIVISION OF EMERGENCY MANAGEMENT <br />EMERGENCY MANAGEMENT PREPAREDNESS AND ASSISTANCE GRANT - EMPA BASE GRANT <br />QUARTERLY FINANCIAL REPORT <br />Form 1A <br />Recipient: <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 />THIS IS A REQUIRED DOCUMENT AND MUST BE SUBMITTED QUARTERLY <br />CUM. FUNDS REMAINING <br />CUMULATIVE TOTAL ALLOCATED CURRENT CLAIM EXPENDED 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 />EMAP if applicable) <br />TOTAL <br />TOTAL AMOUNT TO BE PAID ON THIS INVOICE $0.00 <br />I hereby certify that the above costs are true and valid costs incurred in accordance with the project agreement. <br />Signed <br />Recipient 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 />1. THIS SECTION BELOW IS TO BE COMPLETED BY DEM WITH EACH QUARTERLY FINANCIAL PAYMENT <br />otal EMPA (State) Amount <br />Prior Payments <br />This Pavment <br />Funds <br />191 <br />