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DIVISION OF EMERGENCY MANAGEMENT <br /> EMERGENCY MANAGEMENT PREPAREDNESS AND ASSISTANCE GRANT-EMPA BASE GRANT <br /> QUARTERLY FINANCIAL REPORT <br /> Form 1 <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 1-December 31-Due no later than January 31 <br /> Telephone#: January 1-March 31-Due no later than April 30 <br /> AGREEMENT# April 1-June 30-Due no later than July 31 <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. 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 $0.00 $0.00 $0.00 <br /> TOTAL AMOUNT TO BE PAID ON THIS INVOICE $0.00 <br /> 1 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 /> 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 />