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DEPARTMENT OF ENVIRONMENTAL PROTECTION FLORIDA COASTAL MANAGEMENT PROGRAM INSTRUCTIONS FOR COMPLETING EXHIBIT C - PART 1 PAYMENT REQUEST FORM INSTRUCTIONS DEP AGREEMENT NO.: This is the number on your grant agreement that starts with C####. PAYMENT REQUEST NO.: This is the number of your payment request, not the quarter number. DATE OF REQUEST: This is the date you are submitting the report to DEP. PROJECT TITLE: This should be the project title that is listed on your grant agreement. GRANTEE'S GRANT MANAGER: This is the person identified as grant manager in the grant agreement. GRANTEE: Enter the name of the grantee's agency. MAILING ADDRESS: Enter the address to which you want the state warrant (payment) sent. TASK NO.: Enter the number of the DELIVERABLE for which you are requesting payment. TOTAL AMOUNT REQUESTED: This should match the amount on the "TOTAL AMOUNT" line for the `AMOUNT OF THIS CLAIM" column. PERFORMANCE PERIOD: This is the beginning and ending date of the reporting period requesting reimbursement for. GRANT EXPENDITURES SUMMARY SECTION: "AMOUNT OF THIS REOUEST" COLUMN: Enter the amount that was paid out for all listed deliverables during the invoice period for which you are requesting reimbursement. This must be by budget category as in the currently approved budget in Attachment 3 (Grant Work Plan), or amended of your grant Agreement. Do not claim expenses in a budget category that does not have an approved budget. Do not claim items that are not specifically identified in the current Budget Narrative section of Attachment 3. DO NOT ALTER FORM OR COMBINE BUDGET CATEGORIES. Enter the FCMP budget amount on the "GRANT BUDGET AMOUNT" line. "TOTAL CUMULATIVE FCMP CLAIMS" COLUMN: Enter the cumulative amounts that have been claimed to date for FCMP expenses by budget category. The final report should show the total of all claims, first claim through the final claim, etc. "MATCHING FUNDS CLAIMED" COLUMN": If applicable, enter the amount to be claimed as match for the reporting period. This needs to be shown under specific budget categories according tot what is in the currently approved Attachment 3 (Grant Work Plan). Enter the match budget amount on the "GRANT BUDGET AMOUNT" line for this column. Enter the total cumulative amount of this and any previous match claimed on the "LESS TOTAL CUMULATIVE PAYMENTS OF" line for this column. NOTE: DO NOT ENTER ANYTHING IN THE TABLE'S SHADED AREAS AS THEY ARE AUTO CALCULATED. GRANTEE CERTIFICATION: Must have the original signature of both the Grantee's Grant Manager and the Grantee's Fiscal Agent as identified in the grant agreement. Required Back-ua Documentation for each Deliverable: Exhibit C - Part 2 - Invoice Report Detail for Reimbursement for each deliverable. Exhibit C - Part 3 - Match Schedule Report for each deliverable. Copies of Invoices (Not applicable to state agencies) Copies of canceled checks (Not applicable to state agencies) Copies of Travel Reimbursements (if applicable) FLAIR Report (State agencies only) Copies of Volunteer Logs (if applicable) Copies of all In -Kind Donations NOTE: If claiming reimbursement for travel, you must include copies of receipts and a copy of the travel reimbursement form (available from staff of the Florida Coastal Management Program or use your affiliation's reimbursement form, provided it has been approved by the Florida Department of Financial Services.) **PAYMENT WILL BE BASED ON COMPLETION OF DELIVERABLES: Deliverables must be submitted and approved prior to payment.** Questions regarding completion of the Payment Request Form should be directed to the Department's Grant Manager, identifying on Page 1 of the Agreement. Part 1- Instructions