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A TRUE COPY CERTIFICATION ON LAST PAGE R2114 - Exhibit C J.R. SMITH, CLERK DEPARTMENT OF ENVIRONMENTAL PROTECTION FLORIDA RESILIENT COASTLINES PROGRAM INSTRUCTIONS FOR COMPLETING EXHIBIT C DEP AGREEMENT NO.: This is the number on your grant agreement that starts with R####. PAYMENT REQUEST NO.: This is the number of your payment request, not the quarter number. REQUEST DATE: This is the date you are submitting the report to DEP. 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 TASK for which you are requesting payment. NOTE: More than on task may be submitted for payment request. However, Part II and Part HI REQUIRE a separate table for each task requesting payment for. TOTAL AMOUNT REQUESTED: This should match the amount on the "TOTAL AMOUNT" line for the `AMOUNT OF THIS CLAIM" column. PERFORMANCE PERIOD - Date Range: This is the beginning and ending date of the reporting period requesting reimbursement for. NOTE: This date can not be before the Grant Execution Date, nor after the Grant End Date. GRANT EXPENDITURES SUMMARY SECTION: Enter the total amount budgeted as approved in Attachment 3 in the "BUDGETED AMOUNT" line. Enter the amount of this request as approved in Attachment 3 in the `AMOUNT OF THIS REQUEST" line. Enter the total cumulative amount of this request and all previous payments on the "PAYMENTS RECEIVED" line. The amount for the "REMAINING AMOUNT" line, will automatically calculate and populate. "AMOUNT OF THIS REQUEST" COLUMN: Enter the amount that was paid out for all listed tasks 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 (Project Work Plan), or amendment 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 section of Attachment 3. NOTE: Shaded areas in tables are auto calculated, and are indicated with "$ -". 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-UP DOCUMENTATION FOR EACH TASK REQUESTING PAYMENT FOR: Completed all parts of Exhibit C showing requested funds for payment - Parts II & III Not required for Fixed Price Agreements. NOTE. Parts 11 & III have an example line entered in the table. You mai- delete this line of text out in copied tables for additional tasks. Completed Exhibit A (Progress Report) showing requested task to be 100% completed, for requested funds. Copies of all invoices to the Grantee. Proof of Payment (Copies of canceled checks, front and back, Bank Statement, or EFT verification) - Not required for Fixed Price Agreements. If a sub -contractor was used for any work on the project, a copy of the signed agreement between the sub -contractor and Grantee must be submitted to DEP before payments will be processed. Other supporting documentation, as needed. Exhibit C - Instructions