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ATTACHMENT G - RFPnRTiti(-_ 1=11110RAC <br />FFLORIDA DIVISION OF EMERGENCY MANAGEMENT <br />2020-2021 EMERGENCY MANAGEMENT PERFORMANCE GRANT - EMPG BASE GRANT <br />DIVISION FORM 1A - QUARTERLY FINANCIAL REPORT <br />AGREEMENT #: CLAIM M 1 <br />AWARD AMOUNT: QUARTER #: 1 <br />SUB -RECIPIENT: <br />COUNTY: REPORTING FORMS DUE DATES (30 DAYS AFTER QUARTER) <br />ADDRESS: 1 - July i — Sept. 30, 2020 (Fors are due no later than October 30) <br />2- October 1 — Dec. 31, 2020 (Fors are due no later than January 30) <br />3- January 1 — March 31, 2021 (Fors are due no later than April 30) <br />POINT OF CONTACT: 4- April 1 - June 30, 2021 (Fors are due no later than July 30) <br />PHONE/EMAIL: <br />EMPG ALLOCATION CATEGORIES BUDGETED CUMULATIVE REMAINING <br />ALLOCATIONS 01 CLAIM Q2 CLAIM Q3 CLAIM Q4 CLAIM <br />EXPENDED FUNDS BALANCE <br />1. PLANNING $0.00 $0.00 $0.00 <br />2. ORGANIZATION $0.00 $0.00 $0.00 <br />3. EQUIPMENT $0.00 $0.00 $0.00 <br />4. TRAINING $0.00 $0.00 $0.00 <br />5. EXERCISE $0.00 $0.00 $0.00 <br />N$000$0.00 <br />6. MGMT AND ADMIN (up to 5%) $0.00 $0.00 $0.00 <br />TOTAL $0.00 $0.00 $0.00 $0.00 $0,00 <br />AMOUNT OF REIMBURSEMENT FOR THIS CLAIM: <br />"By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the expenditures, disbursements and cash receipts are for <br />the purposes and objectives set forth in the tens and conditions of the Federal award. I am aware that any false, fictitious, or fraudulent information, or the omission of any material <br />fact, may subject me to criminal, ciN1 or administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Tile 18, Section 1001 and Title 31, Sections <br />3729-3730 and 3801-3812)." <br />SIGNATURE: <br />AUTHORIZED REPRESENTATIVE DATE <br />QUARTERLY STATUS REPORT <br />Please report EM activities, meefin s, training, exercises, or other necessary information to support quarterly progression. <br />LOW IS TO BE COMPLETED BY THE DIVISION <br />ECLAJMAMOUNT <br />DIVISION DATE RECEIVED STAMP <br />BALANCE OF AWARD <br />59 <br />