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ATTACHMENT I- REPORTING FORMS <br /> FLORIDA DIVISION OF EMERGENCY MANAGEMENT <br /> 2020-2021 EMERGENCY MANAGEMENT PREPAREDNESS AND ASSISTANCE GRANT-EMPA <br /> DIVISION FORM 2A-DETAIL OF CLAIMS <br /> RECIPIENT: INCURRED DATE RANGE: Example:July 1 through November 5,2020 <br /> Please use separate Division Form 2A-Detail of Claims per allocation category.Please add additional pages or lines as needed for each allocation category. <br /> Please provide FEMAAEL numbers for EOUPtuENT expenditures only. <br /> Please provide a budget revision along with this form,if expenses being claimed are not allocated on the most recently approved budget. <br /> Please include the Costs Incurred Date Range in the applicable cell above.This is usually the quarterly period;however,a recipient may incorporate a larger date <br /> range to include a forgotten claim for reimbursement for a payment made the previous quarter(within the period of agreement).This allowance does not circumvent <br /> the four(4)required quarterly reporting forms submissions. <br /> ALLOCATION CATEGORIES <br /> PLEASE SELECT FROM THE LIST BELOW <br /> CATEGORY: ORGANIZATION <br /> DATE OF <br /> PAYMENT FOR PAYMENT <br /> # VENDOR DESCRIPTION OF SERVICE OR REFERENCE PURCHASE Equipment FEMAAEL# <br /> EXPENSE SERVICE OR (N/A if equipment was not <br /> EXPENSE (CHECK#,PO#, AMOUNT <br /> (Include full dated JT#,etc.) purchased) <br /> 1 Em Electric Company Monthly Utilities for July 2020 8/5/20 CK#1001 $ 300.00 N/A <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> 16 <br /> 17 <br /> 18 <br /> 19 <br /> 20 <br /> 21 <br /> 22 <br /> 23 <br /> 24 <br /> 25 <br /> TOTAL $ 300.00 <br /> Bi <br /> the <br /> ing this report,I certify to the best of my knowledge and belief that the report is true,complete,accurate and the expenditures,disbursements and cash receipts are <br /> purposes and objectives set forth in the conditions of the 2020-2021 EMPA agreement <br /> SIGNATURE <br /> AUTHORIZED REPRESENTATIVE <br /> PRINTED NAME: <br /> TITLE: <br /> DATE: <br /> 60 <br />