Laserfiche WebLink
ATTACHMENT I-REPORTING FORMS <br /> FLORIDA DIVISION OF EMERGENCY MANAGEMENT <br /> 2020-2021 EMERGENCY MANAGEMENT PREPAREDNESS AND ASSISTANCE GRANT-EMPA <br /> DIVISION FORM 5-CLOSE-OUT REPORT <br /> DIVISION FORM 5-CLOSEOUT REPORT shall be completed and submitted to the Division no later than sixty(60)days after the <br /> termination date of the agreement.The 2020-2021 period of agreement ends on June 30,2021. DIVISION Form 5 is due by August 30, <br /> 2021. <br /> RECIPIENT: AGREEMENT#: <br /> POINT OF CONTACT: EMPA AWARD AMOUNT: <br /> PHONE/EMAIL: UNCLAIMED BALANCE: <br /> REIMBURSEMENTS RECEIVED BY THE RECIPIENT <br /> EXAMPLE (Include any advanced funds and final requested payment) <br /> ALLOCATION CATEGORIES ALLOCATIONS DATE AMOUNT <br /> 1.PLANNING $ $ <br /> 2.ORGANIZATION <br /> 3.TRAINING <br /> 4.EXERCISE <br /> 5.EQUIPMENT <br /> 6.MANAGEMENT AND ADMIN. <br /> $ - $ <br /> AWARD AMOUNT: $ - <br /> (LESS ADVANCED FUNDS) <br /> (LESS REIMBURSEMENTS) <br /> UNCLAIMED BALANCE OF AWARD $ - <br /> M accordance with Rule 27P-19.011,Florida Administrative Code,base grants shall be matched at an amount either equal to the average of the previous three <br /> years'level of county general revenue funding of the County Emergency Management Agency or the level of funding for the County Emergency Management <br /> Agency for the last fiscal year,whichever is lower. Required with this form,the county needs to provide a copy of the current EM local budget(general revenue) <br /> and general ledger expenditure report as of 6/30/2021. <br /> RECIPIENT 2019-2020 AVERAGE OF 2020.2021 EM LOCAL <br /> 2020-2021 LOCAL 2018-2019 LOCAL 2017-2018 LOCAL PREVIOUS GENERAL REVENUE <br /> LOCAL <br /> 3 YEARS EXPENDITURES <br /> Exmple:FL County <br /> SIGNATURE REQUIRED <br /> By signing this report,I certify to the best of my knowledge and belief that the report is true,complete,accurate and the expenditures disbursements <br /> and cash receipts are for the purposes and objectives set forth in the conditions of the 2020-2021 EMPA agreement. <br /> SIGNATURE AND DATE: <br /> AUTHORIZED REPRESENTATIVE <br /> PRINTED NAME AND TITLE: <br /> Refund and/or final interest checks are due no later than ninety(90)days after the expiration of the agreement. Please submit this form and <br /> supporting documentation to: Florida Division of Emergency Management,2555 Shumard Oak Blvd.,Tallahassee,FL 32399,Attn:(Division Grant <br /> Manager) <br /> BELOW TO BE COMPLETED BY DIVISION <br /> SIGNATURE AND DATE: <br /> DIVISION GRANT MANAGER <br /> SIGNATURE AND DATE: <br /> DIVISION PROGRAMMATIC REVIEWER <br /> 64 <br />