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ATTACHMENT G — REPORTING FORMS <br />FLORIDA DIVISION OF EMERGENCY MANAGEMENT <br />2020-2021 EMERGENCY MANAGEMENT PERFORMANCE GRANT, COVID-19 Supplemental <br />DIVISION FORM 1 A - QUARTERLY FINANCIAL REPORT <br />AGREEMENT #: <br />CLAIM 0: 1 <br />AWARD AMOUNT: <br />QUARTER 0: 1 <br />SUB -RECIPIENT: <br />5000 <br />COUNTY: <br />REPORTING FORMS DUE DATES 130 DAYS AFTER OUARTER) <br />ADDRESS: <br />+ ,wy+-5.91 s0. Y.20 (Fames ae 4Jr �tatxtfan ilciro0w sol <br />$000 <br />I - OttaDM I -OK 81.3020 fFarltt ri aw ra NGF San JwutiY 1a! <br />3. EQUIPMENT <br />1. jm%WV 1-Mmb11,2021 (farm ri0w rot fatrtRWlApd b) <br />POINT OF CONTACT: <br />i. "i -A"30.2021 iFofmsri wrrofatK ttan .ldy 101 <br />PHONE/EMAIL: <br />5000 <br />EMPG ALLOCATION CATEGORIES <br />BUDGETED Ot CLAIM O2 CLAM 08 CLAIM Od CLAIM <br />ALLOCATIONS <br />CUMULATIVE <br />EXPENDED FUNDS <br />REMAINING <br />BALANCE <br />1. PLANNING <br />5000 <br />5000 <br />$000 <br />2. ORGANIZATION <br />$000 <br />$000 <br />5000 <br />3. EQUIPMENT <br />$000 <br />$000 <br />$000 <br />4. TRAINING <br />5000 <br />$000 <br />S000 <br />TOTAL <br />$000 1 $0 00 1 50 00 1 $0 00 1 50 DO 1 <br />$000 1 <br />50,00 <br />AMOUNT OF REIMBURSEMENT FOR THIS CLAIM: <br />Da52 a D_f tat Ta arDr+l .4 tM.:w+�p9ir. aM a:<aatr. ab frlr s.pNfQyp®s as krr LM pVPXR aM pQ14(tnK 5N l,nn <br />n fn! larmt »3 fMbDNls O1 M f.0.41 _W11 d m away that ww fatzr. %clv 5 a huOriN ord Jm1iQOn. Or M nIhsY Of m1v TdMm fad mgy WDIKI 1M 10 <nn4M11:. -4 n, <br />asnnntratr-r OrNRwi w frau¢ fx5 6141Mw115 mrs.. 01.1 a dnlr w IU S fepr To. 48.. S*Itm 1001 r0 TM 11, S*dD ft %r21ti1730 ma 5801-5813) <br />MOtlATURC <br />AU THORiZED REPRESENTATIVE DATE <br />QUARTERLY STATUS REPORT <br />Please re ort EIA acsr t,es. meelhn s. Iraining or other necessary m!ormakon to support Warleiny progression <br />THE SECTION BELOW IS TO BE COMPLETED BY THE DIVISION <br />PRIOR CLAIMS <br />THIS CLAIM AMOUNT <br />BALANCE OF AWARD <br />53 <br />