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ATTACHMENT G - REPORTING FORMS <br />FLORIDA DIVISION OF EMERGENCY MANAGEMENT <br />2020.2021 EMERGENCY MANAGEMENT PERFORMANCE GRANT PROGRAM, COVID-19 SUPPLEMENTAL <br />DIVISION FORM 2B - DETAIL OF CLAIMS <br />SALARIES AND FRINGE BENEFITS <br />SALARY DEFINITION: The cath compensalwn for sernces rendered by a regular empioyee m an established position for a specific period of tune <br />SUB -RECIPIENT: <br />CLAIMb <br />DOES THIS CLAIM FOR REIMBURSMENT INCLUDE EXPENSES FOR ANY INCENTIVES OR SPECIAL PAY? <br />Wit (/ I11Y [IAM vt[ILL1ti MlMNti Dr Spttd <br />pity. pltd3t prbvMl lite OMLDn wnn 1M 1snnM HtablSMtl pDli-y (D' SUQpOn <br />EM EMPLOYEE NAME <br />% OF TIME <br />EM POSITION TITLE CHARGED TO SALARY <br />EM PGS <br />FRINGE BENEFITS <br />1 Example Jane Doe <br />EM Planner 50% S 5.00000 S <br />120000 <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 />TOTALS S 5,000.00 f <br />1,200.00 <br />TOTAL S <br />6,200.00 <br />By sgnrng this report f certify to the best of my knowledge and belief Wal the report is true complete and accurate and the expenditures are <br />(o the purposes and ob/echms set forth to Ine terms and conditions of the Federal award t am aware that any false. fictitious or Aauduier" <br />mfornwoon P' the OOYSSipn p(any mdtMBP faCf may subject nee to Cnnxnai civil cr admnistrative penalties for fraudfalse statements false <br />ctaims or otherwise (U S Code Title 18 Section 1001 and Title 31. Sections 3724-3730 and 3801-3812) <br />SIGNATURE: <br />AUTHORIZED REPRESENTATIVE <br />PRINTED NAME: <br />TITLE: <br />DATE: <br />56 <br />