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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 />EMPGS COVID-19 ACTIVITY LOG FORM 3B <br />SUB -RECIPIENT: <br />QUARTERLY REPORTING PERIOD: July 1 - Sept. 30 <br />CLAIM #: <br />1. EMPG-S funding is to support planning and operational readiness for COVID-19 preparedness and response. <br />The Sub -Recipient must provide a quarterly activity log that describes activities throughout the period of performance <br />2 The EMPG•S COVID-19 Activity Log outlines the activities the Sub -Recipient has conducted or will conduct throughout the <br />period of performance. <br />3. Proposed staffing activities must tie linked to accomplishing the activities outlined in the EMPG-S COVID-19 Activity Log <br />uarterly Activities: <br />BY signing this report I certdy to the best of my knowledge and beiref that the report ss true complete and accurate, and the expenditures <br />are for the purposes and ob/ectrHes set forth in the terms and conditions of the Federal award I am aware that any falsefictitious or <br />fraudulent arformatron. or the omrssron of any malerral fact may subfect me to crnminal. civil or administrative penatbes for fraud. false <br />statements false claims cr othenvrse. fU.S. Code Title 18. Section 1001 and Tilt 31, Sections 3729-3730 and 3801-381 . <br />SIGNATURE: <br />AUTHORIZED REPRESENTATIVE <br />PRINTED NAME: <br />TI TL E <br />DATE: <br />58 <br />