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FLORIDA DIVISION OF EMERGENCY MANAGEMENT <br />2021-2022 EMERGENCY MANAGEMENT PREPAREDNESS AND ASSISTANCE GRANT - EMPA <br />I Please use separate Division Form 2ADetail of Claims per allocation eatecorv. Please add additional paces or lines as needed for each allocation catee <br />Please provide FEMAAEL numbers for EQUIPMENT expenditures only. <br />Please provide a budget revision along with this forth, if expenses being claimed are not allocated on the most recentlyapproved budget. <br />Please include the Costs Incurred Date Range in the applicable cell about. This is usually the quarterly period; however, a recipient may incorporate a <br />larger date range to include a forgotten claim for reimbursementfor a payment made the previous quarter (within the period ofagreement). This <br />allowance does not circumvent the four (4) required quartedyme2rting fors submissions. <br />ALLOCATION CATEGORIES <br />PLFASESELECT FROM THE LIST BELOW <br />CATEGORY: ORGANIZATION <br />1 I I I <br />DATE OF PAYMENT <br />DESCRIPTION OF SERVICE OR PAYMENT FOR REFERENCE PURCHASE Equipment FEAAAEL# <br /># VENDOR EXPENSE SERVICE OR (N/A if equipment was not <br />EXPENSE (CHECK#, POO, AMOUNT purchased) <br />(Include full date) JT#, etc.) <br />1 Ex: Electric Company Monthly Utilities for July 2021 8/5/21 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 />TOT $ 300.00 <br />By dgning ddareport, I aerdfy to the best of my knoWedge and bd/ef that the report Is true, complete, aaaurate and the wpercOture; dlaburaamente and <br />sash readpts are for the purposes and Syeodvesan forth In the aont0dona of the 2021.1022 EMPA agreamard. <br />SIGNATURE <br />AUTHORIZED REPRESENTATIVE <br />PRINTED NAME <br />TfTL@ <br />DATE <br />64 <br />