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FLORIDA DIVISION OF EMERGENCY MANAGEMENT 2021-2022 EMERGENCY MANAGEMENT PERFORMANCE GRANT -ARPA DIVISION FORM 1A -QUARTERLY FINANCIAL REPORT AGREEMENT M CLAIM M 1 AWARD AMOUNT: QUARTER M 1 SUB -RECIPIENT: COUNTY: ADDRESS: POINT OF CONTACT: PHONE/EMAIL: REPORTING FORMS DUE DATES (30 DAYS AFTER QUARTER) 1 - July 1 - Sept. 30, 2021 (Form are due no later than October 30) 2 - October 1 - Dec. 31, 2021 (Form are due no later than January 30) 3 - January 1 - March 31, 2022 (Form are due no later than Apri 30) 4 - April 1 - June 30, 2022 (Form are due no later than July 30) EMPG-ARPA ALLOCATION CATEGORIES BUDGETED ALLOCATIONS 01 CLAIM Q2 CLAIM Q3 CLAIM 04 CLAIM CUMULATIVE EXPENDED FUNDS REMAINING BALANCE 1. PLANNING $0.00 S0.00 $0.00 2. ORGANIZATION $0.00 $0.00 $0.00 3. EQUIPMENT $0.00 $0.00 $0.00 4. TRAINING $0.00 $0.00 $0.00 5. EXERCISE $0.00 $0.00 $0.00 6. MGMT AND ADMIN (up to 59/4 $0.00 $0.00 $0.00 TOTAL $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 AMOUNT OF REIMBURSEMENT FOR THIS CLAIM: 'By signing this report, I certify to the best of ny know ledge and belief that the report is true, complete, and accurate, and the expenditures, disburser ants and cash receipts are for the purposes and objectives set forth in the terns and conditions of the Federal aw and. I am aw are that any false, fictitious, or fraudulent information, or the onission of any neterial fact, my subject oe to criminal, civil or adninstrative penalties for fraud, false stater ents, false claim or otherw se. (U.S. Code Title 18, Section 1001 and Title 31, Sections 3729-3730 and 3801-3812)." SIGNATURE: AUTHORIZED REPRESENTATIVE DATE QUARTERLY STATUS REPORT Please report EM activities, meetinas. trainina. exercises. or other necessary information to su000rt auartedv Drooression. THE SECTION BELOW IS TO BE COMPLETED BY THE DIVISION AWARD AMOUNT DIVISION DATE RECBVBJ STAMP PRIOR CLAIMS THIS CLAIM AMOUNT BAL 2 EMPG-ARPA AGREEMENT ATTACHMENT H - REPORTING FORMS 59