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FLORIDA DIVISION OF EMERGENCY MANAGEMENT 2021-2022 EMERGENCY MANAGEMENT PERFORMANCE GRANT -ARPA DIVISION FORM 1B -QUARTERLY TASKS SUB -RECIPIENT: QUARTER: July 1 -Sept. 30 I DELIVERABLES/TASK REQUIREMENTS I T1: Submit Division Form 3A - Quarterly Match to identify the non federal match amount. For those sub -recipients using local funds, supporting documentation is required with the form to support match amount reported (Due Q1-04) T2: Provide meeting minutes and sign -in sheets for 1) Quarterly meetings conducted with your whole community and 2) Quarterly Emergency Management meetings attended that were hosted by the Regional Coordination Team (Due Q1-04) ENTER DATE COMPLETED QTR 1 1 QTR 2 1 QTR 3 1 QTR 4 1 COMMENTS Use for explanation that supports Training & Exercise progression. F`By signing this report, 1 certify to the best ofmy knowledge and beliefthat the report is true, complete, and accurate, and the expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the terms and conditions ofthe Federal award. I am aware that any false, fictitious, or fraudulent information, or the omission ofany material fact, may subject me to criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Section 1001 and Title 31, Sections 3729-3730 and 3801-3812)." SIGNATURE: PRINTED NAME: TITLE: DATE: AUTHORIZED REPRESENTATIVE FY 2021-2022 EMPG-ARPA AGREEMENT ATTACHMENT H - REPORTING FORMS �................�.... MEMO �................�.... MEMO I■■EE■M■■■E■■■■■EI■■■■ NONE IMEIN■■■■■■:■■■NNNE■IN■■■ �................IMMEM ................�.... ................�.... ENEE■■N■■M■■■M■I■■■■ IS■E■■■■■■E■■■E■Oi■■■■ ■■■■E■E■■■■■:■■■I■NN■ IE■■■■■■■E■■■■:■■f■■■■ �N■■■■■■E■■■■■■■EI■■■■ �................�.... NONE NONE NONE SEEM NONE MEMO NONE MEMO ■■m NONE mom MOEN I DELIVERABLES/TASK REQUIREMENTS I T1: Submit Division Form 3A - Quarterly Match to identify the non federal match amount. For those sub -recipients using local funds, supporting documentation is required with the form to support match amount reported (Due Q1-04) T2: Provide meeting minutes and sign -in sheets for 1) Quarterly meetings conducted with your whole community and 2) Quarterly Emergency Management meetings attended that were hosted by the Regional Coordination Team (Due Q1-04) ENTER DATE COMPLETED QTR 1 1 QTR 2 1 QTR 3 1 QTR 4 1 COMMENTS Use for explanation that supports Training & Exercise progression. F`By signing this report, 1 certify to the best ofmy knowledge and beliefthat the report is true, complete, and accurate, and the expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the terms and conditions ofthe Federal award. I am aware that any false, fictitious, or fraudulent information, or the omission ofany material fact, may subject me to criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Section 1001 and Title 31, Sections 3729-3730 and 3801-3812)." SIGNATURE: PRINTED NAME: TITLE: DATE: AUTHORIZED REPRESENTATIVE FY 2021-2022 EMPG-ARPA AGREEMENT ATTACHMENT H - REPORTING FORMS