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FLORIDA DIVISION OF EMERGENCY MANAGEMENT <br />2021-2022 EMERGENCY MANAGEMENT PERFORMANCE GRANT PROGRAM - ARPA <br />DIVISION FORM 2B - DETAIL OF CLAIMS <br />SALARIES AND FRINGE BENEFITS <br />SALARYDERNITION: The cash compensation for services rendered by a regular employee in an established position fora specific period of time. <br />SUB -RECIPIENT: <br />CLAIM#: <br />DOES THIS CLAIM FOR REIMBURSMENT INCLUDE EXPENSES FOR ANY INCENTIVES OR SPECIAL PAY? <br />Note: M this claim includes incentives or special pay, please provide `DEM w ith the written established policy for support. <br />EM EMPLOYEE NAME <br />EM POSITION TITLE <br />%OF TIME <br />CHARGED TO <br />EMPG <br />SALARY <br />FRINGE BENEFITS <br />1 <br />Example: Jane Doe <br />EM Planner <br />50% <br />$ 5,000.00 <br />$ 1 200 00 <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 <br />[$ 5,000.00 <br />$ 1,200.00 <br />TOTAL <br />$ 6,200.00 <br />signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the expenditures, <br />ursements and cash receipts are for the purposes and objectives set forth in the terms and conditions of the Federal award. I am aware <br />any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil or administrative <br />tlties for fraud, false statements, false claims or otherwise. (U. S. Code Title 18, Section 1001 and Title 31, Sections 3729-3730 and <br />SIGNATURE: <br />PRINTED NAME: <br />TITLE: <br />DATE: <br />AUTHORIZED REPRESENTATIVE <br />LW_14i>t 14 L, ra. QZ4=109rAW"WOMAN <br />62 <br />