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A TRUE COPY CERTIFICATION ON LAST PAGE J.R. SMITH, CLERK FY 2022 - 2023 EMPG AGREEMENT ATTACHMENT H REPORTING FORMS FLORIDA DIVISION OF EMERGENCY MANAGEMENT 2022-2023 EMERGENCY MANAGEMENT PERFORMANCE GRANT - EMPG BASE GRANT DIVISION FORM 1A -QUARTERLY FINANCIAL REPORT AGREEMENT #: AWARD AMOUNT: SUB -RECIPIENT: COUNTY: ADDRESS: POINT OF CONTACT: PHONEIEMAIL: CLAIM #: 1 QUARTER #: 1 REPORTING FORMS DUE DATES (30 DAYS AFTER QUARTER) 1 - October i - Dec. 31, 2022 (Form are due no later than January 30) 2 - January 1 - March 31, 2023 (Forms are due no later than April 30) 3 - April 1 - June 30, 2023 (Form are due no later than July 30) 4 - July 1 - Sep. 30, 2023 (Forms are due no later than October 30) EMPG ALLOCATION CATEGORIES BUDGETED ALLOCATIONS 07 CLAIM O2 CLAIM Q3 CLAIM 04 CLAIM CUMULATIVE EXPENDED FUNDS REMAINING BALANCE 1. PLANNING 2. ORGANIZATION $0.00 $0.00 $0.00 $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 51/4 $0.00 $0.00 $0.00 TOTAL $0.00 $0.00 $0.00 r $0.00 r $0.00 $0.00 $0.00 AMOUNT OF REIMBURSEMENT FOR THIS CLAIM: "By signing this report, I certify to the best of my know ledge and belief that the report is true, complete, and accurate, and the expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the terns and conditions of the Federal award. I am aw are that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject ng to crininal, civil or administrative penalties for fraud, false statements, false claims or otherw ise. (U.S. Code Tale 18, Section 1001 and Title 31, Sections 3729-3730 and 3801-3812)." SIGNATURE: AUTHORIZED REPRESENTATIVE DATE 61