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FY 2022- 2023 EMPA AGREEMENT ATTACHMENT B JUSTIFICATION OF ADVANCE PAYMENT RECIPIENT: If you are requesting an advance, indicate same by checking the box below. [ ] ADVANCE REQUESTED Advance payment of $ is requested. Balance of payments will be made on a reimbursement basis. These funds are needed to pay staff, award benefits to clients, duplicate forms and purchase start-up supplies and equipment. We would not be able to operate the program without this advance. If you are requesting an advance, complete the following chart and line item justification below. ESTIMATED EXPENSES BUDGET CATEGORY/LINE ITEMS Fiscal Year 2022 Anticipated Expenditures for (list applicable line items) First Three Months of Contract For example ADMINISTRATIVE COSTS: For example PROGRAM EXPENSES: TOTAL EXPENSES: LINE ITEM JUSTIFICATION (For each line item, provide a detailed justification explaining the need for the cash advance. The justification must include supporting documentation that clearly shows the advance will be expended within the first ninety (90) days of the contract term. Support documentation should include, but is not limited to the following: quotes for purchases, delivery timelines, salary and expense projections, etc. to provide the Division reasonable and necessary support that the advance will be expended within the first ninety (90) days of the contract term. Any advance funds not expended within the first ninety (90) days of the contract term shall be returned to the Division Cashier, 2555 Shumard Oak Boulevard, Tallahassee, Florida 32399, within thirty (30) days of receipt, along with any interest earned on the advance) *REQUESTS FOR ADVANCE PAYMENTS WILL BE CONSIDERED ON A CASE BY CASE BASIS* Signature of Recipient/Subcontractor's Authorized Official Date: Name and Title of Recipient/Subcontractor's Authorized Official 45