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A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />RYAN L. BUTLER, CLERK <br />RECIPIENT: <br />FY 2025 EMPA.AGREEMENT <br />ATTACHMENT B <br />JUSTIFICATION OF ADVANCE PAYMENT <br />If you are requesting an advance, indicate same by checking the box below. <br />[ ] ADVANCE REQUESTED <br />Advance payment of $ is requested. Balance of payments will be made on a reimbursement basis. These funds <br />are needed to pay staff, award benefits to clients, duplicate forms and purchase start-up supplies and equipment. We would not <br />be able to operate the program without this advance. <br />If you are requesting an advance, complete the following -chart and line item justification below. <br />ESTIMATED EXPENSES <br />BUDGET CATEGORY/LINE ITEMS <br />Fiscal Year 2025 Anticipated Expenditures for <br />(list applicable line items) <br />First Three Months of Contract <br />For example <br />ADMINISTRATIVE COSTS: <br />For example <br />PROGRAM EXPENSES: <br />TOTAL EXPENSES: <br />LINE ITEM JUSTIFICATION (For each line item, provide a detailed justification explaining the need for the <br />cash advance. The justification must include supporting documentation that clearly shows the advance will be <br />expended within the first ninety (90) days of the contract term. Support documentation should include, but is <br />not limited to the following: quotes for purchases, delivery timelines, salary and expense projections, etc. to <br />provide the Division reasonable and necessary support that the advance will be expended within the first <br />ninety (90) days of the contract term. Any advance funds not expended within the first ninety (90) days of the <br />contract term shall be returned to the Division Cashier, 2555 Shumard Oak Boulevard, Tallahassee, Florida <br />32399, within thirty (30) days of receipt, along with any interest earned on the advance) <br />*REQUESTS FOR ADVANCE PAYMENTS WILL BE CONSIDERED ON A CASE BY CASE BASIS* <br />Signature of Recipient/Subcontractor's Authorized Official Date: <br />Name and Title of Recipient/Subcontractor's Authorized Official <br />43 <br />