Laserfiche WebLink
Attachment I <br />Close -Out Report Form <br />2025-2026 Hazard Analysis Grant Agreement <br />This form should be completed and submitted to FDEM no later than thirty (30) days after <br />termination date of the Agreement. <br />SUB -RECIPIENT: <br />Grant Agreement #: <br />For Each Deliverable, Enter the Award Amount from Attachment A - Budget and Scope of Work <br />Cost Category <br />HA Agreement <br />Deliverable Amounts <br />Date or Quarter <br />Completed <br />Total Amount Paid <br />Per Deliverable <br />Deliverable 1 <br />$2.00 <br />Deliverable 2 <br />$1.00 <br />Deliverable 3 <br />$1.00 <br />Total Paid for <br />Completed Deliverables: <br />$ 0.00 <br />HA Agreement Amount: <br />$ 4.00 <br />Amount Previously Paid: <br />$ 0.00 <br />Unused Balance: <br />By signing this report, l certify to the best of my knowledge and belief that the report is true, complete, and accurate, <br />and the expenditures, disbursements, and cash receipts are for the purposes and objectives set forth in the Terms and <br />Conditions of the State -Funded Hazards Analysis Agreement. l am aware that any false, fictitious, or fraudulent <br />information, or the omission of any material fact, may subject me to criminal, civil, or administrative penalties for fraud, <br />false statements, false claims, or otherwise as proscribed by law. <br />Recipient Printed Name & Title <br />Recipient Signature Date Signed <br />FDEM Grant Manager Signature Date Signed <br />29 ILA Attachment M Close -Out Report Form 6/6/2022 <br />