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Attachment C <br /> JUSTIFICATION OF ADVANCE PAYMENT <br /> RECIPIENT : <br /> Indicate by checking one of the boxes below, if you are requesting an advance. If an advance payment <br /> is requested , budget data on which the request Is based must be submitted . Any advance Payment <br /> under this Agreement is sub1'ect to s. 216. 181 (16)(a)(b) , Florida Statutes. The amount which maybe <br /> advanced shall not exceed the expected cash needs of the recipient within the initial three months. <br /> [ I ADVANCE REQUESTED <br /> [� NO ADVANCE REQUESTED <br /> Advance payment of $ is requested . Balance of <br /> No advance payment is requested . payments will be made on a reimbursement basis. These funds <br /> Payment will be solely on a are needed to pay staff, award benefits to clients, duplicate forms <br /> reimbursement basis. No additional and purchase start-up supplies and equipment. We would not be <br /> information is required . able to operate the program without this advance. <br /> ADVANCE REQUEST WORKSHEET <br /> If you are requesting an advance, complete the following worksheet <br /> (A) (B) (C) ( D) <br /> FFY FFY FFY Total <br /> DESCRIPTION 2003-2004 2004-2005 2005-2006 <br /> 1 INITIAL CONTRACT ALLOCATION <br /> 2 FIRST THREE MONTHS CONTRACT <br /> EXPENDITURES' <br /> 3 AVERAGE PERCENT EXPENDED IN FIRST <br /> THREE MONTHS <br /> ( Divide line 2 b line 1 . <br /> First three months expenditures need only be provided for the years in which you requested an advance . If <br /> you do not have this information, call your consultant and they will assist you. <br /> MAXIMUM ADVANCE ALLOWED CALULATION : <br /> X $ _ <br /> Cell D3 DCA/DEM Award MAXIMUM <br /> (Do not include any match) ADVANCE <br /> REQUEST FOR WAIVER OF CALCULATED MAXIMUM <br /> [ ] Recipient has no previous DCA/DEM contract history . Complete Estimated Expenses chart and <br /> Explanation of Circumstances below. <br /> [ ] Recipient has exceptional circumstances that require an advance greater than the Maximum <br /> Advance calculated above. <br /> 35 <br />