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FEDERAL EMERGENCY MANAGEMENT AGENCY COST SUMMARY ROLL -UP APPLICANT JURISDICTION CATEGORY DISASTER County of Orange City of Santa Ana B 4482-DR-CA CATEGORY CLAIM COST COMMENTS ELIGIBLE COSTS LABOR REGULAR TIME $ 4,928.06 Resources requested by the County and deployed at the (At -POD) POD site and IMT $ 4,928.06 LABOR OVERTIME $ 2,201.75 Resources requested by the County and deployed at the (At -POD) POD site and IMT $ 2,201.75 LABOR REGULAR TIME $ Resources requested by the County and deployed outside (Outside -POD) the POD site and IMT $ LABOR OVERTIME $ Resources requested by the County and deployed outside (Outside -POD) the POD site and IMT $ OTHER COSTS $ (If pre -approved) $ TOTAL $ 7,129.81 $ 7,129.81 I certify that the above information was transcribed from timesheets, payroll records, equipment log, invoices, stock records or other documents which are available for audit. This claim is for cost incurred within the approved Grant Performance Period. By signing this report, I certify to the best of my knowledge 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 term and conditions of the Federal award. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Section 1001 and Title 31, Section 3729-3730 and 3801-3812). The above resources were requested by the County of Orange for Vaccination Efforts and provided or deployed by Mutual Aid Partner certifying this report. CERTIFICATION AND COMMENTS: Certified by: Date: Kristine Ridge, City Manager / is Z/ Applicant's records have been reviewed and found correct with the exceptions and/or comments noted below: