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Instruction Sheet for the Reimbursement Request Subgrantee The subgrantee is the agency identified in the original grant application and indicated in the Notification of Application Approval letter. Do not identify any sub - departments or offices as the applicant. Award Number The Award Number is identified on the Notification of Application Approval letter OES ID # The OES ID# is identified on the Notification of Application Approval letter. Payment Request Indicate the time period for which funds are being requested. For reimbursements, the time period chosen Period should represent the period in which the grant funds have been expended. Only one period can be chosen per payment request and the request period cannot cross state fiscal years; therefore, separate requests must be submitted for expenditures incurred on or before June 30, and on or after July 1. Definition of For the purposes of this form, expenditure is defined as the actual payment of funds, by subgrantees, to Expenditure contractors, vendors, or employee labor, equipment, etc. Project Number Indicate the project number as noted on the Project Summary which is attached to your Notification of Application Approval letter. Federal Funds For each project, indicate the amount of the federal funds being requested from your EMPG grant award. This Requested for the should be exactly what you want us to reimburse you for. Do no include the local share. time period checked above Total Funds In this column, indicate all funds expended so far for each project, including the local portion. This will help us Expended to Date ensure you are meeting the match requirements. Authorized Agent Complete all line items requested and ensure that the form is signed by an Authorized Agent named in the Information Governing Body Resolution, or the State Agency Signature Authority form. Address Changes Indicate a change of address by checking the box shown and noting the address in the area marked "mailing address ". The new address will be used to update OES' records. Supporting Supporting documents are not required to be submitted with the Payment Request; however, the state reserves Documents the right to request documentation at any time. Subgrantees are reminded to maintain documents that support the expenditure and reimbursement amounts shown on the request. Mail Mail the original Payment Request form to OES at: Governor's Office of Emergency Services Coastal Region Inland Region Southern Region 1300 Clay Street, Suite 408 3650 Schriever Avenue 4671 Liberty Avenue Oakland, CA 94612 Mather, CA 95655 Los Alamitos, CA 90720 FY 06 EMPG Grant Guide for Local Government Page 48 of 51 39