Laserfiche WebLink
FY08 Emergency Management Performance Grant Exhibit B of ASR <br />Reimbursement Request <br />Award # <br />Mail Reimbursement Request to vour Regional Office Subgrantee: <br />OES ID #: <br />Office of Emergency Services Office of Emergency Services <br />Coastal Region Inland Region <br />1300 Clay Street, Suite 400 3650 Schriever Avenue <br />Oakland, CA 94612 Mather, CA 95655 <br />Office of Emergency Services <br />Southern Region <br />4671 Liberty Avenue <br />Los Alamitos, CA 90720 <br />1. Reimbursement Request far which state fiscal year? (Check only onefrscal year box per Reimbursement <br />request) Check the Final Reimbursement Request boz if this is your final request: <br />^ 10/01/07 to 6/30/08 <br />2 Federal Funds Expended <br />(A3=AI+A2) <br />^ 07/01/08 to 06/30/09 ^ Final Reimbursement Request <br />Loca] Subgrant Match Expended <br />(B3=B7 +B2) <br />Total Subgrant Expenditures <br />(C = A3 + B3) <br />3 Total Emergency Program Expenditures <br />(C + Additional Local Expenditures) <br />Cumulative Previously Currctd iteques[ed Cumulative Amount <br />:oestedAmount Amount to Date <br />AI ,u _ <br />9/ g1 _ <br />Under penalty of perjury, I certify that: <br />^ I am the duly Authorized Agent of the claimant herein. <br />This reimbursement request is in all respects true, correct, and in accordance with applicable <br />laws, rules, regulations, subgrant conditions and assurances. <br />^ All funds requested as a reimbursement have been matched with local funds. <br />• Emergency Program Expenditures may not be used for any other match. <br />Authorized Agent (Per Governing Body Resolution/State Agency Signature Authority Form) <br />Printed <br />Phone <br />E-Mail Address <br />Mailing Address <br />City, State, Zip Code <br />Signature <br />Fax No. <br />Date <br />^ Check this box if this is a new address for the Authorized AgP9~je 63 of 80 <br />FY08 EMPG Recipient Subgran[ Guide for Local Government 45 <br />