CLOSEOUT-FY20 18-09Nth RFF#1 WF7.10.2020Request for FundsCFDA: 97.047INVOICE REQUEST PERIOD: From 1/1/2020 to 6/30/2020 GRANT AMOUNT: $25,000.00ACTIVITY / COST CLASSIFICATION a. Total Budget Approvedb. Total of ALL costs PAID to datec. Federal Share available (% of approved budget)d. Federal share being requested (must have been paid)e. Total of previous federal payments requested and/or paidf. Balance of grant (c less d less e)1Hazard Mitigation Plan$33,333.00 $26,479.26 $25,000.00 $19,465.00 $0.00 $5,535.0023456789101112Subtotal$33,333.00 $26,479.26 $25,000.00 $19,465.00 $0.00 $5,535.001314Total Project Costs$33,333.00 $26,479.26 $25,000.00 $19,465.00 $0.00 $5,535.00DATE:7/10/2020DATE:DATE:MEMA USE ONLY- COMMENTSColumn a: Enter approved budget. Column b: Enter amounts paid by City/Town to date.This is a reimbursement program so column b must always be a running total. Column c: Federal share available(this is the percentage of the approved budget available for reimbursement, normally 75%) This column should remain the same, and the total should be grant amount. Column d: Enter amount for reimbursement. Column e: This is the total of previous federal payments made( Must be a running total) Column f: Balance of grant ( Must be running total) (Columc c minus column d minus column e)SIGNATURE: REQUEST FOR FUNDS- MITIGATION PROGRAMS DATE: 7/10/2020 REQUEST #: 1VENDOR CODE: VC6000192124NAME OF SUB-RECIPIENT: CITY OF NORTHAMPTONMEMA DISASTER RECOVERY MANAGER APPROVING PAYMENTSIGNATURE:MEMA MITIGATION COORDINATOR REVIEWING PAYMENTCERTIFICATION BY AUTHORIZED AGENT/DESIGNATED OFFICIAL OF CONTRACTOR/SUB-RECIPIENT: 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 terms 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, Sections 3729-3730 and 3801-3812).TITLE: Wayne Feiden, Director of Planning and SustainabiltySIGNATURE:GRANT PROGRAM #: PDMC 18-09NTH1MEMA RFF FORM REV: 1/2009
Request for FundsInstructions:1 Date of Request2 Request Number: (ex. #3)3 Name of Grantee4 Grant Program Number5 Vendor Code (if known)6Invoice request period (Time period of invoices) THIS IS VERY IMPORTANT FOR FISCAL CONCERNS7 Grant Amount (Amount of FEMA Grant Award)Column a: Total approved budget- Fill in amounts from your approved budgetColumn b: Enter total of Costs paid to date. This must be a running totalColumn c: This is a new column. This is the percentage of federal reimbursement of the approved budget amount (usually 75%, must be confirmed with application or award letter.) This column should not change. The total of this column should equal grant amount found in the upper right corner of the form. Column d: Federal share being requested.Column e: Total of previous federal payments. This must be a running totalColumn f: Balance of grant. Column c minus column d minus column e. This must be a running total.8 If there is Project/Program income, subtrat from Column B TOTAL OF ALL COSTS PAID ONLY. 2MEMA RFF FORM REV: 1/2009