HomeMy WebLinkAboutExhibit 9Attachment C
JUSTIFICATION OF ADVANCE PAYMENT
RECIPIENT:
Indicate by checking one of the boxes below, if you are requesting an advance. If an advance payment
Is requested, budget data on which the request is based must be submitted. Any advance paych ment
be
advanced shall
not exceed tt is hect to s. expect d cash needs of herida recipientwithin thtes. The e nount t I l three months.
[ ] NO ADVANCE REQUESTED
No advance payment is requested.
Payment will be solely on a
reimbursement basis. No additional
information is required.
[ ) ADVANCE REQUESTED
Advance payment of $ is requested. Balance of
payments will be made on a reimbursement basis. These funds
are needed to pay staff, award benefits to clients, duplicate forms
and purchase start-up supplies and equipment. We would not be
able to operate the program without this advance.
ADVANCE REQUEST WORKSHEET
If you are requesting an advance, complete the following worksheet
DESCRIPTION
1
INITIAL CONTRACT ALLOCATION
2
3
FIRST THREE MONTHS CONTRACT
EXPENDITURES'
AVERAGE PERCENT EXPENDED IN FIRST
THREE MONTHS
(Divide line 2 by line 1.)
First three months expenditures need only be provided for the years In which you requested an advance. If
you do not have this information, call your consultant and they will assist you.
MAXIMUM ADVANCE ALLOWED CALULATION:
X $ =
Cell D3 DCAIDEM Award
(Do not include any match)
(A)
FFY
2003-2004
(B)
FFY
2004-2005
(C)
FFY
2005-2006
MAXIMUM
ADVANCE
(D)
Total
REQUEST FOR WAIVER OF CALCULATED MAXIMUM
] Recipient has no previous DCAIDEM contract history. Complete Estimated Expenses chart and
Explanation of Circumstances below.
] Recipient has exceptional circumstances that require an advance greater than the Maximum
Advance calculated above.
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Complete estimated expenses chart and Explanation of Circumstances below. Attach additional
pages if needed.
ESTIMATED EXPENSES
BUDGET CATEGORY
ADMINISTRATIVE COSTS
(Include Secondary Administration.)
PROGRAM EXPENSES
TOTAL EXPENSES
Explanation of Circumstances:
2006-2007 Anticipated Expenditures for First Three Months of
Contract
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