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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. 43 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 44