HomeMy WebLinkAboutExhibit 9Attachment D
FLORIDA DEPARTMENT OF COMMUNITY AFFAIRS
DIVISION OF EMERGENCY MANAGEMENT
Request for Advance or Reimbursement of
Hazard Mitigation Grant Program Funds
RECIPIENT NAME: City of Miami DECLARATION NO: FEMA-1345-DR-FL
ADDRESS:
CITY, STATE, ZIP CODE
PAYMENT No:
FEMA Tracking Numbers: 1345-0037
Eligible
Amount
100%
Obligated
Federal
100%
Previous
Payments
DCA Agreement No: 04HM-M5-11-23-02-010
Current
Request
DCA Use Only
Approved
Comments
TOTAL CURRENT REQUEST $
I certify that to the best of my knowledge and belief the above accounts are correct, and that all disbursements were
made in accordance with all conditions of the DCA agreement and payment is due and has not been previously
requested for these amounts.
RECIPIENT SIGNATURE
NAME AND TITLE
DATE:
TO BE COMPLETED BY DEPARTMENT OF COMMUNITY AFFAIRS
APPROVED PROJECT TOTAL. $
ADMINISTRATIVE COST $ GOVERNOR'S AUTHORIZED REPRESENTATIVE
APPROVED FOR PAYMENT $ DATE
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