HomeMy WebLinkAboutExhibit 6Attachment D
DIVISION OF EMERGENCY MANAGEMENT
REQUEST FOR ADVANCE OR REIMBURSEMENT OF
HAZARD MITIGATION GRANT PROGRAM FUNDS
RECIPIENT NAME: City of Miami
ADDRESS:
CITY, STATE, ZIP CODE:
PAYMENT No:
FEMA Tracking Numbers: 1602-02-R
DEM Agreement No: 07HM-O:-1-23-02-018
Eligible
Amount
100%
Obligated
Federal
75%
Obligated '
Non -Federal)
25% ,
Previous
Payments
Current
Request
DEM 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 DEM agreement and payment is due and has not been
previously requested for these amounts.
RECIPIENT SIGNATURE
NAME AND TITLE DATE:
TO BE COMPLETED BY DIVISION OF EMERGENCY MANAGEMENT
APPROVED PROJECT TOTAL $
ADMINISTRATIVE COST $ GOVERNOR'S AUTHORIZED REPRESENTATIVE
APPROVED FOR PAYMENT $
DATE
29
DIVISION OF EMERGENCY MANAGEMENT
SUMMARY OF DOCUMENTATION IN SUPPORT OF AMOUNT
CLAIMED FOR ELIGIBLE DISASTER WORK UNDER THE
HAZARD MITIGATION GRANT PROGRAM
Applicant: City of Miami Disaster No. 1602
DEM Agreement No. 07HM-O;-11-23-02-018
FEMA Tracking # 1602-02-R
Applicant's
Reference No.
(Warrant, Voucher,
Claim Check, or
Schedule No.)
Date of delivery
of articles,
completion of
work or
performance
services.
DOCUMENTATION
List Documentation (Applicant's payroll, material out of
applicant's stock, applicant owned equipment and name of
vendor or contractor) by category and line item in the
approved project application and give a brief description of
the articles or services.
t„
Applicant's
Eligible Costs
100%
TOTAL
30