Reso 2013-2143 - Laserfiche WebLink

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1 2 3 4 5 6 7 6 Name of Agency /City: Project Title: SUMMARY STATEMENT OF QUARTERLY PROJECT COSTS (Salaries and Benefits) Date: Claim Number: Page 2 of 5 Name Date of Type of Total Total Officer /Staff Activity Activity Hours Amount `(Presentation, Parent Meeting, Field trip, etc.) Total Amount for Salaries and Benefits (if applicable): $0.00 Total Hours: 0.00 I CERTIFY THAT PAYMENT FOR THE AMOUNT OF $0.00 IS CORRECT. BELOW IS THE SIGNATURE OF EACH STAFF (EMPLOYEE) IN THE ORDER LISTED ABOVE: 1 OFFICER /STAFF SIGNATURE: EMPLOYEE ID: 2 OFFICER /STAFF SIGNATURE: EMPLOYEE ID: 3 OFFICER /STAFF SIGNATURE: EMPLOYEE ID: 4 OFFICER /STAFF SIGNATURE: EMPLOYEE ID: 5 OFFICER /STAFF SIGNATURE: EMPLOYEE ID: 6 OFFICER /STAFF SIGNATURE: EMPLOYEE ID: 7 OFFICER /STAFF SIGNATURE: EMPLOYEE ID: 8 OFFICER /STAFF SIGNATURE: EMPLOYEE ID: I VERIFY THAT THE ABOVE SERVICES WERE PROVIDED: r CHIEF OF POLICE /CITY OFFICIAL SIGNATURE: Note: Payroll registers, time sheets and OT slips (if applicable), documenting payroll expenses must be attached to process this reimbursement.