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<br />Edward Byrne Memorial State and Local Law Enforcement Assistance Formula Grant Program <br /> <br />SUMMARY STATEMENT OF QUARTERLY PROJECT COSTS <br />(To Be Copied on Jurisdiction Letterhead) <br /> <br />Ci : <br /> <br />Date of Claim: <br /> <br />Pro'ect Name: <br /> <br />Claim Number: <br /> <br />T ele hone: <br /> <br />Claim Period: <br /> <br />Name of Person Completing Form: <br /> <br /> <br />1. Total Federal Budget $ <br /> <br />2. Amount This Invoice $ <br />(75% of your current claim) <br /> <br />3. Amount of Previous Invoices $ <br /> <br />4. Remaining Federal Balance $ <br />(Subtract lines 2 & 3 from line 1) <br /> <br />Sub Object <br />Code <br /> <br />Budget <br />Categories <br /> <br />Line Item <br />Disallowed <br /> <br />Exceeds <br />Budget <br /> <br />Federal <br />Funds <br /> <br />Local <br />Match <br /> <br />Category <br />Totals <br /> <br />Salaries & <br />Benefits <br /> <br />Contractual <br />Services <br /> <br />Operating/ <br />Capital Equipment <br /> <br />Expenses <br /> <br />Total Claim <br /> <br />We request payment in accordance with our contract agreement in the amount of 75% of the Total Costs for this <br />Claim $ (75%), the balance of costs, $ (25%), to be recorded as our in-kind contribution to <br />comply with the local match requirements. <br /> <br />Attached, please find the records which substantiate the above expenditures. I certify that all of the costs have been paid and <br />none of the items have been previously reimbursed. All of the expenditures comply with the authorized budget and fall within <br />the contractual scope of services and all of the goods and services have been received, for which reimbursement is requested. <br /> <br />Respectfully submitted, <br /> <br />Chief of Police/Other City Official <br /> <br />Payment Approved, Miami Dade County <br />