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<br />3. The recipient must provide an estimated budget for each quarter covered by the agreement. The <br />summary information should include salaries, fringe benefits, overhead, contracts (specify services to <br />be contracted out), equipment, if authorized (specify items to be purchased), supplies, travel, and <br />other costs. <br />A sample summary format is provided below, The summary should include the breakdown for each quarter of the <br />agreement period. <br /> Description First Quarter Second Third Quarter Fourth Quarter <br /> Ouarter <br />Salaries <br />(identifv personnel/titles) <br />Frinqe Benefits <br />Contractual Services <br /> (list services and estimated <br />costs) <br />Equipment <br />(identify each item and cost) <br />SUDDlies <br />Travel <br />Other (specify) <br />Overhead/Indirect <br /> Total: <br />Certification Statement <br />The forgoing information is presented to the Florida Department of Environmental Protection in support of our <br /> request for advance payment. I certify that the information provided accurately reflects the financial <br /> issues facing the entity at this time. <br />By: <br />Type Name of Signatory: Date <br />Title: Chief Financial Officer or desiqnee <br />DEP Proqram Area Review/Approval <br />Recommendation: o Approve Request o Deny Request <br />By: <br />Type Name of Signatory: Date <br />Title: Bureau: Division: <br />The DEP Program Area should forward this information to the Contracts Disbursements Section at MS78. The <br />Contracts Disbursements Section will forward requests for advance payment to the State Comptroller for review <br />and leqislature consultation as appropriate. <br />Bureau of Finance & Accounting Use Only <br /> <br />DEP 55-222 (03-02) <br />DEP Agreement No. LP6862, Attachment F, Page 3 of3 <br /> <br />S\B <br />