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.. . . <br /> R___.• EVERETT <br /> WASHINGTON <br /> City of Everett Human Needs Grant <br /> April 1, 2020 through December 31, 2020 <br /> Exhibit C <br /> Request for Reimbursement <br /> Organization & Program: Faith Lutheran Church:Safe Streets COVID-19 Hot Meals Coalition <br /> Mailing Address: 6708 Cady Road, Everett,WA 98203 <br /> Report Month and Year:Click or tap here to enter text. <br /> The expenditures made during the report month were for the specific purpose of: <br /> Providing food and supplies to hot meal programs which provide free meals to all people in the City of Everett. <br /> Define one unit of service: A meal. The cost/value of a meal is$2.50 <br /> During this billing period a total of Click or tap here to enter text. units of service were provided to Click or tap here to enter <br /> text. residents of the City of Everett using these grant funds. <br /> Contact name/phone for questions on invoice: Roxana Boroujerdi: 425.971.0402;Jack Harris: 206.755.5225 <br /> Expenditures <br /> Category Total Budget Current Report Total Expenses Balance Remaining <br /> Period Billed to Date <br /> Salaries/Wages $ $ $ $ <br /> Benefits $ $ $ $ <br /> Office and Operating $ $ $ $ <br /> Supplies <br /> Professional Services $ $ $ $ <br /> Other: Food and distributii $ $ $ <br /> $ <br /> costs for COVID relief <br /> Other:Click or tap here to ente $ $ $ $ <br /> text. <br /> Total $10,000.00 $ $ $10,000.00 <br /> Request for Payment: The undersigned Program Manager certifies that the information submitted in support of this Request for <br /> Reimbursement is true, accurate and complete t e be of their knowledge. <br /> Program Ma ger Signature Date <br /> Approved for Payment <br /> Kembra Landry Date <br /> Community Development Specialist <br /> GL Code: 009-5000199410 <br /> Vendor No: 39972 (City use only) <br /> 9 <br />