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EVERETT <br /> WASHINGTON <br /> City of Everett Human Needs Grant <br /> January 1, 2020 through December 31, 2020 <br /> Exhibit C <br /> Request for Reimbursement <br /> Organization& Program: Cocoon House -Hot Meals Coordinator <br /> Mailing Address: 3530 Colby Ave, Everett,WA 98201 <br /> Report Month and Year: December 2020 <br /> The expenditures made during the report month were for the specific purpose of: <br /> Hot Meals Coalition Coordinator <br /> Define one unit of service: Professional Services by 1 Meal Coordinator position <br /> During this billing period a total of one units of service were provided to 250 residents of the City of Everett using these grant <br /> funds. <br /> Contact name/phone for questions on invoice:Chris Willis, Director of Finance,425.259.58o2 Xii5 <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: $ $ $ $ <br /> Other: $ $ $ $ <br /> Total $«Funding_Recommendation» $ $ $ <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 to the best of their knowledge. <br /> Program Manager Signature Date <br /> Approved for Payment <br /> Kern bra Landry Date <br /> Community Development Specialist <br /> GL Code: 009-5000199410 <br /> Vendor No: «Vendor_» (City use only) <br /> 9 <br />