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ism <br /> Lig <br /> 2020 CDBG Subrecipient Agreement EVERETT <br /> Exhibit D <br /> WASHINGTON <br /> City of Everett <br /> Community Development Block Grant <br /> 2020 Program Year Reimbursement Request <br /> Agency: Homage <br /> Program: Meal Delivery Services <br /> Mailing Address: 5026 196th St. SW, Lynnwood, WA 98036 <br /> The expenditures listed below were incurred during the following time period Click or tap here to enter <br /> text. for the purpose of Click or tap here to enter text. <br /> Contact name/email for questions on expenditures: Click or tap here to enter text. <br /> Category Budget Current Period Total Expenses to Balance <br /> Expenditures Date Remaining <br /> TOTAL 10000 <br /> REIMBURSEMENT WITH ORIGINAL SIGNATURE AND BACKUP DOCUMENTATION MUST BE MAILED TO <br /> CITY OF EVERETT AT 2930 WETMORE AVENUE,SUITE 8A, EVERETT,WA 98201. <br /> The undersigned Program Manager certifies that the information submitted in support of this Request <br /> for Reimbursement is true, accurate and complete to the best of their knowledge. <br /> Payment Signature: Date: Click or tap to enter a date. <br /> Printed Name and Title of Program Manager: Click or tap here to enter text. <br /> City Use Only: Vendor Number 01286' <br /> 2020 Grant Amount:10,000 <br />