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EVERETT <br /> III 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: Catholic Community-Clare's Place <br /> Mailing Address: 1918 Everett Avenue, Everett,WA 98201 <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 /> Personnel and operating costs to provide residential counseling housing support services to sixty five(65)extremely low-income, <br /> chronically homeless households consisting of youth(18-24 year old),veterans,and other individual households referred by the <br /> Snohomish County Coordinated Entry System <br /> Define one unit of service: Direct Service Hour <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 /> .. residents of the City of Everett using these grant funds. <br /> Contact name/phone for questions on invoice: Click or tap here to enter text. <br /> Expenditures <br /> Category Total Budget Current Report Total Expenses Balance Remaining <br /> Period Billed to Date <br /> Salaries/Wages $124,408.00 $ $ $ <br /> Benefits $31,400.00 $ $ $ <br /> Office and Operating $6,232.00 $ $ $ <br /> Supplies <br /> Occupancy/Equipment $3,918.00 $ $ $ <br /> Other:Telephone,Travel, $ $ $ <br /> $30,665.00 <br /> Training,Administration <br /> Other:Client Assistance $3,377.00 $ $ $ <br /> Total $200,000.00 $ $ $ <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 to the best of their knowledge. <br /> Program Manager Signature Date <br /> Approved for Payment <br /> Kembra Landry Date <br /> Community Development Specialist <br /> GL Code: 009-5000037410 <br /> Vendor No: 03304 (City use only) <br /> 10 <br />