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Shelter Program Grant Exhibit E <br /> Subrecipient Agreement EVE R E T T <br /> WASHINGTON <br /> City of Everett <br /> WA State Department of Commerce — Shelter Program Grant <br /> Reimbursement Request <br /> Agency: Everett Gospel Mission <br /> Program: Pallet Shelter Program <br /> Mailing Address: <br /> The expenditures listed below were incurred during the following time period <br /> for the purpose of providing pallet shelters and site maintenance. <br /> Contact name/phone for questions on expenditures: <br /> ALL REQUESTS FOR PAYMENT MUST HAVE ORIGINAL SIGNATURE.This form must match the project <br /> budget on file and be accompanied by backup documentation. Failure to do so may result in delay of <br /> reimbursement. <br /> Category Budget Current Period Total Expenses to Balance <br /> Expenditures Date Remaining <br /> TOTALS $664,594.00 $664,594.00 <br /> Request for Payment: The undersigned Program Manager certifies that the information submitted in <br /> support of this Request for Reimbursement is true, accurate and complete to the best of their <br /> knowledge. <br /> Approved for Payment: Date: <br /> Printed Name and Title of Program Manager: <br /> Please return this form, with original signature, to:Kembra Landry, Office of Community, Planning and <br /> Economic Development, 2930 Wetmore Avenue, Suite 8A, Everett, WA 98201 <br />