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2022 CV CDBG Subrecipient Agreement <br />Exhibit E <br />IE <br />EVE R ETT <br />COMMUNITY DEVELOPMENT BLOCK GRANT <br />2022 CV PROGRAM YEAR REIMBURSEMENT REQUEST <br />Contact Name and Phone for expenditure questions:_Porsche Thompson (425) 954-8340 <br />Expenditures listed below were incurred during the following time period <br />This form must match the project budget on file and be accompanied by backup documentation. <br />Failure to do so may result in delay of reimbursement. Execution and delivery of this Contract Exhibit <br />by the parties shall be legally valid and effective through any combination of: (i) executing and <br />delivering a paper copy, (ii) transmitting the executed paper copy by email in pdf format or other <br />electronically scanned format, or (iii) execution and transmittal by AdobeSign or DocuSign or similar e- <br />signature method. <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 <br />Printed Name and Title of Program Manager: <br />Pleose return this form to: Vicki Dorwoy, Office of Plonning and Community Development, 29i0 <br />Wetmore Avenue, Suite 8A, Everett, WA 9820L or vdorway@everettwo.gov <br />Date:s/u2o23 <br />Project Title:Rental Assistance for Covid relief <br />Subrecipient:Hand in Hand <br />Budget Category Budget Amount Current Period <br />Expenditures <br />Total Expenses to <br />Date <br />Balance <br />Remaining <br />s <br />s <br />s <br />s <br />s <br />s <br />s <br />TOTAL s s s s