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ATTACHMENT B - EMPG REIMBURSEMENT SPREADSHEET <br />JURISDICTION: <br />FUNCTION <br />0 r4. MT jADM1N 0 E:,ER.CISE TRAINING Pk.ANNIN <br />CONTRACT #: <br />0AGO-11ZATIC EQUIP114ENT <br />GRANT: FFY05 EMPG <br />SALARY/BENEFITS/OVERTIME/CONSULTANT-CONTRACTOR FEES <br />Staff/Consultant <br />Name Activity <br />/Contractor <br />Date Range Salary Benefits Overtime Total <br />TOTAL $ - $ - $ - $ - <br />GOODS & SERVICES <br />Item Vendor Name <br />Invoice # <br />Date Amount <br />Total $ - <br />TRAVEL & PER DIEM <br />Name Activity <br />Date <br />Amount <br />TOTAL <br />$ - <br />EQUIPMENT <br />Item Vendor Name <br />Invoice # <br />Date Amount <br />Total $ - <br />OTHER (Including Indirect) <br />Type of Expenditure Date <br />Amount <br />TOTAL <br />$ - <br />REIMBURSEMENT TOTAL <br />$ - <br />Except for equipment purchases, DO NOT send copies of invoices or financial reports with this spreadsheet. Original invoices, for items <br />other than equipment, shall be made available to the state upon request. Invoices and packing slips for equipment purchased with EMPG <br />grant funds must be attached to this spreadsheet. <br />To receive reimbursement for EMPG expenditures, please send this form with the signed A19 -1A Invoice Voucher to: Michelle Sabin, EMPG <br />Program Manager, Washington Military Department, Emergency Management Division, Building 20, Camp Murray 98430-5122 <br />--J EMPG FFY 2005 Page 18 of 18 City of Everett EM <br />E05-233 <br />