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City of Everett Human Needs Grant <br /> January 1 through December 31,2018 <br /> Exhibit C: Request for Reimbursement <br /> Organization: Volunteers of America Western Washington <br /> Program Name: Hunger Prevention Services—Everett Food Bank <br /> Mailing Address: 2802 Broadway <br /> P.O. Box 839, Everett WA 98206-0839 <br /> Report Month and Year: <br /> The expenditures made during the report month were for the specific purpose of: <br /> Define one unit of service: <br /> During this billing period a total of units of service were provided to residents of the City of <br /> Everett using these grant funds. <br /> Contact name/phone for questions on invoice: <br /> Expenditures <br /> Category Total Budget Current Report Period Total Expenses Billed I Balance Remaining <br /> Date <br /> Salaries/Wages <br /> Benefits <br /> Office and Operating <br /> Supplies <br /> Professional Services <br /> Other: <br /> Total <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 /> Rebecca A. McCrary Date <br /> Housing and Community Development Programs Manager <br /> GL Code: 009-5000199410 <br /> Vendor No: 03058 (City use only) <br /> 7 <br />