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. ~ _i <br /> OMB APPROVAL NO. PAGE OF <br /> REQUEST FOR ADVANCE 0348-0004 1 1 PAGES <br /> a. X"one or both boxes 2. BASIS OF REQUEST <br /> OR REIMBURSEMENT ? ADVANCE ® REIMBURSE- <br /> TYPE OF MENT ? CASH <br /> I PAYMENT b. 'x" fhe applicable box <br /> (See instructions on back) REQUESTED ? FINAL ~ PARTIAL ? ACCRUAL <br /> ' 3. FEDERAL SPONSORING AGENCY AND ORGANIZATIONAL ELEMENT TO 4. FEDERAL GRANTOR OTHER 5. PARTIAL PAYMENT REQUEST <br /> WHICH THIS REPORT IS SUBMITTED ~ IDENTIFYING NUMBER ASSIGNED NUMBER FOR THIS REQUEST <br /> BY FEDERAL AGENCY <br /> FEMA EMS-2004-GR-0035 ` 1 ' <br /> 6. EMPLOYER IDENTIFICATION 7. RECIPIENT'S ACCOUNT NUMBER H. PERIOD COVERED BY THIS REQUEST <br /> NUMBER OR IDENTIFYING NUMBER FROM (month, day, year) - TO (month, day, year) ~ <br /> 93-600216.0 - 10/1 /04 _ 6/N 110.x. ~z`~~ <br /> 9. RECIPIENT ORGANIZATION 10. PAYEE (Where check is to be sent it different than item 9) <br /> Name: CITY OF EUGENE- PW-ENGINEERING Name: SAME <br /> i <br /> ~ Number Number n~ <br /> <br /> ~I and Street: 244 E. BROADWAY and Street: ` w V / <br /> City, State City, State <br /> andZlPCode: EUGENE,OR.97401 andZlPCode: <br /> <br /> I <br /> 11. COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED <br /> la) (b) r,~ (c) <br /> PROGRAMS/FUNCTIONS/ACTIVITIES ? _tD~J <br /> CTP-97-04 Y ~ ~ TOTAL <br /> Z ~ ' ~ ~ <br /> a. Total program (a5 o/dare) <br /> outla s to date ~ ~ ~ $ 235,627.14 <br /> b. Less: Cumulative ro ram income 0.00 <br /> c. Net program outlays (Line a minus ~~F R77 ,I <br /> line b) 4 0.00 0.00 235,627.14 <br /> d. per odted net cash outlays for advance 3,500.00 <br /> e. Total (Sum oflines c & d) ~32,~3 ~ 4 0.00 0.00 239,127.14 <br /> f. Non-Federal share of amount on line a 214,127.14 214,127.14 <br /> . Federal share of amount on line a ~{,-O~ 25,000.00 <br /> h. Federal payments previously requested 0.00 0.00 <br /> i. Federal share now requested (Line g ° <br /> minus line h) Z`-I a~~25;686-@8 0.00 0.00 25,000.00 <br /> 1• Advances required by <br /> month, when requested 1st month 0.00 <br /> by Federal grantor <br /> agency for use in making 2nd month 0.00 <br /> prescheduled advances <br /> 3rd month 0.00 <br /> 12. ALTERNATE COMPUTATION FOR ADVANCES ONLY <br /> a. Estimated Federal cash outlays that will be made during period covered by the advance $ <br /> b. Less: Estimated balance of Federal cash on hand as of beginning of advance period. <br /> c. Amount re uested (Une a minus line b) $ 0.00 <br /> AUTHORIZED FOR LOCAL REPRODUCTION (Gontinued on Reverse) STANDARD FORM 270 (Rev. 7-9n <br /> _ Prescribed by OMB Circulars A-102 and A-110 <br /> l~.~k ~ (1~1--f. 1 d chsi ~ L. ~r~ <br /> <br />