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1 <br /> OMB APPROVAL NO. PAGE OF <br /> 0348-0004 1 2 PAGES <br /> REQUEST FO R ADVAN CE a. 'X'one or both boxes 2. BASIS OF REQUEST <br /> OR REIMBURSEMENT ®ADVANCE ? REIMBURSE- <br /> rrPEOF MENT ? CASH <br /> PAYMENT b. ~"the applicable box ~Vy.~~.f-~~ <br /> (See instructions on back) REQUESTED ? FINAL 0 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 /> U.S. Fish and Wildlife Service 2 <br /> 98210-2-G396 <br /> ,i 8. EMPLOYER IDENTIFICATION 7. RECIPIENTS ACCOUNT NUMBER 8. PERIOD COVERED BY THIS REQUEST <br /> ,NUMBER OR IDENTIFYING NUMBER FROM (month, day, year) TO (month, day., year) <br /> 93-6002160 1536-0031-8601 November 10, 2003 November 10, 2003 <br /> 9. RECIPIENT ORGANIZATION 10. PAYEE (tNhere Check IS t0 be Sent If dllferent than lfem 9) <br /> I <br /> ~ Name: City of Eugene Name: <br /> C <br /> j Number ~ Number <br /> and Street: 777 Pearl Street and Street: <br /> City, state Eu ene, OR 97401 City., state <br /> antl ZIP Code: g and ZlP Code: <br /> <br /> I <br /> 11. , COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCE6 REQUESTED <br /> (a) (b) (cI <br /> PROGRAMSIFUNCTIONSfACTIVITIES ? <br /> TOTAL........ <br /> a. Total program ~A5 ord8~e~ <br /> outlays to date ~ ~ ~ ~ 0.00 <br /> b. Less: Cumulative .rogram income O.OO <br /> c. Net_program outlays (Line a_minus _ _ <br /> fine b) 0.00 0.00 O.OO O.OO <br /> d. Estimated net cash outlays for advance O.OO <br /> [Tod <br /> e. Total (Sum oflines c $ d) 0.00 0.00 0.00 0.00 <br /> f. Non-Federal share of amount on line a O.OO <br /> _g:_F_ederal_share:of=amount:.on=tine e- - _ __Q,~O _ <br /> h. Federal pa merits reviously requested 0.00 <br /> i. Federal share now requested (Line g 0.00 0.00 0.00 0.00 . <br /> minus line h) <br /> 1• Advances required by O.OO. <br /> month, when requested 1st month <br /> by Federal grantor O.OO <br /> agency for use in making 2nd month <br /> prescheduled advances 3rd month 0.00 <br /> 12. ALTERNATE COMPUTATION FOR ADVANCES ONLY <br /> a. Estimated Federal cash outlays that wilt be made during eriod covered b the advance $ 44,275.00 <br /> b. Less: Estimated balance of Federal. cash on hand as of beginning of advance period <br /> c. Amount re nested (Line a minus line 6) $ 44, 275.00 <br /> AUTHORIZED FOR LOCAL REPRODUCTION (Continued on Reverse) STANDARD FORM 270 tRev. 79~ <br /> Prescribed by OM6 Circulars A-102 and A-110 <br /> <br />