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<br /> 13. CERTIFICATION ) ~ u
<br /> SIGNATURE OF AUTHORIZED CERTIFYING ~ DATE REQUEST
<br /> I certify that to the best of my knowledge SUBMITTED
<br /> and belief the data on the reverse are ~J//V'"_7 December 15, 2008
<br /> correct and that all outlays were made in Y
<br /> accordance with the grant conditions or TYPED OR PRINTED NAME AND TITLE TELEPHONE (AREA CODE,
<br /> other agreement and that payment is due
<br /> and has not been previously requested. NUMBER, EXTENSION)
<br /> Trevor Taylor, Natural Area Restoration Supervisor 541.682.4888
<br /> This space for agency use
<br /> Public reporting burden for this collection of information is estimated to average 60 minutes
<br /> per response, including time for reviewing instructions, searching existing data sources,
<br /> gathering and maintaining the data needed, and completing and reviewing the collection of
<br /> information. Send comments regarding the burden estimate or any other aspect of this
<br /> collection of information, including suggestions for reducing the burden to the Office of
<br /> Management and Budget, Paper Reduction Project (0348-0004), Washington DC 20503.
<br /> PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND
<br /> BUDGET, SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
<br /> INSTRUCTIONS
<br /> Please type or print legibly. Items 1, 3, 5, 9, 10, 11 e, 11f, 11 g, 11 i, 12 and 13 are self-explanatory; specific instructions for other items are as follows:
<br />
<br /> . Item Entry Item Entry
<br /> 2 Indicate whether request is prepared on cash or accrued programs, functions, or activities should be shown in the "total'
<br /> expenditure basis. All requests for advances shall be prepared column on the first page.
<br /> on a cash basis.
<br /> 4 Enter the Federal grant number, or other identifying number 11a Enter in "as of date," the month, day and year of the ending of the
<br /> assigned by the Federal sponsoring agency. If the advance or accounting period to which this amount applies. Enter program
<br /> reimbursement is for more than one grant or other agreement, outlays to date (net of refunds, rebates, and discourits), in the
<br /> insert N/A; then, show the aggregate amounts. On a separate appropriate columns. For requests prepared on a cash basis,
<br /> sheet, list each grantor agreement number and the Federal. outlays are the sum of actual cash disbursements for goods and
<br /> share of outlays made against the grant or agreement. services, the amount of indirect expenses charged, the value of in-
<br /> 6 Enter the employer identification number assigned by the U.S. kind contributions applied, and the amount of cash advances and
<br /> Internal Revenue Service, or the FICE (institution) code if payments made to subcontractors and subrecipients. For
<br /> requested by the Federal agency. ~ requests prepared on an accrued expenditure basis, outlays are
<br /> the sum of the actual cash disbursements, the amount of indirect
<br /> 7 This space is reserved for an acwunt number or other expenses incurred, and the net increase (or decrease) in the
<br /> identifying number that may be assigned by the recipient. amounts owed by the recipient for goods and other property
<br /> 8 Enter the month, day, and year for the beginning and ending of received and for services performed by employees, contracts,
<br /> the period covered in this request. If the request is for an subgrantees and other payees.
<br /> advance or for both an advanced and reimbursement, show the
<br /> period that the advance will cover. If the request is for
<br /> reimbursement, show the period for which the reimbursement ,
<br /> covers.
<br /> Not The Federal sponsoring agencies have the option of requiring 11 b Enter the cumulative cash income received to date, if requests are
<br /> e: recipients to complete items 11 or 12, but not both. Item 12 prepared on a cash basis. For requests prepared on an accrued
<br /> should be used when only a minimum amount of information is expenditure basis, enter the cumulative income earned to date.
<br /> needed to make an advance and outlay information contained Under either basis, enter only the amount applicable to program
<br /> in item 11 can be obtained in a timely manner from other income that was required to be used for the project or program by
<br /> reports. the terms of the grant or other agreement.
<br /> 11 .The purpose of the vertical columns (a), (b), and (c), is to 11d Only when making request for advance payments, enter the total
<br /> provide space for separate cost breakdowns when a project has estimated amount of cash outlays that will be made during the
<br /> been planned and budgeted by program, function, or activity. If period covered by the advance.
<br /> additional columns are needed, use as many additional forms
<br /> as needed and indicate page number in space provided in
<br /> -upper right; however, the summary totals of all
<br /> 13 Complete the certifcation before submitting this request.
<br /> STANDARD FORM 270 (Rev. 7-97) Back
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