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Grant 341 - OWEB - Req #3 for reimbursement
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Grant 341 - OWEB - Req #3 for reimbursement
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Last modified
10/3/2011 7:36:33 AM
Creation date
10/3/2011 7:35:50 AM
Metadata
Fields
Template:
COE_Contracts
COE_Contract_Number
2009-05411
COE_Contract_Document_Type
AP/AR Invoices
COE_Contract_Status
Active
COE_Contract_Organization
OWEB
COE_Identification_Info
Grant 341 reimbursement #3
Department
Public Works
Contract_Administrator
Aanderud
Contract_Manager
Holts
Account_Code
341
External_View
No
Permanent_Retention
No
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OREGON WATERSHED ENHANCEMENT BOARD <br />REQUEST FOR RELEASE OF FUNDS <br />Grantee Name: City of Eugene <br />Grantee's Fiscal Agent: Lacey Risdal Phone: 541- 682 -4841 <br />j <br />• <br />Project Number: 209 -3007 Project Name: Delta Ponds Habitat Restoration <br />Payment Request Number 03 OR Final Request <br />In accordance with the terms of the Grant Agreement, I request funds as follows: <br />** Double click on the table to get into it and Single click below the table to get out of it ** <br />Budget Cat o <br />g A Category <br />(per Grant Agreement) <br />Current <br />Budget <br />Amount <br />Total of All <br />Amounts <br />Previously Paid <br />CURRENT <br />Request <br />Amount <br />TOTAL <br />Requested <br />to Date <br />Remaining <br />Budget <br />Pre-Implementation <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />In -House Personnel <br />$12,200.00 <br />$15,467.50 <br />- $5,142.09 <br />$10,325.41 <br />$1,874.59 <br />Contracted Services <br />$178,868.99 <br />$95,020.02 <br />$63,576.85 <br />$158,596.87 <br />$20,272.12 <br />Supplies/Materials <br />$841.01 <br />$841.01 <br />$0.00 <br />$841.01 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />Fiscal Administration <br />$12,458.00 <br />$0.00 <br />$12,122.99 <br />$12,122.99 <br />$335.01 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />TOTALS <br />$204,368.001 <br />$111,328.531 <br />$70,557.751 <br />$181,886.281 <br />$22,481.72 <br />Receipts /invoices and an expense tracking spreadsheet are required to document all funds previously received from <br />OWEB for this project within 120 days of the date of the check. <br />Signature on this form replaces the requirement of submitting letterhead as a receipt for (a) Fiscal Administration <br />and (b) Post - Implementation Status Reporting. All other OWEB receipt requirements remain in effect. <br />By signing this request, I declare that expenses for this project are to the best of my knowledge true, correct, and <br />complete. <br />Grantee's Authorized Signature Date: <br />Print Signature Name: Eric Wold <br />Grantee Contact Phone Number for Billing Questions: 54 1- 682 -4842 <br />Title: Nat Res Manager <br />Fax: 541- 682 -4882 <br />Grantee Contact E -mail Address: eric.n.wold6a_)d.eugene.or.us <br />This R eques t m ust be f orwa r ded to the OWEB P roject Manage for S below <br />I find this request to be consistent with the Grant Agreement and all funding conditions have been met. <br />OWEB Project Manager: Date: <br />July 01, 2009 A <br />
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