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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: <br />Project Number: 209 -3007 <br />,� WAPFA', <br />c��o <br />1 S <br />� AfFN g � <br />541- 682 -4841 <br />Project Name: Delta Ponds Habitat Restoration <br />Payment Request Number OR Final Request F <br />In accordance with the terms of the Grant Agreement, I request funds as follows: <br />Budget Category <br />g g rY <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 />g <br />Pre - Implementation <br />0.00 <br />0.00 <br />0.00 <br />In -House Personnel <br />12,200.00 <br />10,325.41 <br />1,873.87 <br />12,199.28 <br />0.72 <br />Contracted Services <br />178,868.99 <br />158,596.87 <br />20,272.84 <br />178,869.71 <br />(0.72) <br />Supplies /Materials <br />841.01 <br />841.01 <br />841.01 <br />0.00 <br />0.00 <br />0.00 <br />Fiscal Administration <br />12,458.00 <br />12,122.99 <br />335.01 <br />12,458.00 <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 />0.001 <br />0.00 <br />TOTALS 1 <br />204,368.001 <br />181,886.281 <br />22,481.721 <br />204,368.001 <br />0.00 <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. Grantee's signature on this form certifies that all funds being requested under the "Current Request <br />Amount" column are for project activities that either do not require permit(s) / license(s), or copies of required <br />permit(s)/ license(s) for project activities have been provided to the OWEB Project Manager. <br />Grantee's Authorized Signature: Date: 211�1(Z <br />Print Signature Name: Lacey Risdal Title: Finance Manager <br />Grantee Contact Phone Number for Billing Questions: 541 - 682 -4841 <br />Fax: (541) 68 2 -4882 <br />Grantee Contact E -mail Address: lacey.l.risdal @ci.eugene.or.us <br />Thi Request mu be forwar to the OWEB Project Manager for S ignature b <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 />October 10, 2011 pdf <br />