HomeMy Public PortalAboutRequest for Reimbursement OMB Number:4040-0012
Expiration Date:02/28/2022
a. X"one or both boxes 2.BASIS OF REQUEST
1 ❑ADVANCE F CASH
REQUEST FOR ADVANCE TYPE OF ® REIMBURSEMENT ®ACCRUAL
PAYMENT
OR REIMBURSEMENT REQUESTED b. JC"the applicable box
FINAL
® PARTIAL
3.FEDERAL SPONSORING AGENCY AND ORGANIZATIONAL 4.FEDERAL GRANT OR OTHER IDENTIFYING NUMBER
ELEMENT TO WHICH THIS REPORT IS SUBMITTED ASSIGNED BY FEDERAL AGENCY
Federal Aviation Administration- Helena ADO 3-16-0023-028-2020
5.PARTIAL PAYMENT REQUEST 6.EMPLOYER IDENTIFICATION 7.FINANCIAL ASSISTANCE
NUMBER FOR THIS REQUEST NUMBER IDENTIFICATION NUMBER
9 1 82-6000022 1889226110000
8. PERIOD COVERED BY THIS REQUEST
From: 04/30/2020 To. 09/30/2020
9.RECIPIENT ORGANIZATION
Name: City of McCall
Streetl: 216E Park Street
Street2:
City: McCall
County: Valley
State: I D: Idaho
Province:
Country: USA: UNITED STATES
ZIP/Postal Code: 83638
10.PAYEE (Where check is to be sent if different than item 9)
Name:
Streetl:
Street2:
City:
County:
State:
Province:
Country:
ZIP/Postal Code:
11. COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED
PROGRAMS/FUNCTIONS/ (a) (b) (c)
ACTIVITIES
TOTAL
a.Total program (As of date)
outlays to date 09/30/2020 $ 168,386.19 $ $ $ 168,386.19
b.Less: Cumulative program
income
c.Net program outlays (Linea minus line b) 16a,386.19 168,386.19
d.Estimated net cash outlays for
advance period
e.Total (Sum of lines c&d) 168,386.19 168,386.19
f.Non-Federal share of amount
on line e ° 00 0.00
g.Federal share of amount on
line a 168,386.19 168,386.19
h.Federal payments previously
requested 139,301.19 139,301.19
i. Federal share now requested 29,oas.o0 29,oes.°°
(Line g minus line h)
j. Advances required 1st month
by month,when
requested by Federal
grantor agency for 2nd month
use in making
prescheduled 3rd month
advances
12. ALTERNATE COMPUTATION FOR ADVANCES ONLY
a.Estimated Federal cash outlays that will be made during period covered by the advance $
b.Less: Estimated balance of Federal cash on hand as of beginning of advance period
c.Amount requested(Line a minus fine b) $
13. CERTIFICATION
I certify that to the best of my knowledge and belief the data on the reverse are correct and that all outlays were made in accordance with the grant
conditions or other agreement and that payment is due and has not been previously requested.
SIGNATURE OR AUTHORIZED CERTIFYING OFFICIAL DATE REQUEST SUBMITTED
TYPED OR PRINTED NAME AND TITLE
Prefix: First Name: Robert Middle Name:
Last Name: Gi1es Suffix:
Title: Mayor
TELEPHONE(AREA CODE,NUMBER,EXTENSION)
208-634-7142
This space for agency use
Public reporting burden for this collection of information is estimated to average 60 minutes per response,including time for reviewing instructions,
searching existing data sources,gathering and maintaining the data needed,and completing and reviewing the collection of information.Send
comments regarding the burden estimate or any other aspect of this collection of information,including suggestions for reducing this burden,to the
Office of Management and Budget,Paperwork Reduction Project(0348-0004),Washington,DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.SEND IT TO THE ADDRESS
PROVIDED BY THE SPONSORING AGENCY.
Federal Financial Report OMB Number:4040-0014
(Follow form Instructions) Expiration Date:02/28/2022
1.Federal Agency and Organizational Element to Which Report is Submitted 2.Federal Grant or Other Identifying Number Assigned by Federal
Agency(To report multiple grants,use FFR Attachment)
Federal Aviation Administration- Helena ADO
3-16-0023-028-2020
3.Recipient Organization(Name and complete address including Zip code)
Recipient Organization Name: city of McCall
Streetl: 216 E. Park Street
Streetl:
City: McCall County: Valley
State: I D: Idaho Province:
Country: USA: UNITED STATES ZIP/Postal Code: 83638
4a.DUNS Number 4b.EIN 5.Recipient Account Number or Identifying Number
To report multiple grants,use FFR Attachment)
1889226110000 82-6000022
6.Report Type 7.Basis of Accounting 8.Project/Grant Period 9.Reporting Period End Date
Quarterly FI Cash From: To: 09/30/2020
Semi-Annual ® Accrual 04/30/2020 09/30/2020
®Annual
Final
10.Transactions Cumulative
(Use lines a-c for single or multiple grant reporting)
Federal Cash(To report multiple grants,also use FFR attachment):
a.Cash Receipts 0.00
b.Cash Disbursements F 0.0 0
c.Cash on Hand(line a minus b) 0.00
(Use lines d-o for single grant reporting)
Federal Expenditures and Unobligated Balance:
d.Total Federal funds authorized 363,299.70
e.Federal share of expenditures 168,386.19
f. Federal share of unliquidated obligations 0.00
g.Total Federal share(sum of lines a and f) 168,38 6.19
h.Unobligated balance of Federal Funds(line d minus g) 194,913.51
Recipient Share:
i.Total recipient share required 0.0
j.Recipient share of expenditures 0.00
k.Remaining recipient share to be provided(line i minus j) 0.00
Program Income:
I.Total Federal program income earned 0.00
m.Program Income expended in accordance with the deduction alternative 0.00
n.Program Income expended in accordance with the addition alternative 0.00
o.Unexpended program income(line I minus line m and line n) 0.00
11.Indirect Expense
a.Type b.Rate c.Period From Period To d.Base e.Amount f.Federal Share
Charged
g.Totals:
12. Remarks:Attach any explanations deemed necessary or information required by Federal sponsoring agency in compliance with governing legislation:
Add Attachment DE,, 'z Atta ment View Attachment
13.Certification: By signing this report,1 certify to the best of my knowledge and belief that the report is true, complete,and accurate,and the
expenditures,disbursements and cash receipts are for the purposes and objectives set forth in the terms and conditions of the Federal award.I
am aware that any false,fictitious, or fraudulent information,or the omission of any material fact, may subject me to criminal,civil or
administrative penalties for fraud,false statements,false claims or otherwise.(U.S.Code Title 18,Section 1001 and Title 31, Sections 3729-3730
and 3801-3812).
a.Name and Title of Authorized Certifying Official
Prefix: 1First Name: Robert Middle Name:
Last Name: Giles Suffix:
Title: Mayor
b.Signature of Authorized Certifying Official c.Telephone(Area code,number and extension)
208-634-7142
d.Email Address e.Date Report Submitted
P 14.Agency use only:
. . . . .
Standard Form 425