Attachment 2

 

ROUGE RIVER NATIONAL WET WEATHER DEMONSTRATION PROJECT

REQUEST FOR REIMBURSEMENT OF GRANT FUNDS FOR CONSTRUCTION

PER INTER-AGENCY AGREEMENT WITH WAYNE COUNTY

 

Recipient Organization: _____________________

Period Covered by Request: from ____________ to ____________

Payment Request # : ____________

Column 1

Column 2
PROJECT COST COMPONENT

Amount Requested This Period

Amount Requested Cumulative to Date
A. Planning Cost
B. Design Engineering Cost
C. Bid Advertisement
D. Bond Advertisement/Referendum
E. Legal Costs (Contracted)
F. Legal Costs (Recipient's Staff)
G. Bond Consultant/Attorney
H. Administrative
I. Relocation Expenses
J. Land Acquisition
K. Land Purchase
L. Construction Engineering Costs
M. Construction Costs (Bid Contracts)
N. Construction Costs (Purchases<$50,000)
O. Construction Costs (Recipient's Staff)
P. Equipment Costs
Q. Capitalized Interest Costs
R. Project Cost for This Period (A to Q)
S. Total Project Cost from Last Period
T. Total Project Cost to Date
U. Federal Share of Amount on Line "T"
V. Local Share of Amount on Line "T"
W. Federal Payments Previously Requested
X. Federal Share Requested This Period

CERTIFICATION: I certify that to the best of my knowledge and belief, the data above is correct and that all outlays were made in accordance with the grant conditions or other agreements, and that payment is due and has not been previously requested. Also, having reviewed the certified payrolls submitted by the contractor, I find them to be in compliance with the requirements of the "Davis-Bacon Act".

Signature of Authorized Certifying Official: _______________________________________ Date____________

Name of Authorized Certifying Official: ______________________________________

ROUGE RIVER NATIONAL WET WEATHER DEMONSTRATION PROJECT

REQUEST FOR REIMBURSEMENT OF GRANT FUNDS FOR CONSTRUCTION

PER INTER-AGENCY AGREEMENT WITH WAYNE COUNTY

Recipient Organization: ____________________

Period Covered by Request: from ____________ to ____________

Payment Request # : ____________

Column 1

Column 2

Column 3

Column 4
PROJECT COST COMPONENT

Eligible Grant Cost Incurred This Period

SRF Loan Cost Incurred This Period

Ineligible Grant Cost Incurred This Period

Total
A. Municipal Revenue System Development
B. Design Engineering Cost
C. Bid Advertisement
D. Bond Advertisement/Referendum
E. Legal Costs (Contracted)
F. Legal Costs (Recipient's Staff)
G. Bond Consultant/Attorney
H. Administrative
I. Relocation Expenses
J. Land Acquisition
K. Land Purchase
L. Construction Engineering Costs
M. Construction Costs (Bid Contracts)
N. Construction Costs (Purchases<$50,000)
O. Construction Costs (Recipient's Staff)
P. Equipment Costs
Q. Capitalized Interest Costs
R. Project Cost for This Period
S. Total Project Cost From Last Period
T. Total Project Cost to Date
U. Federal Share of Amount on Line "T"
V. Local Share of Amount on Line "T"
W. Federal Payments Previously Requested
X. Federal Share Requested This Period

CERTIFICATION: I certify that to the best of my knowledge and belief, the data above is correct and that all outlays were made in accordance with the grant conditions or other agreements, and that payment is due and has not been previously requested. Also, having reviewed the certified payrolls submitted by the contractor, I find them to be in compliance with the requirements of the "Davis-Bacon Act".

Signature of Authorized Certifying Official: _______________________________________ Date____________

Name of Authorized Certifying Official: ___________________________________

ROUGE RIVER NATIONAL WET WEATHER

DEMONSTRATION PROJECT

MONTHLY PROGRESS REPORT

SUBGRANTEE: _________________________________________________

PERIOD OF: _________________________________________________

**This report is due on the 20th day of the month following the reporting period.**

I. FINANCIAL DATA

Cumulative Amount

% of Total

$ Budget

A. PROJECT BUDGET

B. CUMULATIVE PROJECT-TO DATE COSTS

1. Grant Share

2. Local Share

3. TOTAL CUMULATIVE COSTS

C. BALANCE REMAINING ON CONTRACT(S)

DATE SUBMITTED: _______________________

CONTACT PERSON: _________________________

ADDRESS: ___________________________________________________________________

TELEPHONE NUMBER: __________________________

SIGNED:______________________________________________________________________

Subgrantee's Representative

Rouge River National Wet Weather Demonstration Project
Community Watershed Project Monthly Progress Form
(Due to RPO by 20th of following month)

Progress as of: ____________
Month, Year

Community / Agency: _________________________________________________________________

Project Name: _________________________________________________________________

Summary Project Schedule Update

Task / Milestone

Planned
Start

Current
Start

Planned
Finish

Current
Finish
1 -        
2 -        
3 -        
4 -        
5 -        

Overall Project Start / Finish:

        

Monthly Milestones, Issues, or Obstacles

Please describe any items affecting project performance during the past month. Also note public involvement efforts and opportunities for Rouge River Project assistance, if applicable.

 

______________________________________ _______________
Authorized Community/Agency Representative Signature Date

 

______________________________________ _______________
Name of Representative Title

 

Please address all comments and suggestions about the contents of this Web page to rougeweb@co.wayne.mi.us.

The Rouge River National Wet Weather Demonstration Project is funded, in part, by the United States Environmental Protection Agency (EPA) Grants #XP995743-01, -02, -03, -04, -05, -06, -08 and C-264000-01.