Exh 8B Part 2AGENDA #8B
DECEMBER 11, 2000
ATTACHMENTS
Page 3
III. METHOD OF PAYMENT -
A. Reimbursement
Unless otherwise stated, all contract funds will be released on a reimbursement basis.
Cash request forms (Attachment B, Page 5) may be submitted monthly or more often,
as the need for reimbursement of funds arises. The'time period for the City to process
the cash request from submission of the request to availability of a check is ten to fifteen
working days.
B. Cash Advance
Requests for cash advances will be granted only for immediate rash needs (excluding
salaries) and only for two weeks in advance or to purchase an item or equipment more
than $500.
C. Required Documentation
Cash requests must be accompanied by receipts, canceled checks, invoices, written
bids, phone quotes and any other reasonable and legible dowments to support the
expenditure and amount of cash requested
Requests for reimbursement of wages, salaries and fringe benefits must include copies
of employee time sheets, demonstrating the number of hours worked per day and per
week. Each time it must be signed by the employees~and his or her supervisor. If a full-
time employee is paid partially with CDBG funds, a time distribution sheet reporting the
number of hours spent working on CDBG projects antl on other non-CDBG projects,
must be submitted. All requests for reimbursement of salary, wages and fringe benefits
must be accompanied by a copy of the paycheGc
Cash requests for reimbursement of mileage must be accompanied by a log that
ident~es the employee, "form" where he or she Uaveled, "to" location, "number of
miles", "odometer reading" and "purpose of trip". The mileage log must be signed by
the employee and his or her supervisor.
AGENDA #8B
DECEMBER 11, 2000
ATTACHMENT B
Page 4
D. Procurement
In addition to meeting the requirements of Article VIII of this contract, which outlines the
required procurement procedures and documentation for purchase from under $500 to
over $12,000, all purchases for items over $500 must receive prior approval from the
Community Development Division. ttems not specifically identified in this contract will
not be reimburse with CDBG funds.
.AGENDA #8B
DECEMBER 11, 2000
ATTACHMENTB
Page 5
CASH REQUEST FORM
CDBG
Name Citv of Atlantic Beach Request Number
Address 800 Seminole Road Contract Number
Atlantic Beach FL 322 ~ Phone Number (904) 247-5800
Tax ID No. 26-02-107391-54C Fax Number (9041 274-5 80 5
Date Submitted ,
1. Contract funds received to date $
2. Contract fiords disbursed to date $
4. Conmct funds previously requested
but not yet received. $
4. Amount of this request $
All contract funds must be disbursed within three days of receipt..If line 2 does not equal line I,
please explain.
Atlantic Beach DCDC (1025)
Requested Tlris
Line Item Budeet To Date Request Balance
I.Al. Wages & Salazies $ 1 428.26 _ $ $ $
Totals $ 1.428.26 _ $ $ $
COMMENTS
Bank Account#
I certify that the data above is correct and the amount of the cash requested does not
exceed current needs.
Signed Date
AGENDA #8B
DECEMBER 11, 2444
ATTACHMENT B
Page 8
GASH REQUEST FORM
CDBG
Name Citv of Atlantic Beach Request Number
Address 800 Seminole Road Contract Number
Atlantic Beach. FL 322 Phone Number 1904) 247-5800
Sax ID No. 26-02-107391-54C Fax Number (9041274-5805
Date Submitted
I. Contract funds received to date $
2. Contract funds disbursed to daze $
5. Contract funds previously requested
but not yet received. $
4. Amount of this request $
All cpmsact funds must be disbursed within three days of receipt. if line 2 does not equal line 1,
please explain.
Atlantic Beach 'R'acer/Sewer (1054)
Requested This
ine Item Budeet To Date Recuest Balance
LB. ]. Contract Services $ 137.25 $ $ $
Totals $ 137.25 _ $ $ $
Bank Account#
I certify thatthe data above is correct and the amount of the cash requested does not
exceed current needs.
Title
AGENDA #8B
DECEMBER 11, 2000
ATTACHMENT B
Page 7
CASH REQUEST FORM
COBG
Name Citv of Atlantic Beach Request Number
Address 800 Seminole Road Contract Number
Atlantic Beach. FL 322 . Phone Number (9041247-5800
Tax ID No. 26-02-107391-54C Fax Number (9041 274-5 8 0 5
Date Submitted
1. Contract funds received to date $
2. Contract funds disbursed to date $
6. Contras funds previously requested
but not yet received. $
4. Amount ofthisrequest $
All contras funds must be disbursed within three days of receipt. L: tine 2 does not equal line I,
please explain.
Atlantic Beach Donner RevitOization (1055)
-Requested This
Line Item Budes To Date Re ue Balance
LB.1. Contras Services $ 64.902 Ol $ $ $
Totals $ 64,702.01 $ $ ~ $
Bank Account#
I certify that the data above is correct and the amount of the cash requested does not
exceed current needs.
Signed _
Title
AGENDA #SB
DECEMBER il, 2000
ATTACHMENTB
Page 8
CASH REQUEST FORM
CDBG
Name Citv of Atlantic Beach Request Number
Address 800 Seminole Road Contract Number
Atlantic Beach. FL 322 Phone Number (90412475800
Tax ID No. 26-02-107391-54C Fax Number (9041 274-5805
Date Submitted
1. Contract funds received to date $
2. Contract funds disbursed to date $
7. Contras[funds previously requested
but not yet received. $
' 4. Amount of this request ~ $
All contract funds must be disbursed within three days of receipt. If line 2 does not equal line I,
please explain.
Atlantic Beach `R'ater/Sewer (1226)
Requested This
Line Item Bud et To Date Recuest glance
LB.1. Contract Services $ 5.149.10 $ $ $
Totals $ 5.149.10 _ $ $ $
Bank Account#
I certify that the data above is correct and the amount of the cash requested does not
exceed current needs.
AGENDA #8B
DECEMBER 11, 2000
ATTACHMENTS
Page 9
CASH REQUEST FORM
CDBG
Name City of Atlantic Beach Request Number
Address 800 Seminole Road ~ Contract Number
Atlantic Beach FL 322 Phone Number (9041247-5800
Tax ID No. 26-02-107391-64C Fax Number (904) 274-5805
Date Submitted
L Contract funds received to date $
2: Contract funds disbursed to date $
8. Contract funds previously requested
but not yet received. $
4. Amount of this request $
All contract funds must be disbursed within tlu'ee days of receipt. If line 2 does not equal line I,
please explain.
Atlantic Beach DCDC (1227)
Requested This
Line Item Budeet To Date Request Balance
I.Al. Wages and Salazies $ 14.964.76 $ $ $
Totals $ 14,964.76 $ $ $
COMMENTS
Bank Account#
I certify that the data above is correct and the amount of the cash requested does not
exceed current needs.
Signed _ Date
AGENDA #86 '~
DECEMBER 11, 2000
ATTACHMENT B
Page 10
CASH REQUEST FORM
CDBG
Name Citv of Atlantic Beach Request Number
Address 800 Seminole Road Contract Number
Atlantic Beach. FL 322 Phone Number (9041247-5600
Tax ID No. 26-02-107391-54C Fax Number (9041274-5805
Date Submitted
1. Contract funds received to date $
2. Contract funds disbursedto date $
9. Contract funds previously requested
but not yet received. $
4. Amount of this request $
Alt contract funds must be disbursed within three days of receipt. If line 2 does not equal line 1,
please explain.
Atlantic Beach Donner Revitilization (1229)
Requested This
Line Item Budeet To Date Request Balance
LB.1. Contract Services $ 50.020.24 $ $ $
Totals $ 50,020.24 $ $ $
Bank ~ Account#
I certify that the data above is correct and the amount of the cash requested does not
exceed current needs.
Title
AGENDA #8B
DECEMBER 11, 2000
ATTACHMENTB
Page 11
CASH REQUEST FORM
CDBG
Name Citv of Atlantic Beach Request Number
Address 800 Seminole Road Contract Number
Atlantic Seach. FL 322 Phone Number (904) 2475800
Tax ID No. 26-02-107391-S4C Fax Number !4041274-5805
Date Submitted
I. Comma funds received to date $
2. Contract funds disbursed to date $
10. Contract funds previously requested
but not ya received. $
4. Amount of this request -$
All contract funds must be disbursed within twee days of receipt. If line 2 does not equal line 1,
please explain.
Utility Tap-in Program (1853)
Requested This
Line Item Budeet To Date Re ues Balance
LB.I. Contract Services $ 13.000.00 $ $ $
Totals $ 13,000.00 $ $ $
COMMENTS
I certify that the data above is correct and the amount of the cash requested does not
exceed wrcentneeds.
Date
AGENDA #8B
DECEMBER I1, 2000
ATTACHMENT B
Page 12
CASH REQUEST FORM
CDBG
Name Citv of AOarrtic Beach Request Number
Address 800 Seminole Road Contract Number
Atlantic Beach. FL 322 Phone Number (9041247-5800
Tax ID No. 26-02-107391-54C Pax Number !9041274-5801
Date Submitted
1. Contract funds received to date $
2. Contract funds disbursed to date $
ll. Comract funds previously requested
but not yet received.. $
4. Amount of this request $
fill contract funds must be disbursed within three days of receipt. If line 2 does not equal ]ine 1,
please explain.
Atlautic Beach Recreation/Office Mgr. (1854)
Requested This
ine Ttem Budeet To Date R ue la ce
I.B.1. Contract Services $ 25.000.00 $ $ $
Totals $ 25,000.00 $ $ $
Bank Adcount#
I certify that the data above is corcect and I:he amount of the cash requested does not
exceed current needs.
Signed Date
AGENDA #8B
DECEMBER 11, 2000
ATTACHMENTS
Page 13
CASH REQUEST FORM
CDBG
Name Citv of Atlantic Beach Request Number
Address 800 Seminole Road Contract Number
Atlantic Beach. FL 322 Phone Number (904) 247-5800
Tax ID~ No. 26-02-107391-54C Fax Number (9041 274-5805
Date Submitted
1. Contract funds received to date $
2. Contract funds disbursed to date $
12. Contract funds previously requested
but not yet received. $
4. AmoutA of this request $
All contract funds must be disbursed within three days of receipt. If line 2 does not equal line 1,
please explain.
Atlanfic Beach Downer Revitalization (1855)
Requested This
Line tem Bud et To Date Request alance
LB.1. Contract Services $ 66 517.00 $ $ $
Totals $ 66,517.tD0 $ $ $
COMMENTS
Bank Account#
I certify that the data above is correct and the amount of the cash requested does not
exceed current needs.
AGENDA#8B
DECEMBER 11, 2000
CASH REQUEST FORM
CDBG
ATTACHMENT B
Page 14
Name Citv of Atlantic Beach Request Number
Address 600 Seminole Road Contract Number
Atlantic Beacfi. FL 322 Phone Number 19041247-St300
Tax lD No. 26-02-107391-64C Fax Number !904).274-5805
Date Submitted
I. Contract funds received to date $
2. Contract funds disbwsedto date $
13. Contract funds previously requested
but not yet received. $
4. Amount of this request $
Al] wntract funds must be disbursed within three days of receipt. If tine 2 does not equal line I,
please explain.
Atlantic Beach Rater/Sewer (1856)
Requested This
Line Item Bud¢et To Date Request
I.B.I. Contract Services $ 47.000.00 $ $
Totals $ 47,000.00 $ $
alance
Bank Acccunt#
I certify that the data above is corcect and the amount of the cash requested does not
exceed current needs.
Signed Date
Ti0e
AGENDA #SB
DECEMBER 11, 2000
ATTACHMENTC
Page 1
1
MONTHLY STATUS REPORT
T0: COMMUNITY DEVELOPMENT DIVISION CONTRACT NO.
12B E. FORSYTH STREET, STE. 600 REPORT N0.
RECIPIENT:
PROJECT:
REPORT PERIOD: to_ Date Submitted
PERSON FILLING OUT REPORT:
PROGRESS REPORT: Describe progress to date on:
A Funding a licensed part-time Rehabilitation Inspector to coordinate and ensure
proper rehabilitation of selected homes.
B. Rehabilitation of a minimum of ~ homes of income-eligible, owner occupied
residents in the Donner Redevelopment area.
Provide Direct Beneficiary Information as Indicated Below for:
Number of HouseholdslPersons Directly Assisted
No. of Low and Low White not Black not Am. Hispanic PsiaN Female
Hsltls/ Motl Income Hispanic Hispanic Indian/ Pacifle Heeded ~ ~I
Persons Income Origin Origin Alaskan Islander Hshlds
Assistetl Native
C. Providing a Recreation Coordinator for Donner Park. Providing organized
recreational program for 30 to 60 low and moderate income persons in the area served
by the park. Providing statistical information on number of unduplicated persons
served.
Provide Direct Beneficiary Information as Indicated Below for:
Number of HouseholdspPersons Directly Assisted
No. of Low and Low While not Black not Am. Hispanic AsiaN Female
Hslds! Mod Income Hispanic Hispanic Indian/ Pacific Headed
Persons Income Origin Origin Alaskan Islander Hshlds
Assisted Native
AGENDA #SB
DECEMBER 11, 2000
ATTACHMENT C
Page 2
D. Providing funds for Utility Tap-In Program.
E. Installation of sewer main on Ardetla Road.
Providing aself-evaluation tool with quantitative and qualitative measurements.
Include copies of meeting notes, brochures, programs, promotional materials or other
information pertinent to the contract.
AGENDA #8B
DECEMBER 11, 2000
ATTACHMENT C
Page 3
HOW FUNDS WERE SPEND:
A copy of al4 canceled checks and bank statements during that report period must be
attached to the monthly report to verify the payment of previously submitted invoices
and billings. Account for all checks, including any voided checks.
SUPPLEMENTARY SUPPORT:
Please describe matching and in-kind contributions received during this report period:
ADDITIONAL COMMENTS:
I certify that to the best of my knowledge the data reported is correct.