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STATE OF NORTH CAROLINA <br />DEPARTMENT OF. CRIME CONTROL AND PUBLIC SAFETY <br />Division of Emergency Management <br />•" Physical Address: 116 West Jones Street, Raleigh, NC 27603 -1135. <br />Mailing Address: 4713 Mail Service Center, Raleigh, NC 27699-4713 <br />"EM COST REPORT 1- FISCAL YEAR.2011 <br />EMERGENCY MANAGEMENT <br />PERFORMANCE GRANT <br />Grantee: ORANGE COUNTY EMERGENCY SERVICES <br />Address: 510 MEADOWLANDS DRIVE <br />HILLSBOROUGH NC 27278 - <br />Federal ID No.: 56- 6000327 -A <br />Account No.: 4701- 53692000011- 1510512 <br />Grant Period: 10/01/10 - 09/30/12 <br />Project: <br />Grant File No: <br />Funding <br />Local Match <br />EMPG <br />u,- Al • r`.Pntral <br />h1V1r%J- 6V11 -J11JJ <br />2011 EMPG <br />Initial Amount. <br />Universal Amount <br />(Base Amount) <br />Optional Amount <br />SATCOM <br />Deductions <br />Balance to be Paid <br />$35,000.00 <br />$35,000.00 <br />TBD <br />TBD <br />$ 0 <br />$35,000.00 <br />$35,000.00 <br />TBD <br />TBD <br />$ 0 <br />$70,000.00 <br />$70,000.00 <br />TBD <br />TBD <br />$ 0 <br />-J <br />This is the first of two Cost Reports. This Initial Cost Report reflects the Universal (Base) Amount that your county Is eligible to <br />receive provided all Univeral activities are completed, and documentation is approved by the State before the designated <br />deadline. This Cost Report require appropriate signatures and return to the state for payment of eligible EMPG work activities <br />completed to date. <br />The second Cost Report will reflect completed and approved Optional work activity amounts by your Emergency Management <br />program. SATCOM Deductions and a Balance to be Paid will also be reflected in Cost Report 2 to give you a total 2011 EMPG <br />Final Amount award for your county. <br />Please note that failure to complete any Universal activity will result in a 10% penalty per activity to be assessed <br />against your 2012 EMPG funds. <br />Certification: <br />I certify the above are correct, based on grantee's official accounting system and records, consistently applied and maintained, and that expenditures <br />shown have been made for the purpose of and in accordance with, applicable grant terms and conditions, and that appropriate documentation to support <br />these costs and expenditures is available or attached. <br />dalwu .- <br />Orange CQUNTY Financg <br />ORANGE <br />Authorized Signature <br />(0 -tq -l� <br />Date <br />Date <br />Division of Emergency Management Deputy Director's Approval Signature <br />Date <br />Department of Crime Control and Public Safety Controller's Office Approval <br />Date <br />2011 Cost Report <br />Printed: 8/4/2011 9:51:16 AM <br />