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Please return this COPY to the Clerk's to the Board's <br /> STATE OF NORTH CAR—office for permanent agenda file. r <br /> DEPARTMENT OF PUBLI#1 <br /> Division of Emergency Management 14:2 <br /> Physical Address:1636 Gold Star Drive,Raleigh,NC 27607-3371 <br /> Mailing Address:4236 Mail Service Center,Raleigh,NC 27699-4236 <br /> COST REPORT 1 - FISCAL YEAR 2012 <br /> EMERGENCY MANAGEMENT <br /> PERFORMANCE GRANT <br /> Grantee: ORANGE COUNTY EMERGENCY SERVICES <br /> Address: 510 MEADOWLANDS DRIVE 1901-53690200012-1500-8016-351-11) <br /> HILLSBOROUGH NC 27278- <br /> Federal ID No.: 56-6000327-A <br /> Account No.: 1901-1500-801631111-2012 <br /> Grant Period: 10/01/11 -09/30/13 <br /> Project: EMPG <br /> Grant File No: EMPG-2012-37135 Branch: Central <br /> Funding 2012 EWG Universal Amount Optional Amount SATCOM Balance to be Paid <br /> Worksheet IftliddAmouritt (Base Amount} Deductions <br /> Federal/State $35,000.00 $35,000.00 TBD TBD $0 <br /> Local Match $35,000.00 $35,000.00 TBD TBD $0 <br /> !Total $70,000.00 $70,000.00 TBD TBD so <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 2012 EMPG <br /> Final Amount award for your county. <br /> Please note that failure to complete any Universal activity will result in a 14%penalty per activity to be assessed <br /> against your 2013 EMPG funds. <br /> RECEivED <br /> OCT 18 2012 <br /> NC DPS Accounting <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 /> Or e CO Finance 0 cer o e Signature Date <br /> ORANGE'CnLINTY EMERGNCY S VICES AuqVrizzed Signature Date <br /> IL1:2 O 42, <br /> '-7rsDivisi Emergency Magement Deputy Direc A*proval Sknature Date <br /> rfl..,A'. anI nez:i/nh / - <br /> Department of Crime Control and Public Safe Controller's Office Approval Date <br /> Printed: 6/29/2012 8:09:28 AM 2012 Cost Report 1 <br />