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EXAMPLE OF COST REPORT <br /> 14 STATE STATE OF NORTH CAROUNA <br /> `Id -,a,rzarn, DEPARTMENT OF CRIME CONTROL AND PUBLIC SAFETY <br /> ray Homeland Security <br /> r 4713 Mail Service Center <br /> Raleigh,NC 27603 <br /> QUAM COST REPORT <br /> HOMELAND SECURITY <br /> Vendor: NCEM-OPERATIONS EMERGENCY SV CFDA: 97.074 <br /> Contact Steve Sloan <br /> Address: 4713 Mail Service Center <br /> Raleigh,NC 27699-4713 Request# <br /> Vendor Nbr/Fed ID Nbr. 56600000408 <br /> Account Nbr. 4701-53692010307-1520-030-H1-511 Fund Code: 1520 <br /> OSA Contract Number: RCC: 030 <br /> Grant Period: 7/1/2008-12/30/2010 Grant Identifier. H1 <br /> MOA Nbr. 2007-GET-70048-5006 Project Code: 511 <br /> Remarks: . <br /> Budget Worksheet TRAINING Total <br /> Budget Amounts: 0.00 0.00 0.00 0.00 0.00 <br /> Prior Expenditures: 0.00 0.00 0.00 0.00 0.00 <br /> Current Balance: 0.00 0.00 0.00 0.00 0.00 <br /> Expended this <br /> period: <br /> Balance Remaining: <br /> Funding Worksheet Amount Pmts to Date Balance %Funding Reimbursement New Balance <br /> Federal J "1 100% <br /> State 0.00 0.00 0.00 0% <br /> Match 0.00 0100 0.00 0% <br /> Subtotal 100% <br /> Fed Admin 0.00 0.00 0. 0% <br /> Total - <br /> Certification <br /> I certify the above are correct,based on subgrantees 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 /> r <br /> I <br /> NCEM-OPERATIONS EMERGENCY SVC Authorized Signature Date <br /> Homeland Security Approval Signature Date <br /> Controller's Office Approval Date <br /> e <br /> Printed 10/22/2010 8:30:54 AM Vendor ID: 1231 <br /> Page 12 of 13 <br />