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STATE OF NORTH CAROLINA <br /> DEPARTMENT OF PUBLIC SAFETY <br /> North Carolina Emergency Management <br /> N&3 Physical Address: 1636 Gold Star Drive, Raleigh,NC 27607-3371 &m S <br /> Mailing Address:4236 Mail Service Center,Raleigh, NC 27699-4236 <br /> COST REPORT 2 - FISCAL YEAR 2012 <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 _Please return this copy to <br /> Account No.: 1901-53690200012-1500801635HD Cle,k to the Board's office for PAF <br /> Grant Period: 10/01/11-09/30/13 <br /> Project: EMPG <br /> Grant File No: EMPG-2012-37135 Branch: Central <br /> Funding 2012 EMPG Universal Amount Optional Amount SATCOM Balance to be Paid <br /> Worksheet Final Amount (Previously Paid) Deductions <br /> Federal/State $49,869.88 $35,000.00 $14,877.88 $8.00 $14,869.88 <br /> Local Match $49,877.88 $35,000.00 $14,877.88 $0.00 $14,877.88 <br /> Total $99,747.76 $70,000.00 $29,755.76 $8.00 $29,747.76 <br /> This Final Cost Report reflects completed and approved Optional amounts by your Emergency Management program minus <br /> SATCOM Deductions to give a final Balance to be Paid amount. SATCOM Deductions are from January 1, 2011 to <br /> December 31, 2011 and reflect additional charges over the base amount per month. This Optional Amount can be used for <br /> enhancing your local emergency management program. <br /> This Cost Report require appropriate signatures and return to the state for payment. Payment will be made once all <br /> signatures have been completed and processed. This funding reimburses your county for eligible EMPG work. <br /> RECEIVED <br /> 4 4 i 1' <br /> Certification: NC IDPS CO GRAN T s,. <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 /> V041,� h All_� f 3-21.4-13 <br /> Orange C UNTY inance Offi r thorize ignature D <br /> 3 <br /> ORANGE CO Y EMERGENCY SER C Autho ' Signature` ate <br /> lo— 3 — /? <br /> North C ling Emergency Management Dep tor's A roval Signature Date <br /> /a_tA I n MCI_,.A)-) hJ)7_ -4�� 3 <br /> Department of Public Safety Controller's Office Approval Date <br /> Printed: 2/12/2013 8:00:37 AM 2012 Cost Report 2 <br />