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STATE OF NORTH CAROLINA <br /> ` DEPARTMENT OF PUBLIC SAFETY <br /> North Carolina Emergency Management <br /> Physical Address:1636 Gold Star Drive,Raleigh, NC 27607-3371 <br /> anj Mailing Address:4236 Mail Service Center,Raleigh,NC 27699-4236 <br /> COST REPORT 1 - FISCAL YEAR 2013 <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.: 1901-1500-801635HD-2013 <br /> Grant Period: 10/01/12-09/30/14 <br /> Project: EMPG <br /> Grant File No: EMPG-2013-37135 Branch: Central <br /> Funding 2013 EMPG Universal Amount Optional Amount SATCOM Balance to be Paid <br /> Worksheet Initial Amount (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 $0 <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 2013 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 activt to be assessed <br /> against your 2014 EMPG funds. R CEIVED <br /> JAN 2 4 2014 <br /> #VC CC'S CO GRANTS <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.A y4i <br /> qo--J-, ,Orange C T in e ice t rized r ture Da <br /> OKANKE C.0T%-f-Y'EMPrG1WCYSERV Au orized Signature t)ate <br /> te <br /> /-z -/ -J - 0 <br /> North �rola Emer e y Management s App al Signature Date <br /> r <br /> -19A <br /> Department of Public Safety ControllerS.Office Approval Date <br /> Printed: 9/6/2013 7:45:51 AM 2013 Cost Report 1 <br />