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EXAMPLE OF COST REPORT <br /> s4& STATE OF NORTH CAROLINA <br /> oxy 20.IgjJr DEPARTMENT OF CRIME CONTROL AND PUBLIC SAFETY <br /> Homeland Security <br /> 4713 Mail Service Center <br /> Raleigh,NC 27603 <br /> 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. <br /> Account Nbr: 470l.-53692010307-1520-030-Hl-61 1 Fund Code: 1520 <br /> OSA Contract Number: RCC: 030 <br /> Grant Period: 7/1/2008-12130/2010 Grant Identifier: HI <br /> MOA Nbr: 2007-GET-70048-6006 <br /> Protect Code: 511 <br /> Remarks: <br /> Budget Worksheet TRAINING - Total <br /> Budget Amounts: <br /> V 0.00 0.00 0.00 0.00 0.00 <br /> A.— <br /> Prior Expenditures: 0.00 0.00 0.00 0.00 0.00, <br /> Current Balance: <br /> 0.00 0.00 0.00 0.00 0.00 <br /> Expended this <br /> period: <br /> Balance Remaining: <br /> Funding Worksheet Amount Prints to Date Balance %Funding Reimbursement New Balance <br /> Federal J 9 100% <br /> State 0.00 0100 0.00 0% <br /> Match 0.00 0.00 0.00 0%- <br /> 4 <br /> Subtotal <br /> 100% <br /> Fed Admin 0.01 — 0.00 —0.07, 0% <br /> Total <br /> Certification <br /> I certify the above are correct,based on subgrentees 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 /> NCEM-OPERATIONS EMERGENCY SVC Authorized Signature Date <br /> Homeland Security Approval Signature Date <br /> Controller's Office Approval Date <br /> Printed 11012=010 8:30:54 AM Vendor ID: 1231 <br /> Page 10 of 12 <br />