HomeMy WebLinkAboutEXHIBIT C VOUCHEREXHIBIT C - VOUCHER
To:From:
Attn:Contact:
Address:
Contract #
2022 Sidewalk infill improvements
*Request Period:
*NOTE: request period must be after notice to proceed date
□
1
Personnel Services: includes
Program related managers
and staff salaries, benefits
and taxes 116,827.00$ -$ -$ 116,827.00$
2
Office or Operating Supplies:
including office supplies,
program supplies and office
equipment -$ -$ -$ -$ -$
3
Administration: including:
advertising/marketing,
audit/accounting,
comunication, fees & taxes,
indirect administrative
expenses, insurance, legal
services, training, travel,
transportation,
printing/postage, other as
approved -$ -$ -$
4 Indirect Admin Expenses
(specify): 4,000.00$ -$ -$ -$ 4,000.00$
5 Real Property Acquisition
(document)-$ -$ -$ -$ -$
6 Consultant or Purchased
Services (submit
documentation)-$ -$ -$ -$ -$
7 Other Development Soft
Costs (submit receipts)-$ -$ -$ -$ -$
8 Construction Hard Costs
(submit reciepts)78,333.00$ -$ -$ -$ 78,333.00$
9 Equipment/Materials -$ -$ -$ -$
199,160.00$ -$ -$ -$ 199,160.00$
$0.00
*All revisions must receive CDBG approval
Voucher Reimbursement Request
Housing and Community Development Block Grant Program
Date:632130
Total This
Request
Total
Requested
to date
Award Balance
Remaining
Grand Total
I CERTIFY THAT THE ABOVE COSTS IN THE AMOUNT OF
Check here if this is a final reimbursement request.
Cost Categories Budget Award
Revised
Budget*
(if
applicable)
Total Prior
Requests
This voucher reimbursement is for activities/services rendered under the housing and community development block
Project Name:
Voucher #:
City of Bremerton
Community Development
CDBG Staff
345 6th Street, Suite 100345 6th Street, Ste 600
Bremerton WA 98337Bremerton, WA 98337-1873
2021 Subrecipient Agreement - PW/U Sidewalks and Curbramps
DocuSign Envelope ID: 8C172022-541E-4924-AA56-23EE3ABFEB73
Personnel Services: includes Program related
managers and staff salaries, benefits and taxes 135,962.00$
Indirect Admin Expenses (specify): 5,000.00$
Construction Hard Costs (submit reciepts)78,333.00$
total 219,295.00$
DocuSign Envelope ID: 8C172022-541E-4924-AA56-23EE3ABFEB73