California Code of Regulations
Title 14 - Natural Resources
Division 8 - Environmental Affairs Agency
Chapter 1 - Final Application Procedures: Local Government Coastal Management Improvement Program
Exhibit 3 - Local Government Coastal Management Improvement Program (Sections 19006 and 19007)
Secretary of Environmental Affairs Local Government Coastal Management Improvement Program Financial Status Form
| Page 1 of 2 | ||||
| 1a. | Grantee Name and Address: | 2. | ___________________________Grant No. | |
| ___________________________ | ||||
| 3. | ___________________________Grant Period from _________________________ to | |||
| ___________________________ | ||||
| ___________________________ | ||||
| 4. | Type of Report: | |||
| ___________________________ | _______ Initial | |||
| 1b. | Contact Person: | _______ Quarterly | ||
| Name___________________________ | _______ Final | |||
| This quarter is quarter | ||||
| _________________________________________________________ of | ||||
| Phone No.___________________________ | from___________________________to _________________________ | |||
| 5. | Expenditure and Funding Statement | ||||||
| Expenditures: Line Item | Total Budget | This Quarter | To Date | Unliquidated Obligations | Unencumbered Balance | ||
| A. | Salaries and Wages | $__________ | $__________ | $__________ | $__________ | $__________ | |
| B. | Operating Expenses | __________ | __________ | __________ | __________ | __________ | |
| C. | Consulting Services | __________ | __________ | __________ | __________ | __________ | |
| D. | Construction Expenses | __________ | __________ | __________ | __________ | __________ | |
| E. | Fixed Assets | __________ | __________ | __________ | __________ | __________ | |
| Total Expenditure | $__________ | $__________ | $__________ | $__________ | |||
| 6. | Funding: | ||||||
| A. | Matching | $__________ | $__________ | $__________ | $__________ | $__________ | |
| B. | Other | __________ | __________ | __________ | __________ | __________ | |
| C. | Grant Funds | $__________ | $__________ | $__________ | $__________ | $__________ | |
| Total Funds | $__________ | $__________ | $__________ | $__________ | $__________ | ||
| 7. | Cash on Hand Status Statement | ||||||
| A. | Cash on hand at end of this quarter | $_______________ | |||||
| 8. | Interest Statement | ||||||
| A. | Interest earned on grant funds during this quarter | $__________ | |||||
| B. | Itemized expenditure of interest this quarter | $__________ | |||||
| Total of interest expended this quarter | $__________ | ||||||
| C. | Total interest earned to date | $__________ | |||||
| D. | Total interest expended to date | $__________ | |||||
| 9. | Funding Method (check one) _______ Advance _______ Reimbursement | ||||||
| 10. | Grant Funds Requested | $_______________ | |||||
| 11. | Comments: | ||||||
| 12. | Certification: | |||
| I certify to the best of my knowledge and belief, under penalty of perjury, that these reports are correct and complete and that all information provided is in accordance with the grant agreement. | ||||
| Grantee | ||||
| Signature: ___________________________ | Date: ___________________________ | |||
| Name and Title: ___________________________ | ||||
| (printed or typed) | ||||
| 13. | Grant Manager Approval: | |||
| ___________________________Signature: | ___________________________Date: | |||
| 14. | Chief, Office of Offshore Development Approval: | |||
| ___________________________Signature: | ___________________________Date: | |||
| 15. | Accounting Use Only: | |||
| SEA Retention: _____ % | $_______________ | |||
| Scheduled Amount: | $_______________ | |||
| Date: | _______________ | |||
1a Grantee Name and Address: Self explanatory.
1b Contact Person: Individual who can respond to questions regarding information contained in this report.
2 Grant No.: Assigned by the Secretary of Environmental Affairs upon approval of the Grant Application.
3 Grant Period: Calendar period for this grant.
4 Type of Report: The initial report will be used by a grantee requesting an advance prior to start up of the project. All other types of reports are self explanatory. Include the appropriate reporting period.
5 Expenditure and Funding Statement (Use whole dollars only)
Total Budget: This column must reflect the budget as shown in the Grant Agreement. Refer to the guidelines for instructions regarding budget revisions.
This Quarter: Appropriate expenditure totals for line items during the period of this report. A grantee using the advance payment method should include actual and anticipated expenditures. Anticipated expenditures should be detailed in the Comments section.
To Date: Appropriate cumulative expenditure totals for line items from the beginning of the project up to the ending date of this report period.
Unliquidated Obligations: All funds obligated on purchase orders, contracts, etc., but not expended.
Unencumbered Balance: All funds available for expenditure or obligation. (Total Budget less To Date and Unliquidated Obligations equals Unencumbered Balance.)
Expenditures:
5A Salaries and Wages: Salaries, retirement, workers compensation, employee benefits, group insurance, overtime, etc.
5B Operating Expenses: Communications, insurance, laboratory supplies, maintenance of equipment, structure, and grounds, memberships, office expenses, publications and legal notices, rents and leases, tools, travel, utilities, and any other expenses necessary for routine office operations.
5C Consulting Services: Contracts for outside services.
5D Construction Expenses: All costs for related construction activities.
5E Fixed Assets: Expenditures for assets exceeding $500 in value that have a useful life of more than one year.
6 Funding:
6A Matching Interest, and other funds: Each of these items will be identified on their respective line. District matching funds must total at least 20% of the total grant funds expended pursuant to Section 35042 of the Public Resources Code.
6B Other: Enter all funds accounted for in the project's total budget not identified as grant funds or matching funds.
6B Grant Funds: This is the amount requested from grant funds. This amount must be less than or equal to 80% of the expenditures pursuant to Section 35042 of the Public Resources Code.
7 Cash on Hand Status Statement:
7A Cash on hand at end of quarter. Enter the grant cash on hand at the end of quarter including funds on deposit, funds on hand, and undeposited checks/warrants.
8 Interest Statement:
8A Enter only the amount of interest earned from grant funds during this quarter.
8B Itemize all activities funded this quarter with interest earned this quarter or previous quarters.
8C Enter the total of all interest earned from grant funds up to end of this quarter.
8D Enter the total of all expenditures of interest earned from grant funds up to the end of this quarter.
9 Funding Method: Indicate the chosen method for funding. See guidelines for detailed description of the advance and reimbursement methods available to grantees.
10 Grant Funds Requested: Indicate the dollar amount requested for the subsequent current quarter.
11 Comments: Space to describe special circumstances and situations impacting this report. Attach addition sheets if necessary
12 Certification: Self explanatory.
13 Grant Manager Approval: Self explanatory.
14 Chief, Office of Offshore Development Approval: Self explanatory.
15 Accounting Use Only: Space used by the Secretary of Environmental Affairs' accounting services to indicate payment information.
1. New Exhibit 3 filed 7-22-86 as an emergency; effective upon filing (Register 86, No. 31). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-19-86.
2. Repealed by operation of Government Code Section 11346.1(g) (Register 87, No. 2).
3. New Exhibit 3 filed 1-8-87; effective upon filing pursuant to Government Code Section 11346.2(d) (Register 87, No. 2).
4. Change without regulatory effect filed 3-2-88 (Register 88, No. 11).
