**NOAA REIMBURSABLE AGREEMENT COVER SHEET**

**Incoming Funds**

+-----------------------+---+---------------------+---+-------------------+
| **NOAA Line Office    |   |                     |   |                   |
| and Program Office    |   |                     |   |                   |
| Name:**               |   |                     |   |                   |
+-----------------------+---+---------------------+---+-------------------+
| **NOAA Agreement      |   |                     |   | **OGC Folder      |
| Number:**             |   |                     |   | No.:**            |
+-----------------------+---+---------------------+---+-------------------+
| **Customer Name:**    |   |                     |   |                   |
+-----------------------+---+---------------------+---+-------------------+
| **Customer Agreement  |   |                     |   |                   |
| Number:**             |   |                     |   |                   |
+-----------------------+---+---------------------+---+-------------------+
| **Legal Authority:**  |   |                     |   |                   |
|                       |   |                     |   |                   |
| Economy Act:          |   |                     |   |                   |
|                       |   |                     |   |                   |
| Other (Specify):      |   |                     |   |                   |
|                       |   |                     |   |                   |
| **Programmatic        |   |                     |   |                   |
| Authority**:          |   |                     |   |                   |
+-----------------------+---+---------------------+---+-------------------+
| **Project Code:**     |   | **Project Title:**  |   |                   |
+-----------------------+---+---------------------+---+-------------------+
| **Purpose of          |   |                     |   |                   |
| Agreement:**          |   |                     |   |                   |
+-----------------------+---+---------------------+---+-------------------+
| **Agreement Amount:** | * |                     | * |                   |
|                       | * |                     | * |                   |
|                       | A |                     | D |                   |
|                       | g |                     | a |                   |
|                       | r |                     | t |                   |
|                       | e |                     | e |                   |
|                       | e |                     | S |                   |
|                       | m |                     | u |                   |
|                       | e |                     | b |                   |
|                       | n |                     | m |                   |
|                       | t |                     | i |                   |
|                       | P |                     | t |                   |
|                       | e |                     | t |                   |
|                       | r |                     | e |                   |
|                       | i |                     | d |                   |
|                       | o |                     | f |                   |
|                       | d |                     | o |                   |
|                       | o |                     | r |                   |
|                       | f |                     | A |                   |
|                       | P |                     | p |                   |
|                       | e |                     | p |                   |
|                       | r |                     | r |                   |
|                       | f |                     | o |                   |
|                       | o |                     | v |                   |
|                       | r |                     | a |                   |
|                       | m |                     | l |                   |
|                       | a |                     | : |                   |
|                       | n |                     | * |                   |
|                       | c |                     | * |                   |
|                       | e |                     |   |                   |
|                       | : |                     |   |                   |
|                       | * |                     |   |                   |
|                       | * |                     |   |                   |
|                       |   |                     |   |                   |
|                       | S |                     |   |                   |
|                       | t |                     |   |                   |
|                       | a |                     |   |                   |
|                       | r |                     |   |                   |
|                       | t |                     |   |                   |
|                       | : |                     |   |                   |
|                       |   |                     |   |                   |
|                       | E |                     |   |                   |
|                       | n |                     |   |                   |
|                       | d |                     |   |                   |
|                       | : |                     |   |                   |
+-----------------------+---+---------------------+---+-------------------+
| **Funding Amount:**   | * |                     |   |                   |
|                       | * |                     |   |                   |
|                       | F |                     |   |                   |
|                       | u |                     |   |                   |
|                       | n |                     |   |                   |
|                       | d |                     |   |                   |
|                       | i |                     |   |                   |
|                       | n |                     |   |                   |
|                       | g |                     |   |                   |
|                       | P |                     |   |                   |
|                       | e |                     |   |                   |
|                       | r |                     |   |                   |
|                       | i |                     |   |                   |
|                       | o |                     |   |                   |
|                       | d |                     |   |                   |
|                       | : |                     |   |                   |
|                       | * |                     |   |                   |
|                       | * |                     |   |                   |
|                       |   |                     |   |                   |
|                       | S |                     |   |                   |
|                       | t |                     |   |                   |
|                       | a |                     |   |                   |
|                       | r |                     |   |                   |
|                       | t |                     |   |                   |
|                       | : |                     |   |                   |
|                       |   |                     |   |                   |
|                       | E |                     |   |                   |
|                       | n |                     |   |                   |
|                       | d |                     |   |                   |
|                       | : |                     |   |                   |
+-----------------------+---+---------------------+---+-------------------+
| **Type of Trading     | * |                     | * |                   |
| Partner:**            | * |                     | * |                   |
|                       | N |                     | C |                   |
| Federal:              | O |                     | u |                   |
|                       | A |                     | s |                   |
| State/Local:          | A |                     | t |                   |
|                       | I |                     | o |                   |
| University/College:   | n |                     | m |                   |
|                       | f |                     | e |                   |
| Non-Profit:           | o |                     | r |                   |
|                       | r |                     | I |                   |
| Commercial Entity:    | m |                     | n |                   |
|                       | a |                     | f |                   |
| Foreign Commercial:   | t |                     | o |                   |
|                       | i |                     | r |                   |
| Foreign Government:   | o |                     | m |                   |
|                       | n |                     | a |                   |
| Other DOC Bureau:     | : |                     | t |                   |
|                       | * |                     | i |                   |
| Other:                | * |                     | o |                   |
|                       |   |                     | n |                   |
|                       | T |                     | : |                   |
|                       | r |                     | * |                   |
|                       | e |                     | * |                   |
|                       | a |                     |   |                   |
|                       | s |                     | T |                   |
|                       | u |                     | r |                   |
|                       | r |                     | e |                   |
|                       | y |                     | a |                   |
|                       | S |                     | s |                   |
|                       | y |                     | u |                   |
|                       | m |                     | r |                   |
|                       | b |                     | y |                   |
|                       | . |                     | S |                   |
|                       | : |                     | y |                   |
|                       | 1 |                     | m |                   |
|                       | 3 |                     | b |                   |
|                       | x |                     | . |                   |
|                       | 1 |                     | : |                   |
|                       | 4 |                     |   |                   |
|                       | 5 |                     | A |                   |
|                       | 0 |                     | c |                   |
|                       |   |                     | c |                   |
|                       | C |                     | o |                   |
|                       | B |                     | u |                   |
|                       | S |                     | n |                   |
|                       | A |                     | t |                   |
|                       | C |                     | i |                   |
|                       | C |                     | n |                   |
|                       | S |                     | g |                   |
|                       | : |                     | C |                   |
|                       |   |                     | o |                   |
|                       | D |                     | d |                   |
|                       | U |                     | e |                   |
|                       | N |                     | : |                   |
|                       | S |                     |   |                   |
|                       | / |                     | D |                   |
|                       | B |                     | a |                   |
|                       | P |                     | t |                   |
|                       | N |                     | e |                   |
|                       | : |                     | F |                   |
|                       | 1 |                     | u |                   |
|                       | 5 |                     | n |                   |
|                       | 6 |                     | d |                   |
|                       | 1 |                     | s |                   |
|                       | 4 |                     | E |                   |
|                       | 0 |                     | x |                   |
|                       | 2 |                     | p |                   |
|                       | 0 |                     | . |                   |
|                       | 9 |                     | : |                   |
|                       |   |                     |   |                   |
|                       | E |                     | D |                   |
|                       | I |                     | U |                   |
|                       | N |                     | N |                   |
|                       | : |                     | S |                   |
|                       | 0 |                     | / |                   |
|                       | 6 |                     | B |                   |
|                       | 1 |                     | P |                   |
|                       | 8 |                     | N |                   |
|                       | 3 |                     | : |                   |
|                       | 4 |                     |   |                   |
|                       | 8 |                     | E |                   |
|                       | 7 |                     | I |                   |
|                       | 5 |                     | N |                   |
|                       |   |                     | : |                   |
|                       | A |                     |   |                   |
|                       | L |                     | A |                   |
|                       | C |                     | L |                   |
|                       | : |                     | C |                   |
|                       | 1 |                     | : |                   |
|                       | 3 |                     |   |                   |
|                       | - |                     | O |                   |
|                       | 1 |                     | M |                   |
|                       | 4 |                     | B |                   |
|                       | - |                     | M |                   |
|                       | 0 |                     | a |                   |
|                       | 0 |                     | x |                   |
|                       | 0 |                     | C |                   |
|                       | 1 |                     | o |                   |
|                       |   |                     | d |                   |
|                       | O |                     | e |                   |
|                       | M |                     | : |                   |
|                       | B |                     |   |                   |
|                       | M |                     | B |                   |
|                       | a |                     | E |                   |
|                       | x |                     | T |                   |
|                       | C |                     | C |                   |
|                       | o |                     | : |                   |
|                       | d |                     | D |                   |
|                       | e |                     | I |                   |
|                       | : |                     | S |                   |
|                       | 0 |                     | B |                   |
|                       | 0 |                     |   |                   |
|                       | 6 |                     |   |                   |
|                       | - |                     |   |                   |
|                       | 4 |                     |   |                   |
|                       | 8 |                     |   |                   |
|                       |   |                     |   |                   |
|                       | B |                     |   |                   |
|                       | E |                     |   |                   |
|                       | T |                     |   |                   |
|                       | C |                     |   |                   |
|                       | : |                     |   |                   |
|                       | C |                     |   |                   |
|                       | O |                     |   |                   |
|                       | L |                     |   |                   |
|                       | L |                     |   |                   |
+-----------------------+---+---------------------+---+-------------------+
| **Customer Billing    | * |                     | * |                   |
| Contact:**            | * |                     | * |                   |
|                       | C |                     | N |                   |
| Name:                 | u |                     | O |                   |
|                       | s |                     | A |                   |
| Address:              | t |                     | A |                   |
|                       | o |                     | L |                   |
| City/State/Zip:       | m |                     | i |                   |
|                       | e |                     | n |                   |
| Phone:                | r |                     | e |                   |
|                       | A |                     | O |                   |
| Fax:                  | d |                     | f |                   |
|                       | m |                     | f |                   |
| Email:                | i |                     | i |                   |
|                       | n |                     | c |                   |
|                       | . |                     | e |                   |
|                       | C |                     | C |                   |
|                       | o |                     | o |                   |
|                       | n |                     | n |                   |
|                       | t |                     | t |                   |
|                       | a |                     | a |                   |
|                       | c |                     | c |                   |
|                       | t |                     | t |                   |
|                       | : |                     | : |                   |
|                       | * |                     | * |                   |
|                       | * |                     | * |                   |
|                       |   |                     |   |                   |
|                       | N |                     | N |                   |
|                       | a |                     | a |                   |
|                       | m |                     | m |                   |
|                       | e |                     | e |                   |
|                       | : |                     | : |                   |
|                       |   |                     |   |                   |
|                       | A |                     | A |                   |
|                       | d |                     | d |                   |
|                       | d |                     | d |                   |
|                       | r |                     | r |                   |
|                       | e |                     | e |                   |
|                       | s |                     | s |                   |
|                       | s |                     | s |                   |
|                       | : |                     | : |                   |
|                       |   |                     |   |                   |
|                       | C |                     | C |                   |
|                       | i |                     | i |                   |
|                       | t |                     | t |                   |
|                       | y |                     | y |                   |
|                       | / |                     | / |                   |
|                       | S |                     | S |                   |
|                       | t |                     | t |                   |
|                       | a |                     | a |                   |
|                       | t |                     | t |                   |
|                       | e |                     | e |                   |
|                       | / |                     | / |                   |
|                       | Z |                     | Z |                   |
|                       | i |                     | i |                   |
|                       | p |                     | p |                   |
|                       | : |                     | : |                   |
|                       |   |                     |   |                   |
|                       | P |                     | P |                   |
|                       | h |                     | h |                   |
|                       | o |                     | o |                   |
|                       | n |                     | n |                   |
|                       | e |                     | e |                   |
|                       | : |                     | : |                   |
|                       |   |                     |   |                   |
|                       | F |                     | F |                   |
|                       | a |                     | a |                   |
|                       | x |                     | x |                   |
|                       | : |                     | : |                   |
|                       |   |                     |   |                   |
|                       | E |                     | E |                   |
|                       | m |                     | m |                   |
|                       | a |                     | a |                   |
|                       | i |                     | i |                   |
|                       | l |                     | l |                   |
|                       | : |                     | : |                   |
+-----------------------+---+---------------------+---+-------------------+
| **Billing Schedule:** |   |                     |   |                   |
|                       |   |                     |   |                   |
| Advance (Describe if  |   |                     |   |                   |
| other than full):     |   |                     |   |                   |
|                       |   |                     |   |                   |
| Quarterly             |   |                     |   |                   |
| (Non-advance):        |   |                     |   |                   |
|                       |   |                     |   |                   |
| Other (Describe):     |   |                     |   |                   |
+-----------------------+---+---------------------+---+-------------------+

> Last Updated on 3/14/2008