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)

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
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:
_______________
Instructions for the Financial Status Report
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).