Item O6 06
BOARD OF COUNTY COMMISSIONERS
COUNTY of MONROE �� i Mayor Holly Merrill Raschein,District 5
The Florida Keys Mayor Pro Tern James K.Scholl,District 3
Craig Cates,District 1
Michelle Lincoln,District 2
' David Rice,District 4
Board of County Commissioners Meeting
September 11, 2024
Agenda Item Number: 06
2023-2958
BULK ITEM: Yes DEPARTMENT: Sustainability
TIME APPROXIMATE: STAFF CONTACT: Rhonda Haag
N/A
AGENDA ITEM WORDING: SUSTAINABILITY: Approval of Modification#3 to Federal
Emergency Management Agency(FEMA) Hazard Mitigation Grant Program(HMGP) subgrant
agreement H0856 with Florida Division of Emergency Management to develop Watershed Management
Plans for Monroe County, Layton, Key Colony Beach and Marathon to provide a 6-month extension to
March 31, 2025.
ITEM BACKGROUND:
This item is to authorize a 6 month no cost time extension under modification# 3 to subgrant
agreement H0856 from Federal Emergency Management Agency (FEMA)under the Hazard Mitigation
Grant Program(HMGP)passed through the Florida Division of Emergency Management (FDEM), to
develop Watershed Management Plans for Layton, Key Colony Beach and Marathon and Monroe
County.
The FDEM Watershed Planning Initiative is funded through a grant under the Hazard Mitigation Grant
Program (HMGP), as approved by FDEM and FEMA, with the purpose of creating standardized, cost-
effective, and easily replicable Watershed Master Plans (WMP) throughout the State of Florida. The
Watershed Planning Initiative was created to ensure Florida communities progress to better Community
Rating System(CRS) Class rankings, which in turn would reduce flood insurance costs for Florida
residents and enhance mitigation practices in communities vulnerable to flood risk exposure.
PREVIOUS RELEVANT BOCC ACTION:
10/19/22: Approval of a Federal Emergency Management Agency(FEMA) Hazard Mitigation Grant
Program (HMGP) grant award of $120,843.75 passed through as a sub-recipient agreement with the
Florida Division of Emergency Management to update the County Watershed Management Plan,plus a
$40,281.25 match provided by Resilient Florida Vulnerability Assessment grant 22PLN66, for a total
project value of$161,125.
05/17/23: Approval of Modification# 1 to Federal Emergency Management Agency(FEMA) Hazard
Mitigation Grant Program(HMGP) subgrant agreement H0856 with Florida Division of Emergency
Management to develop Watershed Management Plans for Layton, Key Colony Beach and Marathon,
increasing federal funding by $399,506.25 and bringing the total grant amount to $693,800. The 25%
match will be provided by Resilient Florida Vulnerability Assessment grants 22PLN65 (Marathon) and
23PLN97 (Layton/Key Colony Beach). No County funds are expended for this work.
07/19/23: SUSTAINABILITY: Approval of Modification# 2 to Federal Emergency Management
Agency (FEMA) Hazard Mitigation Grant Program (HMGP) subgrant agreement H0856 with Florida
Division of Emergency Management to develop Watershed Management Plans for Layton, Key Colony
Beach and Marathon to provide a one-year extension to September 30, 2024.
INSURANCE REQUIRED:
No
CONTRACT/AGREEMENT CHANGES:
6 month time extension to March 31, 2025
STAFF RECOMMENDATION: Approval.
DOCUMENTATION:
FDEM Grant#DR-4337-004-P- Modification#3 (8-26-24) JXD Stamped Signed.pdf
FINANCIAL IMPACT:
Effective Date: Upon execution Expiration Date: March 31, 2025
$ Value of Amendment#3: $0
$ Value of Amendment#2: $0
$ Value of Amendment#1: $532,675
$ Value of original GRANT: $161,125
TOTAL $ Value of Revised Grant: $693,800
Total Cost to County: $0 Current Year Portion: N/A
Budgeted: N/A
Source of Funds: N/A for this no cost time extension amendment
CPI: No
Indirect Costs:
Estimated Ongoing Costs Not Included in above dollar amounts: None
Revenue Producing: No If yes, amount:
Grant: Yes Match: N/A for this amendment
Insurance Required: No
Additional Details:
SUB-RECIPIENT AGREEMENT CHECKLIST
DIVISION OF EMERGENCY MANAGEMENT
MITIGATION BUREAU
FISCAL OPERATIONS UNIT
HMGP
REQUEST FOR REVIEW AND APPROVAL
SUB-RECIPIENT: Monroe County
PROJECT#: 4337-004-Pb
PROJECT TITLE: Monroe County Watershed Management Plan Update
CONTRACT#: H0856
MODIFICATION#: 3
SUB RECIPIENT REPRESENTATIVE POINT OF CONTACT
Rhonda Haag
Chief Resilience Officer
1100 Simonton Street
Key West, Florida 33040
Enclosed is your copy of the proposed contract/modification between Monroe County and the
Florida Division of Emergency Management (FDEM).
COMPLETE
❑ This form is required to be included with all Reviews, Approvals, and Submittals
❑ Reviewed and Approved
❑ Signed & Dated Electronic Copy by Official Representative
❑ Copy of the organization's resolution or charter that specifically identifies the
person or position that is authorized to sign, if not Chairman, Mayor, or Chief
❑ Attachment I - Federal Funding Accountability and Transparency Act (FFATA) -
completed, signed, and dated
® N/A for Modifications or State Funded Agreements
❑ Attachment K—Certification Regarding Lobbying - completed, signed, and dated
® N/A for Modifications or State Funded Agreements
® Attachment L—Contracts with Non-Profit Organizations -completed, signed, and
dated
❑ Electronic Submittal to the Grant Specialist
If you have any questions regarding this contract, or who is authorized to sign it, please contact
your Project Manager at (850) 328-5736 or email me at Caitlyn.Stroik@em.myflorida.com.
Contract Number: H0856
Project Number: 4337-004-Pb
MODIFICATION TO SUBGRANT AGREEMENT BETWEEN
THE DIVISION OF EMERGENCY MANAGEMENT AND
MONROE COUNTY
This Modification Number Three made and entered into by and between the State of Florida,
Division of Emergency Management ("the Division"), and Monroe County ("the Sub-Recipient")to modify
Contract Number H0856, dated, December 8, 2022 ("the Agreement").
WHEREAS, the Division and the Sub-Recipient have entered into the Agreement, pursuant to
which the Division has provided a subgrant to the Sub-Recipient under the Hazard Mitigation Grant
Program of$520,350.00, in Federal Funds; and
WHEREAS, the Division and the Sub-Recipient intend to modify the Agreement; and
WHEREAS, the Agreement expired on September 30, 2024; and
WHEREAS, the Division and the Sub-Recipient intend to reinstate and extend the terms of the
Agreement.
NOW, THEREFORE, in consideration of the mutual promises of the parties contained herein, the
parties agree as follows:
1. The Agreement is hereby reinstated and extended as though it had never expired.
2. Paragraph 8 of the Agreement is hereby amended to read as follows:
(8) PERIOD OF AGREEMENT
This Agreement shall begin December 8, 2022 and shall end March 31, 2025, unless
terminated earlier in accordance with the provisions of Paragraph (17)of this Agreement.
3. The Budget and Scope of Work, Attachment A to the Agreement, are hereby modified as set forth
in 3rd Revision Attachment A to this Modification, a copy of which is attached hereto and
incorporated herein by reference.
4. All provisions of the Agreement being modified and any attachments in conflict with this
Modification shall be and are hereby changed to conform with this Modification, effective on the
date of execution of this Modification by both parties.
5. All provisions not in conflict with this Modification remain in full force and effect, and are to be
performed at the level specified in the Agreement.
6. Quarterly Reports are due to the Division no later than 15 days after the end of each quarter of
the program year and shall be sent each quarter until submission of the administrative close-out
report. The ending dates for each quarter of the program year are March 31, June 30,
September 30 and December 31.
7. Attachment L- Florida Accountability Contract Tracking System (FACTS) Requirements for Non-
profit Organizations Under Section 216.1366, Florida Statutes, Instructions and Worksheet is
hereby incorporated into the Agreement and is required to be completed by the subrecipient and
returned the Division.
IN WITNESS WHEREOF, the parties hereto have executed this Modification as of the dates set
out below.
SUB-RECIPIENT: MONROE COUNTY
IYGC NROE COUNTY ATTORNEYS S OWFNCE
APPROVED AS TO FORM
sr rT v NTY A'"0 Mk
Name and Title: NEy
DATiE: 8/2 6/2 024 ..,_
Date:
STATE OF FLORIDA
DIVISION OF EMERGENCY MANAGEMENT
By:
Name and Title: Kevin Guthrie, Director
Date:
Attachment A
Watershed Master Planning Initiative
Monroe County Watershed Management Plan Update
Scope of Work and Budget
Statement of Purpose
The Florida Division of Emergency Management's (the Division) Bureau of Mitigation prioritizes flood risk
management as an integral part of its mission. The goals of this project are to assist local communities in
developing a Watershed Master Plan for the purposes of moving up in the Community Rating System(CRS)
of the National Flood Insurance Program (NFIP)and to increase resiliency in Florida communities.
This project is funded through the Hazard Mitigation Grant Program(HMGP)DR-4337-004-P, as approved
by the Division and the Federal Emergency Management Agency(FEMA)to create and update Watershed
Master Plans (WMPs)throughout the state of Florida.
The Project Manager for the Division will be:
Laura Dhuwe, Project Manager
Hazard Mitigation Grant Program
Florida Division of Emergency Management
850-879-0872
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Scope of Work
The Division will coordinate with eligible Florida entities to produce a Watershed Master Plan (WMP) for
credit under CRS. This project is preceded by the WMP Pilot Program, which consisted of research and
the creation of guidance materials to ensure a consistent statewide approach to WMP development.
Guidance materials produced in the WMP Pilot Program can be found at:
/7 U�...s..:..//www,Hoirirad.sas.toir,:.oi ./.....�.......erT.........mit....i ation/watoirshe .......................................i...in0initiative or
................................................................................................................... ................ ............... ................. ............................................................................................. .......................................................
/7 t 2.J/uwuwuw,fau ,edu�/oin iinooiriin /iroso it l/7/ uwir / log.Liin I/7cr�so/. The Sub-Recipient may use other
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materials provided by ISO and located at �I:tt, .;//F .�!.g.,:.gr!v. The Sub-Recipient shall follow the Credit
Criteria for Element WMP under CRS Activity 452.b (please refer to the 2017 CRS Coordinator's Manual'
and the 2021 Addendum to the Coordinator's Manual2). The Sub-Recipient will finalize the process by
submitting their WMP to ISO/CRS for review and providing the Division with a signed letter from their
applicable county's Local Mitigation Strategy(LMS)Chairperson attesting that the WMP will be adopted in
the Sub-Recipient's next LMS update.
Monroe County will be responsible for all tasks and deliverables for Monroe County, City of Key Colony
Beach, City of Marathon and City of Layton.
Tasks necessary to the completion of a WMP include:
Task 1 —Create Preliminary Project Plan based on Initial Flood Modeling, and Submit Draft WMP
The Sub-Recipient shall create a preliminary Project Plan,which is a narrative detailing how the initial flood
modeling has sufficient detail on the data that went into the model, model specifications, and possible
1 https://www.fema.gov/sites/default/files/documents/fema_community-rating-system_coordinators-
manual_2017.pdf
2 https://www.fema.gov/sites/default/files/documents/fema_community-rating-system_coordinator-
manual_addendum-2021.pdf
solutions for addressing flood risks that the model identified. There must be enough detail in the preliminary
Project Plan to verify the required analysis has been completed. Specifically, the required analysis for the
preliminary Project Plan shall include all the Minimum Criteria required for a creditable WMP3 under the two
categories of Data Inventory and Collection and Initial Flood Modeling as follows:
Data Inventory and Collection:
1. Data inventory(used for initial flood modeling):
a. Inventory of ground characteristics (e.g., soil type, impervious surfaces, wetlands)
b. Inventory of existing drainage system
c. Inventory of data availability
2. Locations of:
a. critical facilities, cultural/historical, and other places/areas of interest
b. vulnerable areas and their descriptions
c. natural and constructed drainage systems and channels
3. Existing regulations and plans in place for reducing flood risks
Initial Flood Modeling
4. For current/existing conditions land use, future land use, and the fully developed watershed
scenarios:
a. Evaluations of the existing drainage system's runoff response from design storms using a
hydrologic and hydraulic study with a hydrograph approach under current and predicted
future land use conditions with assessments of the impacts of climate change and sea level
rise for 10-, 25- & 100-year storm events
b. For currently fully developed watersheds:studies of existing development and the potential
impact of any redevelopment
c. Evaluations of different management scenarios for at least the 100-year rainfall event for
a fully developed watershed at a scale sufficient to determine local problems.
d. Determinations of the change in runoff from current to future, fully developed conditions
e. Recommendations for managing at least the 10-year and the 25-year rainfall events
5. For communities impacted by sea level rise: evaluations of the impacts of the NOAA Intermediate
2100 sea level rise scenario on the 100-year rainfall event
a. It is highly recommended to include 2 other scenarios up to 2100, which could be based
on sea level for 2 time frames into the future or a number of feet of sea level rise within this
timeframe.
6. The plan must include a strategy and action plan to address the results of the studies for:
3 See 2017 CRS Coordinator's Manual at
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............................................................................................g.........................................................................................................................................................................................................................................................................................................Y.................................g.............Y.......................................................................................................................
m anL..a.�.....201...7.f.qf; the 2021 Addendum to the Coordinator's Manual at
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.........................................................................................g.........................................................................................................................................................................................................................................................................................................Y.................................g.............Y................................................................................................................
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a. controlling the timing of peak flows to prevent or minimize problems for the entire
watershed due to new development, redevelopment, and fully developed conditions
b. the impact of climate change and sea level rise on fully developed conditions
c. at least the 25-year rainfall event in fully developed conditions, with a list of possible
solutions for addressing at least the 25-year rainfall event
d. at least one event larger than the 25-year rainfall event, with a list of possible solutions for
addressing this event
e. ensuring that flood hazards from the 10-year and the 25-year events are not increased by
future development (the 2-year storm is also recommended).
7. The community must adopt the final plan.
8. If applicable, WMP plans more than 5 years old must be evaluated to ensure that they remain
applicable to current conditions. For instance, are previous assumptions on hydrology, sea level
rise and future land use still applicable.
Deliverable 1: An (1) electronic copy of the preliminary Project Plan; (2) a separate electronic document
listing how and where in the preliminary Project Plan the Minimum Criteria listed above are met; and (3) a
separate electronic document clarifying the Sub-Recipient's existing data inventory at the time of contract
execution, how the data are used, and which tasks and efforts have already been completed prior to
contract execution. These three electronic documents must be submitted to the Division for review no later
than 24 months after the beginning of the Period of Performance. The Sub-Recipient will provide
Deliverable 1 to the Division via email to ateir lhedji„Ig..D..„iing'),er rn flo ir��c. orn.
Payment for Task 1 will occur once the Sub-Recipient has received feedback from the Division confirming
that their preliminary Project Plan has been approved. To be approved, the preliminary Project Plan must
show how all the listed Minimum Criteria required for a creditable WMP are intended to be met.
The Period of Performance begins with the date of execution of the subgrant agreement by both parties,
and the Sub-Recipient shall provide the Division with the following no later than 24 months from the
beginning of the Period of Performance before payment will be processed.
Jurisdiction Specific Comments for Task 1:
Task 1.1: Data collection for structures — Monroe County, City of Key Colony Beach, City of Marathon
and City of Layton shall provide a list of critical assets, including regionally significant, to be evaluated for
potential impacts by flooding and sea level rise including (but not limited to) transportation assets and
evacuation routes; critical infrastructure; critical community and emergency facilities; and natural, cultural,
and historical resources.
Additionally, Monroe County, City of Key Colony Beach, City of Marathon and City of Layton shall include
an individualized assessment with updated structures from the 2019 Watershed Management Plan, and
any additional field work and analysis stemming from the Countywide Roads and Stormwater Assessment
(2022). Monroe County shall also provide an inventory and description of their drainage system.
Tasks 1.2 and 1.3: Preliminary Flood Modeling and Project Plan — In addition to the above Minimum
Criteria, Monroe County, City of Key Colony Beach, City of Marathon and City Layton shall align the Project
Plan modeling effort with Section 380.093, F.S., and the approach for this assessment will include:
1) mapping potential high tide flooding, future regular tidal inundation from sea level rise and
2) mapping potential storm surge events to project multiple sea-level-adjusted designed storm events (at a
minimum, the 100-year event).
Additionally, Monroe County, City of Key Colony Beach, City of Marathon and City of Layton will clarify in
writing which tasks and efforts have already been completed prior to contract execution. With the mapping
efforts, Monroe County, City of Key Colony Beach, City of Marathon and City of Layton shall provide the
source and dates of data acquisition, locational accuracy, and map projection and coordinate system
information of geospatial data.
Task 2— Revise Draft WMP and Submit Completed WMP
After receiving feedback from the Division on the preliminary Project Plan from Task 1 (Deliverable 1), the
Sub-Recipient shall finalize the flood modeling process and submit their completed WMP. At a minimum,
the modeling and WMP must meet the Minimum Criteria required for a creditable WMP shown above. The
Sub-Recipient shall update their WMP, if revisions are necessary based on the Division's feedback, and
submit the completed WMP to the Division for review.
Throughout the activities for Task 2, the Sub-Recipient shall coordinate with the applicable LMS working
group to ensure that the working group will adopt the WMP as an annex in the next LMS update, and use
the data to inform the risk assessment and mitigation strategy.
Deliverable 2: An electronic copy of the completed WMP will be submitted to the Division no later than 27
months after the beginning of the Period of Performance. If applicable, the Sub-Recipient will revise the
submitted WMP to comply with required revisions and feedback from the Division, and then resubmit the
WMP to the Division no later than 27 months after the beginning of the Period of Performance.
The Period of Performance begins with the date of execution of the subgrant agreement by both parties,
and the Sub-Recipient shall provide the Division with the following no later than 27 months from the
beginning of the Period of Performance before payment will be processed:
1. the completed WMP4 (after incorporating comments from the Division, if applicable); and
2. a signed letter from the applicable county's Local Mitigation Strategy (LMS) Chairperson attesting
that the completed WMP will be adopted and used to update the risk assessment and mitigation
strategy during the next LMS plan update.
The Sub-Recipient will provide Deliverable 2 to the Division via email to
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Method of Compensation:
All deliverables submitted to the Project Manager or to the Division shall be completed by the Sub-Recipient
and approved for completeness and accuracy by the Project Manager or the Division to qualify as reaching
the minimum required criteria for each invoice period.
All tasks shall be performed under the direct supervision of the Division.
The project shall be reimbursed upon receipt of invoices submitted at the completion and acceptance of
each deliverable defined above unless this agreement is terminated early. This is a cost reimbursement
agreement, which will be reimbursed on a fixed-fee, fixed-price agreement as follows:
Deliverables
4 See the Minimum Criteria required for a creditable WMP listed above.
Task 1: Task 2:
Create Preliminary Project Revise Draft
Plan based on Initial Flood WMP and
Modeling and Submit Draft Submit
WMP Completed
Due: WMP
20 months after POP date Due:
24 months after Total
POP date Deliverable
Deliverables Value
Monroe County $46,750.00 $114,375.00 $161,125.00
City of Key Colony Beach $47,500.00 $94,125.00 $141,625.00
City of Marathon $137,800.00 $111,625.00 $249,425.00
City of Layton $47,500.00 $94,125.00 $141,625.00
Totals: $279,550.00 $414,250.00 $693,800.00
Financial Consequences for Non-Performance:
The failure to provide the Division with the required deliverables within the stated timelines shall result in a
penalty of 5 % of the determined deliverable amount for each late deliverable. Penalty may be waived
based upon reasonable explanation with documentation by Sub-Recipient.
Should the Sub-Recipient determine that there are significant barriers to conduct any of the minimum
deliverables due to extenuating circumstances, the Division may re-evaluate performance expectations
upon a formal request from the Sub-Recipient.
If the Sub-Recipient fails to comply with any terms of the agreement, the Division shall take one or more of
the following actions:
1. Temporarily withhold cash payments pending correction of the deficiency by the Sub-Recipient;
2. Disallow all or part of the cost of the activity or action not in compliance;
3. Wholly or partially suspend or terminate the current agreement for the Sub-Recipient's project;
4. Withhold further agreements for the project; or
5. Take other actions that are legally allowed.
Schedule of Work
Task(s) Number of Months
to Complete
Field work and data collection for structures (Task 1) 7
Initial Flood Modeling (Task 1) 10
Preliminary Project Plan (Task 1) 7
Revise Draft WMP and Submit Completed WMP & CRS Plan (Task 2) 3
Total Period of Performance: 27
Total Period of Performance
The Period of Performance for this project begins on the date of execution of the subgrant
agreement by both parties and ends no later than March 31, 2025.
Budget:
Cost Item Project Cost Federal Share Non-Federal Share
Personnel
Fringe Benefits
Travel
Equipment
Supplies
Contractual $693,800.00 $520,350.00 $173,450.00
Other
Project Total: $693,800.00 $520,350.00 $173,450.00
Fundinq Summary Totals
Federal Share Non-Federal Total Project
Cost Item 75% Share 25% Cost
Monroe County $120,843.75 $40,281.25 $161,125.00
City of Key Colony Beach $106,218.75 $35,406.25 $141,625.00
City of Marathon $187,068.75 $62,356.25 $249,425.00
City of Layton $106,218.75 $35,406.25 $141,625.00
Totals: $520,350.00 $173,450.00
Attachment L
Florida Accountability Contract Tracking System (FACTS)
Requirements for Non-profit Organizations Under Section 216.1366, Florida Statutes
Instructions and Worksheet
PURPOSE: Section 215.985, Florida Statutes (F.S.), amended in 2023, requires that each contract
for which a state entity makes a payment pursuant to a contract executed, amended, or extended on
or after July 1, 2023, the Division shall post any documents submitted pursuant to s. 216.1366, F.S.,
which indicates the use of state funds as remuneration under the contract or a specified payment
associated with the contract on the contract tracking system.
CONTRACT DOCUMENTATION REQUIREMENTS
Section 216.1366, F.S., amended in 2023, establishes new documentation requirements for any
contract for services executed, amended, or extended on or after July 1, 2023, with non-profit
organizations as defined in s. 215.97 (2)(m). F.S. The contract must require the contractor to provide
documentation that indicates the amount of state funds:
• Allocated to be used during the full term of the contract for remuneration to any member of
the board of directors or an officer of the contractor.
• Allocated under each payment by the public agency to be used for remuneration of any
member of the board of directors or an officer of the contractor. The documentation must
indicate the amounts and recipients of the remuneration.
Such information must be included in the contract tracking system maintained pursuant to s. 215.985
F.S. and must be posted on the contractor's website if the contractor maintains a website.
• As used in this subsection, the term:
o "Officer" means a Chief Executive Officer(CEO), Chief Financial Officer(CFO), Chief Operating
Officer (COO), or any other position performing an equivalent function.
o "Remuneration" means all compensation earned by or awarded to personnel, whether paid or
accrued, regardless of contingency, including bonuses, accrued paid time off, severance payments,
incentive payments, contributions to a retirement plan, or in-kind payments, reimbursements, or
allowances for moving expenses, vehicles and other transportation, telephone services, medical
services, housing, and meals.
o "State funds" means funds paid from the General Revenue Fund or any state trust fund, funds
allocated by the Federal Government and distributed by the state, or funds appropriated by the state
for distribution through any grant program. The term does not include funds used for the state
Medicaid program.
Note: This "Instructions and Worksheet" is meant to explain the requirements of the Section
216.1366, F.S., amended in 2023, and give clarity to the attached form distributed to recipients and
sub-recipients for completion. All pertinent information below should be filled out, signed, and
returned to the project manager.
NON-PROFIT ORGANIZATION REMUNERATION INFORMATION
1. Is your business or organization a non-profit organization as defined in s. 215.97 (2)(m). F.S.?
Yes ❑ No ❑
If the answer to Question 1 is "Yes," continue to Question 2. If the answer to Question 1 is
"No", move to the signature block below to complete the certification and submittal process.
2. Will state funds be used as remuneration to any member of the board of directors or an officer in
your business or organization?
Yes ❑ No ❑
If the answer to Question 2 is "Yes," provide the information required in the "Total
Compensation Paid to Non-Profit Personnel Using State Funds" form below.A separate form
should be completed for each member of the board of directors or officer being compensated
using state funds. If the answer to Question 2 is "No", move to the signature block below to
complete the certification and submittal process.
Total Compensation Paid to Non-Profit Personnel Using State Funds
Name:
Title:
Agency Agreement/Contract#
Total Contract Amount
Contract Term:
Line Item Budget Category Total Amount Paid Amount Paid from State Funds
Salaries
Fringe Benefits
Bonuses
Accrued Paid Time Off
Severance Payments
Retirement Contributions
In-Kind Payments
Incentive Payments
Reimbursements/Allowances
Moving Expenses
Transportation Costs
Telephone Services
Medical Services Costs
Housing Costs
Meals
CERTIFICATION: I certify that the amounts listed above are true and accurate and in accordance with the
approved budget.
Name:
Signature:
Title:
Date: