MONITORING INFORMATION REQUIREMENTS. Where monitoring information, as set out in schedule 3, is a requirement for the period the payment is requested for, please confirm what has been attached to this payment request form. CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 1 To be supported by a breakdown of expenditure against the cost breakdown detailed in Schedule 1.
MONITORING INFORMATION REQUIREMENTS. Please confirm that a twenty-four month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this payment request form. Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code
MONITORING INFORMATION REQUIREMENTS. Please confirm that a six month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 X012 J001 CPG15010 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2015/16 Grant Recipient: EASTERN EUROPEANS NETWORK CIC Grant Stream: COMMISSIONER’S GRANT Period From: 1st October 2015 to 30th September 2016 (£)
MONITORING INFORMATION REQUIREMENTS. Please confirm that a six month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Type of Spend Total Cost Staff costs £ Volunteer costs £ Operational / activity costs £ Publicity costs £ Monitoring and evaluation costs £ Management and overheads £ Other (please detail) £ TOTALS £
MONITORING INFORMATION REQUIREMENTS. Please confirm that an end of project monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this payment request form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4892 X012 J001 NF15018
MONITORING INFORMATION REQUIREMENTS. Where monitoring information, as set out in Schedule 3, is a requirement for the period the payment is requested for, please confirm what has been attached to this payment request form. ANNEX A - Grant Delivery tracker.xlsx Claim Form_.docx Monitoring form.docx Spending projection Q4.docx SENIOR FINANCE OFFICER CERTIFICATION I certify to the best of my knowledge and belief that:
MONITORING INFORMATION REQUIREMENTS. Please confirm that a twelve month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this payment request form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position:
MONITORING INFORMATION REQUIREMENTS. Where monitoring information, as set out in schedule 3, is a requirement for the period the payment is requested for, please confirm what has been attached to this payment request form. CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code 4891 X012 J001 LG13036
MONITORING INFORMATION REQUIREMENTS. Where monitoring information, as set out in Schedule 3, is a requirement for the period the payment is requested for, please confirm what has been attached to this payment request form. FINANCE OFFICER CERTIFICATION I certify to the best of my knowledge and belief that:
MONITORING INFORMATION REQUIREMENTS. Where monitoring information, as set out in schedule 3, is a requirement for the period the payment is requested for, please confirm what has been attached to this payment request form. CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: OPCC Northumbria sign off: Signature: Name (printed): Date: Position: Agresso codes: Cost centre Account code (1) Account code (2) Project code Supplier code ANNEX B END OF YEAR FINANCIAL MONITORING REPORT - APRIL 2013 TO MARCH 2014 The form should be completed and certified by the Recipient’s Chief Finance Officer and returned to the Commissioner in accordance with Clause 2.6. Grant Recipient: Gateshead Council Grant Stream: Police and Crime Commissioner for Northumbria Community Safety Fund Grant Expenditure Category: Actual Resource Expenditure (£) TOTAL EXPENDITURE: TOTAL GRANT PROVIDED: VARIANCE: total grant provided minus total resource expenditure (To be returned to the Commissioner in accordance with Clause 2.6.6)
