Common use of MONITORING INFORMATION REQUIREMENTS Clause in Contracts

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. 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.. ANNEX B

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: Address Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code code Cost Centre centre Project code Project Grant Reference Supplier code 1 To be supported by a breakdown of expenditure against the cost breakdown detailed in Schedule 1.

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: Directorate code Cost centre Account Code Cost Centre code (1) Account code (2) 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. 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 LG13035 1 To be supported by a breakdown of expenditure against the cost breakdown detailed in Schedule 1.

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: Address Office of the Police and Crime Commissioner for Derbyshire sign off: Authorised Signature: Name (printed): Date: Position: OPCC codes: Account Code code Cost Centre centre Project code Project Grant Reference Supplier code 1 To be supported by a breakdown of expenditure against the any cost breakdown detailed in Schedule 1.

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 LG13034 1 To be supported by a breakdown of expenditure against the cost breakdown detailed in Schedule 1.