Common use of MONITORING INFORMATION REQUIREMENTS Clause in Contracts

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 LCAG16015 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2017/18 Grant Recipient: BRAND RECOVERY CIC Grant Stream: COMMISSIONER’S GRANT Period From: 1st October 2017 to 31st March 2018 (£)

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 LCAG16015 XXXX00000 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2017/18 Grant Recipient: BRAND RECOVERY CIC NORTH EAST DERBYSHIRE CITIZENS ADVICE Grant Stream: COMMISSIONER’S GRANT Period From: 1st October 2017 to 31st March 2018 (£)

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 LCAG16015 LCAG16008 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2017/18 Grant Recipient: BRAND RECOVERY DERVENTIO HOUSING TRUST CIC Grant Stream: COMMISSIONER’S GRANT Period From: 1st October 2017 to 31st March 2018 (£)

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 LCAG16015 CPG15010 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2017/18 2015/16 Grant Recipient: BRAND RECOVERY EASTERN EUROPEANS NETWORK CIC Grant Stream: COMMISSIONER’S GRANT Period From: 1st October 2017 2015 to 31st March 2018 30th September 2016 (£)

MONITORING INFORMATION REQUIREMENTS. Please confirm that a six four 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 LCAG16015 J003 CR14003 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2017/18 2014/15 Grant Recipient: BRAND RECOVERY CIC HIGH PEAK WOMEN’S AID Grant Stream: COMMISSIONER’S GRANT Period From: 1st October 2017 to 31st March 2018 February 2015 To: 30th September 2015 (£)

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 LCAG16015 LCAG16047 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2017/18 Grant Recipient: BRAND RECOVERY CIC THE PRINCE’S TRUST Grant Stream: COMMISSIONER’S GRANT Period From: 1st October 2017 to 31st March 2018 (£)

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 LCAG16015 LCAG16011 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2017/18 Grant Recipient: BRAND RECOVERY LIFE SKILLS EDUCATION CIC Grant Stream: COMMISSIONER’S GRANT Period From: 1st October 2017 to 31st March 2018 (£)

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 LCAG16015 J315 ANNEX A(ii): PAYMENT REQUEST AND END OF IN-YEAR FINANCIAL MONITORING REPORT 2017/18 2019/20 Grant Recipient: BRAND RECOVERY CIC DRINKAWARE Grant Stream: COMMISSIONER’S GRANT Period From: 1st October 2017 April 2019 to 31st March 2018 2020 (£)

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 LCAG16015 CPG15032 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2017/18 2015/16 Grant Recipient: BRAND RECOVERY CIC Grant TRIDENT REACH THE PEOPLE XXXXXXX Xxxxx Stream: COMMISSIONER’S GRANT Period From: 1st May 2016 To: 31st October 2017 to 31st March 2018 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. 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 LCAG16015 LCAG16033 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2017/18 Grant Recipient: BRAND RECOVERY CIC XXXXXX RECREATION GROUND TRUST Grant Stream: COMMISSIONER’S GRANT Period From: 1st October 2017 to 31st March 2018 (£)

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 LCAG16015 LCAG16041 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2017/18 Grant Recipient: BRAND RECOVERY CIC AMBER FACTORY Grant Stream: COMMISSIONER’S GRANT Period From: 1st October 2017 to 31st March 2018 (£)

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 LCAG16015 XXXX00000 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2017/18 Grant Recipient: BRAND RECOVERY CIC MULTI-FAITH CENTRE Grant Stream: COMMISSIONER’S GRANT Period From: 1st October 2017 to 31st March 2018 (£)

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 LCAG16015 LCAG16039 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2017/18 Grant Recipient: BRAND RECOVERY CIC DERBYSHIRE ALCOHOL ADVICE SERVICE Grant Stream: COMMISSIONER’S GRANT Period From: 1st October 2017 to 31st March 2018 (£)

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 LCAG16015 SG15012 ANNEX A(ii): PAYMENT REQUEST AND END OF YEAR FINANCIAL MONITORING REPORT 2017/18 2015/16 Grant Recipient: BRAND RECOVERY CIC VOX FEMINARUM Grant Stream: COMMISSIONER’S GRANT Period From: 1st May 2016 To: 31st October 2017 to 31st March 2018 2016 (£)