Common use of MONITORING INFORMATION REQUIREMENTS Clause in Contracts

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. 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 NF15018NF15006

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 NF15018NF15021

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 NF15018NF15005

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 NF15018NF15003