OPERATIONAL AREA GRANT PLANNING REIMBURSEMENT CHECKLIST

OPERATIONAL AREA GRANT PLANNING REIMBURSEMENT CHECKLIST
Please collect documentation listed on the checklist below and remit package to: Nevada County Office of Emergency Services (HSGP@nevadacountyca.gov)
Agency Information:
Agency Name*
Agency Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Agent Name*

First NameLast Name
Agency Contact Email*
example@example.com
Grant*
Grant Year*
Project Title/Number*
Project Cost*
Upload Documentation (See list below)*

Cancelof
Required Documentation*

Invoice from Second-Tier Sub-Recipient to Nevada CountyInvoice from Vendor to Second-Tier Sub-RecipientProof of Payment to vendor by Second-Tier Sub-RecipientOther Supporting Documentation
Page Numbers of Second-Tier Sub-Recipient to Nevada County*
Page Numbers of Invoice from Vendor to Second-Tier Sub-Recipient*
Page Numbers of Proof of Payment to vendor by Second-Tier Sub-Recipient*
Page Numbers of Other Supporting Documentation*
Invoices to:

Nevada County Office of Emergency Services

Homeland Security Grant Program

950 Maidu Avenue, Suite 129

Nevada City, CA 95959

hsgp@nevadacountyca.gov
Nevada County OES Use:
OK to Pay Amount:*
Coding/PO*
Should be Empty:

Invoices to: