Attachment_1_-Invoice_to_TWRA_Grant_Reimbursement.pdf
PDF 221 KB Posted
- Attached to
- Bat Mist Net Surveys
- Solicitation number
- Event 32801-13563
- Issued by
- Claiborne County, Tennessee
About this file
This is an invoice reimbursement template for a bat mist net data collection grant between the Tennessee Wildlife Resources Agency (TWRA) Biodiversity Division and an unnamed contractor. The template is designed to track both grant expenditures and the required 25% match component, with invoices requiring detailed itemization of expenses including reference numbers, dates, periods of service, and contract numbers.
The template includes multiple expense object line-item categories including salaries, professional fees, supplies, travel, capital purchases, and indirect costs. Each line must be documented according to the Department of Finance and Administration Policy 3 requirements for uniform reporting. The document requires tracking of accumulated requests, remaining grant balance, accumulated match, and remaining match balance, though no specific dollar amounts are included in this blank template.
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Text version
Attachment 1
Bat Mist Net Data 25% Match
Invoice to TWRA Grant Reimbursement Template
A. This template shall ONLY be filled out by the awarded Contractor.
Invoice to TWRA for grant reimbursement
11 Itemization of Reimbursement Requested for the Invoice Period— it must detail, at minimum, all of the following:
11.i
11.ii The amount reimbursed by Grant Budget line-item to date.
11.iii The total amount reimbursed under the Grant Contract to date.
11.iv The total amount requested (all line-items) for the Invoice Period.
Per the contract, each invoice shall clearly and accurately detail all of the following required information (calculations must be extended and totaled correctly).
Invoice/Reference Number (assigned by the Grantee).
Invoice Date (assigned by the Grantee).
Invoice Period (to which the reimbursement request is applicable).
Grant Contract Number (assigned by the State).
Grantee Contact for Invoice Questions (name, phone, or fax).
The amount requested by Grant Budget line-item (including any travel expenditure reimbursement requested and for which documentation and receipts, as required by "State Comprehensive Travel Regulations," are attached to the invoice).
Grantor: State Agency & Division Name.
Grantor Number (assigned by the Grantee to the above-referenced Grantor).
Grantee Name.
Grantee Tennessee Edison Registration ID Number Referenced in Preamble of this Grant Contract.
Grantee Remittance Address.
TWRA / Biodiversity Division
Invoice to TWRA for grant reimbursement
Notes:
POLIC
Y 03
Object Line-item
Refere nce
1. 2 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
4, 15 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
5, 6, 7, 8, 9, 10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
11. 12 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
13 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
14 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
16 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
17 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
18 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
22 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
24 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 n/a $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
25 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
"Grant Contract" column should be entered once and must not be changed unless there is a written, signed, contract amendment obtained.
"Remaining Balance" column contains a formula. Do not hard key an amount in this field.
Each expense object line-item shall be defined by the Department of Finance and Administration Policy 3, Uniform Reporting Reporting Requirements and Cost Allocation Plans for Subrecipients of Federal and State Grant Monies, Appendix A. http://www.tn.gov/finance/look ing-for/policies.html
GRANT BUDGET
The Grant Budget line-item amounts below shall be applicable only to expenses incurred during the following applicable period:
BEGIN: DATE END: DATE
EXPENSE OBJECT LINE-ITEM
CATEGORY 1
GRANT
CONTRACT
GRANTEE
MATCH THIS
INVOICE
Specific Assistance To Individuals
Professional Fee, Grant &
Award 2
Supplies, Telephone, Postage & Shipping, Occupancy, Equipment Rental & Maintenance, Printing & Publications
A Grantee Match Requirement is detailed by this Grant Budget, and the maximum total amount reimbursable by the State pursuant to this Grant Contract, as detailed by the “Grant Contract” column above, shall be reduced by the amount of any Grantee failure to meet the Match Requirement
GRAND TOTAL
GRANTEE
MATCH
REQUIRED
TOTAL THIS
INVOICE
ACCUMULATED
REQUESTS
Indirect Cost
ACCUMULATED
MATCH
In-Kind Expense
Grantee Match Requirement (for any amount of the required Grantee Match that is not specifically delineated by budget line-items above) 2
Depreciation
Other Non-Personnel
Capital Purchase
Interest
REMAINING GRANT
BALANCE
Salaries, Benefits & Taxes
Insurance
Travel, Conferences & Meetings
REMAINING
MATCH
BALANCE
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