Attachment J-12 - Appendix F - 2023 FTA PMOC Invoice Template - V3.0.2 - Final.pdf

RFP Number 69319524R000001

Attachment J-12 Appendix F - 2023 FTA PMOC

Invoice Template - V3.0.2

11/13/2023 v3.0.2

Enter Fee Rate

Task Order Number: Invoice Labor Rates and Firm Info Summary Table

Task Order Description: LaborCategory Personnel Firm Acronym Prime/Sub/Consultant Rate

Invoice Period of Performance Start Date: 01/01/2022 - - -

Invoice Period of Performance End Date: 04/01/2022 - - -

Invoice No. 1

Delphi Invoice #

Invoice Revision

Invoice Date:

FTA COR:

FTA ACOR

Region / HQ

Task Order Period of Performance Start Date: 01/01/2021

Task Order Period of Performance End Date: 01/01/2024 Default Directory:

STEP 7: Add projects as required and enter project name. C:\

Project Number Project Name

Task Order Information

Enter Yellow Highlighted columns first

STEP 6: Enter Task Order Information below. STEP 8: Enter Fee Rate, Select Labor Rate Year, and complete Labor Rate table below for any employee or subcontractor that will appear on the current invoice.

Orange columns are dropdown selections Rates are Invoiced Rates (Either Labor Category Threshold rates or audited employee rates, generally the lower of these rates)

Green columns are populated automatically

Standard Form 1034 Revised October 1987 Department of the Treasury

1 TFM 4-2000

1034-119-01

SCHEDULE NO.:

Federal Transit PAID BY:

Accounting Division TBP-50 0 1200 New Jersey Ave, SE Washington, DC, 20590

0 DATE INVOICE RECEIVED:

0 DISCOUNT TERMS:

PAYEE ACCOUNT NUMBER:

SHIPPED FROM GOVERNMENT B/L NUMBER

AMOUNT

PER

(1)

Task Order Number

Invoice Date: Region:

1/0/1900 0 Title Date

Payment: APPROVED FOR EXCHANGE RATE =$ =$1.00 Differences

BY

TITLE (Signature or initials)

Pursuant to authority vested in me, I certify that this voucher is correct and proper for payment.

1/0/1900 (Date) (Authorizing Certifying Officer) (Title)

CHECK NO. CHECK NUMBER

DATE PAYEE

1. When stated in foreign currency, insert name of currency. PER

TITLE

Previous edition usable

The information requested on this form is required under the provisions of 31 U.S.C. 82b and 82c, for the purpose of disbursing Federal money. The information requested is to identify the particular creditor and the amounts to be paid. Failure to furnish this information will hinder discharge of the payment obligation.

PRIVACY ACT STATEMENT

2. If the ability to certify and authority to approve are combined in one person, one signature only is necessary. Otherwise, the approving officer will sign in the space provided over his actual title.

3. When a voucher is received in the name of a company or corporation, the name of the person writing the company or corporate name, as well as the capacity in which he signs, must appear. For example: "John Doe Company, per John Smith, "Secretary," or "Treasurer," as the case may be.

NSN 7540-00-900-2234

AMOUNT VERIFIED CORRECT PER

ACCOUNTING CLASSIFICATION

Pa id

B y

ON ACCOUNT OF US TREASURY ON (NAME OF BANK)

CASH

(Use continuation sheet(s) if necessary) (Payee must NOT use the space below)

TOTAL $ -

01/01/2022 - 04/01/2022

For details see attached pages

Task Order Description COST REIMBURSABLE-PROVISIONAL PAYMENT-INTERIM VOUCHER (OR COMPLETION VOUCHER, OR FINAL VOUCHER) AS APPLICABLE “I certify that all payments requested are for appropriate purposes and in accordance with the agreements set forth in the contract.”

Type Name & Signature of Official

TO WEIGHT (4)

NUMBER AND

DATE OF ORDER

DATE OF

DELIVERY

OR SERVICE

ARTICLES OR SERVICES

(Enter description, item number of contract or Federal supply schedule, and other information deemed necessary) QUANTITY

UNIT PRICE

COST

PAYEE:

PAYEE ADDRESS:

PAYEE CONTACT NAME: 0

PAYEE PAYMENT INFORMATION: Invoice #1 -

FTAX0000-0021

1/0/1900

CONTRACT NUMBER AND DATE

01/00/1900 - 01/00/1900

REQUISTION NUMBER AND DATE

VOUCHER NO.

PUBLIC VOUCHER FOR PURCHASES AND

SERVICES OTHER THAN PERSONAL

U.S. DEPARTMENT, BUREAU, OR

ESTABLISHMENT AND LOCATION DATE VOUCHER PREPARED

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Provisional

Complete

Partial

Progress

Advance

Provisional

Complete

Partial

Final

Cost Elements

1) Direct Labor

Labor Category Staff Assigned Hours Billed Rate Total Cumulative Category Hours Billed

Total - -$

2) Consultants' Fee -$

3) General and Administrative (G&A) Expense Total G&A Expense -$ Prime - G&A XXX.XX% of Total Direct Costs = -$ Sub - G&A XXX.XX% of Total Direct Costs = -$ Sub - G&A XXX.XX% of Total Direct Costs = -$ Sub - G&A XXX.XX% of Total Direct Costs = -$

4) Overhead Expense Total Overhead Expense -$ Prime - Overhead XXX.XX% of Total Direct Costs = -$ Sub - Overhead XXX.XX% of Total Direct Costs = -$ Sub - Overhead XXX.XX% of Total Direct Costs = -$ Sub - Overhead XXX.XX% of Total Direct Costs = -$

5) Fringe Expense Total Fringe Expense -$ Prime - Fringe XXX.XX% of Total Direct Costs = -$ Sub - Fringe XXX.XX% of Total Direct Costs = -$ Sub - Fringe XXX.XX% of Total Direct Costs = -$ Sub - Fringe XXX.XX% of Total Direct Costs = -$

6) FCCM Expense -$

7) Fixed Fee (8.5%) -$ Fixed Fee Withholding -$

Fixed-Fee Calculations:

i. Total contract fixed-fee -$

ii. 85% allowable fee -$

iii. Total Cumulative fee billed on prior invoices -$

Total Fee Less Withholding -$

Authorized Signature Name (Please Print)

Email Number/Extension

Total DOC Claim Amount

“I hereby certify that the above Declaration of Completion is correct and just, that payment therefore has not been received, and that the information is presented with the knowledge that the amount requested is passable to invoice the United States Government for payment."

Contractor’s Declaration of Completion

This notice is given in support of the request to invoice for the *Direct Productive Labor Hours (DPLH) for work completed under Task Order . The voucher represents reimbursable costs for the billing period from 1/1/2022 through 4/1/2022. Direct Labor consists of salaries and wages paid (or Billed Previously) for direct performance of the contract itemized as follows:

Direct Labor consists of salaries and wages paid (or Billed Previously) for direct performance of the contract itemized as follows: Labor Hours | Rate | Total Dollars | Cumulative Category Hours Billed.

SUPPORTING INFORMATION:

Subtotal (before FCCM)

iv. Fee due this invoice (not to exceed 85% of fee earned )

Task Order No. 0

Expenditure Category Current Contract Budget

Amount Claimed Previously

Previous Value Adjustments

Amount Claimed This Period Cumulative Total

Direct Labor -$ -$ -$ -$ -$ Premium Pay -$ -$ -$ -$ -$ Fringe Benefits -$ -$ -$ -$ -$ Materials/Supplies -$ -$ -$ -$ -$ Staff Travel -$ -$ -$ -$ -$ Consultant Travel -$ -$ -$ -$ -$ Consultant Fees -$ -$ -$ -$ -$ Subcontract -$ -$ -$ -$ -$ Equipment -$ -$ -$ -$ -$ Other Direct -$ -$ -$ -$ -$ Overhead -$ -$ -$ -$ -$ Total Est. Cost -$ -$ -$ -$ -$ G&A -$ -$ -$ -$ -$ Total Costs -$ -$ -$ -$ -$ Fee -$ -$ -$ -$ -$ Fee Withholding -$ -$ -$ -$ -$

FCCM -$ -$ -$ -$ -$

Total -$ -$ -$ -$ -$

(Typed Name of Certifying Official) (Signature)

1/0/1900 (Title) (Date)

SUMMARY OF EXPENDITURES

SUPPORT OF REIMBURSEMENT CLAIM

The Undersigned certifies that the cost of services reimbursable to the Contractor and the amount of fees earned by the Contractor up to the date of this

STEP 4: Enter Approved FTA Labor Categories

Labor Category Firm Firm Acronym

Prime/Sub/Co nsultant Mod Indirect Cost # G&A Rate OH Rate Fringe FCCM Fee Rate

Contractor: - -

Taxpayer I.D. Number:

Bank info for deposit:

Invoice Contact Name:

Invoice Contact Email:

PMO CONTRACT No.:

FTA CO:

Contract Period of Performance Start Date:

Contract Period of Performance End Date:

Firm Prime/Sub/Consultant Firm Acronym

STEP 3: Enter Approved Personnel and Select Firm

Personnel Firm Firm Acronym

STEP 5: Select Firm Name and Enter applicable G&A OH, Fringe, FCCM, & Fee Rates.

Enter Yellow Highlighted columns first Orange columns are dropdown selections Green columns are populated automatically

Personnel Names MUST be Unique!!

Address:

Contract and PMOC Information

STEP 2: Enter Firm Name, Firm Acronym, Sub/Prime

STEP 1 : Enter Contract Information below.

STEP 9: Enter Fixed Fee Withholding.

Order/Mod No.

Withholding of Fixed Fee

Threshold Award CLIN Labor Hours Allotted to Cost Allotted to Fee CPFF Notes Award CLIN Labor Hours Allotted to Cost Allotted to Fee CPFF Notes

Base H.2 TOTAL 1 - -$ -$ -$ B TOTAL 1 - -$ -$ -$

Total -$ H.2 TOTAL 2 - -$ -$ -$ B TOTAL 2 - -$ -$ -$

H.2 TOTAL 3 - -$ -$ -$ B TOTAL 3 - -$ -$ -$

H.2 TOTAL 4 - -$ -$ -$ B TOTAL 4 - -$ -$ -$

H.2 TOTAL 5 - -$ -$ -$ B TOTAL 5 - -$ -$ -$

TOTAL ALL CLINS - -$ -$ -$ TOTAL ALL CLINS - -$ -$ -$

Award CLIN Labor Hours Allotted to Cost Allotted to Fee CPFF Notes Award CLIN Labor Hours Allotted to Cost Allotted to Fee CPFF Notes

BASE 1 -$ BASE 1 -$

BASE 2 -$ BASE 2 -$

BASE 3 -$ BASE 3 -$

BASE 4 -$ BASE 4 -$

BASE 5 -$ BASE 5 -$

SUBTOTAL ALL CLINS - - - -$ SUBTOTAL ALL CLINS - - - -$

Green columns are populated automaticallyEnter Yellow Highlighted columns first

STEP 10: Complete H.2 Table Information as awards are approved. STEP 11: Complete B Table Information as awards are approved.

Orange columns are dropdown selections

H.2 Table Summary B Table SummaryFixed Fee Withholding Details

PROJECT LEVEL COST BREAKDOWN

Invoice #: 1 CLIN LOE (Hours) LOE for Fixed Fee (Hours) Labor G&A Overhead Fringe Subtotal Billed Fixed Fee Withholding of Fixed Fee

Fee Withholding Adjustment FCCM Net Invoice Change in (Billed)/Unbilled Fixed

Fee Unbilled LOE for Fixed

Fee Hours Unbilled LOE for Fixed

Fee Dollars Contractor: CLIN 1 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - Billing Period Start Date: 1/1/2022 CLIN 2 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - Billing Period End Date: 4/1/2022 CLIN 3 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - Invoice Date: CLIN 4 $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ -

CLIN 5 $ - $ - $ -

Task Order: CLIN 1 - 5 Totals $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - Project Number: 1 Prime Totals $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - Project Name: Subcontractor Totals $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - Project Phase: Project Development Consultant Totals $ - $ - $ - $ -

Travel and ODC $ - $ -

TOTALS $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ -

SECTION A: CLIN 1-4 DETAILS

Drop Down Entry Cells Subtotals FCCM Invoice Totals

Personnel LCAT CLIN Firm Prime/Sub/ Consultant Description LOE (Hours) LOE for Fixed Fee (Hours) Indirect Cost # Override Labor Rate Rate Labor G&A Overhead Fringe Subtotal Billed Fixed Fee Withholding of Fixed Fee Fee Withholding Adjustment FCCM Net Invoice Change in (Billed)/Unbilled Fixed Fee

CLIN 1 - 4 TOTALS $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ -

SECTION A: CLIN 1-4 FEE FROM PRIOR INVOICE

Entry Cells Drop Down Entry Cells

Prior Invoice Number OP Number (Optional) CLIN Firm Prime/Sub Description/Report Name/Deliverable ACOR Approval LOE for Fixed Fee (Hours) Billed Fixed Fee Withholding of Fixed Fee Fee Withholding

Adjustment Net Fee Billing Change in

(Billed)/Unbilled Fixed Fee

SECTION B: CLIN 5 DETAILS

Drop Down Entry Cell CLIN 5 Drop Down

Personnel TAR Number CLIN Firm Prime/Sub/ Consultant Travel Date OR Non-Travel ODC Desc Approval Date City State Trip#/ODC TAR or ODCs

Estimated Amount Amount Relevant Invoice

CLIN 5 - - 1

Totals -$ -$

Firm Details

Firm Details

Drop Down

FEE FROM PRIOR INVOICE TOTALS

Entry Cells Entry Cells

Drop Down Entry Cells

Unbilled LOE for Fixed Fee

Entry Cells Fixed Fee & RetainageCost Components

CLIN 1-5 SUMMARY TABLE

INVOICE OVERVIEW

Contractor: 0 FEE BILLING DETAILS Invoice Billed LOE (Hours)

Billed LOE for FF (Hours) Billed Fee Withholding of

FF Net Fee Billed Unbilled LOE for FF (hours)

Unbilled Fixed Fee (Dollars)

0 $ -

0 Total 0.00 0.00 $ - $ - $ - 0.00 $ -

Taxpayer I.D. Number: 0 0 0.00 -$ Bank info for deposit: 0

Invoice Contact Name: 0

Invoice Contact Email: 0

PMO CONTRACT No.: 0

FTA CO: 0

FTA COR: 0

Invoice Period of Performance Start Date: 01/01/2022

Invoice Period of Performance End Date: 04/01/2022

Invoice No. 1

Invoice Date: 01/00/1900

Task Order Number Task Order Expiration

Date 0 1/1/2024

Project Number Project Name FTA ACOR LOE this Invoice

Subtotal Billed this

Invoice Fixed Fee Withholding of

Fixed Fee Fee

Adjustment FCCM Net Invoice Amount

1 0 0 - -$ -$ -$ -$ -$ -$

NOTE: Invoice Overview Format Applies to both Headquarter's and Regional Task Orders

CLIN 1 CLIN 2 CLIN 3 CLIN 4 CLIN 5 Total

EINVOICING RECAP

eInvoice Entry

FEE BILLING DETAILS

Address:

FTA COR

Total Billed This Period

1/0/1900

Task Order Description

Invoice No. 1 Invoice No. 1

Invoice Date: 01/00/1900 Invoice Date: 01/00/1900

Combined Projects

CLIN CLIN Description T.O. Dollars Accrued Previously *

T.O. Hours Billed Previously

Previous T.O. Dollars Adjustments

Previous T.O. Hours Adjustments

Adjusted Previous T.O.

Dollars

Adjusted Previous T.O.

Hours

CLIN CLIN Description T.O. Dollars Billed Previously

T.O. Hours Billed Previously

Previous T.O.

Dollars

Adjustments

Previous T.O.

Hours

Adjustments

Adjusted Previous T.O. Dollars

Adjusted Previous T.O.

Hours

1 Program Support and Lessons Learned $ - 0.00 $ - 0.00 $ - 0.00 1 Program Support and Lessons

Learned $ - 0.00 $ - 0.00 $ - 0.00

2 On-Site Monitoring and Reporting $ - 0.00 $ - 0.00 $ - 0.00 2 On-Site Monitoring and Reporting $ - 0.00 $ - 0.00 $ - 0.00

3 Baseline Oversight $ - 0.00 $ - 0.00 $ - 0.00 3 Baseline Oversight $ - 0.00 $ - 0.00 $ - 0.00

4 Optional Oversight $ - 0.00 $ - 0.00 $ - 0.00 4 Optional Oversight $ - 0.00 $ - 0.00 $ - 0.00

5 Travel and Other Direct Costs $ - $ - $ - 5 Travel and Other Direct Costs $ - $ - $ -

$ - 0.00 $ - 0.00 $ - 0.00 $ - - $ - - $ - -

Project 1: 0 Project 1: 0

CLIN CLIN Description T.O. Dollars Accrued Previously *

T.O. Hours Billed Previously

Previous T.O. Dollars Adjustments

Previous T.O. Hours Adjustments

Adjusted Previous T.O.

Dollars

Adjusted Previous T.O.

Hours

CLIN CLIN Description T.O. Dollars Billed Previously

T.O. Hours Billed Previously

Previous T.O.

Dollars

Adjustments

Previous T.O.

Hours

Adjustments

Adjusted Previous T.O. Dollars

Adjusted Previous T.O.

Hours

1 Program Support and Lessons Learned $ - 0.00 -$ - -$ - 1 Program Support and Lessons

Learned $ - 0.00 $ - - $ - -

2 On-Site Monitoring and Reporting $ - 0.00 -$ - -$ - 2 On-Site Monitoring and Reporting $ - 0.00 $ - - $ - -

3 Baseline Oversight $ - 0.00 -$ - -$ - 3 Baseline Oversight $ - 0.00 $ - - $ - -

4 Optional Oversight $ - 0.00 -$ - -$ - 4 Optional Oversight $ - 0.00 $ - - $ - -

5 Travel and Other Direct Costs $ - -$ -$ 5 Travel and Other Direct Costs $ - $ - $ -

$ - 0.00 $ - 0.00 $ - - $ - 0.00 $ - - $ - -

Combined Total Combined Total

ADJUSTED PREVIOUS COST AND HOURS BREAKDOWN BY CLIN ADJUSTED PREVIOUS COST AND HOURS BREAKDOWN BY CLIN

Combined Projects CLIN Summary with Fixed Fee Adjustments CLIN Summary - Cash Basis Adjustments

Project Total Project Total

CLIN Summary with Fixed Fee Adjustments CLIN Summary - Cash Basis Adjustments

Invoice No. 1 Invoice No. 1 .

Invoice Date: 01/00/1900 Invoice Date: 01/00/1900

Combined Projects

CLIN CLIN Description T.O. Dollars Accrued Previously *

T.O. Hours Billed Previously

T.O. Dollars Accrued This Period *

T.O. Hours Billed This Period

T.O. Dollars Accrued to Date *

T.O. Hours Billed to Date

Unbilled LOE for Fixed Fee Dollars

TO Withholding Billed to Date

TO Billed to Date with Fixed Fee (less Withholding to date) 0

CLIN CLIN Description T.O. Dollars Billed Previously

T.O. Hours Billed Previously

T.O. Dollars Billed This Period

T.O. Hours Billed This

Period

T.O. Dollars Billed to Date

T.O. Hours Billed to Date

1 Program Support and Lessons Learned $ - 0.00 $ - 0.00 $ - 0.00 $ - $ - $ - 1 Program Support and Lessons

Learned 0.00 0.00 $ - 0.00 $ - 0.00

2 On-Site Monitoring and Reporting $ - 0.00 $ - 0.00 $ - 0.00 $ - $ - $ - 2 On-Site Monitoring and Reporting 0.00 0.00 $ - 0.00 $ - 0.00

3 Baseline Oversight $ - 0.00 $ - 0.00 $ - 0.00 $ - $ - $ - 3 Baseline Oversight 0.00 0.00 $ - 0.00 $ - 0.00

4 Optional Oversight $ - 0.00 $ - 0.00 $ - 0.00 $ - $ - $ - 4 Optional Oversight 0.00 0.00 $ - 0.00 $ - 0.00

5 Travel and Other Direct Costs $ - $ - $ - $ - 5 Travel and Other Direct Costs 0.00 $ - $ -

$ - 0.00 $ - 0.00 $ - 0.00 $ - $ - $ - $ - - $ - - $ - -

Project 1 0 Project 1 0

CLIN CLIN Description T.O. Dollars Accrued Previously *

T.O. Hours Billed Previously

T.O. Dollars Accrued This Period *

T.O. Hours Billed This Period

T.O. Dollars Accrued to Date *

T.O. Hours Billed to Date

Unbilled LOE for Fixed Fee Dollars

TO Withholding Billed to Date

TO Billed to Date with Fixed Fee (less Withholding to date) ##

CLIN CLIN Description T.O. Dollars Billed Previously

T.O. Hours Billed Previously

T.O. Dollars Billed This Period

T.O. Hours Billed This

Period

T.O. Dollars Billed to Date

T.O. Hours Billed to Date

1 Program Support and Lessons Learned $ - 0.00 -$ - -$ - - -$ -$ 1 Program Support and Lessons

Learned $ - 0.00 $ - - $ - -

2 On-Site Monitoring and Reporting $ - 0.00 -$ - -$ - - -$ -$ 2 On-Site Monitoring and Reporting $ - 0.00 $ - - $ - -

3 Baseline Oversight $ - 0.00 -$ - -$ - - -$ -$ 3 Baseline Oversight $ - 0.00 $ - - $ - -

4 Optional Oversight $ - 0.00 -$ - -$ - - -$ -$ 4 Optional Oversight $ - 0.00 $ - - $ - -

5 Travel and Other Direct Costs $ - -$ -$ -$ 5 Travel and Other Direct Costs $ - $ - $ -

$ - 0.00 $ - 0.00 $ - - - $ - $ - $ - 0.00 $ - - $ - -

COST AND HOURS BREAKDOWN BY CLIN

Combined Total

COST AND HOURS BREAKDOWN BY CLIN

Combined Total

Combined Projects CLIN Summary - Cash Basis

* includes fixed fee regardless of deliverable acceptance and does not include associated withholding of fixed fee.

CLIN Summary with Fixed Fee

Project Total

CLIN Summary - Cash Basis

Project Total

Less: Accruals to Date

CLIN Summary with Fixed Fee Less: Accruals to Date

Contractor 0

Invoice No.:

Invoice Date: 01/00/00

Task Order Number Task Order Description Task Order Dollars

Not-to-Exceed Authorized

Task Order Hours Not-to-

Exceed Authorized

Task Order Dollars Funded to Date

Task Order Hours Funded to Date

Budgetary Dollars Allocated From H.2

Table

Budgetary Hours Allocated From H.2

Table

Dollars Billed to Date *

Hours Billed to Date

H.2 Balance Available

H.2 Hours Available

Funds Billed To Date (%)

Hours Billed To Date (%)

0 0 $ - - $ - - $ - - $ - - $ - - #DIV/0! #DIV/0!

Project Number Project Name IP/Budgetary Dollars Allocated From H.2

Table

IP/Budgetary Hours Allocated From H.2 Table

Dollars Accrued Previously *

Hours Billed Previously

Dollars Accrued This Period *

Hours Billed This Period

Total Dollars Accrued to Date *

Total Hours Billed to Date

IP/Budgetary Balance

Remaining

IP/Budgetary Hours

Remaining

Funds Billed To Date (%)

Hours Billed To Date (%)

1 - $0.00 0.00 $0.00 0.00 $0.00 0.00 $ - 0.00 0.00% 0.00%

Total $ - 0.00 $0.00 0.00 $ - 0.00 $ - 0.00 $ - 0.00 0.00% 0.00%

Not-to-Exceed (Allotted to Fee) Billed Previously Billed This Period Billed to Date Balance Remaining Billed To

Date (%)

Level of Effort Fee -$ -$ -$ -$ -$

Withholding of Fixed Fee -$ -$ -$ -$ -$

Fee Less Withholding -$ -$ -$ -$ -$ 0.00%

Fee Summary

INVOICE BREAKDOWN

B Table H.2 Table

* includes fixed fee regardless of deliverable acceptance and does not include associated withholding of fixed fee.

IP

Not-to-Exceed (Allotted to Fee)

Billed Previously Billed This Period Billed to Date Balance

Remaining Billed To Date (%)

Level of Effort Fee -$ $0.00 -$ -$ -$ Withholding of Fixed Fee -$ $0.00 -$ -$ -$ Fee Less Withholding -$ $0.00 -$ -$ -$ 0.00%

Current Invoice: 1

Prior Invoice Number Description LOE Billed

(Hours)

LOE for Fixed Fee Billed (Prime

& Subs)

Consultant Hours (Reconciling Fee

Hours)

Change in (Billed)/Unbilled Fixed Fee (excludes fixed fee withhold)

Billed Fixed Fee Withholding of Fixed Fee

Fee Withholding Adjustment Unbilled Hours Net Invoice Total

1 0.00 0.00 0.00 -$ -$ -$ -$ 0.00 -$ Adjustment Totals 0.00 0.00 0.00 -$ -$ -$ -$ 0.00 -$

Invoice Number Description LOE Billed (Hours)

LOE for Fixed Fee Billed (Prime

& Subs)

Consultant Hours (Reconciling Fee

Hours)

Change in (Billed)/Unbilled Fixed Fee (excludes fixed fee withhold)

Billed Fixed Fee Withholding of Fixed Fee

Fee Withholding Adjustment Unbilled Hours Net Invoice Total

1 0.00 0.00 0.00 -$ -$ -$ -$ 0.00 -$ Historical & Current Period Totals 0.00 0.00 0.00 -$ -$ -$ -$ 0.00 -$ Historical & Current Period + Adjustment Totals 0.00 0.00 0.00 -$ -$ -$ -$ 0.00 -$

Fee Summary

Award CLIN Labor Hours CPFF T.O. Hours

Billed to Date T.O. Dollars

Accrued to Date * Labor Hours CPFF Labor Hours CPFF Award CLIN Labor Hours CPFF

T.O. Hours Billed to Date

T.O. Dollars Billed to Date

Labor Hours

CPFF Labor Hours CPFF

B TOTAL 1 0.00 -$ 0.00 -$ 0.00 -$ 0% 0% B TOTAL 1 0 -$ 0.00 -$ 0.00 -$ 0% 0%

B TOTAL 2 0.00 -$ 0.00 -$ 0.00 -$ 0% 0% B TOTAL 2 0 -$ 0.00 -$ 0.00 -$ 0% 0%

B TOTAL 3 0.00 -$ 0.00 -$ 0.00 -$ 0% 0% B TOTAL 3 0 -$ 0.00 -$ 0.00 -$ 0% 0%

B TOTAL 4 0.00 -$ 0.00 -$ 0.00 -$ 0% 0% B TOTAL 4 0 -$ 0.00 -$ 0.00 -$ 0% 0%

B TOTAL 5 0.00 -$ 0.00 -$ 0.00 -$ 0% 0% B TOTAL 5 0 -$ 0.00 -$ 0.00 -$ 0% 0%

TOTAL ALL CLINS 0.00 -$ 0.00 -$ 0.00 -$ 0% 0% TOTAL ALL CLINS 0 -$ 0.00 -$ 0.00 -$ 0% 0%

Award CLIN Labor Hours CPFF T.O. Hours

Billed to Date T.O. Dollars

Accrued to Date * Labor Hours CPFF Labor Hours CPFF Award CLIN Labor Hours CPFF

T.O. Hours Billed to Date

T.O. Dollars Billed to Date

Labor Hours

CPFF Labor Hours CPFF

H.2 TOTAL 1 0.00 -$ 0.00 -$ 0.00 -$ 0% 0% H.2 TOTAL 1 0 -$ 0.00 -$ 0.00 -$ 0% 0%

H.2 TOTAL 2 0.00 -$ 0.00 -$ 0.00 -$ 0% 0% H.2 TOTAL 2 0 -$ 0.00 -$ 0.00 -$ 0% 0%

H.2 TOTAL 3 0.00 -$ 0.00 -$ 0.00 -$ 0% 0% H.2 TOTAL 3 0 -$ 0.00 -$ 0.00 -$ 0% 0%

H.2 TOTAL 4 0.00 -$ 0.00 -$ 0.00 -$ 0% 0% H.2 TOTAL 4 0 -$ 0.00 -$ 0.00 -$ 0% 0%

H.2 TOTAL 5 0.00 -$ 0.00 -$ 0.00 -$ 0% 0% H.2 TOTAL 5 0 -$ 0.00 -$ 0.00 -$ 0% 0%

TOTAL ALL CLINS 0.00 -$ 0.00 -$ 0.00 -$ 0% 0% TOTAL ALL CLINS 0 -$ 0.00 -$ 0.00 -$ 0% 0%

H.2 Table Obligations - Consumption of Funds Cash Basis Task Order Authorized Billed to Date H.2 REMAINING % Billed to Date

B Table Amount Committed - Consumption of Funds Cash Basis Task Order NTE Billed to Date B REMAINING % Billed to Date

B Table Committed - Consumption of Funds Accrual Basis

H.2 Table Obligations - Consumption of Funds Accrual Basis Task Order Authorized Accrued to Date H.2 REMAINING % Billed to Date

Task Order NTE Accrued to Date B REMAINING % Billed to Date

Project CLIN Task Name OP Responsibility Task Start Date Task End Date Due Date Report Submittal Date Days Since Submitted Approval Date FTA approver Status Notes 01/31/00 0

Enter Yellow Highlighted columns first Green columns are populated automaticallyOrange columns are dropdown selections

Invoice Reconciliation 0

Value Inv Summ Inv Summ - Fee Billing Details

TO Summ Clin Summ AFF Drawdown B Drawdown H.2 Sum of Exp 1034 Values Align? Notes/Correction Method

LOE (current period) 0.00 0.00 0.00 0.00 TRUE If Inv Summ - Fee Billing cell is the only error, this requires manual correction from the PMOC in the relevant cell in the fee billing details. The other cells should align as a summation of current period project work, so if they are the issue, call EBI .

Fixed Fee (current period) -$ -$ -$ -$ TRUE See above.

Withholding of Fixed Fee & any fee adjustment -$ -$ -$ -$ TRUE See above.

FCCM -$ -$ TRUE

These cells should automatically match, as they are both summations of project level data entered by a PMOC. If they do not align, contact EBI.

Net Invoice Amount -$ -$ -$ -$ TRUE See above.

Unbilled LOE for FF (Hours) 0.00 0.00 0.00 TRUE If Inv Summ - Fee Billing cell is the only error, this requires manual correction from the PMOC in the relevant cell in the fee billing details. The other cells should align automatically, so if they are the issue, call EBI .

Unbilled Fixed Fee (Dollars) -$ -$ -$ TRUE Same as above.

Fee From Prior Invoice does not exceed Unbilled Threshold by CLIN TRUE

This check ensures that Fee from prior invoice for any project in this workbook does not exceed the unbilled hours or unbilled dollars threshold for a given CLIN. If this check is flagged as false, Please navigate to the CLIN summary tab and inspect columns AW and BA to determine from which Project and CLIN the issue has arisen (the cell(s) will be highlighted red).

Beginning Total Costs - Accrual Basis $0.00 -$ TRUE Contact EBI if this test is FALSE.

Total Costs Current Period - Accrual Basis -$ -$ TRUE These cells should automatically match, as they are both summations of project level data entered by a PMOC. If they do not align, contact EBI.

Total Costs to Date - Accrual Basis -$ -$ -$ -$ TRUE Same as above.

Total LOE Hours Billed to Date 0.00 0.00 0.00 0.00 0.00 TRUE Contact EBI if this test is FALSE.

Total LOE for FF Hours billed to date 0.00 TRUE Contact EBI if this test is FALSE.

Total Consultant Hours Billed to Date 0.00 TRUE Contact EBI if this test is FALSE.

Hourly Check 0.00 TRUE This check ensures that Total LOE Hours Billed to Date equals the sum of LOE for Fixed Fee Billed to Date, Consultant Hours Billed to Date, and Unbilled LOE for Fixed Fee (G17 = G11 + G18 + G19). If this cell is "False", please contact EBI to correct.

Beginning Costs to Date - Cash Basis -$ -$ TRUE Review the Summary of Expenditures to ensure all costs have been properly classified.

Project Summaries (CLIN and Contractor Type) TRUE

This check determines whether CLIN Summary totals are equal to the sum of Prime, Subcontractor, Consultant and Travel/ODC totals. If this cell is False, the PMOC should review the project tabs to ensure all records have been assigned to a CLIN or FIRM type. If cell is still false after review, please contact EBI to resolve.

CLIN Summ Cash Basis to Accrual Reconciliation TRUE This check determines whether or Not CLIN Summary column L agrees with columns T AND column I agrees with column U. If this cell is False please open CLIN Summary Tab to refresh and then return to this sheet. If this cell is still False, please contact EBI

Billed LOE for Fixed Fee Hours 0.00 0.00 TRUE If this test is false, please review Inv Summ - Fee Billing Details for accuracy and correct as necessary.

Worksheet / Table

EBI Task Order Resource Report Version 2

FALSE

Basics Task Order Period of

Performance Current Invoice Period of

Performance COR / ACOR Uninvoiced LOE

Task Order: 0 1/1/2021 1/1/2022 0 Date CLIN 1 CLIN 2 CLIN 3 CLIN 4 CLIN 5 Total LOE

PMOC: 0 1/1/2024 4/1/2022 0 4/1/22 0.00

Region TO Desc: 5/1/22 0.00 6/1/22 0.00

Task Order Max Remaining Expended 7/1/22 0.00 Performance Period (Mnths) 36 1 35 8/1/22 0.00 B LOE (Hours) 0.00 0.00 0.00 9/1/22 0.00 B CPFF (Dollars) -$ -$ -$ 10/1/22 0.00

11/1/22 0.00 Current Invoice Uninvoiced TOTAL 12/1/22 0.00

LOE Expended (Hours) 0.00 0.00 0.00 1/1/23 0.00 Total Cost Accrued (Dollars) -$ -$ -$ 2/1/23 0.00

3/1/23 0.00 4/1/23 0.00

75% Expenditure of Current H.2 Anticipated by: 1/0/1900 5/1/23 0.00

6/1/23 0.00 7/1/23 0.00

Rates Historical Breakeven Current Month 8/1/23 0.00 Burn Rate (Hours/Month) - - - 9/1/23 0.00 Blend Rate (Dollars/Hour) -$ -$ -$ 10/1/23 0.00

11/1/23 0.00 12/1/23 0.00

Est. Completion Statistics Historical Rates (Burn and Blend)

All LOE Used @ Hist.

Blend Rate

All Dollars Used @ Hist.

Blend Rate Total 0.00 0.00 0.00 0.00 0.00

LOE Expended (Hours) 0.0 0.0 0.0 Total Cost (Dollars) -$ -$ -$ Uninvoiced Cost Est'd Completion Month Never Date CLIN 1 CLIN 2 CLIN 3 CLIN 4 CLIN 5 Total Cost

4/1/22 -$ 5/1/22 -$

90 Day Rate Simulation 6/1/22 -$ Proposed Burn Rate (HoursProposed Blend Rate (Dollars) 7/1/22 -$

CLIN 1 8/1/22 -$

CLIN 2 9/1/22 -$

CLIN 3 10/1/22 -$

CLIN 4 11/1/22 -$

12/1/22 -$ 1/1/23 -$

Status of Funds 2/1/23 -$ B Table (Committed) H.2 Table (Obligated) Total Accrued Uninvoiced Total Cost = Accrued + Uninvoiced H.2 Remaining % Expended 3/1/23 -$

LOE CPFF LOE CPFF LOE CPFF LOE CPFF LOE CPFF LOE CPFF 4/1/23 -$

CLIN 1 0.00 -$ 0.00 -$ 0.00 -$ 0.00 -$ 0.00 -$ -$ 0% 0% 5/1/23 -$

CLIN 2 0.00 -$ 0.00 -$ 0.00 -$ 0.00 -$ 0.00 -$ -$ 0% 0% 6/1/23 -$

CLIN 3 0.00 -$ 0.00 -$ 0.00 -$ 0.00 -$ 0.00 -$ -$ 0% 0% 7/1/23 -$

CLIN 4 0.00 -$ 0.00 -$ 0.00 -$ 0.00 -$ 0.00 -$ -$ 0% 0% 8/1/23 -$

CLIN 5 -$ -$ -$ -$ -$ -$ 0% 9/1/23 -$

Total 0.00 -$ 0.00 -$ 0.00 -$ 0.00 -$ 0.00 -$ -$ 0% 0% 10/1/23 -$ 11/1/23 -$

Lookahead and Forecasting 12/1/23 -$ Current Total Cost Total Cost in 90 Days @ Historical Rates Total Cost in 90 Days @ PMOC Proposals Percent Expended (PMOC Forecast) End of Funding / Hours Total -$ -$ -$ -$ -$ -$

LOE CPFF LOE CPFF LOE CPFF LOE CPFF Historical Rates PMOC Rates CLIN 1 0.00 -$ 0.00 -$ 0.00 -$ 0% 0% Not Funded Not Funded CLIN 2 0.00 -$ 0.00 -$ 0.00 -$ 0% 0% Not Funded Not Funded CLIN 3 0.00 -$ 0.00 -$ 0.00 -$ 0% 0% Not Funded Not Funded CLIN 4 0.00 -$ 0.00 -$ 0.00 -$ 0% 0% Not Funded Not Funded

PMOC Commentary Narrative of previous 3 months (LOE consumed, changes in labor mix, effects of grantee activity, major deliverables completed/in progress, unbilled fee status)

Expectations for next 3 months (changes to Burn and Blend Rates [explain proposals for burn and blend rate forecasts in terms of expected deliverables], effects of grantee activity, incremental funding needs) loe cpff 0 -$ 0 -$ 0 -$ 0 -$

$273.49

$546.97

(368.62) -

Bl en d Ra te (D ol la rs /L

O E)

Burn Rate (LOE/Month)

Breakeven Forecast

Historical

Breakeven

Current